调下，以开其痹着。以后则禁诸热食，惟宜冷食。如此再四十日，则药积腹中不下，而空窍填矣。空窍填，则旧风尽出，
新风不受矣。盖矾性得冷即止，得热即行。故嘱云∶热食即下矣，冷食自能助药力，抑何用意之微耶？风引汤治大人风
引，少小惊 螈 ，日数十发，医所不疗。除热方可。见大人中风牵引，少小惊 螈 ，正火热生风，五脏亢甚，归迸
入心之候。盖惊 之来，初分五脏，后迸入心，故同治也。巢氏用此治香港脚，岂非以石性易于下达，可胜其湿热，不使
攻心乎？夫厥阴风木，与少阳相火同居。火发必风生，风生必挟木势侮其脾土。故脾气不行，聚液成痰，流注四末，因
成瘫痪。用大黄为君，以荡涤风火热湿之邪矣，随用干姜之止而不行者以补之，用桂枝、甘草以缓其势，用诸石药之涩
以堵其路。而石药之中，又取滑石、石膏清金以伐其木，赤白石脂浓土以除其湿，龙骨、牡蛎以收敛其精神魂魄之纷驰，
用寒水石以助肾水之阴，俾不为阳亢所劫。更用紫石英以补心神之虚，恐主不安，则十二官皆危也。明此以治入藏之风，
游刃有余矣。何后世以为石药过多，舍之不用，而用脑、麝以散其真气，花蛇以增其恶毒。智耶愚耶，而不解矣。
按∶《金匮》风引汤，当在侯氏黑散之下。本文有正气引邪， 僻不遂等语，故立方即以风引名之。侯氏黑散颛主补
虚以熄其风，此方兼主清热火湿以除其风也，集者误次于寸口脉迟而缓之下，则证与方不相涉矣。
风中五脏，其来有自藏气先伤，后乃中之。火热气湿痰虚，六贼勾引深入。一旦卒倒无知，遍身牵引，四末不用，
但得不死，亦成瘫痪。何藏先伤，调之使平，不令迸入于心，乃为要也。
五脏各藏一神，不可伤之。《经》谓神伤于思虑，则肉脱；意伤于忧愁，则肢废；魂伤于悲哀，则筋变；魄伤于喜乐，
则皮槁；志伤于盛怒，则腰膝难以俯仰。是风虽未入，藏真先已自伤，火热气湿痰虚，迎之内入，多汗恶风等证，因之
外出，治之难矣。善治者，乘风未入，审其何藏先伤何邪，彻土绸缪，最为扼要之法也。
中风外证，错见不一。风火相煽，多上高巅。风湿相搏，多流四末。手足麻木，但属气虚。关节肿痹，湿痰凝滞。
偏正头痛，愈风丹。目蠕面肿，胃风汤。风湿，薏苡仁汤、排风汤。麻木，人参补气汤。肿痹，舒筋散。
寒热似疟，解风为宜。风藏痰隧，搜风最当。
解风散；搜风丸。
经络及府，治分浅深。表里之邪，大禁金石。
中络，桂枝汤。中经，小续命汤加减。表里兼治，防风通圣散。祛风，至宝膏。攻里，三化汤、搜风丸。
左瘫右痪，风入筋骨，宣导其邪，缓以图之。
舒筋保安散。
卒中灌药，宜用辛香。开痰行气，调入苏合。
南星汤调苏合丸、顺气散、匀气散、稀涎散。
四肢不举，有虚有实。阳明虚，则宗筋失润，不能束骨而利机关。阳明实，则肉理致密，加以风邪内淫，正气自不
周流也。
虚用六君子汤，实用三化汤合承气汤。
口眼 斜，邪急正缓。左急治左，右急治右，先散其邪，次补其正。
左急，三圣散。右急，匀气散。
转舌、正舌，方名虽美，少阴脉萦舌本，三年之艾，不言标矣。资寿解语，犹为近之。
转舌膏；正舌散；资寿解语汤。
风初入府，肌肉蠕 ，手足牵强，面肿能食。胃风宜投。
胃风汤。
风初入藏，发热躁烦，先用泻青，兼解表里。次用愈风，磨入四白。
泻青丸；愈风汤；四白丹。
养血豁痰，枘凿不入，先其所急，不宜并施。
养血，大秦艽汤、当归地黄汤、天麻丸。豁痰，涤痰汤、青州白丸子。热痰，竹沥荆沥汤、贝母栝蒌散。阴虚夹痰，
千金地黄汤。
心火内蕴，膻中如燔，凉膈、清心，功见一斑。心血内亏，恍惚不寐，服二丹丸，可以安睡。火盛壮水，勿辞迂缓，
水升火降，枯回燥转。
凉膈散；清心散；二丹丸；壮水地黄汤。
真阳上脱，汗多肢冷，气喘痰鸣，此属不治。黑锡三建，引阳回宅；水土重封，虞渊浴日。
黑锡丹；三建二香汤。
肾水泛痰，真阳未脱，治以星附，十中九活。
星附汤。
外风暴发，内风易炽。热溉甘寒，避居密室，毋见可欲，毋进肥鲜，谨调千日，重享天年。
世传中风之人，每遇外风一发，宜进续命汤以御之。殊为不然，风势才定，更用续命汤重引风入，自添蛇足也。惟
用甘寒药频频热服，俾内不召风，外无从入之路。且甘寒一可息风，二可补虚，三可久服，何乐不用耶？
【律五条】
凡风国中经络，不行外散，反从内夺，引邪深入者，医之过也。治中风一如治伤寒，不但邪在三阳引入三阴为犯大
禁，即邪在太阳引入阳明、少阳，亦为犯禁也。故风国中络，即不可引之入经，中经即不可引之入府，中府即不可引之
入藏。引邪深入，酿患无穷，乃至多死少生，可无戒欤？
凡治中风自汗证，反利其小便者，此医之过也。 毋论风中浅深，但见自汗，则津液外出，小便自少。若更利之，
使津液下竭，则荣卫之气转衰，无以制风火之势，必增其烦热，而真阴日亡也。况阳明经利其小便，尤为犯禁。少阴经
利其小便，必失溲而杀人，可无戒欤？
凡治中风病，不明经络府藏，徒执方书，妄用下法者，必至伤人，医之罪也。 风中经络，只宜宣之使散，误下则
风邪乘虚入府入藏，酿患无穷。若夫中藏之候，多有平素积虚，藏真不守者，下之立亡，不可不慎。惟在胃府一证，内
实便秘者，间有可下。然不过解其烦热，非大下也。所谓一气之微汗，一旬之微利，亦因可用始用之。至于子和以下立
法，机要以中藏者宜下为言，则指下为定法，胡可训耶。然中藏有缓急二候，中府日久，热势深极，传入藏者，此属可
下。而下必使风与热俱去，填其空窍，则风不再生。若开其瘀壅，必反增风势，何以下为哉？其卒虚身中急证，下药入
口，其人即不苏矣，可无辨欤！后世以中府之便秘，指为中藏，见其误下，不致损人，益信子和机要之法为可用。设遇
真中藏证，下不中病，难可复追矣。
凡治中风四肢不举证，不辨虚实，妄行补泻者，医之过也。四肢不举，皆属脾土，膏粱太过，积热内壅者，为脾土
瘀实，宜泻以开其壅。食少体羸，怠惰嗜卧者，为脾土虚衰，宜补以健其运。若不辨而实者补之，虚者泻之，宁不伤人
乎？
凡治外中于风，不辨内挟何邪，误执一家方书，冀图弋获，其失必多，医之过也。风邪从外入者，必驱之使从外出。
然挟虚者，非补虚则风不出。挟火者，非清热则风不出。挟气者，非开郁则风不出。挟湿者，非导湿则风不出。挟痰者，
非豁痰则风不出。河间东垣丹溪，各举一端，以互明其治。后学不知变通，但宗一家为主治，倘一病兼此五者，成方果
安在？况不治其所有，反治其所无，宁不伤人乎？
附风痱（法一条）
岐伯谓中风大法有四∶一曰偏枯，半身不遂；二曰风痱，于身无痛，四肢不收；三曰风懿，奄忽不知人；四曰风痹，
诸痹类风状。后世祖其说而无其治，《金匮》有古今录验三方，可类推之。
《经》谓内夺而厥，则为风痱。仲景见成方中，有治外感风邪兼治内伤不足者，有合《经》意，取其三方，以示法
程。一则曰古今录验续命汤，再则曰千金三黄汤，三则曰近效白术附子汤。前一方，治荣卫素虚而风入者。中一方，治
虚热内炽而风入者。后一方，治风已入藏，脾肾两虚，兼诸痹类风状者。学人当会仲景意，而于浅深寒热之间，以三隅
反矣。《古今录验》续命汤。《千金》三黄汤。《近效》白术附子汤。
附风懿
按∶风懿曰奄忽不知人，即该中风卒倒内，《金匮》不重举其证，意可知矣。
附风痹（法七条）
中风四证，其一曰风痹，以诸痹类风状，故名之也。然虽相类，实有不同。风则阳先受之，痹则阴先受之耳。致痹
之因，曰风、曰寒、曰湿，互相杂合，匪可分属。但以风气胜者为行痹，风性善行故也。以寒气胜者为痛痹，寒主收急
故也。以湿气胜者为着痹，湿主重滞故也。邪之所中，五浅五深，不可不察。在骨则重而不举；在筋则屈而不伸；在肉
则不仁；在脉则血凝而不流；在皮则寒。此五者在躯壳之间，皆不痛也。其痛者，随血脉上下，寒凝汁沫，排分肉而痛，
虽另名周痹，不隶于血脉之中也。骨痹不已，复感于邪，内舍于肾。筋痹不已，复感于邪，内舍于肝。脉痹不已，复感
于邪，内舍于心。肌痹不已，复感于邪，内舍于脾。皮痹不已，复感于邪，内舍于肺。此五者，亦非径入五脏也。五脏
各有合病，久而不去，内舍于其合也。盖风寒湿三气，杂合牵制，非若风之善行易入，故但类于中风也。《经》论诸痹至
详，然有大阙，且无方治。《金匮》补之。一曰血痹、二曰胸痹、三曰肾着、四曰三焦痹。《金匮》论血痹，谓尊荣人骨
弱肌肤盛，重因疲劳汗出，卧不时动摇，加被微风，遂得之。但以脉自微涩在寸口，关上小紧，宜针引阳气，令脉和、
紧去则愈。
血痹，阴阳俱微，寸口关上微，尺中小紧，外证身体不仁，如风痹状，黄 桂枝五物汤主之。
《经》但言在脉则血凝而不流，《金匮》直发其所以不流之故。言血既痹，脉自微涩，然或寸或关或尺，其脉见小紧
之处，即风入之处也。故其针药所施，皆引风外出之法也。
《金匮》论胸痹脉证，并方治绎明，入二卷胸寒痹痛条下，此不赘。《金匮》肾着之病，其人身体重，腰中冷，如坐
水中，形如水状，反不渴，小便自利，饮食如故。病属下焦，身劳汗出，衣里冷湿，久久得之。腰以下冷痛，腹重如带
五千钱，甘姜苓术汤主之。
《经》但言骨痹不已，复感于邪，内舍于肾。仲景知湿邪不能伤肾藏之真，不过舍于所合。故以身重腰冷等证为言，
曰饮食如故，曰病属下焦，意可知矣。然湿土之邪，贼伤寒水，恐害两肾所主生气之原，关系尤大，故特举肾着一证，
立方以开其痹着。
《金匮》复有总治三痹之法，今误编历节黄汗之下，其曰∶诸肢节疼痛，身体 羸，脚肿如脱，头眩短气，温温欲
吐，桂枝芍药知母汤主之是也。
短气，中焦胸痹之候也。属连头眩，即为上焦痹矣。温温欲吐，中焦痹也。脚肿如脱，下焦痹也。肢节疼痛，身体
羸，筋骨痹也。荣、卫、筋、骨、三焦俱病，又立此法以治之，合四法以观精微之蕴，仲景真百世之师矣。 治痹诸
方，不另立门，姑附风门之后，实与治风不侔，不可误施。痹症琐屑，不便立法者，俱于用方条下发之，宜逐方细玩。
【律一条】
凡治痹症，不明其理，以风门诸通套药施之者，医之罪也。 痹症非不有风，然风入在阴分，与寒湿互结，扰乱其
血脉，致身中之阳，不通于阴，故致痹也。古方多有用麻黄、白芷者，以麻黄能通阳气，白芷能行荣卫，然已入在四物、
四君等药之内，非颛发表明矣。至于攻里之法，则从无有用之者。以攻里之药，皆属苦寒，用之则阳愈不通，其痹转入
诸府，而成死症者多矣，可无明辨而深戒欤？
服用后，以开通经络的痹阻。此后禁止食用各种热性食物，只宜吃冷食。像这样再过四十天，药力积聚在腹中不再下行，而空窍就被填满了。空窍被填满，那么旧有的风邪就会全部排出，新的风邪就无法侵入。因为矾石的特性是遇冷则停止作用，遇热则发挥作用。所以嘱咐说：如果吃热食药就会立即下行，吃冷食自然能辅助药力，这其中的用意多么精微啊？
风引汤治疗成人中风牵引抽搐，以及小儿惊痫抽搐，每天发作几十次，这是医生难以治疗的病症。此方只有清除热邪才能见效。看到大人中风牵引，小儿惊痫抽搐，这正是火热生风，五脏功能亢盛至极，邪气迸发进入心脏的征候。大概惊痫发作之初，病邪分散在五脏，后来迸发进入心脏，所以治疗方法相同。巢元方用此方治疗脚气病，难道不是利用石药性质易于向下运行，可以胜其湿热，不让邪气攻心吗？
厥阴风木与少阳相火同居一处。火发动必然生风，风生必然挟带木势欺侮脾土。所以脾气不能运化，聚积津液变成痰，流注到四肢末端，因而形成瘫痪。用大黄作为君药，来荡涤风、热、火、湿等邪气；随即用干姜的止而不行的特性来补益它；用桂枝、甘草来缓和病势；用各种石药的涩性来堵塞邪气通路。而在石药之中，又选取滑石、石膏清肃肺气以克制肝木，赤白石脂厚培脾土以祛除湿气，龙骨、牡蛎来收敛纷乱奔驰的精神魂魄，用寒水石来助益肾水的阴液，使其不被阳亢所劫夺。再用紫石英来补益心神的虚弱，恐怕心神不安，那么十二脏腑都会危险。明白这些道理来治疗入脏的风邪，就能游刃有余了。为什么后世认为石药过多，舍弃不用，反而用脑麝香来耗散真气，用花蛇来增加恶毒？这是明智还是愚笨呢？实在让人不解。
按语：《金匮要略》中的风引汤，应当放在侯氏黑散的下面。原文中有“正气引邪”、“口眼歪斜不遂”等话语，所以立方的名字就叫风引。侯氏黑散专门主补虚以熄风，此方兼主清热、火、湿以除风。编集者错误地把它排在寸口脉迟而缓的下面，那么证候与方剂就不相关了。
风邪侵入五脏，其来源有自，是因为脏气先受伤，然后才受风邪侵袭。火热、气滞、湿邪、痰浊、虚损，六贼勾引深入体内。一旦突然昏倒无知，遍身牵引，四肢不能使用，只要不死，也会成为瘫痪。关键在于哪个脏先受伤，调理使之平和，不让邪气迸入心脏，这才是最重要的。
五脏各藏一个神，不可伤害它们。《内经》说：神思虑过度而受伤，肌肉就会消瘦；意忧愁过度而受伤，肢体就会废用；魂悲哀过度而受伤，筋脉就会变形；魄喜乐过度而受伤，皮肤就会枯槁；志盛怒过度而受伤，腰膝就难以俯仰。这说明风邪虽然还没进入，但脏真之气已经先自我损伤，火热、气滞、湿邪、痰浊、虚损迎向内入，多汗、恶风等症状，因此向外发散，治疗就很难了。善于治病的人，趁风邪未入，审察是哪个脏先伤、什么邪气所致，彻底加固脾胃（土），这是最为扼要的方法。
中风的外在证候，错杂出现不一。风火相互煽动，多向上侵犯高巅头部。风湿相互搏结，多流注于四肢末端。手足麻木，只属于气虚。关节肿胀痹痛，是湿痰凝滞。偏头痛或正头痛，用愈风丹。眼睛跳动面部浮肿，用胃风汤。风湿证，用薏苡仁汤、排风汤。麻木，用人参补气汤。肿痹，用舒筋散。
寒热像疟疾一样，用解风散为宜。风邪藏在痰隧之中，搜风是最恰当的。解风散；搜风丸。
经络及腑的病，治疗要分深浅。表里的邪气，严禁使用金石类药物。
中络，用桂枝汤。中经，用小续命汤加减。表里兼治，用防风通圣散。祛风，用至宝膏。攻里，用三化汤、搜风丸。
左瘫右痪，风邪侵入筋骨，宣导邪气，缓慢图谋治愈。舒筋保安散。
卒中灌药，宜用辛香之品。开痰行气，调入苏合香丸。南星汤调服苏合丸、顺气散、匀气散、稀涎散。
四肢不能举动，有虚有实。阳明虚，则宗筋失去滋润，不能约束骨骼而利于关节运动。阳明实，则腠理致密，加上风邪内侵，正气自然不能周流全身。
口眼歪斜，邪气急而正气缓。左边急治左边，右边急治右边，先疏散邪气，再补益正气。左边急，用三圣散。右边急，用匀气散。
转舌、正舌，方名虽然美好，但少阴经脉环绕舌本，三年陈艾，不谈表面症状。资寿解语汤，还比较接近。转舌膏；正舌散；资寿解语汤。
风邪刚初入腑，肌肉蠕动，手足牵强，面部浮肿但能进食。适宜投用胃风汤。胃风汤。
风邪刚初入脏，发热烦躁，先用泻青丸，兼解表里。其次用愈风汤，磨入四白丹。泻青丸；愈风汤；四白丹。
养血豁痰，如果两者格格不入，应先处理紧急的情况，不宜同时施用。养血，用大秦艽汤、当归地黄汤、天麻丸。豁痰，用涤痰汤、青州白丸子。热痰，用竹沥荆沥汤、贝母栝蒌散。阴虚夹痰，用千金地黄汤。
心火内蕴，膻中如焚烧，凉膈散、清心散，功效可见一斑。心血内亏，恍惚失眠，服用二丹丸，可以安睡。火盛壮水，不要推辞迂缓，水升火降，干枯燥热就会回转。凉膈散；清心散；二丹丸；壮水地黄汤。
真阳上脱，汗多肢冷，气喘痰鸣，这属于不治之症。黑锡丹、三建二香汤，引阳气回归宅舍；水土重封，如同虞渊浴日。黑锡丹；三建二香汤。
肾水泛溢成痰，真阳未脱，治疗用星附汤，十人中能活九个。星附汤。
外风暴发，内风容易炽盛。用甘寒药灌溉，避居密室，不要看可欲之物，不要吃肥鲜食物，谨慎调养千日，重新享受天年。
世间流传中风病人，每当遇到外风发作，适宜进服续命汤来抵御。这非常不对，风势刚刚安定，再用续命汤重新引风入体，简直是画蛇添足。只用甘寒药频频热服，使内部不招引风邪，外部没有入侵的路径。而且甘寒药一可息风，二可补虚，三可久服，有什么理由不用呢？
【五条医律】
凡是风邪中于经络，不向外发散，反而从内部夺取正气，引邪深入的，是医生的过错。治疗中风就像治疗伤寒一样，不但邪气在三阳经引入三阴经是大禁忌，就是邪气在太阳经引入阳明、少阳经，也是犯禁的。所以风邪中于络，就不可引它进入经；中于经，就不可引它进入腑；中于腑，就不可引它进入脏。引邪深入，酿成无穷祸患，以至于多死少生，能不戒慎吗？
凡是治疗中风自汗证，反而利其小便的，这是医生的过错。不论风中深浅，只要见到自汗，就是津液外出，小便自然减少。如果再利小便，使津液下竭，那么营卫之气更加衰弱，无法制约风火之势，必定增加烦热，真阴日益消亡。况且阳明经利小便，更是犯禁。少阴经利小便，必定导致失禁而杀人，能不戒慎吗？
凡是治疗中风病，不明白经络腑脏，徒然执着方书，妄用下法的，必定伤人，是医生的罪过。风邪中于经络，只宜宣散使之外出，误用下法则风邪乘虚进入腑脏，酿成无穷祸患。至于中脏的证候，多有平素积虚，脏真不固守的，下之立即死亡，不可不慎重。只有在胃府一证，内实便秘的，间或有可下的。但这不过是解除烦热，并非大下。所谓一气之微汗，一旬之微利，也是因可用才使用的。至于张子和以下立法，机要以中脏者宜下为言，则将下法定为定法，怎么可以作为准则呢？然而中脏有缓急两种证候，中腑日久，热势深极，传入脏的，这属于可下。而下法必须使风与热俱去，填其空窍，则风不再生。如果打开瘀壅，必反增风势，怎么能叫下法呢？那些突然虚损身体中的急证，下药入口，其人立即就不清醒了，能不辨别吗！后世将中腑的便秘，指为中脏，见其误下不致损人，更相信张子和机要之法可用。假使遇到真正中脏证，下法不中病，很难再挽回啊。
凡是治疗中风四肢不举证，不辨虚实，妄行补泻的，是医生的过错。四肢不举，都属脾土。膏粱太过，积热内壅的，为脾土瘀实，宜泻以开其壅塞。食少体弱，怠惰嗜卧的，为脾土虚衰，宜补以健其运化。如果不辨别而实者补之，虚者泻之，难道不伤人吗？
凡是治疗外中于风，不辨内挟何邪，误执一家方书，冀图侥幸获效，其失误必然很多，是医生的过错。风邪从外入者，必驱之使从外出。然而挟虚的，不补虚则风不出。挟火的，不清热则风不出。挟气的，不开郁则风不出。挟湿的，不导湿则风不出。挟痰的，不豁痰则风不出。河间、东垣、丹溪，各举一端，以互相阐明其治法。后学不知变通，只宗奉一家为主治，倘若一病兼此五者，成方究竟在哪里？何况不治其所有，反治其所无，难道不伤人吗？
附风痱（一条法则）
岐伯说中风大法有四：一是偏枯，半身不遂；二是风痱，周身无痛，四肢不收；三是风懿，突然不知人事；四是风痹，各种痹症类似风状。后世沿袭其说而无其治法，《金匮要略》有古今录验三方，可以类推。
《内经》说内夺而厥，则为风痱。仲景见成方中，有治外感风邪兼治内伤不足的，有符合《内经》之意，取其三方，以示法度。一曰古今录验续命汤，二曰千金三黄汤，三曰近效白术附子汤。前一方，治营卫素虚而风入者。中方，治虚热内炽而风入者。后一方，治风已入脏，脾肾两虚，兼诸痹类风状者。学人应当领会仲景之意，而在浅深寒热之间，举一反三。《古今录验》续命汤。《千金》三黄汤。《近效》白术附子汤。
附风懿
按语：风懿说突然不知人事，即包括中风卒倒在内，《金匮要略》不重复列举其证，意思可知了。
附风痹（七条法则）
中风四证，其一曰风痹，因为各种痹症类似风状，所以叫它风痹。然而虽然相似，实际上不同。风邪则阳分先受之，痹邪则阴分先受之。导致痹的原因，曰风、曰寒、曰湿，互相杂合，不可分别归属。但以风气胜者为行痹，因为风性善行故也。以寒气胜者为痛痹，因为寒主收引故也。以湿气胜者为着痹，因为湿主重滞故也。邪气所中，有深有浅，不可不察。在骨则沉重而不能举起；在筋则屈曲而不能伸展；在肉则麻木不仁；在脉则血凝而不流；在皮则寒冷。这五种情况在躯壳之间，都不痛。其痛的，随血脉上下，寒凝汁沫，排挤分肉而痛，虽然另名周痹，不属于血脉之中。骨痹不已，复感于邪，内舍于肾。筋痹不已，复感于邪，内舍于肝。脉痹不已，复感于邪，内舍于心。肌痹不已，复感于邪，内舍于脾。皮痹不已，复感于邪，内舍于肺。这五种情况，也不是直接入五脏。五脏各有合病，久而不去，内舍于其合。大概风寒湿三气，杂合牵制，不像风之善行易入，所以只是类似于中风。《内经》论诸痹非常详细，但有大的缺失，且无方治。《金匮要略》补之。一曰血痹、二曰胸痹、三曰肾着、四曰三焦痹。《金匮要略》论血痹，说尊贵之人骨弱肌肤盛，重因疲劳汗出，卧不时动摇，加被微风，遂得之。但以脉自微涩在寸口，关上小紧，宜针引阳气，令脉和、紧去则愈。
血痹，阴阳俱微，寸口关上微，尺中小紧，外证身体不仁，如风痹状，黄芪桂枝五物汤主之。
《内经》只说在脉则血凝而不流，《金匮要略》直接揭示其不流的原因。说血既痹，脉自微涩，然而或寸或关或尺，其脉见小紧之处，即风入之处也。所以其针药所施，都是引风外出之法。
《金匮要略》论胸痹脉证，并方治解释明确，收入二卷胸寒痹痛条下，这里不赘述。《金匮要略》肾着的病，其人身体重，腰中冷，如坐水中，形如水状，反不渴，小便自利，饮食如故。病属下焦，身劳汗出，衣里冷湿，久久得之。腰以下冷痛，腹重如带五千钱，甘姜苓术汤主之。
《内经》只说骨痹不已，复感于邪，内舍于肾。仲景知道湿邪不能伤肾藏之真，不过舍于所合。所以以身重腰冷等证为言，曰饮食如故，曰病属下焦，意思可知了。然而湿土之邪，贼害肾水，恐害两肾所主生气之原，关系尤其大，所以特举肾着一证，立方以开通其痹阻。
《金匮要略》又有总治三痹之法，现在错误编在历节黄汗之下，其曰：诸肢节疼痛，身体羸瘦，脚肿如脱，头眩短气，温温欲吐，桂枝芍药知母汤主之是也。
短气，是中焦胸痹的证候。连头眩，即为上焦痹。温温欲吐，是中焦痹。脚肿如脱，是下焦痹。肢节疼痛，身体羸瘦，是筋骨痹。荣、卫、筋、骨、三焦俱病，又立此法以治之，合四法以观精微之蕴，仲景真是百世之师啊。治痹诸方，不另立门，姑附风门之后，实际与治风不同，不可误施。痹症琐屑，不便立法者，都在用方条下发之，宜逐方细玩。
【一条医律】
凡是治疗痹症，不明其理，以风门诸通套药施之的，是医生的罪过。痹症并非没有风，然而风入在阴分，与寒湿互结，扰乱其血脉，致身中之阳，不通于阴，故致痹也。古方多有用麻黄、白芷的，以麻黄能通阳气，白芷能行营卫，然而已在四物、四君等药之内，非专发表明矣。至于攻里之法，则从无有用之者。以攻里之药，皆属苦寒，用之则阳愈不通，其痹转入诸府，而成死症的多了，能不明辨而深戒吗？
After administration, to open the obstruction in the collaterals. Thereafter, all hot foods are prohibited, and only cold food is suitable. In this manner, after another forty days, the medicinal accumulation in the abdomen will not descend further, and the empty cavities (acupoints or tissue spaces) will be filled. Once the empty cavities are filled, the old wind pathogen will be completely expelled, and new wind cannot invade. This is because the nature of alum (Bofan, 白矾) stops acting when cold and acts when hot. Therefore, it is instructed: if hot food is taken, the medicine will immediately descend; if cold food is taken, it naturally assists the medicinal power. How subtle is the intention here?
Fengyin Tang (Wind-Driving Decoction) treats adult wind-drawing convulsions and pediatric惊痫 (epileptic seizures with fright) occurring dozens of times a day, conditions difficult for physicians to treat. This formula is effective only by clearing heat. Observing adult wind-stroke with drawing and convulsions, and pediatric惊痫, indicates that fire-heat generates wind, the five zang organs are hyperactive to an extreme, and pathogens burst into the Heart. Generally, the onset of惊痫 initially disperses among the five zang organs, then bursts into the Heart, hence the treatment is similar. Chao Yuanfang used this formula to treat Hongxiangjiao (podagra/gouty arthritis), was it not to utilize the nature of stone minerals to easily descend, overcoming damp-heat, and preventing the pathogen from attacking the Heart?
Jueyin Wind-Wood resides together with Shaoyang Ministerial Fire. When fire flares, wind must arise; when wind arises, it must carry the Wood momentum to insult Spleen-Earth. Thus, Spleen Qi fails to transport, fluids accumulate into phlegm, flowing to the four limbs, resulting in paralysis. Using Dahuang (Rhubarb Rhizome) as the sovereign herb to purge wind, fire, heat, and dampness pathogens; followed by Ganjiang (Dried Ginger) whose stopping and non-moving nature to tonify it; using Guizhi (Cinnamon Twig) and Gancao (Licorice Root) to moderate the momentum; using various stone minerals' astringent nature to block the path. Among the stone minerals, Huashi (Talcum) and Shigao (Gypsum Fibrosum) are selected to clear Metal (Lung) to subdue Wood (Liver); Chi Baishi Zhi (Red Kaolin) and Bai Baishi Zhi (White Kaolin) to thicken Earth (Spleen) and remove dampness; Longgu (Fossilized Bones) and Muli (Oyster Shell) to converge the chaotic spirit and soul; Hanshuishi (Stalactite) to assist Kidney Water Yin, preventing it from being hijacked by Yang hyperactivity. Further, Zhi Yingshi (Hematite) is used to tonify the deficiency of Heart Spirit, fearing that if the Master is unsettled, the twelve officials (organs) will all be in danger. Understanding this allows one to treat wind entering the zang organs with ease. Why do later generations consider too many stone minerals, discard them, and instead use Nao (Camphor) and She (Musk) to scatter true Qi, and Hua She (Flower Snake) to increase toxicity? Is this wisdom or folly? It remains incomprehensible.
Note: The Fengyin Tang in *Jinkui Yaolue* should follow Houji Heisan (Black Powder of Hou). The text mentions "healthy qi draws pathogens" and "hemifacial paralysis," hence the formula is named Fengyin. Houji Heisan specifically tonifies deficiency to extinguish wind; this formula concurrently clears heat, fire, and dampness to remove wind. The compiler erroneously placed it below the pulse description of slow and slack at Cun Kou, making the syndrome and formula irrelevant.
When wind enters the five zang organs, its origin lies in prior injury to the organ qi, followed by wind invasion. Fire-heat, Qi stagnation, dampness, phlegm, and deficiency act as six thieves guiding deep invasion. Suddenly falling unconscious, whole-body drawing, and four limbs unusable, even if survival occurs, paralysis results. The key is which organ was injured first; regulating it to balance prevents pathogens from bursting into the Heart, which is crucial.
Each zang organ houses a Shen (Spirit), which must not be injured. The *Classic* states: Shen injured by excessive thought leads to muscle wasting; Yi (Intent) injured by sorrow leads to limb disability; Hun (Ethereal Soul) injured by grief leads to tendon deformation; Po (Corporeal Soul) injured by excessive joy leads to withered skin; Zhi (Will) injured by rage leads to difficulty bending and extending waist and knees. This shows that before wind enters, the True Qi of the zang is already self-injured. Fire-heat, Qi stagnation, dampness, phlegm, and deficiency invite inward entry, while symptoms like profuse sweating and aversion to wind disperse outward, making treatment difficult. A skilled physician, while wind has not yet entered, examines which organ is injured first and what pathogen is involved, reinforcing Earth (Spleen/Stomach) thoroughly, which is the most essential method.
External manifestations of wind-stroke vary erratically. Wind and fire fanning each other often attack the high peaks (head). Wind and dampness battling often flow to the four limbs. Numbness of hands and feet belongs solely to Qi deficiency. Swollen and bi-joint pain is due to damp-phlegm stagnation. Migraine or frontal headache uses Yufeng Dan (Wind-Resolving Pill). Twitching eyes and swollen face use Weifeng Tang (Stomach-Wind Decoction). Wind-damp uses Yiyiren Tang (Coix Seed Decoction) and Paifeng Tang (Wind-Expelling Decoction). Numbness uses Renshen Buzhi Tang (Ginseng Qi-Tonifying Decoction). Swollen bi-pain uses Shujin San (Sinew-Relaxing Powder).
Chills and fever resembling malaria are best treated with Jiefeng San (Wind-Resolving Powder). Wind hiding in phlegm tunnels requires searching wind. Jiefeng San; Soufeng Wan (Wind-Searching Pill).
Treatment of meridians and fu organs distinguishes depth. Pathogens in exterior and interior strictly prohibit mineral drugs.
Wind entering collaterals uses Guizhi Tang (Cinnamon Twig Decoction). Wind entering meridians uses Xiao Xuming Tang (Minor Life-Sustaining Decoction) with modifications. Exterior and interior treated simultaneously uses Fangfeng Tongsheng San (Saposhnikovia Unblocking and Resolving Powder). Expelling wind uses Zhibao Gao (Precious Ointment). Purging interior uses Sanhua Tang (Three Transformations Decoction) and Soufeng Wan.
Left hemiplegia and right paralysis indicate wind entering sinews and bones; guide and conduct pathogens, planning slowly. Shujin Bao'an San (Sinew-Relaxing Peace-Preserving Powder).
For sudden stroke requiring forced medication, pungent and aromatic substances are suitable. To resolve phlegm and move Qi, mix in Suhe Xiang Wan (Styrax Pill). Nanxing Tang (Arisaema Decoction) mixed with Suhe Wan, Shunqi San (Qi-Regulating Powder), Yunqi San (Balancing Qi Powder), and Xixian San (Foaming Saliva Powder).
Four limbs unable to rise have deficiency and excess patterns. Yangming deficiency causes Zongjin (major sinews) to lose moisture, failing to bind bones and facilitate joints. Yangming excess causes dense interstices; plus internal wind invasion, healthy Qi fails to circulate.
Deficiency uses Liujunzi Tang (Six Gentlemen Decoction); Excess uses Sanhua Tang combined with Chengqi Tang (Descending Qi Decoction).
Facial deviation involves urgent pathogen and slack healthy Qi. Left urgency treats left, right urgency treats right; first scatter pathogen, then tonify healthy Qi. Left urgency uses Sansheng San (Three Saints Powder); Right urgency uses Yunqi San.
Zhongshe Gao (Tongue-Correcting Paste) and Zhengshe San (Straight-Tongue Powder) have beautiful names, but Shaoyin meridians circle the tongue base; three-year-old mugwort addresses root, not branch. Zishou Jieyu Tang (Longevity Speech-Unblocking Decoction) is closer. Zhongshe Gao; Zhengshe San; Zishou Jieyu Tang.
Wind newly entering fu organs causes muscle twitching, limb stiffness, facial swelling, but ability to eat. Weifeng Tang is appropriate. Weifeng Tang.
Wind newly entering zang organs causes fever and irritability; first use Xieqing Wan (Draining Green Pill), resolving both exterior and interior. Then use Yufeng Tang, ground with Sibai Dan (Four Whites Pill). Xieqing Wan; Yufeng Tang; Sibai Dan.
Nourishing blood and resolving phlegm may be incompatible; address emergencies first, do not apply simultaneously. Nourishing blood: Da Qinjiao Tang (Large Gentian Decoction), Danggui Dihuang Tang (Angelica Rehmannia Decoction), Tianma Wan (Gastrodia Pill). Resolving phlegm: Ditang Tang (Phlegm-Washing Decoction), Qingzhou Baiwanzi (Qingzhou White Pill). Heat-phlegm: Zhuli Jingli Tang (Bamboo Juice and Perilla Juice Decoction), Beimu Gulua San (Fritillaria Trichosanthes Powder). Yin-deficiency with phlegm: Qianjin Dihuang Tang (Thousand Gold Rehmannia Decoction).
Heart fire internally stored, chest feels burning; Liangge San (Cooling Diaphragm Powder) and Qingxin San (Clearing Heart Powder) show efficacy. Heart blood internally deficient,恍惚 (fluctuating consciousness) and insomnia; Erfan Wan (Two Cinnabar Pills) ensures sleep. Strengthening water to control fire need not be considered slow; water rises, fire descends, dryness returns to moisture. Liangge San; Qingxin San; Erfan Wan; Zhuangshui Dihuang Tang (Strengthening Water Rehmannia Decoction).
True Yang escaping upward, profuse sweat, cold limbs, asthma with rattling phlegm, this is incurable. Heixi Dan (Black Tin Pill) and Sanjian Erxiang Tang (Three Builders and Two Aromatics Decoction) guide Yang back home; sealing Earth and Water is like bathing the sun in Yu Yuan. Heixi Dan; Sanjian Erxiang Tang.
Kidney water flooding with phlegm, True Yang not yet escaped, treating with Xingfu Tang (Arisaema and Aconite Decoction) saves nine out of ten. Xingfu Tang.
External storm triggers, internal wind easily flares. Irrigate with sweet-cold herbs, dwell in secret rooms, avoid desirable sights, avoid rich/fresh foods, carefully regulate for a thousand days, enjoy longevity again.
Worldly tradition says stroke patients, upon external wind recurrence, should take Xuming Tang (Life-Sustaining Decoction) to resist. This is incorrect. Once wind stabilizes, using Xuming Tang re-invites wind, adding unnecessary steps. Only frequent hot intake of sweet-cold herbs prevents internal wind recruitment and external entry. Sweet-cold herbs calm wind, tonify deficiency, and allow long-term use. Why not use them?
[Five Medical Laws]
Whenever wind strikes meridians/collaterals, does not scatter externally, but夺 (seizes) internally, drawing pathogens deeper, it is the physician's fault. Treating wind-stroke is like treating cold damage; not only is moving pathogens from Three Yang to Three Yin a major prohibition, but also moving from Taiyang to Yangming or Shaoyang is forbidden. Thus, wind in collaterals must not be drawn into meridians; in meridians, not into fu organs; in fu organs, not into zang organs. Drawing pathogens deeper breeds infinite trouble, leading to more deaths than survivals. Must one not beware?
Whenever treating wind-stroke with spontaneous sweating, and contrary diuresis is used, it is the physician's fault. Regardless of wind depth, seeing spontaneous sweating means fluids exit externally, reducing urination. Further diuresis exhausts lower fluids, weakening Ying and Wei Qi, failing to restrain wind-fire, increasing irritability/heat, and daily destroying True Yin. Especially, diuresis in Yangming meridian is forbidden. In Shaoyin meridian, it causes incontinence and death. Must one not beware?
Whenever treating wind-stroke without understanding meridians/zang-fu, blindly following books and妄用 (recklessly using) purgatives, inevitably harms people; this is the physician's crime. Wind in meridians/collaterals should only be dispersed; mistaken purgation lets wind enter fu/zang deeply. Zang syndromes often involve chronic deficiency and unstable True Qi; purgation leads to immediate death. Caution is required. Only in Fu organ syndromes with internal excess and constipation is purgation occasionally applicable. This merely relieves irritability/heat, not severe purgation. Mild sweating over one breath, mild bowel movement over ten days, is used only when necessary. Zhang Hezi's laws stating zang syndromes require purgation sets a rigid rule, how can this be a model? However, zang syndromes have slow and urgent types. Long-standing fu syndrome with extreme heat transmitting to zang is purgable. Purgation must remove both wind and heat, filling empty cavities so wind doesn't regenerate. Opening stasis increases wind, invalidating purgation. Sudden deficiency emergency cases, upon taking purgatives, become unresponsive. Must one not distinguish? Later generations mistook fu constipation for zang syndrome, seeing no harm from mistaken purgation, believing Zhang Hezi's methods usable. If encountering true zang syndrome, ineffective purgation is irrecoverable.
Whenever treating four-limb paralysis without distinguishing deficiency/excess, and recklessly tonifying/purging, it is the physician's fault. Four-limb paralysis relates to Spleen Earth. Excessive rich food causing internal heat stagnation is Spleen Earth excess/stasis, requiring purgation to open obstruction. Poor appetite, emaciation, lethargy is Spleen Earth deficiency, requiring tonification to strengthen transport. Not distinguishing and tonifying excess or purging deficiency harms people.
Whenever treating external wind without distinguishing internal accompanying pathogens, blindly following one school's formulas hoping for success, errors are numerous; this is the physician's fault. External wind must be driven out. Accompanying deficiency requires tonification to expel wind. Accompanying fire requires clearing heat. Accompanying Qi stagnation requires opening depression. Accompanying dampness requires guiding dampness. Accompanying phlegm requires resolving phlegm. He Jian, Dong Yuan, and Dan Xi each highlight one aspect to clarify treatments. Later students lack flexibility, adhering to one school. If one disease combines these five, where are the fixed formulas? Moreover, treating what isn't there rather than what is present harms people.
Appendix: Fengfei (One Law)
Qibo stated four main wind-stroke methods: 1. Piangu (Hemiplegia), half-body immobility; 2. Fengfei, body painless, four limbs unreceptive; 3. Fengyi, sudden unconsciousness; 4. Fengbi, various bi-syndromes resembling wind. Later generations inherited the theory but not the treatment. *Jinkui Yaolue* has three formulas from Gubing Luyan, allowing inference.
The *Classic* states internal seizure and厥 (syncope) leads to Fengfei. Zhang Zhongjing saw existing formulas treating external wind and internal deficiency, aligning with the *Classic*, selecting three to demonstrate principles. First, Gubing Luyan Xuming Tang (Ancient and Modern Record Verification Life-Sustaining Decoction); Second, Qianjin Sanhuang Tang (Thousand Gold Three Huang Decoction); Third, Jinxiao Baizhu Fuzi Tang (Near Effect Atractylodes Aconite Decoction). The first treats Wei-Qi deficiency with wind invasion. The second treats internal deficiency-heat with wind invasion. The third treats wind entering zang with Spleen-Kidney dual deficiency and bi-resembling wind. Students should understand Zhongjing's intent, inferring from depth and temperature differences. Gubing Luyan Xuming Tang; Qianjin Sanhuang Tang; Jinxiao Baizhu Fuzi Tang.
Appendix: Fengyi
Note: Fengyi describes sudden unconsciousness, included in stroke syncope. *Jinkui* does not repeat the syndrome, implying its meaning.
Appendix: Fengbi (Seven Laws)
Among four wind-stroke syndromes, one is Fengbi, named because various bi-syndromes resemble wind. Though similar, they differ. Wind affects Yang first; Bi affects Yin first. Causes of Bi are Wind, Cold, Damp, mixed inseparably. Dominant Wind is Xingbi (Wandering Bi) due to Wind's mobility. Dominant Cold is Tongbi (Painful Bi) due to Cold's contraction. Dominant Damp is Zhuobi (Fixed Bi) due to Damp's heaviness. Pathogen depth varies. In bone: heavy, immobile. In sinew: flexed, not extended. In flesh: numb. In vessels: blood coagulates, stagnant. In skin: cold. These five in the shell are painless. Pain follows vessels, cold condenses fluids, squeezing muscles. Though called Zhoubi (Circular Bi), it is not within vessels. Bone Bi unchecked, re-infected, enters Kidney. Sinew Bi unchecked, enters Liver. Vessel Bi unchecked, enters Heart. Muscle Bi unchecked, enters Spleen. Skin Bi unchecked, enters Lung. These five do not directly enter zang. Zang have corresponding diseases; lingering, they enter their correspondences. Wind-Cold-Damp mix and constrain, unlike Wind's easy entry, thus resembling wind-stroke. *Classic* details Bi but lacks formulas. *Jinkui* supplements: 1. Blood Bi, 2. Chest Bi, 3. Kidney Zhuo, 4. Sanjiao Bi. *Jinkui* on Blood Bi: Noble persons with weak bones and fleshy skin, fatigued, sweating, restless sleep, exposed to slight wind, develop it. Pulse slightly choppy at Cun Kou, slightly tight at Guan, needle to guide Yang, harmonize pulse, remove tightness to cure.
Blood Bi, Yin-Yang both微弱 (weak), Cun/Guan微弱, Chi slightly tight, external symptom body numbness resembling Fengbi, Huangqi Guizhi Wuwu Tang (Astragalus Cinnamon Five Substance Decoction) governs.
*Classic* said vessel blood coagulates; *Jinkui* reveals why. Blood Bi, pulse choppy; wherever tight, wind enters. Needle/drug methods guide wind out.
*Jinkui* explains Chest Bi pulse/syndrome/formula clearly, found in Vol 2 Cold-Bi Pain section, not repeated here. *Jinkui* Kidney Zhuo: Body heavy, waist cold, sitting in water, shape like edema, no thirst, normal urination, normal diet. Disease in Lower Jiao, labor sweating, cold wet clothes, chronic onset. Waist/lower body cold pain, abdomen heavy like carrying 5000 coins, Gan Jiang Ling Zhu Tang (Ginger Poria Atractylodes Decoction) governs.
*Classic* said Bone Bi enters Kidney. Zhongjing knew dampness doesn't injure Kidney True Qi, but stays in correspondence. Symptoms like heavy body/waist cold, normal diet, Lower Jiao disease imply this. Damp-Earth insults Kidney Water, endangering life source, crucial. Hence Kidney Zhuo is highlighted to open obstruction.
*Jinkui* has general Bi treatment, wrongly edited under Lijie Huanghan. "All joint pain, emaciated body, swollen feet like detaching, dizziness, shortness of breath, nausea, Guizhi Shaoyao Zhimu Tang (Cinnamon Peony Anemarrhena Decoction) governs."
Shortness of breath is Middle Jiao Chest Bi. With dizziness, Upper Jiao Bi. Nausea, Middle Jiao Bi. Swollen feet, Lower Jiao Bi. Joint pain, emaciation, Sinew-Bone Bi. Ying, Wei, Sinew, Bone, Sanjiao all diseased, this formula treats. Combining four methods reveals subtlety; Zhongjing is teacher of ages. Bi formulas not separate, attached to Wind section, distinct from Wind treatment, do not misuse. Bi details complex, laws不便 (inconvenient), listed under formulas, study carefully.
[One Medical Law]
Treating Bi without understanding principle, using generic Wind-section drugs, is physician's crime. Bi has wind, but wind enters Yin, binds with Cold-Damp, disturbs vessels, blocking Yang from Yin, causing Bi. Ancient formulas used Mahuang (Ephedra) and Baizhi (Angelica Dahurica) to pass Yang and move Ying-Wei, but within Siwu/Sijunzi formulas, not for surface release. Interior purging never used. Interior purges are bitter-cold, blocking Yang further, turning Bi into Fu organ fatal cases. Must one not distinguish and beware?