Inheriting the legacy of Qi Huang, a public account with substance and warmth.
Ai Yu Xiang Tang
What is Excess Syndrome and what is Deficiency Syndrome?According to the “Suwen: General Discussion on Deficiency and Excess,” it states: “When evil qi is strong, it is excess; when vital essence is depleted, it is deficiency.” Here, the evil qi refers to the pathogenic factors of wind, cold, dryness, heat, dampness, and fire. The depletion of vital essence refers to the loss and consumption of vital energy. This describes the pathogenesis of deficiency and excess from the perspective of the rise and fall of evil and righteous qi.
Deficiency is associated with Yin, while excess is associated with Yang. Deficiency and excess are a pair of opposing contradictions in Yin and Yang, yet they also have an intrinsic connection. Taking heat evil as an example: heat evil is excess, and heat evil consumes Yin fluids leading to Yin deficiency, which can manifest symptoms of both Yin deficiency and heat evil existing simultaneously. At this time, it is a case of righteous deficiency with evil 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 to treat the disease. The “Suwen: 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 that blood and qi are lost to each other, it is deficiency.” The pathogenesis of “deficiency and excess” has two types: one is due to the strong evil qi (excess) leading to a lack of righteous qi (deficiency), or due to a lack of righteous qi (deficiency) resulting in the emergence of evil 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 exists a pathogenesis of blood deficiency (deficiency) due to qi being combined (excess); there is also qi stagnation transforming into fire, which consumes Yin fluids leading to Yin deficiency; compounded by the pathogenesis of stagnation fire (excess) leading to Yin deficiency (deficiency), thus intertwining the pathogenesis of deficiency and excess.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 persists for a long time, weight loss, spontaneous sweating, lack of energy, dull eyes, low and timid speech, long-term loss of appetite, vague 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 disease, with a more severe condition, but generally recover faster.2. Due to the intense struggle between evil and righteous qi, the body’s response to the pathogenic evil 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 matter in the body (stones, tumors, blood stasis, ascites, phlegm, etc.) is classified as excess. In cupping therapy for excess symptoms, the cupping marks are very obvious, often appearing bright red or purplish-red, or blisters may appear.Mixed Deficiency and Excess Any deficiency syndrome mixed with excess syndrome, excess syndrome mixed with deficiency syndrome, and the simultaneous presence of deficiency and excess are all classified as mixed deficiency and excess syndrome. 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 in treatment, both attacking and tonifying methods must be employed. However, in the process of attacking and tonifying, it is also necessary to distinguish which is more, as the use of herbs will have different weights and priorities. In mixed deficiency and excess, based on the amount of deficiency and excess, there are three situations: excess syndrome with deficiency, deficiency syndrome with excess, and equal emphasis on deficiency and excess. 1. Excess syndrome with deficiency. This syndrome often occurs in patients with excess syndrome where righteous qi is damaged, and can also be seen in patients who were originally deficient and newly contracted external evil. Its characteristic is that the excess evil is predominant, and the deficiency is secondary. For example, the Bai Hu Jia Ren Shen Tang syndrome in the “Shang Han Lun” is originally due to the heat in the Yangming channel, presenting with 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 evil excess with deficiency. The treatment should primarily attack the evil with Bai Hu, supplemented with Ren Shen to support righteous qi.2. Deficiency syndrome with excess. This syndrome often occurs in patients with severe excess syndrome, prolonged duration, significant damage to righteous qi, and residual evil. It can also be seen in patients with significant deficiency who are re-exposed to pathogenic evil. Its characteristic is that the deficiency is predominant, and the excess evil is secondary. For example, the kidney Yin deficiency syndrome in the late stage of warm disease occurs when the evil heat damages the Yin of the liver and kidneys, presenting with symptoms of low fever that does not subside, dry mouth, and a dry, red tongue. At this time, the treatment should primarily nourish Yin and replenish fluids, supporting righteousness while clearing residual heat.3. Equal emphasis on deficiency and excess. This syndrome is seen in two situations: one is originally a severe excess syndrome that has prolonged over time, causing significant damage to righteous qi, while the evil has not diminished; the other is a patient who originally had weak righteous qi but contracted a significant pathogenic evil. 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 disease arises from dietary stagnation, damaging the spleen and stomach, presenting with both deficiency and excess, and treatment should combine food elimination and tonifying the spleen.Transformation of Deficiency and Excess The development of disease is often a process of struggle between evil 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 evil damaging righteous qi; conversely, some conditions that are deficient may lead to the accumulation of phlegm, food, blood, and fluids due to dysfunction of the organs, resulting in excess due to deficiency. For example, a case of excess heat syndrome with high fever, thirst, sweating, and a flooding pulse, if treated improperly and prolonged, 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. Conversely, if the original condition is heart and spleen qi deficiency, often presenting with palpitations, shortness of breath, and prolonged treatment without improvement, suddenly experiencing persistent heart pain indicates 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 removing stasis to relieve pain.True and False Deficiency and Excess Deficiency and excess can be distinguished as true and 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 syndrome, 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 symptoms that seem deficient. For example, in cases of heat accumulation in the stomach and intestines, phlegm and food stagnation, presenting with significant accumulation, yet the patient appears calm, with cold limbs and a deep or slow pulse. Upon careful examination, it can be found that although the patient appears calm, their speech is loud and forceful; 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 the 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 symptoms that seem excess. For example, in cases of spleen deficiency and impaired transportation, presenting with abdominal distension and pain, and a wiry pulse. Upon careful examination, it can be found that the abdominal distension may sometimes alleviate, unlike the constant fullness seen in excess; although there is abdominal pain, the patient prefers pressure; and although the pulse is wiry, it becomes 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 flourishing 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 index of heat consumption required by the body when not eating, drinking, or moving, individuals with a lower basal metabolic rate or poor peripheral blood circulation are prone to cold hands and feet in winter, indicating a “deficiency constitution”; while those with a higher basal metabolic rate not only have warm hands and feet but may also experience “excess heat” symptoms such as dry mouth and constipation, indicating an “excess constitution.” The constitution of an individual as either excess or deficiency primarily depends on genetic factors, as well as environmental conditions, dietary habits, and health status. For instance, northern individuals often present a robust appearance, with a bright complexion and resilience to cold, while southern individuals tend to lean towards a deficiency constitution, being more sensitive to cold. Surveys have found that the proportion of deficiency constitution among women is significantly higher than that of men, hence more women tend to feel cold in winter.This is for clinical reference only; non-professional practitioners should not attempt acupuncture or medication.
Copyright Statement:Edited by Yi Dan, Proofread by Feng Tu / Based on publicly available online materialsCopyright belongs to the original author.
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