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。
治疗肺痿引起的声音嘶哑。喉痹、咳血、烦躁不安。
即通关丸（见通剂章节）
罗东逸说：这个丸药是为肾水枯竭、虚火上炎的情况而设立的。水枯竭则肾阴干涸，肾阴干涸则下焦源泉不充盛，导致阳气亢盛于上。
因此产生这些症状。此时如果用六味地黄丸补水，水液不能迅速生成；用生脉散保肺金，肺金难免仍然干燥。只有紧急使用黄柏的苦味来坚固肾气，才能降伏肾中如龙雷般的沸火，这叫作疏通源头以安定水流。接着使用知母的清凉来滋润肺脏，才能修复受损的燥金，这叫作沛然降雨并升腾为露水。然而担心水火不相容而相互冲射，所以加入肉桂作为反佐药发挥作用，同时引导龙火回归大海（肾）。
于是肾水充盈（KT注：原文“KT”疑为衍文或排版错误，意指坎宫/肾水），水流逐渐增长。这就是滋肾丸的宗旨。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，才能化生水。所谓“天一生水”，指的是阳气，也就是火。气是水之母，阳是阴之根。必须让火有所归依，水才有所主宰。所以用肉桂的甘温作为反佐，引导知母、黄柏进入肾经而发挥疗效。这是相辅相成的深厚道理，也是承制（制约与生化）的原理。
治疗阴虚火旺。骨蒸潮热。白天安静晚上加重的情况。妇人热邪陷入血室。产前发热的情况。
即用四物汤。加地骨皮、牡丹皮各三钱。（四物汤见补剂章节）柯韵伯说：阴虚的人，阳气必定凑合其上。
所以发热。张仲景说：阴弱则发热，阳气下陷进入阴分中，必然发热。然而应当根据三阴经分别治疗。阳邪陷入太阴脾部，应当用补中益气汤来升举它，清阳复位，火自然熄灭。如果陷入少阴肾部，应当用六味地黄丸来应对，壮大肾主之气而火自然平息。陷入厥阴肝部，当地骨皮饮来凉补。血液有所藏摄，火自然安宁。
四物汤是肝脏滋阴调血的方剂。加入地骨皮，清除志中之火以安肾，这是补其母（水生木，肾为肝母）。加入牡丹皮，清除神中之火以凉心，这是泻其子（木生火，肝为心母）。这两味皮类药材性凉而不滋润，只清肝火，不损伤脾胃，这与四物汤加知母、黄柏的湿润苦寒性质不同。所以逍遥散，治疗肝火郁结在本脏的情况，顺应肝木条达之性。地骨皮饮，治疗阳邪陷入肝脏的情况，祛除客邪，不要放纵寇贼留下后患。这两者都是肝脏得力的方剂。
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.