《痿论》云∶五脏使人痿,而本于肺热叶焦。终之曰∶治痿独取阳明。是痿病原于手太阴一经,以热
相传而成,而治之者,惟取足阳明一经以为要。阳明为五脏六腑之海,总宗筋而束骨以利机关。阳明虚则
宗筋纵,带脉不引,故手足不用而成痿。是痿之来,起于肺经,而治则取于阳明。后人谓独取阳明,此
“取”字有教人补之意。是以丹溪独引越人泻南方、补北方之法,以发明“独取阳明”之旨。究未能尽所
以取阳明之义,而意反有相戾者。夫南方,离火也;北方,坎水也。其言曰∶金体燥而居上,主畏火;土
性湿而居中,主畏木。泻南方,则肺金清而东方不实;补北方,则心火降而西方不虚。此其论似为肺热
叶焦者发明之,而于治痿取阳明之法,反未之悉也。阳明者,胃土也。补火可以生土,而反云泻南;滋水
则能助湿,而反云补北,则与取阳明之义有不合矣。夫足阳明为水谷之海,以为阳明虚而宗筋不用似矣,
何以病痿之人,有两足不任身,而饮食如故,其啖物反有倍于平人者何也?岂阳明之气旺,而水谷入海,
独不能运化精微,以强筋骨乎?何饮啖日盛,形体日肥,而足痿不能用也?则知阳明之虚,非阳明之
本虚,而火邪伏于胃中,但能杀谷,而不能长养血气、生津液,以灌溉百骸,是以饮食倍于平人,而足反为
之不用。此所谓“壮火食气”,而邪热不杀谷也。阳明之邪热,原是肺热中传来,故治痿独取阳明者,非补阳
明也,治阳明之火邪,毋使干于气血之中,则湿热清而筋骨强,筋骨强而足痿以起。张子和尝言痿病皆因客
热而成,断无有寒。丹溪亦云治痿以清热为主,不可作风治用风药。诚得取阳明之义者矣。
The *Treatise on Flaccidity* (Wei Lun) states: "Dysfunction of the five zang organs leads to flaccidity syndromes, with the root lying in lung heat causing the lung leaves to become scorched and dry." It concludes by stating: "In treating flaccidity syndromes, one should exclusively focus on the Yangming channel." This indicates that the origin of flaccidity syndrome lies in the Hand-Taiyin Lung channel, developing through the transmission of heat pathogens, while the treatment primarily targets the Foot-Yangming Stomach channel. The Foot-Yangming is the sea of the five zang and six fu organs, governing the Zongjin (major tendons) and binding the bones to facilitate joint movement. If the Yangming is deficient, the Zongjin will relax, and the Dai Mai (Girdle Vessel) will fail to exert its pulling force, resulting in the inability to use the hands and feet, thus forming a flaccidity syndrome. Therefore, the onset of flaccidity originates from the Lung channel, but the treatment focuses on the Yangming channel. Later scholars interpreted the word "qu" (take/focus on) in "exclusively focus on Yangming" as implying instruction to tonify. Consequently, Zhu Danxi solely cited the method of "draining the South and tonifying the North" proposed by Yue Ren (Bian Que) to elucidate the principle of "exclusively focusing on Yangming." However, this failed to fully explain the rationale behind focusing on the Yangming channel, and its intent was actually contradictory. The South corresponds to the Fire of the Li trigram; the North corresponds to the Water of the Kan trigram. Their argument was: Metal has a dry nature and resides superiorly, primarily fearing Fire; Earth has a damp nature and resides centrally, primarily fearing Wood. Draining the Southern Fire clears the Lung Metal and prevents the Eastern Wood from becoming excessive; tonifying the Northern Water descends the Heart Fire and prevents the Western Metal from becoming deficient. While this discussion seems to elucidate the condition of "lung heat causing scorched lung leaves," it does not fully comprehend the method of focusing on the Yangming channel for treating flaccidity. Yangming corresponds to the Stomach Earth. Tonifying Fire can generate Earth, yet they advocate draining the Southern Fire; nourishing Water can assist Dampness, yet they advocate tonifying the Northern Water. Thus, their approach contradicts the true meaning of focusing on the Yangming channel. The Foot-Yangming is the sea of water and grain. It might seem plausible to attribute the dysfunction of the Zongjin to Yangming deficiency, but why do patients with flaccidity, whose legs cannot support their body weight, have normal appetites and even consume more food than healthy individuals? Is it because the Qi of Yangming is vigorous, allowing food and drink to enter the stomach, yet failing to transform and transport essential nutrients to strengthen the sinews and bones? Why does increased intake lead to increasing obesity while the legs remain flaccid and unusable? This reveals that the deficiency of Yangming is not an intrinsic deficiency of the Yangming itself, but rather fire pathogens lurking within the Stomach. These pathogens can digest food ("kill grain") but cannot generate blood and Qi or produce body fluids to irrigate the entire body. Hence, dietary intake exceeds that of normal people, yet the legs are unusable. This is what is meant by "vigorous fire consumes Qi" and "pathogenic heat fails to properly transform grain." The pathogenic heat in the Yangming channel originally transmits from lung heat. Therefore, "exclusively focusing on the Yangming channel" in treating flaccidity does not mean tonifying the Yangming, but rather clearing the fire pathogens in the Yangming to prevent them from interfering with the blood and Qi. Once the damp-heat is cleared, the sinews and bones will strengthen, and the leg flaccidity will resolve. Zhang Zihe once stated that flaccidity syndromes are caused by exogenous heat and absolutely never by cold. Zhu Danxi also said that treating flaccidity should prioritize clearing heat and should not be treated as wind syndromes using wind-dispelling herbs. This truly captures the essence of focusing on the Yangming channel.