病原具载前方，毋庸复赘。惟是心烦不安，乃阳回阴液未充，肾不交心，阴不上承，最宜持心息虑，当思静则生阴之理。 大熟地（八钱） 人参（二钱） 炙甘草（五分） 当归身（三钱） 云茯神（三钱） 炮姜灰（三分） 酸枣仁（三钱） 女真子（三钱） 旱莲草（三钱）
服五剂后，更以十剂加五味子五钱为末，水叠丸，每早晚开水服三钱。 旋转掉摇，火之象也。志意烦惑，阴液亏也。肾虚无以荣肝，一水不胜二火，木横土虚，壮火蚀气，血热化风，乃痱中之渐，当以脾肾为主，水能生木，土能培木，水为物源，土为物母，水土平调，肝木自荣，则无血燥化风之患。故陈临川曰：治风先治血，血行风自灭。拟六味、四物、归脾合为偶方主治。 大熟地（八两） 粉丹皮（三两） 福泽泻（三两） 怀山药（四两） 山萸肉（四两） 云茯苓（三两） 当归身（三两） 川芎䓖（一两） 大白芍（二两） 人参（三两） 炙黄芪（三两） 冬白术（三两） 炙甘草（一两） 煨木香（五钱） 酸枣仁（三两） 远志肉（两半） 为末，龙眼肉八两，煎水叠丸，每早晚开水服三钱。
阴亏于前，阳损于后，阴阳相失，子午不交，卒然昏愦无知，口开不合，涎流不止，神败于心，精败于肾，在经之气脱于阳明，在脏之气脱于太阴，脱绝已著，虽司命不可为也。勉以回阳一法，追敛散亡之气于乌有之乡，以副诸明哲，冀望回春之意。 大熟地（八钱） 人参（三钱） 制附子（三钱） 油肉桂（钱半） 炮姜（一钱）
经以击仆偏枯痿厥，肥贵人则膏粱之疾也。形丰，柔胜于刚，志乐气骄多欲，七情五志失其中，炙煿肥甘过其当，致令皮肉筋骨不相保，卒然倾跌，右肢偏废而不用，天产作阳，厚味发热，阳热蒸腾，动中无静，阴亏可知，法当静补真阴为主，崇经旨承制之意，仍须薄食味，省思虑，方克有济。 大熟地（八钱） 粉丹皮（三钱） 福泽泻（三钱） 淮山药（四钱） 云茯苓（三钱） 山萸肉（四钱） 女真子（三钱） 旱莲草（三钱）
素耽酒色，心肾本亏，精损于频，气伤于渐，卒然神志沉迷，口眼㖞斜，语言蹇涩，慎防汗脱，脉来微细如丝，当从色厥论治。 大熟地（八钱） 淮山药（四钱） 山萸肉（四钱） 人参（三钱） 麦门冬（三钱） 五味子（一钱） 制附子（三钱） 经以暴病暴死，皆属于火，火性疾速故也。卒然昏愦无知，脉象洪空劲直，口开手撒，遗溲自汗，痰鸣气促，真阴枯竭，心主自焚，五绝之中，兹见三证，虽司令不可为也。所议人参竹沥苏合香丸极是，愚意更益以镇固之法，以副或免之望。 人参（三钱） 淡竹沥（三钱） 苏合香丸（一粒） 外以生铁一块，约重八两，烧红，好醋沃之，近病人口鼻，使气薰入。 蒋宝素曰：类中风者，乃阴亏火盛，阳虚暴脱之击仆偏枯神昏不语诸证，与真中风之击仆偏枯神昏不语诸证相类，而以类相从，从类相别之证也。《灵枢·本神篇》曰：脾忧愁不解则伤意，意伤则悗乱，四肢不举。又经脉篇曰：足阳明血所生病者，口㖞。又五色篇曰：大气入于藏府者，不病而卒死矣。《素问·生气通天论》曰：汗出偏沮，使人偏枯。又阴阳别论曰：三阳三阴发病，为偏枯痿易，四肢不举。又通评虚实论曰：凡治击仆偏枯，肥贵人则膏粱之疾也。又脉解篇曰：所谓入中为喑者。阳盛已衰，故为喑也。内夺而厥，则为阴俳。（素按：《素问》王冰注：俳、废也。）此肾虚也。又调经论曰：血之与气，并走于上，则为大厥，厥则暴死。又至真要大论曰：诸热瞀瘈，皆属于火。此《内经》诸篇，言四肢不举，口㖞卒死，击仆偏枯，入中为喑，暴死，瞀瘈，乃阴亏火盛，阳虚暴脱，与真中风相似，而非关风气，如此其明且著也。而河间、东垣、丹溪执此无风之似中，以证有风之真中，为无风之证，何耶。《庄子》言民湿寝，则腰脊偏死。《史记》魏其侯救灌夫不得，伤意病痱。《伤寒论》脉病人不病，以无旺气，卒眩仆而死，《晋书》皇甫谧半身不仁。诸家之论如是，上与经旨相符，下与今阴亏火盛，阳虚暴脱之似中诸证相合，与风邪绝不相关，而形证则与真中风相似，岂可以相似而反失其真，故当以类相从，从类以相别也。刘河间曰：凡人风病，多因热甚，而风燥者为其兼化，以热为其主也。俗云风者，言末而忘其本也。所以中风瘫痪者，非谓肝木之风实甚，而卒中之也。亦非外中于风尔，由乎将息失宜，而心火暴甚，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。多因喜怒思悲恐，五志有所过极，而卒中者，由五志过极，皆为热甚故也。此河间主火立说，本是《内经》阴亏火盛诸证，与真中风相似，即类中风也。乃不知自所论者，是无风之类中，错作有风之真中为无风之证，为未合乃义也。李东垣曰：阳之气，以天地之疾风名之。此中风者，非外来风邪，乃本气自病也。凡人年逾四旬气衰之际，或忧喜忿怒伤其气者，多有此疾。壮岁之时无有也。若肥盛者，则间有之，亦是形盛气衰而如此耳。此东垣主气立说，本是《内经》阳虚暴脱诸证，与真中风相似，即类中风也。乃不知自所论者，是无风之类中，错作有风之真中为无风之证，同于河间之误。朱丹溪曰：中风大率主血虚有痰。又曰：气虚卒倒者，用参芪补之。又曰：按《内经》已下，皆谓外中风邪，然地有南北之殊，不可一途而论。惟刘守真作将息失宜，水不制火极是。由今言之。西北二方，亦有真为风所中者，但极少耳。东南之人，多是湿土生痰，痰生热，热生风耳。此丹溪主湿痰立说，本是阴亏火盛，阳虚暴脱诸证，与真中风相似，即类中风也。乃不知自所论者，是无风之类中，错作有风之真中为无风之证，强分南北，谓东南无中风，以附会河间、东垣之意，可谓不揣其本，而齐其末矣。王肯堂蹈三子之辙，言元气素弱，或过于劳役，伤于酒色，而卒然厥仆，状类中风。此论本是阳虚暴脱之类中，而曰状类中风，类中上加状字，即非类中，曷不曰即类中风也。张景岳复蹈河间、东垣之辙，曰：凡非风等证，其病为强直掉眩之类，皆肝邪风木之化，其为四肢不用，痰涎壅盛，皆胃败脾虚之候。又曰：凡非风卒倒等证，无非气脱而然。此论本是阴亏火盛，阳虚暴脱之类中，而反以非风名之，曷不曰即类中风也。由是观之，自河间、东垣一错，后世悉宗其谬，由其不知同一击仆偏枯神昏不语等证，有邪证，邪脉，可据者，真中风也。无邪证邪脉可据者，乃阴亏火盛，阳虚暴脱诸证，与真中风相似，即名类中风也。然风本无类，惟识之不真，致真伪莫辨，故名类中风者，正欲以类相从，从类以相别也。类中之证既明，则真中风形证自著。所谓邪证邪脉，见真中风门，当与此篇互阅。 略曰：自河间以下，错认中风面目，故有类中之名。然所论虽非，所治仍是。宣明之地黄饮子，丹溪之用四物人参竹沥诸法，景岳之用地黄、当归、枸杞之类，俱是峻补阴阳之剂，正合类中机宜，故所论虽偏，而不能偏废者，殆为此也。故医案仍宗其法而推广之。若医话之三黄风汤，虽约而应变无穷，名正治当，更详于昔矣。
类中风论列方
伤寒第三
《椿田医话》曰：十味羌防散，主治三冬感冒风寒，兼治三时不正寒凉之气，颠疼身痛，恶寒发热，无汗，或有汗不透，舌苔白滑，或淡黄不腐，胸次或舒或不舒，饮食或进或不进，脉浮或缓或数或紧，小便色白，或淡黄不浑，大便或解，或不解，若溲赤而浑，便黑如酱，乃伏邪证据，当从伏邪门论治。虚人本方去枳壳，加当归身三钱。 羌活（一钱） 防风（一钱） 云茯苓（三钱） 炙甘草（五分） 制半夏（钱半） 陈皮（一钱） 枳壳（一钱） 川芎（一钱） 苍术（钱半） 桔梗（一钱） 生姜（一片） 葱白（一茎）
经以辛甘发散为阳，仲景汗剂，必以温散。羌活气味辛甘苦，防风气味辛甘温，二味俱是辛甘之品，以达三阳之表。川芎气味辛温，治颠痛主药。苍术气味甘苦温，崇土行其津液，最能发汗。枳壳气味苦凉，陈皮气味苦辛，半夏气味辛平，三味利气宽中，以化宿痰宿食，推陈致新，使津液易达。桔梗气味苦辛平，为药中舟楫，载诸药上行。茯苓气味甘淡，益气以帅津液。甘草气味甘平，协和群品。葱姜通气温经。药液入胃，输于脾，营注于肺卫，达于皮毛，开腠理，致津液，通阳气，冲寒氛于大表，返正气于诸经，濈然汗出，诸证悉平，足以贯三冬风寒在表诸病。
又论麻黄汤曰：在内为血，发外为汗。汗即血也，随气以化。肺司百脉之气，脾统诸经之血，寒则伤营，为风所引，先伤皮毛，内舍于肺，同气相求，直入足太阳寒水之经。麻黄气味苦辛热，乃肺经专药，据卫驱寒，为发汗之主，以治受病之原，使肺卫之气不寒，以温分肉，充皮毛，肥腠理，而司开阖。桂枝气味甘辛热，散风救表，伐肝和脾，入营融血，为发汗之资，祛寒之援，使脾营之血不涩，溶溢于肺卫而为津液，则肺卫之津液，得气化布渗于皮毛而为汗。佐以杏仁利肺以舒气化，使以甘草和中，以缓麻桂之性，从容不迫，云蒸雨化，使在表之寒邪得汗而解，则传次原流已断，而先入足太阳之邪，孤悬自散。此仲景独得之心法，近代多畏而不用，何哉。故笔之于此，以俟识者。
《左传·昭元》曰：晋侯求医于秦伯，秦伯使医和视之。又曰：阴淫寒疾。
《范汪方》曰：故督邮顾子献，得伤寒已瘥未健，诣毕甫视脉。甫曰：虽瘥尚虚未平复，阳气不足，勿为劳事也。能劳尚可，女劳即死，临死当吐舌数寸。献妇闻其瘥，从百余里来省之。住数宿，止交接之间三日死。
《九峰医案》曰：伤寒恶寒，寒伤营，血涩无汗，皮肤闭而为热，头身腰背俱痛，脉浮紧，溲色澄清，大便五日不解，尚属太阳经证，宜麻黄汤。 麻黄（一钱） 桂枝（一钱） 炙甘草（一钱） 苦杏仁（三钱）
苔白，脉浮，颠痛，身疼，恶寒发热，溲便自调，痰嗽气促，有汗不透，风寒两伤，营卫俱病，法宜解肌兼汗，议取青龙。 麻黄（八分） 桂枝（八分） 炙甘草（五分） 赤芍药（钱半） 五味子（五分） 北细辛（五分） 干姜（五分） 制半夏（钱半）
发热恶寒者，发于阳也。颠疼身痛无汗，苔白胸否，脉浮紧，宜先开表。 羌活（一钱） 防风（一钱） 川芎（一钱） 香白芷（八分） 苍术（钱半） 北细辛（五分） 大生地（三钱） 炙甘草（五分） 黄芩（一钱，酒炒）
脉体尺寸俱浮，证势头身俱痛，翕翕发热，洒洒振寒，禀赋虽充，寒邪甚厉，星驰无寐，二气乖违，正逢月郭空虚，遂罹霜露之疾，谨拟南阳败毒散，祛邪返正，得汗便解，公议如是，敬呈钧鉴。 人参（一钱） 云茯苓（三钱） 枳壳（一钱） 川芎（一钱） 炙甘草（五分） 桔梗（一钱） 羌活（一钱） 独活（一钱） 柴胡（一钱） 前胡（一钱） 生姜（一钱） 长流水煎服。 昨进南阳法，濈然汗出，诸证悉平。惟胸次不舒，不思饮食，溲色澄清，大便未解，余氛未尽，尚宜和里。 人参（八分） 云茯苓（三钱） 焦白术（钱半） 炙甘草（五分） 福橘皮（一钱） 麸炒枳实（一钱） 制半夏（钱半） 炒谷芽（三钱） 六和神曲（二钱）
The pathogenesis has been detailed in the preceding text, requiring no further elaboration. However, the restlessness and irritability indicate that while Yang Qi has returned, Yin fluids are still insufficient; Kidney Water fails to ascend to nourish Heart Fire, and Yin fails to rise. At this juncture, it is most appropriate to calm the mind and eliminate distracting thoughts, reflecting on the principle that "stillness generates Yin." *Shu Di Huang* (Prepared Rehmannia Root) [8 qian], *Ren Shen* (Ginseng Radix et Rhizoma) [2 qian], *Zhi Gan Cao* (Honey-fried Licorice Root) [5 fen], *Dang Gui Shen* (Body of Angelica Sinensis Root) [3 qian], *Yun Fu Shen* (Poria with Hostwood) [3 qian], *Pao Jiang Hui* (Charred Ginger Ash) [3 fen], *Suan Zao Ren* (Ziziphus Jujuba Seed) [3 qian], *Nv Zhen Zi* (Ligustrum Lucidum Fruit) [3 qian], *Han Lian Cao* (Ecliptae Herba) [3 qian].
After taking five doses, prepare ten more doses by adding *Wu Wei Zi* (Schisandra Chinensis Fruit) [5 qian], grinding them into fine powder, and forming pills using water as a binder. Take 3 qian each morning and evening with warm boiled water.
Rotational dizziness and tremors are manifestations of Wind-Fire. Mental confusion and agitation indicate a deficiency of Yin fluids. When Kidney Essence is deficient and fails to nourish Liver Wood, one unit of Water cannot overcome two units of Fire. This leads to Liver Wood becoming hyperactive while Spleen Earth becomes weak; vigorous Fire consumes Qi, Blood Heat transforms into Internal Wind, which is a precursor to Apoplexy (*Fei Zhong*). Treatment should focus primarily on regulating the Spleen and Kidneys, for Water generates Wood, and Earth nurtures Wood. Water is the source of all things, and Earth is the mother of all things. When Water and Earth are harmonized, Liver Wood flourishes naturally, preventing complications from Blood Dryness transforming into Wind. Thus, Chen Linchuan stated: "To treat Wind, first treat the Blood; when Blood flows, Wind extinguishes itself." The proposed prescription combines *Liu Wei Di Huang Wan* (Six-Ingredient Pill with Rehmannia), *Si Wu Tang* (Four-Substance Decoction), and *Gui Pi Tang* (Restore the Spleen Decoction). *Shu Di Huang* (Prepared Rehmannia Root) [8 liang], *Fen Dan Pi* (Moutan Cortex) [3 liang], *Fu Ze Xie* (Alisma Rhizome) [3 liang], *Huai Shan Yao* (Dioscorea Opposita Rhizome) [4 liang], *Shan Yu Rou* (Cornus Officinalis Fruit) [4 liang], *Yun Fu Ling* (Poria) [3 liang], *Dang Gui Shen* (Body of Angelica Sinensis Root) [3 liang], *Chuan Xiong* (Ligusticum Chuanxiong Rhizome) [1 liang], *Da Bai Shao* (White Peony Root) [2 liang], *Ren Shen* (Ginseng Radix et Rhizoma) [3 liang], *Zhi Huang Qi* (Astragali Radix) [3 liang], *Dong Bai Zhu* (Atractylodes Macrocephala Rhizome) [3 liang], *Zhi Gan Cao* (Honey-fried Licorice Root) [1 liang], *Wei Mu Xiang* (Costus Root) [5 qian], *Suan Zao Ren* (Ziziphus Jujuba Seed) [3 qian], *Yuan Zhi Rou* (Polygalae Radix) [1.5 liang]. Grind into powder, use 8 liang of *Long Yan Rou* (Longan Aril) decocted in water to form pills. Take 3 qian each morning and evening with warm boiled water.
Previously, Yin was depleted, followed by damage to Yang. Yin and Yang have lost their connection, and the Heart-Kidney axis fails to interact. Suddenly, the patient falls into unconsciousness, the mouth hangs open, saliva flows uncontrollably, the Spirit is ruined in the Heart, and Essence is exhausted in the Kidney. Qi in the meridians collapses in the Yangming Meridian, and Qi in the zang-fu collapses in the Taiyin Meridian. With collapse being so evident, even a divine physician could not save him. Reluctantly employing the method of restoring Yang, we attempt to gather scattered Qi from non-existence, hoping to fulfill the wishes of wise physicians who desire recovery. *Shu Di Huang* (Prepared Rehmannia Root) [8 qian], *Ren Shen* (Ginseng Radix et Rhizoma) [3 qian], *Zhi Fu Zi* (Prepared Aconite Lateral Root) [3 qian], *You Rou Gui* (Cinnamon Bark) [1.5 qian], *Pao Jiang* (Prepared Ginger) [1 qian].
The *Neijing* states that sudden falls, hemiplegia, flaccidity, and cold extremities are diseases of the rich and obese due to excessive consumption of rich foods. Those with full figures are soft rather than firm; they enjoy life, are arrogant, and have many desires. The Seven Emotions and Five Wills lose their balance, and excessive intake of fried and sweet foods damages the skin, flesh, sinews, and bones. Suddenly collapsing with right-sided paralysis indicates that heavenly products (animal foods) are Yang, and rich flavors generate heat. Yang heat steams upward, movement lacks stillness, revealing Yin depletion. The treatment should prioritize quiet supplementation of True Yin, following the *Neijing* principle of "control through subordination," while maintaining a bland diet and reducing mental exertion to achieve efficacy. *Shu Di Huang* (Prepared Rehmannia Root) [8 qian], *Fen Dan Pi* (Moutan Cortex) [3 qian], *Fu Ze Xie* (Alisma Rhizome) [3 qian], *Huai Shan Yao* (Dioscorea Opposita Rhizome) [4 qian], *Yun Fu Ling* (Poria) [3 qian], *Shan Yu Rou* (Cornus Officinalis Fruit) [4 qian], *Nv Zhen Zi* (Ligustrum Lucidum Fruit) [3 qian], *Han Lian Cao* (Ecliptae Herba) [3 qian].
Chronic indulgence in alcohol and sex causes inherent deficiency of the Heart and Kidney. Essence is damaged by frequency, and Qi is injured gradually. Suddenly, consciousness becomes clouded, the mouth and eyes deviate, and speech is slurred. One must guard against collapse via sweating. The pulse is faint and threadlike. Treatment should follow the pattern of *Se Jue* (Collapse due to Sexual Excess). *Shu Di Huang* (Prepared Rehmannia Root) [8 qian], *Huai Shan Yao* (Dioscorea Opposita Rhizome) [4 qian], *Shan Yu Rou* (Cornus Officinalis Fruit) [4 qian], *Ren Shen* (Ginseng Radix et Rhizoma) [3 qian], *Mai Men Dong* (Ophiopogon Tuber) [3 qian], *Wu Wei Zi* (Schisandra Chinensis Fruit) [1 qian], *Zhi Fu Zi* (Prepared Aconite Lateral Root) [3 qian].
The *Neijing* states that acute illnesses and sudden deaths belong to Fire, due to the rapid nature of Fire. Sudden unconsciousness, a pulse that is洪大 (surging) yet empty and straight, an open mouth, relaxed hands, urinary incontinence, spontaneous sweating, phlegm rattle, and shortness of breath indicate exhaustion of True Yin and self-burning of the Heart Master. Three of the Five Extinctions are present; even a divine physician cannot save him. The proposal to use *Ren Shen* (Ginseng Radix et Rhizoma), *Zhu Li* (Bamboo Sap), and *Su He Xiang Wan* (Styrax Pill) is excellent. I suggest adding methods to stabilize and secure, hoping for survival. *Ren Shen* (Ginseng Radix et Rhizoma) [3 qian], *Dan Zhu Li* (Light Bamboo Sap) [3 qian], *Su He Xiang Wan* (Styrax Pill) [1 pill]. Externally, take a piece of raw iron weighing about 8 liang, heat it red-hot, pour good vinegar on it, and hold it near the patient's nose and mouth to inhale the fumes.
Jiang Baosu said: *Lei Zhong Feng* (Stroke-like Syndrome) refers to symptoms such as sudden falls, hemiplegia, coma, and mutism caused by Yin deficiency with Fire excess or Yang deficiency with sudden collapse. These resemble *Zhen Zhong Feng* (True Stroke) but are categorized together due to similarity, yet distinguished by their underlying nature. The *Ling Shu: Ben Shen* chapter states: "If the Spleen is troubled by worry, Yi (Intellect) is injured; if Yi is injured, there is confusion, and the four limbs cannot move." The *Jing Mai* chapter states: "Diseases of the Foot Yangming Meridian include deviation of the mouth." The *Wu Se* chapter states: "When Great Qi enters the Zang-Fu, death occurs suddenly without prior illness." The *Su Wen: Sheng Qi Tong Tian Lun* states: "Sweating on only one side leads to hemiplegia." The *Yin Yang Bie Lun* states: "Disease onset in the Three Yang and Three Yin results in hemiplegia, flaccidity, and inability to move the limbs." The *Tong Ping Xu Shi Lun* states: "For treating sudden falls and hemiplegia, these are diseases of the rich and obese due to rich diets." The *Mai Jie* chapter states: "Entering the interior causing aphonia is due to extreme Yang excess followed by decline." Internal depletion leading to厥 (Jue) is Yin Pai (Kidney Deficiency). The *Tiao Jing Lun* states: "When Blood and Qi rush upward together, it is Da Jue (Great Collapse), leading to sudden death." The *Zhi Zhen Yao Da Lun* states: "All heat-related disorders involving stupor and convulsions belong to Fire." These chapters of the *Neijing* describe limb immobility, facial deviation, sudden death, falls, aphonia, stupor, and convulsions as resulting from Yin deficiency with Fire excess and Yang deficiency with sudden collapse, resembling True Stroke but unrelated to Wind Pathogens. Why did Liu Hejian, Li Dongyuan, and Zhu Danxi insist on these windless stroke-like syndromes to prove True Stroke with Wind? The *Zhuangzi* mentions that sleeping in dampness causes waist and spine paralysis. The *Shiji* records Marquis Weiji suffering from fei (paralysis) after injuring his Yi. The *Shang Han Lun* describes pulse abnormalities with asymptomatic patients dying suddenly from dizziness and falls. *Jin Shu* records Huangfu Mi having half-body numbness. These theories align with the classics and modern stroke-like syndromes of Yin deficiency/Fire excess and Yang deficiency/collapse, having nothing to do with Wind Pathogens, yet resembling True Stroke clinically. Therefore, they should be grouped by category but distinguished by essence. Liu Hejian stated: "Wind diseases are mostly due to severe Heat, with Wind-Dryness as a secondary transformation; Heat is primary. Commonly called 'Wind,' this confuses the branch for the root. Paralysis is not due to strong Liver Wind striking suddenly, nor external Wind invasion, but due to poor regimen, violent Heart Fire, and deficient Kidney Water failing to control it, leading to Yin deficiency and Yang excess, Qi stagnation, mental clouding, and sudden collapse. It is often caused by extreme emotions (Five Wills) generating intense Heat." This is Liu's theory of Fire, describing stroke-like syndromes similar to True Stroke. However, he mistakenly treated these windless stroke-like conditions as if they were true strokes without wind. Li Dongyuan stated: "Yang Qi is named after the swift wind of heaven and earth. This stroke is not external Wind but internal Qi disease. It occurs in those over forty whose Qi declines, or those injured by emotions. It rarely occurs in youth. Obese individuals may suffer from it due to excess form and deficient Qi." This is Li's theory of Qi, describing stroke-like syndromes similar to True Stroke. Yet he similarly mistook windless stroke-like conditions for true strokes. Zhu Danxi stated: "Stroke is mostly due to Blood deficiency with Phlegm. For Qi deficiency collapse, use Ginseng and Astragalus. Post-*Neijing*, all attribute stroke to external Wind, but geography matters. Liu Shouzhen was correct regarding poor regimen and Water failing to control Fire. In the Northwest, true Wind invasion exists but is rare. In the Southeast, Damp-Earth generates Phlegm, Phlegm generates Heat, and Heat generates Wind." This is Zhu's theory of Damp-Phlegm, describing stroke-like syndromes similar to True Stroke. Yet he wrongly differentiated North and South, claiming no stroke in the Southeast to accommodate Liu and Li, confusing the root and branch. Wang Kentang followed these three, stating that weak Yuan Qi, overwork, or sexual injury leads to sudden collapse resembling stroke. This is Yang deficiency collapse, yet he called it "resembling" stroke rather than "stroke-like syndrome." Zhang Jingyue followed Liu and Li, stating that non-wind disorders like stiffness and dizziness are Liver Wind transformations, while limb immobility and phlegm are Spleen/Stomach failure. He claimed all sudden collapses are Qi depletion. This is Yin deficiency/Fire excess and Yang deficiency/collapse, yet he named it "Non-Wind" instead of "Stroke-like Syndrome." Thus, since Liu and Li erred, later generations followed suit. They failed to distinguish between True Stroke (with pathogenic signs/pulses) and Stroke-like Syndrome (Yin deficiency/Fire excess/Yang deficiency/collapse, resembling True Stroke but lacking pathogenic signs). "Stroke-like" implies grouping by similarity to distinguish from true Wind. Once Stroke-like Syndrome is clarified, True Stroke becomes distinct. See the True Stroke section for pathogenic signs/pulses.
Briefly: Since Liu Hejian, the face of stroke was misrecognized, leading to the name "Stroke-like Syndrome." Although their theories were flawed, their treatments remained valid. *Di Huang Yin Zi* (Rehmannia Decoction), Zhu Danxi's use of *Si Wu Tang*, *Ren Shen*, and *Zhu Li*, and Zhang Jingyue's use of *Di Huang*, *Dang Gui*, and *Gou Qi* are all potent tonics for Yin and Yang, fitting the mechanism of Stroke-like Syndrome. Hence, despite theoretical bias, their methods cannot be discarded. Medical cases follow and expand upon these methods. The *San Huang Feng Tang* (Three Yellow Wind Decoction) in medical conversations is concise yet versatile, correctly named and more detailed than before.
Formulas Listed for Stroke-like Syndrome
*Su He Xiang Wan* (Styrax Pill) (6) *Di Huang Yin Zi* (Rehmannia Decoction) (7) *Si Wu Tang* (Four-Substance Decoction) (8)
Shaoyang Third
*Chuntian Yihua* (Medical Conversations from Chuntian) states: *Shi Wei Qiang Fang San* (Ten-Ingredient Notopterygium and Saposhnikovia Powder) treats Cold-Damage from Wind-Cold in winter and incorrect Cold-Qi in other seasons. Symptoms include headache, body pain, aversion to cold, fever, absence of sweat, or incomplete sweating, white slippery tongue coating or pale yellow non-coated coating, chest discomfort or comfort, appetite fluctuation, floating/slow/rapid/tight pulse, clear urine or pale yellow non-turbid urine, bowel movements either regular or irregular. If urine is red and turbid, or stool is black like paste, it indicates latent pathogens, to be treated according to the Latent Pathogen section. For deficient persons, remove *Zhi Ke* (Aurantium Fructus Immaturus) from the base formula and add *Dang Gui Shen* (Body of Angelica Sinensis Root) [3 qian]. *Qiang Huo* (Notopterygii Rhizoma et Radix) [1 qian], *Fang Feng* (Saposhnikoviae Radix) [1 qian], *Yun Fu Ling* (Poria) [3 qian], *Zhi Gan Cao* (Honey-fried Licorice Root) [5 fen], *Zhi Ban Xia* (Prepared Pinellia Tuber) [1.5 qian], *Chen Pi* (Citri Reticulatae Pericarpium) [1 qian], *Zhi Ke* (Aurantium Fructus Immaturus) [1 qian], *Chuan Xiong* (Ligusticum Chuanxiong Rhizome) [1 qian], *Cang Zhu* (Atractylodis Rhizoma) [1.5 qian], *Jie Geng* (Platycodonis Radix) [1 qian], *Sheng Jiang* (Zingiberis Rhizoma Recens) [1 slice], *Cong Bai* (Allii Fistulosi Bulbus) [1 stem].
The *Neijing* states that pungent and sweet dispersing agents are Yang. Zhang Zhongjing's diaphoretic formulas must use warm dispersants. *Qiang Huo* is pungent, sweet, and bitter; *Fang Feng* is pungent and sweet and warm. Both are pungent-sweet to reach the exterior of the Three Yang Meridians. *Chuan Xiong* is pungent and warm, the main herb for headache. *Cang Zhu* is sweet, bitter, and warm, strengthens Earth, circulates fluids, and induces sweat. *Zhi Ke* is bitter and cool; *Chen Pi* is bitter and pungent; *Ban Xia* is pungent and neutral. These three promote Qi, broaden the middle, resolve old Phlegm and food retention, push out the old and bring in the new, facilitating fluid distribution. *Jie Geng* is bitter, pungent, and neutral, acting as a boat to carry herbs upward. *Fu Ling* is sweet and淡 (bland), benefits Qi to guide fluids. *Gan Cao* is sweet and neutral, harmonizes the ingredients. *Sheng Jiang* and *Cong Bai* unblock Qi and warm meridians. Upon entering the stomach, herbs transmit to the Spleen, enter Ying and disseminate to Lung and Wei, reaching the skin and hair, opening pores, distributing fluids, unblocking Yang Qi, driving out Cold from the great exterior, returning Righteous Qi to the meridians, inducing steady sweating, resolving all symptoms, and effectively treating Winter Wind-Cold at the exterior.
Regarding *Ma Huang Tang* (Ephedra Decoction): Internally it is Blood, externally it is Sweat. Sweat is Blood, transformed by Qi. The Lung governs Qi of all vessels; the Spleen controls Blood of all meridians. Cold injures Ying, guided by Wind, first damaging skin and hair, then residing internally in the Lung. Like attracts like, entering directly into the Foot Taiyang Bladder Meridian. *Ma Huang* (Ephedrae Herba) is pungent, bitter, and hot, a specific herb for the Lung Meridian, guarding the Wei level to expel Cold, serving as the chief diaphoretic to treat the origin of disease, keeping Lung-Wei Qi warm, warming muscle tissue, filling skin and hair, thickening pores, and controlling opening and closing. *Gui Zhi* (Cinnamomi Ramulus) is sweet, pungent, and hot, disperses Wind, saves the exterior, regulates Liver and Spleen, enters Ying to melt Blood, serving as the resource for sweating and aid in expelling Cold, preventing Spleen-Ying Blood from stagnating, allowing it to overflow into Lung-Wei as fluids, which then transform into sweat via Qi transformation. *Xing Ren* (Armeniacae Semen Amarum) assists the Lung to soothe Qi transformation. *Gan Cao* (Licorice Root) harmonizes the middle, moderating the properties of Ma Huang and Gui Zhi, ensuring gentle action like clouds steaming and rain falling. This allows exterior Cold to be resolved via sweat, cutting off transmission pathways, leaving the initial Taiyang pathogen isolated and dissipated. This is Zhang Zhongjing's unique insight, often feared and unused in modern times. Why? I record this here for those who understand.
*Zuo Zhuan: Zhao Yuan* states: The Marquis of Jin sought doctors from the Earl of Qin. The Earl sent Yi He to examine him. It also states: Excessive Yin causes Cold diseases.
*Fan Wang Fang* states: Former Inspector Gu Zixian suffered from Cold Damage, recovered but was not fully restored. Bi Fu examined his pulse and said: "Although recovered, you are still deficient and unstable. Your Yang Qi is insufficient; avoid labor. General labor is acceptable, but sexual activity will cause death. At death, your tongue will protrude several inches." Gu's wife, hearing of his recovery, traveled over a hundred li to visit. After staying a few nights, engaging in intercourse, he died three days later.
*Jiufeng Yian* states: Cold Damage with aversion to cold indicates Cold injuring Ying, causing blood stagnation and no sweat. Skin closure generates heat. Head, body, waist, and back all hurt. Pulse is floating and tight. Urine is clear. Bowels have not moved for five days. This still belongs to the Taiyang Meridian pattern. Use *Ma Huang Tang*. *Ma Huang* (Ephedrae Herina) [1 qian], *Gui Zhi* (Cinnamomi Ramulus) [1 qian], *Zhi Gan Cao* (Honey-fried Licorice Root) [1 qian], *Ku Xing Ren* (Armeniacae Semen Amarum) [3 qian].
White tongue coating, floating pulse, headache, body pain, aversion to cold and fever, normal urination and defecation, cough with phlegm and shortness of breath, incomplete sweating. Wind-Cold injures both Ying and Wei. Treatment should release the muscle layer and induce sweat. Prescribe *Qing Long Tang* (Azure Dragon Decoction). *Ma Huang* (Ephedrae Herba) [8 fen], *Gui Zhi* (Cinnamomi Ramulus) [8 fen], *Zhi Gan Cao* (Honey-fried Licorice Root) [5 fen], *Chi Shao Yao* (Red Peony Root) [1.5 qian], *Wu Wei Zi* (Schisandra Chinensis Fruit) [5 fen], *Bei Xi Xin* (Asari Radix et Rhizoma) [5 fen], *Gan Jiang* (Zingiberis Rhizoma) [5 fen], *Zhi Ban Xia* (Prepared Pinellia Tuber) [1.5 qian].
Fever and aversion to cold indicate onset in Yang. Headache, body pain, no sweat, white tongue coating, chest fullness, floating and tight pulse. First, open the exterior. *Qiang Huo* (Notopterygii Rhizoma et Radix) [1 qian], *Fang Feng* (Saposhnikoviae Radix) [1 qian], *Chuan Xiong* (Ligusticum Chuanxiong Rhizome) [1 qian], *Xiang Bai Zhi* (Angelicae Dahuricae Radix) [8 fen], *Cang Zhu* (Atractylodis Rhizoma) [1.5 qian], *Bei Xi Xin* (Asari Radix et Rhizoma) [5 fen], *Da Sheng Di* (Rehmanniae Radix) [3 qian], *Zhi Gan Cao* (Honey-fried Licorice Root) [5 fen], *Huang Qin* (Scutellariae Radix) [1 qian, wine-fried].
Pulse is floating at Cun and Chi positions. Symptoms include head and body pain, mild fever, chills. Constitution is robust, but Cold Evil is severe. Sleepless nights, Qi and Blood disharmony. Coinciding with the waning moon, exposure to frost and dew occurred. Carefully prescribing *Nanyang Bai Du San* (Nanyang Resisting Toxin Powder) to expel evil and restore righteousness. Resolution comes with sweat. Public opinion agrees; respectfully submitted for review. *Ren Shen* (Ginseng Radix et Rhizoma) [1 qian], *Yun Fu Ling* (Poria) [3 qian], *Zhi Ke* (Aurantium Fructus Immaturus) [1 qian], *Chuan Xiong* (Ligusticum Chuanxiong Rhizome) [1 qian], *Zhi Gan Cao* (Honey-fried Licorice Root) [5 fen], *Jie Geng* (Platycodonis Radix) [1 qian], *Qiang Huo* (Notopterygii Rhizoma et Radix) [1 qian], *Du Huo* (Angelicae Pubescentis Radix) [1 qian], *Chai Hu* (Bupleuri Radix) [1 qian], *Qian Hu* (Peucedani Radix) [1 qian], *Sheng Jiang* (Zingiberis Rhizoma Recens) [1 qian]. Decoct with long-flowing water. Yesterday, administering the Nanyang method resulted in steady sweating and resolution of all symptoms. Only chest discomfort and loss of appetite remain. Urine is clear, bowels not yet moved. Residual pathogenic factors remain; harmonizing the interior is appropriate. *Ren Shen* (Ginseng Radix et Rhizoma) [8 fen], *Yun Fu Ling* (Poria) [3 qian], *Jiao Bai Zhu* (Carbonized Atractylodis Macrocephalae Rhizoma) [1.5 qian], *Zhi Gan Cao* (Honey-fried Licorice Root) [5 fen], *Fu Ju Pi* (Fortune's Tangerine Peel) [1 qian], *Fu Chao Zhi Shi* (Bran-fried Aurantium Fructus Immaturus) [1 qian], *Zhi Ban Xia* (Prepared Pinellia Tuber) [1.5 qian], *Chao Gu Ya* (Sprouted Hordeum Vulgare) [3 qian], *Liu He Shen Qu* (Six-Harmony Medicated Leaven) [2 qian].