治肝肾俱虚，精血不足，足膝酸疼，步履不随，风寒湿气脚痛。
虎胫骨（酥炙） 天麻 宣木瓜（一个，去瓤） 肉苁蓉（各一两，酒浸、焙） 没
药乳香（各五钱） 川乌（一两，炮、去皮） 川牛膝（一两五钱，酒浸） 为末，入木瓜
膏，和酒杵捣为丸，如桐子大，每服七十丸，空心温酒淡盐汤送下。
当归拈痛汤
见前肩背门。
痿者，手足痿软无力，百节缓纵不收也。《经》曰∶五脏使人痿，盖言五脏皆有
痿也。又曰∶肺热叶焦，则皮毛虚弱急薄着则生痿 也。盖言肺主皮毛，为脏之长，
心之盖也。若肺热叶焦，则皮毛虚弱急薄，着则生痿 也。且肺热则肾受热气。故足
挛，不得伸以行也。心主身之血脉，血热则下脉厥而上，上则下脉虚则生脉痿，枢
折而不能提挈，胫纵而不任地也。肝主筋膜，肝热则胆泄口苦，筋膜干则筋急而挛，
发为筋痿也。脾主肌肉，脾热则胃干而渴，肌肉不仁，发为肉痿也。肾主骨髓，肾热则
腰脊不举，骨枯而髓减，发为骨痿也。又曰∶大经空虚，发为肌痹，传为脉痿。入房
太甚，费竭精气，宗筋弛纵，发为筋痿。居处相湿则肌肉不仁，色黄而蠕动，是谓肉
痿，故曰∶肉痿者，得之湿地也。有远行劳倦，遇大热而渴，渴则阳气内伐，阴气内
消，乃热舍于肾，肾者，水脏也。水不胜火则骨枯而髓虚，故足不任身，腰脊不举，发
为骨痿，故曰∶骨痿生于大热也。凡此五痿与柔风香港脚相类，但柔风香港脚皆外因，痿则
五内不足耳。
治痿者，独取阳明何也？盖阳明为五脏六腑之海，主润宗筋，宗筋主束骨而利机关
也。宗筋谓阴毛中横骨上下脐两傍之坚筋也，凡人身上下前后无处不达。阳明虚，则
宗筋纵，带脉不引，故足痿不用也。且四肢皆禀于胃，必因于脾乃得禀也。脾为太阴，
其脉贯胃，行气于手足之三阴，胃为阳明，行气于手足之三阳。若脾病，则不能为胃行
其津液，以达四肢，四肢不得禀水谷之气，筋骨肌肉无气以生乃痿也。然脾太过，亦令
人四肢不举，《经》所曰∶土太过，则敦阜。阜者，高也。敦者，浓也。既浓又高，其治
则泻，以令气弱阳衰，土平而愈，乃膏粱之疾也。若脾虚则不用，《经》所谓土不及，
则卑监也，其治宜培本为主。
《内经》治痿，独取阳明，乃治痿之大概。欲使宗筋润，能束骨而利机关，是澄其
源而流自清，以其原皆自于肺，故以五痿之所主者，而参治之。庶得以尽其用。《经》
曰∶各补其荣而通其输调其虚实，和其逆顺，可见治法不专于阳明也。
手阳明大肠经，肺之腑也。足阳明胃经，脾之腑也。治痿之法，惟取阳明一经，
何也？《经》云∶诸痿生于肺热，盖五行之中，惟火有二，肾虽有二，水居其一，阳常
有余，阴常不足，故《经》曰∶一水不胜二火，理之必然，肺金体燥而居上，主气化，
畏火者也。脾土性湿而居中，主四肢，畏木者也。夫火性炎上，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，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，脾伤则四肢皆不为用，而诸
痿之病作矣。泻南方则肺金清而东方不实，
何俾伤之有？补北方则心火降，而西方不虚，何肺热之有？故阳明实则宗筋荣润，自
能束骨而利机关矣。治痿之法无出于此，故曰∶风火既炽，当滋肾水，是以东垣先生取
黄柏为君，黄 等补药辅之为佐，然有兼痰积者，有湿多者，有热多者，有湿热相半
者，有挟气者，临病制方难于一定，且浓味发热，乃先哲格言，但是患痿之人，若不淡
薄食味必不能安全也。
夫筋脉短劲，肝气内锢，须明金伐木荣之道，惟金失其刚，转而为柔，是以木失其
柔，转而为刚，故治此患，专以清金为第一义也。然清金尤先于清胃，否则，饮酒而热
气输于肺矣，浓味而浊气输于肺矣。药力几何，能胜清金之任哉！如金不清则大敌在
前，主将懦弱，焉望其成功耶！
夫风痿之别，凡痛则为风，不痛则为痿。《经》曰∶痛则为实，不痛则为虚，曰
风，曰痿，虚实二者而已。东垣曰∶气盛痿盛，气衰病衰，何以盖人之气血充实，则风
寒客于经络之间，邪正尚能交攻，而疼痛作矣。人之气血虚弱，则痰火郁于肢节之内，
而正不能胜邪，乃痿痹作矣。故丹溪曰∶痿症切不可作风治而用风药，亦以风为实，而
痿为虚也。曰散邪，曰补虚，岂可紊乱，兼忌妄用燥烈之药，致伤真阴真气，药势偏有
所助，则胜克流变，其害益甚矣。
痿症若草木失于培植，枝叶枯稿，根本尚未大伤，以其不咳嗽，不吐血，不发寒
热，为异于虚劳耳。故久沾床褥，而形色绝无病状，亦并无痛楚麻木若痹证也。盖痹证
由于三气外伤，病在经络血脉之中，气血闭涩者也。尚可作有余，论痿证由于气血不
足。受病在五脏六腑之中，不能充固者也，当纯从不足治。
夫痿。热症也。本于五内不足，而其原则由于肺，论治则独取阳明，盖真气受于
天，与谷气并而充身，谷始入于胃，以溉五脏真气者，天之道谷气者，地之道，真气与
谷气并，而后形气之道立，阳明虚则五脏无所禀，不能行气血而奉生身者，弱矣。阳明
主润宗筋，宗筋足之强弱所系，故曰偏枯痿易，四肢不用者，脾病也。《经》曰∶四肢
皆禀气于胃，必因于脾，乃得禀也。令脾病不能为胃行其津液，水谷日虚，气日以衰，
脉道不利，筋骨肌肉皆无气以生，而四肢不举。《经》又曰∶岁土太过，中满食减，四
肢不举，是四脏之痿，又独重于阳明者，明矣。及后世诸肾主论，有主乎虚损成也者，
有主于实邪为病者，当兼以脉候辩之。有曰精虚血耗，五内不足而成痿者；有曰燥金气
郁，血液衰少，不能荣养百骸而成痿者；有曰阳明湿热熏蒸于肺，困水之上源而成痿
者；有曰使内太过，水少不能胜心火，火除肺金而六叶焦，以成痿者；有曰肾主骨而藏
精，肝主筋而藏血，嗜欲无度，则肝肾虚而成痿者。凡此皆论内伤不足为病，而总归于
热，故曰∶痿病无寒，不可作寒治。又曰∶痿属湿热，不可作风治，当以清热补精养血
为主，观此则知痿病之一外感也，明矣。但始因气热而成，不可骤用辛热峻补之剂耳。
其以实邪为病立论者∶有曰劳心太过，心气热则火独光肾脉随火上行而痿者；有曰燥金
受邪，寒水生化之源绝，而湿热下流肾肝而痿者；有曰醇酒膏粱，命门相火过盛，逼阴
于外而痿者；有曰长夏服热药太过，阴明火邪内伏而痿者；有曰肺气不舒，郁遏成火而
痿者。又曰∶湿痰聚于中焦，手足软而痿者，有曰肾肝气虚，风邪袭虚而痿者，即经
文治痰，独取阳明，亦非谓阳明之本虚立见，否则何以病痿之人，饮食日盛，形体日
肥，而足终痿易不用，岂水谷入海，阳明气旺，独不能运化精微，以强筋骨乎？此乃火
邪伏诸胃中，但能杀谷，而不能长养血气，以生津液，灌溉百骸，最以饮食倍于平人，
而足反为之不用，此所谓壮火食气，胃热消谷善饥是也。阳明之热邪，原是肺热中传
来，故治痿独取阳明者，非补阳明也。治阳
明火邪，毋使干于气血之中，则湿热清而筋骨强，足痿自起，此经不言补而言取者，取
出阳明之热邪耳，凡此皆以实邪为病立论也。然病名虽一，而脉候自殊，虚实之间，
岂无辩乎，要知虚者，乃正气虚，实者，乃邪气实，岂有气血精髓充足，而筋骨为之受
病者乎。
治疗肝肾两虚，精血亏少，导致足膝酸痛，行走无力，以及风寒湿邪引起的脚痛。
虎胫骨（用酥油炙烤） 天麻 宣木瓜（一个，去掉瓤） 肉苁蓉（各一两，用酒浸泡、焙干） 没药、乳香（各五钱） 川乌（一两，炮制、去皮） 川牛膝（一两五钱，用酒浸泡） 研为细末，加入木瓜膏，和着酒捣匀制成丸药，大小如梧桐子，每次服用七十丸，空腹时用温酒或淡盐汤送服。
当归拈痛汤
见前文肩背门。
痿证，是指手足痿软无力，全身关节松弛无法收持。《内经》说：五脏病变都能使人发生痿证，这是说五脏各自都有对应的痿证。又说：肺热叶焦，则皮毛虚弱急薄，进而产生痿躄（下肢痿弱不能行走的病证）。这是说肺主皮毛，是五脏之长，心的覆盖物。如果肺热导致叶焦，则皮毛虚弱急薄，进而产生痿躄。而且肺热会传热气给肾。所以足部拘挛，不能伸直行走。心主管身体的血脉，血热则下部血脉厥逆而上行，上行则下部血脉空虚从而产生脉痿，枢机折断而不能提举，小腿纵缓不能站立于地。肝主管筋膜，肝热则胆汁外泄口苦，筋膜干燥则筋脉拘急而挛缩，发为筋痿。脾主管肌肉，脾热则胃干口渴，肌肉麻木不仁，发为肉痿。肾主管骨髓，肾热则腰脊不能抬起，骨骼枯槁而髓液减少，发为骨痿。又说：大经空虚，发为肌痹，传变为脉痿。房事过度，耗竭精气，宗筋弛缓纵散，发为筋痿。居住潮湿环境则肌肉麻木不仁，面色发黄且肌肉蠕动，这叫做肉痿，所以说：肉痿是由于湿地引起的。有远行劳倦，遇到大热而口渴，渴则阳气内伐，阴气内消，于是热邪留舍于肾，肾是水脏。水不胜火则骨骼枯槁而髓虚，所以足不能支撑身体，腰脊不能抬起，发为骨痿，所以说：骨痿生于大热。凡是这五种痿证与柔风、香港脚（一种以足胫肿大软弱为主的疾病）相似，但柔风和香港脚都是外因所致，痿证则是五脏内部不足所致。
治疗痿证，为什么要独取阳明经呢？因为阳明经是五脏六腑气血的海源，主管滋润宗筋，宗筋主管约束骨骼而利于关节运动。宗筋是指阴毛中横骨上下、脐旁两侧的坚韧筋脉，凡人身上下前后无处不到。阳明经虚弱，则宗筋弛纵，带脉不能牵引，所以足部痿废不能用。而且四肢都禀受于胃，必须依赖脾的转输才能禀受营养。脾为太阴经，其脉贯串胃部，将气运行于手足三阴经；胃为阳明经，将气运行于手足三阳经。如果脾有病，就不能为胃传输津液，以到达四肢，四肢得不到水谷之气，筋骨肌肉没有气以生养就会发生痿证。然而脾太过，也会让人四肢不能举起，《内经》所说：土气太过，则地势高厚。阜，是高。敦，是浓。既浓又高，治疗就要泻，以使气弱阳衰，土气平和而痊愈，这是饮食肥甘厚味导致的疾病。如果脾虚则功能减退，《内经》所谓土气不及，则地势低洼如监，治疗应当以培补根本为主。
《内经》治痿独取阳明，这是治疗痿证的大概原则。想要使宗筋滋润，能约束骨骼而利于关节运动，这是澄清源头而水流自然清澈，因为根源都在于肺，所以要结合五痿各自所主的脏腑来参合治疗。这样才能尽其效用。《内经》说：分别补益它们的荣穴并疏通它们的输穴，调和虚实，顺接逆乱，可见治疗方法并不专限于阳明经。
手阳明大肠经，是肺的腑。足阳明胃经，是脾的腑。治疗痿证的方法，只取阳明一经，为什么呢？《内经》说：各种痿证都生于肺热。大概五行之中，只有火有两种，肾虽然有两个，但水居其一，阳常有余，阴常不足，所以《内经》说：一水不能胜二火，这是必然的道理。肺金体燥而居上，主气化，畏惧火邪。脾土性湿而居中，主四肢，畏惧木邪。火性炎上，如果嗜欲无节制，则水失所养，火少了畏惧，就欺侮它所胜的脏，肺得到火邪而发热了。木性刚急，肺受热，则金失所养，木少了畏惧，就欺侮它所胜的脏，脾得到木邪而受伤了。肺热则不能管摄一身，脾伤则四肢都不能使用，各种痿病就发作了。泻南方（心火）则肺金清而东方（肝木）不实，有什么伤害呢？补北方（肾水）则心火降，而西方（肺金）不虚，有什么肺热呢？所以阳明充实则宗筋荣润，自然能约束骨骼而利于关节运动。治疗痿证的方法没有超出这个范围，所以说：风火既然炽盛，应当滋补肾水，因此东垣先生取黄柏为君药，黄耆等补药为辅佐。然而有的兼有痰积，有的湿多，有的热多，有的湿热相半，有的挟气滞，临病制方难以固定不变，况且浓味发热是先哲的格言，但是患痿的人，如果不清淡饮食一定不能安全康复。
筋脉短劲，肝气内锢，必须明白金克木、养肝气的道理，只有金失去刚硬，转为柔和，那么木失去柔和，转为刚强，所以治疗此患，专门以清金为第一要义。然而清金尤其要先于清胃，否则，饮酒后热气输送到肺，浓味食物后浊气输送到肺，药物的力量有多少，能胜任清金的任务呢！如果金不清则大敌当前，主将懦弱，哪里指望成功呢！
风痿的区别，凡是疼痛就是风，不疼痛就是痿。《内经》说：痛则为实，不痛则为虚，说是风，说是痿，不过是虚实两种罢了。东垣说：气盛则痿盛，气衰则病衰，为什么人的气血充实，则风寒客于经络之间，邪正尚能交攻，而疼痛发作。人的气血虚弱，则痰火郁于肢节之内，而正气不能胜邪，于是痿痹发作。所以丹溪说：痿症切不可当作风证治疗而用风药，也是因为风为实，而痿为虚。说是散邪，说是补虚，岂可混乱，同时忌妄用燥烈之药，以致损伤真阴真气，药势偏颇有所助长，则胜克流变，危害更加严重。
痿症如果像草木失于培植，枝叶枯稿，根本尚未大伤，因为它不咳嗽，不吐血，不发寒热，区别于虚劳。所以久卧床褥，而形色绝无病状，也没有痛楚麻木像痹证那样。大概痹证是由于三气外伤，病在经络血脉之中，气血闭涩。还可以作为有余论，痿证是由于气血不足。受病在五脏六腑之中，不能充固，应当纯从不足治疗。
夫痿，是热症。本于五脏内部不足，而其原则由于肺，论治则独取阳明，大概真气受于天，与谷气合并而充满身体，谷始进入胃，以灌溉五脏真气，天之道是谷气，地之道是真气，真气与谷气合并，而后形气之道确立，阳明虚弱则五脏无所禀受，不能行气血而奉养身体，就弱了。阳明主管滋润宗筋，宗筋关乎足的强弱，所以说偏枯痿易，四肢不用，是脾病。《内经》说：四肢都禀受气于胃，必须依赖脾，才能禀受。现在脾病不能为胃传输津液，水谷日渐虚少，气日渐衰弱，脉道不利，筋骨肌肉都没有气以生养，而四肢不能举起。《内经》又说：岁土太过，中满食减，四肢不举，这是四脏的痿证，又特别重于阳明，是很明显的了。到了后世诸家关于肾主的论述，有主张虚损而成的，有主张实邪致病的，应当兼以脉候辨别。有的说精虚血耗，五脏内部不足而成痿；有的说燥金气郁，血液衰少，不能荣养百骸而成痿；有的说明明湿热熏蒸于肺，困阻水之上源而成痿；有的说房事太过，水少不能胜心火，火除灼肺金而六叶焦枯，以成痿；有的说肾主骨而藏精，肝主筋而藏血，嗜欲无度，则肝肾虚而成痿。凡是这些论述内伤不足为病，而总归于热，所以说：痿病无寒，不可当寒证治疗。又说：痿属湿热，不可当作风证治疗，应当以清热补精养血为主，看这些就知道痿病也有外感的情况，很明白了。只是开始因气热而成，不可骤然使用辛热峻补的药剂。
那些以实邪为病立论的：有的说劳心太过，心气热则火独光，肾脉随火上行而痿；有的说燥金受邪，寒水生化之源绝，而湿热下流肾肝而痿；有的说醇酒膏粱，命门相火过盛，逼阴于外而痿；有的说长夏服热药太过，阴明火邪内伏而痿；有的说肺气不舒，郁遏成火而痿。又说：湿痰聚于中焦，手足软而痿；有的说肾肝气虚，风邪袭虚而痿。即经文治痰独取阳明，也不是谓阳明之本虚立见，否则为什么患痿的人，饮食日盛，形体日肥，而足终痿废不用，难道水谷入海，阳明气旺，独不能运化精微，以强筋骨吗？这是火邪伏于胃中，只能杀谷（消化食物），而不能长养血气，以生津液，灌溉百骸，最显著的是饮食倍于常人，而足反而为之不用，这就是所谓壮火食气，胃热消谷善饥。阳明之热邪，原是肺热中传来，所以治痿独取阳明者，不是补阳明。治疗阳明明火邪，不要干扰气血之中，则湿热清而筋骨强，足痿自然起立，此经文不言补而言取者，是取出阳明之热邪罢了，凡是这些都以实邪为病立论。然而病名虽一，而脉候自殊，虚实之间，岂无辨别乎，要知道虚者，乃正气虚，实者，乃邪气实，岂有气血精髓充足，而筋骨为之受病的呢。
Treatment for deficiency of both Liver and Kidney, insufficiency of Essence and Blood, leading to soreness and pain in the feet and knees, inability to walk freely, and foot pain caused by Wind-Cold-Dampness pathogens.
Hu Jing Gu (Tiger Tibia Bone) [prepared with Su oil], Tian Ma (Gastrodia Rhizome), Xuan Mu Gua (Chaenomeles Fruit) [one piece, pith removed], Rou Cong Rong (Cistanche Stem) [each 1 liang, soaked in wine, baked], Mo Yao (Myrrh), Ru Xiang (Olibanum/Gum Resin) [each 5 qian], Chuan Wu (Aconitum Carmichaelii Dehxan Root) [1 liang, processed, skin removed], Chuan Niu Xi (Cyathulae Radix) [1 liang 5 qian, soaked in wine]. Grind into fine powder, add Mu Gua Gao (Papaya Paste), mix with wine, pound and knead into pills, size of Wutong seeds (Cercidiphylli Fructus). Take 70 pills per dose, swallow with warm wine or light salt water on an empty stomach.
Dang Gui Nian Tong Tang (Angelica Sinensis Decoction for Relieving Pain)
See previous section on Shoulder and Back.
Wei Syndrome (Flaccidity Syndrome) refers to flaccid weakness of the hands and feet, and laxity of all joints unable to hold themselves. The *Classic* states: "The Five Zang organs can cause Wei," implying that each Zang organ has its corresponding Wei syndrome. It also states: "When Lung Heat scorches the leaves, the skin and hair become weak, tight, and thin, leading to Wei Bi (flaccidity of the lower limbs)." This means the Lung governs the skin and hair, is the chief of the Zang organs, and covers the Heart. If Lung Heat causes leaf scorching, the skin and hair become weak, tight, and thin, leading to Wei Bi. Furthermore, Lung Heat transmits heat qi to the Kidney. Thus, the legs cramp and cannot extend to walk. The Heart governs the blood vessels of the body; when blood is hot, the lower vessels revolt and move upward. Upward movement makes the lower vessels deficient, generating Mai Wei (Vessel Flaccidity), where the pivot breaks and cannot lift, the shins are lax and cannot bear weight. The Liver governs the tendino-muscular system; Liver Heat causes gallbladder bile to leak resulting in a bitter taste, dry tendons lead to tendon tension and cramping, manifesting as Jin Wei (Tendon Flaccidity). The Spleen governs the muscles; Spleen Heat causes dryness and thirst in the Stomach, muscle insensibility, manifesting as Rou Wei (Muscle Flaccidity). The Kidney governs the bone marrow; Kidney Heat causes inability to raise the waist and spine, bone desiccation and marrow reduction, manifesting as Gu Wei (Bone Flaccidity). It also states: "When the large channels are empty, Ji Bi (Muscle Bi) develops, transmitting to Mai Wei." Excessive sexual activity exhausts Essence and Qi, causing Zong Jin (Major Tendons) to relax and loosen, manifesting as Jin Wei. Dwelling in damp places causes muscle insensibility, yellowish complexion, and muscle twitching, called Rou Wei; thus it is said: "Rou Wei arises from damp ground." Traveling far while fatigued, encountering intense heat and thirst, thirst leads to internal attack by Yang Qi and internal consumption of Yin Qi, so Heat resides in the Kidney. The Kidney is the Water Organ. When Water cannot overcome Fire, bones become dry and marrow deficient, so the feet cannot support the body, the waist and spine cannot rise, manifesting as Gu Wei; thus it is said: "Gu Wei is born of great heat." All these five Weis resemble Rou Feng (Soft Wind) and Xiang Gang Jiao (Hong Kong Foot - a disease characterized by swollen and weak calves), but Rou Feng and Xiang Gang Jiao are due to external factors, whereas Wei is due to internal deficiency of the Five Zang.
Why does treating Wei focus solely on the Yangming? Because Yangming is the sea of the Five Zang and Six Fu organs, governing the moistening of Zong Jin. Zong Jin binds the bones and facilitates joint movement. Zong Jin refers to the tough tendons above and below the horizontal bone in the pubic region and beside the navel, reaching everywhere in the body. When Yangming is deficient, Zong Jin becomes lax, the Dai Mai (Girdle Vessel) fails to draw, so the feet become flaccid and unusable. Moreover, the four limbs receive their nourishment from the Stomach, but must rely on the Spleen to distribute it. The Spleen is Taiyin, its meridian passes through the Stomach, distributing Qi to the three Yin meridians of the hand and foot. The Stomach is Yangming, distributing Qi to the three Yang meridians of the hand and foot. If the Spleen is diseased, it cannot transport fluids for the Stomach to reach the four limbs. The four limbs do not receive Qi from grain and water, and the sinews, bones, and muscles lack Qi to generate, resulting in Wei. However, if Spleen Qi is excessive, it also causes inability to raise the limbs. As the *Classic* says: "When Earth is excessive, it is high and thick." 'Fu' means high, 'Dun' means thick. Being both thick and high requires purging treatment to weaken Qi and decline Yang until Earth returns to balance, curing the disease caused by rich foods. If Spleen is deficient, it fails to function. As the *Classic* says: "When Earth is insufficient, it is low and supervising." Treatment should primarily focus on tonifying the root.
*T Nei Jing*'s principle of treating Wei by focusing solely on Yangming is the general approach. To make Zong Jin moist, able to bind bones and facilitate joints, one must clear the source so the flow becomes clear, as the origin lies in the Lung. Therefore, one should treat according to the specific Zang associated with each of the five Weis. This ensures comprehensive efficacy. The *Classic* says: "Tonify their Ying points and unblock their Shu points, regulate deficiency and excess, harmonize reversal and smoothness." This shows treatment is not exclusive to Yangming.
Hand Yangming Large Intestine Meridian is the Fu organ of the Lung. Foot Yangming Stomach Meridian is the Fu organ of the Spleen. Why does treating Wei take only the Yangming meridian? The *Classic* says: "All Weis arise from Lung Heat." Among the Five Elements, there are two Fires. Although the Kidney has two aspects, Water occupies one. Yang is often in excess, Yin is often insufficient. Thus, the *Classic* says: "One Water cannot overcome Two Fires," which is inevitable. Lung Metal is dry in nature and resides superiorly, governing Qi transformation, fearing Fire. Spleen Earth is damp in nature and resides centrally, governing the four limbs, fearing Wood. Fire nature is flaming upward. If desires are unregulated, Water loses nourishment, Fire lacks restraint, and overcomes what it normally controls. Lung receives Fire pathogen and becomes hot. Wood nature is rigid and urgent. Lung receiving heat causes Metal to lose nourishment, Wood lacks restraint, and overcomes what it normally controls. Spleen receives Wood pathogen and is injured. Lung Heat cannot control the whole body; Spleen injury causes the four limbs to be unusable, and various Wei diseases arise. Purging the South (Heart Fire) clears Lung Metal and prevents East (Liver Wood) from being solid, preventing harm. Tonifying the North (Kidney Water) descends Heart Fire and prevents West (Lung Metal) from being deficient, preventing Lung Heat. Thus, when Yangming is substantial, Zong Jin is nourished and moist, naturally binding bones and facilitating joints. Treating Wei methods do not exceed this. Thus it is said: "When Wind and Fire are blazing, one must nourish Kidney Water." Therefore, Mr. Dongyuan took Huang Bo (Phellodendri Cortex) as the sovereign herb, assisted by tonics like Huang Qi (Astragali Radix) as ministers. However, some have phlegm accumulation, some have much Dampness, some have much Heat, some have half Dampness and half Heat, some have Qi stagnation. Formulating prescriptions based on the disease is difficult to fix. Moreover, rich flavors causing heat is an ancient maxim. But patients with Wei must eat bland food to ensure safety.
Short and tense sinews and vessels indicate Liver Qi trapped internally. One must understand the way Metal conquers Wood and nurtures it. Only when Metal loses rigidity and turns soft, does Wood lose softness and turn rigid. Therefore, treating this condition prioritizes clearing Metal. However, clearing Metal must precede clearing the Stomach. Otherwise, alcohol transports heat to the Lung, and rich flavors transport turbidity to the Lung. How much medicinal power can胜任 the task of clearing Metal! If Metal is not cleared, the major enemy is before us, the commander is weak, how can success be expected!
The difference between Feng (Wind) and Wei (Flaccidity): Pain indicates Wind, no pain indicates Wei. The *Classic* says: "Pain is Excess, no pain is Deficiency." Saying Wind, saying Wei, it is merely Excess and Deficiency. Dongyuan said: "Qi abundance leads to Wei abundance, Qi decline leads to disease decline." Why? When human Qi and Blood are substantial, Wind-Cold lodges in the collaterals, Evil and Righteous still contend, causing pain. When human Qi and Blood are deficient, Phlegm-Fire stagnates within the joints, Righteous cannot overcome Evil, so Wei-Bi arises. Danxi said: "Wei syndrome must never be treated as Wind using Wind medicines," because Wind is Excess, while Wei is Deficiency. Dispersing Evil and Tonifying Deficiency must not be confused. Also, avoid reckless use of acrid-hot drugs to damage True Yin and True Qi. If drug potency is biased and assists, the cycle of overcoming and flowing changes, causing greater harm.
Wei syndrome is like plants failing to be cultivated, branches and leaves wither, but the root is not greatly damaged. It differs from Xu Lao (Consumption) because there is no cough, hemoptysis, or aversion to cold/fever. Thus, prolonged bedridden patients show no pathological signs in appearance, nor pain/numbness like Bi syndrome. Bi syndrome is due to external Three Evils, disease in collaterals and blood vessels, blocking Qi and Blood. It can be discussed as Excess. Wei syndrome is due to Qi and Blood insufficiency. Disease is in the Five Zang and Six Fu, unable to fill and secure. Treatment should purely address Deficiency.
Wei is a Heat syndrome. It originates from internal deficiency of the Five Zang, with the principle lying in the Lung. Treatment focuses on Yangming. True Qi is received from Heaven, combined with Grain Qi to fill the body. Grain enters the Stomach first to irrigate the True Qi of the Five Zang. Heaven's Way is Grain Qi, Earth's Way is True Qi. True Qi and Grain Qi combine, establishing the Way of Form and Qi. Yangming deficiency means the Five Zang have nothing to receive, cannot circulate Qi and Blood to nourish the body, becoming weak. Yangming governs moistening Zong Jin, which determines the strength of the feet. Thus, hemiplegia and Wei Yi (flaccidity/ease), inability to use the four limbs, are Spleen diseases. The *Classic* says: "The four limbs receive Qi from the Stomach, must rely on the Spleen to receive it." Now, Spleen disease cannot transport fluids for the Stomach. Grain and water become daily deficient, Qi daily declines, vessel pathways are unfavorable, sinews, bones, and muscles lack Qi to generate, and the four limbs cannot be raised. The *Classic* again says: "In years of excessive Earth, abdominal fullness, reduced appetite, inability to raise the four limbs occur." This shows the Wei of the Four Zang is particularly heavy on Yangming, which is clear. Later theories on Kidney dominance include those attributing Wei to deficiency damage and those to excess pathogens. These must be distinguished by pulse diagnosis. Some say Essence deficiency and Blood consumption, internal deficiency of Five Zang causing Wei. Some say Dry Metal Qi stagnation, Blood depletion, inability to nourish the hundred bones causing Wei. Some say Yangming Damp-Heat steaming the Lung, obstructing the upper source of Water causing Wei. Some say excessive intercourse, insufficient Water failing to overcome Heart Fire, Fire burning Lung Metal and six leaves scorching, causing Wei. Some say Kidney governs bones and stores Essence, Liver governs tendons and stores Blood, immoderate desires lead to Liver-Kidney deficiency causing Wei. All these discuss internal injury and deficiency causing disease, totaling to Heat. Thus it is said: "Wei disease has no Cold, do not treat as Cold." It also says: "Wei belongs to Damp-Heat, do not treat as Wind. Focus on clearing Heat, tonifying Essence, and nourishing Blood." From this, it is clear that Wei disease also involves external contraction. However, since it initially arises from Qi Heat, sudden use of acrid-hot strong tonics is contraindicated.
Those establishing theories based on Excess Pathogens: Some say excessive mental labor, Heart Qi Heat causes Fire to shine alone, Kidney channel follows Fire upward causing Wei. Some say Dry Metal receives pathogen, source of Cold Water generation is cut off, Damp-Heat flows downward to Kidney and Liver causing Wei. Some say pure wine and rich foods, Ming Men Minister Fire excessively strong, forcing Yin outward causing Wei. Some say taking hot medicines excessively in late summer, Yin brightens and Fire-Evil hides internally causing Wei. Some say Lung Qi not soothing, stagnation transforms into Fire causing Wei. It also says: Damp-Phlegm gathers in the Middle Jiao, hands and feet soft and Wei. Some say Kidney-Liver Qi deficiency, Wind pathogen attacks deficiency causing Wei. Even the Classic text says treating Phlegm focuses on Yangming, it does not mean Yangming original deficiency is immediately seen. Otherwise, why do Wei patients have increasing appetite, fattening bodies, yet feet remain flaccid and unusable? Does Grain entering the Sea, Yangming Qi flourishing, fail to transform essence and subtle substances to strengthen sinews and bones? This is Fire-Evil hiding in the Stomach, only capable of killing grain (digestion), but unable to grow Blood-Qi, generate fluids, and irrigate the hundred bones. Most notably, diet is double that of normal people, yet feet are unusable. This is what is called "Strong Fire consumes Qi," Stomach Heat consuming grain and causing hunger. Yangming Heat-Evil originally comes from transmission of Lung Heat. Therefore, "Treating Wei focuses on Yangming" does not mean tonifying Yangming. Treating Yangming Bright Fire-Evil, without interfering with Qi and Blood, clears Damp-Heat and strengthens sinews and bones, so foot Wei naturally rises. The Classic says "take" not "tonify" because it means extracting Yangming Heat-Evil. All these establish theories based on Excess Pathogens. However, although the disease name is one, pulse diagnoses differ. Between Excess and Deficiency, is there no distinction? Know that Deficiency is Righteous Qi deficiency, Excess is Evil Qi excess. Can there be sufficient Qi, Blood, and Essence, yet sinews and bones suffer disease?