论
《内经》曰∶肺热叶焦，五脏因而受之，发为痿 。心气热为脉痿，则胫纵而不任地。肝气热为筋痿，故筋急而挛。
脾气热为肉痿，则胃干而渴，肌肉不仁。肾气热为骨痿，则腰膝不举，骨枯而髓减。又曰∶治痿者独取阳明一经，阳明
者五脏六腑之海，主润宗筋，能束骨而利机关也。冲脉者经脉之海也，主渗灌溪谷，与阳明合于宗筋、阴阳总宗筋之会，
会于气冲，而阳明为之长，皆属于带脉，而络于督脉。故阳明虚则宗筋弛纵，带脉不引，故足痿不用也。治法各补其荥
而通其 ，调其虚实，和其逆顺，筋脉骨肉。各以其时受月，则病已矣。言治诸痿宜调补各脏，以待其旺月而病安也。
丹溪曰∶《内经》谓诸痿起于肺热，又谓治痿独取阳明一经。盖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。虽然天产作阳，浓味发热，凡病痿者，若不淡薄食味，吾知必不能保其安全也。又曰∶内经论风论痿，各有篇
目，源流不同，治法迥异，局方乃以治风之药通治诸痿，何其谬哉。按丹溪此论一出，扫尽千古之弊，叮咛告戒，极其
明白，学人睨而不视，则为聩者之雷霆，瞽者之日月耳。夫医者为人之司命，其可不尽心于此乎。
脉法
《脉经》曰∶肺痿脉必浮而弱，其人欲咳不得咳，咳则出干沫，久久则小便不利。
寸口脉不出，反为发汗，阳脉早索，阴脉不涩，三焦踟蹰，入而不出，阴脉不涩，身体反冷，其内反烦，多吐唇燥，
小便反难，此为肺痿，伤于津液，便如烂瓜，亦如豚脑，但因误发汗故也。
方法
丹溪曰∶有湿热，有痰，有血虚，有气虚，亦有死血者，有食积妨碍升降者。
卢氏曰∶上文论痿起于肺热，实痿之本论，治法之大要也。而此云然者，盖以其发而为病，所因所挟或有不同，而
主治亦当各着其重也。
东垣取黄柏为君，黄 等补药为辅佐，以治诸痿，无一定之方，有兼痰积者，有湿多者，有热多者，有湿热相半者，
有挟气者，临病制方，其善于治痿者乎。
湿热，用东垣健步丸，加燥湿降火之剂──黄柏、黄芩、苍术之类。
湿痰，用二陈汤，加苍术、白术、黄芩、黄柏之类，入竹沥、姜汁。
血虚，用四物汤，加苍术、黄柏，下补阴丸。
气虚，用四君子汤，加苍术、黄芩、黄柏。
黄柏、苍术，治痿之要药也。
虎潜丸、补肾丸皆可治痿。
加味四物汤 治诸痿，四肢软弱，不能举动。
当归身（一钱） 熟地黄（三钱） 白芍药 川芎（各七分半） 五味子（九枚） 麦门冬（一钱） 人参（五分）
黄柏（一钱） 黄连（五分） 知母（三分） 杜仲（七分半） 牛膝（三分，足不软者不用） 苍术（一钱）
上细切，作一服，水二盏，煎至一盏，空心温服。酒糊为丸服，亦可。一云∶血虚者，以四物汤加黄柏、苍术，下
补阴丸。
（以上丹溪方法凡九条）
健步丸（东垣） 治膝中无力，屈伸不便，腰背腿脚沉重，行步艰难。
羌活 柴胡 滑石（炒） 甘草（炙） 栝蒌根（酒洗） 肉桂（各五分） 防风 泽泻（各三钱） 防己（酒洗，
一两） 川乌（炮） 苦参（酒浸，各三钱）
上为细末，汤煮面糊为丸，如梧桐子大，每服七十丸，煎愈风汤下。（一云荆芥汤下，按荆芥汤又号为愈风汤也。）
大防风汤（局方） 治两足痿弱，或沉重麻痹，不能行动，两膝虚肿，名曰鹤膝风等证。（方见中风门。）
（祖传方）治两足痿弱软痛，或如火焙，从足踝下，上冲腿胯等证，因湿热所成者。
苍术（米泔浸一、二宿） 黄柏（酒浸日干，各四两） 牛膝（去芦，二两） 龟板（酥炙） 虎胫骨（酥炙） 防
己（各一两） 当归尾（二两）
上为细末，面糊为丸，如梧桐子大，每服七十丸或一百丸。空心姜、盐汤下。
一方，加炮附子五钱。
鹿角胶丸 治血气虚弱，两足痿软，不能行动，久卧床褥之证，神效。
鹿角胶（一斤） 鹿角霜 熟地黄（各半斤） 川牛膝 白茯苓 菟丝子 人参（各二两） 当归身（四两） 白
术杜仲（各二两） 虎胫骨（酥炙） 龟板（酥炙，各一两）
上为细末，另将鹿角胶用无灰酒三盏烊化，为丸如梧桐子大，每服一百丸，空心姜、盐汤下。
论
《黄帝内经》说：肺脏有热导致肺叶枯萎焦灼，五脏因此受到影响，从而引发痿证。心气热盛称为脉痿，表现为小腿松弛无法支撑身体站立。肝气热盛称为筋痿，所以筋脉拘急而挛缩。脾气热盛称为肉痿，表现为胃中干燥且口渴，肌肉麻木不仁。肾气热盛称为骨痿，表现为腰膝无力抬起，骨骼枯槁且髓液减少。又说：治疗痿证应当专门选取阳明经，因为阳明经是五脏六腑气血汇聚的大海，主要滋润宗筋（全身筋膜），能够约束骨骼并利于关节运动。冲脉是经脉的海，主要渗透灌溉溪谷（肌肉间隙），与阳明经会合于宗筋，阴阳诸经总汇于宗筋，会合于气冲穴，而阳明经在其中起主导作用，都归属于带脉，并联络于督脉。所以阳明经虚弱则宗筋弛缓纵弛，带脉不能牵引，因此足部痿废不能使用。治疗方法应分别补益各经的荥穴并疏通其输穴，调节虚实，调和逆顺，使筋、脉、骨、肉得到调理。根据各脏腑所主的时间月份进行治疗，疾病就能痊愈。这是说治疗各种痿证适宜调补各脏，等待其旺盛的月份到来则病愈。
朱丹溪说：《黄帝内经》称各种痿证起于肺热，又说要治疗痿证专门选取阳明一经。这是因为肺属金，体性燥，位居上焦而主司气，畏惧火邪。脾属土，性湿，位居中焦而主司四肢，畏惧木邪。火性炎上，如果嗜欲没有节制，则肾水失去滋养，火因缺乏制约而反侮其所胜之金，肺受到火邪侵袭而发热。木性刚烈急躁，肺受热后金失所养，木因缺乏制约而反侮其所胜之土，脾受到木邪侵袭而受伤。肺热则不能统摄一身之气，脾伤则四肢不能发挥作用，于是各种痿证发作了。泻南方（心火）则肺金清凉而东方（肝木）不实，哪里还有脾伤的问题呢？补北方（肾水）则心火下降而西方（肺金）不虚，哪里还有肺热的问题呢？所以阳明经充实则宗筋得到滋润，能够约束骨骼并利于关节运动。治疗痿证的方法，没有超出这个范围的。虽然如此，天产之物（动物类药材或食物）性质偏阳，浓厚滋味容易生热，凡是患痿证的人，如果不饮食清淡，我知道一定不能保证安全。又说：《黄帝内经》论述风病和痿病各有篇目，源流不同，治疗方法截然不同，《局方》却用治疗风病的药物通治各种痿证，这多么荒谬啊！按照丹溪的这个理论一出，扫尽了千古以来的弊端，反复叮咛告诫，极其明白，学者如果斜视不看，那就是聋子的雷霆，瞎子的日月啊。医生是人的命运主宰，怎么能不尽心于此呢？
脉法
《脉经》说：肺痿的脉象必定浮而弱，病人想咳嗽却咳不出来，咳嗽时吐出干沫，时间久了则小便不利。
寸口脉不出，反而使用发汗法，阳脉早先枯竭，阴脉不涩滞，三焦徘徊不前，气入而不能出，阴脉不涩滞，身体反而寒冷，体内反而烦闷，多呕吐，嘴唇干燥，小便反而困难，这是肺痿，损伤了津液，痰液像烂瓜一样，也像猪脑一样，这都是因为误用发汗法造成的。
方法
朱丹溪说：有湿热引起的，有痰湿引起的，有血虚引起的，有气虚引起的，也有死血（瘀血）引起的，有食积妨碍气机升降引起的。
卢氏说：上文论述痿证起于肺热，确实是痿证的根本论述，也是治疗方法的纲要。而这里这样说，是因为发病为病时，病因和夹杂的病邪可能有所不同，所以主治重点也应当各有侧重。
李东垣取黄柏作为君药，黄耆等补药作为辅佐，来治疗各种痿证，没有固定的方剂，有兼夹痰积的，有湿气重的，有热气重的，有湿热各半的，有挟带气滞的，根据病情制定方剂，这算是善于治疗痿证了吧。
湿热证，使用东垣健步丸，加上燥湿降火的药物——如黄柏、黄芩、苍术之类。
湿痰证，使用二陈汤，加上苍术、白术、黄芩、黄柏之类，加入竹沥、姜汁。
加味四物汤 治疗各种痿证，四肢软弱，不能活动。
当归身（一钱） 熟地黄（三钱） 白芍药 川芎（各七分半） 五味子（九枚） 麦门冬（一钱） 人参（五分）
黄柏（一钱） 黄连（五分） 知母（三分） 杜仲（七分半） 牛膝（三分，足部不软者不用） 苍术（一钱）
以上切碎，作一服药，用水两盏，煎至一盏，空腹温服。用酒糊做成丸剂服用也可以。另一说法：血虚者，用四物汤加黄柏、苍术，送服补阴丸。
（以上丹溪的方法共九条）
健步丸（东垣） 治疗膝盖无力，屈伸不便，腰背腿脚沉重，行走艰难。
羌活 柴胡 滑石（炒） 甘草（炙） 栝蒌根（酒洗） 肉桂（各五分） 防风 泽泻（各三钱） 防己（酒洗，一两） 川乌（炮制） 苦参（酒浸，各三钱）
以上研为细末，用面汤煮面糊为丸，如梧桐子大小，每次服用七十丸，用愈风汤送下。（另一种说法是用荆芥汤送下，按荆芥汤又被称为愈风汤。）
大防风汤（局方） 治疗两足痿弱，或沉重麻痹，不能行动，两膝虚肿，名为鹤膝风等证候。（方剂见中风门。）
（祖传方）治疗两足痿弱软痛，或者像火烤一样，从足踝下方，向上冲击腿胯等证候，因湿热所致者。
苍术（米泔水浸泡一至两个晚上） 黄柏（酒浸晒干，各四两） 牛膝（去芦头，二两） 龟板（酥炙） 虎胫骨（酥炙） 防己（各一两） 当归尾（二两）
以上研为细末，用面糊为丸，如梧桐子大小，每次服用七十丸或一百丸。空腹用姜、盐汤送下。
一方，加入炮附子五钱。
鹿角胶丸 治疗气血虚弱，两足痿软，不能行动，长期卧床不起的证候，效果神奇。
鹿角胶（一斤） 鹿角霜 熟地黄（各半斤） 川牛膝 白茯苓 菟丝子 人参（各二两） 当归身（四两） 白术 杜仲（各二两） 虎胫骨（酥炙） 龟板（酥炙，各一两）
以上研为细末，另外将鹿角胶用无灰酒三盏烊化，制成丸剂如梧桐子大小，每次服用一百丸，空腹用姜、盐汤送下。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Heat in the Lung causes the lung leaves to wither and scorch, affecting the Five Zang organs, thereby leading to Wei syndrome (flaccidity syndrome). Heat in Heart Qi manifests as Mai Wei (Vessel Flaccidity), characterized by flaccid calves unable to support the body weight. Heat in Liver Qi manifests as Jin Wei (Sinew Flaccidity), resulting in tight and contracted sinews. Heat in Spleen Qi manifests as Rou Wei (Flesh Flaccidity), causing dryness and thirst in the stomach, and insensitivity of the muscles. Heat in Kidney Qi manifests as Gu Wei (Bone Flaccidity), leading to inability to raise the waist and knees, withered bones, and depleted marrow." It further states: "In treating Wei syndrome, one should exclusively focus on the Yangming channel. The Yangming is the sea of the Five Zang and Six Fu organs, primarily moistening the Zongjin (general sinews), binding the bones, and facilitating joint movement. The Chong vessel is the sea of the channels, primarily permeating and irrigating the muscle valleys. It converges with the Yangming at the Zongjin. All Yin and Yang channels converge at the Zongjin, meeting at the Qichong acupoint, with the Yangming taking the lead. They all belong to the Dai vessel and network with the Du vessel. Therefore, when Yangming deficiency occurs, the Zongjin becomes flaccid and lax, and the Dai vessel fails to draw, resulting in foot flaccidity and inability to use them." The treatment method involves tonifying the Ying-spring points and unblocking the Shu-stream points of each respective channel, regulating excess and deficiency, harmonizing reversal and smooth flow, and adjusting the sinews, vessels, bones, and flesh. Treatment should be timed according to the months when each organ is most active, then the disease will be cured. This means that for treating various Wei syndromes, it is appropriate to regulate and tonify the respective Zang organs, waiting for their prosperous months for recovery.
Zhu Danxi stated: "The *Neijing* says that all Wei syndromes originate from Lung heat, yet also states that treatment should exclusively target the Yangming channel. This is because Lung belongs to Metal, has a dry nature, resides in the Upper Jiao, governs Qi, and fears Fire. Spleen belongs to Earth, has a damp nature, resides in the Middle Jiao, governs the four limbs, and fears Wood. Fire nature tends upward. If desires are unrestrained, Water loses its nourishment. Fire, lacking restraint, insults the metal it normally overcomes, causing the Lung to suffer fire pathogenic factors and become hot. Wood nature is rigid and urgent. When the Lung suffers heat, Metal loses nourishment; Wood, lacking restraint, insults the earth it normally overcomes, causing the Spleen to suffer Wood pathogenic factors and become injured. Lung heat prevents it from governing the whole body; Spleen injury prevents the four limbs from functioning, thus various Wei syndromes arise." By purging the South (Heart Fire), Lung Metal becomes clear and East (Liver Wood) does not become excessive, so how can there be Spleen injury? By tonifying the North (Kidney Water), Heart Fire descends and West (Lung Metal) does not become deficient, so how can there be Lung heat? Thus, Yangming becomes substantial, Zongjin is moistened, able to bind bones and facilitate joints. The methods for treating Wei syndrome do not go beyond this. Nevertheless, products of heaven (animal-based substances) are yang in nature, and rich flavors generate heat. For those suffering from Wei syndrome, if they do not eat blandly, I know they cannot ensure safety. He also said: "The *Neijing* discusses Wind and Wei separately with different chapters, origins, and flows, and their treatments are vastly different. Yet the *Ju Fang* uses wind-treating herbs to treat all Wei syndromes generally. How erroneous is this!" With Danxi's theory emerging, ancient弊 (malpractices) were swept away. His earnest warnings are extremely clear. If scholars ignore them, it is like thunder to the deaf or the sun and moon to the blind. Physicians are the masters of life for others; how can they not devote themselves to this?"
Pulse Diagnosis
The *Mai Jing* (Classic of Pulse Diagnosis) states: "The pulse for Fei Wei (Lung Flaccidity) must be floating and weak. The patient desires to cough but cannot; when coughing, dry froth is expectorated. After a long time, urination becomes difficult."
If the Cun Kou pulse does not emerge, and sweating is mistakenly induced, the Yang pulse depletes early while the Yin pulse is not choppy. The Sanjiao hesitates; qi enters but cannot exit. The Yin pulse is not choppy, yet the body feels cold, while internally there is vexation. There is much vomiting, dry lips, and difficulty urinating. This is Fei Wei, caused by damage to body fluids. The sputum resembles rotten melon or pig brain, solely due to mistaken sweating therapy.
Methods
Zhu Danxi stated: "There are cases caused by Damp-Heat, Phlegm, Blood Deficiency, Qi Deficiency, Fixed Blood (Blood Stasis), and Food Retention obstructing the ascending and descending mechanisms."
Mr. Lu stated: "The above discussion on Wei originating from Lung heat is indeed the fundamental theory of Wei, and the general outline of treatment. The reason for stating otherwise here is that upon manifestation as disease, the causes and accompanying pathogens may differ, so the primary treatment focus should vary accordingly."
Li Dongyuan used Huangbai (Phellodendron Bark) as the sovereign herb, with tonics like Huangqi (Astragalus Root) as ministers and assistants, to treat various Wei syndromes. There is no fixed formula; some have concurrent Phlegm retention, some have heavy Dampness, some have heavy Heat, some have equal Damp-Heat, some have Qi stagnation. Formulating based on the specific disease demonstrates skill in treating Wei.
For Damp-Heat: Use Dongyuan Jianbu Wan (Strengthening Legs Pill), adding herbs that dry Dampness and descend Fire, such as Huangbai, Huangqin (Scutellaria Root), Cangzhu (Atractylodes Rhizome).
For Damp-Phlegm: Use Erchen Tang (Two-Cured Decoction), adding Cangzhu, Baizhu (Atractylodes Macrocephala Rhizome), Huangqin, Huangbai, along with Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice).
For Blood Deficiency: Use Siwu Tang (Four Substances Decoction), adding Cangzhu and Huangbai, taken with Buyin Wan (Tonify Yin Pill).
For Qi Deficiency: Use Sijunzi Tang (Four Gentlemen Decoction), adding Cangzhu, Huangqin, and Huangbai.
Huangbai and Cangzhu are essential herbs for treating Wei syndrome.
Huxian Wan (Tiger-Hiding Pill) and Bushen Wan (Tonify Kidney Pill) can both treat Wei syndrome.
Jiawei Siwu Tang (Modified Four Substances Decoction) treats various Wei syndromes with weak and soft limbs unable to move.
Danggui Shen (Angelica Sinensis Root Body) (1 qian) Shudihuang (Prepared Rehmannia Root) (3 qian) Shaoyao (White Peony Root) Chuanxiong (Ligusticum Rhizome) (each 0.75 qian) Wuweizi (Schisandra Berry) (9 berries) Maimendong (Ophiopogon Tuber) (1 qian) Renshen (Ginseng Root) (0.5 qian)
Huangbai (Phellodendron Bark) (1 qian) Huanglian (Coptis Rhizome) (0.5 qian) Zhimu (Anemarrhena Rhizome) (0.3 qian) Duzhong (Eucommia Bark) (0.75 qian) Niuxi (Achyranthes Root) (0.3 qian, omit if legs are not soft) Cangzhu (Atractylodes Rhizome) (1 qian)
Finely cut, prepare as one dose. Add two zhan of water, decoct to one zhan. Take warm on an empty stomach. Alternatively, make into pills with wine paste. Another version: For Blood Deficiency, use Siwu Tang plus Huangbai and Cangzhu, taken with Buyin Wan.
(Above are nine methods from Danxi.)
Jianbu Wan (Dongyuan) treats weakness in the knees, difficulty bending and extending, heaviness in the lower back, back, legs, and feet, and difficult walking.
Qianghuo (Notopterygium Rhizome) Chaihu (Bupleurum Root) Huashi (Talcum) (stir-fried) Gancao (Licorice Root) (honey-fried) Gualougen (Trichosanthes Root) (wine-rinsed) Rougui (Cinnamon Bark) (each 0.5 qian) Fangfeng (Saposhnikovia Root) Zexie (Alisma Rhizome) (each 3 qian) Fangji (Stephania Root) (wine-rinsed, 1 liang) Chuanwu (Aconite Lateral Root) (processed) Kushen (Sophora Root) (wine-soaked, each 3 qian)
Grind into fine powder. Boil in water with wheat paste to form pills the size of paulownia seeds. Take 70 pills per dose, washed down with Yufeng Tang (Wind-Healing Decoction). (Another version says wash down with Jingjie Tang; note that Jingjie Tang is also called Yufeng Tang.)
Da Fangfeng Tang (Great Saposhnikovia Decoction) (*Ju Fang*) treats flaccidity and weakness in both legs, or heaviness and numbness, inability to walk, and swollen knees, known as Hexi Feng (Crane Knee Wind) and other conditions. (Formula see Stroke Section.)
(Ancestral Formula) treats flaccidity, weakness, and pain in both legs, or burning sensation like roasting, rising from below the ankle up to the thighs and hips, caused by Damp-Heat.
Cangzhu (Atractylodes Rhizome) (soaked in rice washing water for 1-2 nights) Huangbai (Phellodendron Bark) (wine-soaked and sun-dried, each 4 liang) Niuxi (Achyranthes Root) (deprived of rhizome, 2 liang) Guiban (Turtle Shell) (roasted with su) Hujinggu (Tiger Tibia Bone) (roasted with su) Fangji (Stephania Root) (each 1 liang) Dangguiwei (Angelica Sinensis Tail) (2 liang)
Grind into fine powder. Make into pills with wheat paste, size of paulownia seeds. Take 70 or 100 pills per dose. Wash down with ginger and salt water on an empty stomach.
One variation adds Pao Fuzi (Processed Aconite Lateral Root) 5 qian.
Lujiao Jiao Wan (Deer Antler Glue Pill) treats Qi and Blood deficiency, flaccidity and weakness in both legs, inability to walk, and prolonged bedridden condition. It is miraculous.
Lujiao Jiao (Deer Antler Glue) (1 jin) Lujiaoshuang (Deer Antler Horn Powder) Shudihuang (Prepared Rehmannia Root) (each half jin) Chuan Niuxi (Cyathula Root) Baifuling (Poria) Tusizi (Cuscuta Seed) Renshen (Ginseng Root) (each 2 liang) Danggui Shen (Angelica Sinensis Root Body) (4 liang) Baizhu (Atractylodes Macrocephala Rhizome) Duzhong (Eucommia Bark) (each 2 liang) Hujinggu (Tiger Tibia Bone) (roasted with su) Guiban (Turtle Shell) (roasted with su, each 1 liang)
Grind into fine powder. Separately melt Lujiao Jiao in three zhan of pure wine. Form pills the size of paulownia seeds. Take 100 pills per dose. Wash down with ginger and salt water on an empty stomach.