治中风昏愦，狂语失音。
白鲜皮 白术 芍药 桂心 川芎 当归 杏仁 防风 甘草 独活 麻黄 茯苓
姜枣同煎。
治中风不省人事，涎鸣反张，失音厥冷。
麻黄 人参 黄芩 川芎 芍药 甘草 杏仁 防己 肉桂（各八分） 防风（一钱） 附
子（泡，去皮、脐，四分） 姜枣水煎服。
治诸般风热，或斑疹不快，热极黑陷，惊风发热，卒中不语。
防风 川芎 当归 薄荷 大黄 芍药 麻黄 连翘 芒硝 石膏 黄芩 桔梗
滑石 山栀 荆芥 白术 甘草 锉散，每服三钱，生姜葱白同煎。
治中风，内有便溺之阻隔，以此导之。
浓朴（姜制） 大黄 枳实 羌活（各等分） 水煎服，微利则已。
人有卒暴僵仆，或偏枯，或四肢不举，或不知人，或死或不死者，世以中风呼之，
方书亦以中风治之，考诸《内经》，则曰∶风者百症之始也∶又曰∶风者百病之长也；
又曰∶风者善行而数变；又曰∶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，或为风，其卒暴僵仆不知人，四肢不举者，并无所论，止有偏枯一语
而已。及观《千金方》则引歧伯曰∶中风大法有四，一曰偏枯，二曰风痱，三曰风懿，
四曰风痹。偏枯者，半身不遂；风痱者，身无痛，四肢不收；风懿者，奄忽不知人；风
痹者，诸痹类风状。《金匮》中风篇曰∶寸口脉浮而紧，紧则为寒，浮则为虚，寒虚相
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，脊重不伸；邪入于腑，则不识
人；邪入于脏，舌即难言，口吐涎沫。由是观之，则知卒暴僵仆不知人，偏枯四肢不举
等症，固为因风而致者矣，故用续命排风等汤治之。及后刘河间、李东垣、朱彦修三贤
者所出之论，始与昔人异矣。河间曰∶中风瘫痪者，非肝木之风实甚而卒中之，亦非外
中于风，由乎将息失宜，心火暴盛，肾水虚衰，不能制之，则阴虚阳实，而热气拂郁，
心神昏冒，筋骨不用，而卒倒无所知也。多因喜怒思悲恐，五志有所过极，而卒中者，
由五志过极，皆为热甚故也。俗云风者，言未而忘其本也。东垣云∶中风者，非外来风
邪，乃本气病也。凡人年遇四旬，气衰之际，或因忧喜忿怒伤其志者，多有此疾，壮
岁之时无有也。若肥盛则间有之，亦是形盛气衰而如此。彦修曰∶西北气寒，为风所
中，诚有之矣。东南气温，而地多湿，有风病者非风也。皆湿土生痰，痰生热，热生风
也。三贤者之论，河间主乎火，东垣主乎气，彦修主乎湿，反以风为虚象，而与昔人
所论大异矣，以三氏为是，则三氏未出之前，固有从昔人而治愈者矣。以昔人为是，
则三氏已出之后，亦有从三氏而治愈者矣。盖昔人三氏之论，皆不可偏废，但三氏以相
类中风之病而立论，故使后人狐疑而莫决，殊不知因于风者，真中风也。因于火，因于
气，因于湿者，类中风而非中风也。如《内经》所谓∶三阴三阳发病，为偏枯痿易，四
肢不举，亦未尝必因于风而后能也。夫风火气湿之殊，望闻问切之间，岂无所辨乎辨之
为风，则从昔人以治，辨之为火气湿，则从三氏以治，如此庶乎，晰理明而用治当矣。
中风一症，轻重有三，治各不同。中血脉者，病在半表半里，外无六经之证，内无
二便之闭，但见口眼 邪，半身作痛，不可过汗，以虚其卫，不可大下，以伤其营，惟
当养血顺气，以大秦艽汤及羌活愈风汤和之。中腑者其病在表，多着四肢，故肢节
废，脉浮恶风，拘急不仁，外有六经之形证，内无便溺之阻隔，宜疏风汤及小续命汤
汗之。中脏者，其病在里，多滞九窍，故唇缓，二便闭，不能言，耳聋鼻塞，目瞀痰涎
昏冒，宜三化汤及麻仁丸下之。然凡中血脉中腑之病，切勿用龙麝牛黄，盖麝香入脾治
肉，牛黄入肝治筋，龙脑入肾治骨，引风深入骨髓，如油入面，莫之能出，且闭症或
宜，脱症深所切忌也。并勿概用大戟、芜花、甘遂，泻大肠大便之药，否则损其阴
血，真气愈虚，何能驱邪出外？
中风之风乃内虚暗风，的系阴阳两虚，而五脏本气自病，为内夺暴厥也。然阴虚者
为更多与外来风邪迥别，急者参 术附，固本为先，缓者顺气化痰，以救其标。补阳养
阴，以固其本。阴甚虚者偏于阴，阳甚虚者偏于阳，阴阳两虚甚者，气血峻补，则虽外
有风候之假象，不治自愈，所谓养也风自灭，盖指内起之风，由于阴虚内起之火耳。
若用辛温风燥之药，焉能活病？徒速其毙。至于丹溪以瘫痪，分左右，别气血，四君四
物为治，皆非至论，盖左半虽血为主，非气以统之则不流，右半虽气为主，非血以丽之
则易散，故肝胆居左，其气常行于右，脾肺居右，其气常行于左，往来灌注，是以生生
不息也。
中络者，邪方入卫，尚在经络之外，故但肌肤不仁。中经则入荣脉之中，骨肉皆失
所养，故身体重着，至中腑、中脏，则离外而内，邪入深矣。中腑必归于胃者，胃为六
腑之总司也。中脏必归于心者，心为神明之主也。风入胃中，胃热必盛，蒸其精液，结
为痰涎，胃之大络入心。痰涎壅盛，堵其出入之窍，故中腑则不识人也。轻者风入胃
中，反倍能食，是风能生热，热能杀谷也。诸脏受邪，迸入于心，则神明无主，故中脏
者，舌纵难言，廉泉开而流涎沫也。廉泉穴在舌下窍，通于肾，津液之所出也。
中风之症，有因外感，有因内伤。言风者外感也。言气言火言痰者，内伤也。然外
感者亦因内有郁热，腠里疏豁，中气不固，暴风得而中之。内伤者，气上逆而为火，火
亢极而生风，风行水动，水涌为痰，故气也火也痰也。其实一源流也。为治之法，外感
者，分中血脉、中腑、中脏之异而治之，渐伤而缓者，先用开关利窍，次用固本调元，
急则只为取本，毋容次第，盖命在须臾，缓则援生不及也。严用和曰∶人之元气强壮，
外邪焉能为害？必真气先虚，荣卫空疏，邪能乘虚而入。若内因七情者，法当调气，不
当治风，即外因六淫者，亦当先救本气，后根据所感六气治之。
肥人多中气，以盛于外而歉于内也。然中气与中风相类，但中风身温有痰涎，多不
能治，中气身凉无痰涎，须臾便醒，何也？盖中风中气，一源流也。皆由忿怒所致，人
之喜怒思悲恐五志，惟怒为甚，所以为病之参也。少壮之人，气血未虚，真水未竭，适
因怒动肝火，火煨于水，不能上升，所以身凉无痰涎，须臾便醒者，水旺足以降火也，
名为中气。许学士云∶暴怒伤阴，暴喜伤阳，忧愁不己，气多厥逆，往往得中气之
症，不可作中风治也。若衰老之人，气血俱虚，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，名为中风。然亦有少
壮而中风不治者，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，而气无所附，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。治法之大概，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，均断不可也。
用药之法，寒因热用，热因寒用，乃正治也。今中风瘫痪之症，本风火阳邪，而用
乌附等热药治之何哉？盖中风瘫痪乃湿痰死血，结滞于脏腑经络之间，非乌附等热药，
焉能开散流通！此非正治，乃从治也。《经》曰∶从少从多，各观其事。则从治之药，只
可为引经而已，况风本于热而生，岂可概谓虚寒？用附子取效者，必中寒阴毒之症，及
肥白人多湿者，丹溪所谓肥白人多湿，少用乌附行经是也。若中风阳毒之症忌之，但至
瘫痪既久，则痰火拂郁。若于辛凉药中而无香热之药为之向导，则将捍格而不能入也。
况此时阳症多系假象，盖真火既已上升而为病矣，有何真阳仍存坎宫而不动耶！能此则
无是病矣。所以乌附为对症之宜，但必兼滋补，便可制其僭热矣。惟中脏阴寒之症，又
宜纯阳，忌用阴药，盖略兼阴药，则阳药便难小效，甚有益令阳亡，诚不思无阴则阳无
以化，当此根据希之阳，能经阴药所化乎？所以参术 附等汤，不入地黄当归者此耳。
一凡饮食如常，但失音不语者，名曰哑风，只宜小续命汤，去附子加石膏、菖蒲各一钱。
一凡国中昏倒，宜急掐人中，俟其苏醒，方用痰药，或用吐法。若脱势急迫，不
能姑待者，急为补精补神补气，以为性命之需，慎勿降火降痰降气，益促丧生之速，河
间、东垣专治本而不治风，可谓至当不易之论，学人必须以阴虚阳虚为主，自后医书杂
出，而使后学狐疑不决。丹溪曰∶有气虚血虚湿痰，左手脉不足及左半身不遂者，以四
物补血，加竹沥、姜汁。右手脉不足，及右半身不遂者，以四君补气，佐以竹沥、姜
汁。如气血两虚而挟痰者，以八物汤加南星、半夏、竹沥、姜汁。平正通达宜人盛宗
之，但持此以治而多不效，何也？盖治气血痰之标，不治气血痰之本也。况气虚气滞而
血脉不能运动者，岂可谓之死血？气血气闭而津液为之凝结者，岂可谓之湿痰？人之四
肢，如木之枝干，人之气血，荣养乎四肢，犹木之浆水，灌溉乎枝叶，木有枝叶，必有
根本，人之气血，岂无根本乎？人有半身不遂，迁延不死者，如木之根本未甚枯，而一
边枝干先萎耳。人有形容肥壮，忽然倒仆而即毙者。如木之根本已绝，其枝叶虽向荣，
犹枯杨生华，何可久也？忽遇大风而摧折，观此则根本之论明矣。气血之根本者何？火
为阳气之根，水为阴血之根，而火与水之总根，两肾间动气是也。此五脏六腑之本，十
二经之源，呼吸之门，三焦之根，又名守邪之神。《经》曰∶根于中者，命曰神机，神
去则机息；根于外者，名曰气立，气止则化绝。今人纵情嗜欲，肾气虚衰，根先绝矣。
一或内伤劳役，六淫七情少触，皆能卒中。此阴虚阳暴绝，即内夺暴厥之症也。须以参
附大剂，峻补其阳，继以地黄丸十补丸之类，填实真阴。又有心火暴甚，肾水虚衰，
兼之五志过极，以致心神昏闷，卒倒无知，其手足牵掣，口眼 邪，乃水不能荣筋，筋
急而纵也。俗云∶风者，乃风淫未疾之假象，风自之出也。须以河间地黄饮子峻补其
阴，继以人参、麦冬、五味子之类，滋其化源，此根阴根阳之至论。若夫所谓痰者何？
独中风为然，要知痰从何处来，痰者，水也，其源出于肾，仲景曰∶气虚痰泛，以肾
气丸补而逐之。观此，凡治中风者，既以前法治其根本，则痰不治而自化矣。惟初时痰
涎壅盛，汤药不入，暂用稀涎散之类，使咽喉疏通，能进汤液即止。若欲尽攻其痰，顷
刻立毙矣。
偏枯者，本乎精神内耗不足，而气血不能周及也。然不足之中，略有虚实之别，
《经》所谓土太过则敦阜，令人四肢不遂，症之实者也，其治当泻不当补。又有脾胃虚
弱，水谷之精气不周，气血偏虚，为邪所中，症之虚者也，其治当补不当泻。虚者正
气虚，实者邪气实，泻者泻其邪，补者补其正。又名之左瘫右痪者，盖气顺血涩则为瘫
疯。瘫疯者，筋脉拘急拳挛也。血顺气虚，则为痪疯，痪疯者，抬动不能也。瘫者，坦
也。筋脉弛纵，坦然不举。痪者，涣也。血气散漫，涣然不收。求本以论，总皆气血不
足，亦不必以左右分，而以湿痰死血为定论。至于拘挛，则急多而缓少、乃寒多而热
少，《经》所谓寒则筋挛是也。其治莫如养血温经，使阳气以和柔之，阴津以灌溉之，
如补中汤加附子，六味丸加肉桂，附子行参 之力，而阳和自转，肉桂通行血脉，而筋
节自荣。其螈 者，或伸或缩，而动不止，火之象也，本于肝家风热火燥，搏于筋络，
则手足为之抽搐，《经》曰∶火郁之发，民病螈 是也。虽然亦有寒伤荣，血凝而拘急
者；有热伤荣，血燥筋枯而拘急者；有寒伤卫，气虚不能摄而弛纵者；有热伤卫，筋软
不收而弛纵者，当兼脉候辨之。大概不外乎血虚不能荣筋，而燥气乘之，故其治亦不外
乎滋补肝肾，灌溉筋脉，俾水旺火息，风
木自平也。然治之即愈则可，若延久治之，则经脉闭塞，药力难以流通，便成痼疾矣。
舌喑者，中风而舌不转运，舌强不能言是也。经曰∶喉咙者，气之所以上下。会厌
者，声音之户。舌者，声音之机。唇者，声音之扇。横骨者，神气所使，主发舌者也。然
心之本脉，系于舌根；脾之络脉，系于舌傍；肝脉循阴器，络于舌本；少阴之脉，走喉
咙，系舌本。是四经之脉，皆上于舌。邪中其经，则痰涎闭其脉道，舌不能转运而为之
喑矣。有喉喑者，劳嗽而失音，即喉咙声哑是也。故喉喑者，喉中之声嘶，而舌本自能
治疗中风导致的神志昏迷、胡言乱语、失音。
白鲜皮、白术、芍药、桂心、川芎、当归、杏仁、防风、甘草、独活、麻黄、茯苓，用生姜和大枣同煎服用。
治疗中风导致的不省人事、喉间痰鸣、角弓反张、失音、四肢厥冷。
麻黄、人参、黄芩、川芎、芍药、甘草、杏仁、防己、肉桂（各八分）、防风（一钱）、附子（炮制，去皮和脐，四分），用姜枣水煎服。
治疗各种风热证，或者斑疹透发不畅、热极导致皮疹黑陷、惊风发热、突然卒中不能言语。
防风、川芎、当归、薄荷、大黄、芍药、麻黄、连翘、芒硝、石膏、黄芩、桔梗、滑石、山栀、荆芥、白术、甘草，锉成散剂，每次服用三钱，用生姜和葱白同煎。
治疗中风，体内有大小便不通的阻隔，用此方来通导。
浓朴（姜制）、大黄、枳实、羌活（各等分），水煎服，大便微通即可停止。
人突然僵硬倒仆，或者半身不遂，或者四肢不能举动，或者神志不清，或者死亡或者不死，世人称之为中风，医书也按中风治疗。考证《黄帝内经》，说：风是百病开始的根源；又说：风是百病之长；又说：风善于行走且变化多端；又说：风邪伤人，有的表现为寒热，有的表现为热中，有的表现为寒中，有的表现为疠风，有的表现为偏枯，有的表现为风病。其中突然僵硬倒仆、神志不清、四肢不能举动的症状，《内经》并未详细论述，只提到了偏枯这一种情况。等到看《千金方》则引用歧伯的话说：中风的大法有四类，一是偏枯，二是风痱，三是风懿，四是风痹。偏枯，是指半身不遂；风痱，是指身体无痛，四肢不能收持；风懿，是指突然神志不清；风痹，是指各种痹症类似风病的状貌。《金匮要略》中风篇说：寸口脉浮而紧，紧脉主寒，浮脉主虚，寒与虚相互搏结，邪气在皮肤，浮脉表示血虚，络脉空虚，贼邪不能排出，邪气或左或右，邪气所在的一侧肌肉松弛，正气所在的一侧紧张，正气牵引邪气，导致口眼歪斜、肢体不能随意运动。邪气在络脉，肌肤麻木不仁；邪气在经脉，脊背沉重不能伸展；邪气进入腑，则不识人；邪气进入脏，舌头僵硬难以言语，口吐涎沫。由此看来，就知道突然僵硬倒仆、神志不清、半身不遂、四肢不能举动等症状，确实是由风邪引起的，所以用续命汤、排风汤等方剂治疗。到了后来刘河间、李东垣、朱彦修三位贤者提出的理论，才与古人不同。河间说：中风瘫痪，不是肝木之风特别盛而突然击中，也不是外感风邪，而是因为调养失宜，心火暴盛，肾水虚衰，不能制约心火，导致阴虚阳实，热气拂郁，心神昏冒，筋骨不用，从而突然倒下失去知觉。多因喜怒思悲恐五志有所过极，而卒中的发生，是因为五志过极都化为热甚的缘故。世俗所说的风，是说错了而忘记了根本。东垣说：中风，不是外来风邪，而是本气生病。凡人年届四十，气衰之际，或者因为忧喜忿怒损伤其志气的人，多有这种病，壮年时是没有的。如果形体肥胖的人偶尔也有，也是形盛气衰才这样的。彦修说：西北气候寒冷，被风所中，确实有这种情况。东南气候温暖，且地多湿气，有风病的人并非风邪所致。都是湿土生痰，痰生热，热生风。三位贤者的理论，河间主张火，东垣主张气，彦修主张湿，反而把风看作虚象，这与古人的论述大不相同。认为三氏是对的，那么在三氏提出之前，本来就有遵循古人治愈的案例；认为古人是正确的，那么在三氏提出之后，也有遵循三氏治愈的案例。大概古人和三氏的理论，都不可以偏废，只是三氏是针对相似的中风病症而立论，使得后人疑惑而不能决断，殊不知因于风邪的，才是真中风。因于火、因于气、因于湿的，是类中风而不是真中风。如《内经》所说：三阴三阳发病，导致偏枯痿易、四肢不能举动，也未必一定要因于风才能发生。风、火、气、湿的不同，在望闻问切之间，难道没有区别吗？辨明为风，就遵循古人的方法治疗；辨明为火、气、湿，就遵循三氏的方法治疗，这样就能理清道理明确，治疗得当了。
中风这一病症，轻重有三种，治疗方法各不相同。中血脉的，病在半表半里，外无六经的症状，内无二便闭塞，只见口眼歪斜，半身疼痛，不可过度发汗，以免耗伤卫气；不可峻下，以免损伤营血，只应当养血顺气，用大秦艽汤及羌活愈风汤调和它。中腑的，病在表，多涉及四肢，所以肢节废用，脉浮恶风，拘急麻木，外有六经的形证，内无大小便的阻隔，宜用疏风汤及小续命汤发汗。中脏的，病在里，多阻滞九窍，所以唇缓，二便闭，不能言语，耳聋鼻塞，视物模糊，痰涎昏冒，宜用三化汤及麻仁丸泻下。然而凡是中血脉、中腑的病，千万不要使用龙脑、麝香、牛黄，因为麝香入脾治肉，牛黄入肝治筋，龙脑入肾治骨，会引风深入骨髓，像油渗入面一样，无法取出，而且闭症或许适宜，脱症则深为禁忌。也不要一概使用大戟、芜花、甘遂等泻大肠大便的药物，否则会损伤阴血，真气更加虚弱，怎么能驱除邪气外出呢？
中风的风乃是内虚暗风，确实是阴阳两虚，五脏本气自病，属于内夺暴厥。然而阴虚者与外来风邪截然不同，急症用人参、白术、附子，以固本为先；缓症顺气化痰，以救其标。补阳养阴，以巩固根本。阴甚虚者偏于阴，阳甚虚者偏于阳，阴阳两虚严重的，气血峻补，那么虽然外有风候的假象，不治也会自愈，所谓“养正积自除，风自灭”，指的是内起之风，是由于阴虚内起之火罢了。如果用辛温风燥的药物，怎么能治好病？只会加速死亡。至于丹溪将瘫痪分左右，辨别气血，用四君子汤、四物汤治疗，都不是至理名言，盖左边虽以血为主，但没有气来统摄就不能流动；右边虽以气为主，但没有血来依附就容易散失，所以肝胆居左，其气常行于右；脾肺居右，其气常行于左，往来灌注，生生不息。
中络的，邪气刚进入卫分，还在经络之外，所以只是肌肤麻木不仁。中经的，则进入荣脉之中，骨肉都失去滋养，所以身体沉重。到了中腑、中脏，则离开外表而入内，邪气深入了。中腑必定归于胃，因为胃是六腑的总司。中脏必定归于心，因为心是神明之主。风入胃中，胃热必盛，蒸腾精液，凝结为痰涎，胃的大络进入心。痰涎壅盛，堵塞出入的窍道，所以中腑就不识人。轻者风入胃中，反而加倍能食，这是风能生热，热能消谷。诸脏受邪，迸入于心，则神明无主，所以中脏者，舌纵难言，廉泉穴开而流涎沫。廉泉穴在舌下窍，通于肾，是津液所出的地方。
中风的病症，有因外感的，有因内伤的。言风的是外感。言气、言火、言痰的是内伤。然而外感者也因内有郁热，腠理疏豁，中气不固，暴风得以乘虚而入。内伤者，气上逆而为火，火亢极而生风，风行水动，水涌为痰，所以气、火、痰，其实是一源流。治疗的方法，外感者，区分中血脉、中腑、中脏的不同而治疗；渐伤而缓的，先用开关利窍，次用固本调元；急症则只为取本，不容许有次第，因为命在须臾，缓则援生不及。严用和说：人的元气强壮，外邪怎么能危害？一定是真气先虚，营卫空疏，邪气才能乘虚而入。如果是内因七情，法当调气，不当治风；即使是外因六淫，也应当先救本气，后根据所感的六气治疗。
肥人多中气，因为外盛而内歉。然而中气与中风相类似，但中风身温有痰涎，多不能治；中气身凉无痰涎，须臾便醒，为什么呢？盖中风和中气，是一源流。都是由忿怒所致，人的喜怒思悲恐五志，只有怒最厉害，所以成为疾病的参差。少壮之人，气血未虚，真水未竭，恰好因为怒动肝火，火煨于水，不能上升，所以身凉无痰涎，须臾便醒，这是因为水旺足以降火，名为中气。许学士说：暴怒伤阴，暴喜伤阳，忧愁不已，气多厥逆，往往得中气的症，不可作中风治疗。若衰老之人，气血俱虚，真水已竭。恰好因为怒动肝火，火寡于畏，得以上升，所以身温有痰涎，其多不能治，是因为水竭无以降火，名为中风。然而也有少壮而中风不治的，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，恰好因为忿怒动火，而气无所附，故随火而发越。阴和血，难道不是阳气的根本吗？《经》说：肾气内夺，则舌喑足废。治法的大概，用气药治风还可以，用风药治气则不可以；用血药治风，用气药治痰都可以；用风药治血，用痰药治气，均绝对不可以。
用药的方法，寒因热用，热因寒用，是正治。现在中风瘫痪的症，本是风火阳邪，而用乌头、附子等热药治疗为什么呢？盖中风瘫痪是湿痰死血，结滞于脏腑经络之间，不用乌头、附子等热药，怎么能开散流通！这不是正治，是从治。《经》说：从少从多，各观其事。那么从治的药，只能作为引经而已，况且风本于热而生，岂可一概说是虚寒？用附子取效的，必须是中寒阴毒的症，以及肥白人多湿的人，丹溪所谓肥白人多湿，少用乌附行经是也。若是中风阳毒的症则忌用，但只要到瘫痪既久，则痰火拂郁。如果在辛凉药中没有香热之药作为向导，则将格格不入而不能进入。况且此时阳症多系假象，盖真火既然已经上升而为病，有何真阳仍存坎宫而不动呢！能做到这样就没有这个病了。所以乌附是对症的适宜，但必须兼滋补，便可制约其僭热。只有中脏阴寒的症，又宜纯阳，忌用阴药，盖略兼阴药，则阳药便难见效，甚至有益令阳亡，诚然不思无阴则阳无以化，当此极其需要的阳，能经得起阴药的化解吗？所以参术附等汤，不入地黄当归的原因就在这里。
一凡饮食如常，但失音不语的，名叫哑风，只宜用小续命汤，去掉附子加石膏、菖蒲各一钱。
一凡国中昏倒，宜急掐人中，等他苏醒，再用痰药，或者用吐法。如果脱势急迫，不能姑待的，急为补精补神补气，作为性命之需，慎勿降火降痰降气，以免加速丧生。河间、东垣专治本而不治风，可以说是至当不易之论，学人必须以阴虚阳虚为主，自从后世医书杂出，而使后学狐疑不决。丹溪说：有气虚血虚湿痰，左手脉不足及左半身不遂的，用四物汤补血，加竹沥、姜汁。右手脉不足，及右半身不遂的，用四君子汤补气，佐以竹沥、姜汁。如气血两虚而挟痰的，用八物汤加南星、半夏、竹沥、姜汁。平正通达宜人盛宗之，但持此法治疗而多不效，为什么呢？盖治气血痰的标，不治气血痰的本。何况气虚气滞而血脉不能运动，岂能说是死血？气血气闭而津液为之凝结，岂能说是湿痰？人的四肢，如树木的枝干；人的气血，荣养乎四肢，犹如树木的浆水，灌溉乎枝叶。木有枝叶，必有根本；人的气血，岂无根本乎？人有半身不遂，迁延不死的，如树木的根本未甚枯，而一边枝干先萎。人有形容肥壮，忽然倒仆而即毙的，如树木的根本已绝，其枝叶虽向荣，犹枯杨生华，何可久也？忽遇大风而摧折，观此则根本之论明矣。气血的根本是什么？火为阳气之根，水为阴血之根，而火与水的总根，两肾间动气是也。这是五脏六腑之本，十二经之源，呼吸之门，三焦之根，又名守邪之神。《经》说：根于中者，命曰神机，神去则机息；根于外者，名曰气立，气止则化绝。今人纵情嗜欲，肾气虚衰，根先绝矣。
一或内伤劳役，六淫七情稍触，皆能卒中。这是阴虚阳暴绝，即内夺暴厥的症。须以人参、附子大剂，峻补其阳，继以地黄丸、十补丸之类，填实真阴。又有心火暴甚，肾水虚衰，兼之五志过极，以致心神昏闷，卒倒无知，其手足牵掣，口眼歪斜，是水不能荣筋，筋急而纵。俗云：风者，乃风淫未疾之假象，风自之出也。须以河间地黄饮子峻补其阴，继以人参、麦冬、五味子之类，滋其化源，这是根阴根阳的至论。至于所谓的痰是什么呢？唯独中风如此，要知道痰从何处来，痰是水，其源出于肾，仲景说：气虚痰泛，以肾气丸补而逐之。观此，凡治中风者，既以前法治其根本，则痰不治而自化。只有初时痰涎壅盛，汤药不入，暂用稀涎散之类，使咽喉疏通，能进汤液即止。若想尽攻其痰，顷刻立毙。
偏枯，本乎精神内耗不足，而气血不能周及。然而不足之中，略有虚实之别，《经》所谓土太过则敦阜，令人四肢不遂，是症的实证，其治当泻不当补。又有脾胃虚弱，水谷之精气不周，气血偏虚，为邪所中，是症的虚证，其治当补不当泻。虚者是正气虚，实者是邪气实，泻者是泻其邪，补者是补其正。又名之左瘫右痪，盖气顺血涩则为瘫疯。瘫疯，是筋脉拘急拳挛。血顺气虚，则为痪疯，痪疯，是抬动不能。瘫，是坦，筋脉弛纵，坦然不举。痪，是涣，血气散漫，涣然不收。求本以论，总皆气血不足，也不必以左右分，而以湿痰死血为定论。至于拘挛，则急多而缓少，乃寒多而热少，《经》所谓寒则筋挛是也。其治莫如养血温经，使阳气以和柔之，阴津以灌溉之，如补中益气汤加附子，六味丸加肉桂，附子行参术之力，而阳和自转，肉桂通行血脉，而筋节自荣。其抽搐者，或伸或缩，而动不止，是火的象，本于肝家风热火燥，搏于筋络，则手足为之抽搐，《经》说：火郁之发，民病抽搐是也。虽然也有寒伤荣，血凝而拘急的；有热伤荣，血燥筋枯而拘急的；有寒伤卫，气虚不能摄而弛纵的；有热伤卫，筋软不收而弛纵的，应当兼脉候辨之。大概不外乎血虚不能荣筋，而燥气乘之，故其治亦不外乎滋补肝肾，灌溉筋脉，俾水旺火息，风木自平。然而治之即愈则可，若延久治之，则经脉闭塞，药力难以流通，便成痼疾。
舌喑，是中風而舌不转运，舌强不能言。经说：喉咙者，气之所以上下。会厌者，声音之户。舌者，声音之机。唇者，声音之扇。横骨者，神气所使，主发舌者也。然而心的本脉，系于舌根；脾的络脉，系于舌傍；肝脉循阴器，络于舌本；少阴之脉，走喉咙，系舌本。这四经之脉，皆上于舌。邪中其经，则痰涎闭其脉道，舌不能转运而为之喑。有喉喑者，劳嗽而失音，即喉咙声哑。故喉喑者，喉中之声嘶，而舌本自能……
Treats stroke (Zhong Feng) leading to coma, delirium, and aphasia.
Bai Xian Pi (Dictamni Cortex), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Shao Yao (Paeoniae Radix), Gui Xin (Cinnamomi Ramulus), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), Xing Ren (Armeniacae Semen Amarum), Fang Feng (Saposhnikoviae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Du Huo (Angelicae Pubescentis Radix), Ma Huang (Ephedrae Herba), Fu Ling (Poria), decocted with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus).
Treats stroke leading to unconsciousness, phlegm rattle in the throat, opisthotonos, aphasia, and cold extremities.
Ma Huang (Ephedrae Herba), Ren Shen (Ginseng Radix et Rhizoma), Huang Qin (Scutellariae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Shao Yao (Paeoniae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Xing Ren (Armeniacae Semen Amarum), Fang Ji (Stephaniae Tetrandrae Radix), Rou Gui (Cinnamomi Cortex) (each 8 fen), Fang Feng (Saposhnikoviae Radix) (1 qian), Fu Zi (Aconiti Lateralis Radix Praeparata) (processed, peel and navel removed, 4 fen), decocted with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus) in water.
Treats various wind-heat syndromes, or slow eruption of macules and papules, extreme heat causing blackening and depression of lesions, convulsive fever, sudden stroke with inability to speak.
Fang Feng (Saposhnikoviae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), Bo He (Menthae Haplocalycis Herba), Da Huang (Rhei Radix et Rhizoma), Shao Yao (Paeoniae Radix), Ma Huang (Ephedrae Herba), Lian Qiao (Forsythiae Fructus), Mang Xiao (Natrii Sulfas), Shi Gao (Gypsum Fibrosum), Huang Qin (Scutellariae Radix), Jie Geng (Platycodonis Radix), Hua Shi (Talcum), Shan Zhi (Gardeniae Fructus), Jing Jie (Schizonepetae Spica), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), crushed into powder, each dose 3 qian, decocted with Sheng Jiang (Zingiberis Rhizoma Recens) and Cong Bai (Allii Cepae Bulbus).
Treats stroke where there is obstruction of stool and urine internally, using this formula to guide them out.
Hou Po (Magnoliae Officinalis Cortex) (processed with ginger), Da Huang (Rhei Radix et Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), Qiang Huo (Notopterygii Rhizoma et Radix) (equal parts), decocted in water, stop when slight diarrhea occurs.
When a person suddenly stiffens and falls, or suffers hemiplegia, or limbs cannot move, or loses consciousness, or dies or survives, the world calls it stroke (Zhong Feng), and medical books also treat it as such. Examining the *Nei Jing* (Inner Canon), it says: "Wind is the beginning of hundreds of diseases"; again: "Wind is the chief of hundreds of diseases"; again: "Wind moves swiftly and changes frequently"; again: "When wind attacks humans, it may manifest as chills and fever, or heat in the middle, or cold in the middle, or leprosy, or hemiplegia, or wind disease." Among these, symptoms like sudden stiffness and falling, loss of consciousness, and inability to move limbs are not discussed in detail, except for the mention of hemiplegia. When observing the *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold), it quotes Qibo saying: "There are four major categories of stroke: one is hemiplegia (Pian Ku), two is wind flaccidity (Feng Fei), three is wind yi (Feng Yi), and four is wind bi (Feng Bi)." Hemiplegia refers to paralysis of half the body; wind flaccidity refers to no pain in the body but inability to control the limbs; wind yi refers to sudden loss of consciousness; wind bi refers to various bi syndromes resembling wind patterns. The Stroke Chapter of *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) states: "The pulse at the cunkou is floating and tight. Tight indicates cold, floating indicates deficiency. Cold and deficiency interact, and the pathogen is in the skin. Floating indicates blood deficiency, and the collaterals are empty. The thief pathogen cannot be expelled. The pathogen affects either the left or the right side. The qi on the affected side becomes slack, while the healthy qi becomes tense. The healthy qi pulls the pathogen, resulting in deviation and inability to move." If the pathogen is in the collaterals, the skin and muscles become numb; if in the meridians, the spine feels heavy and cannot extend; if entering the fu organs, the person does not recognize others; if entering the zang organs, the tongue becomes stiff and speech is difficult, with saliva foaming from the mouth. From this, we know that sudden stiffness and falling, loss of consciousness, hemiplegia, and inability to move limbs are indeed caused by wind, hence formulas such as Xu Ming Tang (Continuing Life Decoction) and Pai Feng Tang (Expelling Wind Decoction) are used. Later, the theories proposed by Liu Hejian, Li Dongyuan, and Zhu Yanshou differed from those of the ancients. Hejian said: "Stroke paralysis is not due to excessive liver wood wind striking suddenly, nor is it external wind invasion. It arises from improper lifestyle management, where heart fire erupts violently, and kidney water is deficient and unable to control it, leading to yin deficiency and yang excess. Heat Qi stagnates, clouding the heart spirit and rendering tendons and bones useless, causing sudden collapse and unconsciousness. This often occurs because the five emotions (joy, anger, worry, thought, fear) reach extremes, and all extremes generate intense heat. The common term 'wind' forgets the root cause." Dongyuan said: "Stroke is not external wind evil, but a disease of the original qi. People around forty years old, when qi declines, or those injured by sorrow, joy, anger, or indignation, often suffer this disease, which is absent in youth. Even obese individuals occasionally suffer it, due to robust form but deficient qi." Yanshou said: "In the northwest, where the climate is cold, being struck by wind is indeed possible. In the southeast, where the climate is warm and dampness is prevalent, wind diseases are not caused by wind. They arise from damp earth generating phlegm, phlegm generating heat, and heat generating wind." The theories of these three sages differ: Hejian emphasizes fire, Dongyuan emphasizes qi, and Yanshou emphasizes dampness, regarding wind as a deficiency pattern, which greatly differs from ancient views. If the three sages are correct, there were cases cured by following the ancients before their time; if the ancients are correct, there are cases cured by following the three sages after their time. Generally, neither the ancients' nor the three sages' theories should be discarded. However, the three sages formulated their theories based on similar stroke-like diseases, causing confusion among later practitioners. One must realize that cases caused by wind are true stroke (Zhen Zhong Feng), while those caused by fire, qi, or dampness are pseudo-stroke (Lei Zhong Feng) rather than true stroke. As stated in the *Nei Jing*: "Diseases of the three yin and three yang meridians lead to hemiplegia, flaccidity, and inability to move the limbs," which does not necessarily require wind as a cause. The distinctions between wind, fire, qi, and dampness can be discerned through observation, listening/smelling, inquiry, and palpation. If identified as wind, follow the ancients' treatment; if identified as fire, qi, or dampness, follow the three sages' treatment. This ensures clear reasoning and appropriate therapy.
Stroke has three levels of severity with different treatments. Stroke affecting the blood vessels (Mai Xue) involves the half-exterior and half-interior, without six-channel exterior symptoms or interior constipation/urinary retention. Symptoms include facial deviation and unilateral pain. Do not induce excessive sweating to deplete Wei Qi, nor purge severely to damage Ying Blood. Instead, nourish blood and regulate qi using Da Qin Jiao Tang (Great Notopterygium Decoction) and Qiang Huo Yu Feng Tang (Notopterygium Expelling Wind Decoction). Stroke affecting the fu organs (Fu) is at the exterior level, often involving the limbs, leading to joint dysfunction, floating pulse, aversion to wind, stiffness, and numbness. There are six-channel exterior symptoms but no interior obstruction of stool or urine. Use Shu Feng Tang (Dispersing Wind Decoction) and Xiao Xu Ming Tang (Minor Continuing Life Decoction) to induce sweating. Stroke affecting the zang organs (Zang) is at the interior level, often blocking the nine orifices, leading to relaxed lips, constipation and urinary retention, aphasia, deafness, nasal congestion, blurred vision, phlegm, and coma. Use San Hua Tang (Three Transformations Decoction) and Ma Ren Wan (Hemp Seed Pill) to purge. However, for stroke affecting blood vessels or fu organs, avoid using Long Nao (Camphor), She Xiang (Musk), and Niu Huang (Calculus Bovis), as Musk enters the spleen to treat flesh, Niu Huang enters the liver to treat tendons, and Camphor enters the kidneys to treat bone, potentially drawing wind deep into the marrow like oil into dough, which is irretrievable. While suitable for closure syndromes, they are strictly contraindicated in collapse syndromes. Also, avoid indiscriminate use of Da Ji (Euphorbiae Pekinensis Radix), Wu Hua (Genkwa Flos), and Gan Sui (Kansui Radix), purgatives for large intestine stool, as they damage yin blood and further weaken true qi, hindering the expulsion of pathogens.
The wind in stroke is internal deficiency dark wind, truly representing dual deficiency of yin and yang, with the original qi of the five zang organs malfunctioning, constituting internal depletion and sudden syncope. Yin deficiency differs significantly from external wind invasion. In acute cases, use Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Fu Zi (Aconiti Lateralis Radix Praeparata) to secure the root first; in chronic cases, regulate qi and resolve phlegm to address the branch. Tonify yang and nourish yin to consolidate the root. Severe yin deficiency leans towards yin, severe yang deficiency leans towards yang. For severe dual deficiency, vigorously tonify qi and blood. Although external wind-like symptoms may appear, self-healing occurs through nourishment, as "nourishing the righteous eliminates accumulation, and wind extinguishes itself." This refers to internally generated wind due to yin deficiency and internal fire. Using acrid-warm and drying wind-dispelling drugs cannot cure the disease but accelerates death. Danxi's division of paralysis into left/right and differentiation of qi/blood, treating with Si Jun Zi Tang (Four Gentlemen Decoction) and Si Wu Tang (Four Substance Decoction), is not the ultimate theory. Although the left side is primarily blood, without qi to govern it, it does not flow; although the right side is primarily qi, without blood to anchor it, it scatters easily. Thus, Liver and Gallbladder reside on the left, but their qi flows to the right; Spleen and Lung reside on the right, but their qi flows to the left. Their mutual infusion ensures continuous life processes.
Stroke affecting the collaterals (Luo) means the pathogen has just entered the Wei level, remaining outside the meridians, causing only skin and muscle numbness. Stroke affecting the meridians (Jing) enters the Ying level, depriving flesh and bone of nourishment, causing heavy body sensation. Stroke affecting fu and zang organs moves from exterior to interior, indicating deep pathogen penetration. Stroke affecting fu organs returns to the Stomach, as the Stomach is the master of the six fu organs. Stroke affecting zang organs returns to the Heart, as the Heart is the master of spirit. Wind entering the Stomach generates intense heat, steaming fluids into phlegm-drool. The Stomach's large collateral enters the Heart. Phlegm-drool abundance blocks the orifices, causing loss of recognition in fu stroke. Mild cases: wind in Stomach increases appetite, as wind generates heat and heat digests grain. Pathogens from other zang enter the Heart, losing spiritual mastery, causing tongue relaxation and difficulty speaking in zang stroke, with fluid leaking from Lian Quan (Ren-23). Lian Quan is below the tongue, connecting to the Kidney, the source of fluids.
Stroke causes include external contraction and internal injury. "Wind" refers to external contraction. "Qi," "Fire," and "Phlegm" refer to internal injury. External contraction also stems from internal stagnant heat, loose pores, weak middle qi, allowing violent wind to invade. Internal injury involves qi reversing upward to become fire, extreme fire generating wind, wind moving water to generate phlegm. Thus, qi, fire, and phlegm share one source. Treatment for external contraction distinguishes between stroke affecting blood vessels, fu, and zang. For gradual and mild injury, first open orifices and unblock pathways, then secure the root and regulate yuan qi. For acute cases, focus solely on the root, as life hangs in the balance. Yan Yonghe said: "If original qi is strong, how can external pathogens harm? True qi must be deficient first, and Ying-Wei loose, allowing pathogens to invade." For internal seven emotions, regulate qi, do not treat wind. Even for external six climatic factors, first rescue original qi, then treat based on the contracted factor.
Obese people often suffer "qi strike" (Zhong Qi) due to external robustness and internal deficiency. Qi strike resembles stroke but differs: stroke patients have warm bodies and phlegm-drool, often untreatable; qi strike patients have cool bodies, no phlegm-drool, and wake quickly. Why? Both stem from anger. Anger is the most intense of the five emotions. Young people with robust qi and abundant kidney water, angered by liver fire, experience fire simmering in water, preventing ascent, resulting in cool body and quick recovery due to water controlling fire, named Qi Strike. Xu Xueshi said: "Violent anger injures yin, violent joy injures yang, endless sorrow causes qi reversal and syncope, often resulting in Qi Strike, not to be treated as Stroke." Elderly people with deficient qi and blood and exhausted kidney water, angered by liver fire, experience fire rising due to lack of restraint, resulting in warm body and phlegm-drool, often untreatable due to water exhaustion failing to control fire, named Stroke. Some young people also suffer untreatable stroke due to excessive sexual desire depleting lower yuan water (men) or excessive blood loss postpartum/menstruation (women), failing to anchor qi. Anger moves fire, and qi follows fire upward. Yin and blood are the root of yang. The *Classic* states: "Internal depletion of Kidney Qi leads to aphasia and leg paralysis." General treatment principles: Using qi medicines for wind is acceptable; using wind medicines for qi is not. Using blood medicines for wind and qi medicines for phlegm are acceptable; using wind medicines for blood and phlegm medicines for qi are absolutely unacceptable.
Medication methods: Treating heat with cold and cold with heat is direct treatment (Zheng Zhi). Now, stroke paralysis is wind-fire yang pathogen, yet why use hot drugs like Wu Tou (Aconiti Radix) and Fu Zi (Aconiti Lateralis Radix Praeparata)? Stroke paralysis involves wet phlegm and dead blood stagnating in zang-fu and meridians. Only hot drugs can disperse and circulate! This is indirect treatment (Cong Zhi). The *Classic* states: "Follow less or more, observe the matter." Indirect drugs serve only as guiding agents. Since wind originates from heat, how can it be generally considered deficiency-cold? Fu Zi is effective only for cold-yin toxicity or obese-damp individuals, as Danxi noted. It is contraindicated for stroke yang-toxicity. However, in long-term paralysis, phlegm-fire stagnates. Without aromatic-hot guides in acrid-cool drugs, penetration fails. Yang symptoms are often false appearances; true fire has risen, so no true yang remains in Kan (Kidney). Thus, Wu Tou/Fu Zi are suitable only if combined with tonics to counteract their hyperactivity. Pure yang is indicated for zang stroke cold syndrome, avoiding yin drugs, as slight yin inclusion hinders yang efficacy and may cause yang collapse. Remember, without yin, yang cannot transform. Therefore, Shen Qi Wan (Kidney Qi Pill) variants exclude Di Huang (Rehmanniae Radix) and Dang Gui (Angelicae Sinensis Radix).
For those eating normally but suffering aphasia, named Mute Wind, use Xiao Xu Ming Tang (Minor Continuing Life Decoction), remove Fu Zi, add Shi Gao (Gypsum Fibrosum) and Shi Chang Pu (Acori Tatarinowii Rhizoma) 1 qian each.
For sudden fainting, urgently press Ren Zhong (GV-26). Once revived, use phlegm-resolving drugs or emetics. If collapse is urgent, urgently tonessence, spirit, and qi for survival. Avoid clearing fire, phlegm, or qi, which accelerates death. Hejian and Dongyuan's focus on the root over wind is irrefutable. Practitioners must prioritize yin/yang deficiency. Later miscellaneous books cause confusion. Danxi said: For qi/blood deficiency with wet phlegm, weak left pulse/left hemiplegia, use Si Wu Tang (Four Substance Decoction) plus Zhu Li (Bambusa Textilis Sap) and Jiang Zhi (Zingiberis Juice). For weak right pulse/right hemiplegia, use Si Jun Zi Tang (Four Gentlemen Decoction) plus Zhu Li and Jiang Zhi. For dual qi/blood deficiency with phlegm, use Ba Wu Tang (Eight Substance Decoction) plus Nan Xing (Arisaematis Rhizoma Preparatum), Ban Xia (Pinelliae Rhizoma), Zhu Li, and Jiang Zhi. This approach is sound but often ineffective because it treats the branch, not the root. Qi stagnation prevents blood movement, not necessarily dead blood. Qi closure condenses fluids, not necessarily wet phlegm. Limbs are like tree branches; qi/blood nourish them like sap. Trees have roots; so do humans. Hemiplegia survivors are like trees with intact roots but withered branches. Sudden death in robust individuals is like dead roots with flourishing leaves, unsustainable. The root of qi/blood is Fire (root of yang) and Water (root of yin), with the total root being the Moving Qi between the two Kidneys. This is the root of zang-fu, source of twelve channels, gate of respiration, root of San Jiao, and God guarding against pathogens. The *Classic* states: "Rooted within is Shen Ji (Spirit Mechanism); if spirit goes, mechanism stops. Rooted externally is Qi Li (Qi Establishment); if qi stops, transformation ends." Modern indulgence depletes Kidney Qi, severing the root.
Internal injury from labor or minor exposure to six excesses/seven emotions can cause sudden stroke. This is yin deficiency and sudden yang collapse, i.e., internal depletion syncope. Use large doses of Ren Shen (Ginseng Radix et Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) to vigorously tonify yang, followed by Di Huang Wan (Rehmannia Pill) and Shi Bu Wan (Ten Tonics Pill) to fill true yin. Heart fire excess with kidney water deficiency and emotional extremes cause mental clouding, sudden collapse, limb twitching, and facial deviation due to water failing to nourish tendons. Commonly called "wind," it is a false appearance of wind淫. Use Hejian's Di Huang Yin Zi (Rehmannia Infusion) to vigorously tonify yin, followed by Ren Shen, Mai Dong (Ophiopogonis Radix), and Wu Wei Zi (Schisandrae Fructus) to nourish the source. This is the ultimate theory of rooting yin and yang. Regarding phlegm in stroke: Phlegm is water, originating from the Kidney. Zhang Zhongjing said: "Qi deficiency with phlegm flooding is treated with Shen Qi Wan (Kidney Qi Pill) to tonify and expel." Thus, treating the root resolves phlegm naturally. Only initially, if phlegm blocks the throat preventing medicine intake, temporarily use Xi Xian San (Thin Saliva Powder) to clear the throat, stopping once liquid intake resumes. Attempting to completely purge phlegm causes immediate death.
Hemiplegia stems from internal depletion of spirit and essence, with insufficient qi/blood circulation. Within insufficiency, there are deficiency and excess patterns. Excess: Earth element excessive ("Dun Fu") causes limb immobility; treat by purging, not tonifying. Deficiency: Spleen/Stomach weakness leads to inadequate grain essence, qi/blood deficiency, and pathogen invasion; treat by tonifying, not purging. Deficiency is true qi deficiency; excess is pathogen excess. Purging expels pathogens; tonifying strengthens true qi. Left flaccidity and right paralysis: Qi smooth and blood stagnant causes flaccidity (Tan Feng), characterized by tendon/muscle spasm. Blood smooth and qi deficient causes paralysis (Huan Feng), characterized by inability to lift. Tan implies relaxation; Huan implies scattering. Fundamentally, both are qi/blood insufficiency, not strictly left/right, but determined by wet phlegm and dead blood. Spasm is mostly cold, rarely heat; cold causes tendon contraction. Treat by nourishing blood and warming meridians, harmonizing yang and irrigating yin, e.g., Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fu Zi, or Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia) plus Rou Gui (Cinnamomi Cortex). Fu Zi enhances Ren Shen/Bai Zhu power to turn yang warm; Rou Gui unifies blood vessels to nourish joints. Twitching (Chou Chu) involves extension/flexion and constant motion, a fire sign, originating from Liver wind-fire-dryness combusting tendons. The *Classic* states: "When fire stagnates erupts, people suffer twitching." However, cold injuring Ying causes blood coagulation and spasm; heat injuring Ying causes blood dryness and tendon withering with spasm; cold injuring Wei causes qi deficiency and flaccidity; heat injuring Wei causes soft tendons and flaccidity. Differentiate via pulse. Generally, blood deficiency fails to nourish tendons, allowing dryness to attack. Treat by tonifying Liver/Kidney and irrigating tendons, ensuring water prosperity and fire extinction to calm Wood wind. Delayed treatment leads to meridian blockage and stubborn disease.
Tongue aphasia (She Yin) involves tongue stiffness and inability to speak. The Classic states: Throat is the passage for qi; Epiglottis is the door of sound; Tongue is the mechanism of sound; Lips are the fan of sound; Horizontal Bone is governed by spirit and controls the tongue. Heart meridian connects to tongue root; Spleen collateral connects to tongue sides; Liver meridian loops around genitals and connects to tongue root; Shaoyin meridian passes through throat and connects to tongue root. These four meridians ascend to the tongue. Pathogen invading meridians blocks pathways with phlegm-drool, causing tongue immobility and aphasia. Throat aphasia (Hou Yin) is hoarseness from chronic cough. Hou Yin involves hoarse throat sound but normal tongue function...