内经曰肺热叶焦五脏因而受之发为痿蹶心气热生脉痿故胫纵不任地肝气热为筋痿故宗筋
弛纵
脾气热生肉痿故痹而不任肾气热生骨痿故足不任身然治痿独取阳明阳明者五脏六腑之海主润
宗筋宗筋主束骨而利机阙也云云故阳明虚则宗筋纵带脉不引故足痿不用也(详见本文)
陈无择云人身有皮毛血脉筋膜肌肉骨髓以成其形内则有肝心脾肺肾以主之若随情妄用喜
怒劳
逸致五内精血虚耗使皮血筋骨肉痿弱无力以运动故致痿 状与柔风香港脚相类柔风香港脚皆外所
因痿则五内不足之所致也
原病式曰病痿皆属肺金大抵肺主气病则其气 郁至于手足痿弱不能收持由肺金本燥燥则
血液衰少不能营养百骸故也
张子和曰痿因肺热相传四脏其脉多浮而大今人便作寒湿香港脚治之骤用燥药针艾汤蒸痿弱
转甚此证与治痹颇异风寒湿痹犹可蒸汤燔灸惟痿因热而成若作寒治是杀之也
丹溪曰内经痿论肺热叶焦五脏因而受之发为痿 又曰诸痿皆属于土指病之本在肺也又曰
昏惑
又曰螈 曰瞀闷曰瞀昧曰暴病皆属于火又曰四支不举曰舌本强曰足痿不收曰痰涎有声皆属于
土又礼记注曰鱼肉天产也以养阳作阳德以为倦怠悉是湿热之病当作诸痿治之何局方治风之方
兼治痿者十居八九不思诸痿皆起于肺热传入五脏散为诸证大抵只宜补养若以外感风邪治之宁
免实实虚虚之祸乎或曰诸风掉眩皆属于肝诸暴强直皆属于风至于振掉不能久立善暴僵仆皆以
木病风者木之气何为皆属于火曰舌本强痰涎有声何为皆属于土痿论未尝言及而吾子合火土二
家之病而又与倦怠并言总作诸痿治之何也予曰按原病式曰风病多因热甚俗云风者言末而忘其
本也所以中风而有瘫痪诸证者热甚故也又病源曰脾之脉连舌本散舌下今脾湿受邪故舌强又河
间曰胃膈热甚火气炎上故津液涌而为痰涎潮上因甚稠粘难出故作声也一以属脾一以属胃热谓
之属火与土不亦宜乎或曰内经治痿之法独取阳明何也曰诸痿生于肺热只此一句便见治法大意
经曰东方实西方虚泻南方补北方此固是就生克言补泻而大经大法不外于此五行之中惟火有二
肾虽有两水惟其一阳常有余阴常不足故经曰一水不能胜二火理之必然金体燥而居上主气畏火
者也土性湿而居中主四支畏本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
邪而热矣木性刚急肺受邪热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营摄一
身脾伤则四支不能为用而诸痿之病作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之法无出于此骆龙吉亦曰风
火相炽当滋肾水东垣先生取黄柏为君黄 等补药为辅佐而无一定之方有兼痰积者有湿多者有
热多者有湿热相半者有狭寒者临病制方其善于治痿乎虽然药中肯綮矣若将理失宜圣医不治
也但是患痿之人若不淡薄食味吾知其必不能安全也
谨按五痿等证内经特立篇目所论至详后代诸方独于此证概多缺略考其由皆因混入中风条
内故
也丹溪先生痛千古之弊悯世之罹此疾者多误于庸医之手故叮咛告戒极其明白有志之士必当于
此究心焉若夫陈无择谓痿因五内不足所致诚得之矣然痿之所不足者乃阴也血也而诸方悉是补
阳补气之剂能免实实虚虚之患乎且无择以二因立方可谓诸方之冠其余此证犹且未明况求之于
他者乎
《黄帝内经》说：肺热导致叶焦枯，五脏因此受邪，发为痿蹶。心气热则生脉痿，所以小腿纵缓不能站立于地；肝气热则生筋痿，所以宗筋弛缓松弛；脾气热则生肉痿，所以肢体麻木不仁且无力支撑；肾气热则生骨痿，所以双脚无法承载身体。然而治疗痿证，唯独要取法阳明经。阳明经是五脏六腑气血汇聚的大海，主要滋润宗筋，宗筋主司约束骨骼而利于关节运动。……所以阳明经虚弱则宗筋弛缓，带脉不能牵引，导致足部痿废不能使用。（详见本文）
陈无择说：人体有皮毛、血脉、筋膜、肌肉、骨髓来构成形体，内部则有肝、心、脾、肺、肾来主宰它们。如果随着情志妄用，喜怒无常，劳逸失度，导致五脏精血虚耗，使皮、血、筋、骨、肉痿弱无力以进行运动，故而致痿。其症状与柔风、香港脚（脚气病）相似。柔风和香港脚都是外感所致的病因，而痿证则是五脏内里不足所致。
《原病式》说：痿病都归属于肺金。大抵肺主气，生病时气机郁滞，至于手足痿弱不能收持，是因为肺金本燥，燥则血液衰少，不能营养百骸的缘故。
张子和说：痿因肺热相传至四脏，其脉象多浮而大。今人便将其当作寒湿香港脚来治疗，骤然使用燥药、针艾、汤蒸等方法，导致痿弱更加严重。此证与治疗痹证颇为不同。风寒湿痹还可以用蒸汤、燔灸的方法，但痿证是因热而成，若当作寒证治疗，就是害死病人啊。
朱丹溪说：《内经·痿论》说肺热叶焦，五脏因而受之，发为痿证。又说诸痿皆属于土，是指病的根本在肺。又说昏惑、抽搐、闷乱、瞀昧、暴病皆属于火。又说四肢不举、舌根强直、足痿不收、痰涎有声皆属于土。又《礼记注》说鱼肉是天产之物，用以养阳，作为阳德，凡是倦怠都是湿热之病，应当作为诸痿来治疗。为什么《局方》中治风的方子兼治痿证的占了八九成？不思量诸痿皆起于肺热，传入五脏散为各种证候，大抵只宜补养。若以外感风邪来治疗，难道能避免“实实虚虚”（使实证更实，虚证更虚）的祸患吗？有人问：诸风掉眩皆属于肝，诸暴强直皆属于风，至于振掉不能久立、善于突然僵仆，都以木病风者论之，木之气为何皆属于火？舌根强、痰涎有声为何皆属于土？《痿论》未曾提及，而您把火、土两家的病又与倦怠并言，总作诸痿来治疗，为什么呢？我回答说：按《原病式》说，风病多因热甚，俗云风者是言末而忘其本也。所以中风而有瘫痪诸证者，是因为热甚。又《病源》说脾的经脉连舌本，散舌下，今脾湿受邪故舌强。又河间（刘完素）说胃膈热甚，火气炎上，故津液涌而为痰涎，潮上因甚稠粘难出，故作声也。一者属脾，一者属胃热，谓之属火与土，不也是适宜的吗？有人问：《内经》治痿之法独取阳明，为什么呢？我说：诸痿生于肺热，只此一句便见治法大意。《内经》说东方实西方虚，泻南方补北方。这固然是就五行生克而言补泻，而大经大法不外于此。五行之中惟火有二，肾虽有两水，惟其一阳常有余，阴常不足，所以经曰一水不能胜二火，理之必然。金体燥而居上，主气，畏火者也。土性湿而居中，主四支，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。木性刚急，肺受邪热则金失所养，木寡于畏而侮所胜，脾得木邪而伤矣。肺热则不能营摄一身，脾伤则四支不能为用，而诸痿之病作。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。治痿之法无出于此。骆龙吉也说：风火相炽，当滋肾水。东垣先生（李杲）取黄柏为君，知母等补药为辅佐，而无一定之方。有兼痰积者，有湿多者，有热多者，有湿热相半者，有挟寒者，临病制方，其善于治痿乎？虽然药中肯綮矣，若将理失宜，圣医不治也。但是患痿之人若不淡薄食味，吾知其必不能安全也。
谨按五痿等证，《内经》特立篇目，所论至详。后代诸方独于此证概多缺略，考其由，皆因混入中风条内故也。丹溪先生痛千古之弊，悯世之罹此疾者多误于庸医之手，故叮咛告诫极其明白。有志之士必当于此究心焉。若夫陈无择谓痿因五内不足所致，诚得之矣。然痿之所不足者乃阴也、血也，而诸方悉是补阳补气之剂，能免实实虚虚之患乎？且无择以二因立方可谓诸方之冠，其余此证犹且未明，况求之于他者乎？
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Lung heat causes the leaves to wither and dry out, and the five Zang organs are thereby affected, leading to Wei syndrome (flaccidity syndrome). Heart heat generates Mai Wei (Pulse Flaccidity), resulting in flaccid lower legs that cannot support standing on the ground; Liver heat generates Jin Wei (Tendon Flaccidity), resulting in relaxation and laxity of the Zong Jin (Major Sinews); Spleen heat generates Rou Wei (Flesh Flaccidity), resulting in numbness and inability to bear weight; Kidney heat generates Gu Wei (Bone Flaccidity), resulting in feet unable to support the body. However, in treating Wei syndrome, one should exclusively focus on the Yangming channel. The Yangming channel is the sea of Qi and Blood of the five Zang and six Fu organs, primarily moistening the Zong Jin. The Zong Jin governs binding the bones and facilitating joint movement... Therefore, when Yangming is deficient, the Zong Jin becomes lax, and the Dai Mai (Girdle Vessel) fails to draw, resulting in foot flaccidity and inability to use them. (See detailed text herein)
Chen Wuyue stated: The human body is formed by skin, hair, blood vessels, fascia, muscles, and bone marrow, internally governed by the Liver, Heart, Spleen, Lung, and Kidney. If one acts recklessly according to emotions, experiencing excessive anger or joy, labor or rest, it leads to the depletion of essence and blood in the five internal organs, causing the skin, blood, tendons, bones, and flesh to become weak and powerless for movement, thus resulting in Wei syndrome. Its symptoms are similar to Rou Feng (Soft Wind) and Xiangjiao Jiao (Hong Kong Foot/Charley Horse). Rou Feng and Xiangjiao Jiao are caused by external pathogens, whereas Wei syndrome is caused by insufficiency within the five internal organs.
The *Yuan Bing Shi* (Book on Disease Origins) states: Wei diseases all belong to Metal of the Lung. Generally, the Lung governs Qi; when diseased, Qi stagnates, leading to flaccidity and weakness of the hands and feet that cannot grasp or hold. This is because Lung Metal is inherently dry; dryness leads to a decline in blood and fluids, which fail to nourish the entire body.
Zhang Zihe stated: Wei syndrome arises from Lung heat transmitting to the four other Zang organs, and their pulses are often floating and large. Nowadays, people treat it as Cold-Damp Xiangjiao Jiao, suddenly using drying herbs, acupuncture with moxa, and steam baths, causing the flaccidity to worsen. This condition differs significantly from Bi syndrome (Obstruction Syndrome). For Bi syndrome caused by Wind-Cold-Damp, steaming and burning moxibustion can still be used. However, Wei syndrome is formed by Heat; if treated as Cold, it is fatal.
Zhu Danxi stated: In the *Wei Lun* (Treatise on Flaccidity) of the *Neijing*, it says Lung heat causes leaf withering, affecting the five Zang organs and generating Wei syndrome. It also states that all Wei syndromes belong to Earth, indicating the root of the disease lies in the Lung. It further states that confusion, convulsions, oppression, dizziness, and sudden illnesses all belong to Fire. It also states that limbs failing to move, stiffness of the tongue base, foot flaccidity and inability to retract, and audible phlegm-rattle all belong to Earth. Furthermore, the commentary on the *Liji* (Book of Rites) states that fish and meat are products of nature, used to nourish Yang and constitute Yang Virtue; all fatigue is due to Damp-Heat and should be treated as various Wei syndromes. Why do the prescriptions in the *Ju Fang* (Standard Formulas) treat Wind and include treatments for Wei in eighty or ninety percent of cases? One fails to consider that all Wei syndromes originate from Lung Heat, which transmits to the five Zang organs and disperses into various manifestations. Generally, only tonification and nourishment are suitable. If treated as an external Wind pathogen, how can one avoid the disaster of "reinforcing excess and depleting deficiency"? Someone asked: All wind-induced tremors and vertigo belong to the Liver; all sudden rigidity belongs to Wind. As for trembling inability to stand long and sudden stiff falls, these are discussed as Wood diseases related to Wind. Why does the Qi of Wood belong to Fire? Why do tongue stiffness and audible phlegm belong to Earth? The *Wei Lun* does not mention this, yet you combine diseases of Fire and Earth with fatigue and treat them all as Wei syndromes. Why? I reply: According to the *Yuan Bing Shi*, Wind diseases are mostly due to extreme Heat. Commonly calling it "Wind" is focusing on the branch and forgetting the root. Thus, stroke with paralysis occurs due to extreme Heat. Also, the *Bing Yuan* states the Spleen meridian connects to the tongue base and spreads under the tongue; now Spleen Dampness receiving pathogenic factors causes tongue stiffness. Also, Hejian (Liu Wansu) stated that extreme Heat in the Stomach and Diaphragm causes Fire Qi to flare upward, so body fluids surge and transform into phlegm-saliva, rising turbulently, becoming thick and sticky and difficult to expel, thus making sound. One belongs to Spleen, one to Stomach Heat; calling them belonging to Fire and Earth is appropriate, is it not? Someone asked: Why does the *Neijing* state that the method for treating Wei syndrome is exclusively taking Yangming? I say: "All Wei syndromes arise from Lung Heat." Just this sentence reveals the general idea of treatment. The *Neijing* says: When the East is Excess and the West is Deficient, drain the South and tonify the North. This is indeed discussing supplementation and drainage based on generation and restriction, but the great principles do not go beyond this. Among the Five Elements, there are two Fires. Although the Kidneys have two Waters, the One Yang is always in excess and Yin is always insufficient. Thus, the scripture says one Water cannot overcome two Fires; this is logically inevitable. Metal is dry and resides above, governing Qi, and fears Fire. Earth is damp and resides in the center, governing the four limbs, and fears Wood. Fire nature flares upward. If desires are unregulated, Water loses its nourishment, Fire lacks restraint and overacts upon what it conquers, and the Lung receives Fire pathogenic factors and becomes hot. Wood nature is rigid and urgent. When the Lung receives pathogenic heat, Metal loses nourishment, Wood lacks restraint and overacts upon what it conquers, and the Spleen is injured by Wood pathogenic factors. Lung heat fails to manage and regulate the whole body; Spleen injury causes the four limbs to be unusable, and the diseases of various Wei syndromes arise. Draining the South clears Lung Metal and prevents East from being Excess; how can Spleen injury occur? Tonifying the North lowers Heart Fire and prevents West from being Deficient; how can Lung heat occur? Thus, when Yangming is full, the Zong Jin is moistened, able to bind the bones and facilitate the joints. The method for treating Wei syndrome does not go beyond this. Luo Longji also said: When Wind and Fire blaze together, one should nourish Kidney Water. Dongyuan (Li Gao) took Huangbai (Phellodendron Bark) as the sovereign herb, and Zhimu (Anemarrhena Rhizome) etc. as supporting herbs, without a fixed formula. There are cases with concurrent Phlegm accumulation, cases with much Dampness, cases with much Heat, cases with half Dampness and half Heat, and cases with夹杂 Cold. Adapting formulas to the disease, is this not good at treating Wei syndrome? Although the medication hits the mark, if nursing care is improper, even a sage doctor cannot cure it. However, for those suffering from Wei syndrome, if they do not eat bland food, I know they will certainly not recover safely.
Respectfully noting: The *Neijing* established specific chapters for the five Wei syndromes, discussing them in great detail. Later prescriptions generally lack coverage for this condition. Investigating the reason, it is because they were mixed into the Stroke (Zhong Feng) category. Mr. Danxi lamented this ancient malpractice and pitied those afflicted by this disease who were often misled by mediocre doctors, hence his earnest warnings were extremely clear. Those with ambition must study this carefully. Regarding Chen Wuyue's statement that Wei syndrome is caused by insufficiency of the five internal organs, this is indeed correct. However, what is insufficient in Wei syndrome is Yin and Blood, yet all prescriptions are agents that tonify Yang and Qi. Can they avoid the harm of reinforcing excess and depleting deficiency? Moreover, Chen Wuyue establishing formulas based on two causes can be considered the crown of prescriptions, but other aspects of this condition remain unclear, let alone seeking them elsewhere.