This article explores the complexities faced by herbalists in applying foundational Traditional Chinese Medicine (TCM) principles to intricate modern illnesses like Lyme disease, caused by Borrelia burgdorferi. Lyme often progresses to debilitating chronic or post-treatment Lyme disease syndrome (PTLDS), affecting the neurological, digestive, and joint systems. While Western antibiotics are effective early on, chronic cases often respond poorly or require additional support due to digestive sensitivity. A skillfully crafted TCM formula must utilize Emperor, Deputy, Assistant, and Envoy herbs to simultaneously target the pathogen and holistically support the body by modulating immunity and improving detoxification. TCM diagnosis often reveals patterns like spleen/stomach disharmony (fatigue) or liver/kidney imbalances (joint pain). The author emphasizes that strict pattern differentiation sometimes lacks the pathogen specificity needed for complex infectious diseases. Therefore, effective modern formula creation must integrate insights from Western medical science and pathophysiology alongside classical principles to safely and effectively address the persistent challenges of chronic Lyme.