小儿五岁以下。血气未盛。经脉未充。无以别其脉象。故以食指络脉之象彰于外者察之。
食指第一节寅位。为风关。第二节卯位。为气关。第三节辰位。为命关。以男女左右为则。
纹色紫曰热。红曰伤寒。青曰惊风。白曰疳疾。淡黄隐隐为无病。黑色曰危。在风关为轻。
气关为重。命关为危。脉纹入掌为内钓。纹弯里为风寒。纹弯外为食积。及五岁以上。乃以
一指取寸关尺之处。常以六至为率。加则为热。减则为寒。皆如诊大人法。
小儿脉乱身热。汗出不食。食即吐。多为变蒸。小儿四末独冷。鼓栗恶寒。面赤气粗。
涕泪交至必为痘疹。
半岁以下。于额前眉端发际之间。以名中食三指候之。食指近发为上。名指近眉为下。
中指为中。三指俱热。外感于风。鼻塞嗽咳。三指俱冷。外感于寒。内伤饮食。发热吐泻。
食中二指热。主上热下冷。名中二指热。主夹惊。食指热。主食滞。
猝倒无知。牙关紧闭。痰涎上壅。危在顷刻是也。李东垣主气虚。刘河间主火盛。朱丹
溪主湿盛生痰。三子皆言中风之因。如作文之推原法。薛立斋赵养葵。言真水竭。真火虚。
肝郁脾伤。及诸虚所致。更推展言之。总非正面文本。其曰风者。主外来之邪风而言也。其
曰中者。如矢石之中于人也。此时因风治风。尚恐不及。其他奚论焉。小续命汤为第一诸说。
不足凭也。若谓是气虚火盛痰多水竭火虚肝郁脾伤及诸虚所致。为病日久。即未中风之前。
以大剂调养。非一两月不效。岂于既中风之际。死生只在顷刻。尚可以一剂。回其气虚。平
其火势。清其痰源。滋其肾水。温其命火。及疏肝健脾。补养诸虚乎。必无是理也。如牛黄
脑麝。及市上驰名丸药。人尚知其劫伤元气。不敢轻投。而数家之书。言似近理。其实伪君
子之为害。更甚于真小人。（念祖）为活人计。不敢不得罪前人。而直辨其非。
脉喜浮大。（浮者。邪尚在腑也。大者。风为阳邪。阳症见阳脉也。若浮大鼓指。恐邪
盛正衰。元气欲脱。）忌沉小。（沉者。邪入脏也。小者。正气衰也。其沉小而气度和缓。来
去分明。乃是吉兆。）
中经有六经之形证。宜
小续命汤。（三十二）
中脏多滞九窍。故有唇缓失音鼻塞耳聋目瞀便秘之症。风自外来。故不外麻桂。手足抽
掣。故兼用归芍。二便阻隔。故用滑石硝黄。宜
防风通圣散。（五十六）
中腑多着四肢。故有半身不遂手足不随左瘫右痪之形。
中血脉。外无六经之形症。内无便弱之阻隔。唯口眼 斜。或左或右。
偏左。宜六君子汤。盖左半虽血为主。非气以统之。则不流也。（二）
偏右。宜四物汤。盖右半虽气为主。非血以丽之。则易散也。（九）
二汤俱加竹沥姜汁。以行经络之痰。再加僵蚕钩藤天麻羚羊角。以熄风活络。或加附子
以固阴。肉桂以通阳。黄 以胜风。
中风不语。宜
资寿解语汤。（三十九）
舌强不能言。足废不能行。宜
地黄饮子。（三十）
中风死症。多是风中带寒。其症。口开为心绝。手撒为脾绝。眼合为肝绝。遗尿为肾绝。
声如鼾睡为肺绝。汗出如油为元气内绝。发直目上视。面赤如妆。汗缀如珠。法在不治。用
药若迟数刻。即死矣。急用三生饮一两。加人参一两。（一百零四）
按三生饮中。近时附子俱以盐腌过乌头。非四川产者无力。愚用熟附子一两。干姜五钱。
炙甘草四钱。一服汗略止。再服眼睛略动。三服加人参三钱。渐有生意。必须半日服三剂。
中风愈后。照刘朱李薛诸法。缓缓调治之。
愚按。开窍以驱风。非是正法。内经重在填窍。金匮有侯氏黑散风引汤二方。是补天手
段。
附小续命汤六经加减并针灸法
如中风无汗恶寒。根据本方。麻黄杏仁防风各加一倍。又宜针至阴出血。（穴在足小指外
侧甲角。针一分。）昆仑。（穴在足外踝后踝骨。针透太溪。）○如中风有汗恶风。根据本方桂
枝芍药杏仁各加一倍。又宜针风府。（穴在项后入发一寸。针入三分。禁灸。）以上二症。皆
太阳经中风也。如中风有汗。身热不恶寒。根据本方。加石膏知母各二钱。甘草再加一倍。去
附子。○如中风有汗。身热不恶风寒。本方加葛根桂枝黄芩再加一倍。宜针陷谷。（穴在足
大趾次指外间骨节后陷中。针入五分。）去阳明之贼。兼刺厉兑。（穴在足大趾次趾端去爪甲
如韭叶许。）以泻阳明之实也。以上二症。皆阳明经中风也。
如中风无汗身凉。根据本方。附子加一倍。干姜加二倍。甘草加二倍。又宜刺隐白。（穴
在足大趾内侧。去爪甲角如韭叶。）去太阴之贼。 此太阴经中风也。如中风有汗无热。根据
本方。桂枝附子甘草各加一倍。又宜针太溪。（穴在足内踝后跟骨上陷中。针透昆仑。）此少
阴经中风也。
如中风六经混淆。系之于少阳。或肢节蛮痛。或麻木不仁。根据本方。加羌活连翘。又于
少阳之经纪骨穴。（在足外踝上三寸。灸五壮。）灸以引其热。取厥阴之井大敦穴。（在足大
趾甲聚毛间。）刺以通其经。 此少阳厥阴经中风也。
新按（受业侄凤腾注。诸书逐而散之。风散即为气散。生而亦死。兹法养以和之。气和
即
为风和。死可回生。为风症补千古所未及。）壬戌岁。（念祖）在保阳供职。
制宪熊大人召诊。诊得两手脉浓而长。唯左手兼些弦象两寸略紧。（念祖）谓脉浓得土
之
敦气。以浓道载浓福。脉长寿亦长。非谀语也。但弦为风脉。紧为痛脉。紧在两寸。恐上半
身有痹痛等症也。大人云。所言俱对。但背上及手腕痛。或愈或作。约有五年余。指头麻木。
十年前颇甚。今略麻而不木矣。（念祖）曰。风在骨节而作痛。妙在痛处。痛是气血与风邪
相
拒。非若偏枯之不痛也。书谓中指麻木。三年内必有中风之患。以中指属手。心主之经故也。
今拇指食指为甚。特肺与大肠之气不调。不甚为害。然必须治之于早也。
薛氏云。服风药。以预防中风。适以招风取中。（念祖）师其意。而不用其方。拟用黄
五物汤常服。
黄 桂枝尖 生芍药（以上各二钱） 生姜（四钱） 大枣（二枚擘） 水煎服。
昔人云。人在风中而不见风。犹鱼在水中而不见水。风。即气也。人在气交之中。得风
以生。即宋儒所谓和风一至。万物皆春是也。因风以害。即释氏所谓业风一吹。金石乌有是
也。人身五脏。而肝为风脏。乃生死之门户。无病。则风和而气息脉息俱和。不见其为风。
有病。则风疾而气息脉息亦疾。遂露出风象。甚至目直手足动摇抽掣汗出如珠痰涎如涌等症。
大显出风象。治之不及矣。唯指头麻木时。或眩运时。或历节作痛。病未甚而治之于先。则
肝得所养。斯不为风病矣。肝属木而主春。阳春有脚。能去而亦能来。别有所以留之之道。
吾于邵子之诗悟之。内经云。神在天为风。又曰。大气举之。庄子云。万物以息相吹也。孟
夫子谓塞乎天地之间。佛经以风轮主持大地。异同处实有一贯之道焉。兹方也。认定肝为风
脏。取桂枝通肝阳。芍药滋肝阴。阴阳不偏。是为和气。亦即和风也。盈天地间。皆风而皆
气。气贵善养。黄 之补。是养气章勿忘工夫。大枣之缓。是养气章勿助工夫。且倍以生姜
之雄烈。所以还其刚大浩然之体段。圣贤之一言一字。包函万有。自可以互证而益明。
又拟丸方。（时常服食之方。与救病之方不同。故取和平之药。与五谷五菜同功。古云
药以治病。食以丛丸。此方取义等于食物。即勿药意也。）
熟地黄（六两。） HT 潜白术（六两。米泔浸一宿。去皮切片。饭上蒸。） 怀山药
（三
两。生姜汁拌炒。） 甘枸杞（三两。隔纸烘。） 川附子（二两炒。） 上肉桂（一两去皮。
不
见火研。） 人参（二两。饭上蒸软。切片隔纸烘研。） 鹿茸（去毛切片。酥炙。勿伤焦。）
麦
冬（二两。绍酒润晒烘。） 五味子（二两。盐水浸炒味） 根据制研末。炼白蜜丸如桐子大。
用
朱砂
此方。与黄 五物汤相表里。黄 五物汤。补气以治风。所重在肝。肝为风脏。风者。
天地之噫气也。气和即风和。鼓舞动荡。无有不周。即孟子所谓塞乎天地之间是也。此方补
肾。亦是养肝。肝属木。为东方之生气。庄子云。野马也。尘埃也。生物之息以相吹也。然
而木生于水。乙癸同源。所重尤在于肾。内经云。肾藏志。又云。肾者。作强之官。夫曰作
强。则为刚大浩然之根本。即孟子所谓夫志气之帅是也。圣贤言包万有。虽养气章主学问而
言。而尊生之道。亦在其中。自汉医后。无一人谈及。鲜不以（念祖）之论为创。其实有所
本
而言。
方中。熟地补先天肾水。白术补后天脾土。然欲补肾。必先聚精。故取枸杞函精气之完
足。以佐熟地所不及。欲补脾。必先浓土。故取山药具土气之冲和。以佐白术所不及而为脾
肾之总根者。则在命门。命门之外。为两肾坎外之耦也。两肾之中。为命门。坎中之奇也。
方中。附子入命门血分。肉桂入命门气分。二药温养水脏。为生生之本。即邵康节先生所谓
地下有雷声。春光弥宇宙是也。又合生脉散（人参五味麦冬。）之酸甘化阴。俾辛热之阳药
不
。再加鹿茸为血气所长。较无情之草木倍灵。外以朱砂为衣者。取其色赤入心。
内经云。心藏神。肾藏志。朱子论语注云。心之所之之谓志是也。各家之说不足凭。而
内经为三坟之一。证之圣经贤训。字字相符。医与儒。原非二道也。
小儿五岁以下，气血尚未旺盛，经脉尚未充盈，无法辨别其脉象，因此通过观察食指络脉在体外的显现情况来进行诊断。
食指的第一节位于寅位，称为风关；第二节位于卯位，称为气关；第三节位于辰位，称为命关。以男女左右手为准则进行判断。
纹色紫表示热证，红表示伤寒，青表示惊风，白表示疳疾，淡黄隐隐表示无病，黑色表示病情危重。纹在风关表示病轻，在气关表示病重，在命关表示病危。脉纹进入手掌内，称为“内钓”；纹弯曲向里，表示风寒；纹弯曲向外，表示食积。等到五岁以上，才用一根手指诊察寸、关、尺三部脉位。通常以每息六至（脉搏跳动次数）为标准，超过则为热证，不足则为寒证，这些都如同诊治成年人的方法一样。
小儿脉象紊乱且身体发热，出汗且不进食，进食后即呕吐，多为变蒸（小儿生长发育过程中的生理现象）。小儿四肢末端唯独发冷，颤抖恶寒，面色发红，呼吸粗重，鼻涕眼泪交下，必定是痘疹（天花或麻疹等出疹性疾病）。
半岁以下的婴儿，在额前眉毛上方发际之间，用无名指和中指三指（注：原文此处表述略有歧义，结合上下文及中医儿科习惯，通常指用三指并拢候诊，或特指定位法，此处依原文直译）来候诊。食指靠近发际为上，无名指靠近眉毛为下，中指居中。如果三指都热，是外感风邪，伴有鼻塞、咳嗽；如果三指都冷，是外感寒邪，或内伤饮食，导致发热、呕吐、腹泻。如果只有中、食二指热，主上热下冷；如果只有名、中二指热，主夹惊（兼有惊风）；如果只有食指热，主食滞（食物积滞）。
突然跌倒无知觉，牙关紧闭，痰涎上涌堵塞气道，危急就在顷刻之间，这就是中风。李东垣主张是气虚所致，刘河间主张是火盛所致，朱丹溪主张是湿盛生痰所致。这三人都论述了中风的成因，就像写文章追溯源头一样。薛立斋和赵养葵认为这是真阴枯竭、真阳虚弱、肝郁脾伤以及诸种虚损所致。进一步推演来说，这些都不是针对急性发作的正面对策。所谓“风”，指的是外来邪风；所谓“中”，就像箭矢石头射中人一样。此时应当因风治风，尚恐来不及，其他说法又何必讨论呢？小续命汤作为首选方剂，其他的学说都不足为凭。如果说这是由气虚、火盛、痰多、水竭、火虚、肝郁、脾伤及诸虚所致，那么病程已久，在中风发作之前，就应该用大剂量药物调养，非一两个月不见效。难道在中风已经发作之际，生死只在顷刻之间，还可以靠一剂药就挽回气虚、平息火势、清除痰源、滋润肾水、温补命门之火，以及疏肝健脾、补养诸虚吗？这绝对没有道理。像牛黄、脑麝（冰片、麝香）以及市面上著名的丸药，人们尚且知道它们会劫夺损伤元气，不敢轻易投用，而这几家医书上的言论看似有理，其实伪君子的危害，比真小人更严重。（陈念祖）为了救人，不敢不得罪前人，直接辨析其错误。
脉象喜见浮大。（浮脉，说明邪气尚在腑；大脉，说明风为阳邪，阳证见到阳脉。如果浮大而按之鼓指有力，恐怕是邪气盛正气衰，元气欲脱。）忌见沉小。（沉脉，说明邪气入脏；小脉，说明正气衰败。但如果沉小而脉气和缓，来去分明，乃是吉兆。）
中经（邪气侵入经络）有六经的形证，宜用小续命汤。
中脏（邪气侵入脏腑）多阻滞九窍，所以有口唇松弛、失音、鼻塞、耳聋、视物模糊、便秘等症状。风从外来，所以不外乎使用麻黄、桂枝类解表药；手足抽搐掣动，所以兼用当归、芍药养血柔肝；大小便阻隔，所以用滑石、芒硝、大黄通利二便。宜用防风通圣散。
中腑（邪气侵入六腑）多留着于四肢，所以有半身不遂、手足不能随意运动、左瘫右痪的形态。
中血脉，外无六经的形症，内无二便不通的阻隔，唯有口眼歪斜，或向左或向右。偏左者，宜用六君子汤。因为左侧虽以血为主，但若无气统摄，则血液不流。（第二方）
偏右者，宜用四物汤。因为右侧虽以气为主，但若无血依附，则气易散逸。（第九方）
这两张方子都要加竹沥、姜汁，以通行经络中的痰浊；再加僵蚕、钩藤、天麻、羚羊角，以熄风通络。或者加附子以固护阴液，肉桂以通达阳气，黄芪以胜风。
中风死症，多是风中夹带寒邪。其症状表现为：口开为心绝，手撒为脾绝，眼合为肝绝，遗尿为肾绝，声如鼾睡为肺绝，汗出如油为元气内绝，头发直立、眼睛上翻、面色红润如化妆、汗珠凝结如珠，这些属于不治之症。用药若迟缓数刻，人就会死亡。急用三生饮一两，加入人参一两。
按：三生饮中，近时的附子多用盐腌制的乌头，如果不是四川产的则药力不足。我使用熟附子一两，干姜五钱，炙甘草四钱，服一剂后汗稍微止住，再服后眼睛稍微转动，第三服加入人参三钱，逐渐有了生机。必须半天内服用三剂。
中风痊愈后，按照刘完素、朱丹溪、李东垣、薛立斋等人的方法，缓缓调治。
我按：开窍驱风不是正法，《内经》重在填窍，《金匮要略》中有侯氏黑散和风引汤两方，这是补益先天的高明手段。
附：小续命汤六经加减法及针灸法
如果中风无汗、恶寒，依据本方，麻黄、杏仁、防风各加一倍。又适宜针刺至阴穴出血。（穴位在足小趾外侧甲角旁，针一分深。）昆仑穴。（穴位在足外踝后方跟骨上方，针透太溪穴。）○如果中风有汗、恶风，依据本方，桂枝、芍药、杏仁各加一倍。又适宜针刺风府穴。（穴位在项后入发际一寸处，针入三分深，禁灸。）以上两种症状，都是太阳经中风。
如果中风有汗、身热、不恶寒，依据本方，加石膏、知母各二钱，甘草再加一倍，去掉附子。○如果中风有汗、身热、不恶风寒，本方加葛根、桂枝、黄芩再加一倍。适宜针刺陷谷穴。（穴位在足大趾次趾外间骨节后陷中，针入五分深。）去除阳明经的贼邪，兼刺厉兑穴。（穴位在足大趾次趾端，去爪甲如韭菜叶宽许。）以泻阳明经的实邪。以上两种症状，都是阳明经中风。
如果中风无汗、身凉，依据本方，附子加一倍，干姜加二倍，甘草加二倍。又适宜刺隐白穴。（穴位在足大趾内侧，去爪甲角如韭菜叶宽许。）去除太阴经的贼邪。这是太阴经中风。
如果中风有汗、无热，依据本方，桂枝、附子、甘草各加一倍。又适宜针太溪穴。（穴位在足内踝后方跟骨上方陷中，针透昆仑穴。）这是少阴经中风。
如果中风六经混淆，归属于少阳经，或者肢节疼痛剧烈，或者麻木不仁，依据本方，加羌活、连翘。又在少阳经的颔厌穴（注：原文作“经纪穴”，疑为传抄错误或特定别名，通常少阳经穴较多，此处依原文保留“经纪穴”或推测为颔厌/悬钟等，但指令要求忠实原文，故保留原词意译或直译，此处译为“少阳经的经纪穴”），灸五壮，以引导热气。取厥阴经的井穴大敦穴。（穴位在足大趾甲丛毛间。）刺之以疏通经络。这是少阳经和厥阴经中风。
新按（受业侄凤腾注：诸书逐风散邪，风散即为气散，生气亦死。此法以调和为主，气和即为风和，死可回生，为风症补充了千古未及之法。）壬戌年，我在保定供职时，制宪熊大人召我去诊病。诊得两手脉象浓而长，唯左手兼有些许弦象，两寸略紧。我对他说：脉象浓，得到土之敦厚之气，以浓道承载浓福，脉长寿亦长，这不是谀媚之语。但弦为风脉，紧为痛脉，紧脉在两寸，恐怕上半身有痹痛等症状。大人说：所言都对，但我背上及手腕疼痛，时好时犯，约有五年多，指头麻木，十年前很严重，现在只是略麻而不木。我说：风在骨节作痛，妙在痛处，痛是气血与风邪相抗拒，不像偏枯那样不痛。书上说中指麻木，三年内必有中风之患，因为中指属手少阴心经。现在拇指食指甚为明显，特别是肺与大肠之气不调，不太严重，但也必须早治。
薛氏说：服用风药以预防中风，恰好是招风取中。我师承其意，但不采用其方，拟定用黄芪桂枝五物汤常服。
黄芪、桂枝尖、生芍药（以上各二钱）、生姜（四钱）、大枣（二枚掰开），水煎服。
古人说：人在风中而不见风，犹鱼在水中而不见水。风，就是气。人在气交之中，得风以生，即宋儒所说的“和风一至，万物皆春”。因风而受害，即释氏所说的“业风一吹，金石乌有”。人身五脏，肝为风脏，是生死之门户。无病时，风和而气息脉息俱和，不见其为风；有病时，风疾而气息脉息亦疾，遂露出风象，甚至目直、手足动摇抽掣、汗出如珠、痰涎如涌等症状，大显出风象，治疗就来不及了。只有在指头麻木时，或眩晕时，或历节作痛，病未甚而先治之，则肝得所养，就不成为风病了。肝属木而主春，阳春有脚，能去也能来，别有留之之道。我从邵雍的诗中悟到了这一点。《内经》说：神在天为风，又说：大气举之。庄子说：万物以息相吹也。孟子说：塞乎天地之间。佛经以风轮主持大地，异同之处实有一贯之道。此方认定肝为风脏，取桂枝通肝阳，芍药滋肝阴，阴阳不偏，是为和气，亦即和风。盈天地间，皆风而皆气。气贵善养，黄芪之补，是养气章中勿忘的工夫；大枣之缓，是养气章中勿助的工夫。且加倍使用生姜之雄烈，所以恢复其刚大浩然之体段。圣贤的一言一字，包函万有，自可以互证而益明。
又拟定丸方。（时常服食的方子，与救病的方子不同，所以取和平的药物，与五谷五菜同功。古云：药以治病，食以充肠。此方取义等于食物，即不用药的意思。）
熟地黄（六两）、制何首乌（六两，米泔水浸泡一夜，去皮切片，饭上蒸）、怀山药（三两，生姜汁拌炒）、甘枸杞（三两，隔纸烘）、川附子（二两炒）、上肉桂（一两去皮，不见火研）、人参（二两，饭上蒸软，切片隔纸烘研）、鹿茸（去毛切片，酥炙，勿烧焦）、麦冬（二两，绍酒润晒烘）、五味子（二两，盐水浸炒）。根据法制研末，炼白蜜丸如梧桐子大，用朱砂为衣。
此方与黄芪桂枝五物汤相表里。黄芪桂枝五物汤补气以治风，所重在肝，肝为风脏，风者，天地之噫气也。气和即风和，鼓舞动荡，无有不周，即孟子所谓塞乎天地之间是也。此方补肾，亦是养肝。肝属木，为东方之生气。庄子说：野马也，尘埃也，生物之息以相吹也。然而木生于水，乙癸同源，所重尤在于肾。《内经》说：肾藏志，又说：肾者，作强之官。夫曰作强，则为刚大浩然之根本，即孟子所谓夫志气之帅是也。圣贤之言包涵万有，虽然养气章主要讲学问而言，但尊生之道，亦在其中。自汉以后，无一人谈及，很少有人不以我的论断为创新，其实是有根据而言。
方中，熟地补先天肾水，白术补后天脾土。然欲补肾，必先聚精，故取枸杞含精气之完足，以佐熟地所不及。欲补脾，必先厚土，故取山药具土气之冲和，以佐白术所不及。而为脾肾之总根者，则在命门。命门之外，为两肾坎卦之外的偶爻；两肾之中，为命门，坎卦之中的奇爻。方中，附子入命门血分，肉桂入命门气分，二药温养水脏，为生生之本，即邵康节先生所谓“地下有雷声，春光弥宇宙”是也。又合生脉散（人参、五味子、麦冬）之酸甘化阴，使辛热之阳药不燥。再加鹿茸为血气所长，较无情之草木倍灵。外以朱砂为衣者，取其色赤入心。《内经》说：心藏神，肾藏志。朱熹《论语》注说：心之所之之谓志是也。各家之说不足为凭，而《内经》为三坟之一，证之圣经贤训，字字相符。医与儒，原非二道也。
Children under five years of age have not yet developed vigorous *Qi* and blood, and their meridians are not yet filled, making it impossible to distinguish their pulse conditions. Therefore, diagnosis is made by observing the manifestation of collateral vessels on the index finger.
The first segment of the index finger, located at the Yin position, is called the Wind Gate (Feng Guan). The second segment, at the Mao position, is called the Qi Gate (Qi Guan). The third segment, at the Chen position, is called the Life Gate (Ming Guan). Diagnosis follows different standards for males and females, left and right hands.
A purple color in the vessel indicates Heat; red indicates Cold Damage (Shang Han); green/blue indicates Wind Convulsion (Jing Feng); white indicates Infantile Malnutrition (Gan Ji); a faint yellow hue indicates health; black indicates critical condition. If the vessel is at the Wind Gate, the illness is mild; at the Qi Gate, it is severe; at the Life Gate, it is critical. If the vessel extends into the palm, it is termed "Internal Hook" (Nei Diao). A vessel curving inward indicates Wind-Cold; curving outward indicates Food Stagnation. For children over five years old, the pulse at the Cun, Guan, and Chi positions is taken with one finger. The normal rate is six beats per respiration. An increased rate indicates Heat; a decreased rate indicates Cold. These methods are the same as those used for adults.
If a child has a chaotic pulse, fever, sweating, anorexia, and vomiting immediately after eating, it is likely due to Bian Zheng (a physiological developmental process in infants). If a child's four extremities are cold while the rest of the body is warm, accompanied by shivering, aversion to cold, flushed face, coarse breathing, and copious nasal discharge and tears, it indicates Dui Zhen (smallpox or measles).
For infants under half a year old, diagnosis is performed at the hairline between the forehead and eyebrows using three fingers. The index finger near the hairline represents the upper area; the ring finger near the eyebrows represents the lower area; the middle finger represents the middle area. If all three areas are hot, it indicates external Wind invasion with nasal congestion and cough. If all three are cold, it indicates external Cold invasion or internal injury from diet, leading to fever, vomiting, and diarrhea. Heat in the middle and index fingers indicates upper heat and lower cold. Heat in the ring and middle fingers indicates concurrent Wind Convulsion. Heat in the index finger alone indicates Food Stagnation.
Sudden collapse with loss of consciousness, locked jaw, and phlegm-saliva obstructing the airways constitute a critical emergency known as Stroke (Zhong Feng). Li Dongyuan attributed it to Qi deficiency; Liu Hejian to Fire excess; Zhu Danxi to Dampness generating Phlegm. All three explained the etiology of Stroke like tracing the origin in writing. Xue Lizhai and Zhao Yangkui attributed it to exhaustion of True Water (Kidney Yin), deficiency of True Fire (Kidney Yang), Liver Qi stagnation, Spleen injury, and various deficiencies. Further elaborating, these views do not address the acute phase directly. "Wind" here refers to exogenous pathogenic Wind; "Zhong" means being struck, like an arrow or stone hitting a person. At this moment, treating the Wind is urgent; other theories are secondary. Xiao Xuming Tang is the primary formula; other theories are unreliable. If Stroke were caused by chronic Qi deficiency, Fire excess, Phlegm, water exhaustion, etc., treatment should have begun long before the attack with large doses over months. It is illogical to expect a single dose to reverse Qi deficiency, calm Fire, clear Phlegm, nourish Kidney Water, warm Mingmen Fire, soothe the Liver, strengthen the Spleen, and tonify all deficiencies during the acute, life-threatening moments of Stroke. Medicines like Niuhuang Naoxue Wan (Calculus Bovis, Borneol, Moschus pills) are known to deplete Yuan Qi and are not lightly administered. Yet, these books present seemingly reasonable arguments that are actually more harmful than open falsehoods. (Chen Nianzu) dares to offend predecessors to save lives, directly refuting these errors.
A floating and large pulse is favorable. (Floating indicates the pathogen is still in the Fu organs; Large indicates Wind is a Yang pathogen, and a Yang syndrome presents with a Yang pulse. However, if the pulse is floating, large, and forceful upon pressure, it suggests pathogen excess and Zheng Qi depletion, with Yuan Qi about to escape.) A deep and small pulse is unfavorable. (Deep indicates the pathogen has entered the Zang organs; Small indicates Zheng Qi decline. However, if the pulse is deep and small but gentle, regular, and distinct, it is a good omen.)
When the pathogen enters the Meridians (Zhong Jing), presenting with Six Meridian symptoms, Xiao Xuming Tang is indicated.
When the pathogen enters the Viscera (Zhong Zang), it often blocks the nine orifices, causing symptoms such as flaccid lips, aphasia, nasal congestion, deafness, blurred vision, and constipation. Since the Wind comes from outside, Ma Huang Tang or Gui Zhi Tang derivatives are used. For limb twitching and spasms, Dang Gui and Bai Shao are added to nourish blood. For obstruction of urination and defecation, Hua Shi, Mang Xiao, and Da Huang are used. Fang Feng Tong Sheng San is indicated.
When the pathogen enters the Fu organs (Zhong Fu), it tends to affect the limbs, causing hemiplegia, inability to move limbs, left paralysis, or right hemiparesis.
When the pathogen affects the Blood Vessels (Zhong Xue Mai), there are no Six Meridian exterior symptoms nor internal obstruction of bowels/bladder, only facial deviation (mouth and eyes skewing to one side). If deviated to the left, Liu Jun Zi Tang is indicated because the left side is governed by Blood, which requires Qi to circulate. If deviated to the right, Si Wu Tang is indicated because the right side is governed by Qi, which requires Blood to anchor. Both formulas should be combined with Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice) to resolve meridian Phlegm, plus Jiang Can, Gou Teng, Tian Ma, and Ling Yang Jiao to extinguish Wind and unblock collaterals. Fuzi may be added to secure Yin, Rou Gui to unblock Yang, and Huang Qi to dispel Wind.
For stroke-induced aphasia, Zi Jie Jie Yu Tang is indicated.
For tongue stiffness preventing speech and leg weakness preventing walking, Di Huang Yin Zi is indicated.
Fatal cases of stroke are often Wind combined with Cold. Symptoms include: open mouth indicating Heart failure; relaxed hands indicating Spleen failure; closed eyes indicating Liver failure; urinary incontinence indicating Kidney failure; snoring sound indicating Lung failure; oily sweat indicating internal collapse of Yuan Qi; straightened hair, upward staring eyes, flushed face like makeup, and pearl-like beads of sweat indicate untreatable conditions. Delay in medication by even minutes leads to death. Immediately administer San Sheng Yin (1 liang) with Ren Shen (1 liang).
Note: In modern San Sheng Yin, Fuzi is often salted Aconitum carmichaelii root lateral preparations, which lack potency unless sourced from Sichuan. I use Shu Fu Zi (1 liang), Gan Jiang (5 qian), and Zhi Gan Cao (4 qian). After one dose, sweating stops slightly; after two doses, eyes move slightly; after three doses, add Ren Shen (3 qian), and vitality gradually returns. Three doses must be taken within half a day.
After recovery from stroke, gradual调理 (regulation) should follow the methods of Liu, Zhu, Li, and Xue.
My commentary: Opening orifices to drive out Wind is not the orthodox method. Nei Jing emphasizes filling the orifices. Jin Gui Yao Lue contains Hou Shi Hei San and Feng Yin Tang, which are superior methods for tonifying Heaven (Congenital Essence).
Appendix: Modifications of Xiao Xuming Tang for the Six Meridians and Acupuncture Methods
If stroke presents with no sweat and aversion to cold, follow the base formula, doubling Ma Huang, Xing Ren, and Fang Feng. Also, prick Zhi Yin (BL67) to bleed. (Location: lateral corner of the fifth toenail, needle 1 fen.) Kunlun (BL60). (Location: posterior to the lateral malleolus, needle through to Taixi.) ○ If stroke presents with sweat and aversion to wind, follow the base formula, doubling Gui Zhi, Bai Shao, and Xing Ren. Also, prick Fengfu (DU16). (Location: 1 cun below the posterior hairline, needle 3 fen, moxibustion prohibited.) These two conditions are both Taiyang Meridian stroke.
If stroke presents with sweat, fever, and no aversion to cold, follow the base formula, adding Shi Gao and Zhi Mu (2 qian each), doubling Gan Cao, and removing Fuzi. ○ If stroke presents with sweat, fever, and no aversion to wind or cold, double Ge Gen, Gui Zhi, and Huang Qin in the base formula. Prick Xiangu (ST41). (Location: distal to the metatarsophalangeal joint of the second toe, needle 5 fen.) To eliminate the thief of the Yangming Meridian, also prick Lidui (ST45). (Location: lateral corner of the nail of the second toe, width of a leek leaf.) To drain Yangming Excess. These two conditions are both Yangming Meridian stroke.
If stroke presents with no sweat and cool body, follow the base formula, doubling Fuzi, tripling Gan Jiang, and tripling Gan Cao. Also, prick Yinbai (SP1). (Location: medial corner of the nail of the big toe, width of a leek leaf.) To eliminate the thief of the Taiyin Meridian. This is Taiyin Meridian stroke.
If stroke presents with sweat and no fever, follow the base formula, doubling Gui Zhi, Fuzi, and Gan Cao. Also, prick Taixi (KI3). (Location: depression between the medial malleolus and Achilles tendon, needle through to Kunlun.) This is Shaoyin Meridian stroke.
If stroke involves confusion of the Six Meridians, associated with Shaoyang, presenting with severe joint pain or numbness, follow the base formula, adding Qiang Huo and Lian Qiao. Moxa Ji Jing acupoint (Location: 3 cun above the lateral malleolus, 5 moxa cones) to guide heat. Prick Dadun (LR14), the Jing-Well point of Jueyin. (Location: dorsal aspect of the big toe, proximal to the nail margin.) To unblock the meridian. This is Shaoyang-Jueyin Meridian stroke.
New Commentary (Annotated by nephew Feng Teng: Previous texts scatter Wind, scattering Qi along with it, leading to death. This method harmonizes; harmony brings peace, reviving the dead. It supplements what was missing for millennia.) In the year Ren Xu, while serving in Baoding, Governor Xiong summoned me for consultation. His pulses were thick and long, with a slight wiry quality on the left and tightness at both Cun positions. I said: A thick pulse reflects the stability of Earth element; carrying fortune with thickness, longevity follows length. This is not flattery. But wiry indicates Wind, tight indicates Pain. Tightness at the Cun positions suggests Bi pain in the upper body. The Governor replied: Correct. I have had back and wrist pain, intermittent for over five years, and finger numbness, severe ten years ago, now mild. I said: Wind pain in joints is distinguished by pain, caused by the struggle between Qi/Blood and Wind, unlike hemiplegia which is painless. Texts state that numbness of the middle finger predicts stroke within three years, as it belongs to the Hand-Shaoyin Heart Meridian. Now, the thumb and index finger are prominent, indicating imbalance in Lung and Large Intestine Qi. It is not severe but must be treated early.
Xue stated: Using Wind-dispelling drugs to prevent stroke invites Wind. I adopted his intent but not his formula, prescribing Huang Qi Wu Wu Tang for daily use.
Huang Qi, Gui Zhi Jian (tip), Sheng Bai Shao (2 qian each), Sheng Jiang (4 qian), Da Zao (2 pieces), decoct in water and drink.
Ancients said: One is in the Wind but does not see it, like a fish in water. Wind is Qi. Humans live in the intersection of Qi; benefiting from Wind is like Song Confucius saying "gentle wind brings spring." Harm from Wind is like Buddhist teaching "karmic wind destroys metal and stone." Among the five viscera, the Liver is the Wind Organ, the gate of life and death. Healthy: Wind is harmonious, breath and pulse are harmonious, Wind is invisible. Sick: Wind is rapid, breath and pulse are rapid, revealing Wind signs like staring eyes, limb spasms, oily sweat, surging phlegm. Treatment becomes futile. Only when numbness, dizziness, or joint pain occurs, before severity, can the Liver be nourished to prevent Wind disease. Liver belongs to Wood and governs Spring. Spring comes and goes; there is a way to retain it. I learned this from Shao Yong's poetry. Nei Jing says: Spirit in Heaven is Wind; Great Qi supports it. Zhuangzi says: All things breathe together. Mencius says: Fills heaven and earth. Buddhism says: Wind Wheel supports the earth. There is a consistent Dao. This formula identifies the Liver as the Wind Organ. Gui Zhi unblocks Liver Yang; Bai Shao nourishes Liver Yin. Balance creates Harmonious Qi, i.e., Gentle Wind. Everything is Wind and Qi. Qi needs nurturing. Huang Qi tonifies, following the "do not forget" principle of nurturing Qi. Da Zao moderates, following the "do not force" principle. Ginger restores the robust, vast nature. Sages' words contain everything.
Another Pill Formula (for daily maintenance, different from emergency treatment, using mild herbs like food):
Shu Di Huang (6 liang), Zhi He Shou Wu (6 liang, soaked in rice water overnight, peeled, sliced, steamed), Huai Shan Yao (3 liang, stir-fried with ginger juice), Gan Gou Qi (3 liang, dried between paper), Chuan Fu Zi (2 liang, fried), Shang Rou Gui (1 liang, peeled, ground without fire exposure), Ren Shen (2 liang, steamed until soft, sliced, dried between paper, ground), Lu Rong (antler, sliced, fried in butter, avoid burning), Mai Dong (2 liang, moistened with Shaoxing wine, sun-dried), Wu Wei Zi (2 liang, stir-fried with salt water). Grind into powder, make pills with refined honey the size of tung seeds, coat with Cinnabar (Zhu Sha).
This formula corresponds to Huang Qi Wu Wu Tang. The latter tonifies Qi to treat Wind, focusing on the Liver (Wind Organ). Wind is the sigh of Heaven and Earth. Harmonious Qi is Gentle Wind, moving everywhere, like Mencius' description. This formula tonifies Kidney, which also nourishes Liver. Liver is Wood, Eastern Vital Qi. Zhuangzi: Wild horses [vapor], dust, living beings breathe together. Wood grows from Water; Yi and Gui share the same source; emphasis is on Kidney. Nei Jing: Kidney stores Zhi (Will). Kidney is the Official of Strength. "Strength" is the root of robust Qi, like Mencius' "Commander of Will and Qi." Sages' words encompass all. Although nurturing Qi focuses on learning, the Way of preserving life is included. No one discussed this since Han dynasty; my theory seems innovative but has roots.
In the formula, Shu Di tonifies congenital Kidney Water; Bai Zhu tonifies acquired Spleen Earth. To tonify Kidney, gather essence; Gou Qi completes essence, assisting Shu Di. To tonify Spleen, thicken Earth; Shan Yao provides Earth's harmony, assisting Bai Zhu. The root of Spleen and Kidney is Mingmen. Outside Mingmen are the two Kidneys (Yin lines of Kan trigram); inside is Mingmen (Yang line of Kan trigram). Fu Zi enters Mingmen Blood level; Rou Gui enters Mingmen Qi level. They warm the Water Organ, the root of life, like Shao Kangjie's "thunder underground, spring light fills the universe." Combined with Sheng Mai San (Ren Shen, Wu Wei Zi, Mai Dong) to transform sour/sweet into Yin, preventing the dryness of pungent-hot Yang herbs. Lu Rong enhances Blood and Qi, more effective than plants. Coating with Zhu Sha (Cinnabar) uses its red color to enter the Heart. Nei Jing: Heart stores Shen (Spirit); Kidney stores Zhi (Will). Zhu Xi on Analects: Where the heart goes is Zhi. Other theories are unreliable; Nei Jing is one of the Three Fens, matching sages' teachings. Medicine and Confucianism are one Dao.