经曰∶神伤思虑则肉脱,意伤忧愁则肢废,魂伤悲哀则筋挛,魄伤喜乐则皮槁,志伤盛
怒则
腰脊难俯仰,所以筋挛不便之证,为内因之病,不可倒作风治。然五痿论云∶有所失亡,所
求不得,则肺热叶焦,皮毛枯燥而生痿 ,名曰皮毛痿。悲哀太甚,则经络绝,名曰脉痿
。
思虑无穷,热入于肝,致出白淫,名曰筋痿。感于卑湿,土气伤脾,致肌肉不仁名曰肉痿。
劳倦热渴,阳气内乏,热舍于肾,腰脊不举,甚则骨髓枯减,名曰骨痿。夫皮毛筋脉三痿,
固为内因,而骨肉二痿,又属外感。况生气通天论云∶因于湿,首如裹,湿热不攘,大筋软
短,小筋弛长,软短为拘,弛长为痿,观此则痿亦有外感者矣。丹溪以痹为外感风寒实邪,
痿为内因湿热本虚。愚谓痹乃正气本和,因外感之风寒冷湿,为刚烈之邪,当以有余名之。
痿乃正气本虚,致成怫郁懈惰之病,为柔缓之邪,当以不足名之。故或因初感七情,乃饮食
浓味,中焦郁积,淫气不清,湿热乘虚而痿者有之。或因初感湿痹,郁久成热,气血渐虚为
痿者有之,难以拘论也。至于治法,如湿胜者,则有脾胃虚湿之证,脉微而缓弱,宜渗水燥
土。热胜者,则有内伤郁热之证,脉虚而浮大,宜益气清热,此内经治痿独取阳明之法也。
如肝肾精血虚而湿多者,谓之正虚,宜温补精髓,内虽有热,乃为虚热,补之自除。若真火
热胜者,谓之偏虚,脉必沉数,及兼遗精,白浊、阴火等证,宜滋阴降火。热甚者,宜服泻
火表剂以救肺热,此丹溪治痿泻南补北之法也,有用愈风汤、健步丸,以治湿热相半之痿,
愚谓止可施于挟风之证。若风邪甚者,又为痹矣。
The *Classic* states: When the Shen (Spirit) is injured by excessive thinking, flesh wastes away; when the Yi (Intellect) is injured by excessive sorrow, limbs become useless; when the Hun (Ethereal Soul) is injured by excessive grief, sinews contract; when the Po (Corporeal Soul) is injured by excessive joy, skin becomes withered; when the Zhi (Will) is injured by excessive anger, the waist and spine become difficult to flex and extend. Therefore, conditions of sinew contraction and inconvenience are diseases caused by internal factors and should not be mistakenly treated as wind disorders. However, the *Treatise on Five Wei Syndromes* states: Loss or unfulfilled desires lead to Lung heat and scorched leaves, causing dryness of hair and skin and generating a Wei syndrome, named Pi Mao Wei (Skin and Hair Wei). Excessive grief causes the meridians to sever, named Mai Wei (Vessel Wei). Endless thinking allows heat to enter the Liver, resulting in Bai Yin (seminal emission or leukorrhea), named Jin Wei (Sinew Wei). Exposure to damp-biases injures Spleen Earth, causing muscle insensibility, named Rou Wei (Flesh Wei). Labor fatigue, heat, and thirst deplete internal Yang Qi, allowing heat to lodge in the Kidney, preventing the raising of the waist and spine, and in severe cases, causing marrow depletion, named Gu Wei (Bone Wei). Thus, the Pi Mao, Jin, and Mai Wei syndromes are indeed due to internal factors, while the Rou and Gu Wei syndromes belong to external pathogenic influences. Furthermore, the *Treatise on Sheng Qi Tong Tian* states: Due to dampness, the head feels wrapped; if damp-heat is not resolved, large sinews become short and soft, and small sinews become lax and long. Shortness leads to spasm, and laxity leads to Wei. From this, we see that Wei syndromes can also arise from external influences. Danxi considered Bi syndrome to be an external excess of wind-cold-dampness, while Wei syndrome is an internal deficiency with damp-heat. I believe Bi syndrome arises when healthy Qi is originally harmonious but is attacked by the harsh pathogens of wind, cold, and dampness, and should be termed "Excess" (You Yu). Wei syndrome arises when healthy Qi is originally deficient, leading to stagnation and lethargy, characterized by soft and slow pathogens, and should be termed "Deficiency" (Bu Zu). Therefore, some cases arise from initial emotional injuries or rich dietary intake causing middle-jiao accumulation, turbid Qi, and damp-heat exploiting deficiency to cause Wei. Other cases arise from initial damp-Bi transforming into heat over time, gradually depleting Qi and Blood to cause Wei; these cannot be rigidly categorized. Regarding treatment methods: For damp excess, there are signs of Spleen-Stomach deficiency with dampness, presenting with a faint, slow, and weak pulse; treatment should involve leaching water and drying Earth. For heat excess, there are signs of internal injury with stagnant heat, presenting with a deficient, floating, and large pulse; treatment should involve tonifying Qi and clearing heat. This is the method of "solely taking Yangming" for treating Wei as stated in the *Neijing*. For cases where Liver and Kidney essence and blood are deficient with much dampness, termed Zheng Xu (True Deficiency), one should warm and tonify essence and marrow; although there is internal heat, it is empty heat, which will resolve with tonification. If there is excess of True Fire (Ministerial Fire), termed Pian Xu (Partial Deficiency), the pulse must be deep and rapid, accompanied by seminal emission, white turbidity, and Ministerial Fire symptoms; treatment should involve nourishing Yin and descending fire. In severe heat, one should administer purgative and exterior-releasing agents to rescue Lung heat. This is Danxi's method of "Purging South and Supplementing North" for treating Wei. Some use Yufeng Tang and Jianbu Wan to treat Wei with equal parts of damp-heat; I believe this is only applicable to conditions complicated by Wind. If Wind pathogens are severe, it transforms into Bi syndrome.