中风证宜从洁古、东垣之论,以中脏、中腑、中血脉为辨证之的。洁古云∶中腑多着四肢,中脏多滞
九窍。东垣亦云∶中腑则肢节废,中脏则性命危,中血脉则口眼 斜。而方书所载,混言外有六经之形
症,以大小续命汤为主。夫人身脏腑有十二经,手有三阳三阴,足有三阳三阴。中风之有六经形症也,手
之六经乎?抑足之六经乎?六经之症,惟伤寒有之。或谓中风六经形症,即是伤寒六经形症,至有引伤寒
六经之症,以解中风六经之症。其言为大可嗤也。夫伤寒六经症,只伤足而不伤手,故一日巨阳,则有发热、恶寒、头
项痛、腰脊强之症,而中风无有也;二日阳明,则有身热、目痛、鼻干、不得眠之症,而中风无有也;三日少阳,则胁
痛、耳聋、口苦、寒热往来而呕之症,而中风无有也。此足三阳之见症也。至传入足三阴,四日有腹满、咽干、自利、
不渴、腹痛之症,是足太阴之见症,而中风有之乎?五日有引衣蜷卧、舌干、口燥之症,是足少阴之见症也,而中
风有之乎?六日有烦满、囊缩之症,是足厥阴之见症也,而中风有之乎?伤寒六经次第传变,故仲景有麻
黄、桂枝、大小承气之法,若中风为猝暴病,一时猝倒昏迷,难分经络,而有脏腑、血脉之别,或中于足之
六经,或中于手之六经,非若伤寒之有次第传焉者也。若谓中风六经形症,即是伤寒六经形症,是欲以
治伤寒之法治中风,其不至于杀人也几希矣!若论中风,则十二经皆有见症,而不止于六经也。如四肢
不收、手足拘挛者,风中足太阴脾也;口眼 斜、口噤不开,风中足阳明胃也;痰涎壅塞,声如曳锯,风
中手太阴肺也;大便闭结,风中手阳明大肠也;舌喑不语,风中足少阴肾也;目瞀昏迷、不省人事,风中
手少阴心与手厥阴包络也;螈 强直、角弓反张,风中足厥阴肝与足太阳膀胱也;耳聋、胁痛,风中足少阳
胆也。此皆中风之形症,岂可以六经拘之乎?其不同于伤寒之六经也明矣!
中风证应当遵循洁古(张元素)、东垣(李杲)的论述,以中脏、中腑、中血脉作为辨证的准则。洁古说:中腑多表现为四肢症状,中脏多表现为九窍阻滞。东垣也说:中腑则肢节废用,中脏则性命危险,中血脉则口眼歪斜。而方书中所记载的,混淆地说外感有六经的症状表现,以大小续命汤为主治方剂。人身脏腑有十二经脉,手经有三阳三阴,足经有三阳三阴。中风出现的六经症状表现,是手经的六经呢?还是足经的六经呢?六经的症状,只有伤寒病才有。有人称中风的六经症状表现,就是伤寒的六经症状表现,甚至引用伤寒六经的症状来解释中风六经的症状。这种说法是非常可笑的。伤寒的六经症状,只伤及足经而不伤及手经,所以第一天巨阳经受邪,就有发热、恶寒、头项痛、腰脊强直的症状,而中风没有这些症状;第二天阳明经受邪,就有身热、目痛、鼻干、不能安睡的症状,而中风没有这些症状;第三天少阳经受邪,就有胁痛、耳聋、口苦、寒热往来且呕吐的症状,而中风没有这些症状。这是足三阳经的表现症状。至于传入足三阴经,第四天有腹满、咽干、自利、不渴、腹痛的症状,这是足太阴脾经的表现症状,而中风有这些症状吗?第五天有引衣蜷卧、舌干、口燥的症状,这是足少阴肾经的表现症状,而中风有这些症状吗?第六天有烦满、囊缩的症状,这是足厥阴肝经的表现症状,而中风有这些症状吗?伤寒六经依次传变,所以仲景有麻黄汤、桂枝汤、大小承气汤的方法。如果中风是猝然暴发的疾病,一时猝倒昏迷,难以分辨经络,而有脏腑、血脉的区别,或者是中于足经的六经,或者是中于手经的六经,不像伤寒那样有次第地传变。如果说中风的六经症状表现,就是伤寒的六经症状表现,这是想用治疗伤寒的方法来治疗中风,这离杀人就不远了!如果论中风,那么十二经都有表现症状,而不止于六经。如四肢不收、手足拘挛的,是风邪中于足太阴脾经;口眼歪斜、口噤不开,是风邪中于足阳明胃经;痰涎壅塞,声音像拉锯一样,是风邪中于手太阴肺经;大便闭结,是风邪中于手阳明大肠经;舌喑不语,是风邪中于足少阴肾经;目瞀昏迷、不省人事,是风邪中于手少阴心经和手厥阴心包络经;抽搐强直、角弓反张,是风邪中于足厥阴肝经和足太阳膀胱经;耳聋、胁痛,是风邪中于足少阳胆经。这些都是中风的症状表现,怎么可以用六经来拘泥限制呢?它不同于伤寒的六经是很明显的!
The syndrome of wind-stroke (Zhong Feng) should follow the theories of Jiegu (Zhang Yuansu) and Dongyuan (Li Gao), taking involvement of the Zang organs, Fu organs, and vessels and collaterals as the criteria for differentiation. Jiegu stated: Involvement of the Fu organs mostly manifests in the four limbs, while involvement of the Zang organs mostly manifests as obstruction of the nine orifices. Dongyuan also said: Involvement of the Fu organs leads to dysfunction of joints and limbs; involvement of the Zang organs endangers life; involvement of the vessels and collaterals leads to deviation of the mouth and eyes. However, medical texts confuse the issue by stating that external pathogens present with symptoms of the Six Channels (Liu Jing), using Da Xu Ming Tang (Large Life-Sustaining Decoction) and Xiao Xu Ming Tang (Small Life-Sustaining Decoction) as primary treatments. The human body has twelve meridians associated with the Zang and Fu organs: the Hand meridians consist of three Yang and three Yin, and the Foot meridians consist of three Yang and three Yin. Regarding the six-channel symptoms in wind-stroke, are they the six channels of the Hand? Or are they the six channels of the Foot? Symptoms of the Six Channels exist only in Shang Han (Cold Damage). Some claim that the six-channel symptoms of wind-stroke are identical to those of Shang Han, even citing Shang Han's six-channel symptoms to explain wind-stroke's six-channel symptoms. This statement is highly ridiculous. The six-channel symptoms of Shang Han affect only the Foot meridians and not the Hand meridians. Therefore, on the first day, when the Taiyang (Greater Yang) channel is affected, there are symptoms such as fever, aversion to cold, headache and stiffness of the neck and back, which are absent in wind-stroke; on the second day, when the Yangming (Yang Brightness) channel is affected, there are symptoms such as body heat, eye pain, dry nose, and insomnia, which are absent in wind-stroke; on the third day, when the Shaoyang (Lesser Yang) channel is affected, there are symptoms such as hypochondriac pain, deafness, bitter taste in the mouth, alternating chills and fever, and vomiting, which are absent in wind-stroke. These are the presenting symptoms of the Three Yang channels of the Foot. As for transmission to the Three Yin channels of the Foot, on the fourth day, there are symptoms of abdominal fullness, dry throat, spontaneous diarrhea, lack of thirst, and abdominal pain, which are symptoms of the Taiyin (Greater Yin) channel of the Foot; does wind-stroke have these symptoms? On the fifth day, there are symptoms of curling up while drawing clothes close, dry tongue, and dry mouth, which are symptoms of the Shaoyin (Lesser Yin) channel of the Foot; does wind-stroke have these symptoms? On the sixth day, there are symptoms of vexation and fullness, and contraction of the genitals, which are symptoms of the Jueyin (Terminal Yin) channel of the Foot; does wind-stroke have these symptoms? Shang Han transmits sequentially through the six channels; thus, Zhongjing employed methods such as Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), and Da Chengqi Tang (Major Order the Qi Decoction) and Xiao Chengqi Tang (Minor Order the Qi Decoction). Wind-stroke, however, is a sudden and violent disease. One may suddenly fall into coma, making it difficult to distinguish meridians, but distinctions can be made between Zang/Fu involvement and vessel/collateral involvement. It may affect the six channels of the Foot or the six channels of the Hand, unlike Shang Han which follows a sequential transmission pattern. To claim that the six-channel symptoms of wind-stroke are identical to those of Shang Han is to attempt to treat wind-stroke with methods for Shang Han, which would almost certainly prove fatal! If discussing wind-stroke, symptoms can appear in all twelve meridians, not just limited to six. For instance, flaccidity of the four limbs and contracture of hands and feet indicate wind invading the Foot Taiyin Spleen meridian; deviation of the mouth and eyes and lockjaw indicate wind invading the Foot Yangming Stomach meridian; copious phlegm and rattling breath indicate wind invading the Hand Taiyin Lung meridian; constipation indicates wind invading the Hand Yangming Large Intestine meridian; aphasia indicates wind invading the Foot Shaoyin Kidney meridian; visual disturbance, coma, and loss of consciousness indicate wind invading the Hand Shaoyin Heart meridian and the Hand Jueyin Pericardium meridian; convulsions, rigidity, and opisthotonos indicate wind invading the Foot Jueyin Liver meridian and the Foot Taiyang Bladder meridian; deafness and hypochondriac pain indicate wind invading the Foot Shaoyang Gallbladder meridian. These are all manifestations of wind-stroke; how can they be restricted to the six channels? It is clear that wind-stroke differs from the six channels of Shang Han.