经云∶风气善行而数变，又为百病之长也。亦随人身之盛衰为转移，假如西北地土凛
烈，人体刚劲，外风骤入，卒然倒仆，昏不知人，口眼 斜，频吐涎沫，有真中、类中之分
别，中脏、中腑、中经、中血脉之殊证，有闭、脱之异。药用开固之法，如用小续命汤开其卫
气，以参附、 附汤固其荣气，他如侯氏黑散、风引汤，皆填窍以息风之治也。迨李东垣谓元
气虚弱，骤然卒倒无知；刘河间以风乘火势，火藉风威，其人亦卒然仆倒昏厥；朱丹溪以东
南气温多湿，湿生痰，痰生热，热生风，忽然神昏搐搦，口眼歪僻等候现矣。由是观之，三子
之言中风，言其因也，名之曰类中风；仲景、《外台》言中风，言其本也，即真中风也。近世
类中风多，真中风罕见也。市医不知，一见动摇之状，不辨正虚、痰火之因，辄用散风逐邪
之方，枢纽离脱，则命亦随之而倾矣。
至于肿胀一症，因阳气衰败而成，治宜大培元阳，温中扶气，则水自行而肿胀除矣。盖
人身之卫气，周护一身之表，犹天包地之义，肌肤之温柔、坚密，皆本乎此。若卫受邪伏于
内，阴反居于外，水从阴化则成肤肿，中阳气遏则生 胀，治宜温发阳气，以逐阴邪，是为
探本之治也。余恒见庸工每用行水利湿之剂，如五苓、舟车等方，初获小效，久则病加，肿盛
胀增，甚至背平脐突，阴 阳位，为喘为阻，则大命倾矣。余目睹其症已危，心欲拯之，而势
难挽也。特将致病之源、理，不惮烦而辨之，以作后进之殷鉴也可。
澜按∶古人论中风，论其本也；后世言中风，言其因也。治有开邪、固正之法，息风、涤
痰、扶本之方，精审明辨，大法备矣。他如肿胀有虚、实之异，《内经》言之详尽，《金匮》分之
明晰，奈何市医不明，妄执治标渗利以误人。先生目睹其害，不惮烦而辨正之，济世利人之
苦心，昭然若揭矣。
《黄帝内经》说：风邪善于游走且变化迅速，又是各种疾病的先导。它也随着人体正气的盛衰而转移。例如西北地区的土地气候寒冷凛冽，人体体质刚劲有力，外来的风邪突然侵入，导致人突然昏倒仆地，意识丧失，口眼歪斜，频繁吐出涎沫，这种情况有“真中风”和“类中风”的区别，有中脏、中腑、中经、中血脉的不同证候，还有闭证与脱证的差异。治疗用药采用开泄与固涩的方法，如使用小续命汤来开通卫气，用参附汤或四逆汤来固护营气，其他如侯氏黑散、风引汤，都是填补孔窍以平息内风的治法。等到李东垣认为元气虚弱，导致突然昏倒无知；刘河间认为风邪乘着火势，火借风威，人也突然仆倒昏厥；朱丹溪认为东南地区气温多湿，湿气生痰，痰生热，热生风，忽然出现神志昏迷、抽搐掣动、口眼歪斜等症状。由此看来，这三位医家所说的中风，讲的是病因，称为“类中风”；张仲景及《外台秘要》所说的中风，讲的是病本，即“真中风”。近代类中风多见，真中风罕见。市井医生不懂这些道理，一见肢体动摇的症状，不辨别是正气虚损还是痰火所致，就随意使用散风祛邪的方剂，导致人体枢纽（阴阳气血）离决脱失，性命也随之倾覆。
至于肿胀这一病症，是因为阳气衰败而形成的，治疗应当大补元阳，温中扶气，这样水液自然运行，肿胀就能消除。大概人体的卫气，周流护卫一身之表，犹如天包裹大地的道理，肌肤的温柔、坚实致密，都根本于此。如果卫气受邪潜伏于内，阴气反而居于外，水液从阴化则形成肤肿，中焦阳气被遏制则产生胀满，治疗应当温发阳气，以驱逐阴邪，这才是探求根本的治疗。我常常见到庸医每用行水利湿的药剂，如五苓散、舟车丸等方子，起初获得小效，时间久了病情加重，肿胀更盛，甚至背部变平、肚脐突出，阴阳位置颠倒，导致喘息阻塞，最终大命归西。我亲眼目睹其症已危重，心里想要挽救，但形势难以挽回。特意将致病的源头、原理，不怕麻烦地辨析清楚，作为后学的深刻借鉴。
澜按语：古人论述中风，讲的是病本；后世谈论中风，讲的是病因。治疗有开泄邪气、固护正气的法则，有息风、涤痰、扶本的方药，精细审慎，明辨是非，大法已经完备了。其他如肿胀有虚证、实证的差异，《黄帝内经》论述详尽，《金匮要略》分类明晰，为什么市井医生不明白，妄自执着于治标渗利的方法来误人。先生亲眼目睹其危害，不怕麻烦地辨析纠正，济世救人的苦心，昭然若揭了。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Wind pathogen is good at moving and changing rapidly, and is the leader of a hundred diseases. It also shifts according to the decline or prosperity of the body's vital qi. For example, in the northwest, where the land and climate are biting cold, the human body is robust and strong. When external wind suddenly enters, it causes sudden collapse, unconsciousness, deviation of the mouth and eye, frequent spitting of saliva, which can be distinguished as "True Stroke" (Zhen Zhong Feng) or "Resembling Stroke" (Lei Zhong Feng). There are distinct syndromes involving the Zang organs, Fu organs, meridians, and vessels, as well as differences between Obstruction syndrome (Bi Zheng) and Collapse syndrome (Tuo Zheng). Medicinal treatment employs methods of opening and securing, such as using Xiaoxuming Tang (Minor Continuation Decoction) to open the Wei Qi (Defensive Qi), and using Shenfu Tang (Ginseng and Aconite Decoction) or Sini Tang (Frigid Extremities Decoction) to secure the Ying Qi (Nutritive Qi). Others, such as Houji Heisan (Houji Black Powder) and Fengyin Tang (Wind-Driving Decoction), are treatments that fill the orifices to extinguish wind. Later, Li Dongyuan argued that when Yuan Qi (Primal Qi) is weak, sudden collapse and loss of consciousness occur; Liu Wansu believed that wind takes advantage of fire, and fire borrows wind's power, causing people to suddenly fall and faint; Zhu Danxi stated that in the southeast, where warmth and humidity prevail, dampness generates phlegm, phlegm generates heat, and heat generates wind, suddenly appearing with symptoms like coma, convulsions, and facial paralysis. From this, we see that the words of these three masters regarding stroke refer to its etiology, naming it "Resembling Stroke"; Zhang Zhongjing and the *Waitai Miyao* (Secrets of the Outer Cabinet) refer to its pathology/origin, i.e., "True Stroke." In recent times, Resembling Stroke is common, while True Stroke is rare. City physicians do not understand this; upon seeing signs of tremor or movement, without distinguishing between deficiency of upright qi and phlegm-fire, they indiscriminately use formulas for dispersing wind and expelling pathogens. This leads to the disintegration of the body's pivot (Yin-Yang and Qi-Blood), and life follows suit into ruin.
Regarding the symptom of swelling and distension, it arises from the failure of Yang Qi. Treatment should greatly cultivate Yuan Yang, warm the middle and support Qi, so that water metabolism proceeds naturally and swelling subsides. The body's Wei Qi (Defensive Qi) circulates and protects the exterior of the whole body, akin to the heaven enveloping the earth. The tenderness and firmness of the skin and muscles are rooted in this. If Wei Qi is invaded by pathogens and lies latent within, Yin resides on the outside instead. Water transforms under Yin influence, resulting in edema of the skin; if Middle Yang Qi is obstructed, distension occurs. Treatment should warm and release Yang Qi to drive out Yin pathogens, which is a treatment that probes the root. I often see incompetent doctors using diuretic and damp-draining agents, such as Wuling San (Five-Ingredient Powder with Poria) or Zhouche Wan (Boat Cart Pill). Initially achieving minor effects, over time the disease worsens, swelling becomes severe, and distension increases, even to the point of a flat back and protruding umbilicus, inversion of Yin and Yang positions, leading to wheezing and obstruction, and finally death. I have witnessed cases where the condition was critical, desiring to save them, but the situation was beyond recovery. I specifically elucidate the source of the disease and its principles, not shunning the trouble, to serve as a profound warning for future generations.
Commentary by Lan: Ancients discussed stroke focusing on its origin; later generations discussed stroke focusing on its cause. Treatments include methods of expelling pathogens and consolidating righteousness, and formulas for extinguishing wind, eliminating phlegm, and supporting the root. These are precise, prudent, clearly differentiated, and the major principles are complete. Regarding swelling, there are differences between deficiency and excess syndromes, elaborated in detail in the *Neijing* and clearly classified in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet). Why do city physicians fail to understand, blindly adhering to symptomatic treatment with diuretics and thereby harming patients? The Master, witnessing the harm, did not shy away from clarifying and correcting it. His heartfelt intention to benefit the world and aid people is self-evident.