素问云。肺热叶焦。则皮毛虚弱急薄。着则生痿 也。心气热。则下脉厥而上。上则下脉虚。
虚则生脉痿。枢折挈胫纵而不任地也。肝气热。则胆泄口苦。筋膜干。筋膜干则筋急而挛。发为
筋痿。脾气热。则胃干而渴。肌肉不仁。发为肉痿。肾气热。则腰脊不举。骨枯而髓减。发为骨痿。
戴人云。痿之为状。两足痿弱不能行。皆由肾水不能胜心火。心火上烁肺金。肺受火制。六
叶皆焦。皮毛虚弱。急而薄者。则生痿 。 者。足不能伸而行步 然也。肾乃肺金之子。今肾
水衰少。随火上炎。肾水既衰。则骨髓衰竭。由使内太过所致。直断曰。痿病无寒。故痿之作也。
五六七月。皆其时也。故病痿之人。其脉浮软。今之行药者。凡见脚膝痿弱难于行步。或一足不
伸。便作寒湿香港脚治之。骤用乌、附、乳、没、威灵仙之类。燔针艾火。汤蒸袋蒸。痿弱转加。
如此而死。岂非夭乎。夫治痿与治痹颇异。风寒湿痹。犹可蒸汤灸燔。时或一效。惟痿用之转甚
者。何也。盖痿以肺热叶焦而成。以此传于五脏。岂有寒者欤。若痿作寒治。是杀之也。夫痿病
不死。死者皆药之误也。
石顽曰。痿证脏腑病因。虽曰不一。大都起于阳明湿热。内蕴不清。则肺受热乘而日槁。脾
受湿淫而日溢。遂成上枯下湿之候。举世靡不以肾虚为事。阳明湿热。从无齿及之者。或云。痿
病既属湿热。何古方多用附子辛热而愈者。殊
不知湿热沉滞既久。非借辛热之力。不能开通经隧。原非为肾脏虚寒而设。若真阳未衰。概行温
补。而不知清热渗湿。宁无反助湿热之患耶。
凡人自觉两足热如火炙。自足踝下上冲膝腿。且痿弱软痛。能行而不能久立。脉濡而数。乃
阴虚而挟湿热也。虎潜丸。不应。少加附子。骨痿不能起于床者。金刚丸。经言骨痿者。生于大
热也。有所远行劳倦。逢大热而渴。渴则阳气内伐。内伐则热舍于肾。肾者水脏也。今水不胜火。
则骨枯而水虚。足不任身。发为骨痿。此湿热成痿。多发于夏。令人骨乏无力。故治痿独取阳明。
东垣独得其秘。而用清燥之剂。主以清暑益气汤。属湿痰者。手足软弱。脉沉滑。兼腰膝麻木。
或肿。二陈汤加二术、羌活、黄柏、竹沥、姜汁。黑瘦人脉涩弱。或左脉大而无力。行步艰难。
或兼盗汗阴虚等证者。是血虚有火。四物加牛膝、肉桂、黄柏、苍术。阴血衰弱。不能养筋。筋
缓不能自收持。故痿弱无力。补血荣筋丸。气虚痿弱无力。四君子加苍术、黄柏、肉桂、黄 。
肥白人脉沉缓。或滑。恶心。胸膈不利。属气虚有痰。六君子加苍术、黄柏、竹沥、姜汁。兼食
积。即气口弦滑。腹胀恶食。是食积妨碍。脾气不得运于四肢。导痰汤加楂、曲、木瓜、防己。
挟死血者。脉沉涩或弦。而按之则芤。为恶血流于腰膝。或因产后。或跌扑伤损而得者。不可作虚治。
痿厥 足痿弱不收为痿厥。有二。一属肾与膀胱。经云。恐惧不解则伤精。精伤则骨酸痿厥。
精时自下。是肾伤精脱也。都气丸。审系阳虚。用八味丸。又云。三阳为病发寒热。下为痈肿。
及为痿厥 。是膀胱在下发病也。五苓散。一属脾湿伤肾。经云。凡治痿厥发逆。肥贵人膏粱
之疾也。肾着汤加萆 。又云。秋伤于湿。上逆而咳。发为痿厥。小青龙汤去麻黄加羌浩。肾虚
之人。六七月之间。湿令大行。湿热相合。痿厥之病大作。脉沉濡而数。小水赤涩。或作肿痛。
腰以下痿软不能动。行走不正。两足欹侧。清燥汤。伸不能屈。屈不能伸。腰膝腿脚肿痛。行步
艰难。安肾丸。目中流火。视物昏花。耳鸣耳聋。困倦乏力。寝汗憎风。行步不正。两脚欹侧。
卧而多惊。腰膝无力。腰以下消瘦。加味虎潜丸。凡老人痿厥。累用虎潜丸不愈。即于本方加附
子立愈。盖附子有反佐之力也。又有脚膝痿弱。下尻臀皆冷。阴汗臊臭。精滑不固。脉沉数有力。
此为膏粱浓味所致。火郁于内。逼阳向外。即阳盛拒阴。滋肾丸苦寒下之。肥盛苍黑人。足膝痿
。皆属湿热。潜行散、二妙散。误用温补必殆。
子和云。风痹痿厥四证。本自不同。而近世不能为辨。一概作风冷治之。下虚补之。此所以
旷日弥年而不愈者也。夫四末之疾。动而或劲者为风。不仁或痛者为痹。弱而不用者为痿。逆而
寒热者为厥。其状未尝同也。故其本源又复大异。风者必风热相兼。痹者必风寒湿相合。痿者必
火乘金。厥者或寒或热。皆从下起。今治之者。不察其源。见于手足 曳。便谓之风。左传虽谓
风淫末疾。不知风暑燥湿火寒六气。皆能为四末之疾也。
祝仲宁治一人。病腰膝痹痛。皆以为寒。率用乌、附、蛇酒药。盛暑犹着绵。如是者三载。
祝诊之。曰。此湿热相搏而成。经所谓诸痿生于肺热也。即令褫其绵。与清燥汤饮之。曰。疾已
深。又为热药所误。非百帖不效。服三月余而痊。李士材治兵尊高玄圃。患两足酸软。神气不足。
向服安神壮骨之药不效。改服滋肾牛膝、薏苡、二妙散之属。又不效。纯用血药。脾胃不实。诊
之。脉皆冲和。按之亦不甚虚。惟脾部重取之。涩而无力。此土虚下陷。不能制水。则湿气坠于
下焦。故膝胫为患耳。进补中益气倍用升、柴。数日即愈。夫脾虚下陷之证。若误用牛膝等下行
之剂。则愈陷。此前药之所以无功也。
According to the *Suwen* (Basic Questions): "When lung heat causes the leaves to scorch, the skin and hair become weak, tight, and thin; if this condition persists, flaccidity syndrome develops." When heart qi is hot, the meridians below reverse and ascend; ascending leads to deficiency in the lower meridians. Deficiency generates Mai Flaccidity (vascular flaccidity), characterized by the breaking of joints, flaccid shins, and inability to bear weight on the ground. When liver qi is hot, bile leaks causing bitter taste in the mouth, and the sinews dry up. Dry sinews lead to spasms and contractures, manifesting as Jin Flaccidity (sinew flaccidity). When spleen qi is hot, the stomach becomes dry with thirst, and muscles lose sensation, manifesting as Rou Flaccidity (muscle flaccidity). When kidney qi is hot, the waist and spine cannot be lifted, bones wither, and marrow decreases, manifesting as Gu Flaccidity (bone flaccidity).
Dai Ren (Zhang Congzheng) stated: The manifestation of Flaccidity syndrome involves both legs being weak and unable to walk. This is all due to Kidney Water failing to control Heart Fire. Heart fire scorches Lung Metal; the lungs are constrained by fire, causing all six lobes to scorch. With weak skin and hair that are tight and thin, Flaccidity develops. The term "Fei" refers to the inability to extend the feet, resulting in a limping gait. The Kidney is the son of Lung Metal. Now, with deficient Kidney Water rising with the fire, and having declined, the bone marrow deteriorates. This is caused by excessive sexual activity. I state directly: Flaccidity disease has no cold pattern. Therefore, Flaccidity often occurs in the fifth, sixth, and seventh months, which are its appropriate seasons. Thus, patients with Flaccidity have a floating and soft pulse. Nowadays, practitioners who see weak legs and knees difficult to walk, or one leg unable to straighten, treat them as Cold-Damp Hong Kong Foot (Gouty Arthritis/Charcot Foot). They suddenly use herbs like Wutou (Aconiti Lateralis Radix Preparata), Fuzi (Aconiti Radix Preparata), Ruxiang (Boswelliae Resina), Moya (Myrrhae Resina), and Weilingxian (Clematidis Radix et Rhizoma), employing burning needles, moxa fire, hot soup baths, and bag steaming. Consequently, the weakness worsens, leading to death. Is this not premature death? Treating Flaccidity differs significantly from treating Bi Syndrome (Painful Obstruction). Wind-Cold-Damp Bi can sometimes respond to steam baths, moxibustion, and burning needles. However, applying these to Flaccidity exacerbates it. Why? Because Flaccidity originates from Lung Heat scorching the leaves and transmitting to the five zang organs; how could there be cold? Treating Flaccidity as cold is fatal. Flaccidity itself is not fatal; deaths result from medication errors.
Shiwan (Luo Mei) stated: Although the etiology of Flaccidity involving the zang-fu is varied, it mostly arises from Damp-Heat accumulating in the Yangming meridian without clearing. This allows Lung Heat to consume the lungs daily, making them dry, and Spleen Dampness to overflow daily, leading to a condition of upper dryness and lower dampness. The world universally focuses on Kidney deficiency, never mentioning Yangming Damp-Heat. Some ask: If Flaccidity belongs to Damp-Heat, why do ancient formulas often cure it using acrid-hot herbs like Fuzi? It is unknown that when Damp-Heat stagnates deeply for a long time, only acrid-hot power can open the meridians and collaterals; this was originally not intended for Kidney Yang deficiency and cold. If true Yang is not depleted but one generally applies warming tonification without knowing to clear heat and leach out dampness, would there not be a risk of assisting Damp-Heat?
When a person feels their two feet burning like fire, rushing from the ankles up to the knees and thighs, accompanied by flaccidity, softness, and pain, able to walk but not stand for long, with a soggy and rapid pulse, this is Yin deficiency complicated by Damp-Heat. If Hujian Wan (Tiger-Hide Pill) is ineffective, add a small amount of Fuzi. For Gu Flaccidity where one cannot rise from bed, use Jingang Wan (Diamond Pill). The classic states that Gu Flaccidity arises from great heat. After long journeys and fatigue, encountering great heat and thirst, thirst causes internal attack by Yang qi; internal attack means heat resides in the Kidney. The Kidney is the Water organ; now Water fails to overcome Fire, so bones wither and Water becomes empty, feet cannot support the body, manifesting as Gu Flaccidity. This type of Damp-Heat induced Flaccidity occurs mostly in summer, causing bone fatigue and weakness. Hence, treating Flaccidity focuses solely on the Yangming meridian. Dongyuan (Li Dongyuan) uniquely grasped this secret and used drying-clearing agents, primarily Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction). For cases belonging to Damp-Phlegm, with weak hands and feet, deep-slippery pulse, plus numbness or swelling of waist and knees, use Erchen Tang (Two-Cured Decoction) plus Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Huangbai (Phellodendri Cortex), Zhuli (Bambusae Caulis in Taenia), and Jiangzhi (Zingiberis Rhizoma Recens Juice). For dark-thin individuals with choppy-weak pulse, or large-powerless left pulse, difficulty walking, or night sweats indicating Yin deficiency, this is Blood deficiency with Fire. Use Siwu Tang (Four-Substance Decoction) plus Niuxi (Achyranthis Bidentatae Radix), Rougui (Cinnamomi Cortex), Huangbai, and Cangzhu. When Yin-Blood is weak and cannot nourish sinews, sinews relax and cannot hold themselves, causing flaccidity and weakness; use Buchong Rongjin Wan (Tonify Blood and Nourish Sinews Pill). For Qi deficiency causing flaccidity and weakness, use Sijunzi Tang (Four-Gentlemen Decoction) plus Cangzhu, Huangbai, Rougui, and Huangqi (Astragali Radix). For fat-white individuals with deep-slow or slippery pulse, nausea, and chest oppression, belonging to Qi deficiency with Phlegm, use Liujunzi Tang (Six-Gentlemen Decoction) plus Cangzhu, Huangbai, Zhuli, and Jiangzhi. If complicated by Food Stagnation, indicated by wiry-sliply pulse at the Qi Kou, abdominal distension, and aversion to food, this is Food Stagnation hindering Spleen Qi from transporting to the four limbs; use Daotan Tang (Eliminate Phlegm Decoction) plus Shanzha (Crataegi Fructus), Shenqu (Meditatis Fermentum), Mugua (Chaenomelis Fructus), and Fangji (Stephaniae Tetrandrae Radix). For cases with Dead Blood (Stasis), with deep-choppy or wiry pulse, hollow upon pressure, indicating evil blood flowing to waist and knees, or obtained postpartum or from trauma, do not treat as deficiency.
Wei Jue (Flaccidity and Reversal): Foot flaccidity and inability to retract is called Wei Jue. There are two types. One belongs to Kidney and Bladder. The classic says: Unresolved fear injures Jing (Essence); injured Jing causes bone soreness, flaccidity, and reversal, with spontaneous leakage of essence. This is Kidney injury and Essence depletion. Use Duqi Wan. If confirmed as Yang deficiency, use Bawei Wan (Eight-Ingredient Pill). It also says: Disease of the Three Yang meridians presents with chills and fever, abscesses below, and Wei Jue. This is Bladder disease manifesting below. Use Wuling San (Five-Ingredient Powder). The other belongs to Spleen Dampness injuring the Kidney. The classic says: Generally treating Wei Jue reversal is the disease of rich people consuming rich foods. Use Shen Zhuo Tang (Kidney-Attaching Decoction) plus Bibi (Dioscoreae Hypoglaucae Rhizoma). It also says: Autumn injury by Dampness, reversing upward causing cough, manifests as Wei Jue. Use Xiaoqinglong Tang (Minor Green Dragon Decoction) minus Mahuang (Ephedrae Herba) plus Qianghuo. For Kidney-deficient persons, between the sixth and seventh months, Dampness commands prevail. Damp-Heat combines, and Wei Jue disease erupts. Pulse is deep-soggy-rapid, urine is red and scanty, or painful/swollen. Waist below is flaccid and immobile, walking is abnormal, feet tilt sideways. Use Qingzao Tang (Clear Dryness Decoction). Inability to extend or flex, swollen-painful waist-knees-legs-feet, difficult walking. Use Anshen Wan (Peace the Kidney Pill). Fire flowing in eyes, blurred vision, tinnitus/deafness, fatigue, night sweats, aversion to wind, abnormal walking, tilted feet, frequent dreams while lying down, weak waist-knees, emaciation below waist. Use Jiawei Hujian Wan (Modified Tiger-Hide Pill). For elderly Wei Jue unresponsive to repeated Hujian Wan, adding Fuzi to the base formula cures immediately, as Fuzi has a counter-assistant force. Another case: Weak legs/knees, cold buttocks/perineum, foul-smelling genital sweat, spermatorrhea, deep-numerous-forceful pulse. This results from rich foods; Fire郁 (stagnant) internally, forcing Yang outward, i.e., Excess Yang rejecting Yin. Use Zishen Wan (Nourish Kidney Pill) with bitter-cold downward-draining herbs. Fat, dark-skinned individuals with weak legs/knees all belong to Damp-Heat. Use Qianxing San and Ermiao San (Two-Awesome Powders). Mistakenly using warming tonification will be dangerous.
Zihe (Zhang Congzheng) said: Wind, Bi, Flaccidity, and Jue syndromes are fundamentally different, yet modern physicians fail to distinguish them, treating all as Cold-Wind and tonifying deficiency below. This is why they linger for years without healing. Diseases of the four extremities: twitching or stiff are Wind; numb or painful are Bi; weak and unusable are Flaccidity; reversed with cold/heat are Jue. Their appearances are never the same, so their origins differ greatly. Wind must combine with Heat; Bi must combine with Wind-Cold-Damp; Flaccidity must involve Fire attacking Metal; Jue may be Cold or Heat, all arising from below. Current practitioners, not examining the source, see dragging limbs and assume Wind. Although the *Zuo Zhuan* says Wind dominates extremity diseases, it does not know that Wind, Summerheat, Dryness, Dampness, Fire, and Cold—the six qi—all cause extremity diseases.
Zhu Zhongning treated a patient with waist-knee Bi pain. Everyone assumed Cold, uniformly using Wutou, Fuzi, and Snake Wine. Even in midsummer, the patient wore cotton. This lasted three years. Zhu diagnosed: This is Damp-Heat struggling together, as the classic states all Flaccidities arise from Lung Heat. He ordered the patient to remove cotton and drink Qingzao Tang. He said: The disease is deep, mistaken by hot medicines; it requires over a hundred doses to be effective. After three months of taking medicine, the patient recovered. Li Shicai treated Gao Xuanpu, a military official, suffering from sore-weak legs and insufficient spirit. Previous treatment with Spirit-Calming and Bone-Strengthening medicines failed. Changing to Zishen (Nourish Kidney), Niuxi, Yiyiren (Coicis Semen), and parts of Ermiao San also failed. Purely using Blood medicines did not solidify the Spleen/Stomach. Diagnosis: Pulses were harmonious, not very deficient upon pressure. Only pressing heavily on the Spleen area revealed choppy and powerless pulse. This is Earth deficiency sinking, failing to control Water, causing Dampness to sink to the Lower Jiao, thus affecting knees and shins. Administered Buzhong Yiqi Tang (Middle-Boosting and Qi-Generating Decoction) with doubled Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix); cured in a few days. For Spleen deficiency with sinking, mistakenly using descending agents like Niuxi causes further sinking; this explains why previous medicines were ineffective.