病机云四肢不举俗曰瘫痪经谓土太过则令人四肢不举此真膏粱之疾非肝肾经虚其治泻令
气弱
阳虚土平而愈三化汤调胃承气汤选而用之若脾虚亦令人四肢不举其治可补十全散加减四物去
邪留正
按四肢不举世俗皆以为中风病此云脾土太过不及皆能致之其可一概用药乎
发明曰经云阳之气以天地之疾风名之此中风者非外来风邪乃本气病也凡人年逾四旬气衰
之际
或因忧喜忿怒伤其气者多有此疾壮岁之时无有也若肥盛则间有之亦是形盛气衰而如此治法当
和脏腑通经络便是治风然亦有贼风袭虚伤之者也治法轻重有三见前分在经在腑在脏之异
按此云本气自病乃与刘河间论内热所生相合但彼云热而此云虚虚之与热并行而不相悖也
河间曰风病多因热甚俗云风者言末而忘其本也所以中风有瘫痪者非谓肝木之风实甚而卒
中之
也亦非外中于风良由将息失宜而心火暴甚肾水虚衰不能制之则阴虚阳实而热气拂郁心神昏冒
筋骨不用而卒倒无知也多因喜怒悲忧恐五志过极而卒中者皆为热甚故也若微则但僵仆气血流
通筋脉不挛缓者发过如故或热气太甚郁滞不通阴气暴绝阳气后竭而死 疾涎者由热甚则水化
制火而生 偏枯者由经络一侧得通否者痹和瘫痪也 口噤筋急者由风热太甚以胜水湿又津液
滞于胸膈以为痰涎则筋太燥然燥金主于收敛劲切故也 或筋反缓者乃燥之甚血液衰少也诸筋
挛易愈诸筋痿难复以见燥之微甚也
《病机》中说：四肢不能举动，俗称瘫痪。《内经》说：土气太过，就会使人四肢不能举动。这确实是因过食肥甘厚味所致的疾病，并非肝肾经脉虚损所致。其治疗方法应通过泻下使气机减弱，阳气虚弱、脾土平和后自然痊愈。可选用三化汤或调胃承气汤进行治疗。如果是脾虚，也会使人四肢不能举动，其治疗方法可以采用十全散加减。四物汤能祛除邪气、留存正气。
按语：四肢不能举动，世俗之人皆认为是中风病。此处指出脾土太过或不及都能导致此症，怎么可以一概用药呢？
发明曰：《内经》说：阳气的运行如同天地间疾速的风。所谓中风，并非外来的风邪，而是本气发生的病变。凡是年龄超过四十岁、元气衰退的人，或者因为忧愁、喜悦、愤怒等情绪损伤了元气的人，大多会有这种病。在壮年时期则没有这种情况。如果身体肥胖的人，偶尔也会有此病，这也是形体盛实而元气衰败的表现。治疗这类疾病的方法应当调和脏腑、疏通经络，这就是治疗风病的原则。然而也有贼风侵袭虚处而致病的情况。治疗的轻重程度有三种，详见前文关于病位在经、在腑、在脏的区别。
按语：此处所说的本气自病，与刘河间论述的内热产生相吻合。但他说是“热”，这里说是“虚”。虚与热并行而不矛盾。
河间说：风病多因热势极盛所致。世俗称其为“风”，是只言其末流而忘记了根本。所以中风导致的瘫痪，并不是因为肝木之风实盛而突然中伤人体，也不是外感风邪。确实是因为调养失宜，导致心火暴盛，肾水虚衰不能制约心火，从而出现阴虚阳实，热气拂郁，心神昏乱蒙蔽，筋骨失去作用而突然倒下无知觉。大多是因为喜怒悲忧恐五志过度极盛而猝然发病的，都是因为热势极盛的原因。如果病情轻微，只是暂时僵仆倒地，气血流通，筋脉不痉挛拘急，发作过后如常人一样；如果热气太盛，郁滞不通，阴气突然断绝，阳气随后枯竭而死。有痰涎的是因为热势极盛，水气受制于火而生痰；偏枯（半身不遂）是因为经络一侧通畅与否的问题，痹证和瘫痪也是此类；口噤、筋脉拘急是因为风热太盛，克制了水湿，津液停滞于胸膈化为痰涎，导致筋脉过于干燥。因为燥金主收敛、劲切，所以如此。或者筋脉反而松弛的，乃是燥热太甚、血液衰少的缘故。诸般筋脉拘挛容易治愈，诸般筋脉痿软难以恢复，由此可见燥热的轻微与严重程度的区别。
According to the *Pathogenesis* (Bingji): The inability of the four limbs to move is commonly known as paralysis. The *Classic of Internal Medicine* (Jing) states: "Excess of Earth causes the person to be unable to move their four limbs." This is indeed a disease caused by excessive consumption of rich and sweet foods, not a deficiency of the Liver and Kidney meridians. The treatment should involve purging to weaken the Qi; when Yang Qi becomes weak and the Spleen-Earth returns to balance, health is restored. One may select Sanhua Tang (Three Transformations Decoction) or Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Atractant Decoction) for use. If it is due to Spleen deficiency, it also causes the inability to move the four limbs; the treatment can involve modifying Shiquan San (Ten Complete Powder). Siwu Tang (Four Substances Decoction) removes pathogenic factors while preserving healthy Qi.
Commentary: The general public considers the inability to move the four limbs to be Zhongfeng (Wind Stroke). Here it is stated that both excess and deficiency of Spleen-Earth can cause this condition. How can one apply medication indiscriminately?
Elucidation: The *Classic* states: "The movement of Yang Qi is likened to the swift wind in heaven and earth." Therefore, Zhongfeng (Wind Stroke) is not caused by exogenous Wind Evil, but is a disease originating from the body's own Qi. Generally, individuals over forty years old, during periods of declining Qi, or those whose Qi has been damaged by emotions such as worry, joy, anger, or resentment, often suffer from this ailment. It is absent in young adults. Even among those who are obese, it occasionally occurs, which is also a case of robust physique but deficient Qi. The treatment method for such conditions should focus on harmonizing the Zang-Fu organs and unblocking the collaterals; this constitutes the treatment of Wind. However, there are also cases where "thief wind" (exogenous pathogenic wind) attacks areas of deficiency. There are three degrees of severity in treatment, as detailed previously regarding the differentiation of disease location in the meridians, fu organs, and zang organs.
Commentary: The concept here of "self-originating disease of the proper Qi" aligns with Liu Hejian’s discussion on the generation of internal heat. While he emphasizes "heat," this text emphasizes "deficiency." Deficiency and heat coexist without contradiction.
Hejian stated: Wind diseases are mostly caused by extreme heat. The common term "wind" refers only to the superficial manifestation while forgetting the root. Thus, paralysis resulting from Zhongfeng (Wind Stroke) is not because the Wind of Liver Wood is excessively strong and suddenly strikes the body, nor is it an external contraction of wind. It is truly due to improper lifestyle management leading to a sudden surge of Heart Fire, while Kidney Water is deficient and fails to control it. This results in Yin deficiency and Yang excess, with hot qi stagnating and obstructing, causing the heart-mind to become confused and obscured, and the sinews and bones to lose function, leading to sudden collapse and loss of consciousness. This is mostly caused by the extreme excess of the five emotions (anger, joy, sorrow, worry, fear), all attributed to extreme heat. If mild, it merely involves temporary collapse; if Qi and Blood flow smoothly and sinews do not spasm, the person returns to normal after the episode. If the heat is too severe, causing stagnation and blockage, Yin Qi may suddenly cease, followed by the exhaustion of Yang Qi, leading to death. Phlegm-saliva arises because extreme heat restricts Water, which then generates phlegm to control Fire. Hemiplegia (Pianku) results from whether one side of the meridians is patent or blocked; Bi syndrome (Bihe) and paralysis are similar. Lockjaw and tendon stiffness occur because Wind-Heat is too severe, overcoming Dampness-Water, causing fluids to stagnate in the chest and diaphragm, transforming into phlegm-saliva, making the sinews overly dry. Since Dryness-Metal governs contraction and sharpness, this occurs. Alternatively, if the sinews become flaccid, it is due to extreme dryness and depletion of blood. Sinew spasms are easy to cure, whereas sinew atrophy is difficult to recover from, demonstrating the difference between mild and severe dryness-heat.