古云盗汗属阴虚,自汗阳羸卫外疏(阳气卫外而为固。阴(虚)则六黄汤阳(虚)参附(等汤),互根
(阴阳互根,其旨甚妙)当究五车书。
中风证,余于《金匮浅注》论之甚详,然难为初学道也。尤在泾着有《金匮心典》,卓
然大家,续出《金匮翼》,全失本来面目。但中风总论虽于《金匮》有出入处,而采集时说
,堪为行道者开一觅食之路。今就原论而韵之,以便初学之记诵。
《金匮真言论》曰∶天有八风(东、西、南、北、东南、西南、东北、西北八方之风也,
经有五风(经,经脉也,五风,五脏之风也,)八风发邪以为经风,触五脏邪气发病。仲景《金
匮》专宗此说,皆指外邪而言。尤氏《金匮翼》则合内外虚实以统论之,恐《金匮翼》为后
人之托名而刻者。
中风各论杂而繁,大要惟分真与类,贼风邪气中为真,痰火食气类中隧。其人先有此肝
风(《内经》云∶“风气通于肝”。又云∶“诸风掉眩,皆属于肝。”)真类二端由此致(设无
肝风,亦只为他病,安有卒倒、偏枯、歪斜、牵引等症哉。)脏腑经络各不同,病浅病深分难
易。络病口眼俱 斜,在络病轻尚易治。手足不治病在经,语言错乱从腑议,经腑皆有倒
仆
形,倒仆之后明所自。在精神清尚识人,在腑神昏如失智,脏病最重中最深,唇缓失音耳聋
备,目瞀遗尿鼻声鼾,六证见半死期至。经腑脏病或兼连,临证细认惟会意。更察虚实得大
纲,闭证脱证因之异(二证详于八法歌,)脱应固兮闭应开,吉凶关头非姑试。八法之说本在泾
,平易近人休弃置。
古人说盗汗属于阴虚,自汗则是阳气虚弱、卫气不固(阳气具有护卫体表并使其固密的作用)。阴虚者可用六味地黄丸合当归六黄汤治疗,阳虚者可用人参、附子等组成的方剂治疗,阴阳互根的道理非常精妙,应当深入研读大量书籍。
关于中风证,我在《金匮浅注》中论述得非常详细,但这很难向初学者讲清楚。尤在泾著有《金匮心典》,造诣卓越,堪称大家;他又续写《金匮翼》,却完全失去了原本的面目。虽然他对中风的总论与《金匮要略》有些出入,但他采集的医说,足以为行医者提供一条谋生的途径。现在我根据原论将其编成韵文,以便初学者记诵。
《金匮真言论》说:天有八风(指东、西、南、北、东南、西南、东北、西北八方之风),经有五风(“经”指经脉,“五风”指五脏之风)。八风引发的邪气成为经风,触动五脏,导致邪气发病。张仲景的《金匮要略》专门遵循这一说法,都指的是外邪而言。尤氏的《金匮翼》则将内外虚实合并统论,恐怕《金匮翼》是后人托名刻印的作品。
中风的各论内容繁杂,大要只分为真中风和类中风两类。贼风邪气直接侵袭人体为真中风,因痰、火、食积、气滞引起的类似症状为类中风。患者事先已有肝风内动(《内经》说:“风气通于肝”。又说:“各种风病引起的动摇眩晕,都归属于肝。”),真中风和类中风这两种情况由此产生(如果没有肝风内动,也只是其他疾病,怎么会有突然昏倒、半身不遂、口眼歪斜、肢体牵引等症状呢?)。脏腑经络各不相同,病情深浅不同,治疗的难易程度也不同。病在络脉,表现为口眼歪斜,病在络脉较轻,尚且容易治疗。手足不能活动,病在经脉;语言错乱,应从腑病来讨论。经脉和腑病都有突然昏倒仆地的表现,但在昏倒之后要明确病因所在。如果在精神尚清醒时还能认识人,说明病在腑;如果神志昏迷如同失去智慧,说明病在腑;脏病最为严重,病位最深,表现为口唇松弛、失音、耳聋完备,眼睛昏花、遗尿、鼻出鼾声,这六种症状见到一半,死亡期限就到了。经病、腑病、脏病可能相互兼连,临证时要仔细辨认,只有融会贯通才能领会。更要察辨虚实以把握大纲,闭证和脱证因此而有区别(这两种证候在八法歌中有详细说明),脱证应当固脱,闭证应当开窍,这是决定吉凶的关键时刻,不可轻易尝试。八法的理论本出自尤在泾,平易近人,不要丢弃不用。
Ancient texts state that night sweats (Dao Han) belong to Yin deficiency, while spontaneous sweating (Zi Han) is due to Yang depletion and loose defensive exterior (Yang Qi guards the exterior and maintains consolidation). For Yin deficiency, Liuwei Dihuang Tang combined with Danggui Liuhuang Tang may be used; for Yang deficiency, formulas containing Renshen (Ginseng Radix et Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata), etc., are appropriate. The principle of mutual root between Yin and Yang is profound and should be thoroughly investigated through extensive study.
Regarding Stroke Syndrome (Zhong Feng Zheng), I discussed it in detail in *Jinkui Qianzhu* (Annotated Brief Commentary on the Golden Cabinet), but it is difficult to explain to beginners. You Zaijing authored *Jinkui Xindian* (Heart Classic of the Golden Cabinet), demonstrating卓越 expertise as a master scholar. His subsequent work, *Jinkui Yi* (Wings of the Golden Cabinet), completely lost the original essence. Although his general discussion on stroke differs somewhat from *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet), his collection of medical theories provides a viable path for practitioners. Herein, I rhyme the original theory to facilitate memorization for beginners.
*Jinkui Zhenyan Lun* states: Heaven has Eight Winds (the winds from the eight directions: East, West, South, North, Southeast, Southwest, Northeast, Northwest); the Channels have Five Winds ("Channels" refer to meridians; "Five Winds" refer to wind affecting the five zang organs). Pathogenic factors induced by the Eight Winds become channel winds, touching the five zang organs and causing disease via pathogenic qi. Zhang Zhongjing's *Jinkui Yaolue* strictly follows this view, referring exclusively to external pathogens. You Shi's *Jinkui Yi*, however, combines internal and external, excess and deficiency into a unified discussion, suggesting that *Jinkui Yi* might be a posthumous forgery or pseudonymous publication.
The detailed discussions on various types of stroke are complex and numerous; the main point lies in distinguishing True Stroke (Zhen Zhong) from Pseudo-Stroke (Lei Zhong). True stroke is caused by thief wind and pathogenic qi directly striking the body; pseudo-stroke arises from phlegm, fire, food stagnation, and qi obstruction. If one already possesses internal Liver Wind (as stated in *Neijing*: "Wind qi communicates with the Liver"; and "All wind diseases involving tremors and dizziness belong to the Liver"), both true and pseudo strokes originate from this. Without internal Liver Wind, these would merely be other diseases, how could there be sudden collapse, hemiplegia, facial deviation, or limb traction? The zang organs and channels differ, and the depth of disease varies, making treatment difficulty distinct. Disease in the collaterals manifests as mouth and eye deviation; being in the collaterals indicates a lighter condition, still relatively easy to treat. Inability to move hands and feet indicates disease in the channels; disordered speech suggests discussing from the perspective of fu organs. Both channel and fu diseases present with sudden collapse; after collapse, one must clarify the origin. If mental clarity remains and the patient can recognize others, the disease is in the fu; if consciousness is lost resembling dementia, the disease is in the fu. Zang organ disease is the most severe and deepest, presenting with flaccid lips, loss of voice, complete deafness, blurred vision, urinary incontinence, and snoring. If half of these six signs appear, death is imminent. Channel, fu, and zang diseases may overlap; clinical diagnosis requires careful identification and intuitive understanding. Furthermore, one must examine excess and deficiency to grasp the general principle, differentiating between Closed Syndrome (Bi Zheng) and Collapsing Syndrome (Tuo Zheng) (detailed in the Song of Eight Methods). Collapsing syndrome requires securing and consolidating; Closed syndrome requires opening and releasing. This is a critical juncture determining life and death, not to be trifled with. The theory of Eight Methods originated with You Zaijing; it is accessible and should not be discarded.