观刘宗浓《玉机微义》云∶余尝居凉州，其地高阜，四时多风少雨，天气常寒，每见中
风或暴死者有之。盖折风燥烈之甚也。时洪武乙亥秋八月，大风起自西北时，甘州城外路死
者数人，余亦始悟《经》谓西北之折风伤人，至病暴死之旨不诬，丹溪之言有所本也。吁！
医之不明运气、地理、造化、病机之微，而欲行通变之法者，难矣哉！
据此一说，是诚风之杀人也。然风气兼温，虽烈未必杀人，惟带寒威则杀人耳。矧以西
北地寒，而塞风起于八月，则寒随风至，寒必彻骨。凡暴露之人，虽曰中风，而不知实中阴
寒之毒也。此在强者固能支持，弱者焉得不死。然亦以所遇之异，故特纪。若此方是真中风
邪，则亦百十年间始或仅遭一二。而此证之不多见者，从可知矣。此外如贼风虚邪之伤人，
则岁岁有之，处处有之，是无非外感之病，未闻有因外感而卒然昏愦致死也。矧今人之所谓
中风者，或于寂然无风之时，或于食饮严密之处，素无外感而忽然运仆，忽然偏废。此其是
风非风，又可知矣。而尽以风治，其能堪哉！
按历代相传治中风之方，皆以续命等汤为主。考其所自，则始于《金匮要略》附方中有
《古今录验》续命汤，然此必宋时校正之所增，而非仲景本方也。此自隋唐以来，则孙氏《
千金方》乃有小续命、大续命、西川续命、排风等汤，故后世宗之。无不以此为中风主治矣
。夫续命汤以麻黄为君，而以姜、桂并用，本发散外邪之佳方也。至小续命、大续命、西川
续命等汤，则复加黄芩以兼桂、附，虽曰相制，而水火冰炭，道本不同，即有神妙，终非余
之心服者。其他无论，独怪乎河间、东垣、丹溪三子者，既于中风门皆言此病非风矣，而何
于本门皆首列小续命汤，而附以加减之法。曰∶无汗恶寒，麻黄续命汤；有汗恶风无热，桂
枝续命汤；有汗身热不恶寒，白虎续命汤；有汗身热不恶风，葛根续命汤；无汗身凉，附子
续命汤。若此诸法，但用治外感则可，用治内伤则不可。而三子之卷卷不舍者，皆此数方，
又何前后之言不相应耶？再如大秦艽等汤，在《机要》《发明》俱云∶治中风外无六经之形
证，内无便溺之阻隔。如是血弱不能养筋，宜养血而筋自荣，以大秦艽汤，羌活愈风汤主之
。夫秦艽汤虽有补血之药，而寒散之剂居其半。夫既无六经之外邪，而用散何为也？既无阻
隔之火邪，而用寒何为也？寒散既多，又果能养血气而壮筋骨乎？秦艽汤且不可，愈风汤则尤
其不可者也。吾不知用此法者，果出何意？
看刘宗浓在《玉机微义》中说：我曾经居住在凉州，那里地势高亢，四季多风少雨，天气常常寒冷，经常见到有人因中风或突然死亡的情况。这大概是西北折风（指从西北方向吹来的猛烈寒风）燥烈程度太甚的缘故。当时是洪武乙亥年秋八月，大风从西北方刮起，甘州城外路上死了几个人，我这才领悟到《内经》所说的西北方的折风伤人，导致病人暴死的宗旨并非虚妄，朱丹溪的说法是有根据的。唉！医生如果不明白运气、地理、造化、病机的微妙之处，却想要施行通变之法，那就太难了！
根据这一说法，这确实是风邪杀人。然而风气兼有温性时，虽然猛烈未必会杀人，只有带着寒威时才杀人。况且西北地方寒冷，而塞外的风在八月兴起，那么寒气便随着风到来，寒气必定深入骨髓。凡是身体暴露在外的人，虽然说是中了风，但实际上并不知道是中了阴寒之毒。这在体质强壮的人身上固然还能支撑，体弱的人怎么能不死呢？这也是因为遭遇的情况不同，所以特别记录下来。如果这种方剂治疗的是真正的中风邪气，那么在百十年间也仅仅遇到一两次。由此可知这种证候不多见的原因了。此外像贼风虚邪伤害人体，则是年年都有，处处都有，这无非是外感病，没听说过因为外感而突然昏倒死亡的。况且现在人所谓的中风，或者在寂静无风的时候，或者在饮食严密的地方，平时没有外感却忽然晕倒，忽然半身不遂。这究竟是风不是风，也就显而易见了。却都用治风的方法去治疗，他们能承受得住吗！
按照历代相传治疗中风的方剂，都以续命汤等为主。考察其来源，则始于《金匮要略》附方中的《古今录验》续命汤，但这一定是宋代校正医书时所增补的，而不是张仲景的原方。自从隋唐以来，孙思邈的《千金方》就有小续命汤、大续命汤、西川续命汤、排风汤等，所以后世都效法它。无不把这些作为治疗中风的主要方剂。续命汤以麻黄为君药，同时使用生姜、桂枝，本是发散外邪的好方子。至于小续命汤、大续命汤、西川续命汤等，又加入黄芩来配合桂枝、附子，虽然说相互制约，但水火冰炭，道理本不相同，即使有神妙之处，终究不是我内心信服的方法。其他的不必说，唯独奇怪河间、东垣、丹溪三位先生，既然在中风门都说这个病不是风，为什么在本门都首先列出小续命汤，并附上加减方法？说：无汗恶寒，用麻黄续命汤；有汗恶风无热，用桂枝续命汤；有汗身热不恶寒，用白虎续命汤；有汗身热不恶风，用葛根续命汤；无汗身凉，用附子续命汤。像这些方法，只用来治疗外感是可以的，用来治疗内伤就不可以了。而这三位先生的著作中紧紧抓住不放的都是这几个方子，为什么前后的言论不相呼应呢？再比如大秦艽汤等，在《机要》《发明》中都说是治疗中风外无六经形证，内无二便阻隔。如果是血弱不能养筋，应该养血而筋自然荣润，以大秦艽汤、羌活愈风汤主治。大秦艽汤虽然有补血药，但寒散之剂占了一半。既然没有六经的外邪，为什么要用散法？既然没有阻隔的火邪，为什么要用寒药？寒散既多，果真能养血气而壮筋骨吗？大秦艽汤尚且不可取，愈风汤更是尤其不可取的。我不知道使用这种方法的人，究竟出于什么用意？
As Liu Zongnong stated in *Yuji Wei Yi* (Subtle Meanings of the Jade Mechanism): I once resided in Liangzhou, where the terrain is high and elevated, with much wind and little rain throughout the four seasons, and the weather is often cold. I frequently observed cases of stroke or sudden death. This is likely due to the extreme dryness and ferocity of the "Zhe Feng" (cutting wind from the northwest). At that time, in the eighth month of autumn during the Yihai year of the Hongwu era, a strong wind rose from the northwest, and several people died on the roads outside Ganzhou City. It was then that I realized the principle stated in the *Classic of Internal Medicine* (*Huangdi Neijing*)—that the cutting wind from the northwest injures humans and leads to sudden death—is not false, and that Zhu Danxi’s statements had a basis. Alas! If physicians do not understand the subtleties of *Yunqi* (Five Movements and Six Qi), geography, creation/nature, and the mechanisms of disease, yet wish to practice adaptive methods, it would be extremely difficult!
Based on this perspective, it is indeed the wind that kills. However, when wind qi combines with warmth, although fierce, it may not necessarily kill; only when it carries the might of cold does it cause death. Moreover, since the northwestern region is cold, and the frontier winds arise in the eighth month, cold arrives with the wind, penetrating deeply into the bones. For those exposed to the elements, although it is said they have contracted wind, in reality, they have been infected by the toxin of Yin-Cold. In robust individuals, this can certainly be endured, but how could weak individuals survive? This is recorded specifically because of the differences in circumstances encountered. If these formulas were truly treating genuine wind-stroke, such occurrences would happen only once or twice in a century. From this, we can understand why this syndrome is rarely seen. Furthermore, injuries caused by thief-wind and deficient evil occur every year and everywhere; these are merely exterior-constraint diseases. It has never been heard that sudden fainting and death result solely from exterior constraints. Besides, what modern people call "stroke," sometimes occurs in still, windless times, or in places where food and drink are consumed closely, without prior exterior constraint, yet suddenly leading to collapse or hemiplegia. That this is or is not wind is evident. Yet, treating all such cases with wind-dispelling methods—can they bear it?
According to prescriptions for treating stroke passed down through generations, the primary formulas are the Xuming Decoctions (Continuing Life Decoctions) and similar ones. Examining their origin, they began with the *Xuming Tang* (Continuing Life Decoction) from *Gujin Luyan* found in the attached formulas of *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet). However, this was likely added during the Song Dynasty medical text corrections, rather than being Zhang Zhongjing’s original formula. Since the Sui and Tang dynasties, Sun Simiao’s *Qianjin Fang* (Prescriptions Worth a Thousand Gold) included Xiao Xuming Tang (Minor Continuing Life Decoction), Da Xuming Tang (Major Continuing Life Decoction), Xichuan Xuming Tang, Paifeng Tang (Dispersing Wind Decoction), etc., so later generations followed suit. All regarded these as the main treatments for stroke. Xuming Tang uses Ephedrae Herba (Mahuang, 麻黄) as the sovereign herb, combined with Ginger Rhizome (Shengjiang, 生姜) and Cinnamon Twig (Guizhi, 桂枝); it is an excellent formula for dispersing exterior pathogens. As for Xiao Xuming Tang, Da Xuming Tang, and Xichuan Xuming Tang, they add Scutellariae Radix (Huangqin, 黄芩) alongside Cinnamon Twig and Aconite Root (Fuzi, 附子). Although it is said they mutually restrain each other, water and fire, ice and charcoal, follow fundamentally different principles. Even if miraculous, they are ultimately not convincing to me. Leaving aside others, I am particularly puzzled by He Jian, Dong Yuan, and Dan Xi. Although they stated in the Stroke section that this disease is not wind, why did they list Xiao Xuming Tang first in that same section, along with modification methods? They stated: For no sweat and aversion to cold, use Mahuang Xuming Tang; for sweating, aversion to wind, and no heat, use Guizhi Xuming Tang; for sweating, body heat, and no aversion to cold, use Baihu Xuming Tang; for sweating, body heat, and no aversion to wind, use Gegen Xuming Tang; for no sweat and cool body, use Fuzi Xuming Tang. Such methods are suitable only for treating exterior constraints, not interior injuries. Yet, these three scholars clung tightly to these few formulas in their works. Why do their preceding and subsequent statements not correspond?
Furthermore, regarding Da Qin Jiao Tang (Large Gentian Decoction) and others, both *Jiyao* (Essentials) and *Faming* (Clarifications) state they treat stroke where there are no exterior signs of the Six Channels and no internal obstruction of urination or defecation. If blood deficiency fails to nourish the sinews, one should nourish the blood, and the sinews will naturally flourish, primarily using Da Qin Jiao Tang and Qianghuo Yufeng Tang (Notopterygium Wind-Relieving Decoction). Although Da Qin Jiao Tang contains blood-nourishing herbs, half of its ingredients are cooling and dispersing. If there are no exterior pathogens of the Six Channels, why use dispersing agents? If there is no obstructing Fire-Evil, why use cooling agents? With so many cooling and dispersing herbs, can they truly nourish blood and qi and strengthen sinews and bones? Da Qin Jiao Tang is already questionable, and Yufeng Tang is even more unacceptable. I do not know what intention lies behind using such methods.