四太爷之病，肝肾素虚，肺胃新感之病也。夫肝属乙，肾属癸，乙癸同源，病则本重。
但病者多花甲之年，即使不病新邪，筋骨间早已空虚，何堪再经磨耐，又意寒热陡发，直至
一候有余而解。解则急急补之，犹恐填而不足，乃又经复食消克等剂，在所必需。幸而外
热遽减，里热不清，已虚而益着。其虚咳嗽更剧，渴，痰粘腻，出而不爽，气息短促，形神困
顿，饮食不思，病势有加。无已因病致虚，因虚更病，互相为患者也。至于苔色，或黄或白，现
在又多剥象，左胁曾疼，两膝常屈，卧床不起，小水仍黄，干而未渴，加以音不扬，睡中语，显
系肺胃两经之热。既不能从外而泄，又不能从上而清，邪无出路，断无中道而立之理。势已
逼入下焦，两伤肝肾。所谓最虚之处，是客邪之处是也。然邪之所凑，其气必虚，留而不去，
其病为实。实则泻之，虚则补之。以使补不足，其邪泻，不伤其正，一举两得，方合实必因虚
之计，此等之法，似属从证，而未言脉。然所诊之脉，岂有不合之理。右寸关部弦而且滑，左
尺关部细而且数。数则为热，滑则为痰。弦主乎肝，细主乎肾，岂非肺胃两经之热痰正甚，
肝肾两经之虚气大昭，无怪乎其气从左逆，卧不能，侧更着。上实下虚之症焉为日已久，肺
失清肃之司，相传无权；肾失封藏之本，作强无主。而来喘息标本两治，否则气不归原，难
卜其旋见吉兆，三才汤合十味温胆汤两经法加减。
生地 人参 天冬 竹茹 橘红 茯神 枣仁 归身 羚羊角 川贝 桑皮 骨皮 蛤壳
四太爷的病症，是肝肾素来虚弱，肺胃新近感受外邪所致的疾病。肝属乙木，肾属癸水，乙癸同源（肝肾同源），一旦发病，根本之虚便显得严重。
患者年过六十，即使没有感染新的外邪，筋骨之间早已空虚，怎能再经受病邪的折磨？况且寒热症状突然发作，持续了一个多候（约五天）才缓解。缓解后应当立即进补，还担心填补不足，却又经过服用消食导滞等药物，这是必要的步骤。幸好体表的热势迅速减退，但体内的热邪并未清除，原本就虚弱，现在更加严重。因此咳嗽加剧，口渴，痰液粘稠腻滞，咳出但不畅快，气息短促，形体和精神困顿疲惫，不想饮食，病情有加重之势。无奈因病致虚，因虚更致病，两者互为因果，相互为患。至于舌苔颜色，或黄或白，现在又多见剥落之象，左胁曾疼痛，双膝常弯曲，卧床不起，小便仍呈黄色，口干但不想喝水，加上声音不响亮，睡中说胡话，这明显是肺、胃两经的热邪所致。既然不能从体表发散泄出，又不能从上焦清解，邪气没有出路，绝不可能在中道停留。病势已经逼入下焦，同时损伤了肝和肾。所谓最虚弱的地方，就是邪气客居的地方。然而邪气聚集之处，正气必然虚弱；邪气停留不去，病机表现为实。实证则用泻法，虚证则用补法。以使补充不足的正气，泻除邪气，且不伤害正气，一举两得，这才符合“实必因虚”的治疗计策。这种治法，看似顺应证候，但未提及脉象。然而所诊察的脉象，难道会有不合道理的吗？右寸关部脉弦且滑，左尺关部脉细且数。数脉主热，滑脉主痰。弦脉主肝病，细脉主肾虚，这难道不是肺胃两经的热痰正盛，肝肾两经的虚气大显吗？难怪其气从左胁逆上，侧卧困难。上实下虚的症状由来已久，肺失去清肃的功能，传变无力；肾失去封藏的根本，作强之功无主。而来诊时喘息并作，必须标本同治，否则气不归元，难以预料何时能出现好转的迹象。使用三才汤合十味温胆汤对两经之法进行加减。
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)