散，烦热多汗，暑热未清，气虚者，参术苓 人参养营汤；血虚者，何首乌散（有汗、无汗、新
久、虚实）。疟邪日久不散，私结营垒于肝木之部，名曰疟母，宜鳖煎丸。常在左胁结癖，其延
久气血衰而寒热时作者疟劳，仍当从阴阳偏处调补。
问∶滞下之病古称肠癖，后世名痢。痢字作顺利解，今以涩滞名痢者何居？其所以涩滞
者何故？赤色者何故？色白者何故？赤白相
兼见者何故？色黑者何故？色青者何故？纯血者何故？如浓血稀薄者何故？如豆汁者何
故？如屋漏水者何故？自古论痢诸名家其精当可道者，能详述乎？诸家皆谓湿火，景岳、石
顽独有寒冷一种，其故安在？厌食者曰噤口痢，时发者曰休息痢，当详所因所治，孕妇尤
难，皆宜辨。
经曰∶“饮食不节，起居不时，阴受之则入，五脏填满闭塞，下为飧泄，久为肠癖。”言
“脏气久滞不能营运，津液移于二肠而为 积崩迫，阴气受伤所致也。”审是痢疾，古名肠
，今以痢名，传述之谬也。欲其所以滞下，所以五色，当求之诸名家。李东垣曰∶“饮食起居
不时损，其胃气则上升，清阳之气反下降为飧泄，久则太阴伤少阴为肠 ，寒冷伤中而胀者
为飧泄，宜温热消导。湿热伤中下浓血，宜苦寒疏利。风邪下陷，宜升举。湿热内盛，宜分
别∶里急者宜下，后重者宜调，洞泄肠鸣脉细者温收之，稠粘涩滞脉有力者寒下之。”按∶此
条前注经而后统论痢病，最明晰。朱丹溪曰∶“赤痢自小肠来，白痢自大肠来，皆以湿热为
本。”按∶此条明金色白而火色赤。王宇泰曰∶“胃有湿热拂郁不化，气凝注大肠成白痢，血
凝注小肠成赤痢，二肠均受赤白并下，以大肠合肺、小肠合心也。初起实者必推荡之，通因
通用也。如失下，五六日后脾胃虚，难胜下。白者平胃加楂、槟、枳、芍、芩、连、滑、曲、归、姜，
红者芍药汤加桃仁、滑石、枳壳、青皮、苍术，以引血调气。纯血脉弦，风邪伤肝，肝主血，宜
防风白芍汤；痢如豆汁者，此元气大虚，香参散加当归、粟壳；赤黑相杂者，此湿胜也。”按∶
此条论痢甚明。薛立斋曰∶“久痢黄中带青，肝木刑脾土，宜补脾平肝，四君白芍；黄而兼白，
子全母虚，宜补脾胃，用益黄散；黄而兼黑，肾水侮土，宜补土制水，六君加姜桂。”按∶此条
明青黑色之所以然。张景岳曰∶“痢起夏秋，湿蒸热郁，本乎天也。因热求冷，过吞生冷，由乎
人也。气壮而伤于天者，郁热居多；气弱而伤于人者，阴寒为甚。寒者必虚，热者必实。”按∶
此条似痢有阴寒一种。周慎斋曰∶“夏日太阴用事，过食生冷，积而不化，积久成热。发于秋
者，阳气入里攻之使发，治宜苦寒，燥湿涤热，佐以辛热，开郁达气，故曰∶行血则便脓自已，
调气则后重自除。又曰∶肺主气，凝滞伤气，移热大肠，气凝涩而成白痢。心主血，郁热伤血，
移热小肠，则血凝涩而成赤痢。此二脏二腑之积热也。若胃伤于冷物则胃寒，精气不输于
脾，脾不能散精干肺，津液留滞于胃为胃积。症见呕逆、恶心、便色如桃胶不臭、右关沉细
而紧，当用朴、桂、萸、姜、木香；虚者附子理中，非二肠之积可比也。”按∶此条辨寒者属胃
积，热者是肠积。又曰∶“色黑有两种。焦黑者，热极反兼胜己之化，芩芍汤送香连丸；如漆有
光者，瘀血凝久，桃核承气汤。”按∶此条辨黑色更明。张石顽曰∶“刘、李、朱三家皆以痢主
湿热，恣用苦寒，蒙害至今未已，曷知血色鲜紫浓浓者，信乎属热。若瘀晦稀淡及玛瑙色
者，如阳虚不能制阴而下，非温理其气则血不清，理气如炉冶分金，最为捷法。余凡遇五色
噤口及瘀晦清血诸痢，每用甘草干姜汤专理脾胃，肉桂茯苓专伐肾邪，其效如神。腹痛后
重加木香槟榔以泄之；饮食艰进，兼枳实焦术以运之；阴气上逆干呕，木香吴萸以温之；呕
吐涎水，橘半生姜以豁之；脓血稠粘，茜根乌梅理之。”按∶此条合以温法。秦元宫曰∶“秋时
肺金气欲降，而小肠有火，间不使达于大肠。小肠丙火克庚金，秋金燥，故腹痛后重而气不
能通。正治之法，不过沙糖利小肠，莱菔汁以通大肠，加陈松萝茶四五钱以泻火，淡关头海
蜇以润，燥则愈。火甚闭结者，用槟榔二三钱，煎汤下黑金丸三四钱，或酒蒸大黄饭丸三四
钱亦可。若其人肥甘过度，瓜果炙 煎炒热毒遗积肠间，肺气敛降随小肠之火而急奔大肠，
则如被火焚，腹大痛、痢不休、烦躁口渴，急须芩连槟柏大剂以救之。脉必数而有力，缓则肠
胃腐烂。若兼发热脉浮者，必有外邪，用败毒散热服取微汗。兼疟者，先治疟。先辈脾传胃
之说迂而未当，此症腹痛是丙火克庚金，与木
克土不同，宜用通法，不宜芍草归等。若纯红者，热入血分，用凉血汤地榆、槐花、神曲酒炒
各三钱，煎七分，藕汁一杯，沙糖调服。”按∶此条明白晓畅，胜于前辈。从来论痢皆属火，而
石顽、景岳独言寒凉者皆寒药误治而变之痢，非痢之本病也。因其始不急通大肠，而徒用栀
柏芩连，肠仍未通而胃已寒。或屡用香陈槟朴，致火未除而气已大耗，未有痢疾起始而先
虚寒者也。此丙火小肠闭塞而肾燥，肉苁蓉为对症之的药。他如恶心厌食者曰噤口痢，是湿
热之气上塞于胃口也。若未下者脉有力，仍须大黄，下通上自宽也。若下过脉弱者，养胃汤
茉莉、扁豆花、连肉、菖蒲根、枳壳、粳米、炒黄米、绿豆皮、人参，用老苏梗乘热泡药，再隔煮
三四沸，即服。渴者加连一分，银花露温服数杯亦妙。服此不愈者，胃气大虚，用升麻一钱、
炒莲肉五钱、人参三钱、煎服，此治噤口症也。又如经年累月时作时止者曰休息痢，因兜涩
太早，积未尽除之故，宜再投荡积之药，后调脾胃。如虚者，以调养之中微加消导药。仲景
云∶“下痢已瘥，至其年月日后发者，以积未尽也。当下之余，用补中益气加肉果煎送驻车
丸，多效。至如孕妇痢疾里急后重最为棘手，只用苏梗、杏仁、枳壳，不宜槟榔，黄芩可以重
用，中气不和少加木香，重用砂仁，金银花露宜多服，不可缺也，若夫纯血如尘腐色，如屋
漏水，大孔如竹筒，唇如朱红，身热脉大有力，四肢肿冷及呃逆者，皆不治。”
问∶中风急症也，先当分辨闭脱二症，若何见症？脱者何因？闭者何因？其次有中外
风见症、有中内风见症、有风入肠胃见症、有风入经络见症、有类中风见症、有痰厥见症、
有中暑见症、有客忤见症、又有无病忽然风发见症，以上十症各宜分别定方。此症风外惟
痰，痰有从火化者，有从湿化者，皆宜明辨。又此症初病时往往不能言，切脉又为要务，当分
别详细书之。
中风当先辨闭脱二证。脱者见症∶口开、目合、自汗、遗尿、喘急，此由真阴本衰，不能
外固其阳，加以忧思劳心，郁火既久，一值酒色过伤，或触大怒，于是坎中之阳与雷电肝胆
之火一齐冲击而上，卒然颠仆，脾绝而口开，肾绝而遗尿，肝绝而目合，心绝则自汗，肺绝
则喘促。急治之法用奠坤汤。此脱症也，犹地震山崩也，故不治者多，亦有一脏未绝，停七
日而死者（已上脱症）外。此皆闭症也。闭者手握、口噤、目张、晕眩、昏迷，此名中风。有外
内之别。中外风者，有六经见证，脉浮、恶寒、发热、拘急、不仁，用录验续命汤，即大青龙加
芎归人参也；河间小续命，即益以熟、附、黄芩、防己、防风；其夹食者腹满便闭，用三化
汤，即小承气加羌活。此纯实症也，江以南极少间有之（以上外风）。中内风者，肝胆火郁，
冲击于上，火盛风生，狂风勃发，其性刚急，气血大乱，风火由下直上，将胃中津液顷刻皆化
为痰涎，壅塞上焦，痰因凝聚而心气混浊。难言者，舌本干燥也；昏愦者，气血内乱也；手足
劲直或摇动者，风能烁真阴也；口眼歪斜者，风入经络也；麻痹不仁者，血痹不流也；半身
偏枯者，经络无血也。此皆风从火出，所谓内风也，位在震巽，左关寸之脉必弦急洪滑或数
疾；如木反侮金，右寸亦弦数滑大。《史记》仓公传曰∶“迥风其脉滑，滑者内风发也。”巽风
大旺，自当以助金平木为要义，以养血滋木为正治，治宜缓风汤。若饮食未消而风逼则痰食
交结而胸满作痛，先用盐汤探吐之。口不开者，胜金丹或侧柏叶汤（以上内风）。若内风入
肠胃者，《金匮》有风引汤及侯氏黑散，取诸石属金、金能平本之义。其冷食十日俾药积腹中
填塞空窍，治法高出千古（以上风入肠胃）。若内风入经络，及风息血不归经，筋被风燥，手
足不遂，半身偏枯，宜养血以润之，宜润枯汤及煮酒方（风入经络）。若肥人素多痰湿，脉缓
或沉涩，肢节重痛，手足筋软，是痰湿积于络中也，宜桑枝汤（痰入络中）。又有类中风者不
可不辨。其人素多湿痰，忽然气逆痰塞，牙关紧急是名痰厥中风者，左脉浮弦。此症右脉沉
涩左脉和平，亦有脉伏者，以胆星、木香为末
灌之，后用顺气汤。若醉饱恼怒之后忽然昏迷，右脉紧盛，急用陈皮姜盐汤，调以消食健
脾之品（以上痰食）。又有暑天闷倒，昏不知人，冷汗出，手足冷或吐泻、喘满，是谓中暑，
急用皂角末烧存性同甘草新汲水调下。轻者香薷饮冷服，大渴大热者茅术白虎汤（以上中
暑）。又有飞尸鬼击、卒厥客忤或吊死问丧，忽然面青、错语、牙闭、口噤、昏愦，是名中恶，急
以苏合香丸灌之（以上客忤）。若夫似轻而实重，毫无病苦，忽然一手一足重不能举，心神
如醉，少顷复常，其脉沉迟，非风也，是脾肾阳虚胃中有痰有时不运，为后来脱症之根，急急
用六君培养（以上阳虚）。此外内风一种内有痰从火化，心中烦闷言语謇涩者，经所谓风淫
于内，治以甘凉。是症多阴虚瘦削之人，肝火郁热而生痰招风，宜先服竹沥汤。脾胃热者，
用地黄煎。若邪中经络与痰气相抟，神暴昏、脉暴绝者，惟香药能达经隧通神明。然亦有寒
热之别。其脉沉缓或迟或伏，须用回天再造丸，或地黄饮子。有脉数大有力或浮或滑，须
用苏合香丸及至宝丹。同一开法有寒热各分，虚者以四君汤送（以上痰有火湿）。他如经络
中有死血、湿痰留滞者，宜活络丹。此症名论最多，略举数家。喻嘉言曰∶“河间指火为本，
东垣指气为本，丹溪指痰为本，曷不曰∶阳虚邪害孔窍为本，而风从外入者，必扶身中素有
之邪或火或气或痰而为标耶，故挟虚者补虚则风去，挟火者清热则风去，挟气者开郁则风
去，挟痰者 痰则风去。”按∶此条笔最该括，然犹不敢别乎外风而言也。薛立斋曰∶“阳主
气，以天地之疾风名之，不必外感而名风也。左半肝肾之居。肝藏血，主筋，肾藏精主骨。精
血枯槁不能滋养，故筋骨废。”缪仲淳曰∶“南方质多柔脆，多热，多痰，真阴既亏，内热弥
甚，煎熬津液凝结为痰，壅塞气道不得通利。热甚生风，亦致卒仆。”按∶此二条皆言内风
也。张景岳曰∶“人之根本真阴也。阴虚有二，阴中之水虚，病在精血；阴中之火虚，病在神
气。阳衰则气去，神志昏乱，非火虚乎！阴亏则形坏，支体废驰，非水虚乎！以神离形坏之证
。不求其源而治风乎，宜培养真阴以救根
本。惟有实症者，但察其因痰因气，而暂开之。”按∶此条分明补阴为主。张石顽曰∶“中风
之脉皆真气内亏，即南方属痰，总由肾气衰微不能主持，是以脉不能沉，随虚风鼓激而见浮
缓之象。”昔人云∶中风脉见沉伏，亦有脉随气奔指下洪盛者。当知中风者多体肥痰盛，外有
余中不足，加以房劳。国中气闭脉必沉伏，少顷气还脉见洪盛，皆风火痰湿用事也。大都中
风之脉浮小缓弱者生，坚大急疾者危。盖浮缓为中风之本脉，兼紧则多表邪，兼大则多气
虚，兼迟则多虚寒，兼数则多虚热，兼滑则多痰湿，皆为可治之脉。惟兼涩者为脉不应病，
多为危状。以痰症脉涩为正虚气衰经络闭滞，难于搜剔也，所以中风之脉最忌伏涩，尤忌坚
大急疾云。
问∶虚劳一症仲景《金匮》七方多偏重阳虚，丹溪多用寒凉，后人薛立斋、张景岳、李
士材等多非丹溪之寒凉而是温补，又未必用仲景之方，今人遵用立斋、景岳等法，又未必
效，其故何欤？夫病有寒热虚实，岂容预定，自宋元以来各家出入是非可详晰言之欤？近时
名家治此病者能否有细腻沉着胜前人者乎？抑或另出心裁因症论治可补前人之未备乎？
医贵实效，不必拘守前辈也，其细参之。
虚劳一症古今治法各殊，仲景七法卓然典型，其失精家少腹急、阴头寒、目眩，用桂枝
龙牡汤。张石顽曰∶“人身气血全赖后天水谷滋生，水谷入胃，清者为营，浊者为卫，营气不
营上热血溢，卫气不卫下寒精亡。营卫和三焦各司其职，而火自归根，热者不然，寒者不寒，
水谷之精微输化，而精血之源有赖矣。以亡脱既愦恐下焦虚滑不紧，乃加龙牡以固敛之，以
散（表证已解），烦热多汗，暑热未清，气虚者，用人参养营汤；血虚者，用何首乌散（根据有汗、无汗、新病、久病、虚证、实证辨证施治）。疟邪日久不散，私自结聚于肝经部位，称为疟母，适宜使用鳖煎丸。若常在左胁下结成痞块，病程迁延导致气血衰弱且寒热交替发作的，称为疟劳，仍应当从阴阳偏盛偏衰之处进行调补。
问：滞下之病古称肠癖，后世称为痢疾。“痢”字作顺利解，如今以涩滞来命名“痢”，原因何在？之所以出现涩滞的原因是什么？大便色赤的原因是什么？色白的原因是什么？赤白相兼出现的原因是什么？色黑的原因是什么？色青的原因是什么？纯血便的原因是什么？如脓血稀薄的原因是什么？如豆汁样的原因是什么？如屋漏水样的原因是什么？自古以来论述痢疾的各位名家，其中精当可说的，能详细陈述吗？各家都认为是湿火所致，唯独张景岳、石顽认为有一种是寒冷引起的，这是什么缘故？食欲不振的称为噤口痢，时发时止的称为休息痢，应当详细探究病因和治疗，孕妇患此病尤为困难，都需要仔细辨别。
经典记载：“饮食不节制，起居没有规律，阴经受邪则病邪入内，五脏充满闭塞，向下表现为飧泄（完谷不化的腹泻），久了成为肠癖。”这里说“脏气长久停滞不能营运，津液转移到大肠和小肠而变成积滞崩迫，这是阴气受伤所致”。如果是痢疾，古名肠癖，现在叫痢，是传述的错误。想要知道它所以滞下的原因，以及五色不同的原因，应当向各位名家请教。李东垣说：“饮食起居不时损伤，胃气应该上升，清阳之气反而下降为飧泄，久了太阴伤及少阴成为肠癖，寒冷伤中导致胀满的为飧泄，适宜温热消导。湿热伤中下部出现脓血的，适宜苦寒疏利。风邪下陷，适宜升举。湿热内盛，应当分别治疗：里急后重的适宜攻下，后重明显的适宜调理，洞泄肠鸣脉细的温收之，稠粘涩滞脉有力的寒下之。”按语：这一条先引用经文然后总论痢病，最清晰明了。朱丹溪说：“赤痢来自小肠，白痢来自大肠，都以湿热为本。”按语：这一条说明金色白而火色赤。王宇泰说：“胃中有湿热拂郁不化，气凝注大肠成白痢，血凝注小肠成赤痢，大小肠均受邪赤白并下，因为大肠合肺、小肠合心。初起实证必须推荡，通因通用。如果失于攻下，五六日后脾胃虚弱，难以承受攻下。白痢用平胃散加山楂、槟榔、枳实、芍药、黄芩、黄连、滑石、神曲、当归、生姜，红痢用芍药汤加桃仁、滑石、枳壳、青皮、苍术，以引血调气。纯血脉弦，风邪伤肝，肝主血，适宜防风白芍汤；痢如豆汁样，这是元气大虚，香参散加当归、粟壳；赤黑相杂，这是湿胜。”按语：这一条论述痢疾很明白。薛立斋说：“久痢黄中带青，是肝木刑克脾土，适宜补脾平肝，用四君子汤加白芍；黄而兼白，子全母虚，适宜补脾胃，用益黄散；黄而兼黑，肾水侮土，适宜补土制水，六君子汤加干姜、肉桂。”按语：这一条说明青黑色产生的原因。张景岳说：“痢疾起于夏秋，湿蒸热郁，本乎天时。因热求冷，过食生冷，由乎人为。气壮而伤于天时的，郁热居多；气弱而伤于人为的，阴寒为甚。寒者必虚，热者必实。”按语：这一条似乎指出痢疾有阴寒一种。周慎斋说：“夏日太阴用事，过食生冷，积而不化，积久成热。发于秋季的，阳气入里攻之使发，治疗适宜苦寒，燥湿涤热，佐以辛热，开郁达气，所以说：行血则便脓自止，调气则后重自除。又说：肺主气，凝滞伤气，移热大肠，气凝涩而成白痢。心主血，郁热伤血，移热小肠，则血凝涩而成赤痢。这是二脏二腑的积热。如果胃伤于冷物则胃寒，精气不输于脾，脾不能散精干肺，津液留滞在胃成为胃积。症状见呕逆、恶心、便色如桃胶不臭、右关脉沉细而紧，应当用厚朴、肉桂、吴茱萸、生姜、木香；虚的用附子理中汤，不是二肠的积滞可比。”按语：这一条辨别寒者属胃积，热者是肠积。又说：“色黑有两种。焦黑的，是热极反兼胜己之化，用黄芩芍药汤送服香连丸；如漆有光的，是瘀血凝久，用桃核承气汤。”按语：这一条辨别黑色更明确。张石顽说：“刘、李、朱三家都认为痢主湿热，恣意使用苦寒，蒙害至今未已，哪里知道血色鲜紫浓浓的，确实属于热。如果晦暗稀淡及玛瑙色的，如阳虚不能制阴而下，不温理其气则血不清，理气如同炉冶分金，是最为快捷的方法。我凡是遇到五色噤口及瘀晦清血诸痢，每用甘草干姜汤专门调理脾胃，肉桂茯苓专门伐肾邪，效果如神。腹痛后重加木香槟榔以泄之；饮食难进，加枳实炒白术以运之；阴气上逆干呕，用木香吴茱萸以温之；呕吐涎水，用橘皮半夏生姜以豁之；脓血稠粘，用茜根乌梅调理。”按语：这一条结合温法。秦元宫说：“秋季肺金气欲降，而小肠有火，间或不使达于大肠。小肠丙火克庚金，秋金燥，故腹痛后重而气不能通。正治之法，不过沙糖利小肠，莱菔汁以通大肠，加陈松萝茶四五钱以泻火，淡关头海蜇以润，燥则愈。火甚闭结的，用槟榔二三钱，煎汤下黑金丸三四钱，或酒蒸大黄饭丸三四钱也可以。如果其人肥甘过度，瓜果炙煎炒热毒遗积肠间，肺气敛降随小肠之火而急奔大肠，则如被火焚，腹大痛、痢不休、烦躁口渴，急须芩连槟柏大剂以救之。脉必数而有力，缓则肠胃腐烂。若兼发热脉浮的，必有外邪，用败毒散热服取微汗。兼疟的，先治疟。先辈脾传胃的说法迂腐而未当，此症腹痛是丙火克庚金，与木克土不同，适宜用通法，不宜用芍药甘草当归等。若纯红的，热入血分，用凉血汤地榆、槐花、神曲酒炒各三钱，煎七分，藕汁一杯，沙糖调服。”按语：这一条明白晓畅，胜于前辈。从来论痢皆属火，而石顽、景岳独言寒凉的，都是寒药误治而变成的痢，不是痢的本病。因为其开始不急通大肠，而徒用栀柏芩连，肠仍未通而胃已寒。或屡用香陈槟朴，致火未除而气已大耗，未有痢疾起始而先虚寒者也。这是丙火小肠闭塞而肾燥，肉苁蓉是对症的良药。其他如恶心厌食的称为噤口痢，是湿热之气上塞于胃口。如果未下的脉有力，仍须大黄，下通上自宽。如果下过的脉弱的，养胃汤茉莉、扁豆花、连肉、菖蒲根、枳壳、粳米、炒黄米、绿豆皮、人参，用老苏梗乘热泡药，再隔煮三四沸，即服。渴的加黄连一分，银花露温服数杯亦妙。服此不愈的，胃气大虚，用升麻一钱、炒莲肉五钱、人参三钱、煎服，这是治噤口症。又如经年累月时作时止的称为休息痢，因兜涩太早，积未尽除的缘故，适宜再投荡积的药，后调脾胃。如虚的，在调养之中微加消导药。仲景说：“下痢已瘥，至其年月日后发者，以积未尽也。当下之余，用补中益气加肉果煎送驻车丸，多效。至于孕妇痢疾里急后重最为棘手，只用苏梗、杏仁、枳壳，不宜槟榔，黄芩可以重用，中气不和少加木香，重用砂仁，金银花露宜多服，不可缺也，若夫纯血如尘腐色，如屋漏水，大孔如竹筒，唇如朱红，身热脉大有力，四肢肿冷及呃逆的，都不治。”
问：中风是急症，首先应当分辨闭脱二症，有什么见症？脱者什么原因？闭者什么原因？其次有中风的见症、有中内风的见症、有风入肠胃的见症、有风入经络的见症、有类中风的见症、有痰厥的见症、有中署的见症、有客忤的见症，又有无病忽然风发的见症，以上十症各自适宜分别定方。此症风外惟痰，痰有从火化的，有从湿化的，都适宜明辨。又此症初病时往往不能言，切脉又是重要事务，应当分别详细书写。
中风应当先辨闭脱二证。脱者的见症：口开、目合、自汗、遗尿、喘急，这是由于真阴本衰，不能外固其阳，加上忧思劳心，郁火既久，一旦值酒色过伤，或触大怒，于是坎中之阳与雷电肝胆之火一齐冲击而上，突然颠仆，脾绝而口开，肾绝而遗尿，肝绝而目合，心绝则自汗，肺绝则喘促。急救之法用奠坤汤。这是脱症，犹如地震山崩，所以不治的多，也有一脏未绝，停七日而死的（以上脱症）之外。这都是闭症。闭者手握、口噤、目张、晕眩、昏迷，这名叫中风。有外内之别。中外风者，有六经见证，脉浮、恶寒、发热、拘急、不仁，用录验续命汤，即大青龙加川芎当归人参；河间小续命，即益以熟地、附子、黄芩、防己、防风；其夹食的腹满便闭，用三化汤，即小承气加羌活。这是纯实证，江以南极少间有（以上外风）。中内风者，肝胆火郁，冲击于上，火盛风生，狂风勃发，其性刚急，气血大乱，风火由下直上，将胃中津液顷刻皆化为痰涎，壅塞上焦，痰因凝聚而心气混浊。难言的，舌本干燥；昏愦的，气血内乱；手足劲直或摇动的，风能烁真阴；口眼歪斜的，风入经络；麻痹不仁的，血痹不流；半身偏枯的，经络无血。这都是风从火出，所谓内风，位在震巽，左关寸的脉必弦急洪滑或数疾；如木反侮金，右寸亦弦数滑大。《史记》仓公传说：“迥风其脉滑，滑者内风发也。”巽风大旺，自当以助金平木为要义，以养血滋木为正治，治疗适宜缓风汤。若饮食未消而风逼则痰食交结而胸满作痛，先用盐汤探吐。口不开的，胜金丹或侧柏叶汤（以上内风）。若内风入肠胃，《金匮》有风引汤及侯氏黑散，取诸石属金、金能平本之义。其冷食十日俾药积腹中填塞空窍，治法高出千古（以上风入肠胃）。若内风入经络，及风息血不归经，筋被风燥，手足不遂，半身偏枯，适宜养血以润之，适宜润枯汤及煮酒方（风入经络）。若肥人素多痰湿，脉缓或沉涩，肢节重痛，手足筋软，是痰湿积于络中，适宜桑枝汤（痰入络中）。又有类中风者不可不辨。其人素多湿痰，忽然气逆痰塞，牙关紧急是名痰厥中风，左脉浮弦。此症右脉沉涩左脉和平，亦有脉伏的，用胆星、木香为末灌之，后用顺气汤。若醉饱恼怒之后忽然昏迷，右脉紧盛，急用陈皮姜盐汤，调以消食健脾之品（以上痰食）。又有暑天闷倒，昏不知人，冷汗出，手足冷或吐泻、喘满，是谓中暑，急用皂角末烧存性同甘草新汲水调下。轻者香薷饮冷服，大渴大热的茅术白虎汤（以上中暑）。又有飞尸鬼击、卒厥客忤或吊死问丧，忽然面青、错语、牙闭、口噤、昏愦，是名中恶，急以苏合香丸灌之（以上客忤）。若夫似轻而实重，毫无病苦，忽然一手一足重不能举，心神如醉，少顷复常，其脉沉迟，非风也，是脾肾阳虚胃中有痰有时不运，为后来脱症之根，急急用六君培养（以上阳虚）。此外内风一种内有痰从火化，心中烦闷言语謇涩的，经所谓风淫于内，治以甘凉。此症多阴虚瘦削之人，肝火郁热而生痰招风，适宜先服竹沥汤。脾胃热的，用地黄煎。若邪中经络与痰气相抟，神暴昏、脉暴绝的，惟香药能达经隧通神明。然亦有寒热之别。其脉沉缓或迟或伏，须用回天再造丸，或地黄饮子。有脉数大有力或浮或滑，须用苏合香丸及至宝丹。同一开法有寒热各分，虚的用四君汤送（以上痰有火湿）。其他如经络中有死血、湿痰留滞的，适宜活络丹。此症名论最多，略举数家。喻嘉言说：“河间指火为本，东垣指气为本，丹溪指痰为本，何不曰：阳虚邪害孔窍为本，而风从外入的，必扶身中素有之邪或火或气或痰而为标耶，故挟虚者补虚则风去，挟火者清热则风去，挟气者开郁则风去，挟痰者 痰则风去。”按语：这一条笔最该括，然而还不敢别乎外风而言。薛立斋说：“阳主气，以天地之疾风名之，不必外感而名风也。左半肝肾之居。肝藏血，主筋，肾藏精主骨。精血枯槁不能滋养，故筋骨废。”缪仲淳说：“南方质多柔脆，多热，多痰，真阴既亏，内热弥甚，煎熬津液凝结为痰，壅塞气道不得通利。热甚生风，亦致卒仆。”按语：这两条都言内风。张景岳说：“人之根本真阴也。阴虚有二，阴中之水虚，病在精血；阴中之火虚，病在神气。阳衰则气去，神志昏乱，非火虚乎！阴亏则形坏，支体废驰，非水虚乎！以神离形坏之证。不求其源而治风乎，宜培养真阴以救根本。惟有实症者，但察其因痰因气，而暂开之。”按语：这一条分明补阴为主。张石顽说：“中风之脉皆真气内亏，即南方属痰，总由肾气衰微不能主持，是以脉不能沉，随虚风鼓激而见浮缓之象。”昔人说：中风脉见沉伏，亦有脉随气奔指下洪盛的。当知中风者多体肥痰盛，外有余中不足，加以房劳。国中气闭脉必沉伏，少顷气还脉见洪盛，皆风火痰湿用事也。大都中风之脉浮小缓弱者生，坚大急疾者危。盖浮缓为中风之本脉，兼紧则多表邪，兼大则多气虚，兼迟则多虚寒，兼数则多虚热，兼滑则多痰湿，皆为可治之脉。惟兼涩者为脉不应病，多为危状。以痰症脉涩为正虚气衰经络闭滞，难于搜剔也，所以中风之脉最忌伏涩，尤忌坚大急疾云。
问：虚劳一症仲景《金匮》七方多偏重阳虚，丹溪多用寒凉，后人薛立斋、张景岳、李士材等多非丹溪之寒凉而是温补，又未必用仲景之方，今人遵用立斋、景岳等法，又未必效，这是什么缘故？夫病有寒热虚实，岂容预定，自宋元以来各家出入是非可详细言之吗？近时名家治此病者能否有细腻沉着胜前人吗？抑或另出心裁因症论治可补前人之未备吗？医贵实效，不必拘守前辈，请仔细参详。
虚劳一症古今治法各殊，仲景七法卓然典型，其失精家少腹急、阴头寒、目眩，用桂枝龙牡汤。张石顽说：“人身气血全赖后天水谷滋生，水谷入胃，清者为营，浊者为卫，营气不营上热血溢，卫气不卫下寒精亡。营卫和三焦各司其职，而火自归根，热者不然，寒者不寒，水谷之精微输化，而精血之源有赖矣。以亡脱既愦恐下焦虚滑不紧，乃加龙牡以固敛之，以
Dispersed (exterior syndrome resolved), with vexation, heat, and profuse sweating, where summer-heat is not yet cleared, and Qi deficiency prevails, use Renshen Yangying Tang (Ginseng Nourishing the Constitution Decoction); for Blood deficiency, use Heshouwu San (Polygonum Multiflorum Powder) (differentiate based on presence or absence of sweating, acute or chronic onset, and deficiency or excess patterns). If malaria pathogen lingers for a long time without dispersing, it privately forms an accumulation in the Liver channel region, termed Malaria Mass (Nodule), suitable for Biejian Wan (Softshell Turtle Pill). If a mass frequently forms in the left hypochondrium, and the prolonged course leads to Qi and Blood depletion with alternating chills and fever, termed Malaria Consumption (Malaria Labor), treatment should still focus on tonifying from the perspective of Yin-Yang imbalance.
Question: The disease known as "Zhi Xia" (dysentery with tenesmus) was anciently called Chang Pi (Intestinal Dysentery), and later named Li (Dysentery). The character 'Li' implies smoothness, yet why is it named 'Li' implying obstruction? What causes this obstruction? Why is the stool red? White? Mixed red and white? Black? Green? Pure blood? Thin pus and blood? Resembling bean curd dregs? Like leaking roof water? Among the renowned physicians who have discussed dysentery since antiquity, which of their precise and appropriate theories can be detailed? Most schools attribute it to Damp-Heat Fire, but Zhang Jingyue and Shiwan alone propose a Cold type; what is the reason? Loss of appetite is termed Jin Kou Li (Closed-Mouth Dysentery), and intermittent recurrence is termed Xiu Xi Li (Resting Dysentery). The etiology and treatment must be detailed, especially for pregnant women, requiring careful differentiation.
The Classics state: "Irregular diet and improper daily routine cause Yin channels to receive pathogens, entering internally until the Zang organs are filled and blocked, manifesting downward as Sun Xie (undigested food diarrhea), and over time becoming Chang Pi." This refers to "long-term stagnation of Zang Qi failing to circulate, causing body fluids to shift to the Large and Small Intestines, resulting in accumulation and urgent expulsion, caused by injury to Yin Qi." If it is indeed dysentery, anciently named Chang Pi, now called Li, it is an error in transmission. To understand the cause of obstruction and the five colors, one must consult the masters. Li Dongyuan said: "Irregular diet and routine damage the Stomach Qi; instead of ascending, Clear Yang descends causing Sun Xie. Over time, Taiyin injures Shaoyin leading to Chang Pi. Cold injuring the Middle causing distension is Sun Xie, treated with warming and guiding out. Damp-Heat injuring the Lower causing pus and blood requires bitter-cold draining. Wind pathogen sinking requires lifting. For internal Damp-Heat excess, differentiate: urgency requires purging, heaviness requires regulating, clear diarrhea with bowel sounds and fine pulse requires warming and astringing, thick sticky obstruction with forceful pulse requires cold purging." Commentary: This section cites the Classics then summarizes dysentery theory, most clearly. Zhu Danxi said: "Red dysentery originates from the Small Intestine, white from the Large Intestine, both rooted in Damp-Heat." Commentary: This clarifies that metal color is white and fire color is red. Wang Yutai said: "Damp-Heat in the Stomach stifles transformation; Qi condenses into the Large Intestine forming white dysentery, Blood condenses into the Small Intestine forming red dysentery. When both intestines are affected, red and white discharge together because Large Intestine connects to Lung and Small Intestine to Heart. Early excess stages require purging, using 'treat obstruction with unblocking.' If purgatives are missed, after five to six days Spleen-Stomach becomes deficient and cannot tolerate purging. For white dysentery, use Pingwei San plus Hawthorn, Betel Nut, Immature Bitter Orange, Peony, Scutellaria, Coptis, Talc, Saccharomyces, Angelica, Ginger; for red, use Shaoyao Tang plus Peach Kernel, Talc, Immature Bitter Orange, Tangerine Peel, Atractylodes, to guide blood and regulate Qi. Pure blood with wiry pulse indicates Wind injuring Liver (Liver governs Blood), use Fangfeng Baishao Tang; dysentery resembling bean curd dregs indicates severe Yuan Qi deficiency, use Xiangshen San plus Danggui and Poppy Shell; mixed red-black indicates Dampness excess." Commentary: This discussion on dysentery is very clear. Xue Lizhai said: "Long-term dysentery yellow with green indicates Liver Wood attacking Spleen Earth, treat by tonifying Spleen and soothing Liver, use Six Gentlemen Decoction plus Peony; yellow with white indicates Son complete but Mother deficient, tonify Spleen-Stomach, use Yi Huang San; yellow with black indicates Kidney Water insulting Earth, tonify Earth to control Water, use Six Gentlemen Decoction plus Ginger and Cinnamon." Commentary: This explains the origin of green and black colors. Zhang Jingyue said: "Dysentery arises in Summer-Autumn from steaming Dampness and stagnant Heat, originating from Heaven (climate). Seeking cold due to heat and consuming excessive raw/cold items originates from Man. Those strong constitutionally injured by Heaven have mostly stagnant heat; those weak constitutionally injured by Man have severe Yin-Cold. Cold implies deficiency, Heat implies excess." Commentary: This suggests a Yin-Cold type of dysentery. Zhou Shenzhai said: "In Summer, Taiyin dominates; excessive raw/cold consumption accumulates and fails to transform, eventually generating heat. In Autumn, Yang Qi enters the interior and attacks, triggering eruption. Treatment uses bitter-cold to dry Dampness and purge Heat, assisted by acrid-hot to open depression and move Qi. Thus: moving Blood stops pus/blood, regulating Qi relieves tenesmus. Also: Lung governs Qi, stagnation injures Qi, transferring Heat to Large Intestine causes Qi stagnation and white dysentery. Heart governs Blood, stagnant Heat injures Blood, transferring Heat to Small Intestine causes Blood stagnation and red dysentery. This is accumulated Heat in two Zang and two Fu organs. If Stomach is injured by cold items, Stomach Cold results; Essence/Qi does not transmit to Spleen, Spleen cannot scatter Essence to Lung, fluids stagnate in Stomach forming Stomach Accumulation. Symptoms include vomiting, nausea, stool like peach gum odorless, Right Guan pulse deep-thin-tight, use Magnolia Bark, Cinnamon, Cornus, Ginger, Aucklandia; deficiency use Fuzi Lizhong Tang, not comparable to intestinal accumulation." Commentary: This differentiates Cold as Stomach Accumulation and Heat as Intestinal Accumulation. Also: "Black has two types. Scorched black indicates extreme Heat mimicking the controlling element, use Huangqin Shaoyao Tang with Xianglian Wan; lacquer-like shiny black indicates old Blood stasis, use Taohe Chengqi Tang." Commentary: This differentiates black color more clearly. Zhang Shiwan said: "Liu, Li, and Zhu all attribute dysentery to Damp-Heat, recklessly using bitter-cold, causing harm to this day. They do not know that bright purple-rich blood truly belongs to Heat. If dull, thin, pale, or agate-colored, it is Yang Deficiency failing to control Yin descending; without warming and regulating Qi, Blood will not clarify. Regulating Qi is like refining gold in a furnace, the most rapid method. Whenever I encounter five-color closed-mouth dysentery or dull-clear blood dysentery, I use Gancao Ganjiang Tang to regulate Spleen-Stomach, Rougui Fuling to attack Kidney pathogen, with miraculous effect. Abdominal pain and tenesmus add Aucklandia and Betel Nut to drain; difficulty eating adds Immature Bitter Orange and fried Atractylodes to transport; Yin Qi reversing upward causing dry heaves adds Aucklandia and Evodia to warm; vomiting saliva adds Tangerine Peel, Pinellia, Ginger to resolve; thick sticky pus-blood adds Rubia and Mume to regulate." Commentary: This combines warming methods. Qin Yuangong said: "In Autumn, Lung Metal Qi desires to descend, but Small Intestine Fire prevents reaching the Large Intestine. Small Intestine Bing Fire controls Geng Metal, Autumn Metal is dry, causing abdominal pain, tenesmus, and Qi obstruction. Correct treatment uses brown sugar to benefit Small Intestine, radish juice to unblock Large Intestine, add aged Songluo tea 4-5 qian to drain Fire, plain cuttlefish bone to moisten dryness. For severe Fire with constipation, use Betel Nut 2-3 qian decocted to administer Heijin Wan 3-4 qian, or wine-steamed Rhubarb rice pills 3-4 qian. If the person consumes excessive rich/sweet foods, fruits, roasted/fried items leaving heat-toxin residue in intestines, Lung Qi descending follows Small Intestine Fire rushing to Large Intestine, burning like fire, causing severe abdominal pain, incessant dysentery, irritability, thirst. Urgently use large doses of Scutellaria, Coptis, Betel Nut, Phellodendron to save. Pulse must be rapid and forceful; if slow, intestines/stomach rot. If accompanied by fever and floating pulse, exterior pathogen exists, use Baidu Sanre to induce slight sweat. If accompanied by malaria, treat malaria first. Ancestors' theory of Spleen transmitting to Stomach is pedantic and incorrect; this abdominal pain is Bing Fire controlling Geng Metal, different from Wood controlling Earth. Use unblocking methods, avoid Peony, Licorice, Angelica. If pure red, Heat entered Blood level, use Liangxue Tang: Diyu, Sophora Flower, Saccharomyces (wine-fried) each 3 qian, decoct to 70%, mix with 1 cup lotus root juice and brown sugar." Commentary: This is clear and superior to predecessors. Traditionally, dysentery is attributed to Fire, but Shiwan and Jingyue mention Cold types resulting from misusing cold herbs, not the original disease. Because they did not urgently unblock the Large Intestine initially, but used Gardenia, Phellodendron, Scutellaria, Coptis, the intestines remained blocked while the Stomach became cold. Or repeatedly using aromatic/drying agents depleted Qi before removing Fire. No dysentery starts with primary deficiency-cold. This is Bing Fire Small Intestine blockage causing Kidney dryness; Congrong is the specific remedy. Others like nausea/loss of appetite is Jin Kou Li, caused by Damp-Heat blocking the Stomach opening. If no evacuation yet and pulse is forceful, still use Rhubarb; lower unblocks, upper relaxes. If post-evacuation pulse is weak, use Yangwei Tang: Jasmine, Lablab Flower, Lotus Seed, Acorus Root, Immature Bitter Orange, Rice, Fried Millet, Mung Bean Skin, Ginseng. Soak in Old Perilla Stem hot water, boil briefly, take warm. Add a small amount of Coptis for thirst; Silver Flower Dew taken warm is also good. If unresponsive, Stomach Qi is severely deficient, use Shengma 1 qian, Fried Lotus Seed 5 qian, Ginseng 3 qian, decoct and take. This treats Closed-Mouth Syndrome. Also, intermittent episodes over years is Xiu Xi Li, caused by premature astringency leaving residue. Re-administer resolving-residue drugs, then regulate Spleen-Stomach. For deficiency, add mild resolving drugs during tonification. Zhongjing said: "If dysentery resolves but recurs months/years later, it is due to incomplete residue. After purging remaining residue, use Buzhong Yiqi Tang with Myrobalan decocted to send Chuche Wan, often effective. For pregnant women with dysentery, urgency and tenesmus are most difficult. Use only Perilla Stem, Apricot Seed, Immature Bitter Orange; avoid Betel Nut. Huangqin can be used heavily; if Middle Qi disharmony, add little Aucklandia; use Sandaren heavily; Silver Flower Dew should be taken abundantly. If pure blood like dust/rotten color, like leaking roof water, anus like bamboo tube, lips vermilion, body fever, forceful large pulse, limb swelling/cold, and hiccups, these are untreatable."
Question: Stroke is an emergency; first differentiate Bi (Closure) and Tuo (Collapse) syndromes. What are the symptoms? What causes Collapse? What causes Closure? Secondly, there are Exterior-Internal Wind symptoms, Internal Wind symptoms, Wind entering Intestines/Stomach symptoms, Wind entering Collaterals symptoms, Pseudo-Stroke symptoms, Phlegm-Jue symptoms, Summerheat symptoms, External Intrusion symptoms, and sudden Wind emergence without prior illness. These ten syndromes require distinct formulas. Regarding Wind, only Phlegm is external; Phlegm transforms via Fire or Dampness, requiring clear differentiation. Initially, patients often cannot speak; pulse diagnosis is crucial, detail this separately.
Stroke requires distinguishing Bi and Tuo syndromes first. Collapse symptoms: mouth open, eyes closed, spontaneous sweating, urinary incontinence, panting. This is due to True Yin deficiency failing to secure Yang externally. Added to worry/thought/mental labor, stagnant Fire persists; once alcohol/sex are excessive or anger strikes, Yang from Kan (Kidney) and Liver/Gallbladder Fire surge upward simultaneously, causing sudden collapse. Spleen failure opens mouth, Kidney failure causes incontinence, Liver failure closes eyes, Heart failure causes sweating, Lung failure causes panting. Emergency treatment uses Diankun Tang. This is Collapse, like earthquake/mountain collapse; many are untreatable, though some die after seven days if one Zang remains intact (Above: Collapse). These are all Bi syndromes. Closure symptoms: clenched hands, locked jaw, eyes open, vertigo, coma. This is Stroke. There is Exterior/Internal distinction. Exterior-Internal Wind presents with Six Channels symptoms: floating pulse, aversion to cold, fever, stiffness, numbness. Use Luyuan Xuming Tang (Da Qing Long plus Chuanxiong, Danggui, Renshen); Hejian's Xiao Xuming Tang adds Shudi, Fuzi, Huangqin, Ji Feng, Fangfeng; if complicated by food retention with fullness/constipation, use Sanhua Tang (Xiao Cheng Qi plus Qianghuo). These are pure excess syndromes, rare south of the Yangtze (Above: Exterior Wind). Internal Wind involves Liver/Gallbladder Fire depression surging upward; Fire generates Wind, fierce and rigid, disrupting Qi/Blood. Wind/Fire rise directly, converting Stomach fluids into Phlegm instantly, obstructing Upper Jiao, confusing Heart Qi. Difficulty speaking indicates tongue dryness; coma indicates internal Qi/Blood chaos; stiff/shaking limbs indicate Wind scorching True Yin; facial deviation indicates Wind entering collaterals; numbness indicates Blood Bi; hemiplegia indicates lack of Blood in collaterals. All are Wind from Fire, termed Internal Wind, located in Zhen/Xun, Left Guan/Cun pulses wiry-rapid-slippery or rapid. If Wood insults Metal, Right Cun is also wiry-rapid-slipping-large. *Shiji* Cang Gong biography states: "Revolving Wind pulse is slippery; slippery indicates Internal Wind eruption." When Xun Wind is vigorous, assisting Metal to calm Wood is key; nourishing Blood to moisten Wood is correct treatment, use Huanfeng Tang. If undigested food is forced by Wind causing Phlegm-Food knotting and chest pain, induce vomiting with salt water. If mouth won't open, use Shengjin Dan or Ce Bai Ye Tang (Above: Internal Wind). If Internal Wind enters Intestines/Stomach, *Jingui* offers Fengyin Tang and Houshi Heisan, utilizing stones belonging to Metal to calm the Root. Using cold food for ten days allows medicine to accumulate in abdomen filling cavities; treatment surpasses antiquity (Above: Wind entering Intestines/Stomach). If Internal Wind enters collaterals, Wind stops Blood returning to vessels, tendons dried by Wind, limbs paralyzed, hemiplegia, nourish Blood to moisten, use Runku Tang and Zhujing Fang (Wind entering collaterals). If fat persons have Phlegm-Damp, pulse slow/deep-choppy, heavy painful joints, soft tendons, Phlegm-Damp accumulates in collaterals, use Sangzhi Tang (Phlegm entering collaterals). Pseudo-Stroke must be differentiated. Persons with Phlegm-Damp suddenly experience Qi reversal/Phlegm obstruction, tight jaw, termed Phlegm-Jue Stroke, Left pulse floating-wiry. If Right pulse deep-choppy, Left peaceful, or hidden, use Danxing and Muxiang powder insufflated, then Shunqi Tang. After drunkenness/anger, sudden coma with tight-full Right pulse, urgently use Chenpi Ginger Salt Water with digestive/Spleen-tonifying agents (Above: Phlegm-Food). Summer heat fainting, unconscious, cold sweat, cold limbs, vomiting/diarrhea, panting/fullness is Summerheat. Urgently use Sichuan Pepper ash with Licorice in fresh water. Mild cases use Xiangru Yin cold; severe thirst/heat use Maoyu Baihu Tang (Above: Summerheat). Flying Corpse, Ghost Strike, sudden Syncope, External Intrusion, or attending funerals, sudden blue face, confused speech, tight jaw, coma is Zhong E (Evil Strike). Urgently suffocate with Suhe Xiang Wan (Above: External Intrusion). Seeming mild but actually severe, no discomfort, sudden heaviness in one arm/leg unable to lift, mind drunk then normal, pulse deep-slow, is not Wind, but Spleen/Kidney Yang Deficiency with Stomach Phlegm failing to transport occasionally, root of future Collapse. Urgently use Liu Jun to cultivate (Above: Yang Deficiency). Additionally, Internal Wind with Phlegm transforming via Fire, mental vexation, slurred speech, Classics say "Wind harassing inside, treat with sweet-cool." This affects Yin-deficient thin persons, Liver Fire stagnant generating Phlegm attracting Wind, first use Zhuli Tang. Stomach-Spleen Heat use Dihuang Jian. If Evil enters collaterals combining with Phlegm-Qi, sudden coma, abrupt pulse disappearance, only aromatic herbs reach collaterals and open Spirit. However, Cold/Heat differ. Deep-slow/hidden pulse requires Huitian Zaizao Wan or Dihuang Yinzi. Rapid-large-forceful or floating-slippery pulse requires Suhe Xiang Wan and Zhibao Dan. Same opening method differs by Cold/Heat; deficiency sent with Sijun Tang (Above: Phlegm with Fire/Damp). Dead Blood/Damp Phlegm in collaterals use Huoluo Dan. Many theories exist, citing a few. Yu Jiayan said: "Hejian points to Fire as root, Dongyuan to Qi, Danxi to Phlegm. Why not say Yang Deficiency allowing Evil to harm orifices is root, and Wind entering externally supports inherent Fire/Qi/Phlegm as branch? Thus, deficiency-complex tonifies deficiency to remove Wind, Fire-complex clears Heat to remove Wind, Qi-complex opens depression to remove Wind, Phlegm-complex resolves Phlegm to remove Wind." Commentary: This summary is comprehensive, yet still distinguishes Exterior Wind. Xue Lizhai said: "Yang governs Qi, named Wind like heaven's gale, not necessarily external sensation. Left half houses Liver/Kidney. Liver stores Blood, governs tendons; Kidney stores Essence, governs bones. Essence/Blood exhaustion fails to nourish, so bones/tendons fail." Miao Zhongchun said: "Southern constitutions are fragile, prone to Heat/Phlegm. True Yin deficient, internal Heat intense, boiling fluids into Phlegm, blocking airways. Extreme Heat generates Wind, causing sudden collapse." Commentary: Both discuss Internal Wind. Zhang Jingyue said: "Human root is True Yin. Yin Deficiency has two: Water deficiency in Yin affects Essence/Blood; Fire deficiency in Yin affects Spirit/Mind. Yang decline means Qi loss, spirit confusion, is not Fire deficiency! Yin loss means form destruction, limb flaccidity, is not Water deficiency! For signs of spirit departing/form breaking, seek source rather than treating Wind. Cultivate True Yin to save root. Only for excess syndromes, check Phlegm/Qi cause and temporarily open." Commentary: This clearly prioritizes Yin tonification. Zhang Shiwan said: "Stroke pulses all show internal True Qi deficiency. Even Southern Phlegm cases stem from Kidney Qi decline failing to control, hence pulse cannot sink, appearing floating-slow driven by defunct Wind." Ancients said: Stroke pulse hidden, or pulse surging forcefully under finger. Know stroke patients are often fat with Phlegm, exterior excess but interior deficiency, compounded by sexual indulgence. Interior Qi closure pulse hidden, soon Qi returns pulse surges, all Wind/Fire/Phlegm/Damp acting. Generally, stroke pulse floating-small-slow-weak indicates survival, firm-large-rapid indicates danger. Floating-slow is fundamental stroke pulse; combined tight indicates exterior pathogen, combined large indicates Qi deficiency, combined slow indicates deficiency-cold, combined rapid indicates deficiency-heat, combined slippery indicates Phlegm-Damp, all treatable. Combined choppy indicates pulse mismatching disease, usually dangerous. Choppy pulse in Phlegm syndrome indicates true deficiency/Qi decline/collateral blockage, hard to search out. Thus, stroke pulse fears hidden/choppy, especially firm-large-rapid.
Question: Xu Lao (Deficiency Consumption) in Zhongjing's *Jingui* seven formulas mostly emphasize Yang Deficiency; Danxi uses cold/cooling; later Xue Lizhai, Zhang Jingyue, Li Shicai criticize Danxi's cold/cool favoring warm-tonic, yet don't necessarily use Zhongjing's formulas. Modern practitioners following Lizhai/Jingyue methods often lack efficacy. Why? Diseases have Cold/Heat/Deficiency/Excess, how can they be predetermined? Since Song/Yuan, various schools' deviations and correctness can be detailed? Can modern experts treat this with finer, steadier methods surpassing predecessors? Or innovate symptom-based treatments to supplement predecessors? Medicine values practical effect, do not stick to ancestors, please study carefully.
Xu Lao treatments differ古今. Zhongjing's seven methods are exemplary. For loss-of-essence patients with lower abdominal urgency, cold genitalia, vertigo, use Guizhi Longmu Tang. Zhang Shiwan said: "Body Qi/Blood rely on Post-Heaven Grain/Water for generation. Grain/Water enter Stomach, clear becomes Ying (Nutritive), turbid becomes Wei (Defensive). If Ying fails to nourish upper, Hot Blood overflows; if Wei fails to guard lower, Cold Essence escapes. Ying/Wei and Sanjiao perform duties, Fire returns to root. Heat doesn't behave thus, Cold doesn't behave thus. Grain/Water essence transformation relies on this for Essence/Blood source. Due to collapse/confusion fearing Lower Jiao deficiency/slippage, add Longgu/Muoli to secure/astringe, to..."