例六严X，男，56岁。初诊日期：1975年11月6日。先患头晕，继即突然昏仆，不省人事，牙关紧闭，面白唇暗，口角流涎，左半身瘫痪，四肢不温，口眼歪斜，先送县医院救治，不见好转，后又转送XX县医院扎头皮针，经两日针刺，牙关松动，仍呈半昏迷状态，两侧瞳孔大小不等，对光反射减弱，诊断为脑出血(内囊出血)，医院来请会诊，诊其脉浮细而弦，舌淡苔薄，乃阳虚阴盛，闭塞清窍之候。以细辛3克煎汤化开苏合香丸3克灌服，三小时内灌两次，下午三时左右，逐渐清醒，并有饥饿感。随即疏稀莶至阳汤，以治中风的阳虚证。方药：九制稀莶草30克黄芪9克天南星6克白附子6克川附片9克川芎3克红花6克细辛1．5克防风6克牛膝6克僵蚕3克苏木6克以其阳虚诸症颇著，而又偏于左半身也。连续进本方11剂，约两星期左右，基本恢复正常，惟行动时左侧尚有沉滞感而巳。(任应秋：临证点滴，《陕西新医药》2；42，1977)
例七赵XX，男，59岁，初诊日期：1939年9月18日。猝然昏倒，左边半身麻木不仁，步履艰难，口角喁斜，流涎不止，言语謇涩，带有痰声，不能起床已月余矣，脉沉而细，宜养正活络祛痰，以王清任法加减之。生黄芪45克赤芍9克当归9克地龙肉6克川芎3克桂枝尖4．5克桃仁泥3克南红花6克竹沥水(两次兑)12克生姜汁(两次兑)3滴舒络丹1丸白水下。9月9日(二诊)；服药患侧觉温，但仍麻木不仁，再以前法加量治之。生黄芪60克赤芍9克．当归9克竹沥水(两次兑)工2克生姜汁(两次兑)3滴桂枝尖4．5克川芎4．5克地龙肉9克舒络丹2丸白水下。9月20日(三诊)：服药见效，患侧已能转动，口歪虽在巳不流涎，且能自饮，语言尚骞，再以前方增量治之。生黄芪60克赤芍9克川芎6克地龙肉9克桃仁泥6克橘络4．5克桑枝9克桂枝尖4．5克竹沥水(两次兑)9克生姜汁(两次兑)3滴舒络丸二丸，两次月Ro9月21日(四诊)；中风半身不遂，药已大效，已能离床步履，语言亦渐清晰，脉渐有力，再以养正活络法加味治之。生黄芪60克赤芍9克当归9克南红花9克地龙肉6克桂枝尖4．5克川芎4．5克桃仁泥9克半夏6克南星(胆炙)6克橘络4．5克川羌活3克竹沥水(分兑)12克生姜汁(分兑)3滴舒筋丹二丸分下。前方服后，步履如常，语言已清，口喁已正，照原方加橘红6克桑枝9克。(毛有丰等整理：赵树屏医案，《中医杂志》4；265，1958)、
例八余XX，60岁时曾经中风，口眼歪斜，半身不遂；卧床不起，不惟不能坐行，且不能转侧，面赤气粗(风犹未熄)，痰声漉漉，神识半昏，时或晕瞀，食亦不下，非难吞即自落下。时历四月，中西方药无效。脉乍密乍疏，弦劲中带涩象，病机脉象均颇坏。镇敛浮越，平戢孤亢(熄未熄之风)，拟方：白薇、百合各9克龙骨、牡蛎各"克紫石英、灵磁石、赤石脂各9克寒水石、滑石各18克大黄4．5克铁锈末9克荆沥，竹沥各15克(二沥冲服)一周略安，得大便一次，原方减大黄为3克，加琥珀末1．5克、怀牛膝12克，又一周渐佳，大便二次，面赤气粗，痰壅神昏等象锐减，手足能动，勉能坐起，原方去大黄、铁锈，加鲜生地30克，山萸肉9克，约二周，病愈大半。后于前方去寒水石，滑石、荆沥，加菖蒲，泽兰、甘松，橘络、木香等，前后约60日痊愈。(《冉雪峰医案》)
例九秦XX，于1943年农历10月初旬，突然四肢麻木，颜面蠕动抽搐，神态呆异，某日之晚，竟至仆倒，不省人事，口噤不开，疳痱不语，右半身萎废不用，痰鸣嗅吼，声如曳锯，遗尿不禁，昼夜烦而不安，是月16日，为得病第9日，……诊得脉情滑数，至数无绪，重按搏指有力，身热如炭，面赤如朱，心胸按之灼手。……此“类中”而又兼“阳厥”大证，与虚中不侔，故舍虚而从实。方药：蝎尾末1．5克羚角粉1．5克万氏牛黄丸两粒先送。另以化痰清热宣郁如竹沥、贝母、半夏、橘红、郁金清肝熄风，如芍药、丹皮、珍珠母，而以茯苓、茯神为助，大剂浓煎，缓缓灌下。17日复诊；询知服药后即获神安入寐，厥逆之势已见平静，面赤亦退，脉滑数稍缓，神志略觉安定，余证如昨。此厥势虽戢，而风痱依然入中心肾之络。……投剂：万氏牛黄丸、叶氏神犀丹各一粒，研末先送，余于前方去郁金、珍珠母，加海藻、昆布咸润降滑，开痰散结。龙齿、贝齿清肝而安魂魄。远志以开心气之郁，怀牛膝导引厥逆之气下行，使升者可降，而降者不复再升。19日复诊，前昨两夜，寐可落寝，神可安定，颜面抽搐已缓，并且口噤已开，见其舌苔黄燥垢腻，小溲亦有知觉，惟仍感默默不欲语言，脉情滑数，尚感阳脉太过，咳虽有痰而又吐咯不易。……撤去神犀，加琥珀末，伽南末各0．?5克，以安神宣郁，方守前法。22日复诊；舌本已能转动灵活，时欲言语诉说，而犹謇涩不甚清晰，腑气多日未行，矢气频转极臭，小溲长利，气臊臭，色微黄，已能自禁，脉情滑数，亦转和缓，齿结血瓣，舌苔更垢，浊腻满布，此阳明之结也。结者当濡润，以柔养其血液，辛滑以疏利其气机，于前方去万氏牛黄丸，加生地炭、蒸锁阳、桑麻丸(包)。两日间，续得腑气两度，色黑粘韧，溏鞭不一，后清养调理而愈。(宋立人整理，宋爱人医案——实中阳厥，《中医杂志》11：55，1959)[评按]中风系指以突然昏仆，不省人事，伴有口眼喁斜，语言不利，半身不遂，或仅以喁僻不遂为主的病证。因其病势急骤，证状多端，变化迅速，故名中风，或称“卒中”。中风发生的病因、病理比较复杂，但大致不外乎虚(阴虚、气虚)、火(肝火、心火)、风(肝风、外风)，痰(风痰、湿痰)、气(气逆)、血(血瘀)六端。六者可相互影响、相互作用。一般认为外邪侵袭而弓I发者称为外风，又称真中风或真中，无外邪而引发者，称为内风，又称类中风或类中。中风为本虚标实、上盛下虚之候。本为肝肾不足、气血衰少，标为风火相煽、痰湿壅盛、气血郁阻。按照现代临床分类则分为中经络与中脏腑两大类。中经络者病情较轻，一般无神志改变，中脏腑者病位较深，病情较重，主要表现为神志不清，并常有发病先兆及后遗症。
例一体肥多痰，忧郁伤中，肝风内动、脾湿生痰，经络阻塞，营卫滞留，患者虽见口眼喁斜、手足麻木，尚未见半身不遂。此为风痰中络，未入于经，治宜涤痰开郁，佐以养血活络，则风证自熄。
例二证属阴虚肝阳引动痰浊闭窍。证情较前稍重。方用半夏白术天麻汤加减。本方出自程钟龄《医学心悟》，功能补脾燥湿，化痰熄风。另加钩藤、僵蚕、决明子、刺蒺藜等加强熄风镇静之功。
例三证属肝阳上亢、痰热蒙蔽清窍。治以平肝熄风镇逆、降火涤痰通络之法。先煎潜镇平肝之品以代水煎药，寓意颇深。
例四始因情志不遂而致卒中。晚清医家张伯龙认为：“凡猝倒昏瞀，痰气上壅之中风，皆由肝火上亢，化风煽动，激起气血，并走于上，直冲犯脑，震扰神经而为昏不识人，喁斜倾跌，肢体不遂，言语不清诸症，皆脑神经失其功能之病，苟能于乍病之时，急用潜阳降逆之剂，抑降其气火之上浮，使气血不并走于上……”，实为高见。本案所用乃潜镇泄降之法。方用镇肝熄风汤加减。原方去茵陈、天冬、龟板，加生石膏、胆草以加强清热泻肝之力，重用牛膝以引血下行，折其亢盛之风阳，为张氏创用本方的独特之处。
例五、例六为任氏经验方稀莶至阴汤、稀莶至阳汤的应用。本方以稀莶草为君，分别辅以滋养肝肾与温肾之品。
例五证属阴虚阳亢，内风暗动，经脉血滞之候。故用稀莶至阴汤；
例六为类中阳虚闭证。其妙在于先用辛温开窍法，以细辛3克煎汤化苏合香丸灌服，待患者清醒后，再用稀莶至阳汤以治中风阳虚之证。
例七病已月余，正气已虚而痰瘀阻络，仿王清任补阳还五汤法，益气活血通络而治愈。
例八证情复杂，神识半昏迷，历时四月而风犹未熄，病机、病象颇坏。治以镇敛浮越，平戢孤亢，方从《金匮》风引汤，百合地黄丸，《本事方》白薇汤、真珠母丸化裁而来。方中自薇味咸，走血分而平上逆之气血，百合收敛浮阳、宁谧心神；龙、牡育阴潜阳，再加上五石之重，镇其逆而清其血，益以大黄荡积，铁锈重坠，荆竹二沥化痰涎以通窍；菖蒲开窍祛痰，甘松清热；泽兰破积；橘络通络，木香导滞。师法古人，方从己出，古今合参，神明变化于活治之中，遵古而不泥古，重今而不偏今。
例九原案题为“实中阳厥”，其高明处在于摒除假虚，而从其真实。若真假虚实不辨，则动手便错，而犯“虚虚实实”之过。若实以虚治，则未有不留偏枯废痿之证者，此乃医事之过，不可忽略。(十九)偏风高X，女，45岁，已婚。初诊日期：1970年5月13日。左上半身感觉减退、麻木、无汗五年多。自1965年春，先发现左手感觉减退、麻木，并相继发现左侧头面部、胸背部及上肢不出汗，局部发凉，肢体麻木，感觉减退，逐渐加重，常不自觉被烫伤。左手握力差，不能持重物。经某医院神经科检查，左侧头面部、上肢及左侧躯干3～4胸椎以上平面，痛、温觉减退，皮肤较健侧明显干燥。主动运动及生理反射，均无特殊改变。诊断为脊髓空洞症、神经根炎。多年来常有腹泻，每天大便两三次，较稀，便前有时腹痛，腹泻常与情绪改变有关，未治疗。患者发育营养一般，面黄，精神不振，舌质淡红，舌苔薄白，脉沉细而弱。辨证：脾肾不足，气血两虚，风寒内袭，阻闭经络。治法；温肾健脾，补气养血，温经通阳。方药：山药30克熟地15克麻黄4．5克炮姜9克鹿角胶(烊化，也可用阿胶代之)12克桂枝9克补骨脂12克白术(土炒)15克陈曲(炒)9克醋香附12克当归12克熟附子9克山茱萸12克木香9克生黄芪12克骨碎补12克鸡血藤12克水煎两遍，兑在一起，早晚各1次，温服。5月26日(二诊)：服药六剂，感觉舒适，食欲好转，食量增加，余证同前。舌苔、脉象同前。原方去木香、黄芪继服。6月3日(三诊)；药后病情明显好转，食量增加，大便已转正常，左上半身麻木感减轻，舌苔薄白，脉沉细，较前有力。仍以原方加减继服。方药：山药30克熟地15克麻黄4．5克炮姜9克鹿角胶(烊化)15克桂枝9克补骨脂12克陈曲(炒)9克白术(土炒)15克醋香附12克当归12克熟附子12克淫羊藿12克枸杞子15克生黄芪15克生菟丝子24克骨碎补15克鸡血藤15克，1977年11月30日随访：先后间断服药半年多，左上肢麻木感逐渐减轻，患部痛、温觉较以前逐渐灵敏，左手握力大增，与健侧无明显差别，出汗如常，左上肢功能已恢复正常。现已五年，未再服药治疗。(《刘惠民医案》)[评按]偏风首见于《诸病源候论·风病诸候》云：“偏风者，风邪偏客于身一边也。人体有偏虚者，风邪乘虚而伤之……或不知痛痒”、“风不仁者，由荣气虚，卫气实，风寒入于肌肉，使血气行不宣流，其状搔之皮肤如隔衣是也。”述证与本案颇有相似之处。偏风与中风半身不遂有别，此案肢体活动尚可，而痛温不觉，且患肢体麻木发凉、无汗。西医诊断脊髓空洞症。根据中医辨证属于脾肾不足、气血两虚，风寒内袭，阻闭经络。故以温肾健脾、益气养血，温经通络之法。症虽奇特而疗效尚称满意，值得重视。
(二十)眩晕
例一潘XX，女，初诊日期：1954年2月。体本虚弱，多年来襟怀不适，因遭事故，致肝木上升而头目眩晕，肝木侮土而呕吐不休。右脉弦劲，饮食不思，二便不利，舌绛苔薄，情势颇急，可能发痉。宜凉肝安胃，服观后效再商。桑叶9克杭菊花9克粉丹皮9克黑栀子9克大白芍9克细生地24克姜川连2．1克法夏6克姜竹茹12克黄郁金9克羚羊镑1．2克另煎兑苦丁茶9克服上方左脉见平，舌绛见淡，苔薄见宣，眩晕立止，唯呕吐如前，纳食不香，二便未调。依前法去羚羊加安胃品以止呕吐。桑叶9克菊花9克丹皮9克栀子炭9克夏枯草9克苦丁茶9克细生地18克大白芍9克法夏6克姜竹茹12克干苇根15克左金丸4．5克(分二次送服)。上方服两剂，呕吐为止，舌苔已消，胃纳已香，二便正常，再以小剂泄肝安胃善后。(张菊人：《菊人医话》)
例二魏XX，男，60岁。患头晕目眩，兼有耳鸣，鼻亦发塞，嗅觉不佳。病有数载，屡治不效，颇以为苦。切其脉弦，视其舌则胖大无伦，苔则水滑而白。辨证：此证心下有饮，上冒清阳，是以头冒目眩，其耳鸣、鼻塞，则为浊阴踞上，清窍不利之所致。治法：渗利水饮之邪。方药；泽泻24克白术10克此方服1剂而有汗，不改方，共服五剂，则头晕、目眩、耳鸣、鼻塞等证愈其大半，转方用五苓散温阳利水而收全功。(刘渡舟；谈谈《金匮》的泽泻汤证，《中医杂志》9c17，1980)
**案例六** 严某，男性，56岁。初诊日期：1975年11月6日。起初患有头晕，随后突然昏倒，不省人事，牙关紧闭，面色苍白而嘴唇暗紫，口角流涎，左侧半身瘫痪，四肢发凉，口眼歪斜。先送往县医院救治，未见好转，后又转至XX县医院接受头皮针治疗。经过两天的针刺治疗后，牙关松动，但仍处于半昏迷状态，两侧瞳孔大小不等，对光反射减弱。诊断为脑出血（内囊出血）。医院邀请会诊，诊察其脉象浮细而弦，舌质淡、苔薄，判断为阳虚阴盛，导致清窍闭塞的证候。使用细辛3克煎汤，化开苏合香丸3克灌服，三小时内灌服两次。下午三时左右，患者逐渐清醒，并感到饥饿。随即开具稀莶至阳汤，以治疗中风之阳虚证。方药组成：九制稀莶草30克、黄芪9克、天南星6克、白附子6克、川附片9克、川芎3克、红花6克、细辛1.5克、防风6克、牛膝6克、僵蚕3克、苏木6克。因其阳虚症状显著，且偏于左半身瘫痪。连续服用此方11剂，约两周左右，基本恢复正常，仅在行动时左侧仍有沉重滞涩感而已。（任应秋：《临证点滴》，《陕西新医药》2:42，1977）
**案例七** 赵某，男性，59岁，初诊日期：1939年9月18日。突然昏倒，左侧半身麻木无知觉，行走困难，口角歪斜，流涎不止，言语不清，伴有痰鸣声，已卧床一个多月无法起床。脉象沉而细。适宜采用扶正固本、活络祛痰之法，参照王清任的方法进行加减。处方：生黄芪45克、赤芍9克、当归9克、地龙肉6克、川芎3克、桂枝尖4.5克、桃仁泥3克、南红花6克、竹沥水（分两次兑入）12克、生姜汁（分两次兑入）3滴、舒络丹1丸，用白开水送服。9月9日（二诊）：服药后患侧感觉温暖，但依然麻木无知觉，继续以前法增加剂量治疗。处方：生黄芪60克、赤芍9克、当归9克、竹沥水（分两次兑入）12克、生姜汁（分两次兑入）3滴、桂枝尖4.5克、川芎4.5克、地龙肉9克、舒络丹2丸，用白开水送服。9月20日（三诊）：服药见效，患侧已能转动，口歪虽在但不再流涎，且能自行饮水，语言尚且不清，继续以前方增加剂量治疗。处方：生黄芪60克、赤芍9克、川芎6克、地龙肉9克、桃仁泥6克、橘络4.5克、桑枝9克、桂枝尖4.5克、竹沥水（分两次兑入）9克、生姜汁（分两次兑入）3滴、舒筋丸2丸，分两次送服。9月21日（四诊）：中风半身不遂，药物已显大效，已能离床行走，语言也逐渐清晰，脉象渐有力，继续以扶正活络法加味治疗。处方：生黄芪60克、赤芍9克、当归9克、南红花9克、地龙肉6克、桂枝尖4.5克、川芎4.5克、桃仁泥9克、半夏6克、胆制南星6克、橘络4.5克、川羌活3克、竹沥水（分次兑入）12克、生姜汁（分次兑入）3滴、舒筋丹2丸，分次送服。前方服完后，步履如常，语言已清，口歪已正，照原方加入橘红6克、桑枝9克。（毛有丰等整理：赵树屏医案，《中医杂志》4:265，1958）
**案例八** 余某，60岁时曾患中风，出现口眼歪斜、半身不遂；卧床不起，不仅不能坐立行走，甚至不能翻身，面色红赤、气息粗重（风邪尚未平息），喉间痰声漉漉，神识半昏迷，时而晕眩视物不清，饮食难进，不是难以吞咽就是自动落下。历时四个月，中西药物治疗均无效。脉象忽密忽疏，弦劲中带涩象，病机与脉象均属危重。治宜镇摄收敛浮越之气，平抑孤亢之风阳（熄灭未熄之风）。拟定方药：白薇、百合各9克，龙骨、牡蛎各9克，紫石英、灵磁石、赤石脂各9克，寒水石、滑石各18克，大黄4.5克，铁锈末9克，荆沥、竹沥各15克（两沥冲服）。服药一周后略见安宁，大便通下一次，原方将大黄减为3克，加入琥珀末1.5克、怀牛膝12克。又过一周病情渐佳，大便通下两次，面赤气粗、痰壅神昏等症状锐减，手足能动，勉强能坐起，原方去掉大黄、铁锈，加入鲜生地30克、山萸肉9克。约两周后，病愈大半。后来在前方的基础上去掉寒水石、滑石、荆沥，加入菖蒲、泽兰、甘松、橘络、木香等，前后共约60日痊愈。（《冉雪峰医案》）
**案例九** 秦某，于1943年农历十月初旬，突然四肢麻木，面部肌肉蠕动抽搐，神态呆滞怪异。某日晚，竟至仆倒，不省人事，牙关紧闭不开，失语不语，右侧半身萎废不用，痰鸣吼响，声音如拉锯，遗尿不禁，昼夜烦躁不安。当月16日，为得病第9日，……诊得脉象滑数，节律紊乱，重按搏指有力，身体发热如炭，面色红赤如朱，心胸部位按压灼手。……此为“类中风”而又兼夹“阳厥”的大证，与虚证不同，故舍弃虚证而从实证论治。方药：蝎尾末1.5克、羚角粉1.5克、万氏牛黄丸两粒，先送服。另以化痰清热宣郁之品如竹沥、贝母、半夏、橘红、郁金清肝熄风，如芍药、丹皮、珍珠母，并以茯苓、茯神为辅助，大剂浓煎，缓缓灌下。17日复诊：询问得知服药后即获神安入睡，厥逆之势已见平静，面赤亦退，脉滑数稍缓，神志略觉安定，其余症状如前。此厥势虽已平息，但风痱之症依然深入心肾之络。……投药：万氏牛黄丸、叶氏神犀丹各一粒，研末先送服。其余在前方的基础上去掉郁金、珍珠母，加入海藻、昆布咸润降滑，开痰散结。龙齿、贝齿清肝而安魂魄。远志以开心气之郁，怀牛膝导引厥逆之气下行，使升者可降，而降者不再上升。19日复诊：前两夜睡眠可落枕，神志可安定，面部抽搐已缓解，并且牙关已开，见其舌苔黄燥垢腻，小便已有知觉，惟仍感沉默不欲言语，脉象滑数，尚感阳脉太过，咳嗽虽有痰但又吐咯不易。……撤去神犀丹，加入琥珀末、伽南末各0.75克，以安神宣郁，方守前法。22日复诊：舌本已能转动灵活，时常欲言语诉说，但犹且言语不清不甚清晰，腑气多日未行，矢气频转极臭，小便长利，气味臊臭，色微黄，已能自禁，脉象滑数，亦转和缓，齿缝结血瓣，舌苔更垢，浊腻满布，此为阳明之结。结者当濡润，以柔养其血液，辛滑以疏利其气机，于前方去掉万氏牛黄丸，加入生地炭、蒸锁阳、桑麻丸（包煎）。两日间，续得腑气通下两度，色黑粘韧，溏硬不一，后以清养调理而愈。（宋立人整理，宋爱人医案——实中阳厥，《中医杂志》11:55，1959）[评按] 中风系指以突然昏仆，不省人事，伴有口眼歪斜，语言不利，半身不遂，或仅以歪僻不遂为主的病证。因其病势急骤，症状多端，变化迅速，故名中风，或称“卒中”。中风发生的病因、病理比较复杂，但大致不外乎虚（阴虚、气虚）、火（肝火、心火）、风（肝风、外风）、痰（风痰、湿痰）、气（气逆）、血（血瘀）六端。六者可相互影响、相互作用。一般认为外邪侵袭而引发者称为外风，又称真中风或真中；无外邪而引发者，称为内风，又称类中风或类中。中风为本虚标实、上盛下虚之候。本为肝肾不足、气血衰少，标为风火相煽、痰湿壅盛、气血郁阻。按照现代临床分类则分为中经络与中脏腑两大类。中经络者病情较轻，一般无神志改变；中脏腑者病位较深，病情较重，主要表现为神志不清，并常有发病先兆及后遗症。
**案例一** 体型肥胖多痰，忧郁伤及中焦，肝风内动、脾湿生痰，经络阻塞，营卫滞留，患者虽见口眼歪斜、手足麻木，尚未见半身不遂。此为风痰中络，未入于经，治宜涤痰开郁，佐以养血活络，则风证自熄。
**案例二** 证属阴虚肝阳引动痰浊闭窍。证情较前稍重。方用半夏白术天麻汤加减。本方出自程钟龄《医学心悟》，功能补脾燥湿，化痰熄风。另加钩藤、僵蚕、决明子、刺蒺藜等加强熄风镇静之功。
**案例三** 证属肝阳上亢、痰热蒙蔽清窍。治以平肝熄风镇逆、降火涤痰通络之法。先煎潜镇平肝之品以代水煎药，寓意颇深。
**案例四** 始因情志不遂而致卒中。晚清医家张伯龙认为：“凡猝倒昏瞀，痰气上壅之中风，皆由肝火上亢，化风煽动，激起气血，并走于上，直冲犯脑，震扰神经而为昏不识人，喁斜倾跌，肢体不遂，言语不清诸症，皆脑神经失其功能之病，苟能于乍病之时，急用潜阳降逆之剂，抑降其气火之上浮，使气血不并走于上……”，实为高见。本案所用乃潜镇泄降之法。方用镇肝熄风汤加减。原方去茵陈、天冬、龟板，加生石膏、胆草以加强清热泻肝之力，重用牛膝以引血下行，折其亢盛之风阳，为张氏创用本方的独特之处。
**案例五、案例六** 为任氏经验方稀莶至阴汤、稀莶至阳汤的应用。本方以稀莶草为君药，分别辅以滋养肝肾与温肾之品。
**案例五** 证属阴虚阳亢，内风暗动，经脉血滞之候。故用稀莶至阴汤；
**案例六** 为类中风阳虚闭证。其妙在于先用辛温开窍法，以细辛3克煎汤化苏合香丸灌服，待患者清醒后，再用稀莶至阳汤以治中风阳虚之证。
**案例七** 病已月余，正气已虚而痰瘀阻络，仿王清任补阳还五汤法，益气活血通络而治愈。
**案例八** 证情复杂，神识半昏迷，历时四月而风犹未熄，病机、病象颇坏。治以镇敛浮越，平戢孤亢，方从《金匮》风引汤，百合地黄丸，《本事方》白薇汤、真珠母丸化裁而来。方中白薇味咸，走血分而平上逆之气血，百合收敛浮阳、宁谧心神；龙、牡育阴潜阳，再加上五石之重，镇其逆而清其血，益以大黄荡积，铁锈重坠，荆竹二沥化痰涎以通窍；菖蒲开窍祛痰，甘松清热；泽兰破积；橘络通络，木香导滞。师法古人，方从己出，古今合参，神明变化于活治之中，遵古而不泥古，重今而不偏今。
**案例九** 原案题为“实中阳厥”，其高明处在于摒除假虚，而从其真实。若真假虚实不辨，则动手便错，而犯“虚虚实实”之过。若实以虚治，则未有不留偏枯废痿之证者，此乃医事之过，不可忽略。
**(十九) 偏风** 高某，女性，45岁，已婚。初诊日期：1970年5月13日。左上半身感觉减退、麻木、无汗五年多。自1965年春，先发现左手感觉减退、麻木，并相继发现左侧头面部、胸背部及上肢不出汗，局部发凉，肢体麻木，感觉减退，逐渐加重，常不自觉被烫伤。左手握力差，不能持重物。经某医院神经科检查，左侧头面部、上肢及左侧躯干3～4胸椎以上平面，痛、温觉减退，皮肤较健侧明显干燥。主动运动及生理反射，均无特殊改变。诊断为脊髓空洞症、神经根炎。多年来常有腹泻，每天大便两三次，较稀，便前有时腹痛，腹泻常与情绪改变有关，未治疗。患者发育营养一般，面黄，精神不振，舌质淡红，舌苔薄白，脉沉细而弱。辨证：脾肾不足，气血两虚，风寒内袭，阻闭经络。治法：温肾健脾，补气养血，温经通阳。方药：山药30克、熟地15克、麻黄4.5克、炮姜9克、鹿角胶（烊化，也可用阿胶代之）12克、桂枝9克、补骨脂12克、白术（土炒）15克、陈曲（炒）9克、醋香附12克、当归12克、熟附子9克、山茱萸12克、木香9克、生黄芪12克、骨碎补12克、鸡血藤12克。水煎两遍，兑在一起，早晚各1次，温服。5月26日（二诊）：服药六剂，感觉舒适，食欲好转，食量增加，余证同前。舌苔、脉象同前。原方去木香、黄芪继服。6月3日（三诊）：药后病情明显好转，食量增加，大便已转正常，左上半身麻木感减轻，舌苔薄白，脉沉细，较前有力。仍以原方加减继服。方药：山药30克、熟地15克、麻黄4.5克、炮姜9克、鹿角胶（烊化）15克、桂枝9克、补骨脂12克、陈曲（炒）9克、白术（土炒）15克、醋香附12克、当归12克、熟附子12克、淫羊藿12克、枸杞子15克、生黄芪15克、生菟丝子24克、骨碎补15克、鸡血藤15克。1977年11月30日随访：先后间断服药半年多，左上肢麻木感逐渐减轻，患部痛、温觉较以前逐渐灵敏，左手握力大增，与健侧无明显差别，出汗如常，左上肢功能已恢复正常。现已五年，未再服药治疗。（《刘惠民医案》）[评按] 偏风首见于《诸病源候论·风病诸候》云：“偏风者，风邪偏客于身一边也。人体有偏虚者，风邪乘虚而伤之……或不知痛痒”、“风不仁者，由荣气虚，卫气实，风寒入于肌肉，使血气行不宣流，其状搔之皮肤如隔衣是也。”述证与本案颇有相似之处。偏风与中风半身不遂有别，此案肢体活动尚可，而痛温不觉，且患肢体麻木发凉、无汗。西医诊断脊髓空洞症。根据中医辨证属于脾肾不足、气血两虚，风寒内袭，阻闭经络。故以温肾健脾、益气养血，温经通络之法。症虽奇特而疗效尚称满意，值得重视。
**(二十) 眩晕**
**案例一** 潘某，女性，初诊日期：1954年2月。体质本虚弱，多年来襟怀不适，因遭事故，致肝木上升而头目眩晕，肝木侮土而呕吐不休。右脉弦劲，饮食不思，二便不利，舌绛苔薄，情势颇急，可能发痉。宜凉肝安胃，服后效再商。桑叶9克、杭菊花9克、粉丹皮9克、黑栀子9克、大白芍9克、细生地24克、姜川连2.1克、法夏6克、姜竹茹12克、黄郁金9克、羚羊镑1.2克（另煎兑）、苦丁茶9克。服上方左脉见平，舌绛见淡，苔薄见宣，眩晕立止，唯呕吐如前，纳食不香，二便未调。依前法去羚羊加安胃品以止呕吐。桑叶9克、菊花9克、丹皮9克、栀子炭9克、夏枯草9克、苦丁茶9克、细生地18克、大白芍9克、法夏6克、姜竹茹12克、干苇根15克、左金丸4.5克（分二次送服）。上方服两剂，呕吐为止，舌苔已消，胃纳已香，二便正常，再以小剂泄肝安胃善后。（张菊人：《菊人医话》）
**案例二** 魏某，男性，60岁。患头晕目眩，兼有耳鸣，鼻亦发塞，嗅觉不佳。病有数载，屡治不效，颇以为苦。切其脉弦，视其舌则胖大无伦，苔则水滑而白。辨证：此证心下有饮，上冒清阳，是以头冒目眩，其耳鸣、鼻塞，则为浊阴踞上，清窍不利之所致。治法：渗利水饮之邪。方药：泽泻24克、白术10克。此方服1剂而有汗，不改方，共服五剂，则头晕、目眩、耳鸣、鼻塞等证愈其大半，转方用五苓散温阳利水而收全功。（刘渡舟；谈谈《金匮》的泽泻汤证，《中医杂志》9:17，1980）
**Case 6** Yan, male, 56 years old. Initial consultation date: November 6, 1975. Initially suffered from dizziness (dizziness), followed by sudden collapse and loss of consciousness (loss of consciousness), locked jaw (locked jaw), pale complexion with dark lips, drooling from the corner of the mouth, left-sided hemiplegia (hemiplegia on one side), cold limbs, and deviation of the mouth and eyes. First sent to the county hospital for treatment with no improvement, then transferred to XX County Hospital for scalp acupuncture (scalp acupuncture). After two days of needle therapy, the jaw loosened, but the patient remained in a semi-comatose state (semi-coma), with unequal pupil sizes bilaterally and weakened light reflexes. Diagnosed as cerebral hemorrhage (internal capsule hemorrhage). The hospital invited a consultation. Pulse was floating, fine, and wiry; tongue was pale with thin coating. This was judged as a pattern of Yang deficiency with Yin excess, causing obstruction of the clear orifices (obstruction of the clear orifices). Xixin (Asari Radix et Rhizoma) 3g was decocted in water to dissolve Suhexiang Wan (Suhexiang Pill) 3g for administration. Administered twice within three hours. Around 3:00 PM, the patient gradually regained consciousness and felt hungry. Subsequently, Xishen Zhiyang Tang (Xishen Zhiyang Decoction) was prescribed to treat stroke due to Yang deficiency. Prescription: Jiuzhi Xishen Cao (Prepared Siegesbeckia Herb) 30g, Huangqi (Astragali Radix) 9g, Tiannanxing (Arisaematis Rhizoma) 6g, Baifuzi (Typhonii Rhizoma) 6g, Chuan Fupian (Prepared Aconiti Lateralis Radix) 9g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 3g, Honghua (Carthami Flos) 6g, Xixin (Asari Radix et Rhizoma) 1.5g, Fangfeng (Saposhnikoviae Radix) 6g, Niuxi (Achyranthis Bidentatae Radix) 6g, Jiangcan (Bombyx Batryticatus) 3g, Sumu (Sappan Lignum) 6g. Given the prominent symptoms of Yang deficiency and left-sided hemiplegia. The patient took this prescription continuously for 11 doses. After about two weeks, basic recovery was achieved, except for a sensation of heaviness and stagnation in the left limb during movement. (Ren Yingqiu: *Lin Zheng Dian Di*, *Shaanxi New Medicine* 2:42, 1977)
**Case 7** Zhao, male, 59 years old. Initial consultation date: September 18, 1939. Sudden collapse, numbness and insensibility of the left half of the body, difficulty walking, deviation of the mouth and angle of the mouth, continuous drooling, slurred speech with phlegm rales, bedridden for over a month. Pulse was deep and fine. Treatment should focus on nourishing righteousness (nourishing healthy Qi), activating collaterals, and dispelling phlegm, following Wang Qingren’s method with modifications. Prescription: Sheng Huangqi (Raw Astragali Radix) 45g, Chi Shao (Paeoniae Radix Rubra) 9g, Danggui (Angelicae Sinensis Radix) 9g, Dilong Rou (Pheretima) 6g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 3g, Guizhi Jian (Cinnamomi Ramulus Tip) 4.5g, Taoren Ni (Persicae Semen Paste) 3g, Nan Honghua (Safflower) 6g, Zhuli Shui (Arum Rhizoma Juice) 12g (mixed in two portions), Shengjiang Zhi (Zingiberis Rhizoma Fresh Juice) 3 drops (mixed in two portions), Shuluo Dan (Shuluo Pill) 1 pill, taken with plain boiled water. September 9 (Second Consultation): After taking the medicine, the affected side felt warm, but numbness persisted. Continue with the previous method with increased dosage. Prescription: Sheng Huangqi (Raw Astragali Radix) 60g, Chi Shao (Paeoniae Radix Rubra) 9g, Danggui (Angelicae Sinensis Radix) 9g, Zhuli Shui (Arum Rhizoma Juice) 12g (mixed in two portions), Shengjiang Zhi (Zingiberis Rhizoma Fresh Juice) 3 drops (mixed in two portions), Guizhi Jian (Cinnamomi Ramulus Tip) 4.5g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 4.5g, Dilong Rou (Pheretima) 9g, Shuluo Dan (Shuluo Pill) 2 pills, taken with plain boiled water. September 20 (Third Consultation): Effective after medication; the affected side can now move. Although the mouth is still deviated, drooling has stopped, and self-drinking is possible. Speech remains slurred. Continue with the previous formula with increased dosage. Prescription: Sheng Huangqi (Raw Astragali Radix) 60g, Chi Shao (Paeoniae Radix Rubra) 9g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 6g, Dilong Rou (Pheretima) 9g, Taoren Ni (Persicae Semen Paste) 6g, Juluo (Citri Reticulatae Pericarpium Venosum) 4.5g, Sangzhi (Mori Ramulus) 9g, Guizhi Jian (Cinnamomi Ramulus Tip) 4.5g, Zhuli Shui (Arum Rhizoma Juice) 9g (mixed in two portions), Shengjiang Zhi (Zingiberis Rhizoma Fresh Juice) 3 drops (mixed in two portions), Shujin Wan (Shujin Pill) 2 pills, taken in two portions. September 21 (Fourth Consultation): Stroke with hemiplegia; the medicine has shown great effect. The patient can now get out of bed and walk. Speech is gradually becoming clear. Pulse is becoming stronger. Continue with the method of nourishing righteousness and activating collaterals with added herbs. Prescription: Sheng Huangqi (Raw Astragali Radix) 60g, Chi Shao (Paeoniae Radix Rubra) 9g, Danggui (Angelicae Sinensis Radix) 9g, Nan Honghua (Safflower) 9g, Dilong Rou (Pheretima) 6g, Guizhi Jian (Cinnamomi Ramulus Tip) 4.5g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 4.5g, Taoren Ni (Persicae Semen Paste) 9g, Banxia (Pinelliae Rhizoma) 6g, Nanting (Dried Arisaematis Rhizoma Prepared with Gallbladder) 6g, Juluo (Citri Reticulatae Pericarpium Venosum) 4.5g, Chuan Qianghuo (Notopterygii Rhizoma et Radix) 3g, Zhuli Shui (Arum Rhizoma Juice) 12g (mixed in portions), Shengjiang Zhi (Zingiberis Rhizoma Fresh Juice) 3 drops (mixed in portions), Shujin Dan (Shujin Pill) 2 pills, taken in portions. After taking the previous prescription, gait returned to normal, speech became clear, and mouth deviation corrected. Add Juhong (Citri Reticulatae Pericarpium) 6g and Sangzhi (Mori Ramulus) 9g to the original formula. (Organized by Mao Youfeng et al.: *Zhao Shuping Medical Cases*, *Chinese Journal of Traditional Medical Science and Technology* 4:265, 1958)
**Case 8** Yu, when 60 years old, suffered a stroke, presenting with deviation of the mouth and eyes and hemiplegia. Bedridden, unable to sit, walk, or even turn over. Face red, breath coarse (wind not yet extinguished), loud rattling phlegm sounds, semi-comatose mental state, occasional dizziness and blurred vision, inability to eat (either difficult to swallow or falling out automatically). Four months passed with no effect from Chinese or Western medicines. Pulse was intermittent, wiry and forceful with a choppy quality; both pathogenesis and pulse image were critical. Treatment aimed to suppress and gather floating Yang, and calm isolated hyperactivity (extinguish unextinguished wind). Proposed prescription: Baiwei (Cynanchi Atrati Radix) and Baihe (Lilii Bulbus) each 9g, Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) each 9g, Zishiying (Mineral Pyrolusite) 9g, Ling Cishi (Magnetitum) 9g, Chishizhi (Halloysitum Rubrum) 9g, Hanshuishi (Halloysitum Album) 18g, Huashi (Talcum) 18g, Dahuang (Rhei Radix et Rhizoma) 4.5g, Tieshu Mo (Ferrugo) 9g, Jingli (Scrophulariae Radix Juice) and Zhuli (Arum Rhizoma Juice) each 15g (two juices mixed and administered). After one week, slight relief; one bowel movement occurred. Original formula modified: Dahuang reduced to 3g, added Hupo Mo (Electroplachi Carapax et Plastrum Powder) 1.5g and Huainiuxi (Achyranthis Bidentatae Radix) 12g. After another week, condition gradually improved; two bowel movements occurred. Symptoms of red face, coarse breath, phlegm obstruction, and coma decreased sharply. Hands and feet could move;勉强 able to sit up. Original formula modified: remove Dahuang and Tieshu Mo, add Xianshengdi (Rehmanniae Radix Recens) 30g and Shanyurou (Corni Fructus) 9g. After about two weeks, more than half recovered. Later, from the previous formula, remove Hanshuishi, Huashi, and Jingli; add Changpu (Acori Tatarinowii Rhizoma), Zelan (Lygodii Herba), Gansong (Nardostachyos Radix et Rhizoma), Juluo (Citri Reticulatae Pericarpium Venosum), and Muxiang (Aucklandiae Radix). Total duration approximately 60 days until full recovery. (*Ran Xuefeng Medical Cases*)
**Case 9** Qin, in early October 1943 (lunar calendar), suddenly experienced numbness of all four limbs, facial muscle twitching and convulsions, and a dull, abnormal expression. One evening, collapsed and lost consciousness, jaw locked, aphasia, right-side flaccid paralysis, loud phlegm rales sounding like sawing, urinary incontinence, restlessness day and night. On the 16th of that month, the 9th day of illness... Pulse was slippery and rapid, irregular, forceful upon heavy pressure. Body heat like charcoal, face red like cinnabar, chest and heart area burning to touch. This is "pseudo-stroke" combined with "Yang Jue" (cold extremities due to Yang constraint) major syndrome, distinct from deficiency patterns, so treat based on excess. Prescription: Xiewei Mo (Scorpio Tail Powder) 1.5g, Lingjiao Fen (Saiga Tataricae Cornu Powder) 1.5g, Wanshi Niuhuang Wan (Wanshi Calculus Bovis Pill) 2 pills, administer first. Additionally, use herbs to transform phlegm, clear heat, and relieve depression such as Zhuli (Arum Rhizoma Juice), Beimu (Fritillariae Thunbergii Bulbus), Banxia (Pinelliae Rhizoma), Juhong (Citri Reticulatae Pericarpium), Yujin (Curcumae Radix) to clear liver and extinguish wind; Shaoyao (Paeoniae Radix), Danpi (Moutan Cortex), Zhenzhumu (Concha Margaritifera) to assist; Fu Ling (Poria) and Fushen (Poria with Hostwood) as support. Decoct heavily in large dose, administer slowly. 17th Second Consultation: Learned that after medication, spirit calmed and sleep ensued, Jue trend calmed, red face faded, pulse slippery and rapid slightly slowed, spirit slightly stabilized, other symptoms same as before. Although Jue trend subsided, Feng Fei (wind-flaccidity) still entered heart and kidney collaterals. ... Prescribe: Wanshi Niuhuang Wan (Wanshi Calculus Bovis Pill) and Ye Shi Shenxi Dan (Ye's Divine Spark Pill) each 1 pill, grind to powder and administer first. In remaining prescription, remove Yujin and Zhenzhumu, add Haizao (Sargassum Herba) and Kunbu (Eckloniae Thallus) for salty moistening and sliding down, opening phlegm and dissipating nodules. Longchi (Dentalis Fossum) and Beichi (Concha Meretricis et Cyprinae) clear liver and calm soul. Yuanzhi (Polygalae Radix) opens heart Qi depression. Huainiuxi (Achyranthis Bidentatae Radix) guides rebellious Qi downward, allowing ascending to descend and descending not to ascend again. 19th Second Consultation: Previous two nights, sleep stable, spirit calm, facial convulsions slowed, jaw opened. Tongue coating yellow, dry, greasy. Urination sensation present. Still silent, unwilling to speak. Pulse slippery and rapid, Yang pulse excessive. Cough with phlegm but difficult to expectorate. ... Remove Shenxi Dan, add Hupo Mo (Electroplachi Carapax et Plastrum Powder) and Gan'an Mo (Agar Wood Powder) each 0.75g to calm spirit and relieve depression, maintain previous method. 22nd Second Consultation: Tongue root mobile and flexible, often wants to speak but slurred and unclear. Bowel gas stagnant for many days, frequent flatulence extremely foul-smelling. Urination frequent, smelly, slightly yellow, now controllable. Pulse slippery and rapid, turning harmonious. Blood crusts in teeth, tongue coating more greasy, turbid and greasy covering fully. This is Yangming binding. Binding should be moistened, nourish blood with softness, use acrid-slippery to smooth Qi mechanism. Remove Wanshi Niuhuang Wan from previous formula, add Shengditai (Carbonized Rehmanniae Radix), Zheng Suoyang (Processed Cynomorphi Herba), Sangma Wan (Mulberry and Hemp Seed Pill wrapped). In two days, continued bowel gas passage twice, black sticky tough stool, varying consistency. Finally cleared and nourished to recover. (Organized by Song Liren, Song Airen Medical Case - Excess Stroke Yang Jue, *Chinese Journal of Traditional Medical Science and Technology* 11:55, 1959) [Commentary] Stroke refers to a syndrome characterized by sudden collapse, loss of consciousness, accompanied by deviation of the mouth and eyes, speech impairment, hemiplegia, or mainly deviation and limpness. Due to its rapid onset, diverse symptoms, and quick changes, it is named Stroke or "Apoplexy". The etiology and pathology of stroke are complex, generally involving six aspects: Deficiency (Yin deficiency, Qi deficiency), Fire (Liver fire, Heart fire), Wind (Liver wind, External wind), Phlegm (Wind-phlegm, Damp-phlegm), Qi (Qi rebellion), Blood (Blood stasis). These six interact. Generally, those triggered by external pathogens are called External Wind, also True Stroke or True Zhong; those without external pathogens are called Internal Wind, also Pseudo-Stroke or Pseudo-Zhong. Stroke is a pattern of root deficiency and branch excess, upper excess and lower deficiency. Root is Liver-Kidney insufficiency and decline of Qi and Blood; Branch is Wind-Fire stirring together, Phlegm-Damp abundance, and Qi-Blood stagnation. According to modern clinical classification, it is divided into Middle of Collaterals and Middle of Organs. Middle of Collaterals is milder, usually without consciousness change; Middle of Organs is deeper, more severe, mainly manifesting as unconsciousness, often with prodromal signs and sequelae.
**Case 1** Obese and prone to phlegm, melancholy injuring the middle, Liver Wind moving internally, Spleen dampness generating phlegm, collaterals blocked, Ying and Wei stagnant. Patient presents with deviation of mouth and eyes, numbness of hands and feet, but no hemiplegia yet. This is Wind-Phlegm affecting collaterals, not entering meridians. Treatment should focus on eliminating phlegm and relieving depression, assisted by nourishing blood and activating collaterals, so Wind syndrome will extinguish itself.
**Case 2** Pattern belongs to Yin deficiency with Liver Yang stirring up turbid phlegm obstructing orifices. Condition slightly heavier than previous. Formula used: Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) with modifications. This formula originates from Cheng Zhongling's *Medical Heart Enlightenment*, functioning to tonify Spleen, dry dampness, transform phlegm, and extinguish wind. Added Gouteng (Uncariae Ramulus cum Uncis), Jiangcan (Bombyx Batryticatus), Juemingzi (Cassiae Semen), and Cilibili (Tribuli Fructus) to strengthen wind-extinguishing and sedative effects.
**Case 3** Pattern belongs to Liver Yang hyperactivity and Phlegm-Heat obscuring clear orifices. Treatment uses method of calming Liver, extinguishing wind, suppressing rebellion, reducing fire, transforming phlegm, and activating collaterals. First decoct herbs for subduing and calming Liver to replace water for decocting other herbs, implying profound meaning.
**Case 4** Initially caused by emotional frustration leading to apoplexy. Late Qing physician Zhang Bolong believed: "All strokes with sudden collapse, drowsiness, and phlegm-Qi congestion are due to Liver Fire hyperactivity, transforming into wind and stirring, agitating Qi and Blood, rushing upwards, directly attacking the brain, shaking nerves, causing unconsciousness, deviation, falling, limb paralysis, unclear speech, etc., all diseases of brain nerve dysfunction. If at the onset, urgent use of agents to subdue Yang and direct Qi downward, suppressing floating Qi and Fire, preventing Qi and Blood from rushing together upwards...", truly a high insight. This case uses method of subduing, settling, draining, and directing downward. Formula used: Zhen Gan Xi Feng Tang (Settle Liver and Extinguish Wind Decoction) with modifications. Original formula removed Yinchén (Artemisiae Scopariae Herba), Tiandong (Asparagi Radix), Guiban (Testudinis Carapax et Plastrum), added Sheng Shigao (Gypsum Fibrosum) and Danshen (Scutellariae Radix - *Note: Text says Dancao likely referring to Scutellaria or Gentiana contextually, but standard Zhen Gan Xi Feng Tang modification often uses Huangqin or similar bitter cold herbs; text says 'Dancao' which might be typo for Danpi or specific herb, assuming Scutellariae Radix/Huangqin context or literal translation*) to strengthen clearing heat and purging Liver fire. Heavy use of Niuxi (Achyranthis Bidentatae Radix) to guide blood downward, breaking hyperactive Wind-Yang, unique to Zhang's creation of this formula.
**Case 5, Case 6** Application of Ren's empirical formulas Xishen Zhiyin Tang (Xishen Zhiyin Decoction) and Xishen Zhiyang Tang (Xishen Zhiyang Decoction). This formula uses Xishen Cao (Siegesbeckiae Herba) as sovereign herb, assisted respectively by herbs nourishing Liver-Kidney and warming Kidney.
**Case 5** Pattern belongs to Yin deficiency with Yang hyperactivity, internal wind moving secretly, and blood stasis in meridians. Thus, Xishen Zhiyin Tang is used.
**Case 6** Is Pseudo-Stroke Yang deficiency closure syndrome. Its brilliance lies in first using acrid-warm opening orifice method, decocting Xixin (Asari Radix et Rhizoma) 3g in water to dissolve Suhexiang Wan (Suhexiang Pill) for administration. After patient regains consciousness, use Xishen Zhiyang Tang (Xishen Zhiyang Decoction) to treat stroke Yang deficiency pattern.
**Case 7** Illness lasted over a month, righteous Qi already deficient, phlegm and blood stasis blocking collaterals. Imitate Wang Qingren's Buyang Huanwu Tang (Tonify Yang and Restore Five Tenths Decoction) method, tonify Qi, activate blood, activate collaterals, and cure.
**Case 8** Complex condition, semi-comatose mental state, wind not extinguished after four months, pathogenesis and manifestations very bad. Treatment aims to suppress gathering floating Yang, calm isolated hyperactivity. Formula derived from *Jin Gui* Fengyin Tang (Wind-Guiding Decoction), Baihe Dihuang Wan (Lily and Rehmannia Pill), *Ben Shi Fang* Baiwei Tang (Baiwei Decoction), Zhenzhumu Wan (Pearl Mother Pill). In formula, Baiwei (Cynanchi Atrati Radix) salty, enters blood level to calm upward-rebellious Qi and Blood; Baihe (Lilii Bulbus) gathers floating Yang, calms mind; Longmu (Dragon Bone and Oyster Shell) nourishes Yin and subdues Yang, plus five stones' weight, suppresses rebellion and clears blood, aided by Dahuang (Rhei Radix et Rhizoma) sweeping accumulation, Tieshu (Iron Rust) heavy sinking, Jingli and Zhuli (Scrophularia and Arum Juices) transforming phlegm saliva to open orifices; Changpu (Acori Tatarinowii Rhizoma) opens orifices and expels phlegm, Gansong (Nardostachyos Radix et Rhizoma) clears heat; Zelan (Lygodii Herba) breaks accumulation; Juluo (Citri Reticulatae Pericarpium Venosum) activates collaterals, Muxiang (Aucklandiae Radix) directs stagnation. Learning from ancients, formula from oneself, combining ancient and modern, divine changes in active treatment, respecting ancient without being bound by it, valuing modern without bias towards it.
**Case 9** Original case titled "Excess Stroke Yang Jue", its brilliance lies in discarding false deficiency and following true reality. If true/false, deficiency/excess are not distinguished, action will be wrong, committing error of "treating deficiency as excess and excess as deficiency". If treating excess as deficiency, inevitably leaving sequelae of hemiplegia and wasting, this is medical fault, cannot be ignored.
**(XIX) Biased Wind** Gao, female, 45 years old, married. Initial consultation date: May 13, 1970. Left upper body sensory reduction, numbness, anhidrosis for over five years. Since spring 1965, first noticed left hand sensory reduction and numbness, subsequently noticed left head/face, chest/back, and upper limbs anhidrosis, local cooling, limb numbness, sensory reduction, gradually worsening, often unknowingly burned. Left hand grip weak, unable to hold heavy objects. Examined by neurology department of a certain hospital: left head/face, upper limbs, and left trunk above T3-T4 plane, pain and temperature sensation reduced, skin significantly drier than healthy side. Active movement and physiological reflexes, no special changes. Diagnosed as syringomyelia, radiculitis. Often had diarrhea for many years, 2-3 times daily, loose, sometimes abdominal pain before defecation, diarrhea related to emotional changes, untreated. Patient development and nutrition average, sallow face, poor spirit, tongue pale red, thin white coating, pulse deep, fine, and weak. Syndrome differentiation: Spleen-Kidney insufficiency, dual deficiency of Qi and Blood, internal invasion of Wind-Cold, blocking collaterals. Treatment method: Warm Kidney and invigorate Spleen, tonify Qi and nourish Blood, warm meridians and unblock Yang. Prescription: Shanyao (Dioscoreae Rhizoma) 30g, Shudi (Rehmanniae Radix Preparata) 15g, Mahuang (Ephedrae Herba) 4.5g, Paojiang (Zingiberis Rhizoma Preparatum) 9g, Lu Jiao Jiao (Colla Cornus Cervi, melted, can substitute with Ejiao) 12g, Guizhi (Cinnamomi Ramulus) 9g, Buguzhi (Psoraleae Fructus) 12g, Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried) 15g, Chenqu (Medicated Leaven, fried) 9g, Cu Xiangfu (Cyperi Rhizoma, vinegar-processed) 12g, Danggui (Angelicae Sinensis Radix) 12g, Shu Fuzi (Aconiti Lateralis Radix Preparata) 9g, Shanzhuyu (Corni Fructus) 12g, Muxiang (Aucklandiae Radix) 9g, Sheng Huangqi (Astragali Radix) 12g, Gusui Bu (Drynariae Rhizoma) 12g, Jixueteng (Spatholobi Caulis) 12g. Decoct twice in water, mix together, take morning and evening, warm administration. May 26 (Second Consultation): Took six doses, felt comfortable, appetite improved, food intake increased, other symptoms same. Tongue coating and pulse same. Original formula remove Muxiang, Huangqi, continue taking. June 3 (Third Consultation): Condition obviously improved after medicine, food intake increased, stool turned normal, left upper body numbness reduced, tongue coating thin white, pulse deep and fine, stronger than before. Still modify and continue taking original formula. Prescription: Shanyao (Dioscoreae Rhizoma) 30g, Shudi (Rehmanniae Radix Preparata) 15g, Mahuang (Ephedrae Herba) 4.5g, Paojiang (Zingiberis Rhizoma Preparatum) 9g, Lu Jiao Jiao (Colla Cornus Cervi, melted) 15g, Guizhi (Cinnamomi Ramulus) 9g, Buguzhi (Psoraleae Fructus) 12g, Chenqu (Medicated Leaven, fried) 9g, Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried) 15g, Cu Xiangfu (Cyperi Rhizoma, vinegar-processed) 12g, Danggui (Angelicae Sinensis Radix) 12g, Shu Fuzi (Aconiti Lateralis Radix Preparata) 12g, Yinyanghuo (Epimedii Folium) 12g, Gouqizi (Lycii Fructus) 15g, Sheng Huangqi (Astragali Radix) 15g, Sheng Tusizi (Cuscutae Semen) 24g, Gusui Bu (Drynariae Rhizoma) 15g, Jixueteng (Spatholobi Caulis) 15g. Follow-up Nov 30, 1977: Intermittently took medicine for over half a year, left upper limb numbness gradually reduced, pain and temperature sensation in affected part gradually more sensitive than before, left hand grip greatly increased, no obvious difference from healthy side, sweating normal, left upper limb function restored to normal. Now five years, no further medication treatment. (*Liu Huimin Medical Cases*) [Commentary] Biased Wind first appeared in *Zhu Bing Yuan Hou Lun · Wind Disease Syndromes*: "Biased Wind means Wind Evil resides biasedly on one side of the body. If the human body has biased deficiency, Wind Evil takes advantage of deficiency to injure... or unaware of pain and itch." "Wind Insensibility means Ying Qi deficient, Wei Qi solid, Wind-Cold enters muscles, making Qi and Blood flow not freely spreading, its appearance is scratching skin feels like隔着 clothes." Description similar to this case. Biased Wind differs from stroke hemiplegia; this case limb activity acceptable, but pain/temperature absent, and affected limb numb, cool, anhidrotic. Western diagnosis: Syringomyelia. According to TCM syndrome differentiation belongs to Spleen-Kidney insufficiency, dual deficiency of Qi and Blood, internal invasion of Wind-Cold, blocking collaterals. Thus use method of warming Kidney and invigorating Spleen, tonifying Qi and nourishing Blood, warming meridians and activating collaterals. Symptoms peculiar but efficacy satisfactory, worthy of attention.
**(XX) Vertigo**
**Case 1** Pan, female. Initial consultation date: February 1954. Constitution originally weak, long-term dissatisfaction, due to accident, causing Liver Wood rising leading to head/eye vertigo, Liver Wood insulting Earth leading to incessant vomiting. Right pulse wiry and forceful, no desire for food, urination and defecation difficult, tongue crimson with thin coating, situation urgent, possibly developing spasms. Should cool Liver and calm Stomach, consult again after effect. Sangye (Mori Folium) 9g, Hang Juhua (Chrysanthemi Flos) 9g, Fen Danpi (Moutan Cortex) 9g, Hei Zhizi (Gardeniae Fructus Preparata) 9g, Da Baishao (Paeoniae Radix Alba) 9g, Xi Shengdi (Rehmanniae Radix) 24g, Jiang Chuanlian (Coptidis Rhizoma prepared with Ginger) 2.1g, Fa Xia (Pinelliae Rhizoma Preparata) 6g, Jiang Zhuru (Bambusae Caulis in Taenia preparated with Ginger) 12g, Huang Yujin (Curcumae Radix) 9g, Lingyang Bang (Saigae Tataricae Cornu) 1.2g (decoct separately and mix), Kuding Cha (Ilicis Kudingchaefolium) 9g. Take above prescription, left pulse becomes level, tongue crimson fades, thin coating spreads, vertigo stops immediately, only vomiting as before, poor appetite, urination/defecation不调. Follow previous method, remove Lingyang, add Stomach-calming items to stop vomiting. Sangye (Mori Folium) 9g, Juhua (Chrysanthemi Flos) 9g, Danpi (Moutan Cortex) 9g, Zhizi Tan (Gardeniae Fructus Carbonized) 9g, Xiakucao (Prunellae Spica) 9g, Kuding Cha (Ilicis Kudingchaefolium) 9g, Xi Shengdi (Rehmanniae Radix) 18g, Da Baishao (Paeoniae Radix Alba) 9g, Fa Xia (Pinelliae Rhizoma Preparata) 6g, Jiang Zhuru (Bambusae Caulis in Taenia preparated with Ginger) 12g, Gan Weigen (Phragmitis Rhizoma) 15g, Zuojin Wan (Left Metal Pill) 4.5g (taken in two portions). Take above prescription two doses, vomiting stops, tongue coating disappears, stomach appetite fragrant, urination/defecation normal, finally use small dose to drain Liver and calm Stomach for follow-up care. (Zhang Juren: *Juren Medical Talks*)
**Case 2** Wei, male, 60 years old. Suffers from dizziness and vertigo, accompanied by tinnitus, nasal congestion, poor smell. Illness for several years, multiple treatments ineffective, very suffering. Pulse wiry, tongue fat and huge, coating watery, slippery and white. Syndrome differentiation: This case has fluid retention in Heart region, floating up to obscure Clear Yang, thus head dizziness and eye vertigo. Tinnitus and nasal congestion are due to Turbid Yin occupying upper, Clear Orifices not benefiting. Treatment method: Leach and drain Fluid-Evil. Prescription: Zexie (Alismatis Rhizoma) 24g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g. This prescription after 1 dose causes sweating, do not change formula, total 5 doses, then dizziness, vertigo, tinnitus, nasal congestion mostly cured. Change formula to Wuling San (Five-Ingredient Powder with Poria) to warm Yang and promote urination to achieve complete success. (Liu Duzhou; Discussing *Jin Gui* Zexie Tang Syndrome, *Chinese Journal of Traditional Medical Science and Technology* 9:17, 1980)