按中风之证，先哲皆尚论邪之所凑，其气必虚，而未尝言虚之所自。乃后世辄指之曰∶
某中
风因少年曾多斫丧也，某中风因高年尚有侍姬也。以余视之，房劳致虚者固众，而沉湎致虚
者尤多。盖尝历治中风之人，强半系善饮者，亦大明验也。按《内经》云∶饮酒中风，亦名
酒风。《医垒元戌》云∶酒湿之为病，亦能作痹证，口眼斜歪，半身不遂云云。丹溪亦曰；
头风之病，多见于嗜酒之人，头风眩晕，即中之渐也。是知酒人多中，洵不诬也。盖酒性温
散，善解腠理，卫虚则外邪易入，酒气湿热，能酿痰涎，痰多则内风易动。当少壮时，血强
气雄，不能为害。中年以后，经脉骨肉，皆糟粕之味，所积谷食渐减，蒸胃腐肠，虽或色泽
荣华，而中实败坏。譬之本根朽蠹，未遇狂风耳。丹溪论中风主湿与痰，虽未尝专指曲，然
致痰湿者，莫盛于酒。岂徒以衽席议虚哉？若酒色并嗜之流，又为双斧伐木，其仆可立而待
，不得独冤狂乐矣。
痹者，闭也，皮肉筋骨，为风寒湿气杂感，血脉闭塞而不流通也。三气之中，一气独盛
，即
能为痹也。《内经》痹名甚多，不能细数。如云风痹寒痹湿痹者，指病之因；行痹痛痹着痹
者，言病之状；脾肝心肺肾痹者，言病之所属；筋脉皮肉骨痹者，言病之所在。故昔人云∶
风寒湿气所谓行痹痛痹着痹，又以所遇之时，所客之处，而命其名，非行痛着之外，别有何
脉之五痹也。今世有愦愦者，问及痹证，辄曰；此痛风之类耳，亦不谬哉？惟近代王损庵列
证最为有见，既以痹字提纲，复分条而直断之曰∶行痹者，行而不定，世称走注、疼痛之类
是也；
痛痹者，疼痛苦楚，世称痛风、白虎
历节之类是也；着痹者，着而不移，世称麻木不仁之类是也。又走注与历节不同，但支节疼
痛，未必流行也。至于治痹之要，治行痹者，散风为主，祛寒利湿，仍不可废。大抵参以治
血之药，盖治风先治血，血行风自灭也。治痛痹者，散寒为主，疏风燥湿，仍不可缺。大抵
参以补火之剂，非大辛大温，不能释其凝寒为害也。治着痹者，利湿为主，祛风解寒，仍不
可
少，大抵参以补脾补气之剂，盖土强可以制湿，而气自足，自无麻顽也。然痹而因三气者，
治之宜然。若邪郁病久，风变为火，寒变为热，湿变为痰，即当易辙寻之，以降火清热溪痰
为主，参以通经活血，流散邪滞之剂，安可全作三气治哉？此义惟丹溪得之。在《内经》原
自有热痹之证，非凿说也，故凡痹而知痛知痒易治，不红不痛而痹者难医。又宜图之于早，
迟则必至烦闷喘呕，肺伤；上气嗌干腹满，心伤；多饮数溲，夜卧则惊，肝伤；尻以代肿，
脊以代头，肾伤。四肢懈惰。发咳呕沫，脾伤五脏，证险而难愈矣。外有胞痹、肠痹、周痹
、血痹、支饮作痹等证。仍当博考群书，以求全旨。
按：中风这一病证，先贤们大多论述邪气聚集之处，正气必然虚弱，却未曾说明虚损是从何而来的。然而后世医者往往将其归因于：某人患中风是因为年轻时过度纵欲耗损，某人患中风是因为年老仍拥有侍妾纵情声色。依我看来，因房劳导致虚损的人固然众多，但因酗酒沉溺酒色导致虚损的人尤其多。我曾诊治过许多中风患者，其中大半是善于饮酒之人，这也是非常明显的验证。据《内经》记载：饮酒后引发的中风，也称为“酒风”。《医垒元戌》说：酒湿引起的疾病，也能导致痹证，出现口眼歪斜、半身不遂等症状。朱丹溪也说：头风之病，多见于嗜酒之人，头风眩晕，即是中风的先兆。由此可知，饮酒之人容易患中风，确实不是虚假的说法。因为酒性温热发散，善于开泄腠理（皮肤毛孔），卫气虚弱则外邪容易侵入；酒气湿热，能酿生痰涎，痰多则内风容易扰动。在年少强壮时，气血强盛，酒害尚不能为祸。中年以后，经脉骨肉都被酒的糟粕气味所侵蚀，体内积聚的谷食精气逐渐减少，蒸胃腐肠，虽然外表可能色泽荣华，但内部实际上已经败坏。这就好比树根腐朽蛀空，只是尚未遇到狂风罢了。朱丹溪论中风主张以湿和痰为主因，虽然未专门指向曲蘖（酿酒原料），但导致痰湿最盛的莫过于酒。这岂止是用床笫之事来议论虚损呢？如果是既好酒又好色的人，就像是双斧砍伐树木，其倒下是立刻可以等待的结果，不能只怪罪于狂乐了。
痹证，就是闭塞的意思，皮肉筋骨被风寒湿气混杂侵袭，导致血脉闭塞而不流通。在这三种邪气中，只要有一种邪气特别强盛，就能形成痹证。《内经》中关于痹的名称很多，无法一一细数。比如所说的风痹、寒痹、湿痹，是指致病的原因；行痹、痛痹、着痹，是指疾病的症状；脾痹、肝痹、心痹、肺痹、肾痹，是指疾病所属的脏腑；筋痹、脉痹、皮痹、肉痹、骨痹，是指疾病所在的部位。所以古人说：所谓的风寒湿气导致的行痹、痛痹、着痹，又是根据遭遇的气候时节、邪气停留的部位来命名它们的，并不是在行、痛、着之外，另有五种由脉决定的痹证。如今世上有些糊涂的人，一问到痹证，就说：这是痛风之类的病吧？这也算不上错误吗？只有近代的王损庵对辨证的见解最为深刻，他既以“痹”字作为提纲，又分条直接断言说：行痹，特点是游走不定，世人称为走注、疼痛之类的是；痛痹，特点是疼痛剧烈痛苦，世人称为痛风、白虎历节之类的是；着痹，特点是固定不移，世人称为麻木不仁之类的是。另外，走注与历节不同，只是肢体关节疼痛，未必会游走流行。至于治疗痹证的关键，治疗行痹，以祛散风邪为主，祛除寒邪、利除湿邪也不可废弃。大抵要参入调理血的药物，因为治风先治血，血行风自灭。治疗痛痹，以散寒为主，疏风燥湿也不可缺少。大抵要参入补火（温阳）的药剂，如果不是大辛大温的药物，就不能解除凝寒的危害。治疗着痹，以利湿为主，祛风解寒也不可少，大抵要参入补脾补气的药剂，因为土（脾）强可以制湿，而气自然充足，自然就没有麻木顽钝了。然而痹证如果是由这三种邪气引起的，治疗应当如此。如果邪气郁结日久，风变为火，寒变为热，湿变为痰，就应当改变治疗方法，以降火清热、化痰为主，参入通经活血、流散邪滞的药剂，怎么可以完全按照三种邪气来治疗呢？这个道理只有朱丹溪领悟到了。在《内经》中原就有热痹的病证，并非穿凿附会的说法，所以凡是痹证知道疼痛、知道瘙痒的容易治疗，不红不痛而表现为痹阻的难医。又宜尽早图谋治疗，拖延下去必定会导致烦闷喘呕，损伤肺脏；上气、咽喉干燥、腹部胀满，损伤心脏；多饮、小便频数、夜间睡眠惊悸，损伤肝脏；尾椎代替臀部坐卧、脊柱弯曲头部前倾，损伤肾脏；四肢懈怠无力、发作咳嗽呕吐泡沫，损伤脾脏。五脏受损，病情险恶且难以痊愈。此外还有胞痹、肠痹、周痹、血痹、支饮作痹等证候。仍然应当广泛考证各类书籍，以求得完整的宗旨。
According to the syndrome of Zhongfeng (Wind Stroke, 中风), ancient sages mostly discussed that where pathogenic factors gather, Qi must be deficient, yet they did not explain the origin of this deficiency. Later generations, however, often attribute it thus: "This case of Zhongfeng is due to excessive dissipation in youth," or "That case is due to maintaining concubines in old age." In my view, while those whose deficiency stems from sexual excess are indeed numerous, those whose deficiency results from indulgence in alcohol are even more so. I have treated many patients with Zhongfeng, and nearly half were heavy drinkers; this is a clear verification. According to the *Neijing* (Inner Canon): Zhongfeng induced by drinking is also called "Jiufeng" (Alcohol Wind, 酒风). *Yilei Yuanxu* states: Diseases caused by alcohol-dampness can also manifest as Bi Syndrome (Obstruction Syndrome, 痹证), presenting with deviation of the mouth and eye, hemiplegia, etc. Zhu Danxi also said: Head wind diseases are common among those who love alcohol; dizziness from head wind is the precursor to Zhongfeng. Thus, it is true that drinkers are prone to Zhongfeng. Alcohol has a warm and dispersing nature, capable of opening the Couli (interstitial spaces/pores, 腠理); when Wei Qi (Defensive Qi, 卫气) is deficient, external pathogens easily enter. The damp-heat of alcohol can brew phlegm-saliva; when phlegm is abundant, internal wind easily stirs. In youth and strength, when blood and Qi are robust, alcohol cannot cause harm. After middle age, meridians, bones, and muscles are eroded by the dregs of alcohol; the accumulated essence from grains and food gradually diminishes, steaming the stomach and rotting the intestines. Although one may appear radiant externally, the interior is actually ruined. It is like a tree root that has rotted and been eaten by insects, merely awaiting a fierce gale. Zhu Danxi argued that Zhongfeng is primarily caused by dampness and phlegm; although he did not specifically point to Qu (fermented starter, 曲), nothing causes phlegm and dampness more than alcohol. Is this merely discussing deficiency through bedchamber affairs? For those who indulge in both alcohol and lust, it is like double axes felling a tree; their collapse is imminent, and they cannot solely blame reckless pleasure.
Bi (Obstruction, 痹) means closure. Skin, flesh, sinews, and bones are mixedly affected by wind, cold, and dampness, causing blood vessels to close and circulation to stagnate. Among these three pathogens, if any one becomes predominant, it can form a Bi syndrome. The *Neijing* lists many names for Bi, which cannot be enumerated in detail. For instance, Fengbi (Wind Bi, 风痹), Hanbi (Cold Bi, 寒痹), and Shibi (Damp Bi, 湿痹) refer to the etiology; Xingbi (Wandering Bi, 行痹), Tongbi (Painful Bi, 痛痹), and Zhuobi (Fixed Bi, 着痹) describe the symptoms; Pibei (Spleen Bi, 脾痹), Ganbi (Liver Bi, 肝痹), Xinbi (Heart Bi, 心痹), Feibi (Lung Bi, 肺痹), and Shenbi (Kidney Bi, 肾痹) indicate the associated organs; Jinbi (Sinew Bi, 筋痹), Maibi (Vessel Bi, 脉痹), Pibei (Skin Bi, 皮痹), Roubei (Flesh Bi, 肉痹), and Gubi (Bone Bi, 骨痹) denote the location of the disease. Therefore, ancients stated: The so-called Xingbi, Tongbi, and Zhuobi caused by wind, cold, and dampness are named according to the climatic conditions encountered and the site of pathogen lodging; there are no other five types of Bi determined by meridians besides wandering, painful, and fixed types. Today, some confused individuals, when asked about Bi syndrome, say: "Is this similar to Tongfeng (Gout, 痛风)?" This is not entirely wrong. However, Wang Sun'an of recent times had the most insightful classification. He used "Bi" as the outline and directly categorized them: Xingbi, characterized by wandering instability, is what the world calls Zouzhú (Running Injection, 走注) and pain syndromes; Tongbi, characterized by severe pain and suffering, is what the world calls Tongfeng (Gout, 痛风) and Baihuli Jie (White Tiger Joint, 白虎历节); Zhuobi, characterized by fixation without movement, is what the world calls numbness and insensitivity (Mamu Buren, 麻木不仁). Furthermore, Zouzhú differs from Li Jie; it involves joint pain but does not necessarily wander. Regarding the key to treating Bi: Treating Xingbi focuses on dispersing wind, while dispelling cold and draining dampness should not be abandoned. Generally, herbs that regulate blood should be added, because treating wind requires treating blood first; when blood flows, wind extinguishes itself. Treating Tongbi focuses on dispelling cold, while venting wind and drying dampness are indispensable. Generally, fire-tonifying (Warming Yang, 补火) formulas should be added; only potent acrid-warm herbs can resolve the harm of congealed cold. Treating Zhuobi focuses on draining dampness, while dispelling wind and resolving cold are still necessary. Generally, spleen-qi tonifying herbs should be added, because strengthening Earth (Spleen, 脾) controls dampness, and sufficient Qi eliminates numbness and stiffness. However, if Bi is caused by the three pathogens, treatment should follow this logic. If pathogens remain stagnant for a long time, wind transforms into fire, cold into heat, and dampness into phlegm; then the treatment strategy must change, focusing on purging fire, clearing heat, and resolving phlegm, supplemented by herbs that unblock meridians, invigorate blood, and dissipate pathogenic stagnation. How can one treat it solely based on the three pathogens? Only Zhu Danxi grasped this principle. The *Neijing* originally included Rebi (Heat Bi, 热痹); this is not a forced interpretation. Therefore, Bi syndromes where pain and itching are known are easier to treat, whereas those without redness or pain but with obstruction are difficult to cure. Early intervention is crucial; delay will inevitably lead to irritability, panting, and vomiting, injuring the Lung; upper Qi rising, dry throat, and abdominal fullness, injuring the Heart; excessive drinking, frequent urination, and night terrors, injuring the Liver; sitting on the coccyx instead of buttocks, spine curved replacing the head, injuring the Kidney; limb flaccidity, coughing, and foamy vomiting, injuring the Spleen. When the five Zang organs are damaged, the condition is perilous and hard to heal. Additionally, there are cases such as Baobi (Bladder Bi, 胞痹), Changbi (Intestinal Bi, 肠痹), Zhoubi (General Bi, 周痹), Xuebi (Blood Bi, 血痹), and Zhiyin acting as Bi (Fluid Retention mimicking Bi, 支饮作痹). One must extensively consult various texts to seek the complete understanding.