冒风者,风邪冒于皮毛,而未传经入里也。汪 庵曰∶轻为冒,重为伤,又重则为中。可见冒风之病,
较伤风为轻浅耳。近世每以冒风之病,指为伤风,不知伤风之病,即仲景书中风伤卫之证也。今谓冒风,
乃因风邪复冒皮毛,皮毛为肺之合,故见恶风、微热、鼻塞、声重、头痛、咳嗽,脉来濡滑而不浮缓,
此皆春时冒风之证据,与风伤卫之有别也,宜乎微辛轻解法治之。倘或口渴喜饮,是有伏气内潜,如脉
数有汗为风温,脉紧无汗为春温,务宜区别而治,庶几无误。
或问曰∶曾见灵胎书中有头痛、发热、咳嗽、涕出,俗语所谓伤风,非仲圣《伤寒论》中之伤风也。
今先生竟以风伤卫分为伤风,与灵胎相悖,究竟谁是谁非?曰∶灵胎所论之伤风,即是书之冒风;是书之伤
风,即仲圣书中风伤卫分之伤风。据理而论,当遵圣训为是,俗语为非。曰∶观先生所论之冒风,
较伤风为轻,灵胎所论之伤风,为至难治之疾,一轻一重,何其相反?曰∶丰谓风邪初冒皮毛,其证轻而且
浅,不难数服而瘥,故曰轻也;彼谓邪由皮毛而入于肺,经年累月,病机日深,
变成痨怯,故曰至难治之疾也。一论初起,一论病成,何相反之有。
中风之病,如矢石之中人,骤然而至也。古人谓类中为多,真中极少,是书专为六气而设,故论真中
为亟耳。观夫卒中之病,在春中风为多,在夏中暑为多,在秋中湿为多,在冬中
寒为多,是以中风之病,详于春令。盖风之中于人也,忽然昏
倒,不省人事,或 斜舌强,痰响喉间等证。当其昏倒之时,急以通关散取嚏,有则可治,无则多死;
口噤者,用开关散擦牙软之;痰涎壅盛,用诸吐法涌之;此乃急则治标之法。再考诸贤论治,惟《金匮》分
为四中,最为确当,堪为后学准绳,一曰中经,一曰中络,一曰中腑,一曰中脏。如左右不遂,筋骨不用,
邪在经也,当用顺气搜风法治之;口眼 斜,肌肤不仁,邪在络也,当用活血祛风法治之;昏不识人,便溺
阻隔,邪在腑也,当用宣窍导痰法,益以百顺丸治之;神昏不语,唇缓涎流,邪在脏也,亦宜此法,佐以
牛黄清心丸治之。如口开则心绝,目合则肝绝,手撒则脾绝,鼾睡则肺绝,遗溺则肾绝;又有摇头上窜,
汗出如油,脉大无伦,或小如纤,皆不可治。
或问∶古人治中风,每有中腑、中脏、中血脉之分,中腑以小续命汤,中脏以三化汤,中血脉以大秦艽
汤。今既曰遵《金匮》之四中,然与原文不符合者何?曰∶此遵《金鉴》订正之文,谅无有误耳。曰∶论
中又谓真中极少,类中为多,究竟真类,何以别耶?曰∶忽然昏倒,真类皆有之证,然类中者,但无
口眼 斜,不仁不用等证也。曰∶真类既分,不知类中有几?曰∶类中之病有八也∶一因气虚之体,烦劳
过度,清气不升,忽然昏冒为虚中也,治宜补气;一因气实之人,暴怒气逆,忽然昏倒为气中也,治宜顺气;
一因七情过极,五志之火内发,卒然昏倒无知为火中也,治宜凉膈;一因过饱感受风寒,或因恼怒
气郁食阻,忽然昏厥为食中也,治宜宣消;一因登冢入庙,冷屋栖迟,邪气相侵,卒然妄语,头面青黑,昏
不知人为恶中也,治宜辟邪;所有暑中论在卷四,湿中论在卷六,寒中论在卷八。此八者,皆称为类中也。
程曦曰∶是书以《金匮》之四中为准绳,而不以《内经》偏枯、风痱、风懿、风痹四者为纲领何?思
之良久,恍然有会。盖
偏枯者,半身不遂也;风痱者,四肢不举也;风懿者,卒然不语也;风痹者,遍身疼痛也。窃谓偏枯、风
痱、风懿,皆属中风,而风痹一病,断断不能混入,恐后学人,以痹为中,所以宗后圣而未宗先圣,职是故耳。
江诚曰∶诸书以半身不遂,分出左瘫、右痪,不用、不仁。盖谓瘫者坦也,筋脉弛纵,坦然不收;痪者
涣也,气血涣散,筋骨不用。又谓右为不用,左为不仁,其实瘫与不仁,即论中之邪中乎络也;
痪与不用,即论中之邪中乎经也。今以此四中括之,真所谓要言不烦矣。
Mao Feng (Exposure to Wind) refers to a pathological condition where wind pathogen invades the skin and hair but has not yet transmitted into the meridians or interior. Wang Ang stated: "Light is Mao, heavy is Shang, and heavier still is Zhong." This indicates that the illness of Mao Feng is lighter and more superficial than Shang Feng (Wind Injury). In recent times, people often mistake Mao Feng for Shang Feng, unaware that the disease named Shang Feng in this context actually corresponds to the syndrome of "wind injuring the Wei level" described in Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage). The current concept of Mao Feng arises when wind pathogen again invades the skin and hair; since the skin and hair are the exterior union of the Lung, symptoms such as aversion to wind, slight fever, nasal congestion, hoarseness, headache, and cough appear. The pulse is slippery and soft without being floating and slow. These are evidences of Mao Feng occurring in spring, which differs from wind injuring the Wei level, and thus should be treated with mild acrid-light resolving methods. If the patient experiences thirst and desire to drink, it indicates latent Qi (latent pathogenic factors) hiding within. For instance, if the pulse is rapid with sweating, it is Feng Wen (Wind-Warmth); if the pulse is tight without sweating, it is Chun Wen (Spring-Warmth). It is essential to distinguish between them and treat accordingly to avoid errors.
A question was raised: "I have seen in Zhao Xianke's (Lingtai's) book that symptoms such as headache, fever, cough, and runny nose, commonly known as 'Shang Feng' in vernacular language, are not the 'Shang Feng' in Zhang Zhongjing's *Shanghan Lun*. Now, Mr. Lei distinguishes 'wind injuring Wei' as 'Shang Feng', which contradicts Lingtai. Who is right and who is wrong?" The answer was: "The 'Shang Feng' discussed by Lingtai is exactly what this book calls 'Mao Feng'; and the 'Shang Feng' in this book is the 'Shang Feng' of 'wind injuring Wei' in Zhang Zhongjing's writings. Based on reasoning, one should follow the Sage's teachings as correct and vernacular usage as incorrect." The questioner asked: "Observing your discussion, Mao Feng is lighter than Shang Feng, whereas Lingtai's 'Shang Feng' is a very difficult-to-treat disease. Why are they so opposite in severity?" The answer was: "I consider that when wind pathogen initially invades the skin and hair, the symptoms are light and superficial, easily cured after taking a few doses, hence I call it light. Lingtai refers to pathogens entering the Lung from the skin and hair, deepening over years until becoming consumptive weakness, hence he calls it a very difficult-to-treat disease. One discusses the onset, the other discusses the established disease; where is the contradiction?"
Zhong Feng (Apoplexy/Stroke) strikes suddenly, like being hit by an arrow or stone. Ancients believed that Lei Zhong (Internal Stroke mimicking external stroke) was common, while Zhen Zhong (True External Stroke) was rare. Since this book is specifically designed for the six qi (pathogens), it focuses urgently on discussing Zhen Zhong. Observing sudden apoplexy, in spring, wind is predominant; in summer, heat; in autumn, dampness; in winter, cold. Therefore, the discussion on Zhong Feng is detailed regarding the spring season. Generally, when wind attacks a person, there is sudden collapse, loss of consciousness, or deviation of the mouth and eyes, stiff tongue, and phlegm rattling in the throat. During the collapse, urgently use Tong Guan San (Pass-the-Gate Powder) to induce sneezing; if sneezing occurs, it is treatable; otherwise, death is likely. For lockjaw, use Kai Guan San (Open-the-Gate Powder) to rub the teeth and soften them. For excessive phlegm and saliva, use various emetic methods to vomit it out. These are methods for treating the branch in acute situations. Examining the discussions of sages, only the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) divides it into four categories: Zhong Jing (Invading the Meridians), Zhong Luo (Invading the Collaterals), Zhong Fu (Invading the Fu Organs), and Zhong Zang (Invading the Zang Organs). This division is most accurate and serves as a standard for students.
1. Zhong Jing: Hemiplegia and inability to move limbs/bones/tendons indicate pathogen in the Meridian; treat with methods to regulate Qi and search for wind.
2. Zhong Luo: Deviation of mouth and eyes, numbness of skin and muscles indicate pathogen in the Collaterals; treat with methods to invigorate blood and dispel wind.
3. Zhong Fu: Unconsciousness, inability to recognize people, obstruction of urination and defecation indicate pathogen in the Fu Organs; treat with methods to open orifices and guide out phlegm, aided by Bai Shun Wan (Hundred-Compliance Pill).
4. Zhong Zang: Coma, inability to speak, flaccid lips, flowing saliva indicate pathogen in the Zang Organs; also treat with this method, aided by Niu Huang Qing Xin Wan (Calvescent Calculus Heart-Clearing Pill).
If the mouth opens, it signifies Heart Qi exhaustion; if eyes close, Liver Qi exhaustion; if hands scatter, Spleen Qi exhaustion; if snoring sleep occurs, Lung Qi exhaustion; if enuresis occurs, Kidney Qi exhaustion. Additionally, head shaking with upward gaze, sweat like oil, pulse extremely large and disordered, or pulse tiny as a thread, are all untreatable.
A question was raised: "Ancient treatments for Zhong Feng distinguished between Zhong Fu, Zhong Zang, and Zhong Xue Mai (Blood Vessels), using Xiao Xu Ming Tang for Zhong Fu, San Hua Tang for Zhong Zang, and Da Qin Jiao Tang for Zhong Xue Mai. Since we now follow the four categories of *Jin Gui*, why does it not match the original text?" The answer was: "This follows the corrected text of *Yi Zong Jin Jian* (Medical Standard Gold Mirror), which is presumably error-free." The questioner asked: "The discussion states Zhen Zhong is rare and Lei Zhong is common. How to distinguish true from internal?" The answer was: "Sudden collapse is a symptom of both, but Lei Zhong lacks symptoms like deviation of mouth and eyes, numbness, and paralysis." The questioner asked: "Since true and internal are separated, how many types of Lei Zhong are there?" The answer was: "There are eight types of Lei Zhong: 1. Xu Zhong (Deficiency Stroke): Due to Qi deficiency constitution, excessive labor, failure of clear Qi to ascend, causing sudden dizziness/collapse; treat by tonifying Qi. 2. Qi Zhong (Qi Stroke): Due to excess Qi constitution, sudden anger causing Qi rebellion, causing sudden collapse; treat by regulating Qi. 3. Huo Zhong (Fire Stroke): Due to extreme emotions, fire from five zangs erupting internally, causing sudden collapse and unconsciousness; treat with Liang Ge San (Cool the Diaphragm Powder). 4. Shi Zhong (Food Stroke): Due to overeating combined with wind-cold, or anger/qi stagnation blocking food, causing sudden fainting; treat by promoting digestion and dispersing. 5. E Zhong (Evil Stroke): Due to visiting tombs/temples, staying in cold houses, invading evil qi, causing sudden delirium, blue-black face, and unconsciousness; treat by expelling evil. Discussions on Summer Heat, Dampness, and Cold Apoplexy are in volumes 4, 6, and 8 respectively. All eight are called Lei Zhong."
Cheng Xi said: "Why does this book take the four categories of *Jin Gui* as the standard, rather than the four categories of Pian Ku (Hemiplegia), Feng Fei (Wind Paralysis), Feng Yi (Wind Aphasia), and Feng Bi (Wind Bi) from *Nei Jing*? After thinking for a long time, I suddenly understood. Pian Ku is hemiplegia; Feng Fei is inability to lift limbs; Feng Yi is sudden aphasia; Feng Bi is generalized body pain. I privately believe that Pian Ku, Feng Fei, and Feng Yi all belong to Zhong Feng, but Feng Bi absolutely cannot be mixed in, lest later students confuse Bi syndrome with Zhong Feng. This is why I follow the Later Sage (Zhang Zhongjing) rather than the Earlier Sage (*Nei Jing*)."
Jiang Cheng said: "Various books divide hemiplegia into Left Tan (Paralysis) and Right Huan (Flaccidity), using Bu Yong (Inability to use) and Bu Ren (Numbness). Tan means flat/relaxed, referring to relaxed tendons and vessels that cannot contract; Huan means scattered, referring to scattered Qi and Blood and inability of bones and tendons to function. Some say the right side is 'Bu Yong' and the left is 'Bu Ren'. Actually, Tan and Bu Ren correspond to the pathogen invading the Collaterals in this discussion; Huan and Bu Yong correspond to the pathogen invading the Meridians. Using these four categories to encompass them is truly concise and comprehensive."