脉
尺脉虚弱，缓而紧，病为足痛，或者痿病。张子和云∶痿因
肺热相传，四脏其脉多浮而大，不可作寒湿香港脚治。
病
夫痿者，谓手足痿弱，无力以运动也。《内经》谓诸痿起于肺热。又曰∶治痿独取阳明。盖肺经体
燥，居上而主气，畏火者也；脾土性湿，居中而主四肢，畏水也。火性上炎，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
木邪而伤邪，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。治痿必须戒
浓味，节嗜欲，庶可保其全安也。
陈无择云∶痿 之疾，状类柔风、香港脚，但柔风、香港脚皆外所因，痿则五内不
足所致也。治之不可混作外因立治。
治
丹溪曰∶有挟湿热，有痰，有血虚。亦有死血者，有食积妨碍升降者。上文论火起于肺热，实痿
之本，论此云然者，盖以其发而为所因所挟，或有不同，而主治亦当各着其所重也。
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，用四物汤加黄柏、苍术，下用补阴丸。气虚，用四君子汤，加苍术、
黄柏、黄 之类。食积，用小调中汤，加神曲、麦芽、山楂、枳实之类。色劳，用补阴丸、虎潜丸之类补之。
方
清燥汤 六七月间，湿令大行，子能令母实而热旺，湿热相合，而形庚大肠，故寒冷以救之，燥金
受湿热之邪，绝寒水生之源，源绝则肾亏痿厥之病大作，腰下痿软瘫痪，不能动一履。
黄 （一钱五分） 苍术（一钱） 白术 陈皮 泽泻（各五分） 人参 白茯苓 升麻（各三分）
麦门冬 当归身 生地黄 神曲末 猪苓（各二分） 黄柏（酒炒） 柴胡 黄连（各一分）
五味子（九个） 甘草（炙，二分）
上锉一剂，水煎空心服。
滋筋养血汤（云林制） 专治血气两虚，双足痿软，不能行动，久卧床褥。
川归（一钱） 熟地黄（一钱五分） 白芍药（一钱五分） 川芎（七分半） 人参（八
分） 五味子（九粒） 麦门冬（去心，一钱） 黄柏（一钱） 知母（五分） 牛膝（酒浸，一
钱） 杜仲（酒炒，一钱） 苍术（一钱） 薏苡仁（一钱） 防风（六分） 羌活（三分） 甘草（三分）
筋骨痿软，加桂枝三分，陈皮八分；如觉心烦，加黄连六分，酸枣仁炒六分，白茯神去木一钱。
上锉一剂，姜、枣煎服。
养血壮筋健步丸（云林制） 〔批〕（按此方补虚除湿热之剂） 治证同前。
黄 （盐水炒，一两） 山药（一两） 五味子（一两） 破故纸（盐水炒，一两） 人
参（一两） 白芍（酒炒，一两五分） 熟地黄（四两） 枸杞子（一两） 牛膝（酒浸，二两）
菟丝子（酒炒，一两） 川归（二两，酒洗） 白术（一两，炒） 杜仲（姜汁炒，二两） 虎
胫骨（酥炙，一两） 龟板（酥炙，一两） 苍术（米泔浸，三两） 黄柏（盐水炒，二两） 防
风（六钱，酒洗） 羌活（五钱，酒洗） 汉防己（五钱，酒洗）
上为末，用猪脊髓七条，炼蜜为丸，如梧子大。每服百丸，空心盐汤下。
鹿角霜丸（方见中风）〔批〕（按此方补虚除湿热之剂） 治血气虚弱，两足痿软，不
能行动，久卧床褥之症。
蒸法 治肾气虚弱，肝脾三经，风寒湿停于腿膝，使经络滞而
不行，变成脚痹，故发疼痛，此荣卫通经络。
川椒（一把） 葱（三大茎） 盐（一把） 小麦（面约四五升许） 酒（一盏）
上用醋和，湿润得所，炒令极热，摊卧褥下，将所患腿脚就卧熏蒸，薄衣被盖得汗出匀遍，约半个时辰，
撤去炒麸，上就铺褥中卧，待一两个时辰，觉汗稍解，勿令见风，立效。
一妇人血气两虚，虚中受孕，新血供养胎元，无血健用厥阴、少阴二经，以致两腿足软弱，战栗不
能步履，必待生产后，大补气血，壮筋骨，则行步轻健矣。
人参（一钱） 白术（一钱，炒） 茯苓（一钱） 甘草（五分，炙） 川芎（七分） 当
归（一钱，酒洗） 白芍（二钱，炒） 熟地黄（一钱，姜汁炒） 肉桂（一钱，去皮） 黄
（一钱盐水炒） 牛膝（一钱二分，去芦，酒洗） 杜仲（姜汁炒，一钱二分） 木瓜（一钱，酒
洗） 防风（去芦，八分） 独活（一钱，酒洗） 薏苡仁（一钱） 大附子（一钱，制） 沉
香（三分，研，水入药服不见火）
上锉一剂，姜三片，枣一枚，水煎，空心服。
脉象
尺部脉象虚弱，或缓而紧，病症表现为足部疼痛，或者是痿病。张子和说：痿病是因为肺热传变所致，其他四脏的脉象多呈现浮大而有力的特点，不能当作寒湿引起的香港脚（一种以足胫肿痛、软弱无力为特征的疾病）来治疗。
病症
所谓痿病，是指手足痿弱无力，无法运动。《内经》说各种痿病都起于肺热。又说：治疗痿病要独取阳明经。这是因为肺经体性干燥，位居上焦而主司气机，畏惧火邪；脾土体性湿润，位居中焦而主司四肢，畏惧水邪。火性炎上，如果嗜欲没有节制，就会导致肾水失去滋养，火邪因缺乏制约而反侮其所胜之脏（即脾土），使肺受到火邪侵袭而产生热证；木性刚急，肺受热后，金（肺）失去滋养，木（肝）因缺乏制约而反侮其所胜之脏（即脾土），使脾受到木邪侵袭而受伤。肺热则不能统摄全身，脾伤则四肢不能正常使用，于是各种痿病就产生了。泻南方（心火）则肺金得以清肃，东方（肝木）就不会过于亢盛，脾又怎么会受伤呢？补北方（肾水）则心火下降，西方（肺金）就不会虚弱，肺又怎么会有热呢？所以阳明经充实，宗筋就能得到滋润，从而能够约束骨骼并利于关节活动。治疗痿病必须戒除肥甘厚味，节制嗜欲，才可以保全健康安宁。
陈无择说：痿病的症状类似柔风（中风的一种轻症）、香港脚，但柔风和香港脚都属于外感病因，而痿病则是五脏内虚所致。治疗时不可混淆为外因而立治法。
治法
朱丹溪说：有的夹带湿热，有的有痰，有的是血虚。也有瘀血阻滞的，有食积妨碍气机升降的。上文论述火起于肺热，这是痿病的根本；这里论述上述情况，是因为发病时的兼夹因素可能不同，主治时应当各自侧重其重点。
对于湿热，使用东垣健步丸，加上黄柏、黄芩、苍术等燥湿降火的药物。对于湿痰，使用二陈汤，加上苍术、白术、黄芩、黄柏等药物，并加入竹沥、姜汁。对于血虚，使用四物汤加黄柏、苍术，配合服用补阴丸。对于气虚，使用四君子汤，加上苍术、黄柏、黄芪等药物。对于食积，使用小调中汤，加上神曲、麦芽、山楂、枳实等药物。对于房劳过度，使用补阴丸、虎潜丸等药物进行补益。
方剂
清燥汤 在六七月间，湿气盛行，子（湿土）能令母（燥金）实而导致热势旺盛，湿热相合，影响大肠（庚金），因此需要用寒冷性质的药物来救治。燥金受到湿热邪气的侵害，断绝了寒水（肾）生成的源头，源头枯竭则肾亏，导致痿厥病大作，腰部以下痿软瘫痪，完全不能行动。
黄芪（一钱五分） 苍术（一钱） 白术 陈皮 泽泻（各五分） 人参 白茯苓 升麻（各三分）
麦门冬 当归身 生地黄 神曲末 猪苓（各二分） 黄柏（酒炒） 柴胡 黄连（各一分）
五味子（九个） 甘草（炙，二分）
以上药材锉碎为一剂，加水煎煮，空腹服用。
滋筋养血汤（云林制） 专门治疗气血两虚，双足痿软，不能行走，长期卧床的症状。
川当归（一钱） 熟地黄（一钱五分） 白芍药（一钱五分） 川芎（七分半） 人参（八分） 五味子（九粒） 麦门冬（去心，一钱） 黄柏（一钱） 知母（五分） 牛膝（酒浸，一钱） 杜仲（酒炒，一钱） 苍术（一钱） 薏苡仁（一钱） 防风（六分） 羌活（三分） 甘草（三分）
若筋骨痿软，加桂枝三分，陈皮八分；如果觉得心烦，加黄连六分，炒酸枣仁六分，去木心的白茯神一钱。
以上药材锉碎为一剂，加生姜、大枣煎服。
养血壮筋健步丸（云林制）〔批注〕（按：此方为补虚兼除湿热的药剂） 主治症状同上。
黄芪（盐水炒，一两） 山药（一两） 五味子（一两） 破故纸（即补骨脂，盐水炒，一两） 人参（一两） 白芍（酒炒，一两五分） 熟地黄（四两） 枸杞子（一两） 牛膝（酒浸，二两）
菟丝子（酒炒，一两） 川当归（二两，酒洗） 白术（一两，炒） 杜仲（姜汁炒，二两） 虎胫骨（酥炙，一两） 龟板（酥炙，一两） 苍术（米泔水浸，三两） 黄柏（盐水炒，二两） 防风（六钱，酒洗） 羌活（五钱，酒洗） 汉防己（五钱，酒洗）
以上研为细末，用七条猪脊髓和炼蜜制成丸药，如梧桐子大小。每次服用一百丸，空腹时用盐汤送下。
鹿角霜丸（方见中风篇）〔批注〕（按：此方为补虚兼除湿热的药剂） 治疗气血虚弱，两足痿软，不能行走，长期卧床的症状。
蒸法 治疗肾气虚弱，肝、脾、三焦经络中风寒湿邪停滞，导致经络阻滞不通，变成脚痹，从而引发疼痛，此法旨在通调营卫经络。
川椒（一把） 葱（三大茎） 盐（一把） 小麦面粉（约四五升） 酒（一盏）
以上用醋调和，湿度适宜，炒至极热，摊在卧褥下面，将患病的腿脚置于上面熏蒸，穿着薄衣被盖好，使汗出均匀遍布全身，大约半个时辰（一小时），撤去炒热的麸皮，直接在铺好的褥子上躺卧，等待一两个时辰，感觉汗稍退后，不要吹风，立即见效。
有一位妇女气血两虚，虚损状态下受孕，新血供养胎元，导致用于濡养厥阴、少阴二经的血液不足，以致双腿足软弱，战栗不能行走，必须等到生产之后，大补气血，强壮筋骨，才能行走轻健。
人参（一钱） 白术（一钱，炒） 茯苓（一钱） 甘草（五分，炙） 川芎（七分） 当归（一钱，酒洗） 白芍（二钱，炒） 熟地黄（一钱，姜汁炒） 肉桂（一钱，去皮） 黄芪（一钱，盐水炒） 牛膝（一钱二分，去芦头，酒洗） 杜仲（姜汁炒，一钱二分） 木瓜（一钱，酒洗） 防风（去芦头，八分） 独活（一钱，酒洗） 薏苡仁（一钱） 大附子（一钱，制过） 沉香（三分，研末，在水入药时冲服，不经过煎煮）
以上药材锉碎为一剂，加生姜三片，大枣一枚，加水煎煮，空腹服用。
Pulse Diagnosis
The pulse at the Chi position (distal radial pulse) is weak, or slow and tight. The disease manifests as foot pain or Wei syndrome (flaccidity syndrome). Zhang Zihe stated: Wei syndrome arises from heat transmission from the Lung. The pulses of the other four Zang organs are often floating and large; it should not be treated as Hong Kong Foot (a condition characterized by swelling and weakness of the lower legs and feet caused by cold-dampness).
Pathogenesis
Wei syndrome refers to the flaccidity and weakness of the hands and feet, with insufficient strength for movement. The *Neijing* states that all Wei syndromes originate from Lung heat. It also states: "In treating Wei syndrome, focus exclusively on the Yangming channel." This is because the Lung meridian has a dry nature, resides in the upper jiao, governs Qi, and fears Fire; the Spleen earth has a damp nature, resides in the middle jiao, governs the four limbs, and fears Water. Fire nature tends to flare upward. If desires and sexual activity are unregulated, Kidney Water loses its nourishment. Fire, lacking restraint, overacts upon what it normally controls (Spleen Earth), causing the Lung to suffer from Fire pathogenic factors and develop heat. Wood nature is rigid and urgent. When the Lung suffers heat, Metal (Lung) loses nourishment. Wood (Liver), lacking restraint, overacts upon what it normally controls (Spleen Earth), causing the Spleen to be injured by Wood pathogenic factors. Lung heat fails to regulate the whole body; Spleen injury causes the four limbs to lose their function. Thus, various Wei syndromes arise. Purging the South (Heart Fire) clears Lung Metal, preventing East (Liver Wood) from becoming excessive, so how could the Spleen be injured? Tonifying the North (Kidney Water) descends Heart Fire, preventing West (Lung Metal) from becoming deficient, so how could Lung heat exist? Therefore, when the Yangming channel is full, the Zongjin (tendons gathering at the genitalia) are moistened, capable of binding the bones and facilitating joint movement. Treating Wei syndrome requires abstaining from rich flavors and regulating desires to ensure health and safety.
Chen Wuyue stated: The symptoms of Wei syndrome resemble Roufeng (a mild form of wind-stroke) and Hong Kong Foot. However, Roufeng and Hong Kong Foot are caused by external factors, whereas Wei syndrome is caused by internal deficiency of the five Zang organs. Treatment must not be confused with methods for external causes.
Treatment Methods
Zhu Danxi said: Some cases involve damp-heat, some involve phlegm, some involve blood deficiency. There are also cases of dead blood (blood stasis) and food stagnation interfering with the ascending and descending of Qi. The previous discussion attributed fire to Lung heat, which is the root of Wei syndrome. The current discussion mentions these variations because the precipitating factors or accompanying pathogens may differ, and treatment should emphasize the specific key aspects accordingly.
For damp-heat, use Dongyuan Jianbu Wan, added with herbs that dry dampness and descend fire such as Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix), and Cangzhu (Atractylodis Rhizoma). For damp-phlegm, use Erchen Tang, added with Cangzhu, Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqin, Huangbai, along with Zhuli (Bambusae Caulis in Taenia) and Jiangzhi (Zingiberis Juice). For blood deficiency, use Siwu Tang added with Huangbai and Cangzhu, taken concurrently with Buyin Wan. For Qi deficiency, use Sijunzi Tang added with Cangzhu, Huangbai, and Huangqi (Astragali Radix). For food stagnation, use Xiaozhongtang Tang added with Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), Shanzha (Crataegi Fructus), and Zhishi (Aurantii Fructus Immaturus). For sexual exhaustion, use Buyin Wan and Huqian Wan for tonification.
Formulas
Qingzao Decoction In the months of June and July, dampness prevails. Since the child element (Damp/Earth) can make the mother element (Dry/Metal) excess, heat becomes vigorous. Damp-heat combines and affects the Large Intestine (Geng Metal). Therefore, cold-natured herbs are used to rescue it. When Dry Metal suffers from damp-heat pathogens, the source of Cold Water (Kidney) generation is cut off. When the source is exhausted, Kidney deficiency occurs, leading to severe Wei-Jue syndrome (flaccidity and cold extremities), with flaccidity and paralysis below the waist, rendering the patient unable to move or walk.
Huangqi (Astragali Radix) (1.5 qian) Cangzhu (Atractylodis Rhizoma) (1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma) Chenpi (Citri Reticulatae Pericarpium) Zexie (Alismatis Rhizoma) (each 0.5 qian) Renshen (Panacis Ginseng Radix) Baifuling (Poria) Shengma (Cimicifugae Rhizoma) (each 0.3 qian)
Maidong (Ophiopogonis Tuber) Dangguishen (Angelicae Sinensis Radix Body) Shengdihuang (Rehmanniae Radix) Shenqu (Massa Medicata Fermentata) Zhuling (Polyporus) (each 0.2 qian) Huangbai (Phellodendri Cortex, wine-fried) Chaihu (Bupleuri Radix) Huanglian (Coptidis Rhizoma) (each 0.1 qian)
Wuweizi (Schisandrae Fructus) (9 berries) Gancao (Licorice Root, honey-fried) (0.2 qian)
Decoct one dose in water and take on an empty stomach.
Zijin Yangxue Decoction (Prepared by Yunlin) Specifically treats dual deficiency of Qi and Blood, resulting in flaccid weakness of both feet, inability to walk, and prolonged bedridden state.
Chuangui (Angelicae Sinensis Radix) (1 qian) Shudihuang (Rehmanniae Radix Preparata) (1.5 qian) Baishaoyao (Paeoniae Radix Alba) (1.5 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma) (0.75 qian) Renshen (Panacis Ginseng Radix) (0.8 qian) Wuweizi (Schisandrae Fructus) (9 berries) Maidong (Ophiopogonis Tuber, heart removed) (1 qian) Huangbai (Phellodendri Cortex) (1 qian) Zhimu (Anemarrhenae Rhizoma) (0.5 qian) Niuxi (Achyranthis Bidentatae Radix, wine-soaked) (1 qian) Duzhong (Eucommiae Cortex, wine-fried) (1 qian) Cangzhu (Atractylodis Rhizoma) (1 qian) Yiyiren (Coicis Semen) (1 qian) Fangfeng (Saposhnikoviae Radix) (0.6 qian) Qianghuo (Notopterygii Rhizoma et Radix) (0.3 qian) Gancao (Licorice Root) (0.3 qian)
If tendons and bones are flaccid, add Guizhi (Cinnamomi Ramulus) 0.3 qian and Chenpi (Citri Reticulatae Pericarpium) 0.8 qian. If feeling mental restlessness, add Huanglian (Coptidis Rhizoma) 0.6 qian, fried Suanzaoren (Ziziphi Spinosae Semen) 0.6 qian, and Baifushen (Poria with Hostwood removed) 1 qian.
Decoct one dose with Ginger and Jujube and take orally.
Yangxue Zhuangjin Jianbu Pill (Prepared by Yunlin) [Note] (This formula tonifies deficiency and drains damp-heat.) Treats the same conditions as above.
Huangqi (Astragali Radix, salt-water fried) (1 liang) Shanyao (Dioscoreae Rhizoma) (1 liang) Wuweizi (Schisandrae Fructus) (1 liang) Poguzhi (Psoraleae Fructus, salt-water fried) (1 liang) Renshen (Panacis Ginseng Radix) (1 liang) Baishao (Paeoniae Radix Alba, wine-fried) (1.5 liang) Shudihuang (Rehmanniae Radix Preparata) (4 liang) Gouqizi (Lycii Fructus) (1 liang) Niuxi (Achyranthis Bidentatae Radix, wine-soaked) (2 liang)
Tusizi (Cuscutae Semen, wine-fried) (1 liang) Chuangui (Angelicae Sinensis Radix, wine-washed) (2 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, fried) (1 liang) Duzhong (Eucommiae Cortex, ginger-juice fried) (2 liang) Hu Jinggu (Tigris Tibia, su-grease roasted) (1 liang) Guiban (Testudinis Carapax et Plastrum, su-grease roasted) (1 liang) Cangzhu (Atractylodis Rhizoma, rice-water soaked) (3 liang) Huangbai (Phellodendri Cortex, salt-water fried) (2 liang) Fangfeng (Saposhnikoviae Radix, wine-washed) (6 qian) Qianghuo (Notopterygii Rhizoma et Radix, wine-washed) (5 qian) Hanfangji (Stephaniae Tetrandrae Radix) (5 qian, wine-washed)
Grind into powder. Use seven pig spinal cords and refined honey to form pills the size of wu zi (loquat seeds). Take 100 pills per dose with salt water on an empty stomach.
Lujiaoshuang Pill (See Stroke section) [Note] (This formula tonifies deficiency and drains damp-heat.) Treats deficiency of Qi and Blood, flaccid weakness of both feet, inability to walk, and prolonged bedridden state.
Steaming Therapy Treats Kidney Qi deficiency, where Wind-Cold-Dampness stagnates in the Liver, Spleen, and Sanjiao meridians, blocking the collaterals and causing Jiao Bi (foot numbness/pain), leading to pain. This method aims to unblock Ying and Wei Qi through the meridians.
Chuanjiao (Zanthoxyli Pericarpium) (1 handful) Congbai (Allii Fistulosi Bulbus) (3 large stalks) Yan (Salt) (1 handful) Xiaomian (Wheat Flour) (approx. 4-5 sheng) Jiu (Wine) (1 zhan)
Mix with vinegar to achieve appropriate moisture. Stir-fry until extremely hot. Spread under the bedding. Place the affected legs and feet on top to steam. Cover with thin clothing and blankets to induce uniform sweating. After about half a shichen (one hour), remove the hot bran. Lie directly on the prepared bedding. Wait for one to two shichen. When sweat subsides slightly, avoid exposure to wind. Immediate effect will occur.
A woman suffered from dual deficiency of Qi and Blood. She conceived while in a deficient state. New blood was diverted to nourish the fetus, leaving insufficient blood to nourish the Jueyin and Shaoyin meridians. Consequently, her legs and feet became weak and tremulous, unable to walk. She had to wait until after childbirth, then vigorously tonify Qi and Blood and strengthen tendons and bones to regain light and healthy gait.
Renshen (Panacis Ginseng Radix) (1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, fried) (1 qian) Fuling (Poria) (1 qian) Gancao (Licorice Root, honey-fried) (0.5 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma) (0.7 qian) Danggui (Angelicae Sinensis Radix, wine-washed) (1 qian) Baishao (Paeoniae Radix Alba, fried) (2 qian) Shudihuang (Rehmanniae Radix Preparata, ginger-juice fried) (1 qian) Rougui (Cinnamomi Cortex, peeled) (1 qian) Huangqi (Astragali Radix, salt-water fried) (1 qian) Niuxi (Achyranthis Bidentatae Radix, de-rhizome, wine-washed) (1.2 qian) Duzhong (Eucommiae Cortex, ginger-juice fried) (1.2 qian) Mugua (Chaenomelis Fructus, wine-washed) (1 qian) Fangfeng (Saposhnikoviae Radix, de-rhizome) (0.8 qian) Duohuo (Angelicae Pubescentis Radix, wine-washed) (1 qian) Yiyiren (Coicis Semen) (1 qian) Da Fuzi (Aconiti Lateralis Radix Preparata, processed) (1 qian) Chenxiang (Aquilariae Lignum Resinatum, powdered, taken with water mixed into the decoction without boiling) (0.3 qian)
Decoct one dose with three slices of ginger and one jujube in water. Take on an empty stomach.