古人定病之名,必指其实。后人既曰中风,如何舍风而别治,观仲师侯氏黑散、风引汤
数方自见。余此书原为中人以下立法,只取唐人续命汤一方为主,盖以各家所列风症,头绪
纷繁,议论愈深则愈晦,方法愈多则愈乱,不如只取一方,以驱邪为本,庶法一心纯,不至
多歧反惑。要知此汤长于治外,非风则不可用,是风则无不可用也。至云风为虚邪,治风必
先实窍,此旨甚微,能于侯氏黑散、风引汤二方研究十年,而知其妙处,则可与共学适道矣。
侯氏黑散
治大风四肢烦重,心中恶寒不足者。(《外台》治风癫)《内经》云∶邪害空窍
,此则驱风之中,兼填空窍。空窍满,则内而旧邪不能容,外而新风不复入。
风引汤(俱见《金匮》)除热癫痫(巢氏治香港脚)
大人中风牵引,小儿惊痫螈 ,皆火热生风,五脏亢甚,归迸入心之候,夫厥阴风木,
与少阳相火同居,火发必风生,风生必挟木势而害土,土病则聚液成痰,流注四肢而瘫痪。
此方用大黄为君,以荡涤风火热湿之邪,随用干姜之止而不行者以补之,用桂枝、甘草以缓其
势,又取石药之涩以堵其路,而石药之中,又取滑石、石膏清金以伐其木,赤白石脂浓土以除
其湿,龙骨、牡蛎以敛其精神魂魄之纷驰,用寒水石以助肾之真阴,不为阳光所劫。更用紫
石英以补心神之虚,恐心不明而十二官危也。明此以治入脏之风,游刃有余矣。喻嘉言此解
最妙。
古人确定疾病的名称,必定是指其实质。后人既然称之为“中风”,为何要舍弃风邪而采用其他治疗方法呢?观察张仲景的侯氏黑散、风引汤等方剂,自然就能明白其中的道理。我编写这本书原本是为了针对中等资质以下的医者确立法则,只选取唐代《续命汤》这一方作为主方。这是因为各家所列的风症,头绪纷繁复杂,议论越深入就越晦涩难懂,方法越多就越混乱,不如只取一方,以驱除邪气为根本,这样法度专一、心志纯粹,不至于因多歧路反而使人困惑。要知道此汤擅长治疗外感风邪,如果不是风邪则不可使用,只要是风邪则没有不可以使用的。至于说风属于虚邪,治疗风邪必须先充实空窍,这个旨意非常微妙,如果能深入研究侯氏黑散、风引汤这两个方剂十年,从而知晓其妙处,那么就可以与他共同学习并通达医道了。
侯氏黑散
主治大风导致四肢沉重烦闷,心中感觉寒冷且不足。(《外台秘要》用于治疗风癫)《黄帝内经》说:邪气侵害空窍,此方则在驱除风邪的同时,兼有填补空窍的作用。空窍充满后,则内部旧的邪气无法容纳,外部新的风邪也不再侵入。
风引汤(均见于《金匮要略》)
主治除热癫痫(巢元方《诸病源候论》用于治疗香港脚)。
大人中风出现肢体牵引抽搐,小儿惊痫发生抽搐痉挛,这都是火热生风,五脏功能亢盛至极,邪气归并冲击心脏的表现。厥阴风木与少阳相火同居一处,火发动必然生风,风生发必然挟带木势来伤害脾土,脾土生病则聚积津液形成痰湿,流注于四肢而导致瘫痪。此方用大黄作为君药,用来荡涤风、热、火、湿之邪,随即用干姜的守而不走来补益正气,用桂枝、甘草来缓和病势,又取石类药物(矿物药)的涩性来堵塞邪气之路,而在石药之中,又取滑石、石膏清肃肺气以克制肝木,赤石脂、白石脂厚培脾土以祛除湿气,龙骨、牡蛎来收敛精神魂魄的纷乱奔驰,用寒水石来资助肾中真阴,不被阳光(邪火)所劫夺。更用紫石英来补益心神的虚弱,恐怕心神不明而导致十二脏腑危殆。明了这些原理来治疗入脏之风邪,就能游刃有余了。喻嘉言对此的解释最为精妙。
The ancients designated disease names by referring to their substantial nature. Since later generations termed it "Zhong Feng" (Wind Stroke), why abandon the treatment of wind and adopt other therapies? Observing Zhang Zhongjing's Hou Shi Hei San (Black Powder of Hou Shi) and Feng Yin Tang (Wind-Driving Decoction), the rationale becomes clear. This book was originally intended to establish principles for physicians of average or below-average aptitude, taking only one formula from the Tang Dynasty, Xu Ming Tang (Continuing Life Decoction), as the primary basis. This is because the wind syndromes listed by various schools are complex and numerous; the deeper the discussion, the more obscure it becomes, and the more methods there are, the more chaotic it gets. It is better to select a single formula with the expulsion of pathogenic factors as the foundation, so that the therapeutic method remains pure and unified, avoiding confusion caused by divergent approaches. One must understand that this decoction excels in treating external wind; if it is not wind, it should not be used; if it is wind, there is no case where it cannot be used. Regarding the statement that wind is a deficient pathogen and that treating wind requires first solidifying the orifices, this principle is subtle. If one can study the Hou Shi Hei San and Feng Yin Tang for ten years and grasp their essence, then one may learn together and attain the Dao.
Hou Shi Hei San (Black Powder of Hou Shi)
Treats severe wind causing heaviness and discomfort in the four limbs, and a sensation of cold and deficiency in the heart. (From *Waitai Miyao* [Essential Prescriptions Worth a Thousand Gold for Emergencies], treating wind-dian). The *Neijing* (Inner Canon) states: "Pathogens harm the orifices." This formula expels wind while simultaneously filling the orifices. When the orifices are filled, internal old pathogens cannot reside, and external new wind cannot enter.
Feng Yin Tang (Wind-Driving Decoction) (Both formulas appear in *Jin Gui Yao Lue* [Essential Prescriptions from the Golden Cabinet])
Treats heat-induced dian-xian (epilepsy/seizures). (Chao Yuanfang treats Hong Kong foot [podagra/gout]).
Adults suffering from Zhong Feng (Wind Stroke) with牵引 (traction/spasms) and children with jing-xian (startle epilepsy) experiencing chuan-rong (convulsions/twitching), all result from fire generating wind. The five zang organs are hyperactive to an extreme, and the pathogenic qi converges into the Heart. Jueyin Wind-Wood and Shaoyang Ministerial Fire coexist; when fire flares, wind arises; when wind arises, it carries the force of Wood to damage Earth (Spleen/Stomach). When Earth is diseased, fluids accumulate to form Phlegm, which flows into the four limbs causing paralysis. This formula uses Da Huang (Rhubarb Rhizome) as the sovereign herb to purge pathogenic factors of wind, heat, fire, and dampness. It is followed by Gan Jiang (Dried Ginger), whose stabilizing and non-migratory nature tonifies the body. Gui Zhi (Cinnamon Twig) and Gan Cao (Licorice Root) are used to moderate the pathogenic momentum. Mineral drugs (Stone Medicines) are employed for their astringent properties to block the path of the pathogen. Among these, Hua Shi (Talcum) and Shi Gao (Gypsum Fibrosum) clear Lung Metal to subdue Liver Wood. Chi Shi Zhi (Halloysitum Rubrum) and Bai Shi Zhi (Halloysitum Album) thicken Earth to eliminate dampness. Long Gu (Fossilized Bones) and Mu Li (Oyster Shell) restrain the chaotic rushing of spirit and soul. Han Shui Shi (Metastone) assists the True Yin of the Kidney, preventing it from being plundered by Yang Fire (Evil Heat). Zi Shi Ying (Fluorite) is added to tonify the deficiency of Heart Spirit, fearing that unclear Heart Spirit would endanger the Twelve Officials. Understanding these principles allows one to treat wind entering the Zang organs with ease and proficiency. Yu Jiayan's interpretation of this is the most exquisite.