平按∶此篇自篇首至末，见《素问》卷十二第四十四《痿论》篇，又见《甲乙经》
卷十第四。又自阳明者五脏六腑之海至足痿不用，见本书卷十第二《带脉》篇。
问曰∶五脏使人痿何也？（痿者，屈弱也。以五脏热，遂使皮肤、脉、筋、肉、骨，
缓痿屈弱不用，故名为痿。然五脏之热，使人有痿何如也。）曰∶肺主身之皮毛，心主
身之血脉，肝主身之筋膜，脾主身之脂肉，肾主身之骨髓。（欲明五脏之痿，先言五脏
所主也。膜者，人之皮下肉上膜，肉之筋也。平按∶《素问》、《甲乙》脂肉作肌肉。
注欲明袁刻作欲知。）故肺气热叶焦，则皮毛肤弱急薄着，则生痿辟。（肺热即令肺叶
焦干，外令皮毛及肤弱急相着，生于手足痿辟不用也。平按∶《素问》肺下无气字。肤
《素问》、《甲乙》作虚。《甲乙》焦下复有焦字，着下复有着字，辟作 ，下同。）
心气热，则下脉厥而上，上则下脉虚，虚则生脉痿，枢折挈胫 而不任地。（心主血脉，
心藏气热，令下血脉厥逆而上。下脉血气上行则下脉虚，故生脉痿，枢折脚胫 缓不能
履地。平按∶《素问》 作纵。《甲乙》挈作 ， 作肿。）肝气热，则胆泄口苦筋膜
干，膜干则急而挛，发为筋痿。（挛者筋寒急。有热膜筋干为挛，如筋得火，卷缩为挛，
伸为 ，故为筋痿也。平按∶《甲乙》胆下有热字，《素问》、《甲乙》筋膜干三字重，
急上有筋字。）脾气热，则胃干而渴，肌肉不仁，发为肉痿。（脾胃相根据，故脾热则胃
干燥，故肉不仁，发为肉痿也。）肾气热，则腰脊不举，骨枯而髓减，发为骨痿。（肾
在腰中，所以肾气热，腰脊不举，骨干，热煎髓减，故发为骨痿也。）问曰∶何以得之？
曰∶肺者，脏之长也，为心之盖，有所失亡，所求不得，发则肺喝，喝则肺热叶焦，故
五脏因肺热叶焦，发为痿辟，此之谓也。（肺在五脏之上，是心之盖，主气，故为脏之
长也。是以心有亡失，求之不得，即伤于
肺，肺伤则出气有声动肺叶焦，五脏因肺叶焦热，遂发为痿辟也。平按∶《甲乙》失
亡作亡失。袁刻亡误作已。喝《素问》、《甲乙》作鸣。故下《素问》有曰字。《甲乙》
无“故五脏因肺热叶焦，此之谓也”十二字。又注肺在袁刻误作肺上。）悲哀太甚，胞
络绝，绝则阳气内动，发则心下崩，数溲血，故《本病》曰∶大经空虚，发为脉痹，传
为脉痿。（胞络者，心上胞络之脉。心悲哀太甚，则令心上胞络脉绝，手少阳气内动有
伤，心下崩损，血循手少阳脉下，尿血，致令脉虚为脉痹，传为脉痿。平按∶《素问》、
《甲乙》胞络绝三字重，脉痹均作肌痹。《素问》新校正云∶“杨上善云∶胞络者，心
上胞络之脉。详经注中胞字俱当作包，全本胞作肌。”）思想无穷，所愿不得者，意
淫于外，入房太甚，宗筋施纵，发为筋痿，及为白淫，故下经曰∶筋痿者生于使内。
（思想所爱之色，不知穷已，无涯之心，不遂所愿，淫外心深，入房太甚，遂令阴器
施纵也。阴为诸筋之宗，故宗筋伤则为筋痿，妇人发为白淫。经曰者，已说之经，引之
为证也。使内者，亦入房。平按∶《素问》、《甲乙》施作弛，生于使内作生于肝使
内也。）有渐于湿，以水为事，若有所留，居处相湿，肌肉濡渍，痹而不仁，发为肉
痿，故下经曰∶肉痿者得之湿地。（渐，渍也。湿处停居相渍，致肌肉痹而不仁，遂
使肉皆痿 也，名曰肉痿也。平按∶《甲乙》相湿作伤湿。）有所远行劳倦，而逢大热
而渴，渴则阳明气内代，则热合于肾，肾者水脏也，今水者不胜火，则骨枯而髓虚，故
足不任身，发为骨痿，故下经曰∶骨痿生于大热也。（劳倦逢于大热，渴则阳明内代者，
阳明主谷，其气热盛，复有外热来加，阳明之脉内即代绝，内外
热盛，下合水肾，水不胜火，故骨枯髓竭。骨枯髓竭，故足不任身，发为骨痿。平按∶
《素问》、《甲乙》内代作内伐。《素问》合于肾作舍于肾。《甲乙》髓虚作髓空，发
为骨痿作热发为骨痿。）问曰∶何以别之？（五脏痿有外内，何候知其别异也。）曰∶
肺热者，色白而毛败；（白是肺色。毛，肺之所主也。）心热者，色赤而络脉溢；（赤
是心色。络脉，心之所主也。络脉胀见为溢也。平按∶《甲乙》赤作青。）肝热者，色
苍而爪枯；（苍，青也。青为肝色。爪，肝所主也。）脾热，色黄而肉濡动；（黄为脾
色。肉，脾所主也。平按∶《素问》、《甲乙》濡作蠕。）肾热者，色黑而齿 。（
当为槁，色黑齿枯槁也。黑为肾色。齿，肾所主也。故毛败、脉溢、爪枯、肉濡动、齿
槁者，即知五脏热痿也。平按∶ 《素问》、《甲乙》作槁。）问曰∶如夫子言可矣，
论言治痿者独取阳明何也？曰∶阳明者，五脏六腑之海也，主润宗筋。宗筋者，束骨肉
而利机关。冲脉者，经之海也，主渗灌溪谷，与阳明合于筋阴，总宗筋之会，会于气街，
而阳明为之长，皆属于带脉而络于督脉，故阳明虚则宗筋纵，带脉不引，故足痿不用。
（阳明胃脉，胃主水谷，流出血气，以资五脏六腑，如海之资，故阳明称海。从于脏腑
流出，行二十八脉，皆归冲脉，故称冲脉为经脉之海。是为冲脉，以阳明水谷之气，与
带脉督脉相会，润于宗筋，所以宗筋能管束肉骨而利机关。宗筋者，足太阴、少阴、厥
阴三阴筋，及足阳明筋，皆聚阴器，故曰宗筋，故阳明为长。若阳明水谷气虚者，则带
脉不能控引于足，故足痿不用也。平按∶《素问》、《甲乙》束骨肉，无肉字；经之海
作经脉之海，本书《带脉》篇同；筋阴作“宗筋阴阳”四字。气街《甲乙》作气冲。）
黄帝曰∶治之奈何？答曰∶各补其荥而通其输，调其虚实，和其逆顺，则宗筋脉骨
肉，各以其时受日，则病已矣。黄帝曰∶善。（五脏热痿，皆是阴虚，故补五脏阴经
之荥。阴荥，水也。阴输是木，少阳也。故热痿通其输也。各以其时者，各以其时受病
之日调之皆愈也。平按∶输《素问》、《甲乙》作俞，筋脉上无则宗二字，受日作受月，
王冰注云∶“时受月，谓受气时月，如肝王甲乙，心王丙丁之类，皆王气法。”不若此
注之明显。）
【平按】：本篇从开头到结尾，见于《素问》卷十二第四十四篇《痿论》，又见于《甲乙经》卷十第四。另外，“自阳明者五脏六腑之海至足痿不用”这一段，见于本书卷十第二篇《带脉》。
问：为什么五脏的病变会导致人产生痿证？（痿，是指肢体屈伸无力、软弱。因为五脏有热，导致皮肤、脉、筋、肉、骨变得松弛、萎缩、屈曲无力，所以称为痿。然而五脏的热邪，是如何使人产生痿证的呢？）答：肺主管身体的皮毛，心主管身体的血脉，肝主管身体的筋膜，脾主管身体的肌肉脂肪，肾主管身体的骨髓。（这里先说明五脏所主管的部位，以便阐明五脏痿的机理。膜，是指人体皮下与肌肉之间的薄膜，是肌肉的筋络。平按：《素问》和《甲乙经》中“脂肉”写作“肌肉”。注：欲明，袁刻本写作“欲知”。）因此，如果肺气热盛，肺叶就会焦枯，导致皮毛虚弱、紧张、变薄且附着于肌肤，从而产生痿躄（手足痿废不用）。（肺热会使肺叶焦干，外在表现为皮毛及皮肤虚弱、紧张并相互粘连，导致手足痿废不用。平按：《素问》中“肺”下无“气”字。“肤”在《素问》、《甲乙经》中作“虚”。《甲乙经》中“焦”下多一个“焦”字，“着”下多一个“着”字，“辟”通“躄”，下同。）如果心气热盛，则下肢的血脉会厥逆上行，上部血脉充盈而下部血脉空虚，下部空虚则产生脉痿，关节枢纽折断般松弛，小腿软弱无法站立行走。（心主管血脉，心藏之气热盛，导致下肢血脉厥逆上行。下部血脉气血上行后，下部血脉便空虚，因此产生脉痿，关节如折，小腿松软不能履地。平按：《素问》中“ ”作“纵”。《甲乙经》中“挈”作“ ”，“ ”作“肿”。）如果肝气热盛，则胆汁外泄口苦，筋膜干燥，筋膜干燥则拘急挛缩，发为筋痿。（挛，是指筋寒而紧急。如果有热邪使筋膜干燥，就会发生挛急，就像筋遇到火一样，卷缩为挛，伸展则为弛缓，所以称为筋痿。平按：《甲乙经》中“胆”下有“热”字，《素问》、《甲乙经》中“筋膜干”三字重复出现，“急”前有“筋”字。）如果脾气热盛，则胃干燥而口渴，肌肉麻木不仁，发为肉痿。（脾胃相互依存，所以脾热则胃干燥，肌肉失去知觉，发为肉痿。）如果肾气热盛，则腰脊不能挺举，骨骼枯槁、髓液减少，发为骨痿。（肾位于腰部，所以肾气热盛时，腰脊不能挺举，骨骼枯槁，热邪煎熬导致髓液减少，因此发为骨痿。）
问：这些痿证是如何产生的呢？
答：肺是五脏之长，位于心之上如同盖子，如果人有丧失亡失之事，或所求不得，就会导致肺气郁闭，肺气郁闭则肺热叶焦，因此五脏因肺热叶焦，而产生痿躄，说的就是这个道理。（肺在五脏之上，是心的覆盖物，主气，所以是五脏之长。因此心中有所亡失，追求而不得，就会伤及肺，肺受伤则呼气有声，动及肺叶焦枯，五脏因肺叶焦热，遂发为痿躄。平按：《甲乙经》中“失亡”作“亡失”。袁刻本中“亡”误作“已”。“喝”在《素问》、《甲乙经》中作“鸣”。故字下《素问》有“曰”字。《甲乙经》无“故五脏因肺热叶焦，此之谓也”十二个字。另外注文中“肺在”在袁刻本误作“肺上”。）如果悲哀太过，胞络断绝，断绝则阳气在内扰动，发作时心下血崩，频繁小便出血，所以《本病》说：大经脉空虚，发为脉痹，传变为脉痿。（胞络，是指心脏外面的包络之脉。心悲哀太过，则导致心脏外面的胞络脉断绝，手少阳阳气在内扰动受损，心下崩损，血液循着手少阳脉下行，尿血，致使脉虚成为脉痹，传变为脉痿。平按：《素问》、《甲乙经》中“胞络绝”三字重复，“脉痹”均作“肌痹”。《素问》新校正说：“杨上善说：胞络者，心上胞络之脉。详细考察经文注释中的‘胞’字都应当作‘包’，全本‘胞’作‘肌’。”）如果思虑无穷，愿望无法满足，意念淫逸于外，房事过度，宗筋弛纵，发为筋痿，以及白淫（男子滑精、女子带下），所以下经说：筋痿是由于入房过度引起的。（思想所爱之色，不知穷尽，无涯之心，不能满足愿望，淫逸于心深处，房事过度，遂令阴器弛纵。阴器是诸筋的宗主，所以宗筋受伤则成为筋痿，妇人发为白淫。所谓“经曰”，是指已经论述过的经典，引用它作为证据。“使内”，也是指入房。平按：《素问》、《甲乙经》中“施”作“弛”，“生于使内”作“生于肝使内也”。）如果逐渐感受湿邪，以水为业，或者湿气停留，居住处潮湿，肌肉被湿气浸渍，麻痹而不仁，发为肉痿，所以下经说：肉痿是由于居住在湿地引起的。（渐，即浸渍。在潮湿处停留居住相互浸渍，导致肌肉麻痹而不仁，遂使肌肉全部痿废，名叫肉痿。平按：《甲乙经》中“相湿”作“伤湿”。）如果远行劳倦，又逢大热而口渴，口渴则阳明之气在内衰竭，热邪结合于肾，肾是水脏，现在水不胜火，则骨骼枯槁、髓液空虚，所以脚不能支撑身体，发为骨痿，所以下经说：骨痿是由于大热引起的。（劳倦遭遇大热，口渴则阳明内衰者，阳明主受纳水谷，其气热盛，又有外热相加，阳明之脉内部即衰竭断绝，内外热盛，下合于水肾，水不胜火，所以骨枯髓竭。骨枯髓竭，所以脚不能支撑身体，发为骨痿。平按：《素问》、《甲乙经》中“内代”作“内伐”。《素问》中“合于肾”作“舍于肾”。《甲乙经》中“髓虚”作“髓空”，“发为骨痿”作“热发为骨痿”。）
问：如何辨别它们呢？（五脏痿有外感和内伤之分，如何通过征候知道它们的区别呢？）
答：肺热的人，面色白而毛发败落；（白色是肺的颜色。毛，是肺所主管的。）心热的人，面色赤而络脉充盈溢露；（赤色是心的颜色。络脉，是心所主管的。络脉胀满显露称为溢。平按：《甲乙经》中“赤”作“青”。）肝热的人，面色苍青而指甲枯槁；（苍，即青色。青色是肝的颜色。爪，是肝所主管的。）脾热的人，面色黄而肌肉蠕动；（黄色是脾的颜色。肉，是脾所主管的。平按：《素问》、《甲乙经》中“濡”作“蠕”。）肾热的人，面色黑而牙齿枯槁。（应当解释为“槁”，面色黑、牙齿枯槁。黑色是肾的颜色。齿，是肾所主管的。所以毛发败落、脉溢、爪枯、肌肉蠕动、牙齿枯槁，就知道是五脏热导致的痿证了。平按：《素问》、《甲乙经》中作“槁”。）
问：像先生所说的那样就可以了，但医论中说治疗痿证要独取阳明，为什么呢？
答：阳明经是五脏六腑的海，主要滋润宗筋。宗筋，是束束骨肉并使关节灵活的关键。冲脉，是经脉的海，主要渗透灌溉溪谷，与阳明经会合于宗筋之阴，总汇宗筋的聚会，会合于气街穴，而阳明经在其中起主导作用，都连属于带脉并联络于督脉，所以阳明经虚弱则宗筋弛纵，带脉不能牵引，因此双脚痿废不能使用。（阳明胃脉，胃主水谷，流出血气，以资助五脏六腑，像大海的滋养一样，所以阳明被称为海。从脏腑流出，运行于二十八脉，都归于冲脉，所以称冲脉为经脉之海。这就是冲脉，凭借阳明水谷之气，与带脉、督脉相会，滋润宗筋，所以宗筋能约束肉骨并使关节灵活。宗筋，是指足太阴、少阴、厥阴三阴之筋，以及足阳明之筋，都聚于阴器，所以叫宗筋，因此阳明经起主导作用。如果阳明水谷之气虚弱，则带脉不能控制牵引足部，所以双脚痿废不能使用。平按：《素问》、《甲乙经》中“束骨肉”无“肉”字；“经之海”作“经脉之海”，本书《带脉》篇相同；“筋阴”作“宗筋阴阳”四字。气街在《甲乙经》中作“气冲”。）
黄帝说：怎么治疗呢？
回答说：分别补益各经的荥穴，疏通各经的输穴，调节虚实，调和逆顺，那么宗筋、脉、骨、肉，各自在其当令之日接受调治，病就好了。
黄帝说：好。（五脏热痿，都是阴虚，所以补益五脏阴经的荥穴。阴荥属水。阴输属木，对应少阳。所以热痿要疏通其输穴。所谓“各以其时”，是指各自在其受病的时日进行调治都能痊愈。平按：输在《素问》、《甲乙经》中作“俞”，“筋脉”上无“则宗”二字，“受日”作“受月”，王冰注说：“时受月，谓受气时月，如肝旺于甲乙，心旺于丙丁之类，皆旺气法。”不如这个注解明显。）
[Ping An]: This chapter, from the beginning to the end, is found in Volume 12, Chapter 44 "Treatise on Wei Syndrome" (Wei Lun) of the *Suwen* (Basic Questions), and also in Volume 10, Chapter 4 of the *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion). Additionally, the passage from "Yangming is the sea of the five zang and six fu organs" to "foot weakness and inability to use" is found in Volume 10, Chapter 2 "Dai Mai" (Girdle Vessel) of this book.
Question: Why do pathologies of the five zang organs cause people to develop Wei syndrome (flaccidity syndrome)? (Wei refers to limb weakness and flaccidity with limited flexion and extension. Due to heat in the five zang organs, the skin, vessels, sinews, muscles, and bones become relaxed, atrophic, and unable to flex or extend, hence named Wei. However, how does heat in the five zang organs lead to Wei syndrome?) Answer: The Lung governs the body's skin and hair; the Heart governs the body's blood vessels; the Liver governs the body's sinews; the Spleen governs the body's muscles and flesh; the Kidney governs the body's bones and marrow. (This first explains the areas governed by the five zang organs to clarify the mechanism of Wei syndromes originating from the zang. Membrane refers to the thin tissue between the subcutaneous layer and muscles, which are the sinews of the muscles. Ping An: In the *Suwen* and *Jiayi Jing*, "zhi rou" (fatty muscle) is written as "ji rou" (muscle). Note: Yu ming [to clarify] in Yuan edition is written as Yu zhi [to know].) Therefore, if Lung Qi is hot, the lung lobes will become scorched and dry, causing the skin and hair to become weak, tense, thin, and adherent to the skin, leading to Wei Bi (flaccidity and inability to use the limbs). (Lung heat causes the lung lobes to become scorched and dry; externally, it manifests as weakness, tension, and adhesion of the skin and hair, resulting in flaccidity and inability to use the hands and feet. Ping An: In the *Suwen*, there is no "Qi" character after "Fei" [Lung]. "Fu" [skin] is written as "Xu" [empty/weak] in the *Suwen* and *Jiayi Jing*. In the *Jiayi Jing*, an additional "Jiao" [scorched] follows "Jiao", and an additional "Zhuo" [adhere] follows "Zhuo". "Pi" is a variant for "Bi" [flaccidity], same below.) If Heart Qi is hot, the blood vessels in the lower body will revolt and move upward; when they move upward, the lower vessels become empty; emptiness leads to Mai Wei (vessel flaccidity syndrome), where the joint pivot breaks and relaxes, and the shins are too weak to bear weight on the ground. (The Heart governs blood vessels. Heat in the Heart's stored Qi causes the lower blood vessels to revolt and move upward. When blood and Qi from the lower vessels move upward, the lower vessels become empty, thus generating Mai Wei, where the joints are like broken pivots, and the shins are soft and cannot walk on the ground. Ping An: In the *Suwen*, " " is written as "Zong" [relax]. In the *Jiayi Jing*, "Qie" is written as " ", and " " is written as "Zhong" [swollen].) If Liver Qi is hot, bile leaks causing bitter taste in the mouth, and the sinews become dry. Dry sinews become tense and contract, developing into Jin Wei (sinew flaccidity syndrome). (Luan refers to the cold-induced tightness of sinews. Heat drying the sinews causes contraction, similar to sinews encountering fire, curling up into luan, while extension is chi [relaxed], hence called Jin Wei. Ping An: In the *Jiayi Jing*, "Re" [heat] appears after "Dan" [gallbladder]. In the *Suwen* and *Jiayi Jing*, "Jin gan gan" [sinews dry] is repeated three times, and "Jin" [sinew] appears before "Ji" [urgent/tense].) If Spleen Qi is hot, the stomach becomes dry and thirsty, and the muscles become numb and insensible, developing into Rou Wei (muscle flaccidity syndrome). (The Spleen and Stomach are mutually dependent; thus, Spleen heat causes Stomach dryness, leading to insensible muscles and Rou Wei.) If Kidney Qi is hot, the waist and spine cannot be held upright, the bones become withered, and the marrow decreases, developing into Gu Wei (bone flaccidity syndrome). (The Kidney is located in the waist region; thus, Kidney heat prevents the waist and spine from being held upright, the bones become withered, and heat scorching reduces the marrow, hence Gu Wei.)
Question: How are these Wei syndromes acquired?
Answer: The Lung is the chief of the five zang organs and serves as the cover for the Heart. If one experiences loss or deprivation, or desires that cannot be fulfilled, it causes Lung Qi to stagnate. Stagnation leads to Lung heat and scorched lung lobes. Consequently, due to Lung heat and scorched lobes, the five zang organs generate Wei Bi, which is what this refers to. (The Lung is above the other five zang organs, covering the Heart, and governs Qi, hence it is the chief of the zang. Thus, if the Heart suffers loss or unfulfilled desires, it injures the Lung. Lung injury causes audible exhalation and moves the scorched lung lobes. The five zang organs, due to the scorched and hot lung lobes, subsequently develop Wei Bi. Ping An: In the *Jiayi Jing*, "Shi wang" is written as "Wang shi". In the Yuan edition, "Wang" is mistakenly written as "Yi". "He" [stagnant voice] is written as "Ming" [sound] in the *Suwen* and *Jiayi Jing*. The *Suwen* has the character "Yue" [say] after "Gu" [therefore]. The *Jiayi Jing* lacks the twelve characters "Gu wu zang yin fei re ye jiao, ci zhi wei ye" [Therefore, because the five zang organs suffer from Lung heat and scorched lobes, this is called...]. Also, in the note, "Fei zai" [Lung is] in the Yuan edition is mistakenly written as "Fei shang" [above the Lung].) If grief is excessive, the Bao Luo (pericardium collaterals) are severed. Severance causes Yang Qi to move internally. Upon manifestation, there is heart-bottom blood collapse and frequent hematuria. Thus, the *Ben Bing* states: The large meridians become empty, developing into Mai Bi (vessel bi syndrome), which transmits into Mai Wei. (Bao Luo refers to the vessels of the pericardium surrounding the Heart. Excessive grief in the Heart causes the pericardium vessels to sever. Hand Shaoyang Yang Qi moves internally and is injured; heart-bottom collapse damages blood, which flows down along the Hand Shaoyang vessel, causing hematuria, leading to vessel deficiency becoming Mai Bi, transmitting into Mai Wei. Ping An: In the *Suwen* and *Jiayi Jing*, "Bao luo jue" [Bao Luo severed] is repeated three times; "Mai Bi" is uniformly written as "Ji Bi" [muscle bi]. The *Suwen* Xin Zheng Jiao says: "Yang Shangshan said: Bao Luo refers to the vessels of the pericardium surrounding the Heart. Carefully examining the text and notes, all 'Bao' characters should be 'Bao' [wrap], and the whole text uses 'Ji' [muscle]." ) If thoughts are endless and wishes remain unfulfilled, the mind wanders externally, and sexual intercourse is excessive, causing Zong Jin (major sinews) to relax. This develops into Jin Wei and Bai Yin (white turbidity, i.e., spermatorrhea in men or leukorrhea in women). Thus, the lower classic states: Jin Wei arises from excessive sexual activity. (Thinking about beloved objects without limit, hearts with boundless desires not satisfied, wandering deeply outside the heart, excessive sexual intercourse, leads to relaxation of the genital organ. The yin organ is the master of all sinews; thus, injury to Zong Jin results in Jin Wei. Women develop Bai Yin. "Classic states" refers to previously discussed classics cited as evidence. "Shi nei" also means sexual intercourse. Ping An: In the *Suwen* and *Jiayi Jing*, "Shi" is written as "Chi" [relax]; "Sheng yu shi nei" is written as "Sheng yu gan shi nei ye" [arises from Liver and excessive sexual activity].) If gradually exposed to dampness, working with water, or if dampness lingers, living in damp places, muscles are soaked by dampness, becoming bi and insensible, developing into Rou Wei. Thus, the lower classic states: Rou Wei is caused by living in damp lands. (Jian means soaking. Staying in damp places leads to mutual soaking, causing muscle bi and insensibility, making all muscles flaccid, named Rou Wei. Ping An: In the *Jiayi Jing*, "Xiang shi" is written as "Shang shi" [injure dampness].) If traveling far and laboring, encountering great heat and thirst, thirst causes Yangming Qi to fail internally. Heat combines with the Kidney. The Kidney is the Water organ; now Water cannot overcome Fire, so bones become withered and marrow becomes empty. Thus, the feet cannot support the body, developing into Gu Wei. Thus, the lower classic states: Gu Wei arises from great heat. (Laboring and encountering great heat, thirst causes internal failure of Yangming. Yangming governs grains, its Qi is hot and abundant, compounded by external heat, the Yangming meridian fails internally. Internal and external heat combine with the Water Kidney; Water cannot overcome Fire, so bones wither and marrow exhausts. Withered bones and exhausted marrow mean feet cannot support the body, developing into Gu Wei. Ping An: In the *Suwen* and *Jiayi Jing*, "Nei dai" is written as "Nei fa" [internal attack]. *Suwen* writes "He yu Shen" as "She yu Shen" [dwell in Kidney]. *Jiayi Jing* writes "Sui xu" as "Sui kong" [marrow empty]; "Fa wei gu wei" as "Re fa wei gu wei" [heat causes Gu Wei].)
Question: How can they be distinguished? (Five zang Wei syndromes have external and internal origins; how can their differences be known through signs?)
Answer: Lung heat manifests as white complexion and damaged hair; (White is the color of the Lung. Hair is governed by the Lung.) Heart heat manifests as red complexion and overflowing collateral vessels; (Red is the color of the Heart. Collateral vessels are governed by the Heart. Swollen and visible collaterals are called overflow. Ping An: In the *Jiayi Jing*, "Chi" [red] is written as "Qing" [green/cyan].) Liver heat manifests as cyan complexion and withered nails; (Cyan is green. Green is the color of the Liver. Nails are governed by the Liver.) Spleen heat manifests as yellow complexion and twitching muscles; (Yellow is the color of the Spleen. Muscles are governed by the Spleen. Ping An: In the *Suwen* and *Jiayi Jing*, "Ru" is written as "Ru" [twitch/wriggle].) Kidney heat manifests as black complexion and withered teeth. (Should be interpreted as "Gao" [withered], black complexion and withered teeth. Black is the color of the Kidney. Teeth are governed by the Kidney. Thus, damaged hair, overflowing vessels, withered nails, twitching muscles, and withered teeth indicate Wei syndromes caused by heat in the five zang organs. Ping An: In the *Suwen* and *Jiayi Jing*, it is written as "Gao".)
Question: As the Master said, this is sufficient. But medical theories state that treating Wei syndrome requires focusing solely on Yangming. Why?
Answer: Yangming is the sea of the five zang and six fu organs and primarily moistens the Zong Jin. Zong Jin binds the bones and flesh and facilitates joint movement. Chong Mai is the sea of the meridians, primarily seeping and irrigating the valleys. It merges with Yangming at the Yin of Zong Jin, gathering all Zong Jin meetings, converging at Qichong (St30), with Yangming acting as the leader. All belong to Dai Mai (Girdle Vessel) and network with Du Mai (Governor Vessel). Thus, if Yangming is deficient, Zong Jin relaxes, Dai Mai cannot pull, and the feet become weak and unusable. (Yangming Stomach meridian: the Stomach governs water and grain, producing blood and Qi to nourish the five zang and six fu organs, like the sea's nourishment, hence Yangming is called the Sea. Flowing from the zang and fu, running through the twenty-eight meridians, all return to Chong Mai, hence Chong Mai is called the Sea of Meridians. Regarding Chong Mai, relying on Yangming's water-grain Qi, it meets with Dai Mai and Du Mai, moistening Zong Jin, so Zong Jin can bind flesh and bones and facilitate joints. Zong Jin refers to the sinews of Foot Taiyin, Shaoyin, and Jueyin, and Foot Yangming, all gathering at the yin organ, hence called Zong Jin, so Yangming is the leader. If Yangming's water-grain Qi is deficient, Dai Mai cannot control and pull the feet, hence foot weakness and inability to use them. Ping An: In the *Suwen* and *Jiayi Jing*, "Shu gu rou" lacks the character "Rou"; "Jing zhi hai" is written as "Jing mai zhi hai" [Sea of Jing Mai], same as Book's "Dai Mai" chapter; "Jin yin" is written as four characters "Zong jin yin yang" [Zong Jin Yin Yang]. Qichong in *Jiayi Jing* is written as "Qichong".)
Huangdi said: How to treat it?
Answer: Tonify the Ying-Spring points of each meridian and unblock the Shu-Stream points. Regulate excess and deficiency, harmonize reversal and smooth flow. Then, the Zong Jin, vessels, bones, and muscles, each receiving treatment on their respective days of dominance, will recover.
Huangdi said: Excellent. (Five zang heat Wei syndromes are all Yin deficiency, so tonify the Ying-Spring points of the five zang Yin meridians. Yin Ying belongs to Water. Yin Shu belongs to Wood, corresponding to Shaoyang. Hence, for heat Wei, unblock the Shu points. "Each according to its time" means treating them on the days they were afflicted, and they will all heal. Ping An: Shu is written as "Yu" in *Suwen* and *Jiayi Jing*; "Ze Zong" is missing above "Jin Mai"; "Shou ri" is written as "Shou yue" [receive month]. Wang Bing notes: "Shou yue refers to receiving Qi during specific months, such as Liver dominating on Jia-Yi, Heart on Bing-Ding, etc., following the dominant Qi method." This is not as clear as this annotation.)