秦子曰∶以其不因外感，故曰内伤；以其症类中风症，故亦曰中风。古人名类中风，即
【中风之症】平居无故，倏尔仆倒，随即苏醒；一年半载，又复举发；三四发作，其
病渐重；或犯半身不遂，口眼 斜，甚则痰涎壅闭，便溺不通；至手撒口开，遗尿不语，乃为不
治。此内伤中风之症也。
【中风之因】或本元素弱，劳役过度，五志厥阳之火，煎熬真阴，阴虚则热，热则
风生，风火相搏，痰涎自聚，不由外邪，其病自发；或膏粱积久，湿热之气，上熏成痰，迷其心
窍，亦能倒仆，而成内伤之症。
【中风之脉】空大气虚，微细血弱，沉数沉实，膏粱积热。
【中风之治】初起脉细神清，宜活血安神，加减茯神汤。古人云治风先治血，血行风
自灭，此指内伤中风虚者而言也。若脉数沉实，昏冒不省，先宜清火为急，安神丸；痰涎壅盛，
当化痰理气，涤痰汤；膏粱积热者，清胃汤；俟诸症平安，然后养血安神。气虚者，四君
子汤；血虚者，四物汤；气血皆虚，加味归脾汤。
加减茯神汤
白茯神 当归 远志 麦冬 知母 羚羊角 犀角
心火旺，加黄连；肺火旺，加山栀；肝火旺，加丹皮、山栀；尺脉数，加黄柏；元气虚
安神丸 治痰迷心窍。
麦冬 白茯神 山药 辰砂 甘草 马牙硝 寒水石
痰多，加胆星，甚则加牛黄；心火，加黄连；肺火，加黄芩；肝火，加山栀；肾火，加
黄柏；虚人，加人参。
涤痰汤 治痰涎壅盛。
南星 半夏 枳实 石菖蒲 竹茹 橘红 甘草 白茯神
痰不化，加竹沥、生姜；热甚，加黄连；胸满闷，加枳壳；大便闭结，加大黄；虚人，
清胃汤 治胃中湿热。
川黄连 升麻 山栀 甘草
四君子汤 治气虚不足。
人参 白术 白茯苓 炙甘草
血虚合四物，恐凝滞不用四物，竟加当归一味。
四物汤 治血虚。
当归 白芍药 川芎 怀熟地
气虚，合四君子；恐燥，加黄 ，即合当归补血汤。
归脾汤 诸症平安，此方调理。
白术 白茯神 远志 枣仁 当归 黄 广皮 白芍药 甘草 丹皮 山栀 人参
《家秘》加升麻、柴胡，即合补中益气汤，以升举中气。
六淫之邪，皆能中人，非止得风邪也。故《准绳》书立卒中七条。以感而轻者名伤；感
而重者名中；若忽然中倒，遍身发热，世名中风。方书充栋。惟河间立四时加减续命汤诸方
，以治中风。外有六经表症，开示化方用药之妙悟，立愈风汤、通圣散，以和解有表有里之
症；又立三化汤，以治内有便溺阻格，土太过之里实症；又立十全大补等，以治土不及之虚
中，则散邪、和解、清里、补虚，四法全备。东垣复发卒中昏倒，偏废手足舌强语塞之类中
风，而立理气开郁，疏通经络，以治气中。丹溪又补痰涎壅闭，痰火攻冲，而立竹沥、姜汁
、半夏、南星等，豁痰散结，以治痰中。此皆发明卒中之症，不独外中于风，有因气郁痰迷
，内伤壅闭致病者；家秘于是分外感内伤，各立一条；又发内伤卒中气郁痰迷，手足偏废，
多因膏粱积热，酒湿成瘫所致。既详各条治法，又立总论于卷首，大凡着书垂后，每症之下
，必要详明经系何经，病因何气。使后学有实据可凭，临症庶不数数更方，朝攻暮补，贪图
秦子说：因为不是由外感邪气引起，所以称为内伤；因为症状类似中风病，所以也称为中风。古人名类中风，即
【中风的症状】平时没有缘故，突然仆倒在地，随即苏醒；一年半载后，又再次发作；发作三四次后，病情逐渐加重；或者出现半身不遂、口眼歪斜，严重时痰涎壅塞闭阻，大小便不通；到了手撒开、口张开、遗尿、不能说话的地步，就属于不治之症。这就是内伤中风的症状。
【中风的病因】有的人原本体质虚弱，过度劳累，导致五志（喜、怒、忧、思、恐）化火，厥阳之火煎熬真阴，阴虚则生热，热极则生风，风火相互搏结，痰涎自然聚集，不由外邪侵袭，疾病自发；或者是长期食用肥甘厚味，湿热之气积聚，上熏形成痰浊，迷蔽心窍，也能导致突然仆倒，从而形成内伤病症。
【中风的脉象】空大是大气虚，微细是血弱，沉数或沉实是膏粱积热。
【中风的治疗】初起时脉细而神志清醒，宜用活血安神法，选用加减茯神汤。古人说治风先治血，血行风自灭，这是针对内伤中风中虚证而言的。如果脉象数而沉实，昏蒙冒昧不知人事，应先以清火为急务，选用安神丸；如果痰涎壅盛，应当化痰理气，选用涤痰汤；如果是膏粱积热者，选用清胃汤；等到各种症状平稳后，然后再养血安神。气虚者，选用四君子汤；血虚者，选用四物汤；气血皆虚者，选用加味归脾汤。
加减茯神汤
白茯神、当归、远志、麦冬、知母、羚羊角、犀角。
心火旺，加黄连；肺火旺，加山栀；肝火旺，加丹皮、山栀；尺脉数，加黄柏；元气虚，加人参。
安神丸 治疗痰迷心窍。
麦冬、白茯神、山药、辰砂、甘草、马牙硝、寒水石。
痰多，加胆星，严重者加牛黄；心火，加黄连；肺火，加黄芩；肝火，加山栀；肾火，加黄柏；体虚者，加人参。
涤痰汤 治疗痰涎壅盛。
南星、半夏、枳实、石菖蒲、竹茹、橘红、甘草、白茯神。
痰不化，加竹沥、生姜；热甚，加黄连；胸满闷，加枳壳；大便闭结，加大黄；体虚者，加人参。
四君子汤 治疗气虚不足。
人参、白术、白茯苓、炙甘草。
若血虚合用四物汤，恐怕药性凝滞不用四物汤，竟只加一味当归。
四物汤 治疗血虚。
当归、白芍药、川芎、怀熟地。
若气虚，合用四君子汤；恐怕药性燥烈，加黄芪，即合当归补血汤。
归脾汤 诸症平安后，此方用于调理。
白术、白茯神、远志、枣仁、当归、黄芪、广皮、白芍药、甘草、丹皮、山栀、人参。
《家秘》加入升麻、柴胡，即合补中益气汤，以升举中气。
六淫之邪，都能中人，不仅仅是风邪。所以《准绳》书中列出了卒中七条。感受邪气而轻的名为伤；感受邪气而重的名为中；如果突然中倒，遍身发热，世人称为中风。医书非常多。只有刘河间创立了四时加减续命汤等方剂，来治疗中风。此外还有六经表证，开示了化裁方药用药的妙悟，创立了愈风汤、通圣散，用来和解有表有里的症状；又创立了三化汤，用来治疗内有大小便阻塞格拒，土气太过导致的里实证；又创立了十全大补汤等，用来治疗土气不及导致的虚中，这样散邪、和解、清里、补虚，四种方法齐全。李东垣又补充了卒中昏倒、偏废手足、舌强语塞之类中风，创立了理气开郁、疏通经络的方法，来治疗气中。朱丹溪又补充了痰涎壅闭、痰火攻冲的情况，创立了使用竹沥、姜汁、半夏、南星等药物，豁痰散结的方法，来治疗痰中。这些都是阐明了卒中的症状，不仅仅有外中于风，还有因气郁痰迷、内伤壅闭致病的情况；家秘于是将外感和内伤分别立为一门；又阐发了内伤卒中气郁痰迷、手足偏废，多因膏粱积热、酒湿成瘫所致。既然详细说明了各条治法，又在卷首设立了总论，大凡著书流传后世，每个症状之下，必须详细说明归属于哪一经，病因是什么气。使后学者有实在的依据可凭靠，临症时不至于频繁更换方剂，早上攻伐晚上进补，贪图……
Qin Zi said: Because it is not caused by external pathogenic factors, it is called internal injury; because its symptoms resemble those of stroke (Zhong Feng), it is also called stroke. The ancients named "stroke-like conditions" as...
[Symptoms of Stroke] Without any apparent cause in daily life, one suddenly collapses but regains consciousness immediately; after a year and a half or two years, it may recur; after three or four recurrences, the condition gradually worsens; or it may lead to hemiplegia (half-body paralysis) and deviation of the mouth and eyes. In severe cases, phlegm-saliva obstructs and closes the orifices, and urination and defecation are blocked; when the hands relax open, the mouth opens, there is urinary incontinence, and speech is lost, it becomes an incurable condition. This is the symptom pattern of internal injury stroke.
[Etiology of Stroke] Some individuals have originally weak constitutions and suffer from overwork, causing the fire of Jue Yang generated by the Five Emotions (Joy, Anger, Worry, Thought, Fear) to simmer and consume True Yin. Yin deficiency generates heat, and extreme heat generates wind. Wind and fire contend with each other, causing phlegm-saliva to accumulate spontaneously. Without invasion by external pathogens, the disease arises internally. Alternatively, long-term consumption of rich and sweet foods leads to the accumulation of damp-heat qi, which steams upward to form phlegm, confusing the heart orifices, also leading to sudden collapse and forming internal injury conditions.
[Pulse Patterns of Stroke] An empty and large pulse indicates deficiency of Great Qi; a fine and thin pulse indicates blood weakness; a deep, rapid, or solid pulse indicates accumulated heat from rich foods.
[Treatment of Stroke] At the initial stage, if the pulse is fine and the spirit is clear, invigorate blood and calm the spirit using Modified Fushen Decoction (Jiān Jiǎn Fúshén Tāng). The ancients said, "To treat wind, first treat the blood; when blood moves, wind extinguishes." This refers specifically to deficiency-type internal injury stroke. If the pulse is rapid and deep/solid, with confusion and loss of consciousness, clearing fire is urgent; use Anshen Wan (Calming Spirit Pill). If phlegm-saliva is abundant, resolve phlegm and regulate qi using Ditang Tang (Phlegm-Clearing Decoction). For those with accumulated heat from rich foods, use Qingwei Tang (Stomach-Clearing Decoction). After all symptoms stabilize, then nourish blood and calm the spirit. For Qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction); for Blood deficiency, use Siwu Tang (Four Substances Decoction); for both Qi and Blood deficiency, use Jiawei Guipi Tang (Modified Heart-Spleen Tonifying Decoction).
**Modified Fushen Decoction (Jiān Jiǎn Fúshén Tāng)**
Bai Fushen (Poria with Hostwood), Danggui (Angelicae Sinensis Radix), Yuanzhi (Polygalae Radix), Maidong (Ophiopogonis Radix), Zhimu (Anemarrhenae Rhizoma), Lingyangjiao (Saiga Tataricae Cornu), Xijiao (Rhinocerotis Cornu - *Note: Use substitutes in modern practice*).
If Heart Fire is hyperactive, add Huanglian (Coptidis Rhizoma); if Lung Fire is hyperactive, add Shanzhi (Gardeniae Fructus); if Liver Fire is hyperactive, add Danpi (Moutan Cortex) and Shanzhi; if the Chi pulse is rapid, add Huangbai (Phellodendri Cortex); if Yuan Qi is deficient, add Renshen (Ginseng Radix et Rhizoma).
**Anshen Wan (Calming Spirit Pill)**
Treats phlegm confusing the heart orifices.
Maidong, Bai Fushen, Shanyao (Dioscoreae Rhizoma), Chensha (Cinnabar), Gancao (Glycyrrhizae Radix et Rhizoma), Mayaxiao (Natrii Sulfas), Hanshuishi (Aragoniti Fibrosum).
If phlegm is excessive, add Danning (Arisaematis Cum Bile); if severe, add Niuhuang (Bovis Calculus); for Heart Fire, add Huanglian; for Lung Fire, add Huangqin (Scutellariae Radix); for Liver Fire, add Shanzhi; for Kidney Fire, add Huangbai; for deficient persons, add Renshen.
**Ditang Tang (Phlegm-Clearing Decoction)**
Treats abundant phlegm-saliva.
Nanxing (Arisaematis Cum Bile), Banxia (Pinelliae Rhizoma), Zhishi (Aurantii Fructus Immaturus), Shichangpu (Acori Tatarinowii Rhizoma), Zhuru (Bambusae Caulis in Taenia), Juhong (Citri Reticulatae Pericarpium Rubrum), Gancao, Bai Fushen.
If phlegm does not transform, add Zhuli (Bambusae Sap) and Shengjiang (Zingiberis Rhizoma Recens); if heat is severe, add Huanglian; if chest fullness and oppression occur, add Zhike (Aurantii Fructus); if constipation occurs, add Dahuang (Rhei Radix et Rhizoma); for deficient persons, add Renshen.
**Qingwei Tang (Stomach-Clearing Decoction)**
Treats damp-heat in the stomach.
Chuan Huanglian, Shengma ( Cimicifugae Rhizoma), Shanzhi, Gancao.
**Sijunzi Tang (Four Gentlemen Decoction)**
Treats Qi deficiency insufficiency.
Renshen, Baizhu (Atractylodis Macrocephalae Rhizoma), Baifuling (Poria), Zhi Gancao (Prepared Licorice Root).
If Blood deficiency combines with Siwu Tang, fearing stagnation, do not use the full Siwu Tang; instead, add only Danggui.
**Siwu Tang (Four Substances Decoction)**
Treats Blood deficiency.
Danggui, Baishaoyao (Paeoniae Radix Alba), Chuanxiong (Ligustici Chuanxiong Rhizoma), Huaishudi (Rehmanniae Radix Praeparata).
If Qi deficiency, combine with Sijunzi Tang; fearing dryness, add Huangqi (Astragali Radix), which forms Danggui Bu Xue Tang (Danggui Tonifies Blood Decoction).
**Guipi Tang (Heart-Spleen Tonifying Decoction)**
For regulation after all symptoms have stabilized.
Baizhu, Bai Fushen, Yuanzhi, Zaoren (Zizyphi Semen), Danggui, Huangqi, Guangpi (Citri Reticulatae Pericarpium), Baishaoyao, Gancao, Danpi, Shanzhi, Renshen.
*Jiami* adds Shengma and Chaihu, combining with Buzhong Yiqi Tang (Middle-Boosting Qi-Enhancing Decoction) to raise Middle Qi.
The six excess pathogens can all attack humans, not just wind pathogen. Therefore, the book *Zhunsheng* lists seven categories of apoplexy. Mild contraction is named "Shang" (Injury); severe contraction is named "Zhong" (Stroke); if one suddenly collapses with fever throughout the body, the world calls it "Zhong Feng" (Wind Stroke). Medical books are numerous. Only Liu Hejian established various formulas like the Four-Season Modified Xuming Decoction to treat stroke. Furthermore, regarding the six meridians' exterior syndromes, he revealed the subtleties of modifying formulas and medications, establishing Yufeng Tang (Wind-Dispelling Decoction) and Tongsheng San (Unimpeded Salvation Powder) to harmonize exterior-interior syndromes; he also established Sanhua Tang (Three Transformations Decoction) to treat interior excess syndromes caused by blockage of urination/defecation and excessive Earth qi; and he established Shiquan Dabu Tang etc. to treat deficiency-stroke caused by insufficient Earth qi. Thus, dispersing pathogens, harmonizing, clearing the interior, and tonifying deficiency—the four methods were complete. Li Dongyuan further supplemented stroke-like conditions such as sudden collapse, hemiplegia of limbs, stiff tongue, and speech impediment, establishing methods to regulate qi, open depression, and unblock collaterals to treat "Qi Stroke". Zhu Danxi further supplemented cases of phlegm-saliva obstruction and phlegm-fire attacking, establishing methods using Zhuli, Jiangzhi, Banxia, Nanxing, etc., to resolve phlegm and dissipate nodules to treat "Phlegm Stroke". These all elucidated that stroke symptoms are not solely due to external wind invasion, but also due to internal injury from Qi stagnation and phlegm confusion causing obstruction. *Jiami* thus separated external and internal injuries into distinct categories; it further expounded that internal injury stroke with Qi stagnation, phlegm confusion, and limb hemiplegia is often caused by accumulated heat from rich foods and alcohol-dampness leading to paralysis. Having detailed the treatment methods for each category, a general discussion was established at the beginning of the volume. Generally, when writing books for posterity, under each symptom, it is necessary to clearly state which meridian it belongs to and what pathogenic qi causes it. This allows later learners to have substantial evidence to rely on, so that during clinical practice, they do not frequently change prescriptions, attacking in the morning and tonifying in the evening, seeking...