〔钱〕肾主虚。无实也，惟疮疹肾实则黑陷。儿本虚怯，由胎气不成，则神
不足，目中白睛多，其颅则解，囟开，面色 白，此皆难养，纵长不过八八之数，
若恣色欲，不及四旬而亡。或有因病而致肾虚者，非也。又，肾气不足则下窜，盖
骨重惟欲坠下而身缩也。肾者阴也，肾虚则畏明，皆宜补肾，地黄丸主之。（心气热则
上窜、宜导赤散，肾气虚则下窜、宜地黄丸是也。）肾病见夏，水胜火，肾胜心也，当治肾，轻者
肾病退，重者悸动当搐。〔洁〕肾主寒，自病则足胫寒而逆。人之五脏，惟肾无实，
小儿疮疹变黑陷，则是肾实，水克退心火。心乘肾，微邪，内热不恶寒，桂枝汤
主之。肺乘肾，虚邪，喘嗽皮涩寒，百部丸主之。肝乘肾，实邪，拘急气搐身
寒，理中丸主之。脾乘肾，贼邪，体重泄泻身寒，理中丸主之。〔刘〕五行之中，
惟有肾之一脏，母盛而子反受邪，何则？肺属金，射于皮毛，所主者气。肾属水，
主于骨髓，所藏者精。气之轻浮，能上而不能下，精之沉重，能下而不能上，此物
性之自然，今肺之盛，盖热之作也，热上蒸于肺，则不能下生于肾，而肾受邪矣。
急服凉药解之，使肺气清和而后可，此肾病必先求之于肺，若肺脏安和而肾忽然受
病者，不过脾之湿相刑于肾而生疾，所以有解肺热、去脾邪两药，若脾肺两脏俱和
而肾自生疾，亦察其本脏而治之。〔薛〕下窜等证，足不喜覆者，盖腰以下皆肾所
主，乃心气下行于肾部也，法用地黄丸壮肾水以制心火。若因脾肺虚而不能生肾水
者，用补中益气汤、六味地黄丸以滋化源。其疮疹黑陷，乃肾虚而邪气实也，尤
当用地黄丸。
地黄丸（钱氏）
熟干地黄（八钱） 山茱萸肉 干山药（各四钱） 泽泻 牡丹皮 白茯苓（去皮。各三钱）
上为末，炼蜜和丸如桐子大。三岁以下一二至三丸，空心温水化下。
〔垣〕或问，钱氏地黄丸补肾，又曰补肝何也。曰然，手厥阴心主包络、足厥阴肝
经、俱治在下焦，经云∶不足者，滋其化原，故肝肾之病，同一治法，此地黄丸
补二经之意也。海藏云∶若加五味，为肾气丸，此滋肺之源，以生肾水。
〔薛〕前丸，治肾肝血虚，燥热作渴，小便淋秘，痰气上壅。或风客淫气，瘰
结核。或四肢发搐，眼目 动。或咳嗽吐血，头目眩晕。或咽喉燥痛，口舌疮裂。
或自汗盗汗，便血诸血。或禀赋不足，肢体瘦弱，解颅失音。或畏明下窜，五迟
五软，肾疳肝疳。或早近女色，精血亏耗，五脏齐损。凡属肾肝诸虚不足之证，
宜用此以滋化原，其功不可尽述。
〔海〕肾实，须泽泻泻之。肾本无实，不可泻，钱氏止有补肾地黄丸，无泻肾之
药。治脉洪而实，钱氏地黄丸加生地黄，去山茱萸是也，此治左手本部脉实。
若右尺洪实，以凤髓丹泻之。（凤髓丹、方见杂病遗精门。）
[Qian Yi] The Kidney governs deficiency and has no excess conditions, except when sores and rashes manifest as black depression due to Kidney excess. Children are inherently weak and timid; if the fetal qi is incomplete, the Shen (Spirit) is insufficient, presenting with excessive white sclera, open cranial sutures, wide fontanelles, and pale complexion. These conditions are difficult to nurture; even if they survive, they rarely live beyond sixty-four years (the number of eight eights). If parents indulge in sexual desire excessively, the child may die before forty. The notion that illness causes Kidney deficiency is incorrect. Furthermore, insufficient Kidney Qi leads to downward shrinking/curling, as the bones feel heavy and wish to fall while the body contracts. The Kidney belongs to Yin; Kidney deficiency causes fear of light. All these cases are suitable for tonifying the Kidney, primarily using Dihuang Wan (Rehmannia Pill). (If Heart Qi is hot, it leads to upward curling, treated with Daochi San; if Kidney Qi is deficient, it leads to downward curling, treated with Dihuang Wan.) When Kidney disease appears in summer, Water overcomes Fire, meaning the Kidney overcomes the Heart; treatment should focus on the Kidney. In mild cases, the Kidney disease recedes; in severe cases, palpitations and tremors may occur, leading to convulsions.
[Li Gao] The Kidney governs Cold. Self-disease presents as coldness and reversal in the lower legs and calves. Among the five Zang organs, only the Kidney has no excess condition. When pediatric sores and rashes turn black and depress, it indicates Kidney excess, where Water overcomes and retreats Heart Fire. If the Heart pathogen attacks the Kidney, it is a slight pathogen, presenting with internal heat but no aversion to cold, treated with Guizhi Tang (Cinnamon Twig Decoction). If the Lung pathogen attacks the Kidney, it is a deficient pathogen, presenting with wheezing, cough, dry/rough skin, and coldness, treated with Baibu Wan (Stemona Pill). If the Liver pathogen attacks the Kidney, it is an excess pathogen, presenting with stiffness/tension, Qi spasms, and coldness, treated with Lizhong Wan (Regulate the Middle Pill). If the Spleen pathogen attacks the Kidney, it is a destructive pathogen, presenting with heaviness, diarrhea, and coldness, treated with Lizhong Wan (Regulate the Middle Pill).
[Liu Wansu] Among the Five Elements, only the Kidney organ exhibits a situation where the Mother element is excessive and the Child element suffers from pathogenic influence. Why? The Lung belongs to Metal, connects to the skin and hair, and governs Qi. The Kidney belongs to Water, governs bone marrow, and stores Jing (Essence). Qi is light and floating, capable of ascending but not descending; Jing is heavy and sinking, capable of descending but not ascending. This is the natural property of things. Currently, Lung excess is likely caused by Heat. Heat steams upward into the Lung, preventing it from descending to nourish Kidney Water, thereby causing the Kidney to suffer from pathogens. One must urgently administer cooling medicines to resolve this, allowing Lung Qi to become clear and harmonious. This illustrates why Kidney disease must first seek its cause in the Lung. If the Lung is harmonious but the Kidney suddenly becomes diseased, it is merely due to Spleen Dampness punishing the Kidney and generating illness. Hence, there are remedies to clear Lung Heat and remove Spleen Pathogens. If both Spleen and Lung are harmonious yet the Kidney generates disease spontaneously, one must observe the primary organ and treat accordingly.
[Xue Ji] Symptoms such as downward curling, where the feet dislike being covered, occur because the area below the waist is governed by the Kidney, representing Heart Qi descending into the Kidney region. The method is to use Dihuang Wan (Rehmannia Pill) to strengthen Kidney Water to control Heart Fire. If the cause is Spleen and Lung deficiency failing to generate Kidney Water, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to nourish the source of transformation. Regarding sores and rashes turning black and depressing, this is Kidney deficiency with excess pathogens, requiring Dihuang Wan (Rehmannia Pill).
Dihuang Wan (Qian Shi's Formula):
Shudihuang (Prepared Rehmannia Root, 8 qian), Shanzhuyu (Cornus Fruit Flesh), Shanyao (Dioscorea Rhizome, each 4 qian), Zexie (Alisma Rhizome), Mudanpi (Moutan Cortex), Bai Fuling (Poria with Removed Skin, each 3 qian).
Grind all into powder, mix with refined honey, and form pills the size of tung seeds. For children under three years old, administer 1 to 3 pills per dose, dissolved in warm water on an empty stomach.
[Zhang Yuansu] Someone asked: Qian Shi's Dihuang Wan tonifies the Kidney, yet also says it tonifies the Liver. Why? I reply: The Hand Jueyin Pericardium and Foot Jueyin Liver Meridians both govern the Lower Jiao. The Classics state: "For insufficiency, nourish the source of transformation." Therefore, diseases of the Liver and Kidney share the same treatment method; this is the intent behind Dihuang Wan tonifying these two meridians. Haizang (Zhang Yuansu's pseudonym) said: If Wuweizi (Schisandra Berry) is added, it becomes Shenqi Wan (Kidney Qi Pill), which nourishes the Lung source to generate Kidney Water.
[Xue Ji] The aforementioned pill treats Liver and Kidney Blood deficiency, dryness-heat causing thirst, dysuria or retention, and phlegm-Qi obstruction above. It treats wind pathogens invading with chaotic Qi, leading to scrofula or nodules. It treats limb convulsions and eye twitching. It treats coughing with blood, dizziness, and vertigo. It treats dry/painful throat, and cracked mouth/tongue ulcers. It treats spontaneous sweating, night sweats, hematochezia, and various bleeding disorders. It treats congenital insufficiency, emaciation, open cranium (jie lu), and aphonia. It treats aversion to light, downward curling, five delays, five softnesses, Kidney Gan, and Liver Gan. It treats premature sexual activity, depletion of Jing and Blood, and damage to all five Zang organs. For all conditions belonging to Liver and Kidney deficiency and insufficiency, this formula is suitable to nourish the source of transformation; its merits cannot be fully described.
[Hua Shou] For Kidney Excess, Ze Xie (Alisma) must be used to drain it. The Kidney fundamentally has no excess and should not be drained. Qian Shi only had Bushen Dihuang Wan (Tonify-Kidney Rehmannia Pill) and no draining-Kidney medicine. To treat a pulse that is surging and excess, Qian Shi's Dihuang Wan adds Shengdihuang (Raw Rehmannia Root) and removes Shanzhuyu (Cornus Fruit); this treats excess in the primary pulse position of the left hand. If the Right Chi (Gate) pulse is surging and excess, use Fengsui Dan (Phoenix Marrow Pill) to drain it. (Fengsui Dan, see the section on miscellaneous diseases regarding spermatorrhea.)