王节斋治一壮年。忽得暴病如中风。口不能言。目不识人。四肢不举。急投苏合香丸。
不效。王偶遇闻之。询其由。曰。适方陪客。饮食后忽得此证。遂教以煎生姜淡盐汤。多饮
探吐之。吐出饮食数碗而愈。
郑显夫年六十余。因大怒。遂昏仆。四肢不用。丹溪曰。怒则火起于肝。手足厥阴二经
之气闭而不行。故神无知。怒甚则伤于筋。纵其若不容故手足不用。乃以连柏泻其上逆之火
香附降其肝气。一二日。神智渐回。再调其气血。全愈。
有一妇人。先胸胁胀痛。后四肢不收。自汗如雨。小便自遗。大便不实。口紧目 。或
以为中脏。甚忧。请薛立斋视之。曰。非也。若风既中脏。真气既脱。恶证既见。祸在反掌
安能延至十日。乃候其色。面目俱赤而或青。诊其脉。左三部洪数。惟关尤甚。乃知胸乳
胀痛。肝经血虚。肝气痞塞也。四肢不收。肝经血虚。不能养筋也。自汗不止。肝经血热。
津液妄泄也。小便自遗。肝经热甚。阴挺失职也。大便不实。肝木炽盛。克脾土也。遂用犀
角散四剂。诸证顿减。又用加味逍遥散调理而安。
太史杨方壶夫人。忽然晕倒。医以中风之药治之。不效。迎李士材诊之。左关弦急。右
关滑大而 。本因元气不足。又因怒后食停。乃进理气消食药。得解黑屎数枚。急改用六君
子加姜汁。服四剂而后晕止。更以人参五钱。 、术、半夏各三钱。茯苓、归身各二钱。加
减调理。两月即愈。此名虚中。亦兼食中。
给谏晏怀泉夫人。先患胸腹痛。次日卒然晕倒。手足厥逆。时有医者。以牛黄丸磨就将
服矣。士材诊之。六脉皆伏。惟气口稍动。此食满胸中。阴阳痞隔。升降不通。故脉伏而气
口独见也。取陈皮、砂仁各一两。姜八钱。盐三钱。煎汤灌之。以指探吐。得宿食五六碗。
六脉尽见矣。左关弦大。胸腹痛甚。知为大怒所伤也。以木香、青皮、橘红、香附、白术煎
服。两剂痛止。更以四君子加木香、乌药。调理十余日方瘥。此是食中兼气中。
震按此二条。与节斋丹溪所治同中有异。是善学古人者。故并录之。
章仲舆令爱在阁时。昏晕不知人。苏合香丸灌醒后。狂言妄语。喃喃不休。士材诊之。
左脉七至。大而无伦。右脉三至。微而难见。正所谓两手脉如出两人。此祟凭之脉也。线带系
定二大拇指。以艾炷灸两介甲。至七壮。鬼即哀词求去。服调气平胃散加桃奴。数日而祟绝
此即恶中也。
易思兰治瑞昌王孙毅斋。年五十二。素乐酒色。九月初。夜起小解。忽倒地。昏不知人
目闭气粗。手足厥冷。身体强硬。牙关紧闭。诸医有以为中风者。有以为中气中痰者。用
乌药顺气散等药。俱不效。又有用附子理中汤者。愈加痰响。五日后。易诊之。六脉沉细紧
滑。愈按愈有力。乃曰。此寒湿相搏。 症也。 属膀胱。当用羌活胜湿汤。其兄宏道问曰
病无掉眩。知非中风。然与中气中痰夹阴三者相似。先生独云 病。但吾宗室之家过于浓
暧者有之。何由得寒湿而成 病耶。易曰。运气所为。体虚者得之。本年癸酉。岁火不及。
寒水侮之。季夏土旺。土为火子。即能制水。七月八月。主气是湿。客气是水。寒水得令。
不伏土制。是以寒湿相搏。太阳气郁而不行。其证主项背强直。卒难回顾。腰似折。项似拔
乃膀胱经 病也。其脉沉细紧滑。沉为病在里。细为湿。紧为寒。中又有力而滑。此寒湿
有余而相搏也。若虚证之脉。但紧细而不滑。若风脉当浮。今脉不浮而沉。且无掉眩等证。
何为中风。若痰气之脉不紧。今脉紧而体强直。何言中气中痰。 病诗云。强直反如弓。神
昏似中风。痰流唇口动。螈 与痫同。乃先以稀涎散吐痰一二碗。昏愦即醒。随进胜湿汤。
六剂全愈。以八味丸调理一月。精气复常。
震按类中有十种。曰中气。中食。中寒。中暑。中湿。中恶。中痧。中瘴。痰中。虚中
散见诸书。当荟萃而详辨之。其异于中风者。虽卒倒昏愦。而无偏枯涡斜也。其治之异于
中风者。惟虚中宜补。而余皆不宜补也。只在临证时。审其轻重浅深耳。至如名医类案有虚
风一门。临证指南有肝风一门。总不出缪氏内虚暗风四字。类案谓阴虚者凉肝补肾。阳虚者
温肺健脾。诚为要言。然其法已备于中风门中。似不必另立名色。至指南所载泄木安胃。镇
阳熄风。浊药轻投。辛甘化风。种种妙义。直驾古人而上之。又洗缪氏之髓者矣。特是议论
虽精。仍属景岳所谓非风之治法耳。集书者以一类而分二门。未免头上安头之病。
俞节斋治疗一位壮年男子。突然患上类似中风的急病，口不能说话，眼睛看不见人，四肢无法抬起。急忙服用苏合香丸，没有效果。王节斋偶然听说了这件事，询问发病原因。那人说，刚才陪客人饮酒吃饭后，突然得了这个病证。于是教他煎煮生姜淡盐汤，大量饮用并探喉催吐。吐出几碗饮食后痊愈。
郑显夫六十多岁，因为大怒，随即昏倒，四肢不能活动。朱丹溪说：怒则肝火起于肝脏，手足厥阴经（手厥阴心包经、足厥阴肝经）的气机闭塞而不运行，所以神志无知觉。愤怒过甚则损伤筋脉，导致筋脉松弛无力，所以手脚不能活动。于是用黄连、黄柏清泻上逆之火，用香附降泄肝气。一两天后，神智逐渐恢复。再调理气血，完全康复。
有一位妇人，先出现胸胁胀痛，随后四肢不能收持，自汗如雨下，小便失禁，大便稀溏不成形，口紧眼斜。有人认为是中脏（中风重症），非常担忧，请薛立斋诊治。薛立斋说：不是这样。如果风邪已经侵入脏腑，真气已经脱失，恶证已经显现，灾祸就在顷刻之间，怎么能拖延到十天呢？于是观察她的面色，面目都发红或发青。诊察她的脉象，左三部脉洪大而数，唯独关脉尤为明显。于是知道胸乳胀痛，是肝经血虚，肝气痞塞所致；四肢不能收持，是肝经血虚，不能滋养筋脉所致；自汗不止，是肝经血热，津液妄泄所致；小便失禁，是肝经热盛，阴器失职所致；大便稀溏，是肝木炽盛，克制脾土所致。于是使用犀角散四剂，各种症状顿时减轻。又用加味逍遥散调理而安定。
太史杨方壶的夫人，忽然晕倒。医生用治疗中风的药物治疗，没有效果。请来李士材诊治。左关脉弦急，右关脉滑大且涩。本因元气不足，又因发怒后食物停滞。于是给予理气消食的药物，排出几枚黑便。急忙改用六君子汤加姜汁，服用四剂后晕厥停止。更用人参五钱，白术、半夏各三钱，茯苓、当归身各二钱，加减调理。两个月即痊愈。这名叫虚中，也兼有食中。
给谏晏怀泉的夫人，先患胸腹痛，第二天突然晕倒，手足厥冷。当时有医生，准备磨牛黄丸给她服用。李士材诊察，六脉皆伏，只有气口脉稍动。这是食物充满胸中，阴阳痞隔，升降不通，所以脉伏而气口独见。取陈皮、砂仁各一两，生姜八钱，盐三钱，煎汤灌服，用手指探喉催吐，吐出宿食五六碗，六脉全部显现。左关脉弦大，胸腹痛剧烈，知道是被大怒所伤。用木香、青皮、橘红、香附、白术煎服，两剂后疼痛停止。再用四君子汤加木香、乌药，调理十余天才痊愈。这是食中兼气中。
我（俞震）按语：这两条医案，与节斋、丹溪所治疗的案例同中有异，这是善于学习古人的表现，所以一并记录下来。
章仲舆的女儿在闺阁中时，昏晕不知人事，灌服苏合香丸醒后，胡言乱语，喃喃不休。李士材诊察，左脉七至，大而无伦次；右脉三至，微而难见。正所谓两手脉象如出两人，这是祟凭（鬼邪作祟）的脉象。用线带系住两个大拇指，用艾炷灸两拇指指甲旁的穴位，灸到七壮，鬼就哀求离去。服用调气平胃散加桃奴，几天后祟邪断绝。这就是恶中。
易思兰治疗瑞昌王的孙子毅斋，五十二岁。平时喜好酒色。九月初，夜里起来小便，忽然倒地，昏不知人，眼睛闭合，呼吸粗重，手足厥冷，身体强硬，牙关紧闭。各位医生有的认为是中风，有的认为是中气、中痰。使用乌药顺气散等药物，都没有效果。又有使用附子理中汤的，更加痰声辘辘。五天后，易思兰诊察，六脉沉细紧滑，越按越有力。于是说：这是寒湿相搏，痉症（此处原文似有缺字或通假，结合下文“太阳气郁”及症状，指项背强直之症，属膀胱经病变）。病属膀胱，应当用羌活胜湿汤。他的哥哥宏道问道：病无掉眩（头晕目眩），知道不是中风。然而与中气、中痰、夹阴三者相似。先生唯独说是痉症。只是我们宗室之家过于温暖者有之，怎么会得寒湿而成痉症呢？易思兰说：这是运气所为，体质虚弱的人得了这个病。本年癸酉年，岁火不及，寒水侮之。季夏土旺，土为火之子，即能制水。七月八月，主气是湿，客气是水。寒水得令，不伏土制，所以寒湿相搏，太阳经气郁滞而不运行。其证主要表现为项背强直，突然难以回顾，腰像折断，项像被拔起，这是膀胱经的痉症。其脉沉细紧滑，沉表示病在里，细表示湿，紧表示寒，中间又有力而滑，这是寒湿有余而相搏。如果是虚证的脉，只紧细而不滑。如果是风脉应当浮，现在脉不浮而沉，且无掉眩等症状，怎么说是中风？如果是痰气的脉不紧，现在脉紧而身体强直，怎么说中气中痰？《痉症诗》云：强直反如弓，神昏似中风。痰流唇口动，螈 与痫同。于是先用稀涎散吐痰一二碗，昏愦立即清醒。随即进服胜湿汤，六剂全愈。以八味丸调理一个月，精气恢复正常。
我（俞震）按语：类中（类中风）有十种，叫中气、中食、中寒、中暑、中湿、中恶、中痧、中瘴、痰中、虚中，散见于各种书籍，应当荟萃而详细辨别。它与中风的不同之处，虽然突然跌倒昏愦，但没有偏枯和口眼歪斜。它的治疗与中风的不同之处，只有虚中适宜补益，而其他都不宜补益。只在临证时，审察其轻重浅深罢了。至于像《名医类案》有虚风一门，《临证指南》有肝风一门，总不出缪希雍所说的“内虚暗风”四个字。《类案》说阴虚者凉肝补肾，阳虚者温肺健脾，确实是关键之言。然而这些方法已经备于中风门中，似乎不必另立名目。至于《指南》所载的泄木安胃、镇阳熄风、浊药轻投、辛甘化风等种种妙义，简直超越古人之上，又是洗刷缪氏理论精髓的方法了。只是议论虽然精妙，仍属于张景岳所说的“非风”的治疗方法。编书的人将一类分为两门，未免有头上安头之弊。
Yu Jiezhai treated a young man who suddenly fell ill with symptoms resembling stroke: inability to speak, failure to recognize people, and paralysis of the four limbs. Suhe Xiang Wan (Styrax Pills) was administered urgently but without effect. Wang Jiezhai happened to hear of this and inquired about the cause. The patient replied that he had just been entertaining guests and consuming food and drink when the condition suddenly arose. Wang then instructed him to decoct fresh ginger and light salt water, drink it in large quantities, and induce vomiting by stimulating the throat. After vomiting several bowls of undigested food, he recovered.
Zheng Xianfu, over sixty years old, fainted and became paralyzed after a fit of extreme anger. Zhu Danxi said: Anger causes fire to rise from the Liver. The Qi of the Hand-Jueyin (Pericardium) and Foot-Jueyin (Liver) meridians becomes blocked and fails to circulate, resulting in loss of consciousness. Severe anger damages the sinews, causing them to become lax and useless, hence the paralysis of the hands and feet. He prescribed Coptis and Phellodendron to clear the rebellious fire upward, and Cyperi Rhizoma to descend Liver Qi. Within one or two days, his consciousness gradually returned. Subsequently, his Qi and Blood were regulated, leading to full recovery.
A woman first experienced distending pain in her chest and hypochondrium, followed by flaccidity of the four limbs, profuse spontaneous sweating like rain, urinary incontinence, loose stools, tight mouth, and squinting eyes. Some believed it was Stroke involving the Zang organs and were deeply worried. They invited Xue Lizhai to examine her. Xue said: It is not so. If Wind had penetrated the Zang organs and the True Qi had collapsed, with malignant signs appearing, death would occur in an instant; how could it last ten days? Observing her complexion, her face and eyes were red or bluish. Palpating her pulse, the three positions on the left were surging and rapid, especially at the Guan position. Thus, he knew that the chest and breast distension was due to Liver Blood deficiency and stagnation of Liver Qi; the flaccidity of the limbs was due to Liver Blood deficiency failing to nourish the sinews; the continuous sweating was due to Heat in the Liver meridian causing leakage of body fluids; the urinary incontinence was due to severe Heat in the Liver meridian causing dysfunction of the Yin; and the loose stools were due to excessive Liver Wood suppressing Spleen Earth. He prescribed Xijiao San (Rhinoceros Horn Decoction) for four doses, after which all symptoms markedly decreased. Then, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) was used for regulation, leading to stability.
The wife of Taishi Yang Fanghu suddenly fainted. Physicians treated her with medicines for Stroke without effect. Li Shicai was summoned. The Guan position on the left was wiry and urgent; the Guan position on the right was slippery, large, and choppy. Her constitution was originally deficient in Yuan Qi, and she had food stagnation following anger-induced Qi rebellion. He administered Qi-regulating and food-resolving herbs, resulting in the passage of several black stools. He urgently switched to Liujunzi Tang (Six Gentlemen Decoction) with ginger juice. After four doses, the fainting ceased. Further treatment involved Ginseng Radix (5 qian), Atractylodis Macrocephalae Rhizoma and Pinelliae Tuber (3 qian each), Poria (2 qian), and Angelicae Sinensis Radix (2 qian), adjusted as needed. She recovered in two months. This is called Xu Zhong (Deficiency Stroke), also combined with Shi Zhong (Food Stroke).
The wife of Jianyan Yan Huaiquan first suffered chest and abdominal pain, then suddenly fainted the next day with cold extremities. A physician prepared Niuhuang Wan (Calculus Bovis Pills) for administration. Li Shicai palpated the pulse: all six pulses were hidden (Fu), only the Qikou (Radial) pulse showed slight movement. This indicated food filling the chest, blocking Yin and Yang, obstructing ascending and descending movements, hence the hidden pulses with visibility only at Qikou. He took Chenpi (Citri Reticulatae Pericarpium) and Amomi Fructus (1 liang each), Ginger (8 qian), and Salt (3 qian), decocted them, administered the liquid, and induced vomiting with a finger. Five or six bowls of retained food were vomited, and all six pulses became visible. The left Guan pulse was wiry and large, with severe chest and abdominal pain, indicating injury from extreme anger. He prescribed Mugwort Fruit, Tangerine Peel, Citri Reticulatae Pericarpium, Cyperi Rhizoma, and Atractylodis Macrocephalae Rhizoma decocted and taken orally. Pain ceased after two doses. Then, Si Junzi Tang (Four Gentlemen Decoction) with Mugwort Fruit and Lindera Root was used for regulation for over ten days until recovery. This is Shi Zhong (Food Stroke) combined with Qi Zhong (Qi Stroke).
Commentary: These two cases are similar yet distinct from those treated by Jiezhai and Danxi, demonstrating skillful learning from ancients. Hence, they are recorded together.
Zhang Zhongyu’s daughter fainted and lost consciousness while in her boudoir. After being revived with Suhe Xiang Wan (Styrax Pills), she spoke wildly and incessantly. Li Shicai palpated: the left pulse beat seven times per respiration, large and unregulated; the right pulse beat three times per respiration, minute and difficult to see. This is precisely what is meant by "two hands' pulses like two different people," a sign of demonic possession. Two thumbs were tied with thread, and moxa cones were applied to the Jing-Well points near the fingernails for seven moxibustions each. The spirit pleaded to leave. She took Tiaoqi Pingwei San (Regulate Qi and Harmonize Stomach Powder) plus Prunus Persica Nucleus (Tao Nu). After several days, the possession ceased. This is E Zhong (Evil Stroke).
Yi Silan treated Yi Zhai, grandson of the Prince of Ruichang, aged fifty-two. He habitually indulged in alcohol and sex. In early September, upon rising at night to urinate, he suddenly fell, unconscious, with closed eyes, coarse breathing, cold extremities, rigid body, and locked jaw. Physicians differed on diagnosis: some said Stroke, others Qi obstruction or Phlegm obstruction. Wuyao Shunqi San (Mayapple Smooth Qi Powder) and other formulas failed. Fuzi Lizhong Tang (Aconite Regulate Middle Decoction) worsened the rattling phlegm. Five days later, Yi examined him: the six pulses were deep, fine, tight, and slippery, becoming stronger with pressure. He said: This is Cold-Dampness clashing, causing Spasm (Jing Zheng). It belongs to the Bladder meridian. One should use Qianghuo Shengshi Tang (Notopterygium Overcoming Dampness Decoction). His brother Hongdao asked: There is no dizziness or vertigo, so we know it is not Stroke. However, it resembles Qi obstruction, Phlegm obstruction, or Yin-collapsing. Why do you specifically call it Spasm? Our royal clan lives in overly warm environments; how can Cold-Dampness cause Spasm? Yi replied: This is determined by the Six Qi transformations. Those with weak constitutions contract it. In the year Guiyou, Fire Qi was insufficient, allowing Cold Water to insult it. In late summer, Earth Qi was prosperous; Earth is the child of Fire and thus controls Water. In July and August, the dominant Qi is Dampness, and the guest Qi is Water. Cold Water gains command and is not controlled by Earth, so Cold and Damp clash. Taiyang Qi stagnates and fails to circulate. Symptoms mainly include rigidity of the neck and back, sudden difficulty turning the head, waist feeling like breaking, and neck feeling like pulling. This is Spasm of the Bladder meridian. The pulse deep, fine, tight, and slippery indicates Deep (illness in interior), Fine (Dampness), Tight (Cold), and Slippery/Strong (excess Cold-Damp clashing). A deficiency pulse would be only tight and fine, not slippery. A Wind pulse should be Floating; now it is Deep, without dizziness, so why Stroke? A Phlegm-Qi pulse is not Tight; now it is Tight with rigidity, so why Qi or Phlegm obstruction? The Spasm Poem says: Rigidity like a bow, unconsciousness like Stroke. Phlegm flows at lips and mouth, twitching same as epilepsy. First, Xixian San (Saliva Clearing Powder) was used to vomit one or two bowls of phlegm; consciousness immediately cleared. Then, Shengshi Tang was administered. After six doses, full recovery. Bawei Wan (Eight-Ingredient Pill) was used for regulation for a month, restoring essence and Qi.
Commentary: Lei Zhong (Stroke-like conditions) includes ten types: Qi Zhong, Shi Zhong, Han Zhong, Shu Zhong, Shi Zhong, E Zhong, Sha Zhong, Zhang Zhong, Tan Zhong, and Xu Zhong. These are scattered in various books and should be collected and distinguished in detail. Unlike true Stroke, although there is sudden collapse and unconsciousness, there is no hemiplegia or facial deviation. Unlike the treatment of Stroke, only Xu Zhong requires tonification; the rest do not. It depends on judging severity and depth during clinical practice. Regarding "Xu Feng" in *Mingyi Leian* and "Gan Feng" in *Linzheng Zhinan*, both fall under Miao Xiyong's concept of "Nei Xu An Feng" (Internal Deficiency Hidden Wind). *Leian* states that for Yin deficiency, cool the Liver and tonify Kidney; for Yang deficiency, warm Lung and strengthen Spleen. This is indeed crucial. However, these methods are already covered in the Stroke section, so establishing separate categories seems unnecessary. The profound principles in *Zhinan* such as draining Wood to calm Stomach, anchoring Yang to extinguish Wind, using heavy substances lightly, and transforming Wind with Acrid-Sweet combinations surpass ancient methods and refine Miao's theories. Yet, these discussions still belong to Zhang Jingyue's "Fei Feng" (Non-Wind) treatment principles. Compiling authors dividing one category into two doors commits the error of "adding a head to a head."