《灵枢经》云∶虚邪（即外风）。偏客于身半，（因其人半身血气空虚，故风邪偏客之。）其入深，
内居营卫，营卫衰则真气去，邪气独留，发为偏枯。（偏，谓半身枯，枯，废也。真气衰乃偏枯，
其非一外感即偏枯，可知。可见外感风寒，必无卒仆及偏废等证，惟内伤而后有。）身偏不用（不能运动也）。而痛，
（血气为邪滞故痛。）言不变，志不乱，（邪未入脏腑，神明不乱也。）病止在分（分肉）。腠（腠理）之间，巨针
取之。（刺经络以通其血脉。）益其不足，损其有余，乃可复也。痱之为病也，（《经》谓∶中风有四，
一曰偏枯，如木之根本未甚枯，而一边枝干先萎也，即上证。二曰风痱，即下证。三曰风 ，谓奄然忽不知人也，
即中脏证。四曰风痹，谓痹证因风所成者也，详痹门。）身无痛者，（病在里，故外不痛也。）四肢不收，（如瘫
痪是也。瘫者，坦也，筋脉弛纵，坦然不举也。痪者，涣也，血气散涣而无用也。较偏枯止病半
身者为甚矣。）志乱不甚，其言微知，（其言尚可晓也。）可治。甚则不能言，不可治也。
仲景谓∶中风络脉空虚，（经络之血气虚。）贼邪不泻，或左或右，邪气反缓，（邪滞故缓
也。缓，迟滞弛纵之意。）正气即急。（正被邪遣，故急迫也。如左被邪气凝滞，而寒则迫正气于右而热，故右之
筋脉缩急也。）正气引邪， 僻不遂。（即口眼 斜。）邪在于络（肌表浮络，）肌肤不仁。（麻木不知痛痒。）
邪在于经，即重不胜。（营分着邪，筋脉废而不用，则转动艰难，故重。或兼湿气也。）邪入于腑，即不
识人。（中腑必归胃，胃热蒸液成痰，由胃之大络入迷心窍，故不识人也。）邪入于脏，舌不能言，口吐涎。
（中脏必归心，舌者心之苗，心经痰滞，筋脉不灵，无以运舌，故舌强难言。心火上蒸，舌下廉泉穴开，故吐涎也。）
东垣则分∶中血脉（盖兼仲景中络、中经言之。）者，外有六经之形症；中腑者，内有便
溺之阻隔；（二便不通。）中脏者，痰涎昏冒卒倒，口不能言，不识人。（东垣所谓中脏，
盖兼仲景中腑言之。）
中血脉者，（偏枯歪斜，麻木者是。）小续命汤加减，分六经证治之。证见太阳，无汗恶
寒，（此伤寒也，非中风也。然风每兼寒，故通言之。）本汤倍麻黄、防风、杏仁；（并针至阴、昆仑、举跷。）
有汗恶风，本汤倍桂枝、芍药、杏仁。（针风腑。）证见阳明，无汗身热，（亦是伤寒证。）不恶
寒，（伤寒恶寒，传至阳明则不恶寒，而反恶热）。本汤加石膏、知母各二两，甘草一两；有汗身
热不恶风，本汤加葛根二两，倍桂枝、黄芩。（针陷谷，刺厉兑。）证见太阴，无汗身凉，
（伤寒在三阳经则身热，传至太阴则热入于里，身但微温，今言凉者，盖主直中言也。）
本汤倍附子，加干姜二两，甘草三两。（针隐白。）证见少阴，有汗无热，（太阴不言有汗，少阴不言无汗，
当是互文。）本汤倍桂枝、附子、甘草。（针太溪。）若无此四证，而但见少阳、厥阴证者，或六经证
混淆者，或支节挛痛，麻木不仁者，每本汤八两，加羌活四两，连翘六两。（其证见少
阳者，灸绝骨；见厥阴者，刺大敦，以引其热。按小续命汤，乃麻黄、桂枝之变方，止可
用于中血脉，然亦不可轻用，内热炽者尤忌，慎之。《金鉴》以口眼 斜，肌肤麻木不仁为中络，形气实者乌
药顺气散，虚者大秦艽汤。以
斜瘫痪不遂为中经，实者换骨丹，虚者小续命汤、黄 五物汤。）按六经形证，在伤寒以
头疼、（脑后巅顶。）项强、背痛，属太阳；以头痛、（额前。）目痛、鼻干，属阳明；头痛、（两太阳穴两角。）
胁痛、呕、口苦、寒热往来，属少阳。此皆以其经脉所行之部分言也。若太阴之腹痛自利，
（饮食不消，腹胀嗳气，身重黄肿，亦是。）少阴之脉沉细，但欲寐，（唾沫、善恐、奔豚、骨
痿、脊腰两股后廉内痛、足下热痛，亦是。）厥阴之消渴，气上撞心等证，（闭癃、遗尿、疝、小门痛、面尘、
呕逆，亦是。）则皆以其经脉受邪之为病言之。然三阴主里，病辄经脏相连，病在经者有此证，入
脏者亦有此证，何以别之？曰∶三阴入脏则身无热，在经则身热。（观《伤寒论》三阴证，
以发热为邪还于表，可悟。）则但有身热恶风寒，而内无便溺阻隔及昏迷等证，则可知为病
在血脉之表，而不在脏腑之里矣。抑又思之，此皆以足经言耳，岂手经独无可言者
乎。考其经脉可知也。再按六经形证，可参下文中腑兼中脏条。中腑者，内有便溺
之阻隔，（大、小二便不通也，不利于饮食者亦是。）三化汤或局方麻仁丸通利之。
（《金鉴》实者三化汤，虚者搜风顺气丸。）
若外无六经之形证，内无便溺之阻隔，而但手足不能运动，舌强不能语言，乃
血弱不能养筋故也。大秦艽汤养血而筋自荣。若内外证俱有，先解表而后攻里，表
里邪既解，当服愈风汤，以行中道。（行中道犹云和解。）久服大风尽去，纵有微邪，
亦从愈风汤加减治之。然治病之法，不可失于通塞，（塞固不可，太通利亦不可也。）或一气之
微汗，（十五日也。）或一旬（十日也）之微利，（内外分解，使余邪尽出也。问∶此证既兼内
伤，何得数为汗、下，罔顾虚虚耶？曰；虚者自虚，实者自实，不去其邪，何以存正？庸医惟
知温补，反訾古人，亦可哂矣。久之清浊自分，营卫自和矣。）
中脏者，痰涎昏冒，至宝丹、活命金丹之类。内有麝香入脾治肉，牛黄入肝治
筋，龙脑入肾治骨。中血脉、中腑者不可用，恐其通窍而引邪入筋骨，不能出也。
（《金鉴》实者牛黄清心丸，虚者参附汤，脱症见者倍参。）
中腑多兼中脏，如左关脉浮弦，面目青，左胁偏痛，（两胁皆肝部位，而左胁尤肝所居。）
筋脉拘急，（肝主筋。）目 ，（肝窍于目。）头目眩，（肝火上冲。）手足不收，坐HT 不得，（皆筋
病也，）此中胆兼中心，犀角散之类。如左寸脉浮洪，面赤汗多，（汗为心液。）心神颠倒，
舌强，言语謇涩，（心脉上荣舌本。）忪悸恍惚，此中小肠兼中心，加味牛黄散之类。如
右关脉缓或浮大，面唇黄，汗多，（脾湿盛也。）身重怠惰，嗜卧，肌肉 动不仁，（脾主肌肉。）
腹胀不食，（脾气不运。）此中胃兼中脾也，防风散之类。如右寸脉浮涩而短，鼻流清涕，
多喘，（肺气上壅。）胸中冒闷，（胸中，肺之部分也。）气短声嘶，（肺主声音。）四肢痿弱，（肺热则痿。）此
中大肠兼中肺也，五味子汤之类。如左尺脉浮滑，面目黧黑，腰脊痛引小腹，不能
俯仰，两耳虚鸣，骨节疼痛，足痿，善恐，此中膀胱兼中肾，独活散之类。（按中脏必
有痰涎、昏冒、卒倒等危证，非只此等，此等特用以分别其为何腑、脏耳。）
治风之法，初得之当顺气，（顺气则可，破气、泻气则不可。）及其久也，当活血。（四物汤吞
活络丹即此义。）若不顺气，徒用乌附，又不活血，徒用防风、天麻、羌活辈，未见其能
治也。按中风必由于真气虚，则宜补气以顺之。（黄 、人参必用之药。）气虚而逆冲，则宜
降气以顺之。（沉香之属。）气虚而滞，则宜宣导以顺之。（木香、陈皮之属。）皆所谓顺也。
（气热则凉之，气寒则温之，亦为顺。）热则血枯涩，寒则血凝滞，或滋润以活之，或温行以活之，皆
所谓活也。此证未有不因真气不周而病者，故黄 为必用之君药，防风为必用之臣
药，黄 助真气者也，防风载黄 助真气以周于身者也，亦能发散风邪。许胤宗治
王太后中风口噤，煎二药熏之而愈，况服之乎？多怒则加羚羊角；渴加葛根汁、秦
艽；口噤口 ，亦加秦艽；恍惚错语，加茯神、远志；不得睡，加酸枣仁；内热加
梨汁、人乳、生地黄汁；痰多加竹沥、荆沥，少佐以姜汁。治此证用诸汁最妙，以
其行经络，渗分肉，捷于诸药也。
以上所论，乃内伤而兼外风者也。盖内伤气血亏败，日久有所触，则随触而发，
故一遇外感风寒而卒然倒仆，显出如许危证，知非一朝一夕之故矣。
The *Ling Shu Jing* (Spiritual Pivot) states: Deficient pathogenic factors (i.e., external wind). If they invade only one side of the body, (because the patient's blood and qi are deficient on that side, the wind pathogen invades preferentially there.) If the invasion is deep, residing internally within Ying and Wei (Nutritive and Defensive levels), when Ying and Wei decline, the True Qi departs, leaving only the pathogen to remain alone, developing into hemiplegia (hemiplegic atrophy). (Hemiplegia refers to withering of one half of the body; withering means dysfunction. True Qi decline leads to hemiplegia; it is evident that a single episode of external contraction does not immediately cause hemiplegia. This shows that external contraction of wind-cold will certainly not result in sudden collapse or hemiplegia; these occur only after internal injury.) The affected side cannot move, (limbs are unusable.) and pain occurs, (due to blood and qi being obstructed by the pathogen.) Speech remains normal, and spirit/mind is undisturbed, (the pathogen has not entered the Zang-Fu organs, so the Spirit is not chaotic.) The disease is confined to the intermuscular spaces and Cou Li (interstitial tissues). Giant needles should be used for treatment. (Puncturing meridians to unblock blood vessels.) Tonify the deficiency, reduce the excess, and recovery is possible.
Fei disease (Flaccidity syndrome), (The Classic states: There are four types of stroke: 1. Hemiplegia, like a tree whose roots are not completely withered but one side's branches wither first—this is the above-mentioned condition. 2. Wind Fei, which is the following condition. 3. Wind Aphasia, characterized by sudden unconsciousness—this is the Zang-invading stroke. 4. Wind Bi, Bi syndrome caused by wind—see the Bi chapter.) The body feels no pain, (the disease is interior, so there is no exterior pain.) limbs cannot hold themselves, (similar to paralysis. Tan means relaxed/flaccid, tendons and vessels are lax and cannot lift. Huan means scattered, blood and qi are scattered and useless. This is more severe than hemiplegia which affects only half the body.) Spirit/mind is slightly confused but not severely, speech is understandable, (his words can still be understood.) this is treatable. If severe enough that speech is impossible, it is untreatable.
Zhang Zhongjing stated: Stroke occurs because collateral vessels are empty, (blood and qi in collaterals are deficient.) allowing thief pathogens to remain unchecked, affecting either the left or right side. The side affected by the pathogen becomes flaccid, (pathogen obstruction causes flaccidity. Flaccid implies sluggishness and laxity.) while the healthy side becomes tense. (Healthy Qi is driven by the pathogen, causing tension. For example, if the left is stagnant with pathogen, cold forces Healthy Qi to the right, and heat also forces it to the right, causing right-sided tendon contraction and tension.) Healthy Qi pulls the pathogen, resulting in facial deviation and inability to move smoothly. (Facial deviation.) Pathogen in Collaterals (superficial skin collaterals) causes numbness and insensitivity of skin and flesh. (Numbness, lack of pain/itch sensation.) Pathogen in Meridians causes heaviness and inability to bear weight. (Ying level affected, tendons/vessels dysfunctional, movement difficult, hence heavy. May also involve dampness.) Pathogen entering Fu organs causes loss of recognition of people. (Fu invasion returns to Stomach; Stomach heat steams fluids into phlegm, enters the heart via the Stomach's major Luo vessel, clouding the mind, hence loss of recognition.) Pathogen entering Zang organs causes tongue stiffness and inability to speak, with drooling. (Zang invasion returns to Heart; tongue is the sprout of the Heart; Heart channel phlegm obstruction makes tendons/vessels inflexible, unable to move the tongue, hence tongue stiffness. Heart fire steams upward, opening the Lianquan acupoint under the tongue, causing drooling.)
Li Dongyuan divided it thus: Invading Blood Vessels (roughly combining Zhang Zhongjing's Collateral and Meridian invasions): Exterior symptoms of the Six Channels appear. Invading Fu organs: Interior blockage of urination and defecation. (Obstruction of both excretions.) Invading Zang organs: Phlegm-saliva, coma/fainting, sudden collapse, inability to speak, loss of recognition. (Li Dongyuan's Zang invasion roughly combines Zhang Zhongjing's Fu invasion.)
For those invading Blood Vessels, (hemiplegia, deviation, numbness,) use Xiao Xuming Tang (Minor Continuation Decoction) with modifications, treating according to Six Channel patterns. Symptoms appearing in Taiyang: No sweat, aversion to cold, (this is Cold Damage, not Stroke. However, wind often combines with cold, so it is generally referred to as such.) Double Mahuang (Ephedrae Herba), Fangfeng (Saposhnikoviae Radix), Xingren (Armeniacae Semen Amarum) in the base formula; (also puncture Zhiyin, Kunlun, and Qiao vessels.) With sweat, aversion to wind, double Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix Alba), Xingren. (Puncture Fengfu.) Symptoms appearing in Yangming: No sweat, body heat, (also a Cold Damage pattern.) No aversion to cold, (Cold Damage involves aversion to cold; upon transmission to Yangming, aversion to cold ceases, replaced by aversion to heat.) Add Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma) 2 liang each, Gancao (Glycyrrhizae Radix et Rhizoma) 1 liang. With sweat, body heat, no aversion to wind, add Gegen (Puerariae Lobatae Radix) 2 liang, double Guizhi, Huangqin (Scutellariae Radix). (Puncture Xangu, prick Lidui.) Symptoms appearing in Taiyin: No sweat, cool body, (Cold Damage in Three Yang channels causes body heat; transmission to Taiyin moves heat inward, body is only slightly warm. Here "cool" refers to direct invasion.) Double Fuzi (Aconiti Lateralis Radix Praeparata), add Ganjiang (Zingiberis Rhizoma) 2 liang, Gancao 3 liang. (Puncture Yinbai.) Symptoms appearing in Shaoyin: With sweat, no heat, (Taiyin chapter doesn't mention sweat, Shaoyin doesn't mention absence of sweat; this is likely mutual textual reference.) Double Guizhi, Fuzi, Gancao. (Puncture Taixi.) If none of these four patterns are present, but only Shaoyang or Jueyin patterns appear, or Six Channel patterns are mixed, or limb joints are spasmodic/painful with numbness, use 8 liang of the base formula, add Qianghuo (Notopterygii Rhizoma et Radix) 4 liang, Lianqiao (Forsythiae Fructus) 6 liang. (For Shaoyang patterns, moxa Jiegu; for Jueyin patterns, puncture Dacun to draw out heat. Note: Xiao Xuming Tang is a variation of Mahuang Tang and Guizhi Tang, usable only for Blood Vessel invasion, but should not be used lightly; especially contraindicated in intense internal heat. Be cautious. *Yi Zong Jin Jian* considers facial deviation and skin numbness as Collateral invasion: Wuyao Shunqi San for excess constitution, Da Qin Jiao Tang for deficiency. Facial deviation and paralysis as Meridian invasion: Huangu Dan for excess, Xiao Xuming Tang or Huangqi Wuwu Tang for deficiency.) Regarding Six Channel patterns in Cold Damage: Headache (occipital/crown), neck stiffness, back pain belong to Taiyang; Headache (frontal), eye pain, nasal dryness belong to Yangming; Headache (temporal/angular), hypochondriac pain, vomiting, bitter taste, alternating chills and fever belong to Shaoyang. These refer to the parts where their meridians travel. For Taiyin abdominal pain and spontaneous diarrhea, (undigested food, abdominal distension, belching, heavy body, yellow edema, also Taiyin); Shaoyin pulse deep and fine, desire to sleep, (excessive saliva, fearfulness, running piglet, bone flaccidity, pain along spine/waist/posterior thigh/inner leg, hot feet, also Shaoyin); Jueyin thirst, Qi rushing up to strike the heart, (urinary retention, enuresis, hernia, genital pain, dusty complexion, vomiting, also Jueyin)—these refer to diseases caused by pathogen affecting the meridians. However, Three Yin channels govern the interior; disease often links meridians and Zang organs. Disease in meridians has these symptoms; disease entering Zang organs also has them. How to distinguish? Answer: When Three Yin pathogen enters Zang, there is no body heat; when in meridians, there is body heat. (Observing *Shanghan Lun* Three Yin patterns, where fever indicates pathogen returning to the exterior, one can understand this.) Thus, if there is only body heat and aversion to wind/cold, without interior blockage of excretions or coma, one knows the disease is in the superficial Blood Vessels, not the interior Zang-Fu organs. Further thought: These discussions focus on Foot channels; do Hand channels have nothing to say? Examining their meridians reveals this. Also refer to the "Fu Invasion Combining Zang Invasion" section below.
Fu invasion involves interior blockage of excretions, (obstruction of large and small bowels, difficulty eating also counts.) Use Sanhua Tang or Ju Fang Maren Wan to promote bowel movement. (*Yi Zong Jin Jian*: Excess uses Sanhua Tang, Deficiency uses Soushun Fengqi Wan.)
If there are no exterior Six Channel patterns and no interior blockage of excretions, but only inability to move limbs and tongue stiffness/inability to speak, this is due to blood deficiency failing to nourish tendons. Da Qin Jiao Tang nourishes blood, and tendons naturally become prosperous. If both interior and exterior patterns exist, resolve the exterior first, then attack the interior. Once exterior and interior pathogens are resolved, take Yufeng Tang to harmonize the middle pathway. (Harmonizing the middle pathway means resolving harmony.) Long-term use expels major wind pathogens; even minor pathogens can be treated with modifications of Yufeng Tang. However, treatment methods must not lose balance between unblocking and obstructing. (Obstruction is bad, but excessive unblocking is also bad.) Either induce slight sweating over one Qi cycle (15 days), or slight purgation over one decade (10 days), (to decompose interior/exterior and expel residual pathogens. Question: Since this condition combines internal injury, why use sweating and purging repeatedly without worrying about damaging deficiency? Answer: The deficient remains deficient, the excess remains excess. Without removing the pathogen, how can Zheng Qi be preserved? Quack doctors only know warming and tonifying, criticizing ancients, which is laughable. Over time, clear and turbid separate naturally, Ying and Wei harmonize.)
Zang invasion involves phlegm-saliva, coma/fainting; use Zhibao Dan (Precious Treasure Pill), Huoming Jindan (Life-Preserving Golden Pill), etc. These contain She Xiang (Moschus) entering Spleen to treat flesh disorders, Niu Huang (Bovaris Calculus) entering Liver to treat tendon disorders, Long Nao (Borneolum Syntheticum) entering Kidney to treat bone disorders. These are contraindicated for Blood Vessel and Fu invasions, lest they open orifices and draw pathogens deeper into tendons/bones, making them impossible to expel. (*Yi Zong Jin Jian*: Excess uses Niuhuang Qingxin Wan, Deficiency uses Shenfu Tang; double Ren Shen for collapse syndromes.)
Fu invasion often combines Zang invasion. E.g., Left Guan pulse floating and wiry, greenish face, left hypochondriac pain, (both hypochondria are Liver areas, left is specifically Liver residence.) tendon spasm, (Liver governs tendons.) eye deviation, (Liver opens into eyes), dizziness, (Liver fire rising), limbs unable to hold, inability to sit/stand comfortably, (all tendon diseases). This is Gallbladder invasion combining Heart invasion; use Xijiao San (Rhinoceros Horn Powder). E.g., Left Cun pulse floating and surging, red face, profuse sweat, (sweat is Heart fluid), mental confusion, tongue stiffness, slurred speech, (Heart pulse nourishes tongue root), palpitations, trance. This is Small Intestine invasion combining Heart invasion; use Jiawei Niuhuang San (Modified Bovaris Calculus Powder). E.g., Right Guan pulse slow or floating-large, yellow face/lips, profuse sweat, (Spleen dampness excess), heavy body, lethargy,嗜卧 (desire to lie down), muscle twitching/numbness, (Spleen governs flesh), abdominal distension, anorexia, (Spleen Qi stagnation). This is Stomach invasion combining Spleen invasion; use Fangfeng San (Saposhnikoviae Powder). E.g., Right Cun pulse floating, choppy, and short, runny nose, frequent panting, (Lung Qi congestion), chest oppression, (chest is Lung area), shortness of breath, hoarseness, (Lung governs voice), limb flaccidity, (Lung heat causes flaccidity). This is Large Intestine invasion combining Lung invasion; use Wuweizi Tang (Schisandra Decoction). E.g., Left Chi pulse floating and slippery, dark complexion, lower back/spine pain radiating to lower abdomen, inability to bend/straighten, tinnitus, joint pain, foot flaccidity, fearfulness. This is Bladder invasion combining Kidney invasion; use Duhuo San (Angelicae Pubescentis Powder). (Note: Zang invasion must have critical signs like phlegm-saliva, coma, sudden collapse, not just these; these are listed specifically to differentiate which Fu/Zang is involved.)
Treatment of wind: Initially, regulate Qi. (Regulating Qi is acceptable; breaking or draining Qi is not.) Later, invigorate Blood. (Taking Siwu Tang with Huoluo Dan embodies this principle.) If one does not regulate Qi, using only Wutou/Fuzi, and does not invigorate Blood, using only Fangfeng, Tianma, Qianghuo, cure is unlikely. Stroke must stem from True Qi deficiency; thus, tonify Qi to regulate it. (Huangqi, Renshen are essential.) If Qi is deficient and counterflows upward, descend Qi to regulate it. (Chenxiu group.) If Qi is deficient and stagnant, guide/unblock Qi to regulate it. (Muxiang, Chenpi group.) All are called "regulating." (Cooling hot Qi, warming cold Qi is also regulating.) Heat causes blood dryness/stagnation; cold causes blood coagulation/stagnation. Moisten/nourish to activate, or warm/move to activate. All are called "activating." This condition invariably arises from True Qi failing to circulate uniformly. Thus, Huangqi is the essential Sovereign herb, Fangfeng the essential Minister herb. Huangqi assists True Qi; Fangfeng carries Huangqi to assist True Qi in circulating throughout the body, and also disperses wind pathogens. Xu Yinzong treated Empress Dowager Wang's stroke with locked jaw by fumigating with decoction of these two herbs, curing her; how much more effective would ingestion be? Add Lingyangjiao (Capricornis Cornu) for anger; Ge Gen juice, Qin Jiao for thirst; locked jaw/deviation, add Qin Jiao; trance/confused speech, add Fushen, Yuanzhi; insomnia, add Suanzaoren; internal heat, add Pear juice, human milk, Sheng Dihuang juice; excessive phlegm, add Zhuli, Jingli, with a little Jiangzhi. Using various juices for this condition is excellent because they travel meridians, penetrate interstices, and act faster than other drugs.
The above discusses internal injury combined with external wind. Generally, internal injury depletes blood and Qi; after a long time, any trigger causes immediate onset. Thus, encountering external wind-cold leads to sudden collapse and critical signs, indicating this is not a one-day or one-night occurrence.