中风之有真假。限南北而分治者。不过曰病有标本。初无二途。如百病中。俱有因有证。盖因为本。而病为
标。古人尚论。仅言其证。三贤析论。并道其因。缘西北土地高寒。风气刚猛。真气空虚。卒为所中。名曰真中。
已列前幅。颇详审矣。若夫大江以南。两浙八闽。及滇南鬼方之域。天地之风气既殊。人之禀质亦异。且肥
人气居于表。瘦人阴亏于内。肥人多痰。瘦人多火。煎熬津液。凝结壅蔽。以致气道不利。蓄积成热。热极生
风。亦致僵仆。故曰类中。似与前论稍异。殊不知三贤虽各出一见。开示后学。其言似异。其旨实同。河间以
将息失宜。水不制火。丹溪以东南卑下。湿热生痰。痰热生风。东垣以气虚卒倒。力主培补。究竟真中者亦
由气体虚弱。荣卫失调。然后感于外邪。其因火因气因湿者。亦未必绝无外邪侵侮而作也。若夫外邪侵
侮。则因火因气因湿。各自为症。又何暇为歪僻瘫痪。暴仆暴喑之候乎。乃知古今一理。幸毋岐为二途可也。
火中
风自火出。（易经）故火病多因热生。俗云风者。言末而忘其本也。良由将息失宜。五志过极。心火暴甚。肾水
虚衰。不能制之。则阴虚阳实。热气怫郁而卒倒无知。轻者筋脉虽挛。发过自醒。重者阴气暴绝。阳气后竭
而死。故痰涎者。瘫痪者。口噤者。筋急者。皆为风热之症也。其阴虚者。地黄汤。阴阳两虚者。地黄饮子。若风
火相煽。忽然昏冒。脉洪大。发热恶寒者。防风通圣散。不恶寒反恶热而烦躁者。此风热内郁。宜泻青丸。面
赤昏闷。心神不爽。此心火太旺。牛黄清心丸。若胸闷烦渴。便闭脉大。此火热内盛。宜滚痰丸。（微论）若发热
面赤。脉弦大而虚。足暖者。此肝血虚而肝火旺。宜加味逍遥散。（立斋）均一火。中有虚实不同如此。可不详辨哉。
痰中
东南之人。气温地湿。多湿土生痰。痰生热。热生风。所谓亢则害。承乃制也。故凡卒然麻眩。舌本强直。痰涎
有声。四肢不举。脉象洪滑者。悉属于湿热。重者不醒为痰中。轻者自醒为痰厥。宜导痰汤主之。（丹溪）醒后
见虚症者。清燥汤主之。（东垣）又有酒湿痹症。口 眼斜。舌强肢废。浑似中风。当泻湿毒。从微汗微下之法。
（元戎）其脉滑数。或沉弦而数。口角流涎。偏枯口噤者。皆痰热在内。上溢于阳明也。筋挛急者。痰凝不利也。
筋反纵者。血液衰耗也。然筋挛易愈。筋痿难复。（立斋）
气中
恚怒太过。逆气上升。每多卒厥。有类暴中。牙关紧闭。身冷脉沉。口无痰沫。此为中气。与中风身温脉浮。口
多涎沫为异耳。若作风治则误。宜八味顺气散。（许学士）重者竹沥姜汁。调苏合香丸。经言。无故而喑。脉不至
者。不治自愈。谓气暴逆也。气复则已。此乃轻症。若重者。亦见五绝。死。（汇补）少壮之人。真水未竭。适因怒动
肝火。火畏水而不能上升。所以身凉无痰涎。其须臾自醒者。水旺足以制火也。此名中气。衰老之人。真水
已竭。适因怒动肝火。火寡于畏。得以上升。所以身温有痰涎。其多不能治者。水竭无以降火也。此名中痰。
然少壮亦有不治者。男子色欲过度。女人胎产经后。血弱水亏。忿怒动火。阳无所附。则随火而发越。可不
谅其根本乎。（绳山）
食中
饮食醉饱之后。或感风寒。或着恼怒。食填太阴。胃气不行。须臾厥逆。昏迷不醒。口喑肢废。绝似中风。但气
口急盛。或沉伏。非比中风。左脉浮盛。若作中风中气治之。必死。宜盐汤探吐。吐不出者死。吐后无别症者。
平胃散调理。（杂着）大抵忽然仆倒。不可即断是风。须审其曾着怒气否。曾用饮食否。若系饮食前后感气
而发者。藿香正气散。（茭山）
情志
神伤于思虑则肉脱。意伤于忧愁则肢废。魂伤于悲哀则筋挛。魄伤于喜乐则皮槁。志伤于盛怒则腰脊
难以俯仰也。（经文）此情志所伤。而有似于中腑中经之风症。宜调荣养血。不可用风药。昔有孀妇。十指蜷
挛。掌重莫举。肌肤疮驳。风药杂进。绝不奏效。竟以舒郁结调气血药而愈者。不可不知。（立斋）
似中风选方
地黄饮子（宣明）治舌痿不能言。足痿不能行。肾弱气厥。不至舌下。
熟地 巴戟（去心） 山茱萸（去核） 肉苁蓉（酒浸焙） 石斛 附子（炮）
五味子 白茯苓 菖蒲 远志（炮去心） 官桂 麦门冬（去心各等分）
为末。每服三钱。生姜五片。枣一枚。薄荷七分。水一盏。煎服。
防风通圣散（河间） 治中风。风热之剂。
防风 川芎 当归 芍药 大黄 薄荷 麻黄 连翘 芒硝（各四分） 石膏 黄芩 桔梗（各八分）
滑石（二钱四分） 甘草（一钱） 荆芥（三分） 白术（炒三分） 栀子（三分）
为粗末。加生姜三片。水煎服。自利。去硝黄。自汗。去麻黄。
解利伤寒两感。每两加益元散一两。葱白十茎。豆豉一撮。姜五片。水煎。
牛黄清心丸（和剂）
白芍药 麦门冬 黄芩 当归 防风 白术 柴胡 桔梗 川芎 茯苓 杏仁（麸炒各一两二钱） 神曲
蒲黄 人参（各二两半） 羚羊角 麝香 龙脑 肉桂 大豆黄卷（碎炒） 阿胶（炒各一两七钱半） 白蔹 干姜（炮
各七钱半） 牛黄（研一两二钱） 犀角（二两） 雄黄（研飞八钱） 山药（七两） 甘草（五两） 金箔（一千二
百片内四百片为衣） 大枣（一百枚蒸捣）
各为末。炼蜜和枣膏为丸。每丸重一钱。金箔为衣。温水化下。
导痰汤（济生）
半夏（四两） 南星（炮） 枳实（麸炒） 赤茯苓 橘红（各一两） 甘草（炙五钱）
每服四钱。水一盏。姜十片。煎服。
清燥汤（东垣）
黄 （钱半） 黄连 苍术 白术（各一钱） 陈皮（五分） 五味子（九粒） 人参 白茯苓 升麻（各三分） 当
归（一钱二分） 泽泻（五分） 柴胡 麦冬 生地 神曲（炒） 猪苓 黄柏（酒炒） 甘草（炙各二分）
每服半两。水煎。
八味顺气散
人参 白术 陈皮 茯苓 青皮 白芷 乌药（各一两） 炙草（五钱）
为末。每服三钱。水煎。
苏合香丸 治中风中气。牙紧不省。及邪祟症。
白术 青木香 乌犀角 香附（炒） 朱砂（研水飞） 诃黎勒（煨去皮）
檀香 安息香（另末酒熬膏） 沉香 麝香（研） 丁香 荜茇（各二两）
龙脑（研） 苏合香油（入安息香膏内） 薰陆香（别研一两）
为末。入安息香膏。加炼蜜。丸如桐子大。每服四丸。水下。
平胃散（方见暑症） 藿香正气散（方见霍乱） 滚痰丸（方见痰症） 泻青丸（方见火症）
Zhongfeng (Stroke) has distinctions between Zhenzhong (True Stroke, caused by external pathogenic factors) and Leizhong (Resembling Stroke, caused by internal imbalances). Historically, some differentiated treatments based on geographical North-South divisions, but this merely reflects the distinction between Ben (Root/Cause) and Biao (Branch/Symptom); essentially, there are not two separate paths. Just as with all diseases, there are causes and manifestations. The cause is the Root, and the manifestation is the Branch. Ancient scholars discussed only the manifestations; later, three eminent physicians (Liu Wansu, Zhu Danxi, Li Dongyuan) analyzed the causes.
Because the Northwest has high, cold terrain and fierce wind Qi, human Zhengqi (Upright Qi/Vital Energy) becomes deficient, making one susceptible to sudden invasion by external pathogens, termed "Zhenzhong." This was detailed earlier. In contrast, south of the Yangtze River, including Zhejiang, Fujian, and Yunnan, the climatic Qi differs, and human constitutions vary. Fat individuals have Yang Qi floating on the surface, while thin individuals have Yin deficiency internally. Fat people tend to have Phlegm-Dampness; thin people tend to have Internal Fire. Fire scours body fluids, causing Phlegm to coagulate and obstruct, leading to blocked Qi pathways. Accumulated heat generates extreme heat, which produces Wind, also resulting in sudden collapse and stiffness. Thus, it is called "Leizhong." This seems slightly different from previous theories, yet the three physicians, though offering unique insights to guide students, had similar intents despite differing words.
Liu Wansu attributed it to improper lifestyle, where Kidney Water fails to control Heart Fire. Zhu Danxi attributed it to the damp, low terrain of the Southeast generating Damp-Heat and Phlegm, which generates Wind. Li Dongyuan attributed sudden collapse to Qi deficiency, advocating strong tonification. Ultimately, even Zhenzhong arises from weak Ying and Wei (Nutritive and Defensive Qi), leading to susceptibility to external pathogens. Conditions caused by Fire, Qi stagnation, or Dampness may also involve external pathogenic invasions. If it were purely external invasion, the symptoms would differ from those caused by Fire, Qi, or Dampness alone, and would not necessarily present as typical stroke symptoms like facial deviation, paralysis, sudden collapse, or aphasia. Therefore, ancient and modern principles align; do not divide them into opposing schools.
[Fire Zhong]
Wind originates from Fire. (*I Ching*) Thus, Fire diseases often arise from Heat. The common term "Wind" refers to the branch, forgetting the root. This is usually due to improper lifestyle and extreme emotional excess, causing Heart Fire to surge violently while Kidney Water declines, failing to control it. This results in Yin deficiency and Yang excess, with stagnant Heat leading to sudden collapse and unconsciousness. Mild cases involve muscle spasms that resolve upon waking; severe cases involve sudden exhaustion of Yin Qi and subsequent death from Yang depletion. Symptoms such as excessive phlegm, paralysis, locked jaw, and tendon tension belong to Wind-Heat syndromes. For Yin deficiency, use Dihuang Tang (Rehmannia Decoction). For both Yin and Yang deficiency, use Dihuang Yinzi (Dihuang Infusion). If Wind and Fire stir each other, causing sudden dizziness, with a surging pulse, fever, and aversion to cold, use Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder). If there is no aversion to cold but rather heat intolerance and irritability, indicating internal stagnation of Wind-Heat, use Xieqing Wan (Drain the Green Pill). Red face, drowsiness, and mental unrest indicate excessive Heart Fire; use Niuhuang Qingxin Wan (Calves' Gallbladder Clearing Heart Pill). Chest fullness, thirst, constipation, and a large pulse indicate internal excess of Fire-Heat; use Guntan Wan (Rolling Phlegm Pill). (*Wei Lun*) Fever, red face, wiry-large-deficient pulse, and warm feet indicate Liver Blood deficiency with vigorous Liver Fire; use Jiawei Xiaoyao San (Modified Free Wanderer Powder). (*Li Zhai*) Even among Fire syndromes, there are Deficiency and Excess differences; careful differentiation is essential.
[Tan Zhong]
People in the Southeast live in warm, humid climates, prone to Spleen Earth generating Phlegm, which generates Heat, then Wind. This follows the principle: "When things reach an extreme, they become harmful; only then is there regulation." Sudden numbness, dizziness, stiff tongue, audible phlegm rattle, inability to move limbs, and a surging-slippery pulse all belong to Damp-Heat. Severe cases result in coma, termed "Tan Zhong"; mild cases involve spontaneous awakening, termed "Tan Jue" (Phlegm Syncope). Treat primarily with Daotan Tang (Guiding Phlegm Decoction). (*Danxi*) If deficiency signs appear after awakening, treat with Qingzao Tang (Clearing Dryness Decoction). (*Dongyuan*) Alcohol-induced Bi syndrome presents with facial deviation, stiff tongue, and limb dysfunction, resembling stroke. It requires draining Damp-Toxicity via mild sweating and purgation. (*Yuanrong*) Slippery-rapid or deep-wiry-rapid pulses, drooling, hemiplegia, and locked jaw indicate internal Phlegm-Heat overflowing into the Yangming Meridian. Tendon tension indicates Phlegm obstruction; tendon flaccidity indicates Blood depletion. Tension is easier to cure than flaccidity. (*Li Zhai*)
[Qi Zhong]
Excessive anger causes rebellious Qi to rise, often leading to sudden syncope resembling acute stroke. Symptoms include locked jaw, cold body, deep pulse, and absence of phlegm foam. This is "Zhong Qi," distinct from Zhong Feng (stroke), which features warm body, floating pulse, and excessive saliva. Treating Zhong Qi as Zhong Feng is an error. Use Bawei Shunqi San (Eight-Ingredient Regulating Qi Powder). (*Xu Xueshi*) Severe cases: mix Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice) with Suhexiang Wan (Styrax Pill). Classics state: "Aphasia without cause and absent pulse heals spontaneously" because sudden Qi rebellion resolves when Qi returns. This is a mild case. Severe cases may show Five Extinctions signs and lead to death. (*Huibui*) Young adults with intact True Water may experience Liver Fire stirred by anger; since Fire fears Water, it cannot ascend, resulting in cool body and no phlegm, with spontaneous awakening due to Water controlling Fire. This is Zhong Qi. Elderly people with depleted True Water experience Liver Fire rising uncontrollably, resulting in warm body and phlegm, often untreatable due to lack of Water to descend Fire. This is Zhong Tan. However, young men with excessive sexual activity or women post-partum/post-menstruation with weak Blood and deficient Water may suffer from anger-stirred Fire where Yang has no anchor and floats away. One must consider the root constitution. (*Shengshan*)
[Shi Zhong]
After overeating or drunkenness, combined with Cold-Wind exposure or anger, food stagnates in the Taiyin Spleen, blocking Stomach Qi. Sudden syncope, coma, aphasia, and limb dysfunction occur, mimicking stroke. However, the Cun Kou (Radial) pulse is rapid/full or deep-hidden, unlike the floating Left pulse of stroke. Treating as stroke or Qi strike is fatal. Use Yan Tang Tan Tu (Salt Soup Induced Vomiting). Death if vomiting fails. Post-vomit, if no other symptoms, regulate with Pingwei San (Peaceful Stomach Powder). (*Zazhuo*) Generally, sudden collapse should not be immediately diagnosed as Wind. Investigate recent anger or dietary indiscretion. If triggered by Qi disturbance around eating, use Huoxiang Zhengqi San (Agarwood Regulating Qi Powder). (*Jiaoshan*)
[Qingzhi - Emotional Injury]
Mental injury from overthinking wastes flesh; Yi (Intellect) injury from sorrow wastes limbs; Hun (Ethereal Soul) injury from grief contracts sinews; Po (Corporeal Soul) injury from excessive joy withers skin; Zhi (Willpower) injury from rage stiffens waist and spine. (*Classic Text*) These emotional injuries mimic Zhong Fu (Stroke of the Organs) or Zhong Jing (Stroke of the Collaterals). Treat by regulating Ying and nourishing Blood; do not use Wind-dispelling herbs. A widow once suffered curled fingers, heavy palms, and skin lesions. Various Wind herbs failed. She recovered only after using herbs to soothe depression and regulate Qi/Blood. (*Li Zhai*)
[Selected Formulas for Resembling Stroke]
**Dihuang Yinzi** (*Xuanming Lun*)
Treats tongue atrophy with aphasia, leg atrophy with immobility, weak Kidney Qi, and failure of essence to reach the tongue base.
Ingredients: Shudi (Prepared Rehmannia Root), Bajitian (Morinda Officinalis Root), Shanzhuyu (Cornus Fruit), Rongrong (Cistanche Stem), Shihu (Dendrobium Stem), Fuzi (Prepared Aconite Root), Wuweizi (Schisandra Fruit), Baifuling (Poria), Changpu (Acorus Rhizome), Yuanzhi (Polygala Root), Guigui (Cinnamon Bark), Maimendong (Ophiopogon Tuber). Equal parts.
Directions: Powder. Take 3 qian per dose. Add 5 slices of fresh ginger, 1 jujube, 7 fen of mint. Decoct in 1 sheng water.
**Fangfeng Tongsheng San** (*Hejian*)
Treats stroke, Wind-Heat formula.
Ingredients: Fangfeng (Saposhnikovia Root), Chuanxiong (Ligusticum Rhizome), Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Dahuang (Rhubarb Rhizome), Bohe (Mint Leaf), Mahuang (Ephedra Stem), Lianqiao (Forsythia Fruit), Mangxiao (Mirabilite). Each 4 fen. Shigao (Gypsum), Huangqin (Scutellaria Root), Jiegeng (Platycodon Root). Each 8 fen. Huashi (Talcum). 2 qian 4 fen. Gancao (Licorice Root). 1 qian. Jingjie (Schizonepeta Spikelet). 3 fen. Baizhu (Atractylodes Rhizome, stir-fried). 3 fen. Zhizi (Gardenia Fruit). 3 fen.
Directions: Coarse powder. Add 3 slices of ginger. Decoct in water. If diarrhea occurs, remove Mangxiao and Dahuang. If spontaneous sweating occurs, remove Mahuang.
For treating Shaoyang-Taiyang simultaneous contraction (Cold Damage): Add 1 liang of Yiyuan San per 2 liang of formula. Add 10 stems of Congbai (Green Onion White), 1 cuo of Douchi (Fermented Soybean), 5 slices of ginger. Decoct.
**Niuhuang Qingxin Wan** (*Heji Ju Fang*)
Ingredients: Baishaoyao (White Peony Root), Maimendong, Huangqin, Danggui, Fangfeng, Baizhu, Chaihu (Bupleurum Root), Jiegeng, Chuanxiong, Fuling, Xingren (Apricot Seed, bran-fried). Each 1 liang 2 qian. Shenqu (Medicated Leaven), Puhuang (Typha Pollen), Renshen (Ginseng Root). Each 2 liang 5 qian. Lingyangjiao (Antelope Horn), Shexiang (Musk), Longnao (Borneol), Rougui (Cinnamon Bark), Dadouhuangjuan (Soja Glycines Sprout, crushed and fried), Ejiao (Donkey-hide Gelatin, fried). Each 1 liang 7 qian 5 fen. Bailian (Belamcanda Rhizome), Ganjiang (Dried Ginger, prepared). Each 7 qian 5 fen. Niuhuang (Calves' Gallstone, ground). 1 liang 2 qian. Xijiao (Rhino Horn). 2 liang. Xionghuang (Realgar, ground and floated). 8 qian. Shanyao (Dioscorea Rhizome). 7 liang. Gancao (Licorice Root). 5 liang. Jinbo (Gold Foil). 1200 pieces (400 for coating). Dazao (Jujube, steamed and mashed). 100 pieces.
Directions: Grind all to powder. Mix with refined honey and jujube paste to form pills. Each pill weighs 1 qian. Coat with gold foil. Dissolve in warm water and take.
**Daotan Tang** (*Jisheng Fang*)
Ingredients: Banxia (Pinellia Tuber, 4 liang), Nanxing (Arisaema Tuber, prepared), Zhishi (Immature Bitter Orange, bran-fried), Chi Fuling (Red Poria), Juhong (Citrus Peel). Each 1 liang. Gancao (Licorice Root, honey-fried). 5 qian.
Directions: Take 4 qian per dose. Decoct in 1 sheng water with 10 slices of ginger.
**Qingzao Tang** (*Dongyuan*)
Ingredients: Huangqi (Astragalus Root). 1 qian 5 fen. Huanglian (Coptis Rhizome), Cangzhu (Atractylodes Lancea Rhizome), Baizhu. Each 1 qian. Chenpi (Aged Tangerine Peel). 5 fen. Wuweizi (Schisandra Fruit). 9 grains. Renshen, Baifuling, Shengma (Cimicifuga Rhizome). Each 3 fen. Danggui. 1 qian 2 fen. Zexie (Alisma Rhizome). 5 fen. Chaihu, Maidong (Ophiopogon Tuber), Shengdi (Rehmannia Root), Shenqu (Medicated Leaven, fried), Zhuling (Polyporus), Huangbai (Phellodendron Bark, wine-fried), Gancao (Licorice Root, honey-fried). Each 2 fen.
Directions: Take 0.5 liang per dose. Decoct in water.
**Bawei Shunqi San**
Ingredients: Renshen, Baizhu, Chenpi, Fuling, Qingpi (Young Bitter Orange), Baizhi (Angelica Dahurica Root), Wuyao (Lindera Root). Each 1 liang. Zhi Cao (Honey-fried Licorice Root). 5 qian.
Directions: Powder. Take 3 qian per dose. Decoct in water.
**Suhexiang Wan**
Treats stroke and Qi strike causing locked jaw and unconsciousness, and evil spirit disorders.
Ingredients: Baizhu, Qingmuxiang (Aquilaria Wood), Wuxijiao (Black Rhino Horn), Xiangfu (Cyperus Rhizome, fried), Zhusha (Cinnabar, ground and floated), Helile (Chebula Fruit, baked and peeled), Tanxiang (Sandalwood), Anshixiang (Styrax, separately ground and boiled in wine to paste), Chenxiang (Agarwood), Shexiang (Musk, ground), Dingxiang (Clove), Bibo (Long Pepper Fruit). Each 2 liang. Longnao (Borneol, ground). Suhe Xiangyou (Styrax Oil, added to Anshixiang paste). Xunluxiang (Frankincense, separately ground). 1 liang.
Directions: Grind to powder. Mix with Anshixiang paste and refined honey. Form pills sized like paulownia seeds. Take 4 pills with water.
Pingwei San (See Summerheat section), Huoxiang Zhengqi San (See Cholera section), Guntan Wan (See Phlegm section), Xieqing Wan (See Fire section).