去茱萸、五味。
去肉豆蔻、破故纸。
程郊倩曰∶命门无火，不能为中宫腐熟水谷，藏寒在肾，谁复司其闭藏？故木气才萌，
不疏
之能，五味子有酸收固涩之性，吴茱萸散邪补土，肉豆蔻涩滑益
使气壮，补肾仍是补脾矣。
李士材曰∶肾水受时于子，弱土不能禁制，故子后每泻也。
柯韵伯曰∶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
肤、
为一
阴，阴
脾虚不
辛温者
虚无
萸之辛
症则同
可互用
曰四神
治肺痿声嘶，喉痹，咳血，烦躁。
黄柏（二两，酒炒） 知母（二两，酒浸，炒） 肉桂（一钱）
上为细末，熟水丸桐子大。每服五十丸，空心下。
罗东逸曰∶此丸为肾家水竭火炎而设。夫水竭则肾涸，肾涸则下泉不钟，而阳盛于上，
斯喉
焦
苦
燥
龙归海，于是坎盈 而流渐长矣。此滋肾之旨也。
柯韵伯曰∶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
制水
所主
治肾阴不足，筋骨痿软，不能步履。
龟板 黄柏（各四两） 知母 熟地（各二两） 牛膝（三两五钱） 芍药（一两五
钱） 锁阳 虎骨 当归（各一两） 陈皮（七钱五分）
上为末，煮羯羊肉，捣为丸桐子大，淡盐汤下。
王又原曰∶肾为作强之官，有精血以为之强也。若肾虚精枯，而血必随之，精血交败，
湿热
搏，
君；
母愈
北方
又有
焉。
叶仲坚曰∶痿原虽分五脏，然其本在肾，其标在肺。《内经》云∶五脏因肺热叶焦，发
为痿
视为
为肺
潜之
夫潜之
必用二者为君，
知母清太阴之
骨正筋柔矣
以温之。羊
去掉肉豆蔻、补骨脂。
程郊倩说：命门火衰，不能腐熟水谷，肾寒则闭藏失职。所以肝木之气刚萌动时，（若用酸收之药）不仅不能疏泄，反而因五味子的酸收固涩之性，以及吴茱萸散邪补土、肉豆蔻涩肠止泻益气的功效，导致气机壮实（实则壅滞），补肾最终变成了补脾。
李士材说：肾水在子时受邪，弱土不能制约，所以在子时之后发生腹泻。
柯韵伯说：泄泻是腹部疾病，而腹部是三阴经的会合之处，一脏不调，就能导致泄泻。所以三阴经下利，张仲景分别论述……（原文此处有缺漏或排版错误，似指不同证型）。
（注：原文片段“肤、为一阴，阴脾虚不辛温者虚无萸之辛症则同可互用曰四神”语意破碎，推测为对四神丸组成及机理的讨论，即针对脾肾虚寒之泄泻，可用吴茱萸之辛温等法。）
治疗肺痿声音嘶哑，喉痹，咳血，烦躁。
黄柏（二两，酒炒） 知母（二两，酒浸，炒） 肉桂（一钱）
以上药物研成细末，用热水泛丸，如梧桐子大。每次服用五十丸，空腹服用。
罗东逸说：这个丸剂是为肾家水竭火炎而设的。水枯竭则肾干涸，肾干涸则下焦源泉不涌出，而上部阳气亢盛，于是咽喉焦苦燥热。此方意在引龙归海，使坎宫充盈而水流渐长。这就是滋补肾阴的宗旨。
柯韵伯说：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，才能蒸化水液以制水……（原文此处有缺漏）。
治疗肾阴不足，筋骨痿软，不能行走。
龟板 黄柏（各四两） 知母 熟地黄（各二两） 牛膝（三两五钱） 芍药（一两五钱） 锁阳 虎骨 当归（各一两） 陈皮（七钱五分）
以上药物研成粉末，煮羯羊肉，捣烂混合制成梧桐子大小的丸剂，用淡盐汤送服。
王又原说：肾是作强之官，依靠精血来维持其强健。如果肾虚精枯，血液必然随之亏损，精血互相败坏……（原文此处有缺漏，似指湿热搏结等病机）。
叶仲坚说：痿证虽然分属五脏，但其根本在肾，其标在肺。《内经》说：五脏因肺热叶焦，发为痿躄……（原文此处有缺漏，似指将痿证视为肺热所致，而虎潜丸旨在滋阴降火，强壮筋骨，必用龟板、虎骨等为君药，知母清太阴肺热，配合羊肉温养，使骨骼端正、筋脉柔和）。
Remove Fructus Evodiae (Wuzhuyu) and Schisandrae Fructus (Wuweizi).
Remove Semen Myristicae (Roudoukou) and Fructus Psoraleae (Poguzhi).
Cheng Jiaoqian stated: When the Fire of the Gate of Life (Mingmen) is deficient, it cannot rot and ripen food and drink in the Middle Jiao. Cold in the Kidney leads to failure in its storing function. Therefore, when the Qi of Wood begins to sprout, if not properly dispersed, the astringent and consolidating nature of Schisandrae Fructus (Wuweizi), along with the properties of Fructus Evodiae (Wuzhuyu) to scatter pathogens and tonify Earth, and Semen Myristicae (Roudoukou) to stop diarrhea and benefit Qi, may result in Qi becoming stagnant rather than vigorous. Thus, tonifying the Kidney effectively becomes tonifying the Spleen.
Li Shicai stated: When Kidney Water is affected at the Zi hour (11 PM - 1 AM), weak Earth fails to control it, leading to diarrhea occurring after the Zi hour.
Ke Yunbo stated: Diarrhea is an abdominal disease, and the abdomen is the convergence point of the Three Yin meridians. If one Zang organ is dysfunctional, it can lead to diarrhea. Therefore, for lower purging involving the Three Yin meridians, Zhang Zhongjing discussed them separately... [Text fragmentary]. [Note: The fragmented text likely refers to the composition and mechanism of Si Shen Wan, addressing Spleen-Kidney Yang deficiency diarrhea, potentially utilizing the acrid-warm nature of Fructus Evodiae.]
Treats Lung萎 (Fei Wei - Lung Atrophy/Withering) with hoarseness, throat obstruction (Hou Bi), hemoptysis, and irritability.
Phellodendri Cortex (Huangbai) (2 liang, stir-fried with wine)
Anemarrhenae Rhizoma (Zhimu) (2 liang, soaked in wine, stir-fried)
Cinnamomi Ramulus (Rougui) (1 qian)
Grind the above into fine powder, make pills with warm water, sized like paulownia seeds. Take 50 pills per dose, on an empty stomach.
Luo Dongyi stated: This pill is designed for cases where Kidney Water is exhausted and Fire flares up. When Water is exhausted, the Kidney dries up; when the Kidney dries up, the springs below do not flow, causing Yang to flourish above, leading to dryness, bitterness, and heat in the throat. The purpose here is to guide the Dragon back to the Sea, filling the Kan (Water) palace so that the flow gradually lengthens. This is the essence of nourishing Kidney Yin.
Ke Yunbo stated: Water is the substance of the Kidney, and Fire is its function. People know that Water in the Kidney can control Fire; but they do not know that Fire in the Kidney is necessary to transform Water and control it... [Text fragmentary].
Treats insufficient Kidney Yin, resulting in flaccidity of sinews and bones, and inability to walk.
Testudinis Carapax et Plastrum (Guiban)
Phellodendri Cortex (Huangbai) (each 4 liang)
Anemarrhenae Rhizoma (Zhimu)
Prepared Rehmanniae Radix (Shudi) (each 2 liang)
Achyranthis Bidentatae Radix (Niuxi) (3 liang 5 qian)
Paeoniae Radix Alba (Shaoyao) (1 liang 5 qian)
Cynomorii Herba (Suoyang)
Ossis Tigridis (Hugu)
Angelicae Sinensis Radix (Danggui) (each 1 liang)
Citri Reticulatae Pericarpium (Chenpi) (7 qian 5 fen)
Grind the above into powder, boil male sheep meat, mash together, and form pills sized like paulownia seeds. Take with light salted broth.
Wang Youyuan stated: The Kidney is the official of strength and vigor, relying on Essence and Blood for this strength. If Kidney deficiency leads to Essence depletion, Blood will inevitably follow, causing mutual deterioration of Essence and Blood... [Text fragmentary, likely referring to damp-heat interaction].
Ye Zhongjian stated: Although Wei syndrome (Flaccidity Syndrome) is divided among the Five Zang organs, its root lies in the Kidney, and its branch in the Lung. The *Neijing* states: When the Five Zang organs suffer from Lung Heat causing the leaves to wither, Wei syndrome develops... [Text fragmentary, likely explaining that while Wei is often viewed as Lung-related, Huo Quan Wan aims to nourish Yin and descend Fire, using Guiban and Hugu as chief ingredients, Zhimu to clear Taiyin Lung heat, and mutton to warm and nourish, ensuring straight bones and flexible sinews].