痿病肺虚，脉多微缓。或涩或紧，或细或濡。
痿者，委也。足痿不用，有委靡不振之义，故字从委。其证五脏俱能成，而此
独归于肺者，本《素问》也。《素问》痿论岐伯曰∶肺热焦，则皮毛虚弱急薄，着而
生痿 。又曰∶肺者脏之长也，为心之盖也。有所失忘，所求不得，则发肺鸣。鸣
则肺热叶焦。五脏因肺热叶焦，发为痿 。观岐伯所言，则知五脏之痿，必自肺始。
内则先叶焦，而外则先皮毛虚弱急薄也。盖肺居心上，为最高。外合皮毛，为最表。
故云脏之长，心之盖，主一身之气而司呼吸，朝百脉而行荣卫。故平人气象论曰∶
脏真高于肺，以行荣卫阴阳也。其令收降，其化清肃。设有失忘，求谋不得，则肺
气郁。郁则收者愈收，气遏为火而热生焉。热则清肃之化不行，炎蒸之邪自迫。斯
时也，气不宁静，则喘鸣；脏不濡润，则焦萎，然不独一肺止也。蒸熏荣卫，耗竭
脏阴，嗣是五脏之合，如筋、脉、肉、骨之属，亦皆不得其荣润，而诸痿之证作矣。
故岐伯又曰∶心气热，则下脉厥而上。上则下脉虚，虚则生脉痿，枢折挈，胫纵而
不任地也。（宜丹溪虎潜丸、补阴丸之类。）肝气热，则胆泄口苦，筋膜干。筋膜干，则筋急而挛，
发为筋痿。（宜四物汤、三因加减四斤丸之类。）脾气热，则胃干而渴，肌肉不仁，发为肉痿。（宜
东垣神效黄 汤、钱氏泻黄散之类。）肾气热，则腰脊不举，骨枯而髓减，发为骨痿。（宜丹溪虎潜丸、
三因加减四斤丸之类。）此皆言肺热叶焦，皮毛急薄，热留着不去，灾及四脏而发为诸痿也。
若四脏不虚，无隙可乘，则热亦不能遽袭。故下文岐伯复曰∶悲哀太甚则胞络绝。
胞络绝，则阳气内动，发则心下崩，数溲血也。故本论曰∶大经空虚，发为肌痹，
传为脉痿。（宜仲景炙甘草汤、黑地黄丸之类。）此言悲哀太甚，致心系急而胞络绝。评热论曰∶
胞脉者，属心而络于胞中。绝则不能上交于心，亢阳内迫。内迫则血溢下崩，随溲
而出。崩则大经空虚，无以荣灌脉络，故先为肌痹，而渐传为脉痿也。又曰∶思想
无穷，所愿不得，意淫于外，入房太甚，宗筋弛纵，发为筋痿，及为白淫。故《下
经》曰∶筋痿者，生于肝，使内也。（宜知柏八味丸、四物汤、加味逍遥散之类。）此言外想邪淫而
不遂，及甚于入房。一则肝火抑郁，一则阴精耗亡，皆前阴所关。前阴者，宗筋也。
宗筋无阴以养，而反为火迫，故弛纵痿弱，及淫念动而白物随下。故筋痿者，生于
肝使内也。又曰∶有渐于湿，以水为事，若有所留，居处相湿，肌肉濡渍，痹而不
仁，发为肉痿。故《下经》曰∶肉痿者，得于湿地也。（宜胃苓汤、仲景防己黄 汤、东垣参术汤
之类。）此言从事于水湿之处，居处皆湿，渐受其邪，留着而濡渍肌肉之间。久则肌肉
不仁，发为肉痿。故肉痿者，得之湿地也。又曰∶有所远行劳倦，逢大热而渴。渴
则阳气内伐，内伐则热舍于肾。肾者水脏也，今水不胜火，则骨枯而髓虚，故足不
任身，发为骨痿。故《下经》曰∶骨痿者，生于大热也。（宜知柏八味丸、六味丸、补阴丸之类。）
此言远行劳倦，逢热而渴。渴则内热殊甚。内热甚，则乘其虚者而迫之。远行劳倦，
则肾气适虚。（经脉别论云∶持重远行，汗出于肾，肾虚明矣。）肾虚，则受其热而不能胜，渐至髓减
骨枯，以致足不任身，发为骨痿。故骨痿者，生于大热也。又曰∶阳明者，五脏六
腑之海，主润宗筋，宗筋主束骨而利机关也。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，会于气街，而阳明为之长，皆属于带脉而络于
督脉。（腰脊不举，似兼督脉证。）故阳明虚则宗筋纵，带脉不引，（前白淫似带脉不引证。）故足痿不
用也。又曰∶各补其荥而通其俞，调其虚实，和其逆顺。筋、脉、骨、肉，各以其
时月受，则病已矣。前岐伯论痿之感受传变，可谓尽矣，而终复归之阳明者，何哉？
盖阳明为水谷之海，冲为血海。此不言水谷而言五脏六腑之海，不言血而言经脉之
海，见脏腑经脉，无非二者为之源。一润宗筋为阳，一灌溪谷为阴。总宗筋而会于
气街，推阳明为之长者。气街乃阳明正脉，亦有尊水谷之义。督脉直行，带脉横围，
阳明冲脉，皆属带而络督。阳明虚，则不能荣养宗筋，而带脉亦无力收引，故足痿
不用也。是知束骨利机关者，必藉乎宗筋，而宗筋又藉阳明之荣润，故治痿者独取
阳明也。然必兼视各脏之荥俞，宜补宜通；受病之时月，或衰或盛，而后逆顺可和，
虚实可调，病良已矣。此岐伯答帝治痿之针法也。其脉多微缓，或涩或紧，或细或
濡者，以微应皮毛，缓应肌肉，涩应血脉，紧应筋膜，细濡应骨髓耳。
痿病若因肺虚所致，脉象多表现为微缓。也可能出现涩、紧、细或濡的脉象。
“痿”字意为委顿。足部痿弱不能行走，有委靡不振的含义，所以该字从“委”。其症状可由五脏病变引起，但此处特别归结于肺，这是依据《素问》的理论。《素问·痿论》中岐伯说：肺热导致津液干枯，则皮毛虚弱、紧缩变薄，进而发生痿证。又说：肺是五脏之长，位于心的上面（如盖）。若有遗忘之事或所求不得，会导致肺气上逆发出鸣声。鸣响则使肺热叶焦。五脏因肺热叶焦，从而引发各种痿证。观察岐伯的话，可知五脏的痿证必然从肺开始。在内则是先出现肺叶焦枯，在外则是先出现皮毛虚弱紧缩变薄。因为肺位于心之上，位置最高；外合皮毛，处于最表层。所以说肺是脏之长，心的覆盖物，主管一身之气并司呼吸，朝会百脉而运行营卫之气。所以《素问·平人气象论》说：脏真之气高于肺，用以运行营卫阴阳。肺的令气主收敛下降，其气化特性为清肃。如果有遗忘之事或谋望不得，则肺气郁结。郁结则收敛之气更加收敛，气机阻滞化为火而产生热邪。热邪产生则清肃的气化功能不行，炎蒸的邪气自然逼迫。在这个时候，气不宁静则出现喘鸣；脏腑得不到濡润则焦枯萎软，这不仅仅局限于肺一脏。热邪熏蒸营卫，耗竭脏腑阴液，此后五脏所主的组织，如筋、脉、肉、骨等，也都得不到荣润，于是各种痿证的病症就发作了。
所以岐伯又说：心气热，则下部经脉厥逆而上行。上行则下部经脉空虚，空虚则生脉痿，关节枢纽折断般提举无力，小腿纵弛而不能站立。（适宜使用丹溪虎潜丸、补阴丸之类的方剂。）肝气热，则胆汁外泄口苦，筋膜干燥。筋膜干燥，则筋脉拘急挛缩，发为筋痿。（适宜使用四物汤、三因加减四斤丸之类的方剂。）脾气热，则胃干口渴，肌肉麻木不仁，发为肉痿。（适宜使用东垣神效黄芪汤、钱氏泻黄散之类的方剂。）肾气热，则腰脊不能挺举，骨骼枯槁而骨髓减少，发为骨痿。（适宜使用丹溪虎潜丸、三因加减四斤丸之类的方剂。）这些都是说肺热叶焦，皮毛紧缩变薄，热邪留滞不去，祸及四脏而引发各种痿证。如果四脏不虚，没有空隙可乘，那么热邪也不能迅速侵袭。所以下文岐伯又说：悲哀太过则胞络隔绝。胞络隔绝，则阳气内动，发作时心下出血，频繁小便带血。所以本论说：大经空虚，发为肌痹，传变为脉痿。（适宜使用仲景炙甘草汤、黑地黄丸之类的方剂。）这是说悲哀太过，导致心系紧急而胞络隔绝。《素问·评热病论》说：胞脉属于心而联络于胞中。隔绝则不能上交于心，亢盛的阳气内迫。内迫则血液溢出向下崩漏，随小便而出。崩漏则大经空虚，无法荣灌脉络，所以先成为肌痹，逐渐传变为脉痿。
又说：思虑无穷，愿望不得，意念淫乱于外，房事过度，宗筋弛缓纵弛，发为筋痿，以及白淫（指男子滑精、女子带下等白色分泌物）。所以《下经》说：筋痿生于肝，由房事引起。（适宜使用知柏八味丸、四物汤、加味逍遥散之类的方剂。）这是说外想邪淫而不遂意，以及房事过度。一种是肝火抑郁，一种是阴精耗亡，都与前阴有关。前阴就是宗筋。宗筋没有阴液滋养，反而被火邪逼迫，所以弛缓纵弛、痿弱，以及淫念发动而白色物质随之流出。所以筋痿是生于肝且与房事有关。
又说：逐渐受湿气影响，以水为业，或者有所停留，居处潮湿，肌肉浸渍，麻木不仁，发为肉痿。所以《下经》说：肉痿得自湿地。（适宜使用胃苓汤、仲景防己黄芪汤、东垣参术汤之类的方剂。）这是说从事于水湿之处，居处皆湿，逐渐受到邪气侵袭，留滞浸渍在肌肉之间。久了则肌肉麻木不仁，发为肉痿。所以肉痿是得自湿地。
又说：有所远行劳倦，遇到大热而口渴。口渴则阳气内伐，内伐则热邪舍于肾。肾是水脏，如今水不胜火，则骨骼枯槁而骨髓空虚，所以脚不能支撑身体，发为骨痿。所以《下经》说：骨痿生于大热。（适宜使用知柏八味丸、六味丸、补阴丸之类的方剂。）这是说远行劳倦，逢热而渴。口渴则内热非常严重。内热甚，则乘其虚弱而逼迫它。远行劳倦，则肾气恰好虚弱。（《素问·经脉别论》说：持重远行，汗出于肾，肾虚是很明显的。）肾虚，则承受热邪而不能胜任，逐渐至髓减骨枯，以致脚不能支撑身体，发为骨痿。所以骨痿是生于大热。
又说：阳明经是五脏六腑的海，主要滋润宗筋，宗筋主要约束骨骼而利于关节运动。冲脉是经脉的海，主要渗透灌溉溪谷，与阳明经会合于宗筋。阴阳总汇于宗筋，会合于气街穴，而阳明经为之统领，都归属于带脉而联络于督脉。（腰脊不能挺举，似乎兼有督脉证候。）所以阳明虚则宗筋弛纵，带脉不能牵引，（前面的白淫似乎也是带脉不能牵引的证候），所以足部痿弱不能使用。又说：各补其荥穴而通其俞穴，调节虚实，调和逆顺。筋、脉、骨、肉，各自在其当令的月份接受治疗，病就好了。前面岐伯论述痿证的感受传变，可以说详尽无遗了，但最终又归结于阳明经，为什么呢？因为阳明是水谷之海，冲脉是血海。这里不说水谷而说五脏六腑之海，不说血而说经脉之海，可见脏腑经脉，无非是以这两者为源头。一个滋润宗筋为阳，一个灌溉溪谷为阴。总汇宗筋而会合于气街，推举阳明经为其统领。气街是阳明经的正脉，也有尊崇水谷的意义。督脉直行，带脉横围，阳明冲脉，都属于带脉而联络督脉。阳明虚，则不能荣养宗筋，而带脉也没有力量收引，所以足部痿弱不能使用。由此可知，约束骨骼利关节的，必须依靠宗筋，而宗筋又依赖阳明的荣润，所以治疗痿证要独取阳明。但是必须同时观察各脏的荥穴和俞穴，适宜补则补，适宜通则通；根据受病的月份，或衰或盛，然后逆顺可以调和，虚实可以调节，病就能好了。这是岐伯回答皇帝关于治疗痿证的针刺方法。其脉象多微缓，或涩或紧，或细或濡的，是因为微脉对应皮毛，缓脉对应肌肉，涩脉对应血脉，紧脉对应筋膜，细濡脉对应骨髓罢了。
If Wei syndrome (Flaccidity Syndrome) is caused by Lung deficiency, the pulse is mostly fine and moderate. It may also present as choppy, tight, thready, or soggy.
"Wei" (Flaccidity) means to yield or collapse. The flaccidity of the legs rendering them unusable implies a state of listlessness and lack of vigor; hence the character contains the component "Wei" (Yield). Although its manifestations can arise from disorders of all five Zang organs, this text specifically attributes it to the Lung, following the *Su Wen* (Basic Questions). In the *Su Wen*, Qibo stated: "When the Lung is hot and scorched, the skin and hair become weak, tight, and thin, leading to Wei syndrome." He further said: "The Lung is the chief of the Zang organs and acts as a cover for the Heart." If one experiences forgetfulness or unfulfilled desires, it causes Lung Qi to rebel and produce wheezing sounds. These sounds indicate Lung heat scorching the lung leaves. Because of this Lung heat and scorching, the other four Zang organs develop Wei syndromes. Observing Qibo's words, we know that Wei syndromes of the five Zang organs must originate from the Lung. Internally, the lung leaves are scorched first; externally, the skin and hair become weak, tight, and thin first. This is because the Lung resides above the Heart, at the highest position, and connects with the skin and hair on the exterior, being the most superficial layer. Thus, it is called the chief of the Zang organs and the cover of the Heart. It governs the Qi of the whole body and controls respiration, meeting with the hundred vessels to circulate Ying (Nutrient) and Wei (Defensive) Qi. Therefore, the *Ping Ren Qi Xiang Lun* (Treatise on Normal and Abnormal Physiological and Pathological Signs) states: "The true Qi of the Zang organs is higher in the Lung, to circulate Ying, Wei, Yin, and Yang." Its function is to gather and descend, and its transformation is clear and肃 (pure/quiet). If there is forgetfulness or unfulfilled schemes, Lung Qi becomes stagnant. Stagnation causes the gathering function to over-gather, blocking Qi which transforms into fire, generating heat. Heat prevents the clear and descending transformation, forcing inflammatory and steaming pathogens. At this time, if Qi is not tranquil, wheezing occurs; if Zang organs are not moistened, they become scorched and flaccid. This is not limited to the Lung alone. Steaming Ying and Wei, depleting Zang Yin, subsequently the tissues associated with the five Zang organs, such as sinews, vessels, flesh, and bones, all fail to receive nourishment and moisture, causing various Wei syndromes to manifest.
Therefore, Qibo also said: "Heart Qi heat causes lower vessels to revolt and move upward. Upward movement makes lower vessels empty; emptiness generates Mai Wei (Vessel Flaccidity), where the joint pivot breaks and cannot lift, the shins are loose, and unable to bear weight. (Suitable formulas include Danxi's Hujian Wan [Tiger-Hide Pill] and Buyin Wan [Nourish-Yin Pill].)" "Liver Qi heat causes gallbladder bile to leak, resulting in a bitter taste, and dries the fascia. Dry fascia leads to tight and contracted sinews, developing into Jin Wei (Sinew Flaccidity). (Suitable formulas include Siwu Tang [Four Substances Decoction] and Sanyin Jiajian Sijin Wan [Three Causes Modified Four-Jin Pill].)" "Spleen Qi heat causes dryness and thirst in the stomach, numbness of muscles, developing into Rou Wei (Flesh Flaccidity). (Suitable formulas include Dongyuan's Shenxiao Huangqi Tang [Miraculous Efficacy Astragalus Decoction] and Qian's Xiehuang San [Drain-Yellow Powder].)" "Kidney Qi heat causes inability to raise the waist and spine, withered bones, and reduced marrow, developing into Gu Wei (Bone Flaccidity). (Suitable formulas include Danxi's Hujian Wan and Sanyin Jiajian Sijin Wan.)" All these describe how Lung heat scorches the leaves, making skin and hair tight and thin, with heat lingering and spreading disaster to the four Zang organs, causing various Wei syndromes. If the four Zang organs are not deficient and have no gaps for pathogens to exploit, heat cannot attack suddenly. Thus, Qibo later said: "Excessive grief severs the Bao Luo (Pericardium Collaterals). Severed Bao Luo causes internal movement of Yang Qi; upon manifestation, there is blood bursting from below the heart and frequent hematuria. Hence, the treatise says: 'Major channels become empty, developing into Ji Bi (Muscle Bi), transmitting to Mai Wei.'" (Suitable formulas include Zhongjing's Zhigancao Tang [Honey-Panax Decoction] and Heidihuang Wan [Black Earth Yellow Pill].) This explains that excessive grief causes the Xin Mai (Heart Vessels) to tighten and Bao Luo to sever. The *Ping Re Lun* (Treatise on Evaluating Heat) states: "Bao Mai (Uterine Vessels) belong to the Heart and connect to the Bao (Uterus/Lower Jiao). When severed, they cannot communicate upward with the Heart, allowing hyperactive Yang to press inward. Inward pressing causes blood overflow and downward bursting, exiting with urine. Bursting empties major channels, failing to nourish collaterals, thus starting as Ji Bi and gradually transmitting to Mai Wei."
It also says: "Endless thinking and unfulfilled wishes lead to lustful thoughts projecting outward; excessive intercourse causes Zong Jin (General Sinews) to relax and sag, developing into Jin Wei and Baiyin (White Turbidity)." Hence, the *Xia Jing* (Lower Classic) states: "Jin Wei arises from the Liver due to sexual activity." (Suitable formulas include Zhibai Bawei Wan [Anemarrhena, Phellodendron, and Eight-Ingredient Pill], Siwu Tang, and Jiawei Xiaoyao San [Modified Free Wanderer Powder].) This refers to external lustful thoughts going unsatisfied and excessive intercourse. One involves Liver Fire depression; the other involves depletion of Yin Essence. Both relate to the anterior orifice. The anterior orifice is the Zong Jin. Without Yin to nourish Zong Jin, but instead pressured by fire, it becomes relaxed, flaccid, and weak, and when lustful thoughts stir, white turbidity follows. Thus, Jin Wei arises from the Liver and sexual activity.
It also says: "Gradual exposure to dampness, working with water, staying in damp dwellings, causes muscle immersion, numbness, and development of Rou Wei." Hence, the *Xia Jing* states: "Rou Wei is obtained from damp ground." (Suitable formulas include Weiling Tang [Stomach-Cinnamon Decoction], Zhongjing's Fangji Huangqi Tang [Stephania and Astragalus Decoction], and Dongyuan's Shenzhu Tang [Ginseng and Atractylodes Decoction].) This describes working in wet places, living in damp environments, gradually receiving pathogenic factors that linger and immerse the muscles. Over time, muscles become numb, developing into Rou Wei. Thus, Rou Wei comes from damp ground.
It also says: "Long journeys and fatigue, encountering intense heat and thirst. Thirst causes Yang Qi to invade internally; internal invasion places heat in the Kidney. The Kidney is a Water organ; now Water cannot overcome Fire, leading to withered bones and empty marrow, so the feet cannot support the body, developing into Gu Wei." Hence, the *Xia Jing* states: "Gu Wei arises from intense heat." (Suitable formulas include Zhibai Bawei Wan, Liuwei Wan [Six-Ingredient Pill], and Buyin Wan.) This describes long journeys and fatigue, encountering heat and thirst. Thirst indicates severe internal heat. Severe internal heat attacks weakness. Long journeys and fatigue mean Kidney Qi is temporarily deficient. (*Jing Mai Bie Lun* states: 'Heavy lifting and long walking cause sweat from the Kidney; Kidney deficiency is evident.') With Kidney deficiency, it cannot withstand heat, gradually leading to reduced marrow and withered bones, so feet cannot support the body, developing into Gu Wei. Thus, Gu Wei arises from intense heat.
It also says: "The Yangming Meridian is the Sea of the Five Zang and Six Fu organs, primarily moistening Zong Jin. Zong Jin binds bones and facilitates joint movement. The Chong Meridian is the Sea of the Vessels, primarily infiltrating and irrigating the Xi Gu (Valleys/Cavities), merging with Yangming at Zong Jin. Yin and Yang converge at Zong Jin, meeting at Qijie (Street of Qi), with Yangming as their leader, all belonging to the Dai Mai (Girdle Vessel) and connecting to the Du Mai (Governor Vessel). (Inability to raise the waist and spine seems to involve Du Mai symptoms.) Therefore, Yangming deficiency leads to Zong Jin relaxation and Dai Mai failure to draw in, causing foot flaccidity and inability to use them. (Previous Baiyin seems to be a symptom of Dai Mai failure to draw in.)" It also says: "Tonify their Ying-Spring points and unblock their Shu-Stream points, regulate excess and deficiency, harmonize reversal and smooth flow. For sinews, vessels, bones, and flesh, treating them during their respective seasonal months will cure the disease." Qibo's discussion on the transmission of Wei syndromes was thorough, yet he ultimately returned to Yangming. Why? Because Yangming is the Sea of Water and Grain, and Chong is the Sea of Blood. Here, referring to Yangming as the Sea of Five Zang and Six Fu organs, and Chong as the Sea of Vessels, shows that Zang-Fu and vessels both derive from these two sources. One moistens Zong Jin (Yang); one irrigates Xi Gu (Yin). Converging at Zong Jin and meeting at Qijie, Yangming is promoted as the leader. Qijie is the main pathway of Yangming, also implying respect for Water and Grain. Du Mai runs vertically; Dai Mai encircles horizontally. Yangming and Chong belong to Dai and connect to Du. Yangming deficiency fails to nourish Zong Jin, and Dai Mai lacks strength to contract, causing foot flaccidity. Thus, binding bones and facilitating joints relies on Zong Jin, which in turn relies on Yangming's nourishment. Therefore, treating Wei syndrome focuses solely on Yangming. However, one must simultaneously observe the Ying and Shu points of each Zang, applying tonification or unblocking as appropriate; considering the season of onset, whether declining or flourishing, to harmonize reversal and smooth flow, regulate excess and deficiency, ensuring the disease is cured. This is Qibo's answer to the Emperor regarding acupuncture for Wei syndrome. The pulse being mostly fine and moderate, or choppy, tight, thready, or soggy, corresponds to: fine reflecting skin/hair, moderate reflecting muscles, choppy reflecting vessels, tight reflecting fascia, and thready/soggy reflecting bone/marrow.