风寒暑湿,皆能中人。惟湿气积久,留滞关节,故能中非如风寒暑之有暴中也。
中湿之证,关节重痛,浮肿喘满,腹胀烦闷,昏不知人,其脉必沉而缓,或沉而微
细,宜除湿汤、白术酒。有破伤处因澡浴湿气从疮口中入,其人昏迷沉重,状类中
湿,名曰破伤湿,宜白术酒。
中气,因七情内伤,气逆为病,痰潮昏塞,牙关紧急。七情皆能为中,因怒而
中者尤多。大略与中风相似,风与气亦自难辨。风中身温,气中身冷。风中多痰涎,
气中无痰涎。风中脉浮应人迎,气中脉沉应气口。以气药治风则可,以风药治气则
不可。才觉中气,急以苏合香丸灌之,候醒,继以八味顺气散加香附三五钱,或木
香调气散。尚有余痰末尽平复,宜多进四七汤及星香散。若其人本虚,痰气上逆,
关隔不通,上下升降,或大便虚秘,宜用三和丹。
中食之证,忽然厥逆昏迷,口不能言,肢不能举,状似中风。皆因饮食过伤醉
饱之后,或感风寒,或着气恼,以致填塞胸中,胃气有所不行,阴阳痞隔,升降不
通,此内伤之至重者。人多不识,若误作中风、中气,而以祛风行气之药,重伤胃
气,其死可立而待。不若先煎姜盐汤探吐其食。仍视其风寒尚在者,以藿香正气散
解之。气滞不行者,以八味顺气散调之。吐后别无他证,只用平胃散加白术、茯苓、
半夏、曲 之类调理。如遇此卒暴之病,必须审问明白,或方食醉饱,或饮食过伤,
但觉胸膈痞闷,痰涎壅塞,气口脉紧盛者,且作食滞冶之。戴云∶人之饮食下咽而
入肝,由肝而入脾,由脾而入胃,因食所伤,肝气不理,故痰涎壅塞,若中风然,
亦有半身不遂者,肝主筋故也,治以风药则误矣。按复庵名医也,饮食下咽而先入
肝,于理难通,其必有谓矣。姑存之以俟问。
风寒暑湿,都能侵袭人体。只有湿气积聚日久,滞留于关节,所以能发生“中湿”,不像风寒暑那样有突然发作的“暴中”。
中湿的病证,表现为关节沉重疼痛,浮肿气喘胸满,腹胀烦闷,神志昏迷不省人事,其脉象必定沉而缓,或沉而微细,适宜使用除湿汤、白术酒。如果有破伤处,因洗澡时湿气从疮口进入体内,患者出现昏迷沉重,症状类似中湿,名叫“破伤湿”,适宜使用白术酒。
中气,是由于七情(喜、怒、忧、思、悲、恐、惊)内伤,导致气机逆乱而发病,表现为痰涎上涌、昏塞、牙关紧闭。七情都能导致中气,其中因愤怒而引发的尤为多见。大体上与中风相似,风与气也自然难以辨别。中风者身体温暖,中气者身体寒冷;中风者多痰涎,中气者无痰涎;中风者脉浮且对应人迎脉,中气者脉沉且对应气口脉。用治气的药物治疗中风是可以的,但用治风的药物治疗中气则不可以。刚察觉是中气,应立即灌服苏合香丸,待患者苏醒后,继以八味顺气散加香附三至五钱,或者木香调气散。如果还有余痰未完全平息,适宜多服用四七汤及星香散。如果患者本身体虚,痰气上逆,导致关格不通,上下升降失常,或者大便虚秘,适宜使用三和丹。
中食病证,突然发生厥逆昏迷,口不能言,肢体不能抬起,症状类似中风。都是因为饮食过度损伤,醉饱之后,或者感受风寒,或者遭遇气恼,导致食物填塞胸中,胃气无法运行,阴阳痞塞阻隔,升降不通,这是内伤中最严重的情况。人们大多不认识此病,如果误作中风、中气,而使用祛风行气的药物,会重伤胃气,死亡就在眼前。不如先煎姜盐汤催吐以排出食物。仍然观察是否有风寒残留,若有,用藿香正气散解除。气滞不行的,用八味顺气散调理。吐后没有其他病症,只用平胃散加白术、茯苓、半夏、神曲之类进行调理。如果遇到这种突发急病,必须详细询问清楚,如果是刚进食或醉饱,或者饮食过度损伤,只要觉得胸膈痞闷,痰涎壅塞,气口脉紧盛,暂且按食滞治疗。戴云说:人的饮食咽下后进入肝,由肝进入脾,由脾进入胃,因为饮食所伤,肝气不调理,所以痰涎壅塞,像中风一样,也有半身不遂的,因为肝主筋的缘故,如果用治风药治疗就错了。按语:复庵是名医,饮食咽下后先进入肝,在道理上难以通融,他一定有他的说法。姑且保存下来以便将来请教。
Wind, cold, summer-heat, and dampness can all invade the human body. Only when dampness accumulates over a long period and stagnates in the joints does it cause "Zhong Shi" (Dampness Strike), which differs from the sudden onset ("Bao Zhong") seen with wind, cold, or summer-heat.
The syndrome of Zhong Shi (Dampness Strike) presents with heavy and painful joints, edema, asthma, chest fullness, abdominal distension, irritability, and coma with loss of consciousness. The pulse must be deep and slow, or deep and faint/thin. It is suitable to use Chu Shi Tang (Dampness-Expelling Decoction) and Baizhu Jiu (Atractylodes Macrocephala Wine). If there is an open wound where dampness enters through the sore during bathing, causing coma and heaviness resembling Zhong Shi, it is named Po Shang Shi (Traumatic Dampness), and Baizhu Jiu (Atractylodes Macrocephala Wine) is suitable.
Zhong Qi (Qi Strike) is caused by internal injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), leading to rebellious Qi as the pathology. Symptoms include surging phlegm, stupor, blockage, and lockjaw. All seven emotions can cause Zhong Qi, among which those triggered by anger are particularly common. Generally, it resembles Zh Feng (Wind Strike), making it difficult to distinguish between Wind and Qi. In Wind Strike, the body is warm; in Qi Strike, the body is cold. Wind Strike involves much phlegm-saliva, whereas Qi Strike has none. In Wind Strike, the pulse is floating and corresponds to the Renying point (ST 9); in Qi Strike, the pulse is deep and corresponds to the Qikou point (LU 9). Treating Wind with Qi-regulating herbs is acceptable, but treating Qi with Wind-dispelling herbs is not. Upon suspecting Zhong Qi (Qi Strike), immediately administer Suhe Xiang Wan (Styrax Pill). After the patient regains consciousness, follow up with Ba Wei Shun Qi San (Eight-Ingredient Qi-Regulating Powder) plus Xiangfu (Cyperus Rhizome) three to five qian, or Muxiang Tiao Qi San (Costus Regulating Qi Powder). If residual phlegm remains unresolvied, it is advisable to take Sizhi Tang (Four-Seven Decoction) and Xingxiang San (Star Anise and Costus Powder) frequently. If the person is originally deficient, with rebellious phlegm-Qi causing Guan Ge (obstruction), dysfunction of ascending and descending, or deficiency-type constipation, San He Dan (Three-Harmony Pill) is suitable.
The syndrome of Zhong Shi (Food Strike) presents with sudden syncope, coma, inability to speak, and inability to move limbs, resembling Wind Strike. This is all due to excessive dietary injury, after drunkenness or overeating, or following exposure to wind-cold or emotional distress, causing food to fill and obstruct the chest. Stomach Qi fails to circulate, Yin and Yang become blocked, and ascending and descending mechanisms fail. This is the most severe form of internal injury. Most people do not recognize this condition. If mistakenly treated as Wind Strike or Qi Strike using wind-dispelling and Qi-moving herbs, the Stomach Qi will be severely damaged, and death will follow immediately. It is better to first decoct ginger-salt water to induce vomiting and expel the food. Observe if wind-cold remains; if so, resolve it with Huoxiang Zhengqi San (Patchouli Correcting Qi Powder). For stagnant Qi, regulate it with Ba Wei Shun Qi San (Eight-Ingredient Qi-Regulating Powder). If no other symptoms remain after vomiting, simply use Pingwei San (Peaceful Stomach Powder) added with Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Banxia (Pinellia Rhizome), Qu (Medicated Leaven), etc., for regulation. When encountering such acute conditions, one must inquire thoroughly. If the patient has just eaten or drunk excessively, or suffered dietary injury, and feels chest diaphragm oppression, phlegm-saliva congestion, and a tight/full pulse at the Qikou point (LU 9), treat it temporarily as Food Stagnation. Dai Yun stated: When food is swallowed, it enters the Liver, then the Spleen, then the Stomach. Injury from food causes Liver Qi to fail to flow smoothly, leading to phlegm-saliva congestion resembling Wind Strike, and even hemiplegia, because the Liver governs the sinews. Using wind-dispelling herbs would be a mistake. Commentary: Fu An was a famous physician. The idea that food enters the Liver first upon swallowing is logically difficult to accept; he must have had specific reasoning. I preserve this record here for future inquiry.