经义
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。（《素问》）
足厥阴之筋病，阴器不用，伤于内则不起，伤于寒则阴缩入，
伤于热则纵挺不收。○悲哀动中则伤魂，魂伤则狂妄不精，当人阴缩而挛筋。○恐惧不解则伤精，精伤则骨酸
痿厥。（《灵枢》）
哲言
阳痿一证，《经》文谆谆言之，而后贤诸书并无专论，以其事多隐曲，难以明言，更恐后人复肆强阳，嗜
欲无度，耗竭精气，与其强而纵欲，不若痿而绝欲，所以置而不论。往往少年犯此，无从调治，书曰∶老年多
欲者寿，以其阳强而固也，则少年阳痿而夭之义，已寓于中矣。能施而节，谓之节欲；卦数既终，体天道而绝
之，谓之绝欲，是皆得养生之道也。至于少年阳痿，乃阳气衰败，阴道消亡，欲用而难施，有施而难化，此其
根本既伤，发生难长。然四肢为身之卒伍，卑贱倘有痿痹，尚虑根本有伤，枝叶先萎，必须多方调治。此则更
为宗筋之要领，阴阳之交会，冲、任、督三脉所流通，水火两肾之外候，生人活命之根本，诸经筋脉结聚之总
都，若不内填精髓默固真元，徒取外治强阳之法，益竭其内，尤非保生良策矣。（《冯氏锦囊》）
男子阳痿不起，多由命门火衰，精气虚冷；或以七情劳倦，损伤阳气；亦有湿热炽盛，以致宗筋弛纵而为
痿弱者，譬诸暑热则诸物软痿。《经》云∶壮火食气。即此谓也。然有火无火，脉证可别，但火衰者十居七、
八，火盛者仅有之耳。○思虑焦劳，忧郁太过者，多致阳痿。盖阴阳总宗筋之会，会于气街，而阳明为之长，此
宗筋为精血之孔道，而精血实宗筋之化源。若以忧思太过，抑损心脾，则病及阳明、冲脉，而水谷气血之海必
有所亏，气血亏而阳道斯不振矣。○惊恐不释者，亦致阳痿。《经》曰∶恐伤肾。故凡遇大惊卒恐，能令人遗
失小便，即伤肾之验。又或阳旺之时，忽有惊恐，则阳道立痿，亦其验也。（《景岳全书》）
少年阳痿，有因于失志者，但宜舒郁，不宜补阳。《经》曰∶肾为作强之官，技巧出焉。藏精与志者也。
夫志从士从心，志主决定，心主思维，此作强之验也。苟志意不遂，则阳气不舒；阳
气者即真火也，譬诸极盛之火，置于密器之中，闭闷其气，不得发越，则立死而寒矣。此非真火衰也，乃闷郁
之故也。宣其抑郁，通其志意，则阳气舒而痿自起。（王节斋）
补编
肾乃坎象，水火具焉；阴阳交济，伎巧生焉。故有房劳太甚，宗筋弛纵，发为阴痿者，乃命门火衰，譬之
严冬百卉凋残也。亦有思想无穷，气郁心肾而为阴痿者，乃下焦火郁，譬如炎暑而草木下垂也。火衰者，桂附
八味丸；火郁者，知柏六味丸。不可偏认为火衰也。
失志之人，抑郁伤肝，肝木不能疏达，亦致阴痿不起，宜达郁汤加菖蒲、远志。若精伤阳虚者，宜还少丹。
亦有郁火甚而致痿者，当用黄柏、知母清火坚肾。（沈金鳌）
阴茎属肝之经络。盖肝者木也，如木得湛露则森立，遇酷暑则萎悴。若因肝经湿热而患者，用龙胆泻肝汤，
清肝火导湿热；若因肝经燥热而患者，用六味丸，滋肾水养肝血。（薛立斋）
史国公曰∶若欲兴阳，先滋筋力。然筋力之强，出于精血之所养，今人不滋补精血，而徒以热药为事者，
犹釜中无水而进火也。惟人参能补无形之气，实为补气壮阳之妙用，胜于热药多多矣。（《冯氏锦囊》）
阴痿，当责之精衰，斫丧太过所致。《经》云∶足厥阴之筋伤于内则不起。仲景八味丸特妙，甚者加人参、
鹿茸，或加巴戟、苁蓉、锁阳、枸杞。然亦有郁火甚而致痿者，《经》云∶壮火食气。令服滋肾丸而效。
（《张氏医通》）
男子以八为数，年逾六旬而阳事痿者，理所当然。若过此犹能生育者，此先天禀浓，所谓阳常有余也。若
夫少壮及中年患此，则有色欲伤及肝肾而致者，非峻补真元不可也。盖阳气既伤，真阴必损，若纯乎刚热燥涩
之补，必有偏胜之害，每兼血肉温润之品从缓调之。亦有因恐惧而得者，盖恐则伤肾，恐则气下，治宜固
肾，稍佐升阳。有因思虑烦劳而成者，则心、脾、肾兼治。有郁损生阳者，必从胆治。《经》云∶凡十一脏皆
取决于胆。又云∶少阳为枢。若得胆气展舒，何郁之有？更有湿热为患者，宗筋必弛纵而不坚举，治用苦味坚
阴，淡渗去湿，湿去热清，而病退矣。又有阳明虚则宗筋纵，盖胃为水谷之海，纳食不旺，精气必虚，况男子
外肾，其名为势，若谷气不充，欲求其势之雄壮坚举，不亦难乎？治惟通补阳明而已。（《临证指南》）
选案
一少年遭恐病，似胀非胀，似热非热，绝食而困。余诊之曰∶此恐惧内伤，少阳气索，而病及心肾，大亏
证也。遂峻加温补，兼治心脾。愈后形气虽健，而阳寂不举。余曰∶根蒂若斯，肾伤已甚，非少壮所宜，速宜
培养心肾，庶免他虞。不信，未及半载，复病而殁。可见恐惧之害如此。（《景岳全书》）
【经文释义】
内心思虑无穷，愿望无法实现，精神外驰，房事过度，导致宗筋（指男性生殖器及周围筋膜）松弛纵缓，从而引发筋痿病，以及出现白淫（指男子滑精、尿浊等症）。（出自《素问》）
足厥阴肝经的筋脉发生病变，会导致生殖器功能丧失。若因内伤（如情志或房劳）则阴茎不能勃起；若受寒邪侵袭则阴茎收缩内陷；若受热邪侵袭则阴茎纵挺不收。（出自《灵枢》）
悲哀情绪扰动内脏会损伤魂，魂受损则神志狂妄、精神不集中，表现为阴茎收缩且筋脉拘挛。恐惧情绪久郁不解会损伤肾精，肾精受损则骨骼酸软、四肢痿厥。（出自《灵枢》）
【哲人言论】
关于阳痿这一病症，《黄帝内经》中反复论述，但后世医家的著作中却很少专门讨论，因为此事大多隐晦曲折，难以明言，更担心后人因此更加放纵强求阳刚之气，嗜欲无度，耗竭精气。与其在阳气强盛时放纵欲望，不如在阳痿时断绝性欲，所以将其搁置而不加论述。往往年轻人犯此病，却无从调治。古书说：“老年人多欲者长寿”，是因为他们阳气强固；那么“年轻人阳痿而夭折”的道理，已蕴含其中了。能够行房而懂得节制，称为节欲；卦数既终（指生命自然终结），顺应天道而断绝性欲，称为绝欲，这些都是符合养生之道的方法。至于年轻人的阳痿，乃是阳气衰败，阴精消亡，想要使用却难以施展，即使施展也难以化生。这是因为根本已经受伤，生机难以生长。然而四肢是身体的卒伍（比喻次要部分），如果卑贱的部位尚且有痿痹之患，还要担忧根本有伤，枝叶先枯萎。必须多方调治。这更是宗筋的要领，阴阳交会之处，冲脉、任脉、督脉三脉流通之地，水火两肾的外候，是生育和维持生命的根本，也是诸经筋脉结聚的总汇。如果不从内部填补精髓、默默固守真元，仅仅依靠外部治疗来强行壮阳，只会进一步枯竭体内精气，这绝不是保全生命的良策。（出自《冯氏锦囊》）
男子阳痿不起，多由命门火衰，精气虚冷所致；或者因为七情（喜、怒、忧、思、悲、恐、惊）劳倦，损伤阳气；也有湿热炽盛，导致宗筋松弛纵缓而成为痿弱者的，就像暑热天气万物都会软萎一样。《内经》说：“壮火食气。”就是这个意思。然而，有火和无火，可以通过脉象和证候来辨别，但火衰者占十分之七八，火盛者仅有极少数。○思虑焦躁、忧郁太过的人，多导致阳痿。因为阴阳总汇于宗筋，汇聚于气街穴，而阳明胃经为之统领，宗筋是精血的孔道，而精血实际上是宗筋的化源。如果因为忧思太过，抑损心脾，那么疾病就会波及阳明经和冲脉，而水谷气血之海（脾胃）必然有所亏虚，气血亏虚则阳道自然不振。○惊恐不解的人，也会导致阳痿。《内经》说：“恐伤肾。”所以凡是遇到大惊大恐，能让人遗失小便，这就是伤肾的验证。又或者在阳气旺盛之时，忽然受到惊恐，则阳道立即痿废，这也是验证。（出自《景岳全书》）
少年阳痿，有因失意（志向未遂）导致的，只宜疏解郁结，不宜补阳。《内经》说：“肾为作强之官，技巧出焉。”肾藏精与志。志由心所主，志主决定，心主思维，这是作强功能的体现。如果意志不遂，则阳气不舒；阳气即真火，好比极盛之火，放在密闭容器中，闭塞其气，不得发散，则会立刻死亡变冷。这并不是真火衰微，而是闷郁的缘故。宣发其抑郁，通达其志意，则阳气舒展，痿证自起。（出自王节斋）
【补编】
肾乃坎卦之象，水火兼具；阴阳交济，伎巧由此产生。所以有因房劳太甚，宗筋弛纵，发为阴痿的，这是命门火衰，好比严冬百卉凋残。也有因思虑无穷，气郁心肾而为阴痿的，这是下焦火郁，好比炎暑天草木下垂。火衰者，用桂附八味丸；火郁者，用知柏六味丸。不可偏执认为是火衰。
失志之人，抑郁伤肝，肝木不能疏达，也导致阴痿不起，宜用达郁汤加石菖蒲、远志。若是精伤阳虚者，宜用还少丹。也有因郁火甚而致痿的，当用黄柏、知母清火坚肾。（出自沈金鳌）
阴茎属于肝之经络。肝属木，如同树木得到露水则挺拔，遇到酷暑则萎悴。若因肝经湿热致病者，用龙胆泻肝汤，清肝火导湿热；若因肝经燥热致病者，用六味地黄丸，滋肾水养肝血。（出自薛立斋）
史国公说：若想兴阳，先滋筋力。然而筋力的强健，出于精血的滋养，现在人不滋补精血，而徒然以热药为务，犹如火锅中没有水却进火一样。只有人参能补无形之气，实为补气壮阳的妙用，胜过热药多多。（出自《冯氏锦囊》）
阴痿，应当责之于精衰，是斫丧（过度消耗）太过所致。《内经》说：“足厥阴之筋伤于内则不起。”张仲景的八味丸特别奇妙，严重者加人参、鹿茸，或加巴戟天、肉苁蓉、锁阳、枸杞。然而也有因郁火甚而致痿的，《内经》说：“壮火食气。”令其服用滋肾丸而见效。（出自《张氏医通》）
男子以八为数（指生理周期），年过六十而阳事痿者，理所当然。如果过了这个年龄还能生育的，这是先天禀赋浓厚，所谓“阳常有余”。如果是少壮及中年患此病，则有因色欲伤及肝肾而致的，非峻补真元不可。因为阳气既伤，真阴必损，如果纯用刚热燥涩的补药，必有偏胜之害，每每兼用血肉温润之品从缓调治。也有因恐惧而得的，因为恐则伤肾，恐则气下，治疗宜固肾，稍佐升阳药。有因思虑烦劳而成的，则心、脾、肾兼治。有因郁损生阳的，必从胆治。《内经》说：“凡十一脏皆取决于胆。”又说：“少阳为枢。”如果胆气舒展，何来郁结？更有湿热为患者，宗筋必弛纵而不坚举，治疗用苦味坚阴，淡渗去湿，湿去热清，而病退矣。又有阳明虚则宗筋纵，因为胃为水谷之海，纳食不旺，精气必虚，何况男子外肾，名为势，如果谷气不充，想要求得它的雄壮坚举，不也很难吗？治疗唯有通补阳明而已。（出自《临证指南》）
【选案】
一个少年因遭受惊吓患病，身体似胀非胀，似热非热，绝食且困倦。我诊察后说：这是恐惧内伤，少阳之气索灭，并波及心肾，是大亏损的证候。于是峻加温补，兼治心脾。痊愈后形体气息虽健，但阳寂不举。我说：根基如此，肾伤已甚，不是年轻力壮者应有的状态，速宜培养心肾，以免其他变故。他不相信，不到半年，再次生病而死。可见恐惧的危害如此之大。（出自《景岳全书》）
[Scriptural Interpretation]
Endless thoughts and unfulfilled desires, with the spirit wandering externally and excessive sexual intercourse, lead to the flaccidity of the Zongjin (tendons and genitals), resulting in Jinwei (sinew atrophy) and Baiyin (seminal emission or turbid urine). (From *Suwen*)
Diseases of the tendons of the Foot Jueyin Liver Meridian affect the genitalia. Internal injury results in impotence; cold invasion causes retraction of the penis; heat invasion causes flaccidity and inability to retract. ○ Excessive sorrow damages Hun (Ethereal Soul); when Hun is damaged, madness and lack of concentration occur, accompanied by penile retraction and tendon contraction. Unresolved fear damages Jing (Essence); when Jing is damaged, bone soreness and limb atrophy/coldness occur. (From *Lingshu*)
[Philosophical Discourse]
Regarding the syndrome of Yangwei (impotence), although repeatedly discussed in the *Classic*, later medical texts rarely offer specific treatises on it. This is because the matter is often secretive and difficult to articulate openly, and there is a fear that future generations might further indulge in forcing yang energy, leading to boundless desires and exhaustion of essence and qi. It is better to abstain from desire when impotent than to indulge when yang is strong; thus, it has been set aside without discussion. Often, young people suffer from this but have no means for treatment. The book states: "Old men who indulge in desire live long," due to their solid and strong yang. The meaning that "young men with impotence die young" is implied herein. Practicing moderation in sexual activity is called "moderating desire"; ending sexual activity upon the completion of one's natural lifespan, following the Way of Heaven, is called "abstaining from desire." Both are in accordance with the principles of health preservation. As for impotence in youth, it stems from the decline of yang qi and the depletion of yin essence. There is an urge to function but difficulty in execution, or execution with difficulty in transformation. Since the root is damaged, regeneration is difficult. Although the limbs are merely the "soldiers" of the body, if even the inferior parts suffer from atrophy and numbness, one must worry about damage to the root causing the branches to wither first. Therefore, multi-faceted treatment is necessary. The Zongjin is the key point of the tendons, the intersection of yin and yang, the pathway of the Chong, Ren, and Du meridians, the external manifestation of the water and fire kidneys, the root of life and reproduction, and the gathering point of all meridian tendons. If one does not internally replenish essence and marrow and silently consolidate true yuan, but instead relies solely on external treatments to forcibly boost yang, it will only deplete internal essence further, which is certainly not a good strategy for preserving life. (From *Feng Shi Jin Nang*)
Male impotence is mostly caused by the decline of Mingmen Fire (Gate of Life Fire) and deficiency-cold of essence and qi; or by emotional stress and overwork damaging yang qi; or by flourishing damp-heat causing Zongjin flaccidity, similar to how things soften in summer heat. The *Classic* says: "Blazing fire consumes qi." This refers to such cases. However, the presence or absence of fire can be distinguished by pulse and symptoms. Cases of fire decline account for seven or eight out of ten, while cases of fire excess are rare. ○ Excessive worry, anxiety, and depression often lead to impotence. Yin and yang converge at the Zongjin, meeting at the Qichuan acupoint, with the Stomach Meridian of Foot-Yangming acting as the leader. The Zongjin serves as the channel for essence and blood, which are actually the source of the Zongjin's nourishment. If excessive worry suppresses the Heart and Spleen, the disease affects the Yangming and Chong meridians, causing deficits in the Sea of Water and Grain (Stomach/Spleen). When qi and blood are deficient, the male organ fails to function. ○ Unresolved fright also leads to impotence. The *Classic* states: "Fear injures the Kidney." Thus, sudden fright causing urinary incontinence is evidence of Kidney injury. Similarly, if fright occurs during a state of high yang vitality, immediate impotence may result, which is also verification. (From *Jingyue Quanshu*)
Impotence in youth caused by frustration of ambition should be treated by soothing depression, not by tonifying yang. The *Classic* states: "The Kidney is the official of strength and ingenuity." The Kidney stores essence and zhi (will). Will is directed by the Heart; Will determines, and the Heart thinks. This demonstrates the function of strength. If will is frustrated, yang qi cannot flow freely. Yang qi is true fire; imagine intense fire sealed in a closed container—the heat cannot escape, leading to death and coldness. This is not a decline of true fire, but due to stagnation. By venting depression and unblocking the will, yang qi flows, and impotence resolves spontaneously. (Wang Jiezhai)
[Supplement]
The Kidney corresponds to the Kan trigram, containing both water and fire; through the interaction of yin and yang, ingenuity arises. Impotence caused by excessive sexual fatigue, leading to Zongjin flaccidity, is due to Mingmen Fire decline, akin to plants withering in severe winter. Impotence caused by endless thoughts and qi stagnation affecting the Heart and Kidney is due to lower jiao fire stagnation, akin to plants drooping in summer heat. For fire decline, use Guifu Bawei Wan; for fire stagnation, use Zhibai Liuhua Wan. Do not exclusively assume it is always fire decline.
For individuals whose ambitions are thwarted, depression injures the Liver, preventing the free flow of Liver Wood, leading to impotence. Use Dayu Tang plus Shichangpu (Acori Tatarinowii Rhizoma) and Yuanzhi (Polygalae Radix). For those with essence injury and yang deficiency, use Huanshao Dan. For impotence caused by severe stagnant fire, use Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) to clear fire and strengthen the Kidney. (Shen Jin'ao)
The penis belongs to the Liver meridian. The Liver corresponds to Wood; like trees standing tall with dew, they wither in scorching heat. For patients with Damp-Heat in the Liver meridian, use Longdan Xiegan Tang to clear Liver fire and drain damp-heat. For patients with Dry-Heat in the Liver meridian, use Liuwei Dihuang Wan to nourish Kidney water and Liver blood. (Xue Lizhai)
State Duke Shi said: To restore yang, one must first nourish the tendons. Strong tendons rely on the nourishment of essence and blood. Those who neglect nourishing essence and blood and rely solely on hot medicines are like adding fire to an empty pot. Only Ginseng can tonify formless qi, making it a wonderful agent for tonifying qi and strengthening yang, far superior to hot medicines. (From *Feng Shi Jin Nang*)
Impotence should be attributed to essence depletion caused by excessive debauchery. The *Classic* states: "Injury to the tendons of the Foot Jueyin internally results in inability to erect." Zhang Zhongjing's Bawei Wan is particularly effective; for severe cases, add Renshen (Ginseng Radix et Rhizoma) and Lurong (Cervi Cornus Degelatinatum), or Bajitian (Morindae Officinalis Radix), Rongsheng (Cibotii Rhizoma), Suoyang (Cynomorii Herba), and Gouqi (Lycii Fructus). However, some cases are caused by severe stagnant fire. The *Classic* states: "Blazing fire consumes qi." Administer Zishen Wan with effect. (From *Zhangshi Yitong*)
Men follow the number eight (physiological cycles). Impotence after age sixty is natural. Those capable of procreation beyond this age possess strong congenital endowment, described as "yang is often in excess." For young or middle-aged men suffering from this, it is often due to sexual excess injuring the Liver and Kidney, requiring vigorous tonification of true yuan. Since yang injury inevitably damages true yin, using purely warm, dry, and astringent tonics can cause imbalance. It is best to combine them with moist, warm substances derived from animal products for gradual regulation. Some cases arise from fear; since fear injures the Kidney and causes qi to sink, treatment should focus on securing the Kidney with slight addition of ascending yang herbs. Cases arising from mental toil require simultaneous treatment of the Heart, Spleen, and Kidney. Cases where depression damages yang generation must be treated via the Gallbladder. The *Classic* states: "All eleven organs depend on the Gallbladder," and "Shaoyang acts as the pivot." If Gallbladder qi expands, how can there be stagnation? Other cases involve damp-heat, causing Zongjin flaccidity; treatment uses bitter herbs to firm yin and bland herbs to leach out dampness. Once dampness is removed and heat cleared, the disease recedes. Additionally, Yangming deficiency leads to Zongjin flaccidity. The Stomach is the Sea of Water and Grain; poor appetite leads to qi and blood deficiency. How can the male organ be strong if grain qi is insufficient? Treatment lies in tonifying and unblocking the Yangming. (From *Linzheng Zhinan*)
[Selected Case]
A young man suffered from fright, presenting with distension that was not true distension and heat that was not true heat, accompanied by loss of appetite and fatigue. Upon diagnosis, I stated: This is internal injury from fright, with Shaoyang qi declining, affecting the Heart and Kidney, representing a severe deficiency syndrome. I administered vigorous warming and tonifying herbs, treating the Heart and Spleen simultaneously. After recovery, his physical constitution was robust, but he remained impotent. I remarked: With such a foundation, the Kidney is severely damaged, which is unsuitable for a young person. He should quickly cultivate the Heart and Kidney to avoid other complications. He did not believe me. Within half a year, he fell ill again and died. This illustrates the harm of fright. (From *Jingyue Quanshu*)