（附∶胃风）
论
《内经》曰∶风之伤人也，或为寒热，或为热中，或为寒中，或为疠风，或为偏枯。又曰∶风者，百病之长也，至
其变化，乃为他病，无常方。又曰∶诸风掉眩，皆属肝木。《千金》云∶岐伯所谓中风，大法有四∶一曰偏枯，谓半身不
遂也。二曰风痱，谓身无疼痛，四肢不收也。三曰风懿，谓奄忽不知人也。四曰风痹，谓诸痹类风状也。是以古之名医，
皆以外中风邪，立方处治。惟河间刘守真氏谓∶中风瘫痪者，非谓肝木之风实甚而卒中之，亦非外中于风，良由将息失
宜，心火暴甚，肾水虚衰不能制之，则阴虚阳实，而热气怫郁，心神昏冒，筋骨不用，而卒倒无所知也。亦有因喜怒思
悲恐五志有所过极而卒中者，夫五志过极皆为热甚，俗云风者，言末而忘其本也。东垣李明之亦谓∶中风者，非外来风
邪，乃本气自病也。凡人年逾四旬气衰之际，或因忧喜忿怒伤其气者，多有此证，壮岁之时无有也。若肥盛者则间有之，
亦是形盛气衰故如此耳。丹溪先生亦曰∶有气虚，有血虚，有痰甚。又曰∶西北二方，真为风所中者有之。东南之人，
多是湿土生痰，痰生热，热生风也。夫上古之论中风，一以为外感风邪之候。及乎三先生之论一出，皆以风为
虚象，而谓内伤正气为病。然三先生又别，各有外感之论，而使后学狐疑不决。故王安道有论三子主气、主火、主湿之
不同，而与昔人主风之不合，而立真中、类中之目，歧为二途。愚窃疑焉。曰卒中，曰暴仆，曰暴喑，曰蒙昧，曰 僻，
曰瘫痪，曰不省人事，曰语言蹇涩，曰痰涎壅盛，其为中风之候不过如此，无此候者非中风之病也。夫外候既若是之相
侔，而病因又何其若彼之异耶？欲求归一之论终不可得，于是积年历试四方之病此者若干人，尽因风湿痰火挟虚而作，
何尝见其有真中、类中二者之分哉。是以一旦豁然有所感悟，未知是否，请陈梗 如下，与明达者共议。夫中风之证，
盖因先伤于内而后感于外之候也，但有标本轻重之不同耳。假如百病皆有因有证，因则为本，证则为标。古人论中风者，
言其证也。三先生论中风者，言其因也。知乎此，则中风之候可得而详论矣。其所谓真中风邪者，未必不由气体虚弱，
荣卫失调，然后感于外邪也。若非体虚所致，则西北二方风寒大盛之地，而中风者比比皆是，何暇为他证哉。其所谓因
火、因气、因湿者，亦未必绝无外邪侵侮而作也。若无外邪侵侮，则因气、因火、因湿各自为他证，岂有 僻瘫痪暴仆
暴喑之候乎。经曰邪之所凑，其气必虚是也，岂可以一中风之证歧为二途哉。治之之法，重于外感者，先驱外邪而后补
中气，重于内伤者，先补中气而后驱外邪，或以散风药为君，而以补损药为臣使，或以滋补药为君，而以散邪药为臣使，
全在活法量轻重而处治之也。《内经》曰∶有取本而得者，有取标而得者，有本而标之者，有标而本之者。又曰∶急则治
其标，缓则治其本。若夫初病暴仆昏闷，不省人事，或痰涎壅盛，舌强不语，两寸脉浮大而实者，急宜以瓜蒂、藜芦等
药吐之，以遏其势。或人迎脉紧盛，或六脉俱浮弦者，急宜以小续命汤表之。盖风气大盛，心火暴升，而痰涎壅遏于经
络之中，于斯时也，岂寻常药饵而能通达于上下哉。故本方用附子，以其禀雄壮之资，而有斩关夺将之势，能引人参辈
并行于十二经，以追复其失散之元阳，又能引麻黄、防风、杏仁辈发表开腠理，以驱散其在表之风寒，引当归、芍药、
川芎辈入血分行血养血，以滋养其亏损之真阴。或加石膏、知母以降胃火，或加黄芩以清肺金，看所挟见证，与夫时月
寒温，加减施治。病势稍退，精神稍复，辄当改用丹溪之法，而以补气补血清痰之剂，以调养其本气而安，此急则治其
标与夫标而本之之治也。凡人手足渐觉不随，或臂膊及髀股指节麻痹不仁，或口眼歪斜，语言蹇涩，或胸膈迷闷，吐痰
相续，或六脉弦滑而虚软无力，虽未至于倒仆，其为中风晕厥之候，可指日而定矣。早当从丹溪之法调治，其左手脉不
足及左半身不遂者，以四物汤补血之剂为主治。右手脉不足及右半身不遂者，以四君子汤补气之剂为主治。痰盛者，二
陈、导痰等汤兼用。气血两虚而挟痰者，八物汤加南星、半夏、枳实、竹沥、姜汁之类。若夫真元渐复，痰饮渐消，或
觉有风邪未退者，仍以羌活愈风汤、防风通圣散之类出入加减调治而安。此缓则治其本与夫本而标之之治也。抑
考先哲有云∶其证有中脏、中腑之分，证各不同。中腑者多着四肢，故面加五色，脉浮而恶风寒，四肢拘急不仁，或中
身之后，或中身之前，或中身之侧，皆曰中腑也，其治多易。中脏者多滞九窍，故唇缓失音，耳聋鼻塞目瞀，大小便秘
结，皆曰中脏也，其治多难。大法中腑者小续命等汤以发其表，中脏者三化等汤以通其里，腑脏兼见者又不可以拘泥，
或一气之微汗，或一旬之通利。又曰∶治须少汗，亦须少下，多汗则虚其卫，多下则损其荣，斯又不可不谨。或外无六
经之形证，内无便溺之阻隔，但手足不遂，语言蹇涩者，此邪中于经也，又当从乎中治而不可以标本论也，是宜养血通
气，大秦艽汤、羌活愈风汤之类治之。夫所谓诸方论治，乃先哲立权衡以为后学之矜式耳，其于临证切脉之际，又当顺
时令而调阴阳，安脏腑以和荣卫，察病机，审气宜，全在活法以度其轻重之权量，甚勿胶柱以调瑟也。
脉法
《脉经》曰∶脉微而数，中风使然。寸口沉大而滑，沉则为实，滑则为气，气实相搏，入于脏则死，入于腑则愈，
此为卒厥。不知人，唇青身冷，为入脏，死。身温和，汗自出，为入腑，而复自愈。脉阳浮而滑，阴濡（濡当作 ，与
软通，下同）而弱，或浮而滑，或沉而滑，或微而虚，或微而数，寸口或浮而缓，或缓而迟，皆为中风之证。大
法浮迟者吉，急疾者凶。又曰∶脉浮而迟者易治，大数而急者死。
方法
（先哲有云∶方者法之体，法者方之用，故二者不可偏废也。）
丹溪曰∶中风大率主血虚有痰，或挟火与湿。诸方书皆谓外中风邪，惟刘河间作将息失宜，水不制火，极是。然地
有不同，不可一途而论，西北人外中者亦有，东南之人皆是，湿上生痰，痰生热，热生风也。真中风邪者，东垣中血脉、
中腑、中脏之说甚好。治法以治痰为先，补养次之。国中，急掐人中令省。子和三法亦可用。痰壅盛者，口眼歪斜者，
不能言语者，皆当用吐法。轻者用瓜蒂散，或虾汁，或稀涎散吐之。或重而口噤者，用藜芦末少加麝香或五分或一钱灌
入鼻内吐之，一吐不已再吐。亦有气血虚而不可用吐法者，慎之！（吐法详见痰门。）
半身不遂，大率多痰。在左属死血少血，宜四物汤加桃仁、红花、竹沥、姜汁。在右属痰与气虚，宜二陈汤合四君
子汤加竹沥、姜汁。能食者，去竹沥，加荆沥尤妙。肥人多湿，少加附子行经。
气虚卒倒，参 补之。挟痰则浓煎人参汤加竹沥、姜汁。血虚者，以四物汤补之。挟痰者，其药俱用姜汁炒过，更
加姜汁、竹沥服。
遗尿者，属气虚，多以参 补之。
凡中风，口开手撒，眼合遗尿，吐沫直视，喉如鼾睡，肉脱筋痛发直，摇头上窜，面赤如妆，汗缀如珠，皆为中风
不治之症也。若动止筋痛，是无血滋筋故痛，曰筋枯，不治。
（以上丹溪方法凡五条）
四君子汤 四物汤（二方并见虚损门。） 二陈汤（局方、千金 见痰饮门。）
小续命汤（并易老加减法。） 东垣曰∶中风自汗者，不可重发其汗，故此药亦不可轻用也。
麻黄（去节） 人参（去芦） 黄芩 白芍药 防己 桂枝 川芎（各七分） 防风（去芦一钱） 甘草（炙，七
分） 附子（童便煮去皮脐，五分） 杏仁（去皮尖，另研，一钱）
《金匮要略》本方有石膏、当归，无附子、防风、防己。愚按∶本方石膏、当归固不可无，而附子、防风、防己尤
不可缺，此恐传写者之脱简耳。
上细切，作一服，水一盏半，加生姜五片，煎至一盏，温服。凡中风不审六经之形证加减用药，虽治之不能去其邪
也。《内经》曰∶开则淅然寒，闭则然而闷。知暴中风邪，宜先以加减续命汤随证治之。
中风无汗恶寒，麻黄续命主之。
麻黄 防风 杏仁
根据本方加添一倍，宜针太阳至阴出血，昆仑举跷。
中风有汗恶风，桂枝续命主之。
桂枝 芍药 杏仁
根据本方加一倍，宜针风府。（以上二证，皆太阳经中风也。）
中风无汗身热不恶寒，白虎续命主之。
石膏（一钱四分） 知母（一钱四分） 甘草（七分）
根据本方加之。
中风有汗身热不恶风，葛根续命主之。
葛根（一钱四分） 桂枝 黄芩（根据本方加一倍）
宜针陷谷，刺厉兑。针陷谷者，去阳明经之贼邪；刺厉兑者，泻阳明经之实也。以上二证，阳明经之中风也。
中风无汗身凉，附子续命主之。
附子（加一倍） 干姜（加七分） 甘草（加二钱一分）
宜刺隐白，去太阴之贼邪也。此证，太阴经中风也。
中风有汗无热，桂附续命主之。
桂枝 附子（炮） 甘草（炙）
根据本方加一倍，宜针太溪。此证，少阴经中风也。
中风六经混淆，系之于少阳、厥阴，或肢节挛痛，或麻木不仁，宜羌活连翘续命主之。
小续命汤（八钱） 加羌活（四钱） 连翘（六钱）
古之续命，混淆无六经之别，今各分经治疗，又分经针刺。刺法，厥阴之井大敦，刺以通其经，少阳之经绝骨，灸
以引其热，是针灸同法象之大体也。
愚按∶先哲制小续命汤，以治中风初病无汗，及手足瘫痪、关节不利、表实等证，此急则治标之药也。后人不分表
里虚实，通用以治中风之证，故张易水授东垣以加减之法。夫中风无汗表实者固宜，其有汗表虚之证，虽有加减之法，
恐不可以胶柱鼓瑟也。
大秦艽汤（机要） 中风，外无六经之形证，内无便溺之阻隔，知血弱不能养筋，故手足不能运动，舌强不能
言
语，宜养血而筋自荣，此方主之。
秦艽 甘草 川芎 川归 白芍药 石膏 独活 白茯苓（各一钱） 羌活 防风 黄芩 白术 生地黄 热地黄
白芷（各五分） 细辛（二分半）
上细切，作一服，水煎，温服无时。如遇天阴，加生姜三片同煎。如心下痞满，加枳实一钱同煎服。
愚按∶此方用归、芎、芍药、生熟地黄，以补血养筋，甚得体。既曰外无六经之形证，但当少用羌活、秦艽，引用
以利关节。其防风、独活、细辛、白芷、石膏等药，恐太燥而耗血。虽用此，川芎止可六分之一，尤宜加竹沥、姜汁同
剂最好，达者详之。
三化汤（机要） 中风，外有六经之形证，先以加减续命汤随证治之；内有便溺之阻隔，复以此药利之。
浓朴 大黄 枳实 羌活（各等分）
上细切，每服三两重，水三升，煎至一升半，终日服之，以微利为度。
羌活愈风汤（机要，并加减法。） 疗肾肝虚，筋骨弱，语言蹇涩，精神昏愦。此药安心养神，调理阴阳，使
无偏胜。治中风内外无邪，服此药以行中道。
羌活 甘草 防风 蔓荆子 川芎 细辛 枳壳 熟地黄 人参 麻黄 薄荷 甘菊花 当归 知母 黄 地骨
皮独活 白芷 杜仲 枸杞子 秦艽 柴胡 半夏 紫浓朴 前胡 防己（各三分） 黄芩 白茯苓 芍药（各四分
半） 苍术 生地黄（各六分） 桂枝（一分半） 石膏（六分）
天阴雨，加生姜三片。
上细切，作一服，水二大盏，煎至一盏，去渣温服。空心一服，咽下二丹丹。临卧一服，咽下四白丹。动以安神，
静以清肺。假令一气之微汗，本方药一剂，加麻黄一钱，生姜五片，空心服，以热羹粥投之，得微汗则佳。如一旬之通
利，本方药一剂，加大黄三钱，如前煎，临卧服，得利为度。如望春大寒之后，加半夏三分，人参三分，柴胡三分，谓
迎而夺少阳之气也。望夏之月，加石膏三分，黄芩三分，知母三分，谓迎而夺阳明之气也。季夏之月，加防己三分，白
术三分，茯苓三分，谓胜脾土之湿也。初秋大暑之后，加浓朴三分，藿香三分，桂一分半，谓迎而夺太阴之气也。霜降
之后望冬之月，加附子一分半，桂一分半，当归三分，谓胜少阴之气也。此虽立四时加减之法，更宜临证审察虚实寒热
土地之宜、邪气之多少可也。
四白丹 能清肺气养魄，谓中风者多昏冒气不清利，此药主之。
白芷（一两） 白檀（一钱五分） 白茯苓（五钱） 白术（五钱） 羌活（一钱五分） 知母（二钱） 缩砂仁
（五钱） 人参（五钱） 独活（一钱五分） 防风（五钱） 甜竹叶（二两） 薄荷（三钱五分） 细辛（二钱） 甘
草（五钱） 香附子（五钱，炒） 川芎（五钱） 麝香（一字，另研） 牛黄（五分，另研） 藿香（一钱五分） 龙
脑（五分，另研）
[Appendix: Stomach Wind]
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When wind pathogen attacks the human body, it may manifest as alternating chills and fever, or as heat in the middle jiao (internal heat), or as cold in the middle jiao (internal cold), or as leprosy (Lifeng), or as hemiplegia (Piangu). It further states: Wind is the leader of all diseases; when its changes occur, it transforms into other illnesses without a fixed pattern. It also states: All wind diseases characterized by tremors and dizziness belong to Liver Wood. The *Qianjin Fang* (Prescriptions Worth a Thousand Gold) says: What Qibo referred to as Zhongfeng (Stroke/Wind Stroke) generally falls into four categories: First is Piangu (Hemiplegia), referring to paralysis of half the body. Second is Fengfei (Wind Paraplegia), referring to a condition where the body feels no pain but the limbs cannot be controlled. Third is Fengyi (Wind Obscurity), referring to sudden unconsciousness. Fourth is Fengbi (Wind Bi), referring to various Bi syndromes that resemble wind conditions. Therefore, ancient famous physicians all believed this was caused by external wind pathogen invasion and prescribed formulas accordingly. Only Liu Wansu from Hejian argued that stroke paralysis is not due to excessive excess wind of the Liver Wood striking suddenly, nor is it external wind invasion; rather, it is truly due to improper lifestyle management, where Heart Fire becomes violently excessive, and Kidney Water is deficient and unable to control it, leading to Yin deficiency and Yang excess. Heat qi becomes stagnant and depressed, causing the Heart Spirit to become confused and obscured, resulting in loss of function in tendons and bones, and sudden collapse with loss of consciousness. There are also cases of sudden stroke due to the extreme excess of the Five Emotions (Joy, Anger, Worry, Sorrow, Fear); since extreme excess of the Five Emotions all generates intense heat, the common term "wind" describes only the superficial manifestation while forgetting the root cause. Li Dongyuan also stated: Stroke is not caused by external wind pathogen, but is a disease of the original Qi itself. Whenever people over forty years old, at the stage of declining Qi, or those whose Qi has been damaged by worry, joy, anger, etc., often suffer from this syndrome; young adults do not have it. Even among those who are obese, it occurs occasionally, which is also due to robust form but deficient Qi. Mr. Zhu Danxi also said: There are cases of Qi deficiency, Blood deficiency, and severe Phlegm. He also stated: In the northwest regions, there are indeed cases struck by true wind pathogen. However, people in the southeast mostly suffer from damp earth generating Phlegm, Phlegm generating Heat, and Heat generating Wind. Ancient discussions on stroke uniformly regarded it as a symptom of external wind pathogen invasion. Once the theories of these three masters emerged, they all viewed wind as a sign of deficiency and attributed the disease to internal injury of healthy Qi. However, these three masters each had their own discussions on external contraction, causing later students to remain doubtful and undecided. Thus, Wang Andao discussed the differences between the three masters' emphasis on Qi, Fire, and Dampness, which contradicted the ancients' emphasis on wind. He established the categories of Zhenzhong (True Stroke) and Leizhong (Resembling Stroke), dividing them into two paths. I privately harbor doubts about this. Terms such as sudden attack, sudden fall, sudden aphasia, confusion, facial deviation, paralysis, unconsciousness, slurred speech, and copious phlegm-saliva—all these constitute the manifestations of stroke. Without these manifestations, it is not a stroke disease. Since the external manifestations are so similar, why are the etiologies so different? Seeking a unified theory has proven impossible after years of trial and error treating numerous patients across various regions. I found that all were caused by wind-dampness, phlegm-fire combined with deficiency. I never saw a distinction between True Stroke and Resembling Stroke. Therefore, one day I had a sudden enlightenment. Whether correct or not, I present the main points below for discussion with enlightened scholars. The syndrome of stroke is essentially a condition of internal injury followed by external contraction, differing only in the priority of root and branch and severity. Suppose all diseases have an etiology (root) and a manifestation (branch); the etiology is the root, and the manifestation is the branch. Ancients discussing stroke spoke of the manifestations; these three masters discussed stroke speaking of the etiology. Understanding this allows for a detailed discussion of stroke manifestations. Those considered "true external wind pathogen invasion" were likely not without underlying physical weakness and disharmony of Ying and Wei (Defensive and Nutritive Qi) before contracting external pathogens. If it were not caused by physical weakness, then in the northwest regions where wind and cold are prevalent, stroke cases would be ubiquitous, leaving no time for other diseases. Those attributed to fire, Qi stagnation, or dampness were also unlikely to occur without any external pathogen invasion. Without external invasion, Qi, Fire, or Dampness issues would manifest as other diseases, how could they produce symptoms like facial deviation, paralysis, sudden fall, or sudden aphasia? The Classics state: "Where pathogen gathers, Qi must be deficient." This is exactly the case. How can one stroke syndrome be divided into two paths? Treatment methods prioritize external contraction by first expelling external pathogen and then tonifying Middle Qi; for internal injury, first tonify Middle Qi then expel external pathogen. One may use wind-dispelling herbs as Sovereign drugs and deficiency-nourishing herbs as Ministers/Assistants, or vice versa. It entirely depends on flexible application and weighing severity to prescribe. The *Neijing* states: Some are cured by treating the root, some by treating the branch, some by treating root then branch, some by treating branch then root. It also states: In acute cases, treat the branch; in chronic cases, treat the root. For early-stage sudden collapse and coma, unconsciousness, or copious phlegm-saliva, stiff tongue, inability to speak, with floating, large, and excess pulses at both Cun positions, urgent emesis with Geng Ti (Melon Peduncle) and Li Lu (Veratrum) is indicated to curb the pathogenic momentum. Or if the Renying pulse is tight and full, or all six pulses are floating and wiry, urgent release of the exterior with Xiao Xuming Tang (Minor Continuation Life Decoction) is indicated. Because wind pathogen is abundant, Heart Fire rises violently, and phlegm-saliva obstructs the meridians, at such times, ordinary medicines cannot easily penetrate up and down. Therefore, this formula uses Fuzi (Aconite Root), because it possesses majestic potency and the momentum to break through gates and capture generals, capable of guiding Renshen (Ginseng) and others to circulate through the twelve meridians, recovering scattered Yuan Yang (Original Yang). It also guides Mahuang (Ephedra), Fangfeng (Saposhnikovia), Xingren (Apricot Seed) to release the exterior and open pores, dispersing wind-cold on the surface. It guides Danggui (Angelica Sinensis), Shaoyao (Peony Root), Chuanxiong (Ligusticum) to enter the blood level, move blood, and nourish blood, replenishing depleted True Yin. One may add Shigao (Gypsum) and Zhimu (Anemarrhena) to descend Stomach Fire, or add Huangqin (Scutellaria) to clear Lung Metal, adjusting based on accompanying syndromes and seasonal climate. As the disease momentum recedes and spirit slightly recovers, one should switch to Danxi's method, using formulas to tonify Qi, nourish Blood, and resolve Phlegm to regulate the root Qi and achieve stability. This is the treatment of "acute cases treat the branch" and "treat branch then root." When a person's limbs gradually feel uncoordinated, or arms/thighs/fingers become numb and insensitive, or facial deviation and slurred speech occur, or chest oppression with continuous expectoration happens, or pulses are wiry, slippery yet weak and powerless, although not yet collapsed, this indicates impending stroke syncope. Early treatment according to Danxi's method is required. For insufficient Left hand pulse and left-sided hemiplegia, Siwu Tang (Four Substances Decoction) for nourishing Blood is primary. For insufficient Right hand pulse and right-sided hemiplegia, Sijunzi Tang (Four Gentlemen Decoction) for tonifying Qi is primary. For severe phlegm, Erchen Tang (Two Aged Herbs Decoction) and Daotan Tang (Phlegm-Expelling Decoction) are used concurrently. For dual Qi and Blood deficiency with phlegm, Bawu Tang (Eight Substances Decoction) plus Nanxing (Arisaema), Banxia (Pinellia), Zhishi (Immature Bitter Orange), Zhuli (Bamboo Sap), and Jiangzhi (Ginger Juice) is appropriate. As True Yuan gradually recovers and phlegm-fluids dissipate, if wind pathogen seems unresolved, continue regulating with Qianghuo Yufeng Tang (Notopterygium Wind-Dispelling Decoction) or Fangfeng Tongsheng San (Saposhnikovia Interior-Exterior Releasing Powder) with modifications until stable. This is the treatment of "chronic cases treat the root" and "treat root then branch." Furthermore, examining ancient sages, they stated: Syndromes differ between Zhongzang (Striking the Zang organs) and Zhongfu (Striking the Fu organs). Zhongfu mostly affects the four limbs, hence facial color changes, floating pulse, aversion to wind-cold, limb stiffness and numbness. Whether affecting the back, front, or sides of the body, it is called Zhongfu, and treatment is relatively easy. Zhongzang mostly obstructs the nine orifices, hence flaccid lips, loss of voice, deafness, nasal congestion, blurred vision, constipation of urine and feces. This is called Zhongzang, and treatment is difficult. General principles: Zhongfu is treated with Xiao Xuming Tang to release the exterior; Zhongzang is treated with Sanhua Tang to purge the interior. For simultaneous Fu and Zang involvement, rigid adherence is inappropriate; either induce slight sweating within a short period or promote mild bowel movement over ten days. It is also said: Treatment requires sparing sweating and sparing purgation; excessive sweating empties Wei Qi, excessive purgation damages Ying Blood. This must be handled with caution. If there are no exterior Six Meridian manifestations and no internal obstruction of urination/defecation, but only limb incoordination and slurred speech, this is pathogen striking the Channels. Treatment should follow the "Middle Method" rather than root/branch theory, suitable for nourishing Blood and unblocking Qi, using Da Qinjiao Tang (Great Notopterygium Decoction) or Qianghuo Yufeng Tang. These formulas and treatments established by ancient sages serve as standards for students. However, during clinical pulse diagnosis, one must adapt to seasons to harmonize Yin-Yang, stabilize Zang-Fu to harmonize Ying-Wei, observe pathogenesis, assess Qi suitability, relying entirely on flexible judgment of severity, avoiding rigid adherence to fixed rules.
Pulse Diagnosis
The *Maijing* (Pulse Classic) states: A pulse that is faint and rapid indicates stroke. A Cun Kou pulse that is deep, large, and slippery: deep indicates Excess, slippery indicates Qi stagnation. When Excess Qi clashes, if it enters the Zang, death ensues; if it enters the Fu, recovery occurs. This is called Cu Jue (Sudden Syncope). Unconsciousness, blue lips, cold body indicate entry into Zang (death). Warm body, spontaneous sweating indicate entry into Fu (recovery). Pulses that are Yang-floating and slippery, Yin-soft and weak, or floating and slippery, or deep and slippery, or faint and deficient, or faint and rapid, or Cun Kou floating and moderate, or moderate and slow, are all signs of stroke. Generally, floating and slow pulses are auspicious; rapid and urgent pulses are ominous. It also states: Floating and slow pulses are easy to treat; large, rapid, and urgent pulses indicate death.
Methods
(Ancient sages said: Formulas are the substance of Methods, Methods are the application of Formulas; thus, neither should be neglected.)
Danxi said: Stroke is largely due to Blood deficiency with Phlegm, or accompanied by Fire and Dampness. Most medical texts attribute it to external wind pathogen, only Liu Hejian attributed it to improper lifestyle and Water failing to control Fire, which is very correct. However, geography differs, so one cannot generalize. Northwest people do experience external wind strike, but Southeast people all suffer from dampness rising to generate Phlegm, Phlegm generating Heat, Heat generating Wind. For true external wind strike, Dongyuan's classification of striking Collaterals, Fu, and Zang is excellent. Treatment prioritizes resolving Phlegm, followed by tonification. In general emergencies, pinch Renzhong (GV26) to restore consciousness. Hezi's Three Methods are also applicable. For copious phlegm, facial deviation, or aphasia, emesis is indicated. For mild cases, use Geng Ti San (Melon Peduncle Powder), shrimp juice, or Xi Xian San (Thin Saliva Powder) to induce vomiting. For severe cases with locked jaw, mix Li Lu powder with a small amount of Shexiang (Musk), 0.5 or 1 qian, insufflate into the nose to induce vomiting. Repeat if necessary. Caution: Cases with Qi and Blood deficiency should not use emesis! (See Phlegm section for details on emesis.)
Hemiplegia is mostly due to Phlegm. Left side indicates Blood stasis and Blood deficiency; use Siwu Tang plus Taoren (Peach Kernel), Honghua (Safflower), Zhuli, Jiangzhi. Right side indicates Phlegm and Qi deficiency; use Erchen Tang combined with Sijunzi Tang plus Zhuli, Jiangzhi. If appetite is good, remove Zhuli and add Jingli (Vitex Juice) for better effect. Obese people have much dampness; add a little Fuzi to circulate through channels.
For sudden collapse due to Qi deficiency, tonify with Renshen (Ginseng) and Huangqi (Astragalus). If accompanied by Phlegm, decoct Renshen soup thickly and add Zhuli, Jiangzhi. For Blood deficiency, use Siwu Tang. If accompanied by Phlegm, stir-fry all herbs with Ginger Juice, then add Ginger Juice and Bamboo Sap when taking.
Urinary incontinence indicates Qi deficiency; mostly tonify with Renshen and Huangqi.
In stroke, mouth opening, hand relaxation, eyes closed, urinary incontinence, foaming at the mouth, staring straight, snoring sound in throat, muscle wasting, tendon pain, hair standing erect, head shaking upward, face red like makeup, sweat beads like pearls—all are untreatable stroke signs. If pain occurs upon movement, it is due to lack of Blood nourishing tendons, called "Withered Tendons," which is untreatable.
(Above are five methods from Danxi.)
Sijunzi Tang (Four Gentlemen Decoction), Siwu Tang (Four Substances Decoction) (Both see Deficiency Damage section.) Erchen Tang (Two Aged Herbs Decoction) (Jufang, Qianjin Fang see Phlegm-Fluid section.)
Xiao Xuming Tang (Minor Continuation Life Decoction) (Plus Yi Lao modification methods.) Dongyuan said: For stroke with spontaneous sweating, do not heavily induce sweating; thus, this medicine should not be used lightly.
Mahuang (Ephedra Stem, nodes removed), Renshen (Ginseng Root, rhizome removed), Huangqin (Scutellaria Root), Baishao (White Peony Root), Fangji (Stephania Root), Guizhi (Cinnamon Twig), Chuanxiong (Ligusticum Rhizome) (each 7 fen), Fangfeng (Saposhnikovia Root, rhizome removed, 1 qian), Gancao (Licorice Root, honey-fried, 7 fen), Fuzi (Aconite Lateral Root, boiled in child's urine, skin and bud removed, 5 fen), Xingren (Apricot Seed, skin and tip removed, separately ground, 1 qian).
The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) version of this formula has Shigao and Danggui, but lacks Fuzi, Fangfeng, and Fangji. I note: While Shigao and Danggui are indeed indispensable, Fuzi, Fangfeng, and Fangji are equally crucial. This omission is likely due to copying errors.
Finely chop, prepare as one dose. Add 1.5 cups of water and 5 slices of fresh ginger. Decoct to 1 cup. Take warm. For stroke, if one does not examine Six Meridian manifestations for modification, treatment will fail to eliminate the pathogen. The *Neijing* states: When pores are open, one shivers with cold; when closed, one feels stifled. Knowing sudden wind pathogen invasion, one should first use Modified Xuming Tang according to the syndrome.
Stroke with no sweat and aversion to cold: Mahuang Xuming Tang governs.
Mahuang, Fangfeng, Xingren.
Double the dosage of this base formula. Acupuncture: Bleed Taiyang Zhiyin (BL67), lift Kunlun (BL60).
Stroke with sweat and aversion to wind: Guizhi Xuming Tang governs.
Guizhi, Shaoyao, Xingren.
Double the dosage of this base formula. Acupuncture: Needle Fengfu (GV16). (Above two syndromes are both Taiyang Meridian stroke.)
Stroke with no sweat, body heat, no aversion to cold: Baihu Xuming Tang governs.
Shigao (Gypsum, 1.4 qian), Zhimu (Anemarrhena Rhizome, 1.4 qian), Gancao (Licorice Root, 0.7 qian).
Add to this base formula.
Stroke with sweat, body heat, no aversion to wind: Gegen Xuming Tang governs.
Gegen (Kudzu Root, 1.4 qian), Guizhi, Huangqin (Double the dosage of this base formula).
Acupuncture: Needle Xangu (ST41), prick Lidui (ST45). Needling Xangu removes the thief pathogen of the Yangming Meridian; pricking Lidui drains excess of the Yangming Meridian. Above two syndromes are Yangming Meridian stroke.
Stroke with no sweat, cool body: Fuzi Xuming Tang governs.
Fuzi (Double dosage), Ganjiang (Dried Ginger, add 0.7 qian), Gancao (add 2.1 qian).
Prick Yinbai (SP1) to remove the thief pathogen of the Taiyin Meridian. This syndrome is Taiyin Meridian stroke.
Stroke with sweat, no heat: GuiFu Xuming Tang governs.
Guizhi, Fuzi (Processed), Gancao (Honey-fried).
Double the dosage of this base formula. Acupuncture: Needle Taixi (KI3). This syndrome is Shaoyin Meridian stroke.
Stroke with mixed Six Meridians, involving Shaoyang and Jueyin, or joint spasms/pain, or numbness: Qianghuo Lianqiao Xuming Tang governs.
Xiao Xuming Tang (8 qian), add Qianghuo (Notopterygium Root, 4 qian), Lianqiao (Forsythia Fruit, 6 qian).
Ancient Xuming formulas lacked distinction among Six Meridians. Now we treat by meridian and needle by meridian. Needling method: Jueyin Jingqu point Dazhun (LR1), needle to unblock the channel; Shaoyang channel Juegu (GB39), moxa to draw out heat. This is the general principle of acupuncture and moxibustion correspondence.
I note: Ancient sages formulated Xiao Xuming Tang to treat early-stage stroke with no sweat, limb paralysis, joint stiffness, and exterior excess—this is a drug for acute cases treating the branch. Later generations used it universally for stroke regardless of exterior/interior or excess/deficiency, so Zhang Yishui taught Dongyuan modification methods. While suitable for stroke with no sweat and exterior excess, for cases with sweat and exterior deficiency, even with modifications, one should not rigidly adhere to it.
Da Qinjiao Tang (Jiyao) For stroke, with no exterior Six Meridian manifestations and no internal obstruction of urination/defecation, knowing that weak Blood cannot nourish tendons, causing limb immobility and stiff tongue/inability to speak, one should nourish Blood so tendons naturally thrive. This formula governs.
Qinjiao (Gentiana Macrophylla Root), Gancao, Chuanxiong, Chuanggui (Angelica Sinensis), Baishao, Shigao, Duhuo (Angelica Pubescens Root), Baifuling (Poria, each 1 qian), Qianghuo, Fangfeng, Huangqin, Baizhu (Atractylodes Macrocephala Rhizome), Shengdihuang (Rehmannia Root, raw), Shudihuang (Rehmannia Root, prepared), Baizhi (Angelica Dahurica Root), Xixin (Asarum Root, each 0.5 qian), Xixin (0.25 qian).
Finely chop, prepare as one dose. Decoct in water, take warm at any time. If cloudy/rainy weather, add 3 slices of fresh ginger. If epigastric fullness, add 1 qian Zhishi (Immature Bitter Orange) and decoct together.
I note: This formula uses Danggui, Chuanxiong, Shaoyao, Raw/Prepared Dihuang to nourish Blood and tendons, which is very appropriate. Since it states no exterior Six Meridian manifestations, one should use only small amounts of Qianghuo and Qinjiao to guide and benefit joints. Herbs like Fangfeng, Duhuo, Xixin, Baizhi, Shigao are likely too drying and consume Blood. Even using this, Chuanxiong should be limited to one-sixth of the dose. Adding Zhuli and Jiangzhi is best. Experts should consider this carefully.
Sanhua Tang (Jiyao) For stroke, with exterior Six Meridian manifestations, first treat with Modified Xuming Tang according to syndrome; if there is internal obstruction of urination/defecation, use this medicine to promote drainage.
Houpo (Magnolia Bark), Dahuang (Rhubarb Root), Zhishi, Qianghuo (equal parts).
Finely chop. Each dose weighs 3 liang. Add 3 sheng of water, decoct to 1.5 sheng. Take throughout the day, stopping when mild laxation is achieved.
Qianghuo Yufeng Tang (Jiyao, plus modification methods.) Treats Kidney-Liver deficiency, weak tendons and bones, slurred speech, mental confusion. This medicine calms the Heart and nourishes Spirit, regulates Yin-Yang to prevent imbalance. Treats stroke without internal/external pathogen, taking this medicine to walk the middle path.
Qianghuo, Gancao, Fangfeng, Manjingzi (Vernonia Fruit), Chuanxiong, Xixin, Zhike (Bitter Orange Peel), Shudihuang, Renshen, Mahuang, Bohe (Mint), Ganjuhua (Chrysanthemum Flower), Danggui, Zhimu, Huangbo (Phellodendron Bark), Digupi (Lycium Bark), Duhuo, Baizhi, Duzhong (Eucommia Bark), Gouqizi (Goji Berry), Qinjiao, Chaihu (Bupleurum Root), Banxia (Pinellia Tuber), Zi Houpo (Magnolia Bark), Qianhu (Peucedanum Root), Fangji (each 0.3 qian), Huangqin, Baifuling, Shaoyao (each 0.45 qian), Cangzhu (Atractylodes Lancea Rhizome), Shengdihuang (each 0.6 qian), Guizhi (0.15 qian), Shigao (0.6 qian).
On rainy/cloudy days, add 3 slices of fresh ginger.
Finely chop, prepare as one dose. Add 2 large bowls of water, decoct to 1 bowl. Strain and take warm. On an empty stomach, take one dose and swallow 2 Dandan. Before bed, take one dose and swallow 4 Baidan. Movement calms the Spirit, stillness clears the Lung. For slight sweating within a short period: Use one dose of this base formula, add 1 qian Mahuang, 5 slices fresh ginger, take on empty stomach, follow with hot porridge soup. Mild sweating is desirable. For mild laxation over ten days: Use one dose of this base formula, add 3 qian Dahuang, decoct as before, take before bed, stop when bowel movement is achieved. After severe cold in spring month, add 0.3 qian Banxia, 0.3 qian Renshen, 0.3 qian Chaihu, to intercept and drain Shaoyang Qi. In summer month, add 0.3 qian Shigao, 0.3 qian Huangqin, 0.3 qian Zhimu, to intercept and drain Yangming Qi. In late summer month, add 0.3 qian Fangji, 0.3 qian Baizhu, 0.3 qian Fuling, to overcome Spleen Earth dampness. After great heat in early autumn, add 0.3 qian Houpo, 0.3 qian Huoxiang (Patchouli), 0.15 qian Guizhi, to intercept and drain Taiyin Qi. After Frost Descent towards winter month, add 0.15 qian Fuzi, 0.15 qian Guizhi, 0.3 qian Danggui, to overcome Shaoyin Qi. Although these are seasonal modification methods, one must clinically assess deficiency/excess, cold/heat, geographical suitability, and pathogen quantity.
Sibai Dan (Four Whites Pill) Clears Lung Qi and nourishes Po (Corporeal Soul). Stroke patients often suffer from confusion and turbid Qi; this medicine governs.
Baizhi (1 liang), Baitan (Sandalwood, 0.15 qian), Baifuling (5 qian), Baizhu (5 qian), Qianghuo (0.15 qian), Zhimu (2 qian), Suosharen (Cardamom, 5 qian), Renshen (5 qian), Duhuo (0.15 qian), Fangfeng (5 qian), Tianzhuye (Sweet Bamboo Leaf, 2 liang), Bohe (0.35 qian), Xixin (2 qian), Gancao (5 qian), Xiangfuzi (Cyperi Rhizome, fried, 5 qian), Chuanxiong (5 qian), Shexiang (Musk, 1 zi, separately ground), Niuhuang (Calculus Bovis, 0.5 qian, separately ground), Huoxiang (1.5 qian), Longnao (Borneol, 0.5 qian, separately ground).