风为百病之长，故六淫先之，以其善行数变，受之者轻为感冒，重则为伤，最重则为中，然有真中、类中，
中血脉经络腑脏之辨。西北高寒风劲，真气虚者，猝为所中，是名真中，经所谓中六腑五脏之俞也。真中者，
风邪在表，身痛拘急，宜汗，小续命汤，或疏风散。风邪在经，口眼 斜，偏枯疼痛，大秦艽汤，或愈风汤。
风邪入里，多滞九窍，唇缓便秘，口不能言，耳聋鼻塞目瞀，痰涎昏冒，宜下，三化汤，或麻仁丸。东南卑湿
酿热，真阴亏者，风自内生，虚阳上冒，亦致昏仆，是为类中，实与外风无涉，经所谓阳之气以天地之疾风名
之也。类中者，痰多壅塞，捣萝卜子，以温汤和饮吐之。脾虚呕痰者，六君子汤，异功散。肾虚水泛为痰者，
六味丸，或八味丸汤服。中气虚者，补中汤。阴虚者，补阴煎。夫以地分真、类，谓真中者西北为剧，类中者
东南为多，未可胶柱以谈也。善乎！石顽张氏之说曰∶尝诊西北中风者，验其喑痱遗尿，讵非下元之惫，当
从事地黄、三生等饮乎？ 僻不遂，讵非血脉之废，而从事建中、十全等汤乎？东南类中，岂无六经形症见于
外，便溺阻隔见于内，当从事续命、三化等汤乎？是真通论矣。其中血脉，则口眼 僻。中络，则肌肤不仁。
中经，则脊重不伸。中腑，则肢节废，便溺阻。中脏，则舌喑吐沫。《金匮》分析既明，至《千金》引岐
伯论中风，大法有四∶一偏枯，半身不遂也；二风痱，四肢不收也；三风懿，奄忽不知人，舌强不能言也；四风
痹，诸痹类风状也。迄乎河间主火，谓心火暴盛，肾水虚衰。东垣主气，谓猝中乃本气自病。丹溪主痰，谓
湿生痰，痰生热，热生风。总之，气虚则火动痰升，其症似风非风，皆辨
明类中之由，与真中症异。专宜养气血，兼清痰火，大忌风燥之剂。凡虚风外中，轻则麻痹不仁；羌活愈风汤。
重则瘫痪不用。大秦艽汤。其痰火内生，轻则舌强难语；涤痰汤。重则痰壅神昏。至宝丹。既辨其中络、
中经、中腑、中脏，及中经络，兼中腑脏，并审其兼虚兼实，兼寒兼热兼痰，而入手先分闭症脱症，如牙关
紧闭，两手握固，是为闭症。苏合香丸，三生饮开之。如口开脾绝，手撒心绝，眼合肝绝，遗尿肾绝，鼻鼾肺
绝，以及吐沫、直视、摇头，面赤如妆，汗出如珠，皆为脱症。大剂理中汤灌之。兼灸脐下。凡国中，先用通关
散吹鼻，有嚏可治，无嚏多死。
〔口噤〕足阳明之经上夹口，风寒乘虚袭入，则挛急口噤，先用乌梅肉、冰片、生南星为末擦牙，其噤
可开。宜竹沥、姜汁调苏合香丸灌之，再用巴豆油纸卷皂角末，烧烟熏入鼻中，人事自省。
〔痰壅〕宜吐之，稀涎散加橘红，或姜盐汤灌之。以鹅翎探吐，或三圣散加蝎吐之。后用星香散、二陈汤、
涤痰汤、导痰汤。挟虚，加参、 、竹沥。挟寒，加桂、附、姜汁。脾虚呕痰，六君子汤，异功散。中气虚，
理中汤，温胃饮。
〔口眼 僻〕因血液衰涸，不能荣润筋脉。《灵枢》云∶足阳明筋病，颊筋有寒则急，引颊移口，有热则
筋弛，纵缓不胜收，故僻。又云∶足阳明、手太阳筋急，则口目为僻。宜润燥以熄风。大秦艽汤、或十全大
补汤尤妥。
〔半身不遂〕因气血不至，故痛痒不知，经曰∶营虚则不仁，卫虚则不用，营卫俱虚，则不仁且不用。
自丹溪以左枯属血虚，用四物汤。右枯属气虚，用四君子汤。气血两虚而挟痰，用二陈汤，加钩藤、竹沥、
姜汁。宗其治者多不效，何也？治偏枯，宜从阴引阳，从阳引阴，从右引左，从左引右，使气血灌注，周流
不息，莫如养血温经。补中汤少加附子，下七味地黄丸。以附子能行参、 之力，而阳和自转，肉桂能通血
脉，而筋节自荣，挟痰者，八珍、十全等汤加南星、半夏、姜汁。营卫俱虚者，黄 五物汤，膝骨软，加牛膝、
虎骨，节软，加木瓜、当归。
〔四肢不收〕诸阳经皆取于手足，循行身体，如邪气客于肌肤，随其虚处停滞，与气血相搏，故肢不举，
脉缓大有力，土太过也，
当泻其湿。胃苓汤。脉细小无力，土不足也，当补其气。补中汤。瘦人血枯筋急，木旺风淫者，四物汤加
钩藤、秦艽、防风、木瓜。肥人色白多痰者，六君子汤加秦艽、天麻、竹沥、姜汁。
〔角弓反张〕邪入经络，则腰背反折，挛急如角弓状。小续命汤。如先受风，复感寒，无汗恶寒为刚痉；
先受风，复感湿，恶风有汗为柔痉。刚痉续命汤去附子，柔痉续命汤去麻黄。
〔螈 〕因肝经风火搏于经络，则手足抽搐，或伸或缩，而动不止，由血虚不能荣筋，而燥气乘之，
宜滋肝肾，灌输筋脉，使水火熄，则风木自平。大秦艽汤，或十补汤加减。
〔猝倒无知〕凡类中病出于脏，精去则气去，所以眩晕猝倒，气去则神去，所以昏愦无知，阴阳脱离，精
气不交，须参附大剂，峻补其阳。继以地黄丸，加杞子、当归，或十补丸，填补真阴。若心火盛，肾水衰，
致猝倒神昏，肢掣口 ，宜地黄饮子去桂、附、巴戟，峻补其阴。继以生脉散，滋其化源。
〔舌强不语〕舌为心、脾、肝、肾四经所系，邪中其经，则痰涎闭其脉道，舌机不掉，因痰迷心窍者，
清心火，涤痰汤。因湿痰者，清脾热，六君子汤加枳实、竹茹。因风热者，清肝火，凉膈散加减。肾虚内夺为
喑痱，地黄饮子。舌强口角流涎，脾不能摄者，六君子汤加竹沥、姜汁。惊痰堵塞，舌本强硬者，正舌散加薄
荷。舌麻语謇者，省风汤加沉香。唇缓舌强者，解语汤。肥人舌本强，作湿痰治，瘦人作心火治，不可纯补，
恐堵塞经络中痰火。通用加味转舌膏。外取龟尿少许，点舌神效。（置龟于新荷叶上，以猪鬃戳其鼻，尿立出。）
有饮食照常，但失音不语者，名曰哑风。宜小续命汤去附子，加石膏、菖蒲。
〔遗尿〕系肾气亏极，用参、 、术、附、益智、五味。以保元阳之脱。火虚者，地黄饮子。水虚者，六
味丸。
〔眩晕〕凡虚阳上巅，得痰升则眩晕，经所谓上虚则眩也，宜培其中气。五福饮或大补元煎，加甘菊炭、
牡蛎、白芍、天麻。此猝倒所由来也。
〔麻木不仁〕遍体顽麻，无汗气实。乌药顺气散。十指及面麻木，乃气虚风袭。补中汤去术、归、陈，
加白芍、五味子。麻木体软，搔起白屑，乃脾血不荣。补中汤去柴胡，加地黄、白芍、芝麻。
真中风，虽风从外中，亦由内虚召风，其挛急偏枯，口 舌强，二便不爽，由风挟痰火壅塞，致营卫脉
络失和。先用通关，继则养血顺气，佐以消痰清火，大秦艽汤，或愈风汤。宣通经隧。风闭，用桂枝、羌活。
寒凝，用姜、附、桂心。热痞，用栀、芩、石膏。湿滞，用苍、朴、五苓。血瘀，用桃仁、牛膝、气滞，用
木香、枳壳、青、陈。痰阻，用星、夏、浮石、牛黄。类中风本非外风，猝仆昏厥，无 斜偏废等症，是宜
辨也。故叶氏谓内风乃身中阳气变化，肝为风脏，因血液衰耗，水不涵木，肝阳偏亢，内风时起，宜滋阴熄
风，濡养营络。以熟地、首乌、杞子、当归、牛膝、胡麻、石斛、五味子、甘菊、牡蛎。补阴潜阳，如虎潜、
固本、复脉之类。阴阳并损，无阳则阴无以化，宜温柔濡润。如沙苑子、苁蓉、杞子、人参、阿胶、当归。
通补，如地黄饮子、还少丹之类。风木过动，中土受戕，致不寐不食，卫疏汗泄，饮食变痰。如六君子汤、
玉屏风散、茯苓饮，酸枣仁汤之类。风阳上升，痰火阻窍，神识不清，至宝丹。芳香宣窍，或辛凉之品，
如菊叶、菖蒲、山栀、羚羊角、天麻、丹皮、钩藤。清上痰火。若阴阳失交，真气欲绝，用参附汤回阳，
佐以摄阴，如五味、龙骨、牡蛎。此其治也。自士材以类中症，条分火中、虚中、湿中、寒中、暑中、气中、
食中、恶中，而《金鉴》因之。火中，即河间所谓瘫痪，多由火盛水衰，心神昏冒，筋骨不用也。心火盛，
凉膈散。肾水衰，六味汤。虚中，即东垣所谓猝中昏愦，皆属气虚。烦劳气陷，补中汤。房劳精脱。生脉补
精汤。湿中，即丹溪所谓东南湿土生痰，痰热生风，因而昏冒。内中湿者，醇酒浓味，生冷过节，渗湿汤；
外中湿者，阴雨雾露，坐卧湿地，除湿汤。寒中，体强口噤。脐腹冷痛，姜附汤；身寒无汗，附子麻黄汤。
暑中，面垢晕倒，须分阴阳。得之受暑纳凉，寒外暑内，香薷饮，二香汤；得之赤日长途，中外皆热，昏仆
不醒，蒜汁合水灌之，
继以辰砂益元散。气实者，苍术白虎汤；气虚者，人参白虎汤。气中，气逆痰潮，牙关紧急，极似中风，但
中风身温，中气身冷，中风脉浮，应人迎，中气脉沉，应气口。苏合香丸灌之。俟醒，以八味顺气散加香附。因
怒气逆，忽然昏噤，木香调气饮。有痰，星香散。食中，醉饱后或感寒，或恼怒，胃气不行，忽然厥逆，误
作中风、中气治，必死。姜盐汤探吐。感寒者，藿香正气散。气滞者，八味顺气散。恶中，飞尸鬼击，卒厥
客忤，肢冷口噤，苏合香丸灌之。俟少苏，服调气平胃散。
风是百病的先导，因此六淫邪气中首先侵犯人体的是风邪。因为风邪善于游走变化，受邪轻者表现为感冒，重者表现为伤风，最重者则表现为中风。然而，中风有真中风和类中风的区别，以及中于血脉、经络、腑脏的不同辨证。
西北地区高寒风劲，真气虚弱的人，突然被风邪击中，这叫做真中风，即《内经》所说的中于六腑五脏的俞穴。真中风患者，风邪在体表，身体疼痛且拘急，应当用发汗法治疗，方用小续命汤，或者疏风散。风邪在经络，出现口眼歪斜、半身不遂及疼痛，方用大秦艽汤，或者愈风汤。风邪入里，多阻滞九窍，出现嘴唇松弛、便秘、不能说话、耳聋、鼻塞、视物模糊、痰涎壅盛、神志昏蒙，应当用泻下法治疗，方用三化汤，或者麻仁丸。
东南地区地势低洼潮湿，容易酿生热邪，真阴亏损的人，风从内生，虚阳上冒，也会导致昏倒仆地，这叫做类中风，实际上与外感风邪无关，《内经》所谓“阳气以天地之疾风名之”即是此意。类中风患者，痰多壅塞，可用捣碎的萝卜子，用温水调和饮用以催吐。脾虚呕吐痰涎者，方用六君子汤，或者异功散。肾虚水泛为痰者，方用六味地黄丸，或者八味地黄丸煎汤服用。中气虚者，方用补中汤。阴虚者，方用补阴煎。根据地域区分真中和类中，认为真中风在西北较重，类中风在东南较多，但不能僵化地看待这个问题。石顽张氏的说法很好：“我曾诊治西北中风患者，观察他们出现的失语、足废、遗尿等症状，难道不是下元衰竭吗？应当从事使用地黄、三生饮等方剂吗？出现口眼歪斜、肢体不遂，难道不是血脉废弛吗？应当从事使用建中汤、十全大补汤等方剂吗？东南类中风，难道没有六经的症状表现于外，大小便阻隔表现于内吗？应当从事使用续命汤、三化汤等方剂吗？”这确实是通达的论述。
其中于血脉，则口眼歪斜。中于络脉，则肌肤麻木不仁。中于经脉，则脊背沉重不能伸展。中于腑，则四肢关节废用，大小便阻隔。中于脏，则舌强失语、口吐白沫。《金匮要略》分析得很清楚，到了《千金方》引用岐伯论中风，大法有四：一是偏枯，即半身不遂；二是风痱，即四肢不能收持；三是风懿，即突然不知人事，舌强不能说话；四是风痹，即各种痹症类似风状。
到了刘河间主张火，认为心火暴盛，肾水虚衰。李东垣主张气，认为猝然中风是本气自病。朱丹溪主张痰，认为湿生痰，痰生热，热生风。总之，气虚则火动痰升，其症状似风非风，都是辨明类中风的成因，与真中风的症状不同。专门适宜养气血，兼清痰火，大忌用风燥的药物。凡是虚风外中，轻则麻痹不仁，方用羌活愈风汤。重则瘫痪不用，方用大秦艽汤。如果是痰火内生，轻则舌强难语，方用涤痰汤。重则痰壅神昏，方用至宝丹。既然辨别了其中络、中经、中腑、中脏，以及中经络兼中腑脏，并审察其兼虚兼实、兼寒兼热兼痰的情况，而入手先分闭证和脱证。如牙关紧闭，两手握固，这是闭证。方用苏合香丸，三生饮开窍。如口开脾绝，手撒心绝，眼合肝绝，遗尿肾绝，鼻鼾肺绝，以及吐沫、直视、摇头，面赤如妆，汗出如珠，这些都是脱证。方用大剂量理中汤灌服。同时灸脐下。凡遇中风，先用通关散吹鼻，有喷嚏可治，无喷嚏多死。
【口噤】足阳明经上行夹口，风寒乘虚袭入，则筋脉挛急导致口噤，先用乌梅肉、冰片、生南星研末擦牙，其噤可开。宜用竹沥、姜汁调苏合香丸灌服，再用巴豆油纸卷皂角末，烧烟熏入鼻中，使人苏醒。
【痰壅】宜用吐法，方用稀涎散加橘红，或者姜盐汤灌服。用鹅翎探吐，或者三圣散加全蝎吐之。后用星香散、二陈汤、涤痰汤、导痰汤。挟虚者，加人参、黄芪、竹沥。挟寒者，加桂枝、附子、姜汁。脾虚呕痰者，方用六君子汤，异功散。中气虚者，方用理中汤，温胃饮。
【口眼歪斜】因血液衰涸，不能荣润筋脉。《灵枢》说：足阳明筋病，颊筋有寒则拘急，牵引脸颊移口，有热则筋弛缓，纵缓不胜收，故歪斜。又说：足阳明、手太阳筋急，则口目歪斜。宜用润燥以熄风的方法。方用大秦艽汤，或者十全大补汤尤为妥当。
【半身不遂】因气血不至，所以痛痒不知。经说：营虚则不仁，卫虚则不用，营卫俱虚，则不仁且不用。自从丹溪认为左侧枯槁属血虚，用四物汤。右侧枯槁属气虚，用四君子汤。气血两虚而挟痰，用二陈汤，加钩藤、竹沥、姜汁。遵循其治法的多不效，为什么呢？治疗偏枯，宜从阴引阳，从阳引阴，从右引左，从左引右，使气血灌注，周流不息，莫过于养血温经。补中汤少加附子，或者下七味地黄丸。因为附子能行参、芪之力，而阳和自转，肉桂能通血脉，而筋节自荣，挟痰者，用八珍汤、十全大补汤加天南星、半夏、姜汁。营卫俱虚者，用黄芪五物汤，膝骨软，加牛膝、虎骨，节软，加木瓜、当归。
【四肢不收】诸阳经都取于手足，循行身体，如邪气客于肌肤，随其虚处停滞，与气血相搏，所以肢不举。脉缓大有力，是土太过，当泻其湿。方用胃苓汤。脉细小无力，是土不足，当补其气。方用补中汤。瘦人血枯筋急，木旺风淫者，用四物汤加钩藤、秦艽、防风、木瓜。肥人色白多痰者，用六君子汤加秦艽、天麻、竹沥、姜汁。
【角弓反张】邪入经络，则腰背反折，挛急如角弓状。方用小续命汤。如先受风，复感寒，无汗恶寒为刚痉；先受风，复感湿，恶风有汗为柔痉。刚痉用续命汤去附子，柔痉用续命汤去麻黄。
【抽搐】因肝经风火搏于经络，则手足抽搐，或伸或缩，而动不止，由血虚不能荣筋，而燥气乘之，宜滋肝肾，灌输筋脉，使水火既济，则风木自平。方用大秦艽汤，或者十补汤加减。
【猝倒无知】凡类中风病出于脏，精去则气去，所以眩晕猝倒，气去则神去，所以昏愦无知，阴阳脱离，精气不交，须用大剂量人参、附子，峻补其阳。继以地黄丸，加枸杞子、当归，或者十补丸，填补真阴。若心火盛，肾水衰，致猝倒神昏，肢掣口噤，宜用地黄饮子去桂枝、附子、巴戟天，峻补其阴。继以生脉散，滋其化源。
【舌强不语】舌为心、脾、肝、肾四经所系，邪中其经，则痰涎闭其脉道，舌机不掉。因痰迷心窍者，清心火，方用涤痰汤。因湿痰者，清脾热，方用六君子汤加枳实、竹茹。因风热者，清肝火，方用凉膈散加减。肾虚内夺为喑痱，方用地黄饮子。舌强口角流涎，脾不能摄者，方用六君子汤加竹沥、姜汁。惊痰堵塞，舌本强硬者，方用正舌散加薄荷。舌麻语謇者，方用省风汤加沉香。唇缓舌强者，方用解语汤。肥人舌本强，作湿痰治，瘦人作心火治，不可纯补，恐堵塞经络中痰火。通用加味转舌膏。外用龟尿少许，点舌神效。（将龟置于新荷叶上，以猪鬃戳其鼻，尿立出。）有饮食照常，但失音不语者，名曰哑风。宜用小续命汤去附子，加石膏、石菖蒲。
【遗尿】系肾气亏极，用人参、黄芪、白术、附子、益智仁、五味子。以保元阳之脱。火虚者，方用地黄饮子。水虚者，方用六味地黄丸。
【眩晕】凡虚阳上巅，得痰升则眩晕，经所谓上虚则眩也，宜培其中气。方用五福饮或大补元煎，加甘菊炭、牡蛎、白芍、天麻。这是猝倒所由来。
【麻木不仁】遍体顽麻，无汗气实。方用乌药顺气散。十指及面麻木，乃气虚风袭。方用补中汤去白术、当归、陈皮，加白芍、五味子。麻木体软，搔起白屑，乃脾血不荣。方用补中汤去柴胡，加地黄、白芍、芝麻。
真中风，虽然风从外中，亦由内虚召风，其挛急偏枯，口噤舌强，二便不爽，由风挟痰火壅塞，致营卫脉络失和。先用通关散，继则养血顺气，佐以消痰清火，方用大秦艽汤，或者愈风汤。宣通经隧。风闭，用桂枝、羌活。寒凝，用干姜、附子、桂心。热痞，用栀子、黄芩、石膏。湿滞，用苍术、厚朴、五苓散。血瘀，用桃仁、牛膝。气滞，用木香、枳壳、青皮、陈皮。痰阻，用天南星、半夏、浮海石、牛黄。类中风本非外风，猝仆昏厥，无口眼歪斜偏废等症，是宜辨也。故叶氏谓内风乃身中阳气变化，肝为风脏，因血液衰耗，水不涵木，肝阳偏亢，内风时起，宜滋阴熄风，濡养营络。药用熟地黄、何首乌、枸杞子、当归、牛膝、胡麻、石斛、五味子、甘菊、牡蛎。补阴潜阳，如虎潜丸、固本丸、复脉汤之类。阴阳并损，无阳则阴无以化，宜温柔濡润。如沙苑子、肉苁蓉、枸杞子、人参、阿胶、当归。通补，如地黄饮子、还少丹之类。风木过动，中土受戕，致不寐不食，卫疏汗泄，饮食变痰。如六君子汤、玉屏风散、茯苓饮，酸枣仁汤之类。风阳上升，痰火阻窍，神识不清，方用至宝丹。芳香宣窍，或辛凉之品，如菊叶、石菖蒲、山栀、羚羊角、天麻、丹皮、钩藤。清上痰火。若阴阳失交，真气欲绝，用参附汤回阳，佐以摄阴，如五味子、龙骨、牡蛎。此其治也。自从士材将类中风症，条分火中、虚中、湿中、寒中、暑中、气中、食中、恶中，而《医宗金鉴》因之。火中，即河间所谓瘫痪，多由火盛水衰，心神昏冒，筋骨不用也。心火盛，方用凉膈散。肾水衰，方用六味地黄汤。虚中，即东垣所谓猝中昏愦，皆属气虚。烦劳气陷，方用补中汤。房劳精脱，方用生脉补精汤。湿中，即丹溪所谓东南湿土生痰，痰热生风，因而昏冒。内中湿者，醇酒浓味，生冷过节，方用渗湿汤；外中湿者，阴雨雾露，坐卧湿地，方用除湿汤。寒中，体强口噤，脐腹冷痛，方用姜附汤；身寒无汗，方用附子麻黄汤。暑中，面垢晕倒，须分阴阳。得之受暑纳凉，寒外暑内，方用香薷饮，二香汤；得之赤日长途，中外皆热，昏仆不醒，蒜汁合水灌之，继以辰砂益元散。气实者，方用苍术白虎汤；气虚者，方用人参白虎汤。气中，气逆痰潮，牙关紧急，极似中风，但中风身温，中气身冷，中风脉浮，应人迎，中气脉沉，应气口。方用苏合香丸灌之。俟醒，以八味顺气散加香附。因怒气逆，忽然昏噤，方用木香调气饮。有痰，方用星香散。食中，醉饱后或感寒，或恼怒，胃气不行，忽然厥逆，误作中风、中气治，必死。姜盐汤探吐。感寒者，方用藿香正气散。气滞者，方用八味顺气散。恶中，飞尸鬼击，卒厥客忤，肢冷口噤，方用苏合香丸灌之。俟少苏，服调气平胃散。
Wind is the leader of a hundred diseases; therefore, among the Six Excesses (Liu Yin), wind attacks first. Because it moves swiftly and changes frequently, contracting it lightly results in a common cold (Gan Mao), moderately it results in wind injury (Shang Feng), and severely it results in stroke (Zhong Feng). However, there are distinctions between True Stroke (Zhen Zhong) and Simulated Stroke (Lei Zhong), as well as differentiation based on involvement of the blood vessels, collaterals, fu organs, and zang organs.
In the northwest, where winds are high-cold and fierce, those with deficient true qi may be suddenly struck by wind, which is named True Stroke. This corresponds to the classics' description of wind striking the shu points of the six fu organs and five zang organs. In True Stroke, if the wind pathogen is at the exterior, causing body pain and stiffness, sweating methods should be used, such as Xiao Xu Ming Tang (Minor Continuation of Life Decoction) or Shu Feng San (Disperse Wind Powder). If the wind pathogen is in the meridians, causing facial paralysis (Kou Yan Pian Pi) and hemiplegia with pain, Da Qin Jiao Tang (Great Gentian Root Decoction) or Yu Feng Tang (Curing Wind Decoction) should be used. If the wind pathogen enters the interior, often obstructing the nine orifices, leading to flaccid lips, constipation, aphasia, deafness, nasal congestion, blurred vision, phlegm-saliva accumulation, and stupor, purgative methods should be used, such as San Hua Tang (Three Transformations Decoction) or Ma Ren Wan (Hemp Seed Pill).
In the southeast, where terrain is low and damp, generating heat, those with deficient yin essence may have wind generated internally. Rising deficient yang can also cause sudden collapse, known as Simulated Stroke. This has no relation to external wind; as the classics state, "the qi of yang is named by the swift wind of heaven and earth." In Simulated Stroke, excessive phlegm obstruction can be treated by vomiting with crushed radish seeds mixed in warm water. For spleen deficiency with vomiting of phlegm, Liu Jun Zi Tang (Six Gentlemen Decoction) or Yi Gong San (Extraordinary Power Powder) should be used. For kidney deficiency with water overflowing to form phlegm, Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) decocted in water should be used. For middle jiao qi deficiency, Bu Zhong Tang (Tonify Middle Decoction) is indicated. For yin deficiency, Bu Yin Jian (Yin Tonifying Decoction) is indicated. Distinguishing True and Simulated Stroke by region suggests True Stroke is more severe in the northwest and Simulated Stroke more common in the southeast; however, one must not adhere rigidly to this view. Zhang Shiweng's theory is excellent: "When diagnosing stroke patients from the northwest, observing symptoms like aphasia, foot flaccidity, and enuresis, is this not exhaustion of the lower origin? Should we not employ Decoctions containing Rehmannia or San Sheng Yin? Regarding facial deviation and limb immobility, is this not waste of the blood vessels? Should we not employ Jian Zhong Tang or Shi Quan Da Bu Tang? For southeastern Simulated Stroke, do symptoms of the six meridians not appear externally, and blockage of urination/defecation not appear internally? Should we not employ Xu Ming Tang or San Hua Tang?" This is indeed a comprehensive discussion.
Involvement of blood vessels causes facial deviation. Involvement of collaterals causes insensitivity of skin and flesh. Involvement of meridians causes heavy spine unable to extend. Involvement of fu organs causes limb joint dysfunction and blockage of urination/defecation. Involvement of zang organs causes tongue stiffness, aphasia, and foaming at the mouth. *Jin Gui Yao Lue* analyzes this clearly. Later, *Qian Jin Fang* quotes Qibo’s discussion on stroke, outlining four major methods: 1. Pian Ku (Hemiplegia), half-body immobility; 2. Feng Fei (Wind Paralysis), limbs unable to hold; 3. Feng Yi (Wind Stupor), sudden loss of consciousness, tongue stiffness, inability to speak; 4. Feng Bi (Wind Bi), various bi syndromes resembling wind.
Later, Liu Hejian emphasized Fire, stating violent heart fire and deficient kidney water. Li Dongyuan emphasized Qi, stating sudden stroke is a disease of the root qi itself. Zhu Danxi emphasized Phlegm, stating dampness generates phlegm, phlegm generates heat, and heat generates wind. In summary, qi deficiency leads to fire movement and phlegm rising; symptoms resemble wind but are not wind. These clarify the causes of Simulated Stroke, differing from True Stroke. Treatment should specifically nourish qi and blood while clearing phlegm and fire; wind-drying agents are strictly contraindicated. For deficiency wind attacking externally, mild cases of numbness use Qiang Huo Yu Feng Tang (Notopterygium Curing Wind Decoction); severe cases of paralysis use Da Qin Jiao Tang. For internal phlegm-fire, mild tongue stiffness uses Di Tan Tang (Eliminate Phlegm Decoction); severe phlegm obstruction with stupor uses Zhi Bao Dan (Precious Treasure Pill). After distinguishing involvement of collaterals, meridians, fu, and zang organs, and assessing concurrent deficiency/excess, cold/heat, and phlegm, one must first differentiate Bi Syndrome (Closed Syndrome) and Tuo Syndrome (Collapsed Syndrome). Jaw clenching and clenched fists indicate Bi Syndrome; treat with Su He Xiang Wan (Styrax Pill) or San Sheng Yin (Three Generations Decoction) to open orifices. Mouth opening (spleen exhausted), hand scattering (heart exhausted), eyes closed (liver exhausted), enuresis (kidney exhausted), snoring (lung exhausted), foaming, staring upward, head shaking, flushed face like makeup, and pearl-like sweat indicate Tuo Syndrome; treat with large doses of Li Zhong Tang (Regulate the Middle Decoction) and moxa applied below the navel. For all strokes, first blow Tong Guan San (Open the Pass Powder) into the nose; sneezing indicates treatability, absence implies death.
[Mouth Lock] The Foot Yangming meridian runs alongside the mouth. Wind-cold invading deficiency causes spasms and mouth lock. First, rub teeth with powder of Umei Rou (Ume Fruit Flesh), Bing Pian (Borneol), and Sheng Nan Xing (Raw Arisaema). Then, administer Su He Xiang Wan mixed with Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice). Finally, burn Ba Dou You (Croton Oil) paper rolls with Zao Jiao Mo (Gleditsia Sinensis Powder) and smoke into the nose to restore consciousness.
[Phlegm Obstruction] Vomiting is indicated. Use Xi Xian San (Thin Saliva Powder) with Ju Hong (Tangerine Peel), or Jiang Yan Tang (Ginger Salt Decoction). Induce vomiting with goose feather or San Sheng San (Three Generations Powder) with Quan Xie (Scorpion). Afterwards, use Xing Xiang San, Er Chen Tang, Di Tan Tang, or Dao Tan Tang. With deficiency, add Ren Shen (Ginseng), Huang Qi (Astragalus), and Zhu Li. With cold, add Gui Zhi (Cinnamon Twig), Fu Zi (Aconite), and Jiang Zhi. Spleen deficiency with phlegm vomiting uses Liu Jun Zi Tang or Yi Gong San. Middle qi deficiency uses Li Zhong Tang or Wen Wei Yin (Warm Stomach Drink).
[Facial Deviation] Caused by blood depletion failing to nourish sinews. *Ling Shu* states: Foot Yangming sinew disease, cold in cheek sinews causes tightness pulling the mouth; heat causes relaxation and inability to control, leading to deviation. Also, tension in Foot Yangming and Hand Taiyang sinews causes mouth and eye deviation. Treat by moistening dryness to extinguish wind. Da Qin Jiao Tang or Shi Quan Da Bu Tang (Ten Great Tonifying Decoction) are appropriate.
[Hemiplegia] Caused by lack of qi and blood arrival, resulting in loss of pain/itch sensation. Classics state: Ying deficiency causes insensitivity; Wei deficiency causes immobility; both cause insensitivity and immobility. Since Danxi, left-side flaccidity is attributed to blood deficiency (Si Wu Tang); right-side to qi deficiency (Si Jun Zi Tang). Qi and blood dual deficiency with phlegm uses Er Chen Tang plus Gou Teng (Uncaria), Zhu Li, and Jiang Zhi. Many following this fail. Why? Treating Pian Ku requires drawing yang from yin, yin from yang, right from left, left from right, to circulate qi and blood unceasingly. Nourishing blood and warming meridians is best. Bu Zhong Tang with minor Fu Zi, or Xia Qi Wei Di Huang Wan (Lower Seven-Ingredient Rehmannia Pill). Fu Zi enhances the power of Ren Shen and Huang Qi, turning yang harmoniously; Rou Gui (Cinnamon Bark) unites blood vessels, nourishing sinews. With phlegm, Ba Zhen Tang or Shi Quan Da Bu Tang plus Nan Xing (Arisaema), Ban Xia (Pinellia), and Jiang Zhi. Ying/Wei dual deficiency uses Huang Qi Wu Wu Tang (Astragalus Five Substance Decoction); soft knee bones add Niu Xi (Achyranthes), Hu Gu (Tiger Bone - note: substitute legally); soft joints add Mu Gua (Chaenomeles) and Dang Gui (Angelica).
[Limb Immobility] All yang meridians originate in hands/feet and traverse the body. If evil qi lodges in skin/flesh and stagnates in deficiency areas, interacting with qi/blood, limbs cannot lift. Pulse slow/large/forceful indicates Earth excess; drain dampness with Wei Ling Tang (Poria and Atractylodes Decoction). Pulse fine/small/weak indicates Earth deficiency; tonify qi with Bu Zhong Tang. Thin people with blood dryness/sinew tension and Wood excess/Wind invasion use Si Wu Tang plus Gou Teng, Qin Jiao (Gentian), Fang Feng (Saposhnikovia), and Mu Gua. Fat people with white complexion/phlegm use Liu Jun Zi Tang plus Qin Jiao, Tian Ma (Gastrodia), Zhu Li, and Jiang Zhi.
[Opisthotonos] Evil entering meridians causes back arching, stiff as a bow. Xiao Xu Ming Tang. If wind then cold (no sweat, aversion to cold) is Gang Jing (Rigid Spasm); use Xu Ming Tang minus Fu Zi. If wind then damp (aversion to wind, sweating) is Rou Jing (Flaccid Spasm); use Xu Ming Tang minus Ma Huang (Ephedra).
[Convulsions] Liver channel wind-fire combusting in meridians causes limb twitching, extension/flexion, continuous motion. Due to blood deficiency failing to nourish sinews, dryness exploits it. Nourish liver/kidney, irrigate sinews, balance water/fire, so wind wood calms naturally. Da Qin Jiao Tang or Shi Bu Tang (Ten Tonics Decoction) modified.
[Sudden Collapse with Unconsciousness] Simulated stroke originating in zang organs: loss of essence leads to loss of qi (dizziness/collapse); loss of qi leads to loss of spirit (stupor/unconsciousness). Yin/Yang separation, essence/qi non-interaction requires large dose Ren Shen and Fu Zi to strongly tonify yang. Follow with Di Huang Wan plus Gou Qi Zi (Goji) and Dang Gui, or Shi Bu Wan, to fill true yin. If heart fire excess/kidney water deficiency causes collapse/stupor/twitching/clenching, use Di Huang Yin Zi minus Gui Zhi, Fu Zi, Ba Ji Tian to strongly tonify yin. Follow with Sheng Mai San (Generate Pulse Powder) to nourish transformation source.
[Tongue Stiffness/Aphasia] Tongue connects to Heart, Spleen, Liver, Kidney channels. Evil striking meridians blocks vessel pathways with phlegm-saliva, immobilizing tongue mechanism. Phlegm confusing heart orifice: clear heart fire with Di Tan Tang. Damp-phlegm: clear spleen heat with Liu Jun Zi Tang plus Zhi Shi (Immature Bitter Orange) and Zhu Ru (Bamboo Shavings). Wind-heat: clear liver fire with Liang Ge San (Cool Chest Powder) modified. Kidney deficiency causing aphasia/flaccidity: Di Huang Yin Zi. Tongue stiffness with drooling (spleen failing to control): Liu Jun Zi Tang plus Zhu Li, Jiang Zhi. Shock-phlegm blocking tongue root: Zheng She San (Correct Tongue Powder) plus Bo He (Mint). Tongue numbness/slurred speech: Sheng Feng Tang (Dispel Wind Decoction) plus Chen Xiang (Aquilaria). Flaccid lips/stiff tongue: Jie Yu Tang (Unlock Speech Decoction). Fat people with stiff tongue treated as damp-phlegm; thin people as heart fire. Do not purely tonify to avoid blocking phlegm-fire in meridians. General: Jia Wei Zhuan She Gao (Modified Tongue-Turning Paste). External: Turtle urine drops on tongue (place turtle on lotus leaf, poke nose with hog bristle). Diet normal but voiceless is Ya Feng (Mute Wind); use Xiao Xu Ming Tang minus Fu Zi plus Shi Gao (Gypsum) and Chang Pu (Acorus).
[Enuresis] Extreme kidney qi deficiency. Use Ren Shen, Huang Qi, Bai Zhu (Atractylodes), Fu Zi, Yi Zhi Ren (Alpinia Oxyphylla), Wu Wei Zi (Schisandra) to preserve yuan yang. Fire deficiency: Di Huang Yin Zi. Water deficiency: Liu Wei Di Huang Wan.
[Dizziness] Deficient yang ascending to vertex with rising phlegm causes dizziness ("upper deficiency causes dizziness"). Tonify middle qi with Wu Fu Yin (Five Blessings Drink) or Da Bu Yuan Jian (Great Tonify Origin Decoction) plus Gan Ju Tan (Charred Chrysanthemum), Mu Li (Oyster Shell), Bai Shao (White Peony), Tian Ma. This is the origin of sudden collapse.
[Numbness/Insensitivity] Whole body hard numbness, no sweat, qi excess: Wu Yao Shun Qi San (Mayapple Regulate Qi Powder). Fingers/face numbness, qi deficiency/wind attack: Bu Zhong Tang minus Bai Zhu, Dang Gui, Chen Pi, plus Bai Shao, Wu Wei Zi. Numbness with soft body/scaling, spleen blood failing to nourish: Bu Zhong Tang minus Chai Hu (Bupleurum), plus Di Huang (Rehmannia), Bai Shao, Zhi Ma (Sesame).
True Stroke, though wind attacks externally, is summoned by internal deficiency. Spasms, hemiplegia, mouth lock, tongue stiffness, bowel/bladder issues result from wind carrying phlegm-fire obstructing, causing ying/wei/meridian disharmony. First Tong Guan San, then nourish blood/regulate qi, assist with eliminating phlegm/clearing fire. Da Qin Jiao Tang or Yu Feng Tang to unblock meridians. Wind closure: Gui Zhi, Qiang Huo. Cold coagulation: Jiang (Ginger), Fu Zi, Gui Xin (Cinnamon Heart). Heat blockage: Zhi Zi (Gardenia), Huang Qin (Scutellaria), Shi Gao. Damp stagnation: Cang Zhu (Atractylodes), Hou Po (Magnolia Bark), Wu Ling San (Five Poria Powder). Blood stasis: Tao Ren (Peach Kernel), Niu Xi. Qi stagnation: Mu Xiang (Aucklandia), Zhi Ke (Bitter Orange), Qing Pi (Green Tangerine Peel), Chen Pi (Aged Tangerine Peel). Phlegm obstruction: Nan Xing, Ban Xia, Fu Shi (Floating Coral Stone), Niu Huang (Calculus Bovis).
Simulated Stroke is not external wind; sudden collapse/stupor without facial deviation/hemiplegia requires distinction. Ye Tianshi stated internal wind is change of body yang. Liver is wind organ; blood depletion fails to nourish wood, liver yang hyperactivity generates internal wind. Nourish yin/extinguish wind, moisten ying collaterals. Shu Di Huang, Shou Wu, Gou Qi Zi, Dang Gui, Niu Xi, Hu Ma (Sesame), Shi Hu (Dendrobium), Wu Wei Zi, Gan Ju, Mu Li. Tonify yin/subdue yang: Hu Qian Wan (Tiger Crouching Pill), Gu Ben Wan (Solidify Root Pill), Mai Mai Tang (Pulse-Pulse Decoction). Yin/Yang dual damage: without yang, yin cannot transform; use gentle/moistening. Sha Yuan Zi (Astragalus Complanatus), Rong Rong (Cistanche), Gou Qi Zi, Ren Shen, E Jiao (Donkey-hide Gelatin), Dang Gui. Unblock/tonify: Di Huang Yin Zi, Hai Shao Dan (Young Return Pill). Wind wood overactive damaging middle earth causing insomnia/anorexia, loose defense/sweating, food transforming to phlegm: Liu Jun Zi Tang, Yu Ping Feng San (Jade Windscreen Powder), Fu Ling Yin, Suan Zao Ren Tang (Sour Jujube Decoction). Wind-yang rising, phlegm-fire blocking orifices, unclear spirit: Zhi Bao Dan. Aromatic/unblocking orifices, or acrid-cool: Ju Ye (Chrysanthemum Leaf), Chang Pu, Shan Zhi Zi (Gardenia), Ling Yang Jiao (Antelope Horn), Tian Ma, Dan Pi (Moutan), Gou Teng. Clear upper phlegm-fire. Yin/Yang disconnection, true qi near extinction: Shen Fu Tang (Ginseng and Aconite Decoction) to return yang, assist with gathering yin: Wu Wei Zi, Long Gu (Dragon Bone), Mu Li. This is its treatment.
Since Shi Cai categorized Simulated Stroke into Fire, Deficiency, Damp, Cold, Summerheat, Qi, Food, and Evil types, *Yi Zong Jin Jian* followed. Fire Stroke (Hejian's paralysis): fire excess/water deficiency, spirit stupor, sinew/bone dysfunction. Heart fire excess: Liang Ge San. Kidney water deficiency: Liu Wei Tang. Deficiency Stroke (Dongyuan's sudden stupor): qi deficiency. Overwork/qi sinking: Bu Zhong Tang. Sexual exhaustion/essence loss: Sheng Mai Bu Jing Tang. Damp Stroke (Danxi's southeast damp-phlegm-heat-wind): Internal damp (rich diet/cold raw food): Shen Shi Tang. External damp (rain/fog/damp ground): Chu Shi Tang. Cold Stroke: Body stiff/jaw lock, umbilical/abdominal cold pain: Jiang Fu Tang. Body cold/no sweat: Fu Zi Ma Huang Tang. Summerheat Stroke: Dirty face/collapse, distinguish yin/yang. Summerheat + cooling (cold outside/heat inside): Xiang Ru Yin, Er Xiang Tang. Sun exposure (internal/external heat): Garlic juice/water, then Chen Sha Yi Yuan San. Qi excess: Cang Zhu Bai Hu Tang. Qi deficiency: Ren Shen Bai Hu Tang. Qi Stroke: Qi rebellion/phlegm tide, jaw lock, mimics stroke. Stroke body warm/Qi stroke body cold; Stroke pulse floating/Ren Ying; Qi pulse sinking/Qi Kou. Su He Xiang Wan. Upon waking, Ba Wei Shun Qi San plus Xiang Fu. Anger/rebellion/sudden stupor: Mu Xiang Tiao Qi Yin. With phlegm: Xing Xiang San. Food Stroke: After drunken/full meal, cold/anger, stomach qi stops, sudden厥逆. Mistaking for stroke/Qi stroke is fatal. Ginger salt vomit induction. Cold: Huo Xiang Zheng Qi San. Qi stagnation: Ba Wei Shun Qi San. Evil Stroke (Flying corpse/Ghost strike/Sudden厥/Kehu): Limb cold/jaw lock. Su He Xiang Wan. Upon slight recovery, Tiao Qi Ping Wei San.