一妇因儿痘，惊苦积劳，虚烦不得卧，心胆虚怯，触事惊悸，百药不效。投以温胆汤加枣仁。后因
虚极，加人参数剂而效。质之仲淳曰∶此必有痰而善饮者也。询之果然。
痿者，痿弱无力，举动不能也。经言∶五脏皆能使人痿。以五脏各有所主，如肺主皮毛，心主血
脉，脾主肌肉，肝主筋膜，肾主骨髓。所主不同，故有脉痿、肉痿、筋痿、骨痿之异。然经又谓五脏因肺
热叶焦，发为痿 。〔足弱不能行也。〕言五脏之痿，皆因于肺气之热，致五脏之阴俱不足，而为痿
。五痿虽异，总曰痿 ，悉因肺热。其论肺热之由，谓有所失亡，所求不得，则肺志不得伸，郁而生火，
发为肺鸣，而喘息有声；鸣则肺热叶焦，皮毛虚弱，而为急薄，热气留着不去，而及于筋脉骨肉，则生痿
。此自肺而病及他脏也。而心脾、肝、肾亦各有因热致痿之由。谓大经空虚，发为肌痹，传为脉痿者，生
于心气之热。又谓居处湿地，肌肉濡渍〔侵也。〕发为肉痿者，生于脾气之热。又谓入房太甚，宗筋驰
纵，发为筋痿者，生于肝气之热。又谓水不胜火，骨枯髓虚，发为骨痿者，生于肾气之热。此自他脏
而病及于肺也。其辨五痿之色症，谓肺热者，色白而毛败；心热者，色赤而络脉溢，脾热者；色黄而肉
蠕动；肝热者，色苍而爪枯；肾热者，色黑而齿稿。夫病而毛败爪枯齿稿等症，则势已频危，而治之诚
难。考其论治之法，则言治痿独取阳明。以阳明为五脏六腑之海，主润宗筋，宗筋聚于前阴，为诸筋之
会。凡一身之筋，皆属于此，主束节骨而利机关。故阳明虚则宗筋纵；腰间带脉不能收引，故足痿不用，
此所以独取阳明也。按士材云∶痿为重疾。经言病本五脏各有，而独重太阴肺经者，以五脏之火热熏蒸，
则金必被克，经言治法，亦随五脏见症各调，而独取阳明胃经者，以胃主纳水谷，化气血以灌溉于四肢，
阳明虚则五脏无所禀，不能行血气，濡筋骨，利关节，故肢体中随其不得受水谷处，即不用而为痿，不
独取阳明而何取哉。取阳明者，或清胃火以救肺热，或培胃土以生肺金，皆是也。丹溪有云∶泻南方则
肺金清，而东方不实，何胃伤之有；补北方则心火降，而西方不虚，何肺热之有。斯言意实相同。盖泻
南则金不受邪，而水有所生；补北则金不受窃，而火有所制，同一救肺也。故学人诚能本此施治，其于
痿症，思过半矣。至若方书所论，痿因有多端。如气虚、血虚。脾虚、肾虚、湿热、湿痰、死血、积食之
不一，临症制方，是贵望、闻、问、切
之详明，以通其变，非笔舌之所能罄也。
清燥救肺汤〔见燥。〕治肺热叶焦，发为痿 ，仿此加减用之。原方〔清肺润燥，降气和胃。
参、甘合治痿取阳明之义。〕宜加生地、龟甲〔补北方则火有所制。〕牛膝 石斛〔壮筋骨。〕羚羊
角〔舒筋脉。肺热为本，痿 为标。故标本兼治。〕
此一派甘寒之剂。盖甘则益胃，寒则清热，乃取阳明而用清胃火以救胃热之法也。若取阳明而用
培胃土以生肺金之法，如黄 、四君之类，加麦冬、米仁、白芍、石斛之属，相其症之所宜而投之，可也。
六味加知柏方〔见火。〕治远行劳倦，逢大热而渴，阳气内伐，热舍于肾，水干火旺，骨枯髓
虚，发为骨痿。〔腰脊不举，足不任身。〕又治入房太甚，宗筋驰纵，〔精伤之故。〕发为筋痿。〔精
血枯燥，则筋急拘挛。〕
原方〔六味壮肾水，知、柏泻龙火，又黄柏为诸痿必用之药。〕加二冬〔清肺热。〕龟甲〔补肾阴。〕
猪脊筋〔填精髓。〕牛膝 石斛 杜仲〔均治脚软。〕虎骨〔强悍皆在于胫，借其气有余以补不足。〕
此补水治火，以救肺热之剂。骨痿。筋痿同用此方者，以肾、肝同一治也。
天王补心丹〔见虚劳。〕治大经空虚，〔血失之故。〕发为肌痹，传为脉痿。〔血失无以渗灌
肌肉，而为顽痹不仁，无以养脉络，而为足胫纵缓。〕
此方内有生地、玄参以补北方，黄连、朱砂以泻南方，二冬以救肺热，人参合独取阳明之义。愚谓心
气热而成脉痿者，宜主此加减。
清热渗湿汤〔见湿。〕治久近水湿，湿郁生热，以致肌肉顽痹，〔麻木不仁也。〕发为肉痿。〔不
能举动也。〕
原方〔应加减用。〕加米仁〔燥脾胃之湿，而理拘挛。〕松节〔燥血中之湿，而疗脚弱。〕牛
膝〔壮筋骨，治脚软。〕石斛〔益脾胃，治湿热。〕木瓜〔筋急用之则舒，筋缓用之则利，有养筋之功，
更有祛湿之能。〕
此清热燥湿，健脾利水之剂。仲淳言∶痿属湿热，若果系居处湿地而得之者可用，如有肺经燥湿，咳
嗽痞闷等症，不可用。
卫生膏〔见虚劳。〕虚弱人及老人宜服之，久自神效。
此方内有二地、龟甲补肾，二冬、梨汁清肺，参、圆、牛肉培胃土，牛膝、虎骨壮筋骨，以上数味，
治痿甚宜。按陈氏云∶痿者犹树经杲日，叶垂不布，痿弱不振之意。俗以阳道不举为痿，属寒，谬甚。故
痿症属热者多。方内尚有黄 、鹿角等药，必内无热者，方可全用其方。
一位妇女因为孩子出痘疮，受到惊吓、痛苦和长期劳累，导致虚烦无法入睡，心胆虚弱怯懦，遇事容易惊恐心悸，服用各种药物均无效。给予温胆汤加酸枣仁治疗。后来因为身体极度虚弱，加入人参并加大剂量后见效。向仲淳请教，他说：“这必定是有痰且喜欢饮酒的人。”询问后确实如此。
痿证，是指肢体痿弱无力，动作不能自如。经典经文说：五脏都能使人发生痿证。因为五脏各自有所主管的功能，如肺主管皮毛，心主管血脉，脾主管肌肉，肝主管筋膜，肾主管骨髓。由于所主管的部位不同，所以有脉痿、肉痿、筋痿、骨痿的区别。然而经文又说，五脏因肺热叶焦，发为痿躄（指足部软弱不能行走）。意思是五脏的痿证，都起因于肺气的热邪，导致五脏的阴气都不足，从而形成痿证。五种痿证虽然表现各异，总称为痿躄，都是由于肺热引起的。关于肺热产生的原因，经文认为如果有丧失亲人或愿望不得实现的情况，那么肺的情志就无法舒展，郁结而生火，发出肺鸣声，并且喘息有声；鸣响则导致肺热叶焦，皮毛虚弱，变得急迫薄脆，热气停留不去，进而波及筋脉骨肉，就产生痿证。这是从肺开始病变而影响到其他脏腑。而心、脾、肝、肾也各有因热导致痿证的缘由。经文又说，大经空虚，发展为肌痹，传变为脉痿的，产生于心气的热邪。又说，居住在潮湿地方，肌肉被湿气浸渍，发展为肉痿的，产生于脾气的热邪。又说，房事过度，宗筋弛缓纵散，发展为筋痿的，产生于肝气的热邪。又说，水不胜火，骨骼枯槁髓海空虚，发展为骨痿的，产生于肾气的热邪。这是从他脏开始病变而影响到肺。辨别五种痿证的颜色症状，经文说：肺热的，面色白而毛发败坏；心热的，面色赤而络脉充盈溢出；脾热的，面色黄而肌肉蠕动；肝热的，面色青苍而指甲枯槁；肾热的，面色黑而牙齿干枯。像毛发败坏、指甲枯槁、牙齿干枯等症状，说明病情已经非常危急，治疗确实困难。考察其论述的治疗方法，经文说治疗痿证要独取阳明经。因为阳明经是五脏六腑气血的海源，主要滋润宗筋，宗筋聚集在前阴部位，是众多筋脉的会合之处。全身所有的筋，都属于这里，主要约束关节骨骼而利于机关运动。所以阳明经虚弱则宗筋弛纵；腰间的带脉不能收缩牵引，所以足部痿废不能使用，这就是为什么要独取阳明经的原因。按士材的说法：痿证是重病。经文说病本源于五脏各有不同，而特别重视太阴肺经，是因为五脏的火热熏蒸，则金（肺）必然被克伤；经文说的治法，也是随着五脏见症分别调理，而特别选取阳明胃经，是因为胃主受纳水谷，化生气血以灌溉四肢，阳明经虚弱则五脏无所禀受，不能运行血气，濡养筋骨，利通关节，所以肢体中那些不能接受水谷营养的地方，就会不使用而成为痿证，不独取阳明经还能取哪条经呢？选取阳明经的方法，或者是清胃火来救肺热，或者是培补胃土来生肺金，都是正确的。丹溪曾说：泻南方（心火）则肺金清净，而东方（肝木）不实，怎么会损伤胃呢；补北方（肾水）则心火下降，而西方（肺金）不虚，怎么会有肺热呢。这话的意思其实相同。大概泻南则金不受邪，而水有所生；补北则金不被窃夺，而火有所制约，都是为了救肺。所以学习者如果能依据此理施治，对于痿证的治疗，就掌握了一半以上的要领了。至于方书中所论述的，痿证成因有很多方面。如气虚、血虚、脾虚、肾虚、湿热、湿痰、死血、积食等不一而足，临症制定方剂，贵在望、闻、问、切四诊详明，以通达变化，这不是笔墨语言所能穷尽的。
清燥救肺汤（见燥证章节），治疗肺热叶焦，发为痿躄，仿照此方加减使用。原方（清肺润燥，降气和胃）。参、甘合用体现了治痿取阳明的意义。宜加生地、龟甲（补北方则火有所制）、牛膝、石斛（壮筋骨）、羚羊角（舒筋脉）。肺热是本，痿躄是标。所以标本兼治。这是一派甘寒的药物。甘味能益胃，寒性能清热，这是取阳明经而用清胃火以救肺热的方法。如果取阳明经而用培补胃土以生肺金的方法，如黄芪、四君子汤之类，加上麦冬、薏苡仁、白芍、石斛等属类，根据病症适宜情况投药，也可以。
六味地黄丸加知母、黄柏方（见火证章节），治疗远行劳倦，逢大热而口渴，阳气内伐，热邪舍于肾，水干火旺，骨枯髓虚，发为骨痿（腰脊不能抬起，足不能支撑身体）。又治疗房事过度，宗筋弛缓纵散（精液受伤的缘故），发为筋痿（精血枯燥，则筋脉紧急拘挛）。
原方（六味地黄丸壮肾水，知母、黄柏泻龙雷之火，另外黄柏是治疗各种痿证的必用药物）。加天冬、麦冬（清肺热）、龟甲（补肾阴）、猪脊筋（填精髓）、牛膝、石斛、杜仲（均治疗脚软）、虎骨（强悍之气在于小腿胫骨，借用其有余之气以补不足）。这是补水治火，以救肺热的方剂。骨痿、筋痿同用此方，是因为肾、肝同一治法。
天王补心丹（见虚劳章节），治疗大经空虚（失血的缘故），发为肌痹，传变为脉痿（失血无以渗灌肌肉，而为顽痹不仁；无以养脉络，而为足胫纵缓）。
此方内有生地、玄参以补北方（肾水），黄连、朱砂以泻南方（心火），二冬（天冬、麦冬）以救肺热，人参合用体现独取阳明的意义。我认为心气热而成脉痿者，适宜以此方加减为主治。
清热渗湿汤（见湿证章节），治疗久近水湿，湿郁生热，以致肌肉顽痹（麻木不仁），发为肉痿（不能举动）。
原方（应当加减使用）。加薏苡仁（燥脾胃之湿，而理拘挛）、松节（燥血中之湿，而疗脚弱）、牛膝（壮筋骨，治脚软）、石斛（益脾胃，治湿热）、木瓜（筋急用之则舒，筋缓用之则利，有养筋之功，更有祛湿之能）。这是清热燥湿，健脾利水的方剂。仲淳说：痿证属于湿热，如果确实是居住在潮湿地方而得的可以使用，如果有肺经燥湿，咳嗽痞闷等症状，不可使用。
此方内有二地（生地、熟地）、龟甲补肾，二冬（天冬、麦冬）、梨汁清肺，人参、桂圆、牛肉培补胃土，牛膝、虎骨壮筋骨，以上几味药，治疗痿证很适宜。按陈氏说：痿证就像树木经过烈日暴晒，叶子下垂不舒展，是痿弱不振的意思。世俗把阳道不举当作痿证，归属于寒证，谬误得很。所以痿证属于热证的居多。方内还有黄芪、鹿角等药，必须体内没有热邪的人，才可以全用此方。
A woman, due to her child's smallpox, suffered from fright, pain, and chronic exhaustion, resulting in deficiency-related irritability and insomnia. Her heart and gallbladder were deficient and fearful; she was easily startled and palpitated upon encountering matters. Various medicines proved ineffective. She was prescribed Wendan Tang (Phlegm-Draining Decoction) with added Suanzaoren (Ziziphus Seed). Later, due to extreme deficiency, Ren Shen (Ginseng Root) was added in a larger dosage, which proved effective. When consulted, Zhong Chun said: "This must be a person with phlegm who enjoys drinking alcohol." Inquiries confirmed this.
Wei syndrome refers to flaccidity and weakness of the limbs, with inability to move freely. The Classics state: All five zang organs can cause Wei syndrome. Since each zang organ governs specific tissues—such as the Lung governing skin and hair, the Heart governing blood vessels, the Spleen governing muscles, the Liver governing sinews, and the Kidney governing bones—the manifestations differ into Mai Wei (pulse/flaccidity), Rou Wei (flesh/flaccidity), Jin Wei (sinew/flaccidity), and Gu Wei (bone/flaccidity). However, the Classics also state that when the five zang organs suffer from Lung heat causing the leaves to wither (Fei Re Ye Jiao), it leads to Wei Bi (flaccidity where the feet cannot walk). This means that all types of Wei syndrome originate from heat in the Lung qi, leading to insufficiency of yin in all five zang organs, thus forming Wei syndrome. Although the five types of Wei present differently, they are collectively termed Wei Bi, all caused by Lung heat. Regarding the cause of Lung heat, the Classics suggest that loss or unfulfilled desires prevent the Lung's emotional expression from extending, leading to stagnation and fire generation. This manifests as Lung sounds and wheezing; the sound indicates Lung heat and leaf withering, causing the skin and hair to become weak, urgent, and thin. If the heat lingers and spreads to sinews, vessels, bones, and flesh, Wei syndrome arises. This is pathology originating in the Lung and affecting other organs. Conversely, the Heart, Spleen, Liver, and Kidney each have causes for heat-induced Wei. The Classics state that emptiness of the large meridians developing into Ji Bi (muscle bi-syndrome) and transmitting to Mai Wei originates from heat in Heart qi. Dwelling in damp places, causing muscle immersion in dampness, develops into Rou Wei, originating from heat in Spleen qi. Excessive sexual intercourse, causing弛纵 (relaxation/looseness) of Zong Jin (major sinews), develops into Jin Wei, originating from heat in Liver qi. When water fails to control fire, leading to dry bones and empty marrow, developing into Gu Wei, originates from heat in Kidney qi. This is pathology originating in other organs and affecting the Lung. To differentiate the color symptoms of the five Weis: Lung heat presents with white complexion and damaged hair; Heart heat with red complexion and overflowing collateral vessels; Spleen heat with yellow complexion and twitching muscles; Liver heat with dark/greenish complexion and withered nails; Kidney heat with black complexion and dry teeth. Symptoms such as damaged hair, withered nails, and dry teeth indicate critical severity, making treatment difficult. Examining the therapeutic principles, the Classics state that treating Wei syndrome requires focusing exclusively on the Yangming channel. The Yangming is the sea of the five zang and six fu organs, primarily nourishing the Zong Jin, which gathers at the anterior yin and serves as the convergence of all sinews. All sinews in the body belong here, binding joints and facilitating movement. Thus, Yangming deficiency leads to Zong Jin laxity; if the Dai Mai (Belt Vessel) around the waist cannot contract and draw in, the feet become flaccid and unusable. Hence, the exclusive focus on Yangming. According to Shitai: Wei is a severe disease. Although the Classics attribute the root to the five zang organs, they emphasize the Taiyin Lung meridian because heat/fire from the five zang attacks Metal (Lung). While treatment methods vary according to zang symptoms, the exclusive selection of the Yangming Stomach meridian is because the Stomach receives food and water, transforming them into qi and blood to irrigate the four limbs. Yangming deficiency means the five zang lack nourishment, cannot circulate blood and qi, fail to moisten sinews and bones, and obstruct joints. Therefore, limbs unable to receive water and grain nutrients become flaccid and unusable; why else focus on Yangming? Methods to select Yangming include clearing Stomach fire to rescue Lung heat, or tonifying Stomach earth to generate Lung metal, both being correct. Danxi stated: "Draining the South (Heart Fire) clears Lung Metal, preventing East (Liver Wood) from becoming excessive, thus sparing the Stomach; tonifying the North (Kidney Water) descends Heart Fire, preventing West (Lung Metal) from deficiency, thus eliminating Lung heat." The intent is identical. Draining South protects Metal from evil and generates Water; tonifying North prevents Metal from being drained and controls Fire, both aiming to rescue the Lung. Therefore, practitioners who apply these principles will master more than half of the knowledge regarding Wei syndrome. As for formula books, Wei syndrome has various causes, including qi deficiency, blood deficiency, Spleen deficiency, Kidney deficiency, damp-heat, damp-phlegm, dead blood, and retained food. Clinical prescription relies on detailed observation, listening/smelling, inquiry, and palpation to adapt to changes, which cannot be fully exhausted by words.
Qingzao Jiufei Tang (Clear Dryness and Rescue the Lung Decoction) [see Dryness chapter] treats Lung heat withering the leaves, causing Wei Bi. It should be used with modifications based on this formula. The original formula [clears Lung, moistens dryness, descends qi, and harmonizes the Stomach]. The combination of Ginseng and Licorice embodies the principle of selecting Yangming for treating Wei. It is advisable to add Dihuang (Rehmannia Root), Guijia (Tortoise Shell) [tonifying North controls Fire], Niuxi (Achyranthes Root), and Shihu (Dendrobium Stem) [strengthen sinews and bones], and Lingyangjiao (Antelope Horn) [soothe sinews and vessels]. Lung heat is the root, Wei Bi is the branch. Thus, treat both root and branch. This is a category of sweet-cold agents. Sweet benefits the Stomach, cold clears heat; this is the method of selecting Yangming by clearing Stomach fire to rescue Lung heat. Alternatively, one may use the method of selecting Yangming by tonifying Stomach earth to generate Lung metal, such as Huangqi (Astragalus Root) and Sizijunzi Tang (Four Gentlemen Decoction), plus Maidong (Ophiopogon Tuber), Yiyiren (Coix Seed), Baishao (White Peony Root), and Shihu. Administer according to symptom suitability.
Liujia Zhi Bai Fang (Six Substances Formula with Anemarrhena and Phellodendron) [see Fire chapter] treats fatigue from long journeys, thirst after exposure to great heat, internal attack of yang qi, heat lodging in the Kidney, dry water and flourishing fire, dry bones and empty marrow, leading to Gu Wei [lumbar spine cannot lift, feet cannot support the body]. It also treats excessive sexual intercourse causing Zong Jin laxity [due to essence injury], leading to Jin Wei [dry essence and blood cause sinew urgency and spasms].
The original formula [Six Substances Tonifies Kidney Water, Zhimu and Huangbai drain Dragon Fire; additionally, Huangbai is essential for all Wei syndromes]. Add Dongtian (Asparagus Tuber) and Maidong [clear Lung heat], Guijia [tonify Kidney Yin], Zhujijing (Pig Spinal Sinew) [fill essence and marrow], Niuxi, Shihu, and Duzhong [all treat leg weakness], and Hugu (Tiger Bone) [borrow its surplus strength to fill deficiency]. This is an agent that tonifies water and treats fire to rescue Lung heat. Gu Wei and Jin Wei use this formula together because the Kidney and Liver share the same treatment approach.
Tianwang Buxin Dan (Heavenly Emperor Heart-Nourishing Pill) [see Consumption chapter] treats emptiness of large meridians [due to blood loss], developing into Ji Bi and transmitting to Mai Wei [blood loss fails to seep into muscles, causing numbness and insensitivity; fails to nourish collaterals, causing flaccidity of lower legs].
This formula contains Dihuang and Xuanshen to tonify the North, Huanglian and Zhusha to drain the South, Dongtian and Maidong to rescue Lung heat, and Renshen combined with the principle of exclusive Yangming selection. I believe that for Mai Wei caused by Heart qi heat, this formula with modifications should be the primary treatment.
Qingre Shen Shi Tang (Clear Heat and Percolate Dampness Decoction) [see Dampness chapter] treats prolonged exposure to water and dampness, where dampness stagnates and generates heat, causing muscular numbness and insensitivity [Ji Bi], developing into Rou Wei [inability to move].
The original formula [should be modified]. Add Yiyiren [dries Spleen/Stomach dampness and regulates spasms], Songjie (Cypress Joint) [dries blood-dampness and treats leg weakness], Niuxi [strengthens sinews/bones, treats leg weakness], Shihu [benefits Spleen/Stomach, treats damp-heat], and Mugua (Chaenomeles Fruit) [relaxes tense sinews, benefits loose sinews, nourishes sinews, and expels dampness]. This is an agent that clears heat, dries dampness, strengthens Spleen, and promotes urination. Zhong Chun stated: Wei belongs to damp-heat; it can be used if caused by dwelling in damp places. However, if there are Lung dryness/dampness symptoms like cough and chest fullness, it should not be used.
Weisheng Gao (Health Nourishing Paste) [see Consumption chapter] is suitable for weak individuals and the elderly; long-term use yields miraculous effects.
This formula contains Erdihuang (Rehmannia) and Guijia to tonify the Kidney, Dongtian/Maidong and Pear Juice to clear the Lung, Renshen, Yuanzhi (Polygala Root - *Note: Text says 'Yuan', likely referring to Longan or similar tonic, but context implies Stomach tonification*), and Beef to tonify Stomach earth, Niuxi and Hugu to strengthen sinews and bones. These ingredients are very suitable for treating Wei. According to Chen: Wei resembles a tree exposed to scorching sun, with drooping leaves, indicating flaccidity and lack of vigor. Commonly, impotence is mistaken for Wei and attributed to cold, which is a grave error. Therefore, most Wei syndromes belong to heat. The formula also contains Huangqi and Lujiao (Deer Antler); it can only be fully used if there is no internal heat.