张景岳曰∶非风症,诸书皆云气体虚弱,邪气乘虚而入,此言感邪之由。然有邪无邪,何可不辨?
有邪者,即伤寒、疟、痹之属,寒热走注,肿痛偏枯。此病由于经,宜先扶正气,而通经逐邪之品,不得不
用以为佐。无邪者,即非风衰败之属,本无寒热痛苦,肢体忽废,言语变常。此病由乎脏,故精虚则气去,
为眩运卒倒;气去则神失,为昏愦无知,此时救本不暇,尚可杂用以伤及正气乎?凡非风卒倒等症,无非气
脱而然。七情酒色,先伤五脏之真阴,此致病之本也。内外劳伤,或年力衰迈,积损为颓,此发病之因也。
阴亏于前,阳损于后,阴陷于下,阳乏于上,阴阳相失,精气不交,以致卒尔昏愦倒仆,皆阳气暴绝之候。
其为病者,忽然汗出,荣卫之气脱也;或遗尿者,命门之气脱也;或口开不合者,阳
明经之气脱也;或口角流涎者,太阴脏气之脱也;或四肢瘫软者,肝脾之气败也;或昏倦无知,
语言难出者,神败于心,精败于肾也。此皆冲任气脱,形神俱败而然,故于中年之后,多有此症,治此若
痰气阻塞。必须大剂参附峻补元气,以先其急;随用地黄、当归、枸杞之类,填补真阴,以培其本。盖
精即气之根,经曰精化为气是也。若误指风痰,治从消散,必不救矣。
风厥之症,独重肝邪。肝有胃气之贼,人无胃气则死。病为强直掉眩之类,皆风木之化。病为四肢不
用,痰涎壅盛,皆脾虚之候。虽曰东方之实,然以五阳俱败,肝失所养,责在脾肾之虚。使脾胃不虚,肝木
虽强,必无乘脾之患;使肾水不虚,则肝木得养,何有强直之虞?夫所谓胃气者,即二十五阳也,非独阳明
为言;所谓肾水者,即五脏六腑之精,非独少阴为言,阴阳一败,真脏自见。真脏者,肝邪也,无胃气也。
此即非风类风病之大本也。
非风多痰者,悉由中虚,夫痰即水也,其本在肾,其标在脾。在肾者,水不归源,水泛为痰也;在脾者
,以饮食不化,土不制水也。
故人不能食者,反能生痰。此以脾虚不能化食,而食即为痰。凡病虚劳,其痰必多,正以脾愈虚则水
液悉化为痰。故凡瘫痪螈 ,半身不遂等症,虽痰在经络,使果荣卫和调,则津血自充且行,何痰之有?
惟元阳亏损,则水中无气,津凝血败,皆化为痰。若谓痰在经络,非攻不去,则安有独攻其痰,而津血无动
乎?津血复伤,元气愈竭,惟宜温脾强肾,以治痰之本,使根本渐充,则痰不治而自去矣。
治痰之法,凡初病痰气不盛者,必不可疑其为痰,而妄用痰药。若果痰涎壅盛,填塞胸膈,则不得
不先开其痰,以通药食之道。而开痰之法,唯吐为捷,如独圣散、茶调散、稀
涎散之属。恐元气大虚,不能当此峻剂,或用牛黄丸、抱龙丸之类,但使咽喉气通,能进汤药即止。故治
痰之法,必察其可攻与否,然后用之,斯无误也。若其眼直切牙,肢体拘急,面赤强劲有力者,虽见昏沉,
亦为可治。如形症已定,痰气不甚,万勿治痰,当调其气血。若果痰涎,须分虚实治之。若气不甚虚,或寒
或湿生痰者,六安煎、二陈汤。因火者,清膈饮及竹沥、童便。火甚者抽薪饮。脾虚兼呕多痰者,六君
子汤、五味异功散,阴虚不足,兼燥而咳者,金水六君煎。阴虚水泛为痰者,六味丸、八味丸。脾胃虚寒,
不能运化为痰者,但宜温补根本。中气虚者,理中汤、温胃饮。阴不足者,理阴煎。若死证已具,吐亦无益。
若痰气甚极不能吐者,皆不治之症。盖形气大虚,忌用吐法,是皆不可攻者也。
凡非风口眼 斜,半身不遂,及四肢无力,掉摇拘挛之属,皆筋骨之病。肝肾精血亏损,不能滋养百
骸,故筋有缓急,骨有痿弱。如树木之衰,津液不到,即一枝枯槁。人之偏废,亦犹是也。经曰∶足得血
而能步,掌得血而能握。今偏废如此,讵非衰败之故乎?陈济川曰∶医风先医血,血行风自灭。盖为肝邪
之见,本由肝血之虚,肝血虚,燥气乘之矣。而木从金化,风必随之,宜养血以除燥,则真阴复而假
风自散矣。若用风药,血必愈燥,大非宜也。然阴中有血亦有气,血中无气,则为纵缓废弛;气中无血,
则病抽掣拘挛。盖气主动,无气则不能动,斯不能举矣;血主静,无血则不能静,斯不能舒矣。故筋缓者,
当责其无气;筋急者,当责其无血。无气宜五福饮、四君子汤。十全大补汤,无血宜大、小营煎主。其与痿症
之不动,痛风之不静,义稍不同。凡非风症,多因表里俱虚而病,治法当以培补元气为主。若无兼症,
亦不宜攻补兼施。盖形骸之坏,神志之乱,皆根本伤败
之病,何邪之有?能复其元,庶乎可愈。
一、非风有火盛者,即阳证也。火甚者专治其火,如抽薪饮、白虎汤;火微者兼补其阴,如加减一
阴煎。但使火去六七,即当调治其本。然阳胜者阴必病,故治热必从血分,甚者用苦寒,微者用甘凉。
寒甚者即阴症也,专宜益火。寒微者宜温胃饮、八味丸,寒甚者宜回阳饮、理中、四逆汤。然寒胜
者阳必病,故治寒之法必从气分,如阳脱寒甚者,宜灸关元、气海、神阙,以回其阳气。
一、非风掉眩惑乱者,总由气虚于上而然。经曰∶上气不足,脑为之不满,头为之苦倾,目为之苦眩
。又曰∶上虚则眩。此明训也。微觉有此,当以五福饮之类,培其中气。虚
甚大补元煎。否则,卒倒之渐,所由至也。
一、非风麻木不仁,因气血不至,所以不知痛痒。盖气虚则麻,血虚则木,麻木不已,偏枯痿废,
此魄虚之候也。经曰∶痱之为病,身无痛者,四肢不收,智乱不甚,其言微知,可治,甚则不能言,不可治。
又经曰∶营气虚则不仁;卫气虚则不用;营卫俱虚,则不仁且不用,肉如故也。人身与志不相有曰死。即此类
也。凡遇此症,只宜培养血气,勿得误认为痰。
一、非风烦热自汗,小水不利,不可以药利之。盖津液外泄,小水必少,再用渗利,则阴水愈竭,
无以制火,而烦燥益甚。但使热退汗止,小水自利,况自汗多属阳明,忌利小便,宜生脉散、一阴煎。
一、非风遗尿者,由肾气虚脱,最为危候,宜参、 、归、术补之。然必命门火衰,所以不能收摄,
甚者须加桂、附。
论用药佐使
凡非风有兼症,则通经佐使之法,本不可废。盖脉络不通,皆由血气。血气兼症,各有所因∶
如因于风者必闭抑,宜散而通之,如麻、桂、柴、羌、辛、芷之属;因于寒者必凝涩,宜热而通之,如葱、
椒、桂、附、甘、姜之属;因于热者必干涸,宜凉而通之,如芩,连、栀、柏、石膏、知母之属;因于湿者
必壅滞,宜顺利,如苍术、茵陈、萆 、五苓之属;血滞者宜活,如芎、归,牛膝、红花、桃仁、硝黄之属;
气滞者宜行,如木香、香附、乌、沉、枳壳之属;痰滞者宜开,如星、半、牛黄、天竺黄、朱砂、海石、
元明粉之属;气血虚弱者惟宜温补,如参、 、归、术、熟地、枸杞、牛膝之属。然虚实之异,尤当详审。
盖通实者,各从其类,使无实邪,而妄用通药,必伤元气。通虚者,或阴或阳,尤当知要。如参、 所以
补气,而气虚之甚者,非姜、附之佐,必不能追散失之元阳;归、地所以补精血,而阴虚之极者,非桂、附
之引,必不能复无根之生气。寒邪在经而客强主弱,非桂、附之勇则血脉不行;痰湿在中而土寒水泛,非姜
附之暖则脾肾不健。此通经之法,实者可以用寒凉,虚者必宜温热也。但附子性刚勇而热,阴虚水亏多热
燥者非所宜。但涉阳虚,非此莫达。
一、经病之轻症∶皮毛枯涩、汗出、眩运、鼻塞者,肺之经病。血脉不荣,颜色惟悴者,心之经病。
肌肉消瘦,浮肿不仁,肉 筋惕,四肢不用者,脾之经病。筋力疲困,拘急掉螈,胁肋胀痛者,肝之经病。
口眼歪斜,足阳明及肝胆病。骨弱无力,坐立不能者,肾之经病。
一、经病之危症∶皮腠冰冷,滑汗如油,畏寒之甚者,肺之经病。眼瞀昏黑,筋痛极者,肝肾经病,
耳聋无闻,骨痛极者,肾之经病。反张戴眼,腰脊如折,膀胱经病。舌强不
能言,心肾经病。唇缓口开,手撒,脾之经病。
一、脏病之稍轻症∶咳嗽微喘短气,悲尤不已者,病在肺脏。言语无伦,神昏多笑,不寐者,
病在心脏。腹满少食,吐涎呕恶,吞酸嗳气,谵语多思者,病在脾脏。胸胁气逆,多惊多怒者,病在肝脏。
小腹疼痛,二便不调,动气上冲,呻吟多恐者,病在肾脏。
一、脏病之危症∶气大急大喘,或气脱失声,色灰白或紫赤色者,肺肾气绝。神色脱,昏沉不醒,色
赤黑者,心脏气绝。痰涎壅极,吞吐不能,呃逆不止,腹胀极,色赤黑者,脾胃气绝。眼闭不开,躁急扰乱
,懊 囊缩,色青灰白者,肝脏气绝。声喑寒厥,便闭泄不禁,肾脏气绝。
张景岳说:非风症,各类医书都说是由于人体正气虚弱,邪气乘虚而入,这是论述感受邪气的缘由。然而,有邪气和没有邪气,怎么可以不加以辨别呢?
有邪气的,就是属于伤寒、疟疾、痹证这类疾病,表现为寒热往来、疼痛游走不定、肿胀疼痛或半身不遂。这种病发生在经络,应当先扶助正气,而通经逐邪的药物,不得不作为辅助使用。
没有邪气的,就是属于非风衰败这一类,原本没有寒热和痛苦,肢体突然废用,言语变得异常。这种病源于脏腑,所以精气亏虚则元气耗散,导致眩晕、突然昏倒;元气耗散则神志丧失,导致昏迷无知。此时抢救根本尚且来不及,哪里还能混杂使用其他药物来伤害正气呢?凡是像非风突然昏倒等症状,无非是气脱所致。七情过激、饮酒色欲过度,首先损伤五脏的真阴,这是致病的根本原因。内外劳损,或者年岁力气衰退,积累亏损导致颓败,这是发病的诱因。此前阴液亏虚,随后阳气受损,阴陷于下,阳乏于上,阴阳失调,精气不能相交,以致突然昏迷跌倒,这都是阳气暴绝的征候。
那些患病的人,忽然出汗,是营卫之气外脱的表现;或者遗尿的,是命门之气外脱的表现;或者口开合不拢的,是阳明经之气外脱的表现;或者口角流涎的,是太阴脏气外脱的表现;或者四肢瘫软的,是肝脾之气败坏的表现;或者昏迷疲倦无知、语言难出的,是心神败坏、肾精败坏的表现。这些都是冲任之气外脱,形体与精神俱败所致,所以在中年之后,多有此类病症。治疗此症如果误认为是痰气阻塞,必须用大剂量的参附汤峻补元气,以先解其急;随后用地黄、当归、枸杞等类药物,填补真阴,以培固根本。因为精就是气的根基,《内经》说“精化为气”就是这个道理。如果错误地指认为风痰,治疗从消散风痰入手,必定无法挽救。
风厥症,特别重在肝邪。肝中有胃气的贼邪(克制关系),人如果没有胃气就会死亡。病情表现为强直、抽搐、眩晕之类,都是风木之气的变化。病情表现为四肢不能用,痰涎壅盛,都是脾虚的征候。虽然说是东方(肝)实证,然而由于五阳俱败,肝失所养,责任在于脾肾的虚损。假如脾胃不虚,肝木即使强盛,也必然不会有乘袭脾土的祸患;假如肾水不虚,那么肝木得到滋养,哪里有强直的忧虑呢?所谓胃气,就是指二十五阳(全身阳气),不仅仅指阳明经;所谓肾水,就是指五脏六腑的精气,不仅仅指少阴肾。一旦阴阳败坏,真脏脉象自然显现。真脏脉,就是肝邪显露,也就是没有胃气的表现。这就是非风类风病的根本所在。
非风症多伴有痰湿,全都是由中焦虚损引起。痰就是水,它的根本在肾,标象在脾。在肾方面,是水不归源,水泛溢而为痰;在脾方面,是因为饮食不化,土不能制水。所以人如果不能进食,反而能生痰。这是因为脾虚不能消化食物,食物停滞就变成痰。凡是患有虚劳病的,其痰一定很多,正是因为脾越虚,水液全都化为痰。所以凡是瘫痪、抽搐、半身不遂等症状,虽然痰在经络,但如果荣卫调和,那么津血自然充盈且运行通畅,哪里有痰呢?只有元阳亏损,则水中无气,津液凝结血液败坏,都化为痰。如果说痰在经络,不攻逐就不能去除,那么哪有只攻逐痰而津血不受损伤的道理呢?津血再次受伤,元气更加枯竭,只宜温补脾肾,以治痰的根本,使根本逐渐充盛,那么痰不治疗也会自行消除。
治疗痰的方法,凡是初病痰气不盛的,切不可怀疑是痰,而妄用化痰药。如果确实痰涎壅盛,填塞胸膈,则不得不先开通痰浊,以通利药食之道。而开通痰浊的方法,唯有催吐最为快捷,如独圣散、茶调散、稀涎散之类的方剂。恐怕元气大虚,不能承受这些峻猛药剂,或者使用牛黄丸、抱龙丸之类,只要能使咽喉气机通畅,能够进服汤药就停止。所以治疗痰的方法,必须观察是否可以攻逐,然后才使用,这样才不会出错。如果出现眼睛直视、咬牙、肢体拘急、面色红赤强劲有力的,虽然见到昏沉,也是可治的。如果形症已定,痰气不重,千万不要治痰,应当调理气血。如果确实有痰涎,须分虚实进行治疗。如果气不是很虚,或因寒因湿生痰的,用六安煎、二陈汤。因火生痰的,用清膈饮及竹沥、童便。火很重的用抽薪饮。脾虚兼呕吐多痰的,用六君子汤、五味异功散。阴虚不足,兼燥咳的,用金水六君煎。阴虚水泛为痰的,用六味丸、八味丸。脾胃虚寒,不能运化而生痰的,只宜温补根本。中气虚的,用理中汤、温胃饮。阴不足的,用理阴煎。如果死证已经具备,吐也无益。如果痰气极盛不能吐的,都是不治之症。因为形体元气大虚,忌用吐法,这些都是不可攻逐的。
凡是非风口眼歪斜、半身不遂,以及四肢无力、颤抖摇晃拘挛的,都属于筋骨病变。肝肾精血亏损,不能滋养百骸,所以筋有缓急之分,骨有痿弱之别。就像树木衰老,津液不到达,就会有一枝枯槁。人的偏废,也是这样。《内经》说:“足得血而能步,掌得血而能握。”现在偏废如此,难道不是衰败的缘故吗?陈济川说:“医风先医血,血行风自灭。”这是因为肝邪的出现,本由肝血虚引起,肝血虚,燥气乘虚而入。而木从金化,风必随之,宜养血以除燥,则真阴恢复而假风自然消散。如果使用风药,血必更燥,非常不宜。然而阴中有血也有气,血中无气,则为纵缓废弛;气中无血,则病见抽掣拘挛。气主动,无气则不能动,这就不能举动了;血主静,无血则不能静,这就不能舒展了。所以筋缓的,应当责之于无气;筋急的,应当责之于无血。无气适宜用五福饮、四君子汤、十全大补汤;无血适宜以大、小营煎为主。这与痿症的不动、痛风的不静,含义稍有不同。凡是非风症,多因表里俱虚而发病,治法当以培补元气为主。如果没有兼症,也不宜攻补兼施。因为形骸的毁坏,神志的混乱,都是根本伤败的病,哪里有邪气呢?能恢复其元气,或许可以痊愈。
其一,非风有火盛的,就是阳证。火重的专治其火,如抽薪饮、白虎汤;火轻的兼补其阴,如加减一阴煎。只要火去六七成,就应当调治其根本。然而阳胜者阴必病,所以治热必从血分入手,重的用苦寒,轻的用甘凉。
寒重的就是阴证,专宜益火。寒轻的宜用温胃饮、八味丸,寒重的宜用回阳饮、理中汤、四逆汤。然而寒胜者阳必病,所以治寒之法必从气分入手,如阳脱寒重的,宜灸关元、气海、神阙穴,以回其阳气。
其二,非风出现掉眩惑乱的,总由上焦气虚所致。《内经》说:“上气不足,脑为之不满,头为之苦倾,目为之苦眩。”又说:“上虚则眩。”这是明确的教诲。微觉有此症状,当用五福饮之类,培其中气。虚甚的用大补元煎。否则,就是突然昏倒的征兆,由此而至。
其三,非风麻木不仁,是因为气血不至,所以不知痛痒。气虚则麻,血虚则木,麻木不止,会导致偏枯痿废,这是魄虚的征候。《内经》说:“痱之为病,身无痛者,四肢不收,智乱不甚,其言微知,可治,甚则不能言,不可治。”又《内经》说:“营气虚则不仁;卫气虚则不用;营卫俱虚,则不仁且不用,肉如故也。人身与志不相有曰死。”即此类情况。凡遇到此症,只宜培养血气,勿得误认为是痰。
其四,非风烦热自汗,小便不利,不可以药物利小便。因为津液外泄,小便必然减少,再用渗利药物,则阴水更加枯竭,无以制火,而烦躁更加严重。只要使热退汗止,小便自然通利。况且自汗多属阳明经,忌利小便,宜用生脉散、一阴煎。
其五,非风遗尿的,由肾气虚脱所致,最为危重,宜用人参、[此处原文缺字,推测为黄芪或类似补气药]、当归、白术补之。然而必然是命门火衰,所以不能收摄,严重的须加肉桂、附子。
论用药佐使
凡非风有兼症,则通经佐使之法,本来不可废弃。因为脉络不通,皆由血气问题。血气兼症,各有原因:如因于风的,必然闭抑,宜散而通之,如麻黄、桂枝、柴胡、羌活、辛夷、白芷之类;因于寒的,必然凝涩,宜热而通之,如葱白、花椒、肉桂、附子、甘草、生姜之类;因于热的,必然干涸,宜凉而通之,如黄芩、黄连、栀子、黄柏、石膏、知母之类;因于湿的,必然壅滞,宜顺利,如苍术、茵陈、萆薢、五苓散之类;血滞的宜活血,如川芎、当归、牛膝、红花、桃仁、芒硝、大黄之类;气滞的宜行气,如木香、香附、乌药、沉香、枳壳之类;痰滞的宜开痰,如天南星、半夏、牛黄、天竺黄、朱砂、海浮石、元明粉之类;气血虚弱的只宜温补,如人参、[缺字]、当归、白术、熟地黄、枸杞、牛膝之类。然而虚实的不同,尤其应当详细审察。
通实证的,各从其类,如果没有实邪,而妄用通药,必然损伤元气。通虚证的,或阴或阳,尤其应当知晓要领。如人参、[缺字]用来补气,而气虚严重的,没有姜、附作为佐使,一定不能追回散失的元阳;当归、地黄用来补精血,而阴虚至极的,没有桂、附作为引导,一定不能恢复无根的生气。寒邪在经络而客强主弱,没有桂、附的勇力则血脉不行;痰湿在中而土寒水泛,没有姜附的温暖则脾肾不健。这是通经的方法,实证可以用寒凉,虚证必宜温热。但附子性刚勇而热,阴虚水亏多热燥者不适合。只要涉及阳虚,非此莫属。
其一,经病的轻症:皮毛枯涩、出汗、眩晕、鼻塞的,是肺的经病。血脉不荣,颜色憔悴的,是心的经病。肌肉消瘦,浮肿不仁,肌肉跳动筋惕,四肢不能用的,是脾的经病。筋力疲困,拘急抽搐,胁肋胀痛的,是肝的经病。口眼歪斜,是足阳明及肝胆病。骨弱无力,坐立不能的,是肾的经病。
其二,经病的危症:皮腠冰冷,滑汗如油,畏寒严重的,是肺的经病。眼睛昏暗黑蒙,筋痛极度的,是肝肾经病。耳聋听不见,骨痛极度的,是肾的经病。反张戴眼,腰脊如折,是膀胱经病。舌强不能言,是心肾经病。唇缓口开,手撒,是脾的经病。
其三,脏病的稍轻症:咳嗽微喘短气,悲忧不已的,病在肺脏。言语无伦,神昏多笑,不寐的,病在心脏。腹满少食,吐涎呕恶,吞酸嗳气,谵语多思的,病在脾脏。胸胁气逆,多惊多怒的,病在肝脏。小腹疼痛,二便不调,动气上冲,呻吟多恐的,病在肾脏。
其四,脏病的危症:气大急大喘,或气脱失声,色灰白或紫赤色的,是肺肾气绝。神色脱,昏沉不醒,色赤黑的,是心脏气绝。痰涎壅极,吞吐不能,呃逆不止,腹胀极,色赤黑的,是脾胃气绝。眼闭不开,躁急扰乱,懊憹囊缩,色青灰白的,是肝脏气绝。声喑寒厥,便闭泄不禁,是肾脏气绝。
Zhang Jingyue stated: Regarding Feifeng syndrome (Non-wind syndrome, a category of diseases mimicking wind-stroke but caused by internal deficiency), various medical texts attribute it to the weakness of the body's healthy Qi (Vital Energy), allowing pathogenic factors to enter through the deficiency. This explains the cause of contracting pathogens. However, one must distinguish between cases with pathogens and those without.
In cases with pathogens, these belong to categories such as Shanghan (Cold Damage), Nue (Malaria), and Bi (Obstruction) syndromes, characterized by alternating chills and fever, wandering pain, swelling, or hemiplegia. Since the disease resides in the meridians, one should first support the healthy Qi, while using herbs that unblock the meridians and expel pathogens as adjuvants.
In cases without pathogens, these belong to the category of Feifeng degeneration. There are originally no chills, fever, or pain; instead, there is sudden disability of the limbs and abnormal speech. The disease originates in the Zang organs. Thus, when Essence (Jing) is deficient, Qi departs, leading to dizziness and sudden collapse; when Qi departs, Spirit (Shen) is lost, leading to coma and ignorance. At this moment, rescuing the root is already insufficiently time-consuming, let alone mixing other treatments that might further damage the healthy Qi. All symptoms like sudden collapse in Feifeng are essentially due to Qi collapse. Excessive emotions, alcohol consumption, and sexual indulgence first injure the True Yin of the five Zang organs, which is the root cause of the disease. Internal and external overexertion, or declining strength due to age, accumulate damage leading to decadence, which is the precipitating factor. Previously, Yin was deficient; subsequently, Yang was damaged. Yin sinks below, Yang fails above. Yin and Yang lose harmony, and Essence and Qi fail to interact, resulting in sudden coma and collapse. These are all signs of sudden exhaustion of Yang Qi.
Patients may suddenly sweat, indicating the collapse of Ying (Nutritive) and Wei (Defensive) Qi; they may have urinary incontinence, indicating the collapse of Mingmen (Gate of Life) Qi; their mouths may remain open, indicating the collapse of Qi in the Yangming Meridian; they may drool from the corners of the mouth, indicating the collapse of Qi in the Taiyin Zang; their limbs may be flaccid, indicating the failure of Liver and Spleen Qi; they may be comatose, lethargic, ignorant, and unable to speak, indicating the failure of Heart Shen and Kidney Essence. All these result from the collapse of Chong and Ren vessels, with both form and spirit failing. Therefore, this syndrome often occurs after middle age. If treating this condition, mistaking it for phlegm-Qi obstruction requires large doses of Shenfu Tang (Ginseng and Aconite Decoction) to vigorously tonify Yuan Qi (Original Qi) to address the emergency; subsequently, use herbs like Dihuang (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), and Gouqi (Lycii Fructus) to fill True Yin and cultivate the root. As Essence is the root of Qi, as stated in the Classics: "Essence transforms into Qi." If mistakenly treated as Wind-Phlegm and managed with dispersing methods, salvation will be impossible.
The Fengjue (Wind Jue) syndrome focuses heavily on Liver Pathogen. The Liver contains the "thief" of Stomach Qi (Wood overacting on Earth); if a person lacks Stomach Qi, death ensues. Symptoms such as rigidity, tremors, and dizziness are transformations of Wind-Wood Qi. Symptoms such as limb paralysis and excessive phlegm-saliva are signs of Spleen deficiency. Although described as an excess of the East (Liver), it is actually due to the failure of the Five Yangs, causing the Liver to lose nourishment, with responsibility lying in Spleen and Kidney deficiency. If the Spleen and Stomach were not deficient, even if Liver Wood were strong, it would not attack the Spleen; if Kidney Water were not deficient, Liver Wood would be nourished, and there would be no fear of rigidity. What is called "Stomach Qi" refers to the Twenty-Five Yangs (systemic Yang Qi), not just the Yangming Meridian; what is called "Kidney Water" refers to the Essence of the Five Zang and Six Fu organs, not just the Shaoyin Kidney. Once Yin and Yang fail, the True Zang pulse appears. The True Zang pulse indicates Liver Pathogen, meaning the absence of Stomach Qi. This is the fundamental basis of Feifeng-like wind diseases.
Feifeng with much phlegm is entirely due to Middle Jiao deficiency. Phlegm is water; its root is in the Kidney, and its branch is in the Spleen. In the Kidney, water does not return to its source, flooding to become phlegm; in the Spleen, food is not transformed, and Earth fails to control Water. Thus, inability to eat leads to phlegm generation because Spleen deficiency fails to transform food, turning it into phlegm. In deficiency consumptive diseases, phlegm is abundant because the more deficient the Spleen, the more fluid transforms into phlegm. Therefore, in paralysis, convulsions, and hemiplegia, although phlegm is in the meridians, if Ying and Wei are harmonious, Jin-Ye (Body Fluids) and Blood will naturally充盈 (abound) and circulate, leaving no room for phlegm. Only when Yuan Yang is depleted does water lack Qi, causing fluids to coagulate and blood to deteriorate, transforming into phlegm. To claim that phlegm in meridians must be attacked is flawed; attacking only phlegm damages Jin-Ye and Blood, further exhausting Yuan Qi. One should warm the Spleen and strengthen the Kidney to treat the root of phlegm. As the root becomes sufficient, phlegm will resolve spontaneously without direct treatment.
Regarding phlegm treatment: In early stages with mild phlegm-Qi, do not suspect phlegm and blindly use phlegm-resolving drugs. If phlegm-saliva is excessively obstructing the chest and diaphragm, one must first open the phlegm to restore the pathway for medicine and food. The most effective method to open phlegm is emesis, using formulas like Dusheng San (Single Miracle Powder), Chadiao San (Tea Regulation Powder), or Xixian San (Thin Saliva Powder). Fearing that severe Qi deficiency cannot withstand such harsh agents, one might use Niuhuang Wan (Calculus Bovis Pill) or Baolong Wan (Embracing Dragon Pill), stopping once throat Qi flows and oral medication can be taken. Thus, phlegm treatment requires assessing whether attack is feasible before proceeding to avoid error. If eyes are fixed, teeth are clenched, limbs are spastic, and face is red and rigid, despite coma, it is treatable. If symptoms are stable and phlegm is not severe, do not treat phlegm; regulate Qi and Blood instead. If phlegm exists, differentiate deficiency and excess. For mild Qi deficiency with cold-damp phlegm, use Liu'an Jian (Six Comfort Decoction) or Erchen Tang (Two-Aged Decoction). For fire-induced phlegm, use Qingge Yin (Clear Diaphragm Infusion), Zhuli (Bamboo Juice), or Tongbian (Child's Urine). For severe fire, use Chouxin Yin (Draw Firewood Infusion). For Spleen deficiency with vomiting and much phlegm, use Liujunzi Tang (Six Gentlemen Decoction) or Wuwei Yigong San (Five-Gentleman Extraordinary Power Powder). For Yin deficiency with dryness and cough, use Jinshui Liujun Jian (Metal-Water Six Gentlemen Decoction). For Yin deficiency with water flooding becoming phlegm, use Liuwei Wan (Six-Ingredient Pill) or Bawei Wan (Eight-Ingredient Pill). For Spleen-Stomach deficiency-cold failing to transform, warm and tonify the root. For Middle Qi deficiency, use Lizhong Tang (Regulate the Middle Decoction) or Wenyin Yin (Warm Stomach Infusion). For Yin insufficiency, use Liyin Jian (Nourish Yin Decoction). If death signs are present, emesis is useless. If phlegm is too extreme to vomit, it is incurable. Due to severe form and Qi deficiency, emesis is contraindicated; these are untreatable by attack.
For Feifeng with facial deviation, hemiplegia, limb weakness, tremors, and spasms, these are bone-tendon diseases. Liver-Kidney Essence and Blood deficiency fails to nourish the hundred bones, leading to tendon laxity/tightness and bone weakness. Like trees lacking sap, branches wither. Hemiplegia is similar. The Classics state: "The foot walks when nourished by blood; the palm grasps when nourished by blood." Such paralysis is due to degeneration. Chen Jichuan said: "To treat wind, first treat blood; when blood moves, wind extinguishes." Liver pathogen arises from Liver Blood deficiency, allowing Dryness to invade. Wood transforms under Metal, bringing Wind. Tonifying Blood removes Dryness, restoring True Yin so false Wind dissipates. Using Wind-draining herbs dries Blood further, which is inadvisable. Within Yin, there is Blood and Qi. Lack of Qi in Blood causes flaccidity; lack of Blood in Qi causes spasms. Qi moves; without it, movement is impossible. Blood stills; without it, relaxation is impossible. Tendon laxity blames Qi deficiency; tendon tightness blames Blood deficiency. Qi deficiency suits Wufu Yin, Sijunzi Tang, or Shiquan Dabu Tang. Blood deficiency suits Xiaoying Jian or Daying Jian. This differs slightly from Wei Syndrome (immobility) and Tongfeng (painful obstruction). Feifeng often stems from exterior-interior deficiency; treatment prioritizes tonifying Yuan Qi. Without concurrent symptoms, combining attack and tonification is inappropriate. Form destruction and mental confusion are root failures, not external pathogens. Restoring Yuan Qi offers hope for recovery.
1. Feifeng with excessive Fire is a Yang syndrome. Severe fire treats the fire directly, e.g., Chouxin Yin or Baihu Tang (White Tiger Decoction); mild fire tonifies Yin concurrently, e.g., Jiayi Yiyin Jian. Once fire reduces by 60-70%, treat the root. Yang excess injures Yin; thus, heat treatment targets Blood level. Severe heat uses Bitter-Cold; mild heat uses Sweet-Cool.
Severe cold is a Yin syndrome, requiring Fire tonification. Mild cold suits Wenyin Yin or Bawei Wan; severe cold suits Huiyang Yin, Lizhong Tang, or Sini Tang (Reverse the Yin Decoction). Cold excess injures Yang; thus, cold treatment targets Qi level. For Yang collapse with severe cold, moxa Guanyuan, Qihai, and Shenque acupoints to restore Yang Qi.
2. Feifeng with tremors, dizziness, and confusion stems from Upper Jiao Qi deficiency. The Classics say: "Insufficiency of Upper Qi leaves the brain empty, causing head tilting and eye dizziness." Also: "Upper deficiency causes dizziness." This is clear teaching. Mild symptoms suit Wufu Yin to tonify Middle Qi; severe deficiency suits Dabu Yuan Jian. Otherwise, sudden collapse follows.
3. Feifeng numbness and insensitivity occur because Qi and Blood do not reach the area. Qi deficiency causes numbness; Blood deficiency causes woodiness. Persistent numbness leads to hemiplegia and atrophy, indicating Po (Corporeal Soul) deficiency. The Classics say: "Fei disease involves no body pain, limb incoordination, mild mental confusion, and faint speech; treatable. Severe inability to speak is untreatable." Also: "Ying deficiency causes insensitivity; Wei deficiency causes immobility; Ying-Wei dual deficiency causes both, with flesh unchanged. Separation of body and Zhi (Will) is death." Treat by cultivating Qi and Blood; do not mistake for phlegm.
4. Feifeng with irritability, heat, spontaneous sweating, and dysuria should not be treated with diuretics. External loss of Jin-Ye reduces urine; using diuretics depletes Yin Water further, failing to control Fire, worsening irritability. Once heat subsides and sweating stops, urination resolves naturally. Spontaneous sweating often relates to Yangming; diuretics are contraindicated. Use Shengmai San (Generate Pulse Powder) or Yiyin Jian.
5. Feifeng with urinary incontinence results from Kidney Qi collapse, a critical sign. Use Renshen, [missing character], Danggui, and Baizhu to tonify. It implies Mingmen Fire decline failing to secure retention. Severe cases add Rougui and Fuzi.
On Adjuvant and Guide Herbs:
For Feifeng with concurrent symptoms, meridian-unblocking adjuvants are essential. Meridian blockage stems from Qi-Blood issues. Causes vary: Wind causes closure, requiring dispersion/unblocking with Mahuang, Guizhi, Chaihu, Qianghuo, Xinyi, Baizhi; Cold causes stagnation, requiring warmth/unblocking with Congbai, Huajiao, Guizhi, Fuzi, Gancao, Shengjiang; Heat causes drying, requiring cooling/unblocking with Huangqin, Huanglian, Zhizi, Huangbai, Shigao, Zhimu; Dampness causes obstruction, requiring smooth flow with Cangzhu, Yinchén, Bixie, Wuling San; Blood stasis requires activation with Chuanxiong, Danggui, Niuxi, Honghua, Taoren, Xiaoshi, Dahuang; Qi stagnation requires movement with Muxiang, Xiangfu, Wuyao, Chenxiang, Zhike; Phlegm stasis requires opening with Tian Nanxing, Banxia, Niuhuang, Tianzhuhuang, Zhusha, Haishi, Yuanmingfen; Qi-Blood deficiency requires warming/tonifying with Renshen, [missing character], Danggui, Baizhu, Shudihuang, Gouqi, Niuxi. Differentiate deficiency/excess carefully. Unblocking excess follows its nature; unblocking excess without excess damages Yuan Qi. Unblocking deficiency requires knowing essentials: Renshen tonifies Qi, but severe Qi deficiency needs Jiang/Fuzi to recover scattered Yuan Yang; Dangdi/Dihuang tonifies Essence/Blood, but extreme Yin deficiency needs Gui/Fuzi to guide rootless Sheng Qi. Cold pathogen in meridians with weak host needs Gui/Fuzi to move blood; Phlegm-Damp in Middle with cold Earth/flooding Water needs Jiang/Fuzi to strengthen Spleen/Kidney. Unblocking methods: Excess allows Cold-Cool; Deficiency requires Warm-Hot. Fuzi is hot and aggressive, unsuitable for Yin deficiency with water depletion and dry heat. But for Yang deficiency, nothing else suffices.
1. Mild Meridian Diseases: Dry skin/sweating/dizziness/nasal congestion indicate Lung Meridian disease. Poor vessel nourishment/pale complexion indicate Heart Meridian disease. Muscle wasting/edema/numbness/muscle twitching/limb paralysis indicate Spleen Meridian disease. Tendon fatigue/spasms/costal pain indicate Liver Meridian disease. Facial deviation indicates Foot Yangming/Liver/Gallbladder disease. Weak bones/inability to sit/stand indicate Kidney Meridian disease.
2. Critical Meridian Diseases: Cold skin/oily sweat/severe chills indicate Lung Meridian crisis. Blurred vision/extreme tendon pain indicate Liver-Kidney Meridian crisis. Deafness/extreme bone pain indicate Kidney Meridian crisis. Opisthotonos/upward-gazing eyes/broken-back sensation indicate Bladder Meridian crisis. Stiff tongue/inability to speak indicate Heart-Kidney Meridian crisis. Flaccid lips/open mouth/hand letting go indicate Spleen Meridian crisis.
3. Mild Zang Organ Diseases: Cough/wheeze/shortness of breath/sorrow indicate Lung Zang disease. Disordered speech/coma/laughter/insomnia indicate Heart Zang disease. Abdominal fullness/poor appetite/vomit/phlegm/acid regurgitation/belching/delirium indicate Spleen Zang disease. Chest/hypochondriac Qi reversal/startle/anger indicate Liver Zang disease. Lower abdominal pain/urinary-fecal irregularity/Rising Qi/groaning/fear indicate Kidney Zang disease.
4. Critical Zang Organ Diseases: Rapid breathing/deep panting/Qi collapse/voice loss/gray-white or purple-red complexion indicate Lung-Kidney Qi exhaustion. Spirit loss/coma/red-black complexion indicate Heart Qi exhaustion. Extreme phlegm obstruction/inability to swallow/regurgitation/incessant hiccups/extreme abdominal distension/red-black complexion indicate Spleen-Stomach Qi exhaustion. Closed eyes/restlessness/confusion/genital retraction/blue-gray-white complexion indicate Liver Qi exhaustion. Hoarse voice/cold extremities/constipation or incontinence indicate Kidney Qi exhaustion.