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, 右为细
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, 是绝其流而溺不泄也, 须用气味俱厚, 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: 膀胱者,
州都之官, 津液藏焉, 气化则能出矣. 无液癃秘, 是无阴则阳无以化
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,溺如涌泉而愈. 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.
又名通关丸。
主治热邪位于下焦，小便淋漓闭塞不通，但口不渴的症状。
黄柏（经酒炒制）二两，知母（经酒浸泡后炒制）二两，肉桂一钱。将上述药物研成细末，用熟水泛制成丸，大小如梧桐子，每次服用五十丸，空腹时送服。
【集注】李杲说：小便由足太阳膀胱经所主，其源生于肺金。若肺中伏藏热邪，导致水液不能生化，这就是断绝了小便的源头；若是口渴且小便不通，是因为肺气不得下降所致。因此，使用清燥肺金、气味轻薄淡渗的药物，以泻火清肺，滋补水液的化生之源。如果热邪在下焦而口不渴，这是断绝了水流而尿液无法排泄，必须使用气味浓厚、属于阴中之阴的药物来治疗。《素问》说：“没有阳气，阴气就无法生成；没有阴气，阳气就无法气化。”又说：“膀胱是州都之官，津液储藏其中，经过气化作用才能排出。”无津液导致的癃闭秘结，就是“无阴则阳无以化”的情况。需要使用知母、黄柏等大苦大寒的药剂，佐以一钱肉桂作为引药，服用片刻后，前阴会有如刀刺火烧的感觉，随后尿液像涌泉一样流出而病愈。这种病症，一种在上焦气分表现为口渴，一种在下焦血分表现为不渴。两者的区别，非常容易辨别。柯琴说：水是肾的本体，火是肾的功能。人们知道肾中有水，才能制约火，却不知道肾中有火，才能蒸腾致水。盖因天一生水，“一”即是阳气，也就是火，气为水之母，阳为阴之根，必须使火有所归依，水才有所主宰。所以反佐以肉桂的甘温之性，引导知母、黄柏进入肾脏而发挥疗效。这既是相须（协同）的深厚道理，也是相制（制约）的原理。
Also known as Tongguan Wan (Passage-Opening Pill).
Indicated for heat located in the Lower Jiao (Lower Burner), presenting with strangury and urinary retention, yet without thirst.
Huangbai (Phellodendri Cortex) two liang, processed with wine; Zhimu (Anemarrhenae Rhizoma) two liang, soaked in wine and stir-fried; Rougui (Cinnamomi Cortex) one qian. Grind the above herbs into a fine powder, make pills using cooked water, sized like wutong seeds. Take fifty pills per dose, on an empty stomach.
[Collected Annotations] Li Guo stated: Urination is governed by the Foot-Taiyang Bladder channel and originates from Lung Metal. If latent heat resides in the Lung, preventing the generation of fluids, this severs the source of urine; if accompanied by thirst and urinary obstruction, it is due to the failure of Lung Qi to descend. Therefore, one should use drugs that are light, thin, and diuretic to clear dryness from Lung Metal, purge fire, clear the Lung, and nourish the source of water generation. However, if heat is in the Lower Jiao without thirst, it indicates a blockage of flow where urine cannot be discharged; in such cases, drugs with strong flavors and potent properties, belonging to "Yin within Yin," must be used. The *Suwen* states: "Without Yang, Yin cannot be generated; without Yin, Yang cannot transform." It also says: "The Bladder is the official of the metropolitan area, storing body fluids; only through Qi transformation can they be excreted." Strangury and constipation due to lack of fluids represent "without Yin, Yang cannot transform." One must use the strongly bitter and cold agents Zhi Mu and Huang Bai, with one qian of Rou Gui as a guiding agent. Shortly after ingestion, the external genitalia will feel as if pierced by knives or burned by fire, and urine will gush out like a spring, resulting in cure. This condition differs in that one type involves the Upper Jiao Qi level with thirst, while the other involves the Lower Jiao Blood level without thirst. The distinction between the two is very easy to identify. Ke Qin stated: Water is the substance of the Kidney, and Fire is the function of the Kidney. People know that having water in the Kidney allows it to control fire, but do not realize that having fire in the Kidney is what enables the generation of water. As Heaven generates Water with One, "One" refers to Yang Qi, which is Fire. Qi is the mother of Water, and Yang is the root of Yin. Only when Fire has its归宿 (return/anchoring point) can Water have its master. Therefore, Rou Gui's sweet and warm nature is added in reverse dosage (counter-agent) to guide Zhi Mu and Huang Bai into the Kidney to achieve their effects. This illustrates both the profound principle of mutual assistance (Xiang Xu) and mutual restraint (Xiang Zhi).