Library

When sores and carbuncles have suppurated and ulcerated, and the swelling and toxicity are spreading, with a critical and malignant presentation, it is imperative to differentiate between deficiency (Xu) and excess (Shi). For those without deficiency, tonification is difficult; for those with excess, purgation is easier. The methods of tonification and purgation must not be used lightly; even a slight error can lead to significant harm. However, there are many manifestations of deficiency and excess syndromes, which cannot fail to be distinguished. There are deficiencies and excesses in the sores themselves, in the Zang-Fu organs and Qi and Blood, and in the true Qi versus pathogenic factors, hence they differ. Speaking separately: if the swelling is raised, hard, and the pus is thick, it is an excess syndrome of the sore or carbuncle; if the swelling is flat, soft, slow to rise, and the pus is thin, it is a deficiency syndrome of the sore or carbuncle. If there is diarrhea or dysentery, borborygmus (intestinal rumbling), inability to eat, frequent vomiting, cold hands and feet, weak pulse, cold skin, free urination, or difficulty in urination combined with loose stools, loss of voice, and unclear spirit, these are all deficiency syndromes of the Zang-Fu organs. If there is hard stool, obstructed urination, normal appetite, abdominal fullness and distension, chest and diaphragm oppression, pain in limbs and joints, bitter taste in the mouth and dry throat, irritability with excessive thirst, fever, large pulse, and confused or blocked spirit, these are all excess syndromes of the Zang-Fu organs. Whenever various sores and carbuncles have clear and thin pus, open wounds that do not close, swollen masses that are not red, cold muscles and flesh, spontaneous sweating, and sallow complexion, this is a deficiency of Qi and Blood. If the swelling is raised and red, accompanied by alternating chills and fever, pain, hot skin, thick and sticky pus, and heavy or confused head and eyes, this is an excess of Qi and Blood. Headache and nasal congestion, red eyes, fright, pharyngeal obstruction, sores on the mouth and tongue, vexatious thirst for cold drinks, somnolence with teeth grinding, constitute an upper excess. Slippery seminal emission, unobstructed bowel movements, heavy waist and legs, and restless sleep constitute a lower deficiency. Inconvenience in the shoulders, neck, and nape, heaviness in the four limbs, abnormal vision, unclear gaze, loss of taste, hoarse voice, deteriorated complexion, and edema of the four limbs constitute a deficiency of True Qi (Zhen Qi). Severe swelling, unbearable pain, failure to ulcerate after many days, alternating chills and fever, constipation, urinary frequency and dysuria resembling strangury, mental restlessness, and confusion constitute an excess of Pathogenic Factors (Xie Qi). It is said: depletion of True Qi results in deficiency; victory of Pathogenic Factors results in excess. It is also said: all pain indicates excess, while itching indicates deficiency. It is further stated: a pulse that is surging, large, and rapid indicates excess; a pulse that is faint, fine, and soft indicates deficiency. For deficiency, one tonifies and harmonizes the Qi to support the interior; for excess, one purges, unblocks, and guides the Qi naturally. The *Neijing* states: "If Blood is excess, resolve it [by draining]; if Qi is deficient, draw it up [or guide it]."