WANG Qishi put forward the theory of "

yang

deficiency with three lackings， controlled by the spleen" in

Lixu Yuanjian

（《理虚元鉴》）， which regarded that

yang

deficiency can lead to consumptive diseases with changes of lacking essence， lacking

qi

， and lacking fire， so the treatment should start from the spleen to restore the middle

yang

urgently. This article summarised the experience of treating type 4 cardiorenal syndrome based on the theory of "

yang

deficiency with three lackings， controlled by the spleen"， and proposed that lacking essence is the beginning of the onset of type 4 cardiorenal syndrome， lacking

qi

is the gradual development of the disease， and lacking fire is the changes of the disease， and ultimately resulted in the complex situation of kidney and

qi

deficiency， and edema due to

yang

deficiency， combined with syndromes variation. In the clinical evidence， in the stage of lacking fire， therapies should warm the middle and strengthen the spleen in order to rescue the middle

yang

， prescribed with modified

Baoyuan Decoction

（保元汤） plus

Lizhong Decoction

（理中汤）； in the stage of lacking

qi

， prescriptions can add Taoren （

Juglans regia

）， Tubiechong （

Eupolyphaga sinensis

）， Fuling （

Smilax glabra

）， Guizhi （

Neolitsea cassia

） to activate blood and drain water to transport and restore the center

qi

； in the stage of lacking essence， prescriptions can add Gouqizi （

Lycium barbarum

）， Tusizi （

Cuscuta chinensis

）， Duzhong （

Eucommia ulmoides

）， Bajitian （

Gynochthodes officinalis

） to supplement deficiency and resolve masses to consolidate the root and supplement essence.