脉 脉浮洪。缓滑。右寸浮大而涩。浮缓为虚。洪大为热。滑则多痰涩而少血。
症 丹溪云∶内经言诸痿生于肺热。又谓治痿独取阳明胃。盖肺金体燥。居上。而主气。畏
火者也。脾土性湿居中。而主四肢。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。金肺得火邪而热矣。火性刚急。肺受热。则金失所养。木寡于畏而侮所胜
。土脾得木邪而伤矣。肺热则不能管摄一身。脾伤则四肢不能为用。而诸痿作矣。经虽有筋
脉骨肉之分。一皆主于肺热。临症宜详审之。
治 东垣取横柏苍术为君。黄 当归为佐。以治诸痿。无一定之方。有温多者。有热多者。
有温热相伴。有挟风者。临病制方。其善于治痿者欤。又云∶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。虽然。天产作阳。浓味发热。凡病痿者。若不淡薄
食味。必不能保其全安也。
方 加减清燥汤治诸痿通用。
人参（七分） 黄 （一钱五分） 归身（一钱五分） 麦门冬（一钱） 黄柏（一钱） 苍术（一钱）
黄芩（八分） 五味（九粒） 生地黄（七分） 升麻（二分） 柴胡（三分） 甘草（三分） 白
术陈皮 白茯苓（各八分） 泽泻（五分）
上作一服。姜一片。枣一枚。煎。食远服。
兼风者。加姜活、独活、桑寄生。
兼湿者。加木瓜、防己、薏苡仁。
脉象：脉象浮洪、缓滑。右寸脉浮大而涩。浮缓表示虚证，洪大表示热证，滑脉主多痰，涩脉主血少。
症状：朱丹溪说：《内经》指出各种痿证都产生于肺热。又说治疗痿证应独取阳明胃经。这是因为肺金体性干燥，位居上焦，主管气机，畏惧火邪；脾土体性湿润，位居中焦，主管四肢，畏惧木邪。火性炎上，如果嗜欲没有节制，就会使肾水失去滋养，导致火邪因缺乏制约而反侮其所胜之脏（即火克金）。肺金受到火邪侵害而产生热证。火性刚烈急迫，肺受热邪后，金失所养；同时木因缺乏制约而反侮其所胜之脏（即木克土），脾土受到木邪侵害而受伤。肺热则不能统摄全身，脾伤则四肢不能正常活动，于是各种痿证就发生了。虽然经络中有筋、脉、骨、肉的区别，但都主要归属于肺热。临证时应当详细审察。
治法：李东垣选用黄柏、苍术作为君药，黄芪、当归作为佐药，来治疗各种痿证。并没有固定不变的方剂，有的患者湿邪偏重，有的热邪偏重，有的湿热相伴，有的兼夹风邪。根据病情灵活制定方剂，这才是善于治疗痿证的方法。他又说：清泻南方心火，则肺金得以清凉，东方肝木就不会过于亢盛，脾土又怎么会受伤呢？补益北方肾水，则心火下降，西方肺金就不会虚弱，肺热又怎么会存在呢？所以阳明经充实，宗筋就能滋润，能够约束骨骼并利于关节运动。治疗痿证的方法，不出于此。虽然如此，动物性食物属阳，厚味容易生热，凡是患痿证的人，如果不饮食清淡，一定不能保全健康。
方剂：加减清燥汤，治疗各种痿证的通用方。
人参（七分） 黄芪（一钱五分） 当归身（一钱五分） 麦门冬（一钱） 黄柏（一钱） 苍术（一钱） 黄芩（八分） 五味子（九粒） 生地黄（七分） 升麻（二分） 柴胡（三分） 甘草（三分） 白术、陈皮、白茯苓（各八分） 泽泻（五分）
以上药材为一服量，加生姜一片、大枣一枚，煎煮，饭后服用。
兼有风邪者，加羌活、独活、桑寄生。
兼有湿邪者，加木瓜、防己、薏苡仁。
Pulse: The pulse is floating and surging, or slow and slippery. The right Cun position is floating, large, and choppy. Floating and slow indicates deficiency; surging and large indicates heat; slippery indicates excessive phlegm; choppy indicates blood deficiency.
Symptoms: Zhu Danxi stated: The *Neijing* states that all types of Wei syndrome (flaccidity syndrome) arise from lung heat. It also states that in treating Wei syndrome, one should exclusively focus on the Yangming Stomach meridian. This is because Lung Metal has a dry nature, resides in the upper jiao, governs Qi, and fears Fire. Spleen Earth has a damp nature, resides in the middle jiao, governs the four limbs, and fears Wood. Fire nature flares upward. If desires are unrestrained, Kidney Water loses its nourishment, causing Fire to lack restraint and overact upon its controlled element (Metal). Lung Metal suffers from Fire pathogen and becomes hot. Fire nature is rigid and urgent. When the Lung suffers heat, Metal loses nourishment; simultaneously, Wood lacks restraint and overacts upon its controlled element (Earth), injuring Spleen Earth. Lung heat fails to control the whole body; Spleen injury causes the four limbs to be unusable, thus various Wei syndromes arise. Although there are distinctions among tendons, vessels, bones, and flesh in the meridians, they are all primarily governed by lung heat. In clinical practice, careful examination is required.
Treatment: Li Dongyuan selected Huangbai (Phellodendri Cortex) and Cangzhu (Atractylodis Rhizoma) as sovereign drugs, and Huangqi (Astragali Radix) and Danggui (Angelicae Sinensis Radix) as minister drugs, to treat various Wei syndromes. There is no fixed formula. Some cases have more dampness, some more heat, some have both dampness and heat, and some are complicated by wind. Formulas should be adapted according to the disease; this is the skillful approach to treating Wei syndrome. He further stated: Clearing the Southern Heart Fire clears Lung Metal, preventing Eastern Liver Wood from becoming excessive, so how could Spleen Earth be injured? Tonifying Northern Kidney Water descends Heart Fire, preventing Western Lung Metal from becoming deficient, so how could Lung Heat exist? Therefore, when the Yangming meridian is sufficient, the Zongjin (major sinews) are moistened, able to bind the bones and facilitate joint movement. The method for treating Wei syndrome does not go beyond this. Nevertheless, animal products are yang in nature, and rich flavors generate heat. Patients with Wei syndrome must maintain a bland diet to preserve their health.
Formula: Jiajian Qingzao Tang (Modified Clear-Dryness Decoction) is a general formula for treating various Wei syndromes.
Renshen (Ren Shen, Ginseng Radix et Rhizoma) (7 fen), Huangqi (Huang Qi, Astragali Radix) (1.5 qian), Danggui (Dang Gui, Angelicae Sinensis Radix) (1.5 qian), Maimendong (Mai Men Dong, Ophiopogonis Tuber) (1 qian), Huangbai (Huang Bai, Phellodendri Cortex) (1 qian), Cangzhu (Cang Zhu, Atractylodis Rhizoma) (1 qian), Huangqin (Huang Qin, Scutellariae Radix) (8 fen), Wuweizi (Wu Wei Zi, Schisandrae Chinensis Fructus) (9 grains), Shengdihuang (Sheng Di Huang, Rehmanniae Radix) (7 fen), Shengma (Sheng Ma, Cimicifugae Rhizoma) (2 fen), Chaihu (Chai Hu, Bupleuri Radix) (3 fen), Gancao (Gan Cao, Glycyrrhizae Radix et Rhizoma) (3 fen), Baizhu (Bai Zhu, Atractylodis Macrocephalae Rhizoma), Chenpi (Chen Pi, Citri Reticulatae Pericarpium), Baifuling (Bai Fu Ling, Poria) (each 8 fen), Zexie (Ze Xie, Alismatis Rhizoma) (5 fen).
Take all ingredients as one dose. Add one slice of fresh ginger and one date. Decoct and take after meals.
For cases complicated by wind, add Qianghuo (Qiang Huo, Notopterygii Rhizoma et Radix), Duhuo (Du Huo, Angelicae Pubescentis Radix), and Sangjisheng (Sang Ji Sheng, Taxilli Herba).
For cases complicated by dampness, add Mugua (Mu Gua, Chaenomelis Fructus), Fangji (Fang Ji, Stephaniae Tetrandrae Radix), and Yiyiren (Yi Yi Ren, Coicis Semen).