Deficiency and excess differentiation is a framework for analyzing and distinguishing the rise and fall of pathogenic and righteous qi, while yin and yang serve as the overarching principle of the eight principles differentiation, encompassing the other six aspects.
Key Points:(3) Clinical Manifestations, Interrelationships, and Key Points for Differentiating Deficiency and Excess1. Clinical Manifestations and Key Points for Differentiating Deficiency
Deficiency syndrome is characterized by insufficient righteous qi in the body. The formation of deficiency can arise from congenital insufficiency and acquired malnutrition, with the latter being predominant. Factors such as dietary imbalance, emotional strain, internal injury to the organs’ qi and blood, excessive sexual activity depleting kidney essence, prolonged illness, or improper treatment damaging righteous qi can all lead to deficiency syndrome.
Clinical manifestations of deficiency are difficult to summarize comprehensively, but common signs include: pale or sallow complexion, mental fatigue, physical weakness, palpitations, shortness of breath, cold limbs, or symptoms such as five hearts heat, spontaneous sweating, night sweats, loose stools, urinary incontinence, red tongue with little or no coating, and weak pulse. The key point for differentiation is the manifestation of insufficiency and weakness.
2. Clinical Manifestations and Key Points for Differentiating Excess
Excess syndrome reflects a condition of excessive pathogenic qi. The formation of excess can be attributed to two main causes: first, invasion of external pathogens; second, dysfunction of the organs leading to metabolic disorders, resulting in pathological products such as phlegm, dampness, and blood stasis accumulating in the body. Although excess syndrome is characterized by excessive pathogenic qi, righteous qi can still resist it, indicating that the struggle between righteous and pathogenic qi is at an intense stage.
Clinical manifestations of excess primarily include fever, abdominal distension and pain with tenderness, chest tightness and irritability, even delirium, coarse breathing, excessive phlegm, constipation, difficulty urinating, strong pulse, and thick greasy tongue coating. The key point for differentiation is the manifestation of excess and hyperactivity.
3. Differentiation between Deficiency and Excess:
Deficiency refers to insufficient righteous qi, while deficiency syndrome manifests as symptoms resulting from this insufficiency. Excess refers to excessive pathogenic qi, and excess syndrome manifests as symptoms resulting from this excess.
|
Type |
Clinical Symptoms |
Breath and Voice |
Pain |
Tongue Quality |
Pulse |
|
Excess |
Initial stage of external invasion |
Excessive and hyperactive |
High voice and coarse breath |
Tenderness |
Strong pulse |
|
Deficiency |
Chronic internal injury |
Insufficient and weak |
Weak voice and low breath |
Likes pressure |
Weak pulse |
4. Relationship between Deficiency and Excess
Deficiency and excess syndromes are interrelated and can transform into one another under certain conditions; they can also coexist. In a state of excess, due to improper or erroneous treatment, such as excessive sweating, vomiting, or purging, the depletion of yin fluids and damage to righteous qi can lead to deficiency syndrome; conversely, if the body is weak, organ dysfunction occurs, and metabolic disorders lead to the retention of pathological products such as phlegm, blood, and dampness, a mixed deficiency-excess syndrome can form.
5. Relationship between Deficiency and Excess with Exterior and Interior, Cold and Heat
Exterior and interior syndromes each have cold, heat, deficiency, and excess manifestations. Cold deficiency syndrome corresponds to yang deficiency syndrome, heat deficiency syndrome corresponds to yin deficiency syndrome, cold excess syndrome corresponds to interior cold syndrome, and heat excess syndrome corresponds to interior heat syndrome.(4) Formation, Clinical Manifestations, Interrelationships, and Key Points for Differentiating Yin and Yang Syndromes1. Concepts of Yin and Yang SyndromesYin and yang can be summarized into six syndromes: exterior, interior, cold, heat, deficiency, and excess, serving as the general framework for differentiation. Exterior, heat, and excess syndromes belong to yang syndromes, such as qi diseases belonging to yang, and organ diseases belonging to yang, while yang heat syndrome refers to excess heat syndrome. Interior, cold, and deficiency syndromes belong to yin syndromes, such as blood diseases belonging to yin, and organ diseases belonging to yin, while clinical discussions of yin syndrome often refer to deficiency-cold syndrome.2. Clinical Manifestations and Key Points for Differentiating Yin and Yang Syndromes
The formation of yin syndrome often results from aging, chronic internal injury, or external pathogens invading the five organs, leading to yang deficiency and yin excess, functional decline, and reduced organ function, commonly seen in interior deficiency-cold syndromes. Clinical manifestations often include no fever with aversion to cold, cold extremities, shortness of breath, fatigue, a heavy body, lack of energy, a desire to lie down, vomiting, clear diarrhea, pale urine, blue nails, pale face, pale tongue, and weak pulse. The key point for differentiation is the presence of cold signs.
The formation of yang syndrome often results from excessive pathogenic qi while righteous qi remains intact, indicating that the struggle between righteous and pathogenic qi is in an excited phase, commonly seen in interior excess-heat syndromes. Clinical manifestations often include fever, aversion to heat rather than cold, irritability, thirst, restlessness, coarse and rapid breathing, hot breath from the mouth and nose, insomnia or blurred vision, red face and lips, red nails, red and dry urine, constipation or dry stools, red tongue, and rapid and strong pulse. The key point for differentiation is the presence of heat signs.
3. Differentiation between Yin and Yang Syndromes
Generally, yang syndromes must exhibit heat signs, often presenting with fever, aversion to heat, thirst, and rapid pulse; yin syndromes must exhibit cold signs, often presenting with cold body and limbs, no fever with aversion to cold, mental fatigue, and weak pulse.
Pathological changes in yin and yang themselves refer to the disruption of the relative balance of yin and yang, leading to conditions such as yin deficiency, yang deficiency, loss of yin, and loss of yang.
Yin deficiency and yang deficiency are conditions resulting from the loss of yin and yang in the body, leading to either yin not restraining yang or yang not restraining yin. Therefore, clinical manifestations of yin deficiency syndrome, in addition to signs of body weight loss, dry mouth and throat, dizziness, insomnia, thin pulse, and clean tongue, often accompany symptoms such as five hearts heat, tidal fever, night sweats, red tongue, and rapid pulse, indicating yin not restraining yang and internal heat arising from deficiency. Yang deficiency syndrome, in addition to signs of fatigue, shortness of breath, reluctance to speak, excessive sleepiness, weak pulse, and other symptoms of qi deficiency and functional decline, often also presents with cold extremities, pale tongue, and symptoms of water and cold accumulation.
Loss of yin and loss of yang are critical conditions in the disease process, often occurring in cases of high fever, profuse sweating, severe vomiting and diarrhea, or excessive blood loss, leading to rapid loss of yin fluids or yang qi. Their clinical manifestations, in addition to various critical symptoms of the primary disease, often include varying degrees of sweating. However, sweating in loss of yin is hot and sticky, often accompanied by hot skin, warm extremities, thirst for cold drinks, thin and rapid pulse; loss of yang presents with profuse sweating, cool and thin sweat, often accompanied by cool skin, cold extremities, no thirst but a preference for hot drinks, fatigue, and weak pulse.
Since yin and yang are interdependent, when yin is depleted, yang qi has no support and disperses; when yang is lost, yin cannot transform and is depleted. Therefore, loss of yin and loss of yang cannot be completely separated, but rather differ in priority and sequence.
Additionally, there are some diseases that, based on their different characteristics, can also be classified into yin and yang syndromes. These classifications are based on the nature of the pathological changes and their relative relationships, not implying that these changes are solely caused by alterations in yin and yang.
Practice Questions:
1. A 29-year-old woman has been coughing for over two months, with a dry cough and no phlegm, dry and itchy throat, and occasional hoarseness. Her tongue is red with little coating, and her pulse is thin and rapid. According to the eight principles differentiation, this syndrome belongs to A. Excess B. Deficiency C. Exterior D. Yang E. Cold
2. A 65-year-old man has had asthma for over ten years, with shortness of breath and fatigue, excessive clear phlegm, reduced appetite, abdominal distension, loose stools, and swelling in the feet. His tongue is pale with white coating, and his pulse is thin and weak. According to the eight principles differentiation, this syndrome belongs to A. Exterior B. Cold C. Heat D. Deficiency E. Yang
3. Symptoms of yang deficiency syndrome may include
A. Weight loss
B. Five hearts heat
C. Dry mouth and throat
D. Cold body and limbs
E. Dizziness and insomnia
Answers and Explanations:
1. B Any condition classified as deficiency syndrome is characterized by insufficient righteous qi in the body. According to the eight principles differentiation, this syndrome belongs to deficiency (B correct). Deficiency syndrome is characterized by symptoms of insufficiency and weakness. Excess syndrome (A incorrect) reflects a condition of excessive pathogenic qi. The key point for differentiation is the manifestation of excess and hyperactivity. Exterior syndrome (C incorrect) is a condition located superficially in the skin, characterized by sudden onset, short duration, and symptoms of fever and aversion to cold. Yang syndrome (D incorrect) often arises from excessive pathogenic qi while righteous qi remains intact, indicating an excited phase of the struggle between righteous and pathogenic qi, commonly seen in interior excess-heat syndromes. Yang syndrome is characterized by the presence of heat signs. Cold syndrome (E incorrect) results from the invasion of cold pathogens or from yang deficiency and yin excess, manifesting as cold symptoms and functional decline.
2. D Deficiency syndrome (D correct) clinical manifestations include pale or sallow complexion, mental fatigue, physical weakness, palpitations, shortness of breath, cold limbs, or symptoms such as five hearts heat, spontaneous sweating, night sweats, loose stools, urinary incontinence, red tongue with little or no coating, and weak pulse. 3. D
This question examines the symptoms of yang deficiency syndrome. Clinical manifestations of yang deficiency syndrome include fatigue, shortness of breath, reluctance to speak, excessive sleepiness, weak pulse, and other symptoms of qi deficiency and functional decline, often accompanied by cold extremities, pale tongue, and symptoms of water and cold accumulation.
Little Zhou, the Pharmacist, says:
The differentiation between deficiency and excess, as well as yin and yang, primarily focuses on the identification of clinical symptoms.