痹之与痿。二者近似而实不同。盖痹者从外而入。经谓风寒湿三气杂至
合而为痹是也。痿者自内而出。经谓诸痿皆生于肺热是也。痹从外入。则
风寒湿之三气。由皮肤。而筋骨。而脏腑。其留皮肤间者易已。其留连筋骨
间者疼久。其入脏者殆。然风寒湿之中。又分风胜为行痹。则走注疼痛。风
自火出也。湿胜为着痹。则重着而关节不利也。寒胜为痛痹。则周身疼痛
无已时也。三者之邪。既以杂合而至。即以杂合治之。又云痛属火。肿属湿。
尤须察其所胜。而散风之中。间以清火。除湿之内。间以养血。理气之中。间
以豁痰。丹溪不一其治。殆深得病情者与。虽然。此未入于五脏也。若久而
不已。内舍五脏。则喘呕上气。尻肿脊蜷。筋急肢懈诸症见焉。则邪已侵入
阴分。而非复风寒湿之可驱除也矣。经所以即继之曰。阴气者。静则神藏。
躁则消亡。虽不言及治法。而已明示阴气将欲消亡。不可复躁动之。而当
静养之。则所存一线之阴气。不几危且殆哉。且又曰饮食自倍。肠胃乃伤。
又明示患痹者须薄滋味。以饮食居处为其病本故也。若痿则不然。当其
发也。非有风寒湿之三气为患。而唯一本于肺热。又不独一肺热。而心肝
脾胃四脏之气。亦皆热而上熏于肺。肺由是叶焦而生痿 。原其由来。皆
因于思想无穷。所求不得。或入房太甚。宗筋弛纵。或远行劳役。坐卧湿地。
种种侵犯。五脏之阴日耗。五脏之热日炽。于是而为脉痿。为筋痿。为肉痿
骨痿。而肺失治节之令矣。然治之独取阳明。又何也。阳明总宗筋之会。主
束骨而利机关。为五脏六腑之海。合冲脉而渗灌溪谷。又属于带脉。而络
于督脉。盖阳明属燥金喜润。手太阴属兑金。恶燥。明乎此则知治痿之法。
以润燥为第一义。试以天时观之。秋令主燥。则草木黄落。地坼风劲。非假
雨以润之。则亢旱可虞。所以五脏之痿不同。未有不因精血亏损而得。非
此痹症有风寒湿之杂合也。故以治痿之法治痹。则初终不同。以治痹之
法治痿。则断乎其不可。孰谓痹之与痿。可一视之哉。
按余向患行痹。每过劳及饮酒。便肢节肿痛。屈伸不利。手臂痛。用威灵
仙当归秦艽。酒芩枳壳生地陈皮干葛茯苓甘草。足胫痛。加牛膝木瓜
米仁黄柏苍术。投一二剂即减。以之治诸患痹者。有红肿甚。入连翘花
粉。痛甚。入羌活独活。便闭。加桃仁红花。出入加减。亦罔不效。至戊申初
春。二人患此。痛不可忍。用前法。足能伸缩。独手臂拳挛不开。周身大痛
异常。非人抚摩。便不能安。如此者四五旬寻愈。余自二月中旬。亦构此
疾。其痛倍甚。诸药罕应。惟玄武膏瘥妥。痛至五十日。肌肉尽去。日饮粥
数盏。若进人参荤菜则反剧。一友以木通汤进。服之腹中 闷。小便不
利。大便反泻。当晚昏昏默默。气与俱脱矣。越二日。手足拘挛。有死无生。
会一友原梅曹子。先数日诣余商定膏脂药。以痛伤精血。用苁蓉枸杞
当归生地远志茯神枣仁石斛麦冬五味桂圆肉煎就。入玄武膏收贮。
此时幸已煎成四五日矣。亟索饮之。连进三四盏。筋脉顿舒。其痛稍定。
又煎三料。每日清晨饮一大盏。自后饮食倍增。阅月而起坐。又阅月而
起立。又阅月而始步。肌肉方长。后进八味加苁蓉为丸。调理半载余乃
痊。此虽周痹症而以痿法治。向使不与峻补。焉能有更生之日哉。嗣后
永不再发。
虎潜丸
龟板 黄柏（各四两） 知母 熟地黄（各二钱） 牛膝（三两半） 芍药（一两半） 锁阳 虎骨（酥炙） 当
归（各一两） 陈皮（七钱半） 干姜（五钱）
为末。洒糊丸。加附子更妙。
蠲痹饮
秦艽（一钱） 酒芩（一钱） 羌活（六分） 苍术（七分） 酒柏（一钱） 独活（八分） 威灵仙（一钱酒炒）
木瓜（一钱） 米仁（一钱） 红花（三分） 当归（一钱） 桃仁（七粒研） 枳壳（一钱）
加姜三片。水煎。
痹证与痿证，二者看似相似，实则不同。痹证是由外邪侵入所致，《内经》说风寒湿三气混杂侵袭人体，合而为痹，就是这个道理。痿证则是从体内产生，《内经》说各种痿证都源于肺热，就是这个意思。
痹证由外而入，那么风寒湿这三种邪气，先停留在皮肤，进而深入筋骨，再传入脏腑。邪气停留在皮肤间的容易治愈；邪气滞留于筋骨间的，疼痛时间较长；邪气传入内脏的，病情危重。然而，在风寒湿三种邪气中，又根据偏胜情况分为行痹、着痹和痛痹：风气偏胜的叫行痹，表现为疼痛游走不定，这是因为风自火出；湿气偏胜的叫着痹，表现为身体沉重、关节活动不利；寒气偏胜的叫痛痹，表现为周身疼痛无休止。这三种邪气既然混杂而至，治疗时也应当混杂施治。又说疼痛属于火邪，肿胀属于湿邪，尤其需要考察哪种邪气偏胜。在疏散风邪的同时，间杂清火之法；在祛除湿邪的同时，间杂养血之法；在调理气机的同时，间杂豁痰之法。朱丹溪的治疗方法并不固定，大概是深得病情要领的人吧。
虽然如此，上述情况是指邪气尚未进入五脏。如果病程长久不愈，邪气内舍于五脏，就会出现喘息、呕吐、气逆上冲、尾骶部肿胀、脊柱弯曲、筋脉拘急、肢体懈怠等各种症状。这时邪气已经侵入阴分，就不再是单纯的风寒湿邪可以驱除的了。《内经》接着说：“阴气，静则神藏，躁则消亡。”虽然这里没有直接提及治疗方法，但已经明确暗示阴气即将消亡时，不可再使其躁动，而应当静养。否则，所存留的那一线阴气，岂不是危险且濒危了吗？并且《内经》还说：“饮食加倍，肠胃乃伤。”这也明确提示患痹证的人必须清淡饮食，因为饮食起居是导致疾病根本的原因。
至于痿证则不是这样。当它发作时，并没有风寒湿三种邪气为患，而是唯一根源于肺热。而且不仅仅是肺热，心、肝、脾、胃四脏的气机也都化热而上熏于肺，肺因此叶焦枯槁而生痿证。推究其起因，都是因为思虑无穷、求之不得，或者房事过度，导致宗筋弛纵；或者远行劳役、坐卧湿地等种种因素侵犯，致使五脏之阴日渐耗损，五脏之热日渐炽盛。于是出现脉痿、筋痿、肉痿、骨痿，导致肺失去治理调节的功能。
然而治疗痿证为何要“独取阳明”呢？因为阳明经总汇宗筋，主管约束骨骼而利于关节运动，是五脏六腑气血的海源，与冲脉相合并渗灌溪谷，又归属于带脉，联络督脉。大概阳明属燥金而喜润，手太阴肺属兑金而恶燥。明白这个道理，就知道治疗痿证的方法，以润燥为第一要义。试从天时来看，秋季主燥，草木枯黄凋落，大地干裂，风势强劲，如果不借助雨水滋润，就会担心亢旱成灾。所以五脏的痿证虽然表现不同，但没有不是因为精血亏损而得的。这与痹症有风寒湿邪混杂不同。因此，用治疗痿证的方法来治疗痹证，初终效果截然不同；用治疗痹证的方法来治疗痿证，则是绝对不可以的。谁说痹证与痿证可以同等看待呢？
按：我过去患有行痹，每当过度劳累或饮酒后，就会四肢关节肿痛，屈伸不利，手臂疼痛。使用威灵仙、当归、秦艽、酒芩、枳壳、生地、陈皮、干葛、茯苓、甘草等药，若足胫疼痛，加牛膝、木瓜、薏苡仁、黄柏、苍术，服用一两剂即见减轻。我用此方治疗其他患痹证者，若有红肿严重的，加入连翘、花粉；疼痛剧烈的，加入羌活、独活；大便闭结的，加入桃仁、红花。随证加减，无不有效。
到了戊申年初春，有两人患此病，疼痛难以忍受。使用前法，足部能够伸缩，唯独手臂拳挛无法张开，周身剧痛异常，若非人抚摸安抚，便不能安宁。如此过了四五旬才痊愈。我在二月中旬也得了这种病，疼痛加倍严重，各种药物很少见效，只有玄武膏服用后较为稳妥。疼痛持续了五十天，肌肉几乎耗尽，每天只喝几碗粥，如果吃人参或荤菜反而加重病情。一位朋友用木通汤给我服用，服后腹中闷胀，小便不利，大便反而腹泻。当晚昏昏沉沉，气息随之脱失。两天后，手足拘挛，只有死路一条。
恰逢一位朋友原梅曹子，在几天前曾来与我商定膏脂类药物的配方。他认为疼痛损伤精血，于是用肉苁蓉、枸杞、当归、生地、远志、茯神、枣仁、石斛、麦冬、五味子、桂圆肉煎煮，纳入玄武膏中收贮。此时幸好已经煎好四五天了。我急忙索取饮用，连续进服三四盏，筋脉顿时舒展，疼痛稍定。又煎制了三料，每天清晨饮一大盏。此后饮食倍增，一个月后能坐起，又过一个月能站立，再过一个月才能行走。肌肉才开始生长。后来服用八味丸加肉苁蓉制成丸药，调理半年多才痊愈。这虽然是周痹症，却用治痿的方法治疗，假如不使用峻补之法，怎么能有重生的日子呢？此后此病永不再发。
虎潜丸
龟板、黄柏（各四两），知母、熟地黄（各二钱），牛膝（三两半），芍药（一两半），锁阳、虎骨（酥炙）、当归（各一两），陈皮（七钱半），干姜（五钱）。
研为细末，洒糊为丸。加入附子更妙。
蠲痹饮
秦艽（一钱），酒芩（一钱），羌活（六分），苍术（七分），酒柏（一钱），独活（八分），威灵仙（一钱，酒炒），木瓜（一钱），薏苡仁（一钱），红花（三分），当归（一钱），桃仁（七粒，研碎），枳壳（一钱）。
加生姜三片，水煎服。
Bi syndrome and Wei syndrome appear similar but are fundamentally different. Bi syndrome arises from external invasion; as stated in the Classics, "the three pathogens of Wind, Cold, and Dampness mix together to form Bi," which refers to this condition. Wei syndrome originates from within; as stated in the Classics, "all Wei syndromes arise from Lung Heat," which refers to this condition.
Since Bi syndrome enters from the exterior, the three pathogens of Wind, Cold, and Dampness first remain in the skin, then penetrate into the sinews and bones, and finally enter the Zang-Fu organs. Pathogens remaining in the skin are easy to cure; those lingering between the sinews and bones cause prolonged pain; those entering the internal organs indicate a critical condition. However, among the three pathogens of Wind, Cold, and Dampness, they are further classified based on dominance: Wind predominance is called Xing Bi (Wandering Bi), characterized by wandering pain, because "Wind arises from Fire"; Dampness predominance is called Zhuo Bi (Fixed Bi), characterized by heaviness and joint stiffness; Cold predominance is called Tong Bi (Painful Bi), characterized by ceaseless whole-body pain. Since these three pathogens arrive mixed together, treatment should also be mixed. It is also said that pain belongs to Fire, and swelling belongs to Dampness; thus, one must carefully observe which pathogen predominates. When dispersing Wind, clear Fire intermittently; when removing Dampness, nourish Blood intermittently; when regulating Qi, resolve Phlegm intermittently. Zhu Danxi’s treatments were not fixed, suggesting he deeply understood the nature of the disease.
Although this describes cases where pathogens have not yet entered the five Zang organs, if the condition persists for a long time without resolution, pathogens may lodge internally in the five Zang organs. Symptoms such as panting, vomiting, upward rushing of Qi, swelling of the sacrum, spinal curvature, tendon tightness, and limb flaccidity will appear. At this point, pathogens have invaded the Yin aspect, and they can no longer be expelled merely by treating Wind, Cold, or Dampness. The Classics subsequently state: "Yin Qi, when quiet, stores the Spirit; when agitated, it dissipates." Although no specific treatment method is mentioned here, it clearly implies that when Yin Qi is about to dissipate, it must not be agitated further but should be nurtured quietly. Otherwise, the remaining trace of Yin Qi would indeed be in peril. Furthermore, the Classics state: "If food intake doubles, the intestines and stomach are injured." This explicitly advises patients with Bi syndrome to consume bland foods, as diet and lifestyle are the root causes of the disease.
Wei syndrome, however, is different. Upon onset, it is not caused by the three pathogens of Wind, Cold, and Dampness, but solely stems from Lung Heat. Moreover, it is not only Lung Heat; the Qi of the Heart, Liver, Spleen, and Stomach also transform into heat and ascend to熏 (scorch) the Lung, causing the Lung leaves to become dry and leading to Wei syndrome. Tracing its origin, it results from endless thoughts and unfulfilled desires, excessive sexual activity leading to flaccidity of the Zong Jin (major tendons), or overexertion from long journeys, labor, or sitting/lying on damp ground. These various invasions cause the Yin of the five Zang organs to deplete daily, while the Heat of the five Zang organs intensifies daily. Consequently, Mai Wei (Vessel Wei), Jin Wei (Sinew Wei), Rou Wei (Flesh Wei), and Gu Wei (Bone Wei) occur, and the Lung loses its regulatory function.
However, why does treatment of Wei syndrome focus exclusively on the Yangming channel? Because the Yangming channel converges with all Zong Jin, governs binding the bones and facilitating joint movement, serves as the sea of the five Zang and six Fu organs, merges with the Chong vessel to seep into the Xi Gu (valleys/capillaries), connects with the Dai vessel, and links with the Du vessel. Generally, Yangming belongs to Dry Metal and prefers moisture, while the Hand Taiyin Lung belongs to Wet Metal and dislikes dryness. Understanding this, we know that the primary principle in treating Wei syndrome is moistening dryness. Consider the seasons: Autumn governs dryness, causing grass and trees to yellow and fall, the earth to crack, and winds to be fierce. Without rain to moisten, severe drought is feared. Thus, although the Wei syndromes of the five Zang organs differ, none arise without the loss of Essence and Blood. This contrasts with Bi syndrome, which involves mixed Wind, Cold, and Dampness. Therefore, using Wei-treatment methods for Bi yields entirely different results from start to finish; using Bi-treatment methods for Wei is absolutely inadvisable. Who would say Bi and Wei can be treated identically?
Note: I previously suffered from Xing Bi (Wandering Bi). Whenever I overworked or drank alcohol, my limbs and joints would swell and hurt, with limited flexion and extension, and arm pain. Using Lingzhi Xian (Spiritual Agility Immortal), Dang Gui (Angelica Sinensis), Qin Jiao (Gentiana Macrophylla), Jiu Qin (Wine-processed Scutellaria), Zhi Qiao (Aurantium), Sheng Di Huang (Rehmannia Glutinosa), Chen Pi (Citrus Reticulata), Gan Ge (Pueraria Lobata), Fu Ling (Poria), and Gan Cao (Licorice) reduced symptoms after one or two doses. For lower leg and shin pain, I added Niu Xi (Achyranthes Bidentata), Mu Gua (Chaenomelis Fructus), Mi Yi Ren (Coix Seed), Huang Bo (Phellodendron Bark), and Cang Zhu (Atractylodes Rhizome). I used this formula to treat other Bi patients: for severe redness and swelling, I added Lian Qiao (Forsythia Fruit) and Fen Hua (Trichosanthes Flower); for severe pain, I added Qiang Huo (Notopterygium Rhizome) and Du Huo (Angelica Pubescens); for constipation, I added Tao Ren (Prunus Persica Seed) and Hong Hua (Carthamus Tinctorius Flower). With modifications, it was invariably effective.
In early spring of the Wushen year, two patients suffered from this condition with unbearable pain. Using the previous method, their feet could flex and extend, but their arms remained curled and unable to open, with extreme whole-body pain that required touch to alleviate. They recovered after four or five weeks. In mid-February, I contracted this illness myself. The pain was twice as severe, and most medicines were ineffective. Only Xuwu Gao (Black Tortoise Paste) provided relief. The pain lasted fifty days, during which my muscles wasted away. I drank only a few bowls of porridge daily; consuming Ginseng or meat aggravated the condition. A friend administered Mutong Tang (Akebia Decoction). After taking it, I experienced abdominal fullness, difficulty urinating, and diarrhea. That night, I became lethargic, and my Qi seemed to depart. Two days later, my hands and feet became spasmodic, leaving no hope for survival.
Coincidentally, a friend, Yuan Mei Caozi, had visited me a few days prior to discuss a paste prescription. He reasoned that pain damages Essence and Blood, so he prepared a decoction of Cong Rong (Cistanche Deserticola), Gou Qi (Lycium Fruit), Dang Gui (Angelica Sinensis), Sheng Di Huang (Rehmannia Glutinosa), Yuan Zhi (Polygala Root), Fu Shen (Poria with Hostwood), Zao Ren (Ziziphus Seed), Shi Hu (Dendrobium Stem), Mai Dong (Ophiopogon Tuber), Wu Wei Zi (Schisandra Fruit), and Gui Yuan Rou (Longan Aril), which he stored in Xuwu Gao. Fortunately, it had been brewed for four or five days. I urgently requested some and drank three or four cups consecutively. My sinews and vessels immediately relaxed, and the pain subsided slightly. I brewed three more batches, drinking one large cup every morning. Subsequently, my appetite increased significantly. One month later, I could sit up; another month later, I could stand; and yet another month later, I could walk. My muscles began to regrow. Later, I took Ba Wei Wan (Eight-Ingredient Pill) with added Cong Rong as pills, conditioning myself for over half a year until recovery. Although this was Zhou Bi (Generalized Bi), I treated it using Wei-methods. Had I not used strong tonification, how could I have survived? The disease never recurred thereafter.
Hu Huan Wan (Tiger-Hiding Pill)
Gui Ban (Testudinis Carapax et Plastrum), Huang Bo (Phellodendri Cortex) (each 4 liang); Zhi Mu (Anemarrhenae Rhizoma), Shu Di Huang (Rehmanniae Radix Preparata) (each 2 qian); Niu Xi (Achyranthis Bidentatae Radix) (3.5 liang); Shao Yao (Paeoniae Radix Alba) (1.5 liang); Suo Yang (Cistanches Herba), Hu Gu (Pantheris Os, roasted with rice wine), Dang Gui (Angelicae Sinensis Radix) (each 1 liang); Chen Pi (Citri Reticulatae Pericarpium) (0.75 liang); Gan Jiang (Zingiberis Rhizoma) (0.5 liang).
Grind into powder, bind with honey paste to make pills. Adding Fu Zi (Aconiti Lateralis Radix Preparata) is even better.
Juan Bi Yin (Bi-Dispelling Decoction)
Qin Jiao (Gentianae Macrophyllae Radix) (1 qian); Jiu Qin (Scutellariae Radix processed with wine) (1 qian); Qiang Huo (Notopterygii Rhizoma et Radix) (6 fen); Cang Zhu (Atractylodis Rhizoma) (7 fen); Jiu Bai (Phellodendri Cortex processed with wine) (1 qian); Du Huo (Angelicae Pubescentis Radix) (8 fen); Ling Li Xian (Pedalilii Caulis) (1 qian, processed with wine); Mu Gua (Chaenomelis Fructus) (1 qian); Mi Yi Ren (Coicis Semen) (1 qian); Hong Hua (Carthami Flos) (3 fen); Dang Gui (Angelicae Sinensis Radix) (1 qian); Tao Ren (Persicae Semen) (7 grains, crushed); Zhi Qiao (Aurantii Fructus) (1 qian).
Add 3 slices of fresh ginger, decoct in water, and drink.