古称风、痨、臌、膈为四大难症，而中风居其首焉。可见中风一病自古以来即难治疗，历代医家无不究心于斯症。唐宋以前，每以“内虚邪中”立论，多主外风学说，及至金元，则内风之论出而医家多宗之。其问刘河问主“心火暴盛，”李东垣倡“正气自虚”，朱丹溪持“湿痰生热”。而明·张景岳又作“非风”之说，以内虚积损立论，而明·李中梓，则将卒中分为闭、脱二证。时至清代，温病大家叶天士经过深入之理论研究及长期临床观察，阐明中风之病因病机为“精血耗损，水不涵木”而致“肝阳偏亢，内风时起。”并创用“滋液熄风，补阴潜阳”治法，开养阴柔肝、清热熄风以治本病之先河。
中风患者经治疗后病势渐衰，正气稍复，危象已解而后遗肢体不遂，舌强语蹇，筋脉拘急或弛纵不收等症者，看似渐趋向愈，实则渐成顽疾。当此之时，务宜不失时机，速投对证恰当之药，则多能缓缓康复，若仍失治、误治，则难免抱疾终生，病愈无日矣。是故医家于斯时之决策，对患者之预后，至关重要，治疗之或成或败全系于斯。
中风偏瘫之治疗法则，历代名贤各有独到之见解心得，且经千百年之实践总结，已积累许多宝贵经验。其中余深契于胡念庵与叶天士两位昔贤之说。胡念庵在《医家心法》评语中曰：“其大要和其阴阳，调其气血，或有兼证，随所现而治之，或温，或清，或补，或散，以无失其宜为贵。”而清代温病大家叶天士则以“益气血、清痰火、通经络”为大法。胡叶二贤之论，认识相近，议论平允，可为治疗斯症之准绳。
世传高效验方，以《医学衷中参西录》之镇肝熄风汤及《医林改错》之补阳还五汤最为著名。前者用治阴虚阳亢，气逆火升之证，于此姑置不论。
清代王清任著《医林改错》，专主气虚血瘀立说，立补阳还五汤以治偏枯。此方一出后世医家靡不乐从。殊不知偏瘫一症之病因病机常常错综复杂，固不可用一方统治偏瘫之病。仍宜辨证求因，审因论治。再就补阳还五汤本身而论，方中黄芪用量特重，黄芪有补气升阳之功。而内虚暗风之人，多由肝阳肝火为其主因，又常兼肝肾亏损，或有痰热内恋。若营卫空疏者，易兼外风袭人。虽中风以后，多数患者阳升火逆之势渐减，但一经引动则死灰易于复燃。所虑黄芪大剂服用，其温燥之性易伤肝肾之阴。其补气而兼升阳之能，易助肝阳亢逆之势，或致木火升腾。其气盛而不疏易使痰热阻滞。故补阳还五汤并不适用所有中风后遗症病人。此方之适应证候惟以气虚为主而稍兼血络瘀阻者。若气虚而兼痰热，宜佐消痰清热；气虚而火盛，宜参降火泄热；惟气虚而兼肝肾亏损者，不可早投滋腻血药，盖卒仆大势虽衰，而五脏六腑，经络隧道，阴阳气血及四肢百骸之功能，尚在复苏之初，其力甚微，而于气虚之人尤然。若滋腻浪投，则扼其生生之气，难免不致夭伤也。必待元气渐充，中土消导运化之力已能胜任，始可渐渐加入。若其证不以气虚为主，而是肝肾亏损，或肝阳上亢，或痰热内恋等证型者，则不在此例。余于临证问，细察病者之脉证，气虚者委实不少，而血虚，阴虚，确有所逊，是以知王清任之偏重补气立论，自有临床依据。然气虚之中偏于中气虚而兼痰滞热郁者居多，故明代孙文垣于其医案中屡用六君子汤或四君子汤加减化裁，而竞全功。基于上述认识，余自制偏枯健全汤，以治中风偏瘫中气虚而兼痰热、风邪阻络者，方中重用党参以建中气而健脾胃，脾胃健运则痰浊易化。茯苓、橘红、胆星、竹沥以化痰通络。远志、菖蒲开心气之凝而出音声。秦艽、防风祛经络之风而达四肢。钩藤专清厥阴风木，潜其阳气。红花独理血液之滞，助熄风邪。甘草调和诸药。方中诸药均有职司，惟有石斛一味，似属多余。尤在泾曰：“类中风者，风自内生，肝脏之厥气也。肝之生气暴而病速，肝气既厥，诸气从之。诸液又从之。诸气化火，诸液化痰，辐凑上焦，流涩经络，如风雨之骤至，如潮汐之骤涌不可当也。”尤氏明确指出此证生于肝气暴厥，气升火逆，聚液成痰，阻滞经络隧道之间。液既凝而为痰，其液必伤，脏腑经络自然燥涩。津液能渗灌诸窍及关节，具滑利濡润之功，气血乏津液之润滑，必碍于运行。若津液不充，欲其肢体之速愈实为不能。又津液参与人体精液及血液之化生，精血枯涸，欲其丰腴肌体并使运动自如者，亦不可思议!是以方中必加养阴生津之品。然患者元气衰颓，脾胃不健，而投以滋腻，易致药伤。惟石斛凛清虚纯洁之质，无有此弊。且胃为津液之海，胃津足则五脏六腑皆得其灌溉流益。又肾为水脏而主精，肾精充则生生之机运行不息。石斛入胃生津，入肾滋液，无有过其右者，故独选石斛入于方中。
至于秦艽、防风两味祛风之品似属不轻，真中风为外风乘虚袭入机体，固当祛风之法。而类中风为风自内生，多为肝肾阴亏，厥阳化风，治当涵育滋填，潜镇摄纳，何得亦用风药?徐灵胎曰：“凡古圣定病之名，必指其实。名曰中风则其为病属风可知。既为风病，则主病之方必以治风为本，故仲景候氏黑散、风引汤、防己地黄汤及唐人大小续命汤，皆多风药而因证增减。盖以风人经络，则内风与外风相煽，以致痰火一时壅塞，惟宜先驱其风，续清痰火。而后调其气血，则经脉可以渐通。”徐氏之法为分段治疗，层次分明可师可法。而余则将祛风、消痰、清热、益气之品杂于一方，以求简易。
附：偏枯健全汤方
党参9～24g茯苓9g橘红6g胆南星4～9g炙远志6～9g石菖蒲3～6g钩藤15～30g秦艽9～15g石斛9～15g防风6～9g红花3～4．5g炙草1．5～3g鲜竹沥l～2支(冲服)记忆口诀：偏枯健全汤，苓橘南星党，菖远钩艽斛，沥草红花防。此方使用时，视患者之病状，随证加减之可也。
下附验案两则以就正于读者诸君。
例一金某，男，退休工人。夙有高血压病，于1971年11月突然中风，送至某区中心医院抢救，继发呕血，屡经救治，始脱危险。历四阅月，方得出院。后邀余诊治，诊见半身不遂，上下肢痉挛强直，稍稍活动关节，则剧痛不可忍，言语蹇涩不清，自觉头脑胀热。脉涩滞，舌淡红，苔则厚腻。显然类中风后遗症。中风之治法已如上述，丹溪主乎痰，河间主乎热，东垣主虚，而王清任则主气虚血瘀。就金某脉症而论，良由肝阳素亢，内风暗动，痰湿中阻，络道痹窒，致左右两半身之气血运行违其常度而然。当先行化痰祛风，用胆星、半夏、贝母、茯苓、竹沥、橘红、秦艽、防风、地龙、乌梢蛇等出入为方，送服大活络丸。服至1972年春，渐渐言语清朗，患侧手脚亦稍能活动，可由家人扶掖之而踯躅于室内，至初夏，则可策杖缓行，慢步于街头巷尾矣虽左手痉挛之状未易全除，而精神饮食均觉健旺。
例二
上海某手表厂干部王某，宿有高血压病史，1984年年届半百，春间于无锡出差突患脑溢血，经无锡市第一人民医院抢救脱险，后遗言语蹇涩及半身不遂。返沪后邀余诊视。患者身材不高而形躯敦实，见证右侧手足不能运动，有轻微抽掣疼痛，关节弛缓而不强直，足部内翻。面红色赤，言语不甚清晰，二便自调，胃纳正常。脉小滑，舌质淡红，舌苔薄白。据上述脉证分析，此证属肝阳挟痰上亢，乘春令木气生发之势，阳升过极而致卒中。经治后虽血止神清，危象已除，然元气暗损，经络空疏，痰瘀乘机流入，胶滞不解，致使隧道瘀塞，气血难以运行，遂成偏枯之象。治拟益气、化痰、通络法。内服方以“偏枯健全汤”为主方：
党参24g茯苓9g橘红6g胆星9g炙远志9g石菖蒲9g钩藤30g(后入)秦艽15g石斛15g红花3g鲜竹沥1支(冲入)炙草3g
上药每日服一帖，每隔七日复诊一次，以察脉证之变化，病情之进退而调整用药，同时给予针刺。取穴以通调血脉、活利关节、平衡阴阳气血为主旨。上肢所用主穴：肩髑、曲池、合谷、阳池。
下肢所用主穴：环跳、居髂、风市、阳陵泉、足三里、悬钟、丘墟、解溪。
另取廉泉，一穴二针。进针1．5～2寸深，以利其言语。
针药并进。两周后可在室内缓行，言语较清，两月后已可自理生活，上街散步；四个月后上班复工，直至退休。至今十有余年矣，一向健康安适。
关于此病调理之法，老中医夏宇仁先生，生前为余之忘年交也。曾对余曰：其友周某之母，年五十余，中风半身不遂，治之病虽愈，而患肢酸麻乏力，恒不从心。每至秋冬之交，周亲去乡间采掘全棵枸杞数十株，洗净阴干，连根茎叶花子，一起碾末蜜丸，每日以开水送服数克，如此终年不断，服年余后，肢麻乏力、关节酸软之象均失。服三、四年精神倍壮，服之十余年，已在古稀之外，却如五、六十岁之人，可谓得其功效矣。
口眼㖞斜仗“圣愈”
口眼㖞斜之症，属风邪中络范畴。昔贤不乏精辟论述，如石顽曰：“风淫则血液衰耗，无以荣筋，故筋脉拘急，口目为僻。”石顽又曰：“《灵枢》云：‘足阳明之筋病，颊筋有寒则急，引颊移口。有热则筋弛纵，缓不胜收，故僻。’按左寒右热，则左急而右缓。右寒左热，则右急而左缓。盖左中寒则逼热于右，右中寒则逼热于左，阳气不得宣行故也。又《金匮》云：‘极寒伤经，极热伤络，则知经受寒而急，则络必热而缓。即《素问》大筋软短，小筋弛长之谓也。”、“至于用药，宜润燥则风自息，古法用大秦艽汤，今改用十全大补尤妥。”
石顽论㖞僻之病因病机，引经据典，颇具至理。左右寒热，及寒伤经、热伤络，经受寒而急则络必热而缓等诸说，发遑古义，融会新知。用十全大补汤润燥熄风，亦别具慧眼，远胜一味祛风通络、活血化瘀之法。盖此病虽可由寒热等邪引发，而其致病之因，多由气血亏损，经络空疏，肝风痰浊乘虚袭人络中。故纯用祛风辛燥固非，一味温补亦未为善法。当以调养气血之中，结合化痰通络、清肝熄风，始为完备。余凡遇此症，每以圣愈汤加味而获效，故制为“圣愈正容汤”方。凡服此方者，愈期多在三至四周之间，愈后绝无后遗症状。
干部易某，于1973年秋间，偶觉左颊牵掣，自恃素体强健．未予介意。一周后，口眼歪向右边。始求治焉。其闻某理发师有祖传薄贴法，功效甚著，遂往求治。该师将药粉约如黄豆大许，敷左耳前听宫穴空处，以橡皮膏盖贴之。三日一换，前一、二次确见显效，继则疲沓矣。复求治于余及夏宇仁先生，余与先生共商之。察其面色青黄不泽。脉来弦细，两尺无力。知为肝肾不足，气血内亏，血虚风动，痰涎乘而凝聚，遂致经络受阻而成斯症。治拟圣愈汤加减，参入化痰、平肝、祛风通络之品。方为：
党参12g黄芪12g熟地12g白芍9g当归9g鲜竹沥30g(冲)钩藤12g(后下)橘红4．5g黑芝麻15g僵蚕4．5g
上方加减服约二十剂，膏药仍贴之，历时一月而平复如初。更以前方十倍其量，蜜水泛丸，每日服二次，每次10g，以资巩固。愈后至今病未复发。
与易某同时发病者，有某百货店之营业员，新婚翌晨即口眼㖞斜，随易某同往薄贴，信彼不可服药针灸之言，坚持不服药、不针灸之戒，虽屡劝之而不肯听，遂成痼疾，至今不复能愈，惜哉!薄贴一法，用治实证确有良效，凡贴而不愈或有效而不彻底者，即应针药并进，慎毋讳疾忌医而自遗祸殃也。
附：圣愈正容汤方
生黄芪24g党参15g熟地12g当归9g炒白芍9g川芎3g防风9g秦艽9g鲜竹沥1支(冲)钩藤15g(后入)红花1．5g甘草1．5g
记忆口诀：正容汤从圣愈裁，艽防花草钩沥栽。
此方益气养血，疏风化痰。若因肝阳上亢者则宜平肝潜阳，熄风镇静。如缘其他原因致病者，仍须对证施治。即使确为本方证候，亦须据其脉证，随证加减。岳武穆论兵法曰“运用之妙，存乎一心。”医家兵家，其理一焉。
历节风痛误药辨治
岳父业于金融。七十年代初年方半百，奉命支援外地建设。由于环境简陋，寒湿易侵，渐觉关节疼痛，游走不定。当地所用，尽祛风辛燥之剂。病益笃，来沪调治，始得好转，又急于因公返回。余特书“简述”一文，以供当地医家参考，惜全未采用，及至四肢关节肿胀强直，行动惟艰，始退休回沪，虽勉力调治，终觉良机已失，心长而力短矣。今将当日原文录下，以志其事。
The ancients referred to wind (Zhongfeng, stroke), lao (consumptive disease), gu (abdominal distension/ascites), and ge (dysphagia/chest obstruction) as the four major difficult diseases, with Zhongfeng ranking first. This indicates that since ancient times, Zhongfeng has been difficult to treat, and physicians of all dynasties have devoted themselves to studying this condition. Before the Tang and Song dynasties, theories were based on "internal deficiency with external pathogenic invasion," predominantly advocating the theory of external wind. By the Jin and Yuan dynasties, the theory of internal wind emerged, which physicians largely followed. Liu Wansu advocated "sudden excess of heart fire," Li Dongyuan promoted "deficiency of healthy qi," and Zhu Danxi maintained that "damp-phlegm generates heat." In the Ming dynasty, Zhang Jingyue proposed the concept of "non-wind," basing his theory on internal deficiency and accumulated damage; Li Zhongzi further categorized stroke into closing syndrome (Bi Zheng) and collapsing syndrome (Tuo Zheng). During the Qing dynasty, Ye Tianshi, a master of warm-heat diseases, through in-depth theoretical research and long-term clinical observation, clarified that the etiology and pathogenesis of Zhongfeng are "depletion of essence and blood, failure of water to nourish wood," leading to "hyperactivity of liver yang and frequent onset of internal wind." He created the treatment method of "nourishing fluids to extinguish wind and tonifying yin to submerge yang," pioneering the approach of treating the root cause by nourishing yin, softening the liver, clearing heat, and extinguishing wind.
After treatment, when the pathological trend of Zhongfeng gradually subsides, healthy qi slightly recovers, and critical symptoms resolve, but sequelae such as hemiplegia (limb paralysis), stiff tongue with dysarthria (slurred speech), muscle spasms or flaccidity remain, it may seem that recovery is approaching, but in reality, stubborn chronic conditions are forming. At this time, it is crucial not to miss the opportunity and to promptly administer appropriate medication matching the syndrome pattern. Most patients can recover gradually; however, if misdiagnosed or mistreated, they may suffer from illness for life with no hope of cure. Therefore, the physician's decision-making at this stage is vital to the patient's prognosis, and the success or failure of treatment depends entirely on it.
Regarding the treatment principles for Zhongfeng hemiplegia, famous physicians of past generations each had unique insights, and after thousands of years of practical summary, many valuable experiences have been accumulated. Among them, I deeply agree with the views of Hu Niangan and Ye Tianshi. Hu Niangan stated in the commentary of *Yijia Xinfa*: "The general principle is to harmonize yin and yang, regulate qi and blood. If there are concurrent syndromes, treat them according to their manifestations, whether warming, clearing, tonifying, or dispersing, without losing appropriateness." Ye Tianshi, a master of warm-heat diseases in the Qing dynasty, took "tonifying qi and blood, clearing phlegm-fire, and unblocking collaterals" as the main principle. The discussions of these two sages are similar in understanding and balanced in argument, serving as a criterion for treating this condition.
Highly effective prescriptions circulated in the world include Zhen Gan Xi Feng Tang (Sedating Liver and Extinguishing Wind Decoction) from *Yixue Zhongzhong Canxi Lu* and Buyang Huanwu Tang (Tonifying Yang and Restoring Five Tenths Decoction) from *Yilin Gaicuo*. The former is used for syndromes of yin deficiency with yang hyperactivity and rebellious qi with rising fire, which will be discussed elsewhere.
Wang Qingren of the Qing dynasty wrote *Yilin Gaicuo*, specifically advocating the theory of qi deficiency and blood stasis, creating Buyang Huanwu Tang to treat hemiplegia. Upon its release, physicians of later generations readily accepted it. Little did they know that the etiology and pathogenesis of hemiplegia are often complex and intertwined; thus, one formula cannot govern all cases of hemiplegia. It is still necessary to differentiate the syndrome to find the cause and treat according to the cause. Regarding Buyang Huanwu Tang itself, the dosage of Huangqi (Astragali Radix) is particularly heavy. Huangqi has the function of tonifying qi and raising yang. However, individuals with internal deficiency and latent wind often have hyperactive liver yang and liver fire as the main cause, frequently accompanied by liver-kidney deficiency or internal retention of phlegm-heat. If defensive qi and nutritive qi are sparse, they are prone to external wind invasion. Although after stroke, the trend of rising yang and rebellious fire gradually decreases in most patients, once triggered, dead ashes easily reignite. The concern is that large doses of Huangqi, due to its warm and dry nature, easily injure the yin of the liver and kidney. Its ability to tonify qi and raise yang may assist the hyperactive trend of liver yang, potentially causing liver fire to ascend. Its excessive qi without dispersion may lead to blockage by phlegm-heat. Therefore, Buyang Huanwu Tang is not suitable for all post-stroke patients. Its indications are limited to those where qi deficiency is primary with slight blood vessel stasis. If qi deficiency is accompanied by phlegm-heat, adding phlegm-resolving and heat-clearing herbs is appropriate; if qi deficiency is accompanied by excess fire, adding fire-descending and heat-draining herbs is appropriate; however, if qi deficiency is accompanied by liver-kidney deficiency, cloying blood-tonifying herbs should not be administered early. Although the severe collapse has subsided, the functions of the five zang and six fu organs, meridians, collaterals, yin-yang, qi-blood, and limbs are only just recovering, with weak strength, especially in those with qi deficiency. Indiscriminate use of cloying herbs would suppress the vital energy and likely cause premature death. One must wait until yuan qi gradually fills up and the digestive and transformative power of the middle jiao can handle it before gradually adding them. If the syndrome is not primarily qi deficiency, but rather liver-kidney deficiency, liver yang hyperactivity, or internal retention of phlegm-heat, this does not apply. In my clinical practice, observing patients' pulses and symptoms, there are indeed many cases of qi deficiency, while blood deficiency and yin deficiency are relatively less common. Thus, Wang Qingren's emphasis on qi deficiency theory has its own clinical basis. However, among qi deficiencies, those with middle qi deficiency accompanied by phlegm stagnation and heat depression are predominant. Therefore, Sun Wen Yuan of the Ming dynasty frequently used modified Liu Junzi Tang (Six Gentlemen Decoction) or Si Junzi Tang (Four Gentlemen Decoction) in his medical records, achieving complete success. Based on the above understanding, I self-created Pianku Jianquan Tang (Hemiplegia Recovery Decoction) to treat post-stroke hemiplegia characterized by qi deficiency accompanied by phlegm-heat and wind obstructing collaterals. In this formula, Dangshen (Codonopsis Radix) is heavily used to establish middle qi and strengthen the spleen and stomach; when spleen and stomach function well, turbid phlegm is easily transformed. Fuling (Poria), Juhong (Citri Reticulatae Pericarpium), Danningxing (Arisaematis Cum Bile), and Zhuli (Bambusae Caulis in Taenia) resolve phlegm and unblock collaterals. Yuanzhi (Polygalae Radix) and Changpu (Acori Tatarinowii Rhizoma) open the凝滞 of heart qi to restore voice. Qinjiao (Gentianae Macrophyllae Radix) and Fangfeng (Saposhnikoviae Radix) dispel wind from collaterals to reach the limbs. Gouteng (Uncariae Ramulus cum Uncis) specifically clears jueyin wind-wood and submerges yang. Honghua (Carthami Flos) alone regulates blood stasis and assists in extinguishing wind. Gancao (Glycyrrhizae Radix et Rhizoma) harmonizes the herbs. Each herb in the formula has its specific role, except for Shihu (Dendrobii Caulis), which seems superfluous. You Zaijing said: "In pseudo-stroke, wind arises internally, being the jue qi of the liver. The liver's generation of qi is violent and the disease progresses rapidly. Once liver qi becomes jue, other qi follows it. Other fluids follow it. Other qi transforms into fire, other fluids transform into phlegm, converging on the upper jiao, flowing and stagnating in collaterals, like sudden rain and wind, or surging tides, unstoppable." You explicitly pointed out that this condition arises from sudden liver jue qi, rising qi and rebellious fire, condensing fluids into phlegm, blocking meridians and collaterals. Since fluids condense into phlegm, the fluids must be injured, and the zang-fu organs and collaterals naturally become dry and rough. Body fluids can permeate orifices and joints, possessing slippery and moistening functions. Without the lubrication of body fluids, qi and blood movement will be hindered. If body fluids are insufficient, rapid recovery of limbs is impossible. Furthermore, body fluids participate in the generation of essence and blood. If essence and blood are depleted, expecting a plump body and free movement is inconceivable! Therefore, herbs that nourish yin and generate fluids must be added to the formula. However, patients have declining yuan qi and weak spleen and stomach; administering cloying herbs easily causes medicinal injury. Only Shihu possesses pure and clear qualities without this drawback. Moreover, the stomach is the sea of body fluids; sufficient stomach fluids irrigate and benefit all zang-fu organs. The kidney is the water organ governing essence; sufficient kidney essence ensures continuous vital mechanisms. Shihu generates fluids upon entering the stomach and nourishes fluids upon entering the kidney; nothing surpasses it. Hence, Shihu is uniquely selected for the formula.
As for Qinjiao and Fangfeng, two wind-dispelling herbs, their use might seem inappropriate. True stroke involves external wind invading the body due to deficiency, so wind-dispelling methods are indeed applicable. However, pseudo-stroke involves wind arising internally, mostly due to liver-kidney yin deficiency transforming jueyang into wind; treatment should focus on nurturing, nourishing, submerging, and securing. Why use wind herbs? Xu Lingtai said: "Whenever ancient sages named diseases, they necessarily indicated the reality. Named 'stroke,' it is known to belong to wind. Since it is a wind disease, the main prescription must focus on treating wind. Therefore, Zhang Zhongjing's Hou Shi Hei San, Feng Yin Tang, Fangji Dihuang Tang, and the Tang dynasty's Da Xiao Xuming Tang all contain many wind herbs, adjusted according to syndromes. Because wind enters collaterals, internal wind and external wind fan each other, causing temporary congestion of phlegm-fire. It is best to first disperse the wind, then clear phlegm-fire. Afterwards, regulate qi and blood, so meridians can gradually unblock." Xu's method is staged treatment, with clear layers, worthy of learning and emulation. I, however, mix wind-dispelling, phlegm-resolving, heat-clearing, and qi-tonifying herbs in one formula to seek simplicity.
Appendix: Pianku Jianquan Tang Formula
Dangshen 9–24g, Fuling 9g, Juhong 6g, Dannanxing 4–9g, Zhiyuanzhi 6–9g, Shichangpu 3–6g, Gouteng 15–30g, Qinjiao 9–15g, Shihu 9–15g, Fangfeng 6–9g, Honghua 3–4.5g, Zhigancao 1.5–3g, Xianzhuli 1–2 vials (mixed in).
Mnemonic: Pianku Jianquan Tang, Ling Ju Nan Xing Dang, Chang Yuan Qiu Jiao Hu, Li Cao Hong Hua Fang.
When using this formula, adjust according to the patient's condition and syndrome.
Below are two verified cases for readers' correction.
Case 1: Jin, male, retired worker. Had a history of hypertension. Suddenly suffered a stroke in November 1971, sent to a district central hospital for rescue, developed hematemesis, and escaped danger after repeated treatments. Discharged after four months. Later invited me for treatment. Examination showed hemiplegia, spastic rigidity of upper and lower limbs, unbearable severe pain upon slight joint movement, slurred speech, and a sensation of head swelling and heat. Pulse was choppy and stagnant; tongue was pale red with thick greasy coating. Clearly, sequelae of pseudo-stroke. As mentioned above, treatment methods for stroke vary: Danxi emphasizes phlegm, Hejian emphasizes heat, Dongyuan emphasizes deficiency, and Wang Qingren emphasizes qi deficiency and blood stasis. Regarding Jin's pulse and symptoms, it is undoubtedly due to habitual hyperactivity of liver yang, latent movement of internal wind, obstruction of damp-phlegm in the middle, and blockage of collaterals, causing abnormal circulation of qi and blood in both halves of the body. Initially, phlegm-resolving and wind-dispelling should be performed. Use modified formulas containing Dannanxing, Banxia, Beimu, Fuling, Zhuli, Juhong, Qinjiao, Fangfeng, Dilong, Wushaoshe, etc., taken with Daluowan (Great Luo Unblocking Pill). By spring 1972, speech gradually became clear, and affected limbs could move slightly, supported by family members walking indoors. By early summer, he could walk slowly with a cane in streets and alleys. Although left-hand spasms were not completely eliminated, spirit and appetite were robust.
Case 2: Wang, cadre of a Shanghai watch factory. Had a history of hypertension. Reached fifty in 1984. Sudden cerebral hemorrhage during a business trip in Wuxi in spring. Rescued by Wuxi First People's Hospital, leaving sequelae of slurred speech and hemiplegia. Invited me for consultation upon returning to Shanghai. Patient was short and sturdy. Symptoms included inability to move right hand and foot, slight twitching pain, relaxed but not rigid joints, and inward turning of the foot. Face was red, speech unclear, bowel and bladder movements normal, appetite normal. Pulse was small and slippery; tongue was pale red with thin white coating. Analysis of pulse and symptoms indicates this syndrome belongs to liver yang carrying phlegm upward, taking advantage of the spring wood qi generating momentum, extreme rising of yang leading to stroke. After treatment, bleeding stopped and consciousness cleared, critical signs removed, but yuan qi was secretly damaged, collaterals were sparse, phlegm and stasis flowed in opportunistically, adhering and unresolved, causing blockage of tunnels, making qi and blood circulation difficult, resulting in hemiplegia. Treatment plan: tonify qi, resolve phlegm, unblock collaterals. Internal prescription mainly uses Pianku Jianquan Tang:
Dangshen 24g, Fuling 9g, Juhong 6g, Dannanxing 9g, Zhizhiyuanzhi 9g, Shichangpu 9g, Gouteng 30g (added later), Qinjiao 15g, Shihu 15g, Honghua 3g, Xianzhuli 1 vial (mixed in), Zhigancao 3g.
Take one dose daily, review every seven days to observe pulse/symptom changes and adjust medication accordingly, simultaneously providing acupuncture. Main acupoints for upper limbs: Jianliao (SI15), Quchi (LI11), Hegu (LI4), Yangchi (TE4).
Main acupoints for lower limbs: Huantiao (GB30), Jugu (GB29), Fengshi (GB31), Yanglingquan (GB34), Zusanli (ST36), Xuanzhong (GB39), Qiuxu (GB40), Jiexi (ST41).
Additionally, select Lianquan (CV23), two needles per point. Insertion depth 1.5–2 cun to facilitate speech.
Acupuncture and medicine combined. After two weeks, could walk slowly indoors, speech clearer; after two months, could care for daily life and walk on streets; after four months, returned to work until retirement. Over ten years have passed since then, always healthy and comfortable.
Regarding conditioning for this disease, old TCM doctor Mr. Xia Yuren, a close friend of mine before his death, once told me: His friend Zhou's mother, over fifty, suffered stroke with hemiplegia. Although cured, the affected limbs remained sore, numb, and weak, often disobeying commands. Every autumn-winter transition, Zhou went to the countryside to dig dozens of whole goji berry plants, washed and dried them in shade, ground roots, stems, leaves, flowers, and seeds together into powder, made honey pills, and took several grams daily with boiled water. Continuing this throughout the year, after more than a year, limb numbness, weakness, and joint soreness disappeared. After three to four years, spirit doubled; after more than ten years, though over seventy, he looked like a person in his fifties. Truly effective.
Facial Paralysis Relies on "Shengyu"
Facial paralysis (deviation of mouth and eyes) belongs to the category of wind pathogen invading collaterals. Ancient sages provided profound discussions. For example, Shi Wan said: "Wind excess depletes blood, unable to nourish sinews, causing sinus rigidity and deviation of mouth and eyes." Shi Wan also said: "*Ling Shu* states: 'Disease of foot yangming sinews, cold in cheek sinews causes tension, pulling mouth to side. Heat causes sinuses to relax and loosen, unable to control, hence deviation.' According to left cold right heat, left tense right loose. Right cold left heat, right tense left loose. Because cold in left forces heat to right, cold in right forces heat to left, yang qi cannot circulate freely. Also, *Jin Gui* states: 'Extreme cold injures meridians, extreme heat injures collaterals.' Knowing meridians injured by cold are tense, collaterals must be hot and loose. This refers to *Su Wen*'s statement about large sinews becoming soft and short, small sinuses becoming relaxed and long." "Regarding medication, moisturizing dryness extinguishes wind naturally. Ancient method used Da Qin Jiao Tang, now changing to Shi Quan Da Bu Tang is better."
Shi Wan's discussion on the etiology and pathogenesis of facial deviation cites classics and principles, possessing great logic. Left-right cold-heat, cold injuring meridians, heat injuring collaterals, meridians tense from cold leading to collaterals hot and loose—these theories explore ancient meanings and integrate new knowledge. Using Shi Quan Da Bu Tang to moisten dryness and extinguish wind shows unique insight, far superior to merely dispelling wind, unblocking collaterals, and activating blood resolving stasis. Although this disease can be triggered by cold-heat pathogens, the cause is mostly qi-blood deficiency, sparse collaterals, allowing liver wind and turbid phlegm to invade collaterals due to deficiency. Thus, purely using pungent-dry wind-dispersing herbs is incorrect, and solely using warm-tonifying herbs is not ideal either. It should combine regulating qi-blood with resolving phlegm, unblocking collaterals, clearing liver, and extinguishing wind to be complete. Whenever I encounter this symptom, I usually achieve efficacy with modified Shengyu Tang, hence formulating "Shengyu Zhengrong Tang." Patients taking this formula usually recover within three to four weeks, with absolutely no sequelae after recovery.
Cadre Yi, in autumn 1973, occasionally felt left cheek twitching, relying on his strong constitution, paid no attention. A week later, mouth and eyes deviated to the right. Sought treatment. Heard a barber had an ancestral thin plaster method with significant effects, so went to seek treatment. The barber applied bean-sized powder to the empty space in front of the left ear at Tinggong (SI19), covered with rubber tape. Changed every three days. First one or two applications showed obvious effect, subsequently became ineffective. Sought treatment from me and Mr. Xia Yuren again. We consulted together. Observed bluish-yellow dull complexion. Pulse was string-like and fine, two chi positions powerless. Knew it was liver-kidney insufficiency, internal deficit of qi-blood, blood deficiency generating wind, phlegm-saliva condensing due to opportunity, causing collateral obstruction resulting in this symptom. Treatment plan: modified Shengyu Tang, incorporating phlegm-resolving, liver-calming, wind-dispelling, and collateral-unblocking herbs. Formula:
Dangshen 12g, Huangqi 12g, Shudi 12g, Baishao 9g, Danggui 9g, Xianzhuli 30g (mixed in), Gouteng 12g (added later), Juhong 4.5g, Heihema 15g, Jiangcan 4.5g.
Took approximately twenty doses of the above formula with modifications, continued applying plaster. Took one month to return to normal. Then increased previous formula amount tenfold, made honey-water pills, took twice daily, 10g each time, to consolidate. No recurrence since recovery.
A shop assistant at a department store fell ill simultaneously with Yi. Deviated mouth and eyes the morning after wedding. Went with Yi to apply plaster, believed the claim that medicine and acupuncture were unnecessary, insisted on not taking medicine or acupuncture despite repeated advice, thus becoming a stubborn disease, incurable to this day. Regrettable! The plaster method is indeed effective for excess syndromes. For those who do not heal with plaster or have incomplete effects, acupuncture and medicine should be combined. Do not hide illness and avoid doctors to bring disaster upon oneself.
Appendix: Shengyu Zhengrong Tang Formula
Sheng Huangqi 24g, Dangshen 15g, Shudi 12g, Danggui 9g, Chao Baishao 9g, Chuanxiong 3g, Fangfeng 9g, Qinjiao 9g, Xianzhuli 1 vial (mixed in), Gouteng 15g (added later), Honghua 1.5g, Gancao 1.5g.
Mnemonic: Zhengrong Tang derived from Shengyu, Qiu Fang Hua Cao Gou Li Zai.
This formula tonifies qi and nourishes blood, disperses wind and resolves phlegm. If due to liver yang hyperactivity, it is suitable to calm liver, submerge yang, extinguish wind, and sedate. If caused by other reasons, still treat according to syndrome. Even if definitely this formula's syndrome, must adjust according to pulse and symptoms. Yue Fei discussed military strategy saying "The subtlety of application lies in the mind." Physicians and soldiers share the same principle.
Differentiation of Mismedication in Li Jie Feng Tong (Joint Pain)
Father-in-law worked in finance. In the early 1970s, around fifty, ordered to support construction in another region. Due to crude environment, cold-dampness easily invaded, gradually feeling joint pain, wandering and不定. Local treatments used only pungent-dry wind-dispersing agents. Disease worsened, came to Shanghai for treatment, finally improved, but urgently needed to return for work. I specially wrote a "Brief Description" article for local physicians' reference, unfortunately completely unused. Until limbs and joints swelled and became rigid, movement extremely difficult, finally retired and returned to Shanghai. Although tried hard to treat, ultimately felt the good opportunity was lost, heart long but strength short. Now recording the original text from that day to record the event.