中风之病，《内经》有仆击偏枯之名，而迨至张夫子，其证始了。金元以降，其说纷拿，张会卿别立非风
一门，然就今考之，实无外于长沙之旨。此集一以定证对方为要，如诸家真类之辨，仅存其梗概而已。
源因总说 中风者，风气中于人也。风是四时之气，分布八方，主长养万物。从其乡来者，人中少死
病；不从乡来者，人中多死病。其为病者，藏于皮肤之间，内不得通，外不得泄。其入经脉，行于五脏者，各
随脏腑而生病焉。（《病源论》）
男子则气引其风，女子则风随其血，未有不因风而损命。（《圣惠方》）盖风性紧暴，善行数变，其中人
也卒，其眩人也晕，激人涎浮，昏人神乱，故推为百病长。（《三因方》）
夫中风者，皆因阴阳不调，脏腑气偏，荣卫失度，气血错乱，喜怒过伤，饮啖无节，恣情嗜欲，致于经道
或虚或塞，体虚而腠理不密，风邪之气乘虚而中人也。（《管见大全良方》）
夫人似乎无恙而卒然中风者，岂一朝一夕之故哉，其受病久矣。盖肉必先腐也，而后虫生之，土必先溃也
，而后水决之，木必先枯也，而后风摧之。夫物且然，而况于人乎。经曰∶邪之所凑，其气必虚。风岂能以自
中乎人，亦人之自受乎风耳。使其内气充足，精神完固，则荣卫调和，腠理缄
密，虽有风，将安入乎。惟其不戒暴怒，不节淫欲，或饥不暇于食，或寒不暇于衣，或嗜酒而好色，或勤劳而
忘身，或当风而沐浴，或大汗而行房，或畏热而露卧，或冒雨而奔驰。以致真元耗亡，气血消尽，大经细络，
积虚弥年。平时无甚痛苦，而不知荣卫皆空，徒存躯壳。正犹无心之木，将折未折，无基之墙，欲颓未颓。其
势已不可支，而方且自谓无恙，遂昧而不知戒。一旦为贼风所袭，如剧寇操刃，直入无人之境、势如破竹，不
移时而皆溃，则杯酒谈笑之间，举步转移之顷，卒然颠仆，顿为废人，不亦重可骇哉。由是观之，虽由外风之
中，实因内气之虚也。然人之一身，表里上下未必皆虚；惟积虚之处，气多不贯，而势有偏重，故一为风所入，
而肢体于是乎废矣。（《丹台玉案》）
风有内外 人之为病，有外感之风，亦有内生之风。而天人之气，恒相感召；真邪之动，往往相因。
故无论贼风邪气从外来者，必先有肝风为之内应；即痰火食气从内发者，亦必有肝风为之始基。设无肝风，亦
只为他病已耳，宁有卒倒、偏枯、歪僻，牵引等症哉。
夫邪气所触者，邪风暴至，真气反陷，经络腑脏卒然不得贯通，不相维系，《内经》所谓邪风之至、疾如
风雨是也。藏邪所发者，藏气内虚，肝风独胜，卒然上攻九窍，旁溢四肢，如火之发，如泉之达，而不可骤止
，肝象木而应风，而其气又暴故也。又邪气所触者，风自外来，其气多实；肝病所发者，风从内出，其气多虚
。病虚者气多脱，病实者气多闭。脱者欲其收，不收则死，闭者欲其通，不通亦死。（《金匮翼》）（按∶
风犯肝经为多，戴原礼有说，见于后五脏诸证条，宜参阅。）
论真中类中 人有卒暴僵仆，或偏枯，或四肢不举，或
不知人，或死，或不死者，世以中风呼之，而方书亦以中风治之。余尝考诸《内经》，则曰∶风者百病之始
也。又曰∶风者百病之长也，至其变化，乃为他病，无常方。又曰∶风者善行而数变。又曰∶风之伤人也，
或为寒热，或为热中，或为寒中，或为疠风，或为偏枯，或为风也。其卒暴僵仆、不知人、四肢不举者，并
无所论，止有偏枯一语而已。及观《千金方》（引岐伯）、《金匮要略·中风篇》，知卒暴僵仆、不知人、
偏枯、四肢不举等证，固为因风而致者矣。故用大小续命、西州续命、排风、八风等诸汤散治之。及近代
刘河间、李东垣、朱彦修三子者出，所论始与昔人异矣。三子之论，河间主乎火，东垣主乎气，彦修主乎湿，
反以风为虚象。殊不知因于风者，真中风也；因于火、因于气、因于湿者，类中风而非中风也。三子所论者
，自是因火、因气、因湿，而为暴病暴死之证，与风何相干哉。（《医经溯洄集》）
古人论中风者，言其证也，三先生论中风者，言其因也。知乎此，则中风之候可得而详论矣。其所谓真
中风邪者，未必不由气体虚弱，荣卫失调，然后感于外邪也。若非体虚所致，则西北二方风寒大盛之地，而
中风者比比皆是，何暇为他证哉。其所谓因火、因气、因湿者，亦未必绝无外邪侵侮而作也。若无外邪侵侮，
则因气、因火、因湿，各自为他证，岂有歪僻、瘫痪、暴仆、暴喑之候乎。经曰邪之所凑、其气必虚是也。岂
可以一中风之证，歧为二途哉。（《医学正传》）
脉候 诊其脉虚弱者亦风也，缓大者亦风也，浮虚者亦风也，滑散者亦风也。（《病源论》）
诊人被风不仁痿蹶，其脉虚者生，坚急疾者死。（《脉
经》）
中风之病，口噤筋急，脉迟者生，脉急而数者死。（《中藏经》）
凡人中风，脉无不大者，非热也，是风脉也。（《医说》引《医余》）
风邪中人，六脉多沉伏（按∶此丹溪说），亦有脉随气奔指下洪盛者。（《证治准绳》）
凡脉浮弦无力为风，浮滑不清为痰，浮数有力为火，沉弦有力为气，沉实有力为便结，沉涩而数为血凝。
凡下元无根，则两肾脉不应，或沉滑微细。若尺浮而无力，肾气不足。尺洪而弦数，肾阴大亏。若痰塞气满，
并逆于上，有升无降，则虚弦搏急，一如沸釜。或精神元气一时暴绝，则虚散而欲绝。脉来缓滑，或浮滑，或
滑数，有神者易治；或弦滑，或浮数，或洪大者难治。若两尺绝无，下元已绝。寸关虚豁而空大，真气已散。
或举之搏大，按之绝无，孤阳无根据者死。（《锦囊秘 》）
先兆（宜参灸法）人有患头目眩，或游或风，口眼 动，非痰，乃风之渐也。（《魏氏家藏方》）中
风者，俱有先兆之证。凡人如觉大拇指及次指麻木不仁，或手足不用，或肌肉蠕动者，三年内必有大风之至。
经曰。肌肉蠕动。名曰微风。（《保命集》）（《汪石山医按》举此证曰∶手大指次指，是手太阴阳明经风。
酒肉动痰起火，入房伤阴血，水弱火盛，竟枯竭而然耳。更远色戒酒，自得虚无恬 ，而后用十全大补汤年余
，间服八味丸，遂复康，是亦预防中风之术也。）
中风者，人本气血两虚，或有形盛气衰，或指节不时麻木，或手足间酸疼，或头眩，眼吊或虚跳，痹于半
身或周
身，有如虫行，此中风之兆也。人未之觉，不谨调护者多。（《诸证辨疑》）
大凡见眩晕之渐，劳即耳鸣目眩，背膊酸疼，有时腰痛者，此中风之履霜也，此是病之缓也。（《医经
会元》）
证状总说 岐伯曰∶中风大法有四∶一曰偏枯，二曰风痱，三曰风懿，四曰风痹。夫诸急卒病多是
风，初得轻微，人所不悟，宜速与续命汤，根据 穴灸之。夫风者百病之长，岐伯所言四者，说其最重也。（《
千金方》）
风者百病之长，岐伯所谓大法有四∶一曰偏枯，半身不遂；二曰风痱，于身无痛，四肢不收，三曰风懿者，
奄忽不知人也，四曰风痹者，诸痹类风状。此特言其大概，而又有卒然而中者。（《医方大成》）（按∶此说
据《病源论》，风懿彼作风 。）
中风之证，卒然晕倒，昏不知人，或痰涎壅盛，咽喉作声，或口眼 斜，手足瘫痪，或半身不遂，或舌强
不语。风邪既盛，气必上逆，痰随气上，停留壅塞，昏乱晕倒，皆痰为之也。（《证治要诀》）
其状涎潮昏塞，不省人事，舌强不能言，此等疾证，鲜有不毙者，然亦有轻重。经云∶风中藏则性命危。
且以简易言之，先察口眼开阖，以别重轻。如眼开口噤，无汗搐搦，涎不作声，六脉迟浮者，易治。若眼闭口
开，手足不收，自汗如珠如油，发直吐沫，面赤如妆，鱼口气粗，咽中涎响，似水鸡声，或如拽锯，声如鼾睡
，或时长嘘，摇头上窜，喷药闷乱，目瞪直视，头面青黑，六脉急疾大数，脉迟缓，倘有一证，皆不可治也。
（按∶《妇人良方》曰∶当察口眼开阖，以别重轻；涎沫有无，以明证治。如眼开口闭，手足不开，涎不作声
者，可治。如眼闭口开，声如鼾睡，遗尿者，
死。此较之本文更觉明约，盖陈氏说实为辨闭脱者之嚆矢。）若是中之轻者，涎潮昏塞，不省人事，语言謇涩
，半身不遂，缓纵 曳，左瘫右痪，偏枯风懿，痿痹不仁，口眼 斜，头痛头眩，如坐舟船之上，角弓反张，
摇头马鸣，白虎历节，走注疼痛，虫行搔痒，恍惚惊悸，为癫为痫，暗风倒地，难可枚举，已上之证皆可施治
。（《管见大全良方》）
又有中之轻者，在皮肤之间，言语微謇，眉角牵引，遍身疮癣，状如虫行，目旋耳鸣，又当随证治之。
（《医方大成》）
五脏证候 心中风，但得偃卧，不得倾侧，汗出。若唇赤汗流者可治，急灸心俞百壮。若唇或青或黑，
或白或黄，此是心坏为水，面目亭亭时悚动者，皆不可复治，五六日而死。肝中风，但踞坐不得低头。若绕两
目连额，色微有青，唇青血黄者可治，急灸肝俞百壮。若大青黑，面一黄一白者，是肝已伤，不可复治，数日
而死。脾中风，踞而腹满，身通黄，吐咸汁出者可治，急灸脾俞百壮。若手足青者，不可复治。肾中风，踞而
腰痛。视胁左右，未有黄色如饼粢大者可治，急灸肾俞百壮。若齿黄赤，鬓发直，头面土色者，不可复治。肺
中风，偃卧而胸满短气，冒闷汗出。视目下，鼻上下两边，下行至口，色白可治，急灸肺俞百壮。若色黄，为
肺已伤，化为血，不可复治。其人当妄掇空指地，或自拈衣寻缝，如此数日而死。（《病源论》）
心脾俱中风，则舌强不能言也。肝肾俱中风，则手足不遂也。（《中藏经》）
五脏虽皆有风，而犯肝经为多。盖肝主筋属木，风易入之，各从其类。肝受风则筋缓不荣，或缓或急，所
以有 斜、瘫缓、不遂、舌强、语涩等证（《证治要诀》）
脏腑血脉经络之别 中风虽能言，口不 斜，而手足 曳，脉虚浮而数，风中府也。盖风中脉则口眼
斜，风中府则肢体废，风中藏则性命危。凡风中府，宜汗而解。（《本事方》）
范子默曰∶凡觉手足痹，或麻或痛，良久乃已，此将中府之候。凡觉心中愦乱，神思不怡，或手足麻，此
中藏之候。（《方氏家藏方》）
中府者，面加五色，有表证脉浮而恶寒，拘急不仁，或中身之后，或中身之前，或中身之侧，皆曰中府也
，其治多易。中藏者，唇吻不收，舌不转而失音，鼻不闻香臭，耳聋而眼瞀，大小便秘结，皆曰中藏也，其治
多难。大抵中府者多着四肢，中藏者多滞九窍。虽中府者多兼中藏之证，至于舌强失音，久服大药能自愈也。
（《保命集》）
若以脏腑言之，则又各有形证焉。中藏者多滞九窍，故有瘫缓失音、鼻塞耳聋、目瞀便秘之症。中府者多
着四肢，故有半身不遂、手足不随、左瘫右痪之形。又有中血脉者，则外无六经之形症，内无便溺之阻涩，惟
口眼歪斜、或左或右而已，而手足动静，起居食息，故无恙也。其或股不能举，口不能言，更无别症，乃中经
也。比中脏腑则为轻，比之中血脉犹为重耳。然因其病而药之，则中藏者宜下，中府者宜汗，中经者宜补血以
养筋，中血脉者宜养血以通气，此皆可治之症也；而又有难易于其间，中藏为难而中腑次之，中经又次之。其
或国中于血脉，药之而愈，苟不守禁忌必复中，而中必在于藏。中一次则虚一次，虚一次则重一次。故中府虽
可治也，由先中血脉与经而后及于府，则难治矣；中藏本难治也，由先中府而后及于藏，则不治矣。若中府而
兼中藏，与伤寒两感者何异，其又可生耶。（《丹台玉案》）
中风一证，分中血脉、中府、中藏，始自李东垣。中血脉者大秦艽汤，中府者小续命汤，中藏者三化汤，
然从未见有三化汤中藏之证。惟《金匮》书中分为四证，曰络、曰经、曰府、曰藏，其说最为的当，可为后世
法。盖口眼 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，邪在府也，
神昏不语，唇缓涎出，邪在藏也。学人细阅诸家之论，自知不谬云尔。（《医宗金鉴》）
其为病则有脏腑经络浅深之异。口眼歪斜，络病也，其邪浅而易治。手足不遂，身体重痛，经病也，邪差
深矣，故多从倒仆后见之。卒中昏厥，语言错乱，府病也，其邪为尤深矣。大抵倒仆之候，经府皆能有之，其
倒后神清识人者在经，神昏不识人者在府耳。至于唇缓失音、耳聋目瞀、遗尿声鼾等症，则为中藏，病之最深
者也。然其间经病兼府者有之，藏病连经者有之，腑脏经络齐病者有之，要在临病详察也。（《金匮翼》）
闭脱（宜参后固脱方法） 设或口不能言者为心绝，唇吻（此非讹则脱）手撒者为脾绝，眼合直视者
为肝绝，遗尿而黑者为肾绝，鼾睡自汗者为肺绝，此名脱证。如止牙关紧闭，两手握固，则为闭证。闭证则可
中风这一疾病，《内经》中有“仆击”和“偏枯”的名称，但直到张仲景（字机，后世尊称张夫子），其证候才变得清晰明了。自金元时期以来，各种学说纷繁杂乱，张介宾（号会卿）另立“非风”一门，然而根据现今的考证，其实并没有超出张仲景（长沙太守）的宗旨。本集以确定证候并对应方药为要务，至于各家关于真中风与类中风的辨析，仅保留其大概梗概罢了。
病因总说 所谓中风，就是风气侵袭人体。风是四季的气候之气，分布于八方，主宰万物的生长养育。从风所来的方向（即当令之方）吹来的人，人较少患死病；不从当令之方吹来的人（即虚邪贼风），人较多患死病。风邪致病时，潜伏在皮肤之间，向内不能通达，向外不能宣泄。如果它进入经脉，运行于五脏之中，就会随着脏腑的不同而引发相应的疾病。（《诸病源候论》）
男子则气引动风邪，女子则风随血行，没有不因风邪而损害性命的。（《太平圣惠方》）大概风性紧促暴烈，善于游走且变化多端，它侵袭人时突然发作，使人眩晕，激惹痰涎上浮，扰乱神志，因此被推崇为“百病之长”。（《三因极一病证方论》）
所谓中风，都是因为阴阳不调，脏腑之气偏颇，营卫失去节度，气血错乱，喜怒过度损伤，饮食无节制，放纵情欲嗜好，导致经络或虚或塞，身体虚弱而腠理不致密，风邪之气乘虚侵入人体。（《管见大全良方》）
人看起来似乎安然无恙却突然中风，难道是一朝一夕的原因吗？那是患病已久啊。大概肉必须先腐烂，然后虫子才会生出来；土必须先溃决，然后水才会决堤；树必须先枯死，然后风才会摧折它。万物尚且如此，何况是人呢？经书说：“邪气聚集的地方，正气必定虚弱。”风怎么能自己侵入人体呢，这也是人自己受风罢了。如果体内正气充足，精神完固，那么营卫调和，腠理紧密，虽然有风，又能从哪里进入呢？只因为不戒除暴怒，不节制淫欲，或者饥饿时无暇进食，或者寒冷时无暇添衣，或者嗜好饮酒且贪恋美色，或者勤劳劳作而忘记保养身体，或者对着风洗澡，或者大汗淋漓时行房事，或者怕热而露天睡觉，或者冒着雨奔跑。以致真元耗损灭亡，气血消尽，大经细络，积虚多年。平时没有什么痛苦，却不知道营卫皆空，徒留躯壳。正像没有心的树木，将要折断还未折断；没有基础的墙壁，将要倒塌还未倒塌。形势已经不可支撑，却还自以为安然无恙，于是愚昧而不知道戒备。一旦受到贼风侵袭，就像强盗拿着刀，直入无人之境，势如破竹，不一会儿就全面崩溃，那么在杯酒谈笑之间，举步转移之顷，突然跌倒，顿时成为废人，不也是令人非常惊骇的吗？由此看来，虽然是由外风中袭引起，实际上是因为内气虚弱。然而人的一身，表里上下未必都虚；只有积虚之处，气多不通贯，而且形势有偏重，所以一旦风邪侵入，肢体于是废弃了。（《丹台玉案》）
风有内外之分 人得的病，有外感的风，也有内生的风。而天人之气，常常相互感召；真气与邪气的变动，往往互为因果。所以无论是贼风邪气从外来，必定先有肝风作为内应；即使是痰火食气从内发，也必须有肝风作为基础。如果没有肝风，也只是其他病罢了，怎么会有突然昏倒、偏枯、歪僻、牵引等症状呢？
邪气所触犯的，邪风暴至，真气反而下陷，经络腑脏突然不能贯通，不相维系，这就是《内经》所说的“邪风之至，疾如风雨”。藏邪所引发的，脏气内部虚弱，肝风独盛，突然向上攻冲九窍，向旁溢流四肢，像火爆发一样，像泉水涌出，而不能骤然停止，这是因为肝象木而应风，且其气又暴烈的缘故。另外，邪气所触犯的，风从外来，其气多实；肝病所引发的，风从内出，其气多虚。病虚者气多脱失，病实者气多闭塞。脱者需要收敛，不收敛则死；闭者需要通利，不通利也死。（《金匮翼》）（按：风犯肝经的情况较多，戴原礼有论述，见于后文五脏诸证条，宜参阅。）
论真中风与类中风 人有突然僵硬仆倒，或者偏枯，或者四肢不能举动，或者不知人事，或者死亡，或者不死，世人称之为中风，医方书籍也以中风治疗。我曾考证《内经》，其中说：“风是百病的起始。”又说：“风是百病之长，到了它变化之时，就成为其他病，没有固定的形式。”又说：“风善于行走且变化多端。”又说：“风伤人，有的表现为寒热，有的表现为热中，有的表现为寒中，有的表现为疠风，有的表现为偏枯，有的表现为风病。”对于突然僵硬仆倒、不知人事、四肢不能举动等情况，并没有专门论述，只有“偏枯”一词而已。等到观看《千金方》（引用岐伯的话）、《金匮要略·中风篇》，才知道突然僵硬仆倒、不知人事、偏枯、四肢不能举动等证候，确实是由于风引起的。所以用大小续命汤、西州续命汤、排风散、八风散等汤剂散剂治疗。到了近代刘河间、李东垣、朱彦修三位先生出现，他们的论述才开始与前人不同。三位先生的论述，刘河间主张火，李东垣主张气，朱彦修主张湿，反而把风看作虚象。殊不知因于风的是真中风；因于火、因于气、因于湿的是类中风而不是中风。三位先生所论述的，自然是因为火、因于气、因于湿，而导致的暴病暴死的证候，这与风有什么关系呢？（《医经溯洄集》）
古人论述中风，说的是它的证候；三位先生论述中风，说的是它的病因。明白这一点，那么中风的候象就可以详细论述了。他们所谓的真中风邪，未必不是由于体质虚弱，营卫失调，然后感受外邪所致。如果不是体质虚弱所致，那么在西北两地风寒大盛的地方，中风的人比比皆是，哪里还有空闲得其他病呢？他们所谓的因火、因气、因湿，也未必完全没有外邪侵扰而发病。如果没有外邪侵扰，那么因气、因火、因湿，各自成为其他病，怎么会有歪僻、瘫痪、暴仆、暴喑这些候象呢？经书说“邪气聚集的地方，正气必定虚弱”，就是这个道理。怎么能把一个中风的证候，歧分为两条途径呢？（《医学正传》）
脉候 诊察他的脉象虚弱，也是风；脉象缓大，也是风；脉象浮虚，也是风；脉象滑散，也是风。（《诸病源候论》）
诊察病人被风邪所伤导致麻木痿厥，脉象虚的能活，脉象坚急疾速的死。（《脉经》）
中风病，牙关紧闭筋脉拘急，脉迟的能活，脉急而数死的。（《中藏经》）
凡人中风，脉象没有不大（指盛大）的，这不是热，是风脉。（《医说》引《医余》）
风邪中人，六脉多沉伏（按：这是朱丹溪的说法），也有脉随气奔涌至指下洪盛有力的。（《证治准绳》）
凡是脉浮弦无力为风，浮滑不清为痰，浮数有力为火，沉弦有力为气，沉实有力为大便干结，沉涩而数为血凝。凡是下元无根，两肾脉不应指，或者沉滑微细。如果尺脉浮而无力，肾气不足。尺脉洪大而弦数，肾阴大亏。如果痰塞气满，并逆于上，有升无降，则脉象虚弦搏急，就像沸腾的锅。或者精神元气一时暴绝，则脉象虚散而欲绝。脉来缓滑，或者浮滑，或者滑数，有神气的易治；或者弦滑，或者浮数，或者洪大的难治。如果两尺脉绝无，下元已绝。寸关脉虚豁而空大，真气已散。或者轻取搏大，重按绝无，孤阳无依凭的死。（《锦囊秘录》）
先兆（宜参考灸法）有人患头目眩晕，或者游走不定，口眼抽动，不是痰，是风的前兆。（《魏氏家藏方》）中风的人，都有先兆的证候。凡人如果觉得大拇指及食指麻木不仁，或者手足不能用，或者肌肉蠕动的，三年内必有严重的风病到来。经书说：肌肉蠕动，名叫微风。（《保命集》）（《汪石山医按》举此证说：手大拇指和食指，是手太阴肺经和手阳明大肠经的风。酒肉动痰起火，房事伤阴血，水弱火盛，竟然枯竭而成这样。如果能远色戒酒，自然得到虚无恬淡的境界，然后用十全大补汤服用一年多，间服八味丸，于是恢复健康，这也是预防中风的方法。）
中风的人，本来气血两虚，或者有形体盛壮但气衰，或者指节不时麻木，或者手足间酸疼，或者头晕，眼睛吊起或虚跳，半身或全身痹痛，好像虫行，这是中风的前兆。人们没有察觉，不谨慎调护的人很多。（《诸证辨疑》）
大凡见到眩晕的渐进，劳累就耳鸣目眩，背膊酸疼，有时腰痛，这是中风将发的迹象，这是病势较缓的。（《医经会元》）
证状总说 岐伯说：中风大法有四：一是偏枯，二是风痱，三是风懿，四是风痹。那些急骤发生的病多是风，初起轻微，人所不觉，应该迅速给予续命汤，并根据穴位施灸。风是百病之长，岐伯所说的四种，是说其中最重的。（《千金方》）
风是百病之长，岐伯所说的大法有四：一是偏枯，半身不遂；二是风痱，身上无痛，四肢不能收持；三是风懿，突然不知人事；四是风痹，各种痹症类似风状。这特别说的是大概情况，又有突然中风的。（《医方大成》）（按：此说法依据《诸病源候论》，风懿在那里写作风噎。）
中风的证候，突然晕倒，昏迷不知人事，或者痰涎壅盛，咽喉发出声音，或者口眼歪斜，手足瘫痪，或者半身不遂，或者舌强不语。风邪既盛，气必上逆，痰随气上，停留壅塞，昏乱晕倒，都是痰造成的。（《证治要诀》）
其症状为涎潮昏塞，不省人事，舌强不能言语，这类疾病，很少有不被治死的，但也有轻重之分。经书说：风邪中入脏则性命危险。且用简易的话来说，先观察口眼的开合，以辨别轻重。如果眼开牙关紧闭，无汗抽搐，涎液不出声，六脉迟浮，易治。如果眼闭口开，手足不收，自汗如珠如油，头发直立吐沫，面色红如化妆，鱼口气粗，咽中涎响，像水鸡叫声，或者像拉锯，声音像打鼾睡，或者时常叹气，摇头上窜，喷药闷乱，目瞪直视，头面青黑，六脉急疾大数，脉迟缓，倘若有其中一个证候，都不可治。（按：《妇人良方》说：应当观察口眼开合，以辨别轻重；有无涎沫，以明确证治。如果眼开口闭，手足不开，涎液不出声，可治。如果眼闭口开，声音像打鼾睡，遗尿，死。这比本文更觉得简明扼要，大概陈氏的说法确实是辨别闭证脱证的开端。）如果是中风的轻症，涎潮昏塞，不省人事，语言謇涩，半身不遂，松弛拖曳，左瘫右痪，偏枯风懿，痿痹不仁，口眼歪斜，头痛头晕，像坐在船上一样，角弓反张，摇头马鸣，白虎历节，走注疼痛，虫行搔痒，恍惚惊悸，为癫为痫，暗风倒地，难以枚举，以上证候都可以施治。（《管见大全良方》）
又有中风的轻症，在皮肤之间，言语轻微謇涩，眉角牵引，遍身疮癣，状如虫行，目旋耳鸣，又应当随证治疗。（《医方大成》）
五脏证候 心中风，只能仰卧，不能侧身，出汗。如果嘴唇赤色汗流的可治，紧急灸心俞穴一百壮。如果嘴唇或青或黑，或白或黄，这是心坏化为水，面目亭亭时时惊恐颤动的，都不可再治，五六天后死。肝中风，只能蹲坐不能低头。如果环绕两眼连额头，颜色微有青色，唇青血黄的可治，紧急灸肝俞穴一百壮。如果大青黑色，脸一半黄一半白的，是肝已受伤，不可再治，几天后死。脾中风，蹲着腹部胀满，全身发黄，吐出咸汁的可治，紧急灸脾俞穴一百壮。如果手脚发青，不可再治。肾中风，蹲着腰痛。看胁肋左右，没有黄色像饼粢大小的可治，紧急灸肾俞穴一百壮。如果牙齿黄赤，鬓发直立，头面呈土色的，不可再治。肺中风，仰卧而胸满短气，冒闷出汗。看眼下，鼻上下两边，下行至口，颜色白色可治，紧急灸肺俞穴一百壮。如果颜色黄，为肺已受伤，化为血，不可再治。其人应当妄抓空中指向地，或者自己揪衣服找缝，这样几天后死。（《诸病源候论》）
心脾俱中风，则舌强不能言语。肝肾俱中风，则手足不遂。（《中藏经》）
五脏虽都有风，但侵犯肝经的居多。大概肝主筋属木，风容易侵入，各从其类。肝受风则筋缓不荣，或缓或急，所以有口眼歪斜、瘫缓、不遂、舌强、语涩等证。（《证治要诀》）
脏腑血脉经络之别 中风虽然能说话，口眼不歪斜，但手足拖曳，脉虚浮而数，这是风中府。大概风中脉则口眼歪斜，风中府则肢体废弃，风中脏则性命危险。凡是风中府，宜用发汗法解表。（《本事方》）
范子默说：凡是觉得手足痹，或者麻或者痛，很久才缓解，这是将中府的候象。凡是觉得心中烦乱，神思不愉快，或者手足麻，这是中藏的候象。（《方氏家藏方》）
中府，面部加上五色变化，有表证脉浮而恶寒，拘急不仁，或者中身之后，或者中身之前，或者中身之侧，都叫中府，其治疗多容易。中藏，唇吻不收，舌不转动而失音，鼻子不闻香臭，耳聋而眼花，大小便秘结，都叫中藏，其治疗多困难。大体中府多涉及四肢，中藏多滞碍九窍。虽然中府多兼有中藏的证候，至于舌强失音，久服大药能自愈。（《保命集》）
如果用脏腑来说，又各有形证。中藏多滞碍九窍，所以有瘫缓失音、鼻塞耳聋、目瞀便秘的症状。中府多涉及四肢，所以有半身不遂、手足不随、左瘫右痪的形态。又有中血脉的，则外无六经的形症，内无便溺的阻涩，只是口眼歪斜、或者左或右而已，而手足动静，起居食息，所以安然无恙。如果大腿不能举起，口不能言语，更没有其他病症，这是中经。比中脏腑为轻，比之中血脉为重。然而因病用药，中藏宜下法，中府宜汗法，中经宜补血以养筋，中血脉宜养血以通气，这些都是可治的证候；而在其中有难易之分，中藏为难而中腑次之，中经又次之。如果原本中于血脉，用药而愈，如果不守禁忌必然复发，而复发必定在于脏。中一次则虚一次，虚一次则重一次。所以中府虽然可治，由先中血脉与经而后及于府，则难治了；中藏本难治，由先中府而后及于藏，则不治了。如果中府而兼中藏，与伤寒两感有什么不同，又怎么能生存呢？（《丹台玉案》）
中风一证，分中血脉、中府、中藏，开始于李东垣。中血脉者用大秦艽汤，中府者用小续命汤，中藏者用三化汤，然而从未见过有三化汤治疗中藏的证候。只有《金匮》书中分为四证，曰络、曰经、曰府、曰藏，这种说法最为恰当，可为后世效法。大概口眼歪斜，肌肤不仁，邪在络；左右不遂，筋骨不用，邪在经；昏不识人，便溺阻隔，邪在府；神昏不语，唇缓涎出，邪在藏。学者仔细阅读诸家的论述，自然知道没有错误。（《医宗金鉴》）
它发病则有脏腑经络浅深之异。口眼歪斜，是络病，邪气浅而易治。手足不遂，身体重痛，是经病，邪气稍深了，所以多在倒仆后见到。卒中昏厥，语言错乱，是府病，邪气更深了。大体倒仆的候象，经和府都能有，倒仆后神清识人的在经，神昏不识人的在府。至于唇缓失音、耳聋目瞀、遗尿声鼾等症状，则是中藏，是病最深重的。然而其中有经病兼府的，有藏病连经的，有腑脏经络齐病的，关键在于临病详察。（《金匮翼》）
闭脱（宜参考后文固脱方法） 如果口不能言语的是心绝，唇吻（此处若非讹误则是脱证）手撒的是脾绝，眼合直视的是肝绝，遗尿而黑的是肾绝，鼾睡自汗的是肺绝，这叫脱证。如果只是牙关紧闭，两手握固，则为闭证。闭证则可……
Zhongfeng (Stroke), this disease, has the names "Pujī" (Sudden Collapse) and "Pianguku" (Hemiplegia) in the *Neijing* (Inner Canon). However, it was not until Zhang Zhongjing (posthumously honored as Zhang Fuzi) that its syndromes became clear. Since the Jin and Yuan dynasties, theories have been diverse and chaotic. Zhang Jiebin (courtesy name Huiqing) established a separate category of "Feifeng" (Non-Wind), yet according to modern examination, these theories do not actually go beyond the principles of Zhang Zhongjing (the Grandee of Changsha). This collection focuses primarily on determining syndromes and matching them with formulas. Regarding the distinctions between Zhenzhongfeng (True Stroke) and Leizhongfeng (Resembling Stroke) made by various schools, only their general outlines are retained.
**General Discussion on Etiology**
Zhongfeng (Stroke) refers to wind qi invading the human body. Wind is the qi of the four seasons, distributed in eight directions, governing the nourishment and growth of all things. When wind comes from its own direction (the seasonal direction), people rarely suffer fatal diseases; when it comes from non-seasonal directions (deficient evil and treacherous wind), people often suffer fatal diseases. In causing disease, it lodges between the skin, unable to penetrate inward or vent outward. If it enters the meridians and circulates within the five zang organs, it produces diseases corresponding to each organ. (*Zhubing Yuanhou Lun*)
In men, qi draws in wind; in women, wind follows blood. There is no case where wind does not damage life. (*Taiping Shenghui Fang*) Generally, wind nature is tight and violent, good at moving quickly and changing frequently. Its invasion is sudden, causing dizziness, stimulating floating phlegm, and confusing the spirit, hence it is promoted as the "Chief of Hundred Diseases." (*Sanyin Fang*)
Zhongfeng (Stroke) occurs due to disharmony of yin and yang, bias in zang-fu qi, loss of regulation in Ying and Wei (Nutritive and Defensive qi), disorder of qi and blood, excessive injury from anger and joy, unregulated diet, indulgence in desires, leading to deficiency or blockage in meridians. The body is weak, pores are not dense, and pathogenic wind qi invades due to deficiency. (*Guanjian Daquan Liangfang*)
A person who appears healthy but suddenly suffers stroke—could this be the cause of a single day or night? No, the disease has been accumulating for a long time. Flesh must rot before worms arise; earth must collapse before water bursts forth; wood must wither before wind destroys it. If things are so, how much more so for humans? The Classics say: "Where pathogenic qi gathers, healthy qi must be deficient." How can wind invade humans on its own? It is also humans inviting wind upon themselves. If internal qi is sufficient and spirit is solid, then Ying and Wei are harmonious, and pores are sealed tight. Even if there is wind, where would it enter? Only because one does not guard against violent anger, does not restrain lust, or eats when hungry without care, wears insufficiently when cold, indulges in wine and lust, labors excessively forgetting the body, bathes facing the wind, engages in intercourse while sweating profusely, sleeps exposed fearing heat, or runs in the rain. This leads to the consumption of Yuanqi (Original Qi) and exhaustion of qi and blood. Over years, major and minor meridians accumulate deficiency. Usually, there is little pain, but one does not know that Ying and Wei are empty, leaving only a shell. It is like a heartless tree about to break, or a wall without foundation about to fall. The situation is already unsustainable, yet one considers oneself healthy and remains ignorant and unguarded. Once attacked by treacherous wind, like a fierce bandit wielding a blade entering undefended territory, breaking through like splitting bamboo, everything collapses in an instant. Within the time of drinking wine and chatting, or shifting steps, one suddenly falls, instantly becoming disabled. Is this not deeply shocking? From this, we see that although caused by external wind invasion, it is essentially due to internal qi deficiency. However, the whole body is not necessarily deficient inside and out, above and below. Only where deficiency accumulates does qi fail to penetrate, and momentum becomes biased. Thus, once wind enters, limbs become disabled. (*Dantai Yu'an*)
**Wind has Internal and External Origins**
Human diseases include externally contracted wind and internally generated wind. The qi of Heaven and Humanity constantly resonate; the movement of true qi and pathogenic qi often causes each other. Therefore, whether treacherous wind and pathogenic qi come from outside, there must first be Liver Wind as an internal response; even if Phlegm-Fire or Food-Qi originates from inside, there must be Liver Wind as the basis. Without Liver Wind, it would merely be other diseases, how could there be sudden collapse, hemiplegia, deviation, and traction symptoms?
When pathogenic qi touches, the pathogenic storm arrives swiftly, true qi sinks back, meridians and zang-fu organs suddenly cannot connect or sustain each other. This is what the *Neijing* calls: "The arrival of pathogenic wind is swift as wind and rain." When pathogens originate from within zang organs, internal zang qi is deficient, Liver Wind alone prevails, suddenly attacking the nine orifices upward and overflowing into the four limbs like fire erupting or springs bursting, impossible to stop abruptly. This is because Liver corresponds to Wood and Wind, and its qi is violent. Furthermore, when touched by pathogenic qi, wind comes from outside, its qi is mostly Excess; when issued from Liver disease, wind comes from inside, its qi is mostly Deficiency. Disease of Deficiency involves qi leakage; Disease of Excess involves qi closure. Leakage requires consolidation, failure to consolidate leads to death; Closure requires unblocking, failure to unblock also leads to death. (*Jingui Yi*) (Note: Wind invading the Liver Meridian is common. Dai Yuanli has discussed this, see the section on Five Zang Syndromes below.)
**Discussion on True Stroke vs. Resembling Stroke**
People who suddenly stiffen and fall, or have hemiplegia, or limbs cannot move, or lose consciousness, or die, or survive, are called suffering from Zhongfeng (Stroke) by the world, and treated as such in medical texts. I have examined the *Neijing*, which says: "Wind is the beginning of hundred diseases." It also says: "Wind is the chief of hundred diseases; when it changes, it becomes other diseases, with no fixed form." It also says: "Wind moves well and changes frequently." It also says: "Wind injuring humans may manifest as cold-heat, heat-center, cold-center, leprosy, hemiplegia, or wind disease." For sudden stiffness and falling, loss of consciousness, and limb immobility, there is no specific discussion, only the term "hemiplegia." Upon viewing the *Qianjin Fang* (citing Qibo) and *Jingui Yaolue · Zhongfeng Pian*, we know that sudden stiffness, loss of consciousness, hemiplegia, and limb immobility are indeed caused by wind. Hence, Decoctions of Large and Small Xuming, Xizhou Xuming, Paifeng, Bafeng, etc., were used for treatment. Later, Liu Hejian, Li Dongyuan, and Zhu Yanxiu emerged, and their discussions differed from predecessors. Their theories: Liu emphasized Fire, Li emphasized Qi, Zhu emphasized Dampness, reversing wind as a deficiency image. Little did they know, cases caused by wind are True Zhongfeng; cases caused by Fire, Qi, or Dampness are Lei Zhongfeng (Resembling Stroke), not True Zhongfeng. What the three masters discussed were naturally acute illnesses caused by Fire, Qi, or Dampness, what did they have to do with Wind? (*Yijing Suhui Ji*)
Ancients discussing Zhongfeng spoke of its syndromes; the three masters discussed its etiology. Understanding this, the manifestations of Zhongfeng can be detailed. The so-called True Zhongfeng Pathogen likely arises from weak constitution and disharmonious Ying/Wei, subsequently contracting external pathogens. If not caused by weakness, then in the Northwest where wind and cold are abundant, stroke victims would be everywhere, leaving no room for other diseases. The so-called cases caused by Fire, Qi, or Dampness also likely involve some external pathogen invasion. Without external invasion, cases caused by Qi, Fire, or Dampness would each become other diseases; how could there be deviation, paralysis, sudden collapse, or sudden aphasia? The Classic says: "Where pathogenic qi gathers, healthy qi must be deficient." How can one syndrome of Zhongfeng be split into two paths? (*Yixue Zhengchuan*)
**Pulse Diagnosis**
Diagnosing a pulse that is weak indicates Wind; slow and large indicates Wind; floating and deficient indicates Wind; slippery and scattered indicates Wind. (*Zhubing Yuanhou Lun*)
Diagnosing a patient injured by wind with numbness and flaccidity: a deficient pulse indicates survival; a firm, urgent, and rapid pulse indicates death. (*Maiching*)
In Zhongfeng disease, with clenched jaw and tendon tension: a slow pulse indicates survival; an urgent and rapid pulse indicates death. (*Zhongzang Jing*)
For ordinary people with Zhongfeng, pulses are generally large (surging); this is not Heat, but the Wind pulse. (*Yishuo* citing *Yiyu*)
When wind pathogen invades humans, six pulses are mostly deep and hidden (Note: This is Danxi's view); sometimes pulses surge under the fingers vigorously. (*Zhengzhi Zhunsheng*)
Generally, floating, wiry, and powerless pulse indicates Wind; floating, slippery, and unclear indicates Phlegm; floating, rapid, and forceful indicates Fire; deep, wiry, and forceful indicates Qi; deep, solid, and forceful indicates constipation; deep, choppy, and rapid indicates Blood stasis. If the lower origin lacks root, both Kidney pulses may be imperceptible, or deep, slippery, and fine. If Chi (Cun) pulse is floating and powerless, Kidney Qi is insufficient. If Chi pulse is surging, wiry, and rapid, Kidney Yin is severely depleted. If Phlegm blocks and Qi fills, rebelling upward with no descent, the pulse is deficient, wiry, and frantic, like a boiling pot. Or if Spirit and Yuanqi suddenly perish, the pulse is deficient, scattered, and nearly absent. Pulses coming slowly and smoothly, or floating and slippery, or slippery and rapid, possessing Shen (Spirit), are easy to treat; those that are wiry and slippery, or floating and rapid, or surging and large are difficult to treat. If both Chi pulses are completely absent, the lower origin is severed. If Cun and Guan pulses are hollow and vacuously large, True Qi has dispersed. Or if superficial pressure feels surging but deep pressure reveals nothing, indicating solitary Yang without foundation, death ensues. (*Jinnang Mi Lu*)
**Prodromal Symptoms** (Refer to Moxibustion Methods)
Some suffer dizziness and vertigo, or wandering sensations, mouth and eye twitching. This is not Phlegm, but the gradual onset of Wind. (*Wei Shi Jiacang Fang*) Patients with Zhongfeng all have prodromal symptoms. If a person feels numbness and insensitivity in the thumb and index finger, or limbs cannot be used, or muscles twitch, severe wind disease will arrive within three years. The Classic says: Muscle twitching is named Mild Wind. (*Baoming Ji*) (*Wang Shishan Yian* cites this case: Thumb and index finger correspond to Hand Taiyin Lung and Hand Yangming Large Intestine meridians. Wine and meat generate Phlegm and Fire; intercourse damages Yin Blood; Water is weak, Fire is strong, leading to exhaustion. By avoiding lust and alcohol, attaining emptiness and tranquility, then taking Shiquan Dabu Tang for over a year, interspersed with Bawei Wan, health was restored. This is also a method of preventing Zhongfeng.)
Patients with Zhongfeng originally have both Qi and Blood deficiency, or have robust physique but deficient Qi, or intermittent numbness in finger joints, or soreness and pain in limbs, or dizziness, eyes deviating or jumping, numbness in half or whole body, feeling like insects crawling. These are signs of impending Zhongfeng. People do not notice them and fail to care properly. (*Zhuzheng Bianyi*)
Generally, seeing the gradual onset of vertigo, tinnitus and dizziness upon exertion, soreness and pain in back and shoulders, occasional lower back pain—this is the "treading on frost" sign of Zhongfeng, indicating a slow progression of disease. (*Yijing Huiyuan*)
**General Discussion on Syndromes**
Qibo said: There are four major methods of Zhongfeng: 1. Pianguku (Hemiplegia), 2. Fengfei (Flaccid Paralysis), 3. Fengyi (Loss of Consciousness), 4. Fengbi (Wind Bi). Acute diseases are mostly Wind. Initially mild and unnoticed, one should quickly administer Xuming Tang and apply moxibustion to relevant acupoints. Wind is the chief of hundred diseases; Qibo's four types describe the most severe forms. (*Qianjin Fang*)
Wind is the chief of hundred diseases. Qibo's four major types: 1. Pianguku, hemiplegia; 2. Fengfei, no pain in body, limbs cannot hold; 3. Fengyi, sudden loss of consciousness; 4. Fengbi, various Bi syndromes resembling Wind. This speaks generally, but there are also sudden attacks. (*Yifang Dacheng*) (Note: Based on *Zhubing Yuanhou Lun*, Fengyi is written as Feng Ye there.)
Zhongfeng syndromes include sudden fainting, coma, excessive phlegm-saliva, throat sounds, mouth and eye deviation, limb paralysis, hemiplegia, or tongue stiffness and inability to speak. When Wind pathogen is strong, Qi rebels upward; Phlegm follows Qi up, stagnating and blocking, causing confusion and fainting. All are caused by Phlegm. (*Zhengzhi Yaojue*)
Symptoms include salivary flooding, coma, unconsciousness, tongue stiffness and inability to speak. Such diseases rarely survive, though severity varies. The Classic says: Wind entering Zang endangers life. Simply put, first observe mouth and eye opening/closing to distinguish severity. If eyes open, jaw clenched, no sweat/twitching, silent saliva, six pulses slow and floating: easy to treat. If eyes closed, mouth open, limbs relaxed, sweating like pearls/oil, hair standing, foaming, face red like makeup, fish-mouth breath, loud throat sounds like water fowl or sawing, frequent sighing, head shaking, vomiting medicine in confusion, staring eyes, black/blue face, six pulses urgent/large/rapid, or slow pulse—if any one of these exists, it is untreatable. (Note: *Furen Liangfang* states: Observe mouth/eyes for severity; presence of saliva for treatment differentiation. Eyes open, mouth closed, limbs not open, silent saliva: treatable. Eyes closed, mouth open, snoring sound, enuresis: death. This is clearer than the text above; Chen's theory is indeed the precursor to distinguishing Bi and Tuo syndromes.) For mild Zhongfeng: salivary flooding, coma, slurred speech, hemiplegia, flaccid dragging, left/right paralysis, hemiplegia/Fengyi, flaccid Bi numbness, mouth/eye deviation, headache/dizziness, feeling like on a boat, opisthotonos, head shaking/mare-like cry, Baihu Lijie pain, migrating pain, insect-crawling itch,恍惚 palpitations, mania/seizure, dark wind collapse—these are too numerous to list, but all above are treatable. (*Guanjian Daquan Liangfang*)
Another mild form lies in the skin: slight slurred speech, eyebrow corner traction, widespread skin sores/rash feeling like insects, spinning eyes/tinnitus. Treat according to syndrome. (*Yifang Dacheng*)
**Five Zang Syndromes**
Heart Zhongfeng: Can only lie flat, cannot turn side, sweating. If lips red and sweating: treatable. Urgently moxa Xinshu (BL15) 100 moxa cones. If lips blue/black/white/yellow: Heart is ruined turning to Water, face staring and trembling: untreatable, death in 5-6 days.
Liver Zhongfeng: Can only squat, cannot bow head. If color around eyes/forehead slightly blue, lips blue/blood yellow: treatable. Urgently moxa Ganshu (BL18) 100 cones. If dark blue/black, face half yellow/half white: Liver damaged, untreatable, death in few days.
Spleen Zhongfeng: Squatting, abdominal fullness, whole body yellow, spitting salty juice: treatable. Urgently moxa Pishu (BL20) 100 cones. If hands/feet blue: untreatable.
Kidney Zhongfeng: Squatting, lower back pain. Look at sides of ribs, no yellow patches like cake size: treatable. Urgently moxa Shenshu (BL23) 100 cones. If teeth yellow/red, beard straight, face earth-colored: untreatable.
Lung Zhongfeng: Lying flat, chest fullness, shortness of breath, stifling sweat. Look under eyes, sides of nose down to mouth, color white: treatable. Urgently moxa Feishu (BL13) 100 cones. If color yellow: Lung damaged turning to Blood, untreatable. Patient picks at empty air or clothes seams, dies in few days. (*Zhubing Yuanhou Lun*)
Heart and Spleen both Zhongfeng: Tongue stiffness, inability to speak. Liver and Kidney both Zhongfeng: Limbs immobile. (*Zhongzang Jing*)
Although all five Zangs can have Wind, Liver Meridian is most commonly affected. Liver governs tendons and belongs to Wood; Wind easily enters, following its kind. Liver receiving Wind causes tendons to relax and lack nourishment, either lax or tense, hence symptoms like mouth/eye deviation, flaccid paralysis, immobility, tongue stiffness, slurred speech. (*Zhengzhi Yaojue*)
**Distinction of Fu, Zang, Blood Vessels, and Meridians**
If patient can speak, no mouth/eye deviation, but limbs drag, pulse deficient/floating/rapid: Wind in Fu. Generally, Wind in Mai (Vessels) causes deviation; Wind in Fu causes limb disability; Wind in Zang endangers life. Wind in Fu should be treated with sweating. (*Benshi Fang*)
Fan Zimo said: Feeling limb Bi, numbness or pain, resolving after a long time: impending Wind in Fu. Feeling mental confusion, displeasure, or limb numbness: Wind in Zang. (*Fangshi Jiacang Fang*)
Wind in Fu: Face shows five colors, exterior syndrome with floating pulse and aversion to cold, stiffness/numbness, affecting back, front, or side of body. Treatment is relatively easy.
Wind in Zang: Lips/jaw slack, tongue immobile/aphasic, anosmia, deafness/blurred vision, constipation. Treatment is difficult.
Generally, Wind in Fu affects limbs; Wind in Zang affects nine orifices. Although Fu often combines with Zang symptoms, tongue stiffness/aphasia can heal with prolonged herbal use. (*Baoming Ji*)
Speaking by Zang-Fu: Wind in Zang affects nine orifices (paralysis, aphasia, nasal/ear blockage, blurred vision, constipation). Wind in Fu affects limbs (hemiplegia, limb immobility, left/right paralysis). Wind in Blood Vessels: No exterior Six Meridian symptoms, no interior urination/defecation obstruction, only mouth/eye deviation (left or right). Limb movement, daily life remain normal. If thigh cannot lift, mouth cannot speak, no other symptoms: Wind in Meridian. Lighter than Zang-Fu, heavier than Blood Vessels.
Treatment: Wind in Zang needs purgation; Wind in Fu needs sweating; Wind in Meridian needs tonifying Blood to nourish tendons; Wind in Blood Vessels needs nourishing Blood to move Qi. All treatable, but difficulty varies: Zang hardest, Fu next, Meridian easiest.
If originally Wind in Blood Vessels heals with medicine, but taboos are ignored, recurrence happens, and recurrence hits Zang. Each strike increases deficiency and severity. So Fu is treatable, but if preceded by Blood Vessel/Meridian strike, it becomes hard to treat. Zang is inherently hard to treat, but if preceded by Fu strike, it becomes untreatable. If Fu combines with Zang, how is it different from Cold Damage Double Invasion? Can one survive? (*Dantai Yu'an*)
The classification of Zhongfeng into Blood Vessels, Fu, and Zang originated with Li Dongyuan. Blood Vessels: Da Qin Jiao Tang; Fu: Xiao Xuming Tang; Zang: Sanhua Tang. Yet Sanhua Tang for Zang is rarely seen. *Jingui* divides into four: Luo, Jing, Fu, Zang. This is most accurate. Mouth/eye deviation, skin numbness: Pathogen in Luo; Left/right immobility, bone/tendon dysfunction: Pathogen in Jing; Coma/unconsciousness, urinary/fecal retention: Pathogen in Fu; Coma/speechlessness, lip slack/saliva flow: Pathogen in Zang. Students reading various theories will know this is correct. (*Yizong Jinjian*)
Pathogenesis differs by depth of Zang-Fu and Meridians. Mouth/eye deviation: Luo disease, shallow pathogen, easy to treat. Limb immobility, heavy painful body: Jing disease, deeper pathogen, often seen after collapse. Sudden coma, confused speech: Fu disease, deeper still. Generally, collapse can occur in Jing or Fu; lucid after collapse is Jing; comatose is Fu. Lip slack, aphasia, deafness, blurred vision, enuresis, snoring: Zang disease, deepest. However, Jing combining with Fu, Zang connecting to Jing, or simultaneous Zang-Fu-Meridian disease exist; careful observation is key. (*Jingui Yi*)
**Bi and Tuo Syndromes** (Refer to Tuo Consolidation Methods)
If mouth cannot speak: Heart extinction.
If lips/jaw slack, hands scatter: Spleen extinction.
If eyes closed, staring straight: Liver extinction.
If enuresis with blackening: Kidney extinction.
If snoring sleep with spontaneous sweating: Lung extinction.
This is called Tuo Syndrome (Collapse).
If only jaw clenched, hands tightly grasping: Bi Syndrome (Closure).
Bi Syndrome can be...