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The Essentials of Deficiency and Excess

In the *Suwen: Cilun Lun* (Treatise on Needling for Depletion and Fullness), the Yellow Emperor said: "I wish to hear about the essentials of deficiency and excess." Qibo replied: "When Qi is excessive, the form is solid; when Qi is deficient, the form is weak. This is the normal state. The opposite of this indicates disease. When food intake is abundant, Qi is excessive; when food intake is scanty, Qi is deficient. This is the normal state. The opposite of this indicates disease. When the pulse is full, Blood is excessive; when the pulse is empty, Blood is deficient. This is the normal state. The opposite of this indicates disease." The Yellow Emperor asked: "How does one become the opposite?" Qibo replied: "Qi is excessive but the body is cold—this is called the opposite; Qi is deficient but the body is hot—this is called the opposite; food intake is abundant but Qi is scanty—this is called the opposite; the pulse is full but Blood is scanty—this is called the opposite; the pulse is small but Blood is excessive—this is called the opposite. 'Qi excessive with body cold' results from contracting Cold pathogenic factors (Shanghan); 'Qi deficient with body heat' results from contracting Summer-heat pathogenic factors (Shangshu); 'Food intake abundant but Qi scanty' results from blood loss causing Qi dispersion, or Dampness residing in the lower jiao; 'Food intake scanty but Qi excessive' occurs because pathogenic factors are in the Stomach and Lung; 'Pulse small but Blood excessive' occurs due to heat within the Blood from drinking alcohol; 'Pulse full but Blood scanty' occurs because Wind pathogenic factors are in the vessels, and fluids cannot enter the mouth. This is what is meant."

Qi is that which fills the body. The Mai (Vessels) is the residence of Blood. Se (Complexion) is the flourishing manifestation of Qi and Blood. Qi and Blood are transformed from the refined essence of water and grain. Therefore, the deficiency and excess of Xing (Form) and Qi, the deficiency and excess of Mai (Vessels) and Xue (Blood), the brightness or dullness of Se (Complexion), and the amount of food intake must correspond to each other. If they do not correspond or are contrary, it is caused by diseases of external contraction or internal injury, and the key lies in distinguishing between deficiency and excess. For instance, if a person has a solid form and excessive Qi, their body is robust, breathing is coarse, Yang Qi is vigorous, and the body is not cold. If they instead feel cold and fear cold, this is an external contraction of Cold pathogenic factors, where internal Qi is constrained and not free-flowing, so the voice sounds coarse as if Qi were excessive. If a person has a weak form and deficient Qi, their voice is faint, breathing is short and insufficient, Yang Qi is deficient and the body is cold. If they instead feel hot and fear heat, this is Summer-heat damaging Qi, so Qi is deficient and breathing is insufficient. Abundant food intake means strong Stomach Qi and naturally vigorous Qi; if Qi is instead scanty, it is because blood loss causes Qi dispersion, or Dampness pathogenic factors damage Yang Qi. Dampness is a Yin pathogenic factor residing in the lower part, while Yang Qi roots in the lower jiao; thus, Dampness occupying this area causes the generation of Qi to be reduced. Scanty food intake means weak Stomach Qi and deficient Middle Qi; if Qi appears excessive, it is because pathogenic factors lodge in the Lung and Stomach, causing Qi stagnation and rebellion, which is not true excess. Excessive Blood leads to a full pulse and flourishing complexion. If the complexion flourishes seeming like excessive Blood, but the pulse is instead small, it is because drinking alcohol creates heat in the Blood, not because there is excessive Blood. If the pulse seems full suggesting excessive Blood, but the complexion is instead withered and pale, it is because Wind pathogenic factors cause the pulse to be full, not because there is excessive Blood. Wind pathogenic factors obstruct the middle, preventing even fluids from entering; how can there be Grain Qi to generate Blood and Qi?

In the *Suwen: Tongping Xu Shi Lun* (Treatise on Uniformly Evaluating Deficiency and Excess), Qibo said: "When pathogenic factors are excessive, it is Excess; when essential Qi is depleted, it is Deficiency." Qi deficiency refers to Lung deficiency. Qi rebellion manifests as cold feet. If it occurs out of season, life is possible; if it occurs in the corresponding season, death ensues. The same applies to other Zang organs.

This generally discusses the principles of deficiency and excess, citing one Zang organ (Lung) to represent the others. Since the Lung governs the Qi of the whole body, when Qi is deficient, the Lung must be deficient. If Qi rebels and fails to descend, Yang Qi hyper-rises, so the feet must be cold. Lung Metal is prosperous in Autumn. If the Lung is deficient outside of Autumn, survival is still possible. However, if it is deficient during its time of prosperity, the root is clearly ruined. Or, during the summer when Fire is prosperous and overcomes Metal, nourishment becomes even more difficult. Conversely, during autumn and winter when Yang Qi converges and descends, if Qi rebels and feet are cold, it can still be treated. But during spring and summer when Yang Qi ascends and floats, if Qi rebels and feet are cold, there is danger of upper collapse. Hence, "out of season implies survival, in season implies death." Other organs follow similar logic: Liver and Heart Qi prosper in spring and summer and govern ascending; Lung and Kidney Qi prosper in autumn and winter and govern descending; Spleen prospers in late summer and governs transportation. Their deficiency and excess, reversal and compliance, can all be deduced similarly. Xue Shengbai stated: "Pathogenic factors excessive implies Excess; Essential Qi depleted implies Deficiency." These two sentences are the general outline of treatment. The words seem obvious, but the meaning is subtle and hardest to distinguish. It essentially means that excess pathogenic factors should be purged, and deficient righteous Qi should be tonified. Whenever pathogenic factors and righteous Qi contend to cause disease, both excess pathogenic factors and deficient righteous Qi can be discussed. Those advocating purging say "excess pathogenic factors require purging"; those advocating tonification say "depleted essence requires tonification." Each holds one view, using scripture to justify themselves, turning profound teachings into great harm. They fail to realize the immutable principle: examining the urgency and presence/absence of deficiency and excess. Where there is no deficiency, the urgency lies in the pathogenic factors; if not removed quickly, retention will lead to changes. Where deficiency is predominant, the urgency lies in righteous Qi; if not nourished early, it will be useless at the critical moment. In cases of slight deficiency and slight excess, treat the excess, and it can be cleared away completely. In cases of severe deficiency and severe excess, fear the deficiency; only by consolidating the root and ensuring your own invincibility first can the pathogenic factors retreat. In cases of two deficiencies and one excess, address the excess while opening a way out; in cases of two excesses and one deficiency, address the deficiency to prevent unforeseen complications. In summary, mistakenly tonifying an excess condition will inevitably increase pathogenic factors, but it can still be rescued, and the disaster is small. Mistakenly attacking a deficiency condition causes sudden loss of Yuan Qi, which cannot be recovered, and the disaster is huge. The urgency of deficiency and excess must not be overlooked. By "presence and absence," we examine the presence and absence of pathogenic factors. Wind, Cold, Summer-heat, Dampness, Dryness, and Fire are all pathogenic factors. Whether pathogenic factors are in the exterior or interior, Fu or Zang, they must have a location. Finding the root allows direct attack; this is "presence," meaning the excess of pathogenic factors. If there are no Six Qi pathogenic factors, but disease arises from the Three Yin meridians, it is due to emotional desires injuring the interior and fatigue injuring the exterior. It is not pathogenic factors resembling pathogenic factors, nor excess resembling excess; this is "absence," meaning the disease lies in Yuan Qi. Failing to understand this leads to mistaking reversal for compliance and symptoms for root causes, cutting people's lives short. Nan An: The discussion in this section is the most precise; students should repeat it three times. It states that mistakenly tonifying and increasing pathogenic factors is still rescuable with small disaster, but I personally witnessed a case of latent Summer-heat manifesting as malaria. The patient believed in Jingyue's books and used Qi-tonifying medicines. The pathogenic factors temporarily lay dormant, and malaria stopped. Not long after, it recurred. It was again considered deficiency, and Rehmannia preparations were taken, leading immediately to闷痧 (Mensha/Stifling Miasma). I was invited to consult but could not rescue him; he died that night. Generally, Cold and Wind pathogenic factors in the exterior, if mistakenly tonified, are still rescuable, and deficient persons should aid the interior to expel pathogenic factors. However, Summer-heat and Dampness pathogenic factors initially move from the Membrane Source to the Spleen and Stomach. Thus, even if deficient, tonification cannot be used, making it difficult to treat. Light medicines must be used for slow regulation; haste leads to changes. Therefore, in deficiency complicated by pathogenic factors, distinguishing the depth and exterior-interior nature of the pathogenic factors is crucial.

Diseases Manifested by the Five Zang Organs

The *Lingshu: Benshen Pian* (Chapter on the Original Spirit) states: "The Liver stores Blood, and Blood houses Hun (Ethereal Soul). When Liver Qi is deficient, there is fear; when excessive, there is anger. The Spleen stores Ying (Nutritive Qi), and Ying houses Yi (Intellect). When Spleen Qi is deficient, the four limbs cannot be used, and the five Zang organs are unsettled; when excessive, there is abdominal distension and difficulty in urination and defecation. The Heart stores Mai (Vessels), and Mai houses Shen (Spirit). When Heart Qi is deficient, there is sorrow; when excessive, there is incessant laughter. The Lung stores Qi, and Qi houses Po (Corporeal Soul). When Lung Qi is deficient, there is nasal congestion and difficulty in breathing, and shortness of breath; when excessive, there is wheezing and gasping, chest fullness, and仰息 (breathing with head extended backward). The Kidney stores Jing (Essence), and Jing houses Zhi (Will). When Kidney Qi is deficient, there is Jue (Cold extremities/collapse); when excessive, there is distension, and the five Zang organs are unsettled. One must carefully examine the pathological forms of the five Zang organs to know the deficiency and excess of Qi, and regulate them cautiously."

The Heart is the Official of the Sovereign. When Heart Shen is quiet, it is spiritual and clear without action; when active, it transforms into Shi (Cognition). Hun, Po, Yi, and Zhi are all transformations of Heart Shen and are aliases of Shi, lodged in the Liver, Lung, Spleen, and Kidney. Therefore, diseases in any organ relate to the Heart, and pain is known. All movements of emotional desires originate from the Heart and must first injure the various organs. Indeed, Shen and Qi are originally one entity but function in two ways: Shen movement injures Qi, and Qi disturbance confuses Shen. Hence, "maintain your will and do not violently disturb your Qi." Observing the deficiency and excess of Zang Qi manifesting as fear, anger, sorrow, joy, etc., confirms that Shen and Qi are one entity. However, Qi is divided into Yin-Yang and Five Elements, so the diseases manifested by the five Zang organs differ. Zang and Fu are interior-exterior pairs; Fu Qi originates from Zang. Thus, Zang Qi deficiency/excess is Fu Qi deficiency/excess. Liver Qi deficiency leads to gallbladder timidity and much fear; the Liver is a rigid organ, called the Official of the General, so Liver Qi excess leads to gallbladder arrogance and much anger. Ying Qi is generated by the Spleen, so the Spleen stores Ying, and Ying houses Yi. The four limbs receive Qi from the Spleen and Stomach; this Qi reaches the exterior through Spleen transportation. Spleen deficiency leads to powerless limbs unable to move. The Spleen is Central Earth, harmonizing Metal, Wood, Water, and Fire. If its Qi is deficient and cannot circulate, Metal, Wood, Water, and Fire mutually overcome each other, and the five Zang organs become unsettled. The Spleen is located in the abdomen; its Qi excess leads to obstruction and failure of transportation, causing intestinal and gastric blockage, hence abdominal distension and difficulty in urination/defecation. Blood vessels are born from Heart Qi, so the Heart stores Mai, and Mai houses Shen. Often, external pathogens congealing in blood vessels cause confusion and delirium, illustrating that since Shen and Qi are one, Qi deficiency causes Shen loss and sorrow, while Qi excess causes Shen vigor and incessant laughter. Qi of the whole body is weighed and distributed by the Lung, so the Lung stores Qi, and Qi houses Po. The Lung opens into the nose; Qi deficiency causes turbid obstruction of the orifice, leading to poor ventilation and little air entry/exit. Qi excess causes obstruction in the chest, preventing distribution, leading to wheezing, chest fullness, and仰息. Essence and Blood transformed from water and grain are transported by the Spleen; Blood returns to the Liver, and Essence returns to the Kidney. Thus, the Liver stores Blood, and Blood houses Hun; the Kidney stores Essence, and Essence houses Zhi. Zhi is where Shen Fire pours, lodging in Essence. Essence generates Qi and serves as the root of Yang. Qi deficiency leads to Yang decline and much cold extremities. The Kidney is the gate of the Stomach, opening into the two excretions. Kidney Qi excess leads to orifice dysfunction, turbid obstruction in intestines/stomach, chest/abdominal distension, and unsettled five Zang organs. Therefore, one must carefully examine the pathological forms of the five Zang organs to know Qi deficiency/excess, regulate according to principles, taking the five Zang as the root. If the five Zang are harmonious, the whole body will be free of diseases.

Liver Disease

The *Suwen: Zangqi Fashi Lun* (Treatise on Organ Qi and Time) states: "In Liver disease, there is pain under both hypochondria radiating to the lower abdomen, causing frequent anger. In deficiency, vision is blurred (KTKT), unable to see, hearing is lost, frequent fear, as if being hunted. Treat the meridians: Jueyin and Shaoyang. With Qi rebellion, there is headache, deafness and poor hearing, cheek swelling."

This discusses deficiency and excess diseases of the five Zang organs, differing from the *Benshen Pian*. The *Benshen Pian* specifically clarifies the deficiency/excess of the original organ, while this chapter specifically clarifies the pathological forms of contracted pathogens. Thus, it directly labels Liver disease, Heart disease, etc., without explicitly stating Zang images, only showing signs of contracted pathogens, i.e., "pathogen excess is excess, essence depletion is deficiency." Its mention of deficiency also includes conditions with concurrent pathogens. Although both discuss five Zang deficiency/excess, the meanings are distinct, each clarifying its disease. The Liver meridian starts at the foot, passes through the lower abdomen, and spreads to the hypochondria. Thus, Liver disease causes pain under both hypochondria radiating to the lower abdomen. Because of pathogen contraction, there are meridian signs, treated by needling to unblock meridians. Pathogen excess is excess; Liver excess causes frequent anger. In deficiency, Blood is scanty, vision is inherently weak; adding pathogen contraction causes blurred vision (KTKT means dim/dark). The exterior of the Liver is the Gallbladder Fu; the Shaoyang meridian enters the ear. Being deficient and obscured by pathogens, hearing is lost. Gallbladder timidity causes frequent fear, as if being hunted. Treat by selecting Liver and Gallbladder meridians. If Shaoyang Qi rebels and pathogen is excessive, headache, deafness/poor hearing, and cheek swelling occur, all along the Shaoyang meridian pathway. Poor hearing here differs from total deafness in deficiency.

Heart Disease

In Heart disease, there is pain in the chest, fullness and pain in the hypochondria, pain below the hypochondria, pain between the chest, back, and scapula, and pain in the inner arms. In deficiency, the chest and abdomen are large, and pain draws from the hypochondria to the waist. Treat the meridians: Shaoyin and Taiyang. For bleeding under the tongue (a change), puncture the vessels to bleed.

Heart disease, the *Lingshu: Xieke Pian* (Chapter on Evil Invasion) states the Heart is solid and resists pathogens; if invaded, Shen departs and death follows. Thus, "Heart disease" always refers to the Pericardium (Xinbaoluo) and Hand Shaoyin meridian invasion. Therefore, chest pain, hypochondriac fullness/pain, and arm inner pain are all along the Pericardium and Shaoyin meridian pathways. In deficiency, pain drawing from hypochondria to the waist involves the Liver and Kidney. The Liver is the mother of the Heart; the Kidney is the mother of the Liver. Maternal deficiency affects the child. Overworking Heart Fire consumes Liver and Kidney Essence/Blood. Each Zang has connecting vessels to the Heart, as the Heart is the master of the body, commanding Qi and Blood. Thus, Heart disease relates to all organs. Heart generates blood vessels; vessel deficiency fails to moisten, pulling on organs, causing hypochondriac-waist pain. Therefore, emotional injuries to organs require cultivating the Heart first. Medicines adjust Qi and Blood but cannot treat Heart-Mind diseases. Ignorance of this principle in emotional injuries leads to inevitable failure. Acupuncture points are detailed elsewhere; the same applies below.

Spleen Disease

In Spleen disease, the body feels heavy, hunger is frequent, muscles are flaccid, feet cannot retract, walking often involves spasms (Yi), and sole pain. In deficiency, there is abdominal fullness, borborygmus, undigested stool diarrhea, and food malabsorption. Treat the meridians: Taiyin, Yangming, and Shaoyin blood.

This describes Spleen disease transforming into heat from external pathogens. The Spleen governs muscles. Muscle heat causes meridian relaxation, leading to heaviness, muscle flaccidity, frequent hunger, and sole pain—all excess signs of pathogenic heat. Spasms during walking (Yi sound: Qi) occur because the Spleen meridian starts at the foot and relaxes, causing unstable gait. Abdominal fullness, borborygmus, undigested diarrhea, and malabsorption are deficiency-cold pathogens, as the classics state "cold in Zang generates fullness diseases." If fullness, constipation, and fever occur, it is excess. Treatment uses needling; medication can be inferred.

Lung Disease

In Lung disease, there is wheezing and cough, rebellious Qi, shoulder and back pain, sweating, and pain in the sacrum, yin, thigh, knee, thigh bone, and foot. In deficiency, there is shortness of breath, inability to take deep breaths, deafness, and dry throat. Treat the meridians: Taiyin, the exterior of Foot Taiyang, and the interior of Jueyin blood.

Wheezing, cough, rebellious Qi, shoulder/back pain, and sweating result from Lung Qi obstruction, shoulder/back vessel blockage, and stomach fluids failing to descend, instead leaking through skin pores—all manifestations of Lung disease. Pain in sacrum to foot is Foot Taiyang disease. Taiyang governs the exterior and combines with the Lung in skin/hair. External pathogens invading Taiyang connect internally to the Lung. As Zhang Zhongjing discussed, Wind injuring Wei causes nasal congestion/vomiting; Cold injuring Ying causes wheezing/cough—all Taiyang connecting to Lung. However, Taiyang invasion usually causes headache. No headache here indicates pathogens lodged in the Lung, overflowing to skin/hair, extending to Taiyang boundaries but not in the meridian itself, hence no headache, marking Lung disease. Lung deficiency causes shortness of breath, insufficient inspiration. Weak Qi allows turbid pathogens to obscure orifices (deafness) and fails to generate fluids (dry throat). Needling Taiyang drains overflowing pathogens; needling Jueyin works because the twelve meridians connect at Foot Jueyin and Hand Taiyin, providing exit routes for Lung pathogens. Medication methods can be inferred.

Kidney Disease

In Kidney disease, there is abdominal distension, leg swelling, wheezing/cough, body heaviness, nocturnal sweating, and aversion to wind. In deficiency, there is chest pain, lower abdominal pain, cold extremities (Qingjue), and unhappiness. Treat the meridians: Shaoyin and Taiyang blood.

The Kidney is a Cold Water organ. Invaded by Wind, water cannot drain, causing obstruction, abdominal distension, leg swelling, and aversion to wind—forming Fengshui (Wind Edema) disease. Chest pain to unhappiness indicates Yang deficiency. Qingjue means cold extremities. Fengshui carries external pathogens, so Taiyang is added for simultaneous exterior-interior treatment to drain water via the Bladder. The *Suwen: Nidiao Lun* (Treatise on Reverse Regulation) states: "The Kidney is the Water organ, governing fluids, sleep, and wheezing." The Kidney is Water, with Fire rooted within. Fire steams Water into fluids, rising to Lianquan under the tongue, flowing down to irrigate the body. Fluid deficiency causes dry tongue/throat. The Lung governs exhalation; the Kidney governs inhalation. During sleep, Lung Qi enters the Kidney, gathering Heaven-Earth essence to nourish Yuan Qi. Upon waking, Kidney Qi emerges to the Lung to support bodily functions. Thus, fluids, sleep, and wheezing are governed by the Kidney. Both Lung and Kidney diseases cause wheezing/cough: in the Lung, Qi closure is excess; in the Kidney, Qi escape is deficiency. Fengshui also results from Kidney deficiency inviting pathogens, causing wheezing, heaviness, and nocturnal sweating. Middle Jiao obstruction hindering Lung/Kidney Qi ascent/descent also causes wheezing/cough. Causes must be distinguished, and treatment differentiated by deficiency/excess.

Five Excesses and Five Deficiencies

The *Suwen: Tiaojing Lun* (Treatise on Regulating the Meridians) states: "There are five excesses and five deficiencies. Shen has excess and deficiency; Qi has excess and deficiency; Blood has excess and deficiency; Form has excess and deficiency; Zhi has excess and deficiency." The Yellow Emperor said: "Humans have Essence, Qi, Jin, Ye, four limbs, nine orifices, five Zang, sixteen parts, and 365 joints, giving rise to hundred diseases. Hundred diseases arise from deficiency and excess. Now you speak of five excesses and five deficiencies. How do they arise?" Qibo replied: "They all arise from the five Zang. The Heart stores Shen; the Lung stores Qi; the Liver stores Blood; the Spleen stores Flesh; the Kidney stores Zhi, forming the body. Zhi and Yi connect flesh to bone marrow, forming body shape and five Zang. The pathways of the five Zang emerge from Jing Sui (Meridian Channels) to circulate Qi and Blood. When Qi and Blood are disharmonious, hundred diseases arise. Therefore, guard the Jing Sui."

This elucidates the meanings of the *Benshen Pian* and *Fashi Lun*. Shen, Qi, Blood, Flesh, and Zhi are stored in the five Zang. Their pathways enter/exit via Jing Sui to circulate Qi and Blood. Qi and Blood generation are governed by Shen and Zhi. Shen stores in the Heart; Zhi stores in the Kidney. The Kidney generates bone marrow, so Zhi and Yi internally connect to bone marrow, forming body and Zang. Thus, the Kidney is the root of body and Zang. Shen/Zhi diseases prevent Qi/Blood generation; Qi/Blood disharmony disturbs Shen/Zhi, causing hundred diseases. Treating disease requires harmonizing Qi and Blood, which requires guarding Jing Sui depths. As Jing Sui are Zang pathways, distinguishing excess/deficiency harmonizes Zang, curing hundred diseases. Though there are sixteen parts and 365 joints causing disease, it all boils down to Zang harmony/dis-harmony, governed by Heart and Zhi.

The Yellow Emperor asked: "What are excess and deficiency?" Qibo replied: "Shen excess causes incessant laughter; Shen deficiency causes sorrow. Qi excess causes wheezing/cough and upward Qi; Qi deficiency causes smooth breathing but shortness of breath. Blood excess causes anger; Blood deficiency causes fear. Form excess causes abdominal distension and urinary/defecatory difficulty; Form deficiency causes limb immobility. Zhi excess causes abdominal distension and undigested diarrhea; Zhi deficiency causes cold extremities."

These excess/deficiency signs correspond to Heart, Lung, Liver, Spleen, and Kidney diseases, same as the *Benshen Pian*. Previously, Liver Qi excess caused anger; here, dividing by Shen, Qi, Blood, Flesh, Zhi defines Zang deficiency/excess. Since the Liver stores Blood, "Blood excess causes anger, deficiency causes fear," consistent with the *Benshen Pian*. Previously, Kidney Qi excess caused distension; here, "Zhi excess" means Kidney Qi excess. However, "abdominal distension and undigested diarrhea" are Spleen deficiency signs listed under Kidney excess. This is likely because Earth excess and Water deficiency cause...