经言诸痿皆起于肺。说者谓肺气空虚，金不伐木，肝火郁结，大筋短缩，小筋弛长，故成痿症
，此特可为筋痿言之耳。至于脉痿、肉痿、骨痿，岂得谓之金不伐火、金不伐土、金不伐水乎？是
必不然矣。解经者不必过事高深，但求谛当。经又曰∶治痿独取阳明。只此一节，便可知肺胃相关，
诸痿起于肺，治痿重阳明之故。盖胃为水谷之腑，一身之精神气血，从此而生。其糟粕则下归小肠
；其精华则上输于肺，肺受精气，然后泽及诸脏。兹以所求不得，躁急热中，肺受熏蒸，叶焦成痿
，不能散精于他脏，故痿起于肺也。其独取阳明者，因胃为五脏六腑之海，所以滋养一身，又主润
宗筋，宗筋主束骨而利关节也。从此悟彻，则五脏之痿，可以次第区别矣。
经曰∶肺热叶焦，则皮毛虚弱急薄，着则生痿 也。其下又曰∶所求不得，则发肺鸣，鸣则肺
热叶焦。则此症全因肺阴耗散，肺气空虚所致。盖肺为主气之脏，肺伤则元气薄弱而不能下行，故
足膝无力而不能任地，是肺痿即气痿也，玉华煎主之。
玉华煎（自制）
玉竹（四钱） 五味子（一钱） 麦冬（三钱） 沙参（四钱） 党参（四钱）
茯苓（二钱） 白术（一钱） 山药（三钱） 川断（二钱） 牛膝（二钱）
元米（一撮煎汤代水）
经曰∶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。百脉皆朝
于心，心阳上亢，则在下之脉亦厥逆而上，上愈实则下愈虚，故为脉痿。关节之处，如枢纽之折而
不可提挈。足胫纵缓，则脉不通而懈弛也。调营通脉汤主之。
调营通脉汤（自制）
天冬（二钱） 生地（五钱） 丹参（二钱） 柏仁（二钱） 党参（四钱） 茯神
（二钱） 白术（一钱） 黄连（四分酒炒） 当归（二钱） 川断（二钱） 牛膝（二钱）
红枣（十枚） 桑枝（一尺）
经曰∶肝气热则胆泄口苦，筋膜干，筋膜干则筋急而挛，发为筋痿。肝胆相连，肝热则胆亦热
，胆汁内沸，故发为口苦。血为火劫，不能养筋，筋急而挛，故为筋痿也。水木华滋汤主之。
水木华滋汤（自制）
生地（五钱） 当归（二钱） 白芍（一钱五分） 丹皮（二钱） 山栀（一钱五分）
羚羊角（一钱五分） 木瓜（一钱酒炒） 党参（四钱） 茯苓（二钱） 白术（一钱）
川断（二钱） 牛膝（二钱） 人乳（一杯） 桑枝（一尺）
经曰∶脾气热则胃干而渴，肌肉不仁，发为肉痿。脾与胃皆属土，而分燥湿，湿土既热，则燥土更
烈，故胃干而渴。热郁于内，则脾阴耗损，故肉不仁而为痿也。坤顺汤主之。
坤顺汤（自制）
党参（四钱） 茯苓（二钱） 白术（一钱） 甘草（四分） 山药（三钱） 花粉（三钱）
石斛（三钱） 料豆（三钱） 川断（二钱） 牛膝（二钱） 红枣（五枚） 莲子（十粒去心）
经曰∶肾气热则腰脊不举，骨枯而髓减，发为骨痿。又曰∶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，则骨枯而髓虚，故足不任身，发为骨痿
。腰者肾之府，脊者肾之所贯，肾伤故腰脊不举。远行劳倦则伤骨。逢大热而渴者，或外感之热，
或内蕴之热，皆消阴耗髓，故骨枯而痿也。滋阴补髓汤主之。
滋阴补髓汤（自制）
生地（五钱） 龟版（八钱） 黄柏（一钱盐水炒） 知母（一钱盐水炒） 虎胫骨（一钱五
分炙） 当归（二钱） 党参（四钱） 枸杞（三钱） 白术（一钱） 金毛脊（一钱五分）
茯苓（二钱） 牛膝（二钱） 川断（二钱） 猪脊髓（一条同煎）
The classics state that all flaccidity syndromes (Wei Syndrome) originate from the Lung. Commentators explain that this is due to emptiness of Lung Qi, where Metal (Lung) fails to control Wood (Liver), leading to stagnation of Liver Fire, shortening of large tendons, and laxity/elongation of small tendons, thus forming a tendon flaccidity syndrome. However, this applies only to tendon flaccidity. What about pulse flaccidity, flesh flaccidity, and bone flaccidity? How can one say that Metal fails to control Fire, Earth, or Water in these cases? This is certainly incorrect. Those interpreting the classics need not seek excessive profundity but should aim for appropriateness. The classics also state: "In treating flaccidity, exclusively select the Yangming." From this single sentence, one can understand the relationship between the Lung and Stomach, and the reasons why flaccidity originates in the Lung and treatment emphasizes the Yangming. The Stomach is the palace of water and grain; the spirit, qi, blood, and fluids of the entire body are generated from it. Its dregs descend to the Small Intestine; its essence ascends to the Lung. After the Lung receives the essence and qi, it then moistens the other zang organs. Now, due to unfulfilled desires causing restlessness and internal heat, the Lung is steamed, leaves become scorched and dry, resulting in flaccidity. It cannot scatter essence to other organs, hence flaccidity originates in the Lung. The reason for exclusively selecting Yangming is that the Stomach is the sea of the five zang and six fu organs, nourishing the whole body, and it governs the moistening of the Zongjin (Major Tendons). The Zongjin binds the bones and facilitates joint movement. Once thoroughly comprehended, the flaccidity of the five zang organs can be distinguished sequentially.
The classics state: "When Lung Heat scorches the leaves, the skin and hair become weak, thin, and tight; if it lingers, Feibi (flaccidity with inability to walk) arises." It further states: "Unfulfilled desires cause Lung Ming (lung sounds/cough); Ming leads to Lung Heat scorching the leaves." Thus, this condition is entirely caused by the consumption of Lung Yin and emptiness of Lung Qi. Since the Lung is the organ governing Qi, injury to the Lung results in weak Yuan Qi that cannot descend, leading to weakness in the feet and knees unable to bear weight. This is Lung Flaccidity, which is essentially Qi Flaccidity, treated with Yuhua Decoction.
Yuhua Decoction (Self-made Formula)
Polygonati Odorati Rhizoma (Yuzhu, 4 qian) Schisandrae Fructus (Wuweizi, 1 qian) Ophiopogonis Radix (Maidong, 3 qian) Glehniae Radix (Shashen, 4 qian) Codonopsis Radix (Dangshen, 4 qian)
Poria (Fuling, 2 qian) Atractylodis Macrocephalae Rhizoma (Baizhu, 1 qian) Dioscoreae Rhizoma (Shanyao, 3 qian) Dipsaci Radix (Chuanduan, 2 qian) Achyranthis Bidentatae Radix (Niuxi, 2 qian)
Rice (Yuanmi, a pinch, decocted as water substitute)
The classics state: "Heart Qi Heat causes lower vessels to reverse upward; when they reverse upward, lower vessels become deficient; deficiency generates Pulse Flaccidity. The pivot breaks and cannot be lifted; the shins are relaxed and cannot bear the ground." All vessels converge on the Heart. When Heart Yang rises excessively, the vessels below also reverse upward. The more excess above, the more deficiency below, thus generating Pulse Flaccidity. At the joints, it is like a broken pivot that cannot be lifted. The relaxation of the shins means the vessels are blocked and lax. Treated with Tiaoying Tongmai Decoction.
Tiaoying Tongmai Decoction (Self-made Formula)
Asparagi Radix (Tian Dong, 2 qian) Rehmanniae Radix Preparata (Sheng Di, 5 qian) Salviae Miltiorrhizae Radix et Rhizoma (Danshen, 2 qian) Ziziphi Spinosae Semen (Bairen, 2 qian) Codonopsis Radix (Dangshen, 4 qian) Poria cum Pinellia (Fushen, 2 qian)
Atractylodis Macrocephalae Rhizoma (Baizhu, 1 qian) Coptidis Rhizoma (Huanglian, 4 fen, stir-fried with wine) Angelicae Sinensis Radix (Danggui, 2 qian) Dipsaci Radix (Chuanduan, 2 qian) Achyranthis Bidentatae Radix (Niuxi, 2 qian)
Jujubae Fructus (Hongzao, 10 pieces) Mulberry Twig (Sangzhi, 1 chi)
The classics state: "Liver Qi Heat causes Gallbladder bile to leak, resulting in a bitter taste; the fascia becomes dry. Dry fascia leads to tendon tension and contraction, manifesting as Tendon Flaccidity." The Liver and Gallbladder are connected; Liver Heat causes Gallbladder Heat, boiling the bile internally, hence the bitter taste. Blood is seized by fire and cannot nourish the tendons, leading to tension and contraction, thus becoming Tendon Flaccidity. Treated with Shuimu Huazi Decoction.
Shuimu Huazi Decoction (Self-made Formula)
Rehmanniae Radix Preparata (Sheng Di, 5 qian) Angelicae Sinensis Radix (Danggui, 2 qian) Paeoniae Radix Alba (Baishao, 1.5 qian) Moutan Cortex (Danpi, 2 qian) Gardeniae Fructus (Shanzhi, 1.5 qian)
Saiga Tataricae Cornu (Lingyangjiao, 1.5 qian) Chaenomelis Fructus (Mu Gua, 1 qian, stir-fried with wine) Codonopsis Radix (Dangshen, 4 qian) Poria (Fuling, 2 qian) Atractylodis Macrocephalae Rhizoma (Baizhu, 1 qian)
Dipsaci Radix (Chuanduan, 2 qian) Achyranthis Bidentatae Radix (Niuxi, 2 qian) Human Milk (Renru, 1 cup) Mulberry Twig (Sangzhi, 1 chi)
The classics state: "Spleen Qi Heat causes the Stomach to become dry and thirsty; muscles become insensible, manifesting as Flesh Flaccidity." The Spleen and Stomach both belong to Earth, differing in dryness and dampness. If damp Earth is hot, dry Earth becomes even hotter, hence the Stomach is dry and thirsty. Heat stagnating internally consumes Spleen Yin, so the muscles become insensible and flaccid. Treated with Kunshun Decoction.
Kunshun Decoction (Self-made Formula)
Codonopsis Radix (Dangshen, 4 qian) Poria (Fuling, 2 qian) Atractylodis Macrocephalae Rhizoma (Baizhu, 1 qian) Glycyrrhizae Radix et Rhizoma (Gancao, 4 fen) Dioscoreae Rhizoma (Shanyao, 3 qian) Trichosanthis Radix (Huafen, 3 qian)
Dendrobii Caulis (Shihu, 3 qian) Sojae Helvolae Semen (Liaodou, 3 qian) Dipsaci Radix (Chuanduan, 2 qian) Achyranthis Bidentatae Radix (Niuxi, 2 qian) Jujubae Fructus (Hongzao, 5 pieces) Nelumbinis Semen (Lianzi, 10 grains, heart removed)
The classics state: "Kidney Qi Heat causes the waist and spine to be immobile; bones become withered and marrow decreases, manifesting as Bone Flaccidity." It also states: "Traveling far and working to exhaustion, encountering great heat and thirst, thirst causes Yang Qi to attack internally; internal attack allows heat to reside in the Kidney. The Kidney is the Water Organ; now Water cannot overcome Fire, so bones become withered and marrow empty, hence the feet cannot support the body, manifesting as Bone Flaccidity." The waist is the mansion of the Kidney, and the spine is penetrated by the Kidney; Kidney injury causes immobility of the waist and spine. Far travel and exhaustion injure the bones. Encountering great heat and thirst, whether external pathogenic heat or internal accumulated heat, both consume Yin and reduce marrow, so bones become withered and flaccid. Treated with Ziyin Busui Decoction.
Ziyin Busui Decoction (Self-made Formula)
Rehmanniae Radix Preparata (Sheng Di, 5 qian) Testudinis Carapax et Plastrum (Guiban, 8 qian) Phellodendri Cortex (Huangbai, 1 qian, stir-fried with salt water) Anemarrhenae Rhizoma (Zhimu, 1 qian, stir-fried with salt water) Panthera Tigris Os (Hujinggu, 1.5 qian, roasted) Angelicae Sinensis Radix (Danggui, 2 qian) Codonopsis Radix (Dangshen, 4 qian) Lycii Fructus (Gouqi, 3 qian) Atractylodis Macrocephalae Rhizoma (Baizhu, 1 qian) Polyporus Umbellatus (Jinmaoji, 1.5 qian)
Poria (Fuling, 2 qian) Achyranthis Bidentatae Radix (Niuxi, 2 qian) Dipsaci Radix (Chuanduan, 2 qian) Porcine Medulla Spinalis (Zhujingsui, 1 strip, decocted together)