痿者足痛不能行也。凡人壮岁之时。气血未衰。或年及五旬。形体不甚瘦弱者。多因湿热伤脾。不能束骨。
未可即以痿论也。盖热伤其血。则大筋为之软短。热伤其筋。则小筋为之弛长。所以机关不利。
宜用滋筋养荣汤。脉沉细缓者。宜用独活寄生汤。至于年过五十。形体怯弱者。此属痿症无疑。内经曰。
肺热叶焦。五脏因而受之。发为痿 。又谓治痿必主阳明。盖言阳明胃土。为诸筋之宗。肾水不足。
不能上制心火。火来刑金。无以平木。肝邪得以克贼脾土。而痿症作矣。治当补肾水之虚。泻心火之亢。使
肺金清而肝木有制。脾自不伤也。大凡初起身热。脉来洪数。腿痛甚而难忍者。心火流于下焦。内经所谓阳精所降。
其人夭者是也。宜用六味地黄汤。加犀角牛膝木瓜麦冬之类。若脉来细数。痛而不甚者。宜用加味地黄汤。肥甘浓
味。辛热烟酒。既不可尝。恐助肺家之火。痛愈甚也。然痿症固属肺热。若阳
明气虚。宗筋失养。亦令足痿。宜用加味八物汤。至于先天命门火衰。又宜大造地黄丸之类。不可拘于一法也。
滋筋养荣汤
当归 川芎 白芍 熟地 续断 杜仲 牛膝 木瓜 苡仁 车前 五茄皮 麦冬 石斛 独活 秦皮
独活寄生汤
独活 细辛 当归 防风 杜仲 桑寄生 川芎 熟地 桂枝 甘草 秦艽 牛膝 白茯 人参
加味八物汤
人参 白术 白茯 甘草 当归 川芎 白芍 熟地 阿胶 续断 天冬 杜仲 山萸 枸杞 五味 黄
痿症是指足部疼痛导致无法行走。凡是正值壮年的人，气血尚未衰退，或者年龄到了五十岁，身体并不十分消瘦虚弱的人，大多是因为湿热损伤了脾脏，导致脾不能约束骨骼，这种情况还不能立即诊断为痿症。因为热邪损伤血液，大筋就会变得软弱短缩；热邪损伤筋脉，小筋就会变得松弛延长。所以关节活动不利。这种情况适宜使用滋筋养荣汤。如果脉象沉细而缓的，适宜使用独活寄生汤。至于年龄超过五十岁，身体怯弱瘦小的人，这毫无疑问属于痿症。《内经》说：肺热导致叶焦枯，五脏因此受到波及，从而发为痿证。又说治疗痿症必须以调理阳明经为主，这是因为阳明胃土是各种筋脉的宗主。如果肾水不足，就不能向上制约心火，心火亢盛来克制肺金，导致无法平抑肝木，肝气邪气得以克制脾土，于是痿症就发作了。治疗应当补肾水的虚损，泻除心火的亢盛，使肺金清凉而肝木有所制约，脾土自然就不会受伤了。大凡初起时身体发热，脉象洪大数急，腿部疼痛剧烈难以忍受的，这是心火流注于下焦，就是《内经》所说的阳精下降，这样的人寿命不长（早夭）。适宜使用六味地黄汤，加入犀角、牛膝、木瓜、麦冬之类的药物。如果脉象细数，疼痛但不剧烈的，适宜使用加味地黄汤。肥甘厚味、辛辣热性的食物以及烟酒，既然不可尝试，恐怕会助长肺家的火气，使疼痛更加严重。然而痿症固然属于肺热，如果阳明经气虚，宗筋失去滋养，也会导致足部痿废。适宜使用加味八物汤。至于先天命门之火衰微，又适宜使用大造地黄丸之类的方剂，不可以拘泥于一种治法。
滋筋养荣汤
当归 川芎 白芍 熟地黄 续断 杜仲 牛膝 木瓜 薏苡仁 车前子 五加皮 麦冬 石斛 独活 秦皮
Wei syndrome refers to foot pain resulting in the inability to walk. Individuals in their prime, whose qi and blood have not yet declined, or those around fifty years of age who are not significantly emaciated, often suffer from damp-heat injuring the Spleen, which fails to bind the bones. Such cases should not be immediately diagnosed as Wei syndrome. Heat damaging the blood causes the large sinews to become soft and short; heat damaging the sinews causes the small sinews to become lax and long. Consequently, joint movement becomes impaired. In such cases, Zijin Yangrong Tang (Nourish Sinew and Nourish Blood Decoction) is appropriate. If the pulse is deep, fine, and slow, Duhuo Jisheng Tang (Angelicae Pubescentis and Taxillus Decoction) is indicated. However, for individuals over fifty who are physically frail and weak, this undoubtedly belongs to Wei syndrome. The *Neijing* states: "Lung heat causes the leaves to wither and dry up, and the five Zang organs are thereby affected, leading to the development of Wei syndrome." It also states that treating Wei syndrome must primarily focus on the Yangming channel, because the Yangming Stomach Earth is the master of all sinews. If Kidney Water is insufficient, it cannot control Heart Fire upwards; Fire comes to punish Metal, failing to level Wood, allowing Liver pathogenic factors to attack Spleen Earth, thus causing Wei syndrome to arise. Treatment should tonify the deficiency of Kidney Water and drain the excess of Heart Fire, so that Lung Metal becomes clear and Liver Wood is controlled, ensuring the Spleen is not injured. Generally, if there is initial fever, a surging and rapid pulse, and severe, unbearable leg pain, this indicates Heart Fire flowing into the Lower Jiao, which corresponds to what the *Neijing* calls "the descent of Yang essence," suggesting the person may die young. Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Rhinoceros Horn (now substituted), Achyranthes Root, Chaenomelis Fructus, and Ophiopogon Tuber is appropriate. If the pulse is fine and rapid, with pain but not severe, Jiawei Dihuang Wan (Modified Rehmannia Pill) is indicated. Rich, sweet, greasy foods, pungent, hot substances, tobacco, and alcohol should be avoided, as they may exacerbate Lung Fire and worsen the pain. Although Wei syndrome is indeed related to Lung Heat, if Qi of the Yangming is deficient and the Zongjin (General Sinews) lose nourishment, foot atrophy can also occur. Jiawei Bawu Tang (Modified Eight-Ingredient Decoction) is appropriate. For congenital decline of Mingmen Fire, Dazao Dihuang Wan (Great Creation Rehmannia Pill) and similar formulas are suitable; one should not adhere rigidly to a single method.
Zijin Yangrong Tang (Nourish Sinew and Nourish Blood Decoction)
Angelicae Radix (Danggui), Ligusticum Chuanxiong Rhizome (Chuanxiong), Paeoniae Radix Alba (Baishao), Prepared Rehmanniae Radix (Shudi), Dipsaci Radix (Xuduan), Eucommiae Cortex (Duzhong), Achyranthis Bidentatae Radix (Niuxi), Chaenomelis Fructus (Mugua), Coicis Semen (Yiren), Plantaginis Seed (Cheqian), Acanthopanacis Cortex (Wujia Pi), Ophiopogonis Tuber (Maidong), Dendrobii Caulis (Shihu), Angelicae Pubescentis Radix (Duhuo), Qinpi Bark (Qinpi)
Duhuo Jisheng Tang (Angelicae Pubescentis and Taxillus Decoction)
Angelicae Pubescentis Radix (Duhuo), Asari Radix et Rhizoma (Xixin), Angelicae Radix (Danggui), Saposhnikoviae Radix (Fangfeng), Eucommiae Cortex (Duzhong), Taxilli Herba (Sangjisheng), Ligusticum Chuanxiong Rhizome (Chuanxiong), Prepared Rehmanniae Radix (Shudi), Cinnamomi Ramulus (Guizhi), Glycyrrhizae Radix et Rhizoma (Gancao), Gentianae Macrophyllae Radix (Qinjiao), Achyranthis Bidentatae Radix (Niuxi), Poria (Baifu), Ginseng Radix (Renshen)
Jiawei Bawu Tang (Modified Eight-Ingredient Decoction)
Ginseng Radix (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Baifu), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Radix (Danggui), Ligusticum Chuanxiong Rhizome (Chuanxiong), Paeoniae Radix Alba (Baishao), Prepared Rehmanniae Radix (Shudi), Colla Corii Asini (Ejiao), Dipsaci Radix (Xuduan), Asparagi Tuber (Tiantong), Eucommiae Cortex (Duzhong), Corni Fructus (Shanzhuyu), Lycii Fructus (Gouqi), Schisandrae Fructus (Wuweizi), Astragali Radix (Huangqi)