中风者，人间第一大病也，而《金匮》论之甚简，吾初亦怪仲景之太率略矣。细考其义
乃知
察脉审证、施治之法，已提纲挈领而无遗也。后世论中风者，分中经、中腑，而口歪眼斜，
流涎吐沫，偏枯不遂，四肢拘急，痿软瘫痪，呼吸喘促，统列为中风之证，中脏而不辨其阴
阳虚实也。大秦艽汤、排风汤、八风汤、续命汤诸方，统列为治中风之方，而亦不辨其阴
阳
虚实也。河间以为火，东垣以为气虚，丹溪以为湿热生痰，未有辨别阴虚阳虚者；所立之方
，终未有出小续命之范围者也。王节斋始畅发阴虚之论，叶天士始重讲阴虚之治，一洗前人
惯用辛燥之习，而又遗阳虚一层矣。后静读《金匮》脉迟而紧，是阳虚之寒证也，其下系以
口眼歪斜，四肢拘急，口吐涎沫诸证；脉迟而缓，是阴虚之热证也，其下系以心气不足，胸
满短气，缓纵不收之证。黄连泻心汤治心气不足吐血者，义与此同。前人所称邪盛为真中风
者，其所指之证，即皆在阳虚挟寒之条者也；所称正虚为类中风者，其所指之证，即皆在阴
虚
生燥之条者也。故知阴虚、阳虚为中风两大关键，而真之与类，正无庸琐琐也。何者?二证
之
本，皆由正气大虚，转运之权无以自主，而猝为时令升降敛散之气所变乱，以失其常度也。
阳虚者，遇寒冷之令，其阳气不胜天气之敛抑，故多病于秋冬；阴虚者，遇温热之令，其阴
气不胜天气之发越，故多病于春夏。挟寒者，气内结，多现外感之象，世遂以为真中矣；挟
温者，气外泄，多现内虚之象，世遂以为类中矣。治之之法，虚有微甚，即药有重轻，不待
言也。所尤当辨者，阳虚有阴盛，有阴不盛；阴虚有阳盛，有阳不盛。阴盛者为寒冷，治之
以重热，阴不盛为寒燥，治之以温润；阳盛者为燥热，治之以凉润，阳不盛为虚燥，亦治之
以温润也。大抵阳虚之治，药取其气，气重在辛；阴虚之治，药取其味，味重在酸。而总须
重佐之以活血。何者?阳虚血必凝，非此无以拨其机；阴虚血必滞，非此无以通其道也。或
曰
∶气既虚矣，而复活其血，不速之脱乎?曰∶固其气则不脱矣。且活血者正以疏其机关，为
气之脱者辟归之之路也。西医谓病此者，脑中有水，或有死血。殊不知水者，阳衰而水凌也
，死血者，阴虚而血沸也，皆中气暴乱，激之以至脑也。上古之世，所谓真中，必感异风，
猝
伤脑气，以致仆倒，稍延即内变五脏而不治矣。其证不数见，故仲景不论也。华佗《中藏经
》、巢氏《病源候论》中有灸法，宜并考之。
中风，是人间第一大病，而《金匮要略》对其论述非常简略，我起初也责怪张仲景太过粗略。仔细考察其义理，才知道其中察脉审证、施治的方法，已经提纲挈领而无遗漏了。后世论述中风的，分为中经、中腑，将口眼歪斜、流涎吐沫、半身不遂、四肢拘急、痿软瘫痪、呼吸喘促等症状，统列为中风的证候，只说是中脏，却不辨别其阴阳虚实。大秦艽汤、排风汤、八风汤、续命汤等方剂，统列为治疗中风的方子，也不辨别其阴阳虚实。刘河间认为是火，李东垣认为是气虚，朱丹溪认为是湿热生痰，没有人辨别阴虚阳虚；所立的方子，终究没有超出小续命汤的范围。王节斋开始阐发阴虚的论点，叶天士开始重视讲解阴虚的治疗，一扫前人惯用辛温燥烈药物的习气，却又遗漏了阳虚这一层。后来静心研读《金匮要略》，发现“脉迟而紧”，这是阳虚的寒证，其下关联的口眼歪斜、四肢拘急、口吐涎沫等症状；“脉迟而缓”，这是阴虚的热证，其下关联的心气不足、胸满短气、肢体弛缓不收等症状。黄连泻心汤治疗心气不足导致的吐血，义理与此相同。前人所称邪气盛为真中风的，其所指的证候，就都在阳虚挟寒的条文里；所称正气虚为类中风的，其所指的证候，就都在阴虚生燥的条文里。所以知道阴虚、阳虚是中风的两大关键，而真中与类中的区别，根本无需琐碎争论。为什么呢？这两种证候的根本，都是由正气大虚，转运的权能无法自主，突然被时令升降敛散的气机所变乱，从而失去常度。阳虚的人，遇到寒冷的气候，其阳气不能胜天气的收敛抑制，所以多在秋冬发病；阴虚的人，遇到温热的气候，其阴气不能胜天气的发越升腾，所以多在春夏发病。挟寒的，气机内结，多呈现外感的表象，世人便以为是真中风；挟温的，气机外泄，多呈现内虚的表象，世人便以为是类中风。治疗的方法，虚损有轻微严重之分，用药就有轻重之别，这不用多说。特别应当辨别的，阳虚有阴盛，有阴不盛；阴虚有阳盛，有阳不盛。阴盛的是寒冷，用重热的药治疗；阴不盛的是寒燥，用温润的药治疗；阳盛的是燥热，用凉润的药治疗；阳不盛的是虚燥，也用温润的药治疗。大抵治疗阳虚，取药的“气”，气重在辛味；治疗阴虚，取药的“味”，味重在酸味。而且总须重用活血药来辅助。为什么呢？阳虚则血必凝滞，不用活血药就无法拨动病机；阴虚则血必涩滞，不用活血药就无法疏通其道。有人问：气既然已虚，又去活血，难道不会导致气脱吗？回答说：固护好气就不会脱了。况且活血正是为了疏利机关，为气之将脱者开辟回归的道路。西医认为患此病的人，脑中有水湿，或有死血。殊不知水湿，是阳衰而水气凌犯；死血，是阴虚而血沸腾妄行，这都是中气暴乱，激荡上冲至脑部所致。上古时代，所谓的真中风，必定是感受异风，突然伤及脑气，以致仆倒，稍拖延就会内伤五脏而不治。这种证候不常见，所以张仲景不予论述。华佗的《中藏经》、巢元方的《诸病源候论》中有灸法，应当一并考证研究。
Apoplexy (Zhong Feng) is the first major disease among humans, yet *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) discusses it very briefly. I initially also blamed Zhang Zhongjing for being too cursory. Upon careful examination of its principles, one realizes that the methods of observing the pulse and assessing symptoms, as well as applying treatment, have already grasped the main points without omission. Later generations discussing apoplexy divided it into stroke affecting the meridians (Zhong Jing) and stroke affecting the viscera (Zhong Fu), categorizing symptoms such as deviation of the mouth and eyes (Kou Yan Wa Xie), drooling and foaming at the mouth (Liu Xian Tu Mo), hemiplegia (Pian Ku Bu Sui), spasticity of the four limbs (Si Zhi Ju Ji), flaccid paralysis (Wei Ruan Tan Huan), and panting respiration (Hu Xi Chuan Cu) collectively as signs of apoplexy affecting the viscera, without distinguishing between Yin deficiency and Yang deficiency or excess and deficiency. Formulas such as Da Qin Jiao Tang (Great Sophora Root Decoction), Pai Feng Tang (Expel Wind Decoction), Ba Feng Tang (Eight Winds Decoction), and Xu Ming Tang (Continue Life Decoction) were collectively listed as treatments for apoplexy, also without distinguishing between Yin/Yang or excess/deficiency. Liu Hejian attributed it to Fire (Huo), Li Dongyuan to Qi deficiency (Qi Xu), and Zhu Danxi to damp-heat generating phlegm (Shi Re Sheng Tan); none distinguished between Yin deficiency and Yang deficiency; the formulas they established ultimately did not go beyond the scope of Xiao Xu Ming Tang (Minor Continue Life Decoction). Wang Jiezhai was the first to expound on the theory of Yin deficiency, and Ye Tianshi was the first to emphasize the treatment of Yin deficiency, washing away the previous habit of using acrid-warm and drying herbs, yet they omitted the aspect of Yang deficiency. Later, upon quietly studying *Jingui Yaolue*, I found that "pulse slow and tight" indicates a cold syndrome of Yang deficiency, associated with symptoms like deviation of the mouth and eyes, spasticity of the four limbs, and foaming at the mouth; "pulse slow and moderate" indicates a heat syndrome of Yin deficiency, associated with symptoms like insufficiency of Heart Qi (Xin Qi Bu Zu), chest fullness and shortness of breath, and flaccidity with inability to control movement. Huang Lian Xie Xin Tang (Coptis Decoction to Drain the Heart) treats vomiting blood due to insufficiency of Heart Qi, sharing the same principle. What predecessors called "True Apoplexy" (Zhen Zhong Feng) caused by excessive pathogenic factors refers to syndromes in the section on Yang deficiency with cold; what they called "Similar Apoplexy" (Lei Zhong Feng) caused by righteous Qi deficiency refers to syndromes in the section on Yin deficiency generating dryness. Thus, we know that Yin deficiency and Yang deficiency are the two key aspects of apoplexy, and the distinction between True and Similar is unnecessary to debate minutely. Why? The root of both syndromes lies in severe deficiency of Righteous Qi (Zheng Qi), where the power of transformation and transportation loses autonomy, suddenly disrupted by the ascending-descending, condensing-dispersing Qi of the seasons, thereby losing its normal rhythm. Those with Yang deficiency, encountering cold weather, find their Yang Qi unable to withstand the condensing and inhibiting influence of Heaven's Qi, so they often fall ill in autumn and winter; those with Yin deficiency, encountering warm weather, find their Yin Qi unable to withstand the dispersing and ascending influence of Heaven's Qi, so they often fall ill in spring and summer. Those with cold pathogens have internal Qi knotting, presenting external contraction-like phenomena, leading the world to consider them True Apoplexy; those with warm pathogens have external Qi leakage, presenting internal deficiency-like phenomena, leading the world to consider them Similar Apoplexy. The method of treatment: if deficiency is slight or severe, the weight of medication varies accordingly, which needs no further explanation. What particularly requires differentiation is that Yang deficiency can involve either Yin excess or non-excess of Yin; Yin deficiency can involve either Yang excess or non-excess of Yang. Yin excess manifests as cold, treated with heavy hot herbs; non-excess of Yin manifests as cold-dryness, treated with warm-moistening herbs; Yang excess manifests as dry-heat, treated with cool-moistening herbs; non-excess of Yang manifests as deficiency-dryness, also treated with warm-moistening herbs. Generally, treating Yang deficiency involves utilizing the "Qi" (aroma/volatile nature) of herbs, emphasizing the Acrid (Xin) flavor; treating Yin deficiency involves utilizing the "Flavor" (substance/taste) of herbs, emphasizing the Sour (Suan) flavor. Furthermore, one must always heavily assist with Blood-invigorating (Huo Xue) methods. Why? In Yang deficiency, Blood inevitably stagnates; without this, the mechanism cannot be activated; in Yin deficiency, Blood inevitably becomes stagnant; without this, the pathways cannot be unblocked. Some ask: If Qi is already deficient, why invigorate Blood? Will it not cause Qi collapse? I reply: By securing Qi, collapse will not occur. Moreover, invigorating Blood serves to unblock the joints/mechanisms, clearing the path for returning Qi. Western medicine posits that patients with this condition have water in the brain or dead blood. They do not understand that "water" results from Yang decline causing Water Qi to overwhelm, and "dead blood" results from Yin deficiency causing Blood to boil and rush recklessly; both stem from a sudden chaos of Middle Qi (Zhong Qi) agitating upwards to the brain. In ancient times, so-called True Apoplexy was definitely caused by contracting abnormal winds, suddenly injuring Brain Qi, leading to collapse; if delayed slightly, it would internally damage the Five Viscera (Wu Zang) and become incurable. Such syndromes were rare, so Zhang Zhongjing did not discuss them. Moxibustion methods appear in Hua Tuo's *Zhongzang Jing* (Classic of Internal Viscera) and Chao Yuanfang's *Zhubing Yuanhou Lun* (General Treatise on the Origins and Symptoms of All Diseases), which should be studied together.