〔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 primarily governs deficiency patterns and has no excess patterns, except when in the context of smallpox/rash (Chuangzhen), an "excess" condition manifests as black depression. Children are inherently weak and timid; due to incomplete fetal qi development, their Shen (Spirit) is insufficient. This presents with excessive white sclera, fontanelles that fail to close or split open, and a 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. There are cases where kidney deficiency results from illness, but this is not the congenital cause. Furthermore, insufficient Kidney Qi causes downward curling/crawling, because the bones feel heavy and wish to fall down while the body shrinks. The Kidney belongs to Yin; Kidney deficiency leads to fear of light. All these should be treated by tonifying the Kidney, using Dihuang Wan (Rehmannia Pill) as the primary formula. (If Heart Qi is hot, it causes upward crawling, treated with Daochi San; if Kidney Qi is deficient, it causes downward crawling, treated with Dihuang Wan.) When Kidney disease appears in summer, Water overcomes Fire, meaning the Kidney overcomes the Heart. One should treat the Kidney; in mild cases, the Kidney disease recedes, but in severe cases, palpitations and convulsions occur.
[Li Gao] The Kidney governs Cold. Self-disease manifests as coldness and reversal in the feet and shins. Among the five Zang organs, only the Kidney has no excess patterns. In children, smallpox/rash turning black and depressed indicates Kidney Excess, where Water overcomes and retreats Heart Fire. If Heart 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 Lung attacks the Kidney, it is a deficient pathogen, presenting with wheezing, cough, dry/rough skin, and cold, treated by Baibu Wan (Stemona Pill). If Liver attacks the Kidney, it is an excess pathogen, presenting with stiffness/tension, Qi spasms, and body coldness, treated by Lizhong Wan (Regulate the Middle Pill). If Spleen attacks the Kidney, it is a destructive pathogen, presenting with heavy body, diarrhea, and body coldness, treated by Lizhong Wan.
[Liu Wansu] Among the Five Elements, only the Kidney organ exhibits a pattern where the Mother is excessive and the Child 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, able to ascend but not descend; Jing is heavy and sinking, able to descend but not ascend. 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 the Kidney, thus causing the Kidney to suffer from pathogens. It is urgent to administer cooling medicines to resolve this, allowing Lung Qi to become clear and harmonious. This illustrates why treating Kidney disease requires first seeking the source in the Lung. If the Lung is harmonious but the Kidney suddenly becomes diseased, it is merely Spleen Dampness punishing the Kidney and generating illness. Hence, there are remedies for clearing Lung Heat and removing Spleen pathogens. If both Spleen and Lung are harmonious and the Kidney generates disease on its own, one must observe the affected organ itself and treat accordingly.
[Xue Ji] For symptoms such as downward crawling where the feet dislike being covered, it is 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 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 smallpox/rash blackening and depression, this is Kidney Deficiency with Excess Pathogen, and Dihuang Wan is particularly indicated.
Dihuang Wan (Qian Shi Formula)
Shu Gan Di Huang (Prepared Rehmanniae Radix, 8 qian) Shan Zhu Yu (Corni Fructus) Gan Shan Yao (Dioscoreae Rhizoma, each 4 qian) Ze Xie (Alismatis Rhizoma) Mu Dan Pi (Moutan Cortex) Bai Fu Ling (Poria, peeled, each 3 qian)
Grind the above 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 Meridian both govern the Lower Jiao. The Classics state: "For insufficiency, nourish its source." Therefore, diseases of the Liver and Kidney share the same treatment method; this is the intention behind Dihuang Wan tonifying these two meridians. Haizang said: If Wu Wei Zi (Schisandrae Fructus) is added, it becomes Shenqi Wan (Kidney Qi Pill), which nourishes the source of the Lung to generate Kidney Water.
[Xue Ji] The aforementioned pill treats Blood Deficiency of the Liver and Kidney, dryness-heat causing thirst, dysuria with retention, and phlegm-Qi obstructing upwards. It treats wind pathogens invading with chaotic Qi, leading to scrofula and nodules. It treats limb convulsions and eye twitching. It treats coughing with hemoptysis, dizziness, and vertigo. It treats dry/painful throat, and sores/cracks in the mouth and tongue. It treats spontaneous sweating, night sweats, hematochezia, and various bleeding disorders. It treats constitutional insufficiency, emaciated limbs, fontanelle splitting with aphonia. It treats fear of light and downward crawling, five delays and five softnesses, Kidney rickets and Liver rickets. 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 deficiencies and insufficiencies, this formula is suitable to nourish the source of transformation; its merits cannot be fully described.
[Wang Haogu] For Kidney Excess, Ze Xie 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 drugs for draining the Kidney. To treat a pulse that is surging and excess, Qian Shi's Dihuang Wan adds Sheng Di Huang (Rehmanniae Radix Recens) and removes Shan Zhu Yu; this treats excess in the main 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 formula in Miscellaneous Diseases - Seminal Emission section.)