1.五痿皆因肺热生, 阳明无病不能成, 肺热叶焦皮毛瘁, 发为痿躄
不能行, 心热脉痿胫节纵, 肾骨腰脊不能兴, 肝筋拘挛失所养, 脾肉
不仁燥渴频.
【注】五痿, 心, 肝, 脾, 肺, 肾之痿也. 痿属燥病, 故皆因肺热而
生也. 阳明者, 五脏六腑之海, 主润宗筋. 阳明无病, 则宗筋润, 能
束骨而利机关, 虽有肺热不能成痿也. 肺热叶焦, 阳明虚弱, 津液不
化,筋骨失养, 皮毛瘁痿, 发为痿躄不能行也. 因而心气热为脉痿,
则经节纵而不任地, 肺兼心病也. 因而肾气热为骨痿, 则腰脊不能兴
举,肺兼肾病也. 因而肝气热为筋痿, 则筋失所养, 拘挛不伸, 肺兼
肝病也. 因而脾气热为肉痿, 则胃燥而渴, 肌肉不仁, 肺兼脾病也.
2.痿病足兮痹病身, 仍在不疼痛里分, 但观治痿无风药, 始晓虚实
别有因.
【注】痿痹之证, 今人多为一病, 以其相类也. 然痿病两足痿软不痛
,痹病通身肢节疼痛. 但观古人治痿, 皆不用风药, 则可知痿多虚,
痹多实, 而所因有别也.
3.痿燥因何治湿热, 遵经独取治阳明, 阳明无故惟病肺, 胃壮能食
审证攻, 控涎小胃湿痰热, 阳明积热法三承, 胃弱食少先养胃, 久虚
按证始收功.
【注】痿属燥病, 因何而用治湿热苦燥之药? 盖遵『内经』之治法,
独取于阳明胃也. 故胃家无病, 虽有肺热, 惟病肺而不病痿也. 是知
病痿者, 胃家必有故也. 或湿热, 或积热, 或湿痰, 不论新久, 若胃
壮能食, 当先审证攻之. 胃有湿痰, 用控涎丹攻之. 有湿热者, 用小
胃丹攻之. 有积热者, 用三承气汤攻之. 此治胃壮能食之法也. 若胃
弱饮食减少, 气血津液不足, 当先以补养脾胃为主. 其有久病留连,
诸虚燥热, 或攻下之后调理, 当审证治之, 始收全功也.
加味二妙汤
4.加味二妙湿热痿, 两足痿软热难当, 防己当归川萆薢, 黄柏龟板
膝秦苍.
【注】热难当, 谓两足热难当也. 膝秦苍, 谓牛膝, 秦艽, 苍术也.
清燥汤 虎潜丸 十全大补汤 加味金刚丸
5.时令湿热清燥效, 阴虚湿热虎潜灵, 久虚痿软全金主, 萆瓜牛菟
杜苁蓉.
【注】清燥汤在内伤门. 虎潜丸有成方. 全金主, 谓十全大补汤, 加
味金刚丸, 久病气血虚, 以十全大补汤为主, 筋骨痿软, 以加味金刚
丸为主. 加味金刚丸, 即萆薢, 木瓜, 牛膝, 菟丝子, 杜仲, 肉苁蓉
也.
1. 五种痿证皆因肺热而生,若阳明经无病则不能形成。肺热导致肺叶焦枯、皮毛憔悴,进而引发肢体痿弱不能行走;心热导致脉痿,表现为小腿关节松弛无力;肾热导致骨痿,表现为腰脊无法挺举;肝热导致筋痿,表现为筋脉拘挛失养;脾热导致肉痿,表现为肌肉麻木不仁、口干燥渴频繁。
【注】五痿,指心、肝、脾、肺、肾五脏的痿证。痿证属于燥病,因此都因肺热而产生。阳明经是五脏六腑气血的海源,主要滋润宗筋(汇聚于前阴的大筋)。如果阳明经没有病变,那么宗筋得到滋润,就能约束骨骼并利于关节运动,即使有肺热也不能形成痿证。如果肺热导致肺叶焦枯,加上阳明虚弱,津液无法化生,筋骨失去滋养,皮毛憔悴痿废,就会发为痿躄(肢体痿废不能行走)。如果心气热盛导致脉痿,则经脉关节松弛而不能支撑身体站立,这是肺兼有心病。如果肾气热盛导致骨痿,则腰脊不能抬起,这是肺兼有肾病。如果肝气热盛导致筋痿,则筋脉失去滋养,拘挛不能伸展,这是肺兼有肝病。如果脾气热盛导致肉痿,则胃燥而口渴,肌肉麻木不仁,这是肺兼有脾病。
2. 痿病主要在双足,痹病遍布全身,两者的区别在于是否疼痛。只要观察治疗痿证不使用祛风药,就能明白虚实病因是不同的。
【注】痿证和痹证,现在的人常视为一种病,因为它们症状相似。然而,痿病是双足痿软但不疼痛,痹病则是全身肢节疼痛。只要看古人治疗痿证,都不使用祛风药,就可以知道痿证多属虚证,痹证多属实证,其致病原因是有区别的。
3. 痿证本属燥病,为何用清热利湿法?遵循经典,专门选取调理阳明经的方法。阳明经若无病变通常只影响肺,若胃气壮实能进食,应仔细辨证后攻邪;若有控涎小胃丹所治的湿痰热,或阳明积热适用三承气汤法;若胃气虚弱饮食减少,应先养胃气,久病体虚需按证调理才能见效。
【注】痿证属于燥病,为什么使用治疗湿热苦燥的药物?这是因为遵循《内经》的治疗法则,专门取法于阳明胃经。所以胃家没有疾病,即使有肺热,也只表现为肺病而不会发展为痿证。由此可知,患痿证的人,胃家必定有病变。或是湿热,或是积热,或是湿痰,不论新病久病,如果胃气壮实能进食,应当先审察证候进行攻邪治疗。胃中有湿痰,用控涎丹攻逐;有湿热者,用小胃丹攻逐;有积热者,用三承气汤攻逐。这是治疗胃壮能食的方法。如果胃气虚弱饮食减少,气血津液不足,应当以补养脾胃为主。对于久病缠绵、诸虚燥热,或攻下之后的调理,应当审察证候进行治疗,这样才能取得完全的效果。
加味二妙汤
4. 加味二妙汤治疗湿热引起的痿证,症见两足痿软且热感难以忍受,方中含防己、当归、川萆薢、黄柏、龟板、牛膝、秦艽、苍术。
【注】“热难当”,是指两足发热难以忍受。“膝秦苍”,是指牛膝、秦艽、苍术。
清燥汤 虎潜丸 十全大补汤 加味金刚丸
5. 时令湿热所致痿证用清燥汤疗效好,阴虚湿热所致痿证用虎潜丸灵验,久病体虚痿软用十全大补汤主治,方中药物包括萆薢、木瓜、牛膝、菟丝子、杜仲、肉苁蓉。
【注】清燥汤记载在内伤门中。虎潜丸已有成方。全金主,是指十全大补汤和加味金刚丸。久病气血虚弱,以十全大补汤为主治;筋骨痿软,以加味金刚丸为主治。加味金刚丸,即由萆薢、木瓜、牛膝、菟丝子、杜仲、肉苁蓉组成。
1. The five types of Wei syndrome (flaccidity syndrome) all arise from Lung heat; if the Yangming channel is unaffected, the condition cannot develop. Lung heat causes the lung leaves to wither and the skin and hair to deteriorate, leading to Wei Bi (limb flaccidity and inability to walk). Heart heat leads to Mai Wei (vessel flaccidity), characterized by laxity of the lower leg joints. Kidney heat leads to Gu Wei (bone flaccidity), characterized by the inability to raise the waist and spine. Liver heat leads to Jin Wei (tendon flaccidity), characterized by tendon contraction and loss of nourishment. Spleen heat leads to Rou Wei (muscle flaccidity), characterized by muscle numbness, dryness, thirst, and frequent drinking.
[Note] The "Five Weis" refer to the flaccidity syndromes of the Heart, Liver, Spleen, Lung, and Kidney. Wei syndrome belongs to dryness diseases, thus it arises due to Lung heat. The Yangming channel is the sea of the five zang and six fu organs, primarily moistening the Zong jin (major tendons converging at the genitalia). If the Yangming channel is disease-free, the Zong jin are moistened, able to bind the bones and facilitate joint movement; even with Lung heat, Wei syndrome cannot form. If Lung heat causes the lung leaves to wither, combined with Yangming deficiency, fluids fail to transform, causing the sinews and bones to lose nourishment, the skin and hair to wither, resulting in Wei Bi (limb flaccidity and inability to walk). If Heart Qi heat leads to Mai Wei, the meridians and joints become lax and unable to support the body weight, indicating a Lung complication involving the Heart. If Kidney Qi heat leads to Gu Wei, the waist and spine cannot be raised, indicating a Lung complication involving the Kidney. If Liver Qi heat leads to Jin Wei, the sinews lose nourishment and contract without extending, indicating a Lung complication involving the Liver. If Spleen Qi heat leads to Rou Wei, the stomach becomes dry with thirst and muscles become numb, indicating a Lung complication involving the Spleen.
2. Wei syndrome affects the feet, while Bi syndrome (obstruction syndrome) affects the whole body; the distinction lies in the presence or absence of pain. Observing that ancient treatments for Wei syndrome do not use wind-dispelling herbs reveals that the etiology of deficiency and excess differs between the two.
[Note] Wei and Bi syndromes are often considered one disease today due to their similarities. However, Wei syndrome presents as flaccidity and weakness in both legs without pain, whereas Bi syndrome involves pain throughout the limbs and joints. Since ancient practitioners did not use wind-dispelling herbs to treat Wei syndrome, it can be deduced that Wei syndrome is mostly deficiency-type, while Bi syndrome is mostly excess-type, and their causes differ.
3. Why treat Wei syndrome, which stems from dryness, with methods for clearing damp-heat? Follow the classics: exclusively regulate the Yangming channel. If the Yangming is healthy, pathology usually only affects the Lung; if the Stomach is strong and capable of eating, examine the syndrome and attack the pathogen. For damp-phlegm-heat treated by Kong Xian Xiao Wei Dan, or Yangming accumulated heat treated by the Three Chengqi Decoctions, use these methods. If the Stomach is weak and food intake is reduced, first nourish the Stomach; for chronic deficiency, treat according to the syndrome to achieve success.
[Note] Wei syndrome belongs to dryness diseases; why use bitter-dry drugs for damp-heat? This follows the treatment method of the *Nei Jing* (Inner Canon), exclusively taking the Yangming Stomach channel. Therefore, if the Stomach house has no disease, even with Lung heat, it manifests only as Lung disease and does not develop into Wei syndrome. Thus, those suffering from Wei syndrome must have pathology in the Stomach house. Whether it is damp-heat, accumulated heat, or damp-phlegm, regardless of whether it is new or old, if the Stomach is strong and capable of eating, one should first examine the syndrome and attack the pathogen. For damp-phlegm in the Stomach, use Kong Xian Dan to purge. For damp-heat, use Xiao Wei Dan to purge. For accumulated heat, use the Three Chengqi Decoctions to purge. These are methods for treating cases where the Stomach is strong and capable of eating. If the Stomach is weak, dietary intake is reduced, and Qi, Blood, and Body Fluids are insufficient, one should prioritize tonifying and nourishing the Spleen and Stomach. For lingering chronic illness, various deficiencies, and dryness-heat, or for regulation after purgation, one must examine the syndrome to treat it, thereby achieving complete efficacy.
Jiawei Ermiao Tang
4. Jiawei Ermiao Tang treats Wei syndrome caused by damp-heat, characterized by flaccidity in both legs and unbearable heat sensation. Ingredients include Fangji, Danggui, Chuan Bixie, Huangbai, Guiban, Nixi, Qinjiao, and Cangzhu.
[Note] "Unbearable heat" refers to the unbearable heat sensation in both legs. "Xi Qin Cang" refers to Nixi (Niu Xi), Qinjiao, and Cangzhu.
Qingzao Tang, Hujian Wan, Shiquan Dabu Tang, Jiawei Jingang Wan
5. For seasonal damp-heat causing Wei syndrome, Qingzao Tang is effective. For Yin deficiency with damp-heat causing Wei syndrome, Hujian Wan is efficacious. For chronic deficiency causing flaccidity, Shiquan Dabu Tang is the main treatment. Its ingredients include Bixie, Mugua, Niu Xi, Tusizi, Duzhong, and Rongcongrou.
[Note] Qingzao Tang is recorded in the Internal Injury section. Hujian Wan is an established prescription. "Shiquan Dabu Tang and Jiawei Jingang Wan" are the main treatments: for chronic Qi and Blood deficiency, Shiquan Dabu Tang is primary; for flaccidity of sinews and bones, Jiawei Jingang Wan is primary. Jiawei Jingang Wan consists of Bixie, Mugua, Niu Xi, Tusizi, Duzhong, and Rongcongrou.