1.风从外中伤肢体, 痰火内发病心官, 体伤不仁与不用, 心病神昏
不语言. 当分中络经腑脏, 更审虚实寒热痰, 脱证撒手为脾绝, 开口
眼合是心肝, 遗尿肾绝鼾声肺, 闭证握固紧牙关, 初以通关先取嚏,
痰壅不下吐为先.
【注】风, 谓虚邪, 贼风从外而中, 伤人四肢躯体, 故名曰中风. 痰
火,谓痰火从内而发, 病人心主之官, 故名曰痰火. 体中风邪, 轻则
顽麻不仁, 重则瘫痪不用. 心病痰火, 轻则舌强难语, 重则痰壅神昏
.此证或内或外, 单病轻, 兼病重, 当细辨其中络, 中经, 中腑, 中
脏,及中经络兼中腑脏. 并细审其兼虚, 兼实, 兼寒, 兼热, 兼痰与
夫脱证, 闭证之浅深缓急而治之. 凡初中宜先用通关散取嚏, 有嚏可
治,无嚏多死. 口噤者, 用开关散, 擦牙软之. 痰涎壅盛, 用诸吐法
涌之. 若口噤不开, 汤药不能下咽者, 则将应服之药, 随引调如面茶
,含不病人口内, 用苇管或笔管插入病人鼻孔, 使气连药吹之, 其药
自能入咽. 不可用金器撬之, 恐伤齿也.
【按】中风一证, 分中血脉, 中腑, 中脏, 始自李东垣. 中血脉者,
大秦艽汤; 中腑者, 小续命汤; 中脏者, 三化汤. 然从未见有三化汤
中脏之证, 惟『金匮』书中分为四证: 曰络, 曰经, 曰腑, 曰脏, 其
说最为得当, 可为后世法. 盖口眼喎斜, 肌肤不仁, 邪在络也; 左右
不遂, 筋骨不用, 邪在经也; 昏不识人, 便溺阻隔, 邪在腑也; 神昏
不语, 唇缓涎出, 邪在脏也. 学者细阅诸家之论, 自知不谬云尔.
1. 风邪从外部侵袭损伤肢体，痰火从内部发作扰乱心主，身体受伤表现为麻木不仁与运动障碍，心病导致神志昏迷、不能言语。应当区分中络、中经、中腑、中脏，更要审察虚证、实证、寒证、热证及痰证。脱证表现为手撒开、口张开、眼闭合，这是心肝之气绝；遗尿、打鼾声是肾肺之气绝。闭证表现为手握固、牙关紧闭。初起时先用通关散取嚏，若痰涎壅盛不下行，则以涌吐为先。
【注】风，指虚邪、贼风从外侵入，伤害人的四肢躯体，所以称为中风。痰火，指痰火从内发作，病人心主之官受累，所以称为痰火。身体遭受风邪，轻则顽麻不仁，重则瘫痪不用。心病痰火，轻则舌强难语，重则痰壅神昏。此证或在内或在外，单病较轻，兼病较重，应当仔细辨别其中络、中经、中腑、中脏，以及中经络兼中腑脏。并仔细审察其兼虚、兼实、兼寒、兼热、兼痰以及脱证、闭证的浅深缓急而进行治疗。凡初中期宜先用通关散取嚏，有嚏可治，无嚏多死。口噤者，用开关散擦牙使其软化。痰涎壅盛，用各种吐法涌出。如果口噤不开，汤药不能下咽，则将应服之药，随引调如面茶，含在不生病人口内，用苇管或笔管插入病人鼻孔，使气连药吹入，其药自能入咽。不可用金器撬之，恐伤齿也。
【按】中风一证，分中血脉、中腑、中脏，始自李东垣。中血脉者，大秦艽汤；中腑者，小续命汤；中脏者，三化汤。然而从未见过有三化汤中脏之证，惟《金匮》书中分为四证：曰络、曰经、曰腑、曰脏，其说最为得当，可为后世法。盖口眼喎斜，肌肤不仁，邪在络也；左右不遂，筋骨不用，邪在经也；昏不识人，便溺阻隔，邪在腑也；神昏不语，唇缓涎出，邪在脏也。学者细阅诸家之论，自知不谬云尔。
1. Wind pathogen invades from the exterior, damaging the limbs; phlegm-fire erupts from the interior, disturbing the Heart Master (心主). Damage to the body manifests as numbness and loss of function; Heart disease leads to coma and inability to speak. One must differentiate between involvement of the Collaterals (络), Channels (经), Fu-organs (腑), and Zang-organs (脏), and further examine for deficiency, excess, cold, heat, and phlegm. The Collapse syndrome (脱证) is characterized by open hands, open mouth, and closed eyes, indicating exhaustion of the Heart and Liver Qi; incontinence and snoring indicate exhaustion of the Kidney and Lung Qi. The Closure syndrome (闭证) is characterized by clenched fists and locked jaw. In the initial stage, use Tongguan San (Passing Through the Obstruction Powder) to induce sneezing first; if phlegm obstruction is severe and does not descend, emesis (吐法) is prioritized.
[Note] "Wind" refers to deficient evil and thief wind invading from the exterior, harming the four limbs and trunk, hence named Stroke (中风). "Phlegm-fire" refers to phlegm-fire erupting from the interior, affecting the Heart Master organ, hence named Phlegm-Fire. When the body suffers wind pathogen, mild cases present with stiff numbness and insensitivity, while severe cases present with paralysis and loss of movement. When Heart disease involves phlegm-fire, mild cases present with stiff tongue and difficulty speaking, while severe cases present with phlegm obstruction and coma. This condition may be internal or external; single pathology is mild, combined pathology is severe. One must carefully distinguish between involvement of the Collaterals, Channels, Fu-organs, and Zang-organs, as well as combined involvement of Channels/Collaterals with Fu/Zang organs. Furthermore, one must carefully examine accompanying deficiency, excess, cold, heat, phlegm, and the depth and urgency of Collapse or Closure syndromes to determine treatment. For early-stage stroke, Tongguan San should be used initially to induce sneezing; presence of sneezing indicates treatability, absence suggests high mortality. For trismus (口噤), use Kaiguan San (Open the Gate Powder) applied to the teeth to soften them. For excessive phlegm-saliva, various emetic methods should be used to expel it. If trismus prevents opening the mouth and decoctions cannot be swallowed, the prescribed medicine should be mixed with a guiding agent into a paste resembling tea slurry, placed in the mouth of a healthy person, and a reed tube or pen tube inserted into the patient's nostril. Air pressure should blow the medicine through the tube so that it naturally enters the throat. Do not use metal instruments to pry the mouth open, as this may damage the teeth.
[Commentary] The differentiation of Stroke into involvement of Blood-Vessels (血脉), Fu-organs, and Zang-organs originated with Li Dongyuan. For involvement of Blood-Vessels, Da Qin Jiao Tang (Great Gentian Decoction); for involvement of Fu-organs, Xiao Xu Ming Tang (Minor Life-Preserving Decoction); for involvement of Zang-organs, San Hua Tang (Three Transformations Decoction). However, cases of Zang-involvement treated with San Hua Tang have never been seen. Only the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) divides it into four syndromes: Collateral, Channel, Fu-organ, and Zang-organ. This theory is most appropriate and can serve as a model for later generations. Generally, facial deviation and skin numbness indicate pathogen in the Collaterals; hemiplegia on either side and inability of sinews and bones to function indicate pathogen in the Channels; unconsciousness and inability to recognize people, along with urinary/fecal retention, indicate pathogen in the Fu-organs; coma, inability to speak, flaccid lips, and dribbling saliva indicate pathogen in the Zang-organs. Scholars who carefully review the theories of various masters will know that this is correct.