茫然不得其要，反滋千古疑窦，深可慨也！○凡非风卒倒等证，无非气脱而然。何也？盖人之死生，全由乎气，
气聚则生，气散则死。凡病此者，多以素不知慎，或七情内伤，或酒色过度，先伤五脏之真阴。此致病之本也。
再或内外劳伤，复有所触，以损一时之元气；或以年力衰迈，气血将离，则积损为颓。此发病之因也。盖其阴
亏于前，而阳损于后，阴陷于下，而阳乏于上，以致阴阳相失，精气不交，所以忽而昏愦，卒然仆倒。此非阳
气暴脱之候乎？故其为病，或为汗出者，营卫之气脱也；或为遗尿者，命门之气脱也；或口开不合者，阳明经
气之脱也；或口角流涎者，太阴脏气之脱也；或四肢瘫软者，肝脾之气败也；或昏倦无知，言语不出者，神败
于心，精败于肾也。凡此皆冲任气脱，形神俱败而然。故必于中年之后，乃有此证。何今人见此，无不指为风
痰，而治从消散？不知风痰实邪为病，何遽暴绝若此？且既暴绝如此，尚堪几多消散？人犹不悟，良可哀也！
凡治此证，若无痰气阻塞，必须大剂参、附峻补元气，以先其急；随用地黄、当归、枸杞之类，填补真阴，以
培其本。盖精即气之根，《经》曰精化
为气，舍是他求，无实济矣。（张景岳）
窃怪中风一证，古法相传，皆谓六淫之邪，外风之袭，药投三化、续命、愈风等汤。后人守定此法，岂料
指鹿为马？何医学之不明而愚昧如是耶？即有识之士，以类风辨之，以真风目之。然类风者，犹有似于风，真
风者，则实指为风，不能舍六淫之外，而又有所谓风也。今中风之证，其果六淫之风乎哉？又谓中风，须分闭、
脱两种，闭则有六经之证，脱则有五绝之险。夫脱为五绝之险是矣，而闭兼六经之证，亦不外仲景《伤寒》之
所谓中风，脉浮缓，自汗出，而发热也。今中风之证，其果仲景之所谓中风乎哉？盖外风为阳邪，其中人也，
必先皮毛而入，决不比阴邪不从阳经而直中三阴之速。设中属外风，则当入《伤寒》一门，何必于伤寒之外而
又立中风之条？风邪最轻，从无直中伤人之患，何中风疾发有顷刻垂绝之危？仲景《伤寒》，于中风证脉言之
极详，何未闻将中病同发明于伤寒中风之内？以此辨之，则向之所谓风为真风，谓证兼六经者，其何说之辞。
况《经》谓虚邪偏客身半，未尝云实；营卫衰则真气去，明是云虚；其言微知可治，甚则不能言，不可治，从
根本而验生死。又何尝言及外风与六经之形证耶？明张景岳直辟前人之误，断以非风之名，可谓发千古之未发。
奈病家卒不知信，医家卒不知从，旁人卒不知解，有令人读是书而不禁三叹者矣。风自内生，属东方之木气，
气动便是火，火动便是风。分而言之，有三者之名，合而言之，则有一无二之别。且风亦不过气之逆、火之炽
耳，并非气之外别有火，火之外别有风也。第此火发于肾，虚多而实少；此风根于气，阴亏而阳弱。是以中证
之发，大约精血内亏，元气内败者，为此证之旨。亏在阴，则虚火无制；亏在阳，则真气无根。若证之轻者，
乃一半精气未败，尚可挽回于万一，苏后必半身不遂，《经》谓偏枯者此也。口眼 斜者，筋无血养也；舌喑
不能言者，脾肾元亏，不能上达舌本也；口流涎沫者，脾亏不能摄津，肾亏不能藏
液也；口噤不开者，阳明之筋虚，火灼而劲急，真气寒而拘挛也。治法∶五绝证见，用参附汤、参术汤、大补
丸煎之类，以救垂绝；偏中证见，用地黄饮子、八味、生脉汤之类，以扶余生。脾肾大亏，用六君子汤、四君
子汤、归脾汤之类，以回中焦之谷气；肝血大亏，用人参养荣汤、归芍地黄汤之类，以生肝木之汁。倘内有燥
热，风火相煽，亦令人暴厥。盖火之有余，水之不足；阳之有余，阴之不足。中年之后，始有是证；三旬以前，
从无是患；形体丰肥，每遭此祸；质弱清 ，仅见此厄。不亦精血亏、真气衰之明验乎。（《会心录》）
类中风者，乃真阴不守，水衰火盛，风从火出，离其故宫，飞扬飘越，卒然仆倒，其人两肾腰胯及脐
下必冰冷如铁。盖别病必他脏先病，穷到肾经，惟中风竟是肾经与命门无形之水火自病。当其发病之际，必有
一股虚气，从两肾中间上夹脊，穿昆仑，过泥丸，直到命门。命门为三阴三阳聚处，此气一冲，三阴三阳之
气突然而散，遂外不省人事，而在五内腑之气亦随之而去，手撒、眼合、遗尿、声 、口开等证，相随而来矣。
○每验小儿惊证、产后痉证、类中风证，悉属火燥生风。风从内出，非自外来，所谓风淫末疾也。医家不知
风从火出，杂用羌、防、辛、芷，劫风燥血，则火得风而转烈，阴被燥而必亡。（《己任编》）
中风之风，乃内虚暗风，系阴阳两虚，五脏本气自病，为内夺暴厥也。与外来风邪迥别。急者，参、 、
术、附固本为先；缓者，顺气化痰以治其标，补阳养阴以固其本。阴虚甚者偏于阴，阳虚甚者偏于阳，阴阳两
虚甚者，气血峻补。虽外有风候之假象，不治自愈。○中脏阴寒之证，药宜纯阳，忌用阴药。盖略兼阴药，
则阳药便难见效，甚有益令阳亡。试思无阴则阳无以化，当此根据希之阳，能经阴药之化乎？所以参、术、 、
附等汤，不入地黄、当归者此耳。○有少壮中风不治者，男子乃色欲过多，下元水亏，不能制火；女人乃产后、
经后，去血过多，不能配气，适因忿怒
动火，气无所附，故随火而发越矣。阴也，血也，岂不为阳气之根本乎？《经》曰∶肾气内夺，则舌喑足废。
大概以气药治风犹可，以风药治气则不可；以血药治风、以气药治痰均可，以风药治血、以痰药治气均不可也。
（《冯氏锦囊》）
风为百病之长，证有真中、类中、中经络、血脉、脏腑之分；治有攻风、劫痰、养血、润燥、补气、培元
之法。盖真中之病，南少北多。其类中之证，河间立论∶因烦劳则五志过极，动火而卒中。东垣立论∶因元气
不足，则邪凑之。丹溪云∶东南气温多湿，由湿生痰，痰生热，热生风。三者皆辩明类中之由也。类者伪也，
近代不分真伪，每用祛风豁痰，虚证实治，不啻枘凿之殊矣。今叶氏发明内风，乃身中阳气之变动。肝为风
木之脏，因精血衰耗，水不涵木，木少滋荣，故肝阳偏亢，内风时起。治以滋液熄风，濡养营络，补阴潜阳，
如虎潜、固本、复脉之类。若阴阳并损，无阴则阳无以化，故以温柔濡润之通补，如地黄饮子、还少丹之类。
更有风木过动，中土受戕，不能御其所胜，如不寐不食，卫疏汗泄，饮食变痰，治以六君、玉屏风、茯苓饮、
酸枣仁汤之类。或风阳上僭，痰火阻窍，神识不清，则有至宝丹芳香宣窍，或辛凉清上痰火。至于审证，有体
纵不收，耳聋目瞀，口开眼合，撒手遗尿，失音鼾睡，此本实先拨，阴阳枢纽不交，与暴脱无异，并非外中之
风，乃纯虚证也。故急用大剂参附以回阳，恐纯刚难受，必佐阴药，以挽回万一。若肢体拘挛，半身不遂，口
眼斜，舌强言謇，二便不爽，此本体先虚，风阳夹痰火壅塞，以致营卫脉络失和。急则先用开关，继则益
气养血，佐以消痰清火，宣通经隧，气充血盈，脉络通利，则病可愈。（《临证指南》）
风自火出，故热则风生。试观天道，每遇伊芳郁之极，则发大
风，必然之理。故中风之证，多生于内热。若血凉水足，风自何生？风不必皆由外感，常从内生，不可不知。
（《折肱漫录》）
中风大纲有三∶曰气衰，曰火暴，曰痰逆。河间之地黄饮子，为下虚上盛，阴火暴逆而设；东垣之三生饮，
为脾肺气衰，痰积于中而设；丹溪之星香、二陈，为形盛气阻，痰盛于外而设。总皆阳虚邪害空窍所致。
肥人多中风者，以其气盛于外而歉于内也。肺为气出入之道，人胖气必急，急则肺气盛，肺金克肝木，
胆为肝之腑，故痰涎壅盛，治法先须理气。○治风之法，初当顺气，久当活血。若不顺气遽用乌、附，若不活
血遽用羌、防，未见其能治也。然顺气则可，破气、泻气则不可。（戴复庵）
中风，大便必然结燥，盖由痰热郁结于中。宜服润肠丸，使大便常润，则风亦易愈。此釜底抽薪之法，
屡试验者。（汪双泉）
中风自汗，小便不利，不可利之。既已自汗，则津液外亡，小便自少。若复利之，使营卫枯竭，无以制
火，则烦热愈甚。当俟热退汗止，小便自行。○中风多食，其因有二∶一由肝木盛，木盛则克脾土，脾受敌，
故求助于食，当泻肝安脾；一因脾气盛，脾盛则克肾水，水亏不能制火，故食多，宜安土滋水。（张洁古）
中风多养，《经》曰∶诸养为虚，血不荣于肌腠故也。当服滋补药以养阴血，血和肌润，痒自不作。
（薛立斋）
中风之证，成于跌后者居多。○凡中风，不可有呵欠之证，有之多死。（《见闻录》）
凡治外中于风，不辨内挟何邪，误执一家方书，冀图弋获，其失必多，医之过也。○凡风国中经络，不
行外散，反从内夺，引邪深入者，医之过也。○凡治中风，四肢不举，不辨虚实，妄行补泻者，医之过也。
（《医门法律》）
半身不遂
痱，废也，即偏枯之邪气深者也。痱与偏枯是二疾∶偏枯，身
偏痛，言不变，志不乱，邪在分腠之间，即中腑也；痱病，身无痛，手足不遂，言喑志乱，邪入于里，即中脏
也。（《医学纲目》）
偏枯，与痿异。偏枯者，手足脉道为邪气阻塞而然；痿则阳明虚，宗筋纵，带脉不引而然。痱有言变、志
乱之证，痿则无之。盖痱发于击仆之暴，痿发于怠惰之渐，是两证也。（娄全善）
《内经》言偏枯者不一，曰汗出偏沮；曰阳盛阴不足；曰胃脉内外大小不一；曰心脉小坚急；曰肾水虚。
《灵枢》叙偏枯于《热病篇》中，皆不言风，皆不言其本于何邪，岂非以七情、饥饱、房室，凡能虚其脏气，
致营卫经脉痹而不通者，皆可以言邪耶？○四肢不举，有虚有实。阳明虚，则宗筋失润，不能束骨而利机关；
阳明实，则腠理致密，加以风邪内淫，正气自不周流也。（喻嘉言）
朱丹溪曰∶半身不遂，大率多痰，在左属死血与无血，在右属痰与气虚。其说似乎近理，而不知其有不然
也。夫人身气血，本不相离，焉有以左为血病右为痰气耶？盖丹溪之意，以为肝属木而位左，肺属金而位右，
肺主气也；脾属土而寄位西南，故亦在右而脾主湿与痰也。然此以五行方位之序言其理耳，岂曰西无木，东无
金乎？且各经皆有左右，五脏皆有血气，即如胃之大络，乃出于左乳之下，则脾胃之气亦出于左，又岂左非脾，
右非肝，左必血病，右必痰气乎？（张景岳）
按∶半身不遂，与四肢不举大有分别。四肢不举者，有虚有实；半身不遂，悉作实邪。夫一人之身，岂有
半边虚而半边不虚者乎？此证当与口眼 斜同看，非外感六淫之邪，即内伤痰火死血。（《证因脉治》）
人之四肢，如木之枝干也；人之气血荣养，如木之浆水灌溉也。人有半身不遂而迁延不死者，如木之根
本未坏，而一边之枝干先萎耳；人有形容肥壮，忽然倒仆即毙者，如木之根本已绝，枝叶虽荣，犹枯杨生华，
遇风摧折矣。（《赵氏医贯》）
卒仆、偏枯之证，虽有多因，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，亦有治风之功焉。（戴复庵）
凡偏枯半身不遂之证，虽属痰滞经络，然其原大抵本于气虚。盖气不营运，故痰因之而滞也。治宜重用参、
大补为主，以行痰药佐之，久服自效。常见此证服参、 多者，迟以岁月，必然复旧，否则终身不痊。（汪双泉）
口眼 斜
口目 斜者，多属胃土，然有筋、脉之分焉。《经》云∶足之阳明、手之太阳筋急，则口目为僻 急，
不能卒视，此胃土之筋为 斜也。又云∶胃足阳明之脉，挟口环唇，所生病者，口 唇斜，此胃土之脉为 斜
也。（《证治准绳》）
口眼 斜，有筋病，有脉病，且形骸之病，有拘处必有缓处，有缓处必有拘处，要见病在缓处与拘处，
明白不得混也。而筋病在拘处，脉病在缓处，筋病则左以左治，右以右治；脉病则左以右治，右以左治，失之
则千里矣。大都脉病之 斜，人皆知之，筋病之 斜，识者鲜矣。（卢不远）
七窍，惟口目 斜，而耳鼻独无此病者，何也？盖动则风生，静则风息，天地之常理也。考之易象，有
足相符者，震巽主动，坤艮主静，动者皆属木，静者皆属土。观卦者，视之理也。视者，目之用也。目之上纲
则眨，下纲则不眨，故观卦上巽而下坤。颐卦者，养之理也。养者，口之用也。口之下颔则嚼，上颔则不嚼，
故颐卦上艮而下震。口目常动，故风生焉；耳鼻常静，故风息焉。当思目虽斜，而目之眶 未尝斜；口虽 ，
而口之辅车未尝 ，此经之受病，非窍之受病明矣。（《儒门事亲》）
Bewildered and unable to grasp the essence, one instead breeds doubts spanning millennia, which is truly lamentable! ○ All syndromes such as non-wind sudden collapse are nothing but manifestations of Qi depletion. Why? Because human life and death depend entirely on Qi; when Qi gathers, there is life, and when Qi scatters, there is death. Those who suffer from this disease mostly fail to exercise caution in their daily lives, or suffer internal injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), or indulge excessively in alcohol and sexual activity, thereby first damaging the True Yin of the Five Zang Organs. This is the root cause of the disease. Additionally, due to internal and external overexertion, coupled with external triggers, one's momentary Yuan Qi may be damaged; or due to advanced age and declining physical strength, where Qi and Blood are about to separate, accumulated damage leads to collapse. This is the cause of onset. Generally, Yin deficiency precedes, followed by Yang damage; Yin sinks below, while Yang becomes deficient above, leading to a separation of Yin and Yang and a failure of Essence and Qi to interact. Consequently, one suddenly becomes confused and collapses abruptly. Is this not a sign of sudden Yang Qi collapse? Therefore, in this disease: sweating indicates the collapse of Ying and Wei Qi; enuresis indicates the collapse of Mingmen Qi; an open mouth that cannot close indicates the collapse of Yangming Channel Qi; drooling from the corner of the mouth indicates the collapse of Taiyin Organ Qi; flaccid paralysis of the four limbs indicates the failure of Liver and Spleen Qi; coma, fatigue, lack of awareness, and inability to speak indicate the failure of Shen (Spirit) in the Heart and Essence in the Kidney. All these result from the collapse of the Chong and Ren vessels, leading to the failure of both form and spirit. Thus, this syndrome typically occurs only after middle age. Why do people today, upon seeing this, invariably attribute it to Wind-Phlegm and treat it with dispersing methods? They do not realize that pathogenic Wind-Phlegm, being an excess pathogen, does not cause such sudden and severe collapse. Moreover, if the condition is already this critical, how much more dispersing treatment can the body endure? People remain unaware, which is truly pitiable!
When treating this syndrome, if there is no obstruction by Phlegm-Qi, one must use large doses of Renshen (Ginseng Radix et Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) to vigorously tonify Yuan Qi to address the emergency; subsequently, use Shudi (Rehmanniae Radix Preparata), Danggui (Angelicae Sinensis Radix), Gouqi (Lycii Fructus), etc., to replenish True Yin and consolidate the root. As Essence is the root of Qi, the *Classic* states that Essence transforms into Qi; seeking elsewhere yields no practical benefit. (Zhang Jingyue)
I privately wonder at the syndrome of Stroke (Zhong Feng). Ancient traditions attribute it to the Six Excesses (Six Evils) and external Wind invasion, prescribing formulas such as Sanhua Tang (Three Transformations Decoction), Xuming Tang (Continuing Life Decoction), and Yufeng Tang (Extinguishing Wind Decoction). Later generations adhered strictly to this method, which is akin to calling a deer a horse. How can medicine be so unclear and ignorance so profound? Even learned scholars distinguish "pseudo-stroke" (Lei Feng) from "true stroke," yet pseudo-stroke still resembles wind, while true stroke is explicitly identified as wind, inseparable from the Six Excesses. Is the current stroke syndrome truly caused by the Six Excesses? It is also said that stroke must be divided into Obstruction (Bi) and Collapse (Tuo) types. Obstruction presents with Six Channel syndromes, while Collapse carries the danger of Five Extinctions. While Collapse is indeed dangerous, Obstruction involving Six Channels merely corresponds to Zhang Zhongjing’s description of Wind Strike in the *Shanghan Lun*: floating and slow pulse, spontaneous sweating, and fever. Is the current stroke syndrome truly what Zhang Zhongjing called Wind Strike? External Wind is a Yang pathogen; upon entering the body, it must enter via the skin and hair first. It certainly does not penetrate directly into the Three Yin channels as quickly as Yin pathogens. If it were external Wind, it should be classified under *Shanghan*, why establish a separate category for Stroke outside of *Shanghan*? Wind is the lightest pathogen and rarely causes direct severe injury. Why does stroke strike with imminent peril within moments? Zhang Zhongjing’s *Shanghan Lun* details the pulse of Wind Strike extensively, yet never explains the pathology of "being struck" within the context of Wind Strike in *Shanghan*. By this reasoning, what explanation remains for those who claim Wind is "true wind" and that the syndrome involves Six Channels? Furthermore, the *Classic* states that empty pathogens dwell unevenly on half the body, implying deficiency, not excess; when Ying and Wei decline, True Qi departs, clearly indicating deficiency. It says mild cases are treatable, severe cases where speech is lost are untreatable, and life and death are determined from the root. Where does it mention external Wind or Six Channel manifestations? Ming Dynasty physician Zhang Jingyue correctly refuted previous errors, naming it "Non-Wind," a revelation for the ages. Alas, patients do not believe, physicians do not follow, and bystanders do not understand, causing sighs upon reading his works. Wind arises internally, belonging to the Wood Qi of the East. When Qi moves, it becomes Fire; when Fire moves, it becomes Wind. Separately named, they are three; combined, they are one. Wind is merely the rebellion of Qi and the blazing of Fire; there is no Fire apart from Qi, nor Wind apart from Fire. However, this Fire originates in the Kidney, being mostly deficiency and little excess; this Wind roots in Qi, with Yin deficiency and Yang weakness. Thus, stroke generally results from internal deficiency of Essence and Blood and internal failure of Yuan Qi. Deficiency in Yin leads to uncontrolled deficient Fire; deficiency in Yang leads to rootless True Qi. In mild cases, half the Essence and Qi remain intact, allowing for potential recovery; upon waking, hemiplegia usually persists, known as Pian Gu (Hemiplegia) in the *Classic*. Deviation of the mouth and eyes indicates tendons lacking blood nourishment; aphasia indicates deficiency of Spleen and Kidney Yuan Qi failing to reach the tongue root; drooling indicates Spleen deficiency failing to control fluids and Kidney deficiency failing to store fluids; lockjaw indicates deficiency of Yangming tendons, burning with Fire causing stiffness, and Cold True Qi causing spasms. Treatment: For Five Extinctions, use Shenfu Tang (Ginseng and Aconite Decoction), Shenbai Tang (Ginseng and Atractylodes Decoction), or Dabu Wan (Great Tonification Pill) to save impending collapse; for partial stroke, use Dihuang Yinzi (Rehmannia Infusion), Bawei Wan (Eight Flavor Pill), or Shengmai Tang (Generate Pulse Decoction) to support remaining life. For severe Spleen-Kidney deficiency, use Liujunzi Tang (Six Gentlemen Decoction), Sijunzi Tang (Four Gentlemen Decoction), or Guipi Tang (Restore the Spleen Decoction) to restore Middle Jiao Grain Qi; for severe Liver Blood deficiency, use Renshen Yangrong Tang (Ginseng Nourishing Grace Decoction) or Guishao Dihuang Tang (Angelica, Peony, and Rehmannia Decoction) to generate Liver Wood juice. If internal dryness-heat stirs Wind and Fire, sudden syncope may occur. This is due to excess Fire and insufficient Water; excess Yang and insufficient Yin. This syndrome appears after middle age; before thirty, it is rare. Fat individuals often suffer this; thin, weak constitutions rarely do. Is this not clear evidence of Essence-Blood deficiency and True Qi decline? (*Huixin Lu*)
Pseudo-stroke occurs when True Yin is insecure, Water declines and Fire flourishes, causing Wind to emerge from Fire, leaving its home, flying wildly, and causing sudden collapse. The patient’s kidneys, loins, hips, and area below the navel will be cold as iron. Generally, other diseases affect other organs first before reaching the Kidneys; however, stroke is uniquely a self-disease of the invisible Water and Fire of the Kidney and Mingmen. At onset, a wave of deficient Qi rises from between the two kidneys, up along the spine, through Kunlun, past Niwan, to Mingmen. Mingmen is the gathering point of the Three Yin and Three Yang; this Qi rush causes all Three Yin and Three Yang Qi to scatter suddenly. Consequently, consciousness is lost externally, and the Qi of the Five Zang and Six Fu organs departs with it, bringing symptoms like hand letting go, eyes closing, enuresis, snoring, and an open mouth. ○ Upon verifying pediatric convulsions, postpartum tetany, and pseudo-stroke, all belong to Wind generated by Fire-Dryness. Wind arises internally, not externally, as stated in "Wind Yin End Disease." Physicians who do not know Wind comes from Fire indiscriminately use Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Xinyi (Magnoliae Flos), and Zhi Zi (Angelicae Dahuricae Radix), depleting Wind and drying Blood. Fire becomes fiercer with Wind, and Yin perishes with Dryness. (*Jiren Bian*)
The Wind in Stroke is internal deficient hidden Wind, resulting from dual deficiency of Yin and Yang, and self-disease of the Five Zang Original Qi, manifesting as internal loss and sudden syncope. It is distinct from external Wind pathogens. In acute cases, tonifying the root with Renshen, Huangqi, Baizhu, and Fuzi is priority; in chronic cases, regulating Qi and resolving Phlegm treats the branch, while tonifying Yang and nourishing Yin consolidates the root. Severe Yin deficiency leans toward Yin; severe Yang deficiency leans toward Yang; severe dual deficiency requires vigorous tonification of Qi and Blood. Although external Wind-like signs may appear, the condition resolves spontaneously without treating them. ○ For Cold Syndromes of the Zang involved in Stroke, medicines should be purely Yang; Yin medicines are contraindicated. Adding even a slight amount of Yin medicine hinders the efficacy of Yang medicines and may lead to Yang collapse. Consider: without Yin, Yang cannot transform. With scarce Yang present, can it withstand Yin transformation? Hence, decoctions of Renshen, Baizhu, Huangqi, and Fuzi exclude Shudi and Danggui. ○ Young adults with untreatable stroke: men suffer from excessive sexual desire, depleting Lower Yuan Water, failing to control Fire; women suffer from excessive blood loss postpartum or post-menstruation, failing to anchor Qi, exacerbated by anger stirring Fire, causing Qi to float away with Fire. Yin and Blood are the foundation of Yang Qi. The *Classic* states: "When Kidney Qi is internally depleted, aphasia and foot paralysis occur." Generally, using Qi medicines to treat Wind is acceptable, but using Wind medicines to treat Qi is not; using Blood medicines to treat Wind and Qi medicines to treat Phlegm are both acceptable, but using Wind medicines to treat Blood and Phlegm medicines to treat Qi are both unacceptable. (*Fengshi Jinnang*)
Wind is the leader of a hundred diseases. Syndromes include True Stroke, Pseudo-Stroke, Stroke of Channels/Vessels, and Stroke of Zang/Fu. Treatments include attacking Wind,劫ting Phlegm, nourishing Blood, moistening Dryness, tonifying Qi, and cultivating the Root. True Stroke is less common in the South and more common in the North. Hejian proposed that excessive mental labor causes extreme Five Emotions, stirring Fire leading to sudden stroke. Dongyuan proposed that insufficient Yuan Qi allows pathogens to gather. Danxi stated that the Southeast is warm and humid; humidity generates Phlegm, Phlegm generates Heat, and Heat generates Wind. These three theories clarify the causes of Pseudo-Stroke. "Pseudo" means false. Modern practitioners fail to distinguish true from false, often using Wind-dispersing and Phlegm-resolving methods for deficiency syndromes, which is as mismatched as a square peg in a round hole. Ye Tianshi clarified Internal Wind as the movement of the body's Yang Qi. The Liver is the organ of Wind-Wood; due to Essence and Blood depletion, Water fails to nourish Wood, causing Wood to lack nourishment, leading to hyperactive Liver Yang and frequent Internal Wind. Treatment involves nourishing fluids to extinguish Wind, moistening Ying and Collaterals, tonifying Yin to submerge Yang, using formulas like Huqian Wan (Tiger Crouching Pill), Guben Wan (Root-Solidifying Pill), or Maigui Tang (Vessel-Nourishing Decoction). If both Yin and Yang are damaged, and without Yin Yang cannot transform, gentle moistening and tonification is used, such as Dihuang Yinzi or Huanshao Dan. If Wind-Wood overacts and damages Central Earth, failing to control its dominance, symptoms like insomnia, anorexia, loose Wei defensive Qi, sweating, and food transforming into Phlegm occur; treat with Liujunzi Tang, Yupingfeng San (Jade Windscreen Powder), Fuling Yin, or Suanzaoren Tang. If Wind-Yang rebels upward and Phlegm-Fire obstructs orifices causing confusion, use Zhibao Dan (Precious Treasure Pill) for aromatic opening or acrid-cool herbs to clear upper Phlegm-Fire. Regarding syndrome differentiation: body flaccidity, deafness, blurred vision, open mouth/closed eyes, letting go of hands, enuresis, aphasia, and snoring indicate the root is shaken, Yin-Yang pivot fails to interact, similar to sudden collapse, not external Wind, but pure deficiency. Urgently use large doses of Shenfu to restore Yang; fearing pure Yang is too harsh, add Yin medicines to salvage the situation. If limb spasticity, hemiplegia, facial deviation, stiff tongue, dysarthria, and bowel/bladder dysfunction occur, this indicates prior constitutional deficiency, with Wind-Yang clashing with Phlegm-Fire blocking Ying and Wei collaterals. Acute phase: open orifices first; then tonify Qi and Blood, assist with resolving Phlegm and clearing Fire, and unblock meridians. When Qi is abundant and Blood full, collaterals become patent, and the disease heals. (*Linzheng Zhinan*)
Wind arises from Fire, so heat generates Wind. Observing nature, extreme stagnation inevitably leads to great winds; this is inevitable. Thus, stroke syndromes often arise from internal heat. If Blood is cool and Water sufficient, where would Wind come from? Wind need not always come from external contraction; it often arises internally, a fact that must be known. (*Zegong Manlu*)
The outline of Stroke has three aspects: Qi decline, sudden Fire, and rebellious Phlegm. Hejian’s Dihuang Yinzi is designed for lower deficiency and upper excess, with sudden rebellious Yin Fire; Dongyuan’s Sansheng Yin is designed for Spleen-Lung Qi decline and central Phlegm accumulation; Danxi’s Xingxiang and Erchen are designed for robust constitution with obstructed Qi and external Phlegm excess. All result from Yang deficiency allowing pathogens to harm the orifices. Fat people suffer stroke frequently because their Qi is abundant externally but deficient internally. The Lung is the pathway for Qi entry and exit; fat individuals have urgent Qi, leading to excess Lung Qi. Lung Metal overacts on Liver Wood; the Gallbladder is the paired organ of the Liver, leading to copious phlegm-saliva. Treatment must first regulate Qi. ○ Treating Wind: initially regulate Qi, later invigorate Blood. Without regulating Qi, using Wutou (Aconiti Radix) and Fuzi prematurely will not work; without invigorating Blood, using Qianghuo and Fangfeng prematurely will not work. Regulating Qi is correct; breaking or draining Qi is incorrect. (Dai Fu’an)
In stroke, stool is inevitably dry due to Phlegm-Heat stagnation in the center. Use Runchang Wan (Intestine-Moistening Pill) to keep stools moist, facilitating Wind resolution. This is the method of removing firewood from under the cauldron, repeatedly verified. (Wang Shuangquan)
In stroke with spontaneous sweating and difficult urination, do not promote diuresis. Spontaneous sweating indicates loss of Body Fluids externally, leading to scant urine. Promoting diuresis further depletes Ying and Wei, leaving no substance to control Fire, worsening irritability and heat. Wait for heat to subside and sweating to stop; urination will resume naturally. ○ Excessive eating in stroke has two causes: 1. Liver Wood excess overacting on Spleen Earth; Spleen seeks help from food; treat by purging Liver and calming Spleen. 2. Spleen Qi excess overacting on Kidney Water; Water deficiency fails to control Fire, leading to excessive eating; treat by calming Earth and nourishing Water. (Zhang Jiegu)
Itchiness in stroke is common. The *Classic* states: "All itchiness is due to deficiency; Blood fails to nourish muscle and interstices." Use tonifying medicines to nourish Yin and Blood; when Blood harmonizes and skin moistens, itchiness ceases. (Xue Lizhai)
Most stroke syndromes result from falls. ○ Any stroke presenting with yawning is often fatal. (*Jianwen Lu*)
Treating external Wind invasion without distinguishing internal accompanying pathogens, blindly following one school’s prescriptions hoping for success, leads to many errors—the physician’s fault. ○ For Stroke of Channels, failing to disperse externally and instead allowing internal depletion, drawing pathogens deeper, is the physician’s fault. ○ Treating stroke with immobility of limbs without distinguishing deficiency/excess and practicing blind tonification/purging is the physician’s fault. (*Yimen Falv*)
Hemiplegia
Fei means waste/paralysis, referring to deep-seated Pian Gu. Fei and Pian Gu are two diseases: Pian Gu involves pain on one side, unchanged speech, stable mind, pathogen in the interstices, corresponding to Stroke of the Fu organs; Fei disease involves no pain, immobility of limbs, aphasia, and confused mind, pathogen entering the interior, corresponding to Stroke of the Zang organs. (*Yixue Gangmu*)
Pian Gu differs from Wei Syndrome (Atrophy). Pian Gu results from pathogen blocking meridians in limbs; Wei results from Xu deficiency of Yangming, relaxation of Zongjin, and failure of Daibing to guide. Fei has speech changes and mental confusion; Wei does not. Fei arises from sudden trauma/falls; Wei arises from gradual laziness. They are two distinct syndromes. (Lou Quanshan)
The *Neijing* mentions Pian Gu variously: sweating on one side; Yang excess and Yin insufficiency; irregular Stomach pulses; small, firm, and urgent Heart pulses; Kidney Water deficiency. The *Lingshu* discusses Pian Gu in the *Re Bing* chapter, never mentioning Wind or its root pathogen. Is it not because emotions, diet, and sexual activity that weaken Zang Qi, causing Bi obstruction in Ying, Wei, and meridians, can all be considered pathogens? ○ Immobility of four limbs can be deficiency or excess. Yangming deficiency leads to loss of moisture in Zongjin, failing to bind bones and facilitate joints; Yangming excess leads to dense interstices, and with internal Wind invasion, Zheng Qi fails to circulate. (Yu Jiayan)
Zhu Danxi stated: Hemiplegia is mostly Phlegm; left side indicates fixed Blood and Blood deficiency; right side indicates Phlegm and Qi deficiency. This seems reasonable but is flawed. Qi and Blood in the body are inseparable; how can left be Blood disease and right be Phlegm-Qi? Danxi’s intent was based on Liver (Wood, Left) and Lung (Metal, Right); Lung governs Qi; Spleen (Earth, Southwest/Right) governs Dampness and Phlegm. This is theoretical based on Five Elements directions. Does the West lack Wood and East lack Metal? Each channel has left and right; each Zang has Qi and Blood. The Great Luo of the Stomach emerges below the left breast, meaning Spleen-Stomach Qi also emerges from the left. Can we say left is not Spleen, right is not Liver, left is always Blood disease, right is always Phlegm-Qi? (Zhang Jingyue)
Note: Hemiplegia is very different from immobility of four limbs. Immobility of four limbs can be deficiency or excess; hemiplegia is treated as excess pathogen. How can one person have a deficient half and a non-deficient half? This syndrome should be viewed alongside facial deviation; it is either external Six Excesses or internal injury from Phlegm-Fire and Fixed Blood. (*Zhengyin Maizhi*)
Human limbs are like tree branches; Qi and Blood nourishment is like sap irrigation. Some with hemiplegia survive long-term, like a tree with healthy roots but one wilted branch; some stout individuals collapse and die suddenly, like a tree with dead roots, where lush leaves are like flowers on a dying tree, broken by wind. (*Zhao Shi Yi Guan*)
Sudden collapse and Pian Gu, though having multiple causes, all stem from uneven circulation of True Qi. Thus, Huangqi (Astragali Radix) is the essential Sovereign herb, and Fangfeng (Saposhnikoviae Radix) is the essential Minister herb. Huangqi assists True Qi; Fangfeng carries Huangqi, helping True Qi circulate throughout the body, also possessing Wind-treating properties. (Dai Fu’an)
For Pian Gu and hemiplegia, although attributed to Phlegm stagnation in collaterals, the root is largely Qi deficiency. Since Qi fails to circulate, Phlegm stagnates. Treatment should heavily rely on Renshen and Huangqi for major tonification, assisted by Phlegm-resolving herbs; long-term use yields results. I often see this syndrome cured with heavy Renshen and Huangqi over time; otherwise, it remains incurable lifelong. (Wang Shuangquan)
Facial Deviation
Mouth and eye deviation mostly belongs to Stomach Earth, but distinguishes between Tendon and Vessel diseases. The *Classic* says: Tightness of Yangming of Foot and Taiyang of Hand tendons causes mouth and eye deviation and inability to look suddenly; this is tendon deviation of Stomach Earth. Also: The Foot-Yangming Stomach channel circles the lips; diseases it produces include lip and mouth deviation; this is vessel deviation of Stomach Earth. (*Zhengzhi Zhunsheng*)
Facial deviation involves Tendon disease or Vessel disease. In bodily diseases, tight areas must have relaxed areas, and relaxed areas must have tight areas. One must clearly see whether the disease is in the relaxed or tight area; confusing them leads to error. Tendon disease is in the tight area; Vessel disease is in the relaxed area. Tendon disease is treated ipsilaterally (left for left, right for right); Vessel disease is treated contralaterally (left for right, right for left). Mistaking them leads to a thousand-li error. Most know Vessel disease deviation; few recognize Tendon disease deviation. (Lu Buyuan)
Among the seven orifices, only mouth and eyes deviate; ears and nose do not. Why? Movement generates Wind, stillness stops Wind, the constant principle of Heaven and Earth. Examining the I Ching images: Zhen and Xun represent movement; Kun and Gen represent stillness. Moving things belong to Wood; still things belong to Earth. Guan hexagram represents viewing; viewing is the function of the eyes. Upper eyelid movement blinks; lower eyelid stillness does not blink; thus Guan is Xun above and Kun below. Yi hexagram represents nourishment; nourishment is the function of the mouth. Lower jaw chews; upper jaw does not chew; thus Yi is Gen above and Zhen below. Mouth and eyes move constantly, so Wind arises; ears and nose are still, so Wind ceases. Consider: although the eye deviates, the eye socket does not deviate; although the mouth deviates, the mandible does not deviate. Clearly, the Meridian is diseased, not the Orifice. (*Rumen Shiqin*)