治内中风证（亦名类中风，即西人所谓脑充血证），其脉弦长有力（即西医所谓血压过高），或上盛下虚，
头目时常眩晕，或脑中时常作疼发热，或目胀耳鸣，或心中烦热，或时常噫气，或肢体渐觉不利，或口眼渐形
歪斜，或面色如醉，甚或眩晕，至于颠仆，昏不知人，移时始醒，或醒后不能撤消，精神短少，或肢体痿废，
或成偏枯。
怀牛膝（一两） 生赭石（一两，轧细） 生龙骨（五钱，捣碎） 生牡蛎（五钱，捣碎） 生龟板
（五钱，捣碎） 生杭芍（五钱） 玄参（五钱） 天冬（五钱） 川楝子（二钱，捣碎） 生麦芽（二钱）
茵陈（二钱） 甘草（钱半）
心中热甚者，加生石膏一两。痰多者，加胆星二钱。尺脉重按虚者，加熟地黄八钱、净萸肉五钱。大便不
实者，去龟板、赭石，加赤石脂（喻嘉言谓石脂可代赭石）一两。
风名内中，言风自内生，非风自外来也。《内经》谓“诸风掉眩，皆属于肝”。盖肝为木脏，木火炽盛，
亦自有风。此因肝木失和风自肝起。又加以肺气不降，肾气不摄，冲气胃气又复上逆，于斯，脏腑之气化皆上
升太过，而血之上注于脑者，亦因之
太过，致充塞其血管而累及神经。其甚者，致令神经失其所司，至昏厥不省人事。西医名为脑充血证，诚由剖
解实验而得也。是以方中重用牛膝以引血下行，此为治标之主药。而复深究病之本源，用龙骨、牡蛎、龟板、
芍药以镇熄肝风，赭石以降胃降冲，玄参、天冬以清肺气，肺中清肃之气下行，自能镇制肝木。至其脉之两尺虚
者，当系肾脏真阴虚损，不能与真阳相维系。其真阳脱而上奔，并挟气血以上冲脑部，故又加熟地、萸肉以补
肾敛肾。从前所拟之方，原止此数味。后因用此方效者固多，间有初次将药服下转觉气血上攻而病加剧者，于
斯加生麦芽、茵陈、川楝子即无斯弊。盖肝为将军之官，其性刚果，若但用药强制，或转激发其反动之力。茵陈
为青蒿之嫩者，得初春少阳生发之气，与肝木同气相求，泻肝热兼舒肝郁，实能将顺肝木之性。麦芽为谷之
萌芽，生用之亦善将顺肝木之性使不抑郁。川楝子善引肝气下达，又能折其反动之力。方中加此三味，而后用此
方者，自无他虞也。心中热甚者，当有外感，伏气化热，故加石膏。有痰者，恐痰阻气化之升降，故加胆星也。
内中风之证，曾见于《内经》。而《内经》初不名为内中风，亦不名为脑充血，而实名之为煎厥、大厥、
薄厥。今试译《内经》之文以明之。《内经》脉解篇曰∶“肝气当治而未得，故善怒，善怒者名曰煎厥。”盖肝
为将军之官，不治则易怒，因怒生热，煎耗肝血，遂致肝中所寄之相火，掀然暴发，挟气血而上冲脑部，以致
昏厥。此非因肝风内动，而遂为内中风之由来乎？
《内经》调经论曰∶“血之与气，并走于上，此为大厥，厥则暴死。气反则生，气不反则死。”盖血不
自升，必随气而上升，上升之极，必至脑中充血。至所谓气反则生，气不反则死者，盖气反而下行，血即随之
下行，故其人可生。若其气上行不反，血必随之充而益充，不至血管破裂不止，犹能望其复苏乎。
读此节经文，内中风之理明，脑充血之理亦明矣。
《内经》生气通天论曰∶“阳气者大怒则形绝，血宛（即郁字）于上，使人薄厥。”观此节经文，不待诠
解，即知其为肝风内动，以致脑充血也。其曰薄厥者，言其脑中所宛之血，激薄其脑部，以至于昏厥也。细思
三节经文，不但知内中风即西医所谓脑充血，且更可悟得此证治法，于经文之中，不难自拟对证之方，而用之
必效也。
特是证名内中风，所以别外受之风也。乃自唐、宋以来，不论风之外受、内生，浑名曰中风。夫外受之风
为真中风，内生之风为类中风，其病因悬殊，治法自难从同。若辨证不清，本系内中风，而亦以祛风之药发表
之，其脏腑之血，必益随发表之药上升，则脑中充血必益甚，或至于血管破裂，不可救药。此关未透，诚唐、
宋医学家一大障碍也。迨至宋末刘河间出，悟得风非皆由外中，遂创为五志过极动火而猝中之论，此诚由《内
经》“诸风掉眩皆属于肝”句悟出。盖肝属木，中藏相火，木盛火炽，即能生风也。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（逍遥散中柴胡能引血上行最为忌用，是以镇肝熄风汤中
止用茵陈、生麦芽诸药疏肝）。以通圣散（方中防风亦不宜用）、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，引火归源也（虽曰引火归源，而桂、
附终不宜用）。细审河间所用之方，虽不能丝丝入扣，然胜于但知治中风不知分内外者远矣。且其谓有实热者，
宜治以白虎汤，尤为精确之论。愚治此证多次，其昏仆之后，能自苏醒者多，不能苏醒者少。其于苏醒之后，
三四日间，现白虎汤证者，恒十居六七。因知此证，多先有中风基础，伏藏于内，后因外感而激发，是以从前
医家，统名为中风。不知内风之动，虽由于外感之激发，然非激发于外感之风，实激发于外感之因风生热，内
外两热相并，遂致内风暴动。此时但宜治外感之热，不可再散外
感之风，此所以河间独借用白虎汤，以泻外感之实热，而于麻桂诸药概无所用。盖发表之药，皆能助血上行，
是以不用，此诚河间之特识也。吾友张山雷（江苏嘉定人），着有《中风 诠》一书，发明内中风之证，甚为
精详。书中亦独有取于河间，可与拙论参观矣。
后至元李东垣、朱丹溪出，对于内中风一证，于河间之外，又创为主气、主湿之说。东垣谓人之元气不
足，则邪凑之，令人猝倒僵仆，如风状。夫人身之血，原随气流行，气之上升者过多，可使脑部充血，排挤脑
髓神经。至于昏厥，前所引《内经》三节文中已言之详矣。若气之上升者过少，又可使脑部贫血，无以养其脑
髓神经，亦可至于昏厥。是以《内经》又谓∶“上气不足，脑为之不满，耳为之苦鸣，头为之倾，目为之眩。”
观《内经》如此云云，其剧者，亦可至于昏厥，且其谓脑为之不满，实即指脑中贫血而言也。由斯而论，东垣
之论内中风，由于气虚邪凑，原于脑充血者之中风无关，而实为脑贫血者之中风，开其治法也。是则河间之主
火，为脑充血，东垣之主气，为脑贫血，一实一虚，迥不同也。至于丹溪则谓东南气温多湿，有病风者，非风
也，由湿生痰，痰生热，热生风，此方书论中风者所谓丹溪主湿之说也。然其证原是痰厥，与脑充血、脑贫血
皆无涉。即使二证当昏厥之时，间有挟痰者，乃二证之兼证，非二证之本病也。
按∶其所谓因热生风之见解，似与河间主火之意相同，而实则迥异。盖河间所论之火生于燥，故所用之
药，注重润燥滋阴。丹溪所论之热生于湿，其所用之药，注重去湿利痰。夫湿非不可以生热，然因湿生热，而
动肝风者甚少矣（肝风之动多因有燥热）。是则二子之说，仍以河间为长也。
至清中叶王勋臣出，对于此证，专以气虚立论。谓人之元气，全体原十分，有时损去五分，所余五分，虽
不能充体，犹可支持全身。而气虚者经络必虚，有时气从经络虚处通过，并于一
边，彼无气之边，即成偏枯。爰立补阳还五汤，方中重用黄 四两，以峻补气分，此即东垣主气之说也。然王
氏书中，未言脉象何如。若遇脉之虚而无力者，用其方原可见效。若其脉象实而有力，其人脑中多患充血，而
复用黄 之温而升补者，以助其血愈上行，必至凶危立见，此固不可不慎也。前者邑中某人，右手废不能动，
足仍能行。其孙出门，遇一在津业医者甫归，言此证甚属易治，遂延之诊视。所立病案言脉象洪实，已成痪证
无疑。其方仿王氏补阳还五汤，有黄 八钱。服药之后，须臾昏厥不醒矣。夫病本无性命之忧，而误服黄 八
钱，竟至如此，可不慎哉！
刘××丁卯来津后，其脑中常觉发热，时或眩晕，心中烦躁不宁，脉象弦长有力，左右皆然，知系脑充血证。
盖其愤激填胸，焦思积虑者已久，是以有斯证也。为其脑中觉热，俾用绿豆实于囊中作枕，为外治之法。又治
以镇肝熄风汤，于方中加地黄一两，连服数剂，脑中已不觉热。遂去川楝子，又将生地黄改用六钱，服过旬日，
脉象和平，心中亦不烦躁，遂将药停服。
又∶天津于氏所娶新妇，过门旬余，忽然头疼。医者疑其受风，投以发表之剂，其疼陡剧，号呼不止。延
愚为之诊视。其脉弦硬而长，左部尤甚。知其肝胆之火上冲过甚也。遂投以镇肝熄风汤，加龙胆草三钱，以泻
其肝胆之火。一剂病愈强半，又服两剂，头已不疼，而脉象仍然有力。遂去龙胆草，加生地黄六钱，又服数剂，
脉象如常，遂将药停服。
治疗内中风证（也称为类中风，即西医所说的脑充血证），其脉象弦长有力（即西医所说的血压过高），或者上部盛实下部虚弱，头部和眼睛时常眩晕，或者头脑中时常疼痛发热，或者眼睛胀痛耳鸣，或者心中烦热，或者时常打嗝，或者肢体逐渐感觉不灵活，或者口眼逐渐歪斜，或者面色像喝醉了一样，甚至出现眩晕导致突然跌倒，昏迷不省人事，过一段时间才醒来，或者醒来后不能恢复常态，精神短少，或者肢体痿废，或者形成半身不遂。
怀牛膝（一两） 生赭石（一两，轧细） 生龙骨（五钱，捣碎） 生牡蛎（五钱，捣碎） 生龟板（五钱，捣碎） 生杭芍（五钱） 玄参（五钱） 天冬（五钱） 川楝子（二钱，捣碎） 生麦芽（二钱） 茵陈（二钱） 甘草（钱半）
如果心中热甚，加生石膏一两。痰多者，加胆南星二钱。尺脉重按虚者，加熟地黄八钱、净山茱萸五钱。大便不实者，去掉龟板、赭石，加赤石脂（喻嘉言认为石脂可以代替赭石）一两。
风名为“内中”，意思是风从内生，不是风从外感而来。《内经》说“诸风掉眩，皆属于肝”。大概肝为木脏，木火炽盛，自然会有风产生。这是因为肝木失和，风从肝起。又加上肺气不降，肾气不摄，冲气和胃气又向上逆乱，于是脏腑的气化都上升太过，而血液上注于脑的也因而太过，导致血管充塞并累及神经。严重的，导致神经失去其功能，以至昏厥不省人事。西医称为脑充血证，这确实是经过解剖实验得出的结论。所以方中重用牛膝来引血下行，这是治标的主药。然后又深入探究病的本源，用龙骨、牡蛎、龟板、芍药来镇熄肝风，赭石来降胃气和冲气，玄参、天冬来清肺气，肺中的清肃之气下行，自然能镇制肝木。至于脉象两尺虚的，应当是肾脏真阴虚损，不能与真阳相维系。其真阳脱失而上奔，并挟带气血以上冲脑部，所以又加熟地、山茱萸来补肾敛肾。从前所拟定的方子，原本只有这几味药。后来因为用此方有效的固然很多，但间或有初次服药后反而觉得气血上攻而病情加剧的，于是加上生麦芽、茵陈、川楝子就没有这种弊病了。大概肝为将军之官，其性刚强果决，如果只用药物强制压制，或许会激发其反动的力量。茵陈是青蒿的嫩株，得初春少阳生发之气，与肝木同气相求，泻肝热兼舒肝郁，实在能将顺肝木的性情。麦芽是谷物的萌芽，生用也能善于将顺肝木的性情使其不抑郁。川楝子善于引导肝气下达，又能折服其反动的力量。方中加入这三味药，之后使用此方的人，自然没有其他的忧虑了。心中热甚的，应当有外感，伏气化热，所以加石膏。有痰的，恐怕痰阻碍气化的升降，所以加胆南星。
内中风证，曾在《内经》中出现。但《内经》起初并不叫内中风，也不叫脑充血，而是实名之为煎厥、大厥、薄厥。现在试着翻译《内经》的文句来说明它。《内经》脉解篇说：“肝气当治而未得，故善怒，善怒者名曰煎厥。”大概肝为将军之官，不治则易怒，因怒生热，煎熬耗伤肝血，致使肝中所寄的相火，猛然暴发，挟带气血而上冲脑部，以致昏厥。这不是因为肝风内动，从而成为内中风的由来吗？
《内经》调经论说：“血之与气，并走于上，此为大厥，厥则暴死。气反则生，气不反则死。”大概血不会自行上升，必定随气而上升，上升到极点，必至脑中充血。至于所谓气反则生，气不反则死的，大概气反过来下行，血就随之下行，所以其人可生。如果其气上行不反，血必定随之充盈更加充盈，不到血管破裂不止，还能指望他复苏吗？
《内经》生气通天论说：“阳气者大怒则形绝，血宛（即郁字）于上，使人薄厥。”看这一节经文，不用解释，就知道它是肝风内动，以致脑充血。所谓薄厥，是说脑中郁积的血，激薄脑部，以至于昏厥。仔细思考这三节经文，不但知道内中风就是西医所谓的脑充血，而且更可悟得此证的治疗方法，在经文中，不难自己拟定对症的方子，并且使用必然有效。
特别是证名内中风，是为了区别于外受的风。但从唐、宋以来，不论风是外受还是内生，都统称为中风。外受的风为真中风，内生的风为类中风，其病因悬殊，治疗方法自然难以相同。如果辨证不清，本系内中风，却也用祛风的药发表，那么脏腑的血，必定更随着发表的药上升，则脑中充血必定更严重，甚至至于血管破裂，不可救药。这个关口没看透，确实是唐、宋医学家的一大障碍。等到宋末刘河间出来，领悟到风并非都由外中引起，于是创立了五志过极动火而猝中的理论，这确实是从《内经》“诸风掉眩皆属于肝”一句悟出的。大概肝属木，中藏相火，木盛火炽，就能生风。大法，用白虎汤、三黄汤来清热，所以治实火。用逍遥散疏解，所以治郁火（逍遥散中柴胡能引血上行最为忌用，所以在镇肝熄风汤中只用茵陈、生麦芽等药疏肝）。用通圣散（方中防风也不宜用）、凉膈散双解，所以治表里之邪火。用六味丸滋养，所以壮水之主，以制阳光。用八味丸引导，所谓从治之法，引火归源（虽然说是引火归源，但桂枝、附子终究不宜用）。仔细审视河间所用的方子，虽然不能丝丝入扣，然而胜过只知道治中风不知道分内外的人远多了。而且他说有实热的，宜用白虎汤治疗，尤为精确的理论。我治疗此证多次，昏仆之后能自苏醒的多，不能苏醒的少。其在苏醒之后，三四日间，现白虎汤证的，常常十居六七。因此知道此证，多先有中风的底子，伏藏在体内，后因外感而激发，所以从前医家，统称中风。不知道内风的动，虽然由于外感的激发，然而不是激发于外感的风，实在是激发于外感因风生热，内外两热相并，遂致内风暴动。此时只宜治外感的热，不可再散外感的风，这就是为什么河间独借用白虎汤，以泻外感的实热，而对于麻黄、桂枝等药一概不用。大概发表的药，都能助血上行，所以不用，这确实是河间的独特见识。我的朋友张山雷（江苏嘉定人），著有《中风诠》一书，阐发内中风证，非常精详。书中也独有取于河间，可以与我的论述参考阅读。
后至元朝李东垣、朱丹溪出来，对于内中风一证，在河间之外，又创立了主气、主湿的说法。东垣说人的元气不足，则邪气凑之，令人猝倒僵仆，像风状。人身之血，原随气流行，气上升的过多，可使脑部充血，排挤脑髓神经。至于昏厥，前面引用的《内经》三节文中已经说得详细了。如果气上升的过少，又可使脑部贫血，无以养其脑髓神经，也可至于昏厥。所以《内经》又说：“上气不足，脑为之不满，耳为之苦鸣，头为之倾，目为之眩。”看《内经》如此说，严重的，也可至于昏厥，而且他说脑为之不满，实在就是指脑中贫血而言。由此而论，东垣论内中风，由于气虚邪凑，原来与脑充血的中风无关，而实为脑贫血的中风，开创了其治疗方法。这样看来，河间的主火，为脑充血，东垣的主气，为脑贫血，一实一虚，完全不同。至于丹溪则说东南气温多湿，有病风者，不是风，由湿生痰，痰生热，热生风，这是方书论中风者所谓的丹溪主湿的说法。然而其证原是痰厥，与脑充血、脑贫血都无涉。即使二证在昏厥之时，间有挟痰的，乃是二证的兼证，非二证的本病。
按：其所谓因热生风的见解，似乎与河间主火的意思相同，而实则迥异。大概河间所论之火生于燥，所以他用的药，注重润燥滋阴。丹溪所论的热生于湿，他用的药，注重去湿利痰。湿并非不可以生热，然而因湿生热，而动肝风的很少了（肝风的动多因有燥热）。这样看来，二子的学说，仍以河间为长。
到了清中叶王勋臣出来，对于此证，专以气虚立论。说人的元气，全体原十分，有时损去五分，所余五分，虽不能充体，犹可支持全身。而气虚者经络必虚，有时气从经络虚处通过，并于一边，彼无气之边，即成偏枯。于是立补阳还五汤，方中重用黄芪四两，以峻补气分，这就是东垣主气的说法。然而王氏书中，未言脉象如何。如果遇到脉虚而无力的，用他的方子原可见效。如果其脉象实而有力，其人脑中多患充血，而再用黄芪之温而升补的，以助其血愈上行，必至凶危立见，这固然不可不慎。前些年县里某人，右手废不能动，足仍能行。其孙出门，遇到一个在天津业医的医生刚回来，说此证甚属易治，于是延请他诊视。所立的病案说脉象洪实，已成瘫痪证无疑。其方仿王氏补阳还五汤，有黄芪八钱。服药之后，片刻昏厥不醒了。病本来没有性命之忧，而误服黄芪八钱，竟至如此，可不慎哉！
刘××丁卯年来津后，其脑中常觉发热，时或眩晕，心中烦躁不宁，脉象弦长有力，左右皆然，知系脑充血证。大概其愤激填胸，焦思积虑已久，所以有此证。因为其脑中觉热，让他用绿豆实于囊中作枕，作为外治之法。又治以镇肝熄风汤，于方中加地黄一两，连服数剂，脑中已不觉热。于是去掉川楝子，又将生地黄改用六钱，服过旬日，脉象和平，心中亦不烦躁，于是将药停服。
另外：天津于氏所娶新妇，过门旬余，忽然头疼。医者疑其受风，投以发表之剂，其疼陡剧，号呼不止。延请我为其诊视。其脉弦硬而长，左部尤甚。知其肝胆之火上冲过甚。于是投以镇肝熄风汤，加龙胆草三钱，以泻其肝胆之火。一剂病愈强半，又服两剂，头已不疼，而脉象仍然有力。于是去龙胆草，加生地黄六钱，又服数剂，脉象如常，于是将药停服。
Treatment for Internal Wind-Stroke Syndrome (also known as Quasi-Wind-Stroke, i.e., Cerebral Hyperemia as termed by Western medicine), characterized by a wiry, long, and forceful pulse (i.e., hypertension as termed by Western medicine), or excess in the upper part and deficiency in the lower part. Symptoms include frequent dizziness of the head and eyes, frequent pain and heat sensation in the brain, distending pain in the eyes with tinnitus, vexation and heat in the heart, frequent belching, gradual impairment of limb mobility, gradual deviation of the mouth and eyes, facial appearance resembling intoxication, severe cases may involve fainting leading to sudden collapse, unconsciousness, recovering after some time, or inability to return to normal state after waking, shortness of spirit, flaccid paralysis of limbs, or hemiplegia.
Huai Niuxi (Folium et Radix Achyranthis Bidentatae) 1 liang, Sheng Zhe Shi (Hematitum Preparatum) 1 liang (finely ground), Sheng Long Gu (Os Draconis et Ossis Mastodi) 5 qian (crushed), Sheng Mu Li (Concha Ostreae) 5 qian (crushed), Sheng Gui Ban (Carapax et Plastrum Testudinis) 5 qian (crushed), Sheng Hang Shao (Radix Paeoniae Alba) 5 qian, Xuan Shen (Radix Scrophulariae) 5 qian, Tian Dong (Rhizoma Asparagi) 5 qian, Chuan Lian Zi (Fructus Toosendan) 2 qian (crushed), Sheng Mai Ya (Germen Hordei Vulgaris) 2 qian, Yin Chen (Herba Artemisiae Scopariae) 2 qian, Gan Cao (Radix Glycyrrhizae Uralensis) 1.5 qian.
If there is severe heat in the heart, add Sheng Shi Gao (Gypsum Fibrosum) 1 liang. If there is much phlegm, add Dan Xing (Arisaematis Cum Bile) 2 qian. If the Chi pulse is deficient upon heavy pressure, add Shu Di Huang (Radix Rehmanniae Preparata) 8 qian and Jing Yu Rou (Fructus Corni) 5 qian. If stool is loose, remove Gui Ban and Zhe Shi, and add Chi Shi Zhi (Halloysit Rubrum) 1 liang (Yu Jiayan stated that Shi Zhi can replace Zhe Shi).
The term "Internal Wind" implies that wind arises from within, not from external invasion. The *Nei Jing* states: "All wind tremors and dizziness belong to the Liver." The Liver is a Wood organ; when Wood fire blazes, wind naturally arises. This occurs because Liver Wood loses harmony, causing wind to originate from the Liver. Additionally, Lung Qi fails to descend, Kidney Qi fails to secure, and Chong Qi and Stomach Qi rebel upward. Consequently, the Qi transformation of all organs rises excessively, and blood pouring into the brain also becomes excessive, leading to vascular congestion and affecting the nerves. In severe cases, nerve function is lost, resulting in coma and unconsciousness. Western medicine calls this Cerebral Hyperemia, a conclusion derived from anatomical experiments. Therefore, the formula heavily uses Niuxi (Achyranthes Root) to guide blood downward, which is the main drug for treating the branch symptoms. Furthermore, investigating the root cause, it uses Long Gu (Dragon Bone), Mu Li (Oyster Shell), Gui Ban (Turtle Shell), and Shao Yao (Peony Root) to calm and extinguish Liver Wind, Zhe Shi (Hematite) to direct Stomach and Chong Qi downward, and Xuan Shen (Scrophularia Root) and Tian Dong (Asparagus Rhizome) to clear Lung Qi. When the clear and descending Qi of the Lung moves downward, it naturally restrains Liver Wood. For those with deficient pulses at both Chi positions, it indicates damage to the True Yin of the Kidneys, unable to maintain connection with True Yang. The True Yang escapes and rushes upward, carrying Qi and Blood to surge into the brain. Thus, Shu Di Huang (Prepared Rehmannia Root) and Yu Rou (Cornus Fruit) are added to tonify and astringe the Kidneys. The originally proposed formula contained only these ingredients. Later, although many were effective, some experienced aggravated conditions with Qi and Blood rushing upward after the first dose. Adding Sheng Mai Ya (Barley Sprout), Yin Chen (Artemisia Scoparia Herb), and Chuan Lian Zi (Toosendan Fruit) eliminated this drawback. The Liver is the General Officer, possessing a rigid nature. If merely suppressed by medication, it might trigger reactive forces. Yin Chen, the tender shoot of Qing Hao (Artemisia Annua), possesses the rising Qi of early spring Shaoyang, resonating with Liver Wood. It clears Liver Heat and soothes Liver Depression, effectively accommodating the nature of Liver Wood. Sheng Mai Ya, the sprout of grain, also accommodates the nature of Liver Wood when used raw, preventing stagnation. Chuan Lian Zi guides Liver Qi downward and counters reactive forces. Adding these three herbs ensures safety when using this formula. Severe heat in the heart suggests external pathogenic factors transforming into heat; thus, Shi Gao (Gypsum) is added. Phlegm may obstruct Qi transformation; thus, Dan Xing (Arisaema with Bile) is added.
Internal Wind-Stroke appears in the *Nei Jing*, though not named as such nor as Cerebral Hyperemia, but rather as Jian Jue (Boiling Decoction Syncope), Da Jue (Great Syncope), and Bo Jue (Thin Syncope). Translating the *Nei Jing*: The *Mai Jie Pian* says: "When Liver Qi should be regulated but is not, one becomes easily angry; easy anger is called Jian Jue." The Liver is the General Officer; if unregulated, it leads to anger. Anger generates heat, boiling and consuming Liver Blood, causing the Ministerial Fire residing in the Liver to erupt suddenly, carrying Qi and Blood to surge into the brain, resulting in syncope. Is this not the origin of Internal Wind-Stroke due to internal stirring of Liver Wind?
The *Tiao Jing Lun* says: "When Blood and Qi move together upward, this is Da Jue; syncope leads to sudden death. If Qi returns, life is preserved; if Qi does not return, death ensues." Blood does not rise on its own but follows Qi. Extreme upward movement causes cerebral hyperemia. "Qi returning" means Qi reverses and descends, bringing Blood down, allowing survival. If Qi continues upward without reversal, Blood becomes increasingly congested until vessels rupture; recovery is unlikely.
Reading this passage clarifies the principles of Internal Wind-Stroke and Cerebral Hyperemia.
The *Sheng Qi Tong Tian Lun* says: "Yang Qi, under great anger, suffers form severance; Blood stagnates above, causing Bo Jue." Without explanation, this indicates Liver Wind stirring internally leading to cerebral hyperemia. "Bo Jue" refers to stagnant blood in the brain pressing against the brain, causing syncope. Reflecting on these three passages reveals that Internal Wind-Stroke corresponds to Western Cerebral Hyperemia, and treatment methods can be deduced from the classics to formulate effective prescriptions.
The name "Internal Wind-Stroke" distinguishes it from externally acquired wind. Since Tang and Song dynasties, both external and internal winds were indiscriminately called Wind-Stroke. External wind is True Wind-Stroke; internal wind is Quasi-Wind-Stroke. Etiologies differ greatly, so treatments must differ. Misdiagnosing Internal Wind-Stroke as external and using diaphoretic drugs will drive blood upward, worsening cerebral hyperemia, potentially causing vessel rupture and untreatable conditions. This lack of distinction was a major obstacle for Tang and Song physicians. Liu Hejian (Song Dynasty) realized wind is not always external, proposing that extreme emotions generate fire leading to sudden stroke, derived from "All wind tremors and dizziness belong to the Liver." Liver belongs to Wood, containing Ministerial Fire; excessive Wood and Fire generate wind. The general method uses Bai Hu Tang (White Tiger Decoction) and San Huang Tang (Three Yellow Decoction) to treat Excess Fire; Xiao Yao San (Free and Easy Wanderer Powder) to treat Depressed Fire (note: Chai Hu in Xiao Yao San guides blood upward and is contraindicated here; hence Zhen Gan Xi Feng Tang uses Yin Chen and Sheng Mai Ya instead); Tong Sheng San (Universal Salvation Powder) and Liang Ge San (Cool the Chest Powder) to treat exterior-interior pathogenic fire; Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia) to nourish Water to control Yang; Ba Wei Wan (Eight Ingredient Pill) to guide fire back to its source (though called guiding fire back, Gui Zhi and Fu Zi are unsuitable). Although Liu's formulas are not perfect, they surpass those who fail to distinguish internal/external wind. His use of Bai Hu Tang for excess heat is precise. I have treated this syndrome many times; most recover consciousness after collapse. Within 3-4 days post-recovery, Bai Hu Tang syndrome appears in 60-70% of cases. This suggests an underlying latent stroke condition triggered by external pathogens. Former physicians called it Wind-Stroke generally. However, internal wind stirring, though triggered by external factors, is actually ignited by heat generated from external wind, combining internal and external heat to stir internal storm. At this stage, one should treat external heat, not disperse external wind. This explains why Liu borrowed Bai Hu Tang to clear external excess heat, avoiding Ma Huang and Gui Zhi, as diaphoretics aid blood ascent. This is Liu's unique insight. My friend Zhang Shanlei (Jiading, Jiangsu) wrote *Zhong Feng Quan*, detailing Internal Wind-Stroke, favoring Liu's approach, which complements my discussion.
Later, Li Dongyuan and Zhu Danxi (Yuan Dynasty) proposed Qi deficiency and Dampness theories alongside Liu's Fire theory. Li Dongyuan stated that insufficient Yuan Qi allows evil to invade, causing sudden collapse like wind. Blood follows Qi; excessive upward Qi causes cerebral hyperemia and compression of brain tissue/nerves, leading to syncope (as per *Nei Jing*). Insufficient upward Qi causes cerebral anemia, failing to nourish brain tissue/nerves, also leading to syncope. *Nei Jing* says: "Deficiency of upper Qi leads to incomplete filling of the brain, bitter ringing in ears, tilting of the head, and dizziness." Severe cases lead to syncope. "Incomplete filling" refers to cerebral anemia. Thus, Li's theory of Qi deficiency relates to cerebral anemia, distinct from Liu's cerebral hyperemia (Excess vs. Deficiency). Zhu Danxi argued that in the warm, damp southeast, wind diseases are not true wind but arise from Dampness generating Phlegm, Phlegm generating Heat, and Heat generating Wind. This is the "Danxi emphasizes Dampness" view. However, this describes Tan Jue (Phlegm Syncope), unrelated to cerebral hyperemia or anemia. Even if phlegm accompanies syncope in those conditions, it is a concurrent symptom, not the primary pathology.
Analysis: Danxi's view of Heat generating wind seems similar to Liu's Fire theory but differs essentially. Liu's Fire arises from Dryness, so his drugs focus on moistening dryness and nourishing Yin. Danxi's Heat arises from Dampness, so his drugs focus on resolving dampness and draining phlegm. While Dampness can generate Heat, Dampness-induced Liver Wind is rare (Liver Wind usually stems from Dryness-Heat). Thus, Liu's theory is superior.
In mid-Qing Dynasty, Wang Xunchen focused on Qi deficiency. He posited that human Yuan Qi totals ten parts; losing five leaves five, insufficient to fill the body but supporting it. Qi deficiency leads to meridian deficiency. If Qi passes through weak meridians and concentrates on one side, the other side lacks Qi, causing hemiplegia. He created Bu Yang Huan Wu Tang (Tonify Yang and Restore Five Tenths Decoction), heavily using Huang Qi (Astragalus Root) 4 liang to vigorously tonify Qi, following Li Dongyuan's Qi theory. However, Wang did not specify pulse conditions. If the pulse is deficient and weak, his formula works. If the pulse is solid and forceful, indicating cerebral hyperemia, using warming and ascending Huang Qi will drive blood further upward, causing immediate danger. Caution is essential. A case in our county involved a man with right-hand paralysis but walking ability. His grandson consulted a doctor returning from Tianjin, who claimed easy cure. The diagnosis noted a surging, solid pulse, confirming paralysis. The prescription imitated Bu Yang Huan Wu Tang with 8 qian of Huang Qi. After taking it, the patient fell into coma. A non-fatal condition became critical due to misused Huang Qi. How cautious must we be!
Liu XX came to Tianjin in Ding Mao year. He felt frequent heat in the brain, occasional dizziness, and inner restlessness. Pulse was wiry, long, and forceful bilaterally, indicating cerebral hyperemia caused by long-standing frustration and anxiety. For brain heat, he used green beans in a pillow as external therapy. Internally, he took Zhen Gan Xi Feng Tang (Settle the Liver and Extinguish Wind Decoction) with added Di Huang (Rehmannia Root) 1 liang. After several doses, brain heat subsided. Chuan Lian Zi was removed, and Sheng Di Huang was reduced to 6 qian. After ten days, the pulse normalized, and inner restlessness ceased. Medication stopped.
Another case: The new bride of the Yu family in Tianjin suffered sudden headache over a week after marriage. Doctors suspected external wind and administered diaphoretics, worsening the pain significantly. I was consulted. The pulse was wiry, hard, and long, especially on the left, indicating excessive upward rush of Liver and Gallbladder Fire. I prescribed Zhen Gan Xi Feng Tang with Long Dan Cao (Gentiana Root) 3 qian to drain Liver/Gallbladder Fire. One dose improved symptoms by half; two more doses stopped the headache, though the pulse remained forceful. Long Dan Cao was removed, and Sheng Di Huang 6 qian was added. After several doses, the pulse normalized, and medication stopped.