问∶左手臂挛缩，不能伸举，手指拳缩，肩背重坠，有似筋牵引作痛，伸缩间骨节处筋作痛，左足大
指、中指常欲反张难屈，左手指掌时常作麻，指缝近掌处但觉有物夹于其间，左足底近前高突处如肿硬急
胀，摸之无形，步履时只多如一毡垫者，语言短涩，拜起头晕，口眼 斜，舌根痰缠，胸膈痰碍，咽中有
痰核，左肋下有痰核，不时打寒噤，嚏喷、呵欠便牵动手足之病，左耳、左面、左体使手或粗衣摸擦，则
皮肤痛，左腮、左项、左胁肋皆时常木而急，如有物粘贴其上，左体或头项或手足作痒，左眼时常泪流凝
不干，左口角似宽纵，左面上似虫蚁游行，被风吹袭，左鼻孔清涕出，即打嚏喷等症。
答∶大经小络贯串一身谓之脉。脉者，血之隧道也。血随气行，周流无停。筋者，周布四肢，百节络
联而束缚之。此属肝木得血以养之，则和柔缓而不急。脉皆起于手足指端，故十二经皆以手足名之，而
筋则无处无之。皮毛者，属肺，主外，而易于感冒。人身之血行于脉络，而外充于皮毛，渗透肌肉，滋养
筋骨，故百体和，运动无碍。若气滞则血滞，气逆则血逆，得热则瘀浊，得寒则凝泣，衰耗则营运不周，
渗透不遍，而外邪易侵矣。津液者，血之余，行乎脉外，流通一身，如天之清露。若血浊气滞，则凝聚而
为痰。痰乃津液之变，如天之露也。故云痰遍身上下无处不到，盖即津液之在周身者。津液生于脾胃，水
谷所乘，浊则为痰，故痰生于脾土也。所以古人论中风偏枯、麻木、酸痛、不举诸症，以血虚、死血、痰饮
为言，是论其致病之根源。至其得病，则必有所感触，或因风，或因寒，或因湿，或因酒，或因七情，
或劳力、劳心、房劳汗出，因感风寒湿气，遂成此病。此血病、痰病为本，而外邪为标。其病中于皮毛、血
脉、经络、肌肉、筋骨之间，而未入脏腑。故邪在皮毛、肌肉，则不知痛痒，麻木不仁，如有一物重贴于
其上，或如虫游行，或洒洒寒栗，或肿胀，或自汗，遇热则或痒，遇阴虚则沉重酸痛；邪入血脉、经络，
则手足指掌肩背腰膝重硬不遂，难于屈伸举动，或走注疼痛。所陈诸症，皆外自皮毛以至筋骨之病。凡脉
所经所络，筋所会所结，血气津液所行之处，皆凝滞郁遏不得流通而致然也，亦何必一一强度某病属某
经、某病属某脏，而杂治之哉！若邪入脏腑，则为危病，而难于用药，东垣书论之明矣。经云∶知其要
者，一言而终；不知其要，流散无穷。此之谓也。
愚按《难经》曰∶邪在气，气为是动；邪在血，血为所生病。经云∶阳之气，以天地之疾风名之。此风
非外来风邪，乃本气病也。故诸方多言皆由气体虚弱、荣卫失调，或七情过度，以致真气耗散，腠理不
密，邪气乘虚而入及其中也。然左半体者，肝肾所居之地；肝主筋，肾主骨，肝藏血，肾藏精；精血枯槁，
不能滋养，故筋骨偏废而不用也。河间曰∶风病多因热甚。俗云风者，言末而忘其本也。经云∶汗出偏
沮，使人偏枯。如树木一枝津液不到，则此枝枯槁，被风所害。由此观之，实因肝肾二经精血枯槁之所
致也。前症云云，亦当察其形症，审其兼变而治之，尤不可泥执于风。经曰∶三阴三阳发病为偏枯痿易，
四肢不举，亦未尝必指于风也。其真中者，当辨其中脏中腑而治之。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。此五者病深，多为难治。中血脉者，
外无六经之形症，内无便溺之阻隔，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，口歪，语涩，身重，怠惰嗜卧，肌
肤不仁，皮肉 动，腹胀不食，此中胃兼中脾也，用防风散之类。如右寸脉浮涩而短，必鼻流清涕，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。此皆言真中风之症治也。其间亦有气血之分焉。气虚而中者，右手足不仁，用六君子汤加钩藤、姜
汁、竹沥；血虚而中者，左手足不仁，用四物汤加钩藤、竹沥、姜汁；气血俱虚而中者，左右手足皆不
仁，用八珍汤加钩藤、姜汁、竹沥。
其与中风相类者，不可不别。如中于寒，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，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，丹溪所谓因湿土生痰，痰生热，热生风也，用清燥汤之类加竹沥、姜汁。因于火者，河间谓五志过极，
火盛水衰，热气怫郁，昏冒而卒仆也，用六味丸、四君子汤、独参汤之类；内有恚怒伤肝，阴火上炎者，
用小柴胡汤之类；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；食厥者，过于饮食，
胃气不能营运，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，因肾虚耗，气不归源，故昏冒也，用六味丸。此皆类于中风者也。
夫中风者，《内经》主于风，此真中风也。若河间主于火，东垣主于气，丹溪主于湿，皆是因火因气因
湿而为暴病暴死之症类中风，而非真中风也。治者审之！
卒中昏愦，口眼歪斜，痰气上涌，咽喉有声，六脉沉伏，此真气虚而风邪所乘，以三生饮一两，加人
参一两，煎服即苏。若遗尿，手撒，口开，鼾睡，为不治，用前药亦有得生者。三生饮乃行经络、治寒痰
之药，有斩关夺旗之功，每服必用人参两许，以祛其邪而补助真气。否则不惟无益，适足以取败矣。观先
哲用 附、参附等汤，其义可见。
大尹刘孟春，素有痰，两臂顽麻，两目流泪，服祛风化痰药，痰愈甚，臂反痛不能伸，手指俱挛。余
曰∶麻属气虚，误服前药，肝火炽盛，肝血干涸，筋无所养，虚而挛耳！当补脾肺、滋肾水，则风自息、
热自退、痰自清。遂用六味地黄丸、补中益气汤，不三月而痊。
一儒者，素勤苦，恶风寒，鼻流清涕，寒噤，喷嚏，属脾肺气虚，反服祛风之药，肢体麻倦，痰涎自
出，殊类风症。余以为风剂耗散元气，阴火乘其土位，以补中益气汤加麦门、五味子治之而愈。
举人于尚之，素肾虚积劳，足痿不能步履，后舌喑不能言，面色黧黑。余谓肾气虚寒，不能运及所
发，用地黄饮子治之而愈。后不慎调摄而复作，或用牛黄清心丸之类，发热痰甚，诚似中风，用祛风化痰
之类，小便秘涩，口舌干燥，仍用前饮及加减八味丸渐愈，又用补中益气汤而痊。
一膏粱之人，素不慎起居，忽失音不能语，神思昏愦，痰涎上涌。余谓河间云∶夫喑属肾经虚寒，其
气厥不至。《医学纲目》云∶少阴气至则啮舌，少阳气至则啮颊。今失音，肾气不能上接清阳之气也。不信，
仍用风药，后啮舌，始信余言。先用地黄饮子及六味地黄丸而愈。
仪部袁补之，患前症，不信余言，数服祛痰之剂，后啮舌而殁。
一男子，体肥善饮，舌本强，语涩，痰壅，口眼歪斜，肢体不遂。余谓脾虚湿热痰涎所致，用六君子、
煨干葛、山栀、神曲而愈。
外舅年六十余，素善饮，两臂作痛。余曰∶此脾虚有湿也。不信，恪服祛风治痰之药，更加麻木，发
热，体软，痰壅，腿膝拘痛，口噤，语涩，头目晕重，口角宽纵，痰涎流出，两月后遍身如虫行，搔起白屑，
始信。余曰∶臂麻体软，脾无用也；痰涎涌出，脾不能摄也；口斜语涩，脾气伤也；头目晕重，脾气不升
也；痒起白屑，脾气不能营也。遂用补中益气汤加神曲、半夏、茯苓，三十余剂诸症悉愈；又用参术膏而
痊。
一男子，元气素弱，或头目眩晕，或肢体倦热，仲夏因劳役，饮食不时，两手麻木，肢体倦怠。余以为
暑热伤元气，用人参益气汤而愈。
一男子，卒中，口眼歪斜，言语不出，恶见风寒，四肢拘急，脉浮而紧。此属脾胃受症，故舌本强而不
能言，用秦艽升麻汤治之稍愈，乃以补中益气汤加山栀治之而痊。
一妇人，怀抱郁结，筋挛骨痛，喉间似有一核，服乌药顺气等药，口眼歪斜，臂难伸举，痰涎愈多，
内热晡热，食少，体倦。余以郁火伤脾，血燥生风，用加味归脾汤加丹皮、山栀二十余剂，形体渐健，饮
食渐加；又用加味逍遥散十余剂，痰热少退，喉核少消；更用升阳益胃汤数剂，诸症渐愈，但臂不能伸，
此肝经血少而筋挛耳，用地黄丸而愈。
一产妇，两手麻木，服愈风丹、天麻丸，遍身皆麻，神思倦怠，晡热作渴，自汗盗汗。余谓气血俱虚，
用十全大补汤数剂，诸症悉退，又数剂而全愈，但内热，用加味逍遥散而痊。
一产妇，筋挛臂软，肌肉抽掣，皆属气血虚，用十全大补汤而痊。
问∶两腿自膝以下，或时内热，或骨中觉热，或有一点酸痛热者何？
答∶此血热也。但是风病，其血必热；惟其血热，故风寒之气一袭之，则外寒束内热而为痛。丹溪论痛
风，谓血热得寒，污浊凝滞，所以作痛。遇夜痛甚，行于阴也；遇风雨阴寒痛甚，寒湿胜也。又风病必血
燥，风木生火，故血热而燥。
愚按前论最为切当。临川陈先生云∶医风先医血，血行风自灭。盖肝藏血而主风，又肝气为阳为火，肝
血为阴为水。若肝火旺则肝血必虚，故凡风病多因肝经风火为患，当推五脏相胜相生，以益其血。经云∶
肾藏精而主骨，故肾虚者则骨中热，或涌泉穴，或两胫、两足内热，多患骨痿，以致不起，属足三阴亏损
之虚热耳！滋其化源，庶可保其生也。
佥宪高如斋，两腿逸则筋缓痿软而无力，劳则作痛如针刺，脉洪数而有力。余曰∶此肾肝阴虚火之象
也，用六味地黄丸而愈。
知州韩廷仪，先患风症，用疏风、化痰、养血之药而痊。其腿膝骨内发热作痛，服十味固本丸、天麻
丸益甚，两尺脉数而无力。余以为肾水虚不能生肝木，虚火内动而作，非风邪所致也。不信，又服羌活
愈风丹之类，四肢痿软，遍身麻木，痰涎上涌，神思不清。余曰∶皆脾气亏损，不能营养周身，又不能摄
涎归源。先用六君子加芎、归、木香数剂，壮其脾气以摄涎归源；又以八珍汤数剂，以助五脏生化之气，
以荣养周身，而诸证渐愈。乃朝以补中益气汤培养脾肺，夕以六味地黄丸滋补肝肾，如此三月余而安。
一妇人，因怒患痰厥而苏，左手臂不能伸，手指麻木，口 眼斜，痰气上攻，两腿骨热，或骨中酸
痛，服乌药顺气散之类，诸症益甚，不时昏愦，更加内热晡热。余以为肝经血虚，内热生风，前药复耗肝
血，虚火炽盛而益甚也。先以柴胡栀子散，调养肝经气血；数日后用八珍汤加钩藤钩散，诸症稍愈；又用
加减八味丸料，少加酒炒黄柏、知母黑色者数剂，诸证顿退；乃服八珍汤、柴胡栀子散，半载而痊。后劳
役即有复作之意，服柴胡栀子散随安。
问∶有医教以四物汤、二陈汤间服，后惑于南星、半夏不可轻服之言，二陈通不入口，专用四物，
而痰药亦少用，枳术丸可专服否？
答∶此少瘥耳。用血药而无行痰、开经络、达肌表之药以佐之，血药属阴，性颇凝滞，焉能流通经络、
驱逐病邪以成功也！故古人以乌头为半身不遂行经络
者此也。盖风疾原于血虚血热挟火与痰，经络肌表之间病根在矣，后因感冒凉风寒气，或因过饮助痰火，
或因恼怒逆肝气，遂成半身不遂之症。世谓之风病，其病成于肌表皮毛筋骨经络之间，未入五脏六腑，故
治之亦兼在外，而不专于内。若只用四物汤，是专补内也。此病之痰亦在经络，若只用枳术丸，是亦专治
内也。须补养其内以固本，攻治其外以去邪，斯为可耳！
愚按前症若因肾虚阴火而肝燥者，宜用六味地黄丸生肾水滋肝血；若因怒动肝火而血耗者，用四物加
柴、栀、丹皮、茯苓以清肝火、生肝血；若因脾经郁结而血耗者，用归脾、四物二汤以补脾气、生肝血；
若脾气虚而痰滞者，用二陈加白术、柴胡健脾气以化痰；若因脾虚湿而风痰不利者，用二陈加南星、苍术、
防风胜湿以化痰；脾经湿而为痰者，用二陈加白术、防风；脾气郁而滞者，用归脾汤加柴胡、半夏；肾经
败液而为痰者，用六味丸。
顾宪幕，年六十，不慎饮食起居，左半身手足不遂，汗出痰壅，或用参、 之类，汗止，神清，左腿
自膝至足指仍旧肿坠，痰多，作痛，肝、肾、脾脉洪大而数，重按则软涩。余以为足三阴虚，朝用补中益
气汤加黄柏、知母数剂，诸症悉退，但自弛守禁，不能全愈。
问：左手臂拘挛收缩，不能伸展举起，手指握拳蜷缩，肩背沉重下坠，症状类似筋脉被牵引而疼痛，在伸缩时骨节处的筋脉会疼痛；左脚大拇指和中指经常想要反张难以弯曲，左手手掌和手指时常感到麻木，手指缝靠近手掌处只觉得有东西夹在中间；左脚脚底前方高突处感觉像肿胀坚硬急胀，但触摸时没有形状，走路时只感觉多了一层毡垫；说话短促涩滞，行礼起立时头晕，口眼歪斜，舌根有痰缠绕，胸膈部有痰阻碍，咽喉中有痰核，左肋下有痰核，不时打寒战，打喷嚏、呵欠时会牵动手足发病；左耳、左脸、左侧身体只要用手或粗糙衣服摩擦，皮肤就会疼痛；左侧腮部、左侧颈部、左侧胁肋都时常麻木且紧急，好像有东西粘贴在上面；左侧身体或者头颈或者手足发痒；左眼经常流泪凝结不干；左嘴角似乎松弛宽大；左脸上好像有虫蚁爬行；受风吹袭后，左鼻孔流出清涕，随即打喷嚏等病症。
答：大经和小络贯穿全身称为脉。脉，是血液运行的通道。血随着气运行，周流全身不停止。筋，遍布四肢，百节相连并束缚关节。这属于肝木得到血的滋养，就能柔和舒缓而不紧急。经脉都起始于手足指端，所以十二经脉都以手足来命名，而筋则无处不有。皮毛属于肺，主司体表，容易感受外邪。人体内的血在脉络中运行，向外充盈于皮毛，渗透肌肉，滋养筋骨，所以身体各部和谐，运动无障碍。如果气机阻滞则血也阻滞，气机上逆则血也上逆，受热则瘀浊，受寒则凝涩，衰耗则营运不周全，渗透不遍，外邪就容易侵袭了。津液是血的余绪，行于脉外，流通全身，如同天上的清露。如果血浊气滞，就凝聚而成痰。痰是津液的变异，如同天上的露水。所以说痰遍布上下周身无处不到，其实就是津液在周身停留的部分。津液生于脾胃，由水谷精微转化而来，浑浊的变成痰，所以痰产生于脾土。因此古人论述中风偏枯、麻木、酸痛、不能举动的各种病症，归结为血虚、死血（瘀血）、痰饮，这是论述致病的根源。至于得病，则必然有所感触，或因风，或因寒，或因湿，或因酒，或因七情，或劳力、劳心、房劳汗出，因感受风寒湿气，于是形成此病。这是血病、痰病为本，而外邪为标。病邪侵犯在皮毛、血脉、经络、肌肉、筋骨之间，而未进入脏腑。所以邪气在皮毛、肌肉，就不知痛痒，麻木不仁，好像有一重物贴在身上，或者像虫蚁爬行，或者洒洒恶寒战栗，或者肿胀，或者自汗，遇热则可能发痒，遇阴虚则沉重酸痛；邪气进入血脉、经络，则手足指掌肩背腰膝重硬不遂，难于屈伸举动，或者游走性疼痛。上述陈述的各种症状，都是从皮毛到筋骨的病变。凡是经脉所经过联络的，筋脉所会合结聚的，气血津液所运行的地方，都凝滞郁遏不得流通而导致这些症状，又何必一一强行断定某病属某经、某病属某脏，而杂乱治疗呢！如果邪气进入脏腑，就是危重病，而难以用药，李东垣的书对此论述得很明白。经典说：懂得要领的人，一句话就能终结道理；不懂要领，就会流散无穷。说的就是这个道理。
我认为《难经》说：邪气在气分，气分会发生变动；邪气在血分，血分会发生病变。经典说：阳之气，用天地的疾风来命名。这种风不是外来的风邪，而是本气的病变。所以各方大多说都是由气体虚弱、营卫失调，或七情过度，导致真气耗散，腠理不紧密，邪气乘虚而入及其中。然而左半身，是肝肾居住的地方；肝主筋，肾主骨，肝藏血，肾藏精；精血枯竭，不能滋养，所以筋骨偏废而不能使用。刘河间说：风病多因热甚。俗语说的风，是说末梢而忘记了根本。经典说：出汗偏沮（偏身无汗），使人偏枯。就像树木一枝津液不到，则此枝干枯，被风所害。由此看来，实在是因为肝肾二经精血枯竭所致。前述种种症状，也应当观察其形症，审察其兼变而治疗，尤其不可固执于风。经典说：三阴三阳发病为偏枯痿易，四肢不能举动，也未尝一定指于风。如果是真中风，应当辨别其中脏中腑而治疗。眼睛昏花者，中于肝；舌头不能言语者，中于心；嘴唇松弛、便秘者，中于脾；鼻塞者，中于肺；耳聋者，中于肾。这五种情况病位深，多为难治。中血脉者，外无六经的症状，内无大小便的阻隔，肢体不能举起，口不能言语，用大秦艽汤主治。中腑者，多兼中脏。如左关脉浮弦，面目青，左胁偏痛，筋脉拘急，眼睛眯视，头目眩晕，手足不收，坐卧不安，这是中胆兼中肝，用犀角散之类。如左寸脉浮洪，面赤，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，用麻黄散之类。如右关脉浮缓或浮大，面唇黄，汗多，恶风，口歪，语涩，身重，怠惰嗜卧，肌肤不仁，皮肉跳动，腹胀不食，这是中胃兼中脾，用防风散之类。如右寸脉浮涩而短，必鼻流清涕，多喘，胸中闷乱，短气，自汗，声嘶，四肢痿弱，这是中大肠兼中肺，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，这是中膀胱兼中肾，用独活散之类。这都是说真中风的症治。其间也有气血之分。气虚而中者，右手足不仁，用六君子汤加钩藤、姜汁、竹沥；血虚而中者，左手足不仁，用四物汤加钩藤、竹沥、姜汁；气血俱虚而中者，左右手足皆不仁，用八珍汤加钩藤、姜汁、竹沥。
与中风相似的病症，不可不辨别。如中于寒，谓冬季突然遭受寒气，昏冒，口噤，肢挛，恶寒，脉浮紧，用麻黄、桂枝、理中汤之类；中于暑，谓夏季突然冒犯炎暑，昏冒，痿厥，吐泻，喘满，用十味香薷饮之类；中于湿，丹溪所谓因湿土生痰，痰生热，热生风，用清燥汤之类加竹沥、姜汁。因于火者，河间谓五志过极，火盛水衰，热气怫郁，昏冒而卒仆，用六味丸、四君子汤、独参汤之类；内有恚怒伤肝，阴火上炎者，用小柴胡汤之类；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；食厥者，饮食过度，胃气不能营运，故昏冒，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，用补中益气汤；房劳者，因肾虚耗，气不归源，故昏冒，用六味丸。这些都是类中风的病症。
中风，《内经》主张于风，这是真中风。如果河间主张于火，东垣主张于气，丹溪主张于湿，都是因火因气因湿而为暴病暴死的类中风，而非真中风。治疗者要审慎！
卒中昏愦，口眼歪斜，痰气上涌，咽喉有声，六脉沉伏，这是真气虚而风邪所乘，用三生饮一两，加人参一两，煎服即苏醒。如果遗尿，手撒，口开，鼾睡，为不治之症，用前药也有得生的。三生饮是行经络、治寒痰的药，有斩关夺旗之功，每服必用人参一两许，以祛其邪而补助真气。否则不惟无益，反而足以导致失败。看先哲用附子、参附等汤，其中的义理可见。
大尹刘孟春，素有痰，两臂顽麻，两目流泪，服用祛风化痰药，痰更厉害，手臂反而疼痛不能伸展，手指全部拘挛。我说：麻属于气虚，误服前药，肝火炽盛，肝血干涸，筋无所养，虚而拘挛！应当补脾肺、滋肾水，则风自息、热自退、痰自清。于是用六味地黄丸、补中益气汤，不到三个月而痊愈。
一位儒者，素来勤苦，恶风寒，鼻流清涕，寒战，喷嚏，属于脾肺气虚，反而服用祛风药，肢体麻木疲倦，痰涎自出，很像风症。我认为风剂耗散元气，阴火乘其土位，用补中益气汤加麦门冬、五味子治疗而愈。
举人于尚之，素来肾虚积劳，足痿不能步履，后来舌喑不能言，面色黧黑。我认为肾气虚寒，不能运及所发，用地黄饮子治疗而愈。后来不慎调摄而复发，或用牛黄清心丸之类，发热痰多，确实像中风，用祛风化痰之类，小便秘涩，口舌干燥，仍用前饮及加减八味丸渐愈，又用补中益气汤而痊愈。
一位膏粱之人，素来不慎起居，忽然失音不能语，神思昏愦，痰涎上涌。我说河间云：夫喑属肾经虚寒，其气厥不至。《医学纲目》云：少阴气至则啮舌，少阳气至则啮颊。现在失音，肾气不能上接清阳之气。不信，仍用风药，后来咬舌，才相信我的话。先用地黄饮子及六味地黄丸而愈。
仪部袁补之，患前症，不信我的话，多次服用祛痰之剂，后来咬舌而死。
一男子，体肥善饮，舌本强，语涩，痰壅，口眼歪斜，肢体不遂。我说脾虚湿热痰涎所致，用六君子、煨干葛、山栀、神曲而愈。
岳父年六十余，素来善饮，两臂作痛。我说：这是脾虚有湿。不信，严格服用祛风治痰之药，更加麻木，发热，体软，痰壅，腿膝拘痛，口噤，语涩，头目晕重，口角宽纵，痰涎流出，两个月后遍身如虫行，搔起白屑，才相信。我说：臂麻体软，脾无用也；痰涎涌出，脾不能摄也；口斜语涩，脾气伤也；头目晕重，脾气不升也；痒起白屑，脾气不能营也。于是用补中益气汤加神曲、半夏、茯苓，三十余剂诸症悉愈；又用参术膏而痊愈。
一男子，元气素弱，或头目眩晕，或肢体倦热，仲夏因劳役，饮食不时，两手麻木，肢体倦怠。我认为暑热伤元气，用人参益气汤而愈。
一男子，卒中，口眼歪斜，言语不出，恶见风寒，四肢拘急，脉浮而紧。这属于脾胃受症，所以舌本强而不能言，用秦艽升麻汤治疗稍愈，乃以补中益气汤加山栀治疗而痊愈。
一妇人，怀抱郁结，筋挛骨痛，喉间似有一核，服乌药顺气等药，口眼歪斜，臂难伸举，痰涎愈多，内热晡热，食少，体倦。我以郁火伤脾，血燥生风，用加味归脾汤加丹皮、山栀二十余剂，形体渐健，饮食渐加；又用加味逍遥散十余剂，痰热少退，喉核少消；更用升阳益胃汤数剂，诸症渐愈，但臂不能伸，这是肝经血少而筋挛，用地黄丸而愈。
一产妇，两手麻木，服愈风丹、天麻丸，遍身皆麻，神思倦怠，晡热作渴，自汗盗汗。我认为气血俱虚，用十全大补汤数剂，诸症悉退，又数剂而全愈，但内热，用加味逍遥散而痊愈。
一产妇，筋挛臂软，肌肉抽掣，皆属气血虚，用十全大补汤而痊愈。
问：两腿自膝以下，有时内热，或骨中觉热，或有一点酸痛热的是什么？
答：这是血热。只要是风病，其血必热；正因为血热，所以风寒之气一袭之，则外寒束内热而为痛。丹溪论痛风，谓血热得寒，污浊凝滞，所以作痛。遇夜痛甚，行于阴也；遇风雨阴寒痛甚，寒湿胜也。又风病必血燥，风木生火，故血热而燥。
我认为前述论述最为切当。临川陈先生云：医风先医血，血行风自灭。盖肝藏血而主风，又肝气为阳为火，肝血为阴为水。若肝火旺则肝血必虚，故凡风病多因肝经风火为患，当推五脏相胜相生，以益其血。经典说：肾藏精而主骨，所以肾虚者则骨中热，或涌泉穴，或两胫、两足内热，多患骨痿，以致不起，属足三阴亏损之虚热耳！滋其化源，庶可保其生也。
佥宪高如斋，两腿逸则筋缓痿软而无力，劳则作痛如针刺，脉洪数而有力。我说：这是肾肝阴虚火之象，用六味地黄丸而愈。
知州韩廷仪，先患风症，用疏风、化痰、养血之药而痊愈。其腿膝骨内发热作痛，服十味固本丸、天麻丸更厉害，两尺脉数而无力。我认为肾水虚不能生肝木，虚火内动而作，非风邪所致。不信，又服羌活愈风丹之类，四肢痿软，遍身麻木，痰涎上涌，神思不清。我说：皆脾气亏损，不能营养周身，又不能摄涎归源。先用六君子加芎、归、木香数剂，壮其脾气以摄涎归源；又以八珍汤数剂，以助五脏生化之气，以荣养周身，而诸证渐愈。乃朝以补中益气汤培养脾肺，夕以六味地黄丸滋补肝肾，如此三月余而安。
一妇人，因怒患痰厥而苏，左手臂不能伸，手指麻木，口眼歪斜，痰气上攻，两腿骨热，或骨中酸痛，服乌药顺气散之类，诸症更厉害，不时昏愦，更加内热晡热。我认为肝经血虚，内热生风，前药复耗肝血，虚火炽盛而更厉害。先以柴胡栀子散，调养肝经气血；数日后用八珍汤加钩藤钩散，诸症稍愈；又用加减八味丸料，少加酒炒黄柏、知母黑色者数剂，诸证顿退；乃服八珍汤、柴胡栀子散，半载而痊愈。后来劳役即有复作之意，服柴胡栀子散随安。
问：有医生教以四物汤、二陈汤间服，后来惑于南星、半夏不可轻服之言，二陈通不入口，专用四物，而痰药亦少用，枳术丸可专服否？
答：这只是稍微好转罢了。用血药而无行痰、开经络、达肌表之药以佐之，血药属阴，性颇凝滞，怎么能流通经络、驱逐病邪以成功呢！所以古人以乌头为半身不遂行经络者，就是这个原因。大概风疾原于血虚血热挟火与痰，经络肌表之间病根在矣，后因感冒凉风寒气，或因过饮助痰火，或因恼怒逆肝气，遂成半身不遂之症。世谓之风病，其病成于肌表皮毛筋骨经络之间，未入五脏六腑，所以治疗也兼在外，而不专于内。如果只用四物汤，是专补内也。此病的痰也在经络，如果只用枳术丸，也是专治内也。必须补养其内以固本，攻治其外以去邪，这才是可行的！
我认为前述病症如果因肾虚阴火而肝燥者，宜用六味地黄丸生肾水滋肝血；如果因怒动肝火而血耗者，用四物加柴胡、山栀、丹皮、茯苓以清肝火、生肝血；如果因脾经郁结而血耗者，用归脾、四物二汤以补脾气、生肝血；如果脾气虚而痰滞者，用二陈加白术、柴胡健脾气以化痰；如果因脾虚湿而风痰不利者，用二陈加南星、苍术、防风胜湿以化痰；脾经湿而为痰者，用二陈加白术、防风；脾气郁而滞者，用归脾汤加柴胡、半夏；肾经败液而为痰者，用六味丸。
顾宪幕，年六十，不慎饮食起居，左半身手足不遂，汗出痰壅，或用参、附之类，汗止，神清，左腿自膝至足指仍旧肿坠，痰多，作痛，肝、肾、脾脉洪大而数，重按则软涩。我认为足三阴虚，朝用补中益气汤加黄柏、知母数剂，诸症悉退，但自己放松遵守禁忌，不能全愈。
Question: The left arm is contracted and cannot be extended or raised; the fingers are clenched and curled; the shoulder and back feel heavy and sagging, resembling pain caused by tendons being pulled. Pain occurs in the tendons at the joints during extension and flexion. The big toe and middle toe of the left foot often desire to extend backward and are difficult to flex. The palm and fingers of the left hand often feel numb. In the finger webs near the palm, there is a sensation as if something is夹 (pinching/clamped) between them. The anterior high prominence of the sole of the left foot feels swollen, hard, and distended, yet has no palpable shape; when walking, it feels as if there is an extra layer of felt underneath. Speech is short and hesitant. Dizziness occurs when bowing and rising. There is deviation of the mouth and eye. Phlegm entangles the root of the tongue. Phlegm obstructs the chest and diaphragm. There are phlegm nodules in the throat and under the left hypochondrium. Frequent chills occur. Sneezing and yawning trigger symptoms in the limbs. The left ear, left face, and left side of the body become painful upon touch by hand or coarse clothing. The left cheek, left neck, and left hypochondrium are frequently numb and tense, as if something is sticking to them. Itching occurs on the left side of the body, head, neck, or limbs. The left eye constantly tears and does not dry. The left corner of the mouth seems lax and wide. On the left face, there is a sensation of insects crawling. Exposure to wind causes clear nasal discharge from the left nostril, followed by sneezing, among other symptoms.
Answer: The main meridians and collateral vessels traversing the entire body are called Mai (Vessels/Meridians). Vessels are the tunnels through which blood flows. Blood follows Qi in its circulation, flowing continuously throughout the body without stopping. Tendons (Jin) are distributed throughout the four limbs, connecting the hundred joints and binding them together. This belongs to Liver Wood, which requires nourishment by Blood to remain soft, relaxed, and not tense. Meridians all originate from the tips of the fingers and toes; therefore, the Twelve Meridians are named after the hands and feet, whereas Tendons are found everywhere. Skin and hair belong to the Lung, govern the exterior, and are prone to external pathogenic invasions. Blood circulates within the vessels, fills the skin and hair externally, penetrates the muscles, and nourishes the bones and tendons; thus, the body harmonizes and movement is unimpeded. If Qi stagnates, Blood stagnates; if Qi rebels upward, Blood rebels upward; if Heat is acquired, turbidity and stasis form; if Cold is acquired, coagulation and sluggishness occur; if depletion occurs, circulation becomes incomplete and penetration uneven, allowing external pathogens to easily invade. Jin Ye (Body Fluids) are the surplus of Blood, circulating outside the vessels throughout the body, like clear dew from heaven. If Blood is turbid and Qi stagnates, condensation occurs forming Tan (Phlegm). Tan is a transformation of Jin Ye, like dew from heaven. Thus, it is said that Tan can reach anywhere in the upper and lower body; it is essentially Jin Ye remaining in the周身 (whole body). Jin Ye is generated by the Spleen and Stomach from the essence of water and grain; when turbid, it becomes Tan; therefore, Tan is produced by Spleen Earth. Hence, ancient physicians discussed various symptoms of Zhong Feng (Wind Stroke) such as hemiplegia, numbness, soreness, pain, and inability to move, attributing them to Blood deficiency, Si Xue (Dead Blood/Stasis), and Yin Tan (Fluidal Phlegm); this discusses the root cause of disease. However, contracting the disease requires some triggering factor, whether Wind, Cold, Dampness, alcohol, Seven Emotions, physical exertion, mental strain, sexual exhaustion with sweating, leading to invasion by Wind-Cold-Dampness, thereby forming this disease. Here, Blood disorders and Tan disorders are the root, while external pathogens are the branch. The pathogen invades the skin, hair, blood vessels, meridians, muscles, bones, and tendons, but has not entered the Zang-Fu organs. Therefore, if the pathogen is in the skin and muscles, there is insensitivity to pain and temperature, numbness, feeling as if a heavy object is attached, or like insects crawling, or shivering chills, or swelling, or spontaneous sweating; encountering Heat may cause itching, while Yin deficiency causes heaviness, soreness, and pain. If the pathogen enters the blood vessels and meridians, the fingers, palms, shoulders, back, waist, and knees become heavy, stiff, and paralyzed, making flexion, extension, and movement difficult, or causing wandering pain. The aforementioned symptoms are all diseases extending from the skin and hair to the bones and tendons. Wherever meridians pass and connect, where tendons meet and knot, and where Qi, Blood, and Jin Ye flow, all these areas become stagnant and suppressed, failing to circulate freely, resulting in these conditions. Why must one arbitrarily assign every disease to a specific meridian or organ and treat them杂乱ly (haphazardly)! If the pathogen enters the Zang-Fu organs, it becomes a critical illness, difficult to treat with herbs; Dong Yuan's writings discuss this clearly. The Classics state: "He who knows the essentials needs only one word to conclude; he who does not know the essentials wanders infinitely." This is what is meant.
I hold that the Nan Jing states: When pathogen is in Qi, Qi undergoes change; when pathogen is in Blood, Blood generates disease. The Classics state: Yang Qi is named after the swift winds of heaven and earth. This Wind is not an external pathogenic Wind, but a disease of the internal Qi. Therefore, many texts state that it arises from Qi deficiency, disharmony of Ying and Wei (Defensive and Nutritive Qi), or excessive Seven Emotions, leading to dispersion of True Qi, loose interstices (Cou Li), and invasion by pathogens due to emptiness. However, the left half of the body is the residence of the Liver and Kidney; the Liver governs Tendons, the Kidney governs Bones, the Liver stores Blood, and the Kidney stores Essence. When Essence and Blood are exhausted, they cannot nourish, resulting in paralysis and dysfunction of the bones and tendons. He Jian stated: Wind diseases often result from severe Heat. The common term "Wind" refers to the manifestation while forgetting the root. The Classics state: "Uneven sweating leads to hemiplegia." Like a tree branch lacking fluid, it withers and is harmed by wind. From this, it is evident that this is truly caused by the exhaustion of Essence and Blood in the Liver and Kidney meridians. Regarding the aforementioned symptoms, one should observe the signs and symptoms, examine the complications, and treat accordingly, especially avoiding rigid adherence to the concept of Wind. The Classics say: Disease of the Three Yin and Three Yang leads to hemiplegia and flaccidity, with inability to move the limbs; this does not necessarily refer to Wind. For true Zhong Feng, one must distinguish whether it affects the Zang or Fu organs for treatment. Blurred vision indicates involvement of the Liver; inability to speak indicates involvement of the Heart; lax lips and constipation indicate involvement of the Spleen; nasal congestion indicates involvement of the Lung; deafness indicates involvement of the Kidney. These five conditions are deep-seated and mostly difficult to treat. Involvement of the Blood Vessels presents with no exterior Six Meridian symptoms and no interior obstruction of urination/defecation, with inability to raise limbs and speak; Da Qin Jiao Tang (Great Gentian Decoction) is the primary formula. Involvement of the Fu organs often accompanies Zang involvement. If the Left Guan pulse is floating and wiry, with greenish complexion, left hypochondriac pain, tendon spasm, squinting eyes, dizziness, inability to grasp objects, and inability to sit or lie comfortably, this is Gallbladder involvement accompanying Liver involvement; Xi Jiao San (Rhinoceros Horn Powder) type formulas are used. If the Left Cun pulse is floating and surging, with red face, profuse sweating, aversion to wind, mental confusion, speech difficulty, stiff tongue, dry mouth, palpitations, and恍惚 (trance-like state), this is Small Intestine involvement accompanying Heart involvement; Ma Huang San (Ephedra Powder) type formulas are used. If the Right Guan pulse is floating and slow or large, with yellowish face and lips, profuse sweating, aversion to wind, facial deviation, speech difficulty, heaviness, lethargy, insensitivity of skin and flesh, twitching muscles, abdominal distension, and anorexia, this is Stomach involvement accompanying Spleen involvement; Fang Feng San (Saposhnikovia Powder) type formulas are used. If the Right Cun pulse is floating, choppy, and short, with clear nasal discharge, frequent panting, chest oppression, shortness of breath, spontaneous sweating, hoarseness, and limb flaccidity, this is Large Intestine involvement accompanying Lung involvement; Wu Wei Zi Tang (Schisandra Decoction) type formulas are used. If the Left Chi pulse is floating and slippery, with dark complexion, lower back and spine pain radiating to the lower abdomen, inability to bend or stretch, tinnitus, joint pain, leg flaccidity, and fearfulness, this is Bladder involvement accompanying Kidney involvement; Du Huo San (Angelica Pubescens Powder) type formulas are used. These all describe the symptoms and treatments of true Zhong Feng. Among them, there are distinctions between Qi and Blood. Qi deficiency with stroke manifests as insensitivity in the right hand and foot; Liu Jun Zi Tang (Six Gentlemen Decoction) added with Gou Teng (Uncaria), Jiang Zhi (Ginger Juice), and Zhu Li (Bamboo Sap) is used. Blood deficiency with stroke manifests as insensitivity in the left hand and foot; Si Wu Tang (Four Substances Decoction) added with Gou Teng, Zhu Li, and Jiang Zhi is used. Combined Qi and Blood deficiency with stroke manifests as insensitivity in both hands and feet; Ba Zhen Tang (Eight Treasures Decoction) added with Gou Teng, Jiang Zhi, and Zhu Li is used.
Conditions similar to Zhong Feng must not fail to be distinguished. Strike by Cold refers to sudden exposure to cold in winter, causing coma, locked jaw, limb spasms, aversion to cold, and floating-tight pulse; Ma Huang, Gui Zhi, and Li Zhong Tang (Regulate the Middle Decoction) types are used. Strike by Summerheat refers to sudden exposure to intense heat in summer, causing coma, flaccidity/cold extremities, vomiting/diarrhea, wheezing/fullness; Shi Wei Xiang Ru Yin (Ten-Ingredient Elsholtzia Decoction) type is used. Strike by Dampness, as Dan Xi described, involves damp-earth generating phlegm, phlegm generating heat, and heat generating wind; Qing Zao Tang (Clear Dryness Decoction) type added with Zhu Li and Jiang Zhi is used. Due to Fire, He Jian stated that extreme Five Emotions lead to excess Fire and deficient Water, with stifled Heat causing coma and sudden collapse; Liu Wei Wan (Six Flavor Pill), Si Jun Zi Tang, and Du Shen Tang (Single Ginseng Decoction) types are used. For internal anger injuring the Liver with flaming Ministerial Fire ascending, Xiao Chai Hu Tang (Minor Bupleurum Decoction) type is used. Strike by Qi results from extreme Seven Emotions, Qi rebellion causing coma, or tight jaw; Su He Xiang Wan (Styrax Pill) type is used. Food Syncope results from overeating, where Stomach Qi fails to circulate, causing coma; Liu Jun Zi Tang added with Mu Xiang is used. Injury from Labor results from excessive toil, depleting Yuan Qi, causing Spleen-Stomach deficiency and inability to withstand Wind-Cold, leading to coma; Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) is used. Sexual Exhaustion results from Kidney deficiency and depletion, with Qi failing to return to its source, causing coma; Liu Wei Wan is used. These are all conditions resembling Zhong Feng.
Zhong Feng, according to Nei Jing, is primarily due to Wind; this is true Zhong Feng. If He Jian emphasizes Fire, Dong Yuan emphasizes Qi, and Dan Xi emphasizes Dampness, these are all acute illnesses and deaths due to Fire, Qi, or Dampness, classified as Lei Zhong Feng (Resembling Wind Stroke), not true Zhong Feng. Practitioners must exercise caution!
Sudden coma, facial deviation, rushing up of Phlegm-Qi, sounds in the throat, and submerged pulses in all six positions indicate True Qi deficiency with Wind pathogen invasion. Use San Sheng Yin (Three Generations Decoction) 1 liang, plus Ren Shen 1 liang, decocted and taken orally for immediate recovery. If there is urinary incontinence, hand relaxation, open mouth, and snoring sleep, it is incurable, though use of the previous medicine may still yield survival. San Sheng Yin is a medicine that moves meridians and treats Cold-Phlegm, possessing the power of breaking through gates and capturing flags. Each dose must include about 1 liang of Ren Shen to expel evil and supplement True Qi. Otherwise, it will not only be useless but also lead to defeat. Observing the ancients' use of Fu Zi and Shen Fu Tang reveals their intent.
Da Yin Liu Mengchun had chronic Phlegm, stubborn numbness in both arms, and tearing eyes. After taking Wind-expelling and Phlegm-resolving medicines, the Phlegm worsened, the arms became painful and unable to extend, and fingers clamped. I said: Numbness belongs to Qi deficiency. Mistakenly taking the previous medicines caused blazing Liver Fire and dried-up Liver Blood, leaving Tendons without nourishment, resulting in deficiency-induced contraction. One must tonify Spleen and Lung, nourish Kidney Water, so that Wind subsides, Heat retreats, and Phlegm clears. Thus, Liu Wei Di Huang Wan (Six Flavor Rehmannia Pill) and Bu Zhong Yi Qi Tang were used, resulting in recovery within three months.
A scholar, accustomed to hard work, feared Wind and Cold, had clear nasal discharge, chills, and sneezing, belonging to Spleen-Lung Qi deficiency. He mistakenly took Wind-expelling medicines, leading to limb numbness and fatigue, and spontaneous salivation, resembling Wind disease. I believed Wind agents dissipate Yuan Qi, allowing Minsterial Fire to attack the Earth position. Treatment with Bu Zhong Yi Qi Tang added with Mai Men Dong and Wu Wei Zi resulted in cure.
Ju Ren Yu Shangzhi had chronic Kidney deficiency and accumulated fatigue, with leg flaccidity preventing walking. Later, aphasia occurred, and complexion turned dark. I attributed this to Kidney Qi deficiency and Cold, failing to transport to the voice. Treatment with Di Huang Yin Zi resulted in cure. Later, due to improper care, it recurred. Use of Niu Huang Qing Xin Wan caused fever and severe Phlegm, genuinely resembling Zhong Feng. Wind-expelling and Phlegm-resolving medicines caused urinary retention and dry mouth/tongue. Still using the previous Yin Zi and Jia Jian Ba Wei Wan led to gradual improvement, followed by Bu Zhong Yi Qi Tang for full recovery.
A person accustomed to rich food, careless with daily routine, suddenly lost voice, experienced mental confusion, and rushing Phlegm-saliva. I cited He Jian: Aphonia belongs to Kidney Meridian deficiency and Cold, with Qi failing to reach. "Medical Outline" states: When Shao Yin Qi arrives, it bites the tongue; when Shao Yang Qi arrives, it bites the cheek. Now, loss of voice indicates Kidney Qi cannot connect to Clear Yang Qi above. Disbelieving, he continued using Wind medicines, later biting his tongue, finally believing my words. Treatment with Di Huang Yin Zi and Liu Wei Di Huang Wan resulted in cure.
Yi Bu Yuan Buzhi suffered from the previous condition, disbelieved me, repeatedly took Phlegm-resolving agents, and died after biting his tongue.
A man, obese and fond of drinking, had a stiff tongue base, slurred speech, Phlegm obstruction, facial deviation, and limb paralysis. I attributed this to Spleen deficiency with Damp-Heat and Phlegm-saliva. Treatment with Liu Jun Zi Tang, Wei Gan Ge (Prepared Kudzu Root), Shan Zhi (Gardenia), and Shen Qu resulted in cure.
My father-in-law, over sixty, fond of drinking, suffered arm pain. I said: This is Spleen deficiency with Dampness. Disbelieving, he strictly took Wind-expelling and Phlegm-resolving medicines, worsening numbness, fever, body weakness, Phlegm obstruction, knee/leg spasms, locked jaw, slurred speech, heavy dizziness, lax mouth corner, and flowing saliva. Two months later, his whole body felt like insects crawling, scratching produced white scales, then he believed. I said: Arm numbness and body weakness indicate Spleen ineffectiveness; rushing saliva indicates Spleen failure to control; facial deviation and slurred speech indicate Spleen Qi injury; heavy dizziness indicates Spleen Qi failure to ascend; itching with white scales indicates Spleen Qi failure to nourish. Treatment with Bu Zhong Yi Qi Tang added with Shen Qu, Ban Xia, and Fu Ling for over thirty doses cured all symptoms; further treatment with Shen Zhu Gao resulted in recovery.
A man with weak Yuan Qi experienced dizziness or limb fatigue/heat. In midsummer, due to labor and irregular diet, he had hand numbness and limb fatigue. I attributed this to Summerheat damaging Yuan Qi. Treatment with Ren Shen Yi Qi Tang resulted in cure.
A man suffered sudden stroke, facial deviation, inability to speak, aversion to Wind-Cold, limb spasms, and floating-tight pulse. This belongs to Spleen-Stomach syndrome, hence stiff tongue and inability to speak. Treatment with Qin Jiao Sheng Ma Tang resulted in slight improvement, followed by Bu Zhong Yi Qi Tang added with Shan Zhi for cure.
A woman with emotional depression suffered tendon spasms and bone pain, with a lump in the throat. Taking Wu Yao Shun Qi medicines caused facial deviation, difficulty extending arms, increased Phlegm-saliva, internal heat, afternoon fever, poor appetite, and fatigue. I attributed this to Depressive Fire injuring Spleen and Blood dryness generating Wind. Treatment with Jia Gui Pi Tang added with Dan Pi and Shan Zhi for over twenty doses improved physique and appetite; Jia Xiao Yao San for ten doses reduced Phlegm-Heat and throat nodules; Sheng Yang Yi Wei Tang for several doses gradually cured symptoms, but arm extension remained impaired due to Liver Meridian Blood deficiency causing tendon spasm. Treatment with Di Huang Wan resulted in cure.
A postpartum woman had hand numbness. Taking Yu Feng Dan and Tian Ma Wan caused whole-body numbness, mental fatigue, afternoon fever/thirst, and spontaneous/night sweats. I attributed this to combined Qi and Blood deficiency. Treatment with Shi Quan Da Bu Tang for several doses resolved symptoms; further doses led to full recovery, except for internal heat, treated with Jia Xiao Yao San.
Another postpartum woman had tendon spasms, arm weakness, and muscle twitching, all belonging to Qi and Blood deficiency. Treatment with Shi Quan Da Bu Tang resulted in cure.
Question: Why do the legs below the knees sometimes feel internally hot, or hot in the bones, or have a spot of soreness/pain/heat?
Answer: This is Blood Heat. In any Wind disease, the Blood must be hot; because of Blood Heat, when Wind-Cold attacks, the external Cold binds the internal Heat, causing pain. Dan Xi discussed Gout, stating that Blood Heat receiving Cold causes turbid stagnation, hence pain. Pain worsens at night because it travels in Yin; pain worsens in wind/rain/cold because Cold-Dampness prevails. Also, Wind diseases inevitably involve Blood dryness; Wind-Wood generates Fire, hence Blood is hot and dry.
I consider the previous discussion most appropriate. Mr. Chen from Linchuan said: To treat Wind, first treat Blood; when Blood flows, Wind extinguishes itself. The Liver stores Blood and governs Wind; Liver Qi is Yang/Fire, Liver Blood is Yin/Water. If Liver Fire is strong, Liver Blood must be deficient. Thus, Wind diseases are mostly due to Wind-Fire in the Liver Meridian. One should deduce the mutual overcoming and generation of the Five Zang organs to benefit Blood. The Classics state: The Kidney stores Essence and governs Bones. Therefore, Kidney deficiency leads to heat in the bones, or heat in Yongquan acupoint, or inner heat in calves and feet, often suffering from Bone Flaccidity, leading to immobility; this belongs to deficiency-Heat from damage to the Three Yin of the Foot! Nourishing the source of transformation may preserve life.
Qian Xian Gao Ruzhai had legs that were flaccid and weak when resting, but painful like needle pricks when working. Pulse was surging, rapid, and forceful. I said: This is the image of Kidney-Liver Yin deficiency with Fire. Treatment with Liu Wei Di Huang Wan resulted in cure.
Zhi Zhou Han Tingyi first suffered Wind disease, cured by Wind-dispersing, Phlegm-resolving, and Blood-nourishing medicines. His leg/knee bone internal heat and pain worsened with Shi Wei Gu Ben Wan and Tian Ma Wan. Both Chi pulses were rapid and weak. I attributed this to Kidney Water deficiency failing to generate Liver Wood, with internal moving deficiency Fire, not Wind pathogen. Disbelieving, he took Qiang Huo Yu Feng Dan, leading to limb flaccidity, whole-body numbness, rushing Phlegm-saliva, and unclear mentality. I said: All due to Spleen Qi damage, failing to nourish the body and control saliva returning to source. First, Liu Jun Zi Tang added with Xiong Gui and Mu Xiang for several doses strengthened Spleen Qi to control saliva; then Ba Zhen Tang for several doses aided the Five Zang's transformative Qi to nourish the body, gradually improving symptoms. Morning Bu Zhong Yi Qi Tang cultivated Spleen-Lung; evening Liu Wei Di Huang Wan nourished Liver-Kidney. After over three months, he stabilized.
A woman, due to anger, suffered Phlegm Syncope and recovered, but left arm could not extend, fingers were numb, mouth/eye deviated, Phlegm-Qi attacked upward, leg bones were hot, or bones ached/hot. Taking Wu Yao Shun Qi San worsened symptoms, causing frequent coma and internal/afternoon heat. I attributed this to Liver Meridian Blood deficiency, internal heat generating Wind; previous medicines consumed Liver Blood, intensifying deficiency Fire. First, Chai Hu Zhi Zi San regulated Liver Meridian Qi and Blood; days later, Ba Zhen Tang added with Gou Teng San slightly improved symptoms; then Jia Jian Ba Wei Wan material added with wine-fried Huang Bai and Zhi Mu (black ones) for several doses rapidly retreated symptoms; then Ba Zhen Tang and Chai Hu Zhi Zi San were taken, recovering in half a year. Later, labor triggered recurrence, relieved by Chai Hu Zhi Zi San.
Question: A doctor advised alternating Si Wu Tang and Er Chen Tang. Later confused by the statement that Nan Xing and Ban Xia should not be lightly taken, Er Chen Tang was never taken, only Si Wu Tang was used exclusively, and Phlegm medicines were rarely used. Can Zhi Zhu Wan be taken exclusively?
Answer: This is merely slight improvement. Using Blood medicines without Phlegm-moving, meridian-opening, or surface-reaching assistants means using Yin-natured, somewhat stagnant Blood medicines; how can they circulate meridians and expel pathogens to succeed! Thus, the ancients used Wu Tou for hemiplegia to move meridians, for this reason. Generally, Wind disease originates from Blood deficiency and Blood Heat carrying Fire and Phlegm; the root lies in meridians and skin/muscle surface. Later, due to cold Wind-Cold invasion, excessive drinking aiding Phlegm-Fire, or anger rebelling Liver Qi, hemiplegia forms. World calls this Wind disease; it forms in skin, hair, bones, tendons, and meridians, not entering Five Zang and Six Fu organs. Thus, treatment also addresses the exterior, not just the interior. If only Si Wu Tang is used, it solely tonifies the interior. The Phlegm in this disease is also in the meridians; if only Zhi Zhu Wan is used, it also solely treats the interior. One must tonify the interior to secure the root and attack the exterior to remove the pathogen; this is feasible!
I believe if the previous condition is due to Kidney deficiency, Ministerial Fire, and Liver dryness, Liu Wei Di Huang Wan should be used to generate Kidney Water and nourish Liver Blood; if due to anger stirring Liver Fire and consuming Blood, Si Wu Tang added with Chai Hu, Shan Zhi, Dan Pi, and Fu Ling should be used to clear Liver Fire and generate Liver Blood; if due to Spleen Meridian depression consuming Blood, Gui Pi and Si Wu Tangs should be used to tonify Spleen Qi and generate Liver Blood; if Spleen Qi deficiency with Phlegm stagnation, Er Chen Tang added with Bai Zhu and Chai Hu should be used to strengthen Spleen Qi and resolve Phlegm; if Spleen deficiency with Dampness causing unfavorable Wind-Phlegm, Er Chen Tang added with Nan Xing, Cang Zhu, and Fang Feng should be used to overcome Dampness and resolve Phlegm; if Spleen Meridian Dampness forms Phlegm, Er Chen Tang added with Bai Zhu and Fang Feng; if Spleen Qi depression causes stagnation, Gui Pi Tang added with Chai Hu and Ban Xia; if Kidney Meridian depleted fluid forms Phlegm, Liu Wei Wan is used.
Gu Xian Mu, age sixty, careless with diet and routine, suffered left-side limb paralysis, sweating, and Phlegm obstruction. Using Ren Shen and Fu Zi stopped sweating and cleared spirit, but left leg from knee to toe remained swollen/heavy, with much Phlegm and pain. Liver, Kidney, and Spleen pulses were surging, large, rapid, but soft and choppy on heavy pressure. I attributed this to deficiency of the Three Yins of the Foot. Morning Bu Zhong Yi Qi Tang added with Huang Bai and Zhi Mu for several doses retreated all symptoms, but self-relaxation of taboos prevented full recovery.