【歌】诸痿多因肺热生，故云痿独取阳明。分明自是膏粱疾，勿认为风浪立名。
【论】夫痿有五∶脉、筋、骨、肉、痿蹶是也。古方多以治风之药通治痿，何其谬也。至丹溪始辨之，
以风、痿二证另立篇目，源流不同，治法迥别，此开千古之弊也。丹溪云∶《内经》谓诸痿起于肺热。又谓治
痿独取阳明。盖肺金体燥，居上而主气，畏火者也。脾土主湿，居中央，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。木性则急，肺受热邪则金失所养，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。故泻火则肺金清而木不
实，何伤脾之有？补肾水则心火降而肺金不虚，何肺热之有？故阳明实则宗筋润而能束骨，关节利矣，治痿之
法，莫出于此。然或有湿热，或痰，或血虚，或气虚，或死血，或食积，妨碍不得降者，比比皆然，当审而疗
之，尤当淡薄滋味焉。
【脉】痿因肺燥，脉多浮弱。寸口若沉，发汗则错。足痛或软，专审于尺，滑疾而缓，或沉而弱。
虚痿
大率虚与热，气血两虚者，四物汤加参、 、知母、黄柏。热多加黄芩。只血虚，四物汤加黄柏、苍术，
（方见血证。）或丹溪补阴丸。（方见火证。）气虚者，四君子汤加黄柏、知母。（方见脾胃。）
食积
食积瘀血妨碍不得降者，四物汤对二陈汤加桃仁、红花、黄柏、神曲。湿痰者，二陈汤加苍、白术、
芩、柏、竹沥、姜汁。食积者，二陈汤加苍、柏、实、曲。（方见血证及痰证。）
湿热
湿热成痿，二妙散或健步丸。（二方俱见腰痛。）六、七月间湿热成痿，清燥汤。
东垣清燥汤
黄 （一钱半） 苍术（一钱） 白术（五分） 陈皮（五分） 泽泻（五分） 人参（三分） 白茯
苓（五分） 升麻（三分） 麦门冬（二分） 当归身（二分） 生地黄（二分） 酒 （一分） 柴胡（一分）
黄连（一分） 甘草（二分）
煎服。
【歌诀】各种痿证大多是因为肺热产生的，所以说治疗痿证要专门取法于阳明经。这分明是由于饮食肥甘厚味导致的疾病，不要误认为是风邪而随意命名。
【论述】痿证有五种：脉痿、筋痿、骨痿、肉痿和痿蹶（肢体软弱无力，足不能行）。古方常用治疗风病的药物来通治痿证，这是多么错误啊！直到朱丹溪才开始辨析这一点，将风病和痿证分别设立篇目，因为两者的病因源流不同，治疗方法截然不同，这是开启了纠正千古弊端的先河。朱丹溪说：《内经》提到各种痿证起于肺热。又说治疗痿证要专门取法于阳明经。肺属金，体性干燥，位居上焦而主司气，畏惧火邪。脾属土，主司湿气，位居中焦，主司四肢，畏惧木邪。火的性质是炎上的，如果嗜欲没有节制，就会导致肾水失去滋养，火因缺乏制约而反侮其所胜之金，肺受到火邪侵袭而产生热症。木的性质是急迫的，肺受到热邪侵袭则金失所养，木因缺乏制约而反侮其所胜之土，脾受到木邪侵袭而受伤。肺热则不能统摄全身，脾伤则四肢不能正常运作，于是各种痿证就产生了。所以泻火则肺金清凉而木气不致过实，又怎能伤害脾脏呢？补肾水则心火下降而肺金不虚，又怎会有肺热呢？所以阳明经充实则宗筋得到滋润而能约束骨骼，关节也就灵活了，治疗痿证的方法，没有超出这个范围的。然而如果有湿热、痰浊、血虚、气虚、瘀血或食积，妨碍气机不得降下的情况，比比皆是，应当仔细审察后进行治疗，尤其应当清淡饮食。
【脉诊】痿证由于肺燥引起，脉象多表现为浮弱。如果寸口脉沉，误用发汗法就是错误的。足部疼痛或软弱，应专门审视尺脉，若见滑疾而缓，或沉而弱的脉象。
虚痿
大抵是虚证与热证，气血两虚的，用四物汤加人参、黄芪、知母、黄柏。热象重的加黄芩。只是血虚的，用四物汤加黄柏、苍术，（方剂见血证章节。）或者用丹溪补阴丸。（方剂见火证章节。）气虚的，用四君子汤加黄柏、知母。（方剂见脾胃章节。）
食积
食积和瘀血妨碍气机不得降下的，用四物汤合二陈汤加桃仁、红花、黄柏、神曲。湿痰的，用二陈汤加苍术、白术、黄芩、黄柏、竹沥、姜汁。食积的，用二陈汤加苍术、黄柏、枳实、神曲。（方剂见血证及痰证章节。）
湿热
湿热导致成痿，用二妙散或健步丸。（两个方剂均见腰痛章节。）六、七月间湿热导致成痿，用清燥汤。
东垣清燥汤
黄芪（一钱半） 苍术（一钱） 白术（五分） 陈皮（五分） 泽泻（五分） 人参（三分） 白茯苓（五分） 升麻（三分） 麦门冬（二分） 当归身（二分） 生地黄（二分） 酒（一分） 柴胡（一分） 黄连（一分） 甘草（二分）
煎煮服用。
[Verse] Various types of Wei syndrome (flaccidity syndrome) are mostly caused by lung heat, hence it is said that the treatment of Wei syndrome should exclusively focus on the Yangming channel. This is clearly a disease resulting from rich and greasy food intake; do not mistakenly attribute it to wind pathogen and name it arbitrarily.
[Dissertation] There are five types of Wei syndrome: Mai Wei (pulse flaccidity), Jin Wei (tendon flaccidity), Gu Wei (bone flaccidity), Rou Wei (muscle flaccidity), and Wei Jue (limb weakness and inability to walk). Ancient prescriptions often used medicines for treating wind diseases to generally treat Wei syndrome, which is highly erroneous. It was Zhu Danxi who first distinguished this, establishing separate chapters for wind diseases and Wei syndrome, as their etiological origins differ and their treatment methods are vastly different, thereby opening the way to correct this long-standing malpractice. Zhu Danxi stated: The *Neijing* mentions that various Wei syndromes originate from lung heat. It also states that the treatment of Wei syndrome should exclusively target the Yangming channel. Lung belongs to Metal, has a dry nature, resides in the upper jiao, governs Qi, and fears Fire. Spleen belongs to Earth, governs Dampness, resides in the central jiao, governs the four limbs, and fears Wood. The nature of Fire is flaming upward; if desires are unregulated, Kidney Water will lose nourishment. Fire, lacking restraint, will insult the Metal it normally overcomes, causing the Lung to suffer from Fire pathogen and develop heat. The nature of Wood is tense and urgent; when the Lung suffers from Heat pathogen, Metal loses its nourishment. Wood, lacking restraint, will insult the Earth it normally overcomes, causing the Spleen to be injured by Wood pathogen. When the Lung is hot, it cannot control the whole body; when the Spleen is injured, the four limbs cannot function properly, thus various Wei syndromes arise. Therefore, clearing Fire makes Lung Metal cool and prevents Wood from becoming excessive, so how can the Spleen be harmed? Tonifying Kidney Water causes Heart Fire to descend and Lung Metal to remain sufficient, so how can there be Lung heat? Thus, when the Yangming channel is full, the Zongjin (major tendons) are moistened and can bind the bones, making joints flexible. The method for treating Wei syndrome does not go beyond this. However, cases where Damp-Heat, Phlegm, Blood deficiency, Qi deficiency, static Blood, or Food Stagnation obstruct the descending of Qi are common. One must examine carefully and treat accordingly, especially emphasizing a bland diet.
[Pulse Diagnosis] Wei syndrome due to Lung Dryness usually presents with floating and weak pulses. If the Cun Kou pulse is deep, using sweating therapy would be incorrect. For foot pain or softness, one should specifically examine the Chi pulse; slippery and rapid yet slow, or deep and weak pulses may be seen.
Deficiency Wei Syndrome
Generally, these are deficiency and heat patterns. For simultaneous Qi and Blood deficiency, use Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng Radix), Huangqi (Astragali Radix), Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex). If heat is prominent, add Huangqin (Scutellariae Radix). For Blood deficiency alone, use Siwu Tang added with Huangbai and Cangzhu (Atractylodis Rhizoma); see Blood Disease chapter for formula. Or use Danxi Buyin Wan (Danxi's Yin-Nourishing Pill); see Fire Disease chapter for formula. For Qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction) added with Huangbai and Zhimu; see Spleen-Stomach chapter for formula.
Food Stagnation
For cases where Food Stagnation and static Blood obstruct the descending of Qi, use Siwu Tang combined with Erchen Tang (Two Aged Things Decoction) added with Taoren (Persicae Semen), Honghua (Carthami Flos), Huangbai, and Shenqu (Massa Fermentata Medicinalis). For Damp-Phlegm, use Erchen Tang added with Cangzhu, Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqin, Huangbai, Zhuli (Bambusae Caulis in Kalamus), and Jiangzhi (Zingiberis Juice). For Food Stagnation, use Erchen Tang added with Cangzhu, Huangbai, Zhishi (Aurantii Fructus), and Shenqu; see Blood Disease and Phlegm Disease chapters for formulas.
Damp-Heat
For Wei syndrome caused by Damp-Heat, use Ermiao San (Two Marvels Powder) or Jianbu Wan (Leg-Strengthening Pill); both formulas are found in the Low Back Pain chapter. For Wei syndrome caused by Damp-Heat during the sixth and seventh lunar months, use Qingzao Tang (Dryness-Clearing Decoction).
Dongyuan Qingzao Tang
Huangqi (Astragali Radix) (1.5 qian) Cangzhu (Atractylodis Rhizoma) (1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma) (0.5 qian) Chenpi (Citri Reticulatae Pericarpium) (0.5 qian) Zexie (Alismatis Rhizoma) (0.5 qian) Renshen (Ginseng Radix) (0.3 qian) Bai Fuling (Poria) (0.5 qian) Shengma (Cimicifugae Rhizoma) (0.3 qian) Maimendong (Ophiopogonis Radix) (0.2 qian) Dangguishen (Angelicae Sinensis Radix Corpus) (0.2 qian) Shengdihuang (Rehmanniae Radix) (0.2 qian) Wine (0.1 qian) Chaihu (Bupleuri Radix) (0.1 qian) Huanglian (Coptidis Rhizoma) (0.1 qian) Gancao (Glycyrrhizae Radix et Rhizoma) (0.2 qian)
Decoct and take orally.