肾泄者，五更溏泄也。肾虽水脏，而中有元阳，为脾土之母。又肾者主蛰，封藏之本，
而开
窍于二阴，肾阳既虚，即不能温养于脾，又不能禁固于下，故遇子后阳生之时，其气不振，
阴寒反胜，则腹鸣奔响作胀，泻去一二行乃安，积月不愈，或至累年。此病藏于肾，宜治下
而不宜治中者也。
五味子散
五味子（一两） 吴茱萸（半两，细粒绿色者）
上二味，同炒香熟为度，细末每二钱，陈米饮下。
许氏云∶顷年有一亲识，每五更初欲晓时，必溏泄一次，如是数月。有人云∶此名肾泄
，感阴气而然，得此顿愈。
四神丸
肉豆蔻 五味子（各二两） 补骨脂（四两） 吴茱萸（浸炒，一两）
上为末，生姜八两，红枣一百枚，煮熟取枣肉和丸如梧子大，每服五七十丸，空心或食
前白
汤下。一云∶夜食前更进一服。盖暖药虽平旦服之，至夜力已尽，无以敌一夜阴气之故也。
《澹寮》无五味、吴萸，有茴香一两，木香半两。一方去五味、吴萸、入神曲、麦芽。
按∶五更溏泄，不独肾虚一端，酒积、食积、寒积，皆作此病。概与温肾，非其治矣。
食积
、酒积，治法详久泄，吞红丸子，或单服曲 枳术丸。寒积者，积寒在脾肾，宜魏氏椒朴丸
。
椒朴丸
益智仁（去壳，炒） 川椒（炒出汗） 川浓朴（姜制） 陈皮 白干姜 茴香（炒，各等分）
上用青盐等分，于银石器内，以水浸前药，慢火煮干，焙燥为末，酒糊丸如梧子大，每
服三十丸，加至四十丸，空心盐汤温酒任下。
伤酒者，湿热在脾，宜理中汤加干葛、黄连，或葛花解酲汤，吞酒煮黄连丸。
饮食过多，脾胃之气，不能运化，其人必嗳气如败卵，宜治中汤加砂仁半钱，吞红丸子
，或单服曲 枳术丸。
Shen Xie (Kidney Diarrhea) refers to loose stools occurring during the fifth watch of the night (approximately 3-5 AM). Although the Kidney is a Water organ, it contains Primordial Yang, which serves as the mother of Spleen Earth (i.e., congenital foundation nourishes acquired foundation). Furthermore, the Kidney governs hibernation and sealing/storing; it is the root of consolidation. Its orifices open at the two yin passages (anterior and posterior). If Kidney Yang is deficient, it cannot warm and nourish the Spleen, nor can it secure the lower jiao. Therefore, when Yang begins to generate after the Zi hour (11 PM - 1 AM), Qi fails to rise, and Yin-Cold prevails. This leads to abdominal borborygmus, a sensation of Qi rushing upward (Ben Teng), and distension. Relief is felt only after one or two bowel movements. The condition persists for months or even years. Since this disease resides in the Kidney, treatment should focus on the lower jiao rather than solely on the middle jiao (Spleen/Stomach).
Wuweizi San (Schisandra Powder)
Schisandrae Fructus (Wuweizi, 五味子) (1 liang) Evodiae Fructus (Wuzhuyu, 吴茱萸) (0.5 liang, select small, green grains)
The above two herbs are stir-fried together until fragrant and fully cooked, then ground into a fine powder. Take 2 qian per dose, administered with aged rice water.
Xu stated: In recent years, an acquaintance suffered from loose stools once every morning just before dawn for several months. Someone suggested: This is called Shen Xie (Kidney Diarrhea), caused by invasion of Yin Qi. Taking this formula resulted in immediate cure.
Sishen Wan (Four Spirits Pill)
Myristicae Semen (Roudoukou, 肉豆蔻) Schisandrae Fructus (Wuweizi, 五味子) (each 2 liang) Psoraleae Fructus (Buguzhi, 补骨脂) (4 liang) Evodiae Fructus (Wuzhuyu, 吴茱萸) (soaked and stir-fried, 1 liang)
Grind the above herbs into a powder. Take 8 liang of fresh Ginger and 100 Red Dates, boil until cooked, remove the flesh of the dates, and mix with the powder to form pills the size of Sophora seeds. Take 50-70 pills per dose, administered with plain warm water on an empty stomach or before meals. Another method suggests taking an additional dose before bed. This is because although warming herbs taken in the morning may seem effective, their power dissipates by night, leaving them unable to counteract the Yin Cold of the entire night. The *Danliao* prescription excludes Wuweizi and Wuzhuyu but includes 1 liang of Foeniculum Vulgare (Huixiang, 小茴香) and 0.5 liang of Aucklandiae Radix (Muxiang, 木香). Another variation removes Wuweizi and Wuzhuyu, adding Massae Medicatae Fermentatae (Shenqu, 神曲) and Hordeum Fructus Germinatus (Maiya, 麦芽).
Note: Loose stools at the fifth watch are not exclusively due to Kidney deficiency. Alcohol accumulation, Food stagnation, and Cold accumulation can all cause this condition. Applying warming Kidney tonics indiscriminately is incorrect.
For Food stagnation and Alcohol accumulation, refer to the treatment of chronic diarrhea: take Hongwanzi (Red Pills) or Qu Zhizhu Wan (Qu Zhizhu Pills). For Cold accumulation, where cold pathogens accumulate in the Spleen and Kidney, Wei’s Jiaopu Wan (Pepper and Magnolia Bark Pill) is appropriate.
Jiaopu Wan
Alpiniae Oxyphyllae Fructus (Yizhiren, 益智仁) (shelled, stir-fried) Zanthoxyli Fructus (Chuanjiao, 川椒) (stir-fried until "sweating") Magnoliae Officinalis Cortex (Chuanhoupo, 川厚朴) (processed with ginger juice) Citri Reticulatae Pericarpium (Chenpi, 陈皮) Zingiberis Rhizoma Recens (Baiganyjiang, 白干姜) Foeniculum Vulgare (Huixiang, 茴香) (stir-fried, equal parts)
Take equal parts of Halitum (Qingyan, 青盐). Place the above herbs in a silver or ceramic vessel, soak them in water, and simmer slowly over low heat until the water evaporates. Dry the mixture, grind into powder, and bind with wine paste to form pills the size of Sophora seeds. Take 30 pills initially, increasing to 40 pills. Administer on an empty stomach with salt water or warm wine.
For alcohol injury, where damp-heat accumulates in the Spleen, use Lizhong Tang (Regulate the Middle Decoction) modified with Puerariae Radix (Gange, 干葛) and Coptidis Rhizoma (Huanglian, 黄连), or Gehua Jiexing Tang (Kudzu Flower Decoction to Resolve Intoxication), swallowing Jiuzhu Huanglian Wan (Alcohol-Boiled Coptis Pills).
For excessive food intake, where Spleen and Stomach Qi fail to transform and transport, the patient will likely belch with a smell resembling rotten eggs. Treat with Zhizhong Tang (Regulate the Middle Decoction) plus 0.5 qian of Amomi Fructus (Sharen, 砂仁), swallow Hongwanzi (Red Pills), or take Qu Zhizhu Wan (Qu Zhizhu Pills) alone.