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Indicated for deficiency of both the Spleen and Kidney, diarrhea occurring before dawn (cock-crow diarrhea), loss of appetite, and indigestion. *Myristicae Semen* (Nutmeg) 2 liang, *Psoraleae Fructus* (Buguzhi, 补骨脂) [stir-fried] 4 liang, *Schisandrae Fructus* (Wuweizi, 五味子) 2 liang, *Evodiae Fructus* (Wuzhuyu, 吴茱萸) [processed] 2 liang. The above four herbs are ground into fine powder. Red dates (Jujubae Fructus) 49 pieces, fresh ginger (Zingiberis Rhizoma Recens) 4 liang, sliced. Boil in water until the dates are cooked, remove the ginger, take the date pulp, mash it, mix with the herbal powder, and make pills the size of paulownia seeds. Take on an empty stomach with salted warm water.

If Evodiae Fructus and Schisandrae Fructus are removed, it becomes Ershen Wan (Two-Spirit Pill). If Myristicae Semen and Psoraleae Fructus are removed, it becomes Wuweizi San (Schisandra Powder).

[Collected Notes] Ke Qin stated: Diarrhea and dysentery are abdominal diseases, and the abdomen is the convergence point of the Three Yin meridians (Taiyin, Shaoyin, Jueyin). Dysfunction of any single zang organ can lead to diarrhea or dysentery. Therefore, for lower purging caused by the Three Yin meridians, Zhang Zhongjing formulated different prescriptions to treat them respectively: Taiyin has Lizhong Tang (Regulate the Middle Decoction) and Sixine Tang (Four-Reverse Decoction); Jueyin has Wumei Wan (Mume Pill) and Baitouweng Tang (Pulsatilla Decoction); Shaoyin has Taohua Tang (Peach Kernel Decoction), Zhenwu Tang (True Warrior Decoction), Zhuling Tang (Polyporus Decoction), Zhufu Tang (Pig Skin Decoction), Sixin San (Four-Reverse Powder), Baotong Tang (White Connective Decoction), Tongmai Sixinjia Huanglian Ejiao Tang (Pulse-Unblocking Four-Reverse plus Coptis and Donkey-Hide Gelatin Decoction), etc. These can be said to have thoroughly analyzed the disease conditions and provided comprehensive treatment methods. However, these formulas are legislated for a single zang organ. If three organs are interrelated and the illness persists without cure, such as the syndrome of diarrhea before dawn, previous formulas did not address this. From cock-crow to dawn, heaven's yin is dominant, which is yang within yin. Because yang qi should arrive but does not, pathogenic vacuity evil remains and cannot be expelled, thus causing diarrhea at dawn. There are four causes: First, Spleen deficiency fails to control water; second, Kidney deficiency fails to transport water. Therefore, Ershen Wan uses Psoraleae Fructus as the sovereign herb for its acrid-warm nature to tonify the Kidney and move water, assisted by Myristicae Semen for its acrid-warm nature to tonify the Spleen and control water, made into pills with ginger and dates to generate yang qi through acrid-sweet properties; Third, Mingmen (Gate of Life) fire decline fails to generate Earth (Spleen); Fourth, Shaoyang qi deficiency lacks the ability to give birth to new things. Therefore, Wuweizi San uses Schisandrae Fructus as the sovereign herb for its sour-warm nature to gather the scattered fire of Kan Palace (Kidney), allowing Shao Huo (Ministerial Fire) to generate Qi to cultivate Earth, assisted by Evodiae Fructus for its acrid-warm nature to smooth the Liver wood's tendency to disperse, opening a path for water qi generation to serve spring growth. These four cases, although differing in etiology, present similar symptoms, all involving excessive water causing harm. Ershen Wan is a formula for restraining and controlling, while Wuweizi San is a formula for transformation and generation. Although the principles of these two formulas differ, their applications are similar; thus, they can be used interchangeably to enhance efficacy, or combined to achieve greater results. Combined, they form Sishen Wan (Four-Spirit Pill), which is a formula for both restraint and generation. Through restraint comes generation, and chronic diarrhea will naturally heal. It is called "Four Spirits," implying it acts faster than Lizhong Tang or Bawei Wan (Eight-Treasure Pill)!

[Commentary] When Mingmen lacks fire, it cannot perform the function of rotting and ripening food and drink in the Central Palace (Spleen/Stomach). When Kidney Qi is insecure, who manages the duty of closure and storage? Thus, when Wood Qi begins to sprout, even if there is no desire for dispersion, dispersion occurs. Although this appears to be Wood evil invading Earth, it is essentially Kidney deficiency insulting the Spleen. At this time, one should tonify both the Spleen and Kidney, secure and astringe, and calm the Liver. Therefore, Psoraleae Fructus is used to warm the Kidney, Myristicae Semen to tonify the Spleen, Schisandrae Fructus to secure and astringe, and Evodiae Fructus to drain the Liver. When the Kidney is warm, Qi steams normally; when the Liver is calm, the Spleen prospers; when the gate closes, food and drink are properly rotted and digested.