张子和曰∶痿之为状，两足痿弱，不能行用。由肾水不能胜心火，心火上烁肺金，肺金受火制，六叶皆
焦，皮毛虚弱，急而薄者，则生痿 。 者，足不能伸而行也。肾水者，肺金之子也。今肾水衰少，随火
上炎，肾主两足，故骨髓衰竭，由使内太过而致。然《至真要大论》云∶诸痿喘呕，皆属于上。上者，上焦
也。三焦者，手少阳相火也。痿、喘、呕三病，皆在膈上，属肺金之部分也。故肌痹传为脉痿，湿痿不仁传为
肉痿，髓竭足 传为骨痿，房室太过为筋痿，传为白淫。大抵痿之为病，皆因客热而成，好欲贪色，强力
过度，渐成痿疾，故痿 属肺，脉痿属心，筋痿属肝，肉痿属脾，骨痰属肾，总由肺受火邪叶焦之故，相传
于四脏，痿病成矣。故疾病无寒，其人脉必浮而大，治之之法，与治痹颇异，风寒湿痹犹可汤蒸燔炙，时或
一效，惟痿用之转甚。盖痿以肺热
为本，叶焦而成痿，以此传于五脏，若作寒治，是不刃而杀也。《内经》谓治痿之法，独取阳明。阳明者，胃
脉也，五脏六腑之海也，主润养宗筋。宗筋主束骨，又主大利机关。机关者，身中大关节也，以司屈伸。
是以阳明虚则宗筋纵，宗筋纵则大脉不伸，两足痿弱。然取阳明者，胃脉也，胃为水谷之诲，人之四季以
胃气为本，本固则精化，精化则髓充，髓充则足能履矣。
丹溪先生曰∶诸痿起于肺热，只此一句，便见治法大意。盖肺金体燥而居上，主气，畏火者也。脾土
性温而居中，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，而诸痿之病作。经曰∶东方实，西方虚，泻南方，补北方。夫泻南方则肺金清而东方
不实，何脾伤之有？补北方则心火降而四方不虚，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∶风火既炽，当滋肾水。
李士材曰∶丹溪之言，治痿当矣，惜乎其未备。经言病本虽五脏各有，而独重太阴肺；治法虽诸经
各调，而独重阳明胃。盖肺主气化，以行令于一身，五脏之热火熏蒸，则金被克而肺热叶焦，故致疾有五
脏之殊，而手太阴之地未有不伤者也。胃主受水谷以灌溉于四肢，肺金之受邪失正，则本无制而侮其所胜，
故治法有五脏之施，而足阳明之地未有或遗者也。然而独取阳明，所谓真气所受于天，与谷并而充身，
阳明虚则五脏无所禀，不能行气血、濡筋骨、利机关，故百体中随其不得受水谷处不用而为痿，不独取阳明
，而何取哉？
丹溪申明泻南补北之说固当，若胃虚减食者，当以芳香辛温
之剂治之。若拘于泻南之说，则胃愈伤矣。诚能本此施治，其于痿思过半矣。治法∶心热脉痿，铁粉、
银箔、黄连、苦参、龙胆草、石蜜、牛黄、龙齿、秦艽、白藓皮、牡丹皮、地骨皮、雷丸、犀角之属；
肝气热筋痿，生地、天冬、百合、紫葳、白蒺藜、杜仲、萆 、菟丝子、川牛膝、黄芩、黄连之属；脾气热
肉痿，二木、二陈、霞天膏之属；肾气热骨痿，金刚丸、牛膝丸、加味四斤丸、煨肾丸；肺热痿，黄 、
天冬、麦冬、石斛、百合、山药、犀角、通草、桔梗、枯芩、山栀、
杏仁、秦艽之属；挟湿热，健步丸加黄柏、苍术、黄芩，或清燥汤；湿痰，二陈、二术、竹沥、姜汁；血虚，
四物汤、二妙散、补阴丸；气虚，四君子汤合二妙散；气血俱虚，十全大补汤；食积，木香槟榔丸；死血，
桃仁、红花、蓬术、川山甲，四物汤；肾肝下虚，补益肾肝丸。
张子和说：痿病的症状是两脚痿弱无力，不能行走使用。这是由于肾水不能制约心火，心火上炎灼烧肺金，导致肺金受火邪克制，六叶肺叶焦枯，皮毛虚弱，紧缩收敛，从而产生痿躄（足不能伸行的病证）。所谓“躄”，就是脚不能伸展而行走。肾水是肺金的子脏。如今肾水衰少，随着火势上炎，肾主司两足，所以骨髓衰竭，这是由房事过度所致。然而《素问·至真要大论》说：各种痿病、喘证、呕吐，都归属于上焦。上焦，指上焦部位。三焦中，手少阳三焦属相火。痿、喘、呕这三种病，都在膈肌以上，属于肺金的管辖范围。所以肌痹传变为脉痿，湿邪导致的痿证麻木不仁传变为肉痿，髓竭足废传变为骨痿，房室过度导致筋痿，进而传变为白淫（男子滑精、女子带下等症）。大抵痿病这种病症，都是因为外感热邪或内蕴热邪而成，喜好色欲、贪恋美色、强力劳作过度，逐渐形成痿疾。所以痿躄属肺，脉痿属心，筋痿属肝，肉痿属脾，骨痿属肾，总归是因为肺受火邪叶焦的缘故，病气相传于其他四脏，痿病就形成了。因此这类疾病没有寒象，病人的脉象必然浮大而有力。治疗的方法，与治痹证颇为不同。风寒湿痹还可以用汤药熏蒸、火灸等方法，有时能取得疗效；唯独痿病如果用这些方法，病情反而会加重。因为痿病以肺热为本，肺叶焦枯而形成痿病，病气由此传于五脏，如果当作寒证来治，无异于不用刀杀人（加速死亡）。《内经》说治疗痿病的方法，独取阳明经。阳明经，即胃脉，是五脏六腑气血的海源，主要滋润濡养宗筋。宗筋主要约束骨骼，又主管关节的灵活运动。关节，就是身体中的大关节，负责屈伸活动。因此阳明经虚则宗筋松弛，宗筋松弛则大脉不能伸展，两脚痿弱无力。然而所谓“独取阳明”，是指胃脉，胃为水谷之海，人的一年四季都以胃气为根本，根本稳固则精气化生，精气化生则骨髓充盈，骨髓充盈则脚能行走。
丹溪先生说：各种痿病起于肺热，仅这一句话，就可见治疗的大意。肺金体性干燥且位居上部，主司气，畏惧火邪。脾土性温且位居中部，主司四肢，畏惧木邪。火性炎上，如果嗜欲没有节制，则肾水失去滋养，火邪因缺少制约而反侮其所胜之金，肺得到火邪而发热。木性刚急，肺受热则金失所养，木邪因缺少制约而反侮其所胜之土，脾得到木邪而受伤。肺热则不能统摄一身之气，脾伤则四肢不能发挥作用，于是各种痿病发作。经文说：东方实（肝木盛），西方虚（肺金虚），泻南方（心火），补北方（肾水）。泻南方心火则肺金清肃而东方肝木不实，哪里还有脾伤的问题？补北方肾水则心火下降而四方不虚，哪里还有肺热的问题？所以阳明经实则宗筋滋润，能约束骨骼并利关节了。治疗痿病的方法，没有超出这个范围的。骆龙吉也说：风火既已炽盛，应当滋补肾水。
李士材说：丹溪的话，对于治疗痿病是正确的，可惜不够完备。经文说病本虽然五脏各有不同，但特别重视太阴肺；治法虽然各经都要调理，但特别重阳明胃。肺主气化，以行令于一身，五脏的热火熏蒸，则金被克伐而肺热叶焦，所以致病有五脏的区别，但手太阴肺经没有不受损伤的。胃主受纳水谷以灌溉四肢，肺金受邪失正，则本无制约而反侮其所胜之木，所以治法有针对五脏的不同施治，但足阳明胃经没有不被顾及的。然而所谓“独取阳明”，是说真气受之于天，与水谷之气结合而充养全身，阳明虚则五脏无所禀受，不能运行气血、濡养筋骨、利关节，所以在百体中随其不能接受水谷营养的地方不用而成为痿病，如果不独取阳明，还取什么呢？
丹溪阐明“泻南补北”的说法固然恰当，但如果胃虚减食的人，应当用芳香辛温的药剂治疗。如果拘泥于“泻南”的说法，则胃气会更加受伤。如果能以此为基础施治，对于痿病的治疗就掌握了一半了。治疗方法：心热导致的脉痿，用铁粉、银箔、黄连、苦参、龙胆草、石蜜、牛黄、龙齿、秦艽、白鲜皮、牡丹皮、地骨皮、雷丸、犀角之类的药物；肝气热导致的筋痿，用地黄、天冬、百合、紫薇花、白蒺藜、杜仲、萆薢、菟丝子、川牛膝、黄芩、黄连之类的药物；脾气热导致的肉痿，用二术（苍术、白术）、二陈（陈皮、半夏）、霞天膏之类的药物；肾气热导致的骨痿，用金刚丸、牛膝丸、加味四斤丸、煨肾丸；肺热导致的痿病，用黄芪、天冬、麦冬、石斛、百合、山药、犀角、通草、桔梗、枯芩、山栀、杏仁、秦艽之类的药物；挟带湿热，用健步丸加黄柏、苍术、黄芩，或者清燥汤；湿痰，用二陈汤、二术、竹沥、姜汁；血虚，用四物汤、二妙散、补阴丸；气虚，用四君子汤合二妙散；气血俱虚，用十全大补汤；食积，用木香槟榔丸；死血（瘀血），用桃仁、红花、蓬术、穿山甲，配合四物汤；肾肝下虚，用补益肾肝丸。
Zi Hezi stated: The manifestation of Wei syndrome (flaccidity syndrome) is flaccid weakness in both legs, rendering them unable to walk or function. This arises because Kidney Water fails to control Heart Fire; the ascending Heart Fire scorches Lung Metal. With Lung Metal constrained by fire, its six lobes become withered and dry, causing the skin and hair to weaken and contract tightly, thereby generating Wei Bi (a condition characterized by inability to extend the feet for walking). "Bi" here refers to the inability to extend the feet to walk. Kidney Water is the child organ of Lung Metal. Currently, with deficient Kidney Water, it follows the fire to ascend. Since the Kidneys govern the two lower limbs, the bone marrow becomes depleted, a condition caused by excessive sexual activity. However, the *Suwen: Zhi Zhen Yao Da Lun* states: "All Wei syndromes, panting, and vomiting belong to the Upper Jiao." The Upper Jiao refers to the upper burner. Among the Three Burners, the Hand-Shaoyang Sanjiao belongs to Ministerial Fire. These three diseases—Wei syndrome, panting, and vomiting—all occur above the diaphragm and fall under the domain of Lung Metal. Thus, Ji Bi (muscle bi) transmits to Mai Wei (vessel flaccidity); Shi Wei (dampness-induced flaccidity) with numbness transmits to Rou Wei (flesh flaccidity); Sui Jie Zu Fei (marrow exhaustion and foot disability) transmits to Gu Wei (bone flaccidity); excessive sexual intercourse leads to Jin Wei (tendon flaccidity), which further transmits to Bai Yin (seminal emission or leukorrhea). Generally, Wei syndrome arises from pathogenic heat. Excessive desire and lust for beauty, along with overexertion, gradually lead to this disease. Therefore, Wei Bi belongs to the Lung, Mai Wei to the Heart, Jin Wei to the Liver, Rou Wei to the Spleen, and Gu Wei to the Kidney. Ultimately, it is due to Lung Metal being affected by fire, causing leaf withering, with the pathology transmitting to the other four zang organs, thus forming Wei syndrome. Consequently, these diseases lack cold signs, and the pulse is typically floating and large. The treatment method differs significantly from that of Bi syndrome. For Wind-Cold-Damp Bi, herbal steaming and moxibustion may occasionally be effective; however, applying such methods to Wei syndrome exacerbates the condition. This is because Wei syndrome originates from Lung Heat and leaf withering, transmitting to the five zang organs. Treating it as a cold disorder is akin to killing someone without using a blade. The *Neijing* states that the treatment for Wei syndrome focuses exclusively on the Yangming channel. Yangming refers to the Stomach meridian, the sea of the five zang and six fu organs, which primarily moistens and nourishes the Zong Jin (major tendons). Zong Jin binds the bones and facilitates joint movement. Joints are the major articulations of the body, responsible for flexion and extension. Therefore, when Yangming is deficient, Zong Jin becomes lax; lax Zong Jin prevents the extension of major vessels, resulting in flaccid weakness of the lower limbs. "Exclusively taking Yangming" refers to the Stomach meridian. The Stomach is the sea of water and grain; human health throughout the four seasons relies on Stomach Qi. If the root is solid, essence is generated; if essence is generated, marrow is filled; if marrow is filled, the feet can walk.
Mr. Danxi stated: "All Wei syndromes originate from Lung Heat." This single sentence reveals the general principle of treatment. Lung Metal is dry in nature and resides in the upper part, governing Qi, and fears Fire. Spleen Earth is warm in nature and resides in the middle, governing the four limbs, and fears Wood. Fire has an upward-flaring nature. If desires are unregulated, Kidney Water loses nourishment. Fire, lacking restraint, insults the metal it normally controls, causing Lung Heat. Wood is rigid and urgent. When the Lung is heated, Metal loses nourishment. Wood, lacking restraint, insults the earth it normally controls, injuring the Spleen. Lung Heat fails to regulate the whole body, and Spleen injury causes the four limbs to cease functioning, leading to the onset of various Wei syndromes. The classic states: "When the East is excess and the West is deficient, drain the South and tonify the North." Draining the Southern Heart Fire clears Lung Metal, preventing Eastern Liver Wood from becoming excessive, thus sparing the Spleen. Tonifying Northern Kidney Water descends Heart Fire, preventing deficiency in the four directions, thus eliminating Lung Heat. Consequently, when Yangming is full, Zong Jin is moistened, able to bind the bones and facilitate joint movement. The treatment of Wei syndrome does not go beyond this principle. Luo Longji also stated: When wind and fire are blazing, one should nourish Kidney Water.
Li Shicai stated: Danxi’s words are correct for treating Wei syndrome but are incomplete. The classics state that although the root of the disease varies among the five zang organs, particular emphasis is placed on the Taiyin Lung; although treatment involves regulating all meridians, particular emphasis is placed on the Yangming Stomach. The Lung governs Qi transformation and commands the body. When heat and fire from the five zang organs steam and scorch, Metal is overcome, leading to Lung Heat and leaf withering. Thus, while the etiology differs among the five zang organs, the Hand-Taiyin Lung is invariably injured. The Stomach receives water and grain to irrigate the four limbs. When Lung Metal is invaded and loses its proper function, it lacks control and insults the wood it normally controls. Thus, while treatments vary according to the five zang organs, the Foot-Yangming Stomach is never neglected. However, "exclusively taking Yangming" implies that true qi is received from heaven and combines with grain qi to fill the body. If Yangming is deficient, the five zang organs have no source, failing to circulate qi and blood, nourish sinews and bones, and facilitate joints. Therefore, any part of the body that cannot receive water and grain nutrients becomes flaccid. If we do not exclusively take Yangming, whom else should we take?
Although Danxi’s clarification of "draining the South and tonifying the North" is appropriate, for patients with deficient Stomach Qi and reduced appetite, aromatic and acrid-warm formulas should be used. Adhering strictly to "draining the South" would further injure the Stomach. If treatment is based on this principle, half of the understanding of Wei syndrome treatment will be mastered. Treatment methods: For Heart Heat causing Mai Wei, use substances such as Iron Powder, Silver Leaf, Coptis Rhizome (Huanglian), Sophora Root (Kushen), Gentian Root (Longdan Cao), Rock Sugar, Realgar (Niuhuang), Dragon Tooth, Gentian Root (Qinjiao), Dictamnus Root Bark (Baixianpi), Moutan Cortex (Mudanpi), Phellodendron Bark (Digupi), Ophiocordyceps (Leiwan), and Rhinoceros Horn (Xijiao); for Liver Qi Heat causing Jin Wei, use Rehmannia Root (Shengdi), Asparagus Tuber (Tiangong), Lily Bulb (Baihe), Trumpet Vine Flower (Ziwei), Tribulus Fruit (Bajili), Eucommia Bark (Duzhong), Dioscorea Hypoglauca Rhizome (Bixie), Dodder Seed (Tusizi), Achyranthes Root (Chuan Niuxi), Scutellaria Root (Huangqin), and Coptis Rhizome (Huanglian); for Spleen Qi Heat causing Rou Wei, use Atractylodes Macrocephala and Bitter Atractylodes (Er Zhu), Dried Tangerine Peel and Pinellia Tuber (Er Chen), and Xiataian Gao; for Kidney Qi Heat causing Gu Wei, use Jingang Wan, Niuxi Wan, Jiawei Sijin Wan, and Weishen Wan; for Lung Heat causing Wei, use Astragalus Root (Huangqi), Asparagus Tuber (Tiandong), Ophiopogon Tuber (Maidong), Dendrobium Stem (Shihu), Lily Bulb (Baihe), Chinese Yam (Shanyao), Rhinoceros Horn (Xijiao), Akebia Stem (Tongcao), Platycodon Root (Jiegeng), Scorched Scutellaria Root (Kuqing), Gardenia Fruit (Shanzhi), Apricot Kernel (Xingren), and Gentian Root (Qinjiao); for cases complicated by Damp-Heat, use Jianbu Wan added with Phellodendron Bark (Huangbai), Atractylodes Rhizome (Cangzhu), and Scutellaria Root (Huangqin), or Qingzao Tang; for Damp-Phlegm, use Erchen Tang, Er Zhu, Bamboo Sap (Zhuli), and Ginger Juice (Jiangzhi); for Blood Deficiency, use Siwu Tang, Ermiao San, and Buyin Wan; for Qi Deficiency, combine Sijunzi Tang with Ermiao San; for combined Qi and Blood Deficiency, use Shiquan Dabu Tang; for Food Stagnation, use Muxiang Binglang Wan; for Fixed Blood (Blood Stasis), use Peach Kernel (Taoren), Safflower (Honghua), Curcuma Zedoina (Pengzhu), Pangolin Scales (Chuanshanjia), combined with Siwu Tang; for Lower Deficiency of Kidney and Liver, use Buyi Shen Gan Wan.