治贼风口噤。角弓反张。用仓公当归汤。更参痉证治之。
四肢不举 脉缓大有力。而四肢不举者。土太过也。当泻其湿。胃苓汤。脉细小无力。而
四肢不用者。土不及也。当补其气。补中益气汤随证加减。瘦人血枯筋急。土旺风淫者。四物汤加
钩藤、秦艽、防风。肥盛色白痰多者。六君子加秦艽、天麻、竹沥、姜汁。
麻瞀不仁 虚风之证。能食麻瞀。牙关引搐。目内蠕 。升麻胃风汤。麻痹不仁。鼻额间
痛。唇口颊车发际皆痛。口不可开。言语饮食妨碍。左额颊上如糊急。手触之则痛。此足阳明经受
风。气血凝滞不行。犀角升麻汤。一切风气攻注。四肢骨节疼痛。遍身顽麻。手足瘫痪。言语謇
涩。无汗气实。乌药顺气散。十指并面麻瞀。乃气虚风袭。补中益气去
白术、当归、橘皮加白芍、五味。麻瞀体软。痒起白屑。乃脾气不荣。补中益气加地黄、芍药。
风湿相搏。手足麻痹者。千金排风汤。手足麻瞀。膈塞体痛。寒热眩晕。风成为寒热也。千金解风散。
表虚自汗 虚风伤卫而汗出者。黄 建中汤。阳气虚者。加附子。若兼寒热者。小柴胡渴。
气虚。补中益气汤。每夜发热自汗。为血虚。当归补血汤。酒客辈多湿热人。兼房劳汗出中风。
下体多汗。不能劳。衣常濡。口干善渴。十全大补加熟附、防风、黄柏、泽泻。凡中风自汗而小
便少者。不可以药利之。既已自汗。则津液外亡。小便应少。若利之。使营卫枯竭。无以制火。
烦热愈甚。当俟热退汗止。小便自行。且此证属阳明经。大忌利小便。
神气昏冒 虚火妄动。挟痰气逆冲。心主被障。所以昏不知人。须大剂人参、芎、归兼柴
胡、山栀。审系中在心包。而非中腑。闭证而非脱证。牛黄丸。虚人。六君子加星、香、菖、远、
竹沥、姜汁。若狂言语乱。精神恍惚。痰涎壅盛。导痰汤加芩、连、竹沥、姜汁。
遗尿不禁 脾虚下陷而膀胱不约者。补中益气汤加益智。肾虚不能摄者。地黄饮子。若卒中
有此。兼诸恶证者。为肾绝。不治。
不治诸证 发直吐沫。摇头上撺。鱼口气粗。直视。眼小目瞪。喉声如锯。面赤如妆。汗
出如珠。循衣摸床。神昏不语。头面手足爪甲青黑。大吐大泻。吐血下血。其脉坚躁急疾短涩者。
皆不治。
石顽曰。中风一门。为杂证开卷首义。其分经络。定腑脏。与伤寒无异。非精达南阳至理。难
以语此。如西北为真中风。东南为类中风。又为诸病开一辨别方宜大纲。而伤寒主治。虽无一不
具。未尝昭揭其旨也。夫水土之刚柔。非特指
中风而言。当知西北为真中风一语。原是因东南水土孱弱。虽有卒倒昏迷。皆是元气疏豁。为虚
风所袭。不可峻用祛风猛剂而设。其西北为真中风一语。原是对待东南类中而言。以其风气刚暴。
得以直犯无禁。则有卒然倒仆之患。未尝言西北之人。绝无真气之虚而中之者。内经明言阳之气。
以天地之疾风名之。即此一语。可证风从内发。但以西北资禀刚暴。风火素盛。加以外风猛厉易
袭。所以西北中风。较之东南倍剧也。余尝究心斯道。五十年来。历诊西北之人。中风不少。验
其喑痱遗尿。讵非下元之惫。而从事地黄饮、三生饮等治乎。 僻不遂。讵非血脉之废。而从事
建中、十全等治乎。东南类中。岂无六经形证见于外。便溺阻隔见于内。即从事续命、三化等治
乎。若通圣、愈风。即西北真中。曾未一试也。读古人书。须要究其纲旨。以意逆之。是谓得之。
若胶执其语。反成窒碍。岂先哲立言之过欤。诸病各有经脉腑脏之分。而卒然倒仆。犹须审谛。
尝考先哲论中风。首云中血脉则口眼 斜。中腑则肢节废。夫肢节废与口眼 斜。皆属六经形证。
若中腑则有便溺阻隔之患矣。中脏则性命危。此亦不过论其大纲。中脏岂绝无可治。而一概委之
不救乎。
〔诊〕石顽曰。中风之脉。皆真气内亏。风邪得以斩关直入。即南方类中卒倒。虽当分属虚属
火属痰。总由肾气衰微。不能主持。是以脉不能沉。随虚风鼓激而见浮缓之象。昔人有云。中风
之脉。每见沉伏。亦有脉随气奔指下洪盛者。当知中风之人。皆体肥痰盛。外似有余。中实不足。
加以房室内贼。遂致卒倒昏迷。其国中之时。周身之气。闭滞不行。故多沉伏。少顷气还微省。
则脉随气奔而见洪盛。皆风火痰湿用事也。大都中风之脉。浮小缓弱者生。坚大急疾者危。盖浮
缓为中风之本脉。兼紧则多表邪。兼大则多气虚。兼迟则多虚寒。兼数则多虚热。兼滑则多痰湿。皆为可
治之脉。惟兼涩者。为脉不应病。多为危兆。以痰证脉涩。为正气虚衰。经络闭滞。难于搜涤也。
所以中风之脉。最忌伏涩不调。尤忌坚大急疾。素问云。胃脉沉鼓涩。胃外鼓大。心脉小坚急。
皆鬲。偏枯。男子发左。女子发右。不喑舌转可治。则知坚急涩伏。皆难治之脉。况见声喑舌机
不转。肾气内衰之证乎。
罗谦甫治太尉忠武史公。年近七旬。十月初。侍国师于圣安寺。丈室中有煤炭水一 在左侧。
遂觉左颊微汗。因左颊疏缓。被风寒客之。左颊急而口 于右。脉得浮紧。按之洪缓。先于左颊
上灸地仓一七壮。次灸颊车二七壮。后于左颊上热手熨之。以秦艽升麻汤发散风寒。数服而愈。
赵以德治陈学士敬初。因醮事跪拜间。就倒仆。汗注如雨。诊之脉大而空虚。年当五十。新
娶少妇。今又从拜跪之劳役。故阳气暴散。急煎独参汤。连饮半日而汗止。神气稍定。手足俱 。
喑而无声。遂于独参汤中加竹沥。开上涌之痰。次早悲哭。一日不已。因以言慰之。遂笑。复笑
五七日无已时。此哭笑为阴火动其精神魂魄之藏。相并故耳。在内经所谓五精相并者。心火并于
肺则喜。肺火并于肝则悲是也。稍加连、柏之属泻其火。八日笑止手动。一月能步矣。
李士材治徽商汪华泉。忽然昏仆。遗尿撒手。汗出如珠。口不能言。法在不治。然大进参、
附。或救万一。用人参三两。熟附五钱。浓煎灌之。至晚而汗减。再剂身体转动。更用参、附、
白术加姜汁、竹沥。数日渐爽。调补半年而康。
石顽治春榜赵明远。平时六脉微弱。己酉九月。患类中风。经岁不痊。邀石顽诊之。其左手
三部弦大而坚。知为肾脏阴伤。壮火食气之候。且人迎斜内向寸。又为三阳经满。溢入阳维之脉。
是不能无颠仆不仁之虞。右手三部浮
缓。而气口以上微滑。乃顽痰涌塞于膈之象。以清阳之位而为痰气占据。未免侵渍心主。是以神
识不清。语言错误也。或者以其神识不清。语言错误。口角常有微涎。目睛恒不易转。以为邪滞
经络。而用祛风导痰之药。殊不知此本肾气不能上通于心。心藏虚热生风之证。良非风燥药所宜。
或者以其小便清利倍常以为肾虚。而用八味壮火之剂。殊不知此证虽虚。而虚阳伏于肝脏。所以
阳事易举。饮食易饥。又非益火消阴药所宜。或者以其向患休息久痢。大便后常有淡红渍沫。而
用补中益气。殊不知脾气陷于下焦者。可用升举之法。此阴虚久痢之余疾。有何清气在下可升发
乎。若用升、柴升动肝肾虚阳。鼓激膈上痰饮。能保其不为喘胀逆满之患乎。是升举药不宜轻服
也。今举河间地黄饮子助其肾。通其心。一举而两得之。但不能薄滋味。远房室。则药虽应病。
终无益于治疗也。惟智者善为调摄。为第一义。
又治御前侍卫金汉光如夫人。中风四肢不能举动。喘鸣肩息。声如拽锯。不能着枕。寝食俱
废者半月余。方邀治于石顽。诊其脉。右手寸关数大。按久无力。尺内愈虚。左手关尺弦数。按
之渐小。惟寸口数盛。或时昏眩。或时烦乱。询其先前所用诸药。皆二陈、导痰。杂以秦艽、天
麻之类。不应。又与牛黄丸。痰涎愈逆。危殆益甚。因疏六君子。或加胆星、竹沥。或加黄连、
当归。甫四剂而喘息顿除。再三剂而饮食渐进。稍堪就枕。再四剂而手足运动。十余剂后。屏帏
之内。自可徐行矣。因思从前所用之药。未常不合于治。但以痰涎壅盛。不能担当。峻用参、术
开提胃气。徒与豁痰。中气转伤。是以不能奏绩耳。
又治汉川令顾莪在夫人。高年气虚痰盛。迩因乃郎翰公远任广西府。以道远抑郁。仲春十四
夜。忽然下体堕床。
便舌强不语。肢体不遂。以是日曾食湿面。诸医群议消导。消导不应。转增困惫。人事不省。头
项肿胀。事在危急。急邀石顽诊之。六脉皆虚濡无力。诸医尚谓大便六七日不通。拟用攻下。余
谓之曰。脉无实结。何可妄攻。莪在乔梓。皆言素有脾约。大便常五七日一行。而艰苦异常。乃
令先小试糜饮。以流动肠胃之枢机。日进六君子汤。每服用参二钱。煎成炖热。分三次服。四剂后。
自能转侧。大便自通。再四剂。手足便利。自能起坐。数日之间。倩人扶掖徐行。因切嘱其左右
谨防。毋使步履有失。以其气虚痰盛。不得不防杜将来耳。
又治松陵沈云步先生。解组归林。以素禀多痰。恒有麻木之患。防微杜渐。不无类中之虞。
乃谋治于石顽。为疏六君子汤。服之颇验。而性不喜药。入秋以来。渐觉肢体不遂。复邀延医。
脉软滑中有微结之象。仍以前方除去橘皮。加归、 、巴戟。平调半月而安。然此证首在节慎起
居。方能永保贞固。殊非药力可图万全也。
治疗贼风引起的口噤（牙关紧闭）、角弓反张（身体向后弯曲如弓），使用仓公当归汤，并参照痉证的方法进行治疗。
四肢不能抬举：若脉象缓大而有力，而四肢不能抬举的，属于土气太过（湿气过重），应当泻除其湿邪，用胃苓汤；若脉象细小无力，而四肢不能使用的，属于土气不及（脾气虚弱），应当补益其气，用补中益气汤随证加减。瘦人因血枯导致筋脉拘急，且土旺生风者，用四物汤加钩藤、秦艽、防风；肥胖色白、痰多的人，用六君子汤加秦艽、天麻、竹沥、姜汁。
麻木不仁：这是虚风的证候。能进食但出现麻木感，牙关牵引抽搐，眼球内部蠕动的，用升麻胃风汤。麻痹不仁，鼻部和额部疼痛，嘴唇、口角、颊车穴及发际线周围都疼痛，嘴巴无法张开，言语和饮食受阻，左侧额头和脸颊紧绷如糊状，手触摸则疼痛的，这是足阳明经受风，气血凝滞不通，用犀角升麻汤。一切风气攻注，四肢骨节疼痛，全身顽固性麻木，手足瘫痪，言语謇涩（说话不清），无汗且气实者，用乌药顺气散。十指和面部麻木，是气虚受风袭扰，用补中益气汤去掉白术、当归、橘皮，加白芍、五味子。麻木且身体软弱，瘙痒起白屑的，是脾气不能荣养肌肤，用补中益气汤加地黄、芍药。风湿相搏导致手足麻痹的，用千金排风汤。手足麻木，膈部堵塞，身体疼痛，寒热交替眩晕的，是因为风邪转化为寒热，用千金解风散。
表虚自汗：虚风损伤卫气导致出汗的，用黄芪建中汤。阳气虚的，加附子。如果兼有寒热的，用小柴胡汤（原文“小柴胡渴”疑为笔误或特定用法，此处依常规译为小柴胡汤相关证治）。气虚的，用补中益气汤。每夜发热自汗的，为血虚，用当归补血汤。嗜酒之人多湿热体质，兼有房劳后出汗中风，下身多汗，不能劳累，衣服常湿，口干善渴的，用十全大补汤加熟附子、防风、黄柏、泽泻。凡是中风自汗且小便少的，不可以用药利尿。既然已经自汗，津液外泄，小便理应减少。如果强行利尿，会使营卫枯竭，无法制约火邪，烦热会更加严重。应当等待热退汗止，小便自然会恢复。况且此证属阳明经，最忌利小便。
神气昏冒：虚火妄动，挟带痰气上逆冲撞，心主被蒙蔽，所以昏迷不知人。需用大剂量人参、川芎、当归，兼用柴胡、山栀。确认为病位在心包，而非中腑，闭证而非脱证的，用牛黄丸。体虚的人，用六君子汤加南星、香附、石菖蒲、远志、竹沥、姜汁。如果狂言乱语，精神恍惚，痰涎壅盛，用导痰汤加黄芩、黄连、竹沥、姜汁。
遗尿不禁：脾虚下陷导致膀胱约束无力的，用补中益气汤加益智仁。肾虚不能摄纳的，用地黄饮子。如果是突然卒中伴有这些症状，兼有其他危重证候的，为肾气绝，不治。
不治诸证：头发直立，吐沫，摇头上窜，鱼口气粗，直视，眼睛变小或瞪大，喉间有声如锯，面色赤红如化妆，汗出如珠，循衣摸床（意识不清时手部无意识动作），神昏不语，头面手足爪甲青黑，大吐大泻，吐血下血，脉象坚躁急疾短涩的，都属于不治之症。
石顽说：中风这一门类，作为杂证开篇的首要义理，其分经络、定脏腑，与伤寒没有不同。如果不精通张仲景（南阳）的至深道理，很难谈论这个问题。比如西北方是真中风，东南方是类中风，这又为各种疾病提供了一个辨别适宜治疗的纲领。虽然伤寒的主治方法无一不具备，但未曾明确揭示其宗旨。所谓水土的刚柔，不仅指中风而言。应当知道“西北为真中风”这句话，原本是针对东南方水土孱弱而言的。在东南方，虽然有突然倒仆昏迷，都是元气疏豁，被虚风所袭，不可峻烈地使用祛风猛剂。而“西北为真中风”这句话，原本是对待东南类中风而言的，因为那里风气刚暴，得以直犯无禁，则有突然倒仆的祸患。并未说西北的人绝对没有真气虚弱而中风的。《内经》明确说阳气的变化，以天地间的疾风来命名。仅这一句话，就可以证明风从内发。只是因为西北人禀赋刚暴，风火素盛，加上外风猛烈容易侵袭，所以西北中风，比东南加倍剧烈。我曾经潜心研究这门学问，五十年来，诊治西北人，中风者不少。验证他们的喑痱（失音足废）、遗尿，难道不是下元疲惫吗？难道不应该从事于地黄饮子、三生饮等治疗吗？半身不遂，难道不是血脉废用吗？难道不应该从事于建中汤、十全大补汤等治疗吗？东南类中风，难道没有六经形证见于外，便溺阻隔见于内吗？即使从事于续命汤、三化汤等治疗呢？至于防风通圣散、愈风丹，即使是西北真中风，我也未曾尝试过。读古人的书，必须探究其纲旨，以心意去推求，这才叫得其真谛。如果拘泥固执于字句，反而成为阻碍，难道是前哲立言的过错吗？各种疾病各有经脉脏腑的区分，而突然倒仆，还必须审慎辨析。我曾经考察先哲论中风，首先说中血脉则口眼歪斜，中腑则肢节废用。肢节废用与口眼歪斜，都属于六经形证。如果中腑，就会有大小便阻隔的祸患了。中脏则性命危险。这也不过是论述其大纲。中脏难道绝对无可治，而一概推委不救吗？
〔诊法〕石顽说：中风的脉象，都是真气内亏，风邪得以斩关直入。即使是南方类中风突然倒仆，虽然应当分别属于虚、属于火、属于痰，总归是由肾气衰微，不能主持，所以脉不能沉，随着虚风鼓激而出现浮缓的象。古人有话说：中风的脉，常见沉伏，也有脉随着气奔涌到指下洪盛的。应当知道中风的人，大多体肥痰盛，外表似有余，中里其实不足。加上房室内的贼邪（房劳过度），于是导致突然倒仆昏迷。在其发作之时，周身之气闭滞不行，所以多见沉伏。片刻后气还微醒，则脉随着气奔涌而见洪盛。这都是风火痰湿在起作用。大抵中风的脉，浮小缓弱的可生，坚大急疾的危重。盖浮缓是中风的本脉，兼紧则多表邪，兼大则多气虚，兼迟则多虚寒，兼数则多虚热，兼滑则多痰湿，这些都是可治的脉。只有兼涩的，是脉不应病，多为危兆。因为痰证脉涩，是正气虚衰，经络闭滞，难于搜涤。所以中风的脉，最忌伏涩不调，尤其忌坚大急疾。《素问》说：胃脉沉鼓涩，胃外鼓大，心脉小坚急，都是膈病、偏枯。男子发于左，女子发于右，不喑舌转可治。由此可知坚急涩伏，都是难治的脉。何况见到声喑舌机不转，肾气内衰的证候呢？
罗谦甫治疗太尉忠武史公，年龄近七十岁。十月初，在圣安寺侍奉国师。丈室中有煤炭水缸在左侧。于是觉得左颊微微出汗，因为左颊松弛舒缓，被风寒客侵。左颊紧急而口角向右歪斜。脉象得浮紧，按之洪缓。先在左颊灸地仓穴七壮，接着灸颊车穴十四壮，后来在左颊上用热手熨烫。用秦艽升麻汤发散风寒，服几剂而痊愈。
赵以德治疗陈学士敬初。因为祭祀跪拜之间，突然倒仆。汗注如雨。诊察他的脉大而空虚。年龄正当五十岁，新娶少妇，现在又从拜跪的劳役，所以阳气暴散。急煎独参汤，连续饮用半天而汗止。神气稍定，手足僵硬。喑哑无声。于是在独参汤中加入竹沥，开通上涌之痰。第二天早上悲伤哭泣，一天不停。于是用言语安慰他，他就笑了。接着又笑五七天不止。这种哭笑是因为阴火动摇了其精神魂魄之藏，相互兼并的缘故。正如《内经》所说的五精相并：心火并于肺则喜，肺火并于肝则悲。稍微加入连翘、黄柏之类泻其火，八日笑止手动，一个月能走路了。
李士材治疗徽商汪华泉。突然昏仆，遗尿撒手，汗出如珠，口不能言。按照法则是不治之症。但是大进人参、附子，或许能挽救万一。用人参三两，熟附子五钱，浓煎灌服。到了晚上汗减。再服一剂身体转动。再用参、附、白术加姜汁、竹沥。几天后日渐清爽。调补半年而康复。
石顽治疗春榜赵明远。平时六脉微弱。己酉年九月，患类中风，经过一年未痊愈。邀请石顽诊察。他左手三部弦大而坚，知道是肾脏阴伤，壮火食气的证候。而且人迎脉斜内向寸口，又是三阳经满溢入阳维之脉。是不能没有颠仆不仁的忧虑。右手三部浮缓，而气口以上微滑，是顽痰涌塞于膈部的象。因为清阳之位而为痰气占据，未免侵渍心主，所以神识不清，语言错误。有人因为他神识不清，语言错误，口角常有微涎，目睛恒不易转，以为是邪滞经络，而用祛风导痰的药。殊不知这本是肾气不能上通于心，心藏虚热生风的证候，良非风燥药所宜。有人因为他小便清利倍常以为肾虚，而用八味丸壮火之剂。殊不知此证虽虚，而虚阳伏于肝脏，所以阳事易举，饮食易饥，又不是益火消阴药所宜。有人因为他向来患休息久痢，大便后常有淡红渍沫，而用补中益气汤。殊不知脾气陷于下焦者，可用升举之法。此阴虚久痢之余疾，有何清气在下可升发乎？如果用升麻、柴胡升动肝肾虚阳，鼓激膈上痰饮，能保证他不发生喘胀逆满的祸患吗？所以升举药不宜轻服。如今选用河间地黄饮子助其肾，通其心，一举而两得之。但不能薄滋味，远房室，则药虽应病，终无益于治疗也。只有智者善于调摄，是第一要义。
又治疗御前侍卫金汉光的如夫人（妾室）。中风四肢不能举动，喘鸣肩息（呼吸时肩膀耸动），声如拽锯，不能着枕，寝食俱废者半月余。才邀请石顽诊治。诊察他的脉，右手寸关数大，按久无力，尺内愈虚。左手关尺弦数，按之渐小，惟寸口数盛。有时昏眩，有时烦乱。询问他先前所用的诸药，都是二陈汤、导痰汤，杂以秦艽、天麻之类，无效。又给牛黄丸，痰涎更逆，危殆更甚。于是开六君子汤，或者加胆星、竹沥，或者加黄连、当归。刚四剂而喘息顿除。再三剂而饮食渐进，稍堪就枕。再四剂而手足运动。十余剂后，屏风之内，自然可以徐行矣。因此思考从前所用的药，未尝不合于治法。但因为痰涎壅盛，不能担当。峻用参、术开提胃气，徒与豁痰，中气转伤，所以不能奏效耳。
又治疗汉川令顾莪在的夫人。高年气虚痰盛。近来因为儿子翰公远任广西府，因为路途遥远抑郁。仲春十四夜，突然下体堕床。便舌强不语，肢体不遂。因为这一天曾吃湿面，诸医群议消导。消导无效，转增困惫，人事不省，头项肿胀，事在危急。急邀石顽诊察。六脉皆虚濡无力。诸医还说大便六七日不通，拟用攻下。我对他们说：脉无实结，何可妄攻。莪在父子都说素有脾约，大便常五七日一行，而艰苦异常。于是令先小试糜饮，以流动肠胃之枢机。日进六君子汤，每服用参二钱，煎成炖热，分三次服。四剂后，自能转侧，大便自通。再四剂，手足便利，自能起坐。数日之间，倩人扶掖徐行。因此切嘱其左右谨防，毋使步履有失。因为其气虚痰盛，不得不防杜将来耳。
又治疗松陵沈云步先生。解组归林（辞官回家），因为素禀多痰，恒有麻木之患。防微杜渐，不无类中之虞。于是谋治于石顽。为他开六君子汤，服之颇验。而他性格不喜欢吃药。入秋以来，渐觉肢体不遂，复邀延医。脉软滑中有微结之象。仍以前方除去橘皮，加当归、肉苁蓉、巴戟天。平调半月而安。然而此证首在节慎起居，方能永保贞固。殊非药力可图万全也。
Treatment for Tou Feng (robber wind) causing mouth lock (trismus) and opisthotonos (body bent backward like a bow): Use Cang Gong Dang Gui Tang (Cang Gong's Angelica Decoction), and treat with reference to the methods for Jing Zheng (spasm syndrome).
Inability to lift limbs: If the pulse is slow, large, and forceful, yet the limbs cannot be lifted, this indicates excessive Earth (dampness predominance); one should drain the dampness using Wei Ling Tang (Stomach and Pingwei Decoction). If the pulse is fine, small, and weak, and the limbs are unusable, this indicates deficient Earth (Spleen Qi deficiency); one should tonify Qi using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), modified according to symptoms. In thin individuals with blood depletion leading to tendon tension, where Earth excess generates wind, use Si Wu Tang (Four Substances Decoction) plus Gou Teng (Uncaria Ramulus cum Uncis), Qin Jiao (Gentianae Macrophyllae Radix), and Fang Feng (Saposhnikoviae Radix). In obese individuals with pale complexion and profuse phlegm, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Qin Jiao, Tian Ma (Gastrodiae Rhizoma), Zhu Li (Bambusae Succus in Fornice), and Jiang Zhi (Zingiberis Rhizoma Recens Sucus).
Numbness and loss of sensation: This is a manifestation of Empty Wind. If the patient can eat but experiences numbness, with jaw traction and twitching, and internal eyeball movement, use Sheng Ma Wei Feng Tang (Cimicifugae and Gastrodia Decoction). For paralysis and numbness accompanied by pain in the nose and forehead, pain around the lips, corners of the mouth, Jiache acupoint, and hairline, inability to open the mouth, and obstruction in speech and eating; if the left forehead and cheek feel tight as if pasted, and painful to touch, this is Wind invading the Foot Yangming Meridian, causing stagnation of Qi and Blood; use Xi Jiao Sheng Ma Tang (Rhinoceros Horn and Cimicifuga Decoction). For all cases where Wind pathogen attacks and injects, causing pain in limb joints, generalized stubborn numbness, limb paralysis, slurred speech, absence of sweating, and excess Qi, use Wu Yao Shun Qi San (Aucklandia Powder to Smooth Qi). For numbness of the ten fingers and face due to Qi deficiency and Wind invasion, use Bu Zhong Yi Qi Tang removing Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui (Angelicae Sinensis Radix), and Ju Pi (Citri Reticulatae Pericarpium), adding Bai Shao (Paeoniae Radix Alba) and Wu Wei Zi (Schisandrae Chinensis Fructus). For numbness with soft body and itching with white scales, indicating Spleen Qi failing to nourish, use Bu Zhong Yi Qi Tang plus Di Huang (Rehmanniae Radix) and Shao Yao (Paeoniae Radix). For wind-dampness combusting causing limb numbness, use Qian Jin Pai Feng Tang (Thousand Gold Wind-Expelling Decoction). For limb numbness, chest oppression, body pain, alternating chills and fever, and dizziness—where Wind transforms into chills and fever—use Qian Jin Jie Feng San (Thousand Gold Wind-Releasing Powder).
Exterior deficiency with spontaneous sweating: When Empty Wind damages Wei Qi causing sweating, use Huang Qi Jian Zhong Tang (Astragalus Decoction to Establish the Middle). For Yang Qi deficiency, add Fu Zi (Aconiti Lateralis Radix Praeparata). If accompanied by chills and fever, use Xiao Chai Hu Tang (Minor Bupleurum Decoction). For Qi deficiency, use Bu Zhong Yi Qi Tang. For nightly fever and spontaneous sweating indicating Blood deficiency, use Dang Gui Bu Xue Tang (Angelica Tonifying Blood Decoction). For wine drinkers with damp-heat constitution, combined with sweating after sexual exertion leading to Wind stroke, with excessive sweating in the lower body, inability to labor, constantly damp clothes, dry mouth, and thirst, use Shi Quan Da Bu Tang (Great Complete Tonification Decoction) plus Shu Fu Zi (Prepared Aconite), Fang Feng, Huang Bo (Phellodendri Cortex), and Ze Xie (Alismatis Rhizoma). In all cases of Wind stroke with spontaneous sweating and scanty urination, do not use diuretics. Since spontaneous sweating has already occurred, fluids have escaped externally, so urination should naturally be scanty. If diuretics are used, Ying and Wei will become depleted, failing to control Fire, making irritability and heat worse. One must wait for heat to subside and sweating to stop, then urination will resume naturally. Moreover, this syndrome belongs to the Yangming Meridian, where diuresis is strictly contraindicated.
Mental confusion and stupor: Caused by Errant Deficient Fire moving wildly, carrying Phlegm and Qi upward to rush against the Heart Master, obscuring it, leading to coma and unconsciousness. Large doses of Ren Shen (Ginseng Radix et Rhizoma), Xiong Diao (Ligustici Chuanxiong Rhizoma), Dang Gui, along with Chai Hu (Bupleuri Radix) and Shan Zhi (Gardeniae Fructus) are required. If confirmed as affecting the Pericardium rather than the Fu organs, and representing a Closed Syndrome rather than a Collapsing Syndrome, use Niu Huang Wan (Calculus Bovis Pill). For deficient patients, use Liu Jun Zi Tang plus Nan Xing (Arisaematis Cum Bile Radix), Xiang Fu (Cyperi Rhizoma), Shi Chang Pu (Acori Tatarinowii Rhizoma), Yuan Zhi (Polygalae Radix), Zhu Li, and Jiang Zhi. For manic talk, erratic speech, vague spirit, and profuse salivary phlegm, use Dao Tan Tang (Guiding Out Phlegm Decoction) plus Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Zhu Li, and Jiang Zhi.
Incontinence of urine: Due to Spleen deficiency sinking and Bladder failing to restrain, use Bu Zhong Yi Qi Tang plus Yi Zhi Ren (Alpiniae Oxyphyllae Fructus). Due to Kidney deficiency failing to grasp, use Di Huang Yin Zi (Rehmannia Elixir). If sudden onset with these symptoms and other critical signs indicates Kidney Exhaustion, it is untreatable.
Untreatable Syndromes: Hair standing erect, foaming at the mouth, shaking head and jerking upward, fish-mouth breath, fixed gaze, small or staring eyes, sawing sound in throat, flushed face like makeup, sweat like pearls, groping at clothing and bed, mental stupor without speech, cyanosis of head, face, limbs, and nail beds, severe vomiting and diarrhea, hematemesis and hematochezia, with pulses that are firm, restless, rapid, short, and choppy—all are untreatable.
Shi Wen stated: The category of Wind Stroke serves as the opening principle for miscellaneous diseases. Its differentiation of meridians and determination of Zang-Fu organs is no different from Shang Han (Cold Damage). Without mastering the profound principles of Zhang Zhongjing (Nanyang), one cannot discuss this. For instance, Northwest China experiences True Wind Stroke, while Southeast China experiences Pseudo-Wind Stroke. This provides a general outline for distinguishing appropriate treatments for various diseases. Although Shang Han treatments cover everything, their core intent was not explicitly revealed. The concept of "rigidity and flexibility of Water and Earth" applies not only to Wind Stroke. One must understand that the phrase "Northwest is True Wind Stroke" was originally set against the backdrop of Southeast China's weak Water and Earth. In the Southeast, although sudden collapse and coma occur, they are due to scattered Yuan Qi being invaded by Empty Wind; thus, harsh wind-expelling agents should not be used vigorously. Conversely, the phrase "Northwest is True Wind Stroke" contrasts with Southeast Pseudo-Wind Stroke, because the wind there is fierce and violent, invading without restraint, causing sudden collapse. It does not mean people in the Northwest never suffer from Wind Stroke due to true Qi deficiency. The Nei Jing clearly states that Yang Qi changes are named after the swift winds of heaven and earth. This proves Wind originates internally. However, because people in the Northwest have robust constitutions with abundant Wind and Fire, and external fierce Wind easily invades, Wind Stroke in the Northwest is twice as severe as in the Southeast. I have devoted myself to this field for fifty years. Diagnosing many patients in the Northwest, I found cases of aphasia and leg weakness, or urinary incontinence—are these not signs of lower Yuan exhaustion? Should we not treat them with Di Huang Yin Zi or San Sheng Yin? Regarding hemiplegia—is this not waste of blood vessels? Should we not treat with Jian Zhong Tang or Shi Quan Da Bu Tang? Does Pseudo-Wind Stroke in the Southeast lack exterior Six Meridian manifestations or interior bowel/bladder obstruction? Even if treated with Xu Ming Tang or San Hua Tang... As for Fang Tong Sheng San or Yu Feng Dan, even for Northwest True Wind Stroke, I have rarely tried them. When reading ancient texts, one must investigate the main principles and infer meaning; this is true understanding. Clinging rigidly to words creates obstacles; is this the fault of the sages? Each disease has meridian and organ distinctions, but sudden collapse requires careful examination. Ancient sages stated: Invasion of blood vessels causes facial deviation; invasion of Fu organs causes limb dysfunction. Both belong to Six Meridian syndromes. If Fu organs are invaded, bowel/bladder obstruction occurs. If Zang organs are invaded, life is endangered. This is merely a general outline. Are Zang organ invasions absolutely untreatable?
[Diagnosis] Shi Wen stated: Pulse patterns in Wind Stroke indicate internal deficiency of True Qi, allowing Wind Pathogen to breach defenses directly. Even in Southern Pseudo-Wind Stroke sudden collapse, whether attributed to Deficiency, Fire, or Phlegm, it ultimately stems from Kidney Qi decline failing to govern, resulting in pulses that fail to sink, instead showing floating and slow qualities driven by Empty Wind. Ancients said: Wind Stroke pulses often appear deep and hidden, or sometimes surging and full under the fingers. One must know that Wind Stroke patients are often obese with profuse phlegm, appearing excess on the outside but deficient within. Combined with sexual excess, this leads to sudden collapse. During the attack, Qi stagnates, causing deep/hidden pulses. Upon slight recovery, Qi surges, causing full pulses. These are all due to Wind, Fire, Phlegm, and Dampness. Generally, floating, small, slow, and weak pulses indicate survival; firm, large, and rapid pulses indicate danger. Floating-slow is the fundamental Wind Stroke pulse; combined with tightness indicates exterior pathogen; combined with largeness indicates Qi deficiency; combined with slowness indicates Cold deficiency; combined with rapidity indicates Heat deficiency; combined with slippery indicates Phlegm-Dampness—all treatable. Only combined with choppy quality indicates pulse-disease mismatch, a critical sign, as choppy pulses in Phlegm syndromes indicate righteous Qi failure and meridian blockage, hard to clear. Thus, Wind Stroke pulses most fear hidden/choppy irregularities, especially firm/large/rapid ones. Su Wen states: Stomach pulse deep and choppy, or externally full; Heart pulse small, firm, and urgent—all indicate Ge Disease (diaphragmatic constraint) or Pian Ku (hemiplegia). Men affect the left, women the right. If not aphasic and tongue moves, it is treatable. Thus, firm/urgent/choppy/hidden pulses are difficult to treat. Especially with aphasia and immobile tongue, indicating internal Kidney Qi decline.
Luo Qianfu treated Grand Commandant Shi Wuzhong, nearly seventy years old. In early October, serving the State Preceptor at Sheng'an Temple, a coal water vat was on his left. He felt slight sweating on his left cheek. Due to laxity on the left cheek, Wind-Cold invaded. The left cheek tightened, pulling the mouth to the right. Pulse was floating-tight, pressing revealed full-slow. First, moxa Jiache acupoint on the left cheek seven burns, then Jiache fourteen burns. Then applied hot hand compressions to the left cheek. Used Qin Jiao Sheng Ma Tang to disperse Wind-Cold. Recovered after several doses.
Zhao Yi-de treated Academician Chen Jingchu. During a ritual kowtow, he suddenly collapsed. Sweat poured like rain. Pulse was large and empty. Age fifty, recently married young wife, now subjected to kowtow labor, causing sudden dispersion of Yang Qi. Urgently decocted Du Shen Tang (Single Ginseng Decoction), drank continuously for half a day until sweating stopped. Spirit stabilized, limbs stiffened. Aphonic. Added Zhu Li to Du Shen Tang to open upper rushing Phlegm. Next morning, cried incessantly. Comforted verbally, he laughed. Continued laughing for five-seven days. This laughter/crying resulted from Yin Fire disturbing the stores of Spirit and Soul, merging energies. As Nei Jing states: Five Essences merge; Heart Fire merging Lung results in joy; Lung Fire merging Liver results in sorrow. Added Lian Qiao and Huang Bo to clear Fire. After eight days, laughter stopped, hands moved. After one month, could walk.
Li Shicai treated merchant Wang Huaquan. Suddenly collapsed, incontinent, hands released, sweat like pearls, unable to speak. Prognosis hopeless. But administered large doses of Ren Shen and Fu Zi to save him. Used 3 liang Ren Shen, 5 qian Shu Fu Zi, decocted thickly and forced down. By evening, sweating reduced. Second dose allowed body movement. Further used Ren Shen, Fu Zi, Bai Zhu, Jiang Zhi, Zhu Li. Gradually improved over days. Recovered after six months of tonic regulation.
Shi Wen treated Zhao Mingyuan, a successful jinshi candidate. Normally weak pulses. In September of Jiyou year, suffered Pseudo-Wind Stroke, unresolved for a year. Diagnosed by Shi Wen: Left hand three positions string-large-firm, indicating Kidney Yin injury and Strong Fire consuming Qi. Renying pulse slanting inward to cunkou indicates Three Yang Meridian fullness overflowing into Yang Wei vessel. Risk of collapse and numbness exists. Right hand three positions floating-slow, qi kou slightly slippery above, indicating stubborn Phlegm blocking the diaphragm. Clear Yang position occupied by Phlegm-Qi, invading Heart Master, causing unclear consciousness and erroneous speech. Others, seeing unclear consciousness, drooling, fixed eyes, assumed pathogen stagnating meridians, used wind-expelling/phlegm-guiding herbs. Unaware this is Kidney Qi failing to connect to Heart, Heart storing Deficient Heat generating Wind—not suitable for drying wind herbs. Others, seeing frequent clear urination, assumed Kidney deficiency, used Ba Wei Wan (Eight Ingredient Pill) to boost Fire. Unaware though deficient, Deficient Yang hides in Liver, causing easy erection and hunger—not suitable for fire-tonifying/yin-consuming herbs. Others, seeing history of chronic dysentery with bloody mucus, used Bu Zhong Yi Qi Tang. Unaware while Spleen Qi sinking can be lifted, this is residual from Yin-deficient chronic dysentery; what clear Qi is below to lift? Using Sheng Ma/Chai Hu to lift Liver/Kidney Deficient Yang would stir Phlegm-fluids above diaphragm, risking wheezing/bloating. Thus, lifting herbs are unsuitable. Now using He Jian's Di Huang Yin Zi to assist Kidney and unblock Heart, achieving two goals. But without diet restriction and sexual abstinence, medicine alone is useless. Wisdom in self-care is paramount.
Also treated Lady Jin Hanguang, concubine of Imperial Guard. Wind Stroke, limbs immobile, wheezing with shoulder breathing, sawing sound, unable to lie flat, fasting for over half a month. Diagnosed by Shi Wen: Right cunkou/guan positions rapid-large, pressing weak, chi positions more deficient. Left guan/chi string-rapid, pressing smaller, cunkou only rapid-full. Occasional dizziness/confusion. Previous meds: Er Chen Tang, Dao Tan Tang mixed with Qin Jiao/Tian Ma—ineffective. Niu Huang Wan worsened Phlegm/Qi, increasing danger. Prescribed Liu Jun Zi Tang, sometimes adding Dan Xing/Zhu Li, or Huang Lian/Dang Gui. Four doses cleared wheezing. Several more doses improved diet/sleep. Four more doses restored limb movement. Over ten doses, could walk slowly indoors. Realized previous meds weren't wrong, but Phlegm was too heavy to bear. Harsh use of Ren Shen/Bai Zhu to raise Stomach Qi while clearing Phlegm damaged Middle Qi, hence failure.
Also treated Madam Gu Ezai, wife of Magistrate of Hanchuan. Elderly, Qi deficient, Phlegm abundant. Son Gu Han appointed far away in Guangxi, causing depression. Mid-Spring, 14th night, fell from bed. Tongue stiff, aphasic, limbs paralyzed. Ate wet noodles that day. Doctors advised digestion-promoting herbs, ineffective, worsening fatigue/coma, head/neck swelling. Emergency diagnosis: All pulses weak/soft/useless. Doctors noted constipation 6-7 days, suggested purgatives. Shi Wen said: No solid knot in pulse, how can one purge rashly? Family stated habitual spleen constraint, bowel movements every 5-7 days, difficult. Advised trial of millet gruel to move intestinal pivot. Daily Liu Jun Zi Tang with 2 qian Ren Shen, decocted warm, divided into three doses. After four doses, could turn over, bowel opened naturally. Four more doses, limbs functional, sat up. Within days, walked with support. Warned attendants to prevent falls due to Qi deficiency/Phlegm abundance.
Also treated Mr. Shen Yunbu of Songling. Retired, prone to Phlegm and numbness. To prevent Pseudo-Wind Stroke, consulted Shi Wen. Prescribed Liu Jun Zi Tang, effective. Disliked medicine. Autumn came, limbs became less mobile. Resumed treatment. Pulse soft-slippery with slight knot. Removed Ju Pi from previous formula, added Dang Gui, Rou Cong Rong, Ba Ji Tian. Balanced for half a month, stable. However, lifestyle moderation is key to lasting health; medicine alone cannot guarantee perfection.