凝结为痰，壅塞气道，不得通利，热极生风，亦致卒然僵扑，类乎中风，此即内虚暗风。初用清热顺风
化痰，次用治本，或
益阴，或补阳。其药以二冬、二地、菊花、枸杞、胡麻、桑叶、首乌、柏仁、蒺藜、花粉、参、 、归、芍、
鹿茸、虎骨胶、霞天膏、梨膏、竹沥、人乳、童便等，出入互换、另出机轴。今《临证指南》中风一门，大半
宗此，又可补刘、李、朱、张所未备矣。
徐灵胎曰∶下体痿弱，属虚者多，温补肝肾，亦不为过，但其中必兼有风寒痰湿。一味蛮补，亦有未到之
处。此等方法，起于宋而盛于明，古人不如是也。
米南宫五世孙巨秀，亦善医，尝诊史相脉，未发。史谓之曰∶可服红丸子否？米对以正欲用此，亦即愈。
史病手足不能举，朝谒遂废，枢中要务，运之帷榻，米谓必得天地丹而后可。丹头偶失去，历年莫可访寻。史
病甚，召米于常州，至北关，发舟买饭，偶见有进拳石于肆者，颇异，米即而玩之，即天地丹头也。（史当未死，鬼
神犹相之。）问售者，尔自何致此？曰∶去年有人家一奶子以售。米因问厥值。售者漫索钱万。米以三千酬值，持
归调剂以供史，史未敢尝。有阍者亦疾痿，试服即能坐起。又以起步司田帅之疾，史始信而饵，身即轻，遂内
引。及史疾再殆，天地丹已尽，遂薨于赐第。（叶绍翁《四朝闻见录》。）
张子和治武弁宋子玉，因驻军息城，五六月间暴得痿病，腰胯两足，皆不任用， 而不行。求治于张，张
察其脉，俱滑实而有力。张凭《内经》∶火淫于内，治以咸寒。以盐水越其膈间寒热宿痰。新者为热，旧者为
寒，或宿食宿饮在上脘皆可涌之。宿痰既尽，因而下之。节次数十行，觉神志日清，饮食日美，两足渐举，脚
膝渐伸，心降肾升。更继以黄连解毒汤加当归等药，又泻心汤、凉膈散、柴胡饮子，大作剂煎，时时呷之而愈。
经曰∶治心肺之病最近，用药剂不厌频而少，治肝肾之病最远，用药剂不厌频而多，此之谓也。夫痿病无寒，
多发于五六七月。若误作痹与香港脚治之，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，如此而死者，岂亦天乎？
李成章治一人病痿。李察诸方，与治法合而不效，疑之，忽悟曰∶药有新陈，则效有迟速，此病在表而深，
非小剂能愈。乃热药二锅，倾缸内稍冷，令病者坐其中，以药浇之，超时汗大出立愈。（《明史》李明玉。）
龚子才治一人，两足痿弱不能动，止以鹿茸、人参各五钱，又锉一剂，水煎空心温服，连进数服而愈。
孙文垣治徐氏子，年弱冠，肌肉瘦削，尻膝肿大，手肘肩 皆肿，肿处痛热。或作风与湿痰及鹤膝鼓捶风
治，病转甚。诊之，六部皆弦，其色青而白，饮食少，时当长至。曰∶此筋痿也，诸痿皆不可作风治。病转甚
者，以前药皆风剂耳。风能伤血，血枯则筋愈失养，况弦脉乃肝木所主，搀前而至，是肝有余而脾土受克，脾
伤则饮食少而肌肉削也。经曰∶治痿独取阳明。阳明者，肠与胃也。法当滋补肠胃，俾饮食日加，脏腑有所禀
受，荣卫流行，气煦血濡。调养至春，君火主事之时，宗筋润而机关可利也。五加皮、薏仁、甘草、苍耳子、
枸杞子、琐阳、人参、杜仲、黄柏、黄 、防风，服二十剂而精神壮，腰膂健，饮食加。惟间有梦遗，去杜仲，
加远志、当归，三十帖全愈。（雄按∶议论极是，方未尽善。）
易思兰治一妇人，年十九，禀赋怯弱，庚辰春因患痿疾，卧榻年余，首不能举，形瘦如柴，发结若毡，起
便皆赖人扶，一粒不尝者五月，惟日啖甘蔗汁而已，服滋阴降火药百帖不效。有用人参一二钱者，辄喘胀不安。
其脉六部俱软弱无力，知其脾困久矣。以补中益气汤加减治之，而人参更加倍焉，服二剂遂进粥二盏，鸡蛋二
枚。后以强筋健体之药，调理数月，饮食步履如常，全愈。或问曰∶诸人皆用滋阴降火，公独用补中益气，何
也？易曰∶痿因五内不足，治在阳明。阳明者胃也，为五脏六腑之海，主润宗筋，宗筋主束骨而利机关，痿由
阳明之虚，胃虚不能生金，则肺金热不能荣养一方，脾虚则四肢不能为用。兹以人参为君， 、术为佐，皆健
脾土之药也。土健则能生金，金坚而痿自愈矣。又问∶向用人参一二钱，便作喘胀，今倍用之，又加诸补气药
而不喘胀，何也？曰∶五月不食，六脉弱甚，邪气太盛，元气太衰，用参少则杯水车薪，不惟不胜，而反为所
制，其喘胀也宜矣。予倍用之，如以大军摧大敌，岂有不剿除者哉？加减补中益气汤方∶人参一钱，黄 八
分，归身八分，陈皮六分，白术八分，炙甘草五分，泽泻六分，黄柏五分，丹皮六分。
陆养愚治王庚阳，中年后患足拘挛，屈伸不利，以风湿治不效。自制史国公药酒，服之亦不效。脉之左手
细数，重按则驶，右手稍和，重按亦弱。询其病发之由，告曰∶始偶不谨而冒寒，便发寒热口苦，筋骨疼痛。
服发散药，寒热除而口苦疼痛不减。至月余，先左足拘挛，难以屈伸，渐至右足亦然，又渐至两手亦然，手更
振掉不息。医数十人，不外疏风顺气及行气行血而已。数月前，少能移动，而振动疼痛不可忍。今虽不能移动，
幸不振掉疼痛。曰∶若不疼痛，大事去矣。曰∶不移动则不疼痛，若移动极其酸痛。曰∶幸尚可药，此筋痿症
也。少年房帷间，曾有所思慕而不得遂愿否？曰∶早年一婢，其色颇妍，因昵之。拙荆觉而私黜他方，后极想
念。本年间欲事反纵，后患遗精、白浊，今阳事久不起矣。曰∶《内经·痿论》中一条云，肝气热，则胆泄口
苦，筋膜干，筋膜干则筋急而挛，发为筋痿。由思想无穷，所愿不得，意淫于外，入房太甚，宗筋弛纵，发为
筋痿及为白淫。又曰∶筋痿者，生于疾使内也。盖思愿不遂，遇阴必恣，风寒乘虚袭之而不觉。至中年后血气
既衰，寒变为热，风变为火，消精烁髓而病作。医又以风热之药治之，重耗其血，筋无所养，不能束骨而利机
关，宜其病转剧也。所幸饮食未减，大便犹实。盖痿症独取阳明，阳明盛则能生气生血，未为难治。用当归、
地黄、参、 、白术、丹皮、黄柏、青蒿、山萸、枸杞、牛膝，少加秦艽、桂枝、羌活、独活煎服。又以紫河
车、鹿角、龟板、虎胫骨熬膏，酒服两许，调治一月而愈。
李士材治朱太学，八年痿废，屡治无功。诊之，六脉有力，饮食如常。此实热内蒸，心阳独亢，症名脉痿。
用承气汤下六七行，左足便能伸缩。再用大承气，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。曰∶今积滞尽矣。煎三
才膏十斤与之，服毕而痊。
倪文学四年不能起于床，李治之。简其平日所服，寒凉者十六，补肝肾者十三。诊其脉大而无力。此荣卫
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，
温酒送下七钱，凡三月而愈。
高兵尊患两足酸软，神气不足。向服安神壮骨之药不效。改服滋肾，牛膝、薏仁、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。此上虚下陷，不能制水，则
湿气坠于下焦，故膝胫为患耳。进补中益气，倍用升麻，数日即愈。夫脾虚下陷之症，若误用牛膝等下行之剂，
则下愈陷，此前药之所以无功也。
俞东扶曰∶此三案精妙绝伦，以药对脉，确切不移。首案连用承气，继用参汤送寒下药，皆是独取阳明
治法。末案补中益气，与大黄补泻不同，总归乎取阳明也。
喻嘉言治徐岳生，躯盛体充，昔年食指因伤见血，以冷水灌之，血凝不散，肿溃出脓血数升，小筋脱出三
节，指废不伸。后两足至秋畏冷，重棉蔽之，外跗仍热，内 独觉其寒。近从踵至膝后筋痛，不便远行。医令
服八味丸，深中其意。及诊，自云平素脉难摸索，乃肝肺二部反见洪大，大为病进，时在冬月，木落金寒，尤
为不宜。八味丸之桂、附，未可轻服。盖筋者，肝之合也，附筋之血，既经食指外伤，不能荣养筋脉，加以忿
怒，数动肝火，传热于筋，足跗之大筋得热而短，是以牵强不便于行也。然肝木所畏者肺金，故必肺气先清，
周身气乃下行。今肺脉大，则为心主所伤而壅窒，是以气不下达而足寒也。所患虽微，已犯三逆。平素脉细而
今大，一逆也；肝脉大而热下传，二逆也；肺脉大而气上壅，三逆也。设以桂、附治之，壅热愈甚，即成痿痹
矣。故治此患，先以清金为第一义，清金又以清胃为第一义。胃不清则饮酒之热气，浓味之浊气，咸输于肺矣。
药力几何，能胜清金之任哉？金不清，如大敌在前，主将懦弱，已不能望其成功。况舍清金而更加以助火烁金，
倒行逆施以为治耶？必不得之数矣。（原注∶后徐仍服八味，一月余竟成痿痹，卧床一载。闻最后阳道尽缩，
小水全无，乃肺经之气先绝于上，所以致此。）
钱叔翁形体清瘦，平素多火少痰，迩年内蕴之热，蒸湿为痰，夏秋间湿热交胜时，忽患右足麻木，冷如冰
石，盖热极似寒也。误以牛膝、木瓜、防己、五加皮、羌、独之属温之。甚者认为下元虚惫，误用桂、附、河
车之属补之。以火济火，以热益热，由是肿溃出脓水，浸淫数月，足背趾踵，废而不用，（实为痿之变症。）总为
误治使然。若果寒痰下坠，不过坚凝不散已耳，甚者不过痿痹不仁已耳，何至肿而且溃黄水淋漓，腐肉穿筋耶？盖
此与伤寒坏症，热邪深入经络，而生流注同也。所用参膏，但可专理元气，而无清解湿热之药以佐之，是以元
老之官，而理繁治剧也。若与竹沥同事，人参固其经，竹沥通其络，则甘寒气味，相得益彰矣。徐某服人参以
治虚治风，误以附子佐之，迄今筋脉短缩，不便行持，亦由不识甘寒可通经络也。今用参膏后，脾亦大旺，日
食而外，加以夜食，是以参力所生之脾气，不用之运痰运热，只用之运食，诚可惜也。近者食亦不易运，以助
长而反得衰，乃至痰饮胶结胸中，为饱为闷，为频咳，而痰不应。（予常见肺热之人，虽产妇服参亦多此症。）
总为脾失其运，不为胃行津液，而饮食反以生痰，渐渍充满肺窍，咳不易出。（皆由内热之故，与脾却无与。）虽
以治痰为急，然治痰之药，大率耗气动虚，恐痰未出而风先入也。惟是确以甘寒之药，杜风清热，润燥补虚豁痰，
乃为合法。至于辛热之药，断断不可再误矣。医者明明见此，辄用桂、附无算，想必因脓水易干，认为辛热之功，
而极力以催之结局耳。可胜诛哉。
按∶此症实为肝经燥火郁于脾土而成，世罕知者。即喻君亦以脓水浸淫，认为湿热。予有治黄澹翁案附
后。（黄案未见，盖此书脱误甚多也。）
卢不远治织造刘监，病痿一年，欲求速效，人亦以旦暮效药应之。二月诊之，六脉细弱，血气太虚，而其
性则忌言虚，以己为内家也。然多手拥近侍之美者，（此即《内经》所谓思想无穷，所愿不得，意淫于外，入房
太甚，发为筋痿及白淫是也。）乃直谓之曰∶尊体极虚，非服人参百剂，不复能愈。若所云旦暮效者是欺也，
不敢附和。遂用十全大补汤。四剂后，又惑人言，乃为阳不用参，而阴用之。至四月，参且及斤，药将百帖，而能
起矣。次年七月疾作，欲再用前法加参。不信。因断其至冬仍痿，立春必死。果然。
冯楚瞻治李主政足病，疼痛不堪，步履久废。医用香港脚祛风燥湿之剂，久服不效，饮食不甘，精神益惫。
脉之两寸洪大而数，两关便弱，两尺更微，据脉乃上热中虚下寒也。再用祛风燥湿，则气血更受伤矣。夫治痿
独取阳明，而脾主四肢，肝主筋，肾主骨，则足三阴宜并重焉。（羽翼轩岐，诚在此等，余子纷纷不足数也。）
乃与重剂熟地、麦冬、牛膝、五味、制附子、炒黄白术，加杜仲，另煎参汤冲服，十余剂渐愈。再用生脉饮，
送八味丸加牛膝、杜仲，鹿茸丸及归脾汤全瘳。
雄按∶议论虽精，药未尽善。而冯氏最为玉横之所心折，故不觉所许过当也。
孙文垣治一文学，两足不酸不痛，每行动或扭于左而又坠于右，或扭于右而又坠于左，持杖而行不能正步，
此由筋软不能束骨所致。夫筋者，肝之所主，肝属木，木纵不收，宜益金以制之，用人参、黄 、白芍以补肺金，
薏仁、虎骨、龟板、杜仲以壮筋骨，以铁华粉专制肝木，蜜丸早晚服之，竟愈。（然则此亦筋痿病也。）
邱大守侄，丁年患两手筋挛，掉不能伸屈，臂内肉削，体瘠面白，寝食大减。脉之六部俱弦，重按稍驶。
询其病源，盖自去冬偶发寒热，筋骨疼痛，至仲春，寒热退而筋骨之疼不减。药无虚日，甚则三四进。佥谓是
风，而治不效。孙谓此筋痿症也，乃少年多欲，且受风湿，邪气乘虚而入，医者不察天时，不分经络，概行汗
Phlegm turbidity condenses and obstructs the airway, leading to unsmooth qi mechanism. Extreme heat generates wind, which can also cause sudden stiffness and falling, with symptoms resembling stroke; this is what is called "internal deficiency dark wind" (Nei Xu An Feng). Initially, methods of clearing heat, dispelling wind, and resolving phlegm are used. Subsequently, root-treating methods are employed, either nourishing yin or tonifying yang. The herbs used include Tian Dong (Adenophorae Radix), Mai Dong (Ophiopogonis Tuber), Sheng Di Huang (Rehmanniae Radix), Shu Di Huang (Rehmanniae Radix Preparata), Ju Hua (Chrysanthemi Flos), Gou Qi Zi (Lycii Fructus), Hu Ma (Sesami Semen), Sang Ye (Mori Folium), He Shou Wu (Polygoni Multiflori Radix), Bai Ren (Ziziphi Spinosae Semen), Ji Li (Tribuli Fructus), Hua Fen (Trichosanthis Radix), Ren Shen (Ginseng Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Lu Rong (Cervi Cornu Pantotrichum), Hu Gu Jiao (Bovis Os Colla), Xia Tian Gao (Fritillariae Cirrhosae Bulbus processed paste), Li Gao (Pyrri Fructus Juice), Zhu Li (Bambusae Caulis in Taenia), Ren Ru (Humanis Lac), Tong Bian (Humanis Urine), etc., adjusted flexibly according to the condition. Nowadays, the stroke section in "Lin Zheng Zhi Nan" (Guide to Clinical Practice) largely follows this method, which can supplement what Liu Wansu, Li Dongyuan, Zhu Danxi, and Zhang Congzheng did not cover sufficiently.
Xu Lingtai said: Lower body flaccidity is mostly due to deficiency; warming and tonifying the liver and kidney is not excessive, but it must be accompanied by wind-cold, phlegm, and dampness. Blindly tonifying has its shortcomings. This method originated in the Song Dynasty and flourished in the Ming Dynasty; the ancients did not practice it this way.
Mi Juxiu, the fifth-generation grandson of Mi Fu, was also skilled in medicine. He once diagnosed the pulse of Chancellor Shi, before the disease manifested. Chancellor Shi asked him, "Can I take Hong Wan Zi (Red Pill)?" Mi replied, "I am just about to use this medicine, and you will recover." Chancellor Shi suffered from inability to lift his hands and feet, causing him to cease attending court. Important affairs of the Secretariat had to be handled between the curtains and bed. Mi said that only Tiandi Dan (Heaven and Earth Pill) could cure him. The head ingredient of the pill was accidentally lost and could not be found for years. When Chancellor Shi became critically ill, Mi was summoned to Changzhou. Upon arriving at Beiguan, while taking a boat to buy food, he accidentally saw someone putting fist-sized stones into a shop. Finding it strange, Mi examined them and realized they were the head ingredients of Tiandi Dan. (At this time, Chancellor Shi should not have died yet; perhaps spirits were helping.) Asking the seller where he got them, the seller said, "A nursemaid from a household sold them last year." Mi then asked the price. The seller arbitrarily demanded ten thousand coins. Mi paid three thousand coins and took them back to prepare the medicine for Shi. Shi dared not try it. A gatekeeper who also suffered from flaccidity tried it and could sit up. Because of Biyu Si Tian Shuai's illness, Shi finally believed and took it, feeling lighter and being reintroduced to office. When Shi's illness relapsed critically and Tiandi Dan was exhausted, he died in his granted residence. (From Ye Shaoweng's "Si Chao Wen Jian Lu".)
Zhang Hezi treated Song Ziyu, a military officer, who suddenly contracted flaccidity syndrome while stationed in Xicheng during May and June. His waist, hips, and legs were unusable, and he suffered from dry stool and constipation. Seeking treatment from Zhang, Zhang observed his pulse as slippery, solid, and forceful everywhere. Relying on the *Nei Jing* (Inner Canon): "When fire pathogen overflows internally, treat with salty-cold substances," Zhang used salt water to induce vomiting, expelling cold-heat old phlegm from between the diaphragm. New phlegm is heat, old phlegm is cold; or old food/drink retained in the upper jiao can all be vomited out. After the old phlegm was exhausted, he proceeded with purgation. After dozens of treatments, he felt his spirit becoming clearer daily, appetite improving, legs gradually lifting, knees extending, heart fire descending, and kidney water ascending. He continued with Huang Lian Jie Du Tang (Coptis Decoction for Detoxification) plus Dang Gui, Xie Xin Tang (Drain the Epigastrium Decoction), Liang Ge San (Cool the Chest Powder), and Chai Hu Yin Zi (Bupleurum Drink), decocted in large doses and sipped frequently until cured. The classics state: Treating heart and lung diseases, which are close to the surface, requires frequent but small doses; treating liver and kidney diseases, which are far from the surface, requires frequent but larger doses. This is what is meant. Flaccidity syndrome has no cold pattern; it mostly occurs in May, June, and July. If mistakenly treated as Bi syndrome or gout using Wu Tou (Aconiti Radix), Fu Zi (Aconiti Lateralis Radix Preparata), Ru Xiang (Resina Draconis), Mo Yao (Myrrha), Zi Ran Tong (Natron), Wei Ling Xian (Clematidis Radix), and treated with burning needles, moxibustion, hot water soaking, or steam bags, the flaccidity worsens. Those who die like this, is it really fate?
Li Chengzhang treated a patient with flaccidity. Li examined various prescriptions, which matched the treatment principles but failed. Suspecting something, he suddenly realized: "Medicines vary in freshness, affecting speed of efficacy. This disease is superficial yet deep; small doses cannot cure it." He boiled two pots of hot medicine, poured them into a vat to cool slightly, had the patient sit in it, and poured the medicine over him. After an hour of profuse sweating, he recovered immediately. (From *History of Ming*, Biography of Li Mingyu.)
Gong Zicai treated a patient with flaccid, immobile legs. He used only Lu Rong (Cervi Cornu Pantotrichum) and Ren Shen (Ginseng Radix et Rhizoma), each 5 qian. Another dose was prepared, decocted in water, taken warm on an empty stomach, and after several doses, the patient recovered.
Sun Wen Yuan treated the son of the Xu family, aged just twenty, with emaciated muscles, swollen buttocks and knees, and swollen, painful, hot elbows and shoulders. Others treated him as wind-damp-phlegm or crane-knee wind, worsening the condition. Sun diagnosed the pulse as wiry in all six positions, with a bluish-white complexion and reduced appetite. It was the Winter Solstice. Sun said, "This is Jin Wei (Sinew Flaccidity). All flaccidity syndromes should not be treated as wind. The worsening is because previous medicines were wind-dispelling agents. Wind damages blood; when blood is depleted, sinews lose nourishment further. Moreover, the wiry pulse indicates Liver Wood dominance. Premature arrival suggests Liver excess overcoming Spleen Earth. Spleen injury leads to poor appetite and muscle wasting. The classics say: 'In treating flaccidity, exclusively focus on Yangming.' Yangming refers to the Intestines and Stomach. The method should be to tonify the Stomach and Intestines, increasing food intake so organs receive nourishment, allowing Ying and Wei to circulate, warming qi and moistening blood. By spring, when Minister Fire governs, the Zong Jin (Major Sinews) will be moistened, and joints functional. Herbs: Wu Jia Pi (Acanthopanacis Cortex), Yi Ren (Coicis Semen), Gan Cao (Glycyrrhizae Radix et Rhizoma), Cang Er Zi (Xanthii Fructus), Gou Qi Zi (Lycii Fructus), Suo Yang (Cynomorii Herba), Ren Shen (Ginseng Radix et Rhizoma), Du Zhong (Eucommiae Cortex), Huang Bo (Phellodendri Cortex), Huang Qin (Scutellariae Radix), Fang Feng (Saposhnikoviae Radix). After 20 doses, spirit strengthened, loins robust, appetite increased. Occasional nocturnal emission occurred; Du Zhong was removed, Yuan Zhi (Polygalae Radix) and Dang Gui (Angelicae Sinensis Radix) added. After 30 doses, fully recovered. (Wu Qian notes: The discussion is excellent, but the formula is not perfect.)"
Yi Si Lan treated a 19-year-old woman with weak constitution. In spring of Gengchen year, she contracted flaccidity, lying in bed for over a year, unable to lift her head, emaciated, hair matted, requiring assistance for toileting. She ate nothing for five months, consuming only sugarcane juice. Hundred doses of yin-nourishing and fire-clearing herbs failed. Small doses of Ren Shen caused panting and distension. Pulse was weak and powerless in all six positions, indicating long-standing Spleen fatigue. Yi used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with modified dosages, doubling Ren Shen. After two doses, she could eat two bowls of porridge and two eggs. Later, tendon-strengthening and body-building herbs were used for months until diet and walking returned to normal. Asked why others used yin-nourishing/fire-clearing while he used Bu Zhong Yi Qi, Yi explained: "Flaccidity stems from internal deficiency of the five zang organs; treatment focuses on Yangming. Yangming is the Stomach, the sea of the five zang and six fu, primarily moistening Zong Jin, which binds bones and facilitates joints. Flaccidity arises from Yangming deficiency. Stomach deficiency fails to generate Lung Metal; thus Lung Heat cannot nourish the body. Spleen deficiency renders limbs useless. Using Ren Shen as sovereign, Huang Qi (Astragali Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) as ministers, all strengthen Spleen Earth. Strong Earth generates Metal; strong Metal cures flaccidity." Asked why small doses of Ren Shen caused panting but large doses did not, Yi replied: "Five months without food, very weak pulse, pathogenic qi too strong, yuan qi too weak. Small doses of Ren Shen are like a cup of water on a cartload of fuel; insufficient and counterproductive. Doubling the dose is like sending a great army against a great enemy; victory is inevitable." Modified Bu Zhong Yi Qi Tang Formula: Ren Shen 1 qian, Huang Qi 8 fen, Dang Gui Shen 8 fen, Chen Pi 6 fen, Bai Zhu 8 fen, Zhi Gan Cao 5 fen, Ze Xie 6 fen, Huang Bo 5 fen, Mu Dan Pi 6 fen.
Lu Yang Yu treated Wang Gengyang, who developed foot spasms and limited mobility after middle age. Wind-damp treatment failed. Self-made Shi Guo Gong medicinal wine also failed. Left hand pulse was fine and rapid, urgent on heavy pressure; right hand pulse was moderate, weak on heavy pressure. Onset was due to accidental cold exposure, causing chills, fever, bitter taste, and bone/joint pain. Dispersing herbs removed chills/fever but not bitterness/pain. After a month, left foot spasmed, spreading to right foot, then both hands, with tremors. Dozens of doctors used wind-dispelling and qi-moving herbs. Months ago, slight movement was possible but painful. Now immobile but pain-free. Lu said: "If no pain, the matter is serious." Wang said: "No movement means no pain; movement causes severe soreness." Lu diagnosed: "Still treatable. This is Jin Wei (Sinew Flaccidity). In youth, did you have unfulfilled desires regarding women?" Wang admitted to infatuation with a maid dismissed by his wife, leading to nocturnal emissions, white turbidity, and impotence. Lu cited *Nei Jing*: "Liver heat causes gallbladder leakage (bitter taste), sinew dryness, spasms, and Jin Wei. Endless thoughts, unfulfilled wishes, external lust, excessive intercourse lead to Zong Jin relaxation and Jin Wei/Bai Yin. 'Jin Wei arises from excessive sexual activity.'" Youthful indulgence allowed wind-cold invasion unnoticed. Middle age decline turned cold to heat, wind to fire, consuming essence and marrow. Previous wind-heat herbs consumed blood, leaving sinews unsupported. Fortunately, diet and stool remained normal. Focus on Yangming generates qi/blood. Herbs: Dang Gui, Di Huang, Ren Shen, Huang Qi, Bai Zhu, Mu Dan Pi, Huang Bo, Qing Hao, Shan Zhu Yu, Gou Qi, Niu Xi, plus minor amounts of Qin Jiao, Gui Zhi, Qiang Huo, Du Huo. Also, Zi He Che (Placenta Hominis), Lu Jiao (Cervi Cornu), Gui Ban (Testudinis Carapax et Plastrum), Hu Jing Gu (Tigris Ossis) decocted into paste, taken with wine. Recovered in one month.
Li Shi Cai treated Zhu Tai Xue, paralyzed for eight years. Pulse forceful, appetite normal. Diagnosis: Internal excess heat steaming, isolated Heart Yang hyperactivity, named Mai Wei (Vessel Flaccidity). Used Cheng Qi Tang (Order the Qi Decoction) for 6-7 purges; left leg moved. Da Cheng Qi Tang for 10+ purges; hand could hold objects. Then Huang Lian, Huang Qin 1 jin each, Jiu Zheng Da Huang 8 liang honey pills, 4 qian daily with Ren Shen soup. One month later, massive accumulation expelled, limbs extended. "Accumulation cleared." Decocted San Cai Gao (Three Immortals Paste) 10 jin; cured upon finishing.
Ni Wen Xue bedridden for four years. Li Shi Cai treated. Reviewed past meds: 16 cooling, 13 liver/kidney tonics. Pulse large but powerless. Diagnosis: Ying and Wei dual deficiency. Morning: Shi Quan Da Bu Tang (Great Tonification Decoction) + Qin Jiao, Shu Fu Zi 1 qian. Evening: Ba Wei Wan (Eight Ingredient Pill) + Niu Xi, Du Zhong, Yuan Zhi, Bi Xie, Hu Gu, Gui Ban, Huang Bo 7 qian with warm wine. Cured in three months.
Gao Bing Zun had soft, weak legs and low spirit. Calm/Solidifying herbs failed. Kidney-nourishing (Niu Xi, Yi Ren, Er Miao San) failed. Blood-invigorating herbs didn't firm Spleen. Pulse harmonious, not very weak except Spleen position: choppy and powerless on heavy pressure. Diagnosis: Upper deficiency, lower sinking, failing to control water; dampness sinks to lower jiao, affecting knees/shins. Bu Zhong Yi Qi Tang with doubled Sheng Ma cured in days. Mistaking Spleen deficiency sinking for downward-draining herbs (like Niu Xi) worsens sinking.
Yu Dong Fu commented: These three cases are exquisite, matching medicine to pulse accurately. First case uses Cheng Qi repeatedly, then Ren Shen soup with cold-purgatives, focusing on Yangming. Last case uses Bu Zhong Yi Qi, differing from Da Huang's purging, but ultimately also targets Yangming.
Yu Jia Yan treated Xu Yue Sheng, robust man. Past index finger injury treated with cold water, causing blood stasis, swelling, pus/blood discharge, tendon detachment. Later, feet feared cold in autumn despite thick cotton; dorsum hot, sole cold. Recent heel-to-knee posterior tendon pain, difficulty walking. Doctor prescribed Ba Wei Wan. Pulse hard to feel, but Liver/Lung positions were large and surging. Large pulse indicates disease progression. Winter season, wood falls/metal cold, making Gui/Fu inappropriate. Tendons belong to Liver. Finger injury damaged blood nourishing tendons. Anger stirred Liver fire, transmitting heat to tendons, shortening dorsal tendons, causing stiffness. Liver fears Lung Metal. Lung qi must clear first for body qi to descend. Large Lung pulse indicates Heart damage blocking qi, causing foot cold. Though mild, three contraindications exist: 1. Pulse changed from fine to large. 2. Liver pulse large with heat descending. 3. Lung pulse large with qi congested upward. Gui/Fu would worsen heat, causing Wei-Bi. Treatment priority: Clear Metal (Lung), specifically clear Stomach. Unclear Stomach sends alcohol/food turbidity to Lung. Medicine strength insufficient. Unclear Metal is like a weak general facing a strong enemy. Adding fire to melt metal is disastrous. (Note: Xu took Ba Wei Wan, became Wei-Bi in a month, bedridden a year, eventually lost sexual function and urination, Lung qi exhausted first.)
Qian Shu Weng thin, prone to fire/phlegm. Internal heat steamed dampness into phlegm. Summer/Autumn damp-heat conflict caused right foot numbness/cold like ice (extreme heat mimicking cold). Mistakenly warmed with Niu Xi, Mu Gua, Fang Ji, Wu Jia Pi, Qiang Huo, Du Huo. Severe case mistaken for lower yuan deficiency, treated with Gui, Fu, Zi He Che. Fire adding to fire, heat adding to heat, led to swelling, ulceration, pus drainage for months, foot disability (variant of Wei). Caused by misdiagnosis. Cold phlegm sinking would just be hard/stagnant or Wei-Bi numbness, not swelling/ulceration/pus. Similar to Shang Han bad transformation where heat enters collaterals causing abscesses. Ren Shen Gao only tonifies yuan qi, lacks damp-heat clearing. Like an elder handling complex tasks alone. Combined with Zhu Li (Bamboo Sap), Ren Shen stabilizes meridians, Zhu Li opens collaterals, sweet-cold synergy works. Xu took Ren Shen for deficiency/wind, aided by Fu Zi, causing tendon shortening. Ignored sweet-cold opening collaterals. Post-Ren Shen Gao, Spleen strong, eating day/night. Spleen qi used for digestion instead of moving phlegm/heat. Waste. Now digestion difficult, growth hindered, phlegm-fluid congested in chest causing fullness, cough. Spleen fails to transport fluids, food generates phlegm, filling Lung orifices. Due to internal heat, unrelated to Spleen weakness per se. Treating phlegm urgently usually consumes qi/yin, risking wind invasion. Sweet-cold herbs to block wind, clear heat, moisten dryness, tonify deficiency, resolve phlegm is correct. Pungent-hot herbs (Gui/Fu) strictly forbidden. Doctors seeing this still use Gui/Fu, likely mistaking pus drying for pungent-hot efficacy, forcing resolution. Unforgivable.
Note: This case is actually Liver dry-fire郁 in Spleen Earth, rarely known. Even Yu mistook pus for damp-heat. I have a case of Huang Dan Weng attached. (Huang case missing, book has many errors.)
Lu Bu Yuan treated Liu Jian, weaver inspector, with flaccidity for one year, seeking quick results. February pulse: fine/weak, severe blood/qi deficiency. Personality denied deficiency. Had many concubines (matches *Nei Jing*: endless thoughts, unfulfilled wishes, excessive sex -> Jin Wei/Bai Yin). Lu told him: "Body extremely deficient. Must take 100 doses of Ren Shen to recover. Claims of quick effect are lies." Used Shi Quan Da Bu Tang. After 4 doses, influenced by others, stopped Ren Shen in morning, used in evening. By April, 1 jin Ren Shen, nearly 100 doses, could rise. Relapse next July, refused Ren Shen. Predicted flaccidity by winter, death by Spring Equinox. Confirmed.
Feng Chu Zhan treated Li Zhu Zheng's foot disease, unbearable pain, unable to walk. Gout wind-damp-drying herbs failed, appetite poor, spirit weary. Pulse: Cun large/surging, Guan weak, Chi faint. Diagnosis: Upper heat, middle deficiency, lower cold. More wind-damp herbs would hurt qi/blood. Treat Wei focusing on Yangming, but Spleen governs limbs, Liver sinews, Kidney bones; Three Yin meridians of foot must be emphasized. Heavy dose Shu Di, Mai Dong, Niu Xi, Wu Wei Zi, Zhi Fu Zi, Chao Huang Bai Zhu, Du Zhong, with Ren Shen soup. 10+ doses improved. Then Sheng Mai Yin with Ba Wei Wan + Niu Xi, Du Zhong, Lu Rong Wan, Gui Pi Tang. Fully cured.
Wu Qian note: Discussion refined, formula imperfect. Feng was highly admired by Yu Heng, hence praise may be excessive.
Sun Wen Yuan treated a scholar, legs not sore/painful but twisting left/right while walking, unable to walk straight even with cane. Caused by weak sinews failing to bind bones. Sinews governed by Liver (Wood). Wood laxity needs Metal to control. Used Ren Shen, Huang Qi, Bai Shao to tonify Lung Metal; Yi Ren, Hu Gu, Gui Ban, Du Zhong to strengthen sinews/bones; Tie Hua Fen to suppress Liver Wood. Honey pills morning/evening. Cured. (Thus, this is also Jin Wei.)
Grand Tutor Qiu's nephew, young adult, hand/tendon spasms, inability to flex/extend, arm muscle wasting, emaciated, pale, poor sleep/appetite. Pulse wiry in all positions, urgent on heavy pressure. Source: Last winter chills/fever, bone/joint pain. Mid-spring chills/fever stopped, pain persisted. Daily herbs, sometimes 3-4 times. Thought to be wind, ineffective. Sun diagnosed Jin Wei: Youthful excess desire + wind-damp invasion. Pathogens entered via deficiency. Doctors ignored seasons/meridians, used indiscriminate sweating...