What is Excess Syndrome and Deficiency Syndrome? According to the “Su Wen: Discussion on Deficiency and Excess,” it states: “When pathogenic qi is strong, it is excess; when vital essence is depleted, it is deficiency.” Here, pathogenic qi refers to the evils of wind, cold, dryness, heat, dampness, and fire. The depletion of vital essence refers to the loss and exhaustion of vital energy. This describes the pathogenesis of deficiency and excess from the perspective of the rise and fall of pathogenic and righteous qi.
Deficiency belongs to yin, while excess belongs to yang. Deficiency and excess are a pair of opposing contradictions in yin and yang, yet they are also intrinsically connected. Taking heat evil as an example: heat evil is excess, and it consumes yin fluids leading to yin deficiency, which can manifest symptoms of both yin deficiency and heat evil simultaneously. At this point, it is a case of righteous deficiency with pathogenic excess; treatment should employ methods to nourish yin and clear heat, which addresses both ends of yin deficiency and heat evil, using the middle path of treatment. The “Su Wen: Regulation of Menstruation” states: “When qi and blood are combined, yin and yang are tilted; qi is chaotic in the defensive layer, blood is reversed in the channels, blood and qi are separated, one is excess and the other is deficiency. Where there is excess, there is no blood; where there is blood, there is no qi. Now, with blood and qi lost to each other, it is deficiency.” The pathogenesis of “deficiency and excess” has two types: one is due to strong pathogenic qi (excess) leading to a lack of righteous qi (deficiency), or due to a lack of righteous qi (deficiency) resulting in pathogenic qi (excess). The other is due to qi being combined (excess) leading to a lack of blood (deficiency), or due to blood being combined (excess) leading to a lack of qi (deficiency). In clinical practice, it is often encountered that the pathogenesis of “deficiency and excess” is intertwined and mixed, such as in the case of qi stagnation in the heart and brain, where there is already a pathogenesis of blood deficiency (deficiency) caused by qi being combined (excess); there is also qi stagnation transforming into fire, which consumes yin fluids leading to yin deficiency; and additionally, there is the pathogenesis of yin deficiency (deficiency) caused by stagnant fire (excess). This results in a complex intertwining of deficiency and excess in the pathogenesis.Distinguishing Deficiency and ExcessDeficiency Symptoms: 1. Chronic illness often leads to deficiency; generally, deficiency symptoms occur after severe illness, and the duration of the illness is often prolonged, making recovery difficult and prone to recurrence.2. Due to insufficient righteous qi, the body’s response to disease may not be obvious or may not manifest, hence the symptoms are not severe. Symptoms include low fever that lingers, weight loss, spontaneous sweating, lack of energy, dull eyes, soft speech, long-term loss of appetite, lingering abdominal pain, pale tongue with little coating, and thin, weak pulse.3. Deficiency symptoms are often accompanied by cold symptoms (deficiency-cold syndrome).4. In cupping therapy for deficiency symptoms, the cupping marks are generally not obvious, and the skin often appears light red or slightly red.Excess Symptoms: 1. Acute illness often leads to excess; generally, excess symptoms have a shorter course, often occurring in the early or middle stages of the illness, and the condition is more severe, but recovery is generally faster.2. Due to the intense struggle between pathogenic and righteous qi, the body’s response to the pathogenic factor is more pronounced, hence the symptoms are more severe, such as high fever, no sweating, mental excitement, loud speech, abdominal pain with resistance to pressure, constipation, short and red urine, severe cough with abundant phlegm, red tongue with yellow coating, and rapid, strong pulse. Excess symptoms are often accompanied by heat symptoms (excess-heat syndrome).Any pathological foreign substances in the body (such as stones, tumors, blood stasis, ascites, phlegm, etc.) are classified as excess symptoms. In cupping therapy for excess symptoms, the cupping marks are very obvious, often appearing bright red or purple-red, or blisters may appear.Mixed Deficiency and Excess Any deficiency syndrome that contains excess symptoms, or excess syndrome that contains deficiency symptoms, as well as cases where both deficiency and excess are present, are all classified as mixed deficiency and excess syndromes. For example, exterior deficiency with interior excess, exterior excess with interior deficiency, upper deficiency with lower excess, and upper excess with lower deficiency, etc. The symptoms of mixed deficiency and excess are intertwined, so treatment must employ both attacking and tonifying methods. However, in the process of attacking and tonifying, it is also necessary to distinguish which is more prevalent, thus the use of herbs will have distinctions of light and heavy, primary and secondary. In mixed deficiency and excess, based on the degree of deficiency and excess, there are three situations: 1. Excess with Deficiency. This syndrome often occurs in patients with excess syndrome where righteous qi is damaged, and it can also be seen in patients who were originally deficient and newly contracted external evils. Its characteristic is that the excess evil is predominant, and the deficiency is secondary. For example, in the “Shang Han Lun,” the Bai Hu Jia Ren Shen Tang syndrome, which originally presents with strong heat in the Yangming channel, shows symptoms of high fever, thirst, sweating, and a flooding pulse. Due to the intense heat damaging qi and yin, symptoms of dryness and thirst, restlessness, and slight aversion to cold appear, indicating a combination of excess evil with deficiency. The treatment should primarily attack the evil with Bai Hu, while also adding Ren Shen to support righteous qi.2. Deficiency with Excess. This syndrome often occurs in patients with severe excess syndrome that has been prolonged, where righteous qi is greatly damaged, and residual evils remain; it can also be seen in patients with significant deficiency who are newly affected by pathogenic qi. Its characteristic is that the deficiency is predominant, and the excess evil is secondary. For example, the kidney yin deficiency syndrome in warm diseases appears in the late stage of warm diseases, where the evil heat damages the yin of the liver and kidneys, presenting symptoms of less evil and more deficiency. Symptoms include persistent low fever, dry mouth, and a dry, red tongue. At this time, the treatment should focus on nourishing yin and replenishing fluids, while also clearing residual heat.3. Equal Deficiency and Excess. This syndrome is seen in two situations: one is originally a severe excess syndrome that has been prolonged, leading to significant damage to righteous qi, while the excess evil has not diminished; the other is originally weak righteous qi that has been heavily affected by pathogenic qi. Their characteristics are that both deficiency and excess are very evident, and the condition is relatively severe. For example, in pediatric malnutrition, diarrhea, insatiable appetite, thick and turbid tongue coating, and thin, slightly wiry pulse. The illness arises from food stagnation damaging the spleen and stomach, presenting both deficiency and excess, and treatment should combine food elimination and strengthening the spleen.Transformation of Deficiency and Excess The development of disease is often a process of struggle between pathogenic and righteous qi, and the reflection of this struggle in symptoms mainly manifests as changes in deficiency and excess. During the disease process, some conditions that were originally excess may transform into deficiency due to prolonged pathogenic factors damaging righteous qi; conversely, some conditions that are deficient may lead to the accumulation of phlegm, food, blood, or fluids due to dysfunction of the organs, resulting in excess due to deficiency. For example, in cases of high fever, thirst, sweating, and a flooding pulse indicating excess heat, if treated improperly and prolonged, it may lead to the depletion of fluids, resulting in muscle wasting, pale complexion, loss of appetite, and thin, weak pulse, indicating a transformation from excess to deficiency. Similarly, if the original condition is heart and spleen qi deficiency, often presenting with palpitations, shortness of breath, and prolonged treatment without improvement, a sudden onset of persistent heart pain may occur, indicating a transformation from deficiency to excess due to qi deficiency and blood stasis leading to obstruction of the heart vessels; treatment should focus on invigorating blood and eliminating stasis to relieve pain.True and False Deficiency and Excess Deficiency and excess can be distinguished as true or false; when diagnosing, it is essential to differentiate the true from the false among the mixed symptoms to avoid falling into the trap of “false deficiency and true excess.” Distinguishing the true and false of deficiency and excess is fundamentally different from mixed deficiency and excess syndromes, and careful examination and differentiation are necessary.1. True Excess with False Deficiency. This refers to a condition that is fundamentally excess but presents some phenomena that seem deficient. For example, in cases of heat accumulation in the stomach and intestines, phlegm and food stagnation, presenting as excess, yet showing calm demeanor, cold limbs, and a pulse that is deep or slow. Upon careful differentiation, it can be found that although the demeanor is calm, the speech is loud; although the pulse is deep or slow, it is strong upon palpation; and although the limbs are cold, the chest and abdomen feel hot upon prolonged pressure. The reason for these seemingly deficient symptoms is not due to weakness of the body, but rather due to the obstruction of the meridians by excess evil, preventing the flow of qi and blood, hence these symptoms are termed false appearances, historically referred to as “great excess with deficient appearance.” At this time, treatment should still focus on attacking the evil.2. True Deficiency with False Excess. This refers to a condition that is fundamentally deficient but presents some phenomena that seem excess. For example, in cases of spleen deficiency and inability to transform, abdominal distension and pain may occur, with a wiry pulse. Upon careful differentiation, it can be found that the abdominal distension may sometimes alleviate, unlike the constant fullness of true excess; although there is abdominal pain, it is relieved by pressure; and although the pulse is wiry, it is weak upon deeper palpation. The reason for these seemingly excess symptoms is not due to excess evil, but rather the result of weakness of the body, hence this is also termed a false appearance. The ancient saying “extreme deficiency has a strong appearance” refers to this. Treatment should employ tonifying methods. Traditional Chinese Medicine believes that the human body can be classified into two types: “deficiency constitution” and “excess constitution.” Due to differences in the basal metabolic rate, which is the amount of energy required by the body at rest, individuals with a lower basal metabolic rate or poor peripheral circulation may easily experience cold hands and feet in winter, indicating a “deficiency constitution”; while those with a higher basal metabolic rate may have warm hands and feet and may experience “excess heat” symptoms such as dry mouth and constipation, indicating an “excess constitution.” The constitution of deficiency or excess primarily depends on genetic factors, as well as environmental conditions, dietary habits, and health status. For example, northern individuals often present with a strong voice, rosy complexion, and are not afraid of the cold, indicating an excess constitution, while southern individuals tend to have a deficiency constitution and are more sensitive to cold. Surveys have found that the proportion of deficiency constitution among women is significantly higher than that among men, hence women are more likely to feel cold in winter.This is for clinical reference only; non-professional practitioners should not attempt acupuncture or medication.Disclaimer
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