寒气，昏冒、口噤、肢挛、恶寒、脉浮紧，用麻黄、桂枝、理中之类。中于暑者，谓夏月卒冒炎暑，昏冒痿
厥，吐泻喘满，用十味香薷饮之类。中于湿者，丹溪所谓东南之人多因湿土生痰，痰生热，热生风也，用清燥
汤之类，加竹沥、姜汁。中于火者，河间所谓非肝木之风内中，六淫之邪外侵，良由五志过极，火盛水衰，
热气怫郁，昏冒而卒倒也，用六味丸，四君子、独参汤之类。内有恚怒伤肝，火动上炎者，用柴胡汤之类。中
于气者，由七情过极，气厥昏冒，或牙关紧急，用苏合香丸之类，误作风治者死。食厥者，过于饮食，胃气自
伤，不能运化，故昏冒也，用六君子加木香。劳伤者，过于劳役，耗损元气，脾胃虚衰，不任风寒，故昏
冒也；用补中益气汤。房劳者，因肾虚精耗，气不归源，故昏冒也，用六味丸。凡此皆类中风也。夫《内经》
主于风，河间主于火，东垣主于气，丹溪主于湿。愚之斯论，攒补前人之缺。若夫地之南北，人之虚实，固有
不同，其男子女人，大约相似。
附医案
靳阁老夫人，先胸胁胀满，后四肢不收，自汗如水，小便自遗，口紧目 ，饮食不进，十余日矣。
或以为中脏，公甚忧。余曰∶非也。若风既中脏，真气既脱，恶症既见，祸在反掌，焉能延之，乃候其色，
面目俱赤，而时或青。诊其脉，左三部洪数，惟肝尤甚。余曰∶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，肝经风热，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，诸症顿愈。又用加味逍遥散调理而安。后因郁结，前症
复作，兼发热呕吐，饮食少思，月经不止。此木盛克土，而脾不能摄血也。用
加味归脾汤为主，佐以加味逍遥散，调补肝脾之气，清和肝脾之血而愈。
寒邪侵袭，出现神志昏蒙、牙关紧闭、肢体拘挛、怕冷、脉象浮紧等症状，使用麻黄、桂枝、理中汤之类的方剂。中暑者，指夏季突然遭受炎热暑气，出现神志昏蒙、肢体痿软厥逆、呕吐腹泻、气喘胸满等症状，使用十味香薷饮之类的方剂。中湿者，即丹溪所说的东南地区的人多因湿气困阻脾土而生痰，痰郁化热，热极生风，使用清燥汤之类的方剂，并加入竹沥、姜汁。中火者，即河间所说的并非肝木之风内侵，而是六淫之邪外袭，实由五志过极，导致火盛水衰，热气怫郁，出现神志昏蒙而突然倒仆，使用六味丸、四君子汤、独参汤之类的方剂。若体内有愤怒伤肝，导致火气上炎者，使用柴胡汤之类的方剂。中气者，由于七情过极，导致气机逆乱昏蒙，或牙关紧急，使用苏合香丸之类的方剂，如果误当作中风治疗则会致死。食厥者，由于饮食过量，损伤胃气，不能运化，因而出现神志昏蒙，使用六君子汤加木香。劳伤者，由于过度劳累，耗损元气，脾胃虚弱衰退，不能耐受风寒，因而出现神志昏蒙，使用补中益气汤。房劳者，由于肾虚精血耗损，气不归元，因而出现神志昏蒙，使用六味丸。以上这些都属于类中风。《内经》主张病因为风，河间主张病因为火，东垣主张病因为气，丹溪主张病因为湿。我这里的论述，是对前人理论的补充和完善。至于地域的南北差异、人体的虚实不同，固然存在区别，但男女患者的病情大致相似。
附医案
靳阁老夫人，起初胸胁胀满，随后四肢无力无法收持，自汗如水流出，小便失禁，口紧眼斜，饮食不进，已经十多天了。
有人认为是中脏（重症中风），非常担忧。我说：不是这样。如果风邪已经侵入脏腑，真气已经脱失，恶症已经显现，死亡就在顷刻之间，怎么能拖延这么久呢？观察她的面色，面目都发红，有时发青。诊察她的脉象，左手寸关尺三部脉洪大数急，其中肝脏脉象尤为严重。我说：胸乳胀痛，是肝经血虚，肝气痞塞所致。四肢无力无法收持，是肝经血虚不能滋养筋脉所致。自汗不止，是肝经风热，津液妄泄所致。小便失禁，是肝经热甚，阴器功能失职所致。大便不成形，是肝木炽盛，克制脾土所致。于是使用犀角散服用四剂，所有症状顿时痊愈。后又使用加味逍遥散调理而安定。后来因为情绪郁结，之前的症状复发，兼有发热呕吐，饮食减少思虑，月经不止。这是木气过盛克制脾土，而脾不能统摄血液所致。以加味归脾汤为主方，佐以加味逍遥散，调补肝脾之气，清和肝脾之血，从而痊愈。
Cold pathogen invasion, presenting with coma (shen zhi hun meng), lockjaw (kou jin), limb spasms (zhi luan), aversion to cold (e han), and a floating-tight pulse (mai fu jin), is treated with formulas such as Ephedra Decoction (Mahuang Tang), Cinnamon Twig Decoction (Guizhi Tang), or the Regulate the Middle Decoction (Lizhong Tang). Stroke by summerheat (zhong yu) refers to sudden exposure to intense heat in summer, presenting with coma, flaccidity and cold extremities (wei jue), vomiting and diarrhea, wheezing and chest fullness, treated with formulas such as Ten-Ingredient Schizonepeta Drink (Shiwei Xiangru Yin). Stroke by dampness (zhong shi) refers to what Danxi described: people in the southeast often generate phlegm due to damp-earth stagnation; phlegm generates heat, and heat generates wind. This is treated with formulas such as Clear Dryness Decoction (Qingzao Tang), added with Bamboo Sap (Zhuli) and Ginger Juice (Jiangzhi). Stroke by fire (zhong huo) refers to what Hejian described: not internal wind of Liver Wood, but external invasion of the six excess pathogens, actually caused by extreme excess of the five emotions, leading to excessive fire and deficient water, with stagnant heat causing coma and sudden collapse. This is treated with formulas such as Six-Ingredient Rehmannia Pill (Liuwei Wan), Four-Gentlemen Decoction (Sijunzi Tang), or Single-Ginseng Decoction (Dushen Tang). If there is internal anger injuring the Liver, causing fire to flare upward, treat with formulas such as Bupleurum Decoction (Chaihu Tang). Stroke by qi (zhong qi) results from extreme excess of seven emotions, causing qi rebellion and coma, or tight jaw, treated with formulas such as Suhe Xiang Wan (Styrax Pills); mistaking this for wind stroke leads to death. Food syncope (shi jue) results from overeating, damaging Stomach qi, impairing transformation and transportation, thus causing coma, treated with Six-Gentlemen Decoction (Liujunzi Tang) added with Aucklandia (Muxiang). Injury by fatigue (lao shang) results from overwork, depleting primordial qi, causing Spleen and Stomach deficiency and decline, inability to withstand wind-cold, thus causing coma, treated with Tonify the Middle and Boost Qi Decoction (Buzhong Yiqi Tang). Injury by sexual exertion (fang lao) results from Kidney deficiency and essence depletion, with qi failing to return to its source, thus causing coma, treated with Six-Ingredient Rehmannia Pill (Liuwei Wan). All these are classified as pseudo-stroke (lei zhong feng). The *Neijing* emphasizes wind, Hejian emphasizes fire, Dongyuan emphasizes qi, and Danxi emphasizes dampness. My discussion here supplements the deficiencies of previous scholars. Although geographical north-south differences and individual constitution deficiency/excess vary, male and female patients are generally similar.
Attached Medical Case
Elderly Lady Jin Ge initially presented with distension and fullness in the chest and hypochondrium, followed by flaccidity and inability to control the four limbs, profuse spontaneous sweating like water, urinary incontinence, tight mouth, and eye deviation, with no desire for food, persisting for more than ten days.
Others considered it stroke affecting the zang organs (zhong zang), causing great worry. I said: No. If wind had already invaded the zang organs, if true qi had already collapsed, and if malignant symptoms were present, death would occur in an instant; how could it persist so long? Observing her complexion, her face and eyes were red, sometimes turning cyanotic. Palpating her pulse, the three positions on the left hand were flooding and rapid, with the Liver pulse being particularly severe. I said: Chest and breast distension and pain indicate Liver channel blood deficiency and Liver qi stagnation. Inability to control the four limbs indicates Liver channel blood deficiency failing to nourish the sinews. Profuse spontaneous sweating indicates Liver channel wind-heat causing reckless leakage of body fluids. Urinary incontinence indicates severe Liver channel heat causing dysfunction of the genital organs. Loose stools indicate exuberant Liver wood overcoming Spleen earth. Therefore, I used Rhinoceros Horn Powder (Xijiao San) for four doses, after which all symptoms resolved immediately. Subsequently, she was regulated and stabilized with Modified Free and Easy Wanderer Powder (Jiawei Xiaoyao San). Later, due to emotional constraint, the previous symptoms recurred, accompanied by fever, vomiting, poor appetite, and continuous menstruation. This indicates Wood exuberance overcoming Earth, with the Spleen failing to contain blood. Using Modified Gui Pi Decoction (Jiawei Guipi Tang) as the main formula, assisted by Modified Free and Easy Wanderer Powder (Jiawei Xiaoyao San), to regulate and tonify Liver and Spleen qi, and clear and harmonize Liver and Spleen blood, she recovered.