【肝肾虚肿之症】腹冷足冷，小水不利，或小腹肿，腰间痛，渐至肿及遍身，面色黑黄
，此肝肾经真阳虚，即《内经》石水症也。若水亏火旺，喘咳腹胀，内热便涩，此肝肾真阴虚肿，
即《内经》肾水症也。
【肝肾虚肿之因】肝主施泄，肾主闭藏，肝肾之真阳不足，不能司其开阖，则小水不利
。若阴精素虚，色欲太过，肝肾之真阴不足，虚火灼金，小水亦不利，《内经》所云关门不利，聚
【肝肾虚肿之脉】左脉迟弦，肝肾真阳不足。左脉细数，肝肾真阴不足。左脉沉紧，紧
则为寒，沉则为水。左脉沉数，沉则为里，数则阴竭。
【肝肾虚肿之治】肾阳不足，《金匮》肾气丸、河车丸。肾阴不足，人参固本丸，家秘
《金匮》肾气丸 见前脾虚肿。
河车丸 治先天不足，气血两亏。
人胞一具（煎烂），入白茯苓、山药，打为丸。
人参固本丸 见前肺虚肿。
家秘肝肾丸 治肾水不足，虚火上炎。
知母（二两） 黄柏（二两） 当归（三两） 白芍药（三两）
上为细末，另以天冬、地黄各六两，熬膏为丸。
桢按∶肝肾不足，宜分阴虚阳虚。例如治虚火，要分气分、血分。气分虚火，用补中益
，加黄柏、知母。血分虚火，四物汤加黄柏、知母。故治肝肾阴虚火旺者，用家秘肝肾丸，
以养真阴。阳虚火衰者，用八味丸，以养真阳。
[Symptoms of Deficiency Edema of Liver and Kidney] Coldness in the abdomen and feet, difficult urination, or swelling of the lower abdomen, pain in the waist, gradually progressing to edema throughout the body, with a dark yellow complexion. This is due to deficiency of True Yang (Zhen Yang) in the Liver and Kidney meridians, which corresponds to the condition of Stone Water (Shi Shui) described in the *Neijing* (Inner Canon). If Yin fluid is deficient and Fire is hyperactive, manifesting as panting, cough, abdominal distension, internal heat, and scanty or difficult defecation, this is deficiency edema caused by deficiency of True Yin (Zhen Yin) of the Liver and Kidney, corresponding to the condition of Kidney Water (Shen Shui) described in the *Neijing*.
[Etiology of Deficiency Edema of Liver and Kidney] The Liver governs dispersion and excretion, while the Kidney governs closure and storage. If True Yang of the Liver and Kidney is insufficient, it cannot properly regulate opening and closing, leading to difficult urination. If Essence and Yin are inherently deficient, compounded by excessive sexual indulgence, resulting in insufficiency of True Yin of the Liver and Kidney, deficiency Fire scorches Metal (Lung), causing difficult urination. As stated in the *Neijing*, "failure of the gate" leads to the accumulation of water.
[Pulse Diagnosis of Deficiency Edema of Liver and Kidney] A slow and wiry pulse on the left indicates deficiency of True Yang of the Liver and Kidney. A thready and rapid pulse on the left indicates deficiency of True Yin of the Liver and Kidney. A deep and tight pulse on the left: tightness indicates Cold, depth indicates Water retention. A deep and rapid pulse on the left: depth indicates interior syndrome, rapidity indicates exhaustion of Yin.
[Treatment of Deficiency Edema of Liver and Kidney] For insufficiency of Kidney Yang, use Shenqi Wan (Kidney Qi Pill) from *Jinkui Yaolue* (Essential Prescriptions from the Golden Cabinet) and Heche Wan (Placenta Pill). For insufficiency of Kidney Yin, use Renshen Guben Wan (Ginseng Root-Supporting Pill) and the author's secret formula Jinkui Shenqi Wan (see Spleen Deficiency Edema section above).
Heche Wan: Treats congenital insufficiency and dual deficiency of Qi and Blood.
Formula: One human placenta (jelly until soft), added with Baifuling (Poria) and Shanyao (Dioscorea Rhizome), pounded into pills.
Renshen Guben Wan: See Lung Deficiency Edema section above.
Jiami Ganshen Wan (Author's Secret Liver-Kidney Pill): Treats insufficiency of Kidney Water and rising deficiency Fire.
Ingredients: Zhimu (Anemarrhenae Rhizoma, 2 liang), Huangbai (Phellodendri Cortex, 2 liang), Danggui (Angelicae Sinensis Radix, 3 liang), Baishaoyao (Paeoniae Radix Alba, 3 liang).
Preparation: Grind the above ingredients into fine powder. Separately, decoct Tiandong (Asparagi Radix) and Dihuang (Rehmanniae Radix), each 6 liang, into a paste to form pills.
Commentary by Zhen: Insufficiency of the Liver and Kidney should be differentiated into Yin deficiency and Yang deficiency. For example, when treating deficiency Fire, one must distinguish between Qi level and Blood level. For deficiency Fire at the Qi level, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Huangbai and Zhimu. For deficiency Fire at the Blood level, use Siwu Tang (Four Substances Decoction) with added Huangbai and Zhimu. Therefore, for those with Liver-Kidney Yin deficiency and hyperactive Fire, use the author's secret Ganshen Wan to nourish True Yin. For those with Yang deficiency and declining Fire, use Bawei Wan (Eight-Ingredient Pill) to nourish True Yang.