4. Deficiency and Excess

4. Deficiency and Excess

Deficiency refers to a lack of vital energy, while excess refers to an overabundance of pathogenic factors. The basic meaning of Deficiency and Excess is the relationship between the strength of vital energy and the dominance of pathogenic factors. There are differences in physical constitution—some people are strong, others weak—and in the severity of disease—some diseases are mild, others severe. Medication also varies depending on whether it is meant to tonify or purge. The purpose of distinguishing Deficiency and Excess is to determine the correct treatment strategy. Should we attack or tonify? It all depends on whether we correctly identify Deficiency and Excess. If it's excess, we should purge; if it's deficiency, we should tonify. If Deficiency and Excess are misidentified, even a tiny mistake can lead to a huge deviation. Both Deficiency and Excess are major taboos for physicians.

(1) Clinical Manifestations of Deficiency and Excess

Anyone whose vital energy is insufficient or whose yin and yang qi are depleted falls under the category of Deficiency syndrome. Causes of Deficiency syndrome include congenital weakness, post-disease neglect of conditioning, and prolonged untreated illness. Congenital weakness is often attributed to the kidneys, while post-disease deficiency is often attributed to the spleen. Using modern medicine

<!-- translated-chunk:10/53 -->

(2) The True and False of Deficiency and Excess

The "Inner Canon" states: "Great deficiency presents with signs of excess, while extreme deficiency manifests as signs of fullness." Zhang Jingyue said: "In cases of extreme deficiency, one may actually observe signs of fullness; in cases of great excess, one may instead see signs of weakness. This must be carefully distinguished. For example, when illness arises from emotional disturbances, overeating or fasting, fatigue, sexual indulgence, congenital insufficiency, or other factors, the onset of disease often presents with symptoms such as fever, constipation, distension, delirium, and pseudo-rash—appearing at first glance to be conditions of excess. However, the underlying pathology is actually deficiency. Similarly, if external pathogenic factors remain unresolved and latent pathogens linger in the meridians, food stagnation fails to dissipate and accumulates in the zang-fu organs, or qi becomes stagnant and unrelieved, or stubborn phlegm and blood stasis persist, prolonged illness can lead to apparent deficiency on the surface, yet the root cause remains an excess condition. Only when both pathogenic and righteous qi are strong does the struggle between them result in an excess condition. The clinical manifestations of excess include high fever, intense thirst, dry and hard stools, short and reddish urine, coarse breathing and loud voice, abdominal pain with tenderness, fever accompanied by chills without sweating, mental excitement, and a large, forceful pulse. In summary, during excess conditions, physiological functions exhibit pathological hyperactivity, pathogenic factors are powerful, and the body's resistance to disease is also robust."

(2) The True and False of Deficiency and Excess

The "Inner Canon" says: "Great deficiency presents with signs of excess, while extreme deficiency manifests as signs of fullness." Zhang Jingyue said: "In cases of extreme deficiency, one may actually observe signs of fullness; in cases of great excess, one may instead see signs of weakness. This must be carefully distinguished. For example, when illness arises from emotional disturbances, overeating or fasting, fatigue, sexual indulgence, congenital insufficiency, or other factors, the onset of disease often presents with symptoms such as fever, constipation, distension, delirium, and pseudo-rash—appearing at first glance to be conditions of excess. However, the underlying pathology is actually deficiency. Similarly, if external pathogenic factors remain unresolved and latent pathogens linger in the meridians, food stagnation fails to dissipate and accumulates in the zang-fu organs, or qi becomes stagnant and unrelieved, or stubborn phlegm and blood stasis persist, prolonged illness can lead to apparent deficiency on the surface, yet the root cause remains an excess condition. Only when both pathogenic and righteous qi are strong does the struggle between them result in an excess condition. The clinical manifestations of excess include high fever, intense thirst, dry and hard stools, short and reddish urine, coarse breathing and loud voice, abdominal pain with tenderness, fever accompanied by chills without sweating, mental excitement, and a large, forceful pulse. In summary, during excess conditions, physiological functions exhibit pathological hyperactivity, pathogenic factors are powerful, and the body's resistance to disease is also robust."

---

II. Zang-Fu Syndrome Differentiation

Using the zang-fu organs as the framework for syndrome differentiation and treatment is known as zang-fu syndrome differentiation, which is an important component of TCM syndrome differentiation and treatment and serves as the primary method for differentiating internal injuries.