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(When occurring in summer, it is commonly known as "Zhu Xia" [Summer Malaise].)

Wei syndrome (Flaccidity Syndrome) refers to weakness and flaccidity of the hands and feet, where they relax and cannot be controlled voluntarily. (This is what is colloquially referred to as hand paralysis and leg softness.) This is generally caused by heat combined with dampness. Observing all things, cold and dry substances must be hard and contracting; hot and wet substances must be soft and elongated. Dampness belongs to Earth. The Stomach is the Sea of Water and Grain, and it governs the moistening of sinews and vessels. If the Stomach suffers disease, it cannot transport and transform water and grain, causing dampness to stagnate within the sinews and vessels. Instead of moistening, it becomes a flood. Combined with heat, this is why the treatment of Wei syndrome focuses exclusively on the Yangming channels.

Heat exists in all five Zang organs. Heat is Fire. Fire belongs to the Heart and injures Lung Metal. The element that controls Fire is Water. Metal is the source of Water. If the source is injured, the flow ceases. By aggravating the injury to the source, the condition is ultimately attributed to Lung Heat. However, while it is true that this syndrome involves heat without cold, whether dampness is present or not requires careful differentiation. If there is no dampness but drying agents are used indiscriminately to promote urination, the Fire will become even more scorching and dry. The sinews and vessels will instead suffer from withering, dryness, and contraction, making it impossible to achieve relaxation and elongation. Practitioners must exercise caution. (Wei syndrome can also occur without dampness. When body fluids are scorched by heat, they may not immediately dry up. Although not elongated, they are not shortened either; they are merely weak, soft, and unable to move. One can observe this in grass and trees whose leaves and branches wilt under the scorching sun.) *Neijing* divides Wei syndrome into five types.

Lung heat causes the lung leaves to become scorched and dry. The skin and hair become weak, tight, and thin, adhering to the flesh. (The skin becomes dry and tight, binding with the muscles and adhering to them.) This leads to Wei Bi (flaccidity of the legs), where the feet cannot walk. The signs include a pale complexion and deteriorated hair.

Heart heat causes the lower meridians to reverse and ascend. (The meridians of the three Yin channels located below reverse and ascend due to Heart heat.) Ascending excess leads to deficiency in the lower meridians. Deficiency results in Mai Wei (Vessel Flaccidity). The pivot breaks, and lifting is difficult. (The knees and wrists seem broken and cannot support lifting.) The calves are flaccid and cannot bear weight. The signs include a red complexion and overflowing collateral vessels.

Liver heat causes bile leakage and a bitter taste in the mouth. The fascia dries out. Dry fascia leads to tendon tension and contraction, developing into Jin Wei (Tendon Flaccidity). The signs include a bluish-green complexion and withered nails.

Spleen heat causes stomach dryness and thirst. The muscles become insensate, developing into Rou Wei (Muscle Flaccidity). The signs include a yellow complexion and twitching muscles.

Kidney heat causes inability to raise the waist and spine. The bones become withered and the marrow decreases, developing into Gu Wei (Bone Flaccidity). The signs include a black complexion and withered teeth.

Furthermore, regarding the causes of heat: if one experiences loss of aspirations or unfulfilled desires, it triggers Lung Ming (coughing). Lung heat causes the lung leaves to become scorched and dry.

Due to Lung heat and scorched lung leaves, all five Zang organs develop Wei Bi. Excessive grief severs the Bao Mai (uterine/corporeal vessels). Severance causes Yang Qi to move internally, leading to blood eruption from the heart region and frequent bloody urine. The major meridians become empty, developing into Ji Bi (Muscle Bi), which transmits to Mai Wei (Vessel Flaccidity).

Endless thinking and unfulfilled wishes cause the mind to wander externally. Excessive sexual intercourse causes the Zong Jin (General Sinews) to relax and sag, developing into Jin Wei (Tendon Flaccidity) and Bai Yin (white discharge).

Jin Wei originates from the Liver. If the interior gradually becomes infused with dampness (infusion/maceration), and one works with water (such as boat dwellers accustomed to water), living in damp environments causes muscle maceration. Numbness and insensibility develop, resulting in Rou Wei (Muscle Flaccidity).

Contracted from living in damp places, or from long journeys and fatigue, encountering intense heat and thirst. Thirst causes Yang Qi to attack internally. Internal attack allows heat to lodge in the Kidney. Water fails to overcome Fire. Bones become withered and marrow deficient. Thus, the feet cannot support the body, developing into Gu Wei (Bone Flaccidity).

Carefully examining the meaning of the *Classic*, it states that each of the five Zang organs has its own directly induced Wei syndrome, as well as Wei syndromes transmitted from other diseases (as seen in the transmission from Ji Bi to Mai Wei). Ultimately, however, they all attribute to Lung Heat. Regarding the causes of heat, some mention Seven Emotions, some mention sexual indulgence, some mention dampness injury, and some mention fatigue. These are rhetorical devices using mutual text to reveal meaning. External and internal pathogens are sufficient to cause disease; there is no indication that dampness is emphasized above others.

However, in the discussion of treatment for this syndrome, it states that the Yangming channel is the Sea of the Fu and Zang organs. It governs the moistening of the Zong Jin, binds the bones, and facilitates joint movement. It converges with the Chong Mai (Chong Mai is also known as the Sea of Blood) at the Zong Jin and is connected to the Dai Mai. Yangming deficiency (the Chong Mai becomes deficient as it receives nothing from Yangming) causes the Zong Jin to relax, and the Dai Mai fails to hold firm. (As mentioned earlier, deficiency means failing to transport dampness, turning moisture into a flood; thus, all sinews and vessels become flaccid and relaxed.) Consequently, the feet become flaccid and unusable. Therefore, treating Wei syndrome focuses exclusively on Yangming.

Additionally, *Shengqi Tongtian Lun* states: If damp-heat is not removed, large sinews shorten, and small sinews elongate. (Large sinews can also elongate, and small sinews can shorten; do not be rigid.) Shortening leads to spasm; elongation leads to flaccidity. This confirms that this syndrome is discussed in terms of damp-heat, not dry-heat. Therefore, ancient formulas often use Atractylodis Rhizoma (Baizhu/Cangzhu), Poria (Fuling), Alisma (Zexie), and various wind-dispelling herbs. Yet, cases belonging to dry-heat are actually more common. In such cases, nourishing the Qi of water and grain from Yangming to moisten the Zong Jin, and strengthening the Essence of the Shaoyin of the North to irrigate the dried marshes, might still worry about insufficient effect. How could one dare to use diuretics to drain dampness?

Treatment Methods:
For Heat syndrome: Buyin Wan (Nourish Yin Pill). Li Dongyuan uses Phellodendri Cortex (Huangbai) as the sovereign herb to nourish Water and clear Heat. Songya stated: Wind-dispelling herbs and aromatic, drying, warming, and tonifying agents must absolutely not be used. Child's urine alone is most excellent. Qingzao Tang (see Shangshu chapter) uses Coptidis Rhizoma (Huanglian), Phellodendri Cortex (Huangbai), Ophiopogonis Radix (Maidong), Schisandrae Fructus (Wuweizi), Rehmanniae Radix (Shengdi), Angelicae Sinensis Radix (Danggui) to clear Metal, nourish Water, and nourish Blood; Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), and Glycyrrhizae Radix et Rhizoma (Gancao) to tonify Lung Qi. For dampness, use Atractylodis Rhizoma (Baizhu/Cangzhu), Poria (Fuling/Zhuling), and Alisma (Zexie). For dampness in the lower part, add Bupleuri Radix (Shengma/Chaihu) to lift and guide. For poor appetite, use Tangerine Peel (Chenpi) and Medicated Leaven (Shenqu). For Lung Heat, use Astragali Radix (Huangqi), Asparagi Radix (Tianmen/Dongmen), Dendrobii Caulis (Shihu), Lilii Bulbus (Baihe), Dioscoreae Rhizoma (Shanyao), Rhinocerotis Cornu (Xijiao), Platycodonis Radix (Jiegeng), Scutellariae Radix (Kuhuang), Gardeniae Fructus (Zhizi), and Apricot Seed (Xingren). Add Akebia Caulis (Mutong) and Gentianae Macrophyllae Radix (Qinjiao) if dampness is present. For Heart Heat, use Coptidis Rhizoma (Huanglian), Sophorae Flavescentis Radix (Kushen), Calculus Bovis (Niuhuang), Dragon Bone (Longgu), Moutan Cortex (Mudanpi), Lycii Cortex (Digupi), and Rhinocerotis Cornu (Xijiao). For Liver Heat, use Rehmanniae Radix (Shengdi), Asparagi Radix (Tiandong), Paeoniae Radix Alba (Baishao), Bupleuri Radix (Chaihu), Gentianae Radix (Longdancao), Tribuli Fructus (Bajili), Scutellariae Radix (Huangqin), and Coptidis Rhizoma (Huanglian). For Spleen Heat with Phlegm-Dampness, use Er Zhu Er Chen Tang, Xiatiang Gao, etc. In severe cases, use Sanhua Tang (see Fengzhong chapter) or Tiaowei Chengqi Tang (see Bianmi bitong chapter) to purge, or Kongxian Dan (see Tan chapter) to extract. For Kidney Heat, use Liuwei Dihuang Wan (see Xusun chapter) plus Anemarrhenae Rhizoma (Zhimu) and Phellodendri Cortex (Huangbai). For Damp-Heat, use Jianbu Wan plus Phellodendri Cortex (Huangbai), Atractylodis Rhizoma (Cangzhu), and Scutellariae Radix (Huangqin), or Xiaowei Dan (see Tanyin chapter) to attack. For Damp-Phlegm, use Erchen Tang plus Atractylodis Rhizoma (Cangzhu), Phellodendri Cortex (Huangbai), Bamboo Sap (Zhuli), and Ginger Juice (Jiangzhi). For Blood Deficiency, use Siwu Tang (see Xue chapter) with modifications. For Qi Deficiency (Strong Fire consumes Qi), use Buzhong Yiqi Tang (see Qi chapter) plus Atractylodis Rhizoma (Cangzhu) and Phellodendri Cortex (Huangbai). For Stasis Blood, use Peach Kernel (Taoren), Safflower (Honghua), Angelicae Sinensis Radix (Guiwei), and Red Peony Root (Chishao).

If only the two feet are flaccid, the disease is in the lower part, belonging to the Kidney and Bladder. *Neijing* states: Unresolved fear injures Jing (Essence). (Injury to the Kidney has many aspects; citing fear covers the rest; do not be rigid.) Jing injury leads to bone soreness, flaccidity, and coldness of the extremities, and spontaneous leakage of essence. (Kidney injury and Jing depletion mean Water deficiency is known. Water deficiency leads to Fire flaming upward. Heat causes sinew flaccidity, which is known.) It also states: Disease of the Three Yang (i.e., Bladder Taiyang Channel) manifests as chills and fever, sores and swellings below (indicating excess heat), and Wei Jue (flaccidity and coldness of extremities). This also belongs to Spleen Dampness. *Neijing* says: Generally, treating Wei Jue in fat nobles (meaning wealthy people) is a disease of rich foods and drinks. (Rich wine and heavy flavors accumulate into damp-heat.) It also says: Injury to dampness in autumn (Autumn is the command of Dryness, yet it mentions injury to dampness to show that Autumn can also involve dampness injury; do not be rigid), leading to Wei Jue, is also correct.

Li Dongyuan treated Hejian Gong, aged 32, who suffered from this disease. His buttocks and yin area were cold, with sweaty and foul-smelling yin, and insecure seminal emission. This was caused by rich wine and heavy flavors generating fire internally, forcing Yin outward. Doctors mistakenly treated it as Cold, and after 100 days it had not healed. The pulse was deep, rapid, and forceful. He used a strongly bitter-cold formula to nourish the Kidney, applied urgent treatment, and used "treating cold with cold" (Han yin re yong). After two doses, he recovered. (It should be something like Zishen Wan or Shengu Zishen Wan.) Zuojing Wan and Xugu Dan treat Wei syndrome caused by damp-phlegm and turbid blood obstructing the collaterals. If accompanied by exterior pathogen, use Yebip Jia Zhu Tang (see Zhangzhong chapter).