《素问·风论》黄帝问曰∶风之伤人也,或为寒热,或为热中,或为寒中,或为疠风
,或为
偏枯,(滑云∶枯当作风。)或(当作均)。为风也。其病各异,其名不同。或内至五脏六腑,
不知其
解,愿闻其说。岐伯曰∶风气藏于皮肤之间,内不得通,外不得泄。风者善行而数变,腠理
开则洒然寒,闭则热而闷,其寒也,则衰食饮。其热也,则消肌肉。故使人 而不能食,
名曰
寒热。( 音突,忽忘也。又音退。栗,寒战也。)风气与阳明入胃,循脉而上至目内 。
其人
肥则风气不得外泄,则为热中。而目黄人瘦则外泄而寒,则为寒中,而泣出。风气与太阳俱
入行诸脉俞,散于分肉之间,与卫气相干,其道不利,故使肉 (音忿真。)而有疡。卫
气
有所凝而不行,故其肉即不仁也。疠者有(疑当作因)。荣气热 ,(腐同)。其气不清,故
使鼻柱坏
而色败,皮肤疡溃,风寒客于脉而不去,名曰疠风。(滑云∶此当在上收假疠者上)。或曰名
寒热
。(五字疑衍。)以春甲乙伤于风者为肝风,以夏丙丁伤于风者为心风,以季夏戊己伤于风者
为
脾风,以秋庚辛中于邪者为肺风,以冬壬癸中于邪者为肾风。风中五脏六腑之俞,亦为脏腑
之风,各入其门户所中,则为偏风。风气循风府而上,则为脑风。风入系头,则为目风眼寒
。饮酒
中风,则为漏风。入房汗出中风,(书云∶中右为真气已绝,较中左更深,余尝治右偏类中
数人,皆用养血祛风,佐以化痰利湿而愈。已于《治验录》详言之,参观即知。)则为内风
。新沐
中风,则为首风。久风入中,则肠风飧泄。外在腠理,则为泄风。故风者,百病之长也。至
其变化,乃
为他病也。无常方,然致有(当作皆)风气也。帝曰∶五脏风之形状不同者何?愿闻其诊,及
其病态。岐伯曰∶肺风之状,多汗恶风,色 然白,时咳短气,书昼日则瘥,暮则甚。诊
在眉上
,其色白。(仲景云∶肺中风者,口燥而唾,身晕而重,冒而肿胀。)心风之状,多汗恶风,
焦绝
善怒哧,赤色,病甚则言不可快。诊在口,其色赤。(仲景云∶心中风者,翕翕发热,不能
起
,心中饥,食则呕。)肝风之状,多汗恶风,善悲,色微苍,嗌干善怒,憎女子。诊在目
下,
其色青。(仲景云∶肝中风者,头目 ,反胁痛,常呕,令人嗜甘。)脾风之状,多汗恶风,
身体
怠惰,四肢不欲动,色薄微黄,不嗜食。论在鼻上,其色黄。(仲景云∶脾中风者,翕翕发
热,形如醉人,肢中烦重,目皮 而短气。)肾风之状,多汗恶风,面庞然浮肿,脊痛不
能正立
,其色炱,隐曲不利,诊在肌上,其色黑。(《奇病论》云∶有庞然如水状,切其脉大紧,
身无
痛处,形不瘦,不能食,食少。名为何病?岐伯对曰∶病生在肾,名为肾风。不能食,善惊而心
气痿者死。)胃风之状,颈多汗恶风,饮食不下。膈塞不通,腹善满,失衣则 胀,食寒则泄。
论形瘦而腹大。首风之状,头面多汗,恶风。当先风一日,则病甚头痛,不可以出内,至风日则痛
少愈。漏风之状,或多汗,常不可单衣,食则汗出,甚则身汗,喘息恶风,衣常濡,口干
善渴
,不能劳事。泄风之状多汗,汗出泄衣上,口中干,上渍其风,不能劳事,身体尽痛则寒。
中风最宜辨闭脱二症,闭症宜开,脱症宜固,惟当辨其脉虚大以为别。至于闭症气塞,
亦有六脉俱绝者,不得以其无脉而误认为脱症也。
中风将发预防之方
黄 (蜜炙,五钱) 防风(一钱五分) 人参(一钱五分) 橘红(一钱) 归身(酒洗,二
钱五分) 木通(二钱五分) 山栀(一钱) 甘草(五分) 红花(三分)。
脾胃虚弱,语言无力,再加人参三钱,干山药一钱五分,薏仁二钱,白术一钱
。内热加
山栀至二钱,仍多啖悉尼妙。渴加麦冬二钱五分,五味子五分。眩晕加明天麻一
钱。痰多而晕,更加旋复花五分;脚膝麻痹无力,加杜仲姜汁炒去丝,牛膝,酒浸,石
斛,酒浸,
各一钱五分。夜卧不安,或多惊恐,心神不宁,加炒酸枣仁,茯神各一钱五分。上用水
二钟,煎至一钟,入竹沥一杯,梨汁一匙,温服无时。
方书每以六经形证为定法,用小续命汤加减。岂不知《内经》云∶风为百病之长,善行
而数变,必审十二经见证,庶无实实虚虚之诮矣。
中风将发之前,未有不内热者。热极生风,能令母实,故先辈谓以火为本,以风为标,
治法先
以降心火为主,心火既降,肝木自平矣。此实则泄其子之法也。若作风治而以辛热之药疏之
者,固贻害不小,而调气一法,亦百无一验,明者更精思之。
《太平广记》载∶唐·梁新见一朝士诊之曰∶风疾已深,请速归去。其朝士复见 州马
医赵鄂,乃
复诊之,言疾危与梁说同矣。曰∶只有一法,请官人试吃消梨,不限多少,咀 不及,绞汁
而饮。到家旬日,惟吃消梨首爽矣。此亦降火除热之验也。《本草》云∶有士人病危,
诸治不应,遂就诊杨吉老。令服悉尼担余而瘳,与此朝士相仿佛。
卒中之初,有决不可吐者,有决不可进辛剂,即姜汤亦禁用者,不可不知。
今人治五脏气绝,口开手撒,眼合遗尿,鼻声如鼾,昔人所不治者,以大剂参、 浓汤
灌之,多
有得生者。可见世无不可医之证,而昔人徒认此证为有余,不知其不足,见投之以顺气疏风
之药,往往长逝。(顺气疏风而妄损元真,岂可不明辨以悟人哉。)遂目为气绝不治之候也。
则其他之为虚症,而为医所误,或幸而获痊,或不幸而毙者,可胜计哉。
每见时师初用八味顺气散,多不得效。(八味顺气散为治痰多实证之方,涉虚者是抱薪
救火。
今人不辨虚实,以为治风主剂,则遗误非浅,今特正之。)已而用二陈,四物,加胆星、天麻之类,自谓
稳当之极,可以久而奏功,而亦竟无一效,何也?盖妄以南星、半夏为化痰之药,当归、川芎为
生血之剂,而泥于成方,变通无法故也。正不知通血脉,助真元,非大剂人参不可,而有痰
者,惟
宜竹沥,少加姜汁佐之。不宜轻用燥剂。至于归、地甘粘,能滞脾气,使脾精不运,何以能
愈瘫
缓。岂若人参出阳入阴,少则留而多则宜无所不达哉?其能通血脉,虽明载《本草》,人谁
信之。
里中一老医,右手足废,不起于床者二年矣。人传其不起,过数月,遇诸途。讯之,曰
∶吾之病几
危矣,始服顺气行痰之药,了地无应验。薄暮神志辄昏,度不可支,令家人煎进十全大补汤
,即觉清
明。遂日服之,浃数月,能扶策而起,无何,又能拾策而步矣。经云∶邪之所凑,其气必虚
。吾
治其虚,不理其邪,而邪自去,吾所以获全也。余曰∶有是哉,使进顺气疏风之药不辍者,
墓木
拱矣。然此犹拘于成方,不能因病而变通,随时而消息,故奏功稍迟。吾早为之,当不止是
也。姑书之以俟明者采焉。
此老始亦服顺气疏风,病延载余,继因病久年老气虚,试服补剂而有效。遂日进一帖,
沉若失,遂保其身。然亦不幸之幸,执方治病,病必殆是也。
In the *Suwen: Feng Lun* (Treatise on Wind in the Basic Questions), the Yellow Emperor asked: When wind pathogen injures the human body, it may manifest as cold-heat alternation, heat in the middle jiao, cold in the middle jiao, leprosy (Lifeng), hemiplegia (Piangu), or generalized pain. All are caused by wind. Their symptoms vary, and their names differ. Some penetrate deeply into the five zang and six fu organs. I do not understand the mechanism; I wish to hear your explanation. Qibo replied: The wind pathogen lodges between the skin and muscles. It cannot circulate inward nor be excreted outward. Wind is agile and changes rapidly. When the couli (pores) open, one feels chilly; when they close, one feels feverish and stifled. The chilliness leads to decreased appetite; the heatiness consumes muscle tissue. Thus, the person becomes emaciated and unable to eat, a condition named Cold-Heat (*Hanre*). If wind follows the Yangming meridian into the stomach and ascends along the vessels to the inner canthus of the eye: if the person is obese, the wind cannot be excreted outward, resulting in Heat in the Middle Jiao (*Rezhong*) with yellowing of the eyes; if the person is thin, the wind is excreted outward, manifesting as cold, resulting in Cold in the Middle Jiao (*Hanzhong*) with tearing. If wind enters together with the Taiyang meridian, traveling through the shu points of various vessels and scattering between the muscle layers, interfering with Wei Qi (Defensive Qi), causing obstruction in its pathway, the flesh swells and develops sores. If Wei Qi stagnates and fails to circulate, that area of flesh becomes insensible (*Buren*). In cases of Leprosy (*Lifeng*), Ying Qi (Nutritive Qi) is hot and turbid, causing nasal collapse, facial discoloration, and skin ulcers. This is due to wind-cold lodging in the vessels and not departing. In spring on Jia-Yi days, injury by wind is called Liver Wind; in summer on Bing-Ding days, Heart Wind; in late summer on Wu-Ji days, Spleen Wind; in autumn on Geng-Xin days, Lung Wind; in winter on Ren-Gui days, Kidney Wind. Wind entering the shu points of the zang-fu organs causes Wind of the respective organs. Entering through specific portals, it causes Biased Wind (*Pianfeng*). Ascending via the Fengfu point, it causes Brain Wind (*Naofeng*). Entering the head connections, it causes Eye Wind (*Mufeng*). Wind after drinking alcohol causes Leakage Wind (*Loufeng*). Wind after sexual intercourse with sweating causes Internal Wind (*Neifeng*). Wind after washing hair causes Head Wind (*Shoufeng*). Long-standing wind entering the interior causes Intestinal Wind (*Changfeng*) with undigested stool diarrhea. Wind lingering at the couli causes Leakage Wind (*Xiefeng*). Therefore, wind is the chief of all diseases. Its transformations lead to other illnesses without fixed patterns, yet always originating from wind. The Emperor asked: What are the different manifestations of wind affecting the five zang? I wish to know the diagnostic signs and pathological states. Qibo said: Lung Wind presents with profuse sweating, aversion to wind, pale complexion, frequent cough, shortness of breath, improving during the day and worsening at night. Diagnosis is at the supraorbital region, showing white color. Heart Wind presents with profuse sweating, aversion to wind, dry lips, irritability, red complexion, and slurred speech when severe. Diagnosis is at the mouth, showing red color. Liver Wind presents with profuse sweating, aversion to wind, sadness, bluish complexion, dry throat, irritability, and aversion to women. Diagnosis is below the eyes, showing green color. Spleen Wind presents with profuse sweating, aversion to wind, lethargy, desire to remain inactive, sallow complexion, and poor appetite. Diagnosis is on the nose, showing yellow color. Kidney Wind presents with profuse sweating, aversion to wind, puffy face resembling edema, back pain preventing upright standing, dark complexion, and difficulty urinating. Diagnosis is on the muscles, showing black color. Stomach Wind presents with sweating on the neck, aversion to wind, dysphagia, chest fullness, abdominal distension worsened by cold clothing or cold food, and diarrhea. The body is emaciated while the abdomen is distended. Head Wind presents with sweating on the head and face, aversion to wind, headache worsening before windy days and improving on windy days. Leakage Wind presents with profuse sweating, inability to wear single clothes, sweating upon eating, severe whole-body sweating, panting, aversion to wind, wet clothes, dry mouth, thirst, and inability to perform labor. Leakage Wind (*Xiefeng*) presents with profuse sweating soaking clothes, dry mouth, wind invading from above, inability to perform labor, and generalized body pain with chills.
In stroke, it is crucial to distinguish between Closed Syndrome (*Bizheng*) and Collapsed Syndrome (*Tuozheng*). Closed syndrome requires opening methods; collapsed syndrome requires securing methods. Differentiation relies on identifying a deficient and large pulse. Even in closed syndrome with qi blockage, the six pulses may be imperceptible; one must not mistake this for collapsed syndrome due to the absence of pulse.
**Prescription for Preventing Impending Stroke:**
Astragali Radix Huangqi (honey-fried, 5 qian), Saposhnikoviae Radix Fangfeng (1.5 qian), Ginseng Radix Renshen (1.5 qian), Citri Reticulatae Pericarpium Juhong (1 qian), Angelicae Sinensis Radix Danggui Shen (wine-washed, 2.5 qian), Akebiae Caulis Mutong (2.5 qian), Gardeniae Fructus Zhizi (1 qian), Glycyrrhizae Radix et Rhizoma Gancao (0.5 qian), Carthami Flos Honghua (0.3 qian).
For Spleen-Stomach deficiency with weak voice, add Ginseng Radix Renshen (3 qian), Dioscoreae Rhizoma Shanyao (1.5 qian), Coicis Semen Yiren (2 qian), Atractylodis Macrocephalae Rhizoma Baizhu (1 qian). For internal heat, increase Zhizi to 2 qian and consume more snow pears. For thirst, add Ophiopogonis Radix Maidong (2.5 qian), Schisandrae Fructus Wuzhiwei (0.5 qian). For vertigo, add Gastrodiae Rhizoma Tianma (1 qian). For phlegm-dizziness, add Inulae Flos Xuanfuhua (0.5 qian). For numbness and weakness in legs and knees, add Eucommiae Cortex Duzhong (processed with ginger juice), Achyranthis Bidentatae Radix Niuxi (wine-soaked), Dendrobii Caulis Shihu (wine-soaked), each 1.5 qian. For restless sleep, fright, and unsettled mind, add Ziziphi Spinosomi Semen Suanzaoren (stir-fried) and Poria Fu Shen, each 1.5 qian. Decoct these ingredients in two units of water until one unit remains. Add one cup of Bamboo Juice Zhuli and one spoonful of Pear Juice Lizhi. Take warm at any time.
Medical texts often fixate on Six Meridian syndromes, using modifications of Xiao Xuming Tang. They fail to realize that *Neijing* states wind is the chief of all diseases, agile and changeable. One must examine the manifestations of the twelve meridians to avoid errors of reinforcing excess or draining deficiency.
Before stroke onset, internal heat is invariably present. Extreme heat generates wind, causing the mother organ to become excessive. Hence, ancestors viewed fire as the root and wind as the branch. Treatment prioritizes descending Heart Fire; once Heart Fire descends, Liver Wood calms naturally. This is the method of draining the son when there is excess. Treating it as wind with acrid-hot dispersants causes harm. Qi-regulating methods also rarely succeed. Wise practitioners should ponder this deeply.
*Tai Ping Guang Ji* records: Liang Xin diagnosed a court official, saying the wind disease was deep and advised immediate departure. The official consulted Zhao E, a horse doctor in Yangzhou, who confirmed the critical nature. He prescribed consuming unlimited fresh pears, juiced if necessary. After ten days of only eating pears, the official felt refreshed. This verifies the efficacy of descending fire and clearing heat. *Bencao* records a scholar cured by pears under physician Yang Jilao, similar to the official.
In early stroke, vomiting is absolutely contraindicated. Acrid agents, including Ginger Decoction Jiangtang, are strictly forbidden.
Modern physicians treat "Qi Collapse" of the five zang—characterized by open mouth, relaxed hands, closed eyes, urinary incontinence, and snoring—with large doses of Renshen and Fuzi decoctions, often saving patients. This proves no case is incurable. Past physicians mistakenly viewed this as excess rather than deficiency. Using Qi-moving and wind-dispersing drugs often led to death. Thus, it was labeled incurable Qi Collapse. Countless other deficiency cases were misdiagnosed, leading to recovery or death.
Physicians often start with Ba Wei Shunqi San, which usually fails. Ba Wei Shunqi San treats phlegm-excess; using it for deficiency is like adding fuel to fire. Misidentifying it as a primary wind treatment causes grave errors. Subsequently, Er Chen Tang and Si Wu Tang plus Danxing and Tianma are used, claiming stability, yet failing. This is due to blindly using Banxia and Nanxing for phlegm and Danggui and Chuanxiong for blood generation, lacking flexibility. One must recognize that Da Bu Ren Shen is essential to unblock vessels and support True Yuan. For phlegm, Zhuli with少许 Jiangzhi is suitable. Dry agents should be avoided. Danggui and Dihuang are cloying, obstructing Spleen Qi and preventing transformation, thus failing to cure flaccidity. Renshen, entering Yin and Yang, unblocks vessels effectively, though this is often ignored despite being recorded in *Bencao*.
An old physician in my village suffered right-sided paralysis for two years. Rumors of his death proved false. He explained he nearly died after ineffective Qi-moving and phlegm-resolving drugs. Evening confusion prompted him to drink Shiquan Dabu Tang, restoring clarity. Daily use over months allowed him to walk with a cane. As the Classic says: "Where pathogen gathers, Qi is deficient." By treating deficiency and ignoring pathogen directly, the pathogen left. Had he continued wind-dispersing drugs, he would have died. However, sticking to fixed formulas delayed recovery. Early intervention would have been faster. I record this for wise practitioners.
This elder initially took wind-dispersing drugs, prolonging illness for over a year. Later, due to age and Qi deficiency, tonics worked. Daily intake resolved the crisis. Yet, rigid adherence to formulas is dangerous.