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Deficiency and Excess are the definitive nature of all diseases. As stated, "When pathogenic factors are flourishing, it is Excess; when essential qi is depleted, it is Deficiency." These are merely the two conditions. However, the treatments regarding root and branch, and contrary and compliant approaches, all originate from this. One cannot lack the distinction between urgency and non-urgency, or presence and absence, to further seek detailed understanding.

"Urgency and non-urgency" refers to observing the urgency of deficiency and excess conditions. If there is no significant deficiency, the urgency lies in the pathogenic factor; if there is much deficiency, the urgency lies in the healthy qi. In cases of slight excess, although treating the excess is necessary, one must also consolidate the root. In cases of slight deficiency, although treating the deficiency is necessary, one must also guard against unforeseen changes.

"Presence and absence" refers to observing whether pathogenic factors are present. If pathogens reside in the exterior, interior, zang-fu organs, they have a specific location; grasping the root and directly eliminating them constitutes "active intervention," which characterizes the excess of pathogens. Conversely, injuries caused by emotions/desires damaging the interior, or fatigue/overwork damaging the exterior, are "non-pathogens resembling pathogens"; the disease lies in the primordial qi, requiring clear differentiation. This constitutes "non-active intervention," representing the true deficiency of the original qi. If one fails to examine this carefully, mistaking contrary for compliant, or branch for root, it will endanger human life.

Deficiency presents with specific pulse manifestations. Qibo stated: "Qi deficiency is Lung deficiency. Qi rebellion manifests as cold feet." The primordial root of humans is governed by Yuan Qi (Primordial Qi), and the master of Yuan Qi is the Lung. Therefore, Qi deficiency leads to Lung deficiency, and Lung deficiency leads to universal deficiency of the body's Yuan Qi. Deficiency inevitably manifests as Qi rebellion, specifically as cold feet. The Yin and Yang Qi of humans all originate from the feet. If the feet are cold, it indicates insufficient Yang allowing Yin to invade. Thus, this serves as a criterion for judging all deficiencies.

There is a condition called "Double Deficiency." The Classics state: "Pulse deficiency, Upper deficiency, and Chi (Cun Cun) deficiency constitute Double Deficiency." Pulse deficiency means the pulse does not resemble the Yin pattern. Qi deficiency manifests as irregular speech. Chi deficiency manifests as unsteady gait. "Double Deficiency" generally refers to the simultaneous deficiency of Yin and Yang, so this passage is cited as an example of dual deficiency. First, regarding the pulse: saying it "does not resemble Yin" implies that the pulse arises from the Ying (Nutrient) Qi of the Yin aspect. When Ying Qi declines, Shen (Spirit) detaches. Once Shen detaches, it cannot reflect the normal images of the Five Zang Organs responding to the Four Seasons. Such pulses fail to correspond to time or disease, completely losing their Yin image; hence, "not resembling Yin." Second, regarding the Upper: this refers to Lung deficiency. Lung deficiency causes Qi rebellion, often manifesting as upper symptoms and unstable pulse Qi, leading to irregular speech. Third, regarding the Chi position: the Chi pulse corresponds to the Kidney. The Kidney governs bones and Essence, consolidating the union of skin/flesh and the binding of sinews/bones. Now, with an unsteady gait indicating a shaking foundation unable to stand, this confirms the diagnosis. Observers judge deficiency based on these three aspects; thus, deficiency is essentially described here.

The *Nei Jing* states that the generation of all diseases involves deficiency and excess, originating from the Five Zang Organs, and invariably manifesting in Shen (Spirit), Qi, Blood, Flesh, and Zhi (Will). Regarding pathogen invasion, diagnosis follows the sequence through these five aspects. Both root deficiency/excess and pathogenic deficiency/excess are differentiated thus. The Heart stores Shen; excess leads to incessant laughter, deficiency to sorrow. The Lung stores Qi; excess leads to wheezing, coughing, and upward Qi rebellion, while deficiency leads to smooth breathing but shortness of breath. The Liver stores Blood; excess leads to anger, deficiency to fear. the Spleen governs transformation to form the body; excess leads to abdominal distension and difficult urination/defecation, while deficiency leads to inability to use the four limbs. The Kidney stores Zhi; excess leads to abdominal distension and undigested stool diarrhea, while deficiency leads to Jue (Cold Reversal). These excesses represent "Pathogenic Flourishing = Excess"; these deficiencies represent "Healthy Qi Depletion = Deficiency." Even sudden wind pathogens first attack these five aspects, entering layer by layer through the physical form. Zhang Zhongjing’s division of Six Channels for treating Cold Damage inherits this method. Thus, the Classics state regarding invasion: "When Blood and Qi have not yet mingled, the Five Zang are stable." Pathogens enter from outside and do not immediately merge internally. Hence, "When pathogens lodge in the form, shivering starts at the hair follicles" because they have not entered the meridians; this is named "Shen Wei" (Subtle Spirit involvement). The Heart distributes to the Exterior, the Kidney to the Interior. From Shen to Kidney, there is an Exterior-Interior distinction. When pathogens cause shivering and hair erection, Shen perceives it first, hence "Shen Wei." Next, pathogens enter the skin, causing minor skin pathology affecting Lung Qi, named "Qi Wei Xie" (Minor Leakage of Qi). Next, pathogens enter Sun Luo (Sun Collaterals), overflowing externally and affecting Liver Blood, disturbing Ying Qi, hence "Wei You Liu Xue" (Collateral Stasis of Blood). Next, pathogens affect muscles, causing muscle twitching in the Fen Rou (intermuscular spaces) governed by the Spleen, named "Xiao Feng" (Minor Wind). Next, joint movement indicates pathogens entering Jing (Main) Meridians and affecting bones, perceived only by Zhi, meaning Zhi is disturbed and pathogens are deep. However, "Shen perception first" refers to a desolate, unhappy feeling. "Qi" refers to aversion to cold/wind. "Blood" refers to mild fever. "Form" refers to turning pain. "Zhi" refers to restlessness. These are the stages of pathogen invasion. The *Nei Jing* prescribes acupuncture methods according to these five layers and treatments accordingly—is this not what later generations call Exterior-Releasing Methods? Observing deficiency/excess reveals the excess/deficiency of the Five Zang as above; following treatment methods reveals the depth/sequence of physical layers as such. Later physicians treating pathogens need only ponder half as much to understand this.

There is deficiency/excess caused by "Merging." Yin and Yang clash; Qi and Blood merge. Qi becomes chaotic in the Wei (Defensive) level; Blood rebels in the meridians. Qi and Blood separate, resulting in one Excess and one Deficiency. This occurs because Qi and Blood prefer warmth and dislike cold; cold causes stagnation, warmth causes dispersion. Thus, where Qi merges, Blood becomes deficient; where Blood merges, Qi becomes deficient. Therefore, presence indicates Excess, absence indicates Deficiency. For example, if Blood merges into Yin and Qi merges into Yang, it causes惊狂 (Fright and Mania). Blood merging into Yin is Heavy Yin; Qi merging into Yang is Heavy Yang. Heavy Yin leads to Dian (Manic Depression/Epilepsy); Heavy Yang leads to Kuang (Mania). Hence, Fright and Mania occur. If Blood merges into Yang and Qi merges into Yin, it causes Jiong Zhong (Internal Heat/Burning Sensation). Yin at the Exterior implies internal Yin deficiency; Yang at the Interior implies internal Yang heat. Hence, Internal Heat. "Jiong" means heat. If Blood merges upward and Qi merges downward, it causes heart vexation and irritability. Blood merging upward suppresses the Heart with Yin pathogens, causing vexation; Qi merging downward stirs Fire in the Liver, causing irritability. If Blood merges downward and Qi merges upward, it causes mental confusion and forgetfulness. Blood merging downward prevents Yin Qi from ascending; Qi merging upward prevents Yang Qi from descending. Yin and Yang scatter, causing mental confusion and forgetfulness. If Blood and Qi both rush upward, it results in Da Jue (Great Jue Syndrome), leading to sudden death. If Qi returns, life is preserved; if not, death ensues. Generally, loss of connection between Blood and Qi causes Blood Deficiency; merging causes Excess. When Blood and Qi rush upward, there is Upper Excess and Lower Deficiency. Lower Deficiency leads to Yin Collapse. Yin Collapse severs the root, causing Lower Jue and Upper Exhaustion, i.e., Great Jue, leading to sudden death. If Qi reverses at its extreme, Yin can gradually return; once gone without return, survival is impossible. This is the general principle of Merging.

There is deficiency/excess due to External Invasion and Internal Injury. Pathogens arising from Yang come from Wind, Rain, Cold, Summer-heat; these arise externally, termed External Invasion. Pathogens arising from Yin come from Diet, Dwelling, Yin-Yang imbalance, Joy/Anger; these arise internally, termed Internal Injury. External invasions are mostly Excess; Internal injuries are mostly Deficiency. However, Internal injury leading to External invasion results in Deficiency with slight Excess; External invasion still involving Internal injury results in Excess with much Deficiency. The nuances of deficiency/excess here must be carefully distinguished, but primarily, External and Internal categories each have their own deficiency/excess patterns. For instance, Wind/Rain attacking lodges in hair/full collaterals, reaching Fen Cou (skin/muscle intervals), presenting with firm/large pulses—this is Excess. Cold/Dampness attacking damages Wei Qi, causing loose/redundant skin, tight/thin muscles, stagnant Ying in vessels, and Wei leaving vessels—this is Deficiency. Similarly, unregulated Joy/Anger in Internal Injury causes Yin Qi to rebel upward, creating Lower Yin Deficiency attracting Yang pathogens—this is Excess. However, if this Excess stems from Deficiency, it is False Excess. Joy causes Qi to sink; Sorrow causes Qi to dissipate; sinking/dissipating leads to empty pulses. Dietary cold filling the interior causes stagnant Blood and departing Qi—this is Deficiency. This covers the generalities of External and Internal causes.

Key principles governing deficiency/excess include: First, Qi. Human Yuan Qi fills the form and commands Blood. Thus, Excess Qi means Excess Form; Deficient Qi means Deficient Form. If Form and Qi contradict, pathological Excess or Deficiency arises. Second, Grain Qi (Gu Qi). Abundant Grain leads to abundant Qi; scarce Grain leads to scarce Qi. This is "Food enters Yin, nourishes Yang." The Five Zang and Six Fu organs receive Qi from Grain. Third, Pulse. Pulse is the mansion of Blood. Excess Pulse means Excess Blood; Deficient Pulse means Deficient Blood. Usually, they correspond. Sometimes they reverse. Qibo said: "Qi Excess with Cold Body" is a reversal. "Qi Deficiency with Hot Body" is a reversal. Qi Excess should bring Heat; Qi Deficiency should bring Cold. Reversals occur due to Yang depression inside/Yin attacking outside, or Yin deficiency inside/Pathogen excess outside, constituting Form-Qi contradiction. Other reversals: Eating much but having little Qi (Excess Er Yang, Deficiency San Yin); eating nothing but having much Qi (Pathogen merging in Lung/Stomach). Pulse full with little Blood (Yang Excess, Yin Deficiency); Pulse small with much Blood (Yang Deficiency, Yin Excess).

General methods for diagnosing deficiency/excess: Qi filling internally is "Qi Entering," indicating Excess. Qi leaking externally is "Qi Exiting," indicating Deficiency. Qi belongs to Yang Qi. Excess means Yang Excess, necessarily Heat. Deficiency means Yang Deficiency, necessarily Cold. These manifestations of deficiency/excess and cold/heat in Qi can be diagnosed.

Wu Shi (Five Excesses) and Wu Xu (Five Deficiencies) determine life and death. What are the Five Excesses? Full pulse, hot skin, abdominal distension, obstruction of front/back (urination/defecation), and stifling/dizziness. These are the Five Excesses. What are the Five Deficiencies? Thin pulse, cold skin, shortness of breath, diarrhea/incontinence of front/back, and inability to eat/drink. These are the Five Deficiencies. Those exhibiting all five are destined to die, but some survive. If gruel enters the stomach and diarrhea stops, the Deficient patient lives. If sweat appears and bowels/bladder open, the Excess patient lives. These are the prognostic signs.