痿者，手足痿软而无力，百节缓纵而不收也。圣人以痿病在诸证为切要，故特着篇目，分五脏之
热，名病其所属皮、脉、筋、肉、骨之痿。致足不任于地，及叙五脏得热之邪，则以一脏因一邪所伤。
观其微旨，是用五志、五劳、六淫，从脏气所要者，各举其一以为例耳。若会通八十一篇而言，便见
五劳、五志、六淫，尽得成五脏之热以为痿也。何则？言肺气热则皮痿，因有所失亡，所求不得者，
与他篇之谓始富后贫，虽不伤邪，皮焦筋屈，痿 为挛者，同是一于七情之不扬。若病机之谓诸痿喘
呕，诸气愤郁，皆属于上者言之，即此可推，何热而不为痿，何脉而不为热也。如言心气热为脉痿，
因得之悲哀太甚，阳气内动而血崩，大经空虚，乃为脉痿，此以心为神明之官，主脉为要者言也。及
乎推之，五脏各有神，各有志，若
怒则气上逆，甚则呕血之类，亦五志所动，以热伤血，血逆行于经脉亦必空虚。有若形乐志苦，病生
于脉。则是五志皆得以痿其脉，不独悲哀一因也。且五志之在各脏，自伤其所属。若怒甚筋纵，其若
不容与形乐志乐，病生于肉，形苦志乐，病生于筋。又若忧恐喜怒，因太虚则五脏相乘，故病有五五
二十五变，皆至于大骨枯槁，大肉陷下之病。其神志在五脏之为热病者不可胜计。如言肝脏气热，因
思想无穷，所愿不得，犹肺之所求不得也。其入房太甚，宗筋弛纵，亦犹肾之远行劳倦也。即此可见，
五劳各得伤其五脏所合之皮肉筋骨矣。如言脾脏气热，因得之有渐于湿，以水为事者，若岁运太阴湿
土司天，在泉之湿，皆致肌肉痿，足痿不收，此是从五脏中举外感者为例耳。诸脏皆然，少阴之复为
骨痿。少阳之复为脉痿。阳明司天之政，四之气，亦为骨痿。厥阴司天，风气下临，脾气上从，而为
肌肉痿。有因于湿，首如裹，湿热不攘，大筋软短，小筋弛长，软短为拘，弛长为痿。《灵枢》有八
风之变，或伤筋，或伤肉，或伤骨，与邪客筋骨间者，热多则筋弛，骨消肉烁。夫其外淫而生五脏痿
病者如此。然有不言邪，止从经脏之虚而论者，谓脾病者，身重肌肉痿，足痿不收，行善螈。谓肾虚
者，为跛为痱。谓三阳有余，三阴不足为偏枯。谓
足少阳之别，虚则痿 ，坐不能起。足阳明之别，虚则足不收，胫枯。又有饮食所伤，味过于咸，则
大骨气劳。味过于辛，则筋脉沮弛。与夫膏粱之人，病偏枯痿厥。以上所陈，止就本条足痿不用者言
耳。至若五脏尽热，神昏仆倒，手足俱不用，世俗所谓瘫痪者，岂非亦是痿之大者也。又若下条肺痿
之为脏病者，而经又有心气痿者死，则是五脏尽有其痿，盖可知矣。《原病式》论小便遗失，谓肺热
客于肾部，干于足厥阴之经，而气血不得宣通则痿痹，故神无所用，而不遂其机，因致溲便遗失。由
是论之，凡神机气血或劣弱，或闭塞，即脏腑经络四属，若内若外，随处而不用。故《内经》重其事，
叠出诸篇，后之览者，竟失其旨。集方论者，或并见虚劳证，或并见风门，赖丹溪始发挥千余年之误
表而出之，而复语焉不详，可惜也。曰痿论，阳明冲脉合宗筋，会于气街，因阳明虚，故宗筋纵，
带脉不引而足痿，所以独取阳明。今子历陈受病之邪及诸痿证，又将若之何治，曰圣人凡语其一，推
之而可十可百，岂惟足痿而已乎。所谓各补其荥而通其俞，调其虚实，和其逆顺者，则治邪之法尽在
其中矣。所云筋脉骨肉，各以其时受月则病已者，治四属内外诸痿之法，亦在其中矣。然而诸痿之病，
未有不因阳明虚而得者，何以言之？按《灵枢》有谓真
气所受于天，与谷气并而充身也。又谓谷始入于胃之两焦，以溉五脏，别出两行荣卫之道，其大气之
搏而不行者，积于胸中，命曰气海。《素问》则谓足太阴者，三阴也，其脉贯胃属脾络嗌，故太阴为之
行气于三阴。阳明者，表也，五脏六腑之海也，亦为之行气于三阳。脏腑各因其经而受气于阳明，故
为胃行其津液。四肢不得禀水谷气，日以益衰，阴道不利，筋骨肌肉无气以生，故不用焉。而冲脉者，
出于肾下，与任脉起于胞中，治血海亦云，为五脏六腑之海也。五脏六腑皆禀焉。其上行者，渗三阳，
灌诸精。其下行者，渗三阴，灌诸络而温肌肉，与阳明宗筋会于气冲。因言阳明虚则宗筋纵，带脉不
引，故足痿不用也。即此而观，真气者，天之道也。谷气者，地之道也。地非天不生，天非地不成，
是故真气与谷气并而后生成，形气之道立矣。故阳明虚，于五脏无所禀，则不能行血气，营阴阳，濡
筋骨，利关节。气海无所受，则卫气不能温分肉，充皮肤，肥腠理，司开阖。血海无所受，则上下内
外之络脉空虚，于是精神气血之奉生身、周于性命者劣弱矣。故百体中随其不得受水谷气处，则不用
而为痿，治痿不独取阳明而何哉。丹溪云∶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，肺得火邪而热矣。木性刚急，肺受热邪则金失所养，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。故阳明实则宗筋
润，能束骨而利机关矣。治痿之法，无出于此。骆龙吉亦曰风火相炽，当滋肾水。东垣先生取黄柏为
君，黄 等药为辅佐，而无一定之方。有兼痰积者，有湿多者，有热多者，有湿热相半者，有挟寒者，
临病制方，其善于治痿乎。虽然药中肯綮矣，若将理失宜，圣医不治也。天产作阳，浓味发热，凡病
痿者，若不淡薄滋味，吾知其必不能安全也。按丹溪以《难经》泻南补北之法，摘为治痿之方，亦是
举其例耳。若胃口不开，饮食少进者，当以芳香辛温之剂进之，不可拘于此例，宜藿香养胃汤主之。
况根据《内经》当分五脏。肺热叶焦，则皮毛虚弱急薄，着则生痿 。肺者脏之长，为心之盖也。有所
失亡，所求不得，则发肺鸣，鸣则肺热叶焦，故曰五脏因肺热叶焦发为痿 。又曰∶肺热者，色白而
毛败。宜黄 、天、麦门冬、石斛、百合、山药、犀角、通草、桔梗、枯芩、
栀子仁、杏仁、秦艽之属主之。心气热则下脉厥而上，上则下脉虚，虚则生脉痿，枢折挈，胫纵而不
任地，悲哀太甚则胞络绝，胞络绝则阳气内动，发则心下崩，数溲血也。故本病曰大经空虚，发为肌
痹，传为脉痿。又曰∶心热者，色赤而络脉溢。宜铁粉、银屑、黄连、苦参、龙胆、石蜜、牛黄、龙
齿、秦艽、白藓皮、牡丹皮、地骨皮、雷丸、犀角之属主之。肝气热则胆泄口苦，筋膜干，筋膜干则
筋急而挛，发为筋痿。思想无穷，所愿不得，意淫于外，入房太甚，宗筋弛纵，发为筋痿，及为白淫。
故《下经》曰∶筋痿者，生于肝，使内也。又曰∶肝热者，色苍而爪枯。宜生地黄、天门冬、百合、
紫葳、白蒺藜、杜仲、萆 、菟丝子、川牛膝、防风、黄芩、黄连之属主之。又方治筋痿，两手握固
无力，两腿行动无力，急饥食少，口舌生疮，忽生痰涎，忽然睡中涎溢，身上躁热，忽时憎寒，项颈
强急，小便赤白不定，大腑忽冷忽热不调，用连翘、防风、荆芥穗、蔓荆子、羌活、独活、牡丹皮、
山栀仁、秦艽、麻黄、（去根）木香各等分，为细末。每服一钱，食后白汤调下。脾气热则胃干而渴，肌
肉不仁，发为肉痿。有渐于湿，以水为事，若有所留，居处相湿，肌肉濡渍，痹而不仁，发为肉痿。
故《下经》曰∶肉痿者，得之湿地也。又曰∶脾
热者，色黄而肉蠕动。宜苍、白术，二陈，入霞天膏之属主之。肾气热则腰脊不举，骨枯而髓减，发
为骨痿。有所远行劳倦，逢大热而渴，渴则阳气内伐，内伐则热舍于肾，肾者水脏也，今水不胜火则
骨枯而髓虚，故足不任身发为骨痿。故《下经》曰∶骨痿者，生于大热也。又曰∶肾热者，色黑而齿
槁。宜金刚丸。肾肝俱损，骨痿不能起于床，筋弱不能收持，宜益精缓中，宜牛膝丸、加味四斤丸。
肾肝脾俱损，谷不化，宜益精缓中消谷，宜煨肾丸。丹溪云∶痿属湿热。有湿痰者，有气虚者，有血
虚者，有食积妨碍不降者，有死血者。湿热，东垣健步丸，加黄柏、苍术、黄芩，或清燥汤。湿痰，
二陈加苍术、黄柏之类，入竹沥、姜汁。血虚，四物汤加苍术、黄柏，下补阴丸。气虚，四君子汤加
苍术、黄柏。气血俱虚，十全大补汤。食积，木香槟榔丸。死血，桃仁、红花、蓬术、归梢、赤芍药
之类。痿病，食积妨碍不得降者，亦有死血者，俱宜下之。《保命集》云∶四肢不举，俗曰瘫痪，经
所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，既浓而又高，则令除去，
此真所谓膏粱之疾，其治则泻，令气弱阳衰土平而愈。或三化汤，或调胃承气汤，选而用之。若脾虚
则不用也。经所谓土不及则卑陷，卑、下也，
陷、坑也，故脾病四肢不举。四肢皆禀气于胃，而不能至经，必因于脾，乃得禀受。今脾病不能与胃
行其津液，四肢不得禀水谷气，气日以衰，脉道不利，筋骨肌肉皆无气以生，故不用焉。其治可十全
散、加减四物，去邪留正。又云∶心热盛则火独光，火炎上，肾之脉常下行，今火盛而上炎用事，故
肾脉亦随火炎烁而逆上行，阴气厥逆，火复内焰，阴上隔阳，下不守位，心气通脉，故生脉痿。膝腕
枢如折去而不相提挈，经筋纵缓而不任地故也。可下数百行而愈。东垣补益肾肝丸、萧炳神龟滋阴丸、
丹溪补益丸、虎潜丸、王启玄传玄珠耘苗丹、经验方何首乌、牛膝等分，酒浸蜜丸。皆补益肾肝壮筋
骨之药，下虚者选而用之。痿发于夏，俗名注夏。当从东垣法治之，详见伤暑门。
痿病，是指手足软弱无力，全身关节松弛而无法收敛。圣人认为痿病在各种病症中最为切要，因此专门设立篇章，根据五脏之热的不同，将其命名为归属于皮、脉、筋、肉、骨的各类痿证，导致足部无法支撑身体。并叙述五脏受邪热的原因，指出每一脏因特定的邪气所伤。观察其微妙的旨意，是用五志（喜、怒、忧、思、恐）、五劳（久视、久卧、久坐、久立、久行）和六淫（风、寒、暑、湿、燥、火），从脏腑之气所对应的方面，各举一例来说明罢了。如果融会贯通《素问·生气通天论》等八十一篇的内容来看，就会发现五劳、五志、六淫都能导致五脏生热而形成痿病。为什么呢？文中说肺气热则导致皮痿，这是因为有所失亡或所求不得，这与其它篇章所说的“起初富贵后来贫穷，虽然未受外邪侵袭，但皮肤焦枯、筋脉屈曲，形成痿挛”的情况相同，都是由于七情（喜、怒、忧、思、悲、恐、惊）不畅所致。如果说《素问·至真要大论》中提到的“各种痿病伴有喘咳呕吐，各种气机愤郁，都归属于上焦”，由此可以推断，什么热不会导致痿病？什么脉不会受热呢？例如说心气热导致脉痿，是因为悲哀太过，阳气在内扰动导致血崩，大经脉空虚，从而形成脉痿，这是从心为神明之官、主司血脉的角度来说的。进而推究，五脏各有神志，若愤怒导致气机上逆，严重时会呕血等，也是五志所动，以热伤血，血液逆行于经脉也会导致空虚。如果有形体安逸而精神痛苦，病生于脉的情况，那么五志都能使脉发生痿废，不仅仅是悲哀这一种原因。而且五志在各脏中，各自伤害其所归属的脏腑。如大怒导致筋脉纵缓，就像形体安逸精神也安逸，病生于肉；形体劳苦而精神安逸，病生于筋。又有忧愁、恐惧、喜怒，因为正气太虚而导致五脏相互乘克，所以病情有五种变化共二十五种变证，最终都会导致大骨枯槁、大肉陷下的病症。神志在五脏化为热病的情况不可胜数。如说肝脏气热，是因为思虑无穷、愿望不得实现，犹如肺部的所求不得。房事过度，宗筋弛纵，也类似于肾脏远行劳倦。由此可见，五劳各自能伤害五脏所合的皮、肉、筋、骨。如说脾脏气热，是因为逐渐感受湿气，从事与水相关工作的人，如果遇到岁运太阴湿土司天或在泉的湿气，都会导致肌肉痿软、足部痿软不收，这是从五脏中列举外感邪气为例罢了。其他脏腑也是如此，少阴复气导致骨痿。少阳复气导致脉痿。阳明司天之政，四之气时，也导致骨痿。厥阴司天，风气下临，脾气上从，导致肌肉痿。有因于湿气的，头部像被包裹一样沉重，湿热不除，大筋软短，小筋弛长，软短导致拘挛，弛长导致痿废。《灵枢》中有八风的变化，有的伤筋，有的伤肉，有的伤骨，邪气客居筋骨之间，热多则筋弛、骨消、肉烁。外感六淫而生五脏痿病的情况就是这样。然而也有不谈邪气，只从经络脏腑虚弱来论述的，如说脾病，身体沉重、肌肉痿软、足痿不收、行走时容易抽搐。说肾虚，会导致跛行或痱病。说三阳有余、三阴不足会导致偏枯。说足少阳之别络，虚弱则痿废，坐起困难。足阳明之别络，虚弱则足部不收、小腿干枯。又有饮食所伤的，口味过于咸，则大骨气劳。口味过于辛，则筋脉松弛。以及那些食用膏粱厚味的人，患偏枯痿厥。以上所述，只是就本条足痿不能使用的情况而言。至于如果五脏都有热，神志昏迷仆倒，手足都不能使用，世俗所谓的瘫痪，难道不是也是痿病的重大类型吗？又如下一条肺痿属于脏病，而经文又说心气痿者死，那么五脏都有痿病，大概就可以知道了。《原病式》论述小便失禁，说是肺热客居于肾部，干扰足厥阴经，导致气血不通畅而痿痹，所以神机无所用，不能发挥机能，因而导致大小便失禁。由此而论，凡是神机气血或虚弱、或闭塞，那么脏腑经络四肢，无论内外，随处都不能使用。所以《内经》重视此事，在多篇中反复出现，后世的读者竟然失去了其主旨。收集方论的人，有的将其与虚劳证合并，有的将其归入风门，直到朱丹溪才开始发挥千余年的错误，将其表露出来，但又语焉不详，可惜啊。曰：痿论，阳明经和冲脉会合于宗筋，交会于气街穴，因为阳明虚，所以宗筋弛纵，带脉不能牵引，导致足痿，所以治疗独取阳明。现在你详细陈述了致病邪气以及各种痿证，又将如何治疗呢？回答说：圣人凡说其中一点，推演开来可以十可百，岂止是足痿而已呢？所谓“各补其荥穴而通其俞穴，调其虚实，和其逆顺”，那么治邪的方法全在其中了。所说“筋脉骨肉，各以其时受月则病已”，治疗四肢内外各种痿病的方法，也包含在其中了。然而各种痿病，没有不是因为阳明虚而得的，为什么这样说？按《灵枢》所说，真气来源于天，与谷气结合而充养全身。又说谷物进入胃后分为两焦，以灌溉五脏，别出两条营卫之道，其中大气搏结而不行的，积聚在胸中，称为气海。《素问》则说足太阴脾经是三阴经，其脉贯胃属脾络咽，所以太阴为之在三阴经运行气。阳明经是表，是五脏六腑的海，也为之在三阳经运行气。脏腑各自通过经脉从阳明接受气，所以为胃运行津液。四肢不能禀受水谷之气，一天比一天衰弱，阴道不利，筋骨肌肉没有气以生，所以不能使用。而冲脉，出于肾下，与任脉起于胞中，治理血海，也可以说是五脏六腑的海。五脏六腑都禀受于此。其上行的，渗入三阳，灌注诸精。其下行的，渗入三阴，灌注诸络而温养肌肉，与阳明宗筋会合于气冲穴。因此说阳明虚则宗筋弛纵，带脉不能牵引，所以足痿不能使用。由此看来，真气是天之道，谷气是地之道。地非天不生，天非地不成，所以真气与谷气结合而后生成，形气之道确立。所以阳明虚，对五脏无所禀受，就不能运行血气，营阴阳，濡润筋骨，滑利关节。气海无所受，则卫气不能温分肉，充皮肤，肥腠理，司开阖。血海无所受，则上下内外的络脉空虚，于是精神气血奉养身体、周流于性命者变得虚弱。所以在身体的各个部位中，凡是不能接受水谷气的地方，就会不能使用而成为痿病，治疗痿病怎能不独取阳明呢？朱丹溪说：肺金体燥居上而主气，畏火。脾土性湿居中而主四肢，畏木。火性炎上，如果嗜欲无节制，则水失所养，火寡于畏，而侮所胜，肺得火邪而热。木性刚急，肺受热邪则金失所养，木寡于畏而侮所胜，脾得木邪而伤。肺热则不能管摄一身，脾伤则四肢不能为用，而诸痿发作了。泻南方（心火），则肺金清而东方（肝木）不实，有什么脾伤的呢？补北方（肾水），则心火降而西方（肺金）不虚，有什么肺热的呢？所以阳明实则宗筋润，能束骨而利机关。治疗痿病的方法，没有超出这个范围的。骆龙吉也说风火相炽，应当滋补肾水。李东垣先生取黄柏为君药，黄芩等药为辅佐，而没有固定的方剂。有兼痰积的，有湿多的，有热多的，有湿热相半的，有挟寒的，根据病情制定方剂，这算是善于治疗痿病了吧。虽然药物切中要害，但如果调养失宜，圣医也不能治愈。天产之物作阳，浓味发热，凡是患痿病的人，如果不淡薄滋味，我知道他一定不能平安无事。按朱丹溪以《难经》泻南补北之法，摘取作为治疗痿病的方例，这也是举例罢了。如果胃口不开，饮食少进，应当用芳香辛温的药剂进服，不可拘泥于此例，宜用藿香养胃汤主治。况且根据《内经》应当分五脏。肺热叶焦，则皮毛虚弱急薄，附着则生痿躄。肺是脏之长，为心之盖。有所失亡，所求不得，则发肺鸣，鸣则肺热叶焦，所以说五脏因肺热叶焦发为痿病。又说：肺热者，面色白而毛发败落。宜用黄芩、天冬、麦门冬、石斛、百合、山药、犀角、通草、桔梗、枯芩、栀子仁、杏仁、秦艽之类主治。心气热则下脉厥而上，上则下脉虚，虚则生脉痿，枢纽折断提挈无力，胫部纵缓而不能站立，悲哀太过则胞络绝，胞络绝则阳气内动，发作则心下崩漏，多次尿血。所以本病说大经空虚，发为肌痹，传变为脉痿。又说：心热者，面色赤而络脉溢。宜用铁粉、银屑、黄连、苦参、龙胆、石蜜、牛黄、龙齿、秦艽、白鲜皮、牡丹皮、地骨皮、雷丸、犀角之类主治。肝气热则胆泄口苦，筋膜干，筋膜干则筋急而挛，发为筋痿。思虑无穷，愿望不得，意念淫乱于外，房事过度，宗筋弛纵，发为筋痿，以及白淫。所以《下经》说：筋痿者，生于肝，由房事引起。又说：肝热者，面色青而指甲枯。宜用生地黄、天门冬、百合、紫葳、白蒺藜、杜仲、萆薢、菟丝子、川牛膝、防风、黄芩、黄连之类主治。又一方治疗筋痿，两手握固无力，两腿行动无力，急饥食少，口舌生疮，忽生痰涎，忽然睡中涎溢，身上躁热，忽时憎寒，项颈强急，小便赤白不定，大腑忽冷忽热不调，用连翘、防风、荆芥穗、蔓荆子、羌活、独活、牡丹皮、山栀仁、秦艽、麻黄（去根）、木香各等分，研为细末。每服一钱，食后用白开水调下。脾气热则胃干而渴，肌肉麻木不仁，发为肉痿。逐渐感受湿气，从事与水相关工作，如有停留，居住潮湿，肌肉浸渍，痹阻而不仁，发为肉痿。所以《下经》说：肉痿者，得之于湿地。又说：脾热者，面色黄而肌肉蠕动。宜用苍术、白术，二陈汤，加入霞天膏之类主治。肾气热则腰脊不能举动，骨枯而髓减，发为骨痿。有所远行劳倦，逢大热而渴，渴则阳气内伐，内伐则热舍于肾，肾是水脏，今水不胜火则骨枯而髓虚，所以足不能支撑身体发为骨痿。所以《下经》说：骨痿者，生于大热。又说：肾热者，面色黑而牙齿枯槁。宜用金刚丸。肾肝俱损，骨痿不能起床，筋弱不能收持，宜益精缓中，宜用牛膝丸、加味四斤丸。肾肝脾俱损，谷不化，宜益精缓中消谷，宜用煨肾丸。朱丹溪说：痿属湿热。有湿痰的，有气虚的，有血虚的，有食积妨碍不降的，有死血的。湿热，用东垣健步丸，加黄柏、苍术、黄芩，或清燥汤。湿痰，二陈汤加苍术、黄柏之类，加入竹沥、姜汁。血虚，四物汤加苍术、黄柏，送服补阴丸。气虚，四君子汤加苍术、黄柏。气血俱虚，十全大补汤。食积，木香槟榔丸。死血，桃仁、红花、蓬术、归梢、赤芍药之类。痿病，食积妨碍不得降的，也有死血的，都适宜攻下。《保命集》说：四肢不能举起，俗叫瘫痪，经书所说脾太过则令人四肢不举。又说：土太过则敦阜，阜是高，敦是浓，既浓而又高，则令除去，这真是所谓的膏粱之疾，其治法则是泻，使气弱阳衰土平而愈。或用三化汤，或用调胃承气汤，选择使用。如果是脾虚则不用。经书所说土不及则卑陷，卑是下，陷是坑，所以脾病四肢不举。四肢都禀受气于胃，但不能到达经脉，必须经过脾，才能禀受。现在脾病不能与胃运行津液，四肢不能禀受水谷之气，气一天比一天衰弱，脉道不利，筋骨肌肉都没有气以生，所以不能使用。其治法可用十全散、加减四物汤，去邪留正。又说：心热盛则火独光，火炎上，肾之脉常下行，现在火盛而上炎用事，所以肾脉也随火炎烁而逆上行，阴气厥逆，火复内焰，阴上隔阳，下不守位，心气通脉，所以生脉痿。膝腕枢纽如折断离去而不相提挈，经筋纵缓而不能站立，所以如此。可下数百行而愈。东垣补益肾肝丸、萧炳神龟滋阴丸、丹溪补益丸、虎潜丸、王启玄传玄珠耘苗丹、经验方何首乌、牛膝等分，酒浸蜜丸。都是补益肾肝壮筋骨的药，下虚者选择使用。痿病发于夏季，俗名注夏。应当从东垣法治之，详见伤暑门。
Wei syndrome refers to weakness and lack of strength in the hands and feet, with all joints becoming lax and unable to contract. The Sages considered Wei syndrome crucial among various diseases, thus dedicating a specific chapter to it. They differentiated the heat of the five Zang organs, naming the syndromes according to their association with skin, vessels, tendons, muscles, and bones, leading to an inability of the feet to support the body. They also described the pathogenic factors injuring the five Zang organs, citing one example for each. Observing the subtle intent, this uses the Five Emotions (Wu Zhi), Five Exhaustions (Wu Lao), and Six Excesses (Liu Yin) to illustrate how each organ's qi can be affected. If one integrates the content across eighty-one chapters, it becomes clear that the Five Exhaustions, Five Emotions, and Six Excesses can all generate heat in the five Zang organs, resulting in Wei syndrome. Why? When lung heat causes skin Wei, it is due to loss or unfulfilled desires, similar to other texts describing "initial wealth followed by poverty," where despite no external pathogen, scorched skin and contracted tendons lead to Wei and spasms; this is unified under the stagnation of the Seven Emotions (Qi Qing). Referring to the *Suwen* statement that "various Wei syndromes with wheezing and vomiting, and various Qi stagnations and depression, belong to the Upper Jiao," we can infer: what heat does not cause Wei? What vessel is not affected by heat? For instance, heart Qi heat causing vessel Wei occurs when excessive grief moves Yang Qi internally, causing blood collapse and emptiness of the large vessels, resulting in vessel Wei. This is stated from the perspective that the Heart is the official of spirit and governs the vessels. Further reasoning shows that each Zang has its spirit and emotion; anger causing Qi to rebel upward, potentially leading to hematemesis, is also driven by the Five Emotions. Heat damaging blood and causing retrograde flow in vessels leads to emptiness. Cases like physical ease but mental distress, where disease arises in the vessels, show that all Five Emotions can cause vessel Wei, not just grief. Moreover, the Five Emotions affect their respective Zang organs. Severe anger causes tendon laxity, akin to physical and mental ease leading to muscle disease, or physical toil with mental ease leading to tendon disease. Worry, fear, and joy/anger, due to deficiency, cause mutual overacting among Zang organs, leading to twenty-five variations, ultimately resulting in withered bones and sunken muscles. The number of Shen-Zhi transforming into heat diseases in the Zang organs is countless. Liver Qi heat, caused by endless thoughts and unfulfilled wishes, parallels the lung's unfulfilled desires. Excessive sexual activity causing弛纵 of the Zong Jin (major tendons) parallels kidney exhaustion from long journeys. Thus, the Five Exhaustions injure the skin, flesh, tendons, and bones associated with the five Zang organs. Spleen Qi heat, acquired gradually from dampness, affects those working with water; if influenced by Taiyin Damp Earth ruling the year or season, it causes muscle Wei and foot Wei unretractability, using external pathogens as examples. Similarly, Shaoyin rebound causes bone Wei; Shaoyang rebound causes vessel Wei; Yangming ruling the year, fourth Qi, causes bone Wei; Jueyin ruling the year, wind descending, spleen Qi ascending, causes muscle Wei. Dampness causing a heavy head, unchecked damp-heat, softens shortens large tendons and relaxes lengthens small tendons; shortening causes spasm, relaxing causes Wei. The *Lingshu* mentions eight winds injuring tendons, flesh, or bones; excess heat relaxes tendons, consumes bone, and wastes flesh. Such are the external Six Excesses generating five Zang Wei syndromes. However, some discussions ignore pathogens, focusing only on meridian and Zang deficiency: spleen disease causes heaviness, muscle Wei, foot Wei unretractability, and cramps; kidney deficiency causes limping or Fei syndrome; excess in Three Yang and deficiency in Three Yin cause hemiplegia; deficiency in the branch of Foot Shaoyang causes Wei and inability to rise from sitting; deficiency in the branch of Foot Yangming causes foot unretractability and wasting of the shank. Dietary injuries include excessive salt damaging bone Qi and excessive pungency relaxing sinews and vessels; those consuming rich foods suffer hemiplegia and Wei-Jue. These descriptions focus on foot Wei unusability. If all five Zang have heat, leading to coma and total limb paralysis, known as Tan Huan (paralysis), is this not a major form of Wei? Furthermore, Lung Wei is a Zang disease, and texts state heart Qi Wei is fatal, implying all five Zang can have Wei. The *Yuan Bing Shi* discusses urinary incontinence as lung heat invading the kidney region, affecting the Foot Jueyin meridian, blocking Qi and Blood, causing Wei-Bi, rendering the Shen (spirit/mechanism) useless, leading to incontinence. Thus, whenever Shen mechanism and Qi/Blood are weak or blocked, the four limbs and internal/external organs fail. Hence, the *Neijing* emphasizes this in multiple chapters, yet later readers missed the point. Compilers of formulas either merged Wei with Xu Lao (deficiency consumption) or placed it under Wind gates. It was Zhu Danxi who clarified millennia of errors, though his explanation remained incomplete. Regarding Wei Theory: Yangming and Chong meridians converge at Zong Jin and Qichong point. Yangming deficiency causes Zong Jin laxity and Dai meridian failure to pull, causing foot Wei; hence treatment focuses solely on Yangming. You detailed pathogenic factors and Wei types; how to treat? The Sages' statements expand infinitely; it's not just foot Wei. "Tonify Ying points and open Shu points, regulate deficiency/excess, harmonize reversal/flow" covers treating pathogens. "Tendons, vessels, flesh, bones heal in their respective months" covers treating internal/external Wei of the four limbs. Yet, all Wei stems from Yangming deficiency. Why? The *Lingshu* states True Qi comes from Heaven and combines with Grain Qi to nourish the body. Grain enters the stomach, spreads via two Jiaos to irrigate Zang organs, separating into Ying and Wei pathways. The great Qi accumulating in the chest is called Qi Sea. The *Suwen* says Foot Taiyin (Spleen) connects to Stomach and throat, distributing Qi to the three Yin. Yangming is the exterior, the sea of Zang-Fu, distributing Qi to the three Yang. Organs receive Qi from Yangming to transport fluids. Without Grain Qi, limbs weaken, Yin pathways obstruct, sinews/bones/muscles lack Qi, becoming unusable. The Chong meridian originates below the kidney, starting with Ren in the Bao Zhong, governing the Blood Sea, the sea of Zang-Fu. It irrigates the three Yang and three Yin, warming muscles, converging with Yangming Zong Jin at Qichong. Yangming deficiency leads to Zong Jin laxity and Dai meridian failure, causing foot Wei. True Qi is Heaven's way; Grain Qi is Earth's way. Heaven and Earth create each other; True and Grain Qi combine to establish Form-Qi. Yangming deficiency means Zang organs lack nourishment, failing to circulate Qi/Blood, nourish Yin/Yang, moisten sinews/bones, and lubricate joints. Qi Sea deficiency impairs Wei Qi's ability to warm flesh, fill skin, plump pores, and control opening/closing. Blood Sea deficiency empties collaterals, weakening the Spirit/Qi/Blood sustaining life. Thus, any part lacking Grain Qi becomes Wei; hence, treating Wei must focus on Yangming. Zhu Danxi said: Lung Metal is dry, upper, governs Qi, fears Fire. Spleen Earth is damp, central, governs limbs, fears Wood. Fire flares up; unregulated desires deplete Water, reducing Fire's restraint, allowing Fire to insult Metal, causing Lung Heat. Wood is rigid; Lung Heat damages Metal, reducing Wood's restraint, allowing Wood to insult Earth, damaging Spleen. Lung Heat fails to govern the body; Spleen damage prevents limb use, causing Wei. Clearing South (Heart Fire) clears Lung Metal and stabilizes East (Liver Wood), sparing Spleen. Tonifying North (Kidney Water) descends Heart Fire and protects West (Lung Metal), sparing Lungs. Thus, Yangming fullness moistens Zong Jin, binding bones and aiding joints. Treatment lies here. Luo Longji said: Wind-Fire intensification requires nourishing Kidney Water. Li Dongyuan used Huangbai as sovereign, Huangqin as assistant, without fixed formulas, adjusting for phlegm, damp, heat, cold. Though precise, poor lifestyle management defeats even sage doctors. Animal products are Yang; rich flavors generate heat. Wei patients must eat blandly. Danxi's "Clear South, Tonify North" is merely an example. If appetite is poor, use aromatic-warm herbs like Huoxiang Yangwei Tang. According to *Neijing*, differentiate by Zang: Lung Heat scorching leaves causes thin skin/hair and Wei Bi. Lung is chief of Zang, cover of Heart. Loss/unfulfilled desire causes Lung Ming (sound), leading to Lung Heat scorching leaves, causing all Zang Wei. Lung Heat shows white complexion and hair loss. Use Huangqin, Tiandong, Maidong, Shihu, Baihe, Shanyao, Xijiao, Tongcao, Jiegeng, Kuxinpi, Zhizi, Xingren, Qinjiao. Heart Qi heat causes lower vessels to rebel upward, creating empty lower vessels and Mai Wei (vessel Wei), with broken pivots and flaccid calves. Excessive grief severs Baoluo, moving Yang internally, causing heart bleeding and frequent bloody urine. Large vessels empty, causing Ji Bi transmitting to Mai Wei. Heart Heat shows red complexion and overflowing collaterals. Use Tiefen, Yinxie, Huanglian, Kushen, Longdan, Shimii, Niuhuang, Longchi, Qinjiao, Baixianpi, Mudanpi, Digupi, Leiwan, Xijiao. Liver Qi heat causes bitter taste and dry fascia, leading to tendon spasms and Jin Wei (tendon Wei). Endless thoughts, unfulfilled desires, excessive sex cause Zong Jin laxity and Jin Wei/Baiyin. Liver Heat shows blue complexion and withered nails. Use Shengdihuang, Tiandong, Baihe, Ziwei, Bajieli, Duzhong, Bixie, Tusizi, Chuan Niu Xi, Fangfeng, Huangqin, Huanglian. Another formula for Jin Wei (weak grip, leg weakness, irritability, mouth ulcers, phlegm, night salivation, restlessness, chills, neck stiffness, variable urination, bowel irregularity): Lianqiao, Fangfeng, Jingjie Sui, Manjingzi, Qianghuo, Duhuo, Mudanpi, Zhizi Ren, Qinjiao, Mahuang (root removed), Muxiang equal parts, powder. Take 1 qian after meals with warm water. Spleen Qi heat causes dry stomach/thirst, insensible muscles, Rou Wei (muscle Wei). Gradual dampness exposure causes muscle soaking and numbness, Rou Wei. Spleen Heat shows yellow complexion and muscle twitching. Use Cangzhu, Baizhu, Erchen Tang, Xiatiang Gao. Kidney Qi heat causes stiff waist/spine, withered bones, reduced marrow, Gu Wei (bone Wei). Travel fatigue plus heat/thirst causes internal heat attacking Kidney (Water). Water fails to control Fire, leading to bone/marrow depletion and foot Wei. Kidney Heat shows black complexion and withered teeth. Use Jingang Wan. Kidney-Liver damage causing bedridden Gu Wei and weak Jin: use Niuxi Wan, Jiawei Sijin Wan. Kidney-Liver-Spleen damage causing indigestion: use Weishen Wan. Danxi said: Wei belongs to Damp-Heat. Types: Damp-Phlegm (Erchen + Cangzhu, Huangbai, Zhuli, Jiangzhi); Qi Deficiency (Sijunzi + Cangzhu, Huangbai); Blood Deficiency (Siwu + Cangzhu, Huangbai, Fuyin Wan); Food Stagnation (Muxiang Binglang Wan); Fixed Blood (Taoren, Honghua, Pengzhu, Guishao, Chishao). Stagnation/Fixed Blood Wei needs purgation. *Baoming Ji* says: Limb paralysis (Tan Huan) is Spleen Excess ("Earth too high/dense"). Treat by purging (San Hua Tang or Tiaowei Chengqi Tang) to flatten Earth. Spleen Deficiency ("Earth too low/sunken") also causes limb paralysis. Limbs rely on Stomach Qi but need Spleen to transmit. Spleen failure stops fluid transport, starving limbs. Treat with Shiquan Dabu or Jiawei Siwu to remove evil and preserve righteousness. Heart Heat excess causes Fire to flare up, dragging Kidney Meridian upward, causing Yin rebellion and Mai Wei. Knee/ankle joints break, tendons relax. Purge hundreds of lines to cure. Li Dongyuan's Buyi Shen Gan Wan, Xiao Bing's Shengui Ziyin Wan, Danxi's Buyi Wan, Hujian Wan, Wang Qixuan's Xuanzhu Yunmiao Dan, He Shou Wu + Niu Xi honey pills: all tonify Kidney/Liver and strengthen sinews/bones for deficiency. Summer Wei (Zhu Xia) follows Dongyuan's methods; see Shangshu section.