诸风掉眩，皆属肝木。诸痛痒疮疡，皆属心火。诸湿肿满。
皆属脾土。诸气HT 郁病痿，皆属肺金。诸寒收引，皆属肾水。
诸暴强直，支痛 戾，里紧筋缩，皆属于风。厥阴风木，乃肝胆之气也。
诸病喘呕，吐酸，暴注下迫，转筋，小便混浊，腹胀大，鼓之
如鼓，痈疽疡疹，瘤气结核，吐下霍乱，瞀郁肿胀，鼻鼽衄，血
溢，血泄，淋闭，身热，恶寒，战栗，惊惑，悲笑谵妄，衄蔑血污，皆属于热，少阴君火之热，乃真心小肠之气也。
诸痉强直，积饮痞膈中满，霍乱吐下，体重 肿，肉如泥，按
之不起，皆属于湿，太阴湿土，乃脾胃之气也。
诸热瞀 ，暴喑冒昧，躁扰狂越，骂詈惊骇， 肿酸疼，气逆上冲，禁栗如丧神守，嚏呕，疮疡，喉哑，
耳鸣及聋，呕涌溢，食不下，目 不明，暴注 ，暴病暴死，皆属于火，少阳相火之热，
乃心胞络、三焦之气也。
诸病上下所出水液，澄彻清冷， 瘕 疝，坚痞腹满紧痛，下利清白，食已不饥，吐利腥秽，
屈伸不便，厥逆禁固，皆属于寒，太阳寒水，乃肾与膀胱之气也。
脉
风邪中人，六脉多沉伏，亦有脉随气奔，指下洪盛者。挟寒
则脉带浮迟，挟暑则脉虚，挟湿则脉浮涩。《脉经》曰∶脉微而
数，中风使然。寸口沉大而滑，沉则为实，滑则为气，气实相搏，入于腑则愈。此为卒厥不知人，唇青身冷为
入脏，死。身温和，汗自出，为入腑，而复自愈。脉阳浮而滑，阴濡而弱者，宜吐。或浮而滑，或沉而滑，
或微而虚者，皆虚与痰也。大法宜浮迟，不宜强大数。若脾脉缓而无力者，最为难治。盖风喜归肝；肝木克
脾土，则大便洞泄，故不治也。
证
夫风中于人也，曰卒中，曰暴仆，曰暴喑，曰蒙昧，曰 僻，曰瘫痪，曰不省人事，曰语言謇涩，曰痰涎
壅盛，或死，或不死，皆以为中风之候也。《内经》曰∶风者，百病之长也。至为变化，乃
为他病，无常方。又曰∶风者，善行而数变。又曰，风之伤人也，或为寒热，或为热中，或为寒中，或为厉
风，或为偏枯。《千金》云∶岐伯所谓中风，大法有四∶一曰偏枯，谓半身不遂也；二曰风痱，
谓身无疼痛，四肢不收也；三曰风懿，谓奄忽不知人也；四曰风痹，谓诸痹类风状也。《金匮要略》曰∶寸
口脉浮而紧，紧则为寒，寒虚相搏，邪在皮肤；浮者血虚。络脉空虚，贼邪不泻，或左或右，邪
气反缓，正气即急，正气引邪， 僻不遂。邪在于络，肌肤不仁；邪在于经，即克不胜；邪入于腑，即不
识人；邪入于脏，舌即难言、口吐痰沫。是以古之明医，皆以外中风邪立方处治。及近代刘
河间、李东垣、朱丹溪三子者出，始与古人异矣。河间曰∶中风瘫痪者，非谓肝木之风实甚而卒中之，亦非外
中于风，良由将息失宜，心火暴甚，肾水虚衰，不能制之，则阴虚阳实，而热气怫郁；
心神昏冒不用，而卒倒无所知也，多因喜、怒、思、悲、恐五志有所过极，而卒中者。夫五志过极，皆为热
甚故也。俗云∶风者，言末而忘其本也。东垣云∶中风非外来风邪，乃本气自病也。凡人年
逾四旬，气衰之际，或因忧、喜、忿、怒伤其气者，多有此证。壮
岁之时无有也，若肥者，则间而有之，亦是形盛气衰，故如此耳。丹溪曰∶有气虚，有血虚，有痰盛。又曰∶
西北气寒，为风所中，诚有之矣；东南气温，而地多湿，有风者，非风也，皆是湿生痰，
痰生热，热生风也。三子之论，河间主乎火，东垣主乎气，丹溪主乎湿，反以风为虚象。若以三子为是，古人
为非，则三子未出之前，固有从古人而治愈者；若以古人为是，三子为非，则三子已出
之后，亦有从三子而治愈者，大抵古人与三子之论，皆不可偏废。盖古人之论，言其证也；三子之论，言其
因也，因则为本，证则为标，其所谓外中风邪者，未必不由元精虚弱，荣卫失调，而后感之
也，其所谓因火，因气，因湿者，亦未必绝无外邪侵侮而作也。
治
治风之法，全在活变，若重于外感者，先驱外邪，而后补中气，重于内伤者，先补中气，而后驱外邪。
或以散风药为君，而以补损药为臣使；或以滋补药为君，而以散邪药为臣使，量重轻而处之
也。《内经》曰∶有取本而得者，有取标而得者；有本而标之者，有标而本之者。又曰∶急则治其标，缓
则治其本。若夫初病暴仆，昏闷不省人事，或痰涎壅盛，舌强不语，两寸口脉浮大而实者，急宜
瓜蒂，藜芦等药吐之，以遏其势；或人迎脉紧盛，或六脉俱浮弦者，急用小续命汤表之。盖风气太盛，心火
暴甚，而痰涎壅遏于经络之中，于斯时也。岂寻常药饵而能通达于上下哉？或本方加附
子，以其禀雄壮之资，而有斩关夺将之势，能引人参辈并行于十二经，以追复其失散之元阳，又能引麻黄、
杏仁辈发表开腠理，以祛散其在表之风寒；引芎、归、芍药辈入血分，行血养血，以滋养其亏损之真阴。或加
石膏、知母以降胃火；或加黄芩以清肺金，看所挟见证，与夫时月寒温，加减施治。病势稍退，精神稍复，辄
当改用丹溪之法，而以补气补血消痰之剂，以调其本气而安，此急则治
其标，与夫标而本之治也。凡人手足渐觉不随，或臂膊及髀股、指节麻痹不仁，或口眼 斜、语言謇涩，或胃
膈迷闷，吐痰相续，或六脉浮滑而虚软无力，虽未至于倒仆，其为中风晕厥之候，可指日而定矣。早当从丹溪
之法调治，其左手脉不足，及左半身不遂者，以四物汤补血之剂为主治；右手脉不足及右半身不遂者，以四君子
汤补气之剂为主治；痰盛者，二陈、导痰等汤兼用；气血两虚而挟痰者，八物汤加南星、半夏、枳实、竹沥、
姜汁之类。若夫真元渐复，痰饮渐消，或觉有风邪未退者，仍以羌活愈风汤、防风通圣散之类出入加减，调治
而安，此缓则治其本，与夫本而标之之治也。抑考先哲有云∶其证有中脏、中腑之分，证各不同。中腑者多着
四肢，故面加五色，脉浮而恶风寒，四肢拘急不仁，或中身之前，或中身之侧，皆曰中腑也，其治多易。中脏
者，多滞九窍，唇缓失音，鼻塞耳聋，目瞀，大小便闭结，皆曰中脏，其治多难。大法中腑者，小续命以发
其表；中脏者，三化等汤以通其里；脏腑兼见者，又不可拘泥，或一气之微汗，或一旬之通利。又曰∶治须
少汗，亦须少下。多汗则虚其卫，多下则损其荣，斯又不可不谨。或外无六经之形证，内无便溺之阻隔，但手
足不随，语言謇涩者，此邪中于经，又当从乎中治，而不可以标本论也。是以养血通气，大秦艽
汤、羌活愈风之类治之。外有痿痹气厥，脾虚伤食，及乎土太过，令人四肢不举之候，皆似中风，又
当体察明白，各从其类以治之。
不治证
凡中风，但见发直、摇头、吐沫，上窜、面赤如妆、汗缀如珠，或头面青黑、痰声如拽锯者，皆不治。若
目闭，手散、鼻鼾、口张、遗尿不知，此五者为五脏绝，死候。但见其一，犹当施治。若心肾
绝，尤难治也。若动止筋痛，是无血养筋，故痛，白筋枯。不治。
一切国中风、中气，昏倒不知人事、牙关紧急、涎潮壅塞、口眼 斜、半身不遂、精神恍惚，仓卒之际，
急以手大指掐刻人中，即醒。或急令人将病者两手两足，从上而下，频频赶出四肢，痰气
即散，免致攻心，即醒。或急以三棱针刺手中指甲角、十井穴，将
去恶血，就以气针刺合谷二穴、人中一穴，皆是良法。如或未效，用通关散通鼻，即提起头顶法，候有嚏可
治，无嚏不可治。如口噤不开，破棺散擦之，口即开，即多灌香油，或少加麝香一二分，或
用姜汁亦可，或太白散、化风丹、摄生饮之类，当随证选而用之。
如风痰顽结，诸药不效者，夺命散一服即愈。
一痰涎壅盛者，口眼 斜者，不能言语者，皆当用吐法，宜独圣散吐之。或口噤，用藜芦末少加麝香，
灌入鼻内吐之。一吐不已，再吐之，亦有气血虚而不可用吐法者。
肥人多有中风，以其形盛于外，而气歉于内也。肺为气出入之道。人胖者气必急，气急则肺邪盛。肺金
克木，胆为肝之腑，故痰涎壅盛，所以治之，必先理气为急，中后气未尽顺，痰未尽除，调
理之剂，惟当以藿香正气散加南星、木香、防风、当归，此药非特治中风之证，而中恶、中气尤宜。
一气虚卒倒，参 补之。挟痰，则浓煎人参汤，加竹沥、姜汁。血虚四物汤补之。挟痰者，四物汤以姜汁
炒过，更加竹沥、姜汁。
一左瘫右瘫者、因气血虚而痰火流注也。血虚则痰火流注于左，而为左瘫，宜四物汤加白芥子、竹沥、姜
汁；兼有死血，加桃仁、红花。气虚则痰火流注于右，而为右瘫，宜四君子汤合二陈汤，加白芥子、竹沥、姜
汁，能食者去竹沥，加荆沥尤妙。肥人多湿，少加附子行经。瘫痪初起，急治则可，久则痰火郁结而难治也。
一中风饮食坐卧如常，但失音不语，俗呼为哑风，小续命去附子，加石菖蒲一钱，或诃子清音汤亦可。
然不语岂止一端？有舌强不语，有神昏不语，有口噤不语，有舌纵语涩，有舌麻语涩，其间
治痰、治风、安神、养气血，各从活法，又难拘续命、诃子而已。
一中气亦似中风，但风中口中多痰涎，气中则无。又风中身温，气中身冷。风中脉浮洪，气中脉沉伏。
此七情内伤，气逆为病，治当顺气，用乌药顺气散、八味顺气散主之，或藿香正气散亦可。
经云∶无故而喑，脉不至，不治自已，谓气暴逆也，气复则已，审
如是，虽不服药，亦自可。
一中风、中气，口眼 斜，语言謇涩，或口噤牙关紧急，筋脉
挛缩，骨节酸疼，行步艰辛，一应风气疼痛，太乙紫金丹用酒磨服。（方见通治）
一中风不语，瘫痪初起，宜导痰小胃丹，用姜汤送三五十丸，少时即能言语如故。（方见痰饮）
一中风头痛如破，语言謇涩，小续命汤加羌活。
一中风口眼 斜，头疼发热，恶风初作者，羌活冲和汤加独活、 本。（方见伤寒）
一中风一身俱麻，乌药顺气散加人参、白术、川芎、当归、麦门冬。
一中风面目十指俱麻，乃气虚也，补中益气汤加木香、附子、羌活、防风、乌药。（方见内伤）
一中风满身刺痛，四物汤加荆芥、防风、蔓荆子、蝉蜕、麦门冬。（方见补益）
一中风半身不遂，羌活愈风汤加天麻、荆芥、僵蚕。
方
通关散（秘方）〔批〕（按此方治不省人事者，吹鼻通窍之剂）治中风不语，不省人事，水汤不入。
天南星 半夏 猪牙皂荚（各五分）
上为末，每用少许吹鼻。有嚏可治，无嚏不可治。
破棺散〔批〕（按此方治口噤者，擦牙开关之剂）治中风牙关紧急，难以下药。
天南星（五分） 片脑（少许）
上五月五日午时合，每用五分，于病患牙间频频擦之令热，牙关自开。
夺命散 治卒暴中风，涎潮气闭，牙关紧急，眼目上视，破损伤风，搐搦潮作，及小儿急惊风并治。
天南星 甜葶苈 香白芷 半夏（汤泡，去皮） 巴豆（去壳，不去油，各等分，生用）
上为细末，每服五分，生姜汁二三匙调下。牙关紧急，汤剂灌不下者，此药辄能治之。小儿以利痰或吐
为愈。按此方风痰必顽结者，宜用之。
独圣散〔批〕（按此方治痰壅盛者，吐痰之剂）治中风痰迷心窍，癫狂烦
乱，人事昏沉，痰涎壅塞，及五痫心风等证。
甜瓜蒂
上为末，每服五分，重者一钱，熟水调下，即吐，如不吐，须再进一服，倘不止，以白汤止之，或葱
汤亦妙，或麝香少许，研，水饮之，即解。如吐风痰，加全蝎五分微炒。如有虫者，加雄黄
五分，猪脂油五分，甚者加芫花五分，其虫立吐。如湿肿满，如赤小豆末一钱。凡吐令人目睛上窜，吐
时令闭双目。
太白散（秘方）
治中风痰气厥绝，心腹微温，喉间微响，此药下痰如神。
陈锻石（千年古者）
石刮去土为细末，水飞过，每服三钱，水一碗，煎至七分温服。
太玄汤（秘方） 治中风失音，昏迷欲死。
染布活靛缸水一盏，温而灌之，即能言语。
化风丹
治一切中风痰厥风痫，牙关紧急，不省人事，及小儿惊风、搐搦，角弓反张，发热痰嗽喘促。
天南星（牛胆制过，二钱） 天麻（煨） 防风（去芦） 荆芥穗 羌活 独活
（去芦） 人参（去芦） 细辛 川芎（各一钱） 木香（五分）
上为细末，炼蜜为丸，如芡实大，朱砂为衣，薄荷泡汤研化
服。因气忿，用紫苏汤化下。如牙关口噤，用少许擦牙即开。
摄生饮
治一切卒中，不论中风、中寒、中暑、中湿及痰厥、气厥之类，不省人事者，初作即用此方，神效。
苍术（生，一钱） 南木香 天南星（湿纸煨） 半夏（汤泡，各一钱五分） 辽
细辛 石菖蒲 甘草（生，各一钱）
上 咀，生姜七片，水煎温服，痰盛加全蝎（二枚，炙）
诸风引起的肢体震颤、头晕目眩，都归属于肝木。各种疼痛、瘙痒、疮疡，都归属于心火。各种湿邪导致的浮肿、胀满，都归属于脾土。各种气机郁滞、痿证，都归属于肺金。各种寒邪引起的筋脉收缩牵引，都归属于肾水。
各种突然发生的肢体僵硬强直，四肢疼痛，身体扭曲，体内拘急，筋脉缩短，都属于风邪致病。厥阴风木，对应的是肝胆之气。
各种疾病出现的喘息呕吐，吐酸水，急性腹泻且肛门有紧迫下坠感，肌肉痉挛抽筋，小便浑浊，腹部胀大如鼓，敲击声音像鼓声，痈疽疮疡，皮疹，瘿瘤气块，淋巴结结核，上吐下泻的霍乱，神志昏蒙郁闷肿胀，鼻流清涕或鼻出血，血液溢出，便血，淋证闭尿，身体发热，怕冷，战栗发抖，惊恐迷惑，悲伤或嬉笑谵妄，鼻出血及眼部出血污浊，都属于热邪致病。少阴君火之热，对应的是真心和小肠之气。
各种痉挛强直，痰饮积聚导致胸膈痞塞、脘腹痞闷胀满，霍乱吐泻，身体沉重浮肿，肌肉松软如泥，按压后凹陷不起，都属于湿邪致病。太阴湿土，对应的是脾胃之气。
各种热病导致的神志昏蒙，突然失音，头目昏沉不明，烦躁扰乱，狂乱越常，骂人惊骇，红肿酸痛，气逆上冲，颤抖恐惧如同丧失神志主宰，打喷嚏呕吐，疮疡，喉哑，耳鸣及耳聋，呕吐涌溢，饮食不下，眼睛视物不明，急性腹泻，突发疾病甚至突然死亡，都属于火邪致病。少阳相火之热，对应的是心包络和三焦之气。
各种干涩枯槁，皮肤干燥起皱开裂，都属于燥邪致病。阳明燥金，对应的是肺与大肠之气。
各种疾病上下排出的水液，清澈透明寒冷，癥瘕疝气，坚硬痞块，腹部胀满紧痛，下利清稀白色，进食后不觉饥饿，呕吐下利物腥臭秽浊，屈伸不便，四肢厥冷僵硬，都属于寒邪致病。太阳寒水，对应的是肾与膀胱之气。
脉象方面：风邪侵袭人体，六部脉象多表现为沉伏，也有脉象随着气机奔涌，指下感觉洪大旺盛的。如果兼夹寒邪，脉象带浮迟；兼夹暑邪，脉象虚；兼夹湿邪，脉象浮涩。《脉经》说：脉微而数，是中风的表现。寸口脉沉大而滑，沉代表实邪，滑代表气盛，气实相互搏结，邪气入腑则易愈。这是卒厥导致不知人事，如果嘴唇发青、身体冰冷，说明邪气入脏，预后不良（死）。如果身体温和，汗自出，说明邪气入腑，可以自愈。脉象阳部浮而滑，阴部濡而弱的，适宜用催吐法。或者脉浮而滑，或者沉而滑，或者微而虚的，都是虚证和痰证。治疗大法宜见浮迟脉，不宜见强大数脉。如果脾脉缓而无力，是最难治疗的。因为风邪喜欢归并于肝；肝木克制脾土，会导致大便洞泄，所以难以治愈。
证候方面：风邪中于人，称为卒中，或暴仆，或暴喑，或神志蒙昧，或口眼歪斜，或瘫痪，或不省人事，或语言蹇涩，或痰涎壅盛，有的致死，有的不死，都视为中风的征候。《内经》说：风是百病之长。它变化无常，成为其他疾病，没有固定的规律。又说：风善行而数变。又说，风伤人，有的表现为寒热，有的表现为热中，有的表现为寒中，有的表现为厉风，有的表现为偏枯。《千金方》说：岐伯所说的中风，大体有四类：一是偏枯，指半身不遂；二是风痱，指身体无疼痛，四肢不能收持；三是风懿，指突然不知人事；四是风痹，指各种痹症类似风状。《金匮要略》说：寸口脉浮而紧，紧则为寒，寒与虚相搏，邪气在皮肤；浮者表示血虚。络脉空虚，贼邪无法排泄，邪气或左或右，邪气所在处松弛，正气所在处紧急，正气牵引邪气，导致口眼歪斜、肢体不遂。邪气在络，肌肤麻木不仁；邪气在经，即手足无力不胜任；邪气入腑，即不识人；邪气入脏，舌即难言、口吐痰沫。因此古代名医，都以外中风邪来立方治疗。到了近代刘河间、李东垣、朱丹溪三位医家出现，才开始与古人不同。河间说：中风瘫痪，并非肝木之风实盛而突然中受，也不是外感风邪，确实是因为调养失宜，心火暴甚，肾水虚衰，不能制约，导致阴虚阳实，热气怫郁；心神昏冒不用，突然倒下不知人事，多因喜、怒、思、悲、恐五志有所过极，从而卒中。五志过极，都是因为热盛所致。俗语说：风，是只说了末节而忘记了根本。东垣说：中风不是外来风邪，是本气自病。凡人年过四十，气衰之际，或因忧、喜、忿、怒伤其气的，多有此证。壮岁之时没有，如果是肥胖的人，偶尔也有，也是形盛气衰，所以如此。丹溪说：有气虚，有血虚，有痰盛。又说：西北气候寒冷，被风所中，诚然有之；东南气候温暖，地多湿气，有风者，并非风邪，都是湿生痰，痰生热，热生风。三人的论述，河间主火，东垣主气，丹溪主湿，反而把风看作虚象。如果认为三子是对的，古人是错的，那么在三人未出之前，本来就有遵循古人而治愈的案例；如果认为古人是正确的，三子是错误的，那么在三人出现之后，也有遵循三子而治愈的案例。大致古人与三子的论述，都不可偏废。大概古人的论述，说的是证候；三子的论述，说的是病因，因则是本，证则是标，所谓外中风邪，未必不是因为元精虚弱，营卫失调，而后才感受外邪；所谓因火、因气、因湿，也未必绝无外邪侵扰而发病。
治法方面：治疗风病的方法，全在于灵活变通。如果重于外感的，先驱除外邪，然后补益中气；重于内伤的，先补益中气，然后驱除外邪。或者以散风药为君药，以补损药为臣使药；或者以滋补药为君药，以散邪药为臣使药，根据轻重来处理。《内经》说：有取本而得愈的，有取标而得愈的；有治本兼治标的，有治标兼治本的。又说：急则治其标，缓则治其本。如果初病突然仆倒，昏闷不省人事，或痰涎壅盛，舌强不语，两寸口脉浮大而实的，急需瓜蒂、藜芦等药催吐，以遏制病势；或者人迎脉紧盛，或六脉俱浮弦的，急需用小续命汤解表。因为风气太盛，心火暴甚，痰涎壅遏于经络之中，在这个时候，难道寻常药饵能通达上下吗？或者在本方中加入附子，因为它禀赋雄壮资质，有斩关夺将的气势，能引领人参等药并行于十二经，以追回复其失散的元阳，又能引领麻黄、杏仁等药发表开腠理，以祛散在表的风寒；引领川芎、当归、芍药等药入血分，行血养血，以滋养亏损的真阴。或者加入石膏、知母以降胃火；或者加入黄芩以清肺金，根据所挟带的证候，以及时令月份的寒温，加减施治。病势稍退，精神稍复，就应当改用丹溪的方法，使用补气补血消痰的药剂，来调补本气使其安宁，这是急则治其标，以及治标兼治本的治疗方法。凡是人手足渐渐觉得不随，或臂膊及大腿、指节麻痹不仁，或口眼歪斜、语言蹇涩，或胃膈迷闷，吐痰连续不断，或六脉浮滑而虚软无力，虽然未到仆倒程度，其为中风晕厥的征候，是指日可待的。早当从丹溪之法调治，左手脉不足，及左半身不遂的，以四物汤补血剂为主治；右手脉不足及右半身不遂的，以四君子汤补气剂为主治；痰盛的，二陈汤、导痰汤等兼用；气血两虚而挟痰的，八物汤加南星、半夏、枳实、竹沥、姜汁之类。如果真元渐渐恢复，痰饮渐渐消除，或者觉得有风邪未退的，仍以羌活愈风汤、防风通圣散之类出入加减，调治而安，这是缓则治其本，以及治本兼治标的治疗方法。又考察先哲有说：证候有中脏、中腑之分，证候各不相同。中腑的多着于四肢，所以面色加上五色变化，脉浮而恶风寒，四肢拘急不仁，或中身之前，或中身之侧，都叫中腑，治疗多容易。中脏的多滞于九窍，唇缓失音，鼻塞耳聋，目视不明，大小便闭结，都叫中脏，治疗多困难。大法中腑的，用小续命汤发散表邪；中脏的，用三化汤等通利里实；脏腑兼见的，又不可拘泥，或一气之微汗，或一旬之通利。又说：治疗须少汗，亦须少下。多汗则虚其卫气，多下则损其荣血，这又不可不谨慎。如果外无六经形证，内无便溺阻隔，但手足不随，语言蹇涩的，这是邪气中于经，又应当从乎中治，不可以标本论。因此养血通气，用大秦艽汤、羌活愈风汤之类治疗。外有痿痹气厥，脾虚伤食，以及土气太过，令人四肢不能举的证候，都像中风，又应当体察明白，各从其类以治之。
不治证：凡中风，只要见到头发直立、摇头、吐沫，眼球上窜、面赤如妆、汗珠如串，或者头面青黑、痰声如拉锯的，都不治。如果目闭，手散、鼻鼾、口张、遗尿不知，这五种是五脏绝，死候。只要见到其中一种，还应当施治。如果是心肾绝，尤其难治。如果动止筋痛，是无血养筋，所以痛，白筋枯。不治。
一切国中风、中气，昏倒不知人事、牙关紧急、涎潮壅塞、口眼歪斜、半身不遂、精神恍惚，仓促之际，急用手大拇指掐刻人中穴，即醒。或者急让人将病人的两手两足，从上而下，频频赶出四肢，痰气即散，免致攻心，即醒。或者急用三棱针刺手中指甲角、十井穴，将去恶血，就用气针刺合谷二穴、人中一穴，都是良法。如果还未见效，用通关散通鼻，就是提起头顶法，候有喷嚏可治，无喷嚏不可治。如果口噤不开，用破棺散擦之，口即开，即多灌香油，或少加麝香一二分，或用姜汁亦可，或用太白散、化风丹、摄生饮之类，应当随证选而用之。
一、痰涎壅盛的，口眼歪斜的，不能言语的，都应当用吐法，宜独圣散吐之。或者口噤，用藜芦末少加麝香，灌入鼻内吐之。一吐不止，再吐之，也有气血虚而不可用吐法的。
肥人多有中风，因为其形盛于外，而气歉于内。肺为气出入之道。人胖者气必急，气急则肺邪盛。肺金克木，胆为肝之腑，所以痰涎壅盛，所以治疗，必先理气为急，中后气未尽顺，痰未尽除，调理之剂，惟当以藿香正气散加南星、木香、防风、当归，此药不仅治中风之证，而中恶、中气尤宜。
一、气虚卒倒，用人参补之。挟痰，则浓煎人参汤，加竹沥、姜汁。血虚用四物汤补之。挟痰者，四物汤以姜汁炒过，更加竹沥、姜汁。
一、左瘫右瘫的，因气血虚而痰火流注也。血虚则痰火流注于左，而为左瘫，宜四物汤加白芥子、竹沥、姜汁；兼有死血，加桃仁、红花。气虚则痰火流注于右，而为右瘫，宜四君子汤合二陈汤，加白芥子、竹沥、姜汁，能食者去竹沥，加荆沥尤妙。肥人多湿，少加附子行经。瘫痪初起，急治则可，久则痰火郁结而难治也。
一中风饮食坐卧如常，但失音不语，俗呼为哑风，小续命汤去附子，加石菖蒲一钱，或诃子清音汤亦可。然而不语岂止一端？有舌强不语，有神昏不语，有口噤不语，有舌纵语涩，有舌麻语涩，其间治痰、治风、安神、养气血，各从活法，又难拘泥于续命、诃子而已。
一中气也似中风，但风中口中多痰涎，气中则无。又风中身温，气中身冷。风中脉浮洪，气中脉沉伏。这是七情内伤，气逆为病，治当顺气，用乌药顺气散、八味顺气散主之，或藿香正气散亦可。
经云：无故而喑，脉不至，不治自已，谓气暴逆也，气复则已，审如是，虽不服药，亦自可。
一中风、中气，口眼歪斜，语言蹇涩，或口噤牙关紧急，筋脉挛缩，骨节酸疼，行步艰辛，一应风气疼痛，太乙紫金丹用酒磨服。（方见通治）
一中风不语，瘫痪初起，宜导痰小胃丹，用姜汤送三五十丸，少时即能言语如故。（方见痰饮）
一中风口眼歪斜，头疼发热，恶风初作的，羌活冲和汤加独活、 本。（方见伤寒）
一中风一身俱麻，乌药顺气散加人参、白术、川芎、当归、麦门冬。
一中风面目十指俱麻，乃气虚也，补中益气汤加木香、附子、羌活、防风、乌药。（方见内伤）
All wind-induced tremors and dizziness belong to Liver Wood. All pain, itching, sores, and ulcers belong to Heart Fire. All dampness-induced edema and fullness belong to Spleen Earth. All qi stagnation,郁 (stagnation), and flaccidity syndromes belong to Lung Metal. All cold-induced contraction and pulling belong to Kidney Water.
All sudden stiffness and rigidity, limb pain, body twisting, internal tension, and muscle shortening belong to Wind. Jueyin Wind-Wood corresponds to the Qi of the Liver and Gallbladder.
All diseases presenting with panting and vomiting, acid regurgitation, acute diarrhea with tenesmus, muscle spasms, turbid urine, abdominal distension like a drum, carbuncles and sores, rashes, goiters, lymph node tuberculosis, cholera with vomiting and diarrhea, mental confusion and swelling, rhinorrhea or epistaxis, hemorrhage, hematochezia, stranguria and urinary retention, fever, aversion to cold, shivering, fright and confusion, excessive weeping or laughing with delirium, epistaxis and ocular bleeding, all belong to Heat. Shaoyin Sovereign Fire-Heat corresponds to the Qi of the True Heart and Small Intestine.
All spasms and rigidity, accumulation of fluids causing chest and diaphragm obstruction and abdominal fullness, cholera with vomiting and diarrhea, heavy body and edema, muscles soft like mud that do not rebound upon pressure, all belong to Dampness. Taiyin Wet-Earth corresponds to the Qi of the Spleen and Stomach.
All heat-induced mental confusion, sudden aphonia, dizziness and clouded vision, restlessness and mania, cursing and fright, swelling and soreness, rebellious Qi rushing upward, trembling and fear as if losing spiritual control, sneezing and vomiting, sores, hoarseness, tinnitus and deafness, violent vomiting, inability to eat, blurred vision, acute diarrhea, sudden illness or death, all belong to Fire. Shaoyang Ministerial Fire-Heat corresponds to the Qi of the Pericardium and Sanjiao.
All dryness, withering, and skin cracking belong to Dryness. Yangming Dry-Metal corresponds to the Qi of the Lungs and Large Intestine.
All water and fluid discharge from above and below that is clear, transparent, and cold; masses and hernias; hard nodules; abdominal fullness and tight pain; clear white diarrhea; lack of hunger after eating; foul-smelling vomit and diarrhea; difficulty in flexion and extension; cold limbs and rigidity, all belong to Cold. Taiyang Cold-Water corresponds to the Qi of the Kidneys and Bladder.
Regarding pulse diagnosis: When Wind pathogen invades the human body, the six pulses are mostly deep and hidden; sometimes the pulse surges with Qi, feeling vigorous and abundant under the fingers. If accompanied by Cold, the pulse is floating and slow; if accompanied by Summerheat, the pulse is deficient; if accompanied by Dampness, the pulse is floating and choppy. The *Mai Jing* (Pulse Classic) states: A faint and rapid pulse indicates stroke. A Cun Kou pulse that is deep, large, and slippery indicates excess (deep) and Qi abundance (slippery); when Excess Qi clashes, if the pathogen enters the Fu organs, recovery is likely. This is sudden syncope with loss of consciousness. Cyanosis of lips and cold body indicate entry into the Zang organs, which is fatal. Warm body and spontaneous sweating indicate entry into the Fu organs, leading to self-healing. A pulse that is floating and slippery on the Yang side, and soggy and weak on the Yin side, indicates suitability for emesis. Floating and slippery, or deep and slippery, or faint and deficient pulses all indicate Deficiency and Phlegm. The general principle favors floating and slow pulses, not strong and rapid ones. If the Spleen pulse is slow and forceless, it is most difficult to treat. Wind tends to return to the Liver; Liver Wood overacts on Spleen Earth, causing watery diarrhea, hence untreatable.
Regarding symptoms: Wind invading the person is called stroke, sudden collapse, sudden aphonia, mental clouding, facial deviation, paralysis, unconsciousness, dysarthria, copious phlegm-saliva, which may be fatal or not, all considered signs of Stroke (*Zhong Feng*). The *Nei Jing* says: Wind is the chief of all diseases. It changes frequently, becoming other diseases without fixed patterns. It also says: Wind moves swiftly and changes often. Wind injuring humans can manifest as cold-heat, heat-center, cold-center, malignant wind, or hemiplegia. The *Qian Jin Fang* states: Qi Bo's stroke has four main types: 1. Pian Ku (hemiplegia, half-body paralysis); 2. Feng Fei (no pain, limbs unable to hold); 3. Feng Yi (sudden unconsciousness); 4. Feng Bi (bi-syndromes resembling wind). The *Jin Gui Yao Lue* states: Cun Kou pulse floating and tight indicates Cold; Cold and Deficiency clash, pathogen in skin; floating indicates Blood Deficiency. Collaterals empty, evil cannot exit, pathogen on left or right, affected side relaxed, healthy side tense, healthy side pulls pathogen, causing facial deviation and paralysis. Pathogen in collaterals causes insensitivity; in meridians, weakness; in Fu organs, unconsciousness; in Zang organs, tongue stiff, inability to speak, foamy saliva. Thus, ancient physicians treated external wind invasion. Later, Liu Hejian, Li Dongyuan, and Zhu Danxi differed. Hejian said: Stroke paralysis is not due to excessive Liver Wind or external invasion, but due to poor regimen, violent Heart Fire, deficient Kidney Water failing to control it, leading to Yin Deficiency and Yang Excess, heat stagnation, mental clouding, and sudden collapse, often triggered by extreme emotions (joy, anger, worry, sadness, fear). Extreme emotions cause heat. Folk saying: "Wind" mentions the branch but forgets the root. Dongyuan said: Stroke is not external wind, but internal Qi disease. People over forty with Qi decline, or injured by emotions, often have this. Young people rarely do; fat people occasionally do, due to robust form but deficient Qi. Danxi said: There is Qi Deficiency, Blood Deficiency, and Phlegm Abundance. Northwest is cold, wind invasion exists; Southeast is warm and damp, "wind" is actually Damp generating Phlegm, Phlegm generating Heat, Heat generating Wind. Their theories: Hejian emphasizes Fire, Dongyuan Qi, Danxi Damp, viewing Wind as deficiency. If they are right and ancients wrong, there were cures following ancients before them; if ancients right and they wrong, there were cures following them after. Both should not be discarded. Ancients described symptoms; the three described etiology. Etiology is Root, Symptoms are Branch. External wind invasion may stem from Yuan Jing deficiency and Ying-Wei imbalance. Internal Fire/Qi/Damp may also involve external pathogens.
Treatment methods depend on flexibility. For external predominance, expel pathogen first, then tonify Middle Qi; for internal predominance, tonify Middle Qi first, then expel pathogen. Use dispersing herbs as Sovereign and tonifying as Ministers, or vice versa, based on severity. *Nei Jing* says: Treat Root or Branch depending on outcome; treat Branch in emergencies, Root in chronic cases. For sudden collapse, unconsciousness, copious phlegm, stiff tongue, floating-large-solid Cun Kou pulses, urgently use Geng Ti (Melon Seed) and Li Lu (Veratrum) to induce vomiting to curb the pathogen. If Ren Ying pulse is tight-abundant or six pulses are floating-stringy, urgently use Xiao Xu Ming Tang to release the exterior. Due to excessive Wind and violent Heart Fire blocking collaterals with phlegm, ordinary drugs cannot reach upper and lower. Add Fu Zi (Aconite) to lead Ren Shen (Ginseng) through the twelve meridians to recover lost Yuan Yang; lead Ma Huang (Ephedra) and Xing Ren (Apricot Seed) to release exterior and open pores against Wind-Cold; lead Chuan Xiong (Sichuan Lovage Rhizome), Dang Gui (Angelica Sinensis), and Bai Shao (White Peony Root) into Blood level to nourish true Yin. Add Shi Gao (Gypsum) and Zhi Mu (Anemarrhena) to descend Stomach Fire; add Huang Qin (Scutellaria) to clear Lung Metal. Adjust based on accompanying symptoms and seasonal temperature. As condition improves, switch to Danxi's method: tonify Qi and Blood, resolve Phlegm to stabilize the Root. This is treating Branch in emergency and treating Root with Branch consideration. For gradual limb numbness/weakness, facial deviation, dysarthria, gastric stuffiness, continuous phlegm, or floating-slippery-deficient pulses, stroke is imminent. Early treatment per Danxi: Left pulse deficiency/left hemiplegia -> Si Wu Tang (Four Substances Decoction) for Blood; Right pulse deficiency/right hemiplegia -> Si Jun Zi Tang (Four Gentlemen Decoction) for Qi; Copious phlegm -> Er Chen Tang (Two Aged Herbs Decoction) or Dao Tan Tang; Qi-Blood Deficiency with Phlegm -> Ba Wu Tang plus Nan Xing (Arisaema), Ban Xia (Pinellia), Zhi Shi (Immature Bitter Orange), Zhu Li (Bamboo Sap), Jiang Zhi (Ginger Juice). As Yuan recovers and Phlegm clears, if Wind remains, use Qiang Huo Yu Feng Tang or Fang Feng Tong Sheng San. This is treating Root in chronic phase. Ancient sages distinguished Zhong Fu (meridian) and Zhong Zang (organ). Zhong Fu affects limbs, face colors, floating pulse, aversion to wind/cold, limb rigidity; easier to treat. Zhong Zang blocks nine orifices, slack lips, aphonia, nasal/ear blockage, blurred vision, constipation; harder to treat. General rule: Zhong Fu uses Xiao Xu Ming Tang to release exterior; Zhong Zang uses San Hua Tang to purge interior. Combined cases require flexibility (sweating or purging). Caution: avoid excessive sweating (damages Wei Qi) or purging (damages Ying Blood). If no Six Channels symptoms or internal blockage, but limb immobility and dysarthria, pathogen is in meridians; treat centrally with blood-nourishing and Qi-moving herbs like Da Qin Jiao Tang or Qiang Huo Yu Feng Tang. Differentiate from Wei Bi, Qi Jue, Spleen Deficiency with food stagnation, or excessive Earth causing limb heaviness.
Untreatable signs: Stroke with straight hair, head shaking, foaming, eye protrusion, flushed face like makeup, bead-like sweat, or blue-black face and sawing phlegm sound are untreatable. Closed eyes, scattered hands, snoring, open mouth, incontinence indicate Five Zang exhaustion (death). Treat if only one sign appears. Heart-Kidney exhaustion is particularly difficult. Pain on movement indicates Blood Deficiency failing to nourish tendons; white tendons wither; untreatable.
For sudden stroke, Qi strike, unconsciousness, locked jaw, flooding saliva, facial deviation, hemiplegia, mental confusion: Urgently press Ren Zhong (GV26) with thumb. Or vigorously rub limbs from top to bottom to disperse Phlegm-Qi. Or prick Ten Well points and nail corners with three-edged needle to remove bad blood; then needle He Gu (LI4) and Ren Zhong. If ineffective, use Tong Guan San (Pass the Barrier Powder) nasally; lift head. Sneezing indicates treatability; absence indicates untreatability. For locked jaw, apply Po Guan San (Break Coffin Powder) to teeth; open mouth; pour sesame oil or musk/ginger juice. Select Tai Bai San, Hua Feng Dan, or She Sheng Yin as appropriate. For stubborn Wind-Phlegm unresponsive to other drugs, Duo Ming San (Life-Saving Powder) cures in one dose.
For copious phlegm, facial deviation, aphonia: Use emesis. Du Sheng San (Sovereign Holy Powder) is suitable. For locked jaw, mix Li Lu powder with musk, insufflate nose to induce vomiting. Repeat if necessary; contraindicated in Qi-Blood Deficiency.
Fat people often suffer stroke due to robust exterior but deficient interior. Lung governs Qi passage. Fat people have urgent Qi, leading to Lung Evil. Lung Metal overacts on Wood; Gallbladder is Liver's paired organ; thus copious phlegm. Treatment must prioritize regulating Qi. Post-stroke, if Qi is not smooth and Phlegm not cleared, use Huo Xiang Zheng Qi San plus Nan Xing, Mu Xiang, Fang Feng, Dang Gui. This treats stroke, Zhong E (evil invasion), and Qi strike.
For Qi Deficiency sudden collapse: Tonify with Ren Shen. With Phlegm: Strong Ren Shen decoction plus Zhu Li, Jiang Zhi. For Blood Deficiency: Si Wu Tang. With Phlegm: Si Wu Tang stir-fried with ginger juice, plus Zhu Li, Jiang Zhi.
Left/Right hemiplegia results from Qi-Blood Deficiency and Phlegm-Fire flow. Blood Deficiency leads to Phlegm-Fire flowing left -> Left hemiplegia: Si Wu Tang plus Bai Jie Zi, Zhu Li, Jiang Zhi; add Tao Ren, Hong Hua for static blood. Qi Deficiency leads to Phlegm-Fire flowing right -> Right hemiplegia: Si Jun Zi Tang combined with Er Chen Tang, plus Bai Jie Zi, Zhu Li, Jiang Zhi; if appetite good, remove Zhu Li, add Jing Li. Fat people have Dampness; add small amount of Fu Zi to move channels. Early treatment effective; late stage difficult due to Phlegm-Fire stagnation.
Stroke with normal diet/sleep but aphonia ("Mute Wind"): Xiao Xu Ming Tang minus Fu Zi, add Shi Chang Pu (Acorus); or He Zi Qing Yin Tang. Aphonia has many causes: stiff tongue, mental clouding, locked jaw, tongue relaxation, tongue numbness. Treat Phlegm, Wind, calm Spirit, nourish Qi-Blood flexibly; do not limit to Xu Ming or He Zi formulas.
Qi Strike resembles stroke: Wind strike has copious saliva; Qi strike does not. Wind strike body warm; Qi strike body cold. Wind strike pulse floating-large; Qi strike pulse deep-hidden. Caused by Seven Emotions injuring Qi, rebellious Qi. Treat by smoothing Qi: Wu Yao Shun Qi San, Ba Wei Shun Qi San, or Huo Xiang Zheng Qi San. Classics say: Sudden aphonia with absent pulse resolves spontaneously as Qi rebellion subsides.
For stroke/Qi strike with facial deviation, dysarthria, locked jaw, tendon contraction, joint pain, difficult walking, all wind-pain: Tai Yi Zi Jin Dan taken with wine.
For stroke aphonia, early paralysis: Dao Tan Xiao Wei Dan, 30-50 pills with ginger soup, restores speech quickly.
For stroke headache like breaking, dysarthria: Xiao Xu Ming Tang plus Qiang Huo.
For stroke facial deviation, headache, fever, early aversion to wind: Qiang Huo Chong He Tang plus Du Huo, Ben Cao.
For stroke whole-body numbness: Wu Yao Shun Qi San plus Ren Shen, Bai Zhu, Chuan Xiong, Dang Gui, Mai Men Dong.
For stroke face and ten fingers numbness (Qi Deficiency): Bu Zhong Yi Qi Tang plus Mu Xiang, Fu Zi, Qiang Huo, Fang Feng, Wu Yao.
For stroke whole-body stabbing pain: Si Wu Tang plus Jing Jie, Fang Feng, Man Jing Zi, Chan Tui, Mai Men Dong.
For stroke hemiplegia: Qiang Huo Yu Feng Tang plus Tian Ma, Jing Jie, Jiang Can.
Formulas:
Tong Guan San (Secret Formula): For stroke aphonia, unconsciousness, inability to swallow. Nan Xing, Ban Xia, Zhu Ya Zao Jiao (each 0.5 fen). Powder, insufflate nose. Sneezing = treatable; no sneeze = untreatable.
Po Guan San: For locked jaw. Nan Xing (0.5 fen), Pian Nao (camphor,少许). Prepared on May 5th noon. Rub between teeth until hot to open jaw.
Duo Ming San: For sudden stroke, flooding saliva, closed airway, locked jaw, upward gaze, trauma wind, convulsions, pediatric epilepsy. Nan Xing, Tian Ting Li, Bai Zhi, Ban Xia (soaked, peeled), Ba Dou (shelled, oil retained, equal parts, raw). Fine powder, 0.5 fen dose with ginger juice. Cures locked jaw where liquids fail. Pediatric use induces phlegm/vomit. For stubborn Wind-Phlegm.
Du Sheng San: For copious phlegm, stroke phlegm confusing heart, mania, unconsciousness, five epilepsies. Tian Gua Di (Melon Seed). Powder, 0.5 fen (1 qian severe), warm water. Induces vomiting. Stop with plain water, scallion soup, or musk. Add Quan Xie for wind-phlegm; Xiong Huang + pig fat for worms; Yuan Hua for severe worms. For damp edema, add Chi Xiao Dou. Note: Vomiting causes upward eye movement; close eyes during vomiting.
Tai Bai San (Secret Formula): For stroke phlegm-Qi collapse, slight warmth in heart/abdomen, throat sounds. Chen Duan Shi (ancient calcined stone). Fine powder, washed with water. 3 qian dose, boil in 1 bowl water to 0.7 portion, warm drink. Resolves phlegm miraculously.
Tai Xuan Tang (Secret Formula): For stroke aphonia, coma near death. Dye vat water (1 cup), warm and administer. Restores speech.
Hua Feng Dan: For all stroke phlegm-jue, wind-epilepsy, locked jaw, unconsciousness, pediatric convulsions, opisthotonos, fever, cough. Nan Xing (bile-treated, 2 qian), Tian Ma (roasted), Fang Feng, Jing Jie Sui, Qiang Huo, Du Huo, Ren Shen, Xi Xin, Chuan Xiong (each 1 qian), Mu Xiang (0.5 fen). Fine powder, honey pills, cinnabar coating. Dissolve in mint tea. Use Zi Su Tang for emotional anger. Rub between teeth for locked jaw.
She Sheng Yin: For all sudden strikes (wind, cold, summerheat, damp, phlegm-Qi jue), unconsciousness. Cang Zhu (raw, 1 qian), Nan Mu Xiang, Nan Xing (wrapped in wet paper, roasted), Ban Xia (soaked, each 1.5 qian), Liao Xi Xin, Shi Chang Pu, Gan Cao (raw, each 1 qian). Chewed, decoct with 7 ginger slices, warm drink. Add Quan Xie (2 pieces, roasted) for copious phlegm.