痿证，唐宋诸家少见其方说，明以来则概雷同子和、震亨等，故此编所采不过数页，览者勿以漏略为疑。
名义 痿谓痿弱，无力以运动。（《素问次注》）
诊法 尺脉虚弱，缓涩而紧，病为足痛，或者痿病。（《崔氏脉诀》）
痿病肺虚，脉多微缓，或涩或紧，或细或濡。（《四言举要》）
源候总说 夫人身之有皮毛、血脉、筋膜、肌肉、骨髓
以成形，内则有肝、心、脾、肺、肾以主之。若随情妄用，喜怒不节，劳佚兼并，致内藏精血虚耗，荣卫失
度，发为寒热，使皮血筋骨肌肉痿弱，无力以运动，故致痿 。状与柔风脚弱皆相类，以脉证并所因别之，
不可混滥。柔风香港脚皆外所因，痿 则属内，藏气不足之所为也，审之。（《三因》）
病由肺热 大抵肺主气，气为阳，阳主轻清而升，故肺居上部。病则其气 满奔迫，不能上升，至
于手足痿弱，不能收持。由肺金本燥，燥之为病，血液衰少，不能营养百骸故也。经曰∶手指得血而能摄，掌
得血而能握，足得血而能步。故秋金旺则雾气蒙郁而草木萎落，病之象也，痿犹萎也。（《原病式》）
痿之为状，两足痿弱，不能行用。由肾水不能生心火，心火上烁肺金，肺金受火制，六叶皆焦，皮毛虚
弱，急而薄着，则生痿 。 者，足不能伸而行也。大抵痿之为病，皆因客热而成，好欲贪色，强力过极
，渐成痿疾。故痿 属肺，脉痿属心，筋痿属肝，肉痿属脾，骨痿属肾。总由肺受火热叶焦之故，相传于
四脏，痿病成矣，直断曰痿病无寒。故病痿之人，其脉浮而大。（《事亲》）
肺金体燥而居上，主气，畏火者也。脾土性湿而居中，主四肢，畏木者也。火性炎上，若嗜欲无节，则
水失所养，火寡于畏而侮所胜，肺得火邪而热矣。木性刚急，肺受热则金失所养，木寡于畏而侮所胜，脾得
木邪而伤矣。肺热则不能管摄一身，脾伤则四肢不能为用，而诸痿之病作。（《局方发挥》）
痿者，形气惟悴，手足不举是也。由中气不足，土不滋金，金不生水，水不制火，故肺叶焦枯，肾失生
气，以致五
神失位，水干火炙，血涸气燥，使宗筋不润，筋脉骨肉血气皆痿矣。（《心统》）
病由湿热（大筋 短小筋弛长） 痿之一症，全在湿热。由乎酒色太过，气血空虚，反加劳碌，筋骨
有损，由是湿热乘之，热伤于气，不能舒畅其筋，故 短而为拘挛者矣。湿伤其血，则血不养筋而筋不束骨，
故小筋弛长而为痿弱者矣。（《绳墨》）
经曰∶湿热不攘，则大筋 短，小筋弛长， 短为拘，弛长为痿。此《内经》言筋病之概，乃举隅
之谈，以启人之自反耳，非谓大筋必无弛长，小筋必无 短也。即如痿弱必由于弛长，岂大筋果无涉乎，
此经言之意从可知矣。故于痿证之外，凡遇螈 等病，当知拘挛者必由 短，瘫弱者必由
弛长，斯得《内经》之意，而于寒热燥湿之辨，亦可得其据矣。（《景岳》）
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，故成
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。（《医通》）
痿者，手足软弱，纵缓不收也（即俗所谓手摊脚软之意），盖热而兼湿使然。观物之寒而干者，必坚硬
收引；热而湿者，必柔软弛长可见。湿属土，胃为水谷之海，主润筋脉。胃病则不能运化水谷，湿停筋脉中，
不为润而为涝，与热相合，故治痿独取阳明也。然此证之有热无寒则然矣，其有湿与否则须细辨。若无湿而概
用燥药以利水，则火益燥烈，筋脉反致枯干挛缩，求为弛长缓纵而不可得矣，治者审之。（无湿亦有痿者，
以津液为热所灼，尚未即干，虽不弛长，亦未短缩，但困弱柔软而不能行动也。观草木遇烈日而
枝叶萎软，可见矣。）（《医碥》）
病非尽为火证 痿证之义，《内经》言之详矣。观所列五脏之证皆言为热，而五脏之证又总于肺热叶
焦，以致金燥水亏，乃成痿证，如丹溪之论治，诚得之矣。然细察经文，又曰悲哀太甚则胞络绝，传为脉痿，
思想无穷，所愿不得，发为筋痿，有渐于湿，以水为事，发为肉痿之类，则又非尽为火证，此其有余不尽之意
犹有可知。故因此而生火者有之，因此而败伤元气者亦有之，元气败伤则精虚不能灌溉，血虚不能营养者亦不少
矣。若概从火论，则恐真阳亏败及土衰水涸者有不能堪。故当酌寒热之浅深，审虚实之缓急，以
施治疗，庶得治痿之全矣。（《景岳》）
所挟有等 内热成痿，此论病之本也。若有感发，必因所挟而致，有湿热者，有湿痰者，
有气虚者，有血虚者，有阴虚者，有死血者，有食积妨碍升降道路者（按∶此七句本于丹溪），当明辨
之。湿热痿者，雨湿浸淫，邪气蒸脾，流于四肢，自觉足胫热气上腾，或四肢酸软肿痛，或足指麻木顽
痒，小便赤涩，脉来沉濡而数，此皆湿热在下之故，所谓湿热不攘，大筋 短，小筋弛长， 短为拘，
弛长为痿也，宜升阳燥湿，禁用填补之剂。湿痰痿者，肥盛之人，元气不能运动其痰，致湿痰内停，客于
经脉，使腰膝麻痹，四肢痿弱，脉来沉滑，此膏粱酒湿之故，所谓土太过，令人四肢不举是也（按∶此本于
《六要》），宜燥脾行痰。气虚痿者，因饥饿劳倦，胃气一虚，肺气先绝，百骸溪谷皆失所养，故宗筋弛纵，
骨节空虚。凡人病后手足痿弱者，皆属气虚，所谓脾既病，不能为胃行其津液，四肢不得禀水谷气而不用也，
宜补中益气。血虚痿者，凡产后失血后，面色痿黄，手足无
力，不能行动者也，宜滋养荣血。然血生于脾，往往用养血
药而痿如故者，脾虚不能生血也，能补其脾，则血自旺而痿自愈矣。阴虚痿者，酒色过度，下焦肝肾之火，燔灼
筋骨，自觉两足极热，上冲腿膝（按∶《简明医彀》曰∶足常热者，火起涌泉穴，防痿证），酸弱痿软，
行步艰难，不能久立，脉来涩弱，或左脉虽大，按之无力，宜峻补精血以扶肝肾。血瘀痿者，产后恶露未尽，
流于腰膝，或跌扑损伤，积血不消，四肢痛而不能运动，致脉涩而芤者，宜养血行瘀。食积痿者，饮食太过，
妨碍道路，升降失常，脾气不得运于四肢，手足软弱，或腹膨胀痛，或恶心嗳气，右手脉洪弦滑者，宜运脾消
导，从食积治，俟食消积化，然后补脾。（按∶《纲目》引丹溪云∶痿病，食积妨碍不得降者，亦有
死血者，俱宜下之。）痢后脚软胫疼，或膝肿者，此下多亡阴所致，宜补脾兼升举之剂，若作风治，则反燥
其阴而痿难愈。间有痢后兜涩太早，积瘀不清，下注隧道经络而成痿
者，此又当行气逐瘀，与前证迥异矣。（《汇补》）
骨痿 人身之骨，肾所主也。先天本经禀气不足，则骨软而不坚不实，且髓不满骨，筋无血养以束
骨，荣卫弱，故骨痿而骨变也。若初长之花木，经风一折受伤，致有欹斜歪横，形质之义同也。古今骨病俱不
能治，余用返本还元药，及补肾清肺热药品味，十有二三愈者。（《女科百病问答补遗》）
治例 治宜黄芩、黄连、当归、生地、独活、牛膝、秦艽、续断之类，切不可偏于风药而作风治（
按∶此一语本出丹溪），亦不可偏于补药而作虚论。此症宜利小便而除其湿热，宜用清凉而通利其气血，其症
自可者也。若肾气空虚，腰脊不举，髓竭力乏，行立不能，而为骨痿之症者，前方宜
加五味、构杞、山萸、熟地、虎骨、败龟之类，（《绳墨》）
凡痿由湿热，脉洪滑而证多烦热者，必当先去其火，宜二妙散，随证加减用之。若阴虚兼热者，宜《正
传》加味四物汤、虎胫骨丸或丹溪补阴丸、滋阴八味丸（即知柏六味丸）之类主之。若绝无火证，而止因水亏
于肾，血亏于肝者，则不宜兼用凉药以伐生气，惟鹿角胶丸为最善（方见《正传》），或加味四斤丸、八味
地黄丸、金刚丸（用萆 、杜仲、苁蓉，菟丝）之类，俱可择用。若阴虚无湿或多汗者，俱不宜轻用
苍术，盖痿证最忌散表，亦恐伤阴也。（《景岳》）
痿属湿热，经曰∶治痿独取阳明。忌破气、升、辛热发散，宜大补气血、清热除湿、甘
寒、甘温、苦寒、酸寒。（《本草经疏》）
治不宜燥热补阳（附子可否） 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、自然铜、威灵仙之类，燔针艾火，汤煮袋蒸，痿弱转加，如此而死，岂亦
天乎。夫治痿与治痹，其治颇异，风寒湿痹，犹可蒸汤灸燔，时或一效，惟痿用之转甚者何也？盖以肺热为
本，叶焦而成痿，以此传于五脏，岂有寒者欤。（《事亲》）
陈无择谓痿因五内不足，诚得之矣。然痿之所不足者，
乃阴也、血也，而诸方悉是补阳补气之剂，能免实实虚虚之患乎。（《微义》）
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。（《医通》）
用下治验 宛丘营军校三人皆病痿，积年不瘥，腰以下
肿痛不举，遍身疮赤，两目昏暗，唇干舌燥，求疗于戴人。
戴人欲投泻剂，二人不从，为他医温补之药所惑，皆死。其同病有宋子玉者俄省曰∶彼已热死，我其改之。敬
邀戴人。戴人曰∶公之疾，服热药久矣，先去其药邪，然后及病邪，可下三百行。子玉曰∶敬从教。先以舟车
丸、浚川散大下一盆许，明日减三分，两足旧不仁，是日觉痛痒，累至三百行始安。戴人曰∶诸痿独取阳明，
阳明者胃与大肠也，此言不止谓针也，针与药同也。（《三疗》）（按∶又有痿病以盐水吐膈痰治验，当考。）
太学朱修之，八年痿废，更医累百，毫末无功。一日读余《颐生微论》，千里相招。余诊之，六脉有力，
饮食若常，此实热内蒸，心阳独亢，证名脉痿。用承气汤，下六七行，左足便能伸缩。再服大承气，又下
十余行，手中可以持物。更用黄连、黄芩各一斤，酒蒸大黄八两，蜜丸，日服四钱，以人参汤送。一月之内，
去积滞不可胜数，四肢皆能展舒。予曰∶今积滞尽矣。煎三才膏十斤与之，服毕而应酬如
故。（《必读》）（按∶三才膏当是三才封髓丹，方附《积热》中。）
清补诸方 丹溪加味四物汤，治诸痿，四肢软弱，不能举动。
当归身（一钱） 熟地黄（三钱） 白芍药 川芎（各七分半） 五味子（九枚） 麦门冬（一钱） 人参（半
钱） 黄柏（一钱） 黄连（半钱） 知母（三分） 杜仲（七分半） 牛膝（三分足不软者不用） 苍术（一钱）
上细切，作一服，水二盏，煎至一盏，空心温服，酒糊为丸服亦可。一云∶血虚者，以四物汤加黄柏、苍
术，下补阴丸。（《正传》）《回春》参归养荣汤，治痿症，于本方
去川芎、五味、麦门、黄连、苍术，加白术、茯苓、陈皮、破故纸、甘草。
龙胆泻肝汤。
柴胡（一钱） 人参 知母 麦门冬 天门冬 草龙胆 山栀子 生甘草 黄连（各五分） 黄
芩（七分） 五味子（七粒）
肝气热色青，爪枯口苦，筋膜干而挛急者，名曰筋痿，宜此方主之。（《方考》）
五痿汤，治五脏痿。
人参 白术 茯苓（各一钱） 甘草（炙四分） 当归（一钱五分） 苡仁（三钱） 麦冬（二
钱） 黄柏（炒褐色） 知母（各五分）
水煎服。（《心悟》）（按此三方，俱自东垣清燥汤变来。清燥汤繁重难用，今不录。）
虎胫骨丸（原无方名，从《医统》录），祖传经验，治
两足痿弱软痛，或如火焙，从足踝下，上冲腿胯等证，因湿热所成者。
苍术（米泔浸一二宿） 黄柏（酒浸日晒各四两） 牛膝（去芦三两） 龟板（酥炙） 虎胫骨（酥
炙） 防己（各一两） 当归尾（二两）
上为细末，面糊为丸，如梧桐子大，每服七十丸或一百丸，空心姜盐汤下。一方，加炮附子五钱。（《正传》）
温补诸方 崇明文学倪君俦，四年不能起于床，延余航海治之。简其平日所服，寒凉者十六，补肾肝
者十三。诊其脉大而无力，此营卫交虚。以十全大补加秦艽、熟附各一钱朝服之，夕用八味丸加牛膝、杜仲、
远志、萆 、虎骨、龟板、黄柏，温酒送七钱，凡三月而机关利。（《必读》）
大防风汤，气血两虚，风湿相挟，麻痹痿弱。（《赤水》）（方见《历节》）
加味四斤丸，治肝肾脏虚，热淫于内，致筋骨痿弱，不自胜持，起居须人，足不任地。
苁蓉（酒浸） 牛膝（酒浸） 天麻 木瓜干 鹿茸（燎去毛切酥炙）
熟地黄 菟丝子（酒浸通软别研细） 五味子（酒浸各等分）
上为末，蜜丸如梧子大，每服五十丸，温酒米汤食前下。一法，不用五味子，有杜仲。（《三因》）
《魏氏》鹿茸四斤丸，补气血，壮元阳，强筋骨，除风湿。于本方去地黄、菟丝子，加虎胫骨、
附子、杜仲、当归。（互见《香港脚》，宜参。）
Wei Syndrome (Flaccidity Syndrome), in the medical literature of the Tang and Song dynasties, rarely saw discussions on its formulas and theories. Since the Ming Dynasty, views have largely been similar to those of Liu Wansu (Liu Hejian) and Zhang Congzheng (Zi Hizi), Zhu Zhenheng (Danxi), etc. Therefore, the content collected in this compilation is only a few pages; readers should not suspect it is omitted or simplified.
**Nomenclature**: "Wei" refers to flaccidity and weakness, with insufficient strength for movement. (*Suwen Cizhu*)
**Diagnosis Methods**: The pulse at the cun position (radial artery distal segment) is weak, appearing slow, choppy, and tight. The disease presents as foot pain or Wei syndrome. (*Cui Shi Maijue*)
In Wei syndrome due to Lung deficiency, the pulse is often slightly slow, or choppy, tight, fine, or soggy. (*Siyan Juyao*)
**General Discussion on Etiology and Pathogenesis**: The human body forms its structure through skin, hair, blood vessels, sinews, muscles, and bones, which are governed internally by the Liver, Heart, Spleen, Lung, and Kidney. If one indulges in emotional excesses without moderation, combining labor with rest improperly, it leads to the depletion of essence and blood in the Zang organs. This causes an imbalance of Ying (Nutritive) and Wei (Defensive) Qi, manifesting as alternating chills and fever. Consequently, the skin, blood, sinews, bones, and muscles become flaccid and weak, unable to move, resulting in Wei syndrome. Its appearance is similar to Roufeng (Soft Wind) and Hongkong Foot (Jiaoxie). It must be distinguished by pulse, symptoms, and etiology, and not confused. Roufeng and Hongkong Foot are caused by external factors, whereas Wei syndrome belongs to internal factors, specifically insufficiency of Zang Qi. This must be carefully examined. (*Sanyin Fang*)
**Etiology: Lung Heat**: Generally, the Lung governs Qi. Qi is Yang, and Yang is light, clear, and ascending; thus, the Lung resides in the upper jiao. When diseased, its Qi becomes full and rushing, unable to ascend, leading to flaccidity and weakness of the hands and feet, unable to grasp or hold. Since Lung Metal is inherently dry, dryness pathology causes a decline in blood, failing to nourish the entire skeleton. The Classics state: "Fingers receive blood to grasp, palms receive blood to hold, feet receive blood to walk." Thus, when Autumn Metal Qi is prosperous, mist gathers, and grass and trees wither; this is the image of disease. "Wei" is like "Wei" (withered). (*Yuanbing Shi*)
The manifestation of Wei syndrome is flaccidity and weakness of both legs, inability to walk. This occurs because Kidney Water fails to generate Heart Fire, causing Heart Fire to scorch Lung Metal. Lung Metal, controlled by fire, has its six lobes scorched. The skin and hair become weak, contracting and adhering tightly, generating Wei syndrome. "Bi" refers to the inability to extend the feet while walking. Generally, Wei syndrome arises from exogenous heat. Excessive desire and sexual indulgence, forcing strength beyond limits, gradually lead to Wei disease. Therefore, Rou Wei (Flesh Wei) belongs to the Lung, Mai Wei (Vessel Wei) to the Heart, Jin Wei (Sinew Wei) to the Liver, Rou Wei (Flesh Wei) to the Spleen, and Gu Wei (Bone Wei) to the Kidney. Ultimately, it is due to Lung heat scorching the leaves, transmitting to the other four Zang organs, forming Wei syndrome. It is directly stated that Wei syndrome has no cold pattern. Thus, patients with Wei syndrome have a floating and large pulse. (*Shiqin*)
Lung Metal is dry and resides above, governing Qi, and fears Fire. Spleen Earth is damp and resides in the center, governing the four limbs, and fears Wood. Fire nature is flaming upward. If desires are unregulated, Water loses nourishment. Fire, lacking restraint, insults the metal it overcomes, causing Lung heat. Wood nature is rigid and urgent. When Lung receives heat, Metal loses nourishment. Wood, lacking restraint, insults the earth it overcomes, injuring the Spleen. Lung heat cannot control the whole body; Spleen injury prevents the four limbs from functioning, causing various Wei syndromes. (*Jufang Fahui*)
Wei syndrome refers to emaciation and exhaustion of form and Qi, with inability to raise hands and feet. This is due to insufficiency of Middle Qi. Earth fails to nourish Metal; Metal fails to generate Water; Water fails to control Fire. Thus, Lung leaves wither and dry, Kidney loses generative Qi, causing the Five Spirits to lose their positions. Water dries, Fire roasts, Blood empties, Qi becomes dry, causing Zongjin (tendons) to lose moisture. Sinews, vessels, bones, flesh, blood, and Qi all become flaccid. (*Xintong*)
**Etiology: Damp-Heat (Large sinews contract and shorten, small sinews relax and lengthen)**: This symptom of Wei syndrome lies entirely in Damp-Heat. Due to excessive wine and sex, Qi and Blood become empty. Adding labor damages sinews and bones. Damp-Heat then takes advantage. Heat injures Qi, preventing it from smoothing the sinews, causing large sinews to contract and shortening, leading to spasms. Dampness injures Blood, so Blood fails to nourish sinews, and sinews fail to bind bones, causing small sinews to relax and lengthen, leading to flaccidity. (*Shengmo*)
The Classics say: "If Damp-Heat is not removed, large sinews contract and shorten, small sinews relax and lengthen. Shortening causes spasm; lengthening causes flaccidity." This is the general description of sinew diseases in *Neijing*, offering examples to inspire self-reflection, not implying that large sinews never relax or small sinews never contract. Just as flaccidity must result from relaxation, how could large sinews be unrelated? The intent of the Classics can be understood here. Therefore, outside of Wei syndrome, when encountering convulsions, one should know that spasms result from shortening, and paralysis results from lengthening. This aligns with *Neijing* and aids in distinguishing Cold, Heat, Dryness, and Dampness. (*Jingyue Quanshu*)
Although the Zang-Fu etiologies of Wei syndrome vary, they mostly originate from Damp-Heat in the Yangming channel, turbid internally. This causes the Lung to suffer heat invasion and dry up daily, and the Spleen to suffer dampness overflow and swell daily, forming a condition of upper dryness and lower dampness. The world universally focuses on Kidney deficiency, never mentioning Yangming Damp-Heat. (*Yitong*)
Wei syndrome refers to softness and laxity of hands and feet, unable to hold themselves (commonly known as limp hands and weak feet). This is caused by Heat combined with Dampness. Observing objects: cold and dry things are hard and contractile; hot and damp things are soft and lax. Dampness belongs to Earth. The Stomach is the sea of water and grain, moistening sinews and vessels. Stomach disease fails to transform water and grain; dampness stagnates in sinews, becoming flooding rather than moistening. Combined with Heat, treatment of Wei syndrome exclusively targets the Yangming channel. However, while this syndrome is Heat without Cold, the presence of Dampness requires careful differentiation. If there is no Dampness but drying diuretics are used indiscriminately, Fire becomes more arid, and sinews/vessels become dry and contracted, making relaxation impossible. Physicians must examine this. (Note: There are cases of Wei without Dampness, where fluids are scorched by heat but not yet dry. Though not lax or contracted, they are weak and soft, unable to move. Like plants under the scorching sun, leaves wilt.) (*Yique*)
**Not All Cases Are Fire Patterns**: The meaning of Wei syndrome is detailed in *Neijing*. The five Zang patterns listed all mention Heat, summarized as Lung Heat scorching leaves, leading to Metal dryness and Water deficiency. Danxi’s treatment theory is indeed correct. However, examining the text closely, it also says: extreme sorrow closes the Bao Luo (Pericardium collaterals), transmitting to Mai Wei; endless thoughts and unfulfilled desires cause Jin Wei; gradual exposure to dampness and water work cause Rou Wei. Thus, not all are Fire patterns. There are cases where Fire is generated from this, and cases where Yuan Qi (Original Qi) is damaged. Damaged Yuan Qi leads to Essence deficiency failing to irrigate, and Blood deficiency failing to nourish. If treated solely as Fire, those with True Yang failure and Spleen/Water depletion may not withstand it. One must weigh the depth of Cold/Heat and urgency of Deficiency/Excess to treat comprehensively. (*Jingyue Quanshu*)
**Associated Factors**: Internal Heat causing Wei discusses the root. If triggered, it depends on associated factors: Damp-Heat, Damp-Phlegm, Qi Deficiency, Blood Deficiency, Yin Deficiency, Stasis (Dead Blood), Food Stagnation obstructing ascent/descent (based on Danxi). These must be clearly distinguished.
* **Damp-Heat Wei**: Rain/dampness invades, evil steeps the Spleen, flows to limbs. Patients feel heat rising from shins, limb soreness/swelling/numbness/itching, dark/scanty urine, deep/soggy/rapid pulse. This is Damp-Heat below. Treat with raising Yang and drying Dampness; avoid tonifying agents.
* **Damp-Phlegm Wei**: Common in obese people. Original Qi cannot move Phlegm, causing stagnation in meridians. Waist/knees numb, limbs weak, deep/slipping pulse. Caused by rich food/wine. Spleen Earth excess causes limb immobility. Treat with drying Spleen and moving Phlegm.
* **Qi Deficiency Wei**: Caused by hunger/fatigue. Stomach Qi fails, Lung Qi first perishes. Body parts lose nourishment, Zongjin relax, joints empty. Post-illness limb weakness is Qi Deficiency. Spleen fails to transport fluids; limbs lack Grain Qi. Treat with Bu Zhong Yi Qi Tang.
* **Blood Deficiency Wei**: Postpartum blood loss, sallow complexion, limb weakness, inability to move. Treat with nourishing Ying Blood. Note: Blood is born in Spleen; if tonifying blood fails, Spleen is deficient. Tonify Spleen to restore Blood.
* **Yin Deficiency Wei**: Excessive wine/sex, Lower Jiao Liver/Kidney Fire scorches sinews/bones. Feet extremely hot, rushing to knees. Sore/weak/flaccid, difficulty walking, unable to stand long. Pulse choppy/weak or left pulse large but empty upon pressure. Treat with severe tonification of Essence/Blood to support Liver/Kidney.
* **Blood Stasis Wei**: Postpartum lochia not cleared, flowing to waist/knees, or trauma causing stasis. Limb pain, inability to move, choppy/hollow pulse. Treat with nourishing Blood and moving Stasis.
* **Food Stagnation Wei**: Overeating obstructs pathways, disrupting ascent/descent. Spleen Qi fails to reach limbs. Limbs weak, abdominal distension/pain, nausea/belching. Right hand pulse surging/string-tight/slipping. Treat with moving Spleen and resolving stagnation. After resolution, tonify Spleen. (Note: Danxi mentions Wei from food stagnation or stasis should be purged.)
* **Post-Dysentery Weakness**: Soft legs/shin pain/knee swelling after dysentery is due to excessive downward flow depleting Yin. Tonify Spleen and lift. Treating as Wind dries Yin and worsens Wei. Rarely, premature astringency in dysentery leaves stasis flowing into channels, causing Wei. Treat with moving Qi and expelling Stasis, distinct from previous cases. (*Huibu*)
**Bone Wei**: Bones are governed by the Kidney. Congenital insufficiency leads to soft, non-solid bones. Marrow does not fill bones; sinews lack blood to bind bones. Ying/Wei are weak, causing Bone Wei and deformation. Like young plants broken by wind, bending and twisting. Ancient and modern treatments for bone disease often fail. I use "Return to Origin" herbs and Kidney-tonifying/Lung-clearing herbs; 20-30% recover. (*Nuke Baibing Wenda Buyi*)
**Treatment Principles**: Use Huangqin, Huanglian, Danggui, Shengdi, Duhuo, Niuxi, Qinjiao, Xuduan. Do not bias towards Wind herbs or treat as Wind. Do not bias towards tonics and treat as Deficiency. Promote urination to remove Damp-Heat; use cooling herbs to unblock Qi/Blood. For Kidney Qi emptiness, spine cannot rise, marrow exhausted, Bone Wei: add Wuweizi, Gouqi, Shanzhuyu, Shudi, Tiger Bone, Tortoise Shell. (*Shengmo*)
For Wei due to Damp-Heat, surging/slipping pulse, irritability/heat: First clear Fire. Use Ermiao San, modified. For Yin Deficiency with Heat: Zhengchuan Modified Siwu Tang, Hu Jinggu Wan, Danxi Buyin Wan, Ziyin Bawei Wan. For no Fire, only Kidney Water/Liver Blood deficiency: Avoid cooling herbs that damage life Qi. Lujiao Jiao Wan is best. Or Jiawei Sijin Wan, Bawei Dihuang Wan, Jingang Wan. If Yin Deficient without Dampness or with sweating: Avoid Cangzhu. Wei syndrome forbids exterior-releasing herbs to prevent damaging Yin. (*Jingyue Quanshu*)
Wei belongs to Damp-Heat. Classics say: "Treat Wei by exclusively targeting Yangming." Avoid breaking Qi, lifting, acrid-hot dispersing. Use major Qi/Blood tonification, clearing Heat/drying Dampness, Sweet-Cold, Sweet-Warm, Bitter-Cold, Sour-Cold. (*Bencao Jingshu*)
**Treatment Should Not Be Hot/Drying Yang Tonification (Can Fuzi be used?)**: Physicians seeing weak legs/knees or one leg unable to extend often treat as Cold-Damp Hongkong Foot, using Wutou, Fuzi, Ruxiang, Moyao, Ziran Tong, Weilingxian, moxa, hot compresses. This worsens Wei and causes death. Is this fate? Treating Wei differs from Bi (Painful Obstruction). Bi (Wind-Cold-Damp) may respond to heat/moxa. Why does Wei worsen? Because Lung Heat is the root, leaves scorch, transmitting to five Zang. How can it be Cold? (*Shiqin*)
Chen Wuye said Wei is due to five internal deficiencies, which is true. But the deficiency is Yin and Blood. Most formulas tonify Yang and Qi. Can this avoid the error of reinforcing Excess and depleting Deficiency? (*Weiyi*)
Some ask: If Wei is Damp-Heat, why do ancient formulas use acrid-hot Fuzi successfully? Unknowingly, long-standing Damp-Heat stagnation requires acrid-hot power to open meridians; it was not originally for Kidney Cold deficiency. If True Yang is not depleted, indiscriminate warming tonification without clearing Heat/dampness will surely assist Damp-Heat. (*Yitong*)
**Case Study Using Purging**: Three military officers in Wanchou suffered Wei for years, unable to rise, swollen/painful below waist, red sores, dim eyes, dry lips/tongue. They sought Dai Ren (Zhang Congzheng). Dai Ren wanted to purge. Two refused, were seduced by warm-tonifying physicians, and died. Another patient, Song Ziyu, realized they died from heat, invited Dai Ren. Dai Ren said: "You took hot herbs long ago. Remove the drug pathogen first, then the disease pathogen. Purge 300 times." Ziyu agreed. Used Zhouche Wan, Xunchuan San, purged a basin. Next day improved. Legs felt pain/itch (previously numb). After 300 purges, recovered. Dai Ren said: "Treat Wei exclusively via Yangming. Yangming is Stomach and Large Intestine. This applies to needles and medicine alike." (*Suliao*)
Zhu Xiuzhi, a Taixue student, paralyzed for 8 years, seen by hundreds of doctors, no effect. Read my *Yisheng Weilun*, summoned me. Pulse strong, diet normal. Internal Steaming Heat, isolated Heart Yang hyperactivity. Diagnosis: Mai Wei. Used Chengqi Tang, purged 6-7 times. Left foot moved. Used Da Chengqi Tang, purged 10+ times. Hand could hold objects. Then Huanglian, Huangqin (1 jin each), Jiuzheng Dahuang (8 liang), honey pills, 4 qian/day with Renshen soup. Within a month, expelled countless accumulations. Limbs relaxed. I said: Accumulations gone. Prepared Santai Gao (10 jin). Taken, he resumed duties. (*Bixu*)
**Clearing and Tonifying Formulas**:
Danxi Jiawei Siwu Tang: Treats all Wei, limb weakness.
Danggui Shen (1 qian), Shudihuang (3 qian), Baishaoyao, Chuanxiong (each 0.75 qian), Wuweizi (9 fruits), Maimendong (1 qian), Renshen (0.5 qian), Huangbai (1 qian), Huanglian (0.5 qian), Zhimu (0.3 qian), Duzhong (0.75 qian), Niuxi (0.3 qian, omit if feet not soft), Cangzhu (1 qian). Decoct in 2 cups water to 1 cup. Take warm on empty stomach. Or make pills with wine paste. Note: For Blood Deficiency, Siwu Tang + Huangbai, Cangzhu, take Buyin Wan. (*Zhengchuan*)
Huichun Shen Gui Yangrong Tang: For Wei. From base formula remove Chuanxiong, Wuweizi, Maimendong, Huanglian, Cangzhu. Add Baizhu, Fuling, Chenpi, Pogu Zhi, Gancao.
Longdan Xiegan Tang.
Chaihu (1 qian), Renshen, Zhimu, Maimendong, Tianmendong, Cao Longdan, Shanzhizi, Sheng Gancao, Huanglian (each 0.5 qian), Huangqin (0.7 qian), Wuweizi (7 grains).
Liver Qi Heat, blue complexion, withered nails, bitter taste, dry/tight sinews = Jin Wei. Use this formula. (*Fangkao*)
Wuwei Tang: Treats Five Zang Wei.
Renshen, Baizhu, Fuling (each 1 qian), Gancao (roasted 0.4 qian), Danggui (1.5 qian), Yiren (3 qian), Maidong (2 qian), Huangbai (fried brown), Zhimu (each 0.5 qian). Decoct. (*Xinwu*)
Hujinggu Wan: Ancestral experience for weak/painful/flaccid legs, burning sensation from ankle up to thighs, caused by Damp-Heat.
Cangzhu (soaked in rice water 1-2 nights), Huangbai (wine-soaked, sun-dried, 4 liang each), Niuxi (deprived of radicle, 3 liang), Guiban (su-grease roasted), Hujinggu (su-grease roasted), Fangji (each 1 liang), Dangguiwei (2 liang). Powder, wheat paste pills, wutong seed size. 70-100 pills, ginger-salt water on empty stomach. Variation: Add Paofuzi (5 qian). (*Zhengchuan*)
**Warming and Tonifying Formulas**:
Scholar Ni Chouchou of Chongming bedridden for 4 years. I traveled by sea to treat. Reviewed his meds: 16 parts cold-cooling, 13 parts Kidney/Liver tonifying. Pulse large but weak. Ying/Wei both deficient. Morning: Shiquan Dabu Tang + Qinjiao, Shufu (each 1 qian). Evening: Bawei Wan + Niuxi, Duzhong, Yuanzhi, Bibi, Hujinggu, Guiban, Huangbai, 7 qian with warm wine. After 3 months, joints moved freely. (*Bixu*)
Da Fangfeng Tang: Qi/Blood dual deficiency, Wind-Damp entangled, numbness/flaccidity. (*Chishui*)
Jiawei Sijin Wan: Liver/Kidney deficiency, internal heat, sinew/bone weakness, unable to hold oneself, needs assistance, feet cannot bear weight.
Rongrou (wine soak), Niuxi (wine soak), Tianma, Mugua Gan, Lurong (scraped, su-roasted), Shudihuang, Tusizi (wine soak, ground), Wuweizi (wine soak, equal parts). Powder, honey pills. 50 pills, warm wine/rice water before meals. Variation: Omit Wuweizi, add Duzhong. (*Sanyin*)
Wei Shi Lurong Sijin Wan: Tonifies Qi/Blood, strengthens Yuan Yang, fortifies sinews/bones, removes Wind-Damp. From base formula remove Dihuang, Tusizi. Add Hujinggu, Fuzi, Duzhong, Danggui. (See Hongkong Foot).