（附∶起痿汤、养脑利肢汤）
《内经》谓∶“五脏有病，皆能使人痿。”至后世方书，有谓
系中风者，言风中于左，则左偏枯而痿废，风中于右则右偏枯而痿废。有谓系气虚者，左手足偏枯痿废，其
左边之气必虚，右手足偏枯痿废，其右边之气必虚。有谓系痰瘀者。有谓系血瘀者。有谓系风寒湿相并而
为痹，痹之甚者即令人全体痿废。因痰瘀血瘀及风寒湿痹皆能阻塞经络也。乃自脑髓神经司知觉运动之说倡自
西人，遂谓人之肢体痿废皆系脑髓神经有所伤损。而以愚生平所经验者言之，则中西之说皆不可废。今试
列举素所经验者于下，以征明之。
忆在籍时，曾见一猪，其两前腿忽不能动，须就其卧处饲之，半月后始渐愈。又旬余解此猪，见其
肺上新愈之疮痕宛然可辨，且有将愈未尽愈者。即物测人，原可比例，此即《内经》所谓因肺热叶焦发为痿
者也。由斯知五脏有病皆使人痿者，诚不误也。
在奉天曾治一妇人，年近三旬，因夏令夜寝当窗，为风所袭，遂觉半身麻木，其麻木之边，肌肤消瘦，
浸至其一边手足不遂，将成偏枯。其脉左部如常，右部则微弱无力，而麻木之边适在右。此因风袭经络，
致其经络闭塞不相贯通也。不早祛其风，久将至于痿废。为疏方用生箭 二两，当归八钱（用当归者取其血活
风自去也），羌活、知母、乳香、没药各四钱，全蝎二钱，全蜈蚣三条。煎服一剂即见轻，又服数剂全愈。
此中风能成痿废之明征也。
在本邑治一媪，年过六旬，其素日气虚，呼吸常觉短气。偶因劳力过度，忽然四肢痿废，卧不能起，呼
吸益形短气，其脉两寸甚微弱，两尺重按仍有根柢，知其胸中大气下陷，不能斡旋全身也，为疏方用生箭
一两，当归、知母各六钱，升麻、柴胡、桔梗各钱半，乳香、没药各三钱，煎服一剂，呼吸即不短气，手足
略能屈伸。又即原方略为加减，连服数剂全愈，此气虚成痿废之明征也。
在本邑治一媪，年五旬，于仲冬之时忽然昏倒不知人，其胸
中似有痰涎，大碍呼吸。诊其脉，微细欲无，且甚迟缓。其家人谓其平素常觉心中发凉，咳吐粘涎。知其胸
中素有寒饮，又感冬日严寒之气，其寒饮愈凝结杜塞也。急用胡椒三钱捣碎，煎两三沸，取浓汁多半杯灌下，
呼吸顿形顺利。继用干姜六钱，桂枝尖、当归各三钱，连服三剂，可作呻吟，肢体渐能运动，而左手足仍不
能动。继治以助气消痰活络之剂，左手足亦渐复旧。此痰瘀能成痿废之明征也。
在本邑治一室女，素本虚弱，医者用补敛之药太过，月事闭塞，两腿痿废，浸至抑搔不知疼痒，其
六脉皆有涩象，知其经络皆为瘀血闭塞也。为疏方用拙拟活络效灵丹，加怀牛膝五钱，红花钱半， 虫五个。
煎服数剂，月事通下，两腿已渐能屈伸，有知觉。又为加生黄 、知母各三钱，服数剂后，腿能任地。然此
等证非仓猝所能全愈，俾将汤剂作为丸剂，久久服之，自能脱然。此血瘀能成痿废之明征也。
族兄××，冬令两腿作疼，其腿上若胡桃大疙瘩若干。自言其少时恃身体强壮，恒于冬令半冰半水之
中捕鱼。一日正在捕鱼之际，朔风骤至，其寒彻骨，遂急还家歇息，片时两腿疼痛不能任地，因卧热炕上，
复以浓被。数日后，觉其疼在骨，皮肤转麻木不仁，浸至两腿不能屈伸。后经医调治，兼外用热烧酒糠熨之，
其疼与木渐愈，亦能屈伸，惟两腿皆不能伸直。有人教坐椅上，脚踏圆木棍来往，令木棍旋转，久之腿
可伸直。如法试演，迨至春气融和，两腿始恢撤消状。然至今已三十年，每届严寒之时，腿仍觉疼，必服
热药数剂始愈。至腿上之疙瘩，乃当时因冻凝结，至今未消者也。愚曰∶“此病犹可除根。然其寒在骨，非
草木之品所能奏效，必须服矿质之药，因人之骨中多函矿质也。”俾先用生硫黄细末五分，于食前服之，日两
次，品验渐渐加多，以服后觉心中微温为度。果用此方将腿疼之病除根。此风寒湿痹能
成痿废之明征也。
至西人谓此证关乎脑髓神经者，愚亦确有经验。原其神经之所以受伤，大抵因脑部充血所致。盖脑部充
血之极，可至脑中血管破裂。至破裂之甚者，管中之血溢出不止，其人即昏厥不复苏醒。若其血管不至破裂，
因被充血排挤隔管壁将血渗出，或其血管破裂少许，出血不多而自止，其所出之血若粘滞于左边司运动
之神经，其右边手足即痿废；若粘滞其右边司运动之神经，其左边之手足即痿废。因人之神经原左右互相
管摄也。此证皆脏腑气血挟热上冲，即《内经》所谓血之与气并走于上之大厥也。其人必有剧烈之头疼，其
心中必觉发热，其脉象必然洪大或弦长有力。《内经》又谓此证“气反则生，不反则死”，盖气反则气下
行，血亦下行，血管之未破裂者，不再虞其破裂，其偶些些破裂者，亦可因气血之下行而自愈；若其气不反，
血必随之上升不已，将血管之未破裂者可至破裂，其已破裂者更血流如注矣。愚因细参《内经》之旨，而悟
得医治此证之方，当重用怀牛膝两许，以引脑中之血下行，而佐以清火降胃镇肝之品，俾气与火不复相并上
冲。数剂之后，其剧烈之头疼必愈，脉象亦必和平。再治以化瘀之品以化其脑中瘀血，而以宣通气血、畅
达经络之药佐之，肢体之痿废者自能徐徐愈也。特是因脑充血而痿废者，本属危险之证，所虑者辨证不清，当
其初得之时若误认为气虚而重用补气之品，若王勋臣之补阳还五汤，或误认为中风而重用发表之品，若《千
金》之续命汤，皆益助其气血上行，而危不旋踵矣。至用药将其脑充血治愈，而其肢体之痿废或仍不愈，
亦可少用参 以助其气分，然必须用镇肝、降胃、清热、通络之药辅之，方
能有效。因拟两方于下，以备采用。
【起痿汤】治因脑部充血以致肢体痿废，迨脑充血治愈，脉象和平，而肢体仍痿废者。徐服此药，久自能愈。
生箭 （四钱） 生赭石（六钱轧细） 怀牛膝（六钱） 天花粉（六钱）
玄参（五钱） 柏子仁（四钱） 生杭芍（四钱） 生明没药（三钱）
生明乳香（三钱） 虫（四枚大的） 制马钱子末（二分）
共药十一味。将前十味煎汤，送服马钱子末。至煎渣再服时，亦送服马钱子末二分。
【养脑利肢汤】治同前证，或服前方若干剂后肢体已能运动而仍觉无力者。
野台参（四钱） 生赭石（六钱轧细） 怀牛膝（六钱） 天花粉（六钱）
玄参（五钱） 生杭芍（四钱） 生明乳香（三钱） 生明没药（三钱）
威灵仙（一钱） 虫（四枚大的） 制马钱子末（二分）
共药十一味。将前十味煎汤，送服马钱子末。至煎渣再服
时，亦送服马钱子末二分。上所录二方，为愚新拟之方，而用之颇有效验，恒能随手建功，试举一案以明之。
天津贺某，得脑充血证，左手足骤然痿废，其脉左右皆弦硬而长，其脑中疼而且热，心中异常烦躁。
投以建瓴汤，为其脑中疼而且热，更兼烦躁异常，加天花粉八钱。连服三剂后，觉左半身筋骨作疼，盖
其左半身从前麻木无知觉，至此时始有知觉也。其脉之弦硬亦稍愈。遂即原方略为加减，又服数剂，脉象已近
和平，手足稍能运动，从前起卧转身皆需人，此时则无需人矣。于斯改用起痿汤，服数剂，手足之运动渐
有力，而脉象之弦硬又似稍增，且脑中之疼与热从前服药已愈，至此似又微觉疼热，是不受黄 之升补也。
因即原方将黄 减去，又服数剂，其左手能持物，左足能任地矣，头中亦分毫不觉疼热。再诊其脉已和平
如常，遂又加黄 ，将方中花粉改用八钱，又加天冬八钱，连服六剂可扶杖徐步，
仍觉乏力。继又为拟养脑利肢汤，服数剂后，心中又似
微热，因将花粉改用八钱，又加带心寸麦冬七钱，连服十剂全愈。
按∶此证之原因不但脑部充血，实又因脑部充血之极而至于溢血。迨至充血溢血治愈，而痿废仍
不愈者，因从前溢出之血留滞脑中未化，而周身经络兼有闭塞处也。是以方中多用通气化血之品。又恐久
服此等药或至气血有损，故又少加参 助之，且更用玄参、花粉诸药以解参 之热，赭石、牛膝诸药以防参
之升，可谓熟筹完全矣。然服后犹有觉热之时，其脉象仍有稍变弦硬之时，于斯或减参 ，或多加凉药，
精心酌斟，息息与病机相赴，是以终能治愈也。至于二方中药品平均之实偏于凉，而服之犹觉热者，诚以
参之性可因补而生热，兼以此证之由来，又原因脏腑之热挟气血上冲也。
《黄帝内经》说：“五脏发生病变，都能导致人出现肢体痿废。”到了后世的医书，有的认为这是由中风引起的，说风邪侵袭左侧，则左侧半身偏枯且痿废；风邪侵袭右侧，则右侧半身偏枯且痿废。有的认为是气虚所致，左手足偏枯痿废，其左边的气必然虚弱；右手足偏枯痿废，其右边的气必然虚弱。有的认为是痰浊和瘀血阻滞。有的认为是血瘀。有的认为是风寒湿邪合并而为痹证，痹证严重的就会使人全身痿废，因为痰浊、瘀血以及风寒湿痹都能阻塞经络。自从西方人提出脑髓神经主管知觉和运动的学说以来，于是有人声称人的肢体痿废都是由于脑髓神经受到损伤造成的。根据我生平的经验，中西两家的说法都有不可废弃之处。现在试着列举我平时所经验的案例如下，以证明这一点。
回忆我在家乡时，曾见过一头猪，它的两条前腿突然不能动弹，必须就在它躺卧的地方喂食它，半个月后才逐渐痊愈。又过了十几天解剖这头猪，看到它肺上新愈合的疮痕清晰可辨，还有即将愈合但未完全愈合的。由此物推测到人，原本是可以类比推理的，这就是《黄帝内经》所说的因肺热叶焦而发为痿证的情况。由此可知，五脏有病都会使人痿废，确实是不错误的。
在奉天（今沈阳）我曾治疗一位妇女，年龄近三十岁，因为在夏天夜里睡觉对着窗户，被风邪侵袭，于是觉得半身麻木，麻木的一侧肌肤消瘦，进而发展到一边手足不能随意运动，快要形成偏枯了。她的脉象左边如常，右边则微弱无力，而麻木的一侧恰好在右边。这是因为风邪侵袭经络，导致经络闭塞不相贯通。如果不早点祛除风邪，长久下去将会导致痿废。我为她开具处方，用生黄芪二两，当归八钱（使用当归是因为取其活血则风自去的道理），羌活、知母、乳香、没药各四钱，全蝎二钱，全蜈蚣三条。煎服一剂后症状即见减轻，又服用几剂后完全痊愈。这是中风能导致痿废的明确证据。
在本县我曾治疗一位老妇人，年龄超过六十岁，她平素气虚，呼吸时常觉得气短。偶然因为过度劳累，突然四肢痿废，卧床不能起身，呼吸更加显得气短。她的脉象两寸非常微弱，两尺部重按仍有根基，我知道她是胸中大气下陷，不能斡旋全身，于是为她开具处方，用生黄芪一两，当归、知母各六钱，升麻、柴胡、桔梗各钱半，乳香、没药各三钱。煎服一剂后，呼吸就不再气短，手足略微能够屈伸。随后在原方基础上稍作加减，连续服用几剂后完全痊愈，这是气虚导致痿废的明确证据。
在本县我曾治疗另一位老妇人，年龄五十岁，在仲冬时节突然昏倒不省人事，她胸中似乎有痰涎，严重妨碍呼吸。诊察她的脉象，微细欲绝，而且非常迟缓。她的家人说她平时常觉得心中发凉，咳嗽吐粘涎。我知道她胸中素有寒饮，又感受了冬日严寒之气，导致寒饮更加凝结堵塞。急忙用胡椒三钱捣碎，煎煮两三沸，取浓汁多半杯灌服，呼吸顿时变得顺利。接着用干姜六钱，桂枝尖、当归各三钱，连续服用三剂，患者可以发出呻吟声，肢体逐渐能够运动，但左手足仍然不能动。随后用助气消痰活络的药剂治疗，左手足也逐渐恢复正常。这是痰瘀能导致痿废的明确证据。
在本县我曾治疗一位未婚女子，素来身体虚弱，医生使用补益收敛的药物太过分，导致月经闭塞，两条腿痿废，进而发展到抓挠也不知道疼痒，她的六脉都有涩象，我知道是经络都被瘀血闭塞了。于是为我拟定的活络效灵丹，加怀牛膝五钱，红花钱半，土鳖虫五个。煎服几剂后，月经通畅下行，两条腿已经逐渐能够屈伸，有了知觉。后来又加入生黄芪、知母各三钱，服用几剂后，腿能够支撑地面。然而这类病症不是短时间内所能完全治愈的，让将汤剂改为丸剂，长期服用，自然能够彻底康复。这是血瘀能导致痿废的明确证据。
族兄××，冬天两条腿疼痛，腿上有一些像核桃大小的疙瘩。他自己说他年轻时仗着身体强壮，经常在冬令季节半冰半水的环境中捕鱼。有一天正在捕鱼时，北风骤至，寒气彻骨，于是急忙回家休息，片刻之后双腿疼痛难忍无法站立，于是躺在热炕上，再用厚被子覆盖。几天后，觉得疼痛深入骨骼，皮肤转为麻木不仁，进而发展到两条腿不能屈伸。后来经过医生调治，兼外用热烧酒糠熨烫，疼痛和麻木逐渐好转，也能屈伸了，只是两条腿都不能伸直。有人教他坐在椅子上，脚踩圆木棍来回滚动，让木棍旋转，久而久之腿可以伸直。按照这个方法尝试练习，等到春天气候温和时，两条腿才恢复原状。然而到现在已经三十年了，每到严寒的时候，腿仍然觉得疼，必须服用几剂热性药物才能痊愈。至于腿上的疙瘩，那是当时因冻伤凝结而成，至今没有消退。我说：“这个病还可以除根。但是寒邪在骨，不是草木类药物所能奏效的，必须服用矿物类药物，因为人的骨头中多含有矿物质。”让他先用生硫黄细末五分，饭前服用，每天两次，慢慢增加剂量，以服用后感觉心中微微温热为度。果然用这个方子将腿疼的病除根。这是风寒湿痹能导致痿废的明确证据。
至于西方人认为此症关乎脑髓神经的说法，我也有确切的经验。原来神经之所以受伤，大抵是因为脑部充血所致。大概脑部充血到了极点，会导致脑中血管破裂。如果破裂严重，管中的血液溢出不止，这个人就会昏厥不再苏醒。如果血管不至于破裂，因为被充血排挤，隔管壁将血渗出，或者血管破裂少许，出血不多而自行停止，所流出的血如果粘滞在左侧主管运动的神经上，右侧的手足就会痿废；如果粘滞在右侧主管运动的神经上，左侧的手足就会痿废。因为人的神经左右互相管辖摄持。这种病症都是脏腑气血挟带热邪上冲，也就是《黄帝内经》所说的血与气并走于上的大厥证。这种人一定有剧烈的头痛，心中一定觉得发热，脉象必然洪大或弦长有力。《黄帝内经》又说此症“气反则生，不反则死”，意思是气下行则生，气不下行则死。气下行则气向下运行，血也向下运行，未破裂的血管，不再担心其破裂，偶尔有些许破裂的，也可以因为气血下行而自愈；如果气不下行，血必定随之上升不已，将未破裂的血管可导致破裂，已破裂的血管更会血流如注了。我因此仔细参悟《黄帝内经》的宗旨，领悟到医治此症的方子，应当重用怀牛膝一两许，以引导脑中的血下行，并辅以清火、降胃、镇肝的药物，使气和火不再相并上冲。服用几剂之后，剧烈的头痛必然痊愈，脉象也必然平和。再治疗以化瘀的药物以化解脑中的瘀血，并以宣通气血、畅达经络的药物辅助，肢体的痿废自然能慢慢痊愈。特别是因为脑充血而导致痿废的，本来属于危险的病症，所担忧的是辨证不清，在其初得之时如果误认为是气虚而重用补气之品，比如王勋臣的补阳还五汤，或者误认为是中风而重用发表之品，比如《千金方》的续命汤，都会进一步帮助气血上行，从而危险立刻到来。等到用药将脑充血治愈，而其肢体的痿废可能仍然不愈，也可以少用人参以助其气分，但必须用镇肝、降胃、清热、通络的药物辅助，才能有效。因此拟定两个方子如下，以备采用。
【起痿汤】治疗因脑部充血导致肢体痿废，等到脑充血治愈，脉象平和，而肢体仍然痿废的人。慢慢服用此药，久了自然能痊愈。
生黄芪（四钱） 生赭石（六钱轧细） 怀牛膝（六钱） 天花粉（六钱）
玄参（五钱） 柏子仁（四钱） 生杭芍（四钱） 生明没药（三钱）
生明乳香（三钱） 土鳖虫（四枚大的） 制马钱子末（二分）
共十一味药。将前十味药煎汤，送服马钱子末。等到煎渣再服时，也送服马钱子末二分。
【养脑利肢汤】治疗同上症，或者服用前方若干剂后肢体已经能够运动但仍然觉得无力的人。
野台参（四钱） 生赭石（六钱轧细） 怀牛膝（六钱） 天花粉（六钱）
玄参（五钱） 生杭芍（四钱） 生明乳香（三钱） 生明没药（三钱）
威灵仙（一钱） 土鳖虫（四枚大的） 制马钱子末（二分）
共十一味药。将前十味药煎汤，送服马钱子末。等到煎渣再服时，也送服马钱子末二分。上面记录的这两个方子，是我新拟定的方子，用起来颇有疗效，常常能随手建功，试举一个案例来说明。
天津贺某，得了脑充血证，左手足骤然痿废，他的脉象左右都弦硬而长，他脑中疼痛而且发热，心中异常烦躁。
投以建瓴汤，因为他脑中疼痛而且发热，更兼烦躁异常，加了天花粉八钱。连续服用三剂后，觉得左半身筋骨作痛，大概是因为他左半身从前麻木无知觉，到了这个时候才有知觉了。他的脉象的弦硬也稍微好转。随即在原方基础上稍作加减，又服用几剂，脉象已经接近平和，手足稍微能够运动，从前起床睡觉转身都需要人，此时则不需要人了。在这时候改用起痿汤，服用几剂，手足的运动逐渐有力，而脉象的弦硬又似乎稍微增加，并且脑中的疼痛和发热从前服药已经好了，到了这时似乎又微微觉得疼热，这是不耐受黄芪的升补作用。
因此就在原方中将黄芪减去，又服用几剂，他的左手能拿东西，左脚能支撑地面了，头部也分毫不觉得疼热。再诊他的脉已经平和如常，于是又加入黄芪，将方中的花粉改用八钱，又加入天冬八钱，连续服用六剂可以扶着拐杖慢慢走路，仍然觉得乏力。继而又为他拟定养脑利肢汤，服用几剂后，心中又似乎微微发热，因此将花粉改用八钱，又加入带心寸麦冬七钱，连续服用十剂完全痊愈。
按语：此症的原因不但有脑部充血，实在是因为脑部充血到了极点以至于溢血。等到充血溢血治愈，而痿废仍然不愈，是因为从前溢出的血留滞脑中未化，而且周身经络兼有闭塞处。所以方中多用通气化血的药物。又恐怕久服这些药物会导致气血受损，所以又少加人参以辅助，并且更用玄参、花粉等药物来解除人参的热性，赭石、牛膝等药物来防止人参的升提，可以说是考虑得非常周全了。然而服用后仍有觉得热的时候，其脉象仍有稍微变弦硬的时候，在这个时候或者减少人参用量，或者多加凉药，精心斟酌，时刻与病机相符，所以最终能治愈。至于这两个方子中的药品平均来看其实偏向凉性，而服用后仍然觉得热的，确实是因为人参的性质可以因补而生热，兼以此症的形成原因，又是脏腑的热邪挟带气血上冲所致。
(Attached: Qiwei Decoction and Yangnao Lizhi Decoction)
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Diseases of the five zang organs can all cause flaccidity syndrome in humans." In later medical texts, some argue that this is caused by wind-stroke (Zhongfeng), stating that if wind pathogen attacks the left side, the left half of the body becomes hemiplegic and flaccid; if it attacks the right side, the right half becomes hemiplegic and flaccid. Some attribute it to deficiency of qi (Qi Xu), claiming that if the left hand and foot are hemiplegic and flaccid, the qi on the left must be deficient; if the right hand and foot are affected, the qi on the right must be deficient. Others suggest it is due to phlegm turbidity and blood stasis. Some specifically cite blood stasis. Still others propose it results from wind-cold-dampness combining to form bi-syndrome (Bi Zheng); severe cases of bi-syndrome can lead to whole-body flaccidity, as phlegm, blood stasis, and wind-cold-dampness bi-syndrome can all obstruct the meridians. Since Western medicine proposed that the brain marrow and nerves govern perception and movement, some have claimed that human limb flaccidity is entirely due to damage to the brain marrow and nerves. Based on my lifelong experience, neither the Chinese nor the Western perspectives should be discarded. I now list some cases from my personal experience below to demonstrate this.
I recall that when I was at home, I once saw a pig whose two front legs suddenly became immobile and had to be fed where it lay. It gradually recovered after half a month. Ten days later, when dissecting this pig, I could clearly distinguish fresh scar marks of healed sores on its lungs, along with some that were nearly but not fully healed. Inferring from animals to humans, analogy is possible; this corresponds to what the *Huangdi Neijing* describes as flaccidity syndrome arising from lung heat causing the leaves to wither. From this, we know that diseases of the five zang organs indeed cause flaccidity, which is certainly correct.
In Fengtian (now Shenyang), I treated a woman nearing thirty years of age. Because she slept facing a window during summer nights, she was attacked by wind pathogen, resulting in numbness in half her body. The skin on the numb side wasted away, eventually progressing to immobility of the limbs on that side, approaching hemiplegia. Her pulse was normal on the left side but weak and powerless on the right, corresponding to the numb side being on the right. This was due to wind pathogen attacking the meridians, causing obstruction and lack of communication between them. If the wind was not dispelled early, it would long-term lead to flaccidity. I prescribed a formula containing raw Astragali Radix (Sheng Huangqi) 2 liang, Angelicae Sinensis Radix (Danggui) 8 qian (used for its ability to invigorate blood so wind disperses naturally), Notopterygii Rhizoma et Radix (Qianghuo), Anemarrhenae Rhizoma (Zhimu), Frankincense (Ruxiang), and Myrrh (Moyao) each 4 qian, Scorpio (Quanxie) 2 qian, and Centipede (Quangu) 3 pieces. After one dose decocted and taken, symptoms lightened; after several more doses, she was completely cured. This is clear evidence that wind-stroke can lead to flaccidity.
In my county, I treated an elderly woman over sixty years old who suffered from chronic qi deficiency, often feeling short of breath. Due to excessive labor, she suddenly experienced flaccidity of all four limbs, unable to rise from bed, with worsening shortness of breath. Her pulse was very weak at both cun positions, but both chi positions had a root upon deep pressure. I diagnosed sinking of the great qi in the chest, unable to rotate the whole body. I prescribed raw Astragali Radix (Sheng Huangqi) 1 liang, Angelicae Sinensis Radix (Danggui) and Anemarrhenae Rhizoma (Zhimu) each 6 qian, Cimicifugae Rhizoma (Shengma), Bupleuri Radix (Chaihu), and Platycodonis Radix (Jiegeng) each 1.5 qian, Frankincense (Ruxiang) and Myrrh (Moyao) each 3 qian. After one dose, her breathing normalized, and her limbs could slightly flex and extend. With slight modifications to the original formula continued for several doses, she recovered completely. This is clear evidence that qi deficiency can lead to flaccidity.
In my county, I treated another elderly woman, aged fifty, who suddenly fainted and lost consciousness in mid-winter. Phlegm-fluid seemed present in her chest, severely hindering breathing. Her pulse was faint and thin, almost imperceptible, and very slow. Her family said she usually felt cold in her heart and coughed up sticky saliva. I determined she had chronic cold-fluid retention in her chest, aggravated by winter cold air, causing further condensation and blockage. I urgently used Piperis Longi Fructus (Hujiao) 3 qian crushed, boiled briefly, took most of a cup of thick juice, and administered it orally; her breathing immediately smoothed out. Then I used dried Ginger (Ganjiang) 6 qian, Cinnamomi Ramulus (Guizhi Jiantou), and Angelicae Sinensis Radix (Danggui) each 3 qian, taken for three doses. She could then moan, and her limbs gradually moved, though her left hand and foot remained immobile. Subsequent treatment with formulas to assist qi, resolve phlegm, and unblock collaterals gradually restored function to her left hand and foot. This is clear evidence that phlegm and blood stasis can lead to flaccidity.
In my county, I treated an unmarried young woman who was constitutionally weak. A physician had used too much tonifying and astringent medicine, causing amenorrhea and flaccidity of both legs, progressing to insensitivity to pain and itching upon scratching. All six pulses showed a choppy quality, indicating collateral obstruction by blood stasis. I prescribed Huoluo Xiaoling Dan (My Formula for Unblocking Collaterals and Efficacy), adding Achyranthis Bidentatae Radix (Huainiuxi) 5 qian, Carthami Flos (Honghua) 1.5 qian, and Leech (Shuizhongyi) 5 pieces. After several doses, menstruation flowed, her legs could slightly flex and extend, and sensation returned. I then added raw Astragali Radix (Sheng Huangqi) and Anemarrhenae Rhizoma (Zhimu) each 3 qian. After several doses, her legs could bear weight. However, such conditions cannot be cured hastily. I advised converting the decoction into pills for long-term use, leading to complete recovery. This is clear evidence that blood stasis can lead to flaccidity.
My clan brother XX suffered leg pain in winter, with walnut-sized lumps on his legs. He recalled that in his youth, relying on his strong physique, he often fished in semi-ice, semi-water environments during winter. One day, while fishing, a north wind arose suddenly, penetratingly cold. He hurried home to rest. Within moments, his leg pain became unbearable, preventing him from standing. He lay on a heated kang bed and covered himself with thick quilts. Days later, the pain felt deep in the bones, and his skin became numb and insensitive, progressing to inability to flex or extend his legs. Medical treatment combined with external application of hot liquor and bran helped alleviate pain and numbness, allowing some movement, though his legs could not straighten. Someone taught him to sit on a chair and roll a round wooden stick back and forth with his feet, rotating it over time, which eventually allowed his legs to straighten. Following this method, by spring when the weather warmed, his legs recovered shape. Yet, thirty years later, every harsh winter brings leg pain, relieved only by several doses of warming medicines. The lumps on his legs remain unresolved, formed by freezing at that time. I stated: "This disease can still be eradicated. However, the cold is in the bone, and herbal medicines alone cannot achieve this effect; mineral medicines must be taken, as human bones contain many minerals." I instructed him to take fine powder of native Sulfur (Sheng Liuhuang) 5 fen before meals, twice daily, gradually increasing the dose until he felt mild warmth in his heart. Indeed, this formula eradicated his leg pain. This is clear evidence that wind-cold-dampness bi-syndrome can lead to flaccidity.
Regarding the Western view that this condition relates to brain marrow and nerves, I also have definite experience. The injury to nerves is largely caused by cerebral congestion. Extreme cerebral congestion can rupture blood vessels in the brain. Severe rupture leads to continuous bleeding, causing coma and death. If vessels do not rupture, congestion may force blood through the vessel wall, or slight rupture may stop spontaneously. If the leaked blood adheres to the left motor nerve, the right limbs become flaccid; if it adheres to the right motor nerve, the left limbs become flaccid, because nerves cross-control each other. This condition involves viscera qi and blood rushing upward with heat, known in the *Huangdi Neijing* as "Great Jue" where blood and qi move together upward. Patients必有 severe headache, internal heat sensation, and a surging or string-taut and forceful pulse. The *Huangdi Neijing* states, "If qi reverses, life is preserved; if not, death ensues." Reversal means qi descends, blood follows, unruptured vessels are safe, and minor ruptures heal via downward flow. If qi does not reverse, blood continues rising, rupturing intact vessels or worsening existing ones. Studying the *Huangdi Neijing*, I realized treatment should heavily use Achyranthis Bidentatae Radix (Huainiuxi) around 1 liang to guide brain blood downward, assisted by herbs that clear fire, descend stomach qi, and calm liver yang, preventing qi and fire from ascending together. After several doses, severe headaches cease, and pulses normalize. Then, treat with blood-resolving herbs to dissolve brain stasis, aided by qi-invigorating and meridian-unblocking agents, allowing gradual recovery of flaccid limbs. Specifically, flaccidity due to cerebral congestion is dangerous. Misdiagnosing it as qi deficiency and using heavy tonics like Buyang Huanwu Tang (Wang Xunchen) or misdiagnosing it as wind-stroke and using heavy diaphoretics like Xuming Tang (*Qianjin Fang*) will exacerbate upward flow, leading to immediate danger. Even after curing cerebral congestion, if flaccidity persists, small amounts of Ginseng Radix et Rhizoma (Renshen) may aid qi, but must be accompanied by liver-calming, stomach-descending, heat-clearing, and meridian-unblocking herbs to be effective. Thus, I propose two formulas below.
[Qiwei Decoction] For flaccidity due to cerebral congestion, after congestion resolves and pulse normalizes, but limbs remain flaccid. Take slowly for long-term cure.
Raw Astragali Radix (Sheng Huangqi) 4 qian, Raw Oolithum (Sheng Zhe Shi) 6 qian ground fine, Achyranthis Bidentatae Radix (Huainiuxi) 6 qian, Trichosanthis Radix (Tianhuafen) 6 qian, Scrophulariae Radix (Xuanshen) 5 qian, Biota Seed (Baiziren) 4 qian, Raw Paeoniae Radix Alba (Sheng Baishao) 4 qian, Raw frankincense (Sheng Ming Moyao) 3 qian, Raw myrrh (Sheng Ming Ruxiang) 3 qian, Leech (Shuizhongyi) 4 large pieces, Processed Strychni Semen (Zhi Maqianzi) powder 2 fen.
Eleven ingredients. Decoct the first ten, swallow Maqianzi powder with the liquid. When re-decocting dregs, also swallow 2 fen of Maqianzi powder.
[Yangnao Lizhi Decoction] For the same condition, or when limbs move but feel weak after previous formula.
Wild Codonopsis Radix (Yetaishen) 4 qian, Raw Oolithum (Sheng Zhe Shi) 6 qian ground fine, Achyranthis Bidentatae Radix (Huainiuxi) 6 qian, Trichosanthis Radix (Tianhuafen) 6 qian, Scrophulariae Radix (Xuanshen) 5 qian, Raw Paeoniae Radix Alba (Sheng Baishao) 4 qian, Raw myrrh (Sheng Ming Ruxiang) 3 qian, Raw frankincense (Sheng Ming Moyao) 3 qian, Salvia Miltiorrhiza Radix et Rhizoma (Weilingxian) 1 qian, Leech (Shuizhongyi) 4 large pieces, Processed Strychni Semen (Zhi Maqianzi) powder 2 fen.
Eleven ingredients. Decoct the first ten, swallow Maqianzi powder with the liquid. When re-decocting dregs, also swallow 2 fen of Maqianzi powder. These two new formulas are quite effective. I cite one case to illustrate.
Mr. He from Tianjin suffered cerebral congestion with sudden flaccidity of left hand and foot. His pulses were string-taut, hard, and long on both sides. He had brain pain and heat, with extreme irritability.
I administered Jianling Tang (Building Dam Decoction). Due to brain pain/heat and irritability, I added Trichosanthis Radix (Tianhuafen) 8 qian. After three doses, he felt pain in left tendons and bones, likely because the previously numb left side regained sensation. Pulse hardness decreased slightly. Modifying the original formula slightly, he took several more doses; pulse approached normalcy, limbs moved slightly, and he no longer needed assistance for turning in bed. At this point, I switched to Qiwei Decoction. After several doses, limb movement strengthened, but pulse hardness increased slightly, and mild brain pain/heat recurred, indicating intolerance to the ascending nature of Astragalus.
I removed Astragalus from the original formula. After several doses, his left hand could hold objects, left foot could bear weight, and head pain/heat vanished. Pulse normalized. I then re-added Astragalus, changed Trichosanthis Radix (Tianhuafen) to 8 qian, added Asparagi Radix (Tian Dong) 8 qian. After six doses, he could walk with a cane, though still weak. I then prescribed Yangnao Lizhi Decoction. After several doses, mild internal heat returned. I changed Trichosanthis Radix (Tianhuafen) to 8 qian and added Ophiopogonis Radix with Heart (Daixin Maidong) 7 qian. After ten doses, he was fully cured.
Note: The cause of this condition is not only cerebral congestion but extreme congestion leading to hemorrhage. Even after resolving congestion/hemorrhage, flaccidity persists because residual blood remains in the brain untransformed, and systemic meridians are blocked. Hence, the formula uses many qi-moving and blood-resolving herbs. To prevent qi/blood damage from long-term use, small amounts of Ginseng Radix et Rhizoma (Renshen) are added, balanced by Scrophulariae Radix (Xuanshen) and Trichosanthis Radix (Tianhuafen) to counteract Renshen's heat, and Raw Oolithum (Sheng Zhe Shi) and Achyranthis Bidentatae Radix (Huainiuxi) to prevent Renshen's ascending tendency, showing thorough consideration. However, patients may still feel heat or have slightly string-taut pulses. Adjusting Renshen dosage or adding cooling herbs carefully, aligning with pathology, ensures cure. Although these formulas are generally cooling, heat sensations persist because Ginseng generates heat when tonifying, and the condition originates from visceral heat driving qi and blood upward.