【肾热痿软之症】腰骨不举，尻以代踵，脊以代头，足不任地，骨痿不能起于床，此《
内经》肾热痿弱之症也。
【肾热痿软之因】思想无穷，意淫于外，入房太甚，宗筋弛纵；又有远行劳倦，逢大热
而渴，阳气内伐，水不胜火，水亏于下，则肾热而骨痿。
【肾热痿软之脉】尺脉大而虚，肾气不足。尺脉搏而急，肾经火发。尺脉细而疾，肾水
【肾热痿软之治】尺脉大而虚，人参固本丸。尺脉搏而急，知柏天地煎。尺脉细而疾，
人参固本丸 见前精虚三消门。
知柏天地煎 见前肺热痿软。
坎离既济丸
熟地（四两） 当归（三两） 白芍药（三两） 牡丹皮（三两） 知母（二两） 天门冬（四两）
黄柏（二两） 麦门冬（四两）
上为细末，玄武胶、鹿角胶等分为丸。
秦子曰∶痿与挛，症形各别，症因相同，症形各别，故不得不另立一门。症因相同，故
法大同而略异。然二症宜合而互发者也，今立外感二条，内伤二条。
【外感筋挛之症】素无筋骨挛缩之候，一旦恶寒身痛，手足拘挛，不能转侧，此外感寒
湿筋挛之症也。若发热自汗，口燥唇干，二便赤涩，此外感湿热筋挛之症也。
【外感筋挛之因】《内经》云∶因寒则筋急。又云∶寒则筋挛，此外感寒湿之邪，而令
人筋脉挛倦者也。又云∶因于湿，首如裹，湿热不攘，则热伤阳明之血，而大筋软短，
此外感湿热而筋脉挛拳者也。
【外感筋挛之脉】左脉浮紧，寒湿伤血。右脉浮紧，寒湿伤气。左脉洪数，湿热伤血。
【外感筋挛之治】左脉浮紧，寒湿伤于太阳者，羌活胜湿汤。伤于少阳者，柴胡防风汤
右脉浮紧，寒湿伤于阳明者，干葛防风汤、苍术防风汤。若左脉洪数，湿热伤于太阳者，羌
活冲和汤、四味舒筋汤，合独活二妙丸。湿热伤于少阳者，小柴胡汤、圣惠方、秦艽汤。右
脉洪数，湿热伤于阳明者，二妙丸、神术汤。
羌活胜湿汤
羌活 苍术 防风 白术 泽泻 白茯苓 广皮 甘草
柴胡防风汤
柴胡 防风 羌活 甘草 荆芥 川芎 干葛 广皮
干葛防风汤
干葛 防风 荆芥 羌活 川芎 枳壳 甘草
苍术防风汤
苍术 防风
羌活冲和汤
羌活 黄芩 防风 白芷 川芎 生地 广皮 甘草
四味舒筋汤
独活 当归 苍术 黄柏
独活二妙丸
独活 黄柏
小柴胡汤
柴胡 黄芩 陈皮 甘草
圣惠方
秦艽 柴胡 甘草
秦艽汤
秦艽 防风 柴胡 黄芩 广皮 白芍药 甘草
二妙丸
苍术 黄柏
神术汤
苍术 石膏
[Symptoms of Kidney Heat Causing Flaccidity] The lumbar bones cannot be lifted; the buttocks substitute for the heels, and the spine substitutes for the head (bending forward while walking); the feet cannot bear weight; bone flaccidity prevents rising from bed. This is the syndrome of kidney heat causing flaccidity described in the *Neijing* (Classic of Internal Medicine).
[Etiology of Kidney Heat Causing Flaccidity] Endless thoughts and mental indulgence in external objects, excessive sexual intercourse leading to flaccidity of the Zongjin (tendons connecting to the genitals); also, long journeys and fatigue combined with exposure to intense heat and thirst, where internal Yang qi attacks and consumes Yin water, which fails to control Fire. With deficiency of Water below, kidney heat arises, leading to bone flaccidity.
[Pulse Signs of Kidney Heat Causing Flaccidity] A large and deficient pulse at the Chi position indicates insufficiency of Kidney Qi. A rapid and tense pulse at the Chi position indicates the outbreak of Fire in the Kidney Meridian. A fine and rapid pulse at the Chi position indicates deficiency of Kidney Water. [Text incomplete here].
[Treatment of Kidney Heat Causing Flaccidity] If the Chi pulse is large and deficient, use Renshen Guben Wan (Ginseng Root Pill to Secure the Root). If the Chi pulse is rapid and tense, use Zhibai Tiandi Jian (Anemarrhena, Phellodendron, Heaven, and Earth Decoction). If the Chi pulse is fine and rapid, use Renshen Guben Wan. See "Jing Xu San Xiao Men" (Essence Deficiency and Three Wasting-Thirst Chapter) for Renshen Guben Wan. See "Fei Re Wei Ruan" (Lung Heat Flaccidity) for Zhibai Tiandi Jian. Kanli Jizhi Wan (Pill of Kan and Li Mutual Completion): Shudi (Prepared Rehmannia Root, 4 liang), Danggui (Angelica Sinensis, 3 liang), Baishao (White Peony Root, 3 liang), Mudanpi (Moutan Bark, 3 liang), Zhimu (Anemarrhena Rhizome, 2 liang), Tiantianmen (Asparagus Fern Stem, 4 liang), Huangbai (Phellodendron Bark, 2 liang), Maimendong (Ophiopogon Tuber, 4 liang). Grind these into fine powder, mix equally with Xuanwu Jiao (Tortoise Shell Glue) and Lujiao Jiao (Deer Antler Glue), and form into pills.
Qin Zi said: Flaccidity (Wei) and spasm/contracture (Luan) present with different morphological symptoms but share similar etiologies. Because the symptoms differ, a separate category is established. Because the etiology is similar, the treatment methods are largely the same with slight variations. However, these two syndromes should be discussed together for mutual elucidation. Now, two sections on Exogenous causes and two on Endogenous causes are established.
[Symptoms of Exogenous Contracture] Without prior history of tendon or bone contracture, suddenly experiencing aversion to cold, body pain, and contracture of hands and feet preventing turning over, this is exogenous cold-dampness causing tendon contracture. If accompanied by fever, spontaneous sweating, dry mouth and lips, and dark, scanty urination and difficult defecation, this is exogenous damp-heat causing tendon contracture.
[Etiology of Exogenous Contracture] The *Neijing* states: "Cold causes tendons to become tight." It also states: "Cold leads to tendon contracture," indicating that exogenous cold-dampness pathogens cause tendons and vessels to become contracted and fatigued. It further states: "Affected by dampness, the head feels wrapped; if damp-heat is not dispelled, heat damages the blood of the Yangming channel, causing large tendons to become soft and short," indicating that exogenous damp-heat leads to curled and contracted tendons and vessels.
[Pulse Signs of Exogenous Contracture] A floating and tight pulse on the left indicates cold-dampness damaging Blood. A floating and tight pulse on the right indicates cold-dampness damaging Qi. A surging and rapid pulse on the left indicates damp-heat damaging Blood.
[Treatment of Exogenous Contracture] If the left pulse is floating and tight, indicating Cold-Dampness injuring the Taiyang channel, use Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness). If injuring the Shaoyang channel, use Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction). If the right pulse is floating and tight, indicating Cold-Dampness injuring the Yangming channel, use Gange Fangfeng Tang (Kudzu and Saposhnikovia Decoction) or Cangzhu Fangfeng Tang (Atractylodes Macrocephala and Saposhnikovia Decoction). If the left pulse is surging and rapid, indicating Damp-Heat injuring the Taiyang channel, use Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) and Siwei Shujin Tang (Four-Ingredient Tendon-Relaxing Decoction), combined with Duhuo Ermiao Wan (Angelica Pubescens and Two Marvels Pill). If injuring the Shaoyang channel, use Xiaochaihu Tang (Minor Bupleurum Decoction), Shenghui Fang (Sage's Benefit Formula), or Qinjiao Tang (Gentian Decoction). If the right pulse is surging and rapid, indicating Damp-Heat injuring the Yangming channel, use Ermiao Wan (Two Marvels Pill) or Shenzhu Tang (Divine Skill Decoction).
Qianghuo Shengshi Tang: Qianghuo (Notopterygium Rhizome), Cangzhu (Atractylodes Rhizome), Fangfeng (Saposhnikovia Root), Baizhu (Atractylodes Macrocephala Rhizome), Zexie (Alisma Rhizome), Baifuling (Poria with Hostwood), Guangpi (Citrus Peel), Gancao (Licorice Root).
Chaihu Fangfeng Tang: Chaihu (Bupleurum Root), Fangfeng (Saposhnikovia Root), Qianghuo (Notopterygium Rhizome), Gancao (Licorice Root), Jingjie (Schizonepeta Spike), Chuanxiong (Ligusticum Rhizome), Gange (Kudzu Root), Guangpi (Citrus Peel).
Gange Fangfeng Tang: Gange (Kudzu Root), Fangfeng (Saposhnikovia Root), Jingjie (Schizonepeta Spike), Qianghuo (Notopterygium Rhizome), Chuanxiong (Ligusticum Rhizome), Zhike (Aurantii Fructus Immaturus), Gancao (Licorice Root).
Cangzhu Fangfeng Tang: Cangzhu (Atractylodes Rhizome), Fangfeng (Saposhnikovia Root).
Qianghuo Chonghe Tang: Qianghuo (Notopterygium Rhizome), Huangqin (Scutellaria Root), Fangfeng (Saposhnikovia Root), Baizhi (Angelica Dahurica Root), Chuanxiong (Ligusticum Rhizome), Shengdi (Rehmannia Root), Guangpi (Citrus Peel), Gancao (Licorice Root).
Siwei Shujin Tang: Duhuo (Angelica Pubescens Root), Danggui (Angelica Sinensis), Cangzhu (Atractylodes Rhizome), Huangbai (Phellodendron Bark).
Duhuo Ermiao Wan: Duhuo (Angelica Pubescens Root), Huangbai (Phellodendron Bark).
Xiaochaihu Tang: Chaihu (Bupleurum Root), Huangqin (Scutellaria Root), Chenpi (Aged Citrus Peel), Gancao (Licorice Root).
Shenghui Fang: Qinjiao (Gentiana Macrophylla Root), Chaihu (Bupleurum Root), Gancao (Licorice Root).
Qinjiao Tang: Qinjiao (Gentiana Macrophylla Root), Fangfeng (Saposhnikovia Root), Chaihu (Bupleurum Root), Huangqin (Scutellaria Root), Guangpi (Citrus Peel), Baishao (White Peony Root), Gancao (Licorice Root).
Ermiao Wan: Cangzhu (Atractylodes Rhizome), Huangbai (Phellodendron Bark).
Shenzhu Tang: Cangzhu (Atractylodes Rhizome), Shigao (Gypsum Fibrosum).