骨所以驱之；纯阴无阳不能发生，佐锁阳以温之。羊肉为丸，补之以味。淡盐汤下，急于入肾。斯皆潜之为义。
滋肾丸（又名通关丸） 治热在下焦，小便癃闭，而口不渴者。
黄柏（酒炒，二两） 知母（酒浸，炒，二两） 肉桂（一钱）
上为细末，熟水丸，桐子大，每服五十丸，空心下。
【集注】李杲曰∶小便者，足太阳膀胱所主，生于肺金。肺中伏热，水不能生，是绝
小便之源也；渴而小便不通者，肺气不得降是也。故用清燥金之正化气薄淡渗之药，泻
火而清肺，滋水之化源也。若热在下焦而不渴，是绝其流而尿不泄也。须用气味俱浓，阴
中之阴药治之。《素问》云∶无阳则阴无以生，无阴则阳无以化。又云∶膀肮者，州都之官，
津液藏焉，气化则能出矣。无液癃秘，是无阴则阳元以化也。须用知、柏大苦寒之剂，桂
一钱为引，服之须臾，前阴若刀刺火烧，尿如涌泉而愈。此证一在上焦气分而渴，一在
下焦血分而不渴。两者之殊，至易辨耳。
柯琴曰∶水为肾之体，火为肾之用。人知肾中有水，始能制火，不知肾中有火，始
能致水耳。盖天一生水，一者，阳气也，即火也，气为水母，阳为阴根，必火有所归，斯
水有所主。故反佐以桂之甘温，引知、柏入肾而奏其效。此相须之殷，亦相制之理也。
琼玉青 治虚劳干咳。
生地黄（四斤） 白茯苓（十三两） 白蜜（二斤） 人参（六两）
上以地黄汁同蜜熬沸，用绢滤过，将参、茯为细末，入前汁和匀，以瓷瓶用绵纸十数
层，加箬叶封瓶口，入砂锅内，以长流水没瓶颈，桑柴火煮，三昼夜取出，换纸扎口，以
蜡封固，悬井中，一日取起，仍煮半日，汤调服。
【集注】李中梓曰∶干咳者，有声无痰，火来乘金，金极而鸣也。此本元之病，非渐
渍难以成功；若误用苦寒，只伤脾土，金反无母。故丹溪以地黄为君，令水盛则火自息。
又损其肺者益其气，故用人参以鼓生发之元。虚则补其母，故用茯苓以培万物之本。白蜜
为百花之精，味甘归脾，性润悦肺，且缓燥急之火。四者皆温良和浓之品，诚堪宝重。郭
机曰∶起吾沉瘵，珍赛琼瑶。故有琼玉之名。
龟鹿二仙胶 大补精髓，益气养神。
鹿角（血者，十斤） 龟版（自败者，五斤） 枸杞子
（甘州者，三十两） 人参（十五两）
上用铅坛，如法熬胶，初服酒化一钱五分，渐加至三钱，空心下。
【集注】李中梓曰∶人有三奇，精、气、神，生生之本也。精伤无以生气，气伤无以
生神。精不足者，补之以味，鹿得天地之阳气最全，善通督脉，足于精者，故能多淫而
寿；龟得天地之阴气最具，善通任脉，足于气者，故能伏息而寿。二物气血之属，味最
纯浓，又得造化之无微，异类有情，竹破竹补之法也。人参益气，枸杞生精，佐龟、鹿
补阴补阳，无偏胜之忧；入气入血，有和平之美。由是精生而气旺，气旺而神昌，庶几
龟、鹿之年矣。故曰二仙。
四神丸 治脾肾双虚，子后作泻，不思食，不化食。
肉果（二两） 补骨脂（炒，四两） 五味子（二两） 吴茱萸（炮，二两）
上为末，红枣四十九枚，生姜四两、切，水煮，枣熟去姜，取枣肉捣，和药丸，桐子
大。空心盐汤下。
二神丸 去茱萸、五味。
五味子散 去肉果、补骨脂。
【集注】柯琴曰∶泻利为腹疾，而腹为三阴之都会，一脏不调，便能泻利。故三阴下
利，仲景各为立方以主之∶太阴有理中、四逆，厥阴有乌梅、白头翁，少阴有桃花、真
武、猪苓、猪肤、四逆汤散、白通、通脉等剂，可谓曲尽病情，诸法备矣。然只为一脏
立法，若三藏相关，久留不痊，如子后作泻一证，犹未之及也。夫鸡鸣至平旦，天之阴，
阴中之阳也。因阳气当至而不至，虚邪得以留而不去，故作泻于黎明。其由有四∶一为
脾虚不能制水，一为肾虚不能行水，故二神丸君补骨脂之辛燥，补肾以行水，佐肉果之
辛温，补脾以制水，丸以姜、枣，又辛甘发生诸阳也；一为命门火衰不能生土，一为少
阳气虚无以发陈，故五味子散君五味子之酸温，以收坎宫耗散之火，使少火生气以培土
也，佐吴茱萸之辛温，以顺肝木欲散之势，为水气开滋生之路，以奉春生也。此四者，病
因虽异，而见证则同，皆水亢为害。二神丸是承制之剂，五味子散是化生之剂也。二方
理不同而用则同，故可互用以助效，亦可合用以建功。合为四神丸是制生之剂也，制则
生化，久泄自瘳矣。称曰四神，比理中、八味二丸较速欤！
【按】命门无火，不能为中宫腐熟水谷之用，肾气不固，谁复司其闭藏之职。故木气
才萌，不疏泄而亦疏泄矣。虽是木邪干土，亦实肾之侮脾也。此际当脾肾双补，固涩平肝。
故以补骨脂温肾，肉果补脾，五味子收涩，吴茱萸泻肝。肾暖而气蒸，肝平而脾旺，关门闭而水谷腐矣。
骨头之所以能够支撑身体，是因为有阳气来推动；如果纯阴而无阳气，就无法生发，所以用锁阳来温煦它。将羊肉制成丸药，是用食物的味道来补益。用淡盐汤送服，是为了使药力迅速入肾。这些都是“潜”（引药入里、沉降）的含义。
滋肾丸（又名通关丸）：治疗热邪在下焦，导致小便癃闭（排尿困难或不通），但口不渴的症状。
黄柏（酒炒，二两） 知母（酒浸，炒，二两） 肉桂（一钱）
以上药物研成细末，用熟水泛丸，如梧桐子大，每次服用五十丸，空腹时送服。
【集注】李杲说：小便由足太阳膀胱所主，源于肺金。如果肺中有伏热，水液不能正常生成，这就是断绝了小便的源头；口渴且小便不通，是肺气不能下降所致。因此使用清燥金之正化气、气味淡薄而具淡渗作用的药物，泻火并清肺，以滋补水液的化源。如果是热在下焦而不口渴，这是断绝了水流而尿液不泄。必须使用气味浓厚、属于阴中之阴的药物来治疗。《素问》说：“无阳则阴无以生，无阴则阳无以化。”又说：“膀胱者，州都之官，津液藏焉，气化则能出矣。”如果没有津液导致癃秘，就是无阴则阳无法化生。需要用知母、黄柏等大苦寒的药物，加一钱肉桂作为引导，服药片刻后，前阴感觉像刀刺火烧一样，尿液像涌泉一样流出而痊愈。这个证候，一个在上焦气分且口渴，一个在下焦血分且不口渴。两者的区别，非常容易辨别。
柯琴说：水是肾的本体，火是肾的作用。人们知道肾中有水，才能制约火，却不知道肾中有火，才能致水。盖天一生水，“一”指的是阳气，也就是火，气为水之母，阳为阴之根，必须火有所归依，水才有所主宰。所以反佐以肉桂的甘温，引导知母、黄柏进入肾脏而发挥疗效。这是相互需要的深厚关系，也是相互制约的道理。
琼玉膏：治疗虚劳引起的干咳。
生地黄（四斤） 白茯苓（十三两） 白蜜（二斤） 人参（六两）
以上将地黄汁与蜂蜜一起熬沸，用绢布过滤，将人参、茯苓研成细末，加入前面的汁液中搅拌均匀，用瓷瓶盛装，用绵纸十几层覆盖瓶口，加上箬叶密封瓶口，放入砂锅中，用长流水淹没瓶颈，用桑柴火煮，三昼夜后取出，更换纸张扎紧瓶口，用蜡封固，悬挂在井中，一天后取出，再煮半天，用汤调服。
【集注】李中梓说：干咳，是有声音没有痰，是火来乘袭肺金，金气极盛而鸣响。这是本元的疾病，不是逐渐调理就能成功的；如果误用苦寒药物，只会损伤脾土，肺反而失去了母脏。所以丹溪以地黄为君药，让水盛则火自息。又根据“损其肺者益其气”的原则，用人参来鼓动生发的元气。虚则补其母，所以用茯苓来培补万物之本。白蜜是百花的精华，味甘归脾，性润悦肺，且能缓解燥急之火。这四味药都是温和良善、浓厚的物品，确实值得珍重。郭机说：它能治愈我的沉疴痼疾，珍贵胜过琼瑶。所以命名为琼玉。
龟鹿二仙胶：大补精髓，益气养神。
鹿角（取血角，十斤） 龟版（自然死亡的，五斤） 枸杞子（甘州产的，三十两） 人参（十五两）
以上用铅坛，按照方法熬制胶，初次服用时用酒化开一钱五分，逐渐增加到三钱，空腹时送服。
【集注】李中梓说：人有三奇，即精、气、神，是生生不息的根本。精受伤就不能生气，气受伤就不能生神。精不足的，用味道浓厚的食物来补。鹿得到天地最纯粹的阳气，善于通督脉，精充足的人，所以能多淫而长寿；龟得到天地最具象的阴气，善于通任脉，气充足的人，所以能潜伏呼吸而长寿。这两样东西属于气血之物，味道最纯粹浓厚，又得造化之微妙，异类有情，这是“竹破竹补”的方法。人参益气，枸杞生精，辅助龟、鹿补阴补阳，没有偏胜的忧虑；入气入血，有和平之美。由此精生而气旺，气旺而神昌，差不多能达到龟、鹿的寿命了。所以称为二仙。
四神丸：治疗脾肾双虚，黎明时分作泻，不想吃东西，消化不良。
肉果（二两） 补骨脂（炒，四两） 五味子（二两） 吴茱萸（炮制，二两）
以上研成粉末，用红枣四十九枚，生姜四两切片，水煮，枣熟后去掉姜，取枣肉捣烂，和药丸，如梧桐子大。空腹时盐汤送服。
【集注】柯琴说：泻利是腹部疾病，而腹部是三阴经的都会，一脏不调，就能导致泻利。所以三阴下利，张仲景分别制定方剂来主治：太阴有理中汤、四逆汤，厥阴有乌梅丸、白头翁汤，少阴有桃花汤、真武汤、猪苓汤、猪肤汤、四逆散、白通汤、通脉四逆汤等药剂，可以说详尽地顾及了病情，各种方法都具备了。然而这些只针对一脏立法，如果三脏相关联，久留不愈，如黎明作泻这一证候，还没有涉及到。从鸡鸣到平旦，是天中的阴时，阴中之阳。因为阳气应当到来却没有到来，虚邪得以停留而不能去除，所以在黎明作泻。其原因有四种：一是脾虚不能制水，二是肾虚不能行水，所以二神丸以补骨脂的辛燥为君，补肾以行水，佐以肉果的辛温，补脾以制水，用姜、枣做丸，又是辛甘发散以生发诸阳；三是命门火衰不能生土，四是少阳气虚无以发陈，所以五味子散以五味子的酸温为君，收敛坎宫耗散之火，使少火生气以培土，佐以吴茱萸的辛温，顺应肝木欲散之势，为水气开辟滋生的道路，以奉春生之气。这四种情况，病因虽然不同，但见证相同，都是水亢为害。二神丸是承制之剂，五味子散是化生之剂。这两个方子理法不同但用法相同，所以可以互换使用以增加疗效，也可以合用以建功。合起来成为四神丸，是制生之剂，制则生化，久泄自然痊愈。称之为四神，比理中汤、八味丸见效更快吗？
【按语】命门无火，不能起到腐熟水谷的作用，肾气不固，谁再来执行闭藏的职责。所以木气刚刚萌动，不疏泄也变成了疏泄。虽然是木邪干犯脾土，实际上也是肾侮脾。此时应当脾肾双补，固涩平肝。所以用补骨脂温肾，肉果补脾，五味子收涩，吴茱萸泻肝。肾暖而气蒸，肝平而脾旺，关门关闭而水谷得以腐熟。
The bones are able to support the body because they are driven by Yang Qi; if there is pure Yin without Yang, generation cannot occur, so Suoyang (Cynomorii Fructus) is added to warm it. Mutton is formed into pills to tonify using the flavor of food. Taking them with light salt water accelerates their entry into the Kidney. These all illustrate the meaning of "Qian" (sinking/penetrating).
Zishen Wan (Nourishing the Kidney Pill), also known as Tongguan Wan (Passage-Opening Pill): Treats heat in the Lower Jiao causing longbi (dysuria or urinary retention), but without thirst.
Huangbai (Phellodendri Cortex, stir-fried with wine, 2 liang) Zhimu (Anemarrhenae Rhizoma, soaked in wine, stir-fried, 2 liang) Rougui (Cinnamomi Cortex, 1 qian)
Grind the above into fine powder, make pills with cooked water, size of paulownia seeds. Take 50 pills each time on an empty stomach.
[Collected Annotations] Li Guo said: Urination is governed by the Foot-Taiyang Bladder channel and originates from Lung Metal. If latent heat exists in the Lungs, water cannot be generated, which cuts off the source of urine; thirst accompanied by urinary obstruction indicates that Lung Qi fails to descend. Therefore, drugs with thin aroma and mild diuretic properties that clear dryness and transform Metal are used to purge fire, clear the Lungs, and nourish the source of water. If heat is in the Lower Jiao without thirst, the flow is cut off and urine does not drain. One must use drugs with strong aroma and flavor, belonging to Yin within Yin. The *Suwen* states: "Without Yang, Yin cannot be born; without Yin, Yang cannot transform." It also states: "The Bladder is the official of the Zhou Du, where fluids are stored; only through Qi transformation can they be excreted." Longbi due to lack of fluid means Yin is insufficient for Yang to transform. One must use Zhimu and Huangbai, large bitter-cold agents, with 1 qian of Rougui as a guide. Shortly after taking it, the anterior yin feels like being pierced by a knife or burned by fire, and urine flows out like a gushing spring, leading to recovery. This syndrome has two types: one is in the Upper Jiao Qi level with thirst, the other is in the Lower Jiao Blood level without thirst. The difference between the two is very easy to distinguish.
Ke Qin said: Water is the substance of the Kidney, Fire is the function of the Kidney. People know that water in the Kidney can control fire, but do not know that fire in the Kidney is what generates water. Heaven generates water with 'One'; 'One' refers to Yang Qi, which is Fire. Qi is the mother of Water, Yang is the root of Yin. Only when Fire has its return path can Water have its master. Therefore, Rougui's sweet-warm nature is used as a counter-agent to guide Zhimu and Huangbai into the Kidney to achieve efficacy. This is the profound interdependence of mutual assistance, and also the principle of mutual restraint.
Qiongyu Gao (Jade-Jade Paste): Treats dry cough caused by deficiency-labor.
Shengdihuang (Rehmanniae Radix Praeparata, 4 jin) Baifuling (Poria, 13 liang) Baimi (White Honey, 2 jin) Renshen (Ginseng Radix et Rhizoma, 6 liang)
Boil the juice of Shengdihuang together with honey, filter through silk cloth. Grind Renshen and Baifuling into fine powder, mix evenly into the previous liquid. Store in a porcelain bottle, cover the mouth with ten layers of cotton paper, add bamboo leaves to seal, place in a clay pot, submerge the neck in running water, boil with mulberry wood fire for three days and nights. Remove, change paper to tie the mouth, seal with wax, hang in a well. Take out after one day, boil again for half a day, take mixed with water decoction.
[Collected Annotations] Li Zhongzi said: Dry cough produces sound but no phlegm; this is Fire attacking Metal, where Metal reaches extremity and rings. This is a disease of the primordial origin, difficult to succeed without gradual conditioning; if bitter-cold drugs are mistakenly used, Spleen Earth is damaged, and Metal loses its mother. Therefore, Danxi uses Shengdihuang as the sovereign drug, allowing abundant Water to extinguish Fire naturally. Furthermore, "damage the Lung, benefit its Qi," so Renshen is used to stimulate the origin of generation. "Deficiency tonifies its mother," so Baifuling is used to cultivate the root of all things. White honey is the essence of hundred flowers, sweet in taste enters the Spleen, moistening in nature pleases the Lung, and it soothes dryness-induced urgent fire. These four items are all warm, kind, harmonious, and rich substances, truly worthy of treasure. Guo Ji said: It cures my severe consumptive disease, precious as jade. Hence the name Qiongyu.
Guilu Erxian Jiao (Tortoise and Deer Two Immortals Glue): Greatly tonifies essence and marrow, benefits Qi and nourishes Shen.
Lujiao (Deer Antler, blood type, 10 jin) Guiban (Tartaric Testudo Carapace and Plastron, naturally deceased, 5 jin) Gouqizi (Lycii Fructus, from Ganzhou, 30 liang) Renshen (Ginseng Radix et Rhizoma, 15 liang)
Use a lead jar, prepare glue according to method. Initial dose: dissolve 1.5 qian in wine, gradually increase to 3 qian, take on an empty stomach.
[Collected Annotations] Li Zhongzi said: Humans have three wonders: Jing (Essence), Qi (Vital Energy), and Shen (Spirit), which are the roots of life. Damage to Jing prevents generating Qi; damage to Qi prevents generating Shen. For insufficiency of Jing, tonify with flavorful substances. The Deer receives the most complete Yang Qi of heaven and earth, excels in connecting the Du Mai, and those abundant in Jing can be promiscuous yet live long; the Tortoise possesses the most substantial Yin Qi of heaven and earth, excels in connecting the Ren Mai, and those abundant in Qi can lie dormant and breathe slowly yet live long. These two belong to Qi and Blood, with the purest and richest flavors, obtaining the subtleties of creation. They are sentient beings of different species, employing the method of "repairing bamboo with bamboo." Renshen benefits Qi, Gouqizi generates Jing, assisting Guiban and Lujiao to tonify Yin and Yang without fear of excess; entering both Qi and Blood, possessing the beauty of harmony. Thus, Jing is generated, Qi becomes vigorous, Qi being vigorous leads to flourishing Shen, approaching the years of tortoise and deer. Hence called Two Immortals.
Sishen Wan (Four Spirits Pill): Treats dual deficiency of Spleen and Kidney, diarrhea occurring after midnight (cockcrow to dawn), loss of appetite, and indigestion.
Rouguo (Myristicae Semen, 2 liang) Buguzhi (Psoraleae Fructus, stir-fried, 4 liang) Wuweizi (Schisandrae Fructus, 2 liang) Wuzhuyu (Evodiae Fructus, processed, 2 liang)
Grind into powder. Use 49 red dates, 4 liang sliced fresh ginger, boil in water. When dates are cooked, remove ginger, mash date flesh, mix with medicine to form pills, size of paulownia seeds. Take on an empty stomach with salt water.
Ershen Wan (Two Spirits Pill): Removes Wuzhuyu and Wuweizi.
Wuweizi San (Schisandra Powder): Removes Rouguo and Buguzhi.
[Collected Annotations] Ke Qin said: Diarrhea is an abdominal disease, and the abdomen is the confluence of the Three Yin channels. If one organ is dysfunctional, diarrhea can result. Therefore, for Three Yin diarrhea, Zhang Zhongjing created separate formulas: Taiyin has Lizhong Tang and Sini Tang, Jueyin has Wumei Wan and Baitouweng Tang, Shaoyin has Taohua Tang, Zhenwu Tang, Zhu Ling Tang, Zhufu Tang, Sini San, Baotong Tang, Tongmai Sini Tang, etc. This fully covers the pathology and includes various methods. However, these legislate for only one organ. If three organs are related and the condition persists unresolved, such as diarrhea at dawn, it has not been addressed. From cockcrow to dawn is the Yin period of heaven, Yin containing Yang. Because Yang Qi should arrive but does not, pathogenic emptiness remains and does not depart, causing diarrhea at dawn. There are four causes: First, Spleen deficiency fails to control Water; Second, Kidney deficiency fails to move Water. Thus, Ershen Wan uses Buguzhi's pungent-dry nature as sovereign to tonify Kidney and move Water, assisted by Rouguo's pungent-warm nature to tonify Spleen and control Water, made into pills with Ginger and Date, which are pungent-sweet to generate all Yangs. Third, Mingmen Fire decline fails to generate Earth; Fourth, Shaoyang Qi deficiency fails to promote growth. Thus, Wuweizi San uses Wuweizi's sour-warm nature as sovereign to gather scattered Fire of Kan Palace, allowing Minor Fire to generate Qi to cultivate Earth, assisted by Wuzhuyu's pungent-warm nature to follow the Liver Wood's tendency to scatter, opening a path for Water generation to serve Spring growth. Although the etiologies of these four differ, the manifestations are the same, all involving Water hyperactivity causing harm. Ershen Wan is a controlling agent, Wuweizi San is a transforming agent. Their principles differ but applications are similar, so they can be used interchangeably to enhance efficacy or combined to achieve results. Combined as Sishen Wan, it is a controlling-and-generating agent. Controlling leads to transformation and generation, and chronic diarrhea will heal itself. Is it called Four Spirits because it acts faster than Lizhong Tang and Bawei Wan?
[Note] Without Mingmen Fire, the Middle Jiao cannot rot and ripen food and drink; without secure Kidney Qi, who performs the duty of closure and storage? Thus, when Wood Qi begins to sprout, even without venting, it vents. Although this is Wood evil invading Earth, it is essentially Kidney insulting Spleen. At this time, one should tonify both Spleen and Kidney, astringe and calm Liver. Therefore, Buguzhi warms the Kidney, Rouguo tonifies the Spleen, Wuweizi astringes, and Wuzhuyu drains the Liver. With a warm Kidney and steaming Qi, a calm Liver and robust Spleen, the gate closes and food and drink are properly digested.