五痿皆因肺热生，阳明无病不能成，肺热叶焦皮毛瘁，发为痿 不能行，心热脉痿
胫节纵，肾骨腰脊不能兴，肝筋拘挛失所养脾肉不仁燥渴频。
【注】五痿，心、肝、脾、肺、肾之痿也。痿属燥病，故皆因肺热而生也，阳明者，五
脏六腑之海，主润宗筋。阳明无病，则宗筋润、能束骨而利机关，虽有肺热不能成痿也。
肺热叶焦，阳明虚弱，津液不化，筋骨失养，皮毛瘁痿，发为痿 不能行也，因而心气热
为脉痿，则胫节纵而不任地，肺兼心病也。因而肾气热为骨痿，则腰脊不能兴举，肺兼肾
病也。因而肝气热为筋痿，则筋失所养，拘挛不伸，肺兼肝病也。因而脾气热为肉痿，则
胃燥而渴，肌肉不仁，肺兼脾病也。
痿病足兮痹病身，仍在不疼痛里分，但观治痿无风药，始晓虚实别有因。
【注】痿痹之证，今人多为一病，以其相类也。然痿病两足痿软不痛，痹病通身肢节
疼痛。但观古人治痿，皆不用风药，则可知痿多虚，痹多实，而所因有别也。
痿燥因何治湿热，遵经独取治阳明，阳明无故惟病肺，胃壮能食审证攻，控涎小胃
湿痰热，阳明积热法三承，胃弱食少先养胃，久虚按证始收功。
【注】痿属燥病，因何而用治湿热苦燥之药？盖遵《内经》之治法，独取于阳明胃也。
故胃家无病，虽有肺热，惟病肺而不病痿也。是知病痿者，胃家必有故也，或湿热、或积
热、或湿痰，不论新久，若胃壮能食，当先审证攻之。胃有湿痰，用控涎丹攻之。有湿
热者，用小胃丹攻之，有积热者，用三承气汤攻之。此治胃壮能食之法也。若胃弱饮食
减少，气血津液不足，当先以补养脾胃为主。其有久病留连，诸虚燥热，或攻下之后调理，
当审证治之，始收全功也。
加味二妙汤
加味二妙湿热痿，两足痿软热难当，防己当归川萆 ，黄柏龟版膝秦苍。
【注】热难当，谓两足热难当也。膝秦苍，谓牛膝、秦艽、苍术也。
清燥汤 虎潜丸 十全大补汤 加味金刚丸
时令湿热清燥效，阴虚湿热虎潜灵，久虚痿软全金主，萆瓜牛菟杜苁蓉。
【注】清燥汤在内伤门。虎潜丸有成方。全金主，谓十全大补汤、加味金刚丸，久病
气血虚，以十全大补汤为主；筋骨痿软，以加味金刚丸为主。加味金刚丸，即萆 、木
瓜，牛膝、菟丝子、杜仲、肉苁蓉也。
五种痿证皆因肺热而生，若阳明经没有病变则不能形成痿证。肺热导致肺叶焦枯、皮毛憔悴，进而发展为肢体痿软无法行走；心热导致脉痿，表现为小腿关节松弛无力；肾热导致骨痿，表现为腰脊无法挺立；肝热导致筋痿，表现为筋脉拘挛且失去滋养；脾热导致肉痿，表现为肌肉麻木不仁、口干燥渴且频繁饮水。
【注】五痿，指心、肝、脾、肺、肾五脏对应的痿证。痿证属于燥病，因此都因肺热而产生。阳明经是五脏六腑气血的海源，主要滋润宗筋（汇聚于前阴的大筋）。如果阳明经没有病变，那么宗筋得到滋润，就能约束骨骼并利于关节运动，即使有肺热也不能形成痿证。肺热导致肺叶焦枯，加上阳明虚弱，津液无法化生，筋骨失去滋养，皮毛憔悴痿废，从而发为肢体痿软无法行走。由此，心气热成为脉痿，则小腿关节松弛无法承重着地，这是肺兼心病。由此，肾气热成为骨痿，则腰脊无法抬起举重，这是肺兼肾病。由此，肝气热成为筋痿，则筋脉失去滋养，拘挛不能伸展，这是肺兼肝病。由此，脾气热成为肉痿，则胃中干燥而口渴，肌肉麻木不仁，这是肺兼脾病。
痿病主要在足部，痹病主要在身体其他部位，区别在于是否疼痛。只要观察治疗痿证不使用祛风药，才明白虚实病因是不同的。
【注】痿证和痹证的病症，现在的人多视为一种病，因为它们相似。然而痿证是双足痿软但不疼痛，痹证则是全身肢节疼痛。只要观察古人治疗痿证，都不使用祛风药，就可以知道痿证多属虚证，痹证多属实证，其致病原因是有区别的。
痿证本是燥病，为何用治湿热的方法？遵循经典，专门选取调理阳明经的方法。阳明经若无病变，只会影响肺，不会导致痿证。胃功能强壮能进食时，应仔细辨证后攻邪；若有湿痰热，可用控涎丹或小胃丹；若阳明积热，采用三承气汤法；若胃弱食少，先养胃气，久病体虚再按证调理才能见效。
【注】痿证属于燥病，为什么使用治疗湿热苦燥的药物？这是因为遵循《内经》的治疗法则，专门取法于阳明胃经。所以胃家没有疾病，即使有肺热，也只是肺病而不会形成痿证。因此知道患痿证的人，胃家一定有病变。或者是湿热，或者是积热，或者是湿痰，不论新病久病，如果胃壮能食，应当先审察证候进行攻伐治疗。胃有湿痰，用控涎丹攻逐。有湿热者，用小胃丹攻逐，有积热者，用三承气汤攻逐。这是治疗胃壮能食的方法。如果胃弱饮食减少，气血津液不足，应当先以补养脾胃为主。那些久病缠绵，各种虚损燥热，或者攻下之后的调理，应当审察证候治疗，才能取得完全的效果。
加味二妙汤：针对湿热导致的痿证，双足痿软且热感难以忍受，方中含防己、当归、川萆薢、黄柏、龟版、牛膝、秦艽、苍术。
【注】“热难当”，是指双足发热难以忍受。“膝秦苍”，是指牛膝、秦艽、苍术。
清燥汤、虎潜丸、十全大补汤、加味金刚丸：时令湿热用清燥汤效果显著，阴虚湿热用虎潜丸灵验，久病体虚痿软以十全大补汤为主，方中含萆薢、瓜蒌、牛膝、菟丝子、杜仲、肉苁蓉。
【注】清燥汤记载在内伤门中。虎潜丸已有成方。全金主，指十全大补汤和加味金刚丸，久病气血虚弱，以十全大补汤为主；筋骨痿软，以加味金刚丸为主。加味金刚丸，即由萆薢、木瓜、牛膝、菟丝子、杜仲、肉苁蓉组成。
The five types of Wei syndrome (flaccidity syndrome) all arise from Lung heat; without pathology in the Yangming channel, they cannot form. Lung heat scorches the lung leaves and causes the skin and hair to wither, leading to flaccidity where movement is impossible. Heart heat leads to Mai Wei (pulse flaccidity), characterized by laxity of the lower leg joints. Kidney heat leads to Gu Wei (bone flaccidity), characterized by the inability to raise the waist and spine. Liver heat leads to Jin Wei (tendon flaccidity), characterized by tendon spasms and loss of nourishment. Spleen heat leads to Rou Wei (muscle flaccidity), characterized by muscle numbness, dryness, thirst, and frequent drinking.
[Note] The "Five Weis" refer to the flaccidity syndromes associated with the Heart, Liver, Spleen, Lung, and Kidney. Wei syndrome belongs to dryness diseases, thus arising from Lung heat. The Yangming channel is the sea of the five zang and six fu organs, primarily moistening the Zong jin (major tendons). If the Yangming channel has no pathology, the Zong jin are moistened, capable of binding the bones and facilitating joint movement; even with Lung heat, Wei syndrome cannot form. Lung heat scorches the lung leaves, combined with Yangming deficiency, preventing the transformation of body fluids. Without nourishment for the sinews and bones, the skin and hair wither and become flaccid, resulting in limb flaccidity and inability to walk. Consequently, Heart qi heat becomes Mai Wei (pulse flaccidity), causing the lower leg joints to be lax and unable to bear weight on the ground; this is Lung disease combined with Heart disease. Consequently, Kidney qi heat becomes Gu Wei (bone flaccidity), causing the waist and spine to be unable to rise or lift; this is Lung disease combined with Kidney disease. Consequently, Liver qi heat becomes Jin Wei (tendon flaccidity), causing the sinews to lose nourishment, spasm, and fail to extend; this is Lung disease combined with Liver disease. Consequently, Spleen qi heat becomes Rou Wei (muscle flaccidity), causing stomach dryness and thirst, and muscle numbness; this is Lung disease combined with Spleen disease.
Wei syndrome affects the feet, whereas Bi syndrome (painful obstruction syndrome) affects the body; the distinction lies in the presence or absence of pain. Observing that ancient treatments for Wei syndrome do not use wind-dispelling herbs reveals that the etiologies of deficiency and excess are distinct.
[Note] The conditions of Wei syndrome and Bi syndrome are often considered one disease today due to their similarities. However, Wei syndrome presents with flaccidity and weakness in both legs without pain, while Bi syndrome involves pain throughout the limbs and joints. Observing that ancient practitioners did not use wind-dispelling herbs when treating Wei syndrome indicates that Wei syndrome is mostly deficiency, whereas Bi syndrome is mostly excess, and their causes differ.
Why treat Wei syndrome, a dryness condition, with methods for damp-heat? Follow the classics by exclusively targeting the Yangming channel. If the Yangming channel is healthy, Lung heat will only affect the Lung, not cause Wei syndrome. Thus, those suffering from Wei syndrome must have pathology in the Stomach/Yangming. This may be damp-heat, accumulated heat, or damp-phlegm. Regardless of whether it is new or chronic, if the Stomach is strong and appetite is good, first examine the syndrome and apply purgative methods. For damp-phlegm in the Stomach, use Kong Xian Dan (Phlegm-Controlling Pill) to purge. For damp-heat, use Xiao Wei Dan (Minor Stomach-Purging Pill). For accumulated heat, use the Three Chengqi Decoctions method. This is the method for treating strong Stomachs with good appetite. If the Stomach is weak with reduced intake, leading to insufficiency of Qi, blood, and body fluids, prioritize tonifying and nourishing the Spleen and Stomach. For prolonged lingering illness with various deficiencies and dryness-heat, or for regulation after purgation, examine the syndrome and treat accordingly to achieve full efficacy.
Jia Wei Er Miao Tang (Modified Two Marvels Decoction): Treats Wei syndrome caused by damp-heat, where the two legs are flaccid and the heat is unbearable. Ingredients include Fangji (Stephaniae Tetrandrae Radix), Danggui (Angelicae Sinensis Radix), Chuan Bixie (Dioscoreae Hypoglaucae Rhizoma), Huangbai (Phellodendri Cortex), Guiban (Testudinis Carapax et Plastrum), Niu Xi (Achyranthis Bidentatae Radix), Qin Jiao (Gentianae Macrophyllae Radix), and Cang Zhu (Atractylodis Rhizoma).
[Note] "Heat unbearable" refers to the intense heat in the two legs. "Xi Qin Cang" refers to Niu Xi, Qin Jiao, and Cang Zhu.
Qing Zao Tang (Clear Dryness Decoction), Hu Qian Wan (Tiger's Latent Pill), Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction), Jia Wei Jin Gang Wan (Modified Diamond Pill): For seasonal damp-heat, Qing Zao Tang is effective; for Yin deficiency with damp-heat, Hu Qian Ling is efficacious; for prolonged deficiency and flaccidity, Shi Quan Da Bu Tang is primary. Ingredients for the latter context include Bixie, Gualou, Niu Xi, Tusizi, Duzhong, and Rongcongrou.
[Note] Qing Zao Tang is recorded in the Internal Injury section. Hu Qian Wan exists as a established formula. "Quan Jin Zhu" refers to Shi Quan Da Bu Tang and Jia Wei Jin Gang Wan. For prolonged illness with Qi and Blood deficiency, Shi Quan Da Bu Tang is primary; for sinew and bone flaccidity, Jia Wei Jin Gang Wan is primary. Jia Wei Jin Gang Wan consists of Bixie, Mugua, Niu Xi, Tusizi, Duzhong, and Rongcongrou.