典藏书目

Zhongfeng (Stroke) is a disease caused by internal dryness transforming into wind, compounded by external pathogenic factors. The causes of internal dryness vary: in some cases, damp-heat stagnates for a long time and transforms into dry phlegm, obstructing the stomach collaterals. Suddenly, due to fatigue or overexertion, depression, or abnormal climatic conditions, the patient faints, falls into a coma with loss of consciousness, experiences limb convulsions, and has phlegm rales during respiration. This is a syndrome where hot phlegm obstructs the Pericardium (Heart Protector), causing Qi blockage and obstruction. The symptoms include unrousable coma, stiff limbs that do not relax, or even spasticity and difficulty in movement. The pathology is located above the Middle Jiao (Middle Burner), characterized by excess pathogens in the Liver and Spleen. Treatment should involve opening and descending methods, eliminating phlegm and resolving blood stasis, assisted by nourishing Yin.

In other cases, Yin deficiency leads to internal depletion of fluids, which cannot ascend to nourish the Heart, causing severe depletion of Heart Qi and flaccidity of sinews and vessels. Suddenly, without prior fatigue, depression, or climatic abnormalities, the patient collapses, presenting with deviation of the mouth and eye, continuous drooling, flushed cheeks, slight convulsions of hands and feet, flaccid paralysis unable to be controlled, hemiplegia, audible breathing without phlegm rales, and fluctuating consciousness ranging from clear to confused. This results from exhaustion of Yin fluids in the Lower Jiao (Lower Burner), failing to anchor Qi, leading to dispersion of Qi and withering of sinews. The pathology is located in the Liver and Kidney of the Lower Jiao, where Yin is empty and Yang is dispersed, with open pores that fail to close. Treatment should involve moistening and astringent methods, nourishing the Heart and pacifying the Liver, assisted by promoting Qi circulation.

The Zhongfeng described here corresponds to "Fa Wei Jue" mentioned in the *Neijing* (Classic of Internal Medicine), representing a combined disease of Wei Syndrome (Flaccidity) and Jue Syndrome (Reversal/Cold-Heat Extremities). The *Neijing* discusses Jue as having both cold and heat types, but states that Wei arises solely from intense heat. Exploring this principle reveals distinctions in Yin-Yang, Deficiency-Excess, and severity. Zhongfeng invariably stems from Yin deficiency, but may present as Yin deficiency with sinking of Yang Qi, Yin deficiency with dispersion of Yang Qi, pure emptiness of True Qi internally, or co-existing internal excess of phlegm-saliva. Thus, the former presentation leans more towards Jue; excessive Jue indicates weak Yang Qi sinking inward, resulting in forceful internal attack, often accumulating into internal heat due to phlegm and blood stasis. The latter presentation leans more towards Wei; excessive Wei indicates fierce Yang Qi dispersing outward, resulting in flaccid paralysis and weakness, often transforming into internal cold later due to insufficient Jin-Ye (Body Fluids) and Blood to sustain the sinews. Some patients die immediately upon onset, while others suffer for years; this distinguishes disease entering the Zang organs versus entering the Collaterals, and separation between Collapse (Deficiency) and Closure (Excess).

Regarding pulse diagnosis: generally, the left pulse is deep and wiry, while the right pulse is surging and slow. This reflects Yang Qi sinking and knotting internally, and exhaustion of Yin fluids internally. If both hands show deep, fine, wiry, and vigorous pulses, it indicates pure Yang deficiency. If the pulse is deep, surging, and scattered, feeling blurred under heavy pressure, it indicates pure Yin deficiency. Floating, wiry, fine, and vigorous pulses, or thin and scattered floating pulses, indicate imminent death if sweating occurs, but are treatable if no sweat occurs. Irregular pulsation throughout the three positions, sounding like pearls rolling, or isolated hardness at the Guan positions with an empty Chi position, all indicate exhaustion of Yuan Qi (Original Qi). Surging, wiry, slippery, and solid pulses throughout the three positions, coarse and hard like a rope, striking the finger upward, indicate exhaustion of Yin with internal excess of phlegm-saliva; the patient will die if still, but if limbs are restless and movements are forceful like madness, Da Chengqi Tang (Major Order the Qi Decoction) plus Renshen (Ginseng Root) and Dihuang (Rehmannia Root) should be used urgently to purge. Floating-wiry-fine pulses at the superficial level, with moderate-deep pulses being slow, slippery, and surging, becoming empty only under heavy pressure, indicate mild Yang deficiency with internal damp-heat phlegm; this is an excellent pulse prognosis for Zhongfeng. Additionally, if there is Yang deficiency-cold in the Lower Jiao and dry-heat in the Liver-Stomach of the Middle Jiao, with cold blocking heat causing it to rush upward to the Heart, the pulse may be floating and empty, or surging and large, but wiry, fine, and rigidly long upon palpation.

Zhongfeng is a major disease. Previous scholars have offered divergent opinions, reaching no consensus. Therefore, I have emphasized these points repeatedly. Li Dongyuan emphasized deficiency; why are there cases of internal excess? Liu Hejian emphasized fire; why are there cases without fire? Zhu Danxi emphasized phlegm; why are there cases without phlegm? By probing the root cause as exhaustion of Jin-Ye and stagnation of Blood, clarifying the mechanism as either sinking or dispersion of Yang Qi, differentiating syndromes based on the presence of phlegm and severity of external contraction, and investigating transformations into cold or heat, the fundamental principles are comprehensively covered herein.