1 Clinical Manifestations of Deficiency and Excess

Deficiency of righteous qi is considered deficiency, while excess of pathogenic qi is considered excess—both deficiency and excess refer to the relationship between pathogenic factors and righteous qi. Body constitution varies in strength and weakness, disease pathogens exhibit varying degrees of excess and deficiency, and medicinal treatments differ in their methods of tonification and purgation. The purpose of distinguishing between deficiency and excess is to determine the correct therapeutic approach. Whether to attack or to tonify depends entirely on the distinction between deficiency and excess. (1) Clinical Manifestations of Deficiency and Excess Anyone with insufficient righteous qi, or who lacks balance in yin, qi, and blood, falls under the category of deficiency. The causes of deficiency include congenital weaknesses, post-disease imbalances, or prolonged illness without proper treatment. Congenital weaknesses are often attributed to the kidneys, while postnatal deficiency is often linked to the spleen. From a modern medical perspective, deficiency often refers to the decline of physiological functions—though this decline is not only due to congenital physiological impairments, but is also frequently caused by chronic illness or failure to recover after disease. The most common clinical manifestations of deficiency include weight loss, low-pitched voices, poor appetite, fatigue, blurred vision, reduced hearing, a pale, swollen tongue, and a fine, weak pulse. Deficiency can be broadly classified into qi deficiency, blood deficiency, yin deficiency, and yang deficiency. Qi deficiency includes spleen qi deficiency, kidney qi deficiency, lung qi deficiency, and more; blood deficiency includes blood deficiency, heart-spleen deficiency, and more; yin deficiency includes lung yin deficiency, kidney yin deficiency, and liver-kidney yin deficiency; yang deficiency includes spleen yang deficiency, kidney yang deficiency, spleen-kidney yang deficiency, and heart yang deficiency. In recent years, there has been extensive research on spleen yin deficiency and liver yang deficiency, and dedicated books have been published on these topics. The detailed descriptions of deficiency-related conditions associated with the organs will be discussed in greater detail in organ-based diagnoses. Any condition where pathogenic factors are excessively strong, or where pathogenic factors and righteous qi fiercely compete, is considered an excess condition. The fundamental reason for excess conditions is the conflict between pathogenic factors and righteous qi. When the body is strong, pathogenic factors are unlikely to cause illness; however, when the body is weak, Chinese-English Translation:

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Input: Correct diagnosis is essential for providing reliable basis for treatment. Among the Eight Principles, the Yin-Yang principle is particularly important as it serves as the overarching framework for the other six principles. Yin can govern the interior, and deficiency, cold; Yang can govern the exterior, excess, heat. The manifestations of any clinical disease are the result of an imbalance between Yin and Yang. Only by grounding our understanding on the foundation of the Yin-Yang principles can we gain a deeper insight into cold-heat, deficiency-excess, and exterior-interior patterns.

I. Yin and Yang

Yin and Yang serve as the primary framework of the Eight Principles. The nature of all diseases can be broadly categorized into two major types: Yin-type conditions and Yang-type conditions. Despite the intricate and ever-changing clinical presentations, these conditions can ultimately be summarized into two extremes: Yin excess and Yang excess. When diagnosing a condition, one must first distinguish between Yin and Yang, then further differentiate between exterior and interior, cold and heat, deficiency and excess—only in this way can we achieve clear distinctions and accurate diagnoses. As stated in "Suwen · Yin-Yang Yingxiang Da Lun," "Yin and Yang are the Way of Heaven and Earth, the fundamental framework of all things, the parents of change, the origin of life and death, and the realm of divine wisdom. In treating illness, we must always start with the root cause." The "Suwen" also says, "A skilled physician should first discern Yin and Yang through observing color and palpating pulse." Zhang Jingyue further noted, "In all cases of pulse diagnosis and treatment, one must first examine Yin and Yang before distinguishing between them—this is the core principle of medical practice. Without neglecting Yin and Yang, there can be no proper treatment. Though medical practice may be complex, it can be summed up in a single phrase: Yin and Yang." From this, we can see just how crucial Yin and Yang are in both diagnostic reasoning and therapeutic approaches.

(1) Basic Manifestations of Yin-Type Conditions and Yang-Type Conditions The basic manifestations of Yin-type conditions include: listlessness, dull complexion, vacant gaze, faint voice, chills and cold extremities, and a slow pulse. If these symptoms are accompanied by swelling, abdominal distension, or loose stools, it is considered a case of spleen dysfunction; if these symptoms are accompanied by coughing up blood, vomiting blood, bloody stools, or nosebleeds, it is considered a case of spleen blood deficiency; if these symptoms are accompanied by drooping eyelids, uterine prolapse, gastric prolapse, or visceral prolapse, it is considered a case of middle qi descent. The treatment for spleen-yin deficiency is to strengthen the spleen and replenish qi; the basic formula is Si Jun Zi Tang. For spleen dysfunction, it is necessary to strengthen the spleen and replenish qi, promote qi circulation and eliminate dampness—using Xiang Sha Liu Jun Zi Tang (from "Ju Fang"); for spleen blood deficiency, it is necessary to strengthen the spleen and replenish qi, guide blood back to the spleen—using Gui Pi Tang; for middle qi descent, it is necessary to strengthen the spleen and replenish qi, lift yang and lift downward—using Bu Zhong Yi Qi Tang. Xiang Sha Liu Jun Zi Tang, Gui Pi Tang (from "Ji Sheng Fang"), and Bu Zhong Yi Qi Tang are all derived from Si Jun Zi Tang, as spleen dysfunction, spleen blood deficiency, and middle qi descent all stem from spleen-yin deficiency.

(2) Spleen-Yang Deficiency This condition develops from spleen-yin deficiency, so the basic symptoms remain: pale complexion, listlessness, fatigue, and a slow pulse; when Yang deficiency occurs, symptoms such as coldness, chills, and spontaneous sweating may appear. The spleen is responsible for transportation and transformation; when transport and transformation fail, abdominal distension, swelling, and loose stools may occur—these three aspects combine to form the spleen-yang deficiency syndrome. The treatment for spleen-yang deficiency is to strengthen the spleen and warm the center; the basic formula is Li Zhong Tang, which is again derived from Si Jun Zi Tang, as spleen-yang deficiency also stems from spleen-yin deficiency.

(3) Cold-Damp Blockage of the Spleen Headaches with chills and heat, abdominal distension and discomfort, nausea and vomiting, intestinal rumbling and diarrhea, a slippery, moist pulse—treatment focuses on releasing exterior cold, dispersing dampness, and using Huo Xiang Zheng Qi San (from "Ju Fang"). The spleen is inherently weak, once it encounters wind-cold, internal dampness combines with external cold, giving rise to this condition; therefore, this syndrome consists of two parts: ① Headaches with chills and heat, a slippery, moist pulse (external cold); ② Abdominal distension, nausea and vomiting, intestinal rumbling and abdominal pain (internal dampness). (4) Spleen-Damp Heat When dampness and heat combine and become trapped in the spleen, this condition arises. When heat outweighs dampness, high fever, thirst, burning diarrhea, a yellow, greasy coating on the tongue, and a slippery, rapid pulse may occur—treatment focuses on clearing heat and drying dampness, using Ge Gen Qin Lian Tang from "Wen Bing Tiao Bian." When dampness outweighs heat, the condition begins with a sense of heaviness, a body temperature that does not rise, abdominal distension, intestinal rumbling and diarrhea, nausea and vomiting—treatment focuses on clearing heat and eliminating dampness, promoting qi circulation and resolving turbidity, using San Ren Tang from "Wen Bing Tiao Bian," and Huo Pu Xia Ling Tang from "Yi Yuan." When heat outweighs dampness, the condition is acute (acute congestion and obstruction are both due to heat); when dampness outweighs heat, the condition is mild (dampness is sticky and difficult to eliminate quickly)—the former is characterized by heat rushing alongside dampness, while the latter is characterized by dampness lingering and taking time to dissipate. (5) Stomach Fire Excess Dry mouth, bad breath, oral ulcers, toothache and gum swelling, bleeding gums, burning pain in the stomach, a red tongue coated in yellow, and a rapid pulse—treatment focuses on clearing the stomach and reducing fire, using Qing Wei San (Li).

The characteristic of this condition lies in the oral cavity, as the mouth is the gateway of the spleen and stomach, located at the upper part; when fire rises upward, it directly impacts the oral cavity, thus giving rise to this condition.

(6) Stomach Yin Deficiency

Burning pain in the stomach, dry mouth and lack of drinking, a red tongue with little coating, and a fine, rapid pulse. At the same time, there is bone marrow heat and hot flashes, restlessness and heat in the five centers, and spontaneous sweating—treatment focuses on nourishing yin and nourishing the stomach, using Nourishing Stomach Tang (Ye Tian Shi) and Sha Shen Mai Men Dong Tang (Zhang Zhongjing). This condition consists of two parts: ① Yin deficiency syndrome: bone marrow heat, hot flashes, restlessness, spontaneous sweating, dry mouth and lack of drinking, a red tongue with little coating, and a fine, rapid pulse. The first three symptoms are basic signs of Yin deficiency; the last three are general signs of Yin deficiency; ② Stomach heat syndrome: burning pain in the stomach. Although there is stomach heat, it is different from stomach fire excess—while the former damages yin due to heat, the latter experiences fire that becomes rampant, and fire rising upward leads to various oral symptoms.

II. Heart Disease Diagnosis (1) Heart Qi Deficiency, Heart Yang Deficiency, Loss of Yang

Palpitations, shortness of breath, a fine, irregular pulse—these are the basic symptoms of heart qi deficiency; if accompanied by coldness, chills, and spontaneous sweating, it is considered heart yang deficiency. As heart yang deficiency progresses, symptoms such as pale complexion, cold sweat, cold extremities, and a fine, weak pulse may appear—this is loss of Yang. Heart qi deficiency, heart yang deficiency, and loss of Yang are three progressively deepening pathological stages. When qi deficiency reaches its extreme, it leads to yang deficiency; when yang deficiency reaches its extreme, it leads to loss of Yang—this is a fundamental concept in traditional Chinese medicine. Treatment for heart qi deficiency and heart yang deficiency focuses on replenishing qi and calming the heart, using Nourishing Heart Tang (Wang Ken Tang); for loss of Yang, emergency resuscitation to restore yang is needed, using Shen Fu Tang and Si Ni Tang (Zhang Zhongjing).

(2) Heart Blood Deficiency, Heart Yin Deficiency, Loss of Yin

Palpitations, forgetfulness, insomnia, and frequent dreams—these are the basic symptoms of heart blood deficiency. If accompanied by hot flashes and bone marrow heat, restlessness and heat in the five centers, and spontaneous sweating, it is considered heart yin deficiency; as heart yin deficiency progresses, symptoms such as irritability, labored breathing, dry skin, and warm hands and feet may appear—this is loss of Yin. Heart blood deficiency, heart yin deficiency, and loss of Yin are also three progressive pathological stages. When blood deficiency reaches its extreme, it leads to yin deficiency; when yin deficiency reaches its extreme, it leads to loss of Yin—this is one of the fundamental concepts in traditional Chinese medicine. Treatment for heart blood deficiency and heart yin deficiency focuses on nourishing blood and calming the mind, using Tian Wang Bu Xin Dan (Wei Yilin); for loss of Yin, it is necessary to replenish qi and nourish yin, using Sheng Mai San (from "Qian Jin Fang").

(3) Heart Fire Overactive

Burning heat in the chest, restlessness and difficulty sleeping, a red tip of the tongue, and a fine, rapid pulse—these are the basic symptoms of heart fire overactivity. If accompanied by oral ulcers and a short, painful urination, it is considered heart fire shifting heat to the small intestine (organ heat shifting to the viscera). Heart fire resides in the chest; when it rises upward, it causes restlessness and difficulty sleeping, a red tongue; since the heart and small intestine are interconnected through the meridians, although fire rises upward, it can also descend along the meridians to the small intestine—"the small intestine is the organ responsible for storing and transforming substances, playing a role in separating clean from impure," and it has the function of filtering and distinguishing between clean and impure. When the small intestine is heated, urination becomes red and painful. Oral ulcers are caused by the small intestine’s dampness, which is carried upward by fire. Treatment for heart fire overactivity focuses on clearing fire and calming the mind, using Huang Lian A Jiao Tang (Zhang Zhongjing); when heart fire shifts heat to the small intestine, it is necessary to guide the heat downward, using Dao Chi San (from "Xiao Er Yao Zheng Zhi Jue").

(4) Phlegm Blocking the Heart’s Channels

Confusion of consciousness (restlessness, mania, laughter, speech), a slippery pulse, and a greasy tongue—these are the basic symptoms of this condition; treatment focuses on guiding phlegm, opening the channels, and calming the mind, using Sheng Tie Luo Yin (from "Yi Xue Xin Wu"). The heart governs consciousness; when the heart’s channels are blocked, consciousness becomes confused; a slippery pulse and a greasy tongue are signs of phlegm, because the cause of channel blockage is phlegm.

(5) Blood Stagnation in the Heart

Pain in the chest, pain radiating to the arms, palpitations and shortness of breath, a dark purple tongue, and a rough, slow pulse—these are the basic symptoms of this condition; treatment focuses on activating blood circulation, resolving stasis, and promoting yang flow, using Coronary I No. (a collaborative formula from Beijing), or Gua Lou Xie Bai Ban Xia Tang (Zhang Zhongjing). A rough pulse and a dark purple tongue indicate blood stasis; chest pain and palpitations indicate that blood stasis is concentrated in the heart.

III. Liver Disease Diagnosis (1) Liver Qi Stagnation

Bitter taste in the mouth, dry throat, irritability and quick temper, chest and flank discomfort, a tense pulse—these are the basic symptoms of liver qi stagnation. If accompanied by abdominal distension and poor appetite, it is considered liver-stomach disharmony; if there is something stuck in the throat, unable to be expelled or swallowed, it is considered liver qi rising upward (mei he qi). Liver qi stagnation requires soothing the liver and resolving stagnation—using Chai Hu Shu Gan San (from "Jing Yue Quan Shu"); for liver-stomach disharmony, it is necessary to soothe the liver and harmonize the stomach—using Xiao Yaoshan (from "Ju Fang"); for liver qi rising upward, it is necessary to soothe the liver and lower qi—using Ban Xia Hou Po Tang (Zhang Zhongjing). When liver qi flows smoothly, stagnation can lead to cross-currents that affect the stomach (liver-stomach disharmony) —this is the first manifestation; when stagnation rises upward and hits the throat (mei he qi), it is the second manifestation. Both...

Chinese-English Translation:

Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Correct diagnosis is essential for providing reliable basis for treatment. Among the Eight Principles, the Yin-Yang principle is particularly important as it serves as the overarching framework for the other six principles. Yin can govern the interior, and deficiency, cold; Yang can govern the exterior, excess, heat. The manifestations of any clinical disease are the result of an imbalance between Yin and Yang. Only by grounding our understanding on the foundation of the Yin-Yang principles can we gain a deeper insight into cold-heat, deficiency-excess, and exterior-interior patterns.

I. Yin and Yang