风从外中伤肢体，痰火内发病心官，体伤不仁与不用，心病神昏不语言。当分中络
经腑脏，更审虚实寒热痰，脱证撒手为脾绝，开口眼合是心肝，遗尿肾绝鼾声肺，闭证握
固紧牙关，初以通关先取嚏，痰壅不下吐为先。
【注】风，谓虚邪，贼风从外而中伤人四肢躯体，故名曰中风，痰火，谓痰火从内而
发，病患心主之官，故名曰痰火。体中风邪，轻则顽麻不仁，重则瘫痪不用。心病痰火，轻
则舌强难语，重则痰壅神昏。此证或内或外，单病轻，兼病重，当细辨其中络。中经，中
腑，中脏，及中经络兼中腑脏。并细审其兼虚、兼实、兼寒、兼热、兼痰，与夫脱证、闭
证之浅深缓急而治之，凡国中宜先用通关散取嚏，有嚏可治，无嚏多死。口噤者，用开
关散，擦牙软之，痰涎壅盛，用诸吐法涌之。若口噤不开，汤药不能下咽者，则将应服之
药，随引调如面茶，含在不病患口内，用苇管或笔管插入病患鼻孔，使气连药吹之，其
药自能入咽。不可用金器撬之，恐伤齿也。
【按】中风一证，分中血脉、中腑、中脏，始自李东垣，中血脉者，大秦艽汤；中腑者，
小续命汤；中脏者，三化汤。然从未见有三化汤中脏之证，惟《金匮》书中分为四证∶曰
络、曰经、曰腑、曰脏，其说最为的当，可为后世法。盖口眼 斜，肌肤不仁，邪在络
也；左右不遂，筋骨不用，邪在经也；昏不识人，便尿阻隔，邪在腑也；神昏不语，唇
缓涎出，邪在脏也。学人细阅诸家之论，自知不谬云尔。
风邪从外部侵袭损伤肢体，痰火从内部发作扰乱心官。身体受邪则出现麻木不仁与瘫痪不用，心神受扰则神志昏迷不能言语。应当区分是邪气中于络、经、腑还是脏，更要审察病证的虚实、寒热及痰浊情况。脱证表现为手撒不开为脾绝，口开眼合为心肝绝，遗尿为肾绝，喉中鼾声为肺绝；闭证表现为手握固、牙齿紧闭。初起时先用通关散取嚏，若痰涎壅盛不下行，则以涌吐法为先。
【注】所谓“风”，是指虚邪贼风从外部侵入伤害人的四肢躯体，所以称为中风；所谓“痰火”，是指痰火从内部发作，病患的心主之官受到干扰，所以称为痰火。身体遭受风邪，轻则顽麻不仁，重则瘫痪不用。心病因痰火所致，轻则舌强难语，重则痰壅神昏。此证或源于内或源于外，单病较轻，兼病较重，应当仔细辨别其中络、中经、中腑、中脏，以及中经络兼中腑脏的情况。并仔细审察其兼有虚、实、寒、热、痰等证候，以及脱证、闭证的浅深缓急而进行治疗。凡属此类病症，适宜先用通关散取嚏，有嚏者可治，无嚏者多死。口噤不开者，用开关散擦牙使其软化；痰涎壅盛者，用各种吐法涌吐。如果口噤不开，汤药不能下咽，则将应服的药物，随引经药调成如面茶般的稠度，含在患者口内，用苇管或笔管插入患者鼻孔，使气息带动药物吹入，药物自然能进入咽喉。不可用金属器具撬开嘴巴，恐怕损伤牙齿。
【按】中风这一证候，分为中血脉、中腑、中脏，始于李东垣。中血脉者，用大秦艽汤；中腑者，用小续命汤；中脏者，用三化汤。然而从未见过适用三化汤治疗中脏的证候，只有《金匮要略》书中将其分为四证：曰络、曰经、曰腑、曰脏，这种说法最为恰当，可以作为后世的准则。大概口眼歪斜、肌肤不仁，是邪气在络；左右肢体不遂、筋骨不用，是邪气在经；神志昏迷不识人、二便阻隔，是邪气在腑；神志昏迷不能言语、口唇松弛流涎，是邪气在脏。学习的人仔细阅读各家论述，自然知道没有谬误了。
Wind pathogen invades from the exterior, damaging the limbs; phlegm-fire erupts from the interior, disturbing the Heart organ. Damage to the body results in numbness and paralysis (loss of movement); disturbance of the Heart spirit results in coma and aphasia (inability to speak). One must differentiate whether the pathogen has struck the Collaterals (Luo), Channels (Jing), Fu organs, or Zang organs, and further examine the patterns of deficiency/excess, cold/heat, and phlegm. The Collapse syndrome is characterized by open hands (Spleen exhaustion), open mouth and closed eyes (Heart and Liver exhaustion), urinary incontinence (Kidney exhaustion), and stertorous breathing (Lung exhaustion). The Closure syndrome is characterized by clenched fists and tightly shut teeth. Initially, use Tongguan San (Pass-the-Gate Powder) to induce sneezing; if phlegm obstruction prevents downward movement, emesis (inducing vomiting) is prioritized.
[Note] "Wind" refers to empty evils and thief winds invading from the exterior to damage the four limbs and trunk, hence named Stroke (Zhong Feng). "Phlegm-fire" refers to phlegm-fire erupting from the interior, disturbing the official function of the Heart Master, hence named Phlegm-Fire. When the body suffers wind pathogen, mild cases present with stiff numbness and insensitivity, while severe cases present with paralysis and immobility. When the Heart disease is caused by phlegm-fire, mild cases present with a stiff tongue and difficulty speaking, while severe cases present with phlegm obstruction and coma. This condition may originate internally or externally; single diseases are milder, while combined diseases are heavier. One must carefully distinguish between striking the Collaterals, Channels, Fu organs, and Zang organs, as well as striking the Channels/Collaterals combined with Fu/Zang organs. Furthermore, carefully examine concomitant deficiency, excess, cold, heat, and phlegm, as well as the depth and urgency of the Collapse and Closure syndromes to determine treatment. For such conditions, it is appropriate to first use Tongguan San to induce sneezing; if sneezing occurs, it is treatable; if not, death is likely. For trismus (lockjaw), use Kaiguan San (Open-the-Gate Powder) to rub the teeth to soften them; for excessive phlegm-saliva, use various emetic methods to purge it. If trismus persists and decoctions cannot be swallowed, prepare the prescribed medicine mixed with guiding herbs into a paste like strong tea, place it inside the patient's mouth, insert a reed tube or pen tube into the patient's nostril, and blow gently so that breath carries the medicine down, allowing it to enter the throat naturally. Do not use metal instruments to pry the mouth open, lest teeth be damaged.
[Commentary] The classification of Stroke into striking the Blood Vessels, Fu organs, and Zang organs originated with Li Dongyuan. Striking the Blood Vessels uses Da Qin Jiao Tang (Great Notopterygia Decoction); striking the Fu organs uses Xiao Xu Ming Tang (Minor Continuation of Life Decoction); striking the Zang organs uses San Hua Tang (Three Transformations Decoction). However, there have rarely been cases of Zang organ strike suitable for San Hua Tang. Only the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) divides it into four syndromes: Collateral, Channel, Fu, and Zang. This theory is most accurate and can serve as a standard for later generations. Generally, facial paralysis (deviation of mouth and eyes) and cutaneous numbness indicate pathogen in the Collaterals; hemiplegia and inability to move limbs indicate pathogen in the Channels; coma with loss of recognition and bowel/bladder retention indicate pathogen in the Fu organs; coma with aphasia, flaccid lips, and drooling indicate pathogen in the Zang organs. Students who carefully read the discussions of various schools will know that this is without error.