The differentiation of deficiency and excess can identify the strength of the body’s vital energy and the severity of pathogenic factors. Deficiency refers to the weakness of vital energy, which is the fundamental substance for the physiological activities and maintenance of the body’s organs, such as insufficient qi (气), xue (血), and jinye (津液); excess refers to the overabundance of pathogenic energy. Through this differentiation, one can understand the dynamics of pathogenic and vital energies in the body, determine treatment principles, and establish an important basis for prognosis.
1. Deficiency Syndrome (Xu Zheng)
Deficiency syndrome is a pathological summary of various clinical manifestations resulting from the weakness of the body’s vital energy. The main causes include: dietary imbalance, insufficient sources for the production of ying (营) and xue (血); excessive thinking, grief, and fear; overexertion leading to the depletion of qi (气), xue (血), and ying (营); irregular sexual activity depleting shen jing (肾精); prolonged illness without treatment or mismanagement damaging the body’s vital energy; excessive vomiting, diarrhea, bleeding, and loss of essence leading to the depletion of yin (阴), liquid (液), qi (气), and xue (血). Clinical manifestations: Various deficiency syndromes present inconsistently, and different organ deficiencies exhibit different symptoms, making it difficult to summarize with a few symptoms. Common symptoms include palpitations, irregular pulse, cough with little phlegm, flushed cheeks with night sweats, reduced appetite, abdominal distension, loose stools, dizziness, tinnitus, decreased vision, scant menstruation, low back pain, impotence, and cold extremities. Key points for differentiation: Insufficient yang energy (pale complexion, fatigue, shortness of breath with spontaneous sweating, cold limbs, clear urine, loose stools, pale and swollen tongue, weak and slow pulse); insufficient yin (阴) and xue (血) (pale or sallow complexion, emaciation, tidal fever with night sweats, five hearts heat, red tongue with little coating, thin and rapid pulse).
2. Excess Syndrome (Shi Zheng)
Excess syndrome is a summary of various clinical symptoms resulting from the imbalance of yin (阴) and yang (阳), qi (气), and xue (血) during the invasion of external pathogens or the accumulation of pathological products within the body. Causes include: invasion of external pathogens in the early or middle stages, where pathogenic energy is strong and vital energy is not yet weakened, leading to intense conflict between the two; dysfunction of internal organs resulting in the accumulation of pathological products such as yu xue (瘀血), tan yin (痰饮), and shui shi (水湿); accumulation of food or parasites within the body. Clinical manifestations: fever, abdominal distension and pain with tenderness, chest tightness and irritability, even delirium, coarse breathing, excessive phlegm, constipation, or diarrhea with urgency and heaviness, difficulty urinating, or painful urination, with a pale tongue and thick greasy coating, and a strong pulse. Key points for differentiation: Excess syndrome is characterized by strong pathogenic energy without weakened vital energy, resulting from intense conflict between pathogenic and vital energies, with diverse symptoms based on the nature of the pathogenic factors.
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Recommended Reading:
Understanding Disease Differentiation in TCM: The Eight Principles – Cold and Heat
Understanding Disease Differentiation in TCM: The Eight Principles – Interior and Exterior
Understanding TCM Diagnosis – The Four Diagnostic Methods