一火中之说，本于河间。河间举五志过极，动火而卒中。大法以白虎汤、三黄汤沃之，
所以治实火也；以逍遥散疏之，所以治郁火也；以通圣、凉膈散双解之，所以治表里之邪
火也；以六味汤滋之，所以壮水之主，以制阳光也；以八味丸引之，所谓从治之法，引火归
原也；又地黄饮子，治舌喑不能言，足废不能行，神妙无比。
地黄饮子
时贤徐灵胎云∶此治少阴气厥之方，庸医不察，竟以之治一切中风之症，轻则永无愈期
，重则益其病而致死。医者病家，终身不悟也。
孙心典按∶舌喑不能言，有上焦为痰火阻塞者，宜转舌膏；有中风脾缓舌强不语者，宜
资寿解语汤。惟有少阴脉萦舌本，气厥不至，名曰风痱，宜用地黄饮子温之。喻氏用资寿解
语汤去羌、防，加熟地、何首乌、枸杞子、甘菊花、黑芝麻、天门冬治之。
资寿解语汤（俱见《时方》）
治中风脾缓，舌强不语，半身不遂。
一气虚类中，说本李东垣。东垣以元气不足则邪凑之，令人卒倒僵仆如风状。大法以六君子汤加黄 、竹沥、姜汁
治之，补中益气汤亦治之；卒倒遗尿，元气大虚，必重用白术、人参、黄 ，加益智仁主之。又有恼怒气逆而厥，面青
脉大，如中风象，宜景岳解肝煎主之。虚者六君子汤，加乌药、青皮、白芷主之。
一湿中之说，本于朱丹溪。丹溪以东南气温多湿，有病风者，非风也，由湿生痰，痰生
热，热生风，二陈汤加沙参、苍术、白术、竹沥、姜汁主之，或单用半夏六钱，煎半盅，入
生姜汁二滴，风化硝二钱，先治其标，或间服滚痰丸。
亦谓之痰中，可用吐法，后理脾胃，先调经络，以竹沥汤主之。
竹沥汤
竹沥（二酒盏） 生葛汁（一酒盏） 生姜汁（一汤匙）
相合，作两服。
刘、朱、李三子发挥之外，后人又增恶中、食中、寒中、暑中四症。
一食中者，过饱食填太阴，上下之气不通而厥，以平胃散加减煎服，或探吐之，或以备急丸灌之。
备急丸 消暑丸（俱见《时方》）
一恶中者，入古庙山林古墓，及见非常怪物，感其异气，遂昏倒不知人事。其脉两手若
出两人，乍大乍小，以苏合香丸灌之，或以平胃散加雷丸二钱，雄黄精五分，藿香一二钱，
以解秽，或焚降真香、藿香、生 、川芎、苍术、皂角、红枣，使正气自口鼻入。
一寒中者，或暴寒之气直入于内，手足厥冷，腹痛吐泻不止，遂昏倒不知人事，六脉细
小，或沉伏，四肢唇口青黯，宜以生葱白一束，安脐中，以火斗熨之，或灸关元三十壮，以
四逆汤灌之。
一暑中者，夏月感暑气，昏倒不省人事，自汗面垢，吐泻脉虚，以《千金》消暑丸灌之，立
苏。又有长途赤日，卒倒不省人事，以热土取来围脐上，以热尿注之，即苏，或以生蒜捣水灌之。
续论真中风类中风攻痰之误
凡人将死之顷，阳气欲脱，必有痰声漉漉，是一身之津血，将渐化为痰而死也。时医于
此症，开手即以胆南星、石菖蒲直攻其痰，是直攻其津血，而速之死也。
《医学真传》曰∶《本经》只有南星。并无胆星。南星色白味辛，禀金气而驱风豁痰，功同
半夏。今人以牛胆制为胆星，味苦性冷。（庸医皆曰∶丸制者佳，不知愈制愈失其性，为祸更
烈。）中风痰涎上涌，多属三焦火衰，土崩水泛，斯时助正散邪，壮火驱寒，尤恐不济，服
之以苦冷之胆星，加之以清凉之竹沥，必至生阳灭绝而死。
孙心典按∶竹沥为中风必用之药，取其柔润以熄风，轻清以活络。而驱行经络之痰，在
所后也。荆沥、生葛汁，亦是此义。
关于“火中”的说法，源于刘河间。河间提出五志过极，引动内火而导致猝然昏倒（卒中）。治疗大法是用白虎汤、三黄汤来清泻，这是治疗实火的方法；用逍遥散来疏解，这是治疗郁火的方法；用通圣散、凉膈散来表里双解，这是治疗表里邪火的方法；用六味地黄丸来滋补肾阴，这是通过壮水之主以制约阳亢阳光的方法；用八味肾气丸来引导，这是所谓的从治之法，旨在引火归原；还有地黄饮子，用于治疗舌强不能言语、足废不能行走的症状，功效神妙无比。
当时的名医徐灵胎评论说：这是治疗少阴经气机逆乱（气厥）的方剂，庸医不加辨别，竟然用它来治疗所有的中风病症，轻则永远无法痊愈，重则加重病情导致死亡。医生和病人家属终身都不明白其中的道理。
孙心典按语说：舌强不能言语，有的是因为上焦被痰火阻塞，适宜使用转舌膏；有的是因为中风导致脾虚肌肉松弛、舌体僵硬不能言语，适宜使用资寿解语汤。只有少阴经脉环绕舌本，因气机逆乱不至，病名为风痱，才适宜用地黄饮子温补治疗。喻嘉言使用资寿解语汤去掉羌活、防风，加入熟地黄、何首乌、枸杞子、甘菊花、黑芝麻、天门冬来治疗。
资寿解语汤（均见于《时方》）
主治中风脾缓，舌强不能言语，半身不遂。
关于“气虚类中”的说法，源于李东垣。东垣认为元气不足则外邪乘虚而入，使人突然倒下僵仆，状如中风。治疗大法是用六君子汤加黄芪、竹沥、姜汁来治疗，补中益气汤也可以治疗；如果猝倒且遗尿，说明元气大虚，必须重用白术、人参、黄芪，加益智仁为主药。又有因恼怒导致气逆而厥，面色青紫、脉象洪大，状如中风，适宜用张景岳的解肝煎为主治疗。属于虚证的，用六君子汤加乌药、青皮、白芷为主治疗。
关于“湿中”的说法，源于朱丹溪。丹溪认为东南地区气温多湿，患有类似风病的，并非真风，而是由湿生痰，痰生热，热生风。用二陈汤加沙参、苍术、白术、竹沥、姜汁为主治疗，或者单用半夏六钱，煎煮至半盅，加入生姜汁两滴、风化硝二钱，先治其标症，或者间歇服用滚痰丸。
这也称为“痰中”，可以使用吐法，之后调理脾胃，先调畅经络，以竹沥汤为主治疗。
竹沥汤
竹沥（两酒杯量） 生葛根汁（一酒杯量） 生姜汁（一汤匙）
混合在一起，分两次服用。
在刘完素、朱震亨、李杲三位大家发挥论述之外，后人又增加了恶中、食中、寒中、暑中四种病症。
所谓“食中”，是因为过饱饮食填塞太阴脾土，上下气机不通导致厥逆，用平胃散加减煎服，或者探吐，或者用备急丸灌服。
所谓“恶中”，是进入古庙山林古墓，或见到非常怪物，感受了异气，于是昏倒不知人事。其脉象两手仿佛出自两人之手，忽大忽小，用苏合香丸灌服，或者用平胃散加雷丸二钱、雄黄精五分、藿香一二钱，以化解秽浊之气，或者焚烧降真香、藿香、生干姜、川芎、苍术、皂角、红枣，使正气从口鼻进入体内。
所谓“寒中”，或者是暴寒之气直入体内，手足厥冷，腹痛吐泻不止，于是昏倒不知人事，六脉细小，或沉伏，四肢唇口青紫暗滞，适宜用一束生葱白，放在脐中，用火斗熨烫，或者灸关元穴三十壮，再用四逆汤灌服。
所谓“暑中”，是夏季感受暑气，昏倒不省人事，自汗出、面色污垢，吐泻脉虚，用《千金方》中的消暑丸灌服，立刻苏醒。又有长途跋涉在烈日下，突然昏倒不省人事的，取热土围在脐上，注入热尿，即可苏醒，或者用生蒜捣烂成水灌服。
凡人在将死之际，阳气欲脱，必然有痰声漉漉，这是因为一身津血将逐渐化为痰而死。当时的医生对于这种症状，起手就用胆南星、石菖蒲直接攻逐其痰，这实际上是直接攻逐其津血，从而加速死亡。
《医学真传》说：《神农本草经》中只有南星，并没有胆星。南星色白味辛，禀受金气而驱风豁痰，功效同于半夏。现在的人用牛胆汁炮制为胆星，味道苦性寒冷。（庸医都说丸制的更好，不知道越炮制越失去其本性，造成的祸害更猛烈。）中风痰涎上涌，多属于三焦火衰，土崩水泛，此时帮助正气驱散邪气，壮火驱寒，还担心力量不够，如果服用苦冷的胆星，加上清凉的竹沥，必然导致生发之阳气灭绝而死。
孙心典按语说：竹沥是中风的必用药物，取其柔润以熄风，轻清以活络。而驱除经络中的痰，排在次要地位。荆沥、生葛根汁，也是这个意思。
The theory of "Fire Stroke" originates from Liu Hejian. Hejian proposed that extreme excess of the five emotions stirs up internal fire, leading to sudden collapse (stroke). The general treatment principle is to use Baihu Tang and Sanhuang Tang to purge it; this is for treating Excess Fire. Use Xiaoyao San to soothe it; this is for treating Stagnant Fire. Use Tongsheng San and Liange San to resolve both exterior and interior pathogens simultaneously; this is for treating Exterior-Interior Pathogenic Fire. Use Liuwei Dihuang Wan to nourish it; this is to strengthen the source of Water to control the Yang brilliance. Use Bawei Wan to guide it; this is the so-called contrary treatment method, guiding fire back to its origin. Additionally, Dihuang Yinzi treats symptoms where the tongue is stiff and speechless, and the feet are useless and immobile, with miraculous efficacy.
Dihuang Yinzi
Xu Lingtai, a contemporary expert, stated: This formula treats Shaoyin Qi Jue (Qi reversal of the Shaoyin channel). Quack doctors, failing to examine carefully, actually use it to treat all types of stroke cases. For mild cases, there will be no hope of recovery; for severe cases, it exacerbates the disease and causes death. Both doctors and patients' families remain unaware throughout their lives.
Sun Xindian commented: Tongue stiffness and inability to speak can be caused by phlegm-fire blocking the Upper Jiao, suitable for Zhuan She Gao. It can also be caused by wind-stroke leading to Spleen flaccidity, tongue stiffness, and aphasia, suitable for Zishou Jieyu Tang. Only when the Shaoyin meridian winds around the root of the tongue, and Qi reversal prevents its arrival, named Feng Fei (Wind Paraplegia), is it suitable to use Dihuang Yinzi for warming treatment. Yu Jiayan used Zishou Jieyu Tang, removing Qiang Huo and Fang Feng, adding Shu Di Huang, He Shou Wu, Gou Qi Zi, Gan Ju Hua, Hei Zhi Ma, and Tian Men Dong for treatment.
Zishou Jieyu Tang (Both seen in *Shi Fang*)
Treats wind-stroke with Spleen flaccidity, tongue stiffness and aphasia, and hemiplegia.
The theory of "Qi Deficiency Similar Stroke" originates from Li Dongyuan. Dongyuan believed that insufficient Yuan Qi allows pathogens to gather, causing people to suddenly fall and stiffen as if struck by wind. The general treatment principle is to use Liujunzi Tang added with Huang Qi, Zhu Li, and Jiang Zhi; Buzhong Yiqi Tang also treats it. If sudden collapse occurs with urinary incontinence, indicating severe Yuan Qi deficiency, one must heavily use Bai Zhu, Ren Shen, and Huang Qi, adding Yi Zhi Ren as the main prescription. There are also cases of Qi reversal due to anger, with a blue face and large pulse, resembling wind-stroke; these should be treated primarily with Jingyue's Jie Gan Jian. For deficiency patterns, use Liujunzi Tang added with Wu Yao, Qing Pi, and Bai Zhi.
The theory of "Dampness Stroke" originates from Zhu Danxi. Danxi argued that the southeast region has warm temperatures and high humidity. Those suffering from wind-like diseases are not affected by true wind, but rather dampness generates phlegm, phlegm generates heat, and heat generates wind. Erchen Tang added with Sha Shen, Cang Zhu, Bai Zhu, Zhu Li, and Jiang Zhi is the primary treatment. Alternatively, use Ban Xia alone, six qian, decocted to half a cup, adding two drops of Sheng Jiang Zhi and two qian of Fenghua Xiao, to first treat the branch symptoms, or take Gun Tan Wan intermittently.
This is also called "Phlegm Stroke," and emetic therapy can be used, followed by regulating the Spleen and Stomach, and first adjusting the meridians, primarily using Zhu Li Tang.
Zhu Li Tang
Zhu Li (Two wine cups) Sheng Ge Zhi (One wine cup) Sheng Jiang Zhi (One tablespoon)
Combine them, make into two doses.
Beyond the elaborations by Liu, Zhu, and Li, later generations added four more conditions: Evil Stroke, Food Stroke, Cold Stroke, and Heat Stroke.
Regarding "Food Stroke," excessive fullness blocks the Taiyin, preventing the flow of upper and lower Qi, leading to Jue. Pingwei San modified and decocted is taken, or induced vomiting, or Guan Tan (forced feeding) with Beijji Wan.
Beijji Wan Xiaoshu Wan (Both seen in *Shi Fang*)
Regarding "Evil Stroke," entering ancient temples, forests, mountains, or tombs, or seeing extraordinary monsters, one feels strange Qi, leading to fainting and loss of consciousness. The pulse on both hands seems to come from two different people, fluctuating between large and small. Suhe Xiang Wan is forced down, or Pingwei San is added with Lei Wan (two qian), Xiong Huang Jing (five fen), and Huo Xiang (one to two qian) to resolve filth. Alternatively, burn Jiang Zhen Xiang, Huo Xiang, Sheng Gan Jiang, Chuan Xiong, Cang Zhu, Zao Jiao, and Hong Zao, allowing righteous Qi to enter through the mouth and nose.
Regarding "Cold Stroke," violent cold Qi enters directly inside, causing cold limbs, abdominal pain, continuous vomiting and diarrhea, leading to fainting and loss of consciousness. The six pulses are fine and small, or deep and hidden. The four limbs, lips, and mouth are cyanotic and dark. One bundle of fresh scallion white is placed in the umbilicus and warmed with a fire pot, or Guanyuan acupoint is moxibusted for thirty moxa cones, followed by forcing down Sini Tang.
Regarding "Heat Stroke," feeling summer heat in the summer months leads to fainting and unconsciousness, spontaneous sweating, dirty complexion, vomiting, diarrhea, and a deficient pulse. Xiaoshu Wan from *Qianjin Fang* is forced down, resulting in immediate revival. There are also cases of sudden collapse and unconsciousness after long journeys under the scorching sun. Hot earth is taken to surround the umbilicus, and hot urine is poured into it, leading to immediate revival. Alternatively, raw garlic is mashed with water and forced down.
Continued Discussion on the Error of Attacking Phlegm in True Wind-Stroke and Similar Stroke
At the moment of impending death, when Yang Qi is about to escape, there must be gurgling phlegm sounds. This is because the body's Jin Ye and Blood are gradually transforming into phlegm before death. Contemporary doctors, upon encountering this condition, immediately use Dan Nan Xing and Shi Chang Pu to directly attack the phlegm. This is directly attacking the Jin Ye and Blood, thereby hastening death.
*Yixue Zhenchuan* states: *Ben Cao Jing* only mentions Nan Xing. There is no Dan Xing. Nan Xing is white and pungent, inheriting Metal Qi to dispel wind and resolve phlegm, with effects similar to Ban Xia. Nowadays, people use ox bile to process it into Dan Xing, which is bitter and cold in nature. (Quack doctors all say that pill-form processed ones are better; they do not know that further processing destroys its nature even more, causing greater harm.) In wind-stroke with phlegm-saliva surging upward, it mostly belongs to the decline of Fire in the Three Jiao, with Earth collapsing and Water flooding. At this time, assisting righteousness and dispersing pathogens, strengthening Fire to drive out Cold, one still fears insufficiency. Taking bitter-cold Dan Xing, combined with cooling Zhu Li, will inevitably lead to the extinction of Sheng Yang (Life-generating Yang) and death.
Sun Xindian commented: Zhu Li is an essential medicine for wind-stroke, chosen for its softness and moisture to extinguish wind, and its lightness and clarity to activate collaterals. Driving out phlegm in the meridians is secondary. Jing Li and Sheng Ge Zhi share this meaning.