吴云。痿。与萎同。弱而不用之意。高云。承上编痹证。而论痿证也。痿者。四肢委弱。举动不能。如委
弃不用之意。潘氏医灯续焰云。痿者。委也。足痿不用。有委靡不振之义。故字从委。简按痿。 系于四肢委
弱之疾。而有肺痿阴痿等证。巢源。作肺萎阴萎。知是痿与萎同。吴为明确。盖痿痹 三疾相类。古多混同。
说文。痿。痹疾也。前哀帝纪。痿痹。师古云。痿。亦痹病也。枚乘七疑。出舆入辇。命名蹶痿之机。此类是
也。故本经分三篇。而详论之。
筋膜 张云。膜。犹幕也。凡肉理脏腑之间。其成片联系薄筋。皆谓之膜。所以屏障血气者也。凡筋
膜所在之处。脉络必分。血气必聚。故又谓之膜原。亦谓之脂膜。
肺热叶焦 甲乙。焦下。更有焦字。
急薄着则 甲乙。着下。更有着字。吴云。着。留而不去也。张云。皮毛虚弱。而为急薄。热气留着
不去。志云。灵枢云。皮肤薄着。毛腠夭焦。着者。皮毛燥着。而无生转之气。故曰着则生痿 也。
痿 吴云。 。足不用也。肺主气。气病则不能充周于身。故令手痿足 。汪昂云。肺主皮毛。传
精布气。肺热叶焦。则不能输精于皮毛。故虚弱急薄。皮肤燥着。而痿 不能行。犹木皮剥。则不能行津于枝
干而枯也。简按史记韩王信传。仆之思归。如痿人不忘起。张楫云。痿。不能行。吴越春秋云。寡人念吴。犹
者不忘走。 。又作 。礼记释文。 。两足不能行也。由此观之。痿 。并足废之疾。然痿者。痿弱之义。
者。两足不能行之称。自不能无别焉。王则根据疏五过论。痿 为挛之语。释为挛 。吴则分为手足之病。俱
似拘泥。此据他脏之例。当曰皮痿。而曰痿 者。盖肺为痿证之主也。
枢折挈 吴云。枢纽关节之处。或折或挈。志本。挈。一字句。注云。枢析。即骨繇而不安于地。
骨繇者。节缓而不收。（以上根结篇文。）故筋骨悬挈不收。汪昂云。枢纽之间。如折如挈。简按说文。挈。
悬持也。推王意。谓膝腕之枢纽。失其悬持。如折去也。此注为长。甲乙。挈。作 。非。
胆泄 甲乙。胆下。有热字。简按奇病论。胆虚气上溢。而口为之苦。名胆瘅。
肺者脏之长也 志云。脏真高于肺。朝百脉。而行气于脏腑。故为脏之长。简按病能论。九针论。
并云肺者。五脏六腑之盖也。
肺热叶焦 吴。此下。补生痿 三字。简按此据上文着则生痿 之语。亦未为得。
故曰 吴云。以下。古语也。马张同。志云。谓下经本病篇。有此语也。以上论肺热叶焦。而成五
脏之热。此下。论五脏各有所因。而自成脉肉筋骨之痿。
胞络绝 高本。胞。作包。云。包。旧本讹胞。今改。悲哀太甚。则心气内伤。故包络绝。包络。
心包之络也。包络绝。则血外溢。而阳热之气内动。其发病也。则心气下崩。下崩则数溲血也。简按此根据新校
正改字。而其义则原于王及杨注。颇见确实。马云。此胞络者。乃胞络宫之胞字。正妇人受胎之所。彼心包络
之包字。不从肉。王注以胞为包者。非。评热论云。胞脉者。属心而络于胞中。故悲哀太甚。则心系急。胞之
络脉阻绝。上下不交。亢阳内动。逼血下崩。令人数为溺血也。张同。若根据此说。以胞为女子之胞。则丈夫必
无脉痿之证。乖违甚矣。志云。胞之大络。即冲脉也。亦为臆解。但绝字。宜从马注。为阻绝之义。
大经空虚 张云。血失则大经空虚。无以渗灌肌肉。荣养脉络。故先为肌肉顽痹。而后传为脉痿。
简按志以为胞之大络。高同。当从王注。
入房太甚宗筋弛纵 马云。思想既已无穷。所愿又不得遂。其意久淫于外。或至入房太甚。宗筋弛
纵。高云。思想无穷。所愿不得。则怫郁于内。肝气伤矣。意淫于外者。其意淫纵于外。不静存也。入房太甚。
宗筋弛纵者。房劳过度。阴器衰弱也。简按据下文使内也语。筋痿之证。因思想无穷。所愿不得。意淫于外。
而又重之以房劳。马添一或字释之。高以四句为三款。且以宗筋弛纵为阴痿。并似乖于经旨。
白淫 吴云。今之浊带也。马云。在男子为精滑。在女子为白带。简按本神篇云。精伤则骨 痿厥。
精时自下。玉机真脏论云。出白名曰蛊。皆其义也。圣济总录云。淫 不守。随溲而下也。
有渐于湿 马云。渐。音尖。诗云。渐车帷裳。注。渐。
渍也。张云。渐。有由来也。
若有所留居处相湿 吴云。留。久留于水也。相。伴也。言居处之间。或伴乎湿也。张云。相。并也。
马云。其居处又湿。志云。有湿浊之所留。而居处又兼卑下。外内相湿。简按相字难解。姑从志。
肌肉濡渍 甲乙。渍。作溃。滑本同。误。
阳气内伐 马云。卫气内伐其阴气。简按营卫生会篇云。卫气内伐击也。马盖原于此。
络脉溢 简按此以外候言。乃孙络浮见也。
肉蠕动 张云。蠕。音软。微动貌。又曰。虫行貌。
主闰宗筋 甲乙。闰。作润。马吴并云。闰。润同。马云。宗筋在人。乃足之强弱所系也。但阳明
实。则宗筋润。阳明虚。则宗筋纵。世疑宗筋即为前阴。按厥论有曰。前阴者。宗筋之所聚。则宗筋不可以前
阴言。张云。宗筋者。前阴所聚之筋也。为诸筋之会。凡腰脊溪谷之筋。皆属于此。故主束骨而利机关也。简
按五音五味篇云。宦者去其宗筋。根据此则张注似是。然前阴是宗筋之所会。故言断其前阴。而为去其宗筋。但
不可即谓宗筋为前阴也。王注似详备。而有所未尽。宜参考诸篇。而始得其义。（据王所说。 癖 气。横弦
竖弦之属。盖宗筋努张之所致也。）
束骨 吴云。束。管摄也。
机关 骨空论云。侠髋为机。 上为关。又据邪客篇。两肘两腋两髀两 者。皆机关之室。
冲脉者经脉之海也 五音五味篇云。冲脉起于胞中。上循脊里。为经络之海。动输篇并海论云。冲
脉者。为十二经之海。
阴阳总宗筋之会 滑云。愚谓此即厥论。前阴者。宗筋
之所聚。太阴阳明之所合之义也。张云。宗筋聚于前阴。前阴者。足三阴阳明少阳。及冲任督跷九脉之所会也。
九者之中。则阳明为五脏六腑之海。冲为经脉之海。此一阴一阳。总乎其间。故曰阴阳总宗筋之会也。简按高
云。阴阳。阴跷阳跷。阴维阳维也。未若滑张二氏有所据也。
气街 志云。气街者。腹气之街。甲乙。一名气冲。简按说文。街。四通道也。又曰冲。通道也。
知字异而义同。
带脉 经别篇云。当十四椎。出属带脉。二十八难云。带脉者。起于季胁。回身一周。杨注云。带
之为言。束也。言总束诸脉。使得调柔也。回。绕也。绕身一周。犹束带焉。
不引 吴云。不能收引。高云。不引者。不能延引而环约也。简按吴义为长。
补其荥而通其输 吴云。十二经。有荥有输。所溜为荥。所注为输。补。致其气也。通。行其气也。
张云。上文云独取阳明。此复云各补其荥。而通其输。盖治痿者。当取阳明。又必察其所受之经。而兼治之也。
如筋痿者。取阳明厥阴之荥输。脉痿者。取阳明少阴之荥输。肉痿骨痿。其治皆然。高云。各补其在内之荣血。
而通其在外之输穴。正虚则补以调之。邪实则泻以调之。志同。简按当仍吴张。
和其逆顺 马云。补则逆取。泻则顺取。志云。和其气之往来也。高云。逆者和之使顺。顺者和之不
使逆。简按阴阳应象大论。阴阳反作。病之逆从也。吴注。逆从。不顺也。盖此言逆顺。亦是不顺之谓。义始通。
以其时受月 高云。肝主之筋。心主之脉。肾主之骨。脾主之肉。各以其四时受气之月。而施治之。
则病已矣。受气者。筋受气于春。脉受气于夏。骨受气于冬。肉受气于长夏也。简按吴改月作气。不可从。
Wu Yun: Wei (flaccidity) is synonymous with "wei" (withering), meaning weakness and inability to use. Gao Yun: Following the previous section on Bi syndrome (obstruction syndrome), this discusses Wei syndrome. Wei refers to the limbs being flaccid and weak, unable to move, as if discarded and no longer used. Pan's *Yi Deng Xu Yan* states: Wei means "wei" (to yield/fall), referring to the legs being flaccid and unusable, carrying the meaning of listlessness and lack of vigor; hence the character contains the radical "wei". Jian An: Wei is a disease characterized by the flaccidity and weakness of the four limbs, but there are also conditions such as Lung Wei (Lung flaccidity) and Yin Wei (Genital flaccidity). Chao Yuanfang wrote it as "Fei Wei" and "Yin Wei", indicating that Wei and Wei are the same character. Wu's clarification aims for precision. Generally, Wei, Bi, and three other ailments are similar, often confused in ancient texts. The *Shuo Wen Jie Zi* states: Wei is a Bi ailment. In the *Annals of Emperor Ai*, "Wei Bi" is mentioned, and Shi Gu notes: Wei is also a Bi disease. Mei Cheng's *Qi Fa* says: "Exiting in a carriage and entering on a palanquin is called the mechanism of Jue Wei (sudden collapse and flaccidity)." These are examples. Therefore, this classic divides them into three chapters for detailed discussion.
Jin Mo (Fascia and Membranes): Zhang Yun: Mo is like a curtain. Any thin fascia connecting flesh textures and organs in sheets are called Mo. They serve to screen and protect Qi and Blood. Wherever Jin Mo exists, meridians must branch out, and Qi and Blood must gather; thus it is also called "Mo Yuan" or "Zhi Mo" (fatty membrane).
Fei Re Ye Jiao (Lung Heat Scorches the Leaves): The *Jia Yi Jing* adds an extra "Jiao" character after "Jiao".
Ji Bo Zhe Ze (Urgent, Thin, and Adhering): The *Jia Yi Jing* adds an extra "Zhe" character after "Zhe". Wu Yun: Zhe means lingering and not departing. Zhang Yun: The skin and hair are weak, becoming urgent and thin, while hot pathogenic factors linger without leaving. Zhi Yun: The *Ling Shu* states: Skin is thin and adhering, hair and pores are scorched and dry. Zhe refers to the skin and hair being dry and adherent, lacking the vital energy of transformation; hence it is said that "adherence generates Wei".
Wei Bi (Flaccidity and Paralysis of Legs): Wu Yun: Bi refers to the inability to use the feet. The Lung governs Qi; when Qi is diseased, it cannot circulate throughout the body, causing hand flaccidity and leg paralysis. Wang Ang states: The Lung governs skin and hair, transmitting essence and distributing Qi. When Lung heat scorches the leaves, it cannot transport essence to the skin and hair, resulting in weakness, urgency, thinning, dryness, and adherence of the skin, leading to Wei Bi (inability to walk). It is like tree bark peeling off, unable to transport fluids to branches, causing withering. Jian An: The *Records of the Grand Historian* mentions Han Xin: "My longing to return is like a person with Wei who does not forget to stand up." Zhang Ji states: Wei means inability to walk. *Spring and Autumn Annals of Wu Yue* states: "My thinking of Wu is like a person with Bi who does not forget to run." Bi is also written as "Bi". The *Li Ji Shi Wen* explains: Inability to walk with both feet. Thus, Wei and Bi are diseases of leg dysfunction. However, "Wei" implies weakness, while "Bi" specifically denotes the inability to walk with both feet; there is naturally a distinction. Wang Bing, based on the *Shu Wu Gu Lun* stating "Wei Bi is contraction," interpreted it as "Luan Bi." Wu Kun distinguished them as diseases of hands and feet, which seems rigid. Based on examples from other organs, it should be called "Pi Wei" (Skin Flaccidity), but it is called "Wei Bi" because the Lung is the primary organ for Wei syndromes.
Shu Zhe Qie (Hinge Breaks and Lifts): Wu Yun: At the hinge joints, they may break or lift. The *Zhi* edition treats "Qie" as a separate sentence, noting: Hinge separation is like Gu Yao (bone laxity) where one cannot rest securely on the ground. Gu Yao means joints are loose and fail to contract (from the *Gen Jie Pian*). Thus, sinews and bones hang loosely and fail to gather. Wang Ang states: Between hinges, it feels like breaking or lifting. Jian An: The *Shuo Wen Jie Zi* defines Qie as suspending and holding. Inferring Wang's intent, he likely meant that the knee and ankle hinges lose their suspending hold, appearing broken. This annotation is more reasonable. The *Jia Yi Jing* writes "Qie" as "Xie," which is incorrect.
Dan Xie (Gallbladder Leakage): The *Jia Yi Jing* adds the character "Re" (Heat) after "Dan". Jian An: The *Qi Bing Lun* states: Gallbladder deficiency causes Qi to overflow upward, making the mouth bitter, named Dan Dan (Gallbladder Fever).
Fei Zhe Zang Zhi Chang Ye (The Lung is the Chief of the Viscera): Zhi Yun: The True Qi of the Zang organs is superior to the Lung, which receives all vessels and distributes Qi to the viscera; thus, it is the chief of the Zang. Jian An: The *Bing Neng Lun* and *Jiu Zhen Lun* both state: The Lung is the canopy of the five Zang and six Fu organs.
Fei Re Ye Jiao (Lung Heat Scorches the Leaves): Wu's note adds the three characters "Sheng Wei Bi" (Generates Wei Bi) below this line. Jian An: This is based on the earlier phrase "Zhe Ze Sheng Wei Bi," which is not entirely appropriate.
Gu Yue (Thus it is said): Wu Yun: The following text is ancient language. Ma Shih and Zhang Jingyue agree. Zhi Yun: Refers to the existence of this phrase in the *Xia Jing · Ben Bing Pian*. The above discusses how Lung heat scorches the leaves, leading to heat in the five Zang. The following discusses how each Zang has its own causes, independently generating Wei of the vessels, muscles, sinews, and bones.
Bao Luo Jue (Pericardium Collateral Severed): The Gao edition writes "Bao" instead of "Pao," stating: Bao was an error in old editions for Pao, now corrected. Excessive sorrow injures the Heart Qi internally, causing the Pericardium collateral to sever. The Pericardium collateral is the network of the Heart Protector. When severed, blood overflows externally, and Yang-heat moves internally. Upon onset, Heart Qi collapses downward; downward collapse leads to frequent bleeding from urination. Jian An: This correction follows new editorial standards, deriving its meaning from Wang Bing and Yang Shangshan's annotations, which appear accurate. Ma Yun states: Here, "Pao Luo" uses "Pao" as in "Pao Luo Gong" (Uterus Collateral), the place where conception occurs. The "Bao" in "Xin Bao Luo" (Pericardium Collateral) does not have the meat radical. Wang Bing equating Pao with Bao is incorrect. The *Ping Re Lun* states: Pao Mai belongs to the Heart and connects to the Pao (Uterus). Thus, excessive sorrow tightens the Heart connection, blocking the Pao collaterals, preventing upper-lower communication, causing hyperactive Yang to move internally and force blood downward, leading to frequent hematuria. Zhang Jingyue agrees. If one interprets "Pao" as the female uterus, then men would certainly not suffer Mai Wei (Vessel Flaccidity), which is a gross contradiction. Zhi Yun: The large collateral of the Pao is the Chong Mai (Penetrating Vessel); this is also speculative. However, the character "Jue" should follow Ma's note, meaning obstruction/severance.
Da Jing Kong Xu (Large Meridians Empty): Zhang Yun: Loss of blood empties the large meridians, unable to seep into muscles and nourish collaterals, first causing muscle numbness and bi, then transmitting to Mai Wei. Jian An: Zhi considers the large collateral of the Pao; Gao agrees. One should follow Wang Bing's annotation.
Ru Fang Tai Shen Zong Jin Chi Zong (Excessive Intercourse Causes Relaxation of Zong Jin): Ma Yun: Thoughts are endless, desires unfulfilled, mind indulging externally for long, or perhaps excessive intercourse causes Zong Jin (Sinew Bundle) to relax. Gao Yun: Endless thoughts and unfulfilled desires cause stagnation internally, injuring Liver Qi. Indulgence externally means the mind wanders without stillness. Excessive intercourse and Zong Jin relaxation refer to sexual fatigue leading to genital weakness. Jian An: Based on the later mention of "Shi Nei" (sexual activity), Jin Wei (Sinew Flaccidity) arises from endless thoughts, unfulfilled desires, external mental indulgence, compounded by sexual fatigue. Ma added "or" to explain. Gao divided the four sentences into three parts and interpreted "Zong Jin Chi Zong" as "Yin Wei" (Genital Flaccidity), both seeming to deviate from the classic's intent.
Bai Yin (White Leukorrhea/Spermatorrhea): Wu Yun: Now known as turbid discharge. Ma Yun: In men, it is spermatorrhea; in women, leukorrhea. Jian An: The *Ben Shen Pian* states: Essence injury leads to bone Wei and jue, with essence leaking spontaneously. The *Yu Ji Zhen Zang Lun* states: Discharge of white substance is called Gu. Both illustrate this meaning. The *Sheng Ji Zong Lu* states: Unrestrained discharge follows urine down.
You Jian Yu Shi (Gradually Affected by Dampness): Ma Yun: Jian sounds like "jian". The *Shi Jing* says: "Jian che wei chang." Note: Jian means soaking/wetting. Zhang Yun: Jian implies a gradual origin.
Ruo You Suo Liu Ju Chu Xiang Shi (Remaining in Damp Dwelling): Wu Yun: Liu means staying long in water. Xiang means accompanying. It means dwelling places are accompanied by dampness. Zhang Yun: Xiang means together. Ma Yun: Their dwelling is also damp. Zhi Yun: Damp-turbid substances remain, and dwellings are low, so external and internal dampness interact. Jian An: The character "Xiang" is difficult to interpret; tentatively follow Zhi.
Rou Mu Ru Zi (Muscles Soaked and Rotting): The *Jia Yi Jing* writes "Zi" as "Kui". The *Hua* edition agrees, but it is an error.
Yang Qi Nei Fa (Yang Qi Invades Internally): Ma Yun: Wei Qi internally attacks Yin Qi. Jian An: The *Ying Wei Sheng Hui Pian* states: Wei Qi internally invades/strikes. Ma likely derived this from there.
Luo Mai Yi (Collateral Vessels Overflow): Jian An: Described here as an external sign, it refers to the visibility of Sun Luo (Fine Collaterals).
Rou Ru Dong (Muscle Twitching): Zhang Yun: Ru sounds like "ruan". It describes slight movement. Also described as the motion of insects.
Zhu Run Zong Jin (Governs the Lubrication of Zong Jin): The *Jia Yi Jing* writes "Run" instead of "Run". Ma and Wu both state: Run and Run are the same. Ma Yun: Zong Jin in humans determines the strength of the legs. When Yangming is full, Zong Jin is lubricated; when Yangming is deficient, Zong Jin relaxes. People suspect Zong Jin is the anterior yin. The *Jue Lun* states: The anterior yin is where Zong Jin gathers. Thus, Zong Jin cannot simply be equated with the anterior yin. Zhang Yun: Zong Jin are the sinews gathered at the anterior yin, the meeting point of all sinews. Sinews of the waist, spine, and valleys all belong here, governing the binding of bones and facilitating joint movement. Jian An: The *Wu Yin Wu Wei Pian* states: Eunuchs have their Zong Jin removed. Based on this, Zhang's note seems plausible. Since the anterior yin is the gathering point of Zong Jin, cutting the anterior yin is referred to as removing Zong Jin. But Zong Jin should not be immediately equated with the anterior yin. Wang Bing's note is detailed but incomplete; consulting other chapters reveals the true meaning. (According to Wang, conditions like Pi Qi, horizontal and vertical cords, are caused by the tension of Zong Jin.)
Shu Gu (Binding Bones): Wu Yun: Shu means to manage and control.
Ji Guan (Joints/Mechanisms): The *Gu Kong Lun* states: Beside the hip is the Ji (mechanism), above the thigh is the Guan (gate). According to the *Xie Ke Pian*, the two elbows, two axillae, two thighs, and two calves are all rooms of mechanisms.
Chong Mai Zhe Jing Mai Zhi Hai Ye (The Chong Mai is the Sea of the Meridians): The *Wu Yin Wu Wei Pian* states: The Chong Mai originates in the Pao (uterus/sea of blood), ascends along the spine, and is the sea of meridians. The *Dong Shu Pian* and *Hai Lun* state: The Chong Mai is the sea of the twelve meridians.
Yin Yang Zong Zong Jin Zhi Hui (Yin and Yang Gather at the Zong Jin): Hua Shou Yun: I believe this refers to the meaning in the *Jue Lun*: "The anterior yin is where Zong Jin gathers, the convergence of Taiyin and Yangming." Zhang Yun: Zong Jin gathers at the anterior yin. The anterior yin is the convergence of the three Yin meridians of the foot, Yangming, Shaoyang, and the Chong, Ren, Du, and Qiao meridians. Among these nine, Yangming is the sea of the five Zang and six Fu, and Chong is the sea of the meridians. This one Yin and one Yang summarize the middle, hence it is called "Yin and Yang gather at the Zong Jin." Jian An: Gao Yun: Yin and Yang refer to Yin Qiao, Yang Qiao, Yin Wei, and Yang Wei. This is less supported than the views of Hua and Zhang.
Qi Jie (Qi Street): Zhi Yun: Qi Jie is the street of abdominal Qi. The *Jia Yi Jing* calls it Qi Chong. Jian An: The *Shuo Wen Jie Zi* states: Jie is a four-way passage. Also: Chong is a passage. Knowing the characters differ but meanings are the same.
Dai Mai (Girdle Vessel): The *Jing Bie Pian* states: At the 14th vertebra, it emerges and connects to the Dai Mai. The *Nan Jing* Chapter 28 states: The Dai Mai originates at the costal margin and circles the body once. Yang Shangshan notes: Dai means to bind. It binds all meridians to make them flexible. Hui means to circle. Circling the body once is like wearing a belt.
Bu Yin (Cannot Draw Inward): Wu Yun: Unable to contract and draw inward. Gao Yun: Bu Yin means unable to extend and encircle. Jian An: Wu's interpretation is better.
Bu Qi Ying Er Tong Qi Shu (Tonify the Ying-Spring and Unblock the Shu-Stream): Wu Yun: The twelve meridians have Ying and Shu points. Flowing water becomes Ying, pouring water becomes Shu. Tonifying brings Qi; unblocking moves Qi. Zhang Yun: The above text says "Only take Yangming," but here it says "Tonify their Ying and unblock their Shu." Treating Wei requires taking Yangming, but one must also observe the affected meridian and treat it concurrently. For example, for Jin Wei, take the Ying-Shu of Yangming and Jueyin; for Mai Wei, take Yangming and Shaoyin; for Rou Wei and Gu Wei, the treatment is the same. Gao Yun: Tonify the Ying-Blood internally and unblock the Shu-Acupoints externally. Deficiency is tonified to regulate; excess is drained to regulate. Zhi agrees. Jian An: Should follow Wu and Zhang.
He Qi Ni Shun (Harmonize Its Reverse and Smooth Flow): Ma Yun: Tonification is reverse acquisition, draining is smooth acquisition. Zhi Yun: Harmonizing the coming and going of Qi. Gao Yun: Harmonize reverse to make it smooth, harmonize smooth to prevent reversal. Jian An: The *Yin Yang Ying Xiang Da Lun* states: Reversal of Yin and Yang is the reverse and smooth nature of disease. Wu notes: Ni Cong means not smooth. Here, Ni Shun also means not smooth, making the meaning clear.
Yi Qi Shi Shou Yue (In the Month It Receives Qi): Gao Yun: The Liver governs sinews, Heart governs vessels, Kidney governs bones, Spleen governs muscles. Treat them in the months they receive Qi according to the four seasons, and the disease will resolve. Receiving Qi means: Sinews receive Qi in Spring, vessels in Summer, bones in Winter, muscles in Late Summer. Jian An: Wu Kun changing "Yue" (Month) to "Qi" (Energy) is incorrect.