痿者，肢弱而无力，筋弛而不收，为热伤血脉之症。经曰∶五脏因肺热叶焦，发为痿 。夫五脏皆有痿，
如肺热为皮毛痿，宜犀角桔梗汤。心热为脉痿，宜铁粉丸。肝热为筋痿，宜紫葳汤。脾热为肉痿，宜二陈汤
加参、 。肾热为骨痿，宜金钢丸。而经论痿 必原肺热者，以肺为脏之长，体燥居上，主气而畏火。若金受
火烁，则气伤而不能营摄一身，乃发为痿 矣。其治痿独取阳明，何也？经曰∶阳明者脏腑之海，主润宗筋，
宗筋主束筋骨而利机关也。阳明虚则宗筋纵，带脉不引，故足痿不用。此治痿必使胃纳水谷，化精微，五脏得
所禀，以行血气，濡筋骨，利关节也。河间论痿，主血衰不能营养百骸。子和谓痿，必火乘金，病多作于五六
七月。午为少阴君火之位，未者湿土，庚金伏火之地，申者少阳相火之分。故病痿者，脉浮大。戴人主肾水衰，
则骨髓枯竭，直言痿病无寒。丹溪云∶泻南方则肺金清，而东方有制，土不受戕，补北方则心火降，而西方
有养，金不苦燥。凡痿症不可作风治，而用风药。东垣治痿，以黄柏为君，黄 为佐。士材论胃虚食减成痿，
宜藿香养胃汤。治脾下陷足痿，用补中益气汤。
石顽主阳明湿热，各具确见。今参而酌之，通治湿热成痿，脉洪滑者，主清燥。二妙丸、加味二妙丸，随症
加减。湿热伤肺成痿者，主清土。如沙参、麦冬、玉竹、杏仁、石斛、百合、花粉、通草、山栀。湿热壅胃成
痿者，主通腑。大豆黄卷、茵陈、滑石、石膏、萆 、茯苓、枳实、槟榔。湿热着筋骨成痿者，主理隧。金毛
狗脊、地骨皮、知母、防己、牛膝、龟甲、五加皮，或三妙丸。阳明脉虚，宗筋不约者，主润肺。人参、茯苓、
杞子、当归、桑葚、肉苁蓉、桑寄生、芝麻、山药。肝胃阴虚，风动肢痿者，主通摄。熟地、牛膝、远志、
杞子、石斛、钩藤。肝肾阴虚，足热枯痿者，填精髓。牛骨髓、猪骨髓、鹿筋胶、羊肉胶、熟地、杞子、牛膝、
青盐，或滋阴大补丸。肾督阳虚，脊软腿酸者，壮筋骨。鹿角胶丸、四斤丸。太阳督脉虚，形俯痿废者，理
腰脊。香茸丸。衰年足软肌麻，跷维不用者，以温行流畅奇络。橘络、木瓜、杞子、杜仲、狗脊、肉苁蓉、
牛膝、当归须、鹿胶。病后阴伤骨痿，六味丸去丹、泽，加虎胫骨、龟甲、牛膝、当归。久病筋骨痿，不起于
床，金刚丸、牛膝丸、煨肾丸、五兽三匮丹。阴虚挟湿热，脉滞而数，为痿厥，虎潜丸加减，不应，少加川附
子。长夏暑湿成痿，清暑益气汤加减。肾伤暑 痿厥，清燥汤加减。膏粱湿热伤精，胫膝痿弱，神龟滋阴丸、
大补地黄丸。血衰筋缓不收，补血荣筋丸。气虚举动无力，四君子汤加肉桂、黄 。半身偏痿，须分左右，
审气血阴阳，十全大补汤加减。屈伸不利，行步艰难，安肾丸。肢软脉滑，腰膝麻木或肿，属湿痰。二术二
陈汤加姜汁、竹沥。食滞脾气不得运于四肢成痿，脉必气口弦滑而恶食。木香槟榔丸加山楂、神曲、木瓜、
防己。瘀血留于腰胯成痿，脉必沉涩而兼痛。四物汤加桃仁、莪术、穿山甲。心热亢，兼实积者，为脉痿。
大承气汤。瘦人病痿，脉涩或大，多血虚有火，二妙四物汤。肥人病痿，脉滑或沉，多气虚有痰。二妙六君汤。
子和云∶四末之疾，动而或劲，为风。不仁或痛，为痹。弱而不用，为痿。逆而寒热，为厥。风必兼热，
痹必风寒湿合邪，痿必火乘金，厥则或寒或热，皆从下起。奈何不察其源，概谓风淫
末疾，以风药例治耶！
痿症，表现为肢体软弱无力，筋脉弛缓不能收缩，属于热邪损伤血脉的病证。《内经》说：五脏因肺热叶焦，引发痿症。五脏均可发生痿症，如肺热导致皮毛痿，适宜用犀角桔梗汤；心热导致脉痿，适宜用铁粉丸；肝热导致筋痿，适宜用紫葳汤；脾热导致肉痿，适宜用二陈汤加人参、白术；肾热导致骨痿，适宜用金刚丸。而经典论述痿症必定追溯至肺热的原因，是因为肺为五脏之长，体性燥且居上位，主司气而畏惧火邪。若肺金受火邪灼烧，则气受损而不能滋养全身，于是发为痿症。治疗痿症为何独取阳明经呢？《内经》说：阳明经是脏腑气血的海源，主要滋润宗筋，宗筋主管约束筋骨并滑利关节。阳明经虚弱则宗筋松弛，带脉无法牵引，所以足部痿软不能使用。这是治疗痿症必须使胃能纳食水谷，化生精微物质，五脏得到禀受，从而运行血气，濡养筋骨，滑利关节的缘故。刘河间论述痿症，主张血衰不能营养百骸。张子和认为痿症，必定是火邪乘袭肺金，病症多发生在五、六、七月。午时对应少阴君火之位，未月对应湿土，庚金伏藏火气之地，申时对应少阳相火之分。因此患痿症的人，脉象浮大。戴人（张子和）主张肾水衰弱，则骨髓枯竭，直言痿病没有寒证。朱丹溪说：泻南方（心火）则肺金清肃，东方（肝木）受到制约，土（脾）不受伤害；补北方（肾水）则心火下降，西方（肺金）得到滋养，金不致苦燥。凡是痿症不可当作风证治疗，而使用风药。李东垣治疗痿症，以黄柏为君药，黄芩为佐药。士材（缪希雍）论述胃虚食少导致痿症，适宜用藿香养胃汤。治疗脾气下陷导致的足痿，用补中益气汤。王节斋（石顽）主张阳明湿热，各有确切的见解。如今综合参酌，通治湿热成痿，脉象洪滑者，主张清燥。方用二妙丸、加味二妙丸，随症状加减。湿热伤肺成痿者，主张清土（健脾清肺）。如沙参、麦冬、玉竹、杏仁、石斛、百合、花粉、通草、山栀。湿热壅滞于胃成痿者，主张通腑。大豆黄卷、茵陈、滑石、石膏、萆薢、茯苓、枳实、槟榔。湿热留着于筋骨成痿者，主张理隧（疏通经络）。金毛狗脊、地骨皮、知母、防己、牛膝、龟甲、五加皮，或三妙丸。阳明脉虚，宗筋不约者，主张润肺。人参、茯苓、杞子、当归、桑葚、肉苁蓉、桑寄生、芝麻、山药。肝胃阴虚，风动肢痿者，主张通摄（疏通与固摄）。熟地、牛膝、远志、杞子、石斛、钩藤。肝肾阴虚，足热枯痿者，填精髓。牛骨髓、猪骨髓、鹿筋胶、羊肉胶、熟地、杞子、牛膝、青盐，或滋阴大补丸。肾督阳虚，脊软腿酸者，壮筋骨。鹿角胶丸、四斤丸。太阳督脉虚，形体俯仰困难、痿废者，理腰脊。香茸丸。衰老之年足软肌麻，跷维经脉不用者，以温行流畅奇络。橘络、木瓜、杞子、杜仲、狗脊、肉苁蓉、牛膝、当归须、鹿胶。病后阴伤骨痿，六味丸去掉丹皮、泽泻，加虎胫骨、龟甲、牛膝、当归。久病筋骨痿，不起于床，用金刚丸、牛膝丸、煨肾丸、五兽三匮丹。阴虚挟湿热，脉滞而数，为痿厥，用虎潜丸加减，若无效，少加川附子。长夏暑湿成痿，用清暑益气汤加减。肾伤暑湿致痿厥，用清燥汤加减。膏粱厚味湿热伤精，胫膝痿弱，用神龟滋阴丸、大补地黄丸。血衰筋缓不收，用补血荣筋丸。气虚举动无力，用四君子汤加肉桂、黄芪。半身偏痿，须分左右，审察气血阴阳，用十全大补汤加减。屈伸不利，行步艰难，用安肾丸。肢软脉滑，腰膝麻木或肿，属湿痰。用二术二陈汤加姜汁、竹沥。食滞脾气不得运于四肢成痿，脉必气口弦滑而恶食。用木香槟榔丸加山楂、神曲、木瓜、防己。瘀血留于腰胯成痿，脉必沉涩而兼痛。用四物汤加桃仁、莪术、穿山甲。心热亢盛，兼有实积者，为脉痿。用大承气汤。瘦人病痿，脉涩或大，多血虚有火，用二妙四物汤。肥人病痿，脉滑或沉，多气虚有痰。用二妙六君汤。张子和说：四肢的疾病，动作强劲有力，为风证；麻木或疼痛，为痹证；软弱不能使用，为痿证；逆乱而寒热交替，为厥证。风证必定兼热，痹证必定是风寒湿合邪，痿证必定是火邪乘袭肺金，厥证则或寒或热，皆从下部发起。为什么不考察其根源，一概说是风淫末疾，用风药常规治疗呢！
Wei Syndrome (Flaccidity Syndrome) is characterized by weak and powerless limbs, flaccid tendons that cannot contract, and belongs to the category of disorders where heat damages the blood vessels. The Classics state: "When the five zang organs suffer from lung heat causing the leaves to wither, Wei syndrome develops." Each of the five zang organs can develop specific types of Wei syndrome: Lung heat causes Mao Pi Wei (Skin and Hair Flaccidity), treated with Xijiao Jiegeng Tang (Rhino Horn and Platycodon Decoction); Heart heat causes Mai Wei (Vessel Flaccidity), treated with Tie Fen Wan (Iron Powder Pill); Liver heat causes Jin Wei (Tendon Flaccidity), treated with Ziwei Tang (Cornus Flower Decoction); Spleen heat causes Rou Wei (Muscle Flaccidity), treated with Erchen Tang (Two-Cured Decoction) added with Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome); Kidney heat causes Gu Wei (Bone Flaccidity), treated with Jingang Wan (Diamond Pill).
The Classics attribute Wei syndrome primarily to lung heat because the Lung is the chief of the zang organs, possesses a dry nature, resides in the upper jiao, governs qi, and fears fire. If Metal (Lung) is scorched by Fire, qi is damaged and fails to nourish the whole body, leading to Wei syndrome. Why is treatment focused solely on the Yangming channel? The Classics say: "Yangming is the sea of the zang and fu organs, primarily moistening the Zong Jin (Major Tendon). The Zong Jin binds the sinews and bones and facilitates joint movement." 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. This is why treating Wei syndrome requires ensuring the Stomach accepts food and fluids, transforms them into essence and subtle nutrients, allowing the five zang organs to receive these nutrients, thereby circulating blood and qi, moistening sinews and bones, and facilitating joints.
Hejian (Liu Wansu) discussed Wei syndrome, emphasizing that blood deficiency fails to nourish the hundred bones. Hezi (Zhang Yuansu/Zhang Congzheng context implies Zhang Congzheng here as 'Hezi' often refers to him or his school, but text says 'Hezi wei... Bing duo zuo yu wu liu qi yue' which aligns with Zhang Congzheng's theory of seasonal fire) stated that Wei syndrome must involve fire attacking metal, and the disease often occurs in the fifth, sixth, and seventh lunar months. The Wu month is the position of Shaoyin Jun Huo (Ministerial Fire); the Wei month is Wet Earth; Geng Metal lies in the place of hidden fire; the Shen month is the division of Shaoyang Xiang Huo (Ministerial Fire). Therefore, patients with Wei syndrome have a floating and large pulse. Dairen (Zhang Congzheng) advocated that when Kidney water declines, bone marrow dries up, stating directly that Wei disease has no cold patterns. Danxi (Zhu Danxi) said: "Draining the South (Heart Fire) clears Lung Metal, restraining the East (Liver Wood) so Earth is not harmed; tonifying the North (Kidney Water) descends Heart Fire, nourishing the West (Lung Metal) so it does not suffer dryness."
In all cases of Wei syndrome, one must not treat it as Wind and use wind-dispelling drugs. Dongyuan (Li Dongyuan) treated Wei syndrome using Huangbai (Phellodendron Bark) as the sovereign herb and Huangqi (Astragalus Root) as the assistant herb. Shicai (Li Zhongzi) discussed Wei syndrome caused by stomach deficiency and poor appetite, recommending Huoxiang Yangwei Tang (Agarwood and Costus Root Decoction for Nourishing the Stomach). For foot flaccidity due to spleen qi sinking, he used Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi).
Shiwang (Wang Jizheng) emphasized damp-heat in Yangming, each having distinct insights. Now, synthesizing these views: for general treatment of damp-heat causing Wei syndrome with a flooding and slippery pulse, the method is clearing dryness. Use Ermiao Wan (Two Marvels Pill) or Jiawei Ermiao Wan (Modified Two Marvels Pill), adjusted according to symptoms. For damp-heat injuring the Lung causing Wei, the method is clearing Earth (strengthening Spleen to benefit Lung). Herbs include Shashen (Glehnia Root), Maidong (Ophiopogon Tuber), Yuzhu (Polygonatum Odoratum Rhizome), Xingren (Apricot Seed), Shihu (Dendrobium Stem), Baihe (Lily Bulb), Huafen (Trichosanthes Root), Tongcao (Tetrapanax Pith), Shanzhi (Gardenia Fruit). For damp-heat obstructing the Stomach causing Wei, the method is purging the bowels. Herbs include Dadou Huangjuan (Soybean Sprout Fermented), Yinchen (Artemisia Capillaris Herb), Huashi (Talcum), Shigao (Gypsum Fibrosum), Bibie (Dioscorea Hypoglauca Rhizome), Fuling (Poria), Zhishi (Immature Bitter Orange), Binglang (Areca Seed). For damp-heat adhering to sinews and bones causing Wei, the method is regulating the collaterals. Herbs include Jinmao Gouji (Cibotium Barometz Rhizome), Digupi (Lycium Bark), Zhimu (Anemarrhena Rhizome), Fangji (Stephania Tetrandra Root), Niuxi (Achyranthes Root), Guijia (Tortoise Shell), Wujapi (Acanthopanax Bark), or Sanmiao Wan (Three Marvels Pill).
For Yangming pulse deficiency and lax Zong Jin, the method is moistening the Lung. Herbs include Renshen (Ginseng), Fuling (Poria), Qizi (Goji Berry), Danggui (Angelica Sinensis Root), Sangshen (Mulberry Fruit), Roucongrong (Cistanche Stem), Sangjisheng (Taxillus Branch), Zhima (Sesame Seed), Shanyao (Chinese Yam Rhizome). For Liver-Stomach yin deficiency with wind stirring causing limb flaccidity, the method is unblocking and grasping (nourishing yin and extinguishing wind). Herbs include Shudi (Rehmannia Root), Niuxi (Achyranthes Root), Yuanzhi (Polygala Root), Qizi (Goji Berry), Shihu (Dendrobium Stem), Gouteng (Uncaria Rhynchophylla). For Liver-Kidney yin deficiency with hot, dry, and flaccid feet, the method is filling essence and marrow. Herbs include Niu Guisui (Ox Marrow), Zhu Guisui (Pig Marrow), Lu Jinjiao (Deer Antler Glue), Yangrou Jiao (Mutton Glue), Shudi (Rehmannia Root), Qizi (Goji Berry), Niuxi (Achyranthes Root), Qingyan (Rock Salt), or Ziyin Dabu Wan (Nourishing Yin Great Tonification Pill).
For Kidney-Du vessel yang deficiency with soft spine and sore legs, the method is strengthening sinews and bones. Use Lujiao Jiao Wan (Deer Antler Glue Pill) or Sijin Wan (Four Jin Pill). For Taiyang-Du vessel deficiency with forward-bending posture and flaccid paralysis, the method is regulating the waist and spine. Use Xiangrong Wan (Fragrant Musk Pill). For elderly weakness with soft feet and numb muscles, where Qiao and Wei vessels fail to function, use warming and promoting circulation through the extraordinary collaterals. Herbs include Juluo (Orange Peel Network), Mugua (Chaenomeles Fruit), Qizi (Goji Berry), Duzhong (Eucommia Bark), Gouji (Cibotium Rhizome), Roucongrong (Cistanche Stem), Niuxi (Achyranthes Root), Dangguixu (Angelica Sinensis Root Tip), Lu Jiao (Deer Antler).
After illness, yin injury causing bone flaccidity: use Liuwei Wan (Six-Ingredient Pill) removing Mudanpi (Tree Peony Root Bark) and Zexie (Alisma Rhizome), adding Hu Jinggu (Tiger Tibia Bone - *Note: Modern usage substitutes this*), Guijia (Tortoise Shell), Niuxi (Achyranthes Root), Danggui (Angelica Sinensis Root). For chronic illness causing sinew and bone flaccidity, unable to rise from bed: use Jingang Wan (Diamond Pill), Niuxi Wan (Achyranthes Pill), Weishen Wan (Baked Kidney Pill), Wushou Sankui Dan (Five Beasts Three Coffers Elixir). For yin deficiency with damp-heat, stagnant and rapid pulse, constituting Wei-Jue (Flaccidity-Jue): modify Hujian Wan (Tiger-Hiding Pill); if ineffective, add small amounts of Chuan Fuzi (Aconite Lateral Root).
In late summer, summer-heat and dampness causing Wei: modify Qingshu Yiqi Tang (Clear Summer-Heat and Augment Qi Decoction). Kidney injury from summer-heat causing Wei-Jue: modify Qingzao Tang (Clear Dryness Decoction). Rich diet damp-heat damaging essence, causing weak calves and knees: use Shengui Ziyin Wan (Divine Turtle Nourishing Yin Pill) or Dabu Dihuang Wan (Great Tonification Rehmannia Pill). Blood deficiency causing loose tendons: use Buchong Rongjin Wan (Tonify Blood and Nourish Sinews Pill). Qi deficiency causing weak movements: use Sijunzi Tang (Four Gentlemen Decoction) added with Rougui (Cinnamon Bark) and Huangqi (Astragalus Root). Hemiplegic Wei syndrome: distinguish left and right, examine qi, blood, yin, and yang, use Shiquan Dabu Tang (Ten Complete Great Tonification Decoction) modified. Difficulty bending and extending, painful walking: use Anshen Wan (Calming Kidney Pill). Soft limbs with slippery pulse, numb or swollen waist and knees: indicates damp-phlegm. Use Erzhu Erchen Tang (Two Atractylodes and Two-Cured Decoction) added with Jiangzhi (Ginger Juice) and Zhuli (Bamboo Sap). Food stagnation preventing spleen qi from transporting to four limbs causing Wei: pulse must be wiry-slippy at the Qi Kou (Radial Artery) and aversion to food. Use Muxiang Binglang Wan (Costus Root and Areca Seed Pill) added with Shanzha (Hawthorn Fruit), Shenqu (Medicated Leaven), Mugua (Chaenomeles Fruit), Fangji (Stephania Tetrandra Root). Blood stasis remaining in waist and hips causing Wei: pulse must be deep-choppy with pain. Use Siwu Tang (Four Substances Decoction) added with Taoren (Peach Kernel), Ezhu (Curcuma Rhizome), Chuanshanjia (Pangolin Scale).
Excessive heart heat with excess accumulation constitutes Mai Wei (Vessel Flaccidity): use Dachengqi Tang (Major Order the Qi Decoction). Thin persons with Wei syndrome, pulse choppy or large: mostly blood deficiency with fire. Use Ermiao Siwu Tang (Two Marvels Four Substances Decoction). Fat persons with Wei syndrome, pulse slippery or deep: mostly qi deficiency with phlegm. Use Ermiao Liujun Tang (Two Marvels Six Gentlemen Decoction).
Hezi (Zhang Congzheng) said: Disorders of the four extremities, with movement or stiffness, are Wind. Numbness or pain are Bi (Obstruction) syndromes. Weakness and inability to use are Wei (Flaccidity) syndromes. Reversal with cold and heat alternation are Jue (Revulsion) syndromes. Wind must combine with heat; Bi must be combined pathogenic factors of wind, cold, and damp; Wei must be fire attacking metal; Jue may be cold or heat, all arising from below. How can one fail to investigate the source, generally calling it wind invading the extremities, and treating it uniformly with wind-dispelling drugs!