严左 右手足素患麻木，昨日陡然舌强，不能言语，诊脉左细弱，右弦滑，苔前光后腻，此乃气阴本
亏，虚风内动，风者善行而数变，故其发病也速。挟痰浊上阻廉泉，横窜络道，营卫痹塞不通，类中根苗
显著。经云∶邪之所凑，其气必虚。又云∶虚处受邪，其病则实。拟益气熄风，化痰通络。
吉林参须（一钱，另煎汁冲服） 云茯苓（三钱） 炙僵蚕（三钱） 陈广皮（一钱） 生白术（一钱五分）
竹节白附子（一钱） 炙远志肉（一钱） 黑 豆衣（三钱） 竹沥半夏（二钱） 陈胆星（八分） 九节菖蒲（八分）
姜水炒竹茹（一钱五分） 嫩钩钩（后入，三钱）
二诊 舌强蹇于语言，肢麻艰于举动，口干不多饮，舌光绛中后干腻，脉象右细弱，左弦滑，如昨诊
状。心开窍于舌，肾脉络舌本，脾脉络舌旁，心肾阴亏，虚风内动，挟痰浊上阻廉泉。先哲云∶舌废不能
言，足痿不良行，即是喑痱重症。再仿地黄饮子意出入。
大生地（三钱） 云茯苓（三钱） 陈胆星（八分） 九节菖蒲（一钱） 川石斛（三钱） 竹沥半夏（二钱）
川象贝（各二钱） 炙远志（一钱） 南沙参（三钱） 煨天麻（八分） 炙僵蚕（三钱） 嫩钩钩（后入，三钱）
三诊 昨投地黄饮子加减，脉症依然，并无进退。昔人云∶麻属气虚，木属湿痰。舌强言艰，亦是
痰阻舌根之故。肾阴不足是其本，虚风痰热乃是标，标急于本，先治其标，标由本生，缓图其本。以养阴
之剂，多能助湿生痰，而化痰之方，又每伤阴劫液，顾此失彼，煞费踌躇，再宜涤痰通络为主，而以养正
育阴佐之，为急标缓本之图，作寓守于攻之策，能否有效，再商别途。
南沙参（三钱） 云茯苓（三钱） 川象贝（各二钱） 西秦艽（一钱五分） 竹沥半夏（二钱） 炙远志（一钱）
炙僵蚕（三钱） 枳实炭（一钱） 煨天麻（八分） 广陈皮（一钱） 陈胆星（八分） 嫩钩钩（后入，三钱）
九节菖蒲（一钱） 淡竹沥（一两，生姜汁两滴同冲服）
四诊 脉左细滑，右濡数，舌中剥，苔薄腻。诸
恙均觉平和，养正涤痰，通利节络，尚属获效，仍宗原法再进一筹。
前方去秦艽、枳实，加焦谷芽四钱，指迷茯苓丸（包）四钱。
五诊 舌强言语蹇涩，已见轻减，左手足麻木依然，脉象细滑，舌苔薄腻，投剂合度，仍拟涤痰通络
为法。
照前方去煨天麻、焦谷芽、指迷茯苓丸，加生白术二钱、云茯苓三钱、竹节白附子八分。
钟左 类中舌强，不能言语，神识时明时昧。苔薄腻，脉弦小而滑，尺部无神。体丰者，气本虚，湿
胜者，痰必盛。气阴两耗，虚风鼓其湿痰，上阻廉泉之窍，症势颇殆，舍熄风潜阳清神涤痰不为功。
生白芍（三钱） 云茯苓（三钱） 陈胆星（八分） 九节石菖蒲（一钱） 滁菊花（三钱） 煨天麻（八分）
川象贝（各二钱） 蛇胆陈皮（三分） 生石决（一两） 竹沥半夏（三钱） 炙远志（一钱） 嫩钩钩（后入，三钱）
淡竹沥（一两五钱，生姜汁两滴同冲服）
钱左 类中偏左，半体不用，神识虽清，舌强言蹇，切牙嚼齿，牙缝渗血，呃逆频仍，舌绛，脉弦小
而数。诸风掉眩，皆属于肝，阴分大伤，肝阳化风上
扰，肝风鼓火内煽，痰热阻于廉泉之窍，肺胃肃降之令不行，恙势正在险关。勉拟地黄饮子合竹沥饮化
裁，挽堕拯危，在此一举。
鲜生地（四钱） 川石斛（三钱） 栝蒌皮（二钱） 柿蒂（十枚） 大麦冬（二钱） 抱茯神（三钱）
生蛤壳（六钱） 老枇杷叶（四张） 西洋参（一钱五分） 川贝母（二钱） 鲜竹茹（三钱） 嫩钧钩（后入，三钱）
活芦根（去节，一尺） 淡竹沥（冲，一两） 真珍珠粉（一分） 真猴枣粉（一分，二味另服）
顾左 疥疮不愈，湿毒延入经络，四肢酸软，不能步履，痰湿阻于廉泉，舌强不能言语，口角流涎，脾虚
不能摄涎也。《内经》云∶湿热不攘，大筋软短，小筋弛长，软短为拘，弛长为痿。此证是也。恙久根深，蔓
难图治，姑拟温化痰湿，通利节络，以渐除之。
潞党参（二钱） 仙半夏（二钱） 陈胆星（八分） 木防己（三钱） 生白术（一钱） 陈广皮（一钱）
西秦艽（二钱） 全当归（二钱） 竹节白附子（一钱五分） 炙甘草（五分） 陈木瓜（二钱） 紫丹参（二钱）
酒炒嫩桑枝（四钱） 指迷茯苓丸（包，五钱）
董左 心开窍于舌，肾脉络舌本，脾脉络舌旁，外风引动内风，挟湿痰阻于廉泉，横窜络道，右半身
不遂已久，迩来舌强不能言语，苔薄腻，脉弦小而滑，类中风之重症。姑拟熄风涤痰，和营通络。
左牡蛎（四钱） 朱茯神（三钱） 炙僵蚕（二钱） 淡竹沥（一两五钱） 生姜汁（冲服，二滴）
花龙骨（三钱） 炙远志肉（一钱） 陈胆星（八分） 川象贝（各二钱） 仙半夏（二钱） 枳实炭（一钱）
西秦艽（二钱） 煨天麻（八分） 嫩钩钩（后入，三钱）
金左 气阴本亏，外风引动内风，挟湿痰上阻廉泉，横窜络道，陡然右手足不用，舌强不能言语，神识时
明时昧，口干欲饮，舌质红，苔薄腻，脉虚弦而滑，类中重症，急宜熄风潜阳，清神涤痰。
西洋参（一钱五分） 朱茯神（三钱） 煨天麻（八分） 生石决（八钱） 大麦冬（二钱） 竹沥半夏（二钱）
炙僵蚕（三钱） 炙远志肉（一钱） 川石斛（三钱） 川贝母（二钱） 嫩钩钩（后入，三钱） 鲜石菖蒲（一钱）
淡竹沥（冲，一两） 真猴 枣粉（冲服，二分）
Yan, Left. Numbness in the right hand and foot has been a chronic condition. Yesterday, sudden stiffness of the tongue occurred, rendering speech impossible. Pulse diagnosis: the left pulse is fine and weak (Xi Ruo), while the right pulse is wiry and slippery (Xian Hua). The tongue coating is peeled at the front and greasy at the rear. This indicates a fundamental deficiency of Qi and Yin, leading to the stirring of internal deficient wind (Xu Feng). Wind is characterized by its mobility and rapid changes, hence the swift onset of disease. Accompanied by turbid phlegm obstructing the Lianquan acupoint (Ren-23) upwards and invading the collaterals horizontally, the Ying and Wei energies are blocked, manifesting significant signs of Lei Zhong (Apoplexy-like stroke). As stated in the classics: "Where pathogenic factors gather, the Zheng Qi must be deficient." And again: "When pathogenic factors invade a deficient area, the pathology presents as excess." The proposed treatment is to tonify Qi, extinguish wind, resolve phlegm, and unblock collaterals.
Jilin Ginseng Radicula (1 qian, decocted separately, juice taken to mix) Yun Fu Ling (3 qian) Zhi Jiang Can (3 qian) Chen Guang Pi (1 qian) Sheng Bai Zhu (1.5 qian)
Zhu Jie Bai Fu Zi (1 qian) Zhi Yuan Zhi Rou (1 qian) Hei Dou Yi (3 qian) Zhu Li Ban Xia (2 qian) Chen Dan Xing (0.8 fen) Jiu Jie Chang Pu (0.8 fen)
Ginger-water stir-fried Zhu Ru (1.5 qian) Nen Gou Tou (added later, 3 qian)
Second visit. Tongue stiffness causes speech impediment; limb numbness makes movement difficult. Dry mouth with little desire to drink. The tongue surface is crimson and peeled, dry and greasy in the middle and rear. The pulse is fine and weak on the right, wiry and slippery on the left, consistent with the previous diagnosis. The Heart opens into the tongue; the Kidney meridian connects to the root of the tongue; the Spleen meridian connects to the sides of the tongue. Deficiency of Heart and Kidney Yin leads to internal deficient wind stirring, carrying turbid phlegm to obstruct the Lianquan acupoint. Ancient sages said: "Tongue dysfunction causing inability to speak, and leg flaccidity causing inability to walk, constitutes the severe syndrome of Yin Fei (aphasia with lower limb paralysis)." Again imitating the principle of Di Huang Yin Zi (Rehmannia Decoction) with modifications.
Da Sheng Di (3 qian) Yun Fu Ling (3 qian) Chen Dan Xing (0.8 fen) Jiu Jie Chang Pu (1 qian) Chuan Shi Hu (3 qian) Zhu Li Ban Xia (2 qian)
Chuan Xiang Bei Mu (2 qian each) Zhi Yuan Zhi (1 qian) Nan Sha Shen (3 qian) Wei Tian Ma (0.8 fen) Zhi Jiang Can (3 qian) Nen Gou Tou (added later, 3 qian)
Third visit. The modified Di Huang Yin Zi administered yesterday yielded no change in pulse or symptoms. Ancients stated: "Numbness belongs to Qi deficiency; woodiness/stiffness belongs to damp-phlegm." Tongue stiffness and difficulty in speech are also due to phlegm obstructing the tongue root. Insufficiency of Kidney Yin is the root; deficient wind and phlegm-heat are the branch. Since the branch urgency exceeds the root, treat the branch first; since the branch arises from the root, address the root gradually. Tonifying Yin agents often aid dampness and generate phlegm, while phlegm-resolving formulas often injure Yin and deplete fluids, creating a dilemma. It is now appropriate to focus on clearing phlegm and unblocking collaterals, assisted by supporting righteousness and nourishing Yin, adopting a strategy of urgent branch treatment and slow root resolution, employing defense within attack. Whether effective will be reassessed for alternative approaches.
Nan Sha Shen (3 qian) Yun Fu Ling (3 qian) Chuan Xiang Bei Mu (2 qian each) Xi Qin Jiao (1.5 qian) Zhu Li Ban Xia (2 qian) Zhi Yuan Zhi (1 qian)
Zhi Jiang Can (3 qian) Zhi Shi Tan (1 qian) Wei Tian Ma (0.8 fen) Guang Chen Pi (1 qian) Chen Dan Xing (0.8 fen) Nen Gou Tou (added later, 3 qian)
Jiu Jie Chang Pu (1 qian) Dan Zhu Li (1 liang, mixed with 2 drops of fresh ginger juice)
Fourth visit. Pulse: left fine and slippery, right soggy and rapid. The center of the tongue is peeled, coating thin and greasy. All ailments feel peaceful. Supporting righteousness, clearing phlegm, and unblocking joint collaterals has proven effective. Continue with the original method, advancing slightly.
Remove Qin Jiao and Zhi Shi from the previous formula; add Jiao Gu Ya (4 qian) and Zhi Mi Fu Ling Wan (wrapped, 4 qian).
Fifth visit. Tongue stiffness and speech impediment have alleviated; numbness in the left hand and foot persists. Pulse is fine and slippery, tongue coating thin and greasy. The prescription is appropriate. Continue with resolving phlegm and unblocking collaterals.
From the previous formula, remove Wei Tian Ma, Jiao Gu Ya, and Zhi Mi Fu Ling Wan; add Sheng Bai Zhu (2 qian), Yun Fu Ling (3 qian), and Zhu Jie Bai Fu Zi (0.8 fen).
Zhong, Left. Apoplexy-like stroke causing tongue stiffness and inability to speak; consciousness fluctuates between clear and obscure. Coating thin and greasy; pulse wiry, small, and slippery; Chi position lacks spirit. Individuals with robust physique inherently have deficient Qi; those with excessive dampness inevitably have abundant phlegm. Both Qi and Yin are depleted; deficient wind stirs damp-phlegm, obstructing the Lianquan orifice. The condition is perilous; only by extinguishing wind, subduing Yang, clearing spirit, and resolving phlegm can success be achieved.
Sheng Bai Shao (3 qian) Yun Fu Ling (3 qian) Chen Dan Xing (0.8 fen) Jiu Jie Shi Chang Pu (1 qian) Chu Ju Hua (3 qian) Wei Tian Ma (0.8 fen)
Chuan Xiang Bei Mu (2 qian each) She Dan Chen Pi (0.3 fen) Sheng Shi Jue Ming (1 liang) Zhu Li Ban Xia (3 qian) Zhi Yuan Zhi (1 qian) Nen Gou Tou (added later, 3 qian)
Dan Zhu Li (1.5 liang, mixed with 2 drops of fresh ginger juice)
Qian, Left. Apoplexy-like stroke affecting the left side, half-body unusable. Consciousness is clear, but tongue is stiff with speech impediment; teeth grinding, bleeding from gum margins, frequent hiccups. Tongue is crimson; pulse is wiry, small, and rapid. All wind-induced tremors and dizziness belong to the Liver. Severe injury to Yin levels allows Liver Yang to transform into wind and harass upwards; Liver wind drums fire to flare internally. Phlegm-heat obstructs the Lianquan orifice; the descending function of Lung and Stomach fails. The illness is at a critical juncture. Tentatively prescribing a modification of Di Huang Yin Zi combined with Zhu Li Yin to salvage the crisis.
Xian Sheng Di (4 qian) Chuan Shi Hu (3 qian) Gua Lou Pi (2 qian) Shi Di (10 pieces) Da Mai Dong (2 qian) Bao Fu Shen (3 qian)
Sheng Ge Qiao (6 qian) Lao Pi Pa Ye (4 leaves) Xi Yang Shen (1.5 qian) Chuan Bei Mu (2 qian) Xian Zhu Ru (3 qian) Nen Gou Tou (added later, 3 qian)
Huo Lu Gen (de-jointed, 1 chi) Dan Zhu Li (mixed, 1 liang) Zhen Zhen Zhu Fen (1 fen) Zhen Hou Zao Fen (1 fen, these two taken separately)
Gu, Left. Herpes zoster not healing; damp-toxin extends into collaterals. Limbs are sore and weak, unable to walk. Damp-phlegm obstructs Lianquan, causing tongue stiffness and inability to speak; drooling from the corner of the mouth indicates Spleen deficiency failing to control saliva. The Neijing states: "If damp-heat is not eliminated, large tendons become soft and short, small tendons become lax and long. Soft and short leads to spasm; lax and long leads to flaccidity." This case exemplifies this. The disease is deep-rooted and spreading, difficult to treat. Tentatively prescribing warming and resolving damp-phlegm, unblocking joint collaterals to gradually eliminate it.
Lu Dang Shen (2 qian) Xian Ban Xia (2 qian) Chen Dan Xing (0.8 fen) Mu Fang Ji (3 qian) Sheng Bai Zhu (1 qian) Chen Guang Pi (1 qian)
Xi Qin Jiao (2 qian) Quan Dang Gui (2 qian) Zhu Jie Bai Fu Zi (1.5 qian) Zhi Gan Cao (0.5 fen) Chen Mu Gua (2 qian) Zi Dan Shen (2 qian)
Wine-stir-fried Nen Sang Zhi (4 qian) Zhi Mi Fu Ling Wan (wrapped, 5 qian)
Dong, Left. The Heart opens into the tongue; the Kidney meridian connects to the tongue root; the Spleen meridian connects to the tongue sides. External wind stirs internal wind, carrying damp-phlegm to obstruct Lianquan and invade collaterals horizontally. Right-sided hemiplegia has persisted for a long time; recently, tongue stiffness and inability to speak have developed. Coating thin and greasy; pulse wiry, small, and slippery. This is a severe case of Lei Zhong Feng (Apoplexy-like stroke). Tentatively prescribing extinguishing wind, resolving phlegm, harmonizing Ying, and unblocking collaterals.
Zuo Mu Li (4 qian) Zhu Fu Shen (3 qian) Zhi Jiang Can (2 qian) Dan Zhu Li (1.5 liang) Sheng Jiang Zhi (mixed, 2 drops)
Hua Long Gu (3 qian) Zhi Yuan Zhi Rou (1 qian) Chen Dan Xing (0.8 fen) Chuan Xiang Bei Mu (2 qian each) Xian Ban Xia (2 qian) Zhi Shi Tan (1 qian)
Xi Qin Jiao (2 qian) Wei Tian Ma (0.8 fen) Nen Gou Tou (added later, 3 qian)
Jin, Left. Fundamental deficiency of Qi and Yin; external wind stirs internal wind, carrying damp-phlegm to obstruct Lianquan and invade collaterals horizontally. Sudden inability to use right hand and foot, tongue stiffness, inability to speak, consciousness fluctuating between clear and obscure. Dry mouth with desire to drink, tongue body red, coating thin and greasy, pulse deficient, wiry, and slippery. This is a severe case of Lei Zhong; urgently need to extinguish wind, subdue Yang, clear spirit, and resolve phlegm.
Xi Yang Shen (1.5 qian) Zhu Fu Shen (3 qian) Wei Tian Ma (0.8 fen) Sheng Shi Jue Ming (8 qian) Da Mai Dong (2 qian) Zhu Li Ban Xia (2 qian)
Zhi Jiang Can (3 qian) Zhi Yuan Zhi Rou (1 qian) Chuan Shi Hu (3 qian) Chuan Bei Mu (2 qian) Nen Gou Tou (added later, 3 qian) Xian Shi Chang Pu (1 qian)
Dan Zhu Li (mixed, 1 liang) Zhen Hou Zao Fen (mixed, 2 fen)