（附∶干颓汤、补脑振痿汤）
肢体痿废，而其病因实由于脑部贫血也。按生理之实验，人之全体运动皆脑髓神经司之，虽西人之说，而
洵可确信。是以西人对于痿废之证皆责之于脑部。而实有脑部充血与脑部贫血之殊。盖脑髓神经原借血为濡润
者也，而所需之血多少，尤以适宜为贵。彼脑充血者，血之注于脑者过多，力能排挤其脑髓神经，俾失所司。
至脑贫血者，血之注于脑者过少，无以养其脑髓神经，其脑髓神经亦恒至失其所司。至于脑中之所以贫血，
不可专责诸血也，愚尝读《内经》而悟其理矣。
《内经》谓∶“上气不足，脑为之不满，耳为之苦鸣，头为之倾，目为之眩。”夫脑不满者，血少也。因脑
不满而贫血，则耳鸣、头目倾眩即连带而来，其剧者能使肢体痿废不言可知。是西人脑贫血可致痿废之说原
与《内经》相符也。然西医论痿废之由，知因脑中贫血，而《内经》更推脑中贫血之由，知因上气不足。夫
上气者何？胸中大气也（亦名宗气）。其气能主宰全身，斡旋脑部，流通血脉。彼脑充血者，因肝胃气逆，
挟血上冲，原于此气无关，至脑贫血者，实因胸中大气虚损，不能助血上升也。是以欲治此证者，当以补
气之药为主，以养血之药为辅，而以通活经络之药为使也。爰本此义拟方于下。
【干颓汤】治肢体痿废，或偏枯，脉象极微细无力者。
生箭 （五两） 当归（一两） 甘枸杞果（一两） 净杭萸肉（一两）
生滴乳香（三钱） 生明没药（三钱） 真鹿角胶（六钱捣碎）
先将黄 煎十余沸，去渣。再将当归、枸杞、萸肉、乳香、没药入汤同煎十余沸，去渣。入鹿角胶末
融化取汤两大盅，分两次温饮下，
方中之义，重用黄 以升补胸中大气，且能助气上升，上达
脑中，而血液亦即可随气上注。惟其副作用能外透肌表，具有宣
散之性，去渣重煎，则其宣散之性减，专于补气升气矣。当归为生血之主药，与黄 并用，古名补血汤，因气
旺血自易生，而黄 得当归之濡润，又不至燥热也。萸肉性善补肝，枸杞性善补肾，肝肾充足，元气必然壮
旺，元气者胸中大气之根也。且肝肾充足则自脊上达之督脉必然流通，督脉者又脑髓神经之根也。且
二药皆汁浆稠润，又善赞助当归生血也。用乳香、没药者，因二药善开血痹，血痹开则痿废者久瘀之经络自
流通矣。甩鹿角胶者，诚以脑既贫血，其脑髓亦必空虚，鹿角其所熬之胶善补脑髓，脑髓足则脑中贫血之病
自易愈也。此方服数十剂后身体渐渐强壮，而痿废仍不愈者，可继服后方。
【补脑振痿汤】治肢体痿废偏枯，脉象极微细无力，服药久不愈者。
生箭 （二两） 当归（八钱） 龙眼肉（八钱） 杭萸肉（五钱）
胡桃肉（五钱） 虫（三枚大者） 地龙（三钱去净土） 生乳香（三钱）
生没药（三钱） 鹿角胶（六钱） 制马钱子末（三分）
共药十一味，将前九味煎汤两盅半，去渣，将鹿角胶入汤内融化，分两次送服制马钱子末一分五厘。
此方于前方之药独少枸杞，因胡桃肉可代枸杞补肾，且有强健筋骨之效也。又尝阅《沪滨医报》，谓
脑中血管及神经之断者，地龙能续之。愚则谓必辅以 虫，方有此效。盖蚯蚓（即地龙）
善引， 虫善接（断之能自接），二药并用能将血管神经之断者引而接之，是以方中又加此二味也。加
制马钱子者，以其能 动神经使灵活也。此方与前方若服之觉热者，皆可酌加天花粉、天冬各数钱。
天津于××，年过四旬，自觉呼吸不顺，胸中满闷，言语动作皆渐觉不利，头目昏沉，时作眩晕。延
医治疗，投以开胸理气之品，则四肢遽然痿废。再延他医，改用补剂而仍兼用开气之品，
服后痿废加剧，言语竟不能发声。愚诊视其脉象沉微，右部尤不任循按，知其胸中大气及中焦脾胃之气皆虚
陷也。于斯投以拙拟升陷汤加白术、当归各三钱。服两剂，诸病似皆稍愈，而脉象仍如旧。因将 、术、当
归、知母各加倍，升麻改用钱半，又加党参、天冬各六钱，连服三剂，口可出声而仍不能言，肢体稍能运
动而不能步履，脉象较前有起色似堪循按。因但将黄 加重至四两，又加天花粉八钱，先用水六大盅将黄
煎透，去渣，再入他药，煎取清汤两大盅，分两次服下，又连服三剂，勉强可作言语，然恒不成句，人扶之
可以移步。遂改用干颓汤，惟黄 仍用四两，服过十剂，脉搏又较前有力；步履虽仍需人，而起卧可自
如矣；言语亦稍能达意，其说不真之句，间可执笔写出，从前之头目昏沉眩晕者，至斯亦见轻。俾继服补
脑振痿汤，嘱其若服之顺利，可多多服之，当有脱然全愈之一日也。
按∶此证其胸满闷之时，正因其呼吸不顺也。其呼吸之所以不顺，因胸中大气及中焦脾胃之气皆虚而下
陷也。医者竟投以开破之药，是以病遽加重。至再延他医，所用之药补多开少，而又加重者，因气分当虚
极之时，补气之药难为功，破气之药易生弊也。愚向治大气下陷证，病患恒自觉满闷，其实非满闷，实短气
也，临证者细细考究，庶无差误。
肢体痿废，而其病因实际上是由于脑部贫血所致。根据生理学的实验结果，人体的全部运动都由脑髓神经所支配，虽然这是西方人的说法，但确实可以确信。因此，西方人对于痿废之证都归责于脑部。然而，实际上有脑部充血与脑部贫血的区别。因为脑髓神经原本依靠血液来濡润滋养，而所需的血量多少，尤其以适宜为贵。那些脑部充血的患者，注入脑部的血液过多，力量能够排挤其脑髓神经，使其失去正常的功能。至于脑部贫血的患者，注入脑部的血液过少，无法滋养其脑髓神经，其脑髓神经也常常失去正常的功能。至于脑中之所以出现贫血，不能专门归咎于血的问题，我曾阅读《黄帝内经》而领悟其中的道理。
《黄帝内经》说：“上气不足，脑为之不满，耳为之苦鸣，头为之倾，目为之眩。”所谓脑不满，就是血少。因为脑不满而导致贫血，那么耳鸣、头目倾斜眩晕就连带而来，严重的甚至导致肢体痿废，这不言而喻。所以西方人关于脑贫血可导致痿废的说法原本与《黄帝内经》相符。然而西医论述痿废的原因，只知道是因为脑中贫血，而《黄帝内经》更进一步推究脑中贫血的原因，知道是因为上气不足。什么是上气呢？就是胸中大气（也叫宗气）。这种气能主宰全身，斡旋脑部，流通血脉。那些脑部充血的患者，是因为肝胃之气上逆，挟带血液上冲，这与胸中大气无关；至于脑部贫血的患者，实际上是因为胸中大气虚损，不能帮助血液上升。因此，想要治疗此证，应当以补气药为主，以养血药为辅，并以通活经络的药为使药。于是基于此义拟定方剂如下。
【干颓汤】治疗肢体痿废，或偏枯，脉象极微细无力的患者。
生黄芪（五两） 当归（一两） 甘枸杞果（一两） 净杭萸肉（一两）
生滴乳香（三钱） 生明没药（三钱） 真鹿角胶（六钱捣碎）
先将黄芪煎煮十余沸，去渣。再将当归、枸杞、萸肉、乳香、没药放入汤中同煎十余沸，去渣。加入鹿角胶末融化，取汤两大盅，分两次温服。
方中的意义，重用黄芪以升补胸中大气，且能助气上升，上达脑中，而血液也可随气上注。只是它的副作用是能外透肌表，具有宣散的性质，去渣重煎，则其宣散的性质减弱，专于补气升气。当归是生血的主药，与黄芪并用，古名补血汤，因为气旺血自易生，而黄芪得当归的濡润，又不至于燥热。萸肉性善补肝，枸杞性善补肾，肝肾充足，元气必然壮旺，元气是胸中大气的根本。而且肝肾充足则从脊背向上达的督脉必然流通，督脉又是脑髓神经的根本。而且这两味药都是汁浆稠润，又善于赞助当归生血。使用乳香、没药，是因为这两味药善于开通血痹，血痹开通则痿废者久瘀的经络自然流通了。用鹿角胶，诚然因为脑既然贫血，其脑髓也必定空虚，鹿角熬制的胶善于补脑髓，脑髓足则脑中贫血的病自然容易痊愈。此方服用数十剂后身体渐渐强壮，而痿废仍不愈的，可继服后方。
【补脑振痿汤】治疗肢体痿废偏枯，脉象极微细无力，服药久不愈的患者。
生黄芪（二两） 当归（八钱） 龙眼肉（八钱） 杭萸肉（五钱）
胡桃肉（五钱） 土鳖虫（三枚大者） 地龙（三钱去净土） 生乳香（三钱）
生没药（三钱） 鹿角胶（六钱） 制马钱子末（三分）
共十一味药，将前九味煎汤两盅半，去渣，将鹿角胶放入汤内融化，分两次送服制马钱子末一分五厘。
此方比前方唯独少了枸杞，因为胡桃肉可代替枸杞补肾，且有强健筋骨的功效。我又曾阅读《沪滨医报》，说脑中血管及神经断裂的，地龙能接续它。我却认为必须辅以土鳖虫，才有此效果。盖蚯蚓（即地龙）善于引导，土鳖虫善于接合（断裂的能自行接合），两药并用能将血管神经断裂的引导并接合起来，所以在方中又加了这两味。加制马钱子的原因，是因为它能振奋神经使其灵活。此方与前方如果服用后觉得热的，都可酌情加天花粉、天冬各数钱。
天津于某某，年过四十，自觉呼吸不顺，胸中满闷，言语动作都渐渐觉得不利，头目昏沉，时常发生眩晕。请医生治疗，投以开胸理气的药物，则四肢突然痿废。再请其他医生，改用补剂但仍然兼用开气的药物，服用后痿废加剧，言语竟然不能发声。我诊视他的脉象沉微，右部尤其不耐循按，知道他胸中大气及中焦脾胃之气都虚陷。于是投以我自己拟定的升陷汤加白术、当归各三钱。服用两剂，诸病似乎都稍好，但脉象仍然如旧。于是将黄芪、白术、当归、知母各加倍，升麻改用一钱半，又加党参、天冬各六钱，连续服用三剂，口可以出声但仍不能言，肢体稍能运动但不能行走，脉象较前有起色似乎可以循按。于是仅将黄芪加重至四两，又加天花粉八钱，先用六大盅水将黄芪煎透，去渣，再入其他药，煎取清汤两大盅，分两次服下，又连续服用三剂，勉强可以说出话，然而常常不成句，有人扶着可以移步。于是改用干颓汤，惟独黄芪仍用四两，服用过十剂，脉搏又较前有力；走路虽然仍需人扶，但起居可以自如了；言语也能稍微表达意思，从前那些说不真切的话，偶尔可以执笔写出，以前的头目昏沉眩晕，到这时也减轻。让他继服补脑振痿汤，嘱咐他如果服用顺利，可以多服，终有一天会彻底痊愈。
按：此证其胸满闷的时候，正是因为他呼吸不顺。他呼吸之所以不顺，是因为胸中大气及中焦脾胃之气都虚而下陷。医生竟然投以开破的药物，所以病情突然加重。再到后来请其他医生，所用的药物补多开少，而又加重的原因，是因为气分当极度虚弱之时，补气药难以见效，破气药容易产生弊端。我向来治疗大气下陷证，病人常常自觉满闷，其实并非满闷，实际上是短气，临证时细细考究，才没有差错。
(Attached: Gan Tui Tang [Dry Atrophy Decoction], Bu Nao Zhen Wei Tang [Tonify Brain and Revitalize Paralysis Decoction])
Limb paralysis (Wei Fei, 痿废) is actually caused by cerebral anemia (Brain Anemia). According to physiological experiments, all movements of the human body are governed by the brain marrow nerves. Although this is a Western theory, it can be firmly trusted. Therefore, Western medicine attributes cases of limb paralysis to the brain. However, there is a distinction between cerebral congestion (Brain Congestion) and cerebral anemia. This is because the brain marrow nerves originally rely on blood for nourishment and moisture, and the amount of blood required is most valuable when appropriate. In cases of cerebral congestion, too much blood flows into the brain, exerting force that displaces the brain marrow nerves, causing them to lose their function. In cases of cerebral anemia, too little blood flows into the brain, failing to nourish the brain marrow nerves, which also leads to a loss of their normal function. Regarding why anemia occurs in the brain, one cannot solely blame the blood itself. I once read the *Huangdi Neijing* (Yellow Emperor's Inner Canon) and realized the principle therein.
The *Huangdi Neijing* states: "When the Qi of the upper part is insufficient, the brain feels empty, the ears suffer from ringing, the head tilts, and the eyes become dizzy." What is meant by an "empty brain" is a lack of blood. Due to this emptiness leading to anemia, symptoms such as tinnitus, head tilting, and dizziness follow. In severe cases, limb paralysis ensues, which goes without saying. Thus, the Western assertion that cerebral anemia can cause paralysis aligns with the *Huangdi Neijing*. However, while Western medicine identifies cerebral anemia as the cause of paralysis, the *Huangdi Neijing* further investigates the cause of this cerebral anemia, identifying it as insufficiency of the Upper Qi. What is Upper Qi? It is the Great Qi in the chest (also known as Zong Qi / Pectoral Qi). This Qi governs the whole body, facilitates circulation in the brain, and promotes the flow of blood vessels. In cases of cerebral congestion, Liver and Stomach Qi rebel upwards, carrying blood with it; this has nothing to do with the Great Qi. In contrast, cerebral anemia is actually due to the deficiency and damage of the Great Qi in the chest, which fails to assist the ascent of blood. Therefore, to treat this condition, one should primarily use Qi-tonifying herbs, secondarily use Blood-nourishing herbs, and use herbs that unblock and activate meridians as guides. Based on this principle, I have formulated the following prescriptions.
[Gan Tui Tang] Treats limb paralysis or hemiplegia, where the pulse is extremely fine, weak, and powerless.
Sheng Huang Qi (Raw Astragali Radix, 5 liang)
Dang Gui (Angelicae Sinensis Radix, 1 liang)
Gan Gou Qi Guo (Sweet Goji Berry, 1 liang)
Jing Hang Yu Rou (Cleaned Cornus Officinalis Fruit, 1 liang)
Sheng Di Ru Xiang (Raw Frankincense, 3 qian)
Sheng Ming Mo Yao (Raw Myrrh, 3 qian)
Zhen Lu Jiao Jiao (True Deer Antler Glue, 6 qian, crushed)
First, decoct Huang Qi for about ten boils, then remove the dregs. Then add Dang Gui, Gou Qi, Yu Rou, Ru Xiang, and Mo Yao to the liquid and decoct for another ten boils, removing the dregs. Add the Lu Jiao Jiao powder, melt it, and obtain two large bowls of decoction. Take half warm twice daily.
The rationale of this formula relies heavily on Huang Qi to ascend and tonify the Great Qi in the chest, assisting Qi to rise and reach the brain, allowing blood to follow and pour into the brain. Its side effect is penetrating the muscle surface with a dispersing nature. By removing dregs and re-decocting, this dispersing nature is reduced, focusing solely on tonifying and ascending Qi. Dang Gui is the primary herb for generating Blood. Used together with Huang Qi, it is anciently named Bu Xue Tang (Blood Tonifying Decoction), because when Qi is vigorous, Blood is easily generated. Furthermore, Huang Qi, moistened by Dang Gui, does not become dry or hot. Yu Rou tonifies the Liver effectively; Gou Qi tonifies the Kidney effectively. When Liver and Kidney are sufficient, Yuan Qi (Original Qi) becomes robust. Yuan Qi is the root of the Great Qi in the chest. Moreover, when Liver and Kidney are sufficient, the Du Mai (Governing Vessel) flowing up from the spine becomes smooth. The Du Mai is the root of the brain marrow nerves. Additionally, both herbs are rich in viscous juice and assist Dang Gui in generating Blood. Ru Xiang and Mo Yao are used because they effectively open Blood Bi (Blood Stasis obstruction). Once Blood Bi is opened, the long-standing stasis in the meridions of paralysis patients naturally flows. Lu Jiao Jiao is used because if the brain is anemic, the brain marrow must also be empty. Glue made from deer antlers effectively tonifies brain marrow. When brain marrow is sufficient, cerebral anemia heals easily. After taking dozens of doses of this formula, if the body gradually strengthens but paralysis persists, proceed to the next formula.
[Bu Nao Zhen Wei Tang] Treats limb paralysis and hemiplegia with an extremely fine, weak, and powerless pulse, in cases where previous treatments have failed over a long period.
Sheng Huang Qi (Raw Astragali Radix, 2 liang)
Dang Gui (Angelicae Sinensis Radix, 8 qian)
Long Yan Rou (Longan Aril, 8 qian)
Hang Yu Rou (Cornus Officinalis Fruit, 5 qian)
Hu Tao Rou (Walnut Kernel, 5 qian)
Tu Bie Chong (Eupolyphaga/Scolopendra, 3 large specimens)
Di Long (Pheretima/Earthworm, 3 qian, cleaned)
Sheng Ru Xiang (Raw Frankincense, 3 qian)
Sheng Mo Yao (Raw Myrrh, 3 qian)
Lu Jiao Jiao (Deer Antler Glue, 6 qian)
Zhi Ma Qian Zi Mo (Processed Strychnos Seed Powder, 3 fen)
There are eleven ingredients in total. Decoct the first nine ingredients in water to yield two and a half bowls of liquid, remove the dregs, dissolve the Lu Jiao Jiao in the liquid, and take half twice daily, washing down with 1.5 fen of Zhi Ma Qian Zi Mo.
This formula differs from the previous one only by omitting Gou Qi, because Hu Tao Rou can replace Gou Qi to tonify the Kidney and has the effect of strengthening sinews and bones. I once read the *Shubin Yibao* (Shanghai Medical Report), which stated that Di Long can reconnect severed blood vessels and nerves in the brain. I believe this effect requires the assistance of Tu Bie Chong. Earthworms (Di Long) are good at guiding, while Tu Bie Chong is good at connecting (severed parts can reconnect themselves). Using these two herbs together can guide and reconnect severed blood vessels and nerves, hence their addition to the formula. Zhi Ma Qian Zi is added because it can stimulate nerves to make them flexible. If either this formula or the previous one causes heat sensations upon ingestion, Tian Hua Fen (Trichosanthes Root) and Tian Dong (Asparagus Cochinchinensis Rhizome) can be added in small amounts (several qian).
Mr. Yu from Tianjin, over forty years old, complained of difficulty breathing, chest fullness and oppression, gradual difficulty in speech and movement, heavy-headedness, and occasional vertigo. A doctor treated him with herbs to open the chest and regulate Qi, resulting in sudden paralysis of the four limbs. Another doctor was consulted, who switched to tonic herbs but still included Qi-moving herbs. After ingestion, the paralysis worsened, and he lost his voice entirely. Upon examination, his pulse was deep and faint, especially on the right side, indicating deficiency and sinking of the Great Qi in the chest and the Qi of the Middle Jiao (Spleen and Stomach). I prescribed my own Sheng Xian Tang (Ascending the Sinking Decoction) with added Bai Zhu (Atractylodes Macrocephala Rhizome) and Dang Gui, each 3 qian. After two doses, symptoms improved slightly, but the pulse remained unchanged. I then doubled the dosage of Huang Qi, Bai Zhu, Dang Gui, and Zhi Mu (Anemarrhenae Rhizoma), changed Sheng Ma (Cimicifugae Rhizoma) to 1.5 qian, and added Dang Shen (Codonopsis Radix) and Tian Dong, each 6 qian. After three consecutive doses, he could produce sounds but still could not speak; limbs could move slightly but not walk; the pulse showed improvement and became palpable. I then increased Huang Qi to 4 liang, added Tian Hua Fen 8 qian, decocted the Huang Qi thoroughly in six large bowls of water first, removed the dregs, added other herbs, and obtained two large bowls of clear decoction. Taken twice daily for three consecutive doses, he could勉强 speak, though sentences were often incomplete. With support, he could take steps. I then switched to Gan Tui Tang, keeping Huang Qi at 4 liang. After ten doses, the pulse became stronger. Although walking still required assistance, he could rise and lie down independently. Speech improved enough to convey meaning; previously unclear statements could occasionally be written down. His previous symptoms of heavy-headedness and vertigo also lightened. He was instructed to continue with Bu Nao Zhen Wei Tang, advised that if tolerated well, he should take more, promising eventual complete recovery.
Note: During the period of chest fullness and oppression, the patient indeed had difficulty breathing. The reason for this breathing difficulty was the deficiency and sinking of the Great Qi in the chest and the Qi of the Middle Jiao. The physician mistakenly administered dispersing and breaking herbs, causing the disease to worsen suddenly. Later, the second physician used mostly tonics with few Qi-moving herbs, yet the condition worsened because, during extreme Qi deficiency, tonifying herbs struggle to work, while dispersing herbs easily cause harm. In my experience treating Sinking of Great Qi, patients often complain of fullness, but this is not true fullness; it is actually shortness of breath. Careful clinical investigation prevents errors.