脉脉诀云∶浮为中风。又云∶阳浮而滑。阴濡而弱者。为中风。寸浮而滑者为痰。微而弱者
为虚。缓而涩者为血虚。微而迟或沉者为气虚。浮大为风。浮数为热。浮迟为寒。浮缓而涩
为皮肤不仁。浮滑散大为瘫痪。浮弦急数为惊风发搐。大抵六经之脉。亦与伤寒同。但少瘥耳。
症内经曰∶风之伤人也。或为热中。或为寒中。或为偏枯。(半身不遂是也)或为疠风。或为
惊搐。皆风之所为也。抑考风有中腑中脏中血脉之异。中腑者。面如五色。恶风恶寒。拘急
不仁。或中身之后。或中身之前。皆易治。中脏者。唇吻不收。舌卷不转而失音。鼻不闻香
臭。眼昏耳聋。大小便闭皆难治。中血脉者。口眼歪斜。语言謇涩。口吐涎沫。又有寒中热中
瘫痪疠风惊风之类。此皆属湿热。或痰火兼血虚也。亦有气中。因七情所伤。与中风相似。
若作风治。杀人多矣。盖中风者身温。且多痰涎。中气者身凉。而无痰涎。有此不同。丹溪
云。真中风邪者甚少。若阴虚阳乏。痰火内炽。或内伤饮食。变为卒暴僵仆之病。类乎中风
。则常有之。世医不分。悉以风治。杀人多矣。又云。真中风邪。西北人有。东南之人。只
是湿土生痰。痰生热。热生风也。张仲景云。风之为病。当半身不遂。经络空虚。贼邪不泻
。或左或右。邪气反缓。正气即急。正气引邪。 辟不仁。邪在于络。肌肤不仁。在经则重
不胜。入腑则不识人。入脏则吐沫难言。刘河间云。中风者。非为肝木之风实甚而卒中之。
亦非外中于风。由乎将息失宜。心火暴甚。肾水虚衰。不能制之。则阴虚阳实。而蒸热拂郁
。心神昏冒。筋骨不用。而卒倒无知也。或因喜怒思悲恐。五志过极。皆为火甚故也。李东
垣云。中风者非外来风邪。乃本气自病也。凡人年逾四旬。气衰之际。或因忧喜忿怒伤其气
者多有之。若壮岁体肥。则间有之。亦是形盛气衰所致。亦有贼风袭虚而伤者。说者谓昔人
主乎风河间主乎火。东垣主乎气。丹溪主乎湿。而有昔人三子各得其一之说。殊不知河间之论
实具于火类之下。而不以风言。且别注中风论治甚详。东垣谓自内伤气。且曰亦有袭虚挟风
。而分在腑在脏之异。丹溪谓因于湿热。必曰外中者亦有。三子何尝偏于火气湿而言无中风
也耶。愚谓风者乃六淫之一。流行于四时。浩荡于天地。上下八方。无所不至。人居其中犹
鱼在水。水淡则鱼瘦。气乖则人病。体之虚者即感而伤之。但所受浅深不同。八方虚实有异耳。
治东垣云。中腑者多着四肢。有表症而脉浮。恶风寒。拘急不仁。或肢节废。治宜汗之。中
脏者。多滞九窍。唇缓失音。耳聋鼻塞。目瞀。大便秘结。或气塞涎上。不语昏危多致不救
。治宜下之。中血脉则口眼歪斜。三者治各不同。若中血脉而外有六经。之形症则从小续命
汤加减以发其表。调以通圣辛凉之剂。若中腑而内有便溺之阻隔。肢不能举。口不能言。此中
经也。宜大秦艽汤。羌活愈风汤。补血以养筋。瘫痪者。有虚有实经谓土太过。则令人四肢
不举。此膏粱之疾。非肝肾之虚。宜泻之。令土平而愈。三化汤调胃承气汤选而用之。脾虚
亦令人四肢不举。治以十全四物。去邪以留正也。至于子和用汗吐下三法治之。盖吐者如水
郁则达之。谓吐之令其条达也。汗者风随汗出也。下者推陈致新也。失音闷乱。口眼歪斜者
。以三圣散吐之。如牙关紧急者。鼻内灌之。吐出涎沫。口自开也。次用凉膈散调之。大抵风
本为热。热胜则风动。宜静胜其燥。以养阴血为主。阴血旺则风热无由而作矣。须按此法治须少汗
。亦须少下。多汗则伤其卫。多下则损其荣。故经有汗下之戒。尤宜审之。丹溪云。中风大率
主血虚。有痰。或挟火与湿热。治法以顺气、祛痰、清热、疏风、发散、吐下、之类为先。
补养次之。更以伤、中、感三者辨别轻重为治乃妙。在左属死血。四物加杏仁红花之类。甚
者桃仁承气汤下之。在右属痰与气。二陈加南星贝母姜汁竹沥之类。气用乌药顺气散。痰壅盛者。或口眼
歪斜不能言语。皆用吐法。瓜蒂藜芦 汁之类。详轻重用之。气虚卒倒
。用参 补之。挟虚浓煎参汤。加竹沥姜汁。血虚宜四物补之。挟痰亦加姜汁竹沥。半身不遂
。在左在右。治法如前气血二药。并加姜汁竹沥。疠风是受天地间不正之气。得之者。须分
上下。气受之则在上。血受之则在下。气血俱受。则上下皆然。盖皆不外乎阳明一经。阳明
者。胃与大肠也。治宜先泻湿热之剂清之。在血补血。在气补气。治用疏风散毒药治之。妇
人胎产惊风。乃血虚生内热。热则生风。因七情所触而动也。宜四物汤。随症加减。益母丸
。乌金丸。辟巽锭子。皆可选用。小儿惊风。有急有慢。慢惊属脾虚。所主宜温补。参术汤
。化下朱砂安神丸。急惊属痰热。宜凉泻。以牛黄清心丸。或利惊丸主之。七情气中者。忧
愁不已。气多厥逆。初得便觉涎潮雍塞。牙关紧急。宜以苏合香丸灌之。使醒。然后随证调
之。辟巽锭子亦好。用者触类而长之。思过半矣。
方 小续命汤治诸风中风。四时加减通用。
麻黄(一钱去节根) 人参(五分去芦) 黄 (一钱) 当归(一钱酒洗) 川芎(八分) 杏仁(
八分去尖) 防己(八分) 附子(八分炮) 官桂(六分) 防风(一钱五分去芦) 甘草(三分)
白芍药(一钱)
上用姜五片。枣一枚。水二钟。煎一钟。去渣。食前热服。
太阳经中风。有汗。加桂枝汤、无汗。加麻黄汤。
阳明经中风。加葛根汤。
少阳经中风。加羌活、柴胡(各一钱)、或小柴胡汤。
太阳经中风。加干姜(八分)、倍附子。
少阴经中风。加桂枝(八分)、倍附子。
厥阴经中风。加连翘、羌活(各八分)
胎前中风。加荆芥穗、天麻、桑寄生(各一钱),去桂附。
产后中风。加荆芥穗(各一钱)、桃仁、红花、泽兰叶(各八分)。
中风无汗而拘急者。加羌活、白芷、苍术(各一钱),去桂附。
中风汗多而恍惚。加黄 (一钱)、茯神(一钱)、远志(七分),去麻黄、杏仁、桂附。
四肢拘急疼。加大麻、秦艽、羌活(各八分)。
痰涎壅盛。加南星、半夏(各一钱五分)、姜汁(一盏)、竹沥(二盏)。
春月。宜倍用麻黄、川芎。
夏月。宜加石膏、倍用黄芩。
秋月。宜倍用当归,加生地黄(姜汁浸三日焙干)。
冬月。宜倍用附子,加干姜(七分)。
又方 防风通圣散四时通用。治诸风热。
防风(一钱五分) 川芎(八分) 川归(一钱) 白芍药(一钱) 白术(一钱二分) 麻黄(一钱
二分) 石膏(一钱) 滑石(八分) 桔梗(八分) 连乔(八分) 黄芩(八分) 栀子(八分)
荆芥(七分) 薄荷(七分) 大黄(二钱看虚实) 芒硝(一钱) 甘草(五分)
上作一服。姜三片。枣一枚。水二钟。煎一钟。食远热服。
风痰壅盛。加南星、半夏(各一钱五分)、天麻、白附子(各七分)。
热痰。加二陈汤,入姜汁(半盏)、竹沥(一盏)。
气虚卒倒。加参 (各一钱五分),去麻黄、石膏、滑石、桔梗、连翘、栀子、薄荷、芒硝、大黄。
口干有热。加柴胡葛根、天花粉(各八分)。
头痛。加用川芎、石膏(各一倍)、半夏(一钱五分)。
半身不遂。在右者。加痰药、在左者。加血药,并用姜汁竹沥。能食者,去竹沥,加荆沥传送。
抽搐。加天麻、白芷(各一钱)、僵蚕、全蝎(各七分)。
肢节寒湿疼痛。加羌活、苍术(各一钱)、桂(少五分)。
肌肉蠕动。加天麻、羌活、白芷(各一钱)、蝎梢(五分)。
七情所伤。成气中者。中乌药、枳壳、香附、紫苏(各一钱),去麻黄、石膏、滑石、连翘、芒硝、大黄。
饮酒被风。头痛如破。加黄连、葛粉、半夏、苍术(各八分),去麻黄、滑石、连翘芒硝、大
风伤于肺。喘急咳嗽,加半夏、贝母、杏仁、金沸草、款冬花(各八分),去硝、黄、滑石。
利气血。驱逐风邪。本方煎调羌活末、全蝎末(各一钱)。
诸风潮搐。小儿急慢惊风。大便秘结。邪热暴甚。肠胃干燥。寝汗切牙。目睛上撺。HT 语不
安。转筋惊悸。本方倍大黄、栀子、煎调茯苓末、全蝎末(各一钱)。
腰胁走注疼痛。本方加硝石、羌活末(各一钱)、煎调车前子末、海金砂末(各一钱)、木香末(五分)。
打挟伤损。肢节疼痛。腹中瘀血不下。加当归、大黄(倍用)、桃仁、煎调乳香、没药(各一钱)。
头旋脑热。鼻塞浊涕时下。加黄连、辛夷、薄荷、煎服(内经曰。胆多热于脑。则辛 鼻渊浊涕下不已也。)。
气逆者。本方去活石、连翘、硝黄,加枳壳煎调木香末(一钱)。
小便淋闭。去麻黄,加木通、车前子(各一钱)、煎调木香末(五分)。
大便结燥。或秘。去麻黄、桔梗。加桃仁、麻仁、枳壳、倍当归、生瘾疹。或赤或白。加麻黄
、葱白(三根)、升麻(七分)、牛蒡子、连翘(各一钱)、出汗即愈。去芒硝、以其咸走血而肉凝、不得汗故也。
解利四时伤寒。内外所伤者。本方一两、对益原散一两、葱白十茎、盐豉一合、生姜半两、
水一大碗、煎五七沸、温服一半、以筋探吐。吐罢。后热服一半。汗出立解。
疠风。加牛蒡子、苦参(各一钱五分)、全蝎天麻、羌活、白芷(各八分)、蕲蛇肉(二钱),去
冒风症。(右关弦而缓带浮者是)本方去硝、黄、黄芩、连乔、石膏、活石、麻黄、桔梗、荆
芥、薄荷,加人参、白茯苓、入粟米煎、好冒风汤也。
诸疮疡。清热散毒。加牛蒡子、苦参、金银花(各一钱)。
妇人吹乳。加金银花、木通、贝母、蒲公英(各一钱二分)、穿山甲、青皮(各五分)、甘草节(六分)。
杨梅疮与便毒。初起或误服轻粉。用此散热解毒。加木通、白藓皮、五加皮、金银花、皂
角刺(各八分或一钱)、土茯苓(二两)、芭蕉根(三钱)。
又方 开关散治诸中风。中痰中气。牙关紧急。痰涎壅盛者。先用此散灌之。然后随症用药。
荆芥穗(一两)、皂角(去皮弦子一钱五分)、麝香(一字另研)。共为末、每服方寸匕、姜汤调灌下。
又方 辟巽锭子治大人诸风。小儿急慢惊风。四时皆可用。
防风(五钱去芦) 天麻(五钱) 胆南星(七钱) 白附子(炮五钱) 川乌(炮五钱) 干姜(煨
三钱) 川芎(五钱) 白芷(五钱) 白茯神(五钱去木) 人参(五钱去芦) 白术(五钱) 木
香(五钱) 薄荷(五钱去梗) 僵蚕(二十一个) 全蝎(二十一个) 牛黄(三钱) 片脑(五分)
朱砂(一两半另研为衣) 麝香(二钱)
上件除朱砂起。以下五样。各另研。余药为细末。用麻黄一斤。甘草四两。蜜二两。熬作膏
子。稀稠得宜。将药末和匀。印作锭子。金箔为衣。或丸。如龙眼大。蜡包尤好。藏久。每
服用一锭。随症根据后引下。
治大人中风。中痰。中气。厥症。并用姜汤调灌下。
左瘫右痪。荆芥汤下。
风狂颠痫。金银汤下。
大人小儿。伤寒。伤风。伤湿。并姜葱汤热调下。得微汗即解。
破伤风。温酒调下。
小儿急惊风。薄荷汤下。
小儿慢惊风。浓枣汤下。
妇人产后惊风。益母草汤下。
妇人产后。血晕昏迷。童便煎姜汤下。
《脉诀》说:脉象浮是中风。又说:阳脉浮滑,阴脉濡弱,这是中风的脉象。寸口脉浮滑的是有痰,微而弱的是虚证,缓而涩的是血虚,微而迟或沉的是气虚。脉浮大的是风邪,浮数是热,浮迟是寒,浮缓而涩是皮肤麻木不仁,浮滑散大是瘫痪,浮弦急数的是惊风发作抽搐。大致六经的脉象,也与伤寒病相同,只是病情稍轻罢了。
《内经》说:风邪伤人,有的导致热中,有的导致寒中,有的导致偏枯(即半身不遂),有的导致疠风,有的导致惊搐,这都是风邪造成的。考察发现,风邪有中腑、中脏、中血脉的区别。中腑的,面色呈现五色变化,怕风怕冷,肢体拘急麻木,无论是身体后面还是前面受邪,都容易治疗。中脏的,口唇松弛不收,舌头卷缩不能转动且失音,鼻子闻不到香臭,眼睛昏花耳聋,大小便闭塞,都难治疗。中血脉的,口眼歪斜,语言謇涩,口吐涎沫。又有寒中、热中、瘫痪、疠风、惊风等类病症,这些都属于湿热,或者是痰火兼有血虚。也有因气机阻滞导致的“气中”,因七情内伤引起,症状与中风相似,如果当作中风治疗,会害死很多人。大概中风患者身体温热,且多痰涎;气中患者身体凉爽,且无痰涎,有此不同。朱丹溪说,真正由外感风邪引起的很少。如果是阴虚阳乏,痰火内炽,或者内伤饮食,变成突然僵倒仆地的病,类似中风,这种情况常有。世间的医生不分清这些,都用治风的方法,害死了很多人。他又说,真正的中风邪气,西北人有,东南的人,只是湿土生痰,痰生热,热生风。张仲景说,风作为疾病,应当出现半身不遂。经络空虚,贼邪不能排出,邪气在左或在右,邪气所在的一侧肌肉松弛,正气所在的一侧就紧张,正气牵引邪气,导致口眼歪斜和不仁。邪气在络脉,肌肤麻木;在经脉则沉重无力;入腑则不识人;入脏则吐沫难言。刘河间说,中风,不是因为肝木之风实盛而突然击中,也不是外感风邪,而是因为调养失宜,心火暴盛,肾水虚衰,不能制约,导致阴虚阳实,蒸热拂郁,心神昏冒,筋骨不用,而突然倒下无知觉。或者因为喜怒思悲恐,五志过极,都成为火盛的原因。李东垣说,中风不是外来风邪,是本气自病。凡人年过四十,气衰的时候,或者因为忧喜忿怒伤气,多有此病。如果壮年身体肥胖,也偶尔有,也是形盛气衰所致。也有贼风袭击虚弱部位而受伤的。评论者说,古人主风,河间主火,东垣主气,丹溪主湿,有人说昔人的三子各得其一的说法。殊不知河间的论述实际上包含在火类之下,而不以风言,并且另外详细注解了中风的论治。东垣说从内伤气,并且说也有袭虚挟风,而区分在腑在脏的不同。丹溪说因于湿热,必定说外中者也有。这三个人何曾偏于火、气、湿而言没有中风呢?我认为风是六淫之一,流行于四季,浩荡于天地,上下八方,无所不至。人处于其中就像鱼在水中,水淡则鱼瘦,气乖则人病。身体虚弱的人就会感受而受伤,只是所受深浅不同,八方虚实有异罢了。
治疗方面,李东垣说:中腑多在四肢,有表症而脉浮,恶风寒,拘急麻木,或者肢节废用,治疗宜发汗。中脏多滞九窍,嘴唇松弛失音,耳聋鼻塞,眼睛昏花,大便秘结,或者气塞痰上涌,不语昏迷危重,多致不治,治疗宜泻下。中血脉则口眼歪斜。这三种治疗各不相同。如果是中血脉而外有六经的症状,就用小续命汤加减以发散表邪,用通圣散辛凉之剂调理。如果是中腑而内有二便阻隔,肢不能举,口不能言,这是中经,宜用大秦艽汤、羌活愈风汤,补血以养筋。瘫痪有虚有实,《内经》说土太过,则让人四肢不能举起,这是膏粱厚味之疾,不是肝肾之虚,宜泻下,使土气平和而痊愈,可选用三化汤、调胃承气汤。脾虚也让人四肢不能举起,治疗用十全四物汤,祛邪以留正。至于张子和用汗、吐、下三法治疗。大概吐法是如水郁则通达之,谓吐之令其条达。汗法是风随汗出。下法是推陈致新。失音闷乱,口眼歪斜的,用三圣散吐之。如牙关紧急的,鼻内灌药,吐出涎沫,口自然张开。其次用凉膈散调理。大致风本为热,热胜则风动,宜静胜其燥,以养阴血为主。阴血旺盛则风热无从产生。必须按此法治,须少用汗法,也须少用下法,多汗则伤卫气,多下则损营血,所以经文有汗下之戒,尤其应该审慎。朱丹溪说,中风大多主血虚,有痰,或者挟火与湿热,治疗方法以顺气、祛痰、清热、疏风、发散、吐下之类为先,补养次之。更以伤、中、感三者辨别轻重来治疗才妙。在左边属死血,四物汤加杏仁、红花之类,严重的用桃仁承气汤泻下。在右边属痰与气,二陈汤加南星、贝母、姜汁、竹沥之类。气药用乌药顺气散。痰壅盛的,或者口眼歪斜不能言语,都用吐法,瓜蒂、藜芦汁之类,详审轻重使用。气虚卒倒,用人参补之。挟虚浓煎参汤,加竹沥、姜汁。血虚宜四物汤补之,挟痰也加姜汁、竹沥。半身不遂,在左在右,治疗方法如前气血二药,并加姜汁、竹沥。
疠风是受天地间不正之气,得病的人,须分上下,气受之则在上,血受之则在下,气血俱受,则上下皆然。大概都不外乎阳明一经。阳明,就是胃与大肠。治疗宜先用泻湿热之剂清之,在血补血,在气补气,治疗用疏风散毒药治之。妇人胎产惊风,乃血虚生内热,热则生风,因七情触动而动。宜用四物汤,随症加减。益母丸、乌金丸、辟巽锭子,都可选用。小儿惊风,有急有慢,慢惊属脾虚,所主宜温补,参术汤、化下朱砂安神丸。急惊属痰热,宜凉泻,以牛黄清心丸,或利惊丸主之。七情气中者,忧愁不已,气多厥逆,初得便觉涎潮雍塞,牙关紧急,宜以苏合香丸灌之,使其醒,然后随证调之。辟巽锭子也好,使用者触类旁通,思过半矣。
方剂:
小续命汤,治各种风病、中风,四时加减通用。
麻黄(一钱,去节根)、人参(五分,去芦)、黄芪(一钱)、当归(一钱,酒洗)、川芎(八分)、杏仁(八分,去尖)、防己(八分)、附子(八分,炮)、官桂(六分)、防风(一钱五分,去芦)、甘草(三分)、白芍药(一钱)。
以上用药,生姜五片,大枣一枚,水两碗,煎至一碗,去渣,食前热服。
太阳经中风,有汗,加桂枝汤;无汗,加麻黄汤。
阳明经中风,加葛根汤。
少阳经中风,加羌活、柴胡(各一钱),或小柴胡汤。
太阳经中风(此处疑为太阴或误写,原文如此),加干姜(八分),倍用附子。
少阴经中风,加桂枝(八分),倍用附子。
厥阴经中风,加连翘、羌活(各八分)。
胎前中风,加荆芥穗、天麻、桑寄生(各一钱),去桂、附。
产后中风,加荆芥穗(各一钱)、桃仁、红花、泽兰叶(各八分)。
中风无汗而拘急者,加羌活、白芷、苍术(各一钱),去桂、附。
中风汗多而恍惚,加黄芪(一钱)、茯神(一钱)、远志(七分),去麻黄、杏仁、桂、附。
四肢拘急疼痛,加大麻、秦艽、羌活(各八分)。
痰涎壅盛,加南星、半夏(各一钱五分)、姜汁(一盏)、竹沥(二盏)。
春月,宜倍用麻黄、川芎。
夏月,宜加石膏,倍用黄芩。
秋月,宜倍用当归,加生地黄(姜汁浸三日焙干)。
冬月,宜倍用附子,加干姜(七分)。
又一方:防风通圣散,四时通用。治各种风热。
防风(一钱五分)、川芎(八分)、川归(一钱)、白芍药(一钱)、白术(一钱二分)、麻黄(一钱二分)、石膏(一钱)、滑石(八分)、桔梗(八分)、连翘(八分)、黄芩(八分)、栀子(八分)、荆芥(七分)、薄荷(七分)、大黄(二钱,看虚实)、芒硝(一钱)、甘草(五分)。
以上作一服,生姜三片,大枣一枚,水两碗,煎至一碗,食远热服。
风痰壅盛,加南星、半夏(各一钱五分)、天麻、白附子(各七分)。
热痰,加二陈汤,入姜汁(半盏)、竹沥(一盏)。
气虚卒倒,加人参(各一钱五分),去麻黄、石膏、滑石、桔梗、连翘、栀子、薄荷、芒硝、大黄。
口干有热,加柴胡、葛根、天花粉(各八分)。
头痛,加用川芎、石膏(各一倍)、半夏(一钱五分)。
半身不遂,在右者,加痰药;在左者,加血药,并用姜汁、竹沥。能食者,去竹沥,加荆沥传送。
抽搐,加天麻、白芷(各一钱)、僵蚕、全蝎(各七分)。
肢节寒湿疼痛,加羌活、苍术(各一钱)、桂(少五分)。
肌肉蠕动,加天麻、羌活、白芷(各一钱)、蝎梢(五分)。
七情所伤,成气中者,中乌药、枳壳、香附、紫苏(各一钱),去麻黄、石膏、滑石、连翘、芒硝、大黄。
饮酒被风,头痛如破,加黄连、葛粉、半夏、苍术(各八分),去麻黄、滑石、连翘、芒硝、大黄。
大风伤于肺,喘急咳嗽,加半夏、贝母、杏仁、金沸草、款冬花(各八分),去硝、黄、滑石。
利气血,驱逐风邪,本方煎调羌活末、全蝎末(各一钱)。
诸风潮搐,小儿急慢惊风,大便秘结,邪热暴甚,肠胃干燥,寝汗切牙,目睛上撺,谵语不安,转筋惊悸,本方倍大黄、栀子,煎调茯苓末、全蝎末(各一钱)。
腰胁走注疼痛,本方加硝石、羌活末(各一钱),煎调车前子末、海金砂末(各一钱)、木香末(五分)。
打挟伤损,肢节疼痛,腹中瘀血不下,加当归、大黄(倍用)、桃仁,煎调乳香、没药(各一钱)。
头旋脑热,鼻塞浊涕时下,加黄连、辛夷、薄荷,煎服(《内经》说:胆多热于脑,则辛 鼻渊浊涕下不已也。)。
气逆者,本方去滑石、连翘、硝黄,加枳壳,煎调木香末(一钱)。
小便淋闭,去麻黄,加木通、车前子(各一钱),煎调木香末(五分)。
大便结燥,或秘,去麻黄、桔梗,加桃仁、麻仁、枳壳,倍当归。
生瘾疹,或赤或白,加麻黄、葱白(三根)、升麻(七分)、牛蒡子、连翘(各一钱),出汗即愈。去芒硝,以其咸走血而肉凝,不得汗故也。
解利四时伤寒,内外所伤者,本方一两,对益原散一两、葱白十茎、盐豉一合、生姜半两,水一大碗,煎五七沸,温服一半,以筋探吐。吐罢,后热服一半,汗出立解。
疠风,加牛蒡子、苦参(各一钱五分)、全蝎、天麻、羌活、白芷(各八分)、蕲蛇肉(二钱),去...
冒风症。(右关脉弦而缓带浮者是)本方去硝、黄、黄芩、连翘、石膏、滑石、麻黄、桔梗、荆芥、薄荷,加人参、白茯苓,入粟米煎,好冒风汤也。
诸疮疡,清热散毒,加牛蒡子、苦参、金银花(各一钱)。
妇人吹乳,加金银花、木通、贝母、蒲公英(各一钱二分)、穿山甲、青皮(各五分)、甘草节(六分)。
杨梅疮与便毒,初起或误服轻粉,用此散热解毒,加木通、白藓皮、五加皮、金银花、皂角刺(各八分或一钱)、土茯苓(二两)、芭蕉根(三钱)。
又一方:开关散,治各种中风,中痰、中气,牙关紧急,痰涎壅盛者,先用此散灌之,然后随症用药。
荆芥穗(一两)、皂角(去皮弦子一钱五分)、麝香(一字,另研)。共为末,每服方寸匕,姜汤调灌下。
又一方:辟巽锭子,治大人诸风,小儿急慢惊风,四时皆可用。
防风(五钱,去芦)、天麻(五钱)、胆南星(七钱)、白附子(炮五钱)、川乌(炮五钱)、干姜(煨三钱)、川芎(五钱)、白芷(五钱)、白茯神(五钱,去木)、人参(五钱,去芦)、白术(五钱)、木香(五钱)、薄荷(五钱,去梗)、僵蚕(二十一个)、全蝎(二十一个)、牛黄(三钱)、片脑(五分)、朱砂(一两半,另研为衣)、麝香(二钱)。
以上除朱砂外,以下五种,各另研,余药为细末。用麻黄一斤,甘草四两,蜜二两,熬作膏子,稀稠得宜,将药末和匀,印作锭子,金箔为衣,或丸,如龙眼大,蜡包尤好。藏久,每服用一锭,随症根据后引下。
治大人中风,中痰,中气,厥症,并用姜汤调灌下。
左瘫右痪,荆芥汤下。
风狂颠痫,金银汤下。
大人小儿,伤寒,伤风,伤湿,并姜葱汤热调下,得微汗即解。
破伤风,温酒调下。
小儿急惊风,薄荷汤下。
小儿慢惊风,浓枣汤下。
妇人产后惊风,益母草汤下。
妇人产后,血晕昏迷,童便煎姜汤下。
(Stroke, Paralysis, Leprosy, Convulsions [Appendix], and Wind-Cold)
The *Mai Jue* (Pulse Classic) states: A floating pulse indicates wind-stroke. It also says: When the yang pulse is floating and slippery, and the yin pulse is soggy and weak, it indicates wind-stroke. A floating and slippery pulse at the cun position indicates phlegm; a faint and weak pulse indicates deficiency; a slow and choppy pulse indicates blood deficiency; a faint, slow, or deep pulse indicates qi deficiency. A large and floating pulse indicates wind; floating and rapid indicates heat; floating and slow indicates cold; floating, slow, and choppy indicates numbness of the skin; floating, slippery, scattered, and large indicates paralysis; floating, wiry, urgent, and rapid indicates convulsions due to wind-stroke. Generally, the pulses of the six meridians are similar to those in cold damage diseases, but the condition is slightly milder.
The *Nei Jing* (Inner Canon) states: When wind pathogen invades the human body, it may cause heat-center, cold-center, hemiplegia (i.e., paralysis of one side of the body), leprosy, or convulsions. All these are caused by wind. Upon examination, there are differences between wind invading the fu organs, zang organs, and blood vessels. When wind invades the fu organs, the face shows five colors, there is aversion to wind and cold, stiffness and numbness. Whether the pathogen strikes the posterior or anterior part of the body, it is easy to treat. When wind invades the zang organs, the lips cannot close, the tongue curls and cannot move leading to loss of voice, the nose cannot smell fragrances or odors, the eyes are dim, hearing is deafened, and constipation and urinary retention occur; all these are difficult to treat. When wind invades the blood vessels, there is deviation of the mouth and eyes, slurred speech, and drooling. There are also conditions such as cold-center, heat-center, paralysis, leprosy, and convulsions. These all belong to damp-heat, or phlegm-fire combined with blood deficiency. There is also "qi obstruction" caused by emotional injury, which resembles stroke but if treated as stroke, it often leads to death. Generally, stroke patients have warm bodies and abundant saliva/phlegm, whereas qi obstruction patients have cool bodies and no saliva/phlegm; this is the difference. Zhu Danxi said that true external wind invasion is rare. If there is yin deficiency and yang exhaustion, internal blazing phlegm-fire, or internal injury from diet leading to sudden stiff collapse resembling stroke, this is common. Physicians of the world fail to distinguish these and treat them all as wind, causing many deaths. He further stated that true wind pathogen affects people in the northwest, while people in the southeast suffer from damp-earth generating phlegm, phlegm generating heat, and heat generating wind. Zhang Zhongjing said: The disease of wind should present with hemiplegia. When meridians and collaterals are empty, the thief pathogen cannot be expelled. If the pathogen is on the left or right, the side affected becomes relaxed, while the healthy side becomes tense. The healthy qi pulls the pathogen, causing deviation of the mouth and eyes and insensibility. If the pathogen is in the collaterals, there is cutaneous insensibility; in the meridians, heaviness and weakness; entering the fu organs, loss of recognition; entering the zang organs, foaming at the mouth and difficulty speaking. Liu Wansu said: Stroke is not caused by excessive liver wood wind striking suddenly, nor by external wind invasion. It arises from improper lifestyle, sudden blazing heart fire, and deficient kidney water failing to control it, leading to yin deficiency and yang excess, steaming heat and stagnation, confusion of the spirit, dysfunction of sinews and bones, and sudden collapse without consciousness. Or it is due to extreme emotions (joy, anger, worry, sadness, fear) where the five passions become excessive, turning into fire. Li Dongyuan said: Stroke is not an external wind pathogen but a disease of the original qi. People over forty, when qi declines, or those injured by sorrow, joy, anger, etc., often suffer from this. Even strong, obese young adults may occasionally suffer, due to robust form but declining qi. There are also cases of thief wind attacking deficiency. Commentators say that ancients emphasized wind, Liu emphasized fire, Li emphasized qi, and Zhu emphasized dampness, suggesting each obtained one aspect. However, Liu's theory is actually contained under fire and does not emphasize wind, yet he detailed stroke treatment. Li spoke of internal qi injury but also mentioned thief wind attacking deficiency, distinguishing fu and zang involvement. Zhu spoke of damp-heat but acknowledged external wind. Did these three ignore wind? I believe wind is one of the six excesses, circulating through the four seasons, pervasive in heaven and earth, reaching all directions. Humans live within it like fish in water; if water is bland, fish are thin; if qi is discordant, humans fall ill. Those with weak constitutions are easily injured, though depth varies, and reality/deficiency differs by direction.
Regarding treatment, Li Dongyuan stated: Wind invading fu organs mostly affects the limbs, presenting with exterior symptoms, floating pulse, aversion to wind/cold, stiffness, numbness, or limb dysfunction; treatment requires sweating. Wind invading zang organs mostly obstructs the nine orifices, with flaccid lips, loss of voice, deafness, nasal congestion, blurred vision, constipation, or qi blockage with phlegm rising, unconsciousness, often fatal; treatment requires purging. Wind invading blood vessels causes deviation of the mouth and eyes. Treatments differ for these three. If wind invades blood vessels with exterior six-meridian symptoms, use Xiao Xuming Tang modified to release the exterior, and regulate with Tongsheng San (cool and acrid). If wind invades fu organs with internal bowel/bladder obstruction, inability to lift limbs or speak, this is mid-meridian stroke; use Da Qinjiao Tang or Qianghuo Yufeng Tang to nourish blood and tendons. Paralysis has deficiency and excess types. The *Nei Jing* states: Excess earth causes inability to lift limbs; this is a disease of rich food, not liver/kidney deficiency; treatment requires purging to balance earth, using Sanhua Tang or Tiaowei Chengqi Tang. Spleen deficiency also causes inability to lift limbs; treat with Shiquan Siwu Tang to eliminate pathogens and preserve righteous qi. Zhang Hezi used sweating, vomiting, and purging methods. Vomiting is like resolving water stagnation to allow flow; sweating expels wind with sweat; purging eliminates old to generate new. For loss of voice, confusion, and deviation, use Sansheng San to induce vomiting. For locked jaw, instill nasally to expel phlegm, opening the mouth, then regulate with Liangge San. Generally, wind originates from heat; excessive heat generates wind. Calmness overcomes dryness; nourishing yin-blood is primary. When yin-blood is robust, wind-heat cannot arise. Treatment must follow this, using mild sweating and purging. Excessive sweating damages wei qi; excessive purging harms ying blood. Thus, the classics warn against rash sweating/purging. Zhu Danxi said: Stroke is mostly due to blood deficiency with phlegm, or accompanied by fire/damp-heat. Treatment prioritizes regulating qi, resolving phlegm, clearing heat, dispersing wind, inducing vomiting/purging, followed by tonification. Distinguish severity based on injury, obstruction, or infection. Left-sided involves static blood: Siwu Tang plus Xingren, Honghua; severe cases use Taoren Chengqi Tang. Right-sided involves phlegm/qi: Erchen Tang plus Nanxing, Beimu, Jiangzhi, Zhuli. Qi disorders use Wuyao Shunqi San. Severe phlegm obstruction or facial deviation uses vomiting methods (Gua Di, Lic Lu juice) based on severity. Sudden collapse due to qi deficiency: Tonify with Renshen. Deficiency with phlegm: Concentrated Renshen decoction plus Zhuli, Jiangzhi. Blood deficiency: Siwu Tang. With phlegm: Add Jiangzhi, Zhuli. Hemiplegia (left/right): Use the aforementioned blood/qi formulas plus Jiangzhi, Zhuli.
Leprosy is caused by abnormal qi of heaven and earth. Pathogen location determines symptoms: qi level affects upper body, blood level affects lower body, both affect both. It primarily involves the Yangming meridian (Stomach and Large Intestine). Treatment first clears damp-heat with purgatives, then tonifies blood or qi, using wind-dispersing and detoxifying herbs. Postpartum convulsions in women result from blood deficiency generating internal heat, which generates wind, triggered by emotions. Use Siwu Tang modified. Yi Mu Wan, Wu Jin Wan, Bi Xun Ding Zi are optional. Pediatric convulsions are acute or chronic. Chronic belongs to spleen deficiency: warm and tonify with Shen Zhu Tang or Zhusha Anshen Wan. Acute belongs to phlegm-heat: cool and purge with Niuhuang Qingxin Wan or Lijing Wan. Emotional qi obstruction: prolonged sorrow causes qi reversal, salivary flooding, locked jaw. Instill Suhexiang Wan to awaken, then regulate. Bi Xun Ding Zi is also effective.
Formulas:
Xiao Xuming Tang treats various winds and stroke, usable year-round with modifications.
Mahuang (1 qian, remove nodes/roots), Renshen (0.5 qian, remove rhizomes), Huangqi (1 qian), Danggui (1 qian, wine-washed), Chuanxiong (0.8 qian), Xingren (0.8 qian, remove tips), Fangji (0.8 qian), Fuzi (0.8 qian, processed), Guizhi (0.6 qian), Fangfeng (1.5 qian, remove rhizomes), Gancao (0.3 qian), Baishao (1 qian).
Add 5 slices of Shengjiang, 1 Zao, 2 bowls of water. Decoct to 1 bowl. Strain. Take hot before meals.
Taiyang meridian stroke with sweating: add Guizhi Tang. Without sweating: add Mahuang Tang.
Yangming meridian stroke: add Gegen Tang.
Shaoyang meridian stroke: add Qianghuo, Chaihu (each 1 qian), or Xiaochaihu Tang.
Taiyin meridian stroke (text error likely): Add Ganjiang (0.8 qian), double Fuzi.
Shaoyin meridian stroke: Add Guizhi (0.8 qian), double Fuzi.
Jueyin meridian stroke: Add Lianqiao, Qianghuo (each 0.8 qian).
Pre-natal stroke: Add Jingjie Sui, Tianma, Sangjisheng (each 1 qian), remove Guizhi, Fuzi.
Post-natal stroke: Add Jingjie Sui (1 qian), Taoren, Honghua, Zelan Ye (each 0.8 qian).
Stroke without sweating and stiffness: Add Qianghuo, Baizhi, Cangzhu (each 1 qian), remove Guizhi, Fuzi.
Stroke with excessive sweating and confusion: Add Huangqi (1 qian), Fushen (1 qian), Yuanzhi (0.7 qian), remove Mahuang, Xingren, Guizhi, Fuzi.
Limb stiffness/pain: Add Dama, Qinjiao, Qianghuo (each 0.8 qian).
Abundant phlegm/saliva: Add Nanxing, Banxia (each 1.5 qian), Jiangzhi (1 liang), Zhuli (2 liang).
Spring: Double Mahuang, Chuanxiong.
Summer: Add Shigao, double Huangqin.
Autumn: Double Danggui, add Shengdihuang (soaked in Jiangzhi 3 days, dried).
Winter: Double Fuzi, add Ganjiang (0.7 qian).
Another Formula: Fangfeng Tongsheng San, usable year-round. Treats various wind-heat.
Fangfeng (1.5 qian), Chuanxiong (0.8 qian), Chuan Gui (1 qian), Baishao (1 qian), Baizhu (1.2 qian), Mahuang (1.2 qian), Shigao (1 qian), Huashi (0.8 qian), Jiegeng (0.8 qian), Lianqiao (0.8 qian), Huangqin (0.8 qian), Zhizi (0.8 qian), Jingjie (0.7 qian), Bohe (0.7 qian), Dahuang (2 qian, adjust for deficiency/excess), Mangxiao (1 qian), Gancao (0.5 qian).
One dose. Add 3 slices Shengjiang, 1 Zao, 2 bowls water. Decoct to 1 bowl. Take hot after meals.
Wind-phlegm abundance: Add Nanxing, Banxia (each 1.5 qian), Tianma, Baifuzi (each 0.7 qian).
Heat-phlegm: Add Erchen Tang, Jiangzhi (0.5 liang), Zhuli (1 liang).
Qi deficiency collapse: Add Renshen (each 1.5 qian), remove Mahuang, Shigao, Huashi, Jiegeng, Lianqiao, Zhizi, Bohe, Mangxiao, Dahuang.
Dry mouth with heat: Add Chaihu, Gegen, Tianhuafen (each 0.8 qian).
Headache: Double Chuanxiong, Shigao; add Banxia (1.5 qian).
Hemiplegia: Right side add phlegm herbs; left side add blood herbs; use Jiangzhi, Zhuli. If appetite good, remove Zhuli, add Jingli.
Convulsions: Add Tianma, Baizhi (each 1 qian), Jiangcan, Quanxie (each 0.7 qian).
Cold-damp pain in joints: Add Qianghuo, Cangzhu (each 1 qian), Guizhi (slightly less than 0.5 qian).
Muscle twitching: Add Tianma, Qianghuo, Baizhi (each 1 qian), Xie Shao (0.5 qian).
Emotional qi obstruction: Add Wuyao, Zhike, Xiangfu, Zisu (each 1 qian), remove Mahuang, Shigao, Huashi, Lianqiao, Mangxiao, Dahuang.
Alcohol + wind, severe headache: Add Huanglian, Gefen, Banxia, Cangzhu (each 0.8 qian), remove Mahuang, Huashi, Lianqiao, Mangxiao, Dahuang.
Severe wind injuring lung, wheezing/cough: Add Banxia, Beimu, Xingren, Jinfeicao, Kuandonghua (each 0.8 qian), remove Mangxiao, Dahuang, Huashi.
Benefit qi/blood, expel wind: Decoct base formula, mix with Qianghuo powder, Quanxie powder (each 1 qian).
Various wind spasms, pediatric acute/chronic convulsions, constipation, intense pathogenic heat, dry intestines, night sweats, teeth grinding, upward rolling eyes, delirium, restlessness, tendon contraction, palpitations: Double Dahuang, Zhizi in base formula, mix with Fuling powder, Quanxie powder (each 1 qian).
Wandering pain in waist/flanks: Add Xiaoshi, Qianghuo powder (each 1 qian), mix with Cheqianzi powder, Haijinsha powder (each 1 qian), Muxiang powder (0.5 qian).
Trauma/injury, joint pain, abdominal blood stasis: Add Danggui, Dahuang (double), Taoren, mix with Rushi, Moyao (each 1 qian).
Dizziness, brain heat, nasal congestion with turbid discharge: Add Huanglian, Xinyi, Bohe, decoct. (*Nei Jing*: Gallbladder heat in brain causes rhinitis/turbid discharge).
Qi rebellion: Remove Huashi, Lianqiao, Mangxiao, Dahuang from base, add Zhike, mix with Muxiang powder (1 qian).
Dysuria/retention: Remove Mahuang, add Mutong, Cheqianzi (each 1 qian), mix with Muxiang powder (0.5 qian).
Constipation: Remove Mahuang, Jiegeng, add Taoren, Haren, Zhike, double Danggui.
Urticaria (red/white): Add Mahuang, Congbai (3 stalks), Shengma (0.7 qian), Niubangzi, Lianqiao (each 1 qian). Sweating resolves it. Remove Mangxiao (salty enters blood, congeals flesh, prevents sweating).
Resolve seasonal cold damage (internal/external): Base formula 1 liang, Yiyuan San 1 liang, Congbai 10 stalks, Yanchi 1 he, Shengjiang 0.5 liang, 1 bowl water. Boil 5-7 times. Warm drink half, induce vomiting with feather. After vomiting, take remaining half hot. Sweating resolves immediately.
Leprosy: Add Niubangzi, Kushen (each 1.5 qian), Quanxie, Tianma, Qianghuo, Baizhi (each 0.8 qian), Qishe Rou (2 qian), remove...
Wind-cold symptoms (Right Guan pulse wiry/slow/floating): Remove Mangxiao, Dahuang, Huangqin, Lianqiao, Shigao, Huashi, Mahuang, Jiegeng, Jingjie, Bohe from base. Add Renshen, Baifuling, cook with Sumi. Good for wind-cold.
Sores/Ulcers, clear heat/detoxify: Add Niubangzi, Kushen, Jinyinhua (each 1 qian).
Breast inflammation: Add Jinyinhua, Mutong, Beimu, Gongying (each 1.2 qian), Chuanshanjia, Qingpi (each 0.5 qian), Gancao Jie (0.6 qian).
Syphilis/Groin abscess, early stage or after calomel misuse: Add Mutong, Baixianpi, Wujia Pi, Jinyinhua, Zaogelaci (each 0.8-1 qian), Tufuling (2 liang), Bajiaogen (3 qian).
Another Formula: Kaiguan San treats stroke, phlegm/qi obstruction, locked jaw, abundant phlegm. Instill first, then treat symptoms.
Jingjie Sui (1 liang), Zaorou (remove skin/strings, 1.5 qian), Shexiang (1 zi, separately ground). Powder. Dose: 1 fangcun bi. Mix with Jiangtang and instill.
Another Formula: Bi Xun Ding Zi treats adult winds, pediatric acute/chronic convulsions, usable year-round.
Fangfeng (5 qian, remove rhizomes), Tianma (5 qian), Dantanxing (7 qian), Baifuzi (processed 5 qian), Chuanwu (processed 5 qian), Ganjiang (baked 3 qian), Chuanxiong (5 qian), Baizhi (5 qian), Baifulen (5 qian, remove wood), Renshen (5 qian, remove rhizomes), Baizhu (5 qian), Muxiang (5 qian), Bohe (5 qian, remove stems), Jiangcan (21 pieces), Quanxie (21 pieces), Niuhuang (3 qian), Pian Nao (0.5 qian), Zhusha (1.5 liang, separately ground for coating), Shexiang (2 qian).
Grind Zhusha separately. Grind the other five ingredients separately. Powder remaining herbs. Decoct Mahuang (1 jin), Gancao (4 liang), Honey (2 liang) into paste. Mix powders with paste. Mold into pills/cakes. Coat with Jinbo. Or make dragon-eye sized pills, wax wrapped preferred. Store long-term. One cake per dose, taken with appropriate guiding liquid.
Adult stroke, phlegm, qi obstruction, syncope: Ginger tea.
Left/Right paralysis: Jingjie tea.
Manic epilepsy: Yinjin tea.
Adult/Child cold, wind-cold, dampness: Ginger-Scallion tea hot. Mild sweating resolves.
Broken wind (tetanus): Warm wine.
Pediatric acute convulsions: Bohe tea.
Pediatric chronic convulsions: Concentrated Jujube tea.
Postpartum convulsions: Yimucao tea.
Postpartum blood晕/coma: Child urine decocted with ginger tea.