(三条 附录龚赵氏常服调理方)
类中之症，多由肝虚生风，所谓内风，非外风也。间有外风引动内风者，然所见甚少。
大抵
风自内生也，故景岳直谓之非风症。其论曰∶凡非风，口眼歪斜，半身不遂，四肢无力，掉
摇拘挛之属，皆筋骨之病也。肝主筋，肾主骨，肝藏血，肾藏精，精血亏损，不能滋养百骸
，故筋有缓急之病，骨有痿弱之病，总由精血败伤而然。如树木之衰，一枝精液不到，即一
枝枯槁。景岳素重温补，而于类中之症，则独重养血。诚以《内经》有云∶足得血而能步，
掌得血而能握，指得血而能摄。治偏废者，能无以养血为主乎?陈临川先生有云∶治风先治
血，血行风自灭，可谓要言不繁。予数十年来，守此法以治类中，未有不效。虽初病亦有痰
涎壅塞，不得不先为疏通者，然如活络丹方，不宜多用，恐养阴不及，反耗其阴也。乃乾隆
年间，扬州盐商；不知所延何医，制有再造丸，药味夹杂五十余味，多用香燥，以为可以通
络开窍，全不思类中多由精血不足，肝失所养，虚风鼓动，经络空虚，焦燥太过，转伤阴血
，何能熄风乎?吾乡有原任池州府吴某者，半身不遂，延予调治。其人好内，肾不养肝，阴
虚火盛，且食量甚大，专嗜肥浓，胃火亦甚旺。予专以滋肝清热，兼以清胃消痰，日见痊好
，惟语言謇滞耳!或劝以须服再造丸，予再三开导与病不合，伊芳见手足如常，亦暂根据从，常
服膏方，不复延医，已数年矣。乃忽急延予诊，至则卧床不起，谓左腿不知何在矣。细询其
过，则有某医者，劝服再造丸，其人本自卖此丸，连服五丸，而左腿若失矣。伊芳悔恨无穷，
求予挽救。予曰∶还尔腿尚可，履步如常，万不能矣。仍以前法加减，调治十数日后，腿渐
有知，又数日渐可待人而行，而软弱无力。其人年逾七旬，现虽尚存，然经年卧床不起矣。
再造丸之害如此，不知医而妄用者，尚慎旃哉!
今之人先天不足，气血多亏，加以利欲熏其心，酒色耗其肾，肝失所养，木燥生风，类
中之
症多由于此。能先事预防，一病即治，调养得法，或即痊愈，或带病延年。予所治者不少，
大约除中风不语，最难获效，予却不治，余则鲜有无效者，但总不用再造丸耳!如庄仪吉类
中风几二十年，至今尚存。刘颂芬类中十年，尚能游览。龚赵氏乃吾义女，类中治愈，今已
十余年，并不复发。又治丹徒县熊公，今亦十余年不复发，即如今岁朱惠畴、王新楼皆有中
象，一治而愈。凡此皆先告以勿妄服再造丸。夫再造丸非必一无所用，如遇肥人多痰，经络
阻塞，或夹外风，其方香药散药不少，亦可有效；而如遇肾不养肝，木燥生风之症，则服之
无益而有损。近来此症甚多，而一遇此症，症者、医者以及旁人，无不欲服再造丸。嗟乎!
医理精深，岂一再造丸遂能治天下之类中症耶?予明辨之，尚望医者同辨之，不然，吴某前
车可鉴也。
予治类中症，尝用十味温胆汤加减。其方有开有合，以开进补，以补进开，不凉不暖，
调理
最宜，而治类中为尤合。惟初病夹痰，不宜用参，则易以沙参、孩儿参；初病风火交盛，则
以地易熟地；心肺火旺，则以麦冬易远志，以白芍或女贞易枣仁。若夫筋惕肉 ，则羚羊角
在所必用，所谓入肝舒筋之圣药也；更佐以 ，虽口眼歪斜，无不应手而愈。至经络不和
，血脉不通，则加以参须、归须，谓之二须饮；或助以橘络、丝瓜络，谓之二络饮。至大便
结燥，养阴即以润燥，久自能通，或以五仁润之，切不可下，致犯虚虚也。方药甚多，不能
尽述，大致如此，在后人神而明之，触类而长之耳!
（附录三条，以及龚赵氏常服调理方）
类中症，大多由肝虚生风所致，这被称为内风，而非外感之风。偶尔有因外风引动内风的情况，但所见极少。
大抵风是从体内产生的，所以张景岳直接称之为“非风症”。他的论述说：凡是非风症，出现口眼歪斜、半身不遂、四肢无力、震颤拘挛等症状，都属于筋骨方面的疾病。肝主管筋，肾主管骨，肝藏血，肾藏精，精血亏损，不能滋养全身骨骼肌肉，所以筋会出现弛缓或拘急的病变，骨会出现痿弱无力的病变，总归是由于精血败伤造成的。就像树木衰败一样，如果一枝的精液不到达，这一枝就会枯槁。张景岳素来重视温补，但对于类中症，却特别重视养血。诚如《内经》所说：脚得到血的滋养才能行走，手掌得到血的滋养才能握持，手指得到血的滋养才能摄取。治疗偏瘫废用的人，怎么能不以养血为主呢？陈临川先生曾说：治风先治血，血行风自灭，这可以说是简明扼要的话。我几十年来，坚守这种方法治疗类中症，没有不奏效的。虽然初病时也有痰涎壅塞的情况，不得不先进行疏通，但是像活络丹这样的方子，不宜多用，恐怕滋阴养血不够，反而耗伤阴液。到了乾隆年间，扬州的盐商们，不知道聘请了哪位医生，制作了再造丸，药味混杂多达五十多种，多使用香燥之品，认为可以通络开窍，完全没考虑到类中症多由精血不足、肝失所养、虚风鼓动、经络空虚引起，过于焦燥反而会损伤阴血，怎么能熄风呢？我的家乡有一位曾任池州府同知的吴姓人士，半身不遂，请我调治。他喜好房事，导致肾不能养肝，阴虚火旺，而且食量很大，特别嗜好肥甘厚味，胃火也很旺盛。我专门采用滋肝清热的方法，兼以清胃消痰，病情日渐好转，只有语言謇涩滞碍！有人劝他必须服用再造丸，我反复向他解释这与病情不合，他见手足功能如常，也暂时听从，常服膏方，不再延医诊治，已经好几年了。然而突然紧急请我去诊病，到了之后，见他卧床不起，说左腿不知道在哪里了。详细询问经过，原来有位医生劝他服用再造丸，那人本来自己售卖这种药丸，连续服用了五丸，左腿就仿佛消失了一样。他悔恨无穷，请求我挽救。我说：让你的腿恢复知觉还可以，像以前那样正常走路，绝对不可能了。仍然用以前的方法加减，调治十几天后，腿渐渐有了知觉，又过了几天，勉强可以扶着人站立行走，但软弱无力。这个人年龄超过七十岁，现在虽然还活着，但是常年卧床不起了。再造丸的危害如此之大，不懂医理而胡乱使用的人，还要谨慎啊！
现在的人先天禀赋不足，气血多有亏虚，加上名利欲望熏心，酒色耗损肾精，肝失所养，木燥生风，类中症多由此产生。如果能事先预防，一旦发病立即治疗，调养得法，或许就能痊愈，或者带病延年。我治疗的这类病人不少，大约除了中风不语最难见效，我就不治之外，其余的很少有不奏效的，只是总不用再造丸罢了！比如庄仪吉患类中风将近二十年，至今还活着。刘颂芬患类中十年，还能游览山水。龚赵氏是我的义女，类中症治愈后，到现在已经十几年，并没有复发。又治疗丹徒县的熊公，到现在也是十几年不复发，就像今年朱惠畴、王新楼都有中风迹象，一经治疗就痊愈了。凡此种种，都是事先告诉他们不要胡乱服用再造丸。其实再造丸并非一无是处，如果遇到肥胖人多痰湿、经络阻塞，或者夹杂外风的情况，这个方子里有不少香散药物，也可以有效；但是如果遇到肾不养肝、木燥生风的病症，那么服用它就没有益处反而有害。近来这种病症很多，一遇到这种情况，患者、医生以及旁人，无不想要服用再造丸。唉！医理精深，难道一个再造丸就能治好天下所有的类中症吗？我明辨此理，希望医者也能共同辨析，不然，吴某的前车之鉴可以作为警示。
我治疗类中症，曾经使用十味温胆汤加减。这个方剂有开有合，以开法进补，以补法助开，不凉不热，调理最为适宜，而治疗类中症尤其合适。只有在初病夹痰时，不宜用人参，则改用沙参、孩儿参；初病风火交盛时，则以生地黄代替熟地黄；心肺火旺时，则以麦冬代替远志，以白芍或女贞子代替酸枣仁。如果出现筋肉跳动抽搐，那么羚羊角是必须使用的，所谓入肝舒筋的圣药；再佐以全蝎、蜈蚣，即使是口眼歪斜，也没有不随手而愈的。至于经络不和、血脉不通，则加入人参须、当归须，称为二须饮；或者辅助以橘络、丝瓜络，称为二络饮。到大便结燥时，通过养阴来润燥，时间久了自然能通畅，或者用五仁丸润之，切不可攻下，以致犯虚虚之戒（使虚者更虚）。方药很多，不能全部叙述，大致情况如此，在于后人能够神而明之，触类旁通加以发挥罢了！
(Appendix: Three Cases and the Routine Conditioning Prescription for Gong Zhao-shi)
Lei Zhong (Apoplexy-like syndrome) is mostly caused by wind generated from liver deficiency, known as internal wind, rather than external wind. Occasionally, external wind may trigger internal wind, but such cases are rare.
Generally, wind arises from within the body; therefore, Zhang Jingyue directly referred to it as "Fei Feng" (Non-Wind Syndrome). He stated: "Regarding all Fei Feng syndromes, manifestations such as facial paralysis (deviation of mouth and eyes), hemiplegia, weakness in the four limbs, tremors, spasms, and contractures belong to diseases of the sinews and bones. The Liver governs the sinews, and the Kidney governs the bones. The Liver stores Blood, and the Kidney stores Essence. When Essence and Blood are depleted, they fail to nourish the entire skeletal structure. Consequently, the sinews suffer from laxity or tension, and the bones suffer from atrophy and weakness. This is fundamentally due to the damage of Essence and Blood. It is like a decaying tree: if the fluids do not reach one branch, that branch withers." Zhang Jingyue generally emphasized warm tonification, but for Lei Zhong, he particularly valued nourishing Blood. As stated in the *Neijing* (Inner Canon): "The feet can walk when nourished by Blood; the palms can grasp when nourished by Blood; the fingers can hold when nourished by Blood." In treating hemiplegia, how can one not prioritize nourishing Blood? Mr. Chen Linchuan said: "To treat wind, first treat the Blood; when Blood flows, wind extinguishes itself." This is indeed concise and essential. For decades, I have adhered to this method in treating Lei Zhong without failure. Although initially there may be phlegm-fluid obstruction requiring unblocking, formulas like Huoluo Dan (Collateral-Activating Pill) should not be used excessively, lest Yin-nourishing effects be insufficient and Yin fluid be further consumed.
During the Qianlong reign, salt merchants in Yangzhou,不知 (unknown to us which doctor), formulated Zaizao Wan (Rebirth Pill). It contained over fifty mixed ingredients, mostly aromatic and drying herbs, purported to open collaterals and orifices. They completely failed to consider that Lei Zhong often stems from Essence-Blood insufficiency, Liver malnourishment, stirring of deficient wind, and emptiness of collaterals. Excessive dryness and heat would further injure Yin-Blood, making it impossible to extinguish wind. A native of my hometown, Mr. Wu, formerly a Tongzhi (Assistant Prefect) of Chizhou Prefecture, suffered from hemiplegia and sought my treatment. He indulged in sexual activity, causing the Kidney to fail to nourish the Liver, resulting in Yin deficiency with hyperactive fire. He had a large appetite, specifically craving rich and fatty foods, leading to strong Stomach fire. I exclusively employed methods to nourish the Liver and clear heat, combined with clearing the Stomach and resolving phlegm. His condition improved daily, except for slurred speech. Someone advised him to take Zaizao Wan. I repeatedly explained this was incompatible with his condition. Seeing his limbs function normally, he temporarily complied, taking paste prescriptions regularly and ceasing medical visits for several years. Suddenly, he urgently summoned me. Upon arrival, he was bedridden, claiming he could not feel his left leg. Inquiry revealed that a certain physician had advised taking Zaizao Wan. Since the patient himself sold this pill, he took five pills consecutively, after which his left leg seemed to vanish. He regretted immensely and begged for rescue. I said, "I can restore sensation to your leg, but walking normally again is impossible." I continued with the previous modified prescription. After more than ten days of treatment, sensation gradually returned to the leg. After a few more days, he could barely stand with assistance, though weak. Now over seventy, he survives but has been bedridden for years. Such is the harm of Zaizao Wan! Those who prescribe blindly without understanding medicine must exercise extreme caution!
Modern people often have congenital insufficiency and Qi-Blood deficits. Added to this are desires clouding the mind and wine/sex depleting the Kidneys. The Liver loses nourishment, Wood becomes dry and generates wind; thus, Lei Zhong often arises from this. If prevented beforehand, treated immediately upon onset, and conditioned properly, recovery is possible, or one may live with the disease for extended years. I have treated many such cases. Generally, except for stroke with aphasia (which is difficult to treat and I often decline), others rarely fail, provided Zaizao Wan is never used. For instance, Zhuang Yiji suffered from Lei Zhong for nearly twenty years and still lives. Liu Songfen suffered for ten years and can still travel. Gong Zhao-shi, my adopted daughter, recovered from Lei Zhong and has remained relapse-free for over ten years. I also treated Duke Xiong of Dantu County, who has been relapse-free for over ten years. Similarly, this year, Zhu Huichou and Wang Xinlou showed signs of stroke and recovered after one course of treatment. In all these cases, I first instructed them not to take Zaizao Wan rashly. Zaizao Wan is not entirely useless; for obese patients with phlegm-dampness blocking collaterals, or those with concurrent external wind, its aromatic and dispersing ingredients can be effective. However, for conditions involving Kidney failing to nourish Liver, Wood dryness generating wind, it is harmful. Recently, such cases are common. Whenever encountered, patients, doctors, and bystanders alike desire to take Zaizao Wan. Alas! Medical principles are profound; can one single pill cure all Lei Zhong cases worldwide? I clarify this distinction and hope fellow physicians will discern similarly. Otherwise, let Mr. Wu’s case serve as a warning.
In treating Lei Zhong, I once used Shiwai Wendan Tang (Ten-Ingredient Warm Gallbladder Decoction) with modifications. This formula combines opening and closing methods, using opening to facilitate tonification and tonification to aid opening. It is neither cooling nor warming, making it ideal for conditioning, especially for Lei Zhong. However, if phlegm is present in the initial stage, Ginseng should be avoided; instead, use Sha Shen (Glehniae Radix) and Hai'er Shen (Pseudostellariae Radix). If wind-fire is intense initially, replace Shu Di Huang (Prepared Rehmanniae Radix) with Sheng Di Huang (Rehmanniae Radix). If Heart-Lung fire is hyperactive, replace Yuan Zhi (Polygalae Radix) with Mai Dong (Ophiopogonis Radix), and replace Suan Zao Ren (Ziziphi Spinosae Semen) with Bai Shao (Paeoniae Radix Alba) or Nv Zhen Zi (Ligustri Lucidi Fructus). If muscle twitching occurs, Ling Yang Jiao (Capricornis Cornu) is essential, regarded as the supreme herb for entering the Liver and relaxing sinews. Combined with Quan Xie (Scorpio) and Wu Gong (Scolopendra), even facial paralysis responds swiftly. For disharmony of collaterals and blood stasis, add Ren Shen Xu (Ginseng Radix et Rhizoma Ramulus) and Dang Gui Xu (Angelicae Sinensis Radix Ramulus), termed Er Xu Yin (Two-Ramulus Drink); or assist with Ju Luo (Citri Reticulatae Pericarpium Retinervum) and Si Gua Luo (Luffae Fructus Retinervum), termed Er Luo Yin (Two-Collateral Drink). For constipation, nourishing Yin moistens dryness, leading to natural passage over time; alternatively, use Wu Ren Wan (Five-Seed Pill). Do not use purgatives, lest you commit the error of "depleting the deficient." There are many formulas, too numerous to list fully. The general principle is as described; it remains for future practitioners to understand profoundly and apply creatively.