钱 类中五年，偏痱在右。元气不足，痰流经络。近今两
月，谷食大增，虽为美事，亦属胃火。火能消谷，故善食而易饥
也。调治方法，不外补养精血，熄风通络，和胃化痰。
制首乌 当归 大熟地 刺蒺藜 三角胡麻 桑寄生 茯苓 半夏曲 麦冬肉 新会皮
渊按∶此肝肾水亏而虚火盛者，故以滋水熄风为治。
赵 风中廉泉，痰阻舌本，口角流涎，舌蹇而涩，右肢麻木仆中根萌。拟熄风和阳，化痰泄络。
羚羊角 石决明 胆星 法半夏 茯苓 甘菊炭 远志 煨天麻 橘红
渊按∶痰火用事，故泻火化痰，通络熄风。甘菊不宜用炭。
某 口歪于左，手废于右，肝风胃湿，互相牵掣。舌强而蹇，痰留心脾之络也，类中显然。
党参 当归 半夏 茯神 钩钩 石决明 川断 秦艽 胆星 桑枝
渊按∶脾虚生痰，肝虚生风。运脾即是化痰，养肝佐以熄风，为虚实参半之治。
王 两手关脉皆见一粒厥厥动摇之象，此脾虚木盛，内风动
跃之候也。左半肢体麻木不仁，头眩面麻，此属偏枯，虑延仆中。
制首乌 当归 白芍 茯苓 陈皮 煨天麻 秦艽 石决明 刺蒺藜 池菊 钩钩 桑枝
复 两关脉厥厥动摇之象大减，其内风有暗熄之机。左手屈
伸稍安，左足麻木未愈。今拟补肾生肝，为治本之计。
地黄饮子去桂、附。
渊按∶去附、桂，水中之火尚不虚也。
金 左手脉沉弦而涩数不调，乃血虚而肝风暗动也；右关脉
独缓滑，胃有湿痰，尺寸俱弱，金水两虚。症见耳聋，两肩膊 而难举，痰多，口中干腻，是其征也。
大生地 麦冬 归身 石决明 半夏 蒺藜 钩钩 橘红 牡蛎 元参 指迷茯苓丸
丁 脉左弱为血虚，右弱为气虚，气血两虚，上为头眩，半
身以下皆形麻木而成瘫痪，甚则心乱神昏，此肝风挟痰所致。法当清上补下。
淡苁蓉 大生地 天冬 牛膝 元参 菖蒲 大麻 萆 茯苓 陈皮 黄柏 洋参
渊按∶清阳明以利机关，养肝肾以滋阴血，运脾气以化湿痰，丝丝入扣。
孙 血不养筋，肝风走络，左臂酸痛，或止或作。法当养血通络。
制首乌 当归 杞子 豆衣 丹参 蒺藜 苡仁 茯苓 秦艽 桑枝 红枣
蒋 酒客中虚嘈杂，木胜风动，头旋掉眩，兼以手振，此内风挟痰为患。须戒酒节欲为要。
天麻 冬术 茯苓 杞子 沙苑子 钩钩 制首乌 当归 白芍 半夏 石决明 池菊
谢 久患肝风眩晕，复感秋风成疟。疟愈之后，周身筋脉跳
跃，甚则发厥。此乃血虚不能涵木，筋脉失养，虚风走络，痰涎凝聚所致。拟养血熄风，化痰通络。
制首乌 紫石英 白蒺藜 半夏 茯神 洋参 陈皮 羚羊角 石决明 煨天麻 枣仁 竹油 姜汁
渊按∶疟后脾气必虚，风动虽由木燥，痰聚由于脾虚。若舌苔浊腻，运脾化痰尤不可少。
薛 年已六旬，肾肝精血衰微，内风痰涎走络，右偏手足无
力，舌强言涩，类中之根萌也。温补精血，兼化痰涎，冀免偏枯之累。然非易事，耐心调理为宜。
苁蓉干 巴戟肉 茯神 木瓜 半夏 杞子（盐水炒） 远志肉（甘
草汤制） 海风藤 萸肉（酒炒） 牛膝 杜仲（盐水炒）
又 肾藏精，肝藏血，肾肝精血衰微，筋骨自多空隙，湿热
痰涎乘虚入络，右偏手足无力，舌根牵强，类中之根。温补精
血，宣通经络，兼化痰涎，守服不懈，加以恬养安泰，庶几却病延年。
苁蓉干 党参（元米炒） 牛膝 半夏 杞子（盐水炒） 陈皮 续断 茯苓 巴戟肉 桑枝
又 丸方。
苁蓉干（二两，酒煮烂，捣入） 党参（三两，元米炒） 熟地（四两，砂仁末、
陈酒拌，蒸烂捣入） 麦冬（二两，去心，元米炒） 枣仁（三两，炒、研） 巴戟肉（三
两，盐水炒） 归身（二两，酒炒） 萆 （三两，炒） 制首乌（四两，炒） 茯神
（三两） 牛膝（三两，盐水炒） 天冬（二两，去心，元米炒） 半夏（二两） 陈皮（二两
五钱） 杜仲（三两，盐水炒） 虎骨（三两，炙） 菖蒲（一两） 杞子（四两，盐水炒）
上药各选道地，如法制炒，共研细末。用竹沥四两，姜汁三
两，捣入，再将白蜜为丸，如黍米大，用瓷器装好。每朝服五钱，开水送下。
唐 风痰入络，脑后胀痛，舌根牵强，言语不利，饮食减进。久防痱中。
羚羊角 防风 制僵蚕 生甘草 羌活 远志肉 川芎 桔
梗桑叶 薄荷 钩钩
又 颈项胀是风，舌根强属痰，风与痰合，久防类中。
熟地 白芍 续断 杞子 杜仲 秦艽 当归 牛膝
渊按∶实多虚少，前方恰合。后方大补，与痰阻舌本者不宜。
费 类中之后，手足不遂，舌根牵强，风痰入络所致。防其复中。
党参 大生地 制南星 白芍 秦艽 冬术 制首乌 羚羊
角虎骨 归身 牛膝 海风藤 沙苑子 茯苓 枣仁 杜仲 生苡仁 陈皮 川贝 半夏
上药煎浓三次，加竹沥二茶杯，姜汁二十匙，白蜜二杯，阿胶四两，烊化收膏。
某 劳碌伤气，肝风、阳气弛张；肥体气虚，湿热痰火扰
动。忽然磕睡，几乎跌仆，舌强言漫，右偏肢痱。此属偏中，犹
幸神识尚清，痰涎未涌，或可图幸。治以熄风化痰，安神清火，冀其得效为妙。
羚羊 决明 天麻 竺黄 茯神 菖蒲 川贝 胆星 半夏 橘红 嫩钩 竹沥 淡姜汁
范 惊动肝胆，风阳与胃中之痰浊交互入络。营卫营运之
气，上下升降之机，阻窒碍滞。周身皮肤，肌肉，关节麻木不
仁，胸脘不畅，饮食无味，口多涎沫，头昏心悸。风阳抑郁不
伸，痰浊弥漫不化。苔白而裂，大便干燥。胃虽有湿，而肠液已枯矣。拟清火熄风，化痰渗湿，参以养血滋液。
羚羊 苁蓉干 天麻 决明 半夏 麻仁 制南星 泽泻 橘红 茯神 当归 嫩钩 姜汁 竹沥
渊按∶饮食不化精微而化痰浊，致胃湿肠燥，由气秘不行，中焦升降失其常度耳。
何 右关脉独滑动如豆，此有痰浊在中焦也。中脘皮肉觉
浓，手足筋脉时或动惕，痰走经络之象。法当攻补兼施。
朝服香砂六君丸三钱，夜服控涎丹十四粒，朱砂为衣。
陆 素有痰饮咳嗽，土弱金虚。金虚不能制木，并不能生
水；土弱不能御木之侮，并不能生金而化痰。病情有似风痰瘫
痪，足软难行，口流涎沫，舌左半无苔，口常不渴，脉虚弦滑，
大便坚燥。种种见症，皆显金土水不足而风痰有余。病根日久，调之不易，姑拟一方备采。
苁蓉干 半夏 五味 牛膝（盐水炒） 麦冬（元米炒） 巴戟天 麻
仁熟地 茯神 陈皮 肉桂 竹沥 姜汁
吴 体肥多湿，性燥多火。十年前小产血崩，遂阴亏火亢，
肝风暗动，筋络失养，其根已非一日。去秋伏暑而成三疟，疟久
营卫偏虚，遂致内风夹痰扰络，右半身麻痹而似偏痱，调理渐
愈。今但右足麻辣热痛，痛自足大趾而起，显系血虚肝经失养。
据云，腿膝常冷，足骱常热。并非足骱有火而腿膝有寒也。想因
痛处则热；上腿之处气血不足，故寒也。至于左胫外 皮肉之
内，结核如棉子，发作则痛甚，此属筋箭，是风痰瘀血交凝入络
而成，与右足之热痛麻辣不同。今且先治其右足，姑拟一方请正。
大生地 萆 茯苓 阿胶 天麻 五加皮 归身 牛膝 冬术 独活 丝瓜络 木瓜
渊按∶筋箭之名甚新。仁渊曰∶中风一证，昔河间言火，
东垣言气，丹溪言痰，各持其说。以余观之，要不外阴精阳气不
能转输布化，或痰或火或气得以乘间窃发，阻其窍隧经络，致无
故昏仆，或口噤语蹇，手足偏废，虽有脏腑经络之分，总是本虚
标实。惟本虚故容易受邪，而风也，火也，痰也，虽名外邪，其实
风即逆气所化，痰即饮食所生，火亦阳气偏盛，乃化良民为盗贼
耳。《内经》曰∶人年四十而阴气自半。阴气者，乃五脏之精气
也。精气暗亏，三邪易发，故病者每在四十以后，少壮者鲜焉。
王清任《医林改错》谓全属虚证，治以大剂黄 ，虽属偏见，不
为无因。而细想病情，若非真脏大虚，安有如是猝暴！与外感伤
风、中风，岂可同年而语！彼则贼自外来，此则舋由内起。古人
以小续命加减治一切中风，余每疑焉。盖以辛温发散之方，而治
内伤精气之病。朱丹溪曰∶西北方气寒土燥，或有真中风；东南则
因湿生痰，痰生火，火生风耳。若然，则西北之病仍是外感风邪
而名为中风，与猝然昏仆偏废，大相悬绝，岂可混同论治！余生
长东南，未见西北之病，读书至中风一篇，每不满意于古人焉。
钱某：患类中风（类似中风的病证）五年，右侧肢体偏瘫失用。元气不足，痰湿流注于经络。近两个月来，食欲大增，这虽是好事，但也属于胃火亢盛。因为火能消谷，所以容易饥饿且食量大。调治方法，不外乎补养精血，熄风通络，和胃化痰。
制首乌、当归、大熟地、刺蒺藜、三角胡麻、桑寄生、茯苓、半夏曲、麦冬肉、新会皮。
渊按：这是肝肾阴水亏虚而虚火旺盛的证候，所以以滋补肾水、平熄肝风为治疗原则。
赵某：风邪中于廉泉穴，痰浊阻滞舌根，导致口角流涎，舌体僵硬言语不清，右侧肢体麻木，有仆倒中风的苗头。拟用熄风和阳，化痰通络之法。
羚羊角、石决明、胆南星、法半夏、茯苓、甘菊炭、远志、煨天麻、橘红。
渊按：这是痰火为患，所以用泻火化痰、通络熄风的方法。甘菊不宜用炭制品。
某人：左侧口眼歪斜，右侧手部功能丧失，肝风与胃湿互相牵掣。舌体僵硬言语不利，痰浊留留心脾之络脉，显然是类中风。
党参、当归、半夏、茯神、钩藤、石决明、川断、秦艽、胆南星、桑枝。
渊按：脾虚生痰，肝虚生风。运化脾气即是化痰，滋养肝木佐以熄风，这是虚实兼顾的治疗方法。
王某：两手关脉都出现一粒粒厥厥动摇的脉象，这是脾虚肝旺，内风动跃的征候。左半身肢体麻木不仁，头晕面麻，这属于偏枯（半身不遂），担心发展为仆倒中风。
制首乌、当归、白芍、茯苓、陈皮、煨天麻、秦艽、石决明、刺蒺藜、池菊、钩藤、桑枝。
复诊：两关脉厥厥动摇的脉象大大减轻，内风有暗中平息的趋势。左手屈伸稍安，左足麻木未愈。现在拟用补肾生肝的方法，作为治本之计。
地黄饮子去桂枝、附子。
金某：左手脉沉弦而涩数不调，这是血虚而肝风暗动；右关脉独缓滑，胃中有湿痰，寸尺脉俱弱，肺金肾水两虚。症状见耳聋，两肩膊沉重难以举起，痰多，口中干腻，就是这些征象。
大生地、麦冬、归身、石决明、半夏、蒺藜、钩藤、橘红、牡蛎、元参、指迷茯苓丸。
丁某：脉左弱为血虚，右弱为气虚，气血两虚，上则头晕，半身以下皆形麻木而成瘫痪，甚则心乱神昏，这是肝风挟痰所致。治法应当清上补下。
淡苁蓉、大生地、天冬、牛膝、元参、菖蒲、大麻仁、萆薢、茯苓、陈皮、黄柏、洋参。
渊按：清阳明经热以利机关，养肝肾以滋阴血，运脾气以化湿痰，丝丝入扣。
孙某：血不养筋，肝风走窜络脉，左臂酸痛，时止时作。治法当养血通络。
制首乌、当归、杞子、豆衣、丹参、蒺藜、苡仁、茯苓、秦艽、桑枝、红枣。
蒋某：酒客中气虚弱嘈杂，木旺风动，头晕目眩，兼以手抖，这是内风挟痰为患。必须戒酒节欲为关键。
天麻、冬术、茯苓、杞子、沙苑子、钩藤、制首乌、当归、白芍、半夏、石决明、池菊。
谢某：久患肝风眩晕，又感秋风成疟疾。疟疾痊愈后，周身筋脉跳跃，甚则发厥。这是血虚不能涵敛肝木，筋脉失养，虚风走络，痰涎凝聚所致。拟用养血熄风，化痰通络之法。
制首乌、紫石英、白蒺藜、半夏、茯神、洋参、陈皮、羚羊角、石决明、煨天麻、枣仁、竹油、姜汁。
渊按：疟后脾气必虚，风动虽由木燥引起，痰聚由于脾虚造成。若舌苔浊腻，运脾化痰尤其不可少。
薛某：年已六十，肾肝精血衰微，内风痰涎走窜络脉，右侧手足无力，舌强言语涩滞，是类中风的萌芽。温补精血，兼化痰涎，希望避免偏枯的拖累。但这并非易事，耐心调理为宜。
苁蓉干、巴戟肉、茯神、木瓜、半夏、杞子（盐水炒）、远志肉（甘草汤制）、海风藤、萸肉（酒炒）、牛膝、杜仲（盐水炒）。
又方：肾藏精，肝藏血，肾肝精血衰微，筋骨自然多有空隙，湿热痰涎乘虚入络，右侧手足无力，舌根牵强，是类中风的根源。温补精血，宣通经络，兼化痰涎，坚持服用不懈怠，加上恬静调养安泰，或许能祛病延年。
苁蓉干、党参（元米炒）、牛膝、半夏、杞子（盐水炒）、陈皮、续断、茯苓、巴戟肉、桑枝。
又方：丸方。
苁蓉干（二两，酒煮烂，捣入）、党参（三两，元米炒）、熟地（四两，砂仁末、陈酒拌，蒸烂捣入）、麦冬（二两，去心，元米炒）、枣仁（三两，炒、研）、巴戟肉（三两，盐水炒）、归身（二两，酒炒）、萆薢（三两，炒）、制首乌（四两，炒）、茯神（三两）、牛膝（三两，盐水炒）、天冬（二两，去心，元米炒）、半夏（二两）、陈皮（二两五钱）、杜仲（三两，盐水炒）、虎骨（三两，炙）、菖蒲（一两）、杞子（四两，盐水炒）。
以上药物各选道地药材，依法炮制，共研细末。用竹沥四两，姜汁三两，捣入药末中，再将白蜜制成丸药，如黍米大小，用瓷器装好。每晨服五钱，开水送下。
唐某：风痰入络，脑后胀痛，舌根牵强，言语不利，饮食减少。长久防范痱中（中风重症）。
羚羊角、防风、制僵蚕、生甘草、羌活、远志肉、川芎、桔梗、桑叶、薄荷、钩藤。
又方：颈项胀是风邪，舌根强属痰浊，风与痰合，长久防范类中风。
熟地、白芍、续断、杞子、杜仲、秦艽、当归、牛膝。
渊按：实证多虚证少，前方恰好合适。后方大补，对于痰阻舌根者不宜。
费某：类中风之后，手足不遂，舌根牵强，是风痰入络所致。防止其复发中风。
党参、大生地、制南星、白芍、秦艽、冬术、制首乌、羚羊角、虎骨、归身、牛膝、海风藤、沙苑子、茯苓、枣仁、杜仲、生苡仁、陈皮、川贝、半夏。
以上药物煎浓三次，加竹沥二茶杯，姜汁二十匙，白蜜二杯，阿胶四两，烊化收膏。
某人：劳碌伤气，肝风、阳气弛张；肥人体质气虚，湿热痰火扰动。忽然嗜睡，几乎跌倒，舌强言语模糊，右侧偏身麻木。这属于偏中，幸好神识尚清，痰涎未涌，或许可以侥幸治愈。治以熄风化痰，安神清火，希望得效为妙。
羚羊角、决明子、天麻、竺黄、茯神、菖蒲、川贝、胆南星、半夏、橘红、嫩钩藤、竹沥、淡姜汁。
范某：惊动肝胆，风阳与胃中之痰浊交互入络。营卫营运之气，上下升降之机，阻窒碍滞。周身皮肤、肌肉、关节麻木不仁，胸脘不畅，饮食无味，口多涎沫，头昏心悸。风阳抑郁不伸，痰浊弥漫不化。苔白而裂，大便干燥。胃虽有湿，而肠液已枯矣。拟用清火熄风，化痰渗湿，参以养血滋液之法。
羚羊角、苁蓉干、天麻、决明子、半夏、麻仁、制南星、泽泻、橘红、茯神、当归、嫩钩藤、姜汁、竹沥。
渊按：饮食不化精微而化痰浊，导致胃湿肠燥，是由于气机秘结不行，中焦升降失去常度所致。
何某：右关脉独滑动如豆，这是有中焦痰浊。中脘部皮肉感觉浓重，手足筋脉时而跳动，这是痰走经络的征象。治法应当攻补兼施。
朝服香砂六君丸三钱，夜服控涎丹十四粒，朱砂为衣。
陆某：素有痰饮咳嗽，土弱金虚。金虚不能制木，也不能生水；土弱不能御木之侮，也不能生金而化痰。病情有似风痰瘫痪，足软难行，口流涎沫，舌左半无苔，口常不渴，脉虚弦滑，大便坚燥。种种见症，皆显金土水不足而风痰有余。病根日久，调理不易，姑拟一方供参考。
苁蓉干、半夏、五味子、牛膝（盐水炒）、麦冬（元米炒）、巴戟天、麻仁、熟地、茯神、陈皮、肉桂、竹沥、姜汁。
吴某：体肥多湿，性燥多火。十年前小产血崩，遂致阴亏火亢，肝风暗动，筋络失养，其根已非一日。去年秋天伏暑而成三疟，疟久营卫偏虚，遂致内风夹痰扰络，右半身麻痹而似偏痱，调理渐愈。现在仅右足麻辣热痛，痛自足大趾而起，显系血虚肝经失养。据云，腿膝常冷，足骱常热。并非足骱有火而腿膝有寒也。想因痛处则热；上腿之处气血不足，故寒也。至于左胫外皮肉之内，结核如棉子，发作则痛甚，此属筋箭（筋瘤），是风痰瘀血交凝入络而成，与右足之热痛麻辣不同。现在暂且先治其右足，姑拟一方请指正。
大生地、萆薢、茯苓、阿胶、天麻、五加皮、归身、牛膝、冬术、独活、丝瓜络、木瓜。
渊按：筋箭之名很新。仁渊说：中风一证，过去河间言火，东垣言气，丹溪言痰，各持其说。在我看来，无非是阴精阳气不能转输布化，或痰或火或气得以乘间窃发，阻塞窍隧经络，导致无故昏仆，或口噤语蹇，手足偏废，虽有脏腑经络之分，总是本虚标实。正因为本虚，所以容易受邪，而风、火、痰，虽名为外邪，其实风即逆气所化，痰即饮食所生，火亦阳气偏盛，乃是化良民为盗贼耳。《内经》说：人年四十而阴气自半。阴气者，乃五脏之精气也。精气暗亏，三邪易发，故病患者多在四十以后，少壮者很少。王清任《医林改错》谓全属虚证，治以大剂黄芪，虽属偏见，不为无因。但细想病情，若非真脏大虚，怎会有如此猝暴！与外感伤风、中风，岂可同年而语！彼则是贼自外来，此则是衅由内起。古人用小续命汤加减治一切中风，我每每怀疑。盖以辛温发散之方，而治内伤精气之病。朱丹溪说：西北方气寒土燥，或有真中风；东南则因湿生痰，痰生火，火生风耳。如果这样，那么西北的病仍是外感风邪而名为中风，与猝然昏仆偏废，大相悬绝，岂可混同论治！我生长在东南，未见西北之病，读书至中风一篇，每每不满意于古人焉。
Qian: Suffering from Lei Zhong Feng (stroke-like syndrome) for five years, with right-sided hemiplegia. Deficiency of Yuan Qi (Primordial Qi), phlegm flowing into the meridians. In the past two months, appetite has increased significantly; although this is a good sign, it also indicates Stomach Fire. Fire can digest food, hence the tendency to eat well and feel hungry easily. The treatment method involves nourishing essence and blood, extinguishing wind and unblocking collaterals, harmonizing the stomach and resolving phlegm.
Prepared Polygonum multiflorum (Zhi Shou Wu), Angelica sinensis (Dang Gui), large prepared Rehmannia root (Da Shu Di), Tribulus terrestris (Ci Ji Li), Sesamum indicum (San Jiao Hu Ma), Taxillus chinensis (Sang Ji Sheng), Poria cocos (Fu Ling), fermented Pinellia ternata (Ban Xia Qu), Ophiopogon japonicus (Mai Dong Rou), Xinhui tangerine peel (Xin Hui Pi).
Commentary by Yuan: This is a case of deficiency of Liver-Kidney Yin water with flourishing deficient fire; therefore, the treatment focuses on nourishing water to extinguish wind.
Zhao: Wind strikes the Lianquan point (Ren-23), phlegm obstructs the tongue base, causing drooling from the corner of the mouth, stiff and slurred speech, numbness in the right limbs, and signs of impending stroke. Proposed treatment: Extinguish wind and harmonize Yang, resolve phlegm and unblock collaterals.
Antelope horn (Ling Yang Jiao), Abalone shell (Shi Jue Ming), Arisaema cum Bile (Dan Xing), processed Pinellia ternata (Fa Ban Xia), Poria cocos (Fu Ling), Chrysanthemum morifolium carbonized (Gan Ju Tan), Polygala tenuifolia (Yuan Zhi), roasted Gastrodia elata (Wei Tian Ma), Tangerine peel (Ju Hong).
Commentary by Yuan: Phlegm-fire is the pathogenic factor; thus, clearing fire and resolving phlegm, unblocking collaterals and extinguishing wind are employed. Chrysanthemum should not be used in carbonized form.
Certain patient: Left-sided facial paralysis, right hand dysfunction, Liver wind and Stomach dampness pulling against each other. Stiff tongue and slurred speech, phlegm lingering in the collaterals of Heart and Spleen, clearly indicating Lei Zhong Feng (stroke-like syndrome).
Codonopsis pilosula (Dang Shen), Angelica sinensis (Dang Gui), Pinellia ternata (Ban Xia), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Uncaria rhynchophylla (Gou Gou), Abalone shell (Shi Jue Ming), Dipsacus asper (Chuan Duan), Gentiana macrophylla (Qin Jiao), Arisaema cum Bile (Dan Xing), Mulberry twig (Sang Zhi).
Commentary by Yuan: Spleen deficiency generates phlegm, Liver deficiency generates wind. Regulating the Spleen is tantamount to resolving phlegm; nourishing the Liver assists in extinguishing wind. This is a treatment balancing deficiency and excess.
Wang: Both Guan pulses exhibit a rolling, trembling sensation like a single grain, indicating Spleen deficiency with Wood hyperactivity, a sign of internal wind stirring. Numbness and insensitivity in the left half of the body, dizziness and facial numbness, belong to Pian Ku (hemiplegia); there is concern about progression to sudden collapse (stroke).
Prepared Polygonum multiflorum (Zhi Shou Wu), Angelica sinensis (Dang Gui), White Peony Root (Bai Shao), Poria cocos (Fu Ling), Tangerine peel (Chen Pi), roasted Gastrodia elata (Wei Tian Ma), Gentiana macrophylla (Qin Jiao), Abalone shell (Shi Jue Ming), Tribulus terrestris (Ci Ji Li), Hangzhou Chrysanthemum (Chi Ju), Uncaria rhynchophylla (Gou Gou), Mulberry twig (Sang Zhi).
Follow-up: The rolling, trembling sensation in both Guan pulses has greatly diminished, indicating that internal wind is secretly subsiding. Flexion and extension of the left hand have slightly improved, but numbness in the left foot persists. Now proposing to tonify Kidney to generate Liver, as a fundamental treatment.
Di Huang Yin Zi (Rehmannia Decoction for the Kidney) minus Cinnamon Twig (Gui Zhi) and Aconite Root (Fu Zi).
Commentary by Yuan: Removing Aconite and Cinnamon is because the fire within the Water (Kidney) is not yet sufficiently deficient.
Jin: Left hand pulse is deep, wiry, choppy, rapid, and irregular, indicating Blood deficiency with latent Liver wind stirring; the right Guan pulse alone is slow and slippery, indicating damp-phlegm in the Stomach; Cun and Chi pulses are both weak, indicating deficiency of Metal (Lung) and Water (Kidney). Symptoms include deafness, heaviness in both shoulders making lifting difficult, excessive phlegm, and dry, greasy feeling in the mouth. These are the signs.
Large Prepared Rehmannia Root (Da Sheng Di), Ophiopogon japonicus (Mai Dong), Angelica sinensis root tip (Gui Shen), Abalone shell (Shi Jue Ming), Pinellia ternata (Ban Xia), Tribulus terrestris (Bi Li), Uncaria rhynchophylla (Gou Gou), Tangerine peel (Ju Hong), Oyster shell (Mu Li), Scrophularia ningpoensis (Yuan Shen), Zhi Mi Fu Ling Wan (Pinellia Pill for Resolving Phlegm).
Ding: Weak left pulse indicates Blood deficiency; weak right pulse indicates Qi deficiency. Both Qi and Blood are deficient, leading to dizziness above and numbness progressing to paralysis below the waist. Severe cases involve mental confusion and unconsciousness, caused by Liver wind carrying phlegm. The method should be to clear the upper and tonify the lower.
Cistanche deserticola (Dan Cong Rong), Large Prepared Rehmannia Root (Da Sheng Di), Asparagus cochinchinensis (Tian Dong), Achyranthes bidentata (Niu Xi), Scrophularia ningpoensis (Yuan Shen), Acorus tatarinowii (Chang Pu), Hemp seed (Da Ma), Dioscorea hypoglauca (Bi Xie), Poria cocos (Fu Ling), Tangerine peel (Chen Pi), Phellodendron amurense (Huang Bo), American Ginseng (Yang Shen).
Commentary by Yuan: Clearing Yangming heat to benefit the joints, nourishing Liver and Kidney to tonify Yin and Blood, regulating Spleen Qi to transform damp-phlegm; every step is precise.
Sun: Blood fails to nourish tendons, Liver wind travels through collaterals, causing soreness and pain in the left arm, intermittent. Treatment should nourish Blood and unblock collaterals.
Prepared Polygonum multiflorum (Zhi Shou Wu), Angelica sinensis (Dang Gui), Lycium barbarum (Qi Zi), Soybean coat (Dou Yi), Salvia miltiorrhiza (Dan Shen), Tribulus terrestris (Bi Li), Coix seed (Yi Ren), Poria cocos (Fu Ling), Gentiana macrophylla (Qin Jiao), Mulberry twig (Sang Zhi), Red date (Hong Zao).
Jiang: Wine drinkers often have deficient Middle Jiao and epigastric discomfort; Wood hyperactivity causes wind stirring, leading to dizziness and vertigo, accompanied by hand tremors. This is internal wind carrying phlegm. Abstaining from alcohol and moderating sexual desire is essential.
Gastrodia elata (Tian Ma), Atractylodes macrocephala (Dong Zhu), Poria cocos (Fu Ling), Lycium barbarum (Qi Zi), Astragalus complanatus (Sha Yuan Zi), Uncaria rhynchophylla (Gou Gou), Prepared Polygonum multiflorum (Zhi Shou Wu), Angelica sinensis (Dang Gui), White Peony Root (Bai Shao), Pinellia ternata (Ban Xia), Abalone shell (Shi Jue Ming), Hangzhou Chrysanthemum (Chi Ju).
Xie: Long-term Liver wind vertigo, complicated by autumn wind causing malaria. After malaria subsided, muscle twitching occurred throughout the body, sometimes leading to syncope. This is due to Blood deficiency failing to anchor Wood, tendons and collaterals losing nourishment, virtual wind traveling through collaterals, and accumulation of saliva-phlegm. Proposed treatment: Nourish Blood and extinguish wind, resolve phlegm and unblock collaterals.
Prepared Polygonum multiflorum (Zhi Shou Wu), Purple Quartz (Zi Shi Ying), White Tribulus (Bai Bi Li), Pinellia ternata (Ban Xia), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), American Ginseng (Yang Shen), Tangerine peel (Chen Pi), Antelope horn (Ling Yang Jiao), Abalone shell (Shi Jue Ming), roasted Gastrodia elata (Wei Tian Ma), Ziziphus jujuba seed (Zao Ren), Bamboo sap (Zhu You), Ginger juice (Jiang Zhi).
Commentary by Yuan: After malaria, Spleen Qi must be deficient. Although wind stirring stems from Dryness of Wood, phlegm accumulation results from Spleen deficiency. If the tongue coating is turbid and greasy, regulating the Spleen and resolving phlegm is indispensable.
Xue: At sixty years old, Essence and Blood of Kidney and Liver are severely depleted. Internal wind and saliva-phlegm travel through collaterals, causing weakness in right-hand and foot, stiff tongue and slurred speech, marking the onset of Lei Zhong Feng (stroke-like syndrome). Warm-tonify Essence and Blood, simultaneously resolve saliva-phlegm, hoping to avoid the burden of hemiplegia. However, this is not easy; patient patience in regulation is advisable.
Cistanche deserticola (Cong Rong Gan), Morinda officinalis (Ba Ji Rou), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Papaya (Mu Gua), Pinellia ternata (Ban Xia), Lycium barbarum (salt-fried), Polygala tenuifolia (Yuan Zhi Rou, prepared with Licorice decoction), Sea grapevine (Hai Feng Teng), Cornus officinalis (Yu Rou, wine-fried), Achyranthes bidentata (Niu Xi), Eucommia ulmoides (Du Zhong, salt-fried).
Second prescription: Kidney stores Essence, Liver stores Blood. Depletion of Kidney-Liver Essence and Blood leaves bones and tendons with gaps; damp-heat and saliva-phlegm enter collaterals exploiting these deficiencies. Weakness in right-hand and foot, stiffness at tongue base, are roots of stroke. Warm-tonify Essence and Blood, diffuse and unblock meridians, simultaneously resolve saliva-phlegm. Persist in taking without懈怠, combined with tranquil nurturing, to hopefully dispel disease and prolong life.
Cistanche deserticola (Cong Rong Gan), Codonopsis pilosula (Yuan Mi fried), Achyranthes bidentata (Niu Xi), Pinellia ternata (Ban Xia), Lycium barbarum (salt-fried), Tangerine peel (Chen Pi), Dipsacus asper (Xu Duan), Poria cocos (Fu Ling), Morinda officinalis (Ba Ji Rou), Mulberry twig (Sang Zhi).
Third prescription: Pill formula.
Cistanche deserticola (2 liang, boiled in wine until soft, pounded in), Codonopsis pilosula (3 liang, fried with millet), Prepared Rehmannia Root (4 liang, mixed with Amomum kravanh powder and aged wine, steamed until soft and pounded in), Ophiopogon japonicus (2 liang, heart removed, fried with millet), Ziziphus jujuba seed (3 liang, fried and ground), Morinda officinalis (3 liang, salt-fried), Angelica sinensis root tip (2 liang, wine-fried), Dioscorea hypoglauca (3 liang, fried), Prepared Polygonum multiflorum (4 liang, fried), Poria cocos with Salvia miltiorrhiza roots (3 liang), Achyranthes bidentata (3 liang, salt-fried), Asparagus cochinchinensis (2 liang, heart removed, fried with millet), Pinellia ternata (2 liang), Tangerine peel (2.5 liang), Eucommia ulmoides (3 liang, salt-fried), Tiger bone (3 liang, roasted), Acorus tatarinowii (1 liang), Lycium barbarum (4 liang, salt-fried).
Select authentic herbs for each ingredient, process according to method, grind into fine powder. Mix with 4 liang of Bamboo sap and 3 liang of Ginger juice, then bind with white honey into pills the size of millet seeds. Store in porcelain vessels. Take 5 qian each morning, washed down with boiling water.
Tang: Wind-phlegm enters collaterals, causing distending pain at the back of the head, stiffness at tongue base, difficulty speaking, and reduced intake of food. Long-term prevention of Fei Zhong (severe stroke) is needed.
Antelope horn (Ling Yang Jiao), Saposhnikovia divaricata (Fang Feng), Processed Bombyx batryticatus (Zhi Jiang Can), Raw Licorice root (Sheng Gan Cao), Notopterygium incisum (Qiang Huo), Polygala tenuifolia (Yuan Zhi Rou), Ligusticum chuanxiong (Chuan Xiong), Platycodon grandiflorus (Jie Geng), Mulberry leaf (Sang Ye), Mentha haplocalyx (Bo He), Uncaria rhynchophylla (Gou Gou).
Second prescription: Neck stiffness is Wind; tongue base stiffness is Phlegm. Wind and Phlegm combine; long-term prevention of Lei Zhong Feng is needed.
Prepared Rehmannia Root (Shu Di), White Peony Root (Bai Shao), Dipsacus asper (Xu Duan), Lycium barbarum (Qi Zi), Eucommia ulmoides (Du Zhong), Gentiana macrophylla (Qin Jiao), Angelica sinensis (Dang Gui), Achyranthes bidentata (Niu Xi).
Commentary by Yuan: Excess is greater than deficiency; the first prescription fits well. The second prescription is strongly tonifying, which is unsuitable for cases with phlegm obstructing the tongue base.
Fei: Post-stroke, limb incontinence, tongue base stiffness, caused by wind-phlegm entering collaterals. Prevent recurrence of stroke.
Codonopsis pilosula (Dang Shen), Large Prepared Rehmannia Root (Da Sheng Di), Processed Arisaema (Zhi Nan Xing), White Peony Root (Bai Shao), Gentiana macrophylla (Qin Jiao), Atractylodes macrocephala (Dong Zhu), Prepared Polygonum multiflorum (Zhi Shou Wu), Antelope horn (Ling Yang Jiao), Tiger bone (Hu Gu), Angelica sinensis root tip (Gui Shen), Achyranthes bidentata (Niu Xi), Sea grapevine (Hai Feng Teng), Astragalus complanatus (Sha Yuan Zi), Poria cocos (Fu Ling), Ziziphus jujuba seed (Zao Ren), Eucommia ulmoides (Du Zhong), Raw Coix seed (Sheng Yi Ren), Tangerine peel (Chen Pi), Fritillaria thunbergii (Chuan Bei), Pinellia ternata (Ban Xia).
Decoct the above herbs three times until concentrated. Add 2 teacups of Bamboo sap, 20 spoons of Ginger juice, 2 cups of white honey, and 4 liang of Donkey-hide gelatin (E Jiao), melt and collect as paste.
Certain patient: Overwork injures Qi, causing Liver wind and Yang Qi to relax and expand; obesity leads to Qi deficiency, with damp-heat, phlegm, and fire disturbing. Sudden sleepiness, nearly falling, stiff tongue and blurred speech, right-sided hemiparesis. This belongs to Pian Zhong (lateral stroke). Fortunately, consciousness is still clear, phlegm-saliva has not surged; perhaps lucky recovery is possible. Treatment: Extinguish wind and resolve phlegm, calm spirit and clear fire, hoping for efficacy.
Antelope horn (Ling Yang), Cassia seed (Jue Ming), Gastrodia elata (Tian Ma), Arisaema cum Arisaematis Rhizoma (Zhu Huang), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Acorus tatarinowii (Chang Pu), Fritillaria thunbergii (Chuan Bei), Arisaema cum Bile (Dan Xing), Pinellia ternata (Ban Xia), Tangerine peel (Ju Hong), Tender Uncaria rhynchophylla (Nen Gou), Bamboo sap (Zhu Li), Light Ginger juice (Dan Jiang Zhi).
Fan: Shock disturbs Liver and Gallbladder, Wind-Yang interacts with turbid phlegm in Stomach, entering collaterals together. The Qi of Ying and Wei circulation, and the mechanism of ascending and descending, are obstructed and stagnant. Numbness and insensitivity in skin, muscles, and joints throughout the body, chest and epigastrium uncomfortable, loss of taste, excessive salivation, dizziness and palpitations. Wind-Yang depressed and unable to extend, turbid phlegm diffusing and unable to transform. Tongue coating white and cracked, dry stool. Although Stomach has dampness, Intestinal fluids are dried up. Proposed treatment: Clear fire and extinguish wind, resolve phlegm and leach out dampness, supplemented by nourishing Blood and moistening fluids.
Antelope horn (Ling Yang), Cistanche deserticola (Cong Rong Gan), Gastrodia elata (Tian Ma), Cassia seed (Jue Ming), Pinellia ternata (Ban Xia), Hemp seed (Ma Ren), Processed Arisaema (Zhi Nan Xing), Alisma orientale (Ze Xie), Tangerine peel (Ju Hong), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Angelica sinensis (Dang Gui), Tender Uncaria rhynchophylla (Nen Gou), Ginger juice (Jiang Zhi), Bamboo sap (Zhu Li).
Commentary by Yuan: Food failing to transform into refined essence but instead generating turbid phlegm leads to Stomach dampness and Intestinal dryness, due to constipation of Qi movement and loss of normal ascending-descending function in the Middle Jiao.
He: Right Guan pulse alone is slippery and rolling like a bean, indicating turbid phlegm in the Middle Jiao. Sensation of heaviness in skin and flesh at Zhongwan (CV-12), occasional twitching of tendons and vessels in hands and feet, signs of phlegm traveling through meridians. Treatment should combine attacking and tonifying.
Morning: Take Xiang Sha Liu Jun Wan (Aucklandia and Amomum Six Gentlemen Pills) 3 qian. Night: Take Kong Yan Dan (Phlegm-Draining Pill) 14 grains, coated with Cinnabar.
Lu: Chronic history of phlegm-fluid cough, weak Earth and deficient Metal. Deficient Metal cannot control Wood, nor generate Water; weak Earth cannot resist Wood's invasion, nor generate Metal to resolve phlegm. Symptoms resemble wind-phlegm paralysis, weak legs difficult to walk, drooling, no coating on left half of tongue, constant lack of thirst, empty-wiry-slippery pulse, hard dry stool. Various symptoms show insufficiency of Metal, Earth, and Water, with excess wind-phlegm. Disease root is long-standing, difficult to regulate; tentatively prescribing one formula for reference.
Cistanche deserticola (Cong Rong Gan), Pinellia ternata (Ban Xia), Schisandra chinensis (Wu Wei), Achyranthes bidentata (salt-fried), Ophiopogon japonicus (fried with millet), Morinda officinalis (Ba Ji Tian), Hemp seed (Ma Ren), Prepared Rehmannia Root (Shu Di), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Tangerine peel (Chen Pi), Cinnamon bark (Rou Gui), Bamboo sap (Zhu Li), Ginger juice (Jiang Zhi).
Wu: Obesity implies much dampness; dry temperament implies much fire. Ten years ago, miscarriage and bloody discharge led to Yin deficiency and fire hyperactivity, latent Liver wind stirring, tendons and collaterals losing nourishment; the root has existed for days. Last autumn, latent summerheat caused triple malaria. Long-lasting malaria made Ying and Wei partially deficient, leading to internal wind carrying phlegm disturbing collaterals, right-side hemiparesthesia resembling hemiplegia, gradually improving with regulation. Now only right foot feels numbing, burning, hot, and painful, starting from the big toe, clearly indicating Liver meridian malnourishment due to Blood deficiency. It is said that legs and knees are often cold, while foot joints are often hot. It is not that foot joints have fire and legs/knees have cold. Rather, pain sites feel hot; where Qi and Blood are insufficient in the upper leg, it feels cold. Regarding the lump inside the skin and flesh on the outer left shin, cotton-seed sized, very painful when occurring, this belongs to Jin Jian (tendon tumor), formed by congealing of wind-phlegm and stasis-blood entering collaterals, different from the hot-numbing pain of the right foot. For now, treat the right foot first; tentatively prescribing one formula for correction.
Large Prepared Rehmannia Root (Da Sheng Di), Dioscorea hypoglauca (Bi Xie), Poria cocos (Fu Ling), Donkey-hide gelatin (E Jiao), Gastrodia elata (Tian Ma), Eucommia bark (Wu Jia Pi), Angelica sinensis root tip (Gui Shen), Achyranthes bidentata (Niu Xi), Atractylodes macrocephala (Dong Zhu), Angelica pubescens (Du Huo), Luffa cylindrica network (Si Gua Luo), Papaya (Mu Gua).
Commentary by Yuan: The name "Jin Jian" is very new. Ren Yuan says: Regarding stroke, He Jian spoke of Fire, Dong Yuan of Qi, Dan Xi of Phlegm, each holding their view. From my perspective, it is nothing more than Yin Essence and Yang Qi failing to transport and transform, allowing Phlegm, Fire, or Qi to take advantage and emerge secretly, blocking orifices, tunnels, and meridians, causing sudden fainting, locked jaw and slurred speech, or hemiplegia. Although there are distinctions of Zang-Fu and meridians, it is always Root Deficiency with Branch Excess. Because of Root Deficiency, it is easy to be invaded by pathogens; Wind, Fire, and Phlegm, though named external pathogens, are actually: Wind is transformed from rebellious Qi, Phlegm is generated from diet, Fire is also excessive Yang Qi transforming. They turn good citizens into bandits. *Neijing* says: When a person reaches forty, Yin Qi halves. Yin Qi refers to the Essence-Qi of the Five Zang organs. Secret depletion of Essence-Qi makes the three pathogens prone to emerge; thus, patients are mostly over forty, rarely young and strong. Wang Qingren's *Yi Lin Gai Cuo* states it is entirely a deficiency syndrome, treated with large doses of Astragalus. Although biased, it is not without reason. But considering the condition closely, if not true Zang organ severe deficiency, how could it be so sudden? How can it be compared to external wind-cold or stroke? The former is a thief coming from outside; the latter is a rift arising from within. Ancients used Xiao Xu Ming Tang (Minor Life-Preserving Decoction) modified for all strokes; I often doubt this. Using acrid-warm dispersing formulas to treat internal injury of Essence-Qi diseases. Zhu Danxi said: Northwest climate is cold and soil dry, possibly true stroke; Southeast generates phlegm from dampness, phlegm generates fire, fire generates wind. If so, Northwest disease is still external wind-pathogen named stroke, vastly different from sudden fainting and hemiplegia, how can they be treated identically! I grew up in the Southeast, never seeing Northwest disease; reading the stroke chapter, I am often dissatisfied with ancients.