经义
帝曰∶五脏使人痿，何也？岐伯曰∶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。故肺热叶焦，则皮毛虚弱急薄，着则生痿 也。心气
热，则下脉厥而上，上则下脉虚，虚则生脉痿，枢折挚，胫纵而不任地也。肝气热，则胆泄口苦，筋膜干，则
筋急而挛，发为筋痿。脾气热，则胃干而渴，肌肉不仁，发为肉痿。肾气热，则腰脊不举，骨枯而髓减，发为
骨痿。○帝曰∶论言治痿者，独取阳明何也？岐伯曰∶阳明者，五脏六腑之海，主润宗筋，宗筋主束骨而利机
关也。冲脉者，经脉之海也，主渗灌溪谷，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。故阳明虚，则宗筋纵，带脉不引，故足痿不用也。帝曰∶治之奈何？岐伯曰∶各补其
营，而通其俞，调其虚实，和其逆顺，筋脉骨肉，各以其时受气，则病已矣。○因于湿，首如裹。湿热不攘，大
筋短，小筋弛长， 短为拘，弛长为痿。（《素问》）
哲言
痿属肺金之燥化。如深秋燥甚，则草木萎落而不收，病之象也。手得血而能握，足得血而能步。燥之为
病，血液衰少，不能通畅，故病。然或云∶筋挛有力则为实热，筋缓不收则为虚寒。又谓∶寒主收引，热主舒
缓。而以筋挛为寒，筋缓为热，皆误也。筋挛虽势恶而易愈，筋缓难以平复。（《原病式》）
痿之为状，两足痿弱，不能行用。由于肾水不能胜心火，心火上灼肺金，金受火制，六叶皆焦，皮毛虚弱
急薄，着则生痿 也。《经》曰∶诸痿喘呕，皆属于上。上者，肺金之部分也。痿病无寒，治与痹异。痿病不
死，死者，药之误也。（《儒门事亲》）
内热成痿，此论病之本也。若有感发，必因所挟而致。有湿热者，有湿痰者，有气虚者，有血虚者，有阴
虚者，有死血者，有食积妨碍升降道路者，当明辨之。○湿热痿者，因于雨湿浸淫，以致邪气蒸脾，流于四肢，
自觉足热上腾，或四肢酸 ，或足指麻木，小便赤涩，脉来沉濡而数，此湿热在下之故。所谓湿热不攘，
大筋 短，小筋弛长， 短为拘，弛长为痿者是也。○湿痰痿者，因于肥盛之人，血气不能运动其痰，以致湿
痰内停，客于经脉。腰膝麻痹，四肢痿弱，脉来沉滑，此膏粱酒湿之故。所谓土太过，令人四肢不举者是也。
○气虚痿者，因于饥饿劳倦，脾胃气虚，百骸溪谷，皆失所养，以致宗筋弛纵。凡人病后手足痿弱者，皆属气虚。
所谓脾病不能为胃行其津液，四肢不得禀水谷气，故不用者是也。○血虚痿者，凡产后及诸失血后，面色萎黄，
手足无力，不能行动者是也。○阴虚痿者，由于酒色过度，下焦阴火燔灼筋骨，以致腿膝痿 ，行步艰难，脉
来涩弱，或左大无力。○血瘀痿者，或产后恶露流于腰膝，或跌扑损伤，积血不消，四肢因而不运，脉涩而芤。
○食积痿者，因于饮食太过，妨碍道路，以致升降失常，脾气不得运于四肢，手足痿弱，或腹膨胀痛，恶心嗳气，
右脉沉滑。（《证治汇补》）
痿证之义，内经言之详矣。观所列五脏之证，皆言为热。而五脏之证又总于肺热叶焦，以致金燥水亏，乃
成痿证。如丹溪之论治，诚得之矣。然细察经文，又曰∶悲哀太甚，则包络绝，传为脉痿。思想无穷，所顾不
得，发为筋痿。有渐于湿，以水为事，发为肉痿之类，则又非尽为火证。此其有余不尽之意，犹有可知。故因
此而生火者有之，因此而败伤元气者亦有之。元气败伤，则精虚不能灌溉，血虚不能荣养者，亦不少矣。若概
从火论，则恐真阳亏败，及土衰水涸者，有不能堪。故当酌寒、热之深浅，审虚、实之缓急，以施治疗，庶得
治痿之全矣。（《景岳全书》）
人身有皮毛、血脉、筋膜、肌肉、骨髓，以成其形，内有肝、心、脾、肺、肾主之。若喜怒劳倦，内藏精
血虚耗，血脉、筋骨、肌肉痿弱无力运动，致成痿 。状与柔风香港脚相类。然柔风香港脚皆由外因风寒，正气与
邪气相搏，故作肿痛，为邪气之实也。痿由五内不足，但足不任身，并无痛楚，此血气之虚也。（陈无择）
痿证若草木失于培植，枝叶枯槁，根本犹未大伤。以其不咳
嗽，不吐血，不发寒热，为异于虚劳耳。故久沾床褥而形色绝无病状，亦无痛楚麻木。盖痹证由于三气外伤，
病在经络、血脉之中，气血闭涩者也，尚可作有余治。痿证由于气血不足，受病在五脏六腑之中，不能充固者
也，当纯从不足治。（《冯氏锦囊》）
痿证是肺热叶焦，足软而不任地，不酸痛，不红肿，与痹证异也。肺气热则通阳明，阳明主宗筋，束骨
而利机关，阳明为热所灼，而筋脉弛长。痿病之作，是阳明之热，肺热累及之也。下部属肝肾，根由阴亏髓空，
火逆于肺，肺叶焦枯，金不生水，水益亏，火益炽，筋为热灼，未有不痿 者也。丹溪有东实西虚、泻南补北
之法，壮水之主，以镇阳光，火归窟宅，金不受刑，而阳明亦无肺热之气乘之，宗筋柔和，机关可利耳。譬之
弓逢暑月而力轻，逢寒月而力重，人之筋痿，亦犹是也。痿手者少，痿足者多。痿而不咳，尚可延缠岁月；痿
而咳嗽，虚损将成，死期近矣。愚更谓痿病之来，确在筋脉之间。肺热叶焦，亦是肺叶之脉络焦枯，不是肺脏
焦枯。若是肺脏其叶已焦，火灼之甚，安有足痿在下，而肺金不咳嗽者乎？尚有十年不咳而其人存者乎？《难
经》曰∶一损损于皮毛，皮聚而毛落。痿果肺脏叶枯，则身中毛发尽皆败落矣，何今日之痿病独不然耶？（《会心录》）
补编
肺金体燥而居上主气，畏火者也；脾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，肺受火热，则金失所养，木寡于畏而侮所胜，脾得木邪
而伤矣。肺热则不能管摄一身，脾伤则四肢不能为用，而诸痿作矣。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？阳明实则宗筋润，能束骨而利机关矣。治痿之法，无出于此。
○痿证无寒，不可用热药，以灼其阴。痿属湿热，不可作风治，以风药多燥，而血更伤。当以清金、补精、养
血为主。（朱丹溪）
痿证病因，虽曰不一，大都起于阳明。湿热内蕴，则肺受热乘而日槁，脾受湿淫而日溢，遂成上枯下湿之
候。举世靡不以肾虚为事，至于阳明湿热，从无齿及之者。或云∶痿病既属湿热，何古方多用辛热而愈者？殊
不知湿热沉滞既久，非借辛热之力，不能开通经隧，原非为肾脏虚寒而设也。若真阳未衰，概行温补而不知清
热渗湿，能无反助湿热之患耶？（张路玉）
湿热成痿，乃不足中之有余也，宜渗泄。若精血枯涸成痿，乃不足中之不足也，全要峻补。（李濒湖）
痿病虽分五脏，然其本在肾，其标在肺。《经》云∶五脏因肺热叶焦发为痿 。又曰∶阳气内伐，热舍
于肾，水不胜火，则骨枯而髓虚，故足不任身，发为骨痿。骨痿者，生于大热也。若视为虚寒，而投以附、桂，
多致不救。（叶仲坚）
真气，所受于天，与谷气并而充身者也。故谷入于胃，其气脾为之行于三阳，又复行之于三阴，是五脏六
腑皆禀气于胃，而四肢筋骨肌肉，皆赖以荣养也。阳明胃气既虚，则脏腑无所禀，四肢无所荣，机关不利而成
痿。《内经》治痿独取阳明，厥有旨哉。丹溪以《难经》泻南补北之法，摘为治痿之方，亦是举其例尔。若
胃口不开，饮食少进者，不可拘于此例。（张三锡）
林氏曰∶《内经》皮、肉、筋、骨、脉五痿，既分属五脏，然则独取阳明，只可治脾、肺、皮、肉之痿。
若肝之筋痿，心之脉痿，肾之骨痿，受病不同，岂可仅取阳明而已乎？故治筋痿宜养其肝，脉痿宜益其心，骨
痿宜滋其肾，未可执一而论。《经》云∶各补其营而通其俞，调其虚实云云。可见治痿之法，不专于阳明也。（《赤水玄珠》）
《经》言治痿独取阳明，非谓阳明之虚而补之也。良由火邪伏于胃中，则阳明实矣，阳明实则饮食日倍，
形体日肥，足反废而难步。岂阳明气旺，但能受食，而不能强筋束骨乎？此乃火邪伏于胃中，止可杀谷，而不
能运化精微以生津布液，灌溉百骸，
所谓壮火食气。胃热消谷善饥，故《内经》不言补而言取者，取去阳明所伏之火邪，则湿热清筋骨强，而痿自
起矣。凡此皆以实邪为病立论也。然病名虽一，而虚实各殊。须知虚者正气虚也，实者邪气实也，岂有血气充
足，而筋骨为之不用乎？（《冯氏锦囊》）
痿痹，筋脉短劲，肝气内锢，须亟讲于金伐木荣之道，以金伐木，而木反荣筋反舒矣。然非金气自壅，则
木且奉令不暇，何敢内拒？惟金失其刚，转而为柔，是以木失其柔，转而为刚。故治此患，先以清金为第一义
也。然清金又先以清胃为第一义，不清其胃，则饮酒焉而热气输于肺矣，浓味焉而浊气输于肺矣，药力几何能
胜清金之任哉！金不清，如大敌在前，主将懦弱，已不能望其成功，况舍清金而更加以助火烁金，倒行逆施以
为治耶？（《寓意草》）
经云∶肺热叶焦则生痿 。又云∶治痿独取阳明，以及脉痿、筋痿、肉痿、骨痿之论，可谓详审精密矣。
夫痿之旨，不外肝、肾、肺、胃四经之证。盖肝主筋，肝伤则四肢不用，而筋骨拘挛。肾藏精，精血相生，精
虚则不能灌溉诸末，血虚则不能荣养筋骨。肺主气，肺虚则高源化绝，水涸则不能濡润筋骨。阳明为宗筋之
长，阳明虚则宗筋纵，不能束筋骨以利机关，此不能步履、痿弱筋缩之证作矣。治痿无一定之法，用方无独执
之见。如冲、任虚寒而成痿者，用通阳摄阴兼实奇脉为主。湿热沉着下焦而成痿者，用苦辛寒燥为主。肾阳、
奇脉兼虚而成痿者，用通纳八脉，收拾散越之阴阳。下焦阴虚及肝肾虚而成痿者，用河间饮子、虎潜诸法，填
纳下焦，和肝熄风。阳明脉空，厥阴风动而成痿者，用通摄为主。肝肾虚，兼湿热蒸灼筋骨而成痿者，益下佐
以流通脉络，兼清热利湿。胃虚窒塞，筋骨不利而成痿者，流通胃气，及通利小肠火腑。胃阳、肾督皆虚而成
痿者，治以两固中、下。阳明虚，营络热，及内风动而成痿者，治以清营热、熄内风。肺热叶焦而成痿者，治
以甘寒清上热。邪风入络而成痿者，治以解毒宣行。
精血内夺，奇脉少气而成痿者，治以填补精髓。（《临证指南》）
脉候
痿属肺热传于五脏，脉多浮大，或尺脉虚弱，或缓涩而紧。（《证治汇补》）
选案
朱修之八年痿废，更医累百，毫末无功。予诊六脉有力，饮食若常，此实热内蒸，心阳独亢，证名脉痿。
用小承气汤，下六、七行，左足便能伸缩。再用大承气汤，又下十余行，手可持物。更用黄连、黄芩各一斤，
酒蒸大黄八两，蜜丸，日服四钱，以人参汤送。一月之内，去积滞不可胜数，四肢皆能展舒。余曰∶积滞尽矣，
煎三才膏十斤，服毕应酬如故。○倪君俦四年不能起床，所服寒凉者十之六，补肾肝者十之三。诊脉大而无力，
此营卫交虚，以十全大补汤加秦艽、熟附朝服之，夕用八味丸加牛膝、杜仲、萆 、虎骨、龟版、黄柏，凡三
月而机关利。（李士材）
附方
补北健行汤 治痿证足不任地，真水不足，阳明热灼。生地、熟地、茯苓、丹皮、龟版、女贞子、生苡仁、
丹参、沙参、阿胶、山药。
附拘挛
肝气热，则筋膜干，筋急而挛。○寒多则筋挛骨痛。（《素问》）
大筋 短者热伤，血不能养筋，故为挛；小筋弛长者湿伤，筋不能束骨，故为痿。挛属肝，肝主筋故也。（朱丹溪）
愚按∶拘挛属肝，肝主筋。古书有风、寒、湿、热、血虚之不同，然总不外亡血，筋无荣养，则尽之矣。
盖阴血受伤则血燥，血燥则筋失所养，为拘为挛，势所必至。又何待风、寒、湿、热相袭耶？且精血不亏，虽
有邪干，决无筋脉拘急之病。而病至坚强，其枯可知，治此必以气血为主。若有微邪，通不必治，气血复，血
脉行，邪自不能留，何足虑哉？《经》曰∶精则养神，柔
则养筋。又曰∶足受血而能步，掌受血而能握，指受血而能摄。此之谓也。（《会心录》）
拘挛则急多缓少，寒多热少。《经》谓寒则筋挛是也。其治莫如养血温经，使阳气以和柔之，阴津以灌溉
之。（《冯氏锦囊》）
附瘫痪
气顺血涩则为瘫，筋脉拘急也；血顺气虚则为痪，抬动不能也。瘫者坦也，筋脉弛纵，坦然不举；痪者涣
也，血气散漫，涣然不收。本皆血气不足，不必以左右分，而以湿痰、死血论。（《冯氏锦囊》）
瘫痪虽分左右，然皆精血不足，不能荣养百骸。虽云邪之所凑，其气必虚。迨夫着而不去，亦有湿、痰、
风、热留而为实者，则去邪养正之间，有标有本，固宜以法治之也。（程郊倩）
四肢不举，俗曰瘫痪。《经》谓脾太过，则令人四肢不举。又曰∶土太过则敦阜。阜，高也；敦，浓也。
【经典理论】
黄帝问道：五脏的疾病都能导致痿证，这是为什么呢？岐伯回答说：肺主管身体的皮毛，心主管身体的血脉，肝主管身体的筋膜，脾主管身体的肌肉，肾主管身体的骨髓。所以，如果肺有热邪，会导致肺叶焦枯，进而使皮毛虚弱、紧缩变薄，久则形成痿证。如果心气有热，会导致下部血脉逆乱而上行，上部血脉充盈而下部血脉空虚，下部空虚则形成脉痿，表现为关节枢纽折断般松弛，小腿纵缓不能站立。如果肝气有热，会导致胆汁外泄而口苦，筋膜干燥，进而筋脉拘急挛缩，发为筋痿。如果脾气有热，会导致胃燥口渴，肌肉麻木不仁，发为肉痿。如果肾气有热，会导致腰脊不能挺举，骨骼枯萎、髓液减少，发为骨痿。
黄帝问道：医论中说治疗痿证要专门调理阳明经，这是什么道理呢？岐伯回答说：阳明经是五脏六腑气血的海源，主要滋润宗筋（汇聚于前阴的众多筋脉），宗筋的功能是约束骨骼并利于关节运动。冲脉是十二经脉气血的海源，主要渗透灌溉肌肉纹理间的空隙，它与阳明经会合于宗筋，阴阳诸经总汇于宗筋，交会于气街穴，其中阳明经起主导作用，所有经脉都联系带脉，并络属于督脉。所以，如果阳明经虚弱，宗筋就会松弛，带脉无法牵引，因此导致下肢痿废不能使用。黄帝问道：如何治疗呢？岐伯回答说：分别补益各经的营气，疏通各经的俞穴，调节虚实，调和气血的逆顺，使筋、脉、骨、肉在各自当令之时得到气血滋养，病就能痊愈了。○因受湿邪侵袭，头部感觉像被包裹一样沉重。如果湿热之邪不及时清除，会导致大筋收缩变短，小筋松弛变长，大筋短缩引起拘挛，小筋松弛引起痿废。（出自《素问》）
【名家言论】
痿证属于肺金燥化的病变。就像深秋时节燥气盛行，草木枯萎凋落而无法收敛，这正是疾病的征象。手得到血液滋养才能握物，脚得到血液滋养才能行走。燥邪致病，是因为血液衰少，运行不畅，从而导致疾病。然而有人说：筋脉拘挛且有力属于实热，筋脉弛缓不收属于虚寒。又有人说：寒邪主收引，热邪主舒缓。如果把筋脉拘挛归为寒证，把筋脉弛缓归为热证，都是错误的。筋脉拘挛虽然症状凶险但容易治愈，筋脉弛缓则难以恢复。（出自刘完素《原病式》）
痿证的症状表现是两足痿弱无力，不能行走使用。这是由于肾水不足，不能制约心火，心火上炎灼伤肺金，肺金受火克制，六叶皆焦，皮毛虚弱紧缩，久则生痿。《内经》说：各种痿证伴有喘咳呕吐的，都属于上焦病变。上焦，指的是肺金的部位。痿证没有寒证，治疗方法与痹证不同。痿证本身不会致死，致死的往往是用药错误造成的。（出自张从正《儒门事亲》）
内热导致痿证，这是论述疾病的根本原因。如果有诱发因素，必定夹杂其他病因所致。有的夹湿热，有的夹湿痰，有的气虚，有的血虚，有的阴虚，有的瘀血，有的食积阻碍了气机升降的道路，应当仔细辨别。○湿热导致的痿证，是因为雨湿浸淫身体，致使邪气蒸腾脾胃，流注于四肢，自觉足部发热上腾，或者四肢酸重，或者脚趾麻木，小便赤涩，脉象沉濡而数，这是湿热在下部的缘故。所谓湿热不除，大筋短缩，小筋弛长，短缩为拘挛，弛长为痿废，说的就是这种情况。○湿痰导致的痿证，多见于肥胖之人，气血不能推动痰湿运行，导致湿痰内停，客居于经脉。表现为腰膝麻痹，四肢痿弱，脉象沉滑，这是过食肥甘厚味及饮酒酿生湿气的缘故。所谓土气太过，令人四肢不能抬举，说的就是这种情况。○气虚导致的痿证，多因饥饿劳累，导致脾胃气虚，全身筋骨肌肉失去滋养，以致宗筋弛缓纵纵。凡是病后手足痿弱的，都属于气虚。所谓脾病不能为胃输送津液，四肢得不到水谷精气的供养，所以不能活动，说的就是这种情况。○血虚导致的痿证，多见于产后及各种失血之后，面色萎黄，手足无力，不能行动。○阴虚导致的痿证，由于酒色过度，下焦阴火炽盛，灼伤筋骨，导致腿膝痿软，行走艰难，脉象涩弱，或者左侧脉大无力。○血瘀导致的痿证，或是产后恶露流入腰膝，或是跌打损伤，积血未消，导致四肢不能运化，脉象涩而芤。○食积导致的痿证，因为饮食过量，阻碍气机道路，导致升降失常，脾气不能运送到四肢，手足痿弱，或者腹部胀满疼痛，恶心嗳气，右脉沉滑。（出自李梴《证治汇补》）
痿证的含义，《内经》已经阐述得很详细了。观察所列的五脏痿证，都说与热有关。而五脏的痿证最终归结于肺热叶焦，导致金燥水亏，从而形成痿证。如朱丹溪的治疗理论，确实抓住了要点。然而仔细考察经文，又说：悲哀太甚，会导致心包络脉绝，传变为脉痿；思虑无穷，所愿不得，发为筋痿；渐受湿气，以水为业，发为肉痿之类，这就又不全是火证了。这其中有余不尽的意思，还是可以看出来的。所以，因此而生火的有之，因此败伤元气的也有之。元气败伤，则精虚不能灌溉，血虚不能荣养的情况，也不在少数。如果一概从火证论治，恐怕对于真阳亏损、土衰水涸的患者，会有不堪承受的后果。所以应当斟酌寒热的深浅，审察虚实的缓急，来实施治疗，这样才能全面掌握治疗痿证的方法。（出自张介宾《景岳全书》）
人体有皮毛、血脉、筋膜、肌肉、骨髓，以此构成形体，内有肝、心、脾、肺、肾主宰它们。如果喜怒劳倦，导致内脏精血虚耗，血脉、筋骨、肌肉痿弱无力运动，从而形成痿证。其症状与柔风、香港脚（脚气）相似。然而柔风和香港脚都是由外感风寒引起，正气与邪气相搏结，所以产生肿痛，这是邪气盛的实证。痿证则是由于五脏内部不足，只是脚不能支撑身体，并没有疼痛，这是气血虚的表现。（出自陈无择）
痿证就像草木缺乏培植，枝叶枯槁，但根本尚未受到大伤害。因为它不咳嗽、不吐血、不发寒热，所以区别于虚劳。所以即使长期卧床不起，外形神色却完全没有病态，也没有疼痛麻木。大概痹证是由于风、寒、湿三气外伤，病在经络、血脉之中，气血闭涩阻滞，还可以当作有余（实证）来治疗。痿证是由于气血不足，受病在五脏六腑之中，不能充实坚固的，应当纯粹从不足（虚证）来治疗。（出自冯兆祖《冯氏锦囊》）
痿证是肺热叶焦，导致足部软弱不能承重，不酸痛，不红肿，这与痹证不同。肺气热则波及阳明经，阳明经主管宗筋，约束骨骼并利于关节运动，阳明经被热邪灼烧，导致筋脉弛长。痿病的发生，是阳明经的热邪，由肺热牵连引起的。下部属肝肾，根源在于阴亏髓空，火气上逆于肺，导致肺叶焦枯，金不生水，水更加亏损，火更加炽盛，筋脉被热邪灼烧，没有不痿废的。朱丹溪提出“东实西虚、泻南补北”的方法，即壮水之主以制阳光，使火归窟宅，肺金不受刑克，而阳明经也就没有肺热之气乘袭，宗筋柔和，关节即可灵活。这就像弓在暑月拉力轻，在寒月拉力重一样，人的筋痿也是如此。痿手的人少，痿足的人多。痿而不咳嗽，还可以拖延岁月；痿而兼咳嗽，虚损将成，死期临近了。我认为痿病的起因，确实在筋脉之间。肺热叶焦，也是指肺叶的脉络焦枯，而不是肺脏实体焦枯。如果是肺脏实体已经焦枯，火灼严重，怎么会有下肢痿废而肺金不咳嗽的呢？还有十年不咳嗽而人还活着吗？《难经》说：一损损于皮毛，皮肤聚拢而毛发脱落。如果痿证真是肺脏叶枯，那么身上毛发都应该败落，为什么现在的痿病唯独不是这样呢？（出自吴谦等《医宗金鉴·会心录》部分观点或类似文献）
【补编】
肺金属燥，位居上焦主气，畏惧火邪；脾土性湿，位居中焦主四肢，畏惧木邪。火性炎上，如果嗜欲无节制，则肾水失去滋养，火失去制约而反侮其所胜（金），肺得到火邪而发热。木性刚急，肺受火热，则金失去滋养，木失去制约而反侮其所胜（土），脾得到木邪而受伤。肺热则不能统摄一身，脾伤则四肢不能运用，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，哪里还有脾伤呢？补北方（肾水），则心火下降而西方（肺金）不虚，哪里还有肺热呢？阳明经实则宗筋滋润，能约束骨骼并利于关节运动。治疗痿证的方法，不出于此。○痿证没有寒证，不可用热药，以免灼伤阴液。痿证属湿热，不可按风证治疗，因为风药多燥，会进一步损伤血液。应当以清金、补精、养血为主。（出自朱震亨《丹溪心法》）
痿证的病因，虽然说不止一种，但大多起于阳明经。湿热内蕴，则肺受热邪乘袭而日渐干枯，脾受湿邪淫溢而日渐肿胀，遂成上枯下湿的局面。世人都只注重肾虚，至于阳明湿热，从未有人提及。有人说：痿病既然属湿热，为什么古方多用辛热药而痊愈？殊不知湿热沉滞日久，非借辛热之力，不能开通经络隧道，原本就不是为了肾脏虚寒而设的。如果真阳未衰，一概进行温补而不知清热渗湿，能不有助长湿热之患吗？（出自张璐《张氏医通》）
湿热导致痿证，是属于不足之中的有余（实证），适宜渗利泄热。如果是精血枯涸导致痿证，是属于不足之中的不足（纯虚证），完全需要峻补。（出自李时珍《本草纲目》引李濒湖语）
痿病虽然分为五脏，但其根本在肾，其标在肺。《内经》说：五脏因肺热叶焦而发为痿证。又说：阳气内伐，热邪留舍于肾，水不胜火，则骨骼枯萎而髓液虚空，所以脚不能支撑身体，发为骨痿。骨痿，是由大热引起的。如果视为虚寒，而投以附子、肉桂等大热之药，多导致不治。（出自叶仲坚）
真气，是禀受于先天，并与后天谷气结合以充养全身的。所以食物进入胃中，其精气由脾输送到三阳经，又复行于三阴经，这样五脏六腑都禀受胃气，而四肢筋骨肌肉，都依赖它来营养。如果阳明胃气虚弱，则脏腑无所禀受，四肢无所营养，关节不利而形成痿证。《内经》说治疗痿证独取阳明，确实是有深意的。朱丹溪引用《难经》泻南补北的方法，作为治疗痿证的方案，也只是举例罢了。如果胃口不开，饮食很少进服的，不可以拘泥于这个例子。（出自张三锡）
林氏说：《内经》中的皮、肉、筋、骨、脉五痿，既然分属于五脏，那么所谓的“独取阳明”，只能治疗脾、肺所属的皮、肉之痿。如果是肝的筋痿，心的脉痿，肾的骨痿，受病不同，难道可以仅仅取阳明经吗？所以治疗筋痿应当滋养肝脏，治疗脉痿应当补益心脏，治疗骨痿应当滋补肾阴，不可固执一端而论。《内经》说：分别补益各经的营气而疏通其俞穴，调节虚实等等。可见治疗痿证的方法，并不专于阳明经。（出自孙一奎《赤水玄珠》）
《内经》说治疗痿证独取阳明，并不是说阳明经虚就补它。良由火邪潜伏在胃中，则阳明经实证，阳明实则饮食倍增，身体日渐肥胖，脚反而废用难以行走。难道是阳明气旺，只能受纳食物，而不能强壮筋骨、约束骨骼吗？这是因为火邪潜伏在胃中，只能消磨谷物，而不能运化精微以生津布液，灌溉全身，这就是所谓的“壮火食气”。胃热消谷善饥，所以《内经》不说“补”而说“取”，意思是取去阳明所伏的火邪，则湿热清、筋骨强，痿证自然痊愈。以上都是以实邪致病立论的。然而病名虽同，虚实却各不相同。须知虚的是正气，实的是邪气，哪有气血充足，而筋骨却不用的呢？（出自冯兆祖《冯氏锦囊》）
痿痹，筋脉短缩劲急，是肝气内郁，必须急于讲究“金伐木荣”的道理，以金气克制木气，而木气反而荣润，筋脉反而舒展。然而如果不是金气自壅，则木气尚且奉令不暇，怎敢内拒？只有金气失去刚强，转为柔弱，所以木气失去制约，转为刚强。所以治疗此患，首先以清金为第一要义。然而清金又先以清胃为第一要义，不清理胃气，则饮酒则热气输于肺，浓味则浊气输于肺，药力怎能胜任清金的任务呢！金不清，如同大敌当前，主将懦弱，已不能指望成功，何况舍弃清金而再加助火烁金，倒行逆施来治疗呢？（出自徐大椿《寓意草》）
经文说：肺热叶焦则生痿证。又说：治疗痿证独取阳明，以及脉痿、筋痿、肉痿、骨痿的论述，可谓详尽精密了。痿证的宗旨，不外乎肝、肾、肺、胃四经的病变。盖肝主筋，肝伤则四肢不用，而筋骨拘挛。肾藏精，精血相生，精虚则不能灌溉四肢末端，血虚则不能荣养筋骨。肺主气，肺虚则高源化绝，水涸则不能濡润筋骨。阳明为宗筋之长，阳明虚则宗筋松弛，不能约束筋骨以利机关，于是出现不能步履、痿弱筋缩的病症。治疗痿证没有固定的方法，用方没有独执的见解。如冲、任虚寒而成痿者，用通阳摄阴兼充实奇经八脉为主。湿热沉着下焦而成痿者，用苦辛寒燥为主。肾阳、奇脉兼虚而成痿者，用通纳八脉，收拾散越之阴阳。下焦阴虚及肝肾虚而成痿者，用河间饮子、虎潜丸诸法，填纳下焦，和肝熄风。阳明脉空，厥阴风动而成痿者，用通摄为主。肝肾虚，兼湿热蒸灼筋骨而成痿者，益下佐以流通脉络，兼清热利湿。胃虚窒塞，筋骨不利而成痿者，流通胃气，及通利小肠火腑。胃阳、肾督皆虚而成痿者，治以两固中、下二焦。阳明虚，营络热，及内风动而成痿者，治以清营热、熄内风。肺热叶焦而成痿者，治以甘寒清上热。邪风入络而成痿者，治以解毒宣行。精血内夺，奇脉少气而成痿者，治以填补精髓。（出自叶天士《临证指南医案》）
【脉候】
痿证属于肺热传于五脏，脉象多浮大，或尺脉虚弱，或缓涩而紧。（出自李梴《证治汇补》）
【选案】
朱修之患痿证八年，更换医生上百位，毫无功效。我诊察六脉有力，饮食如常，这是实热内蒸，心阳独亢，证名为脉痿。用小承气汤，排便六七次，左足便能伸缩。再用大承气汤，又排便十余次，手能持物。更用黄连、黄芩各一斤，酒蒸大黄八两，蜜丸，每日服四钱，用人参汤送服。一个月之内，排出的积滞不可胜数，四肢都能舒展。我说：积滞已尽，煎制三才膏十斤，服完后应酬如故。○倪君俦四年不能起床，所服寒凉药占十分之六，补肾肝药占十分之三。诊脉大而无力，这是营卫俱虚，早晨服用十全大补汤加秦艽、熟附子，晚上服用八味丸加牛膝、杜仲、萆薢、虎骨、龟版、黄柏，共三个月而关节灵活。（出自李中梓《医宗必读》引李士材案）
【附方】
补北健行汤：治疗痿证足不能承重，真水不足，阳明热灼。药物组成：生地、熟地、茯苓、丹皮、龟版、女贞子、生苡仁、丹参、沙参、阿胶、山药。
【附拘挛】
肝气热，则筋膜干燥，筋脉拘急而挛缩。○寒邪多则筋挛骨痛。（出自《素问》）
大筋短缩者是热邪损伤，血液不能养筋，所以为拘挛；小筋弛长者是湿邪损伤，筋不能束骨，所以为痿废。拘挛属肝，因为肝主筋。（出自朱震亨）
我按：拘挛属肝，肝主筋。古书有风、寒、湿、热、血虚的不同，但总不外乎亡血，筋脉失去荣养，就是这样了。大概阴血受伤则血燥，血燥则筋脉失去滋养，成为拘挛，是必然的趋势。又何须等待风、寒、湿、热相袭呢？况且精血不亏，虽有邪气干扰，决不会有筋脉拘急的病。而病至坚强，其枯槁可知，治疗此病必须以气血为主。若有微邪，完全不必治，气血恢复，血脉运行，邪气自然不能停留，有什么可忧虑的呢？《内经》说：精则养神，柔则养筋。又说：足受血而能步，掌受血而能握，指受血而能摄。说的就是这个道理。（出自《会心录》）
拘挛则急多缓少，寒多热少。《内经》说寒则筋挛是正确的。治疗不如养血温经，使阳气来调和柔润，阴津来灌溉滋养。（出自冯兆祖《冯氏锦囊》）
【附瘫痪】
气顺血涩则为瘫，表现为筋脉拘急；血顺气虚则为痪，表现为抬动不能。瘫者坦也，筋脉弛纵，坦然不能举起；痪者涣也，血气散漫，涣然不能收摄。本都是血气不足，不必分左右，而应从湿痰、死血来论治。（出自冯兆祖《冯氏锦囊》）
瘫痪虽然分左右，但都是精血不足，不能荣养全身。虽说邪之所凑，其气必虚。等到邪气附着不去，也有湿、痰、风、热留滞而为实证的，则在祛邪扶正之间，有标有本，固然应该依法治疗。（出自程郊倩）
四肢不能举动，俗称瘫痪。《内经》说：脾太过，则令人四肢不举。又说：土太过则敦阜。阜，高也；敦，浓也。
[Classic Theory]
The Yellow Emperor asked: How can diseases of the five zang organs lead to flaccidity syndromes (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 and fascia; the Spleen governs the muscles; and the Kidney governs the bones and marrow. Therefore, if there is heat in the Lung, the lung leaves become scorched and dry, leading to weakness, tightness, and thinning of the skin and hair; if this condition persists, it develops into Wei Syndrome. If there is heat in the Heart Qi, the lower vessels rebel and move upward, causing the upper vessels to be full and the lower vessels to be empty; emptiness in the lower part leads to Mai Wei (Vessel Flaccidity), characterized by a collapse of the joint pivot, with the calves being lax and unable to support the body's weight. If there is heat in the Liver Qi, bile leaks causing bitter taste in the mouth, the fascia becomes dry, leading to tightness and contraction of the sinews, developing into Jin Wei (Sinew Flaccidity). If there is heat in the Spleen Qi, the stomach becomes dry causing thirst, and the muscles become numb, developing into Rou Wei (Muscle Flaccidity). If there is heat in the Kidney Qi, the waist and spine cannot be lifted, the bones become withered, and the marrow decreases, developing into Gu Wei (Bone Flaccidity).
The Yellow Emperor asked: Medical discussions state that treating Wei Syndrome requires focusing solely on the Yangming channel. What is the reason for this? Qi Bo replied: The Yangming channel is the sea of the five zang and six fu organs, primarily moistening the Zong Jin (major sinews converging at the genital region); the Zong Jin binds the bones and facilitates joint movement. The Chong vessel is the sea of the twelve regular channels, primarily seeping and irrigating the muscle valleys. It combines with the Yangming at the Zong Jin. All yin and yang channels converge at the Zong Jin, meeting at the Qichuan point, with the Yangming acting as their leader. They all connect to the Dai Mai (Girdle Vessel) and link to the Du Mai (Governor Vessel). Therefore, if the Yangming is deficient, the Zong Jin becomes lax, and the Dai Mai fails to draw them in, resulting in lower limb flaccidity and inability to use them. The Yellow Emperor asked: How should it be treated? Qi Bo replied: Tonify the Ying (Nutrient) Qi of each respective channel, unblock their Shu (Transport) points, regulate deficiency and excess, and harmonize the reversal and smooth flow of Qi. If the sinews, vessels, bones, and muscles receive Qi at their appropriate times, the disease will resolve. ○ When affected by dampness, the head feels as if wrapped. If damp-heat is not cleared, the large sinews shorten and the small sinews lengthen and relax; shortening causes spasm (Ju Luan), while lengthening and relaxation cause flaccidity (Wei). (From *Su Wen*)
[Masters' Opinions]
Wei Syndrome belongs to the dry transformation of Lung Metal. Just as in late autumn when dryness is severe, grass and trees wither and fall without recovering, this is the image of the disease. Hands can grasp when nourished by blood, and feet can walk when nourished by blood. Disease caused by dryness occurs because blood is deficient and circulation is obstructed. However, some say: Sinew spasm with strength indicates excess heat, while sinew laxity indicates deficiency cold. Others say: Cold causes contraction, while heat causes relaxation. To classify sinew spasm as cold and sinew laxity as heat are both errors. Although sinew spasm appears severe, it is easy to cure; sinew laxity is difficult to recover from. (From Liu Wansu's *Yuan Bing Shi*)
The manifestation of Wei Syndrome is flaccid weakness in both legs, making walking impossible. This is due to Kidney Water failing to control Heart Fire; Heart Fire flares up and scorches Lung Metal. Lung Metal, controlled by fire, has its six leaves scorched, leading to weak, tight skin and hair, which eventually results in Wei Syndrome. The *Classic* states: "All Wei syndromes accompanied by panting and vomiting belong to the Upper Jiao." The Upper Jiao refers to the region of Lung Metal. Wei Syndrome involves no cold patterns; its treatment differs from Bi Syndrome (Painful Obstruction). Wei Syndrome itself is not fatal; death usually results from medication errors. (From Zhang Congzheng's *Ru Men Shi Qin*)
Internal heat causing Wei Syndrome discusses the root of the disease. If there are triggering factors, they must be due to accompanying pathogens. There are cases of damp-heat, damp-phlegm, Qi deficiency, Blood deficiency, Yin deficiency, static blood, and food stagnation obstructing the pathway of ascending and descending Qi; these must be clearly distinguished. ○ For Wei Syndrome caused by damp-heat: Due to immersion in rain and dampness, pathogenic factors steam the Spleen and flow to the four limbs. Patients feel heat rising from the feet or experience soreness in the limbs or numbness in the toes, with dark, scanty urine and a pulse that is deep, soggy, and rapid. This is due to damp-heat in the lower jiao. This corresponds to the saying: "If damp-heat is not cleared, large sinews shorten and small sinews lengthen; shortening causes spasm, lengthening causes flaccidity." ○ For Wei Syndrome caused by damp-phlegm: Common in obese individuals where Qi and Blood cannot move phlegm, leading to internal accumulation of damp-phlegm lodging in the channels. Symptoms include numbness in the waist and knees, flaccid weakness in the limbs, and a slippery pulse. This is due to rich food and alcohol generating dampness. This corresponds to: "Excess Earth causes inability to lift the limbs." ○ For Wei Syndrome caused by Qi deficiency: Due to hunger and overwork, leading to Spleen-Stomach Qi deficiency. The entire body loses nourishment, causing the Zong Jin to relax. Post-illness flaccidity of hands and feet always belongs to Qi deficiency. This corresponds to: "Spleen disease prevents the transmission of fluids from the Stomach; the four limbs do not receive grain Qi, hence they are unusable." ○ For Wei Syndrome caused by Blood deficiency: Common after childbirth or various hemorrhages, presenting with sallow complexion, weak hands and feet, and inability to move. ○ For Wei Syndrome caused by Yin deficiency: Due to excessive sexual activity and drinking, causing Yin fire in the Lower Jiao to scorch the sinews and bones, leading to flaccid knees and legs, difficulty walking, a choppy and weak pulse, or a large but forceless left pulse. ○ For Wei Syndrome caused by Blood stasis: Such as lochia flowing into the waist and knees postpartum, or traumatic injury with unresolved blood stasis, causing immobility of the limbs and a choppy, knotted pulse. ○ For Wei Syndrome caused by Food stagnation: Due to overeating, obstructing pathways, disrupting ascending and descending functions, preventing Spleen Qi from reaching the limbs. Symptoms include flaccid hands and feet, abdominal distension and pain, nausea, belching, and a deep-slippery right pulse. (From Li Chan's *Zheng Zhi Hui Bu*)
The meaning of Wei Syndrome is detailed in the *Nei Jing*. Observing the listed five zang syndromes, all mention heat. Ultimately, the five zang syndromes are summarized by Lung Heat scorching the leaves, leading to Dry Metal and Deficient Water, forming Wei Syndrome. Zhu Danxi's theory of treatment indeed grasps the essence. However, careful examination of the classic text also states: "Excessive grief cuts off the Pericardium vessel, transmitting to Mai Wei"; "Endless thinking with unfulfilled desires leads to Jin Wei"; "Gradual exposure to dampness, working with water, leads to Rou Wei," etc. Thus, it is not entirely a Fire syndrome. There are nuances here. Therefore, some generate fire from this, and some damage Yuan Qi (Primal Qi). Damaged Yuan Qi leads to Essence deficiency failing to irrigate and Blood deficiency failing to nourish, which is quite common. If one generally treats from the perspective of Fire, those with damaged True Yang and depleted Earth/Water may not tolerate it. Therefore, one must weigh the depth of cold and heat, assess the urgency of deficiency and excess, and apply treatment accordingly to fully master the treatment of Wei Syndrome. (From Zhang Jiebin's *Jing Yue Quan Shu*)
The human body has skin/hair, blood vessels, sinews/fascia, muscles, and bones to form its shape, governed internally by the Liver, Heart, Spleen, Lung, and Kidney. If anger, joy, or fatigue deplete internal Essence and Blood, the vessels, sinews, bones, and muscles become flaccid and weak, leading to Wei Syndrome. Its appearance resembles Rou Feng (Soft Wind) or Hong Kong Foot (Gout/Charcot foot). However, Rou Feng and Hong Kong Foot are caused by external Wind-Cold, where healthy Qi battles pathogenic Qi, causing swelling and pain, representing an Excess pattern of pathogens. Wei Syndrome arises from internal insufficiency of the five zang organs; the feet simply cannot support the body, without pain, representing a Deficiency pattern of Qi and Blood. (From Chen Wuzhe)
Wei Syndrome is like plants lacking cultivation; branches and leaves wither, but the roots are not severely damaged. Because there is no coughing, hemoptysis, or chills/fever, it differs from Xu Lao (Consumption). Thus, even if bedridden for a long time, the physical appearance shows no illness, nor pain or numbness. Generally, Bi Syndrome is caused by external invasion of the three pathogens (Wind, Cold, Damp), affecting meridians and vessels, causing Qi and Blood obstruction; it can be treated as an Excess pattern. Wei Syndrome is caused by insufficient Qi and Blood, affecting the five zang and six fu organs, failing to fill and consolidate; it should be treated purely as a Deficiency pattern. (From Feng Zhaozu's *Feng Shi Jin Nang*)
Wei Syndrome is Lung Heat scorching the leaves, causing soft feet unable to bear weight, without soreness or redness/swelling, differing from Bi Syndrome. Lung Heat affects the Yangming channel; Yangming governs the Zong Jin, binding bones and facilitating joints. If Yangming is scorched by heat, sinews and vessels become lax. The onset of Wei Syndrome is due to Yangming heat, implicated by Lung Heat. The lower part belongs to Liver and Kidney, rooted in Yin deficiency and Empty Marrow. Fire rebels against the Lung, scorching Lung leaves, Metal fails to generate Water, Water becomes more deficient, Fire becomes more blazing. Sinews scorched by heat inevitably become flaccid. Danxi proposed "Draining South and Tonifying North" (clearing Heart Fire and tonifying Kidney Water). By strengthening the Master of Water to suppress Solar Fire, Fire returns to its dwelling, Lung Metal is not punished, and Yangming is free from Lung Heat. The Zong Jin becomes soft, and joints function well. It is like a bow losing tension in summer and gaining it in winter; human sinew flaccidity is similar. Few people have hand flaccidity; many have foot flaccidity. Flaccidity without cough allows survival for years; flaccidity with cough indicates impending consumptive disease and death. I further argue that Wei Syndrome originates in the sinews and vessels. "Lung Heat scorching leaves" refers to the scorching of lung collaterals, not the lung organ itself. If the lung organ were truly scorched, how could there be lower limb flaccidity without lung cough? Could anyone survive ten years without coughing? The *Nan Jing* states: "First degree damage affects skin and hair; skin gathers and hair falls." If Wei Syndrome were true Lung leaf withering, all body hair would fall out. Why is current Wei Syndrome different? (From *Hui Xin Lu*)
[Supplement]
Lung Metal is dry, resides in the upper jiao, governs Qi, and fears Fire; Spleen Earth is damp, resides in the middle jiao, governs the four limbs, and fears Wood. Fire flares upward; if desires are unregulated, Water loses nourishment, Fire lacks restraint and insults its conquered element (Metal), causing Lung Heat. Wood is rigid and urgent; if Lung suffers Heat, Metal loses nourishment, Wood lacks restraint and insults its conquered element (Earth), injuring the Spleen. Lung Heat cannot control the body; Spleen injury prevents limb usage, causing various Wei Syndromes. Draining the South (Heart Fire) clears Lung Metal and prevents East (Liver Wood) from becoming excessive, sparing the Spleen. Tonifying the North (Kidney Water) lowers Heart Fire and prevents West (Lung Metal) from becoming deficient, sparing the Lung. When Yangming is full, Zong Jin is moist, binding bones and facilitating joints. The method for treating Wei Syndrome lies herein. ○ Wei Syndrome has no cold patterns; do not use hot medicines to scorch Yin. Wei Syndrome belongs to damp-heat; do not treat as Wind, as wind medicines are drying and injure Blood. Focus on clearing Metal, tonifying Essence, and nourishing Blood. (From Zhu Zhenheng)
Although Wei Syndrome etiology varies, it mostly originates in the Yangming channel. Internal damp-heat causes Lung to be attacked by Heat and wither daily, and Spleen to be invaded by Damp and swell daily, resulting in upper dryness and lower dampness. The world focuses only on Kidney deficiency, ignoring Yangming damp-heat. Some ask: If Wei is damp-heat, why do ancient formulas often use acrid-hot herbs to cure it? They do not realize that long-standing damp-heat requires acrid-hot power to open meridians; it was not originally set for Kidney deficiency-cold. If True Yang is not declined, indiscriminate warming and tonification without clearing heat and draining dampness will surely aggravate damp-heat. (From Zhang Lu)
Damp-heat causing Wei Syndrome is "excess within deficiency," suitable for leaching and draining. If Essence and Blood depletion causes Wei Syndrome, it is "deficiency within deficiency," requiring vigorous tonification. (From Li Shizhen/Li Binhu)
Although Wei Syndrome is divided among five zang organs, its root is in the Kidney, and its branch is in the Lung. The *Classic* says: "Five zang organs develop Wei Syndrome due to Lung Heat scorching leaves." It also says: "Yang Qi invades internally, Heat lodges in the Kidney; Water cannot overcome Fire, bones wither and marrow empties, so feet cannot support the body, developing into Gu Wei." Gu Wei arises from great heat. If viewed as deficiency-cold and treated with Fu Zi (Aconite) and Gui Zhi (Cinnamon Twig), it often leads to untreatable conditions. (From Ye Zhongjian)
Zhen Qi is received from Heaven and combined with Grain Qi to fill the body. Food enters the Stomach; its Qi is distributed by the Spleen to the Three Yang channels, then to the Three Yin channels. Thus, the five zang and six fu organs all receive Qi from the Stomach, and the four limbs, sinews, bones, and muscles rely on it for nourishment. If Yangming Stomach Qi is deficient, organs lack reception, limbs lack nourishment, joints become unfavorable, and Wei Syndrome forms. The *Nei Jing*'s statement that treating Wei Syndrome focuses solely on Yangming is profound. Danxi adopted the *Nan Jing*'s method of Draining South and Tonifying North as a formula for Wei Syndrome, merely giving an example. If appetite is poor and food intake is low, one should not stick rigidly to this example. (From Zhang Sanxi)
Lin said: The *Nei Jing* divides skin, muscle, sinew, bone, and vessel Wei Syndromes among the five zang organs. Therefore, "focusing solely on Yangming" only treats Spleen and Lung (skin and muscle) Wei Syndromes. If Liver Sinew Wei, Heart Vessel Wei, or Kidney Bone Wei are involved, the pathology differs; can one only take Yangming? Thus, treating Sinew Wei should nourish the Liver; Vessel Wei should benefit the Heart; Bone Wei should nourish the Kidney. One cannot adhere to a single approach. The *Classic* says: "Tonify Ying and unblock Shu points, regulate deficiency and excess..." This shows that treating Wei Syndrome is not exclusive to Yangming. (From Sun Yiqui's *Chi Shui Xuan Zhu*)
The *Classic* says "treat Wei Syndrome focusing solely on Yangming," not implying that Yangming deficiency should be tonified. Rather, if Fire Pathogen lurks in the Stomach, Yangming becomes Excess. Yangming Excess leads to increased eating and obesity, yet feet become useless. Is it that Yangming Qi is strong enough to accept food but not strengthen sinews and bones? No. It is because Fire Pathogen lurks in the Stomach, capable only of digesting grain but not transforming fine essences to generate fluids and irrigate the body—this is "Strong Fire consumes Qi." Stomach Heat digests grain and causes hunger. Thus, the *Nei Jing* says "take" (qu) rather than "tonify" (bu): "Take" means removing the lurking Fire Pathogen from Yangming. Then damp-heat clears, sinews and bones strengthen, and Wei Syndrome rises. These arguments are based on Excess pathogens. Although the disease name is the same, deficiency and excess differ greatly. Know that deficiency is Zheng Qi (Upright Qi) deficiency, and excess is Xie Qi (Pathogenic Qi) excess. Can there be abundant Qi and Blood yet unused sinews and bones? (From *Feng Shi Jin Nang*)
Wei-Bi, with short and tense sinews/vessels, involves internal constraint of Liver Qi. One must urgently discuss "Metal conquering Wood to flourish Wood." By using Metal to conquer Wood, Wood flourishes, and sinews relax. However, if Metal does not self-congest, Wood would obey commands and not resist. Only when Metal loses rigidity and becomes soft does Wood lose restraint and become rigid. Thus, treating this requires clearing Metal as the first principle. Clearing Metal requires clearing the Stomach as the first principle. If the Stomach is not cleared, alcohol transmits heat to the Lung, and rich flavors transmit turbidity to the Lung. How can medicine succeed in clearing Metal? If Metal is not cleared, it is like a weak general facing a great enemy; success is impossible. How much worse to abandon clearing Metal and add fire to scorch Metal, acting counterproductively? (From Xu Dacun's *Yu Yi Cao*)
The Classic states: "Lung Heat scorching leaves generates Wei Syndrome." It also states: "Treat Wei Syndrome focusing solely on Yangming," along with discussions on Mai, Jin, Rou, and Gu Wei, which are detailed and precise. The essence of Wei Syndrome concerns the Liver, Kidney, Lung, and Stomach channels. The Liver governs sinews; Liver injury causes limb non-use and sinew/bone spasm. The Kidney stores Essence; Essence and Blood generate each other. Essence deficiency fails to irrigate extremities; Blood deficiency fails to nourish sinews and bones. The Lung governs Qi; Lung deficiency cuts off the high source, Water dries, and sinews/bones are not moistened. Yangming is the leader of Zong Jin; Yangming deficiency causes Zong Jin laxity, failing to bind bones and facilitate joints, leading to inability to walk and flaccid, shortened sinews. Treating Wei Syndrome has no fixed method; using formulas requires no dogmatic views. For Wei due to Chong and Ren deficiency-cold, use Yang-unblocking and Yin-collecting methods focusing on solidifying extraordinary vessels. For Wei due to damp-heat sinking in the lower jiao, use bitter-acrid-cold drying methods. For Wei due to Kidney Yang and extraordinary vessel deficiency, use methods to enter the eight extraordinary vessels and gather scattered Yin and Yang. For Wei due to Lower Jiao Yin deficiency and Liver/Kidney deficiency, use He Jian Yin Zi and Hu Qian Wan methods to fill the lower jiao, harmonize the Liver, and extinguish Wind. For Wei due to empty Yangming pulses and Jueyin Wind stirring, use collection methods. For Wei due to Liver/Kidney deficiency plus damp-heat steaming sinews/bones, tonify the lower and assist with circulating collaterals, clearing heat, and promoting dampness. For Wei due to Stomach deficiency obstruction and sinew/bone dysfunction, circulate Stomach Qi and unblock the Small Intestine Fire Fu. For Wei due to Stomach Yang and Kidney/Du deficiency, solidify the middle and lower jiao. For Wei due to Yangming deficiency, Ying collateral heat, and internal Wind stirring, clear Ying heat and extinguish internal Wind. For Wei due to Lung Heat scorching leaves, use sweet-cold to clear upper heat. For Wei due to Evil Wind entering collaterals, use detoxification and dissemination. For Wei due to internal deprivation of Essence/Blood and Qi deficiency in extraordinary vessels, use methods to fill Essence and Marrow. (From Ye Tianshi's *Lin Zheng Zhi Nan*)
[Pulse Diagnosis]
Wei Syndrome involves Lung Heat transmitting to the five zang organs. Pulses are mostly floating and large, or the Chi (Cun Kou) pulse is weak, or slow, choppy, and tight. (From *Zheng Zhi Hui Bu*)
[Selected Cases]
Zhu Xiuzhi suffered from flaccidity for eight years, seeing over a hundred doctors with no effect. I palpated six pulses that were forceful, and his diet was normal. This was Internal Steaming Excess Heat with solitary Hyperactivity of Heart Yang, diagnosed as Mai Wei (Vessel Flaccidity). I used Xiao Cheng Qi Tang. After six or seven bowel movements, his left foot could flex and extend. I then used Da Cheng Qi Tang. After another ten-plus bowel movements, his hands could hold objects. Next, I prepared pills of Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root) each one jin, and Da Huang (Rhubarb Root) eight liang steamed in wine, taken daily with Ginseng Decoction. Within a month, countless accumulations were expelled, and all four limbs could stretch and relax. I said: Accumulations are exhausted. Now decoct San Gai Gao (Three Capabilities Paste) ten jin. After finishing it, he resumed his activities normally. ○ Mr. Ni Juntao could not get out of bed for four years. He had taken cooling herbs 60% of the time and Liver/Kidney tonics 30% of the time. His pulse was large but forceless, indicating simultaneous deficiency of Ying and Wei. In the morning, he took Shi Quan Da Bu Tang added with Qin Jiao (Magnolia Leaf Gentian Root) and Shu Fu Zi (Prepared Aconite Root). In the evening, he took Ba Wei Wan (Eight-Ingredient Pill) added with Niu Xi (Achyranthes Root), Du Zhong (Eucommia Bark), Bi Xie (Dioscorea Hypoglauca Rhizome), Hu Gu (Tiger Bone - note: banned/substituted in modern practice), Gui Ban (Tortoise Shell), and Huang Bai (Phellodendron Bark). After three months, his joints became flexible. (From Li Shicai)
[Attached Formulas]
Bu Bei Jian Xing Tang (Tonify North and Strengthen Movement Decoction): Treats Wei Syndrome where feet cannot bear weight, True Water is insufficient, and Yangming Heat scorches. Ingredients: Sheng Di Huang (Rehmannia Root), Shu Di Huang (Prepared Rehmannia Root), Fu Ling (Poria), Dan Pi (Moutan Cortex), Gui Ban (Tortoise Shell), Nu Zhen Zi (Ligustrum Fruit), Sheng Yi Yi Ren (Coix Seed), Dan Shen (Salvia Root), Sha Shen (Glehnia Root), E Jiao (Donkey-Hide Gelatin), Shan Yao (Dioscorea Rhizome).
[Attached: Spasm/Contracture]
Liver Heat causes fascia dryness, leading to sinew tightness and contracture. ○ Excess Cold causes sinew contracture and bone pain. (From *Su Wen*)
Shortening of large sinews is due to Heat injury; Blood cannot nourish sinews, causing contracture. Lengthening and relaxation of small sinews are due to Damp injury; sinews cannot bind bones, causing flaccidity. Contracture belongs to the Liver, as the Liver governs sinews. (From Zhu Danxi)
I observe: Contracture belongs to the Liver, which governs sinews. Ancient texts mention differences due to Wind, Cold, Damp, Heat, and Blood deficiency, but ultimately, it all comes down to Blood loss, leaving sinews without nourishment. When Yin Blood is injured, Blood becomes dry; dry Blood fails to nourish sinews, inevitably leading to contracture. Why wait for Wind, Cold, Damp, or Heat to attack? Moreover, if Essence and Blood are not depleted, even with pathogenic interference, there will definitely be no sinew/vessel cramping. If the disease reaches a state of rigidity, its withered nature is evident. Treatment must focus on Qi and Blood. If there are minor pathogens, they need not be specifically treated; once Qi and Blood recover and vessels flow, pathogens cannot remain. What is there to fear? The *Classic* says: "Essence nourishes Spirit; Softness nourishes Sinews." It also says: "Feet receive Blood to walk; palms receive Blood to grasp; fingers receive Blood to hold." This is what is meant. (From *Hui Xin Lu*)
Contracture involves more tension than relaxation, and more Cold than Heat. The *Classic* stating "Cold causes sinew contracture" is correct. Treatment is best achieved by nourishing Blood and warming the meridians, allowing Yang Qi to harmonize and soften, and Yin Fluids to irrigate. (From *Feng Shi Jin Nang*)
[Attached: Paralysis]
Smooth Qi and stagnant Blood result in Tan (Paralysis), characterized by sinew/vessel tension; Smooth Blood and deficient Qi result in Huan (Flaccid Paralysis), characterized by inability to move. "Tan" implies flatness/laxity; sinews and vessels relax, lying flat and unable to rise. "Huan" implies scattering; Qi and Blood scatter, failing to gather. Both originate from insufficient Qi and Blood. There is no need to distinguish left from right; instead, analyze based on Damp-Phlegm and Dead Blood. (From *Feng Shi Jin Nang*)
Although paralysis is distinguished left and right, it is fundamentally due to insufficient Essence and Blood failing to nourish the body. Although it is said that where pathogens gather, Qi must be deficient, when pathogens linger and do not depart, Damp, Phlegm, Wind, and Heat may remain as Excess. Between expelling pathogens and supporting upright Qi, there are branch and root aspects, which should be treated according to proper methods. (From Cheng Jiaoqian)
Inability to move the four limbs is commonly called Tan Huan (Paralysis). The *Classic* states: "Spleen Excess causes inability to move the four limbs." It also says: "Excess Earth leads to Dun Fu." Fu means high; Dun means thick/dense.