喻嘉言曰∶《金匮》云∶夫风之为病，当半身不遂，或但臂不举者，此为痹病。脉微而数，中风使然。
又云∶寸口脉浮而紧，紧则为寒，浮则为虚，虚寒相搏，邪在皮肤。浮者血虚，络脉空虚，贼邪不泻，
或左或右，邪气反缓，正气即急。正气引邪， 僻不遂，邪在于络，肌肤不仁。邪在于经，即重不胜。
邪入于腑，即不识人。邪入于脏，舌即难言，口流涎沫。又云∶寸口脉迟而级，迟则为寒，缓则为虚。荣缓
则为亡血，卫缓即为中风。邪气中经，则身痒而瘾疹，心气不足。邪气入中，则胸满而短气。以及五脏
风脉死症，语语金针。
仲景以后，英贤辈出，中风一证，方书充栋，竟鲜画一之法。世咸知仲景为立方之祖，然仲景首推侯氏
黑散为主方，后人罔解其意，谨以明之。夫八风之邪，皆名虚邪，人身经络营卫素盛者，无从入之。入之者，
因其虚而袭之耳。《内经》谓以身之虚，而逢天之虚，两虚相感，其气至骨，入则伤五脏，工侯禁之，不能
伤也，又谓贼风数至，虚邪朝夕，内至五脏骨髓，外伤空窍肌肤。《灵枢》谓圣人避邪如避矢石，是则虚邪
之来，为害最烈。然风为阳邪，人身卫外之阳不固，阳邪乘阳，尤为易入，即如偏枯不仁，要皆阳气虚馁，
不能充灌所致。又如中风卒倒，其阳虚更审。设非阳虚，其人必
轻矫便捷，何得卒倒耶？仲景之谓脉微而数，微者指阳之微也，数者指风之炽也。所出诸证诸脉，字字皆
本阳虚为言。然非仲景之言，而《内经》之言也。《内经》谓∶天明则日月不明，邪害空窍。可见风性
善走空窍，阳虚则风居空窍，渐入脏腑，此惟离照当空，群邪始得毕散。若胸中之阳不治，风必不出矣。扁
鹊谓虢太子尸厥之病，曰上有绝阳之络，下有破阴之纽，见五络之纵于头者，皆为阳络，而邪阻绝于上，其
阳之根于阴，阴阳相纽之处，而正复破散于下，故为是病。古人立言之精若此。
仲景以后，医脉斩为中断。后贤之特起者，河间主火，是火召风入，火为本，风为标矣；东垣主气
，是气召风入，气为本，风为标矣；丹溪主痰，是痰召风入，痰为本，风为标
矣。然一人之身，每多兼三者而有之，曷不曰阳虚邪害空窍为本，而风从外入者，必挟身中素有之邪，或火或
气或痰而为标耶？王安道谓∶审其火、气、痰，则从三子；审其为风，则从《内经》。亦为无权执一。从三
子固各有方论可守，从《内经》果何着落耶？中风之初，治其表里，风邪非不外出，而重门洞开，出而复入
，乃至莫御者矣。又谓一旬微汗，一气微利，要亦五十步之走耳。
仲景取侯氏黑散为主方，则驱风之中兼填空窍，空窍一实，庶风出而不复入，其病瘳矣。仲景所谓心折者，
原有所本，乃遵《内经》久塞其空，真切精粹。诸家中风方论，直是依样葫芦，不足观矣。
侯氏黑散
菊花 桔梗 防风 细辛 川芎 桂枝 当归 人参 白术 茯苓 牡蛎 矾石 黄芩 干姜 甘草
上十四味，杵为散。酒服方寸匕，日三服。初服二十日，用温酒调服。禁一切猪肉、大蒜。常宜冷食
，六十日止，即
药积在腹中不下也。热食即下矣，冷食自能助药力。
上治中风四肢烦重，心中恶寒不足者。《外台》用之以治风癫。仲景制方皆匠心独创，乃于
中风症首引此散，岂非深服其方乎？夫立方而但驱风补虚，谁不能之？至于驱补之中，行其堵截之法，则
非思议可到，方中取矾石以固涩诸药，使之留积不散，以渐填其空窍，服之日久，风自以渐填而熄。所
以初服二十日，不得不用温酒调下，以开其痹着。以后则禁诸热食，惟宜冷服，如此再四十日，则药积腹中
不下，而空窍填矣。空窍填则旧风尽出，新风不受矣。盖矾性得冷即止，故嘱云热食即下矣。冷食自能助
药力，抑何用意之微耶。
脉法
新中风挟旧邪，或外感，或内伤，其脉随之忽变。兼寒则脉浮紧，兼风则脉浮缓，兼热则脉浮数，
兼痰则脉浮滑，兼气则脉沉涩，兼火则脉盛大，兼阳虚则脉微，亦大而空，兼阴虚则脉数，亦细如丝；阴
阳两虚则微数或微细；虚滑为头中痛，缓迟为营卫衰。大抵阳浮而数，阴濡而弱，浮滑沉滑，微虚散数，
皆为中风。然虚浮迟缓，正气不足，尚可补救；急大数疾，邪不受制，必死无疑。若大数未至急疾，犹得不
死。
《内经》言偏枯者不一，曰汗出偏阻，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》亦叙偏枯于热病篇中，皆不言风，亦不言其本于何邪。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，皆可言邪？
即河间主火，即肾水虚阳盛阴不足之一端也；东垣主气，即七情抑遏之一端也；丹溪主痰，即饮食伤脾之一
端也。一病之中，每多兼三者而有之，安在举一以括其余？《素
问》云，不能治其虚，安问其余？偏枯阳盛阴不足固有之，而阳气虚衰，痹而不通尤多，可问其余耶？
中络者肌肤不仁，中经者躯壳重着，中腑即不识人，中腑即舌难言，口流涎沫，然中腑必归胃腑，
中脏必归心脏也。
腑邪必归胃者，风性善行空窍，水谷入胃，则胃实肠虚，风邪即进入肠中，少顷水谷入肠，则肠实胃
虚，风复进入胃中，见胃风必奔迫于二肠之间也。风入胃中，胃热必盛，蒸其精液，结为痰涎，壅塞隧道，
胃之支络心者，才有壅塞，即堵其神气出入之窍，故不识人也。诸脏受邪至盛，必进入于心而乱其神明，神
明无主则舌纵难言，廉泉开而流涎沫也。
治中风亦如治伤寒，不但邪在三阳引入三阴为犯大禁，即邪在太阳引入阳明、少阳亦为犯禁也。故风初
中络，即不可引之入经，中经即不可引之入腑，中腑即不可引之入脏。引邪深入，酿患无穷，又毋论中风浅
深，但见自汗，则津液外出，小便自少。若更利之，使津液下竭，则营卫之气转衰，无以制风火之势，必
增其烦热，而其阴日亡也，况阳明利小便，尤为犯禁；少阴利小便，必失溲而杀人矣。且风中经络，只
宜宣之使散，误下则风邪乘虚入腑入脏，酿患无穷。若夫中风之候，多有平素积虚，脏真不守者，下之立亡
。惟在腑一证，内实便闭，间有可下。然不过解其烦热，非大下也。虽
中腑日久，热势深极转入脏者，此属可下，必使风与热俱去为善。若开其壅塞，反增风势，何以下之哉。
李士材曰∶凡中风昏倒，先须顺气，然后治风，用竹沥、姜汁调苏合香丸。如口噤，抉开灌之。如抉不开，
急用牙皂、生半夏、细辛为细末，吹入鼻中，有嚏可治，无嚏则死。最要分别闭与脱二证明白∶如牙关紧
闭，两手握固，即是闭症，用苏合香丸，或三生饮之类开之；若口开心绝，手撒脾绝，眼合肝绝，遗尿
肾绝，声如鼾肺绝，即是脱证。更有吐沫、直视、肉脱、筋骨痛、发直、摇头上窜、面赤如妆、汗出如珠，
皆脱绝之证，
宜大剂理中汤灌之，及灸脐下，虽日不治，亦可救十中之一。若误服苏合香丸、牛黄至宝之类，即不可救
矣。盖斩关夺门之将，原为闭证设，若施之脱症，如人既入井而又下之石也。世人蹈此弊而死，不可胜数，
故特表而出之。惟中脏之症，是闭而非脱者，宜苏合丸、牛黄丸、至宝丹、活命金丹之类。若中腑与中血脉
之症，断不宜用。为内有麝香入脾治肉，牛黄入肝治筋，龙脑入肾治骨，恐反引风邪深入骨髓，如油入面，
莫之能出。
不语
心脾受风，故舌强不语。风寒客于会厌，故卒然无音。若因痰迷心窍，当清心火。若因湿痰，当清脾热。
若因风热，当清肝火。若因风痰，当导痰涎。若因虚火，当壮水之主。若因虚寒厥逆，当益火之源。神仙解
语丹、涤痰汤、加味转舌膏、八味丸随证选用。
手足不随
诸阳之经皆起于手足，风寒客于肌肤始为痹，复伤阳经，随其虚处而停滞，与血气相搏，故风痹而手
足不随。实者脾土太过，当泻其湿；虚者脾土不足，当补其气。血枯筋急者四物汤，木旺风淫者四物汤加钩
藤、秦艽、防风，多痰者加秦艽、天麻、竹沥、姜汁。
半身不遂
偏枯一症，皆由气血不周。经曰∶风气通于肝，风搏则热盛，热盛则水干，水干则气不荣，精乃亡。
此风病之所由作也。故曰∶治风先治血，血行风自灭。
痰涎壅盛
宜用吐法，稀涎散。或橘红一斤，运流水七碗，煎至二碗，顿服，白汤导之，吐痰之圣药也。二陈汤、
星香散加竹
沥、姜汁。虚者六君子同星香散。脉沉伏无热者，三生饮加全蝎。一用养正丹，可以坠下痰，镇安元气。
张子和中风论曰∶口眼 斜，俗工于中风掉眩症一概治之，然而不愈者，盖知窍而不知经，知经而不
知气故也。人之七窍，如肝窍目，目为肝之外候；肺窍鼻，鼻为肺之外候；心窍舌，舌无窍，心与肾合而寄窍
于耳，故舌与耳俱为心之外候。俗工只知目病归之肝，口病归之脾，鼻病归之肺，耳病归之肾，舌病归之心
，更无改张。岂之目之内 ，上下三纲，足太阳及阳明起于此。
目之锐 ，是少阳起于此，手少阳至于此。鼻之左右，足阳明、手阳明夹乎此。口之左右，亦
此两经环之。此七窍有病，不可独归之五脏，当归之六阳经也。然求之世之能知十二经所起所会所交所合，
与夫循环过注、上下夹贯、种种所别，千万人而不得一二人。于其所知，又不过执十二经便为病本，以阳经为
热，阴经为寒，检方寻药治之而已。讵知《灵枢》经曰∶足之阳明、手之太阳，筋急则口目为僻。此十二经
受病之处也，非为病者也。及为病者，天之六气也。俗工不识，往往纷然。然则口眼 斜治之若何？曰∶足之
太阳、足之阳明，右目有之，左目亦有之；足之阳明、手之阳明，口左有之，口右亦有之，此两道也。《灵
枢》又言∶足阳明之筋，其病颊筋有寒则急，引颊移口；热则筋弛，纵缓不胜收，故僻。左寒右热，则左急而
右缓；右寒左热，则右急而左缓。故偏于左者，左寒而右热；偏于右者，右寒而左热也。夫寒不可轻用辛热
之剂，盖左中寒而迫热于右，右中风则逼热于左，阳气不得宣行故也。而况风者甲乙木也，口眼阳明皆为
胃土，风偏贼之，此口眼之所以僻也。或曰七窍惟口眼 斜，而耳鼻独无此病者，何也？曰动则生风，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。动则皆属木，静则皆属土。观卦者视之理也，视者日之用也，
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
未常斜，口虽 而口之辅颊车未尝 ，此经之受病而非窍之受病明矣。此病气虚风入而为偏，上不得出，
下不得泄，真气为邪气所陷，此宜灸承泣、地仓，不效当灸人迎。又风火交胜，两手脉必急数弦实。
盖火胜则制金，金衰则木茂，木茂则风生，止可流湿润燥通郁为主，而用及姜、附、乌、桂、起石、硫黄
之剂者，是耶？非耶？
薛立斋曰∶中风者，即《内经》所谓偏枯、风痱、风懿、风痹是也，而有中腑、中脏、中血脉之分焉。
夫中腑者为在表，中脏者为在里，中血脉者为在中。在表者宜微汗，在里者宜微下，在中者宜调荣。中腑
者多着四肢，如手足拘急不仁、恶风寒。如数者病浅，皆易治，用加减续命汤之类。中
脏多滞九窍，如眼瞀者中于肝，舌不能言者中于心，唇缓便闭者中于脾，鼻塞者中于肺，耳聋者中于肾。此
数者病深，多难治。中血脉者，外无六经之症，内无便溺之阻，肢不能举，口不能言，用大秦艽汤主之。中
腑者多兼中脏，如左关脉浮弦，而目青、左胁偏痛、筋脉拘急、目 、头目眩、手足不收、坐踞不得，
此中胆兼中肝也，用犀角散之类。如左寸脉浮洪，面舌赤、汗多恶风、心神颠倒、言语謇涩、舌强口干、
忪悸恍惚，此中小肠兼中心也，用麻黄散之类。如右关脉浮或浮大，面唇黄、汗多恶风、口 语涩、身重、
怠惰嗜卧。肌肤不仁、皮肉 动、腹膨不食，此中胃兼中脾也，用防风散之类。如右寸脉浮涩而短、面色白
、鼻流清涕、多喘，胸中
冒闷、短气自汗、声嘶、四肢痿弱，此中大肠兼中肺也，用五味汤之类。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，此中膀胱兼中肾也，用独活散之类。此皆言真中风
也，而有气血之分焉∶盖气虚而中者，由元气虚而贼风袭之，则右手足不仁，用六君子汤加钩藤、姜汁、竹
沥；血虚而中者，由阴血虚而贼风袭之，则左手足不仁，用四物汤加钩藤、姜汁、竹沥；气血俱虚而中者，
则左右手足皆不仁，用八珍汤加钩藤、姜汁、竹沥。
其与中风相类者，则有中寒、中湿、中火、中气。食厥、劳伤、房劳等症。如中于寒者。谓冬月卒中
Yu Jiayan said: The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: When a disease is caused by Wind, it typically presents with hemiplegia (half-body paralysis), or only the arm cannot be lifted; this is classified as Bi Syndrome (Obstruction Syndrome). The pulse is faint and rapid, which is due to Stroke.
It further states: The pulse at the Cun position (distal radial artery) is floating and tight. Tightness indicates Cold, while floating indicates Deficiency. Deficiency and Cold contend with each other, and the pathogenic factor resides in the skin. Floating indicates Blood Deficiency, and the collateral vessels are empty. The thief pathogen (external evil) cannot be expelled. It may affect either the left or the right side. The pathogenic factor causes flaccidity on that side, while the healthy Qi becomes tense on the opposite side. The healthy Qi pulls towards the pathogen, resulting in deviation of the mouth and eye and inability to move freely. If the pathogen is in the collaterals, there is numbness of the skin and muscles. If it is in the meridians, the body feels heavy and difficult to lift. If it enters the Fu organs, consciousness is lost and the person does not recognize others. If it enters the Zang organs, speech becomes difficult, and saliva dribbles from the mouth. It also states: The pulse at the Cun position is slow and slack. Slowness indicates Cold, and slackness indicates Deficiency. Slack Ying (Nutrient) Qi indicates loss of Blood, while slack Wei (Defensive) Qi indicates Stroke. If the pathogen strikes the meridians, the body itches and urticaria appears, and Heart Qi is insufficient. If the pathogen enters deeply, there is chest fullness and shortness of breath. Regarding the fatal signs of Wind affecting the five Zang organs and their pulses, every word serves as a golden needle for treatment.
After Zhang Zhongjing, many outstanding physicians emerged. Regarding Stroke, medical books are piled high, yet few offer a unified method. Everyone knows Zhang Zhongjing as the ancestor of prescription formulation, yet he first promoted Hou Shi Hei San (Marquis Hou's Black Powder) as the main formula. Later generations did not understand its meaning, so I will clarify it here. The Eight Winds (pathogens from eight directions) are all called Empty Pathogens. In humans whose meridians, Ying Qi, and Wei Qi are naturally robust, these pathogens have no entry. Those who enter do so because they exploit deficiency. The *Nei Jing* (Inner Canon) says: "When one's own deficiency meets Heaven's deficiency, the two emptinesses interact, and the Qi reaches the bone. Entering inside, it damages the five Zang organs." A skilled physician prevents this, so it cannot cause harm. It also says: "Thief winds arrive frequently, empty pathogens attack morning and evening, entering internally to the five Zang organs and marrow, and externally to the orifices and skin." The *Ling Shu* (Spiritual Pivot) states that sages avoid pathogens as they would avoid arrows and stones. Thus, the arrival of empty pathogens is extremely harmful. However, Wind is a Yang pathogen. If the external-protecting Yang Qi of the body is not solid, Yang pathogens attacking Yang make entry particularly easy. For instance, hemiplegia and numbness are all caused by the deficiency and weakness of Yang Qi, failing to nourish and irrigate. Similarly, sudden collapse in Stroke clearly indicates Yang Deficiency. If it were not Yang Deficiency, the person would be agile and quick, how could they suddenly collapse? Zhang Zhongjing's description of a faint and rapid pulse: "Faint" refers to the weakness of Yang, and "rapid" refers to the intensity of Wind. All the symptoms and pulses described are based on Yang Deficiency. This is not just Zhang Zhongjing's words, but also those of the *Nei Jing*. The *Nei Jing* says: "If Heaven is bright, the sun and moon lose their clarity, and pathogens harm the empty orifices." This shows that Wind has a nature to travel through empty orifices. With Yang Deficiency, Wind occupies the orifices and gradually enters the Zang and Fu organs. Only when the "bright light shines overhead" (Yang Qi is restored) can all pathogens be dispersed. If the Yang Qi in the chest is not treated, Wind will certainly not exit. Bian Que said regarding the Guo Crown Prince's corpse-like coma (Shi Jue): "Above, there are severed Yang collaterals; below, there are broken Yin knots." Seeing the five collaterals extending to the head, all are Yang collaterals, and the pathogen blocks them above. Its Yang root lies in Yin. At the junction where Yin and Yang knot together, the righteous Qi breaks down below, hence this disease. The precision of ancient scholars' statements is such.
After Zhang Zhongjing, the lineage of medicine was severed. Among later rising experts, Liu Hejian emphasized Fire, implying Fire summons Wind into the body; Fire is the root, Wind is the branch. Li Dongyuan emphasized Qi, implying Qi summons Wind; Qi is the root, Wind is the branch. Zhu Danxi emphasized Phlegm, implying Phlegm summons Wind; Phlegm is the root, Wind is the branch. However, in one person's body, these three often coexist. Why not say that Yang Deficiency allowing pathogens to harm empty orifices is the root, and Wind entering from outside necessarily carries pre-existing internal pathogens, whether Fire, Qi, or Phlegm, as the branch? Wang Andao said: "Examine if it is Fire, Qi, or Phlegm, then follow the methods of the Three Masters (Hejian, Dongyuan, Danxi); examine if it is Wind, then follow the *Nei Jing*." This is also lacking flexibility and sticking to one view. Following the Three Masters' methods indeed has prescriptions to follow, but following the *Nei Jing*, where exactly does one start? In the early stage of Stroke, treating both exterior and interior, the Wind pathogen may not fail to exit, but with the gates wide open, it exits and re-enters, becoming uncontrollable. Saying "slight sweating over ten days, slight purgation over a cycle" is merely comparing apples and oranges (or fifty steps laughing at a hundred).
Zhang Zhongjing took Hou Shi Hei San as the main formula, thereby filling the empty orifices while expelling Wind. Once the orifices are filled, Wind exits and does not re-enter, and the illness heals. Zhang Zhongjing's concept of "heart-breaking" (profound realization) has its basis, following the *Nei Jing*'s principle of "long-term sealing of the empty," which is precise and pure. Other physicians' formulas for Stroke are simply copying without understanding, unworthy of observation.
Hou Shi Hei San (Marquis Hou's Black Powder)
Chrysanthemi Flos (Juhua), Platycodonis Radix (Jiegeng), Saposhnikoviae Radix (Fangfeng), Asari Radix et Rhizoma (Xixin), Chuanxiong Rhizoma (Chuanxiong), Cinnamomi Ramulus (Guizhi), Angelicae Sinensis Radix (Danggui), Ginseng Radix (Renshen), Atractodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Ostrea Concha (Muli), Alumen (Fanshi), Scutellariae Radix (Huangqin), Zingiberis Rhizoma Recens (Ganjiang), Glycyrrhizae Radix et Rhizoma (Gancao).
The above fourteen ingredients are pounded into a powder. Take one fangcun bi (a measure roughly equivalent to a tablespoon) with wine, three times a day. For the first twenty days of treatment, take it mixed with warm wine. Avoid all pork and garlic. One should preferably eat cold food. After sixty days, stop taking it, so that the medicine accumulates in the abdomen and does not pass down. Hot food would cause it to pass down quickly; cold food naturally aids the medicinal power.
This treats Stroke with heaviness in the four limbs and a feeling of insufficiency/cold in the heart. The *Wai Tai Mi Yao* (Prescriptions Essential for Emergencies [Ever-Yellow]) uses it to treat wind-induced epilepsy. Zhang Zhongjing's prescriptions are all unique creations, yet he cites this powder first for Stroke, surely deeply admiring this formula? To create a formula merely to expel Wind and tonify deficiency—anyone can do that. But to implement a method of "blocking and plugging" within expulsion and tonification goes beyond mere speculation. In the formula, Alumen is used to astringe the other herbs, keeping them accumulated and不散 (not dispersing), gradually filling the empty orifices. Over long-term use, Wind is gradually filled and extinguished. Therefore, for the initial twenty days, warm wine must be used to descend the medicine, to open up the obstruction. Afterwards, all hot foods are prohibited, and only cold intake is suitable. Doing so for another forty days, the medicine accumulates in the abdomen and does not pass down, and the orifices are filled. Once filled, old Wind is completely expelled, and new Wind is not accepted. Since Alumen stops acting when cold, it is instructed that hot food causes it to pass down. Cold food naturally aids the medicinal power. How subtle the intention!
Pulse Diagnosis
In new-onset Stroke complicated by old pathogens, or external contraction, or internal injury, the pulse changes suddenly accordingly. Complicated by Cold, the pulse is floating and tight; by Wind, floating and slack; by Heat, floating and rapid; by Phlegm, floating and slippery; by Qi stagnation, deep and choppy; by Fire, large and vigorous; by Yang Deficiency, faint, also large and empty; by Yin Deficiency, rapid, also fine like a thread; by both Yin and Yang Deficiency, faint and rapid or faint and fine; deficiency-slippery indicates headache in the head; slack and slow indicates decline of Ying and Wei Qi. Generally, floating and rapid Yang, and soggy and weak Yin, floating-slippery, deep-slippery, faint-deficient, scattered-rapid, are all indicative of Stroke. However, if the pulse is floating, slack, and slow, indicating insufficient healthy Qi, it can still be remedied; if urgent, large, rapid, and swift, the pathogen is uncontrolled, and death is certain. If large and rapid but not yet urgent/swift, death can be avoided.
The *Nei Jing* mentions hemiplegia (Piangu) in various ways: sweating on one side blocking flow, Yang excess and Yin insufficiency, stomach pulse differing internally and externally in size, Heart pulse small and firm/tense, Kidney Water deficiency. The *Ling Shu* also describes Piangu in the chapter on febrile diseases, never mentioning Wind, nor stating what pathogen is the root. Is it not because Seven Emotions, hunger/fullness, and sexual activity, anything that can weaken Zang Qi, causing Ying and Wei meridians to obstruct and not flow, can all be called pathogens?
Thus, Hejian emphasizing Fire is but one aspect of Kidney Water deficiency, Yang excess, and Yin insufficiency; Dongyuan emphasizing Qi is but one aspect of Seven Emotions suppression; Danxi emphasizing Phlegm is but one aspect of dietary injury to the Spleen. In one disease, these three are often present together. How can one cite one to cover the rest? The *Su Wen* says: "If you cannot treat the Deficiency, how can you ask about the rest?" While Piangu involves Yang excess and Yin insufficiency, Yang Qi deficiency leading to obstruction and non-flow is even more common. Can we ask about the rest?
Those struck in the Collaterals have numb skin and muscles; those struck in the Meridians have heavy bodies; those struck in the Fu organs lose consciousness; those struck in the Zang organs have stiff tongues unable to speak and dribble saliva. However, striking the Fu organs must return to the Stomach Fu, and striking the Zang organs must return to the Heart Zang.
Why Fu pathogens must return to the Stomach: Wind has a nature to travel through empty orifices. When food and water enter the Stomach, the Stomach becomes full and the Intestines empty; Wind pathogens enter the Intestines. Shortly after, food and water enter the Intestines, making them full and the Stomach empty; Wind re-enters the Stomach. Seeing Wind in the Stomach, it inevitably rushes between the Large and Small Intestines. Wind entering the Stomach makes Stomach Heat abundant, steaming fluids, condensing into Phlegm-Saliva, blocking the tunnels. The Stomach's branch collaterals connect to the Heart; once blocked, they obstruct the orifices for Shen (Spirit) to enter and exit, hence losing consciousness. When pathogens in other Zang organs become excessive, they must enter the Heart and disturb its Shen. With Shen having no master, the tongue relaxes and speech fails, the Lianquan point opens, and saliva flows.
Treating Stroke is like treating Cold Damage. Not only is it a major taboo to draw pathogens from the Three Yang into the Three Yin, but even drawing pathogens from Taiyang into Yangming or Shaoyang is forbidden. Therefore, when Wind first strikes the Collaterals, do not draw it into the Meridians; when it strikes the Meridians, do not draw it into the Fu organs; when it strikes the Fu organs, do not draw it into the Zang organs. Drawing pathogens deeper creates endless trouble. Regardless of the depth of Stroke, if spontaneous sweating is seen, fluids go out, and urination decreases naturally. If diuretics are used again, depleting fluids downward, Ying and Wei Qi decline further, unable to control Wind and Fire, increasing irritability and heat, and Yin is daily destroyed. Moreover, using diuretics in Yangming is especially forbidden; using them in Shaoyin causes incontinence and death. Furthermore, for Wind in collaterals and meridians, only dispersing is appropriate. Mistaken purgation allows Wind pathogens to enter Fu and Zang organs with void, creating endless trouble. If Stroke patients often have chronic accumulation of deficiency and unstable True Zang Qi, purgation leads to immediate death. Only in the Fu organ syndrome, with internal excess and constipation, is purgation occasionally applicable. This is merely to relieve irritability and heat, not strong purgation. Even if Fu organ Strike lasts long, heat penetrates deeply into Zang organs, making it purgable, provided Wind and Heat are both removed. If opening blockage increases Wind, how can purgation be used?
Li Shicai said: Whenever Stroke causes sudden collapse, one must first regulate Qi, then treat Wind, using Bamboo Juice and Ginger Juice to mix Su He Xiang Wan (Styrax Pill). If the jaw is clenched, pry it open and administer. If it cannot be pried open, urgently use Ya Zhao (Gardenia Fruit), Sheng Banxia (Raw Pinellia), and Xixin (Asari) ground into fine powder, blown into the nose. If sneezing occurs, it is treatable; if not, death ensues. Most importantly, clearly distinguish between Closed Syndrome (Bi Zheng) and Collapsed Syndrome (Tuo Zheng). If the jaw is tightly closed and hands are clenched, it is Closed Syndrome; use Su He Xiang Wan or San Sheng Yin to open it. If the mouth is open (Heart collapsed), hands scattered (Spleen collapsed), eyes closed (Liver collapsed), incontinence (Kidney collapsed), and snoring sound (Lung collapsed), it is Collapsed Syndrome. More symptoms of total collapse include foaming, staring straight ahead, muscle wasting, bone/joint pain, hair standing erect, shaking head and upward gaze, face red like makeup, and sweat like pearls. These require large doses of Li Zhong Tang administered orally, plus moxibustion below the navel. Although critical, one in ten might be saved. If Su He Xiang Wan, Niu Huang Zhi Bao Wan, etc., are mistakenly taken, it is incurable. These "gate-crashing generals" are designed for Closed Syndrome; applying them to Collapsed Syndrome is like pushing a stone into a well after someone has fallen in. Countless people die from this error, so it is specially highlighted. Only for Zang organ Strike that is Closed and not Collapsed should Su He Xiang Wan, Niu Huang Wan, Zhi Bao Dan, Huo Ming Jin Dan, etc., be used. For Fu organ and Blood-Vessel Strike, they are strictly contraindicated. Because Musk enters the Spleen to treat flesh, Niu Huang enters the Liver to treat sinews, and Long Nao (Borneol) enters the Kidney to treat bones, fearing they will instead draw Wind pathogens deep into the bone marrow, like oil entering dough, impossible to remove.
Aphasia
Wind affecting Heart and Spleen causes tongue stiffness and aphasia. Wind-Cold lodging in the epiglottis causes sudden loss of voice. If due to Phlegm confusing the Heart orifice, clear Heart Fire. If due to Damp-Phlegm, clear Spleen Heat. If due to Wind-Heat, clear Liver Fire. If due to Wind-Phlegm, guide out Phlegm-Saliva. If due to Deficient Fire, strengthen the Master of Water. If due to Deficient Cold and reversal, benefit the Source of Fire. Shen Xian Jie Yu Dan, Di Tan Tang, Jia Wei Zhuan She Gao, Ba Wei Wan are selected according to syndrome.
Immobility of Hands and Feet
All Yang meridians originate in the hands and feet. Wind-Cold lodging in skin and muscles initially causes Bi; subsequently injuring Yang meridians, it stagnates in deficient areas, contending with Blood and Qi, causing Wind-Bi and immobility of hands and feet. Excess type: Spleen Earth is too strong, drain Dampness. Deficiency type: Spleen Earth is insufficient, tonify Qi. For Blood dryness and tendon tension, use Si Wu Tang. For Wood excess and Wind hyperactivity, use Si Wu Tang plus Gouteng, Qinjiao, Fangfeng. For much Phlegm, add Qinjiao, Tianma, Zhuli, Jiangzhi.
Hemiplegia
Piangu (hemiplegia) is always due to uneven circulation of Qi and Blood. The Classics say: Wind Qi connects to the Liver. Wind contention causes Heat excess; Heat excess dries Water; dried Water means Qi is not nourished, and Essence is lost. This is how Wind diseases arise. Thus it is said: Treat Wind by first treating Blood; when Blood moves, Wind self-extinguishes.
Excessive Phlegm-Saliva
Use emesis method, Xi Xian San. Or use 1 jin of Juhong (Citrus Reticulata Peel), seven bowls of running water, decoct to two bowls, take in one dose, guided by white soup. This is the holy medicine for vomiting Phlegm. Er Chen Tang, Xing Xiang San plus Zhuli, Jiangzhi. For deficiency, combine Liu Jun Zi Tang with Xing Xiang San. For deep-hidden pulse without heat, use San Sheng Yin plus Quanxie (Scorpion). Use Yang Zheng Dan to sink Phlegm and stabilize Yuan Qi.
Zihehe on Stroke
Facial deviation: Quack doctors treat all Stroke tremors and vertigo uniformly, yet they do not heal because they know the orifices but not the meridians, and know the meridians but not the Qi. The seven orifices of man: Liver orifice is the Eye (Eye is external manifestation of Liver); Lung orifice is the Nose (Nose is external manifestation of Lung); Heart orifice is the Tongue. The Tongue has no orifice; Heart combines with Kidney and lodges its orifice in the Ear, so Tongue and Ear are both external manifestations of Heart. Quacks only know Eye disease belongs to Liver, Mouth disease to Spleen, Nose to Lung, Ear to Kidney, Tongue to Heart, without changing this view. Do they not know that the inner and outer canthi of the Eye, the upper and lower guidelines, are where Foot Taiyang and Yangming originate? The sharp canthus of the Eye is where Shaoyang originates, and Hand Shaoyang reaches here. Left and right of the Nose are where Foot Yangming and Hand Yangming flank. Left and right of the Mouth are encircled by these two meridians. Diseases of these seven orifices cannot be attributed solely to the Five Zang organs; they must be attributed to the Six Yang meridians. However, finding someone in the world who knows the origins, meetings, intersections, and combinations of the Twelve Meridians, their circulation, vertical/horizontal penetration, and distinctions, is rare among thousands. What they know is limited to taking the Twelve Meridians as the root of disease, attributing Yang meridians to Heat and Yin meridians to Cold, checking formulas and seeking herbs to treat. They do not know the *Ling Shu* says: "Foot Yangming and Hand Taiyang, when tendons are tense, cause facial deviation." This is where the Twelve Meridians suffer disease, not the cause of disease itself. The cause of disease is the Six Qi of Heaven. Quacks do not recognize this and often argue confusedly. So how to treat facial deviation? Foot Taiyang and Foot Yangming affect the right eye and left eye; Foot Yangming and Hand Yangming affect the left and right mouth. These are two pathways. The *Ling Shu* also says: "Foot Yangming tendons, if cold in the cheek tendons, become tense, pulling the cheek and moving the mouth; if hot, tendons relax, becoming loose and unable to hold, thus deviating." Left cold and right heat cause left tension and right relaxation; right cold and left heat cause right tension and left relaxation. Thus, deviation to the left means left cold and right heat; deviation to the right means right cold and left heat. Cold should not be lightly treated with pungent-hot agents, because left Cold pressing Heat to the right, or right Wind forcing Heat to the left, prevents Yang Qi from circulating. Moreover, Wind is Jia-Yi Wood, while the mouth and eyes belong to Yangming Stomach Earth. Wind attacks obliquely, causing this deviation. Someone asks: Why only the mouth and eyes deviate, while nose and ears do not? Movement generates Wind, stillness rests Wind, this is the constant law of Heaven and Earth. Examining the *I Ching* images, they correspond. Zhen and Xun govern movement; Kun and Gen govern stillness. Movement belongs to Wood; stillness belongs to Earth. The Guan hexagram represents vision; vision is the function of the Sun. Upper eyelid blinks, lower does not; thus Guan is Xun above and Kun below. The Yi hexagram represents nourishment; nourishment is the function of the mouth. Lower jaw chews, upper does not; thus Yi is Gen above and Zhen below. Mouth and eyes move constantly, so Wind arises; nose and ears are still, so Wind rests. Consider that although the eye deviates, the eye socket does not deviate; although the mouth deviates, the cheekbone and jaw do not deviate. It is clear that the meridians suffer disease, not the orifices. This disease is caused by Qi deficiency and Wind invasion leading to deviation. Upward exit is blocked, downward excretion is blocked, True Qi is trapped by Pathogenic Qi. Moxibustion at Chengqi and Dicang is indicated; if ineffective, moxa at Renying. Also, when Wind and Fire compete fiercely, both wrists' pulses must be urgent, rapid, string-taut, and solid. Fire excess controls Metal; Metal decline allows Wood to flourish; Wood flourishing generates Wind. Treatment should mainly focus on moistening flow, drying dampness, and clearing stagnation. Using agents like Jiang (Ginger), Fu (Aconite), Wu (Aconite/Belladonna family?), Gui (Cinnamon), Qishi (Lead Oxide), Huang (Sulfur)—is this correct or incorrect?
Xue Lizhai said: Stroke is what the *Nei Jing* calls Piangu, Fengfei, Fengyi, and Fengbi, and is divided into striking Fu organs, Zang organs, and Blood-Vessels. Striking Fu organs is in the Exterior; striking Zang organs is in the Interior; striking Blood-Vessels is in the Middle. Exterior should be slightly sweated; Interior should be slightly purged; Middle should harmonize Ying. Fu organ strike often affects the four limbs, such as limb spasm/numbness, aversion to wind/cold. If the pulse is rapid, the disease is shallow and easy to treat; use Jia Jian Xu Ming Tang. Zang organ strike often stagnates in the nine orifices: blurred vision strikes Liver; inability to speak strikes Heart; relaxed lips and constipation strike Spleen; nasal congestion strikes Lung; deafness strikes Kidney. These indicate deep disease, mostly hard to treat. Blood-Vessel strike has no exterior Six Meridian symptoms, no interior urinary/fecal obstruction, limbs cannot lift, mouth cannot speak; use Da Qin Jiao Tang. Fu organ strike often combines with Zang organ strike. E.g., Left Guan pulse floating-stringy, blue eyes, left hypochondriac pain, tendon spasm, eye deviation, dizziness, limbs collapsing, unable to sit upright: this is Gallbladder combining with Liver strike; use Xi Jiao San. Left Cun pulse floating-vigorous, red face/tongue, profuse sweating, aversion to wind, mental confusion, slurred speech, stiff tongue, dry mouth, palpitations,恍惚: this is Small Intestine combining with Heart strike; use Ma Huang San. Right Guan pulse floating or floating-large, yellow face/lips, profuse sweating, aversion to wind, facial deviation, slurred speech, body heaviness, lethargy, skin/muscle twitching, abdominal distension, anorexia: this is Stomach combining with Spleen strike; use Fang Feng San. Right Cun pulse floating-choppy-short, pale face, runny nose, frequent panting, chest oppression, shortness of breath, spontaneous sweating, hoarse voice, limb flaccidity: this is Large Intestine combining with Lung strike; use Wu Wei Tang. Left Chi pulse floating-slippery, dark face/eyes, back/waist pain radiating to lower abdomen, inability to bend/straighten, tinnitus in both ears, joint pain, leg flaccidity, fearfulness: this is Bladder combining with Kidney strike; use Du Huo San. These all refer to true Stroke, differentiated by Qi and Blood. Qi Deficiency strike: due to Yuan Qi deficiency and thief Wind invasion, right hand/foot numb; use Liu Jun Zi Tang plus Gouteng, Jiangzhi, Zhuli. Blood Deficiency strike: due to Yin Blood deficiency and thief Wind invasion, left hand/foot numb; use Si Wu Tang plus Gouteng, Jiangzhi, Zhuli. Both Qi and Blood Deficiency strike: both sides numb; use Ba Zhen Tang plus Gouteng, Jiangzhi, Zhuli.
Conditions similar to Stroke include Cold Strike, Damp Strike, Fire Strike, Qi Strike. Food syncope, labor injury, sexual exhaustion, etc. For example, Cold Strike: referring to sudden onset in winter...