治洞泄。寒中。注下。水谷。或痢赤白。食已即出。食物不消。
附子丸中连与姜。乌梅炒研佐之良。寒中泻痢皆神验。互用温凉请细详。（附子炮乌梅
肉炒。各一两。黄连炒二两。干姜炒一两为末。炼蜜丸桐子大。米饮下。三十丸。）
按原注云春伤于风。邪气流连。至夏发为餐泄。至长夏发为洞泄。○阴生于午。至未为
甚。长夏之时。脾土当旺。脾为阴中之至阴。故阴气盛。阴气既盛。则生内寒而洞泄矣。
治脾肾双虚。子后作泻。不思食。不化食。肾水受时于子。弱土。不能禁制故子后每泻。
四神故纸与吴萸。肉蔻除油五味须。大枣须同姜煮烂。（破故纸四两酒浸炒。吴萸一两
盐水炒。肉豆蔻二两面裹煨。五味子三两炒。大枣四十九枚。生姜四两同煎。枣烂去姜。捣
枣
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
各为立方以主之。大阴有理中四逆。厥阴有乌梅丸白头翁汤。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。诸法备美。然只为一脏立法。若三脏相关。久留不痊。
如子后作泻一症。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。君补骨脂之辛燥者。入肾以制水。佐肉豆蔻之辛温者。入脾以暖土。丸以枣肉。
又辛甘发散为阳也。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。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。而见症则同。皆水亢为害。二神丸是
承制之剂。五味散是化生之剂也。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。制生则化。久泄自瘳矣。称曰四神。比理中八味二丸较速
欤。
Treats Dongxie (profuse diarrhea with watery stools). Cold pathogen invading the interior. Watery and undigested food passing directly down. Or dysentery with red and white discharge. Vomiting immediately after eating. Food not digesting.
Fuzi Wan (Aconite Pill) contains Huanglian (Coptis Rhizome) and Ganjiang (Dried Ginger). Chao Wu Mei (Stir-fried Mume Fruit) ground and assisted for good effect. It is miraculous for cold-involved diarrhea and dysentery. Please carefully examine the mutual use of warming and cooling methods. (Pao Fuzi (Prepared Aconite Lateral Root), Chao Wumei (Stir-fried Mume Flesh) each 1 liang, Chao Huanglian (Stir-fried Coptis Rhizome) 2 liang, Chao Ganjiang (Stir-fried Dried Ginger) 1 liang, ground into fine powder, made into pills the size of tung tree seeds with refined honey, taken with rice water, 30 pills per dose.)
According to the original note: In spring, injured by wind, the pathogenic factor lingers. By summer, it manifests as Xunxie (diarrhea with undigested food). By late summer, it manifests as Dongxie (profuse watery diarrhea). ○ Yin energy arises at Wu hour, reaching its peak at Wei hour. During late summer, Spleen Earth is prosperous. The Spleen is the extreme Yin within Yin, so Yin energy is abundant. Since Yin energy is abundant, internal cold is generated, leading to Dongxie.
Treats dual deficiency of Spleen and Kidney. Diarrhea occurring after Zi hour (11 PM - 1 AM). Loss of appetite. Indigestion. Kidney Water is affected by the seasonal influence at Zi hour, weakening Earth, unable to control, hence diarrhea often occurs after Zi hour.
Sishen Wan consists of Po Gu Zhi (Kochia Seed/Burmannia Root? Note: Standard is Psoralea Fructus/Bu Gu Zhi) and Wu Yu (Evodia Fruit). Rou Dou Kou (Nutmeg) must have oil removed, Wu Wei Zi (Schisandra Berry) must be used together. Da Zao (Jujube) must be boiled rotten with Sheng Jiang (Fresh Ginger). (Po Gu Zhi 4 liang, soaked in wine and stir-fried; Wu Yu 1 liang, stir-fried with salt water; Rou Dou Kou 2 liang, baked in flour coating; Wu Wei Zi 3 liang, stir-fried; Da Zao 49 pieces, Sheng Jiang 4 liang boiled together. After dates are soft, remove ginger, mash the dates.)
Ke Yunbo said: Diarrhea and dysentery are abdominal diseases, and the abdomen is the meeting place of the Three Yin meridians. If one zang organ is dysfunctional, it can cause diarrhea and dysentery. Therefore, for lower jiao diarrhea involving the Three Yin meridians, Zhang Zhongjing formulated specific prescriptions to treat them. Taiyin has Lizhong Tang (Regulate the Middle Decoction) and Sini Tang (Frigid Extremities Decoction); Jueyin has Wumei Wan (Mume Pill) and Baitouweng Tang (Pedicularis Root Decoction); Shaoyin has Taohua Tang (Peach Flower Decoction), Zhenwu Tang (True Warrior Decoction), Zhuling Tang (Polyporus Decoction), Zhufu Tang (Pig Skin Decoction), Sini San (Frigid Extremities Powder), Baotong Tang (Unblock Yang Decoction), Tongmai Sini Tang (Unpulse Frigid Extremities Decoction), etc. This can be said to exhaustively address the disease conditions, with all methods being excellent. However, these only legislate for a single zang organ. If three organs are related and the illness persists without cure, such as the symptom of diarrhea after Zi hour, it had not been covered before. From Jiming (Chicken Crowing time, approx. 3-5 AM) to Pingdan (Daybreak, approx. 5-7 AM), it is the Yin of Heaven, also known as Yang within Yin. Because Yang Qi should arrive but does not, empty pathogens remain and do not depart, thus causing diarrhea at dawn. There are four causes: First, Spleen deficiency cannot control Water; Second, Kidney deficiency cannot move Water. Hence Ershen Wan (Two Spirit Pill), using the pungent and drying Bu Gu Zhi (Psoralea Fructus) as the sovereign herb, entering the Kidney to control Water; assisting with the pungent and warm Rou Dou Kou (Myristica Semen), entering the Spleen to warm Earth. Made into pills with Jujube flesh, which is pungent and sweet, dispersing to generate Yang. Third, Mingmen Fire decline cannot generate Earth; Fourth, Shaoyang Qi deficiency cannot facilitate renewal. Hence Wuweizi San (Schisandra Powder), using the sour and warm Wu Wei Zi (Schisandra Fructus) as the sovereign herb, to gather the scattered fire of Kan Palace, where minor fire generates Qi to cultivate Earth; assisting with the pungent and warm Wu Zhu Yu (Evodia Fructus), to follow the tendency of Liver Wood to disperse, opening a path for Water Qi to generate, to serve the Spring generation. These four cases, although the etiology differs, present the same symptoms, all due to excessive Water Qi causing harm. Ershen Wan is an agent of restraint and control; Wuweizi San is an agent of transformation and generation. The principles of the two formulas differ, but their application is the same, so they can be used interchangeably to enhance efficacy, or combined to achieve results. Combined, they form Sishen Wan (Four Spirit Pill), which is an agent of restraint and generation. Restraint and generation lead to transformation, and chronic diarrhea will naturally heal. Called "Four Spirit," is it faster than Lizhong Tang, Bawei Wan (Eight Immortals Pill), and Ershen Wan?