〔大〕妇人恶寒者，亦有阴阳二证。发热而恶寒者，发于阳也。无热而恶寒者，发
于阴也。发于阳者宜解表，脉必浮数。发于阴者宜温里，脉必沉细。又有汗后、利后恶
寒，及背恶寒。以上疾证方治并载《百问》，不复繁引。仆尝治一妇人，但恶寒，别无他
证，六脉平静，遂用败毒散而安。此药能去表中风邪故也。经云∶恶寒家慎不可过当覆
衣被及近火气，寒热相搏，脉道沉伏，愈令病患寒不可遏，但去被撤火，兼以和表之药，
自然不恶寒矣。妇人恶寒，尤不可近火，寒气入腹，血室结聚，针药所不能治矣。
〔薛〕前证若怠惰嗜卧，洒淅恶寒，乃阳不能伸发，用升阳益胃汤。若劳伤形气而
恶寒，乃无阳以护卫，用补中益气汤。若饮食伤脾胃而恶寒，乃元气虚损，用六君子汤。
若加烦躁、妄言，或欲饮水，仍进前剂，但加姜、桂。若体倦烦渴，头痛自汗，用补中
益气汤加五味、麦门。东垣云∶昼则发热恶寒，是阴气上溢于阳分也，夜则恶寒，是阴
血自旺于阴分也。海藏云∶六月大热之气，反得大寒之证，当舍时从证，治以姜、桂之类。
丹溪云∶久病恶寒，乃痰郁于脾，抑遏阳气，不得外泄，治当解郁。
药隐云∶妇人中风，角弓反张，风痹，手足不随，偏枯口噤，口眼 斜，风眩头
痛，血风，心神惊悸癫狂，骨节风，血风走注，瘙痒瘾疹，风痰诸证，虽各有方论，亦要先明
其大体，察脉之虚实，辨证之冷热，相人强弱，入脏入腑，在络在经，首以方调治，未
要猛速用药。今之治法，先宜顺气，然后治风，万不失一。盖有中风、中寒、中 、中
痰、中气，皆能令人涎潮昏塞，所谓朱紫相凌，玉石不分，医者不可不详而究之。如中
风，若作中气治之，十愈八九。中气若作中风治之，十无一生，所以疑惑之间，不问中
风、中气，首以苏合香丸、五积散加麝煎。如中痰，则有参苏饮。如中寒，则有理中汤。如
中，则有白虎汤。如的然是中风，有三生饮、木香煮散、排风、续命、风引、大小竹
沥、大八风汤。辨其冷热虚实而投之，未有不安者也。然此疾积袭之久，非一日所能致，
今人服药三五服，便责无效，其责医者亦速矣，正宜大剂久服，方有其效。孟子曰∶七
年之病，求三年之艾也。
〔大〕夫中风者，虚风中于人也。风是四时八方之气，常以冬至之日，自坎而起。候
其八方之风，从其乡来者，主长养万物。若不从其乡来者，名为虚风，贼害万物。人体
虚者则中之，当时虽不即发，停在肌肤，后或重伤于风，前后重沓，因体虚则发。入脏
腑俞，俞皆在背，中风多从俞入，随所中之俞而乃发病。妇人血气虚损，故令中风也。当
察口眼开阖，以别重轻。涎沫有无，以明证治。如眼开口闭，手足不开，涎不作声者可
治。如眼闭口开，声如鼾睡，遗尿不觉者死。按∶卒仆暴厥之证，不论男子妇人，是风
是寒，是气是食，是痰是湿，但要分得闭与脱二证明白，如牙关紧闭，两手握固，即是
闭证，宜苏合香丸、三生饮之类开之。若口开手撒，即是脱证，宜用大剂黄 、人参煎
浓汤灌之。虽曰在法不治，亦十救五六。若误服苏合香丸之类，即不可救矣。盖斩关夺
门之药，原为闭证设。若施之脱证，是人既入井，而又下之石也。
〔薛〕中风者，即《内经》所谓偏枯、风痱、风懿、风痹是也，而有中腑、
中脏、中血脉之分焉。夫中腑者为在表，中脏者为在里，中血脉者为在中。在表者宜微
汗，在里者宜微下，在中者宜调荣。中腑者多着四肢，如手足拘急不仁，恶风寒，此数
者病浅皆易治，用加减续命汤之类。中脏者多滞九窍，如眼瞀者中于肝，舌不能言者中
于心，唇缓便
秘者中于脾，鼻塞者中于肺，耳聋者中于肾，此数者病深多难治。中血脉者，外无六经之
证，内无便溺之阻，肢不能举，口不能言，用大秦艽汤主之，中腑者多兼中脏，如左关脉
浮弦，面目青，左胁偏痛，筋脉拘急，目 ，头目眩，手足不收，坐踞不得，此中胆兼中
肝也，用犀角散之类。如左寸脉浮洪，面舌赤，汗多恶风，心神颠倒，言语謇涩，舌强
口干，忪悸恍惚，此中小肠兼中心也，用麻黄散之类。如右关脉浮缓或浮大，面唇黄，汗
多恶风，口 语涩，身重怠惰嗜卧，肌肤不仁，皮肉 动，腹膨不食，此中胃兼中脾也，
用防风散之类。如右寸脉浮涩而短，面色白，鼻流清涕，多喘，胸中冒闷短气，自汗声嘶，
四肢痿弱，此中大肠兼中肺也，用五味子汤之类。如左尺脉浮滑，面目黧黑，腰脊痛引
小腹，不能俯仰，两耳虚鸣，骨节疼痛，足痿善恐，此中膀胱兼中肾也，用独活散之类。
此皆言真中风也，而有气血之分焉。盖气虚而中者，由元气虚而贼风袭之，则右手足不
仁，用六君子汤加钓藤、姜汁、竹沥。血虚而中者，由阴血虚而贼风袭之，则左手足不
仁，用四物汤加钓藤、竹沥。姜汁。气血俱虚而中者，则左右手足皆不仁也，用八珍汤
加钓藤、姜汁、竹沥。其与中风相类者，则有中寒、中湿、中火、中气、食厥、劳伤、房
劳等证。如中于寒者，谓冬月卒中寒气，昏冒口噤，肢挛恶寒，脉浮紧，用麻黄、桂枝、
理中汤之类。中于暑者，谓夏月卒冒炎暑，昏冒痿厥，吐泻喘满，用十味香薷饮之类。中
于湿者，丹溪所谓东南之人，多因湿土生痰，痰生热，热生风也，用清燥汤之类加竹沥、姜
汁。中于火者，河间所谓非肝木之风内中，六淫之邪外侵，良由五志过极，火盛水衰，热
气拂郁，昏冒而卒仆也，用六味丸、四君子、独参汤之类。内有恚怒伤肝，火动上炎者，用
柴胡汤之类。中于气者，由七情过极，气厥昏冒，或牙关紧急，用苏合香丸之类，误作
风治者死。食厥者，过于饮食，胃气自伤，不能运化，故昏冒也，用六君子加木香。劳伤
者，过于劳役，耗损元气，脾胃虚衰，不任风寒，故昏冒也，用补中益气汤。房劳者，因
肾虚精耗，气不归源，故昏冒也，用六味丸。此皆类中风者也。夫《内经》主于风，河间
主于火，东垣主于气，丹溪主于湿，愚之斯论，僭补前人之阙也。若夫地之南北，人之
虚实，固有不同，其男子女人大略相似，当与后论参看通变治之。（内方并见杂病中风。）靳
阁老夫人先胸胁胀痛，后四肢不收，自汗如水，小便自遗，大便不实，口紧目 ，饮食
颇进，十余日矣，或以为中脏，公甚忧。余曰∶非也。若风既中脏，真气既脱，恶证既
见，祸在反掌，焉能延之。乃候其色，面目俱赤，面时或青，诊其脉，左三部洪数，惟
肝尤甚。余曰∶胸乳胀痛，肝经血虚，肝气痞塞也。四肢不收，肝经血虚，不能养筋也。
自汗不止，肝经风热，津液妄泄也。小便自遗，肝经热甚，阴挺失职也。大便不实，肝
木炽盛克脾土也。遂用犀角散四剂，诸证顿愈。又用加味逍遥散调理而安。后因郁怒，前
证复作，兼发热呕吐，饮食少思，月经不止，此木盛克土，而脾不能摄血也，用加味归脾
汤为主，佐以加味逍遥散调补肝脾之气，清和肝脾之血而愈。后每遇怒，或睡中手足抽
搐，复用前药即愈。大参朱云溪母，于九月内，忽仆地痰昧不省人事，唇口 斜，左
目紧小，或用痰血之剂，其热稍缓。至次年四月初，其病复作，仍进前药，势亦渐缓。至
六月终，病乃大作，小便自遗，或谓风中于脏，以为不治。余诊之，左关弦洪而数，此
属肝火血燥也，遂用六味丸加五味子、麦门、芎、归，一剂而饮食顿进，小便顿调，随用
补中益气加茯苓、山栀、钓藤、丹皮而安。至十月，复以伤食腹痛作泻，左目仍小，两关
尺脉弦洪鼓指，余以六君加木香、吴茱、升麻、柴胡，一剂而痛泻俱缓，复以六君加肉
果、故纸，一剂诸脉顿平，痛泻俱止。余谓左关弦洪，由肝火血燥，故左目紧小。右关
弦洪，由肝邪乘脾，故唇口 邪，腹痛作泻。二尺鼓指，由元气下陷。设以目紧口 ，误
作风中，投以风药，以腹痛泄泻，误作积滞，投以峻剂，复耗元气，为害甚矣。后以阳虚
恶寒，围火过热，致痰喘，误服寒剂而卒。一妇人因怒仆地，语言謇涩，口眼 斜，四
肢拘急，汗出遗尿，六脉洪大，肝脉尤甚，皆由肝火炽盛。盖肝主小便，因热甚而自遗也。
用加味逍遥散加钓藤及六味丸，寻愈。 一老妇两臂不遂，语言謇涩，服祛风之药，反
致筋挛骨痛。余谓此肝火血虚所致，用八珍汤补气血，用地黄丸补肾水，佐以排风汤，年
余而愈。一妇人经行口眼歪斜，痰涎壅盛，此血虚而肝火动，用加味逍遥散加丹皮治之，
寻愈。后因饮食停滞，日吐痰涎，此脾气虚不能摄涎归经也，用六君子二十余剂而安。
一妇人因怒，口眼 斜，痰涎上涌，口噤发搐，此脾肺气虚而肝木旺，用六君子加木香、
钓藤、柴胡治之，渐愈。又用加味归脾汤调理而安。 一产妇勤于女工，忽仆地牙关紧
急，痰喘气粗，四肢不遂，此气血虚而发痉，朝用补中益气加茯苓、半夏，夕用八珍加半
夏，各三十余剂，不应。此气血之未复，药之未及也。仍用前二汤，又五十余剂，寻愈。
一妇人素性急，患肝风之证，常服搜风顺气丸、秦艽汤之类。后因大怒吐血，唇口牵
紧，小便频数，或时自遗。余以为肝火旺而血妄行，遂用小柴胡汤加山栀、牡丹皮，渐
愈。五年之后，又大怒吐血，误服降火祛风化痰之剂，大便频数，胸满少食。用清气化
痰之剂，呕而不食，头晕口干，不时吐痰。用导痰降火之类，痰出如涌，四肢常冷。余曰∶
呕而不食，胃气虚弱也。头晕口干，中气不能上升也。痰出如涌，脾气不能摄涎也。四
肢逆冷，脾气不能营运也。用补中益气加茯苓、半夏治之，诸证渐愈。又用加味归脾汤，
兼服而安。
〔陈〕癸丑春，有一妇人年四十二三，其证语言气短，足弱，行得数步，则口若含
霜，七十日内三次经行，则口冷、头目眩晕，足冷则透心冷痛，每行则口中冷气不相续，有
时鼻中热，面赤翕然而热，身体不仁，不能行步，手足不随，不能俯仰，冷痹骨疼，有
时悲伤，梦与前夫相随，则上气奄然而极心惊，志意不定，恍惚多忘，却能食。如此仅
一年许，医者投热药则面翕然而热，气满胸中，咽中窒塞、闷绝，投冷药则泻。又一医
者以十全汤服之，则发烦躁，心惊而跳。一医以双和汤服之，觉面上与腹中如火 ，心
愈惊，欲吐不吐，大便秘，里急后重。求仆诊之，六脉弦缓，喜见于春，此是可治之疾。
未供药间，忽然吐泻，泻后觉肛门如火，虽泻却不多。仆且与俞山人降气汤八服。次日
诊之，脉差有力。云∶服药后觉鼻热，心烦闷，齿噤，与参苏饮八服，黄连丸一两。越
三日云∶服药后如故，与茯苓补心汤服皆无效。仆以脉证详之，只是排风汤甚对。或曰∶
何以知之？一、能饮食，此风饥也。二、七十日三次经行，此是荣经有风，血得风散也。
三、头目眩晕，此肝风也。四、面赤翕然而热，悲伤，此心风也。五、身体不仁，不能
行步，梦与前夫相随，此脾风也。六、手足不随，腰痛难俯仰，冷痹骨疼，此肾风也。因
令人心惊，恍忽多忘，真排风汤证也。或曰∶风脉当浮，今脉弦缓微弱，恐非风也。予曰∶
风无一定之脉，大抵此证肾虚生风，然排风汤药品有十全大补汤料，亦有平补之资，却
不僭燥，供十服，越三日，云服有效，脉亦差胜，只是腹中如烟生微热，大便秘，此真
是风证，再与排风汤服，加牛黄清心丸、皂角丸助之。越三日云∶服前药，大烦躁发热
诸证悉除，只是足弱不能支持。与秘传降气汤十服，诸证悉退。只是梦里虚惊，大便滑
泄频数，脉尚弱，与五积散加人参、盐煎，兼感应丸即愈。但头眩痛重，不能久立久坐，再
与排风汤，脱然而安矣。缪安人年六十，忽中风不省人事，无汗有痰，众医为不可治，召
仆诊之。脉浮缓，脾脉溢关，此真风脉。先
以参苏饮六服，宽气下痰，次以木香煮散而愈。马观文夫人，于七月间病气弱倦怠，四
肢厥逆，恶寒有汗，少饮食。一医谓伏暑，一医谓虚寒，治皆无效。召仆诊之，六脉虽弱，
而两关差甚焉。问是何证？仆曰∶六脉虽弱，而关独甚，此中焦寒也。中焦脾也，脾胃既
寒，不但有此证，必有腹痛、吐泻，今四肢厥冷，脾属四肢，是脾胃虚冷无疑焉。曰∶未
见腹痛吐泻之证，合用何治？仆曰∶宜附子理中汤。未服药间，旋即腹痛而泻，莫不神
之，即投此药而瘥。
防风散 治妇人中风，言语謇涩，四肢拘急，身体壮热，头疼目眩，心胸不利。
防风（去芦，一两） 石膏（二两半） 麻黄（去节） 汉防己（去皮，各七钱半）
细辛（去苗） 黄芩 川升麻 当归（去芦） 桂心 芎 赤茯苓（去皮） 甘草（炙）
羌活（去芦，各半两）
上为粗散，每服八钱，水一中盏半，煎至一大盏，去滓，入淡竹沥一合，更煎一两
沸，温服，不拘时。
【戴元礼】妇女出现恶寒症状，也有阴证和阳证两种情况。发热且恶寒的，属于发于阳经。不发热而仅恶寒的，属于发于阴经。发于阳经的适宜采用解表法治疗，脉象必然浮数。发于阴经的适宜采用温里法治疗，脉象必然沉细。又有出汗后、泻下后出现的恶寒，以及背部恶寒的情况。以上疾病的方剂治法都记载在《百问》中，不再繁琐引用。我曾经治疗一位妇人，只表现为恶寒，没有其他病症，六部脉象平静，于是使用败毒散（羌活胜湿汤类方）而痊愈。这是因为该药能祛除表中风邪的缘故。医经说：患有恶寒症的人，千万不可过度覆盖衣被或靠近火源取暖，否则寒热相互搏结，导致脉道沉伏，更加使病人寒冷难以遏制。只要去掉覆盖物、撤去火源，同时配合调和表里的药物，自然就不会恶寒了。妇女恶寒，尤其不可靠近火源，否则寒气进入腹部，会导致血室（子宫及冲任二脉）气血结聚，届时针灸和药物都难以治愈了。
【薛己】上述症状如果伴有倦怠嗜睡、洒淅恶寒（如冷水浇身般的怕冷），这是阳气不能伸展升发，应使用升阳益胃汤。如果是因劳累损伤形体和气机导致的恶寒，这是没有阳气来护卫体表，应使用补中益气汤。如果是饮食损伤脾胃导致的恶寒，这是元气虚损，应使用六君子汤。如果加上烦躁、胡言乱语，或者想喝水，仍服用前面的方剂，但加入生姜、肉桂。如果身体疲倦、烦渴、头痛、自汗，使用补中益气汤加五味子、麦门冬。李东垣说：白天发热恶寒，是阴气上溢于阳分；夜间恶寒，是阴血在阴分旺盛。张元素（海藏）说：六月大热之时，反而出现大寒之证，应当舍弃季节因素而从症状论治，用干姜、肉桂之类的药物治疗。朱丹溪说：久病恶寒，是痰浊郁结于脾，抑制遏阻阳气，使其不能向外宣泄，治疗应当解郁。
药隐说：妇女患中风，出现角弓反张、风痹、手足不能随意运动、偏枯口噤、口眼歪斜、风眩头痛、血风、心神惊悸癫狂、骨节风、血风走注（疼痛游走不定）、瘙痒瘾疹、风痰等各种证候，虽然各有方论，但也必须先明白其大体原则，观察脉象的虚实，辨别证候的冷热，考虑病人的强弱，判断病邪入脏还是入腑，在络还是在经，首先用方剂调理治疗，不要急于使用猛烈快速的药物。现在的治法，先宜顺气，然后治风，万无一失。因为中风、中寒、中暑、中痰、中气，都能令人涎沫上涌、昏塞不通，所谓朱紫相混，玉石不分，医生不可不详细探究。比如中风，如果当作中气来治，十个人能好八九个。中气如果当作中风来治，十个人没有一个能活，所以在疑惑之间，不论中风还是中气，首先使用苏合香丸、五积散加麝香煎服。如果是中痰，则有用参苏饮。如果是中寒，则有理中汤。如果是中暑，则有白虎汤。如果是确凿无疑的中风，有三生饮、木香煮散、排风汤、续命汤、风引汤、大小竹沥汤、大八风汤等。辨别其冷热虚实而投药，没有不安稳的。然而这种疾病积累侵袭已久，不是一天造成的，现在的人服药三五副，就责怪无效，这也太急切地责备医生了，正应该用大剂量长期服用，才能见效。孟子说：“七年的病，要寻求三年的艾草。”
【戴元礼】所谓中风，是虚邪贼风侵入人体。风是四季八方之气，通常在冬至之日，从坎方（北方）升起。观察八方之风，从其本乡方向吹来的，主生长养育万物。如果不从其本乡方向吹来的，称为虚风，会伤害万物。人体虚弱的人就会被虚风所中，当时虽然不一定立即发病，但邪气停留在肌肤，后来如果再重伤于风，前后邪气重叠，因为体质虚弱而发病。邪气进入脏腑俞穴，俞穴都在背部，中风多从俞穴侵入，随着所中的俞穴而发病。妇女血气虚损，所以容易中风。应当观察口眼的开合，以辨别病情轻重。有无涎沫，以明确证治。如果眼睛睁开嘴巴闭合，手足不能张开，流涎但不发声的，可以治疗。如果眼睛闭合嘴巴张开，声音像打鼾睡觉，遗尿不知晓的，预后不良（死）。按：猝然仆倒暴厥的证候，不论男女，无论是风、寒、气、食、痰、湿所致，只要分清闭证与脱证即可。如果牙关紧闭，两手握固，就是闭证，适宜用苏合香丸、三生饮之类开通窍闭。如果口开手撒，就是脱证，适宜用大剂量黄芪、人参煎浓汤灌服。虽然说在法度上难以治愈，也能救活五六成。如果误服苏合香丸之类，就不可救治了。因为斩关夺门（开窍通闭）的药物，原本是专为闭证设立的。如果施用于脱证，就像人已经掉进井里，又往下扔石头一样。
【薛己】中风，即《内经》所说的偏枯、风痱、风懿、风痹，而有中腑、中脏、中血脉的区别。中腑的在表，中脏的在里，中血脉的在半表半里。在表的适宜微汗，在里的适宜微下，在半表半里的适宜调和营卫。中腑的多侵犯四肢，如手足拘急麻木不仁、恶风寒，这几个病位较浅，都容易治疗，使用加减续命汤之类。中脏的多阻滞九窍，如视物模糊是中于肝，舌强不能言语是中于心，口唇松弛便秘是中于脾，鼻塞是中于肺，耳聋是中于肾，这几个病位较深，大多难治。中血脉的，外无六经证候，内无二便阻塞，肢体不能举起，口不能言语，使用大秦艽汤为主治。中腑的多兼有中脏，如左关脉浮弦，面目青，左胁偏痛，筋脉拘急，目睛上视，头目眩晕，手足不收，坐卧不安，这是中胆兼中肝，使用犀角散之类。如左寸脉浮洪，面舌赤红，汗多恶风，心神颠倒，言语謇涩，舌强口干，心悸恍惚，这是中小肠兼中心，使用麻黄散之类。如右关脉浮缓或浮大，面唇黄，汗多恶风，口歪言语涩，身重倦怠嗜卧，肌肤不仁，皮肉跳动，腹胀不食，这是中胃兼中脾，使用防风散之类。如右寸脉浮涩而短，面色白，鼻流清涕，多喘，胸中闷满短气，自汗声嘶，四肢痿弱，这是中大肠兼中肺，使用五味子汤之类。如左尺脉浮滑，面目黧黑，腰脊痛牵引小腹，不能俯仰，两耳虚鸣，骨节疼痛，足痿善恐，这是中膀胱兼中肾，使用独活散之类。这些都是说真中风，而有气血虚实的区别。气虚而中风的，由元气虚而贼风袭击，则右手足麻木不仁，使用六君子汤加钩藤、姜汁、竹沥。血虚而中风的，由阴血虚而贼风袭击，则左手足麻木不仁，使用四物汤加钩藤、竹沥、姜汁。气血俱虚而中风的，则左右手足皆麻木不仁，使用八珍汤加钩藤、姜汁、竹沥。与中风相似的，有中寒、中湿、中火、中气、食厥、劳伤、房劳等证候。如中寒，指冬季突然遭受寒气，昏冒口噤，肢体挛缩恶寒，脉浮紧，使用麻黄、桂枝、理中汤之类。中暑，指夏季突然冒犯暑热，昏冒痿厥，吐泻喘满，使用十味香薷饮之类。中湿，丹溪所说东南之人，多因湿土生痰，痰生热，热生风，使用清燥汤之类加竹沥、姜汁。中火，河间所说并非肝木之风内中，而是六淫之邪外侵，实由五志过极，火盛水衰，热气拂郁，昏冒而猝然仆倒，使用六味丸、四君子汤、独参汤之类。内有恚怒伤肝，火动上炎的，使用柴胡汤之类。中气，由七情过极，气厥昏冒，或牙关紧急，使用苏合香丸之类，误作风治者死。食厥，由于饮食过度，胃气自伤，不能运化，故昏冒，使用六君子汤加木香。劳伤者，由于过度劳累，耗损元气，脾胃虚衰，不耐风寒，故昏冒，使用补中益气汤。房劳者，因肾虚精耗，气不归源，故昏冒，使用六味丸。这些都是类中风。《内经》主于风，河间主于火，东垣主于气，丹溪主于湿，我的这些论述，是弥补前人的缺失。至于地域南北、人体虚实，固然不同，但男女大致相似，应与后面的论述参考通变治疗。（内部方剂并见杂病中风。）靳阁老夫人先前胸胁胀痛，后来四肢不能收持，自汗如水，小便自遗，大便不实，口紧目斜，饮食尚可，十余天了，有人认为是中脏，我很担忧。我说：不是。如果风已中脏，真气已脱，恶证已现，祸在旦夕，怎么能拖延这么久。于是观察她的神色，面目都赤红，有时发青，诊脉，左三部洪数，唯独肝脉尤为严重。我说：胸乳胀痛，是肝经血虚，肝气痞塞。四肢不能收持，是肝经血虚，不能养筋。自汗不止，是肝经风热，津液妄泄。小便自遗，是肝经热甚，阴挺失职。大便不实，是肝木炽盛克伐脾土。于是使用犀角散四剂，诸证顿愈。又用加味逍遥散调理而安。后来因郁怒，前证复发，兼发热呕吐，饮食少思，月经不止，这是木盛克土，而脾不能摄血，使用加味归脾汤为主，佐以加味逍遥散调补肝脾之气，清和肝脾之血而愈。后来每次发怒，或睡中手足抽搐，复用前药即愈。大参朱云溪的母亲，在九月内，忽然仆倒在地，痰迷不省人事，口眼歪斜，左目紧小，有人用化痰血的药剂，其热稍缓。到次年四月初，病复发，仍进前药，势头也渐缓。到六月终，病大作，小便自遗，有人说风中于脏，认为不可治。我诊脉，左关弦洪而数，这属于肝火血燥，于是使用六味丸加五味子、麦门冬、川芎、当归，一剂而饮食顿进，小便顿调，随后用补中益气汤加茯苓、山栀、钩藤、丹皮而安。到十月，又因伤食腹痛作泻，左目仍小，两关尺脉弦洪鼓指，我用六君子汤加木香、吴茱萸、升麻、柴胡，一剂而痛泻俱缓，再用六君子汤加肉果、故纸（补骨脂），一剂诸脉顿平，痛泻俱止。我认为左关弦洪，由肝火血燥，故左目紧小。右关弦洪，由肝邪乘脾，故口眼歪斜，腹痛作泻。二尺鼓指，由元气下陷。如果因目紧口歪，误作风中，投以风药，因腹痛泄泻，误作积滞，投以峻剂，再耗元气，危害很大。后来因阳虚恶寒，围火过热，致痰喘，误服寒剂而死。一个妇人因怒仆倒在地，语言謇涩，口眼歪斜，四肢拘急，汗出遗尿，六脉洪大，肝脉尤为严重，都是由肝火炽盛所致。肝主小便，因热甚而自遗。使用加味逍遥散加钩藤及六味丸，不久痊愈。一个老妇两臂不遂，语言謇涩，服祛风药，反而导致筋挛骨痛。我说这是肝火血虚所致，使用八珍汤补气血，用地黄丸补肾水，佐以排风汤，一年多而愈。一个妇人经期口眼歪斜，痰涎壅盛，这是血虚而肝火动，使用加味逍遥散加丹皮治之，不久痊愈。后来因饮食停滞，日吐痰涎，这是脾气虚不能摄涎归经，使用六君子汤二十余剂而安。一个妇人因怒，口眼歪斜，痰涎上涌，口噤发搐，这是脾肺气虚而肝木旺，使用六君子汤加木香、钩藤、柴胡治之，渐愈。又用加味归脾汤调理而安。一个产妇勤于女工，忽然仆倒在地，牙关紧急，痰喘气粗，四肢不遂，这是气血虚而发痉，早晨用补中益气汤加茯苓、半夏，晚上用八珍汤加半夏，各三十余剂，无效。这是气血未复，药力未及。仍用前二汤，又五十余剂，不久痊愈。一个妇人素性急躁，患肝风证，常服搜风顺气丸、秦艽汤之类。后来大怒吐血，唇口牵紧，小便频数，有时自遗。我认为肝火旺而血妄行，于是用小柴胡汤加山栀、牡丹皮，渐愈。五年之后，又大怒吐血，误服降火祛风化痰之剂，大便频数，胸满少食。用清气化痰之剂，呕而不食，头晕口干，不时吐痰。用导痰降火之类，痰出如涌，四肢常冷。我说：呕而不食，胃气虚弱。头晕口干，中气不能上升。痰出如涌，脾气不能摄涎。四肢逆冷，脾气不能营运。使用补中益气汤加茯苓、半夏治之，诸证渐愈。又用加味归脾汤，兼服而安。
【陈氏】癸丑年春天，有一个妇人四十二三岁，症状是语言气短，足弱，走几步路，则口中感觉像含着霜，七十天内三次行经，则口冷、头目眩晕，足冷则透心冷痛，每行走则口中冷气不相连续，有时鼻中热，面赤翕然而热，身体不仁，不能行步，手足不随，不能俯仰，冷痹骨疼，有时悲伤，梦与前夫相随，则上气奄然而极心惊，志意不定，恍惚多忘，却能进食。如此仅一年左右，医生投热药则面翕然而热，气满胸中，咽中窒塞、闷绝，投冷药则腹泻。又一医生用十全汤服之，则发烦躁，心惊而跳。一医生用双和汤服之，觉面上与腹中如火烧，心愈惊，欲吐不吐，大便秘，里急后重。求我诊治，六脉弦缓，喜见于春，这是可治的疾病。未供药期间，忽然吐泻，泻后觉肛门如火，虽泻却不多。我先给俞山人降气汤八服。次日诊脉，脉差有力。说：服药后觉鼻热，心烦闷，齿噤，给参苏饮八服，黄连丸一两。越三日说：服药后如故，给茯苓补心汤服皆无效。我以脉证详之，只是排风汤很对症。有人说：怎么知道？一、能饮食，这是风饥。二、七十日三次经行，这是荣经有风，血得风散。三、头目眩晕，这是肝风。四、面赤翕然而热，悲伤，这是心风。五、身体不仁，不能行步，梦与前夫相随，这是脾风。六、手足不随，腰痛难俯仰，冷痹骨疼，这是肾风。因令人心惊，恍忽多忘，真是排风汤证。有人说：风脉当浮，今脉弦缓微弱，恐怕不是风。我说：风无一定之脉，大抵此证肾虚生风，然而排风汤药品有十全大补汤料，亦有平补之资，却不僭燥，供十服，越三日，说服有效，脉亦差胜，只是腹中如烟生微热，大便秘，这真是风证，再给排风汤服，加牛黄清心丸、皂角丸助之。越三日说：服前药，大烦躁发热诸证悉除，只是足弱不能支持。给秘传降气汤十服，诸证悉退。只是梦里虚惊，大便滑泄频数，脉尚弱，给五积散加人参、盐煎，兼感应丸即愈。但头眩痛重，不能久立久坐，再给排风汤，脱然而安矣。缪安人年六十，忽然中风不省人事，无汗有痰，众医认为不可治，召我诊治。脉浮缓，脾脉溢关，这是真风脉。先用参苏饮六服，宽气下痰，次以木香煮散而愈。马观文夫人，在七月间病气弱倦怠，四肢厥逆，恶寒有汗，少饮食。一医谓伏暑，一医谓虚寒，治皆无效。召我诊治，六脉虽弱，而两关差甚焉。问是何证？我说：六脉虽弱，而关独甚，这是中焦寒。中焦脾也，脾胃既寒，不但有此证，必有腹痛、吐泻，今四肢厥冷，脾属四肢，是脾胃虚冷无疑。曰：未见腹痛吐泻之证，合用何治？我说：宜附子理中汤。未服药间，旋即腹痛而泻，莫不神之，即投此药而瘥。
防风散 治疗妇人中风，言语謇涩，四肢拘急，身体壮热，头疼目眩，心胸不利。
防风（去芦，一两） 石膏（二两半） 麻黄（去节） 汉防己（去皮，各七钱半）
细辛（去苗） 黄芩 川升麻 当归（去芦） 桂心 川芎 赤茯苓（去皮） 甘草（炙）
羌活（去芦，各半两）
上为粗散，每服八钱，水一中盏半，煎至一大盏，去滓，入淡竹沥一合，更煎一两沸，温服，不拘时。
[Da Yuanli] Women experiencing aversion to cold may present with either Yin or Yang syndromes. Fever accompanied by aversion to cold indicates a syndrome originating from the Yang aspect. Aversion to cold without fever indicates a syndrome originating from the Yin aspect. For syndromes originating from Yang, exterior-releasing treatment is appropriate, and the pulse will necessarily be floating and rapid. For syndromes originating from Yin, interior-warming treatment is appropriate, and the pulse will necessarily be deep and fine. There are also cases of aversion to cold following sweating, following purgation, and specifically aversion to cold in the back. The formulas and treatments for these conditions are recorded in *Baiwen* (Hundred Questions), so they are not cited here in detail. I once treated a woman who presented only with aversion to cold and no other symptoms; her six pulses were calm. I used Baidu San (Decoction for Overcoming Toxicity) and she recovered. This medicine can expel wind-pathogens from the exterior. The Classics state: Patients with aversion to cold must never be excessively covered with blankets or brought near fire. If cold and heat contend, the pulse channels become deep and hidden, making the patient's coldness unbearable. One should remove the covers and fire, and simultaneously administer medicines that harmonize the exterior, and the aversion to cold will naturally cease. In women with aversion to cold, it is especially important not to approach fire; otherwise, cold qi enters the abdomen, causing stagnation in the Blood Chamber (Zigong and Chong-Ren vessels), which becomes incurable by both acupuncture and herbs.
[Xue Ji] If the aforementioned symptoms are accompanied by lethargy, drowsiness, and shivering aversion to cold (as if splashed by cold water), this is due to Yang Qi failing to extend and rise; use Shengyang Yizhe Tang (Decoction to Raise Yang and Benefit the Stomach). If aversion to cold results from physical exertion damaging form and Qi, indicating a lack of Wei Qi (Defensive Qi) to protect the exterior, use Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi). If aversion to cold results from dietary injury to the Spleen and Stomach, indicating deficiency of Yuan Qi (Original Qi), use Liujunzi Tang (Six Gentlemen Decoction). If irritability, delirious speech, or thirst for water are added, continue the previous formula but add Ginger (Shengjiang) and Cinnamon Twig (Rougui). If fatigue, irritability, thirst, headache, and spontaneous sweating occur, use Buzhong Yiqi Tang with Schisandra (Wuweizi) and Ophiopogon (Maimendong). Li Dongyuan said: Fever and aversion to cold during the day indicate Yin Qi overflowing into the Yang aspect; aversion to cold at night indicates Yin Blood flourishing in the Yin aspect. Zhang Yuansu (Haicang) said: In the great heat of the sixth month, if a great cold syndrome appears, one should disregard the season and treat according to the symptoms, using drugs like Dried Ginger (Ganjiang) and Cinnamon Twig (Rougui). Zhu Danxi said: Chronic aversion to cold is caused by Phlegm-Dampness stagnating in the Spleen, suppressing and obstructing Yang Qi so it cannot vent outward; treatment should focus on resolving stagnation.
Yaoyin stated: When women suffer from Zhongfeng (Wind Stroke), presenting with opisthotonos, Fengbi (Wind Bi), paralysis of limbs, hemiplegia with locked jaw, deviation of mouth and eyes, wind-dizziness with headache, Xuefeng (Blood Wind), mental palpitations and mania, joint wind, wandering blood wind pain, itching and urticaria, and various wind-phlegm syndromes, although there are specific formulas for each, one must first understand the general principles, observe the emptiness or fullness of the pulse, differentiate the cold or heat of the syndrome, consider the patient's strength or weakness, determine if the pathogen has entered the Zang or Fu organs, or the Luo or Jing vessels. Treatment should begin with gentle regulation, avoiding sudden or harsh medications. Current treatment methods should first regulate Qi, then treat Wind, ensuring success. Conditions such as Zhongfeng (Wind Stroke), Zhonghan (Cold Strike), Zhongshu (Heat Stroke), Zhongtan (Phlegm Strike), and Zhongqi (Qi Strike) can all cause excessive salivation and coma. Physicians must carefully distinguish between them. For example, if Zhongfeng is treated as Zhongqi, eight or nine out of ten recover. If Zhongqi is treated as Zhongfeng, none survive. Therefore, amidst doubt, regardless of whether it is Zhongfeng or Zhongqi, initially use Suhexiang Wan (Styrax Pill) or Wuji San (Five Accumulations Powder) with Musk decocted. If it is Zhongtan, use Shenxu Yin (Ginseng and Perilla Drink). If it is Zhonghan, use Lizhong Tang (Regulate the Middle Decoction). If it is Zhongshu, use Baihu Tang (White Tiger Decoction). If it is definitively Zhongfeng, use Sansheng Yin (Three Lives Decoction), Muxiang Zhusan (Aucklandia Boiled Powder), Paifeng Tang (Expel Wind Decoction), Xuming Tang (Continue Life Decoction), Fengyin Tang (Wind Attract Decoction), Da/Xiao Zhuli (Large/Small Bamboo Juice), or Dabafeng Tang (Eight Great Winds Decoction). Differentiate cold, heat, emptiness, and fullness before administering medication, and stability will follow. However, this disease accumulates over a long time and does not arise in a day. Modern patients take three or five doses and blame the doctor for ineffectiveness; this is too hasty. Large doses taken over a long period are necessary for efficacy. Mencius said: "For a seven-year illness, seek three-year-old mugwort."
[Da Yuanli] Zhongfeng (Wind Stroke) is caused by deficient wind invading the human body. Wind is the Qi of the four seasons and eight directions, typically rising from the Kan direction (North) on the Winter Solstice. Observing winds from the eight directions, those coming from their native direction nourish all things. Those not coming from their native direction are called "Empty Wind" (Xu Feng) and harm all things. Humans who are deficient are struck by it. Although it may not manifest immediately, the pathogen remains in the skin and muscles; later, if re-injured by wind, the pathogens overlap, and due to bodily deficiency, the disease manifests. The pathogen enters the Shu points of the Zang and Fu organs; since Shu points are located on the back, Zhongfeng often enters via these points and manifests according to the affected point. Women, being deficient in Blood and Qi, are prone to Zhongfeng. One should observe the opening and closing of the mouth and eyes to distinguish severity. The presence or absence of saliva clarifies the syndrome and treatment. If the eyes are open and the mouth closed, limbs cannot open, and saliva flows without sound, it is treatable. If the eyes are closed and the mouth open, snoring sounds, and involuntary urination occurs, the prognosis is fatal. Note: In cases of sudden collapse and syncope, regardless of gender or whether caused by wind, cold, Qi, food, phlegm, or dampness, one must clearly distinguish between Bi Syndrome (Closed) and Tuo Syndrome (Collapsed). If the jaw is tightly closed and hands are clenched, it is Bi Syndrome; use Suhexiang Wan or Sansheng Yin to open the orifices. If the mouth is open and hands relaxed, it is Tuo Syndrome; use large doses of Astragalus (Huangqi) and Ginseng (Renshen) decocted into thick soup for administration. Although considered difficult to treat by standard laws, five or six out of ten can be saved. Misusing Suhexiang Wan in Tuo Syndrome is incurable. These "gate-crashing" (opening orifice) medicines are designed for Bi Syndrome. Using them in Tuo Syndrome is like throwing stones on someone already in a well.
[Xue Ji] Zhongfeng corresponds to Pianku (Hemiplegia), Fengfei (Wind Flaccidity), Fengyi (Wind Insufficiency), and Fengbi (Wind Bi) in the *Neijing*, and is divided into Zhongfu (Striking the Fu), Zhongzang (Striking the Zang), and Zhongxuemai (Striking the Vessels and Collaterals). Zhongfu is in the Exterior; Zhongzang is in the Interior; Zhongxuemai is in the Middle. Exterior syndromes require mild sweating; Interior syndromes require mild purgation; Middle syndromes require harmonizing Ying and Wei. Zhongfu affects the limbs, causing stiffness, numbness, aversion to wind and cold; these shallow syndromes are easy to treat, using Jiajian Xuming Tang (Modified Continue Life Decoction). Zhongzang obstructs the Nine Orifices: blurred vision indicates Liver involvement; inability to speak indicates Heart involvement; flaccid lips and constipation indicate Spleen involvement; nasal congestion indicates Lung involvement; deafness indicates Kidney involvement; these deep syndromes are difficult to treat. Zhongxuemai presents with no Six Channels symptoms externally and no bowel/bladder obstruction internally, but limbs cannot move and speech is impaired; use Da Qinjiao Tang (Great Nard Decoction) as the primary treatment. Zhongfu often combines with Zhongzang. For example, left Guan pulse floating and wiry, greenish complexion, left hypochondriac pain, tendon stiffness, upward gaze, dizziness, limb relaxation, and inability to sit upright indicate Gallbladder and Liver involvement; use Xijiao San (Rhinoceros Horn Powder). Left Cun pulse floating and surging, red face and tongue, profuse sweating, aversion to wind, mental confusion, slurred speech, stiff tongue, dry mouth, palpitations, and恍惚 (trance) indicate Small Intestine and Heart involvement; use Mahuang San (Ephedra Powder). Right Guan pulse floating and slow or large, yellowish face and lips, profuse sweating, aversion to wind, facial deviation, slurred speech, heaviness, lethargy, numbness, twitching muscles, abdominal distension, and anorexia indicate Stomach and Spleen involvement; use Fangfeng San (Saposhnikovia Powder). Right Cun pulse floating, choppy, and short, pale complexion, clear nasal discharge, frequent panting, chest oppression, shortness of breath, spontaneous hoarseness, and limb flaccidity indicate Large Intestine and Lung involvement; use Wuweizi Tang (Schisandra Decoction). Left Chi pulse floating and slippery, dark complexion, lower back and spine pain radiating to the lower abdomen, inability to bend or stretch, tinnitus, joint pain, leg flaccidity, and fear indicate Bladder and Kidney involvement; use Duhuo San (Angelica Pubescens Powder). These describe true Zhongfeng, differentiated by Qi and Blood deficiency. Qi deficiency leading to stroke, caused by Original Qi deficiency allowing thief-wind invasion, results in right-sided numbness; use Liujunzi Tang with Uncaria (Gouteng), Ginger juice, and Bamboo juice. Blood deficiency leading to stroke, caused by Yin Blood deficiency allowing thief-wind invasion, results in left-sided numbness; use Siwu Tang with Uncaria, Bamboo juice, and Ginger juice. Combined Qi and Blood deficiency results in bilateral numbness; use Bazhen Tang with Uncaria, Ginger juice, and Bamboo juice. Syndromes resembling Zhongfeng include Zhonghan (Cold Strike), Zhongshi (Dampness Strike), Zhonghuo (Fire Strike), Zhongqi (Qi Strike), Shijue (Food Syncope), Laoshang (Exhaustion Injury), and Fanglao (Sexual Exhaustion). Zhonghan: sudden winter cold causing coma, locked jaw, limb cramping, aversion to cold, and floating-tight pulse; use Ephedra, Cinnamon Twig, or Lizhong Tang. Zhongshu: sudden summer heat causing coma, flaccidity, vomiting/diarrhea, panting/fullness; use Shiwei Xiangru Yin (Ten-Ingredient Elsholtzia Drink). Zhongshi: As Danxi stated, people in the Southeast often generate Phlegm from Damp Earth, Heat from Phlegm, and Wind from Heat; use Qingzao Tang (Clear Dryness Decoction) with Bamboo juice and Ginger juice. Zhonghuo: As Hejian stated, not internal Liver Wind, but external Six Evils invading due to extreme Five Emotions, Fire excess, Water deficiency, and stagnant Heat causing sudden collapse; use Liuwei Wan (Six-Ingredient Pill), Sijunzi Tang, or Dushen Tang. If anger injures the Liver causing Fire to flare up, use Chaihu Tang. Zhongqi: Extreme Seven Emotions causing Qi syncope, coma, or tight jaw; use Suhexiang Wan. Mistaking this for Wind leads to death. Shijue: Excessive eating injuring Stomach Qi, failing to transform, causing coma; use Liujunzi Tang with Aucklandia. Laoshang: Excessive labor depleting Original Qi, weakening Spleen/Stomach, unable to resist wind/cold, causing coma; use Buzhong Yiqi Tang. Fanglao: Kidney deficiency and essence depletion causing Qi to fail to root, leading to coma; use Liuwei Wan. These are all Lei Zhongfeng (Resembling Wind Stroke). The *Neijing* emphasizes Wind; Hejian emphasizes Fire; Dongyuan emphasizes Qi; Danxi emphasizes Dampness. My discussion supplements previous scholars' omissions. Regional differences and individual constitution vary, but men and women are largely similar; refer to subsequent discussions for adaptive treatment. (Formulas see Miscellaneous Diseases: Zhongfeng.)
Madam Jin Ge initially had chest/hypochondriac distension and pain, followed by limb immobility, profuse sweating like water, urinary incontinence, loose stools, tight mouth, and deviated eyes, yet appetite remained good for over ten days. Some thought it was Zhongzang, causing me great worry. I said: No. If Wind had struck the Zang and True Qi had escaped, with malignant signs present, death would be imminent, not delayed. Her complexion was red, sometimes green. Pulse: Left three positions were surging and rapid, especially the Liver. I said: Chest/breast distension is Liver Blood deficiency and Qi stagnation. Limb immobility is Liver Blood deficiency failing to nourish tendons. Profuse sweating is Liver Wind-Heat causing fluid leakage. Urinary incontinence is severe Liver Heat causing loss of control. Loose stools are Liver Wood overacting on Spleen Earth. I prescribed Xijiao San for four doses, resolving all symptoms. Then used Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) for regulation. Later, due to depression and anger, symptoms recurred with fever, vomiting, poor appetite, and menorrhagia. This is Wood overacting on Earth, with Spleen failing to control blood. I used Jiawei Guipi Tang (Modified Restore the Spleen Decoction) as the main treatment, assisted by Jiawei Xiaoyao San to tonify Liver/Spleen Qi and clear/nourish Liver/Blood, resulting in recovery. Subsequent anger or sleep-induced tremors responded to the same formula.
Madam Zhu Yunxi (Mother of Grand Secretary Zhu): Sudden collapse in September with phlegm-misting and unconsciousness, deviated mouth/eyes, small left eye. Phlegm-blood resolving agents slightly reduced heat. Relapse in April next year, same treatment, slight improvement. Severe relapse in late June with urinary incontinence; others deemed it Zhongzang and untreatable. My pulse: Left Guan was string-like, surging, and rapid, indicating Liver Fire and Blood dryness. Prescribed Liuwei Wan with Schisandra, Ophiopogon, Ligusticum, and Angelica. One dose improved diet and urination. Followed by Buzhong Yiqi Tang with Poria, Gardenia, Uncaria, and Moutan for stability. In October, food stagnation caused abdominal pain and diarrhea, left eye still small, Guan and Chi pulses string-like, surging, and forceful. I used Liujunzi Tang with Aucklandia, Evodia, Cimicifuga, and Bupleurum; one dose relieved pain/diarrhea. Then Liujunzi Tang with Myrobalan and Psoralea; one dose normalized pulses and stopped pain/diarrhea. I reasoned: Left Guan string-like/surging due to Liver Fire/Blood dryness causing small left eye. Right Guan string-like/surging due to Liver Evil attacking Spleen causing deviation/pain/diarrhea. Chi pulses forceful due to sinking of Original Qi. Mistaking deviation for Wind and using Wind-dispelling herbs, or mistaking diarrhea for stagnation and using harsh purgatives, would deplete Qi and cause great harm. She later died from misusing cold medicines for phlegm-panting caused by overheating while seeking warmth for Yang-deficiency aversion to cold.
A woman collapsed after anger, with slurred speech, deviated mouth/eyes, limb stiffness, sweating, and urinary incontinence. Pulses were surging and large, especially Liver. This was due to blazing Liver Fire. Liver governs urination; heat caused incontinence. Treated with Jiawei Xiaoyao San plus Uncaria and Liuwei Wan, recovering soon.
An old woman with arm paralysis and slurred speech worsened with tendon cramping and bone pain after taking Wind-dispelling herbs. I diagnosed Liver Fire and Blood deficiency. Used Bazhen Tang to tonify Qi/Blood, Dihuang Wan to tonify Kidney Water, assisted by Paifeng Tang. Recovered after over a year.
A woman with menstrual deviation of mouth/eyes and abundant phlegm-drool was treated with Jiawei Xiaoyao San plus Moutan for Blood deficiency and moving Liver Fire, recovering soon. Later, food stagnation caused daily phlegm-vomiting due to Spleen Qi deficiency failing to control fluids. Treated with Liujunzi Tang for over twenty doses, stabilizing.
A woman with anger-induced deviation, phlegm-surging, locked jaw, and convulsions was treated with Liujunzi Tang plus Aucklandia, Uncaria, and Bupleurum for Spleen/Lung Qi deficiency and hyperactive Liver Wood, gradually improving. Regulated with Jiawei Guipi Tang.
A puerperal woman working hard suddenly collapsed with tight jaw, phlegm-panting, coarse breathing, and limb paralysis. This was Qi/Blood deficiency causing Spasm. Morning: Buzhong Yiqi Tang with Poria and Pinellia. Evening: Bazhen Tang with Pinellia. Thirty doses each, ineffective. Qi/Blood not yet restored, medicine not yet sufficient. Continued for another fifty doses, then recovered.
A woman with a quick temper suffering from Liver Wind took Soufeng Shunqi Wan and Qinjiao Tang regularly. After angry hematemesis, lip/tightness, frequent/incontinent urination, I diagnosed Liver Fire causing reckless bleeding. Used Xiao Chaihu Tang with Gardenia and Moutan, gradually improving. Five years later, angry hematemesis again. Misused Fire-descending/Wind-dispelling/Phlegm-resolving herbs, causing frequent stool, chest fullness, poor appetite. Clearing Qi/transforming Phlegm herbs caused vomiting/anorexia, dizziness, dry mouth, expectoration. Guiding Phlegm/descending Fire herbs caused gushing phlegm and cold limbs. I said: Vomiting/anorexia is weak Stomach Qi. Dizziness/dry mouth is Middle Qi failing to ascend. Gushing phlegm is Spleen Qi failing to control fluids. Cold limbs is Spleen Qi failing to circulate. Treated with Buzhong Yiqi Tang plus Poria and Pinellia, gradually improving. Regulated with Jiawei Guipi Tang.
[Chen Shi] Spring of Guichou year: A 42-43 year old woman had shortness of breath, weak legs, and felt like holding frost in her mouth after walking a few steps. Menstruated three times in 70 days, with cold mouth, dizziness, and heart-piercing cold pain from cold feet. Walking caused continuous cold air in mouth, sometimes nasal heat, flushed face, numbness, inability to walk/move limbs/bend, cold Bi bone pain, sadness, dreams of deceased husband, palpitations, indecision, forgetfulness, yet good appetite. For a year, hot medicines caused flushing/chest fullness/blockage; cold medicines caused diarrhea. Quanshen Tang caused irritability/palpitations. Shuanghe Tang caused burning sensation in face/abdomen, increased palpitations, nausea, constipation, tenesmus. My pulse: String-like and slow, favorable for spring. Treatable. Before prescribing, she vomited/diarrheated, feeling anal burning. I gave Yushanren Jiangqi Tang for eight doses. Next day, pulse stronger. She reported nasal heat, irritability, jaw tension. Given Shenxu Yin for eight doses and Huanglian Wan (one liang). Three days later, no change. Fuling Buxin Tang ineffective. Analyzing pulse/symptoms, Paifeng Tang was most suitable. Objections: Wind pulse should be floating; current pulse is string-like/slow/weak, suggesting non-Wind. I replied: Wind has no fixed pulse. This case is Kidney Deficiency generating Wind. Paifeng Tang contains ingredients of Shiquan Dabu Tang, offering balanced tonification without being overly drying. Ten doses given. Three days later, effective, pulse better, but abdominal heat and constipation persisted, confirming Wind. Reinforced Paifeng Tang with Niuhuang Qingxin Wan and Zaojiao Wan. Three days later, restlessness/fever resolved, but leg weakness remained. Given Mishuan Jiangqi Tang for ten doses, symptoms retreated. Remaining dream-fright, loose stool, weak pulse treated with Wuji San plus Ginseng and salt-decoction, combined with Yinggan Wan, curing her. Headache/dizziness preventing standing/sitting treated again with Paifeng Tang, resolving completely.
Madam Miu, age 60, sudden Zhongfeng with unconsciousness, no sweat, with phlegm. Doctors deemed untreatable. My pulse: Floating and slow, Spleen pulse overflowing Guan. True Wind pulse. First, Shenxu Yin for six doses to widen Qi and descend phlegm. Then Muxiang Zhusan cured her.
Madam Ma Guanwen: July illness with weak Qi, fatigue, cold limbs, aversion to cold with sweat, poor appetite. One doctor said latent Summerheat; another said Deficient Cold. Both failed. My pulse: Weak overall, but Guan positions particularly strong. I said: Weak pulse but strong Guan indicates Middle Jiao Cold. Spleen belongs to Middle Jiao; Spleen/Stomach cold causes abdominal pain/diarrhea. Cold limbs confirm Spleen/Stomach Deficient Cold. No pain/diarrhea yet? Use Fuzi Lizhong Tang. Before taking it, she developed pain and diarrhea. Miracle! Immediate cure with this formula.
Fangfeng San treats women with Zhongfeng, slurred speech, limb stiffness, high fever, headache, dizziness, and chest discomfort.
Saposhnikovia (Fangfeng) - removed roots, 1 liang
Gypsum (Shigao) - 2.5 liang
Ephedra (Mahuang) - removed joints
Stephania (Hanfangji) - removed skin, 7.5 qian each
Asarum (Xixin) - removed seedlings
Scutellaria (Huangqin)
Bupleurum (Chuan Shengma)
Angelica Sinensis (Danggui) - removed roots
Cinnamon Bark (Guixin)
Ligusticum (Chuanxiong)
Red Poria (Chifuling) - removed skin
Licorice (Gancao) - honey-fried
Notopterygium (Qianghuo) - removed roots, 0.5 liang each
Grind into coarse powder. Take 8 qian per dose. Add 1.5 lamps of water, decoct to 1 lamp. Strain, add 1 he of light Bamboo Juice, boil briefly. Warm drink, anytime.