卢砥镜曰经云神伤于思虑则内脱意伤于忧愁则肢废魂伤于悲哀则筋挛魄伤于喜乐则皮槁
志
伤于盛怒则腰脊难以俯仰也何侍郎有女适夫夫早世女患十指拳挛掌垂莫举肤体疮疡粟粟然汤
剂杂进饮食顿减几于半载适与诊之则非风也正乃忧愁悲哀所致耳病属内因于是料内因药仍以
鹿角胶辈多用麝香熬膏贴痿垂处渐得掌能举指能伸病渐近安
谨按经云风之伤人也为病善行而数变变至他证之类故为治不得其病情者往往或以风为他
证
或以他证为风皆不免乎得失之诮惟近代河间东垣丹溪诸先生者出始论他证之非中风治法当异
此又卢氏治例可谓深达病情之机者即河间所论五志过极为病之例非真中风也而王安道又曰人
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因尝
考诸内经论风为诸证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则
皆引岐伯之旨金匮要略具脉证邪在络在经入腑入脏之异由是观之则卒暴僵仆不知人偏枯四肢
不举等证固为因风而致者矣乃用大小续命西州续命排风八风等诸汤散治之及近代河间东垣丹
溪三子者出所论始与昔人有异河间主于火东垣主于气丹溪主于湿反以风为虚象而大异于昔人
矣吁昔人之与三子者果孰是与果孰非与若以三子为是则三子未出之前固有从昔人而治愈者矣
以昔人为是则三子已出之后亦有从三子而治愈者矣故不善读其书者往往不得其奥以余观之昔
人与三子之论皆不可偏废但三子以类乎中风之病视为中风而立论故使后人狐疑而不能决殊不
知因于风者真中风也因火因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如内经所谓三阴三阳发病为偏枯痿易四肢不举亦未尝必因于风而
后然也夫风火气湿之殊望闻问切之间岂无所辨乎辨之为风则从昔人以治辨之为火气湿则从三
子以治如此庶乎析理明而用法当矣惟其以因火因气因湿之证强引风而合论之所以真伪不分名
实相紊若以因火因气因湿证分而出之则真中风病彰矣所谓西北有中风东南无中风者其然与否
与斯辨诸子所论名实相紊而不明真中风之异可谓精切又何疑丹溪东南无中风之语哉夫风者天
地之大气也五运之造化四时之正令耳上下八方无所不至者且人在气中形虚者即感之伤之中之
有轻重不同实八风虚实之异耳矧有痿湿火热痰气虚诸证而似中风故古今治例不一是以徐先生
折衷诸经之旨辨以上诸证不得与中风同治又岂惟三子所论哉然王氏以扩充其例因有是辨亦不
害其为叮咛也余尝居凉州即汉之武威郡也其地高阜四时多风少雨土艺粟麦引泉灌溉天气常寒
人之气实腠密每见中风或暴死者有之盖折风燥烈之甚也时洪武乙亥秋八月大风起自西北时甘
州城外路死者数人余亦始悟经谓西北之折风伤人至病暴死之旨不诬丹溪之言有所本也人盖不
经其所虽审经意故莫不有疑者也吁医之不明运气造化地理病机之微而欲行通变之法者难矣哉
卢砥镜说:《内经》记载,神志因过度思虑而受损,会导致内部意志的耗脱;意因忧愁而受伤,会导致肢体废用;魂因悲哀而受损,会导致筋脉拘挛;魄因喜乐过度而受伤,会导致皮肤干枯;志因大怒而受伤,会导致腰脊难以俯仰。何侍郎的女儿嫁人后,丈夫早逝,女儿患病表现为十指拳曲挛缩,手掌下垂无法举起,身体肌肤出现如粟米般的疮疡,汤药杂进,饮食骤然减少,病情持续将近半年。恰逢我为其诊治,发现并非风邪致病,而是由忧愁和悲哀所致。此病属于内因致病,于是推测使用内因类药物,仍以鹿角胶等为主,多用麝香熬制成膏,贴敷于痿软下垂的部位,逐渐得以手掌能举、手指能伸,病情渐渐好转。
我谨按:《内经》记载,风邪伤人,致病特点为善行而数变,变化导致其他证候。因此,治疗时若不能掌握病情本质的人,往往或将风邪误认为其他证候,或将其他证候误认为风邪,都不免受到得失不当的讥讽。直到近代刘河间、李东垣、朱丹溪诸先生出现,才开始论述其他证候并非中风,治疗方法应当不同。像卢氏的治疗案例,可谓深刻通达病情的机理。即河间所论述的五志过极为病的例子,并非真正的中风。而王安道又说:人有突然僵硬仆倒,或半身不遂,或四肢不能举动,或神志不清,或死亡或不死亡的,世人称之为中风,方书也以中风来治疗。我曾考证《内经》论风为各种证候的主宰,其中关于突然僵硬仆倒、神志不清、四肢不能举动的,并没有专门论述,只有关于“偏枯”的一句话罢了。等到观看《千金方》,都引用岐伯的宗旨,《金匮要略》详细列出了脉证以及邪在络、在经、入腑、入脏的区别。由此看来,突然僵硬仆倒、神志不清、偏枯、四肢不能举动等证候,固然是因为风邪所致,于是使用大小续命汤、西州续命汤、排风汤、八风散等各种汤剂来治疗。到了近代刘河间、李东垣、朱丹溪三位先生出现,他们的论述开始与古人不同。河间主张病机在于火,东垣主张病机在于气,丹溪主张病机在于湿,反而将风视为虚象,这与昔人大相径庭。唉!古人和这三位先生,究竟谁对谁错呢?如果认为三位先生是对的,那么在三位先生出现之前,本来就有遵循古人治愈的案例;如果认为古人是正确的,那么在三位先生出现之后,也有遵循三位先生治愈的案例。所以不善于读书的人,往往得不到其中的奥妙。依我看来,古人和三位先生的论述都不可偏废。只是三位先生将类似中风的病视为中风而立论,致使后人狐疑而不能决断。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非中风。三位先生所论述的,自然是因火、因气、因湿而导致的暴病暴死之证,与风有什么关系呢?如《内经》所说三阴三阳发病导致偏枯、痿易、四肢不举,也未尝一定因于风才这样。风、火、气、湿的不同,在望闻问切之间难道没有区别吗?辨明是风,就遵循古人治疗;辨明是火、气、湿,就遵循三位先生治疗。这样或许就能分析道理明确,用法得当。正是因为将因火、因气、因湿的证候强行引风合论,所以真伪不分,名实混乱。如果把因火、因气、因湿的证候分辨出来,那么真中风的病机就彰明了。所谓“西北有中风,东南无中风”,是这样吗?这与上述辨析有关。子(指前文提到的医家)所论述的名实混乱而不明真中风之异,可以说是精切,又何须怀疑丹溪“东南无中风”的话呢?风,是天地的大气,是五运的造化,四时的正令,上下八方无所不至。人在气中,形体虚弱者就会感之,伤之、中之有轻重不同,不过是八风虚实之异罢了。况且还有痿、湿、火热、痰、气、虚等证候而类似中风,所以古今治疗方法不一。因此徐先生折衷各经的宗旨,辨析以上证候不得与中风同治,又岂止是三位先生所论述的呢?然而王氏为了扩充他的例证,因此有了这种辨析,也不妨碍他的叮咛告诫。我曾经居住在凉州,即汉代的武威郡。那里地势高亢,四季多风少雨,土地种植粟麦,引泉水灌溉,天气常寒。人的气实腠理致密,经常见到中风或突然死亡的案例。大概是因为折风燥烈太甚了。当时洪武乙亥年秋八月,大风从西北刮起,当时甘州城外路上死了几个人,我也这才领悟到《内经》所说的西北的折风伤人至病暴死的宗旨是不虚假的,丹溪的话是有根据的。人如果不经历那些地方,虽然审察经意,所以无不有疑惑啊。唉!医生如果不明白运气、造化、地理、病机的微妙,而想要施行通变之法,难啊!
Lu Dijing said: The *Neijing* (Inner Canon) records that when the Shen (Spirit) is damaged by excessive thinking, it leads to internal depletion of Yi (Intellect); when Yi is injured by sorrow and worry, it leads to limb disability; when Hun (Ethereal Soul) is damaged by grief, it leads to tendon contraction; when Po (Corporeal Soul) is injured by excessive joy, it leads withered skin; when Zhi (Will) is injured by extreme anger, it leads to difficulty in bending and stretching the waist and spine. The daughter of Vice Minister He married early, but her husband died young. She suffered from a condition where her ten fingers were curled and contracted, her palms hung down unable to lift, and her body skin presented with millet-like sores. Various decoctions were administered indiscriminately, and her diet suddenly decreased, lasting for nearly half a year. When I examined her, I found it was not Wind disease, but rather caused by sorrow and grief. This illness belongs to internal causes. Therefore, I predicted the use of medicines for internal causes, primarily using Deer Antler Glue (Lujiaojiao), and mostly applying Musk (Shexiang) boiled into an ointment on the flaccid and hanging areas. Gradually, she could lift her palms and extend her fingers, and her condition improved.
I respectfully note: The *Neijing* states that when Wind pathogen injures the human body, the diseases are characterized by rapid movement and frequent changes. These changes lead to other syndromes. Thus, those who treat without grasping the essence of the condition often mistake Wind for other syndromes, or other syndromes for Wind, inevitably facing criticism for their errors. It was only with the emergence of Mr. Liu Hejian, Li Dongyuan, and Zhu Danxi in recent times that they began to argue that other syndromes are not Zhongfeng (Wind Stroke) and that treatment methods should differ. Lu’s case can be considered deeply understanding the mechanism of the condition. That is, Hejian’s discussion of illnesses caused by the excess of the Five Emotions is not true Zhongfeng. Wang Andao also stated: There are people who suddenly stiffen and fall, suffer hemiplegia, have limbs unable to move, lose consciousness, die or survive. The world calls this Zhongfeng, and medical texts treat it as Zhongfeng. I once examined the *Neijing*’s discussion on Wind causing various syndromes. Regarding sudden stiffness and falling, loss of consciousness, and limbs unable to move, there is no specific discussion, except for one mention of Pianku (Hemiplegia). Upon viewing the *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold), all cite Qibo’s principles. The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) details the differences in pulse and symptoms, and whether the pathogen is in the Luo vessels, Jing vessels, Fu organs, or Zang organs. From this perspective, syndromes such as sudden stiffness and falling, loss of consciousness, Pianku, and limbs unable to move are indeed caused by Wind. Thus, various decoctions and powders such as Da Xuming Tang (Large Continuation Life Decoction), Xiao Xuming Tang (Small Continuation Life Decoction), Xizhou Xuming Tang (Xizhou Continuation Life Decoction), Paifeng Tang (Expel Wind Decoction), and Bafeng San (Eight Winds Powder) were used. However, when Liu Hejian, Li Dongyuan, and Zhu Danxi emerged in recent times, their discussions differed from the ancients. Hejian emphasized Fire, Dongyuan emphasized Qi, and Danxi emphasized Dampness. They regarded Wind as a deficiency pattern, which greatly differed from the ancients. Alas! Between the ancients and these three masters, who is right and who is wrong? If we consider the three masters correct, then before their time, there were cases cured by following the ancients. If we consider the ancients correct, then after their time, there were cases cured by following the three masters. Therefore, those who do not read their books well often fail to grasp the subtleties. In my opinion, neither the ancients nor the three masters should be neglected. However, because the three masters treated illnesses resembling Zhongfeng as Zhongfeng in their theories, they caused later generations to hesitate and be undecided. They did not realize that those caused by Wind are True Zhongfeng, while those caused by Fire, Qi, or Dampness are Lei Zhongfeng (Resembling Wind Stroke) and not true Zhongfeng. The conditions discussed by the three masters were naturally acute illnesses and sudden deaths caused by Fire, Qi, and Dampness, having nothing to do with Wind. As the *Neijing* states, the onset of diseases in the Three Yin and Three Yang channels leading to Pianku, Weiyi (flaccidity and ease of movement), and limbs unable to move, does not necessarily require Wind as a cause. Are the distinctions between Wind, Fire, Qi, and Dampness not discernible through Observation, Auscultation/Olfaction, Inquiry, and Palpation? If identified as Wind, follow the ancients’ treatment; if identified as Fire, Qi, or Dampness, follow the three masters’ treatment. This way, reasoning would be clear and methods appropriate. It is precisely because they forced the combination of conditions caused by Fire, Qi, and Dampness with Wind that truth and falsehood became indistinguishable, and names and realities confused. If the conditions caused by Fire, Qi, and Dampness are separated out, then the pathology of True Zhongfeng becomes clear. Is it true that “the Northwest has Zhongfeng, while the Southeast does not”? This relates to the above differentiation. The argument by Zi regarding the confusion of names and realities and the lack of clarity on the distinction of True Zhongfeng can be considered precise. Why doubt Danxi’s statement that “the Southeast has no Zhongfeng”? Wind is the great Qi of heaven and earth, the transformation of the Five Movements, and the proper command of the four seasons. It reaches everywhere up, down, left, and right. Humans exist within this Qi; those with deficient forms are susceptible. Injury and penetration vary in severity, merely differing in the excess or deficiency of the Eight Winds. Moreover, there are conditions such as Flaccidity, Dampness, Heat-Fire, Phlegm, Qi stagnation, and Deficiency that resemble Zhongfeng. Hence, ancient and modern treatment examples vary. Therefore, Mr. Xu synthesized the principles of various classics to differentiate these conditions, stating they should not be treated as Zhongfeng. This applies not only to the three masters. However, since Mr. Wang expanded upon these examples, this differentiation serves as a necessary caution. I once resided in Liangzhou, i.e., Wuwei Commandery of the Han Dynasty. The terrain is high, windy, and rainy-scarce throughout the year. Crops like millet and wheat are grown, irrigated by springs. The climate is often cold. People’s Qi is substantial, and their Couli (pores/skin texture) are dense. I frequently saw cases of Zhongfeng or sudden death. This was likely due to the extreme dryness and ferocity of the Zhefeng (Folding Wind). In the autumn of August in the Yihai year of Hongwu, a strong wind rose from the northwest. Several people died on the roads outside Ganzhou City. I then realized that the *Neijing*’s assertion that the Zhefeng of the Northwest injures humans leading to acute death is not false, and Danxi’s words had a basis. People who have not experienced such places, despite studying the classics, inevitably harbor doubts. Alas! It is difficult for a physician who does not understand the subtleties of Yunqi (Luck and Qi), transformation, geography, and disease mechanisms to practice adaptive methods.