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[Ping An]: This chapter, from the beginning to the end, is found in Volume 12, Chapter 44 "Treatise on Wei Syndrome" (Wei Lun) of the *Suwen* (Basic Questions), and also in Volume 10, Chapter 4 of the *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion). Additionally, the passage from "Yangming is the sea of the five zang and six fu organs" to "foot weakness and inability to use" is found in Volume 10, Chapter 2 "Dai Mai" (Girdle Vessel) of this book.

Question: Why do pathologies of the five zang organs cause people to develop Wei syndrome (flaccidity syndrome)? (Wei refers to limb weakness and flaccidity with limited flexion and extension. Due to heat in the five zang organs, the skin, vessels, sinews, muscles, and bones become relaxed, atrophic, and unable to flex or extend, hence named Wei. However, how does heat in the five zang organs lead to Wei syndrome?) Answer: The Lung governs the body's skin and hair; the Heart governs the body's blood vessels; the Liver governs the body's sinews; the Spleen governs the body's muscles and flesh; the Kidney governs the body's bones and marrow. (This first explains the areas governed by the five zang organs to clarify the mechanism of Wei syndromes originating from the zang. Membrane refers to the thin tissue between the subcutaneous layer and muscles, which are the sinews of the muscles. Ping An: In the *Suwen* and *Jiayi Jing*, "zhi rou" (fatty muscle) is written as "ji rou" (muscle). Note: Yu ming [to clarify] in Yuan edition is written as Yu zhi [to know].) Therefore, if Lung Qi is hot, the lung lobes will become scorched and dry, causing the skin and hair to become weak, tense, thin, and adherent to the skin, leading to Wei Bi (flaccidity and inability to use the limbs). (Lung heat causes the lung lobes to become scorched and dry; externally, it manifests as weakness, tension, and adhesion of the skin and hair, resulting in flaccidity and inability to use the hands and feet. Ping An: In the *Suwen*, there is no "Qi" character after "Fei" [Lung]. "Fu" [skin] is written as "Xu" [empty/weak] in the *Suwen* and *Jiayi Jing*. In the *Jiayi Jing*, an additional "Jiao" [scorched] follows "Jiao", and an additional "Zhuo" [adhere] follows "Zhuo". "Pi" is a variant for "Bi" [flaccidity], same below.) If Heart Qi is hot, the blood vessels in the lower body will revolt and move upward; when they move upward, the lower vessels become empty; emptiness leads to Mai Wei (vessel flaccidity syndrome), where the joint pivot breaks and relaxes, and the shins are too weak to bear weight on the ground. (The Heart governs blood vessels. Heat in the Heart's stored Qi causes the lower blood vessels to revolt and move upward. When blood and Qi from the lower vessels move upward, the lower vessels become empty, thus generating Mai Wei, where the joints are like broken pivots, and the shins are soft and cannot walk on the ground. Ping An: In the *Suwen*, " " is written as "Zong" [relax]. In the *Jiayi Jing*, "Qie" is written as " ", and " " is written as "Zhong" [swollen].) If Liver Qi is hot, bile leaks causing bitter taste in the mouth, and the sinews become dry. Dry sinews become tense and contract, developing into Jin Wei (sinew flaccidity syndrome). (Luan refers to the cold-induced tightness of sinews. Heat drying the sinews causes contraction, similar to sinews encountering fire, curling up into luan, while extension is chi [relaxed], hence called Jin Wei. Ping An: In the *Jiayi Jing*, "Re" [heat] appears after "Dan" [gallbladder]. In the *Suwen* and *Jiayi Jing*, "Jin gan gan" [sinews dry] is repeated three times, and "Jin" [sinew] appears before "Ji" [urgent/tense].) If Spleen Qi is hot, the stomach becomes dry and thirsty, and the muscles become numb and insensible, developing into Rou Wei (muscle flaccidity syndrome). (The Spleen and Stomach are mutually dependent; thus, Spleen heat causes Stomach dryness, leading to insensible muscles and Rou Wei.) If Kidney Qi is hot, the waist and spine cannot be held upright, the bones become withered, and the marrow decreases, developing into Gu Wei (bone flaccidity syndrome). (The Kidney is located in the waist region; thus, Kidney heat prevents the waist and spine from being held upright, the bones become withered, and heat scorching reduces the marrow, hence Gu Wei.)

Question: How are these Wei syndromes acquired?
Answer: The Lung is the chief of the five zang organs and serves as the cover for the Heart. If one experiences loss or deprivation, or desires that cannot be fulfilled, it causes Lung Qi to stagnate. Stagnation leads to Lung heat and scorched lung lobes. Consequently, due to Lung heat and scorched lobes, the five zang organs generate Wei Bi, which is what this refers to. (The Lung is above the other five zang organs, covering the Heart, and governs Qi, hence it is the chief of the zang. Thus, if the Heart suffers loss or unfulfilled desires, it injures the Lung. Lung injury causes audible exhalation and moves the scorched lung lobes. The five zang organs, due to the scorched and hot lung lobes, subsequently develop Wei Bi. Ping An: In the *Jiayi Jing*, "Shi wang" is written as "Wang shi". In the Yuan edition, "Wang" is mistakenly written as "Yi". "He" [stagnant voice] is written as "Ming" [sound] in the *Suwen* and *Jiayi Jing*. The *Suwen* has the character "Yue" [say] after "Gu" [therefore]. The *Jiayi Jing* lacks the twelve characters "Gu wu zang yin fei re ye jiao, ci zhi wei ye" [Therefore, because the five zang organs suffer from Lung heat and scorched lobes, this is called...]. Also, in the note, "Fei zai" [Lung is] in the Yuan edition is mistakenly written as "Fei shang" [above the Lung].) If grief is excessive, the Bao Luo (pericardium collaterals) are severed. Severance causes Yang Qi to move internally. Upon manifestation, there is heart-bottom blood collapse and frequent hematuria. Thus, the *Ben Bing* states: The large meridians become empty, developing into Mai Bi (vessel bi syndrome), which transmits into Mai Wei. (Bao Luo refers to the vessels of the pericardium surrounding the Heart. Excessive grief in the Heart causes the pericardium vessels to sever. Hand Shaoyang Yang Qi moves internally and is injured; heart-bottom collapse damages blood, which flows down along the Hand Shaoyang vessel, causing hematuria, leading to vessel deficiency becoming Mai Bi, transmitting into Mai Wei. Ping An: In the *Suwen* and *Jiayi Jing*, "Bao luo jue" [Bao Luo severed] is repeated three times; "Mai Bi" is uniformly written as "Ji Bi" [muscle bi]. The *Suwen* Xin Zheng Jiao says: "Yang Shangshan said: Bao Luo refers to the vessels of the pericardium surrounding the Heart. Carefully examining the text and notes, all 'Bao' characters should be 'Bao' [wrap], and the whole text uses 'Ji' [muscle]." ) If thoughts are endless and wishes remain unfulfilled, the mind wanders externally, and sexual intercourse is excessive, causing Zong Jin (major sinews) to relax. This develops into Jin Wei and Bai Yin (white turbidity, i.e., spermatorrhea in men or leukorrhea in women). Thus, the lower classic states: Jin Wei arises from excessive sexual activity. (Thinking about beloved objects without limit, hearts with boundless desires not satisfied, wandering deeply outside the heart, excessive sexual intercourse, leads to relaxation of the genital organ. The yin organ is the master of all sinews; thus, injury to Zong Jin results in Jin Wei. Women develop Bai Yin. "Classic states" refers to previously discussed classics cited as evidence. "Shi nei" also means sexual intercourse. Ping An: In the *Suwen* and *Jiayi Jing*, "Shi" is written as "Chi" [relax]; "Sheng yu shi nei" is written as "Sheng yu gan shi nei ye" [arises from Liver and excessive sexual activity].) If gradually exposed to dampness, working with water, or if dampness lingers, living in damp places, muscles are soaked by dampness, becoming bi and insensible, developing into Rou Wei. Thus, the lower classic states: Rou Wei is caused by living in damp lands. (Jian means soaking. Staying in damp places leads to mutual soaking, causing muscle bi and insensibility, making all muscles flaccid, named Rou Wei. Ping An: In the *Jiayi Jing*, "Xiang shi" is written as "Shang shi" [injure dampness].) If traveling far and laboring, encountering great heat and thirst, thirst causes Yangming Qi to fail internally. Heat combines with the Kidney. The Kidney is the Water organ; now Water cannot overcome Fire, so bones become withered and marrow becomes empty. Thus, the feet cannot support the body, developing into Gu Wei. Thus, the lower classic states: Gu Wei arises from great heat. (Laboring and encountering great heat, thirst causes internal failure of Yangming. Yangming governs grains, its Qi is hot and abundant, compounded by external heat, the Yangming meridian fails internally. Internal and external heat combine with the Water Kidney; Water cannot overcome Fire, so bones wither and marrow exhausts. Withered bones and exhausted marrow mean feet cannot support the body, developing into Gu Wei. Ping An: In the *Suwen* and *Jiayi Jing*, "Nei dai" is written as "Nei fa" [internal attack]. *Suwen* writes "He yu Shen" as "She yu Shen" [dwell in Kidney]. *Jiayi Jing* writes "Sui xu" as "Sui kong" [marrow empty]; "Fa wei gu wei" as "Re fa wei gu wei" [heat causes Gu Wei].)

Question: How can they be distinguished? (Five zang Wei syndromes have external and internal origins; how can their differences be known through signs?)
Answer: Lung heat manifests as white complexion and damaged hair; (White is the color of the Lung. Hair is governed by the Lung.) Heart heat manifests as red complexion and overflowing collateral vessels; (Red is the color of the Heart. Collateral vessels are governed by the Heart. Swollen and visible collaterals are called overflow. Ping An: In the *Jiayi Jing*, "Chi" [red] is written as "Qing" [green/cyan].) Liver heat manifests as cyan complexion and withered nails; (Cyan is green. Green is the color of the Liver. Nails are governed by the Liver.) Spleen heat manifests as yellow complexion and twitching muscles; (Yellow is the color of the Spleen. Muscles are governed by the Spleen. Ping An: In the *Suwen* and *Jiayi Jing*, "Ru" is written as "Ru" [twitch/wriggle].) Kidney heat manifests as black complexion and withered teeth. (Should be interpreted as "Gao" [withered], black complexion and withered teeth. Black is the color of the Kidney. Teeth are governed by the Kidney. Thus, damaged hair, overflowing vessels, withered nails, twitching muscles, and withered teeth indicate Wei syndromes caused by heat in the five zang organs. Ping An: In the *Suwen* and *Jiayi Jing*, it is written as "Gao".)

Question: As the Master said, this is sufficient. But medical theories state that treating Wei syndrome requires focusing solely on Yangming. Why?
Answer: Yangming is the sea of the five zang and six fu organs and primarily moistens the Zong Jin. Zong Jin binds the bones and flesh and facilitates joint movement. Chong Mai is the sea of the meridians, primarily seeping and irrigating the valleys. It merges with Yangming at the Yin of Zong Jin, gathering all Zong Jin meetings, converging at Qichong (St30), with Yangming acting as the leader. All belong to Dai Mai (Girdle Vessel) and network with Du Mai (Governor Vessel). Thus, if Yangming is deficient, Zong Jin relaxes, Dai Mai cannot pull, and the feet become weak and unusable. (Yangming Stomach meridian: the Stomach governs water and grain, producing blood and Qi to nourish the five zang and six fu organs, like the sea's nourishment, hence Yangming is called the Sea. Flowing from the zang and fu, running through the twenty-eight meridians, all return to Chong Mai, hence Chong Mai is called the Sea of Meridians. Regarding Chong Mai, relying on Yangming's water-grain Qi, it meets with Dai Mai and Du Mai, moistening Zong Jin, so Zong Jin can bind flesh and bones and facilitate joints. Zong Jin refers to the sinews of Foot Taiyin, Shaoyin, and Jueyin, and Foot Yangming, all gathering at the yin organ, hence called Zong Jin, so Yangming is the leader. If Yangming's water-grain Qi is deficient, Dai Mai cannot control and pull the feet, hence foot weakness and inability to use them. Ping An: In the *Suwen* and *Jiayi Jing*, "Shu gu rou" lacks the character "Rou"; "Jing zhi hai" is written as "Jing mai zhi hai" [Sea of Jing Mai], same as Book's "Dai Mai" chapter; "Jin yin" is written as four characters "Zong jin yin yang" [Zong Jin Yin Yang]. Qichong in *Jiayi Jing* is written as "Qichong".)

Huangdi said: How to treat it?
Answer: Tonify the Ying-Spring points of each meridian and unblock the Shu-Stream points. Regulate excess and deficiency, harmonize reversal and smooth flow. Then, the Zong Jin, vessels, bones, and muscles, each receiving treatment on their respective days of dominance, will recover.
Huangdi said: Excellent. (Five zang heat Wei syndromes are all Yin deficiency, so tonify the Ying-Spring points of the five zang Yin meridians. Yin Ying belongs to Water. Yin Shu belongs to Wood, corresponding to Shaoyang. Hence, for heat Wei, unblock the Shu points. "Each according to its time" means treating them on the days they were afflicted, and they will all heal. Ping An: Shu is written as "Yu" in *Suwen* and *Jiayi Jing*; "Ze Zong" is missing above "Jin Mai"; "Shou ri" is written as "Shou yue" [receive month]. Wang Bing notes: "Shou yue refers to receiving Qi during specific months, such as Liver dominating on Jia-Yi, Heart on Bing-Ding, etc., following the dominant Qi method." This is not as clear as this annotation.)