痿证之义，《内经》言之详矣，观所列五脏之证，皆言为热。而五脏之证，又总于肺热
叶焦，以致金燥水亏，乃成痿证。如丹溪之论治，诚得之矣。然细察经文，又曰悲哀太甚则
胞络绝，传为脉痿。思想无穷，所愿不得，发为筋痿。有渐于湿，以水为事，发为肉痿之类
，则又非尽为火证，此其有余不尽之意，犹有可知。故因此而生火者有之。因此而败伤元气
者，亦有之。元气败伤，则精虚不能灌溉，血虚不能营养者，亦不少矣。若概从火论，则恐
真阳亏败，及土衰水涸者，有不能堪，故当酌寒热之浅深，审虚实之缓急，以施治疗，庶得
治痿之全矣。
经曰∶湿热不攘，则大筋 短，小筋弛长， 短为拘，弛长为痿，此《内经》言筋病之
概，乃举隅之谈，以启人之自反耳，非谓大筋必无弛长，小筋必无 短也。即如痿弱必由于
弛长，岂大筋果无涉乎？此经言之意，从可知矣。故于痿证之外，凡遇螈 等病，
当知拘挛者必由 短，瘫弱者必由弛长，斯得《内经》之意，而于寒热燥湿之辨，亦可得其
据矣。
一、凡痿由湿热，脉洪滑而证多烦热者，必当先去其火，宜二妙散随证加减用之。若阴
虚兼热者，宜《正传》加味四物汤、虎胫骨丸，或丹溪补阴丹、滋阴八味丸之类主之。若绝
无火证，而止因水亏于肾，血亏于肝者，则不宜兼用凉药，以伐生气，惟鹿角胶丸为最善。
或加味四斤丸、八味地黄丸、金刚丸之类，俱可择用。若阴虚无湿，或多汗者，俱不宜轻用
苍术。盖痿证最忌散表，亦恐伤阴也。
一、东垣取黄柏为君，黄 等补药辅佐，以治诸痿，无一定之方。有兼痰积者，有湿多
热多者，有湿热相半者，有挟气者。临病制方，其亦治痿之良法也。
痿证的含义，《内经》已经阐述得非常详细了。观察其中所列的五脏病证，都说属于热证。而五脏的病证，又总归为肺热叶焦，导致金燥水亏，从而形成痿证。像朱丹溪关于治疗痿证的论述，确实抓住了要点。然而仔细考察经文，又说悲哀过度会导致胞络闭塞，传变为脉痿；思虑无穷、愿望不得实现，发为筋痿；长期处于潮湿环境、以涉水为职业，发为肉痿等等，这就并非全都是火证了。这其中蕴含的深意，还是可以理解的。因此，因这些因素而生火的，有这种情况；因这些因素而败伤元气的，也有这种情况。元气败伤，则精虚不能灌溉周身，血虚不能营养肢体，这样的情况也不在少数。如果一概从火证来论治，恐怕对于真阳亏损败坏，以及脾土衰弱、肾水枯竭的患者来说，难以承受（寒凉药物），所以应当斟酌寒热的深浅，审察虚实的缓急，来实施治疗，这样才能掌握治疗痿证的全面方法。
经文说：“湿热不除，则大筋缩短，小筋弛长，缩短为拘挛，弛长为痿软。”这是《内经》关于筋病的概括，是举隅之谈，用来启发人们自我反思罢了，并不是说大筋一定没有弛长，小筋一定没有缩短的情况。就像痿弱必然由于弛长，难道大筋果真没有关系吗？经文的用意，从这里就可以知道了。所以在痿证之外，凡是遇到抽搐等病，应当知道拘挛必定是由于缩短，瘫弱必定是由于弛长，这样才符合《内经》的原意，而在辨别寒热燥湿时，也可以找到依据了。
一、凡是痿证由湿热引起，脉象洪滑且症状多表现为烦热的，必须先去其火热，适宜用二妙散随证加减使用。如果是阴虚兼有热邪的，适宜用《正传》中的加味四物汤、虎胫骨丸，或者丹溪的补阴丹、滋阴八味丸之类为主方。如果完全没有火证，仅仅是因为肾水亏虚、肝血亏虚的，则不适宜兼用凉药，以免损伤生机，只有鹿角胶丸最为适宜。或者加味四斤丸、八味地黄丸、金刚丸之类，都可以选择使用。如果是阴虚而无湿邪，或者多汗的，都不宜轻易使用苍术。因为痿证最忌讳发散表邪，也担心会伤阴。
一、李东垣取黄柏为君药，黄耆等补药作为辅佐，来治疗各种痿证，并没有固定的方剂。有的兼有痰积，有的湿多热少，有的湿热各半，有的挟杂气滞。根据病情制定方剂，这也是治疗痿证的好方法。
The meaning of Wei Syndrome (Flaccidity Syndrome) has been elaborated in detail in the *Neijing* (*Classic of Internal Medicine*). Observing the syndromes listed for the five Zang organs, all are described as Heat syndromes. Furthermore, the syndromes of the five Zang organs are summarized by "Lung Heat causing withering of the lung leaves," leading to dryness of Metal and deficiency of Water, thereby forming Wei Syndrome. Zhu Danxi's discussion on the treatment of Wei Syndrome indeed grasps the key point. However, a careful examination of the classic text also states: "Excessive grief causes the closure of the pericardium collaterals, transmitting into Mai Wei (Vessel Flaccidity); endless thinking and unfulfilled desires develop into Jin Wei (Tendon Flaccidity); gradual exposure to dampness and engaging in water-related work develop into Rou Wei (Muscle Flaccidity)." These indicate that not all cases are Fire syndromes. The deeper implications here can be understood. Thus, there are cases where these factors generate Fire; there are also cases where these factors damage Yuan Qi (Original Qi). When Yuan Qi is damaged, Jing (Essence) becomes deficient and cannot irrigate the body, and Blood becomes deficient and cannot nourish the limbs; such cases are not few. If one generally treats from the perspective of Fire, it may be unbearable for patients with true Yang deficiency and collapse, or those with Spleen Earth decline and Kidney Water exhaustion. Therefore, one must weigh the depth of Cold and Heat, examine the urgency of Deficiency and Excess, and apply treatment accordingly, so as to master the comprehensive approach to treating Wei Syndrome.
The Classic states: "If Damp-Heat is not eliminated, the large tendons shorten, and the small tendons become lax and elongated. Shortening leads to spasm/contracture, while laxity and elongation lead to flaccidity." This is a general statement about tendon diseases in the *Neijing*, serving as an illustrative example to inspire self-reflection, rather than asserting that large tendons never become lax or small tendons never shorten. Just as flaccidity necessarily results from laxity, how could large tendons be irrelevant? The intent of the Classic can be understood from this. Therefore, outside of Wei Syndrome, whenever encountering conditions like convulsions, one should know that contractures must result from shortening, and paralysis/flaccidity must result from laxity. Only then will one grasp the meaning of the *Neijing*, and find a basis for distinguishing among Cold, Heat, Dryness, and Dampness.
1. For Wei Syndrome caused by Damp-Heat, with a洪滑 (Surging-Slippery) pulse and symptoms mostly showing irritability and heat, one must first eliminate the Fire. Er Miao San (Two Marvels Powder) should be used with modifications according to the syndrome. If Yin Deficiency accompanies Heat, Jia Wei Si Wu Tang (Modified Four Substances Decoction) from *Zheng Chuan*, Hu Jing Gu Wan (Tiger Tibia Pill), or Danxi's Bu Yin Dan (Nourish Yin Pill) and Zi Yin Ba Wei Wan (Nourish Yin Eight Ingredients Pill) may be used as main formulas. If there are absolutely no Fire syndromes, but only Kidney Water deficiency and Liver Blood deficiency, cool/cold medicines should not be used concurrently to avoid damaging Sheng Qi (Vitality/Life Force). Lu Jiao Jiao Wan (Deer Antler Glue Pill) is the most suitable. Alternatively, Jia Wei Si Jin Wan (Modified Four Jin Pills), Ba Wei Di Huang Wan (Eight Ingredient Rehmannia Pill), or Jin Gang Wan (Diamond Pill) can be selected. If there is Yin Deficiency without Dampness, or if the patient sweats excessively, Cang Zhu (Atractylodis Rhizoma) should not be used lightly. Wei Syndrome most strictly forbids dispersing the Exterior, as it fears injuring Yin.
2. Li Dongyuan took Huang Bo (Phellodendri Cortex) as the Sovereign herb, assisted by tonifying herbs such as Huang Qi (Astragali Radix), to treat various Wei Syndromes, without a fixed formula. Some cases involve Phlegm accumulation, some have more Dampness than Heat, some have equal Dampness and Heat, and some involve Qi stagnation. Formulating prescriptions based on the specific disease is also an excellent method for treating Wei Syndrome.