承上编痹证而论痿证也。痿者，四肢痿弱，举动不能，如痿弃不用之意。肺为脏之长，故五脏因肺热
叶焦，发为痿 ，阳明为五脏六腑之海，主润宗筋，为诸脉之长，故治痿独取阳明。
黄帝问曰∶五脏使人痿，何也？
痿证发于脏，故问五脏使人痿。
岐伯对曰∶肺主身之皮毛，心主身之血脉，肝主身之筋膜，脾主身之肌肉，肾主身之骨髓。
五脏在内，各有所主，皮毛血脉筋膜肌肉骨髓，肺心肝脾肾之所主也。
故肺热叶焦，则皮毛虚弱急薄，着则生痿 也。
举动自如，皆脏气和于内而主于外，故肺热叶焦，是肺脏病于
内矣。病于内，则肺主皮毛，虚弱急薄应于外，若更留着不行，则
生痿 。 ，两足废弛也。
心气热，则下脉厥而上，上则下脉虚，虚则生脉痿，枢折挈，胫纵而不任地也。
折，音舌。心气热，是心脏病于内矣。病于内，则心主之血脉应于外，下脉厥而上，言血脉在下者，
厥逆而上也。上则下脉虚，言厥逆而上，则在下之血脉虚也。下脉虚，则生脉痿灸。经脉血脉，
不能升降开合，为枢断折而收挈。断折挈，是以胫骨纵缓，而不任地也。
肝气热，则胆泄口苦，筋膜干，筋膜干则筋急而挛，发为筋痿。
肝气热，是肝脏病于内矣。肝热，则胆亦热，故胆气上泄而口苦，肝病于内，则肝主之筋膜应
于外，故血液竭而筋膜干，筋膜干则筋急而拘挛，故发为筋痿。
脾气热，则胃干而渴，肌肉不仁，发为肉痿。
脾气热，是脾脏病于内矣。脾热，则胃亦热，故胃干而渴，脾
病于内，则脾主之肌肉应于外，故肌肉不仁。不仁，不知痛痒也。由是，则发为肉痿。
肾气热，则腰脊不举，骨枯而髓减，发为骨痿。
肾气热，是肾脏病于内矣。病于内，则肾主之骨髓应于外，其
腰脊不能举动，因于骨枯而髓减，由是则发为骨痿，此五脏之所以使人痿也。
帝曰∶何以得之？
五脏之热，何以得之？
岐伯曰∶肺者脏之长也，为心之盖也，有所失亡，所求不得，
则发肺鸣，鸣则肺热叶焦，故曰五脏因肺热叶焦，发为痿 ，此之谓也。
长，上声下同。肺朝百脉，故肺者脏之长也。肺位居高，故为心之盖也，有所失亡，所求不得，致
心气内郁，火刑肺金，则发肺鸣，肺鸣如火熔金而有声也。故鸣则肺热叶焦，上文言肺热叶焦，
着则生痿 ，此言肺为脏之长，故曰五脏因肺热叶焦，发为痿 ，即此肺为脏长之谓也。五脏因肺热叶焦
而发为痿 ，是五脏皆受气于肺，而痿 之证，不但由于肺热，且由五脏之热矣，此明上文肺热成痿之意。
悲哀太甚，则包络绝，包络绝则阳气内动，发则心下崩，数溲
血也。故本病曰，大经空虚，发为肌痹，传为脉痿。
包，旧本讹胞，今改。数，音朔。悲哀太甚，则心气内伤，故包路绝。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，故本经《本病论》曰，大经
空虚，发为肌痹，传为脉痿。大经空虚，犹之包络绝也。包络绝，而血下溲，则不能外充肌肉，故发为肌痹，
更不能内荣经脉，故传为脉痿，此明上文心热成痿之意，按本经有《本病论》，原遗阙，今搜捕，并无此言。
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，故下经曰，筋痿者，生于肝使内也。
下经不可考矣，余俱仿此。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。夫入房太甚，宗筋弛纵，则发为筋痿，
意淫于外，相火不宁，则为白淫，故下经曰，筋痿者生于肝使内也。此明上文肝热成痿之意。
有渐于湿，以水为事，若有所留，居处相湿，肌肉濡渍，痹而不仁，发为肉痿，故下经曰，
肉痿者得之湿地也。
渐，进也。有进于湿，则以水为事，其水若有所留，其湿则居
处相湿，为是则肌肉濡渍，痹而不仁，发为肉痿，故下经曰，肉痿者，得之湿地也，以明上文脾热成痿之意。
有所营运，劳倦逢大热而渴，渴则阳气内伐，内伐则热舍于肾。
肾者，水藏也。今水不胜火，则骨枯而髓虚，故足不任身，发为骨
痿，故下经曰，骨痿者生于大热也。
有所远行，则身体劳倦，复逢大热，则津竭而渴，渴而阳气内
伐。伐，功伐也。阳气内伐，则热舍于肾。夫肾者水脏也，今水不胜火，则骨枯而髓虚，是以足不任身，
发为骨痿，故《下经》曰∶骨痿者，生于大热也。以明上文肾热成痿之意。
帝曰∶何以别之？
别，音逼。伯论五脏之痿，皆从内起，帝欲征之于外，故问何以别之？
岐伯曰∶肺热者，色白而毛败。
欲别其外，当验其色，故肺热者，面色白面毛败。白者肺之色，皮毛者，肺之合也。
心热者，色赤而络脉溢。
赤者，心之色。络脉者，心之合也。
肝热者，色苍而爪枯。
苍者，肝之色。爪者，筋之余也。
脾热者，色黄而肉蠕动。
黄者，脾之色。肉者，脾之合也。
肾热者，色黑而齿槁。
黑者，肾之色。齿者，骨之余也。
帝曰∶如夫子言可矣，论言治痿者，独取阳明何也？
论，疑即《本病论》，五脏之热征于外合，固可见矣。夫子既各举本病论证五脏之痿，而论文言治
痿者独取阳明，则何也，
岐伯曰∶阳明者，五脏六腑之海，主闰宗筋。宗筋主束骨而利机关也。
闰，润同，阳明者，胃也。受盛水谷，故为五脏六腑之海。皮肉筋脉骨，皆资于水谷之精，故
阳明主润宗筋。宗筋前阴之总筋，故主束骨而利机关也。痿，则机关不利，筋骨不和，皆由阳明不能
濡润，所以治痿独取阳明也。
冲脉者，经脉之海也，主渗灌 谷，与阳明合于宗筋。
阳明不但为五脏六腑之海，又为奇经八脉之长。《灵枢·海论》云，冲脉者为十二经之海，故日
冲脉者经脉之海也，冲脉之血，主渗灌
谷，与阳明合于宗筋。《灵枢·五音五味》篇云，宦者，去其宗筋，伤其冲脉，故须不生，是知冲脉会于
宗筋。又云∶天宦者，其任冲不盛。宗筋不成，故须不生，是知冲脉为是，任脉亦如是。
阴阳总宗筋之合，会于气街，而阳明为之长。
阴阳，阴跷阳跷，阴维阳维也。其脉皆从下而上，至于脐腹，故阴阳总宗筋之会，会于气街。气街者，
腹气有街，脐左右之动脉，而阳明为之长。经脉论云，阳明之脉，起于胃口，下挟脐，循
腹里，至气街中而合。
皆属于带脉，而络于督脉。
气街者，皆属于带脉之循行，是阳明又为带脉之长，带脉，如
束带然，前终脐腹，后环腰脊，围身一周而终于督脉，是阳明又从带脉而主于督脉也。
故阳明虚，则宗筋纵，带脉不引，故足痿不用也。
阳明主润宗筋，故阳明虚则宗筋纵。纵者不能束骨而利机关也。宗筋纵，则带脉不引。不引者，不
能延引而环约也。夫宗筋纵，带脉不引，故足痿不用，致成痿 ，所以治痿独取阳明。
帝曰∶治之奈何？
治痿独取阳明，而阳明虚，则何以治之？
岐伯曰∶各补其荣，而通其俞，调其虚实和其逆顺，筋脉骨
肉，各以其时受月，则病已矣。
各补其在内之荣血，而通其在外之俞穴。正虚，则补以调之；邪实，则泻以调之；逆者，和之使顺；
顺者，和之不使逆。由是而肝主之筋，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，肉受于长夏也。
帝曰∶善。
但言筋脉骨肉，不言肺主之皮，以肺为五脏长，五脏因肺热叶焦，发为痿 ，帝故默会其义而善之。
Following the previous discussion on Bi syndrome (Obstruction Syndrome), this section discusses Wei syndrome (Flaccidity Syndrome). Wei refers to flaccidity and weakness of the four limbs, with inability to move, resembling a state of being discarded and unused. The Lung is the chief of the Zang organs; therefore, if the five Zang organs suffer from Lung heat causing the lung leaves to wither and dry up, Wei syndrome develops. The Stomach meridian of Foot-Yangming is the sea of the Qi and Blood of the five Zang and six Fu organs; it primarily moistens the Zong Jin (general tendon, located at the anterior genitalia) and serves as the leader of all meridians. Thus, in treating Wei syndrome, one should exclusively focus on the Yangming meridian.
The Yellow Emperor asked: "How can the five Zang organs cause Wei syndrome?"
Since Wei syndrome originates from the internal organs, he asked why the five Zang organs lead to Wei syndrome.
Qi Bo replied: "The Lung governs the skin and hair of the body; the Heart governs the blood vessels; the Liver governs the sinews (tendons); the Spleen governs the muscles; and the Kidney governs the bone marrow."
The five Zang organs reside internally, each having its specific governance: skin/hair, blood vessels, sinews, muscles, and bone marrow are governed by the Lung, Heart, Liver, Spleen, and Kidney, respectively.
Therefore, when Lung heat causes the lung leaves to wither and dry up, the skin and hair become weak, tight, and thin. If the pathogen lingers without resolving, Fei Bi (flaccidity of the legs) occurs.
Free movement depends on the harmonious regulation of Zang Qi internally and its manifestation externally. Thus, Lung heat and withered leaves indicate disease within the Lung organ. Disease internally manifests externally in the Lung-governed skin and hair as weakness, tightness, and thinning. If it lingers further, Fei Bi (paralysis/flaccidity of both legs) arises. Fei Bi refers to the flaccidity and inability to walk due to leg paralysis.
When Heart Qi is hot, the lower vessels rebel and ascend upwards; consequently, the upper vessels become full while the lower vessels become deficient. Deficiency in the lower vessels leads to Mai Wei (Vessel Flaccidity), where the joint pivot breaks and cannot lift, resulting in flaccid shins that cannot support the body weight.
"Zhe" (break) is pronounced like "She". Heart Qi heat indicates disease within the Heart. Internally diseased, the Heart-governed blood vessels manifest externally. "Lower vessels rebel and ascend" means the vessels originally in the lower part undergo rebellion and move upward. "Upper vessels full, lower vessels deficient" means that after rebellion and ascent, the vessels in the lower part become deficient. Deficiency in the lower vessels leads to Mai Wei. The meridians and blood vessels fail to ascend, descend, open, and close properly, acting like a broken pivot that loses its holding capacity. This breakage and loss of holding result in flaccid shins unable to stand.
When Liver Qi is hot, bile leaks causing a bitter taste in the mouth, and the sinews become dry. Dry sinews lead to spasms and contractures, developing into Jin Wei (Sinew Flaccidity).
Liver Qi heat indicates disease within the Liver. Liver heat also heats the Gallbladder, causing Gallbladder Qi to leak upward and resulting in a bitter taste. Internally diseased, the Liver-governed sinews manifest externally. Blood essence is exhausted, leading to dry sinews. Dry sinews cause spasms and contractures, thus developing into Jin Wei.
When Spleen Qi is hot, the stomach becomes dry causing thirst, and the muscles become numb, developing into Rou Wei (Muscle Flaccidity).
Spleen Qi heat indicates disease within the Spleen. Spleen heat also heats the Stomach, causing dryness and thirst. Internally diseased, the Spleen-governed muscles manifest externally, becoming numb. "Numb" means insensitivity to pain and itch. Consequently, Rou Wei develops.
When Kidney Qi is hot, the waist and spine cannot be lifted, bones become withered, and marrow decreases, developing into Gu Wei (Bone Flaccidity).
Kidney Qi heat indicates disease within the Kidney. Internally diseased, the Kidney-governed bone marrow manifests externally. The inability to move the waist and spine is due to withered bones and decreased marrow. Thus, Gu Wei develops. This explains how the five Zang organs cause Wei syndrome.
The Yellow Emperor asked: "How are these conditions acquired?"
How are the heat syndromes of the five Zang organs acquired?
Qi Bo said: "The Lung is the chief of the Zang organs and the canopy covering the Heart. If one experiences loss or fails to obtain what is desired, it causes Lung Ming (lung sound/cough), which leads to Lung heat and withered leaves. Therefore, it is said that the five Zang organs develop Wei syndrome due to Lung heat and withered leaves."
"Chang" (chief) is pronounced with the rising tone. The Lung meets all meridians, hence it is the chief of the Zang organs. Located high, it acts as the canopy for the Heart. Loss or unfulfilled desires cause Heart Qi to stagnate internally, where Fire insults Metal (Lung), causing Lung Ming (sound like melting metal). This Ming leads to Lung heat and withered leaves. The earlier text stated that lingering Lung heat causes Fei Bi; here, it emphasizes that because the Lung is the chief, the five Zang organs develop Wei syndrome via Lung heat. This clarifies that Wei syndrome involves not only Lung heat but also heat from all five Zang organs, as they all receive Qi from the Lung.
Excessive grief severs the Pericardium Luo (Collateral). When the Pericardium Luo is severed, Yang Qi moves internally, causing Heart Qi to collapse downward, leading to frequent hematuria (blood in urine). Thus, the *Ben Bing Lun* states that empty major meridians lead to Ji Bi (Muscle Bi), which transmits to Mai Wei.
"Bao" was erroneously written as "Bao" (womb) in old editions, now corrected. "Shuo" is pronounced like "Shuo". Excessive grief injures Heart Qi internally, severing the Pericardium Luo. The Pericardium Luo is the collateral of the Pericardium. Severance causes blood to overflow and Yang heat to move internally, collapsing Heart Qi downward. Downward collapse leads to frequent hematuria. The *Ben Bing Lun* states that empty major meridians cause Ji Bi, transmitting to Mai Wei. Empty major meridians equate to severed Pericardium Luo. With blood lost through urine, muscles are not nourished externally (causing Ji Bi), and meridians are not nourished internally (transmitting to Mai Wei). This explains Heart heat causing Wei. Note: The original *Ben Bing Lun* is lost; this quote is reconstructed.
Endless thinking and unfulfilled desires, with mind indulging externally, combined with excessive sexual activity, cause the Zong Jin to relax and flaccid, leading to Jin Wei and Bai Yin (seminal emission or leukorrhea). Thus, the *Xia Jing* says Jin Wei arises from the Liver due to intercourse.
*Xia Jing* is untraceable; other references follow this pattern. Endless thinking and unfulfilled desires cause internal stagnation, injuring Liver Qi. External mental indulgence prevents stillness. Excessive sexual activity weakens the genitals (Zong Jin). Excessive intercourse causes Zong Jin flaccidity (Jin Wei); external mental indulgence agitates Ministerial Fire, causing Bai Yin. Thus, *Xia Jing* states Jin Wei arises from the Liver due to intercourse. This explains Liver heat causing Wei.
Gradual exposure to dampness, working with water, with stagnant water and damp living environments, causes muscles to be soaked, leading to numbness and Bi sensation, developing into Rou Wei. Thus, the *Xia Jing* says Rou Wei comes from damp places.
"Jian" means entering. Exposure to dampness through water work, with stagnant water and damp dwellings, soaks the muscles, causing numbness and Bi, leading to Rou Wei. Thus, *Xia Jing* states Rou Wei comes from damp places. This explains Spleen heat causing Wei.
Labor and fatigue combined with extreme heat and thirst cause Yang Qi to attack internally. This internal attack allows heat to lodge in the Kidney.
The Kidney is the Water organ. If Water cannot overcome Fire, bones wither and marrow empties, making the feet unable to support the body, leading to Gu Wei. Thus, the *Xia Jing* says Gu Wei arises from extreme heat.
Traveling far causes fatigue and extreme heat, depleting fluids and causing thirst. Thirst triggers internal attack by Yang Qi. "Fa" means attack. Internal attack lodges heat in the Kidney. As the Water organ, if Water cannot overcome Fire, bones wither and marrow empties, making feet unable to support the body, leading to Gu Wei. Thus, *Xia Jing* states Gu Wei arises from extreme heat. This explains Kidney heat causing Wei.
The Yellow Emperor asked: "How can they be distinguished?"
"Bie" is pronounced like "Bi". Qi Bo discussed Wei arising internally; the Emperor sought external signs, asking how to distinguish them.
Qi Bo said: "Those with Lung heat have white complexion and damaged hair."
To distinguish externally, observe the complexion. Lung heat presents with white face and damaged hair. White is the color of the Lung; skin/hair is the exterior correspondence of the Lung.
Those with Heart heat have red complexion and overflowing collaterals.
Red is the color of the Heart; collaterals are the exterior correspondence of the Heart.
Those with Liver heat have bluish-green complexion and withered nails.
Bluish-green is the color of the Liver; nails are the surplus of sinews.
Those with Spleen heat have yellow complexion and twitching muscles.
Yellow is the color of the Spleen; muscles are the exterior correspondence of the Spleen.
Those with Kidney heat have black complexion and withered teeth.
Black is the color of the Kidney; teeth are the surplus of bones.
The Yellow Emperor said: "Your explanation is sufficient. However, the texts say to treat Wei by exclusively focusing on Yangming. Why?"
"The Text" likely refers to *Ben Bing Lun*. While internal heat manifests externally, why does the text emphasize exclusively treating Yangming for Wei?
Qi Bo said: "Yangming is the sea of the five Zang and six Fu organs, primarily moistening the Zong Jin. Zong Jin binds the bones and facilitates joint movement."
"Run" (moisten) is used instead of "Run". Yangming refers to the Stomach meridian, which receives and transforms food/water, serving as the sea of Qi/Blood for all organs. Skin, muscle, sinew, vessel, and bone rely on grain essence, so Yangming moistens Zong Jin. Zong Jin is the general tendon of the anterior genitalia, binding bones and facilitating joints. In Wei, joints are stiff and sinews/bones discordant due to lack of Yangming moisture; hence, exclusive focus on Yangming.
The Chong Mai (Penetrating Vessel) is the sea of the twelve regular meridians, primarily infiltrating the Xi Gu (valleys), and merges with Yangming at the Zong Jin.
Yangming is not only the sea of Zang/Fu but also the leader of the Eight Extraordinary Vessels. *Ling Shu: Hai Lun* states Chong Mai is the sea of twelve meridians. Chong Mai blood infiltrates Xi Gu and merges with Yangming at Zong Jin. *Ling Shu: Wu Yin Wu Wei* notes eunuchs lose Zong Jin and injure Chong Mai, resulting in no beard growth, proving Chong Mai meets Zong Jin. It also states congenital eunuchs have weak Ren and Chong Mai, failing to form Zong Jin, hence no beard. Thus, Chong Mai behaves similarly to Ren Mai.
Yin and Yang vessels converge at Zong Jin, meeting at Qi Jie (Street of Qi), with Yangming acting as the leader.
Yin/Yang refer to Yin/Qiao and Yin/Yang Wei vessels. These rise from below to the umbilical/abdominal region, converging at Zong Jin and meeting at Qi Jie. Qi Jie refers to abdominal pathways, specifically arterial pulses left and right of the umbilicus, led by Yangming. *Mai Jing Lun* states Yangming starts at the stomach entrance, descends alongside the umbilicus, travels through the abdomen, and meets at Qi Jie.
All these belong to the Dai Mai (Girdle Vessel) and connect to the Du Mai (Governor Vessel).
Qi Jie vessels belong to the Dai Mai circulation, making Yangming the leader of Dai Mai. Dai Mai encircles like a belt, ending anteriorly at the umbilicus/abdomen and posteriorly around the waist/spine, completing a circle at the Du Mai. Thus, Yangming governs Du Mai via Dai Mai.
Therefore, Yangming deficiency leads to Zong Jin flaccidity, Dai Mai failing to draw in, resulting in foot Wei and inability to use them.
Yangming moistens Zong Jin; deficiency leads to flaccidity. Flaccidity means inability to bind bones and facilitate joints. Zong Jin flaccidity causes Dai Mai to fail in drawing/contracting. Failure to draw means inability to extend and encircle. Zong Jin flaccidity and Dai Mai failure cause foot Wei, forming Fei Bi; hence, exclusive focus on Yangming.
The Yellow Emperor asked: "How to treat it?"
Treating Wei focuses on Yangming, but if Yangming is deficient, how to treat?
Qi Bo said: "Tonify the Ying (Nutrient) points and unblock the Shu (Transport) points of each meridian. Regulate excess and deficiency, harmonize reversal and smooth flow. Treat sinew, vessel, bone, and muscle according to their respective seasons/months, and the disease will resolve."
Tonify internal Ying blood and unblock external Shu points. Deficiency is treated with tonification; excess with purgation. Reversal is harmonized to smooth flow; smooth flow is maintained. Thus, Liver sinews, Heart vessels, Kidney bones, and Spleen muscles are treated in their respective seasonal months (Sinew in Spring, Vessel in Summer, Bone in Winter, Muscle in Late Summer), and the disease resolves.
The Yellow Emperor said: "Excellent."
Only sinew, vessel, bone, and muscle were mentioned, not Lung-governed skin, because the Lung is the chief of Zang organs, and Wei arises from Lung heat affecting all Zang. The Emperor silently understood and praised him.