《灵枢经》云∶虚邪（即外风）。偏客于身半，（因其人半身血气空虚，故风邪偏客之。）其入深，
内居营卫，营卫衰则真气去，邪气独留，发为偏枯。（偏，谓半身枯，枯，废也。真气衰乃偏枯，
其非一外感即偏枯，可知。可见外感风寒，必无卒仆及偏废等证，惟内伤而后有。）身偏不用（不能运动也）。而痛，
（血气为邪滞故痛。）言不变，志不乱，（邪未入脏腑，神明不乱也。）病止在分（分肉）。腠（腠理）之间，巨针
取之。（刺经络以通其血脉。）益其不足，损其有余，乃可复也。痱之为病也，（《经》谓∶中风有四，
一曰偏枯，如木之根本未甚枯，而一边枝干先萎也，即上证。二曰风痱，即下证。三曰风 ，谓奄然忽不知人也，
即中脏证。四曰风痹，谓痹证因风所成者也，详痹门。）身无痛者，（病在里，故外不痛也。）四肢不收，（如瘫
痪是也。瘫者，坦也，筋脉弛纵，坦然不举也。痪者，涣也，血气散涣而无用也。较偏枯止病半
身者为甚矣。）志乱不甚，其言微知，（其言尚可晓也。）可治。甚则不能言，不可治也。
仲景谓∶中风络脉空虚，（经络之血气虚。）贼邪不泻，或左或右，邪气反缓，（邪滞故缓
也。缓，迟滞弛纵之意。）正气即急。（正被邪遣，故急迫也。如左被邪气凝滞，而寒则迫正气于右而热，故右之
筋脉缩急也。）正气引邪， 僻不遂。（即口眼 斜。）邪在于络（肌表浮络，）肌肤不仁。（麻木不知痛痒。）
邪在于经，即重不胜。（营分着邪，筋脉废而不用，则转动艰难，故重。或兼湿气也。）邪入于腑，即不
识人。（中腑必归胃，胃热蒸液成痰，由胃之大络入迷心窍，故不识人也。）邪入于脏，舌不能言，口吐涎。
（中脏必归心，舌者心之苗，心经痰滞，筋脉不灵，无以运舌，故舌强难言。心火上蒸，舌下廉泉穴开，故吐涎也。）
东垣则分∶中血脉（盖兼仲景中络、中经言之。）者，外有六经之形症；中腑者，内有便
溺之阻隔；（二便不通。）中脏者，痰涎昏冒卒倒，口不能言，不识人。（东垣所谓中脏，
盖兼仲景中腑言之。）
中血脉者，（偏枯歪斜，麻木者是。）小续命汤加减，分六经证治之。证见太阳，无汗恶
寒，（此伤寒也，非中风也。然风每兼寒，故通言之。）本汤倍麻黄、防风、杏仁；（并针至阴、昆仑、举跷。）
有汗恶风，本汤倍桂枝、芍药、杏仁。（针风腑。）证见阳明，无汗身热，（亦是伤寒证。）不恶
寒，（伤寒恶寒，传至阳明则不恶寒，而反恶热）。本汤加石膏、知母各二两，甘草一两；有汗身
热不恶风，本汤加葛根二两，倍桂枝、黄芩。（针陷谷，刺厉兑。）证见太阴，无汗身凉，
（伤寒在三阳经则身热，传至太阴则热入于里，身但微温，今言凉者，盖主直中言也。）
本汤倍附子，加干姜二两，甘草三两。（针隐白。）证见少阴，有汗无热，（太阴不言有汗，少阴不言无汗，
当是互文。）本汤倍桂枝、附子、甘草。（针太溪。）若无此四证，而但见少阳、厥阴证者，或六经证
混淆者，或支节挛痛，麻木不仁者，每本汤八两，加羌活四两，连翘六两。（其证见少
阳者，灸绝骨；见厥阴者，刺大敦，以引其热。按小续命汤，乃麻黄、桂枝之变方，止可
用于中血脉，然亦不可轻用，内热炽者尤忌，慎之。《金鉴》以口眼 斜，肌肤麻木不仁为中络，形气实者乌
药顺气散，虚者大秦艽汤。以
斜瘫痪不遂为中经，实者换骨丹，虚者小续命汤、黄 五物汤。）按六经形证，在伤寒以
头疼、（脑后巅顶。）项强、背痛，属太阳；以头痛、（额前。）目痛、鼻干，属阳明；头痛、（两太阳穴两角。）
胁痛、呕、口苦、寒热往来，属少阳。此皆以其经脉所行之部分言也。若太阴之腹痛自利，
（饮食不消，腹胀嗳气，身重黄肿，亦是。）少阴之脉沉细，但欲寐，（唾沫、善恐、奔豚、骨
痿、脊腰两股后廉内痛、足下热痛，亦是。）厥阴之消渴，气上撞心等证，（闭癃、遗尿、疝、小门痛、面尘、
呕逆，亦是。）则皆以其经脉受邪之为病言之。然三阴主里，病辄经脏相连，病在经者有此证，入
脏者亦有此证，何以别之？曰∶三阴入脏则身无热，在经则身热。（观《伤寒论》三阴证，
以发热为邪还于表，可悟。）则但有身热恶风寒，而内无便溺阻隔及昏迷等证，则可知为病
在血脉之表，而不在脏腑之里矣。抑又思之，此皆以足经言耳，岂手经独无可言者
乎。考其经脉可知也。再按六经形证，可参下文中腑兼中脏条。中腑者，内有便溺
之阻隔，（大、小二便不通也，不利于饮食者亦是。）三化汤或局方麻仁丸通利之。
（《金鉴》实者三化汤，虚者搜风顺气丸。）
若外无六经之形证，内无便溺之阻隔，而但手足不能运动，舌强不能语言，乃
血弱不能养筋故也。大秦艽汤养血而筋自荣。若内外证俱有，先解表而后攻里，表
里邪既解，当服愈风汤，以行中道。（行中道犹云和解。）久服大风尽去，纵有微邪，
亦从愈风汤加减治之。然治病之法，不可失于通塞，（塞固不可，太通利亦不可也。）或一气之
微汗，（十五日也。）或一旬（十日也）之微利，（内外分解，使余邪尽出也。问∶此证既兼内
伤，何得数为汗、下，罔顾虚虚耶？曰；虚者自虚，实者自实，不去其邪，何以存正？庸医惟
知温补，反訾古人，亦可哂矣。久之清浊自分，营卫自和矣。）
中脏者，痰涎昏冒，至宝丹、活命金丹之类。内有麝香入脾治肉，牛黄入肝治
筋，龙脑入肾治骨。中血脉、中腑者不可用，恐其通窍而引邪入筋骨，不能出也。
（《金鉴》实者牛黄清心丸，虚者参附汤，脱症见者倍参。）
中腑多兼中脏，如左关脉浮弦，面目青，左胁偏痛，（两胁皆肝部位，而左胁尤肝所居。）
筋脉拘急，（肝主筋。）目 ，（肝窍于目。）头目眩，（肝火上冲。）手足不收，坐HT 不得，（皆筋
病也，）此中胆兼中心，犀角散之类。如左寸脉浮洪，面赤汗多，（汗为心液。）心神颠倒，
舌强，言语謇涩，（心脉上荣舌本。）忪悸恍惚，此中小肠兼中心，加味牛黄散之类。如
右关脉缓或浮大，面唇黄，汗多，（脾湿盛也。）身重怠惰，嗜卧，肌肉 动不仁，（脾主肌肉。）
腹胀不食，（脾气不运。）此中胃兼中脾也，防风散之类。如右寸脉浮涩而短，鼻流清涕，
多喘，（肺气上壅。）胸中冒闷，（胸中，肺之部分也。）气短声嘶，（肺主声音。）四肢痿弱，（肺热则痿。）此
中大肠兼中肺也，五味子汤之类。如左尺脉浮滑，面目黧黑，腰脊痛引小腹，不能
俯仰，两耳虚鸣，骨节疼痛，足痿，善恐，此中膀胱兼中肾，独活散之类。（按中脏必
有痰涎、昏冒、卒倒等危证，非只此等，此等特用以分别其为何腑、脏耳。）
治风之法，初得之当顺气，（顺气则可，破气、泻气则不可。）及其久也，当活血。（四物汤吞
活络丹即此义。）若不顺气，徒用乌附，又不活血，徒用防风、天麻、羌活辈，未见其能
治也。按中风必由于真气虚，则宜补气以顺之。（黄 、人参必用之药。）气虚而逆冲，则宜
降气以顺之。（沉香之属。）气虚而滞，则宜宣导以顺之。（木香、陈皮之属。）皆所谓顺也。
（气热则凉之，气寒则温之，亦为顺。）热则血枯涩，寒则血凝滞，或滋润以活之，或温行以活之，皆
所谓活也。此证未有不因真气不周而病者，故黄 为必用之君药，防风为必用之臣
药，黄 助真气者也，防风载黄 助真气以周于身者也，亦能发散风邪。许胤宗治
王太后中风口噤，煎二药熏之而愈，况服之乎？多怒则加羚羊角；渴加葛根汁、秦
艽；口噤口 ，亦加秦艽；恍惚错语，加茯神、远志；不得睡，加酸枣仁；内热加
梨汁、人乳、生地黄汁；痰多加竹沥、荆沥，少佐以姜汁。治此证用诸汁最妙，以
其行经络，渗分肉，捷于诸药也。
以上所论，乃内伤而兼外风者也。盖内伤气血亏败，日久有所触，则随触而发，
故一遇外感风寒而卒然倒仆，显出如许危证，知非一朝一夕之故矣。
《灵枢经》说：虚邪（即外风）。如果偏侧地侵袭身体的一半，（因为患者半身血气空虚，所以风邪偏侧侵袭。）侵入较深，内居于营卫之中，营卫衰败则真气离去，只有邪气独留，从而发展为偏枯。（偏，指半身枯萎；枯，指废用。真气衰败才会导致偏枯，由此可见，并非一次外感就会立刻导致偏枯。这说明外感风寒，必然不会出现突然仆倒及半身不遂等症状，只有在内伤的基础上才会出现。）半身不能运动，（肢体偏侧不用。）并且疼痛，（血气被邪气阻滞的缘故，所以疼痛。）言语正常，神志不乱，（邪气未侵入脏腑，神明没有紊乱。）病位仅在分肉、腠理之间，可以用巨针来治疗。（针刺经络以疏通血脉。）补益其不足，削减其有余，才可以恢复。痱病这种病症，（《内经》说：中风有四种类型，一是偏枯，像树木的根本没有完全枯萎，但一边的枝干先萎蔫了，就是上述的证候。二是风痱，就是下面的证候。三是风痖，指突然昏迷不知人事，就是中脏证。四是风痹，指因风邪引起的痹证，详见痹门。）身体没有疼痛，（病位在里，所以体表不痛。）四肢不能收持，（就像瘫痪一样。瘫，意思是坦荡，筋脉弛缓纵散，坦然不能举起。痪，意思是涣散，血气涣散而失去作用。这比仅仅病在半身的偏枯要严重得多。）神志虽然有些混乱但不严重，说话还能让人听懂，（他的话语还可以理解。）可以治疗。如果严重到不能说话，就无法治疗了。
张仲景说：中风是因为络脉空虚，（经络中的血气虚弱。）贼邪无法排泻，或者在左边或者在右边，邪气所在的一侧筋脉反而弛缓，（邪气阻滞所以弛缓。缓，是迟滞、弛纵的意思。）正气所在的一侧就会拘急。（正气被邪气逼迫，所以紧迫。比如左侧被邪气凝滞，寒邪迫使正气向右，热邪也迫使正气向右，所以右侧的筋脉收缩拘急。）正气牵引着邪气，导致口眼歪斜且活动不利。（即口眼歪斜。）邪气在络脉（肌表浮络），肌肤麻木不仁。（感觉麻木，不知痛痒。）邪气在经脉，就会沉重难以抬举。（营分受邪，筋脉废用而不能动，所以感觉沉重。或者兼夹湿气。）邪气进入腑，就不认识人。（中腑必定归并于胃，胃热蒸腾津液成痰，通过胃的大络进入迷心之窍，所以不认识人。）邪气进入脏，舌头僵硬不能说话，口吐涎沫。（中脏必定归并于心，舌是心的苗窍，心经痰浊阻滞，筋脉不灵活，无法运舌，所以舌强难言。心火上蒸，舌下的廉泉穴开启，所以吐涎。）
李东垣则分为：中血脉（大概兼指张仲景所说的中络、中经而言。）的患者，外在表现有六经的症状；中腑者，内在表现为大小便不通畅；（二便闭塞。）中脏者，痰涎壅盛、昏冒、突然倒仆，口不能言，不认识人。（李东垣所说的中脏，大概兼指张仲景的中腑而言。）
属于中血脉的，（表现为偏枯歪斜、麻木。）用小续命汤加减，根据六经证候进行治疗。证候见于太阳经，无汗恶寒，（这是伤寒，不是中风。然而风邪常兼夹寒邪，所以通称为中风。）本方加倍使用麻黄、防风、杏仁；（并针刺至阴、昆仑、跷脉穴位。）有汗恶风，本方加倍使用桂枝、芍药、杏仁。（针刺风府穴。）证候见于阳明经，无汗身热，（这也是伤寒证。）不恶寒，（伤寒恶寒，传到阳明经则不恶寒，反而恶热。）本方加石膏、知母各二两，甘草一两；有汗身热不恶风，本方加葛根二两，加倍桂枝、黄芩。（针刺陷谷穴，刺厉兑穴。）证候见于太阴经，无汗身凉，（伤寒在三阳经时身体发热，传到太阴经则热入于里，身体只是微温，这里说凉，大概是针对直中而言。）本方加倍附子，加干姜二两，甘草三两。（针刺隐白穴。）证候见于少阴经，有汗无热，（太阴篇不言有汗，少阴篇不言无汗，应当是互文见义。）本方加倍桂枝、附子、甘草。（针刺太溪穴。）如果没有这四经的证候，而只见到少阳、厥阴证的，或者六经证候混淆的，或者肢节挛痛、麻木不仁的，每剂本方八两，加羌活四两，连翘六两。（证候见于少阳的，灸绝骨穴；见于厥阴的，刺大敦穴，以引泄其热。按小续命汤，是麻黄汤、桂枝汤的变方，只可用于中血脉，但也不可轻易使用，内热炽盛者尤其禁忌，务必谨慎。《医宗金鉴》认为口眼歪斜、肌肤麻木不仁是中络，形体气实者用乌药顺气散，虚者用大秦艽汤。认为口眼歪斜、瘫痪不遂是中经，实者用换骨丹，虚者用小续命汤、黄芪五物汤。）按六经形证，在伤寒中，头痛、（脑后巅顶部位。）项强、背痛，属于太阳经；头痛、（额前部位。）目痛、鼻干，属于阳明经；头痛、（两侧太阳穴及头角部位。）胁痛、呕吐、口苦、寒热往来，属于少阳经。这些都是从经脉循行的部位来说的。如果是太阴经的腹痛自利，（饮食不消，腹胀嗳气，身体沉重发黄浮肿，也是太阴证。）少阴经的脉沉细，只想睡觉，（唾沫多、易惊恐、奔豚、骨痿、脊腰和大腿后内侧疼痛、足底热痛，也是少阴证。）厥阴经的消渴，气上撞心等证候，（小便闭癃、遗尿、疝气、前阴疼痛、面色如尘、呕逆，也是厥阴证。）则是从经脉受邪所导致的疾病来说的。然而三阴经主里，病邪往往经络与脏腑相连，病在经的有此证候，入脏的也有此证候，如何区别呢？回答说：三阴经邪入脏则身体无热，在经则身体发热。（观察《伤寒论》中三阴证的论述，以发热为邪气还归于体表，由此可以领悟。）那么只要身体发热、恶风寒，而内部没有大小便不通及昏迷等证候，就可以知道病在血脉之表，而不在脏腑之里了。再进一步思考，这些都是以足经而言的，难道手经就没有可说的吗？考察其经脉是可以知道的。另外参考六经形证，可以参考下文“中腑兼中脏”条。
中腑者，内部有大小便不通畅，（大、小二便不通，不利于饮食的也算。）可用三化汤或局方麻仁丸通利大便。（《医宗金鉴》认为实者用三化汤，虚者用搜风顺气丸。）
如果外部没有六经的形证，内部没有大小便的阻隔，而只是手足不能运动，舌强不能语言，这是血弱不能滋养筋脉的缘故。大秦艽汤养血则筋脉自然得到荣养。如果内外证候都有，先解表而后攻里，表里邪气既已解除，应当服用愈风汤，以调和气血。（行中道犹言和解。）长期服用可使大风邪气尽去，即使有轻微邪气，也从愈风汤加减治疗。然而治病的方法，不可失于通塞太过，（闭塞固然是不对的，过于通利也是不对的。）或者一气之内微微发汗，（约十五日。）或者一旬（十日）之内微微通便，（使内外分解，让余邪全部排出。问：此证既然兼有内伤，为何多次使用汗法、下法，不顾虑损伤正气吗？答：虚者自虚，实者自实，不去除邪气，如何保存正气？庸医只知道温补，反而指责古人，也可笑啊。久而久之清浊自然分开，营卫自然调和了。）
中脏者，痰涎昏冒，用至宝丹、活命金丹之类。其中含有麝香入脾治肉病，牛黄入肝治筋病，龙脑入肾治骨病。中血脉、中腑者不可用，恐怕其通窍而引邪深入筋骨，无法排出。（《医宗金鉴》认为实者用牛黄清心丸，虚者用参附汤，出现脱症者加倍人参。）
中腑多兼有中脏，如左关脉浮弦，面目青，左胁偏痛，（两胁都是肝的部位，而左胁更是肝所居之处。）筋脉拘急，（肝主筋。）眼睛斜视，（肝开窍于目。）头晕目眩，（肝火上冲。）手足不能收持，坐立不安，（都是筋的病。）这是中胆兼中心，用犀角散之类。如左寸脉浮洪，面赤汗多，（汗为心之液。）心神颠倒，舌强，言语謇涩，（心脉上荣于舌本。）心慌悸动、恍惚，这是中小肠兼中心，用加味牛黄散之类。如右关脉缓或浮大，面唇黄，汗多，（脾湿盛也。）身体沉重怠惰，嗜睡，肌肉跳动麻木不仁，（脾主肌肉。）腹胀不想吃东西，（脾气不运化。）这是中胃兼中脾，用防风散之类。如右寸脉浮涩而短，鼻流清涕，多喘，（肺气上壅。）胸中闷堵，（胸中，是肺的部位。）气短声音嘶哑，（肺主声音。）四肢痿弱，（肺热则痿。）这是中大肠兼中肺，用五味子汤之类。如左尺脉浮滑，面目黧黑，腰脊痛牵引小腹，不能俯仰，两耳虚鸣，骨节疼痛，足痿，易惊恐，这是中膀胱兼中肾，用独活散之类。（按中脏必有痰涎、昏冒、突然倒仆等危重证候，不仅仅是这些，列举这些特用来分别是何腑、何脏罢了。）
治疗风病的方法，初得病时应当顺气，（顺气是可以的，破气、泻气则不可以。）等到日久，应当活血。（四物汤吞服活络丹就是这个意思。）如果不顺气，只用乌头、附子，又不活血，只用防风、天麻、羌活之类，没见到能治愈的。按中风必定由于真气虚，则宜补气以顺之。（黄芪、人参是必用的药。）气虚而上逆冲撞，则宜降气以顺之。（沉香之类的药。）气虚而停滞，则宜宣导以顺之。（木香、陈皮之类的药。）这都是所谓的“顺”。（气热则凉之，气寒则温之，也称为顺。）热则血液干枯涩滞，寒则血液凝滞，或者滋润以使之活，或者温行以使之活，这都是所谓的“活”。此证没有不是因为真气不周流而发病的，所以黄芪为必用的君药，防风为必用的臣药，黄芪辅助真气，防风载着黄芪辅助真气周流于全身，也能发散风邪。许胤宗治疗王太后中风口噤，煎煮这两味药熏蒸而痊愈，何况服用呢？多怒则加羚羊角；口渴加葛根汁、秦艽；口噤口眼歪斜，也加秦艽；恍惚错语，加茯神、远志；睡不着，加酸枣仁；内热加梨汁、人乳、生地黄汁；痰多加竹沥、荆沥，稍佐以姜汁。治疗此证用各种汁液最妙，因为它们通行经络，渗入分肉，比一般药物更快捷。
以上所论述的，是内伤而兼外风的证候。大概内伤导致气血亏败，日久有所触动，则随触动而发作，所以一旦遇到外感风寒就突然倒仆，显现出如此危重的证候，可知这不是一朝一夕形成的缘故。
The *Ling Shu Jing* (Spiritual Pivot) states: Deficient pathogenic factors (i.e., external wind). If they invade only one side of the body, (because the patient's blood and qi are deficient on that side, the wind pathogen invades preferentially there.) If the invasion is deep, residing internally within Ying and Wei (Nutritive and Defensive levels), when Ying and Wei decline, the True Qi departs, leaving only the pathogen to remain alone, developing into hemiplegia (hemiplegic atrophy). (Hemiplegia refers to withering of one half of the body; withering means dysfunction. True Qi decline leads to hemiplegia; it is evident that a single episode of external contraction does not immediately cause hemiplegia. This shows that external contraction of wind-cold will certainly not result in sudden collapse or hemiplegia; these occur only after internal injury.) The affected side cannot move, (limbs are unusable.) and pain occurs, (due to blood and qi being obstructed by the pathogen.) Speech remains normal, and spirit/mind is undisturbed, (the pathogen has not entered the Zang-Fu organs, so the Spirit is not chaotic.) The disease is confined to the intermuscular spaces and Cou Li (interstitial tissues). Giant needles should be used for treatment. (Puncturing meridians to unblock blood vessels.) Tonify the deficiency, reduce the excess, and recovery is possible.
Fei disease (Flaccidity syndrome), (The Classic states: There are four types of stroke: 1. Hemiplegia, like a tree whose roots are not completely withered but one side's branches wither first—this is the above-mentioned condition. 2. Wind Fei, which is the following condition. 3. Wind Aphasia, characterized by sudden unconsciousness—this is the Zang-invading stroke. 4. Wind Bi, Bi syndrome caused by wind—see the Bi chapter.) The body feels no pain, (the disease is interior, so there is no exterior pain.) limbs cannot hold themselves, (similar to paralysis. Tan means relaxed/flaccid, tendons and vessels are lax and cannot lift. Huan means scattered, blood and qi are scattered and useless. This is more severe than hemiplegia which affects only half the body.) Spirit/mind is slightly confused but not severely, speech is understandable, (his words can still be understood.) this is treatable. If severe enough that speech is impossible, it is untreatable.
Zhang Zhongjing stated: Stroke occurs because collateral vessels are empty, (blood and qi in collaterals are deficient.) allowing thief pathogens to remain unchecked, affecting either the left or right side. The side affected by the pathogen becomes flaccid, (pathogen obstruction causes flaccidity. Flaccid implies sluggishness and laxity.) while the healthy side becomes tense. (Healthy Qi is driven by the pathogen, causing tension. For example, if the left is stagnant with pathogen, cold forces Healthy Qi to the right, and heat also forces it to the right, causing right-sided tendon contraction and tension.) Healthy Qi pulls the pathogen, resulting in facial deviation and inability to move smoothly. (Facial deviation.) Pathogen in Collaterals (superficial skin collaterals) causes numbness and insensitivity of skin and flesh. (Numbness, lack of pain/itch sensation.) Pathogen in Meridians causes heaviness and inability to bear weight. (Ying level affected, tendons/vessels dysfunctional, movement difficult, hence heavy. May also involve dampness.) Pathogen entering Fu organs causes loss of recognition of people. (Fu invasion returns to Stomach; Stomach heat steams fluids into phlegm, enters the heart via the Stomach's major Luo vessel, clouding the mind, hence loss of recognition.) Pathogen entering Zang organs causes tongue stiffness and inability to speak, with drooling. (Zang invasion returns to Heart; tongue is the sprout of the Heart; Heart channel phlegm obstruction makes tendons/vessels inflexible, unable to move the tongue, hence tongue stiffness. Heart fire steams upward, opening the Lianquan acupoint under the tongue, causing drooling.)
Li Dongyuan divided it thus: Invading Blood Vessels (roughly combining Zhang Zhongjing's Collateral and Meridian invasions): Exterior symptoms of the Six Channels appear. Invading Fu organs: Interior blockage of urination and defecation. (Obstruction of both excretions.) Invading Zang organs: Phlegm-saliva, coma/fainting, sudden collapse, inability to speak, loss of recognition. (Li Dongyuan's Zang invasion roughly combines Zhang Zhongjing's Fu invasion.)
For those invading Blood Vessels, (hemiplegia, deviation, numbness,) use Xiao Xuming Tang (Minor Continuation Decoction) with modifications, treating according to Six Channel patterns. Symptoms appearing in Taiyang: No sweat, aversion to cold, (this is Cold Damage, not Stroke. However, wind often combines with cold, so it is generally referred to as such.) Double Mahuang (Ephedrae Herba), Fangfeng (Saposhnikoviae Radix), Xingren (Armeniacae Semen Amarum) in the base formula; (also puncture Zhiyin, Kunlun, and Qiao vessels.) With sweat, aversion to wind, double Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix Alba), Xingren. (Puncture Fengfu.) Symptoms appearing in Yangming: No sweat, body heat, (also a Cold Damage pattern.) No aversion to cold, (Cold Damage involves aversion to cold; upon transmission to Yangming, aversion to cold ceases, replaced by aversion to heat.) Add Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma) 2 liang each, Gancao (Glycyrrhizae Radix et Rhizoma) 1 liang. With sweat, body heat, no aversion to wind, add Gegen (Puerariae Lobatae Radix) 2 liang, double Guizhi, Huangqin (Scutellariae Radix). (Puncture Xangu, prick Lidui.) Symptoms appearing in Taiyin: No sweat, cool body, (Cold Damage in Three Yang channels causes body heat; transmission to Taiyin moves heat inward, body is only slightly warm. Here "cool" refers to direct invasion.) Double Fuzi (Aconiti Lateralis Radix Praeparata), add Ganjiang (Zingiberis Rhizoma) 2 liang, Gancao 3 liang. (Puncture Yinbai.) Symptoms appearing in Shaoyin: With sweat, no heat, (Taiyin chapter doesn't mention sweat, Shaoyin doesn't mention absence of sweat; this is likely mutual textual reference.) Double Guizhi, Fuzi, Gancao. (Puncture Taixi.) If none of these four patterns are present, but only Shaoyang or Jueyin patterns appear, or Six Channel patterns are mixed, or limb joints are spasmodic/painful with numbness, use 8 liang of the base formula, add Qianghuo (Notopterygii Rhizoma et Radix) 4 liang, Lianqiao (Forsythiae Fructus) 6 liang. (For Shaoyang patterns, moxa Jiegu; for Jueyin patterns, puncture Dacun to draw out heat. Note: Xiao Xuming Tang is a variation of Mahuang Tang and Guizhi Tang, usable only for Blood Vessel invasion, but should not be used lightly; especially contraindicated in intense internal heat. Be cautious. *Yi Zong Jin Jian* considers facial deviation and skin numbness as Collateral invasion: Wuyao Shunqi San for excess constitution, Da Qin Jiao Tang for deficiency. Facial deviation and paralysis as Meridian invasion: Huangu Dan for excess, Xiao Xuming Tang or Huangqi Wuwu Tang for deficiency.) Regarding Six Channel patterns in Cold Damage: Headache (occipital/crown), neck stiffness, back pain belong to Taiyang; Headache (frontal), eye pain, nasal dryness belong to Yangming; Headache (temporal/angular), hypochondriac pain, vomiting, bitter taste, alternating chills and fever belong to Shaoyang. These refer to the parts where their meridians travel. For Taiyin abdominal pain and spontaneous diarrhea, (undigested food, abdominal distension, belching, heavy body, yellow edema, also Taiyin); Shaoyin pulse deep and fine, desire to sleep, (excessive saliva, fearfulness, running piglet, bone flaccidity, pain along spine/waist/posterior thigh/inner leg, hot feet, also Shaoyin); Jueyin thirst, Qi rushing up to strike the heart, (urinary retention, enuresis, hernia, genital pain, dusty complexion, vomiting, also Jueyin)—these refer to diseases caused by pathogen affecting the meridians. However, Three Yin channels govern the interior; disease often links meridians and Zang organs. Disease in meridians has these symptoms; disease entering Zang organs also has them. How to distinguish? Answer: When Three Yin pathogen enters Zang, there is no body heat; when in meridians, there is body heat. (Observing *Shanghan Lun* Three Yin patterns, where fever indicates pathogen returning to the exterior, one can understand this.) Thus, if there is only body heat and aversion to wind/cold, without interior blockage of excretions or coma, one knows the disease is in the superficial Blood Vessels, not the interior Zang-Fu organs. Further thought: These discussions focus on Foot channels; do Hand channels have nothing to say? Examining their meridians reveals this. Also refer to the "Fu Invasion Combining Zang Invasion" section below.
Fu invasion involves interior blockage of excretions, (obstruction of large and small bowels, difficulty eating also counts.) Use Sanhua Tang or Ju Fang Maren Wan to promote bowel movement. (*Yi Zong Jin Jian*: Excess uses Sanhua Tang, Deficiency uses Soushun Fengqi Wan.)
If there are no exterior Six Channel patterns and no interior blockage of excretions, but only inability to move limbs and tongue stiffness/inability to speak, this is due to blood deficiency failing to nourish tendons. Da Qin Jiao Tang nourishes blood, and tendons naturally become prosperous. If both interior and exterior patterns exist, resolve the exterior first, then attack the interior. Once exterior and interior pathogens are resolved, take Yufeng Tang to harmonize the middle pathway. (Harmonizing the middle pathway means resolving harmony.) Long-term use expels major wind pathogens; even minor pathogens can be treated with modifications of Yufeng Tang. However, treatment methods must not lose balance between unblocking and obstructing. (Obstruction is bad, but excessive unblocking is also bad.) Either induce slight sweating over one Qi cycle (15 days), or slight purgation over one decade (10 days), (to decompose interior/exterior and expel residual pathogens. Question: Since this condition combines internal injury, why use sweating and purging repeatedly without worrying about damaging deficiency? Answer: The deficient remains deficient, the excess remains excess. Without removing the pathogen, how can Zheng Qi be preserved? Quack doctors only know warming and tonifying, criticizing ancients, which is laughable. Over time, clear and turbid separate naturally, Ying and Wei harmonize.)
Zang invasion involves phlegm-saliva, coma/fainting; use Zhibao Dan (Precious Treasure Pill), Huoming Jindan (Life-Preserving Golden Pill), etc. These contain She Xiang (Moschus) entering Spleen to treat flesh disorders, Niu Huang (Bovaris Calculus) entering Liver to treat tendon disorders, Long Nao (Borneolum Syntheticum) entering Kidney to treat bone disorders. These are contraindicated for Blood Vessel and Fu invasions, lest they open orifices and draw pathogens deeper into tendons/bones, making them impossible to expel. (*Yi Zong Jin Jian*: Excess uses Niuhuang Qingxin Wan, Deficiency uses Shenfu Tang; double Ren Shen for collapse syndromes.)
Fu invasion often combines Zang invasion. E.g., Left Guan pulse floating and wiry, greenish face, left hypochondriac pain, (both hypochondria are Liver areas, left is specifically Liver residence.) tendon spasm, (Liver governs tendons.) eye deviation, (Liver opens into eyes), dizziness, (Liver fire rising), limbs unable to hold, inability to sit/stand comfortably, (all tendon diseases). This is Gallbladder invasion combining Heart invasion; use Xijiao San (Rhinoceros Horn Powder). E.g., Left Cun pulse floating and surging, red face, profuse sweat, (sweat is Heart fluid), mental confusion, tongue stiffness, slurred speech, (Heart pulse nourishes tongue root), palpitations, trance. This is Small Intestine invasion combining Heart invasion; use Jiawei Niuhuang San (Modified Bovaris Calculus Powder). E.g., Right Guan pulse slow or floating-large, yellow face/lips, profuse sweat, (Spleen dampness excess), heavy body, lethargy,嗜卧 (desire to lie down), muscle twitching/numbness, (Spleen governs flesh), abdominal distension, anorexia, (Spleen Qi stagnation). This is Stomach invasion combining Spleen invasion; use Fangfeng San (Saposhnikoviae Powder). E.g., Right Cun pulse floating, choppy, and short, runny nose, frequent panting, (Lung Qi congestion), chest oppression, (chest is Lung area), shortness of breath, hoarseness, (Lung governs voice), limb flaccidity, (Lung heat causes flaccidity). This is Large Intestine invasion combining Lung invasion; use Wuweizi Tang (Schisandra Decoction). E.g., Left Chi pulse floating and slippery, dark complexion, lower back/spine pain radiating to lower abdomen, inability to bend/straighten, tinnitus, joint pain, foot flaccidity, fearfulness. This is Bladder invasion combining Kidney invasion; use Duhuo San (Angelicae Pubescentis Powder). (Note: Zang invasion must have critical signs like phlegm-saliva, coma, sudden collapse, not just these; these are listed specifically to differentiate which Fu/Zang is involved.)
Treatment of wind: Initially, regulate Qi. (Regulating Qi is acceptable; breaking or draining Qi is not.) Later, invigorate Blood. (Taking Siwu Tang with Huoluo Dan embodies this principle.) If one does not regulate Qi, using only Wutou/Fuzi, and does not invigorate Blood, using only Fangfeng, Tianma, Qianghuo, cure is unlikely. Stroke must stem from True Qi deficiency; thus, tonify Qi to regulate it. (Huangqi, Renshen are essential.) If Qi is deficient and counterflows upward, descend Qi to regulate it. (Chenxiu group.) If Qi is deficient and stagnant, guide/unblock Qi to regulate it. (Muxiang, Chenpi group.) All are called "regulating." (Cooling hot Qi, warming cold Qi is also regulating.) Heat causes blood dryness/stagnation; cold causes blood coagulation/stagnation. Moisten/nourish to activate, or warm/move to activate. All are called "activating." This condition invariably arises from True Qi failing to circulate uniformly. Thus, Huangqi is the essential Sovereign herb, Fangfeng the essential Minister herb. Huangqi assists True Qi; Fangfeng carries Huangqi to assist True Qi in circulating throughout the body, and also disperses wind pathogens. Xu Yinzong treated Empress Dowager Wang's stroke with locked jaw by fumigating with decoction of these two herbs, curing her; how much more effective would ingestion be? Add Lingyangjiao (Capricornis Cornu) for anger; Ge Gen juice, Qin Jiao for thirst; locked jaw/deviation, add Qin Jiao; trance/confused speech, add Fushen, Yuanzhi; insomnia, add Suanzaoren; internal heat, add Pear juice, human milk, Sheng Dihuang juice; excessive phlegm, add Zhuli, Jingli, with a little Jiangzhi. Using various juices for this condition is excellent because they travel meridians, penetrate interstices, and act faster than other drugs.
The above discusses internal injury combined with external wind. Generally, internal injury depletes blood and Qi; after a long time, any trigger causes immediate onset. Thus, encountering external wind-cold leads to sudden collapse and critical signs, indicating this is not a one-day or one-night occurrence.