生生子曰∶世之病痿者甚多，而治痿之法甚少，考之《内经》，且特立篇目，非泛常总括病机者伦
也。治法之少，由后人或未能尽悉经旨，今按《内经》，皆以气热为五痿受病之胎，则可见痿之病本，皆
自气热中来也。何者？痿 之始，五脏因肺热叶焦，递相传染。缘肺者，统诸气，心之盖，脏之长，君
之相傅，而治节之所由系焉。五痿之疾，殆肺之一气流传，犹宰相承一旨以令天下也。观其独取阳明为治
，不以五痿异者，此又可见以肺热为本，而五痿为标，故治独取阳明，是谓定于一也。此“取”字，有教人
补之之意，非所谓攻取也。盖阳明乃五脏六腑之海，主润宗筋。又冲脉者，经脉之海。与阳明合于宗筋。
阴阳总宗筋之会，会于气街，而阳明为之长，皆属于带脉，而络于督脉。阳明虚则宗筋纵，带脉不引，故
足痿不用。兹补其阳明，使谷气充，冲脉盛，带脉引，宗筋润，是以能束骨而利机关，故其治独取阳明，而
不以五痿异也。既得以热字为本，阳明为用，临症处方，则在人自扩充之，书曷能尽所言哉。
丹溪曰∶《内经·痿论》，肺热叶焦、五脏因而受之，发为痿 。又曰∶诸痿皆属于上，指病之本在肺也。
或曰∶《内经》治痿之法，独取阳明何也？曰∶诸痿生于肺热，只此一句、便见治法大意。《经》曰
∶“东方实，西方虚，泻南方，补北方。”此固是就生克言补泻，而大经大法，不外于此。五行之中
，惟火有二，肾虽有两水，惟其一阳常有余，阴常不足，故《经》曰∶一水不能胜二火，理之必然。
金体燥而居上，主气，畏火者也。土性湿而居中，主四肢，畏木者也。火性炎上。若嗜欲无节，则水失
所养，火寡于畏，而侮所胜，肺得火邪而热矣。木性刚急，肺受邪热，则金失所养，木寡于畏，而侮所
胜，土得木邪而伤矣。肺热则不能营摄一身，脾伤则四肢不能为用，而诸痿之病作。泻南方，则肺金清，
而东方不实，何脾伤之有？补北方，则心火降，而西方不虚，何肺热之有？故阳明实则宗筋润，能束骨而
利机关矣。治痿之法，无出于此。骆龙吉亦曰∶风火相炽，当滋肾水。东垣先生取黄柏为君，黄 等
药为辅佐，而无一定之方，有兼痰积者，有湿多者，有热多者，有湿热相半者，有挟寒者，临病制方，其
善于治痿乎！虽然，药中肯綮矣，若将理失宜，圣医不治也，但是患痿之人，若不淡薄滋味，吾知其必不
能安全也。
生生子曰∶刘宗浓谓治痿方多缺略者，皆因混入中风条内故也，此皆承丹溪治痿不得作风治，斯言深
得病旨。风乃外入者，故当逐散；痿则内藏不足所致，治惟有补而已。但丹溪痿篇中，既以《内经》治痿
独取
阳明之说设为或问矣，乃不答所以取阳明之旨，而以《难经》泻南补北之法，摘为治痿之方，斯亦法外
变通之意，第不思所问取阳明之义，竟何所发明，是欲彰之而复蔽之也。胡不曰阳明者，胃也，坤土也
，万物之所以资生焉，为脾之表，脾胃一虚，肺气先绝，肺虚则不能宣通脏腑，节制经络；必胃浓则脾
充，脾充则能布散津液，使脏腑各有所禀受，四肢健运，如是则何有于叶焦，何有于痿 也。要知痿之终
始，只在肺胃之间而已矣。肺热叶焦，则不能节制诸经，胃气虚弱，则脏腑无所受气。带脉不引，宗筋
枯槁，而痿 之所由兆。故《内经》治痿，所以独取乎阳明也，以阳明为五脏六腑之海也。“独”之一字
，是谓足可以尽其治之辞。彼丹溪泻南补北之法，或可以施肺肾之痿，其于肉痿，敢试之乎？《经》曰∶
“肌肉濡渍，痹而不仁，发为肉痿。”启玄子注曰∶肉属于脾，脾恶湿，湿着肌肉，则卫气不营，故发为
肉痿也。据此，则泻火补水之法，可得以概治肉痿乎否也？丹溪天资甚高，笔力尤健。凡天资高者，或一时
之兴，随笔成文，或自执己见以为是，不复更检，观篇后盛赞东垣治痿之善，即可以见其天分，惜乎不以东
垣之善返照，未免自是之为累欤。
生生子说：世上患痿证的人很多，但治疗痿证的方法却很少。考察《内经》，专门设立了篇章论述，这并非像一般总括病机的内容那样泛泛而谈。治疗方法的稀少，是因为后人或许未能完全通晓经旨。如今依据《内经》来看，都以“气热”作为五种痿证发病的根源，由此可见痿证的病本，都源于气热。为什么呢？痿证开始时，五脏因肺热导致叶焦（肺部津液枯竭），依次相互传染。因为肺统摄诸气，是心的覆盖物，为脏腑之长，是君主的宰相，治理和调节的功能由此系于肺。五种痿证的疾病，大概只是肺中一气流传所致，就像宰相秉承一道旨意来号令天下一样。观察其治疗只取阳明经，而不因五种痿证的不同而区别对待，这又可见是以肺热为本，五种痿证为标，所以治疗只取阳明经，这就是所谓的“定于一”。这个“取”字，有教导人补益的意思，不是所谓攻伐夺取的意思。因为阳明经是五脏六腑的海，主要滋润宗筋（全身筋膜）。还有冲脉，是经脉的海。与阳明经会合于宗筋。阴阳总汇于宗筋，会合于气街穴，而阳明经为之长，都归属于带脉，并联络于督脉。阳明经虚弱则宗筋弛纵，带脉不能牵引，所以足部痿弱不能使用。现在补益阳明经，使水谷之气充盛，冲脉旺盛，带脉能够牵引，宗筋得到滋润，因此能约束骨骼而利于关节运动，所以治疗痿证只取阳明经，而不因五种痿证不同而有所区别。既然确定了以“热”字为本，以阳明经为用，临症处方，就要靠医生自己扩充运用，书本怎能穷尽所有的说法呢？
丹溪说：《内经·痿论》中提到，肺热叶焦，五脏因而受邪，发为痿证。又说：各种痿证都归属于上焦，指病的根本在肺。有人问：《内经》治疗痿证的方法，为什么只取阳明经？回答说：各种痿证生于肺热，仅这一句，就可见治疗大法的大意。《内经》说：“东方实，西方虚，泻南方，补北方。”这固然是从五行生克角度讲补泻，但大经大法，不外乎于此。五行之中，只有火有两种情况，肾虽有两枚，但一阳常有余，阴常不足，所以《内经》说：一水不能胜二火，这是必然的道理。金性燥而居上，主气，畏惧火。土性湿而居中，主四肢，畏惧木。火性炎上。如果嗜欲无节制，则水失所养，火少了畏惧，便欺侮其所胜之金，肺得火邪而热了。木性刚急，肺受邪热，则金失所养，木少了畏惧，便欺侮其所胜之土，土得木邪而受伤了。肺热则不能营摄一身，脾伤则四肢不能发挥作用，于是各种痿证发作。泻南方（心火），则肺金清肃，而东方（肝木）不实，有什么脾伤呢？补北方（肾水），则心火下降，而西方（肺金）不虚，有什么肺热呢？所以阳明经实则宗筋滋润，能约束骨骼而利于关节运动。治疗痿证的方法，没有超出这个范围的。骆龙吉也说：风火相炽，应当滋补肾水。东垣先生取黄柏为君药，黄芩等药为辅佐，而没有固定的方剂，有兼痰积的，有湿多的，有热多的，有湿热各半的，有挟寒的，根据病情制定方剂，他善于治疗痿证吧！虽然如此，药物切中要害，但如果调护失宜，即使是圣医也治不好。那些患痿证的人，如果不淡薄滋味，我知道他们一定不能平安无事。
生生子说：刘宗浓认为治疗痿证的方剂多缺略，都是因为混入中风条目的缘故，这都是承袭丹溪治疗痿证不得当作风证治疗的说法，这话深得病机旨要。风邪是外入的，所以应当驱散；痿证则是内藏不足所致，治疗唯有补益而已。但是丹溪在痿证篇中，既然以《内经》治痿独取阳明的说法设为疑问了，却不回答所以取阳明经的旨意，而以《难经》泻南补北的方法，摘取作为治疗痿证的方法，这也是法外变通的意思，只是没思考所问取阳明经的意义，究竟阐发了什么，是想彰显它却又遮蔽它。为什么不这样说：阳明经，就是胃，属坤土，是万物赖以生存的根本，为脾之表，脾胃一旦虚弱，肺气先绝，肺虚则不能宣通脏腑，节制经络；必须胃气浓厚则脾气充盛，脾气充盛则能布散津液，使脏腑各有所禀受，四肢健运，如果是这样，那还有什么叶焦，还有什么痿证呢？要知道痿证的始终，只在肺胃之间罢了。肺热叶焦，则不能节制诸经，胃气虚弱，则脏腑无所受气。带脉不能牵引，宗筋枯槁，这就是痿证产生的征兆。所以《内经》治疗痿证，之所以独取阳明经，是因为阳明经是五脏六腑的海。“独”这一个字，是说足以穷尽治疗的言辞。丹溪的泻南补北之法，或许可以施用于肺肾之痿，对于肉痿，敢尝试吗？《内经》说：“肌肉濡渍，痹而不仁，发为肉痿。”启玄子注解说：肉属于脾，脾恶湿，湿气附着肌肉，则卫气不营，所以发为肉痿。据此，那么泻火补水的方法，可以概治肉痿吗？丹溪天资很高，笔力尤其强健。凡是天资高的人，有时一时兴起，随笔成文，或者自执己见认为是正确的，不再重新检查，看篇后盛赞东垣治疗痿证的善处，就可以看出他的天分，可惜他不以东垣的善处反观自身，未免被自以为是所累啊。
Shengshengzi said: There are many people in the world suffering from Wei syndrome (flaccidity syndrome), yet there are few methods for treating it. Examining the *Neijing* (Classic of Internal Canon), a specific chapter is dedicated to this topic, which is not like general discussions on pathogenesis that cover various conditions superficially. The scarcity of treatment methods stems from later generations perhaps failing to fully comprehend the principles of the classics. Now, according to the *Neijing*, "Qi heat" (heat in vital energy) is identified as the root cause for all five types of Wei syndrome. Thus, it can be seen that the fundamental pathology of Wei syndrome originates from Qi heat. Why? At the onset of Wei syndrome, the five Zang organs suffer from "lung heat causing leaf scorching" (pulmonary heat leading to fluid depletion and lung tissue damage), transmitting sequentially to one another. This is because the Lung governs all Qi, serves as the canopy over the Heart, is the chief of the Zang organs, acts as the ministerial official to the sovereign (Heart), and is the seat of governance and regulation. The diseases of the five Wei syndromes likely result merely from the transmission of Qi within the Lung, similar to how a prime minister issues orders to the realm based on a single decree. Observing that treatment focuses solely on the Yangming channel without differentiating among the five types of Wei syndrome reveals that lung heat is the root, while the five Wei syndromes are the branches. Therefore, treating by focusing on Yangming represents unifying the approach ("fixing on one"). The character "qu" (select/take) here implies instructing people to tonify, rather than attacking or purging. Yangming is the sea of the five Zang and six Fu organs, primarily responsible for moistening the Zongjin (general tendons/membranes). Additionally, the Chong vessel is the sea of the meridians. It converges with Yangming at the Zongjin. Yin and Yang converge at the Zongjin, meeting at the Qichuan acupoint, with Yangming acting as their leader; they all belong to the Dai vessel and connect to the Du vessel. When Yangming is deficient, the Zongjin becomes flaccid, and the Dai vessel fails to draw them, resulting in foot weakness and inability to use the legs. By tonifying Yangming, grain Qi becomes abundant, the Chong vessel becomes vigorous, the Dai vessel exerts its pulling force, and the Zongjin is moistened. Consequently, bones are bound and joints function smoothly. Hence, treatment focuses solely on Yangming, regardless of the specific type of Wei syndrome. Since "heat" is established as the root and Yangming as the application, clinical prescription depends on the physician's ability to expand upon these principles; how can books exhaustively state everything?
Danxi stated: In the *Neijing*'s "Treatise on Wei Syndrome," it mentions that lung heat causes leaf scorching, affecting the five Zang organs and leading to Wei syndrome. It also states: "All Wei syndromes belong to the Upper Jiao," indicating that the root of the disease lies in the Lung. Someone asked: Why does the *Neijing* state that the method for treating Wei syndrome focuses solely on Yangming? The answer is: "All Wei syndromes arise from lung heat." This single sentence reveals the main idea of treatment. The *Jing* says: "The East is excess, the West is deficient; drain the South, tonify the North." Although this discusses tonification and draining based on generation and restriction cycles, the great principles do not exceed this framework. Among the Five Elements, Fire has two aspects. Although the Kidney has two, "One Yang is often in excess, and Yin is often insufficient." Thus, the *Jing* states: "One Water cannot overcome Two Fires," which is an inevitable principle. Metal is dry and resides above, governing Qi, and fears Fire. Earth is damp and resides in the center, governing the four limbs, and fears Wood. Fire flares upward. If desires are unregulated, Water loses nourishment, Fire lacks restraint, and thus insults the element it normally controls (Metal). The Lung receives Fire evil and becomes hot. Wood is rigid and urgent. When the Lung suffers from evil heat, Metal loses nourishment, Wood lacks restraint, and thus insults the element it normally controls (Earth). Earth suffers from Wood evil and is injured. Lung heat prevents the regulation of the whole body; Spleen injury prevents the limbs from functioning, causing various Wei syndromes to manifest. Draining the South (Heart Fire) clears Lung Metal, preventing Eastern (Liver Wood) excess, thereby avoiding Spleen injury. Tonifying the North (Kidney Water) descends Heart Fire, preventing Western (Lung Metal) deficiency, thereby avoiding Lung heat. Thus, when Yangming is substantial, the Zongjin is moistened, capable of binding bones and facilitating joint movement. The method for treating Wei syndrome does not go beyond this. Luolongji also said: When Wind and Fire blaze together, one should nourish Kidney Water. Dongyuan selected Huangbai (Phellodendri Cortex) as the sovereign herb, with Huangqin (Scutellariae Radix) and others as assistant herbs, without a fixed formula. Depending on whether there is phlegm accumulation, excessive dampness, excessive heat, half-heat half-dampness, or cold, formulas are adjusted clinically. He was indeed skilled in treating Wei syndrome! Nevertheless, although the medication hits the mark, if nursing care is improper, even a sage doctor cannot cure it. Those suffering from Wei syndrome who do not maintain a bland diet will certainly not remain safe.
Shengshengzi said: Liu Zongnong believed that formulas for treating Wei syndrome are often lacking because they were mixed into the Stroke section. This follows Danxi's view that Wei syndrome should not be treated as wind. This statement deeply grasps the pathological essence. Wind is external, so it should be dispersed; Wei syndrome results from internal deficiency, so treatment relies solely on tonification. However, in his treatise on Wei syndrome, Danxi posed the question regarding the *Neijing*'s principle of focusing solely on Yangming but failed to explain the rationale behind selecting Yangming. Instead, he cited the *Nanjing*'s method of "draining South and tonifying North" as the treatment protocol. This represents flexibility beyond standard methods, yet he did not consider what insight was actually provided regarding the meaning of selecting Yangming. He intended to clarify but instead obscured. Why not say: Yangming refers to the Stomach, belonging to Kun Earth, the source of sustenance for all things. It is the exterior of the Spleen. If Spleen and Stomach become deficient, Lung Qi perishes first. Lung deficiency prevents the dissemination through Zang-Fu organs and regulation of meridians. Only when Stomach Qi is robust does Spleen Qi fill up; when Spleen Qi is full, it can distribute fluids, allowing Zang-Fu organs to receive their respective endowments, and limbs to move vigorously. In such a case, how could there be leaf scorching or Wei syndrome? One must understand that the beginning and end of Wei syndrome lie only between the Lung and Stomach. Lung heat and leaf scorching prevent the regulation of all meridians; Stomach Qi deficiency leaves Zang-Fu organs without received Qi. The Dai vessel fails to pull, and the Zongjin withers, marking the onset of Wei syndrome. Therefore, the *Neijing* treats Wei syndrome by focusing solely on Yangming, because Yangming is the sea of the five Zang and six Fu organs. The word "solely" implies that this approach suffices to encompass the entire treatment. Danxi's method of draining South and tonifying North might apply to Lung and Kidney Wei syndromes, but dare we try it for Muscle Wei syndrome? The *Jing* states: "Muscles are soaked, numb and insensible, developing into Muscle Wei." Qixuanzi commented: Flesh belongs to the Spleen; the Spleen dislikes dampness. When dampness adheres to muscles, Wei Qi fails to nourish, resulting in Muscle Wei. Based on this, can the method of draining fire and tonifying water generally treat Muscle Wei? Danxi had high innate talent and strong writing skills. People with high talent sometimes write impulsively or cling to their own views without rechecking. His praise for Dongyuan's skill in treating Wei syndrome at the end of the chapter reveals his talent. Unfortunately, he did not reflect on Dongyuan's excellence to correct himself, falling victim to self-righteousness.