汤（六三） 有年偏痿。日瘦。色苍脉数。从金匮肺热叶焦。则生痿 论。（肺热叶焦）
玉竹 大沙参 地骨皮 麦冬 桑叶 苦百合 甜杏仁
徐（三岁） 面瘰跗 。此属肺热痿 。
连翘 花粉 黑山栀 赤小豆 桑叶 白通草
张 湿中伏热。沉着下焦。用苦胜湿。辛通气分。然必循经入络。渐次达及阳明。（湿火）
绵茵陈（三钱） 生茅术（五分） 黄柏（一钱半） 晚蚕砂（一钱） 寒水石（三钱） 茯苓皮（三钱）
又 色苍脉实。体质强壮。虽年逾四旬。气元充旺。询知平日善啖酒醴甘肥。此酿成湿火。蕴结
下焦。今少腹微肿硬。二便滞涩。自觉少腹气胀上冲。两足沉重。艰于步履。腿股皮中甚热。即
内经所云。湿热不攘大筋 短。小筋弛长 短为拘。弛长为痿也。更述曾因熬炼膏药。中有
虫蜈蚣等物。吸受秽浊毒瓦斯。未始非与湿热纠蓄。沉伏下焦。前议苦辛寒燥。兹再佐以搜
逐络隧。然此病从口而入。必茹素戒饮。一二年之久。病根可拔。当恪守勿懈为要。
绵茵陈（三钱） 黄柏（一钱半） 川萆 （一钱） 茯苓皮（三钱） 金铃子（一钱半） 穿山甲（三钱）
大槟榔汁（一钱）
又 绵茵陈 萆 茯苓皮 黄柏 蚕砂 汉防己 龙胆草 山栀 青黛
又 病去七八。常服二妙丸可也。
黄柏（八两略炒） 茅山术（米泔浸切片同乌芝麻拌饭上蒸三五次去芝麻焙干三两）
二味研末。水法丸。空心服三钱。开水下。
吴（二十） 雨湿泛潮外来。水谷聚湿内起。两因相凑。经脉为痹。始病继以疮痍。渐致痿 筋弛。气隧
不用。湿虽阻气。而热蒸烁及筋骨。久延废弃有诸。（湿热蒸烁筋骨）
大豆黄卷 飞滑石 杏仁 通草 木防己
廉（三二） 诊脉论体。从遗精漏疡。继而环跳穴痛。遂不堪行走。脏阴伤及腑阳。阳气日加窒塞。经脉
不司舒展。食入壅脘欲吐。大便旬日不通。痞阻日甚。而为痿症。内经论治痿独取阳明。无非
流通胃气。盖胃脉主乎束筋骨利机关窍也。议用加味温胆汤。（胃气窒筋骨不利）
又 大便旬日不通。用更衣丸。取意小肠火腑。非苦不通。非下不夺也。
某（五岁） 头目口鼻 邪。继而足痿。此邪风入络所致。（邪风入络）
羚羊角 犀角 元参 细生地 黄柏 川斛 川萆
俞 五旬又四。阳气日薄。阳明脉络空乏。不司束筋骨以流利机关。肩痛肢麻头目如蒙。行动
痿弱无力。此下虚上实。络热。内风沸起。当入夏阳升为甚。燥湿利痰。必不应病。议清营热以
熄内风。（阳明虚营络热内风动）
犀角 鲜生地 元参心 连翘心 冬桑叶 丹皮 钩藤 明天麻
陈 阳明脉空。厥阴风动。自右肩臂渐及足跗痿 。长夏气泄。秋半不主收肃。显然虚症。先用
通摄方法。（肝胃虚内风动）
淡苁蓉 熟地 杞子 川牛膝 川斛 茯苓 远志（炒黑） 石菖蒲
夏（四四） 自稚壮失血遗精。两交夏月。四肢痿 。不得转动。指节亦不能屈曲。凡天地间。冬主收藏。
夏主发泄。内损多年不复元。阳明脉衰所致。（肝胃虚）
当归 羊肉胶 杞子 锁阳 菊花炭 茯苓
青盐
吴（三九） 下焦痿 。先有遗泄湿疡。频进渗利。阴阳更伤虽有参 术。养脾肺以益气。未能救下。即
如畏冷阳微。几日饭后吐食。乃胃阳顿衰。应乎外卫失职。但下焦之病。多属精血受伤。两投
柔剂温通之补。以肾脏恶燥。久病宜通任督。通摄兼施。亦与古贤四斤金刚健步诸法互参。
至于胃药。必须另用。夫胃腑主乎气。气得下行为顺。东垣有升阳益胃之条。似乎相悖。然芩
连非苦降之气味乎。凡吐后一二日。暂停下焦血分药。即用扶阳理胃二日。俾中下两固。经
旨谓阳明之脉。束筋骨以利机关。谅本病必有合矣。（胃阳督肾皆虚）
鹿茸 淡苁蓉 当归 杞子 补骨脂 巴戟天 牛膝 柏子仁 茯苓 川斛
吐后间服大半夏汤加淡干姜姜汁。
沈 长夏湿热。经脉流行气钝。兼以下元络脉已虚。痿弱不耐。步趋常似酸楚。大便或结或溏。
都属肝肾为病。然益下必佐宣通脉络。乃正治之法。倘徒呆补。恐季夏后。湿热还扰。须为预
理。（湿热肝肾虚）
鹿角霜 当归 生茅术 熟地（姜汁制） 茯苓 桑椹子 苁蓉 巴戟 远志 小茴
金气狗脊三斤。酒蒸。水熬膏和丸。淡盐汤送下。
李（四九） 痿 在下。肝肾病多。但素饮必有湿热。热瘀湿滞。气血不行。筋缩。肌肉不仁。体质重者难移。无
非湿邪之深沉也。若论阳虚。不该大发疮痍。但久病非速攻。莫计效迟。方可愈疾。
细生地 咸苁蓉 当归须 牛膝 黄柏 生刺蒺 萆
包（五三） 寝食如常。脉沉而缓。独两腿内外肌肉麻木。五旬又三。阳脉渐衰。跷维不为用事。非三气杂感也。
温通以佐脉络之流畅。仿古贤四斤金刚之属。
淡苁蓉 枸杞子 牛膝 茯苓 白蒺藜 木瓜 川斛 萆 金毛狗脊膏丸。
郭 两足痿弱。遇冷筋掣。三年久病。药力焉得速拔。况不明受病何因。徒见病而治。难期速功。据云精滑溺后。
通纳下焦为宜。
淡苁蓉 茯苓 川斛 生茅术 生杜仲 金毛狗脊
沈（四四） 眩晕怔忡。行走足肢无力。肌肉麻木。骨骱色变。早晨腹鸣瘕泄。此积劳久伤阳气。肝风内动。势欲
痿厥。法当脾肾双补。中运下摄。固体治病。（脾肾阳虚）脾肾双补丸山药粉丸（缪仲淳方）
沈（三六） 寝食如常。仪容日瘦。语言出声。舌络牵强。手足痿弱。不堪动作。是肝肾内损。渐及奇经
诸脉。乃痿痹之症。未能骤期速功。（肝肾虚）地黄饮子去萸味桂。
席 雨水后。诊得右脉颇和。左关尺大。坚搏不附骨。春阳初萌。里真漏泄。有风动枯痿之虑。议
乙癸同涵意。
熟地 淡苁蓉 杞子 五味 萸肉 牛膝 川斛 茯神 菊花 山药粉丸
李（氏） 右肢跗足无力如痿。交子夜痰多呛嗽。带下且频。是冲脉虚寒。浮火上升。非治嗽清热。夫
冲为血海。隶于阳明。女科八脉。奇经最要。内经论之。女子五七年岁。阳明日衰。今天癸将绝
年岁。脉络少气。非见病治病肤浅之见。愚意通阳摄阴以实奇脉。不必缕治。（冲脉虚寒）
薛氏加减八味丸二两匀七服盐汤送下。
许 金疮去血。乃经脉营络之伤。若损及脏腑。倏忽莫救。后此嗔怒动肝。属五志中阳气逆迸。
与客邪化火两途。苦辛泄气。频服既多。阳遂发泄。形虽若丰盈。而收藏固摄失职。少腹约束。
阳道不举。背脊喜靠。步履无力。皆是痿弱症端。渐至痿废。议以通纳之法。专事涵养生真。冀
下元之阳。八脉之气。收者收。通者通。庶乎近理。（肾阳奇脉兼虚）
鹿角霜 淡苁蓉干 生菟丝粉 生杜仲粉 归身 五味 大茴香 远志 家韭子 覆盆子 云茯苓 蒜汁泛丸。
唐（三四） 脉左沉小。右弦。两足腰膝酸 无力。舌本肿胀。剂颈轰然蒸热。痰涎涌出味咸。此肾虚收纳少权。
督脉不司约束。阴火上泛。内风齐煽。久延痿厥沉 。病根在下。通奇脉以收拾散越之阴阳为法。虎潜去知柏归。。加枸
杞青盐。羊肉胶丸。
万 脉濡弱。右大。心热、烦渴。两足膝腰髀伸缩不得自如。此乃下焦阴虚。热烁筋骨而为痿 。（下焦阴虚）生虎
潜去龟广锁加元参。
黄（二四） 冬藏精气既少。当春夏发泄。失血、遗精。筋弛骨痿。不堪行走。精血内怯。奇脉中少气。三年久损。
若不绝欲安闲。有偻废难状之疾。（骨痿）
鹿筋胶 羯羊肉胶 牛骨髓 猪脊髓 线鱼胶 苁蓉干 紫巴戟 枸杞子 茯苓 沙苑子 牛膝 青盐
某 病后。阴伤骨痿。
生杜仲 熟地 龟甲 黄柏 虎骨 牛膝 当归 巴戟
某 症如历节。但汗出筋纵而痛。冬月为甚。腰脊伛偻形俯。据述未病前。梦遗已久。是精血内
损。无以营养筋骨。难与攻迫。议香茸丸。温通太阳督脉。（督阳虚）
鹿茸（三两） 生当归（二两） 麝香（一钱） 生川乌（五钱）
雄羊肾三对。酒煮烂。捣丸。
经云。肺热叶焦。则生痿 。又云。治痿独取阳明。以及脉痿筋痿肉痿骨痿之论。内经于痿
症一门。可谓详审精密矣。奈后贤不解病情。以诸痿一症。或附录于虚劳。或散见于风湿。
大失经旨。赖丹溪先生。特表而出之。惜乎其言之未备也。夫痿症之旨。不外乎肝肾肺胃
四经之病。盖肝主筋。肝伤则四肢不为人用。而筋骨拘挛。肾藏精。精血相生。精虚则不能
灌溉诸末。血虚则不能营养筋骨。肺主气。为高清之脏。肺虚则高源化绝。化绝则水涸。水
涸则不能濡润筋骨。阳明为宗筋之长。阳明虚。则宗筋纵。宗筋纵则不能束筋骨以流利
机关。此不能步履。痿弱筋缩之症作矣。故先生治痿。无一定之法。用方无独执之见。如冲
任虚寒而成痿者。通阳摄阴。兼实奇脉为主。湿热沉着下焦而成痿者。用苦辛寒燥为主。
肾阳奇脉兼虚者。用通纳八脉。收拾散越之阴阳为主。如下焦阴虚。及肝肾虚而成痿者。
用河间饮子虎潜诸法。填纳下焦。和肝熄风为主。阳明脉空。厥阴风动而成痿者。用通摄
为主。肝肾虚而兼湿热。及湿热蒸灼筋骨。而成痿者。益下佐以温通脉络。兼清热利湿为
主。胃虚窒塞。筋骨不利而成痿者。用流通胃气。及通利小肠火腑为主。胃阳肾督皆虚者。
两固中下为主。阳明虚。营络热及内风动而成痿者。以清营热熄内风为主。肺热叶焦而
成痿者。用甘寒清上热为主。邪风入络而成痿者。以解毒宣行为主。精血内夺。奇脉少气
而成痿者。以填补精髓为主。先生立法精详。真可垂诸不朽矣。（邹滋九）
徐评 下体痿弱。确是属虚者多。案中多温补肝肾。亦不为过。但其中必兼有风痰寒湿。一味
蛮补。亦有未到之处。此等方起于宋而盛于明。古人不如是也。
汤（六十三岁）：年事已高，出现偏侧肢体痿软无力。日渐消瘦，面色苍老，脉象数疾。依据《金匮要略》中“肺热叶焦”的理论，认为这是导致痿证的原因。（肺热叶焦：指肺受热邪熏灼，津液耗伤，不能滋润筋骨）
玉竹 大沙参 地骨皮 麦冬 桑叶 苦百合 甜杏仁
徐（三岁）：面部及足背出现瘰疬肿胀。这属于肺热引起的痿证。
连翘 天花粉 黑山栀 赤小豆 桑叶 白通草
张：湿邪中阻，伏热内蕴，病位沉着于下焦。治疗用苦味药胜湿，辛味药通气分。但必须遵循经络入络的原则，逐渐通达至阳明经。（湿火：湿热郁结化火）
绵茵陈（三钱） 生茅术（五分） 黄柏（一钱半） 晚蚕砂（一钱） 寒水石（三钱） 茯苓皮（三钱）
复诊：面色苍老，脉象实有力，体质强壮。虽然年龄超过四十岁，但元气充盛旺盛。询问得知平时喜欢饮酒和食用甘甜肥腻食物。这酿成了湿火，蕴结在下焦。现在少腹部轻微肿胀发硬，大小便滞涩不通。自觉少腹部有气胀向上冲逆，两脚沉重，行走困难。大腿和小腿皮肤内部非常热。这就是《内经》所说的：“湿热不除，大筋收缩变短，产生拘挛；小筋松弛变长，产生痿弱。”又叙述曾因熬制膏药，其中含有蜈蚣等虫类物品，吸入秽浊毒气，未尝不是与湿热纠结蓄积，沉伏在下焦。前次议定用苦辛寒燥之法，这次再辅以搜逐络隧之品。然而此病从口而入，必须吃素戒酒，坚持一两年，病根才能拔除。应当恪守医嘱，不可懈怠。
绵茵陈（三钱） 黄柏（一钱半） 川萆薢（一钱） 茯苓皮（三钱） 金铃子（一钱半） 穿山甲（三钱） 大槟榔汁（一钱）
复诊：绵茵陈 萆薢 茯苓皮 黄柏 蚕砂 汉防己 龙胆草 山栀 青黛
复诊：病情去除了七八成，常服二妙丸即可。
黄柏（八两略炒） 茅山术（米泔水浸切片同乌芝麻拌饭上蒸三五次去掉芝麻焙干三两）
将两味药研成粉末，用水泛丸。空腹服用三钱，开水送下。
吴（二十岁）：雨湿之气从外侵袭，水谷停滞生湿从内而起。内外湿气相合，导致经脉痹阻。起初发病继而出现疮疡，逐渐导致肢体痿软、筋弛缓。气机通道不再通畅。湿邪虽然阻滞气机，但热邪蒸腾灼烁筋骨，日久废弃不用是必然的。（湿热蒸烁筋骨：湿热邪气熏蒸灼烧筋骨）
大豆黄卷 飞滑石 杏仁 通草 木防己
廉（三十二岁）：诊脉论体，因遗精漏疡之后，继而环跳穴疼痛，于是无法行走。脏阴损伤波及腑阳，阳气日益窒塞不通。经脉不能舒展。进食后壅滞在胃脘欲吐，大便十天不通，痞满阻塞日益严重，从而形成痿症。《内经》论述治疗痿证独取阳明经，无非是为了流通胃气。因为胃脉主司约束筋骨、利关节窍道。议定使用加味温胆汤。（胃气窒塞导致筋骨不利）
复诊：大便十天不通，使用更衣丸。取其意在于小肠为火腑，非苦味不能通降，非泻下不能夺其实邪。
某（五岁）：头目口鼻受邪气侵袭，继而足部痿软。这是邪风侵入络脉所致。（邪风入络：风邪侵入经络）
羚羊角 犀角 元参 细生地 黄柏 川斛 川萆薢
俞（五十四岁）：阳气日渐衰弱，阳明脉络空乏，不能约束筋骨以流利关节。肩痛肢麻，头目昏蒙如被遮盖，行动痿弱无力。这是下虚上实，络脉有热，内风沸起。到了夏天阳气升发时症状会更严重。单纯用燥湿利痰的方法，必定不对症。议定清营分热以熄内风。（阳明虚营络热内风动：阳明经虚弱，营分和络脉有热，引发内风）
犀角 鲜生地 元参心 连翘心 冬桑叶 丹皮 钩藤 明天麻
陈：阳明脉空虚，厥阴肝风内动。从右肩臂逐渐发展到足背痿软。长夏时节气机泄越，秋半时节不主收敛肃降。显然是虚证。先用通摄的方法。（肝胃虚内风动：肝胃虚弱，内风妄动）
淡苁蓉 熟地 杞子 川牛膝 川斛 茯苓 远志（炒黑） 石菖蒲
夏（四十四岁）：自幼壮年时失血遗精，两次遇到夏季月份，四肢痿软，不能转动。手指关节也不能屈曲。凡天地间，冬季主收藏，夏季主发泄。体内亏损多年不能恢复元气，这是阳明脉衰败所致。（肝胃虚：肝肾与脾胃虚弱）
当归 羊肉胶 杞子 锁阳 菊花炭 茯苓 青盐
吴（三十九岁）：下焦痿软。先前有遗精泄泻湿疡，频繁使用渗利药物，阴阳更加受伤。虽然有参、术等药，养脾肺以益气，未能挽救下焦。就像畏冷阳微，几天饭后呕吐食物，这是胃阳突然衰败，应对外卫失职。但是下焦的疾病，多属于精血受伤。两次投用柔剂温通的补法，因为肾脏厌恶燥性，久病适宜通调任督二脉。通摄兼施，也与古贤的四斤金刚健步诸法互相参考。至于胃部的药物，必须另外使用。胃腑主司气，气得以下行为顺。李东垣有升阳益胃的条文，似乎相悖。然而黄芩黄连不是苦降的气味吗？凡是呕吐后一两天，暂停下焦血分药，即用扶阳理胃药两天，使中下两固。经旨说阳明之脉，束筋骨以利机关。想必本病一定有符合之处。（胃阳督肾皆虚：胃阳、督脉、肾脏皆虚）
鹿茸 淡苁蓉 当归 杞子 补骨脂 巴戟天 牛膝 柏子仁 茯苓 川斛
呕吐后间服大半夏汤加淡干姜姜汁。
沈：长夏湿热，经脉流行气机迟钝。兼以下元络脉已虚，痿弱不耐受。步趋时常感到酸楚。大便或干结或溏薄。都属肝肾为病。但是补益下焦必须佐以宣通脉络，这才是正治之法。如果徒然呆补，恐怕季夏之后，湿热还会扰乱。须预先调理。（湿热肝肾虚：湿热邪气与肝肾虚弱并存）
鹿角霜 当归 生茅术 熟地（姜汁制） 茯苓 桑椹子 苁蓉 巴戟 远志 小茴
金气狗脊三斤，酒蒸，水熬膏和丸。淡盐汤送下。
李（四十九岁）：痿证在下部，多与肝肾有关。但素日饮酒必有湿热。热瘀湿滞，气血不行，筋缩，肌肉麻木不仁。体质重者难以移动。无非是湿邪深沉。若论阳虚，不该大发疮痍。但久病不宜速攻，不要计较见效慢，才可以痊愈疾病。
细生地 咸苁蓉 当归须 牛膝 黄柏 生刺蒺藜 萆薢
包（五十三岁）：寝食如常，脉沉而缓。唯独双腿内外肌肉麻木。五十三岁，阳脉渐衰，跷脉维脉不为所用。并非三气杂感引起。用温通法以辅助脉络流畅。仿照古贤四斤金刚之类方剂。
淡苁蓉 枸杞子 牛膝 茯苓 白蒺藜 木瓜 川斛 萆薢 金毛狗脊膏丸。
郭：两足痿弱，遇冷筋脉抽搐。三年久病，药力怎能快速拔除。况且不明受病原因，只是见病治病，难期快速功效。据说是精滑溺后，通纳下焦为宜。
淡苁蓉 茯苓 川斛 生茅术 生杜仲 金毛狗脊
沈（四十四岁）：眩晕怔忡，行走足肢无力，肌肉麻木，骨节颜色改变。早晨腹鸣瘕泄。这是积劳久伤阳气，肝风内动，势欲发生痿厥。法当脾肾双补，中运下摄，固体治病。（脾肾阳虚：脾肾阳气虚弱）脾肾双补丸山药粉丸（缪仲淳方）。
沈（三十六岁）：寝食如常，仪容日渐消瘦，语言出声，舌络牵强，手足痿弱，不堪动作。这是肝肾内损，逐渐波及奇经诸脉，乃是痿痹之症。未能骤然期待快速功效。（肝肾虚：肝肾虚弱）地黄饮子去萸肉桂枝。
席：雨水后，诊得右脉颇和，左关尺大，坚搏不附骨。春阳初萌，里真漏泄，有风动枯痿的忧虑。议定乙癸同涵之意（即肝肾同补）。
熟地 淡苁蓉 杞子 五味子 萸肉 牛膝 川斛 茯神 菊花 山药粉丸
李（氏）：右肢跗足无力如痿。交子夜痰多呛嗽，带下且频。这是冲脉虚寒，浮火上升。不是治嗽清热能解决的。冲脉为血海，隶于阳明。女科八脉，奇经最要。《内经》论述之，女子五七之年，阳明脉明日衰。今天癸将绝的年纪，脉络少气。不是见病治病的肤浅之见。愚意通阳摄阴以充实奇脉，不必缕析治疗。（冲脉虚寒：冲脉虚寒）薛氏加减八味丸二两匀七服，盐汤送下。
许：金疮去血，乃经脉营络之伤。若损及脏腑，倏忽间无法救治。此后嗔怒动肝，属五志中阳气逆迸。与客邪化火两途。苦辛泄气，频服既多，阳遂发泄。形虽若丰盈，而收藏固摄失职。少腹约束，阳道不举，背脊喜靠，步履无力，皆是痿弱症端。渐至痿废。议以通纳之法，专事涵养生真。冀望下元之阳，八脉之气，收者收，通者通，庶乎近理。（肾阳奇脉兼虚：肾阳与奇经八脉兼有虚损）
鹿角霜 淡苁蓉干 生菟丝粉 生杜仲粉 归身 五味子 大茴香 远志 家韭子 覆盆子 云茯苓 蒜汁泛丸。
唐（三十四岁）：脉左沉小，右弦。两足腰膝酸软无力。舌本肿胀，颈项轰然蒸热。痰涎涌出味咸。这是肾虚收纳少权，督脉不司约束。阴火上泛，内风齐煽。久延痿厥沉疴。病根在下，通奇脉以收拾散越之阴阳为法。虎潜丸去知母黄柏当归。加枸杞青盐。羊肉胶丸。
万：脉濡弱，右大。心热、烦渴。两足膝腰髀伸缩不得自如。此乃下焦阴虚，热烁筋骨而为痿证。（下焦阴虚：下焦阴液不足）生虎潜丸去龟板广锁阳加元参。
黄（二十四岁）：冬藏精气既少，当春夏发泄时，失血、遗精，筋弛骨痿，不堪行走。精血内怯，奇脉中少气。三年久损。若不绝欲安闲，有偻废难状之疾。（骨痿：骨骼痿弱无力）
鹿筋胶 羯羊肉胶 牛骨髓 猪脊髓 线鱼胶 苁蓉干 紫巴戟 枸杞子 茯苓 沙苑子 牛膝 青盐
某：病后，阴伤骨痿。
生杜仲 熟地 龟甲 黄柏 虎骨 牛膝 当归 巴戟
某：症如历节，但汗出筋纵而痛。冬月为甚。腰脊伛偻形俯。据述未病前，梦遗已久。是精血内损，无以营养筋骨，难与攻迫。议香茸丸。温通太阳督脉。（督阳虚：督脉阳气虚）
鹿茸（三两） 生当归（二两） 麝香（一钱） 生川乌（五钱）
雄羊肾三对，酒煮烂，捣丸。
经文说：肺热叶焦，则生痿躄。又说：治痿独取阳明。以及脉痿、筋痿、肉痿、骨痿的论述。《内经》对于痿证一门，可谓详审精密了。无奈后世贤者不解病情，将诸痿一症，有的附录于虚劳，有的散见于风湿。大失经旨。赖丹溪先生，特意表彰而出之。可惜其言论未完备。夫痿症之旨，不外乎肝肾肺胃四经之病。盖肝主筋，肝伤则四肢不为人用，而筋骨拘挛。肾藏精，精血相生，精虚则不能灌溉诸末，血虚则不能营养筋骨。肺主气，为高清之脏，肺虚则高源化绝，化绝则水涸，水涸则不能濡润筋骨。阳明为宗筋之长，阳明虚，则宗筋纵，宗筋纵则不能束筋骨以流利机关。此不能步履，痿弱筋缩之症作矣。故先生治痿，无一定之法，用方无独执之见。如冲任虚寒而成痿者，通阳摄阴，兼实奇脉为主。湿热沉着下焦而成痿者，用苦辛寒燥为主。肾阳奇脉兼虚者，用通纳八脉，收拾散越之阴阳为主。如下焦阴虚，及肝肾虚而成痿者，用河间饮子虎潜诸法，填纳下焦，和肝熄风为主。阳明脉空，厥阴风动而成痿者，用通摄为主。肝肾虚而兼湿热，及湿热蒸灼筋骨，而成痿者，益下佐以温通脉络，兼清热利湿为主。胃虚窒塞，筋骨不利而成痿者，用流通胃气，及通利小肠火腑为主。胃阳肾督皆虚者，两固中下为主。阳明虚，营络热及内风动而成痿者，以清营热熄内风为主。肺热叶焦而成痿者，用甘寒清上热为主。邪风入络而成痿者，以解毒宣行为主。精血内夺，奇脉少气而成痿者，以填补精髓为主。先生立法精详，真可垂诸不朽矣。（邹滋九评）
徐评：下体痿弱，确是属虚者多。案中多温补肝肾，亦不为过。但其中必兼有风痰寒湿，一味蛮补，亦有未到之处。此等方起于宋而盛于明。古人不如是也。
Tang (63 years old): Advanced age, presenting with hemiplegic flaccidity. Gradual emaciation, sallow complexion, rapid pulse. Based on the theory in *Jingui Yaolue* that "lung heat scorches the leaves," this is identified as the cause of flaccidity syndrome. (Lung heat scorching the leaves: Lung affected by heat pathogen, consuming body fluids, failing to nourish sinews and bones)
Polygonati Odorati Rhizoma (Yuzhu), large-sized Pseudostellariae Radix (Dashashen), Lycii Cortex (Digupi), Ophiopogonis Radix (Maidong), Mori Folium (Sangye), Bitter Lilii Bulbus (Ku Baihe), Sweet Armeniacae Semen (Tian Xingren).
Xu (3 years old): Scrofula and swelling on the face and dorsum of the foot. This belongs to lung-heat-induced flaccidity syndrome.
Forsythiae Fructus (Lianqiao), Tinosporae Radix (Huafen - note: typically Tian Hua Fen is Trichosanthis Radix, here likely referring to Trichosanthis Radix), Gardeniae Fructus (Hei Shanzhi), Phaseoli Semen Rubrum (Chixiaodou), Mori Folium (Sangye), Akebiae Caulis (Bai Tongcao).
Zhang: Dampness obstructing the middle, latent heat embedded, pathology settled in the lower jiao. Treatment uses bitter herbs to overcome dampness and acrid herbs to circulate qi in the qi level. However, one must follow the meridians into the collaterals, gradually reaching the Yangming channel. (Damp-fire: Damp-heat stagnating and transforming into fire)
Artemisiae Scopariae Herba (Mian Yinchun), Zedoary Rhizome (Sheng Maozhu), Phellodendri Cortex (Huangbai), Bombyx Batryticatus (Wan Can Sha), Halloysitum Rubrum (Hanshui Shi), Poria Cocos (Fuling Pi).
Second visit: Sallow complexion, forceful pulse, strong constitution. Although over forty years old, vital qi is abundant and vigorous. Inquired that he usually enjoys drinking alcohol and eating sweet and greasy foods. This has brewed damp-fire, accumulating in the lower jiao. Currently, the lower abdomen is slightly swollen and hard, urination and defecation are sluggish and difficult. He feels a sensation of abdominal distension rushing upward. Both legs feel heavy, walking is difficult. The skin of the thighs and calves feels very hot internally. This is what the *Neijing* says: "If damp-heat is not removed, the large sinews contract and shorten, causing spasms; the small sinews relax and lengthen, causing flaccidity." He also recounted that while boiling ointments containing insects like centipedes, he inhaled foul toxic vapors, which may have tangled and accumulated with damp-heat, sinking into the lower jiao. The previous prescription used bitter, acrid, cold, and drying methods. Now, add herbs that search and purge the collaterals. However, since this disease entered via the mouth, he must abstain from meat and alcohol for one to two years to uproot the disease. He must strictly adhere to the advice without slackening.
Artemisiae Scopariae Herba (Mian Yinchun), Phellodendri Cortex (Huangbai), Dioscoreae Hypoglaucae Rhizoma (Chuan Bibo), Poria Cocos (Fuling Pi), Chaenomelis Fructus (Jin Lingzi), Manis Squama (Chuanshanjia), Arecae Semen Juice (Da Binglang Zhi).
Third visit: Artemisiae Scopariae Herba, Dioscoreae Hypoglaucae Rhizoma, Poria Cocos, Phellodendri Cortex, Bombyx Batryticatus, Stephaniae Tetrandrae Radix (Han Fangji), Gentianae Radix (Longdancao), Gardeniae Fructus, Indigo Naturalis (Qingdai).
Fourth visit: The condition has improved by seventy to eighty percent. Regularly taking Er Miao Wan is sufficient.
Phellodendri Cortex (8 liang, lightly stir-fried), Maoshan Atractylodis Rhizoma (Soaked in rice water, sliced, steamed three to five times with black sesame seeds on rice, then sesame removed and dried to 3 liang).
Grind both into powder, make pills with water. Take 3 qian on an empty stomach, washed down with boiled water.
Wu (20 years old): Rainy dampness invades from outside; accumulation of food and drink generates dampness from within. The two damp factors combine, causing meridian bi-syndrome. Initially presenting with sores, gradually leading to limb flaccidity and sinew relaxation. Qi channels become unresponsive. Although dampness obstructs qi, heat steams and scorches the sinews and bones. Prolonged neglect leads to dysfunction. (Damp-heat steaming and scorching sinews and bones)
Perillae Fructus (Daye Huangjuan), Calcined Talcum Feihuaishi, Armeniacae Semen Amarum (Xingren), Akebiae Caulis (Tongcao), Stephaniae Tetrandrae Radix (Mu Fangji).
Lian (32 years old): Pulse diagnosis indicates that after seminal emission and chronic ulcers, pain occurred at the Huantiao acupoint, making walking unbearable. Visceral yin injury extended to fu yang. Yang qi became increasingly obstructed. Meridians could not stretch. Food stagnated in the epigastrium causing vomiting. Constipation for ten days, worsening obstruction, leading to flaccidity syndrome. The *Neijing* states treating flaccidity focuses on Yangming, primarily to circulate stomach qi. Because the Stomach meridian governs binding sinews and bones and facilitating joints. Proposed Jia Wei Wen Dan Tang. (Stomach qi obstruction leading to sinew/bone dysfunction)
Second visit: Constipation for ten days, use Geng Yi Wan. The intent is regarding the Small Intestine as the Fire Fu organ; only bitter can unblock, only purgatives can drain excess.
Anonymous (5 years old): Pathogens affecting head, eyes, mouth, nose, followed by leg flaccidity. Caused by evil wind entering collaterals. (Evil wind entering collaterals)
Antelope Cornu (Lingyangjiao), Rhinoceros Cornu (Xijiao), Scrophulariae Radix (Yuanshen), Rehmanniae Radix Preparata (Xi Shengdi), Phellodendri Cortex (Huangbai), Dendrobii Caulis (Chuan Hu), Dioscoreae Hypoglaucae Rhizoma (Chuan Bibo).
Yu (54 years old): Yang qi declining daily. Yangming meridians are deficient, unable to bind sinews and bones to facilitate joints. Shoulder pain, limb numbness, head/eyes feeling covered. Movement is weak and powerless. This is deficiency below and excess above, collateral heat, internal wind boiling up. Symptoms worsen in summer when yang rises. Drying dampness and resolving phlegm alone will not work. Proposed clearing Ying-level heat to extinguish internal wind. (Yangming deficiency, Ying/collateral heat, internal wind movement)
Rhinoceros Cornu (Xijiao), Fresh Rehmanniae Radix (Xian Shengdi), Scrophulariae Radix Heart (Yuanshen Xin), Forsythiae Fructus Heart (Lianqiao Xin), Mori Folium (Dong Sangye), Moutan Cortex (Danpi), Uncariae Ramulus cum Uncis (Gouteng), Gastrodiae Rhizoma (Ming Tianma).
Chen: Yangming pulse empty, Jueyin wind stirring. Flaccidity spreading from right shoulder/arm to foot dorsum. Late summer qi dissipates, mid-autumn does not gather. Clearly a deficiency pattern. First use tonifying and securing methods. (Liver/Stomach deficiency, internal wind stirring)
Cistanche Deserticolae (Dan Congrong), Prepared Rehmanniae Radix (Shu Di), Lycii Fructus (Qi Zi), Achyranthes Bidentatae Radix (Chuan Niuxi), Dendrobii Caulis (Chuan Hu), Poria Cocos (Fuling), Polygalae Radix (Yuanzhi, stir-fried black), Acori Tatarinowii Rhizoma (Shichangpu).
Xia (44 years old): Blood loss and seminal emission since youth. During summer months, limbs became flaccid and immobile. Finger joints cannot flex. Winter governs storage, Summer governs release. Internal damage for years fails to recover yuan qi. Caused by decline of Yangming pulse. (Liver/Stomach deficiency)
Angelicae Sinensis Radix (Danggui), Mutton Gelatin (Yang Rou Jiao), Lycii Fructus (Qi Zi), Cynomorii Fructus (Suoyang), Chrysanthemi Flos Carbonized (Juhua Tan), Poria Cocos (Fuling), Rock Salt (Qingyan).
Wu (39 years old): Lower jiao flaccidity. Previously had seminal emission and damp ulcers. Frequent use of draining/diuretic herbs injured yin and yang further. Although Ginseng and Atractylodes tonify Spleen/Lung qi, they failed to save the lower jiao. Cold aversion and weak yang indicate sudden failure of Stomach yang after meals. External defense is compromised. Diseases of the lower jiao often involve injury to essence and blood. Two doses of soft, warming, and unblocking tonics were given. Since the Kidney dislikes dryness, long-term illness requires regulating Ren and Du vessels. Combining unblocking and securing, referencing ancient methods like Si Jin Gang Jing Jian Bu. Stomach medicine must be separate. Stomach governs qi; qi should descend. Li Dongyuan's ascending yang benefiting stomach seems contradictory. However, Scutellaria and Phellodendron are bitter and descending. After vomiting, pause lower jiao blood-nourishing herbs for 1-2 days, use Yang-supporting Stomach-regulating herbs for 2 days to secure middle and lower. The classics state Yangming binds sinews/bones and facilitates joints. This case fits. (Stomach Yang, Du Mai, Kidney all deficient)
Cervum Cornu Degelatinatum (Lurong), Cistanche Deserticolae (Dan Congrong), Angelicae Sinensis Radix (Danggui), Lycii Fructus (Qi Zi), Psoraleae Fructus (Buguzhi), Morus Albae Radix Bark (Bajitian), Achyranthes Bidentatae Radix (Niuxi), Platycodi Semen (Baizi Ren), Poria Cocos (Fuling), Dendrobii Caulis (Chuan Hu).
Between vomiting episodes, take Ban Xia Tang with light dried ginger and ginger juice.
Shen: Long summer damp-heat, meridian qi circulation is sluggish. Plus deficiency of lower origin collaterals. Flaccidity and intolerance to walking. Limbs often feel sore. Stool varies between constipation and diarrhea. All relate to Liver/Kidney. Tonifying the lower must assist unblocking collaterals; this is correct treatment. Mere static tonification risks damp-heat returning later. Must preemptively manage. (Damp-heat, Liver/Kidney deficiency)
Cornu Bubali (Lu Jiao Shuang), Angelicae Sinensis Radix (Danggui), Atractylodis Rhizoma (Sheng Maozhu), Prepared Rehmanniae Radix (Shu Di, ginger juice processed), Poria Cocos (Fuling), Mulberry Fruit (Sangshenzi), Cistanche Deserticolae (Congrong), Morus Albae Radix Bark (Baji), Polygalae Radix (Yuanzhi), Foeniculum Fructus (Xiaohui).
Dryopteris Crassirhizoma (Jinqi Gouji) 3 jin, wine-steamed, water-boiled to paste, made into pills. Taken with light salt water.
Li (49 years old): Flaccidity in the lower body, mostly Liver/Kidney issues. But habitual drinking implies damp-heat. Heat stasis and damp stagnation block qi and blood. Sinews contract, muscles are insensible. Heavy body hard to move. Deep-seated dampness. If it were yang deficiency, severe sores wouldn't occur. Long illness requires slow attack, not expecting quick results.
Rehmanniae Radix Preparata (Xi Shengdi), Salty Cistanche (Xian Congrong), Angelicae Sinensis Radix Tip (Danggui Xu), Achyranthes Bidentatae Radix (Niuxi), Phellodendri Cortex (Huangbai), Tribuli Fructus (Sheng Ciji), Dioscoreae Hypoglaucae Rhizoma (Bibo).
Bao (53 years old): Sleep and appetite normal. Pulse deep and slow. Only inner/outer thigh muscles are numb. At 53, yang pulses decline, Qiao and Wei vessels fail. Not caused by mixed pathogens. Use warming/unblocking to aid meridian flow. Imitate ancient Si Jin Gang methods.
Cistanche Deserticolae (Dan Congrong), Lycii Fructus (Gouqi), Achyranthes Bidentatae Radix (Niuxi), Poria Cocos (Fuling), Tribuli Fructus (Bai Jili), Papaveris Pericarpium (Mugua), Dendrobii Caulis (Chuan Hu), Dioscoreae Hypoglaucae Rhizoma (Bibo). Dryopteris Crassirhizoma paste pills.
Guo: Both legs flaccid, sinew cramping when cold. Three-year chronic illness, how can medicine act quickly? Cause unknown. Treating symptoms alone won't yield quick results. Reported seminal emission and urinary issues. Unblocking and securing the lower jiao is appropriate.
Cistanche Deserticolae (Dan Congrong), Poria Cocos (Fuling), Dendrobii Caulis (Chuan Hu), Atractylodis Rhizoma (Sheng Maozhu), Eucommiae Cortex (Sheng Duzhong), Dryopteris Crassirhizoma (Jinmao Gouji).
Shen (44 years old): Vertigo, palpitations, weak legs, muscle numbness, bone/joint discoloration. Morning borborygmus and hernia-type diarrhea. Accumulated labor injuring yang, internal liver wind stirring, impending flaccidity/fainting. Method: Dual tonification of Spleen/Kidney, central transport, lower securing, solidifying foundation. (Spleen/Kidney Yang Deficiency) Spleen/Kidney Dual Tonification Pill Yam Powder Pill (Miao Zhongchun formula).
Shen (36 years old): Sleep/appetite normal, appearance wasting, speech stiff, tongue collaterals tight, limbs flaccid, unable to move. Liver/Kidney internal damage extending to extraordinary vessels. Flaccidity/Bi syndrome. Cannot expect quick cure. (Liver/Kidney Deficiency) Dihuang Yinzi removing Cornus and Cinnamon.
Xi: After rain, right pulse harmonious, left Guan/Chi large, firm and detached. Spring yang emerging, true qi leaking. Risk of wind-stirring withered flaccidity. Propose Yi-Gui same nourishment (Liver/Kidney dual tonic).
Prepared Rehmanniae Radix (Shu Di), Cistanche Deserticolae (Dan Congrong), Lycii Fructus (Qi Zi), Schisandrae Fructus (Wuwei), Corni Fructus (Yurou), Achyranthes Bidentatae Radix (Niuxi), Dendrobii Caulis (Chuan Hu), Poria Cocos with Stimulus (Fushen), Chrysanthemi Flos (Juhua), Yam Powder Pills.
Li (Female): Right limb/flaccidity. Excess phlegm/cough at midnight, frequent leukorrhea. Chong Mai deficiency-cold, floating fire rising. Not treated by cough-clearing. Chong Mai is Sea of Blood, subordinate to Yangming. Eight extraordinary vessels crucial in gynecology. *Neijing*: Women at 5x7, Yangming declines. Now approaching menopause, vessel qi low. Not superficial symptom treatment. Idea: Unblock yang, secure yin to fill extraordinary vessels. (Chong Mai deficiency-cold) Xue's Modified Ba Wei Wan, divided into 7 doses, taken with salt water.
Xu: Blood loss from wound injures meridians/Ying collaterals. If viscera damaged, death is sudden. Anger stirs Liver, yang qi rebels. Bitter/acrid dispersing qi, frequent use depletes yang. Form looks full but storage/securing fails. Lower abdomen constrained, impotence, back prefers leaning, weak steps. Signs of flaccidity progressing to disability. Method: Unblock and secure, nurture true yang. Hope Yuan Yang and Eight Vessels Qi recover and flow. (Kidney Yang and Extraordinary Vessels combined deficiency)
Cornu Bubali (Lu Jiao Shuang), Dried Cistanche (Dan Congrong Gan), Raw Cuscutae Semen (Sheng Tusifen), Raw Eucommiae Cortex (Sheng Duzhong Fen), Angelicae Sinensis Radix (Guishen), Schisandrae Fructus (Wuwei), Foeniculum Fructus (Dahuixiang), Polygalae Radix (Yuanzhi), Allii Tuberosi Semen (Jia Jiuzi), Rubi Fructus (Fupenzi), Cloud Poria (Yun Fuling). Garlic juice pill base.
Tang (34 years old): Left pulse deep/small, right string-like. Waist/knees sore/weak. Tongue root swollen, neck/face steaming hot. Salty phlegm. Kidney deficiency failing to receive, Du Mai failing to constrain. Yin fire rising, internal wind stirring. Chronic flaccidity/fainting. Root in lower. Unblock extraordinary vessels to gather scattered yin/yang. Hu Qian Wan removing Anemarrhenae Rhizome, Phellodendri Cortex, Angelicae Sinensis Radix. Add Lycii Fructus, Rock Salt. Mutton gelatin pills.
Wan: Pulse soggy/weak, right large. Heart heat, thirst. Legs/knees/hips stiff. Lower jiao yin deficiency, heat scorches sinews/bones causing flaccidity. (Lower Jiao Yin Deficiency) Raw Hu Qian Wan removing Tortoise Plastron, Euryales Semen, adding Scrophulariae Radix.
Huang (24 years old): Winter storage of essence/qi insufficient. Spring/Summer release causes blood loss/seminal emission. Sinew relaxation, bone flaccidity, inability to walk. Essence/blood deficiency, extraordinary vessels lack qi. Three years of damage. Without celibacy/rest, risk of hunchback/disability. (Bone Flaccidity)
Deer Sinew Gelatin, Ram Mutton Gelatin, Ox Marrow, Pig Spinal Cord Gelatin, Hairtail Fish Bladder Gelatin, Dried Cistanche, Purple Morus Albae Radix Bark, Lycii Fructus, Poria Cocos, Astragali Complanati Semen, Achyranthes Bidentatae Radix, Rock Salt.
Anonymous: Post-illness, yin injury, bone flaccidity.
Raw Eucommiae Cortex, Prepared Rehmanniae Radix, Testudo Plastron et Carapax, Phellodendri Cortex, Tiger Bone, Achyranthes Bidentatae Radix, Angelicae Sinensis Radix, Morus Albae Radix Bark.
Anonymous: Symptoms like Lijie (joint pain), but sweating with sinew relaxation/pain. Worse in winter. Hunched spine/back. History of nocturnal emissions. Essence/blood internal damage, failing to nourish sinews/bones. Hard to attack aggressively. Propose Xiang Rong Wan. Warm/unblock Taiyang/Du Mai. (Du Yang Deficiency)
Deer Antler (3 liang), Raw Angelicae Sinensis Radix (2 liang), Moschus (1 qian), Raw Aconiti Radix (5 qian).
Three pairs male sheep kidneys, wine-boiled soft, pounded into pills.
The Classics say: Lung heat scorches leaves, causing flaccidity. Also: Treat flaccidity focusing solely on Yangming. And discussions on Mai, Jin, Rou, Gu flaccidity. *Neijing* is detailed on flaccidity. Later scholars misunderstood, attaching it to Xu Lao or Feng Shi, losing the original intent. Thanks to Danxi, it was highlighted, though incomplete. The essence of flaccidity lies in Liver, Kidney, Lung, Stomach. Liver governs sinews; injury causes limb non-use and spasms. Kidney stores essence; essence/blood generate each other. Essence deficiency fails to irrigate extremities; blood deficiency fails to nourish sinews/bones. Lung governs qi; deficiency cuts off source, drying fluids, failing to moisten sinews/bones. Yangming is leader of sinews; deficiency causes sinew laxity, failing to bind sinews/bones and facilitate joints. Hence inability to walk, flaccidity/spasms arise. Mr. Ye treats flaccidity without fixed methods. For Chong/Ren deficiency-cold: Unblock yang, secure yin, fill extraordinary vessels. For damp-heat in lower jiao: Bitter/acrid/cold/drying. For Kidney Yang/Extraordinary vessel deficiency: Unblock/nourish eight vessels, gather scattered yin/yang. For lower jiao yin deficiency/Liver-Kidney deficiency: Hejian Yinzi/Hu Qian methods, fill lower, harmonize liver/extinguish wind. For Yangming empty/Jueyin wind: Unblock/secure. For Liver-Kidney deficiency with damp-heat: Tonify lower, warm/unblock collaterals, clear heat/drain damp. For Stomach deficiency/blockage: Circulate stomach qi, unblock Small Intestine fire fu. For Stomach Yang/Kidney/Du deficiency: Secure middle/lower. For Yangming deficiency/Ying heat/internal wind: Clear Ying heat/extinguish wind. For Lung heat scorching leaves: Sweet/cold clear upper heat. For evil wind entering collaterals: Detoxify/unblock. For essence/blood depletion/extraordinary vessel qi loss: Fill essence/marrow. Mr. Ye's laws are precise and immortal. (Zou Zijiu)
Xu Comment: Lower body flaccidity is mostly deficiency. Cases show many Liver/Kidney warming tonics, which is not wrong. But wind/phlegm/cold/damp are often involved. Blind tonification has flaws. These formulas started in Song, peaked in Ming. Ancients did not do this.