即前方去桂附。
肾虚则热，水沸为痰，此方主之。
肾中非独水也，命门之火并焉。肾不虚则水足以制火，
虚则火无所制而热症生矣。气虚痰泛，宜肾气丸补而逐之久。病阴火上升，津液生痰不生血，宜壮水以制相火，
痰热自除。地黄滋阴补血，本肮之主药也。然遭气则运用于上，遇血则流走于经，不能挟其一线入肾，装以五者
佐之。怀山，脾药也，水土一气，且能坚少腹之土，真水之源也；山茱萸，肝药也，水木同位，借其酸涩以敛泛
渗；牡丹皮，本泻心火，为水火对居，泻南即所以益北；再有茯苓之淡渗以泻阳，泽泄之咸泄以降阴，疏瀹决排，
使水无不就下，厥工乃竣。此即前八味丸也。钱仲阳以治小儿稚阳纯气，确是阴虚致病，乃去桂附而成此方，应
手神验。明薛新甫因悟，凡病阴虚火动，用丹溪补阴法不效者，以此代之立应。汪 庵谓六经备治，而功专肝肾，
寒燥不偏，而兼补气血。苟能常服，其功未易殚述。自此说行，枵腹之士奉为养生圣果，男女老幼，竞服不疑。
讵知丹、泽二物，除肾衰不能滋木制火，致上炎为热，热久生风、生痰，目赤痛、小便短涩外，他症罕并用，曷
可无故常服。李士材曰用此方有四失∶地黄非怀庆则力薄；蒸晒非九次则不熟；或疑地黄之滞而减之，则君主弱；
或恶泽泻之泄而减之，则使力微。自蹈四失，顾归咎于药之无功，毋乃愚乎。余谓非如前症用此方者，亦有四失∶
木不得敷荣，无故而丹皮克伐；水不得充足，无故而泽泻泄利；火并不炎上，地黄制之；土何曾淫湿，茯苓渗之。
有此四失，顾夸耀药之神奇，毋乃痴乎。况此方薛氏加减甚繁，可见凡症凡药，皆有活法，未可以六味概百病也。
姑述一二于下∶一变为滋肾生肝饮，本方合逍遥去白芍加五味。用五味不用白芍者，既滋宜助，既生焉制也；一
变为滋阴肾气丸，本方去山茱加柴胡、五味、归尾。去山茱不欲强木，用五味补金制本也，归尾行瘀滞，柴胡疏
木气也；一
变为人参补气汤，本方去泽泻合异功，补血生脉。盖为发热作渴，理无再竭，故去泽泻。理无再竭，盒饭急生，
生脉之所由来。既当生脉，异功补血可因而转入也；一变为加味地黄丸，本方加柴、芍、五味。缘耳内痒痛，或
眼花痰喘，热渴便涩，总由肝肾阴虚火郁而致。阴虚五味以补之，火郁柴胡以达之，芍药以平之；一变为九味地
黄丸，本方加川楝、当归、使君子、芎 ，尽是厥阴风木之药。以诸疳必有虫，皆风木所化，仍是肝肾同治之法；
一变为益阴肾气丸，本方加五味、当归、生地。其列症有潮热、晡热，胸膈饱闷。此肝胆燥火蔽伏胃中，虽合都
气，不加归、地，何以消胃中之火而生胃阴乎。再则有加五味者，有加麦门冬者，有加杜仲、牛膝者，有加归、
芍，有加柴、芍，有加益智仁，有加紫河车，游龙戏海，变化无穷，宁必死守六味为古今不易之良剂也哉。嗟夫！
丹皮、泽泻，水火两泄，过服乱服，目昏阴痿。若再从火化，精泄必矣。泄精至再，脉息反加大数，不思火郁发
之，一味水郁折之，不思温能除热，一味苦以坚肾，加黄柏、知母进而毙命者，五年眼见三人。再越十霜二十载，
不知其凡几矣。言不尽意，临书怅然。
肾虚则生内热，如同水被煮沸产生痰浊，此方主治此类病症。
肾脏中不仅仅只有肾水，还有命门之火共存。肾气不虚时，肾水足以制约命门之火；
若肾气虚弱，则火失去制约而产生热证。若是气虚导致痰湿泛滥，适宜用肾气丸长期服用以补益并祛除病邪。若是阴火上升，津液凝聚成痰而非化生血液，适宜通过壮水（滋补肾阴）来制约相火，
痰热自然消除。地黄能够滋阴补血，是肾脏的主药。然而，单用地黄容易使气机运行于上部，血行流走于经络，难以引导其一线之气进入肾脏，因此需要借助其他五味药材作为辅助。
怀山药，属于脾经药物，脾与肾水土一气相通，且能稳固少腹的土气，这是真水的源头；山茱萸，属于肝经药物，肝肾同源（水木同位），借其酸涩之性收敛泛溢渗泄的元气；牡丹皮，原本用于清泻心火，因心肾水火相对居住，清泻南方心火即所以补益北方肾水；再加上茯苓的淡渗利湿以泻阳邪，泽泻的咸寒降泄以引阴下行，疏通疏导、决排水邪，使水液无不向下流动，其功效才算完成。这就是前面的八味丸（肾气丸）。钱乙（钱仲阳）用它治疗小儿稚阳纯气的病症，确属阴虚致病，于是去掉桂枝和附子而创制了此方（六味地黄丸），使用往往神效。明代薛己（薛新甫）由此领悟，凡是阴虚火动的病症，使用朱丹溪的补阴法无效的，用此方替代立刻见效。汪昂认为此方备治六经，但功效专攻肝肾，不偏寒燥，同时兼补气血。如果能经常服用，其功效难以详尽叙述。自从这种说法流行后，空腹无食的读书人将其奉为养生的圣果，男女老幼竞相服用而不怀疑。
哪里知道丹皮、泽泻这两味药，除了肾衰不能滋水制火，导致上炎发热，热久生风、生痰，出现目赤痛、小便短涩等症状外，其他病症很少同时使用这两味药，怎么可以无故经常服用。李中梓（李士材）说使用此方有四种失误：地黄如果不是怀庆产地的则药效薄弱；蒸晒如果不是九次则不够熟透；或者怀疑地黄滋腻而减少用量，则君药力量减弱；或者厌恶泽泻的泄利而减少用量，则使药力微弱。自己陷入这四种失误，却归咎于药物没有功效，岂不是愚笨吗？我认为对于不是前述症状而使用此方的情况，也有四种失误：肝木不得舒展荣发，无故让丹皮克伐；肾水不得充足，无故让泽泻泄利；火并没有炎上，却用地黄制约它；脾土何曾淫湿，却让茯苓渗利它。
有此四种失误，却夸耀药物的神奇，岂不是痴傻吗？况且此方薛己的加减变化非常多，可见凡症凡药，都有灵活的方法，不可以用六味地黄丸概括百病。
姑且陈述一二在下面：一变成为滋肾生肝饮，本方合逍遥散去掉白芍加入五味子。用五味子不用白芍的原因，既然要滋补就应该帮助，既然要生发就应该制约；一变成为滋阴肾气丸，本方去掉山茱萸加入柴胡、五味子、当归尾。去掉山茱萸是不想强行升发肝木，用五味子补肺金以制约肝木，当归尾行瘀滞，柴胡疏达肝木之气；一变成为人参补气汤，本方去掉泽泻合异功散，补血生脉。这是因为发热口渴，理论上不能再耗竭津液，所以去掉泽泻。理论上是不能再耗竭，所以必须急先生脉，这就是生脉散由来。既然应当生脉，异功散补血可以顺势转入；一变成为加味地黄丸，本方加入柴胡、白芍、五味子。因为耳内痒痛，或眼花痰喘，热渴便涩，总由肝肾阴虚火郁所致。阴虚用五味子补益，火郁用柴胡发散，白芍平抑肝阳；一变成为九味地黄丸，本方加入川楝子、当归、使君子、川芎，全是厥阴风木的药物。因为诸疳积必有虫，皆由风木所化，仍是肝肾同治的方法；一变成为益阴肾气丸，本方加入五味子、当归、生地黄。所列症状有潮热、傍晚发热，胸膈饱闷。这是肝胆燥火遮蔽伏匿在胃中，虽然合用都气丸，如果不加当归、地黄，怎么能消除胃中之火并生养胃阴呢。另外还有加入五味子的，有加入麦门冬的，有加入杜仲、牛膝的，有加入当归、白芍的，有加入柴胡、白芍的，有加入益智仁的，有加入紫河车的，变化无穷，难道一定要死守六味地黄丸作为古今不变的良剂吗？唉！丹皮、泽泻，水火两泄，过服乱服，会导致目昏、阳痿。如果再从火化，精气必然泄漏。泄精两次以上，脉象反而加大变数，不想着火郁应该发散，一味用水郁折之法，不想着温能除热，一味用苦寒坚肾，加入黄柏、知母进而导致毙命的，我五年间眼见三人。再过十年二十年，不知会有多少人了。言语不足以表达心意，提笔书写时怅然若失。
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.