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Whenever there is severe consumptive disease (Lao), excessive sexual indulgence, major illness, or prolonged chronic disease leading to deficiency of both Qi and Blood, and exhaustion of both Yin and Yang, this is termed "Si Sun" (Four Damages). If latent pathogenic factors are subsequently contracted, the deficiency of Zheng Qi (Upright Qi) allows pathogens to penetrate deeper; the deeper the pathogens, the harder it is for them to be transmitted out. Sweating and purging methods damage Zheng Qi leading to its collapse, while blind tonification may stagnate pathogens causing them to become entrenched; such cases are mostly incurable. In this dilemma, methods combining tonification and draining, tonifying first then draining, or draining first then tonifying are employed. For instance, Renshen Baihu Tang (Ginseng White Tiger Decoction), Huanglong Tang (Yellow Dragon Decoction), and Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) represent methods combining tonification and draining. Using tonics first followed by sweating or purging represents tonifying first then draining. Using sweating or purging first followed by tonics represents draining first then tonifying. One must inquire into the origin of the disease and carefully deliberate the treatment. It is crucial to examine current symptoms: if purely heat symptoms are present, one must not hesitate and err. Generally, if the whole body exhibits signs of extreme excess and heat, but a small area shows slight deficiency, priority must be given to protecting the deficiency. Conversely, if the whole body shows deficiency signs, but a specific area shows excess symptoms, priority must be given to managing the excess. This is the balance in treating diseases. If sweating causes exterior symptoms to worsen, such as increased headache and body pain, or if clearing and purging causes interior symptoms to worsen, such as increased irritability, thirst, and fullness, this indicates a severe deficiency presenting with false excess signs. Urgent tonification is undoubtedly required. After distinguishing symptoms, pulse diagnosis must be carefully examined. When encountering pulses that appear large and forceful on superficial palpation (Fu), one must carefully check for weakness on deep palpation (Chen). When all six positions show strong pulses, one must carefully check if any single position is uniquely weak. If true weakness is found in a specific position or depth, the false excess signs in other positions can be disregarded. Treating based on this will yield miraculous results. Having inquired about the general history and determined the severity, combined with detailed pulse analysis, the condition becomes clear. The manifestations of these damage syndromes are numerous; refer to the following section on "Si Bu Zu" (Four Insufficiencies) for details.

"Si Bu Zu" and "Si Sun" differ. "Si Sun" arises from lifestyle/human factors, while "Si Bu Zu" stems from congenital endowment. "Si Sun" occurs during acute illness, whereas "Si Bu Zu" exists in the baseline constitution. However, "Si Bu Zu" can also result from "Si Sun"; one cannot assume insufficiency does not exist outside of "Si Sun". "Si Bu Zu" refers to Qi, Blood, Yin, and Yang insufficiencies. Qi insufficiency manifests as shortness of breath and difficulty speaking. Even with heavy pathogenic invasion, bloating and fullness do not typically occur. In such cases, even if dispersing or purging is indicated, nourishing Qi must be the primary approach. Blood insufficiency manifests as sallow complexion and pale lips/mouth. Even with heavy pathogenic invasion, the face lacks a healthy Yang luster. Even if attacking and draining are indicated, nourishing Blood must be primary. Yang insufficiency manifests as cold extremities, aversion to cold, frequent diarrhea worsening at night, or cold air from mouth/nose. Even with heavy pathogenic invasion, fever, prickly tongue coating, irritability, and thirst are absent. Even if clearing heat and draining are indicated, warm tonification must precede it. Wait for the deficiency to recover and true excess signs to emerge before treating the heat. Yin insufficiency naturally leads to dry fluids and rough, scaly skin. Even with heavy pathogenic invasion, sweating or cold limbs may fail to manifest despite indications. Even if attacking and draining are indicated, nourishing Yin must precede it. Wait for Qi transformation and fluid return; pathogens often resolve spontaneously. If they persist, use mild clearing/draining methods cautiously. Premature attacking worsens the condition. These four insufficiencies, combined with the previous four damages, are often seen after recurrent warm-heat diseases. When concurrent deficiency-damage symptoms exist, direct attack on pathogens should be avoided; nourishing Zheng Qi is essential. Administer nourishing medicines first; only when true excess signs fully appear should pathogens be attacked. If attacking medicines cause deficiency signs to reappear, tonification must resume. Nourishing Zheng to expel pathogens, and expelling pathogens to stabilize Zheng, involve mutual adjustment and alternating advancement/retreat. The goal is complete pathogen elimination without damaging Zheng, which constitutes good treatment.

In summary, relapse due to labor, diet, spontaneous recovery, and anger: excess types are easy to treat, deficiency types are difficult; first relapse is treatable, multiple relapses are not. Based on my experience, relapses from various labors often lead to death in those engaging in sexual activity; relapses from diet are most severe with alcohol consumption; relapses from Qi stagnation are worst with great anger. After multiple relapses, if "Si Sun" and "Si Bu Zu" develop, death may occur within 10 days to half a month in acute cases, or after prolonged suffering in chronic cases. Even with proper medical care and suitable nursing, rare recoveries leave the body fragile and prone to re-infection. Success depends entirely on the physician's ability to advise and the patient's awareness to protect themselves.