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Remove Cinnamon Twig (Guizhi) and Aconite Root (Fuzi) from the preceding formula.

Kidney deficiency generates internal heat, akin to water boiling to produce phlegm; this formula governs such conditions.
The Kidney contains not only Kidney Water but also the Fire of the Gate of Vitality (Mingmen). When the Kidney is not deficient, Kidney Water is sufficient to control the Fire of the Gate of Vitality;
when deficient, the Fire loses control and heat syndromes arise. In cases of Qi deficiency with flooding phlegm-dampness, it is appropriate to use Shenqi Wan (Kidney Qi Pill) for long-term tonification and expulsion of pathogenic factors. In cases where Yin fire rises, causing body fluids to congeal into phlegm rather than transform into blood, it is appropriate to strengthen Water (nourish Kidney Yin) to control Ministerial Fire,
so that phlegm-heat is naturally eliminated. Rehmanniae Radix (Dihuang) nourishes Yin and tonifies blood, serving as the principal herb for the Kidney. However, used alone, it tends to move Qi upward and Blood into the collaterals, failing to guide its essence into the Kidney; therefore, five other herbs are needed as assistants.
Huai Shan Yao (Dioscoreae Rhizoma), a Spleen herb, connects Earth and Water through the Spleen-Kidney relationship, and can firm the Earth in the lower abdomen, which is the source of True Water; Corni Fructus (Shanzhuyu), a Liver herb, shares the same position as Water and Wood (Liver-Kidney homology); its sour and astringent properties are borrowed to consolidate overflowing leakage; Moutan Cortex (Mudanpi) originally clears Heart Fire; since Heart and Kidney reside in a water-fire relationship, clearing Southern Heart Fire thereby benefits Northern Kidney Water; additionally, Poria (Fuling) uses light leaching to drain Yang pathogens, and Alisma Rhizoma (Zexie) uses salty cold to descend Yin, dredging and draining so that water flows downward, completing its function. This is the aforementioned Eight-Ingredient Pill (Shenqi Wan/Qianji Guizhi Fuling Wan). Qian Yi (Qian Zhongyang) used it to treat children's "pure Qi of young Yang," accurately addressing illness caused by Yin deficiency, thus removing Cinnamon Twig and Aconite Root to create this formula (Liuwei Dihuang Wan), which proved miraculously effective. Xue Ji (Xue Xinpu) of the Ming Dynasty realized that for any condition involving Yin deficiency with hyperactive fire, if Zhu Danxi’s method of nourishing Yin fails, replacing it with this formula yields immediate results. Wang Ang stated that this formula treats all six meridians but specializes in the Liver and Kidney, neither biased toward cold nor dryness, while simultaneously tonifying Qi and Blood. If taken regularly, its merits are hard to exhaust. Since this theory spread, literati with empty stomachs revered it as a holy fruit for health preservation, with men, women, old, and young competing to take it without doubt.
Little did they know that Mudanpi and Zexie, except in cases of Kidney failure where Water cannot nourish to control Fire, leading to flaming upward heat, prolonged heat generating wind and phlegm, resulting in red painful eyes and scanty dysuric urine, are rarely used together for other conditions. How can one take them routinely without cause? Li Shicai said there are four errors in using this formula: if Dihuang is not from Huaiqing, its potency is weak; if steamed and dried less than nine times, it is not fully cooked; if reduced due to suspicion of Dihuang’s cloying nature, the sovereign herb becomes weak; if reduced due to dislike of Zexie’s draining nature, the ministerial force becomes slight. Falling into these four errors yet blaming the drugs for ineffectiveness is foolish. I believe that for those using this formula for conditions other than those previously described, there are also four errors: when Liver Wood does not flourish, Mudanpi is unnecessarily used to suppress it; when Water is not sufficient, Zexie is unnecessarily used to drain it; when Fire does not flare upward, Dihuang is unnecessarily used to restrain it; when Spleen Earth is not damp-wet, Fuling is unnecessarily used to leach it.
Having these four errors yet boasting of the drug’s magic is foolish. Moreover, Xue Ji’s modifications of this formula were numerous, showing that every syndrome and herb has flexible applications; one cannot generalize Liuwei Dihuang Wan to cover all diseases.
I will briefly describe a few below: One variation is Zishen Shenggan Yin (Nourish Kidney Generate Liver Drink), combining this formula with Xiaoyao San, removing White Peony Root (Baishao) and adding Schisandra Fructus (Wuweizi). Schisandra is used instead of Baishao because, since we nourish, we should assist; since we generate, we should regulate; One variation is Ziyin Shenqi Wan (Nourish Yin Kidney Qi Pill), removing Corni Fructus from this formula and adding Bupleuri Radix (Chaihu), Schisandra Fructus, and Angelicae Sinensis Radix Rubra (Guiwei). Corni Fructus is removed to avoid forcing Liver Wood to rise; Schisandra tonifies Lung Metal to control Liver Wood; Guiwei moves blood stasis; Chaihu soothes Liver Qi. One variation is Renshen Bujing Tang (Ginseng Tonify Qi Decoction), removing Alisma Rhizoma from this formula and combining with Yigong San to tonify blood and generate pulse. This is because for fever and thirst, theoretically, fluids should not be further depleted, hence Alisma is removed. Since depletion must be avoided, generating the pulse is urgent, which explains the origin of Shengmai San. Since generating the pulse is required, Yigong San’s blood tonification can be incorporated. One variation is Jiawei Dihuang Wan (Modified Rehmannia Pill), adding Bupleuri Radix, White Peony Root, and Schisandra Fructus to this formula. This is due to itchy/painful ears, blurred vision, phlegm-panting, heat-thirst, and difficult urination, all caused by Liver-Kidney Yin deficiency with constrained Fire. Yin deficiency is treated with Schisandra to tonify; constrained Fire is treated with Bupleuri to disperse; White Peony Root is used to calm. One variation is Jiwei Dihuang Wan (Nine-Ingredient Rehmannia Pill), adding Toosendan Fructus (Chuanlianzi), Angelicae Sinensis Radix, Quisqualis Fructus (Shijunzi), and Ligusticum Chuanxiong Rhizoma (Chuanxiong) to this formula, all herbs of Jueyin Wind-Wood. Since various childhood malnutrition syndromes (Gan) involve parasites, which transform from Wind-Wood, this remains a method of treating Liver and Kidney together. One variation is Yiyin Shenqi Wan (Benefit Yin Kidney Qi Pill), adding Schisandra Fructus, Angelicae Sinensis Radix, and Rehmanniae Radix Recens (Shengdihuang) to this formula. The listed symptoms include tidal fever, afternoon fever, and chest/diaphragm fullness. This is Dry-Fire of Liver-Gallbladder obscuring and hiding in the Stomach; although combining with Duqi Wan, without adding Angelica and Rehmannia, how can one clear Stomach Fire and generate Stomach Yin? Furthermore, there are variations adding Schisandra, Ophiopogonis Tuber (Maidong), Eucommiae Cortex (Duzhong), Achyranthis Bidentatae Radix (Niuxi), Angelica and White Peony, Bupleuri and White Peony, Alpinia Oxyphylla Fructus (Yizhiren), or Human Placenta (Ziheche). The changes are infinite; why must one rigidly stick to Liuwei Dihuang Wan as an unchangeable excellent prescription for ancient and modern times? Alas! Mudanpi and Zexie drain both Water and Fire; excessive or indiscriminate use causes blurred vision and impotence. If transformed further by Fire, essence leakage is inevitable. After repeated essence leakage, the pulse becomes rapid and large; failing to consider that constrained Fire should be dispersed, instead一味ly using Water-draining methods; failing to consider that warmth can remove heat, instead一味ly using bitter-cold to firm the Kidney, adding Phellodendri Cortex (Huangbai) and Anemarrhenae Rhizoma (Zhimu) leading to death—I have witnessed three such cases in five years. Over the next ten or twenty years, who knows how many more there will be. Words cannot fully express my feelings; writing this, I feel melancholic.