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The illness of the Fourth Grand Master is characterized by a constitutional deficiency of the Liver and Kidney, complicated by a recent external pathogenic invasion of the Lung and Stomach. The Liver corresponds to Yi Wood, and the Kidney to Gui Water; Yi and Gui share the same source (Liver-Kidney homology). When disease occurs, the root deficiency becomes severe.

The patient is over sixty years old. Even without contracting new pathogens, the sinews and bones have long been empty and deficient. How can he endure further debilitation? Moreover, the alternating chills and fever suddenly erupted and persisted for more than one *hou* (approximately five days) before resolving. Upon resolution, urgent tonification is required, yet there is still fear that the deficiency cannot be fully filled. Subsequently, the administration of formulas for digestion and elimination was necessary. Fortunately, the exterior heat subsided rapidly, but the interior heat remained unclarified. Having already been deficient, the condition became even more depleted. Consequently, coughing intensified, thirst developed, sputum became sticky and viscous, difficult to expectorate, breathing became short and rapid, physical form and spirit were exhausted, appetite was lost, and the disease progressed. Helplessly, illness leads to deficiency, and deficiency exacerbates illness, each aggravating the other. Regarding the tongue coating, it may be yellow or white, but currently shows signs of peeling (geographic tongue). There was pain in the left hypochondrium, constant flexion of both knees, inability to rise from bed, yellow urine, dry mouth without desire to drink, hoarseness, and somniloquy (talking in sleep). These clearly indicate heat in the Lung and Stomach meridians. Since the pathogen cannot be vented through the exterior nor cleared from the upper jiao, and has no exit route, it logically cannot remain in the middle jiao. The pathological trend has forced its way into the lower jiao, injuring both the Liver and Kidney. This illustrates the principle: "The place where the body is most deficient is where the pathogenic factor resides." However, where pathogenic factors gather, Qi must be deficient; if they linger and do not depart, the pathology manifests as excess. Excess requires purging, deficiency requires tonifying. This allows for replenishing insufficiency while expelling pathogens, without damaging healthy Qi, achieving two benefits with one action. This aligns with the strategy that "excess often arises from deficiency." Such a method appears to follow the syndrome presentation, though pulse diagnosis was not explicitly detailed in the narrative. Yet, the diagnosed pulses would naturally correspond. The Right Cun and Guan positions are wiry (*Xian*) and slippery (*Hua*); the Left Chi and Guan positions are fine (*Xi*) and rapid (*Shu*). Rapid indicates heat; slippery indicates phlegm. Wiry governs the Liver; fine governs the Kidney. Is this not evidence that heat-phlegm in the Lung and Stomach meridians is intense, while deficiency-Qi in the Liver and Kidney meridians is prominently manifest? No wonder the Qi rebels upward from the left, making side-lying difficult. The syndrome of upper excess and lower deficiency has existed for a long time. The Lung has lost its function of clearing and descending, rendering transmission powerless; the Kidney has lost its essence of sealing and storing, leaving the power of strength without a master. Given the panting and simultaneous involvement of root and branch, treatment must address both simultaneously. Otherwise, Qi will not return to its origin, and recovery is uncertain. Therefore, *Sancai Tang* (Three Powers Decoction) combined with *Shiwei Wendan Tang* (Ten-Ingredient Gallbladder-Warming Decoction) is modified according to the methods for these two meridians.

Rehmanniae Radix Preparata (Shengdi), Ginseng Radix et Rhizoma (Renshen), Asparagi Radix (Tiantong), Bamboo Shavings (Zhuru), Tangerine Peel (Juhong), Poria Cocos (Fushen), Ziziphus Jujuba Seed (Zaoren), Angelica Sinensis Root (Guishen), Antelope Horn (Lingyangjiao), Fritillaria Cirrhosa Bulb (Chuanbei), Mulberry Bark (Sangpi), Cortex Moutan (Bupi), Clam Shell (Gekiao)