治肺痿声嘶。喉痹咳血烦躁。
即通关丸（见通剂）
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
症生。此时以六味补水。水不能遽生也。以生脉保金。金不免犹燥也。惟急用黄柏之苦以坚
肾。则能伏龙家之沸火。是谓浚其源而安其流。继用知母之清以凉肺。则能全破伤之燥金。
是谓沛之两而腾之露。然恐水火之不相入而相射也。故益以肉桂之反佐为用。兼以导龙归海。
于是坎盈KT 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。始能致水耳。盖天一生水者。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。亦承制之理也。
治阴虚火旺。骨蒸发热。日静夜剧者。妇人热入血室。胎前发热者。
即四物汤。加地骨皮牡丹皮各三钱。（四物汤见补剂）柯韵伯曰。阴虚者。阳必凑之。
故
热。仲景曰。阴弱则发热。阳气下陷入阴中。必发热。然当分三阴而治之。阳邪陷入太阴脾
部。当补中益气以升举之。清阳复位。而火自熄也。若陷入少阴肾部。当六味地黄丸以对待
之。壮永之主而火自平也。陷入厥阴肝部。当地骨皮饮以凉补之。血有所藏。而火自安也。
四物汤为肝家滋阴调血之剂。加地骨皮。清志中之火以安肾。补其母也。加牡丹皮。清神中
之火以凉心。泻其子也。二皮凉而不润。但清肝火。不伤脾胃。与四物加知柏之湿润而苦寒
者。不同矣。故逍遥散。治肝火之郁于本脏者也。木郁达之。顺其性也。地骨皮饮。治阳邪
之陷于肝脏也。客者除之。勿纵寇以遗患也。二者皆肝家得力之剂。
Treats hoarseness due to Lung Consumption (Fei Wei). Pharyngolaryngeal obstruction (Hou Bi), hemoptysis, and irritability.
This is Tongguan Wan (see section on Unblocking Agents).
Luo Dongyi stated: This pill is designed for conditions of Kidney water exhaustion with flaming fire. When water is exhausted, the Kidney becomes dry; when the Kidney is dry, the springs below do not nourish, leading to excess Yang above.
Thus these symptoms arise. At this time, if Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is used to replenish water, the water cannot be generated immediately; if Shengmai San (Generate the Pulse Powder) is used to protect the Metal (Lung), the Metal inevitably remains dry. Only by urgently using the bitter nature of Huangbai (Phellodendri Cortex) to firm the Kidney can the boiling fire of the Dragon (Kidney Fire) be subdued. This is called dredging the source to calm the flow. Subsequently, using the cooling nature of Zhimu (Anemarrhenae Rhizoma) to cool the Lung can repair the damaged dry Metal. This is likened to abundant rain rising as dew. However, fearing that Water and Fire may not integrate but instead clash, Rougui (Cinnamomi Cortex) is added as a counter-agent (fan zuo) to facilitate its use, simultaneously guiding the Dragon back to the sea (Kidney).
Thus, the Kan (Water/Kidney) palace becomes full, and the flow gradually increases. This is the essence of Zishen Wan (Nourishing Kidney Pill). Ke Yunbo stated: Water is the substance of the Kidney, and Fire is the function of the Kidney. People know that there is water in the Kidney to control fire, but they do not know that there is fire in the Kidney to generate water. The concept that "Heaven generates One Water" refers to Yang Qi, which is Fire. Qi is the mother of Water, and Yang is the root of Yin. Only when Fire has a place to return can Water have a master. Therefore, the sweet-warm nature of Gui (Rougui/Cinnamomi Cortex) is used as a counter-agent to guide Zhimu and Huangbai into the Kidney meridian to achieve their effects. This reflects the profound principle of mutual assistance (xiang xu) and the theory of restraint and transformation (cheng zhi).
Treats deficiency heat due to Yin deficiency with hyperactive Fire. Bone-steaming tidal fever. Conditions where symptoms are quiet during the day and severe at night. Heat entering the Blood Chamber (Xue Shi) in women. Fever during pregnancy.
Use Siwu Tang (Four Substance Decoction). Add Digupi (Bark of Ground Tree Borer/Digupi) and Mudanpi (Peony Bark/Mudanpi), each 3 qian. (Siwu Tang see section on Tonifying Agents). Ke Yunbo stated: In cases of Yin deficiency, Yang must encroach upon it.
Thus fever occurs. Zhang Zhongjing said: When Yin is weak, fever ensues. When Yang Qi sinks and enters the Yin, fever necessarily occurs. However, treatment should be differentiated according to the three Yin meridians. If Yang pathogen sinks into the Taiyin Spleen region, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be used to raise it. When clear Yang returns to its position, the fire extinguishes itself. If it sinks into the Shaoyin Kidney region, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) should be used to address it. Strengthening the ruler of the Yong (eternal) master causes the fire to calm itself. If it sinks into the Jueyin Liver region, Digupi Yin (Digupi Decoction) should be used for cooling and tonification. When blood is properly stored, the fire settles itself.
Siwu Tang is a formula for nourishing Yin and regulating blood in the Liver. Adding Digupi clears the fire within Zhi (Will/Spirit associated with Kidney) to pacify the Kidney, thereby tonifying its mother (Water generates Wood; Kidney is the mother of Liver). Adding Mudanpi clears the fire within Shen (Spirit/Shen associated with Heart) to cool the Heart, thereby draining its child (Wood generates Fire; Liver is the mother of Heart). These two barks are cooling but not moistening; they only clear Liver Fire without damaging the Spleen and Stomach, which differs from Siwu Tang combined with Zhimu and Huangbai, which are moistening and bitter-cold. Therefore, Xiaoyao San (Free and Easy Wanderer Powder) treats Liver Fire depressed in its own organ, following the principle of "Wood depression should be dispersed," adhering to its natural nature. Digupi Yin treats Yang pathogen sinking into the Liver, following the principle of "Remove the intruder," not allowing the bandit to remain and cause trouble. Both are effective formulas for the Liver.