例三林，50岁。猝然昏仆不省人事，急扶入院请西医救治，醒后左肢不遂，病已十二日，症状尚无好转。脉弦劲，头偏右痛，面红目亦，口眼喁斜，舌苔厚腻，微黄，口苦有火味，此病乃旰阳上亢，痰热蒙蔽清窍。治以平肝熄风镇逆，降火涤痰通络。栀子6克黄芩6克陈皮4．5克半夏6克胆南星6克牛膝9克元参9克羚羊汁一匙又方：石决明30克生牡蛎30克磁石30克龙骨18克龟板18克先煎代水煎药二诊：服4剂头痛已愈，面赤亦退，大便通畅，神情颇清，惟嗜食生果及澄汁，致胃胀不消，呃逆频繁，时带酸味。陈皮4．5克半夏6克川连2．1克黄芩4．5克竹茹6克枳壳4．5克莱菔子6克旋复花6克代赭石18克柿蒂6克三诊，服3剂，呃逆已上，舌苔稍退，口苦亦减，手已能举，惟左脚不用，抚摸则诸筋抽痛，食后有时暖酸，目多眵泪。白蒺藜6克木瓜6克甘菊6克陈皮4．5克半夏6克枳壳4．5克白芍6克胆南星6克川连2．1克钩藤9克(后下)竹茹6克麦芽9克羚羊汁一匙又方：代赭石18克龟板18克龙骨13克磁石20克石决明30克生牡蛎30克(先煎代水煎药)四诊；服4剂，左肢稍能转动，原方加牛膝9克，川楝9克，去竹茹、麦芽。五诊：前方服6剂，近日能由床起，行数步至椅上坐，免人扶腋，目泪未愈。熟地12克淮山药9克山茱6克牛膝9克枸杞9克甘菊6克龟板15克(先煎)磁石18克(先煎)石决明18克(先煎)白芍6克青葙子6克杜仲9克续断6克服10剂，已能扶杖而行。(《刘铁巷医案》)
例四谢X，64岁。因心中懊侬非常。旬日前即觉头疼，不以为意。一日晨起至工所，忽仆于地，状若昏厥。移时复苏，其左手足遂不能动，且觉头疼甚剧。医者投以清火通络之剂，兼法王勋臣补阳还五汤之意，加生黄芪数钱(克)，服后更甚。脑中疼如刀刺，须臾难忍，心中甚热。脉左部弦长，右洪长，皆重按有力。询其家人，谓其素性嗜酒，近因心中懊侬，益以酒浇愁，饥时恒以烧酒当饭。……其左脉之弦长，懊侬所生之热也，右脉之洪长，积酒所生之热也。二热相并，挟脏腑气血上冲脑部。……医者不知致病之由，竟投以治气虚偏枯之药，而此症此脉，岂能受黄芪之升补乎?所以服药后而头疼加剧也。治宜降血平脑。以牛膝善引上部之血下行，为治脑充血症无上之妙晶，屡经实验，故以为君。佐以龙、牡、二石、楝，芍、玄参、胆草、炙草、铁锈水等，潜镇清熄。方药；怀牛膝30克生龙骨18克(打)生牡蛎18克(打)川楝子12克生杭芍18克生石膏30克(研细)代赭石18，克(生打)乌玄参12克龙胆草9克、生甘草6克．服两剂，头疼痊愈，脉亦和平，左手足已能自动，遂改用全当归，生杭芍、玄参，天冬各15克，生黄芪，乳香，没药各9克，红花3克。连服数剂，即扶杖能走矣。方中用红花者，欲以化脑中之瘀血也。为此时脉已和平，头已不疼，可受黄芪之温补。故方中少用9克，以补助其正气，即借以助归、芍、乳、没以流通血脉，更可调玄参、天冬之寒凉也。(《重印全国名医验案类编》张锡纯医案)
例五陈XX，男，50岁，初诊日期：1973年2月4日。20天前刚睡一觉醒来，想翻动身体，即觉手足不灵活，勉强从右侧翻到左侧。可是，再想翻回来就不行了，随即口角歪斜，说话费劲，发音不清，舌头运动不自然，手足左半正常，右半呈弛缓性瘫痪，经XX医院诊断为脑血栓形成。住院半月，疗效不显，后服中药治疗。诊得脉弦细而数，舌质红，苔薄少津，胸闷心烦，咽干思饮，小便色深，乃阴虚阳亢，内风暗动，经脉血滞之候。即疏稀莶至阴汤，以治中风的阴虚证。方药：制稀莶30克干地黄9克盐知母12克当归3克枸杞子9克炒赤芍12克龟板6克牛膝6克甘菊花9克郁金9克丹参9克连翘、栀子，花粉各9克服3剂，烦热退，语言清，口角歪斜也有改善，是心经之热已退，而经筋中所滞之血热，尚未清彻也。复于方中去连翘，栀子，加橘络6克、广地龙3克，连服7剂，瘫痪恢复，手足运动正常。惟舌质尚红，脉仍弦细，阴虚尚待继续滋养，改用六味地黄丸，连服10剂完全康复。(任应秋：临证点滴，《陕西新医药》2：42，1977)
例六严X，男，56岁。初诊日期：1975年11月6日。先患头晕，继即突然昏仆，不省人事，牙关紧闭，面白唇暗，口角流涎，左半身瘫痪，四肢不温，口眼歪斜，先送县医院救治，不见好转，后又转送XX县医院扎头皮针，经两日针刺，牙关松动，仍呈半昏迷状态，两侧瞳孔大小不等，对光反射减弱，诊断为脑出血(内囊出血)，医院来请会诊，诊其脉浮细而弦，舌淡苔薄，乃阳虚阴盛，闭塞清窍之候。以细辛3克煎汤化开苏合香丸3克灌服，三小时内灌两次，下午三时左右，逐渐清醒，并有饥饿感。随即疏稀莶至阳汤，以治中风的阳虚证。方药：九制稀莶草30克黄芪9克天南星6克白附子6克川附片9克川芎3克红花6克细辛1．5克防风6克牛膝6克僵蚕3克苏木6克以其阳虚诸症颇著，而又偏于左半身也。连续进本方11剂，约两星期左右，基本恢复正常，惟行动时左侧尚有沉滞感而巳。(任应秋：临证点滴，《陕西新医药》2；42，1977)
例七赵XX，男，59岁，初诊日期：1939年9月18日。猝然昏倒，左边半身麻木不仁，步履艰难，口角喁斜，流涎不止，言语謇涩，带有痰声，不能起床已月余矣，脉沉而细，宜养正活络祛痰，以王清任法加减之。生黄芪45克赤芍9克当归9克地龙肉6克川芎3克桂枝尖4．5克桃仁泥3克南红花6克竹沥水(两次兑)12克生姜汁(两次兑)3滴舒络丹1丸白水下。9月9日(二诊)；服药患侧觉温，但仍麻木不仁，再以前法加量治之。生黄芪60克赤芍9克．当归9克竹沥水(两次兑)工2克生姜汁(两次兑)3滴桂枝尖4．5克川芎4．5克地龙肉9克舒络丹2丸白水下。9月20日(三诊)：服药见效，患侧已能转动，口歪虽在巳不流涎，且能自饮，语言尚骞，再以前方增量治之。生黄芪60克赤芍9克川芎6克地龙肉9克桃仁泥6克橘络4．5克桑枝9克桂枝尖4．5克竹沥水(两次兑)9克生姜汁(两次兑)3滴舒络丸二丸，两次月Ro9月21日(四诊)；中风半身不遂，药已大效，已能离床步履，语言亦渐清晰，脉渐有力，再以养正活络法加味治之。生黄芪60克赤芍9克当归9克南红花9克地龙肉6克桂枝尖4．5克川芎4．5克桃仁泥9克半夏6克南星(胆炙)6克橘络4．5克川羌活3克竹沥水(分兑)12克生姜汁(分兑)3滴舒筋丹二丸分下。前方服后，步履如常，语言已清，口喁已正，照原方加橘红6克桑枝9克。(毛有丰等整理：赵树屏医案，《中医杂志》4；265，1958)、
例八余XX，60岁时曾经中风，口眼歪斜，半身不遂；卧床不起，不惟不能坐行，且不能转侧，面赤气粗(风犹未熄)，痰声漉漉，神识半昏，时或晕瞀，食亦不下，非难吞即自落下。时历四月，中西方药无效。脉乍密乍疏，弦劲中带涩象，病机脉象均颇坏。镇敛浮越，平戢孤亢(熄未熄之风)，拟方：白薇、百合各9克龙骨、牡蛎各"克紫石英、灵磁石、赤石脂各9克寒水石、滑石各18克大黄4．5克铁锈末9克荆沥，竹沥各15克(二沥冲服)一周略安，得大便一次，原方减大黄为3克，加琥珀末1．5克、怀牛膝12克，又一周渐佳，大便二次，面赤气粗，痰壅神昏等象锐减，手足能动，勉能坐起，原方去大黄、铁锈，加鲜生地30克，山萸肉9克，约二周，病愈大半。后于前方去寒水石，滑石、荆沥，加菖蒲，泽兰、甘松，橘络、木香等，前后约60日痊愈。(《冉雪峰医案》)
例九秦XX，于1943年农历10月初旬，突然四肢麻木，颜面蠕动抽搐，神态呆异，某日之晚，竟至仆倒，不省人事，口噤不开，疳痱不语，右半身萎废不用，痰鸣嗅吼，声如曳锯，遗尿不禁，昼夜烦而不安，是月16日，为得病第9日，……诊得脉情滑数，至数无绪，重按搏指有力，身热如炭，面赤如朱，心胸按之灼手。……此“类中”而又兼“阳厥”大证，与虚中不侔，故舍虚而从实。方药：蝎尾末1．5克羚角粉1．5克万氏牛黄丸两粒先送。另以化痰清热宣郁如竹沥、贝母、半夏、橘红、郁金清肝熄风，如芍药、丹皮、珍珠母，而以茯苓、茯神为助，大剂浓煎，缓缓灌下。17日复诊；询知服药后即获神安入寐，厥逆之势已见平静，面赤亦退，脉滑数稍缓，神志略觉安定，余证如昨。此厥势虽戢，而风痱依然入中心肾之络。……投剂：万氏牛黄丸、叶氏神犀丹各一粒，研末先送，余于前方去郁金、珍珠母，加海藻、昆布咸润降滑，开痰散结。龙齿、贝齿清肝而安魂魄。远志以开心气之郁，怀牛膝导引厥逆之气下行，使升者可降，而降者不复再升。19日复诊，前昨两夜，寐可落寝，神可安定，颜面抽搐已缓，并且口噤已开，见其舌苔黄燥垢腻，小溲亦有知觉，惟仍感默默不欲语言，脉情滑数，尚感阳脉太过，咳虽有痰而又吐咯不易。……撤去神犀，加琥珀末，伽南末各0．?5克，以安神宣郁，方守前法。22日复诊；舌本已能转动灵活，时欲言语诉说，而犹謇涩不甚清晰，腑气多日未行，矢气频转极臭，小溲长利，气臊臭，色微黄，已能自禁，脉情滑数，亦转和缓，齿结血瓣，舌苔更垢，浊腻满布，此阳明之结也。结者当濡润，以柔养其血液，辛滑以疏利其气机，于前方去万氏牛黄丸，加生地炭、蒸锁阳、桑麻丸(包)。两日间，续得腑气两度，色黑粘韧，溏鞭不一，后清养调理而愈。(宋立人整理，宋爱人医案——实中阳厥，《中医杂志》11：55，1959)[评按]中风系指以突然昏仆，不省人事，伴有口眼喁斜，语言不利，半身不遂，或仅以喁僻不遂为主的病证。因其病势急骤，证状多端，变化迅速，故名中风，或称“卒中”。中风发生的病因、病理比较复杂，但大致不外乎虚(阴虚、气虚)、火(肝火、心火)、风(肝风、外风)，痰(风痰、湿痰)、气(气逆)、血(血瘀)六端。六者可相互影响、相互作用。一般认为外邪侵袭而弓I发者称为外风，又称真中风或真中，无外邪而引发者，称为内风，又称类中风或类中。中风为本虚标实、上盛下虚之候。本为肝肾不足、气血衰少，标为风火相煽、痰湿壅盛、气血郁阻。按照现代临床分类则分为中经络与中脏腑两大类。中经络者病情较轻，一般无神志改变，中脏腑者病位较深，病情较重，主要表现为神志不清，并常有发病先兆及后遗症。
例一体肥多痰，忧郁伤中，肝风内动、脾湿生痰，经络阻塞，营卫滞留，患者虽见口眼喁斜、手足麻木，尚未见半身不遂。此为风痰中络，未入于经，治宜涤痰开郁，佐以养血活络，则风证自熄。
例二证属阴虚肝阳引动痰浊闭窍。证情较前稍重。方用半夏白术天麻汤加减。本方出自程钟龄《医学心悟》，功能补脾燥湿，化痰熄风。另加钩藤、僵蚕、决明子、刺蒺藜等加强熄风镇静之功。
例三证属肝阳上亢、痰热蒙蔽清窍。治以平肝熄风镇逆、降火涤痰通络之法。先煎潜镇平肝之品以代水煎药，寓意颇深。
例四始因情志不遂而致卒中。晚清医家张伯龙认为：“凡猝倒昏瞀，痰气上壅之中风，皆由肝火上亢，化风煽动，激起气血，并走于上，直冲犯脑，震扰神经而为昏不识人，喁斜倾跌，肢体不遂，言语不清诸症，皆脑神经失其功能之病，苟能于乍病之时，急用潜阳降逆之剂，抑降其气火之上浮，使气血不并走于上……”，实为高见。本案所用乃潜镇泄降之法。方用镇肝熄风汤加减。原方去茵陈、天冬、龟板，加生石膏、胆草以加强清热泻肝之力，重用牛膝以引血下行，折其亢盛之风阳，为张氏创用本方的独特之处。
例五、
例六为任氏经验方稀莶至阴汤、稀莶至阳汤的应用。本方以稀莶草为君，分别辅以滋养肝肾与温肾之品。
例六为类中阳虚闭证。其妙在于先用辛温开窍法，以细辛3克煎汤化苏合香丸灌服，待患者清醒后，再用稀莶至阳汤以治中风阳虚之证。
例七病已月余，正气已虚而痰瘀阻络，仿王清任补阳还五汤法，益气活血通络而治愈。
例八证情复杂，神识半昏迷，历时四月而风犹未熄，病机、病象颇坏。治以镇敛浮越，平戢孤亢，方从《金匮》风引汤，百合地黄丸，《本事方》白薇汤、真珠母丸化裁而来。方中自薇味咸，走血分而平上逆之气血，百合收敛浮阳、宁谧心神；龙、牡育阴潜阳，再加上五石之重，镇其逆而清其血，益以大黄荡积，铁锈重坠，荆竹二沥化痰涎以通窍；菖蒲开窍祛痰，甘松清热；泽兰破积；橘络通络，木香导滞。师法古人，方从己出，古今合参，神明变化于活治之中，遵古而不泥古，重今而不偏今。
例三：林某，50岁。突然昏倒失去意识，紧急扶送入院请西医救治，醒来后左侧肢体瘫痪，患病已十二天，症状尚无好转。脉象弦而有力，头部右侧疼痛，面色红赤眼睛充血，口眼歪斜，舌苔厚腻微黄，口苦且有火味，此病乃肝阳上亢，痰热蒙蔽清窍（心包）。治疗以平抑肝风、熄风镇逆，降火涤痰通络为法。栀子6克，黄芩6克，陈皮4.5克，半夏6克，胆南星6克，牛膝9克，玄参9克，羚羊角汁一匙。又方：石决明30克，生牡蛎30克，磁石30克，龙骨18克，龟板18克，先煎代水煎药。二诊：服用4剂后头痛已愈，面赤亦退，大便通畅，神情颇清晰，唯独嗜食生冷水果及果汁，导致胃胀不消，呃逆频繁，时常带有酸味。陈皮4.5克，半夏6克，川黄连2.1克，黄芩4.5克，竹茹6克，枳壳4.5克，莱菔子6克，旋覆花6克，代赭石18克，柿蒂6克。三诊：服用3剂后，呃逆已止，舌苔稍退，口苦亦减，手已能举起，惟左脚仍不能使用，抚摸时诸筋抽痛，食后有时嗳气带酸味，眼睛多眵泪。白蒺藜6克，木瓜6克，甘菊花6克，陈皮4.5克，半夏6克，枳壳4.5克，白芍6克，胆南星6克，川黄连2.1克，钩藤9克（后下），竹茹6克，麦芽9克，羚羊角汁一匙。又方：代赭石18克，龟板18克，龙骨13克，磁石20克，石决明30克，生牡蛎30克（先煎代水煎药）。四诊：服用4剂后，左肢稍能转动，原方加牛膝9克，川楝子9克，去竹茹、麦芽。五诊：前方服用6剂后，近日能从床上起身，行走几步至椅子上坐，免人扶持腋下，目泪未愈。熟地黄12克，淮山药9克，山茱萸6克，牛膝9克，枸杞子9克，甘菊花6克，龟板15克（先煎），磁石18克（先煎），石决明18克（先煎），白芍6克，青葙子6克，杜仲9克，续断6克。服用10剂后，已能扶杖而行。（《刘铁巷医案》）
例四：谢某，64岁。因心中烦闷懊恼非常。十日前即觉头疼，不以为意。一日晨起至工作场所，忽然仆倒在地，状若昏厥。过了一会儿复苏，其左手足遂不能动，且觉头疼甚剧。医者投以清火通络之剂，兼取王勋臣补阳还五汤之意，加生黄芪数钱（克），服后病情更重。脑中疼如刀刺，片刻难忍，心中甚热。脉象左部弦长，右部洪长，皆重按有力。询问其家人，谓其素性嗜酒，近因心中懊恼，益以酒浇愁，饥饿时恒以烧酒当饭。……其左脉之弦长，是懊恼所生之热；右脉之洪长，是积酒所生之热。二热相并，挟脏腑气血上冲脑部。……医者不知致病之由，竟投以治气虚偏枯之药，而此症此脉，岂能受黄芪之升补乎？所以服药后而头疼加剧也。治疗宜降血平脑。以牛膝善引上部之血下行，为治脑充血症无上之妙品，屡经实验，故以为君药。佐以龙齿、牡蛎、二石（石膏、代赭石）、川楝子、白芍、玄参、胆草、炙甘草、铁锈水等，潜镇清熄。方药：怀牛膝30克，生龙骨18克（打碎），生牡蛎18克（打碎），川楝子12克，生杭芍18克，生石膏30克（研细），代赭石18克（生打碎），乌玄参12克，龙胆草9克，生甘草6克。服用两剂，头疼痊愈，脉亦和平，左手足已能自动，遂改用全当归、生杭芍、玄参、天冬各15克，生黄芪、乳香、没药各9克，红花3克。连服数剂，即扶杖能走矣。方中用红花者，欲以化脑中之瘀血也。为此时脉已和平，头已不疼，可受黄芪之温补。故方中少用9克，以补助其正气，即借以助归、芍、乳、没以流通血脉，更可调玄参、天冬之寒凉也。（《重印全国名医验案类编》张锡纯医案）
例五：陈某，男，50岁，初诊日期：1973年2月4日。20天前刚睡一觉醒来，想翻动身体，即觉手足不灵活，勉强从右侧翻到左侧。可是，再想翻回来就不行了，随即口角歪斜，说话费劲，发音不清，舌头运动不自然，手足左半正常，右半呈弛缓性瘫痪，经XX医院诊断为脑血栓形成。住院半月，疗效不显，后服中药治疗。诊得脉弦细而数，舌质红，苔薄少津，胸闷心烦，咽干思饮，小便色深，乃阴虚阳亢，内风暗动，经脉血滞之候。即疏稀莶至阴汤，以治中风的阴虚证。方药：制豨莶草30克，干地黄9克，盐知母12克，当归3克，枸杞子9克，炒赤芍12克，龟板6克，牛膝6克，甘菊花9克，郁金9克，丹参9克，连翘、栀子、天花粉各9克。服用3剂，烦热退，语言清，口角歪斜也有改善，是心经之热已退，而经筋中所滞之血热，尚未清彻也。复于方中去连翘、栀子，加橘络6克、广地龙3克，连服7剂，瘫痪恢复，手足运动正常。惟舌质尚红，脉仍弦细，阴虚尚待继续滋养，改用六味地黄丸，连服10剂完全康复。（任应秋：临证点滴，《陕西新医药》2：42，1977）
例六：严某，男，56岁。初诊日期：1975年11月6日。先患头晕，继即突然昏倒，不省人事，牙关紧闭，面白唇暗，口角流涎，左半身瘫痪，四肢不温，口眼歪斜，先送县医院救治，不见好转，后又转送XX县医院扎头皮针，经两日针刺，牙关松动，仍呈半昏迷状态，两侧瞳孔大小不等，对光反射减弱，诊断为脑出血（内囊出血），医院来请会诊，诊其脉浮细而弦，舌淡苔薄，乃阳虚阴盛，闭塞清窍之候。以细辛3克煎汤化开苏合香丸3克灌服，三小时内灌两次，下午三时左右，逐渐清醒，并有饥饿感。随即疏稀莶至阳汤，以治中风的阳虚证。方药：九制豨莶草30克，黄芪9克，天南星6克，白附子6克，川附片9克，川芎3克，红花6克，细辛1.5克，防风6克，牛膝6克，僵蚕3克，苏木6克。以其阳虚诸症颇著，而又偏于左半身也。连续进本方11剂，约两星期左右，基本恢复正常，惟行动时左侧尚有沉滞感而已。（任应秋：临证点滴，《陕西新医药》2：42，1977）
例七：赵某，男，59岁，初诊日期：1939年9月18日。猝然昏倒，左边半身麻木不仁，步履艰难，口角歪斜，流涎不止，言语謇涩，带有痰声，不能起床已月余矣，脉沉而细，宜养正活络祛痰，以王清任法加减之。生黄芪45克，赤芍9克，当归9克，地龙肉6克，川芎3克，桂枝尖4.5克，桃仁泥3克，南红花6克，竹沥水（两次兑入）12克，生姜汁（两次兑入）3滴，舒络丹1丸，白开水送下。9月9日（二诊）：服药患侧觉温，但仍麻木不仁，再以前法加量治之。生黄芪60克，赤芍9克，当归9克，竹沥水（两次兑入）12克，生姜汁（两次兑入）3滴，桂枝尖4.5克，川芎4.5克，地龙肉9克，舒络丹2丸，白开水送下。9月20日（三诊）：服药见效，患侧已能转动，口歪虽在已不流涎，且能自饮，语言尚骞，再以前方增量治之。生黄芪60克，赤芍9克，川芎6克，地龙肉9克，桃仁泥6克，橘络4.5克，桑枝9克，桂枝尖4.5克，竹沥水（两次兑入）9克，生姜汁（两次兑入）3滴，舒筋丸二丸，分两次服下。9月21日（四诊）：中风半身不遂，药已大效，已能离床步履，语言亦渐清晰，脉渐有力，再以养正活络法加味治之。生黄芪60克，赤芍9克，当归9克，南红花9克，地龙肉6克，桂枝尖4.5克，川芎4.5克，桃仁泥9克，半夏6克，南星（胆炙）6克，橘络4.5克，川羌活3克，竹沥水（分次兑入）12克，生姜汁（分次兑入）3滴，舒筋丹二丸分次服下。前方服后，步履如常，语言已清，口喁已正，照原方加橘红6克桑枝9克。（毛有丰等整理：赵树屏医案，《中医杂志》4：265，1958）
例八：余某，60岁时曾经中风，口眼歪斜，半身不遂；卧床不起，不惟不能坐行，且不能转侧，面赤气粗（风犹未熄），痰声漉漉，神识半昏，时或晕瞀，食亦不下，非难吞即自落下。时历四月，中西方药无效。脉乍密乍疏，弦劲中带涩象，病机脉象均颇坏。镇敛浮越，平戢孤亢（熄未熄之风），拟方：白薇、百合各9克，龙骨、牡蛎各9克，紫石英、灵磁石、赤石脂各9克，寒水石、滑石各18克，大黄4.5克，铁锈末9克，荆沥、竹沥各15克（二沥冲服）。一周略安，得大便一次，原方减大黄为3克，加琥珀末1.5克、怀牛膝12克，又一周渐佳，大便二次，面赤气粗，痰壅神昏等象锐减，手足能动，勉能坐起，原方去大黄、铁锈，加鲜生地30克，山萸肉9克，约二周，病愈大半。后于前方去寒水石、滑石、荆沥，加菖蒲、泽兰、甘松、橘络、木香等，前后约60日痊愈。（《冉雪峰医案》）
例九：秦某，于1943年农历10月初旬，突然四肢麻木，颜面蠕动抽搐，神态呆异，某日之晚，竟至仆倒，不省人事，口噤不开，痱痱不语，右半身萎废不用，痰鸣嗅吼，声如曳锯，遗尿不禁，昼夜烦而不安，是月16日，为得病第9日，……诊得脉情滑数，至数无绪，重按搏指有力，身热如炭，面赤如朱，心胸按之灼手。……此“类中”而又兼“阳厥”大证，与虚中不侔，故舍虚而从实。方药：蝎尾末1.5克，羚角粉1.5克，万氏牛黄丸两粒先送。另以化痰清热宣郁如竹沥、贝母、半夏、橘红、郁金清肝熄风，如芍药、丹皮、珍珠母，而以茯苓、茯神为助，大剂浓煎，缓缓灌下。17日复诊：询知服药后即获神安入寐，厥逆之势已见平静，面赤亦退，脉滑数稍缓，神志略觉安定，余证如昨。此厥势虽戢，而风痱依然入中心肾之络。……投剂：万氏牛黄丸、叶氏神犀丹各一粒，研末先送，余于前方去郁金、珍珠母，加海藻、昆布咸润降滑，开痰散结。龙齿、贝齿清肝而安魂魄。远志以开心气之郁，怀牛膝导引厥逆之气下行，使升者可降，而降者不复再升。19日复诊，前昨两夜，寐可落寝，神可安定，颜面抽搐已缓，并且口噤已开，见其舌苔黄燥垢腻，小溲亦有知觉，惟仍感默默不欲语言，脉情滑数，尚感阳脉太过，咳虽有痰而又吐咯不易。……撤去神犀，加琥珀末、伽南末各0.75克，以安神宣郁，方守前法。22日复诊：舌本已能转动灵活，时欲言语诉说，而犹謇涩不甚清晰，腑气多日未行，矢气频转极臭，小溲长利，气臊臭，色微黄，已能自禁，脉情滑数，亦转和缓，齿结血瓣，舌苔更垢，浊腻满布，此阳明之结也。结者当濡润，以柔养其血液，辛滑以疏利其气机，于前方去万氏牛黄丸，加生地炭、蒸锁阳、桑麻丸（包）。两日间，续得腑气两度，色黑粘韧，溏鞭不一，后清养调理而愈。（宋立人整理，宋爱人医案——实中阳厥，《中医杂志》11：55，1959）[评按]中风系指以突然昏仆，不省人事，伴有口眼歪斜，语言不利，半身不遂，或仅以喁僻不遂为主的病证。因其病势急骤，证状多端，变化迅速，故名中风，或称“卒中”。中风发生的病因、病理比较复杂，但大致不外乎虚（阴虚、气虚）、火（肝火、心火）、风（肝风、外风），痰（风痰、湿痰）、气（气逆）、血（血瘀）六端。六者可相互影响、相互作用。一般认为外邪侵袭而引发者称为外风，又称真中风或真中，无外邪而引发者，称为内风，又称类中风或类中。中风为本虚标实、上盛下虚之候。本为肝肾不足、气血衰少，标为风火相煽、痰湿壅盛、气血郁阻。按照现代临床分类则分为中经络与中脏腑两大类。中经络者病情较轻，一般无神志改变，中脏腑者病位较深，病情较重，主要表现为神志不清，并常有发病先兆及后遗症。
例一：体肥多痰，忧郁伤中，肝风内动、脾湿生痰，经络阻塞，营卫滞留，患者虽见口眼歪斜、手足麻木，尚未见半身不遂。此为风痰中络，未入于经，治宜涤痰开郁，佐以养血活络，则风证自熄。
例二：证属阴虚肝阳引动痰浊闭窍。证情较前稍重。方用半夏白术天麻汤加减。本方出自程钟龄《医学心悟》，功能补脾燥湿，化痰熄风。另加钩藤、僵蚕、决明子、刺蒺藜等加强熄风镇静之功。
例三：证属肝阳上亢、痰热蒙蔽清窍。治以平肝熄风镇逆、降火涤痰通络之法。先煎潜镇平肝之品以代水煎药，寓意颇深。
例四：始因情志不遂而致卒中。晚清医家张伯龙认为：“凡猝倒昏瞀，痰气上壅之中风，皆由肝火上亢，化风煽动，激起气血，并走于上，直冲犯脑，震扰神经而为昏不识人，喁斜倾跌，肢体不遂，言语不清诸症，皆脑神经失其功能之病，苟能于乍病之时，急用潜阳降逆之剂，抑降其气火之上浮，使气血不并走于上……”，实为高见。本案所用乃潜镇泄降之法。方用镇肝熄风汤加减。原方去茵陈、天冬、龟板，加生石膏、胆草以加强清热泻肝之力，重用牛膝以引血下行，折其亢盛之风阳，为张氏创用本方的独特之处。
例五：
例六：为任氏经验方稀莶至阴汤、稀莶至阳汤的应用。本方以豨莶草为君，分别辅以滋养肝肾与温肾之品。
例五：证属阴虚阳亢，内风暗动，经脉血滞之候。故用稀莶至阴汤；
例六：为类中阳虚闭证。其妙在于先用辛温开窍法，以细辛3克煎汤化苏合香丸灌服，待患者清醒后，再用稀莶至阳汤以治中风阳虚之证。
例七：病已月余，正气已虚而痰瘀阻络，仿王清任补阳还五汤法，益气活血通络而治愈。
例八：证情复杂，神识半昏迷，历时四月而风犹未熄，病机、病象颇坏。治以镇敛浮越，平戢孤亢，方从《金匮》风引汤，百合地黄丸，《本事方》白薇汤、真珠母丸化裁而来。方中白薇味咸，走血分而平上逆之气血，百合收敛浮阳、宁谧心神；龙、牡育阴潜阳，再加上五石之重，镇其逆而清其血，益以大黄荡积，铁锈重坠，荆竹二沥化痰涎以通窍；菖蒲开窍祛痰，甘松清热；泽兰破积；橘络通络，木香导滞。师法古人，方从己出，古今合参，神明变化于活治之中，遵古而不泥古，重今而不偏今。
Case 3: Lin, male, 50 years old. Sudden collapse with loss of consciousness, urgently supported into the hospital for Western medical treatment. After regaining consciousness, left-sided hemiplegia persisted. The illness had lasted twelve days with no improvement in symptoms. The pulse was wiry and forceful (Xian Jin), pain was localized to the right side of the head, the face was red with congested eyes, and there was deviation of the mouth and eye. The tongue coating was thick, greasy, and slightly yellow, with a bitter taste and sensation of fire in the mouth. This condition is attributed to Hyperactivity of Liver Yang (Gan Yang Shang Kang) and Phlegm-Heat obscuring the Clear Orifices (Tan Re Meng Bi Qing Qiao). Treatment aimed at calming the Liver, extinguishing Wind, suppressing rebellion, reducing Fire, eliminating Phlegm, and unblocking collaterals. Gardenia (Zhi Zi) 6g, Scutellaria Root (Huang Qin) 6g, Tangerine Peel (Chen Pi) 4.5g, Pinellia Tuber (Ban Xia) 6g, Arisaema with Bile (Dan Nan Xing) 6g, Achyranthes Root (Niu Xi) 9g, Scrophularia Root (Xuan Shen) 9g, Antelope Horn Juice (Ling Yang Jiao Zhi) one spoon. Another prescription: Concha Heterodonis (Shi Jue Ming) 30g, Ostrea Shell (Sheng Mu Li) 30g, Magnetite (Ci Shi) 30g, Dragon Bone (Long Gu) 18g, Carapax et Plastrum Testudinis (Gui Ban) 18g, decocted first to replace water for decocting other herbs. Second visit: After taking 4 doses, headache resolved, facial redness subsided, bowel movements became smooth, and mental state was clear. However, craving for raw fruits and juices caused stomach distension, frequent hiccups, sometimes with an acidic smell. Tangerine Peel (Chen Pi) 4.5g, Pinellia Tuber (Ban Xia) 6g, Coptis Rhizome (Chuan Lian) 2.1g, Scutellaria Root (Huang Qin) 4.5g, Bamboo Shavings (Zhu Ru) 6g, Aurantium Fructus (Zhi Ke) 4.5g, Radish Seed (Lai Fu Zi) 6g, Inula Flower (Xuan Fu Hua) 6g, Hematitum (Dai Zhe Shi) 18g, Persimmon Calyx (Shi Di) 6g. Third visit: After 3 doses, hiccups stopped, tongue coating receded slightly, bitterness in mouth decreased, hand could be raised, but left foot remained unusable; touching caused spasms in tendons. Occasional acid belching after meals, excessive eye discharge. Tribulus Fruit (Bai Ji Li) 6g, Papaya Fruit (Mu Gua) 6g, Chrysanthemum Flower (Gan Ju) 6g, Tangerine Peel (Chen Pi) 4.5g, Pinellia Tuber (Ban Xia) 6g, Aurantium Fructus (Zhi Ke) 4.5g, White Peony Root (Bai Shao) 6g, Arisaema with Bile (Dan Nan Xing) 6g, Coptis Rhizome (Chuan Lian) 2.1g, Uncaria Ramulus cum Uncis (Gou Teng) 9g (added later), Bamboo Shavings (Zhu Ru) 6g, Malt (Mai Ya) 9g, Antelope Horn Juice (Ling Yang Jiao Zhi) one spoon. Another prescription: Hematitum (Dai Zhe Shi) 18g, Carapax et Plastrum Testudinis (Gui Ban) 18g, Dragon Bone (Long Gu) 13g, Magnetite (Ci Shi) 20g, Concha Heterodonis (Shi Jue Ming) 30g, Ostrea Shell (Sheng Mu Li) 30g (decocted first to replace water). Fourth visit: After 4 doses, left limb could move slightly. Added Achyranthes Root (Niu Xi) 9g, Toosendan Fruit (Chuan Lian) 9g to original formula; removed Bamboo Shavings (Zhu Ru) and Malt (Mai Ya). Fifth visit: After 6 doses of previous formula, patient could rise from bed, walk a few steps to sit on a chair without support under arms, but tearing persisted. Prepared Rehmannia Root (Shu Di) 12g, Chinese Yam (Huai Shan Yao) 9g, Cornus Fruit (Shan Zhu Yu) 6g, Achyranthes Root (Niu Xi) 9g, Lycium Fruit (Gou Qi) 9g, Chrysanthemum Flower (Gan Ju) 6g, Carapax et Plastrum Testudinis (Gui Ban) 15g (decocted first), Magnetite (Ci Shi) 18g (decocted first), Concha Heterodonis (Shi Jue Ming) 18g (decocted first), White Peony Root (Bai Shao) 6g, Celosia Seed (Qing Xiang Zi) 6g, Eucommia Bark (Du Zhong) 9g, Dipsacus Root (Xu Duan) 6g. After 10 doses, patient could walk with a cane. (From "Medical Cases of Famous Modern Doctors")
Case 4: Xie, male, 64 years old. Experienced extreme mental restlessness and vexation. Ten days prior, felt headache but ignored it. One morning upon arriving at work, suddenly collapsed, resembling syncope. Recovered after a while, but left hand and foot became immobile, and severe headache persisted. Physicians prescribed heat-clearing and collateral-unblocking agents, incorporating the intent of Wang Xunchen's Bu Yang Huan Wu Decoction (Tonify Yang and Restore Five Decoction), adding Raw Astragalus Root (Sheng Huang Qi) several qian (grams). Symptoms worsened after ingestion. Brain pain felt like knife stabbing, unbearable in moments, intense heat in the heart. Pulse: left side wiry and long, right side flooding and long, both forceful upon heavy pressure. Family reported history of alcoholism; recently drank to drown sorrows due to mental restlessness, often using liquor as food when hungry... The wiry-long pulse on the left indicates heat generated by vexation; the flooding-long pulse on the right indicates heat accumulated from alcohol. These two heats combined, carrying Qi and Blood of Zang-Fu organs rushing upward to the brain... The physician did not understand the cause, prescribing medicine for Qi-deficiency hemiplegia. How could this syndrome and pulse tolerate the ascending and tonifying nature of Astragalus? Hence, headache intensified after medication. Treatment should lower Blood and calm the brain. Achyranthes Root (Niu Xi) is excellent at guiding Blood downward from the upper body, considered the supreme remedy for cerebral congestion, verified through experience, thus used as the Sovereign herb. Assisted by Dragon Bone (Long Gu), Oyster Shell (Mu Li), Two Stones (Shi Gao, Dai Zhe Shi), Toosendan Fruit (Chuan Lian), White Peony Root (Bai Shao), Scrophularia Root (Xuan Shen), Gentian Root (Dan Cao), Roasted Licorice Root (Zhi Gan Cao), Iron Rust Water, etc., to anchor, settle, clear, and extinguish. Prescription: Huai Niu Xi 30g, Raw Dragon Bone (Long Gu) 18g (crushed), Raw Oyster Shell (Mu Li) 18g (crushed), Toosendan Fruit (Chuan Lian Zi) 12g, Raw Hangshao Peony Root (Hang Shao) 18g, Raw Gypsum Fibrosum (Shi Gao) 30g (finely ground), Raw Hematitum (Dai Zhe Shi) 18g (raw crushed), Wuxuan Shen 12g, Gentian Root (Long Dan Cao) 9g, Raw Licorice Root (Sheng Gan Cao) 6g. After two doses, headache cured, pulse normalized, left hand and foot moved spontaneously. Changed to Angelica Sinensis (Quan Dang Gui), Raw Hangshao Peony Root (Hang Shao), Scrophularia Root (Xuan Shen), Asparagus Tuber (Tian Dong) each 15g; Raw Astragalus Root (Sheng Huang Qi), Frankincense (Ru Xiang), Myrrh (Mo Yao) each 9g, Safflower Honghua 3g. Taken continuously for several doses, patient could walk with a cane. Safflower (Hong Hua) was used to resolve blood stasis in the brain. Since the pulse was now normal and headache gone, the warming and tonifying properties of Astragalus could be tolerated. Thus, only 9g was used to assist healthy Qi, helping Dang Gui, Bai Shao, Ru Xiang, Mo Yao to circulate blood vessels, and balancing the cold nature of Xuan Shen and Tian Dong. (From "Reprinted National Famous Doctor Medical Cases", Zhang Xichun's Cases)
Case 5: Chen, male, 50 years old, First visit date: February 4, 1973. Twenty days ago, upon waking from sleep and attempting to turn over, felt limbs inflexible. Managed to roll from right to left, but could not return. Subsequently developed deviation of the mouth corner, difficulty speaking, unclear pronunciation, unnatural tongue movement. Left limbs normal, right limbs flaccid paralysis. Diagnosed with cerebral thrombosis at XX Hospital. Hospitalized for half a month with little effect, then treated with Chinese medicine. Pulse wiry, fine, and rapid (Xian Xi Er Shu); tongue red, coating thin with little fluid; chest tightness, mental restlessness, dry throat desiring drink, dark urine. Syndrome: Yin Deficiency with Yang Hyperactivity, latent internal Wind stirring, blood stasis in meridians. Prescribed Xi Xian Zhi Yin Tang (Xi Xian Decoction for Nourishing Yin) to treat Yin-deficiency type stroke. Prescription: Prepared Siegesbeckia Herba (Zhi Xi Xian) 30g, Dry Rehmannia Root (Gan Di Huang) 9g, Salt-processed Anemarrhena Rhizome (Yan Zhi Mu) 12g, Angelica Sinensis (Dang Gui) 3g, Lycium Fruit (Gou Qi Zi) 9g, Stir-fried Red Peony Root (Chao Chi Shao) 12g, Carapax et Plastrum Testudinis (Gui Ban) 6g, Achyranthes Root (Niu Xi) 6g, Chrysanthemum Indicum Flower (Gan Ju Hua) 9g, Curcuma Aromatica Rhizome (Yu Jin) 9g, Salvia Miltiorrhiza Root (Dan Shen) 9g, Forsythia Fruit (Lian Qiao), Gardenia Fruit (Zhi Zi), Trichosanthes Root (Hua Fen) each 9g. After 3 doses, irritability and heat subsided, speech cleared, mouth deviation improved. Heat of Heart Meridian retreated, but blood-heat stagnating in sinews/collaterals not fully cleared. Removed Forsythia and Gardenia, added Tangerine Network (Ju Luo) 6g, Pheretima Earthworm (Guang Di Long) 3g. Taken continuously for 7 doses, paralysis recovered, limb movement normalized. Tongue still red, pulse wiry and fine, Yin deficiency needs continued nourishment. Changed to Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), taken for 10 doses, fully recovered. (Ren Yingqiu: Clinical Notes, Shaanxi New Medicine 2:42, 1977)
Case 6: Yan, male, 56 years old. First visit date: November 6, 1975. Initially suffered dizziness, then sudden collapse with loss of consciousness, clenched jaw, pale face with dark lips, drooling from mouth corner, left-sided hemiplegia, cold extremities, deviation of mouth and eye. Sent to county hospital, no improvement. Transferred to XX County Hospital for scalp acupuncture. After two days of needling, jaw loosened, but remained semi-comatose. Pupils unequal size, light reflex weakened. Diagnosed with cerebral hemorrhage (internal capsule hemorrhage). Hospital requested consultation. Pulse floating, fine, and wiry; tongue pale, coating thin. Syndrome: Yang Deficiency with Yin Excess, blocking Clear Orifices. Decocted Asarum Root (Xi Xin) 3g in water to dissolve Suhexiang Wan (Suhexiang Pill) 3g, administered orally. Given twice within three hours. Around 3 PM, gradually regained consciousness and felt hunger. Immediately prescribed Xi Xian Zhi Yang Tang (Xi Xian Decoction for Warming Yang) to treat Yang-deficiency type stroke. Prescription: Nine-processed Siegesbeckia Herba (Jiu Zhi Xi Xian Cao) 30g, Astragalus Root (Huang Qi) 9g, Arisaema Rhizome (Tian Nan Xing) 6g, Typhonii Rhizoma (Bai Fu Zi) 6g, Prepared Aconite Lateral Root (Chuan Fu Pian) 9g, Ligusticum Rhizome (Chuan Xiong) 3g, Safflower (Hong Hua) 6g, Asarum Root (Xi Xin) 1.5g, Saposhnikovia Root (Fang Feng) 6g, Achyranthes Root (Niu Xi) 6g, Bombyx Batryticatus (Jiang Can) 3g, Sappanwood (Su Mu) 6g. Due to prominent Yang-deficiency symptoms and left-sided predominance. Continued this formula for 11 doses. Approximately two weeks later, basically returned to normal, except for a sense of heaviness/stagnation on the left side when walking. (Ren Yingqiu: Clinical Notes, Shaanxi New Medicine 2:42, 1977)
Case 7: Zhao, male, 59 years old. First visit date: September 18, 1939. Sudden collapse, left-sided numbness and insensitivity, difficult gait, deviation of mouth corner, continuous drooling, slurred speech with phlegm sounds, unable to get out of bed for over a month. Pulse deep and fine. Treatment: Nourish Righteous Qi, activate collaterals, eliminate Phlegm. Modified according to Wang Qingren's method. Raw Astragalus Root (Sheng Huang Qi) 45g, Red Peony Root (Chi Shao) 9g, Angelica Sinensis (Dang Gui) 9g, Pheretima Earthworm (Di Long Rou) 6g, Ligusticum Rhizome (Chuan Xiong) 3g, Twig of Cinnamon Tree (Gui Zhi Jian) 4.5g, Peach Kernel Tao Ren Mud 3g, Southern Safflower (Nan Hong Hua) 6g, Bamboo Sap (Zhu Li Shui) 12g (mixed in twice), Ginger Juice (Sheng Jiang Zhi) 3 drops (mixed in twice), Shuluo Dan 1 pill, washed down with white water. September 9 (Second visit): Affected side felt warm after medication, but still numb. Increased dosage using same method. Raw Astragalus Root (Sheng Huang Qi) 60g, Red Peony Root (Chi Shao) 9g, Angelica Sinensis (Dang Gui) 9g, Bamboo Sap (Zhu Li Shui) 12g (mixed in twice), Ginger Juice (Sheng Jiang Zhi) 3 drops (mixed in twice), Twig of Cinnamon Tree (Gui Zhi Jian) 4.5g, Ligusticum Rhizome (Chuan Xiong) 4.5g, Pheretima Earthworm (Di Long Rou) 9g, Shuluo Dan 2 pills, washed down with white water. September 20 (Third visit): Effective. Affected side could move. Mouth deviation present but no longer drooling, able to drink independently. Speech still slurred. Increased dosage of previous formula. Raw Astragalus Root (Sheng Huang Qi) 60g, Red Peony Root (Chi Shao) 9g, Ligusticum Rhizome (Chuan Xiong) 6g, Pheretima Earthworm (Di Long Rou) 9g, Peach Kernel Tao Ren Mud 6g, Tangerine Network (Ju Luo) 4.5g, Mulberry Twig (Sang Zhi) 9g, Twig of Cinnamon Tree (Gui Zhi Jian) 4.5g, Bamboo Sap (Zhu Li Shui) 9g (mixed in twice), Ginger Juice (Sheng Jiang Zhi) 3 drops (mixed in twice), Shujin Wan 2 pills, divided doses. September 21 (Fourth visit): Stroke hemiplegia, medication highly effective. Able to leave bed and walk. Speech gradually clearer. Pulse becoming stronger. Continue nourishing Righteous Qi, activating collaterals, adding ingredients. Raw Astragalus Root (Sheng Huang Qi) 60g, Red Peony Root (Chi Shao) 9g, Angelica Sinensis (Dang Gui) 9g, Southern Safflower (Nan Hong Hua) 9g, Pheretima Earthworm (Di Long Rou) 6g, Twig of Cinnamon Tree (Gui Zhi Jian) 4.5g, Ligusticum Rhizome (Chuan Xiong) 4.5g, Peach Kernel Tao Ren Mud 9g, Pinellia Tuber (Ban Xia) 6g, Arisaema Rhizome (Dan Zhi Nan Xing) 6g, Tangerine Network (Ju Luo) 4.5g, Notopterygium Rhizome (Chuan Qiang Huo) 3g, Bamboo Sap (Zhu Li Shui) 12g (mixed in parts), Ginger Juice (Sheng Jiang Zhi) 3 drops (mixed in parts), Shujin Dan 2 pills, divided doses. After taking previous formula, gait normal, speech clear, mouth deviation corrected. Add Citrus Peel (Ju Hong) 6g, Mulberry Twig (Sang Zhi) 9g to original formula. (Mao Youfeng et al.整理的: Zhao Shuping Medical Cases, Journal of Traditional Chinese Medicine 4:265, 1958)
Case 8: Yu, 60 years old. Previously suffered stroke with deviation of mouth and eye, hemiplegia. Bedridden, unable to sit or walk, nor even turn over. Face red, breath coarse (Wind not yet extinguished), loud phlegm rales, semi-conscious mind, occasional dizziness/blurring vision, unable to eat (either difficult to swallow or falls out automatically). Duration four months, ineffective with Chinese and Western medicines. Pulse intermittent (dense and sparse), wiry and forceful with choppy quality. Pathogenesis and pulse image were poor. Strategy: Anchor and gather floating Yang, calm solitary hyperactivity (extinguish lingering Wind). Prescription: Codonopsis Root (Bai Wei), Lily Bulb (Bai He) each 9g, Dragon Bone (Long Gu), Oyster Shell (Mu Li) each 9g, Purple Quartz (Zi Shi Ying), Spirit Magnetite (Ling Ci Shi), Red Halloysite (Chi Shi Zhi) each 9g, Cold Water Stone (Han Shui Shi), Talcum (Hua Shi) each 18g, Rhubarb (Da Huang) 4.5g, Iron Rust Powder (Tie Xiu Mo) 9g, Schizonepeta Sap (Jing Li), Bamboo Sap (Zhu Li) each 15g (two saps mixed). One week later, slightly stable, one bowel movement. Original formula reduced Da Huang to 3g, added Amber Powder (Hu Po Mo) 1.5g, Huai Niu Xi 12g. Another week, gradually better, two bowel movements. Facial redness, coarse breath, phlegm obstruction, coma significantly reduced. Hands and feet could move,勉强 able to sit up. Removed Da Huang and Iron Rust, added Fresh Rehmannia Root (Xian Sheng Di) 30g, Cornus Fruit (Shan Yu Rou) 9g. About two weeks later, more than half recovered. Later, removed Cold Water Stone, Talcum, Schizonepeta Sap from previous formula, added Acorus Rhizome (Shi Pu), Polygonatum Odoratum Rhizome (Ze Lan), Spikenard (Gan Song), Tangerine Network (Ju Luo), Aucklandia Root (Mu Xiang), etc. Total duration about 60 days for full recovery. (From "Ran Xuefeng Medical Cases")
Case 9: Qin, early October 1943 (Lunar Calendar). Suddenly experienced numbness in four limbs, facial twitching/spasms, strange demeanor. One evening, collapsed, lost consciousness, jaws locked, aphasia, right-side flaccid paralysis, loud phlegm rattling like sawing wood, urinary incontinence, restless day and night. On the 16th of the month, 9th day of illness... Pulse slippery and rapid, irregular rhythm, forceful upon heavy pressure. Body hot as charcoal, face red as vermilion, chest/hypochondrium burning to touch. This is "Lei Zhong" (Stroke-like) combined with "Yang Jue" (Yang Collapse/Reversal), a major syndrome differing from deficiency patterns. Therefore, abandon deficiency approach and treat excess. Prescription: Scorpion Tail Powder (Xie Wei Mo) 1.5g, Antelope Horn Powder (Ling Jiao Fen) 1.5g, Wan Shi Niu Huang Wan (Wan Shi Calculus Bovis Pill) 2 pills, administered first. Additionally, use Bamboo Sap (Zhu Li), Fritillaria Bulb (Bei Mu), Pinellia Tuber (Ban Xia), Tangerine Peel (Ju Hong), Curcuma Aromatica Rhizome (Yu Jin) to transform Phlegm, clear Heat, diffuse Depression; use Peony Root (Shao Yao), Moutan Cortex (Dan Pi), Mother of Pearl (Zhen Zhu Mu) to clear Liver and extinguish Wind; assist with Poria (Fu Ling), Poria with Hostwood (Fu Shen). Decoct heavily, administer slowly. 17th Follow-up: Patient slept peacefully after medication, reversal trend calmed, facial redness subsided, pulse slippery-rapid slightly slowed, mind slightly stable, other symptoms unchanged. Although reversal calmed, Wind-Paralysis still entered Heart and Kidney collaterals... Prescribe: Wan Shi Niu Huang Wan, Ye Shi Shen Xi Dan (Ye's Divine Crystal Pill) 1 pill each, powdered and administered first. From previous formula, remove Yu Jin and Zhen Zhu Mu, add Kelp (Hai Zao), Kelp-like Algae (Kun Bu) for salty-moistening descending slipperiness, opening Phlegm and dissipating nodules. Dragon Teeth (Long Chi), Clam Shell (Bei Chi) clear Liver and calm Soul. Polygala Root (Yuan Zhi) opens Heart Qi depression. Huai Niu Xi guides rebellious Qi downward, allowing ascending to descend and preventing re-ascending. 19th Follow-up: Slept well previous two nights, mind stable, facial spasms slowed, jaws opened. Tongue coating yellow, dry, greasy. Urination sensation returned. Still silent, unwilling to speak. Pulse slippery-rapid, Yang pulse still too strong. Cough with phlegm but difficult to expectorate... Remove Shen Xi, add Amber Powder (Hu Po Mo), Agarwood Powder (Na Nan Mo) each 0.75g to calm mind and diffuse depression, maintain previous method. 22nd Follow-up: Tongue base flexible, desires to speak but still slurred. Bowel gas stagnant for many days, frequent flatulence extremely foul-smelling. Urination abundant, sour-smelling, slightly yellow, self-controlled. Pulse slippery-rapid turning harmonious. Teeth have blood clots, tongue coating more greasy, turbid-greasy covering all. This is Yangming Knotting. Knots should be moistened, nourish blood with softness, promote Qi mechanism with pungent-slippery. Remove Wan Shi Niu Huang Wan from previous formula, add Charred Rehmannia Root (Sheng Di Tan), Steamed Cynomorium Herb (Zheng Suo Yang), Sang Ma Wan (Mulberry and Hemp Pill, wrapped). Within two days, two bowel movements passed, black sticky/tough consistency, varying form. Finally cleared and nourished for recovery. (Song Liren edited, Song Airen Medical Cases - Excess Stroke Yang Reversal, Journal of Traditional Chinese Medicine 11:55, 1959) [Commentary]: Stroke refers to sudden collapse, loss of consciousness, accompanied by deviation of mouth and eye, speech impairment, hemiplegia, or mainly characterized by unilateral paralysis. Due to rapid onset, diverse symptoms, and quick changes, it is named Stroke or "Apoplexy". Etiology and pathology are complex, generally involving Deficiency (Yin/Qi), Fire (Liver/Heart), Wind (Liver/External), Phlegm (Wind/Damp), Qi (Rebellion), Blood (Stasis). These six factors interact. External pathogen invasion causing it is called External Wind (True Stroke); internal origin without external pathogen is Internal Wind (Stroke-like). Stroke is root deficiency and branch excess, upper excess and lower deficiency. Root is Liver/Kidney insufficiency, Qi/Blood decline; Branch is Wind/Fire stirring, Phlegm/Damp abundance, Qi/Blood stagnation. Modern clinical classification divides into Meridian and Viscera types. Meridian type is milder, usually no consciousness change; Viscera type is deeper, heavier, mainly unconsciousness, often with prodromes and sequelae.
Case 1: Obese with much Phlegm, melancholy injuring Middle Jiao, internal Liver Wind stirring, Spleen dampness generating Phlegm, collaterals blocked, Ying and Wei stagnating. Patient shows deviation of mouth and eye, numbness of hands and feet, but no hemiplegia yet. This is Wind-Phlegm striking Collaterals, not entering Meridians. Treatment: Eliminate Phlegm, open Depression, assist with nourishing Blood and activating collaterals, then Wind syndrome will extinguish itself.
Case 2: Syndrome belongs to Yin Deficiency with Liver Yang stirring Phlegm-Turbidity obstructing Orifices. Condition slightly heavier than previous. Formula: Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) modified. Originates from Cheng Zhongling's "Medical Heart Enlightenment", functions to tonify Spleen, dry Dampness, transform Phlegm, and extinguish Wind. Added Uncaria Ramulus (Gou Teng), Bombyx Batryticatus (Jiang Can), Cassia Seed (Jue Ming Zi), Tribulus Fruit (Ci Ji Li) etc. to strengthen Wind-extinguishing and sedative effects.
Case 3: Syndrome belongs to Liver Yang Hyperactivity, Phlegm-Heat obscuring Clear Orifices. Treatment: Calm Liver, extinguish Wind, suppress rebellion, reduce Fire, eliminate Phlegm, unblock collaterals. Decoct anchoring/calming Liver-soothing agents first to replace water, implying profound meaning.
Case 4: Initially caused by emotional frustration leading to Apoplexy. Late Qing physician Zhang Bolong believed: "All sudden collapses, dizziness, phlegm-Qi obstruction strokes are due to Liver Fire hyperactivity, transforming into Wind stirring, exciting Qi and Blood, moving together upward, directly attacking Brain, shaking nerves, causing unconsciousness, deviation, falling, limb paralysis, unclear speech—all diseases of brain nerve dysfunction. If at onset, urgent use of Yang-anchoring and Qi-lowering agents to suppress floating Qi/Fire, preventing Qi/Blood moving together upward..." Truly a high insight. This case uses Anchoring and Descending method. Formula: Zhen Gan Xi Feng Tang (Settle Liver and Extinguish Wind Decoction) modified. Original formula removed Artemisia Capillaris (Yin Chen), Asparagus Tuber (Tian Dong), Carapax et Plastrum Testudinis (Gui Ban), added Raw Gypsum Fibrosum (Shi Gao), Gentian Root (Dan Cao) to strengthen clearing Heat and purging Liver Fire. Heavy use of Achyranthes Root (Niu Xi) to guide Blood downward, curb hyperactive Wind-Yang, unique to Zhang's creation of this formula.
Case 5:
Case 6: Application of Ren's empirical formulas Xi Xian Zhi Yin Tang and Xi Xian Zhi Yang Tang. This formula uses Siegesbeckia Herba (Xi Xian Cao) as Sovereign, assisted respectively by herbs nourishing Liver/Kidney and warming Kidney.
Case 5: Syndrome belongs to Yin Deficiency Yang Hyperactivity, latent internal Wind stirring, blood stasis in meridians. Thus use Xi Xian Zhi Yin Tang.
Case 6: Stroke-like Yang Deficiency Closure Syndrome. Its brilliance lies in first using Pungent-Warm Opening Orifice method, decocting Asarum Root (Xi Xin) 3g to dissolve Suhexiang Wan, administering orally. After patient awakens, use Xi Xian Zhi Yang Tang to treat Yang-deficiency stroke.
Case 7: Illness lasting over a month, Righteous Qi deficient, Phlegm-Stasis blocking collaterals. Imitate Wang Qingren's Bu Yang Huan Wu Tang method, Tonify Qi, invigorate Blood, unblock collaterals, cured.
Case 8: Complex condition, semi-coma, lasting four months with Wind not extinguished, pathogenesis/image poor. Treatment: Anchor gathering floating Yang, calm solitary hyperactivity. Formula derived from Jingui Feng Yin Tang, Bai He Di Huang Wan, Ben Shi Fang Bai Wei Tang, Zhen Zhu Mu Wan modifications. Bai Wei salty, enters Blood level, calms upward-rebellious Qi/Blood; Bai He gathers floating Yang, calms Spirit; Long/Mu nourish Yin and anchor Yang; plus five Stones' weight, suppress rebellion and clear Blood; aided by Da Huang sweeping accumulation, Iron Rust heavy sinking, Jing/Zhu two saps transforming Phlegm to open orifices; Shi Pu opening orifices removing Phlegm, Gan Song clearing Heat; Ze Lan breaking accumulation; Ju Luo unblocking collaterals, Mu Xiang directing stagnation. Learn from ancients, formula from self, combine ancient/modern, divine changes in active treatment, respect ancient but not rigid, value modern but not biased.