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(Su Wen: Yu Ji Zhen Zang Lun [Plain Questions: Discussion on the True Viscera and Pulse] Appendix: Treatment Methods for Deficiency and Damage)

Huangdi said: I have heard that deficiency and excess can be used to determine life and death; I wish to hear the details. Qibo said: The presence of Five Excesses leads to death, and the presence of Five Deficiencies also leads to death. (The Five Excesses refer to the excess conditions of the five Zang organs; the Five Deficiencies refer to the deficiency conditions of the five Zang organs. If all symptoms of either Five Excesses or Five Deficiencies are present, death ensues. However, if death occurs due to Qi exhaustion reaching its limit, this is logically inevitable. As for why Five Excesses also lead to death: where pathogenic factors gather, Zheng Qi (Upright Qi) must be deficient. Unless there is a collapse leading to death, it ultimately returns to Qi exhaustion. Therefore, I believe that when pathogenic factors are not insufficient and Zheng Qi is not in excess, what appears as "excess" is often false excess, whereas "deficiency" is true deficiency.)

Huangdi said: I wish to hear about the Five Excesses and Five Deficiencies. Qibo said: A surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and chest oppression with dizziness constitute the Five Excesses. (Excess refers to the flourishing of pathogenic factors. A surging pulse is governed by the Heart; hot skin is governed by the Lung; abdominal distension is governed by the Spleen; obstruction of urination and defecation relates to the Kidney, which opens into the two yin orifices; chest oppression and dizziness relate to the Liver meridian penetrating the diaphragm, with Qi rebelling inward. 'Mao' sounds like 'mao' or 'wu', meaning drowsiness or confusion, or sometimes refers to blurred vision.) A fine pulse, cold skin, shortness of breath, diarrhea and incontinence of urine and stool, and inability to take in food constitute the Five Deficiencies. (Deficiency refers to the weakness of Zheng Qi. A fine pulse indicates Heart deficiency; cold skin indicates Lung deficiency; shortness of breath indicates Liver deficiency; diarrhea and incontinence indicate Kidney deficiency; inability to eat indicates Spleen deficiency.)

Huangdi said: Under what circumstances can there be survival? Qibo said: If fermented grain beverages enter the Stomach and diarrheal flux stops, the patient with deficiency will survive; (In treatment, if fermented grain beverages can enter the Stomach, the Spleen Qi gradually revives; if diarrheal flux stops, the Kidney Qi gradually consolidates. With the return of root Qi, the deficient patient survives.) If the body sweats and bowel movements become unobstructed, the patient with excess will survive. These are the signs of survival. (Sweating resolves exterior pathogens; unobstructed bowel movements eliminate interior pathogens. With internal and external pathways clear and harmonious, the excess patient survives. My commentary: Diseases are categorized as deficiency or excess. Deficiency arises from insufficient Zheng Qi; excess arises from surplus pathogenic factors. Diseases entering from outside are mostly excess, such as those caused by the Six Evils or dietary injury. Diseases arising from within are mostly deficiency, such as those caused by the Seven Emotions injuring Qi or labor and desire injuring Essence. Generally, excess conditions should be treated with purgative methods, as stated in the Classic: treat cold with heat, heat with cold, hardness by reducing, invaders by expelling, knots by dispersing, stagnation by attacking, overflow by promoting flow, strength by draining—these all use purgative methods. Generally, deficiency conditions should be treated with tonifying methods, such as gathering scattered Qi, moistening dryness, relaxing tension, strengthening fragility, tonifying decline, warming fatigue, benefiting loss, and calming fright—these all use tonifying methods. The treatment of deficiency and excess is generally as described. However, among people today, few cases are excess, while seven or eight out of ten are deficiency. Excess diseases come quickly and leave quickly, so treatment is easy. Deficiency diseases involve gradual damage and are difficult to restore, so treatment is difficult. Those treating excess know it is often new pathogenic factors in the young and strong, which can be attacked and expelled, causing little worry. Those treating deficiency must observe if the root is compromised; otherwise, sudden changes may occur, which cannot be ignored. The methods for treating excess include dispersing the exterior if there is excess outside, attacking the interior if there is excess inside, moving stagnation if there is excess Qi, and driving out stasis if there is excess Blood. Formulas are numerous, requiring no further elaboration. Only the treatment of deficiency and damage has incomplete methods, necessitating a detailed explanation of key points. Human deficiency and damage stem from congenital insufficiency or acquired insufficiency. Congenital insufficiency results from endowment and requires extra caution, urgently supplemented by postnatal efforts to nourish, thereby extending life. If noticed late or neglected, premature death is inevitable. Acquired insufficiency results from overwork and injury; one must quickly recognize and reflect, adjusting emotions, medication, and diet. If treatment is delayed or illness concealed, regret will be too late. Regarding the differentiation of overwork and injury: 'Overwork' damages Shen Qi (Spirit and Qi), while 'Injury' damages the physical form. Joy, anger, worry, and contemplation injure the Heart; sorrow, worry, and grief injure the Lung—all these damage Shen Qi. Improper diet injures the Spleen; careless living injures the Liver; excessive sexual indulgence injures the Kidney—all these damage the physical form. Damaging the Lung injairs its Qi, manifesting as scorched skin and falling hair. Damaging the Heart injures its Shen, manifesting as reduced blood vessels failing to nourish the viscera; this is damage from above. Damaging the Liver injures its sinews, manifesting as lax sinews unable to support themselves. Damaging the Kidney injures its Essence, manifesting as depleted marrow, atrophy, and inability to rise; this is damage from below. Damaging the Spleen injures the foundation of granaries, manifesting as food failing to transform into flesh and muscle; this is damage from the middle. When Heart and Lung are damaged, spirit and color deteriorate; when Liver and Kidney are damaged, the physical form becomes emaciated; when Spleen and Stomach are damaged, food fails to digest. Diseases feeling these patterns belong to the category of deficiency and damage. The Nan Jing states: Damage to the Lung benefits its Qi; damage to the Heart regulates Ying and Wei (Nutritive and Defensive Qi); damage to the Spleen regulates diet and adjusts to cold and warmth; damage to the Liver relaxes its interior; damage to the Kidney benefits its Essence. These are the methods for treating deficiency and damage. Although damage is divided among the five Zang organs, what they store is nothing but Essence and Qi. Essence is Yin, the water of humanity; Qi is Yang, the fire of humanity. When water and fire are correct, they become Essence and Qi; when water and fire are imbalanced, they become heat and cold. This imbalance arises from partial damage leading to partial dominance. Therefore, water must contain fire; without fire, Yin dominates and cold disease arises. Fire must contain water; without water, Yang dominates and heat disease arises. One must carefully distinguish Yin and Yang, and then the treatment of deficiency and damage will be complete. For example, water deficiency is Yin deficiency; only great tonification of True Yin is suitable, never harming Yang Qi again. Fire deficiency is Yang deficiency; only great tonification of Original Yang is suitable, never harming Yin Qi again. If Yang is already insufficient and Yin is further harmed, Yin is also damaged; if Yin is already insufficient and Yang is further harmed, Yang is also lost. Treating deficiency differs fundamentally from treating excess. In excess, Yin and Yang are surplus; removing the surplus restores balance. In deficiency, Yin and Yang are insufficient; removing what remains leads to mutual failure, how can life be sustained? Thus, the key to treating deficiency: for Yin deficiency with much heat, pungent-dry substances are most abhorrent as they may aid Yang pathogens; bitter-cold substances are especially avoided as they may attack generating Yang Qi; pure sweet-water-nourishing agents are preferred, tonifying Yin to match Yang, so that rigidity is controlled by softness, deficient fire naturally descends, and Yang returns to Yin. For Yang deficiency with much cold, cool-moist substances are most abhorrent as they may aid Yin pathogens; pungent-dispersing substances are especially avoided as they may harm Yin Qi; only sweet-warm fire-benefiting items are suitable, tonifying Yang to match Yin, so that softness finds its master, deep cold naturally gathers, and Yin follows Yang. Therefore, Qi deficiency should be tonified in the upper part; Essence deficiency should be tonified in the lower part; Yang deficiency should be tonified with warmth; Yin deficiency should be tonified with clearing. This is indeed the differentiation of Yin-Yang treatment. Where Qi is deficient due to Essence, one should tonify Essence to generate Qi; where Essence is deficient due to Qi, one should tonify Qi to generate Essence. Furthermore, if Yang separates from Yin, how else can scattered Qi be gathered but by tonifying Yin? If Water fails due to lack of Fire, how else can dormant Yin revive but by tonifying Fire? This is the wonderful application of mutual assistance between Yin and Yang. Therefore, those skilled in tonifying Yang must seek Yang within Yin, so that Yang receives Yin's assistance and generation is endless. Those skilled in tonifying Yin must seek Yin within Yang, so that Yin receives Yang's rising and the spring source does not dry up. Thus, dividing Yin and Yang by Essence and Qi means Yin and Yang cannot be separated; dividing Yin and Yang by cold and heat means Yin and Yang cannot be confused. This is the separation and union of Yin-Yang, pathogenic and righteous factors. Understanding the treatment of Yin-Yang, pathogenic, and righteous factors leads to Yin-Yang harmony and the attainment of the Dao. The Classic says: If you cannot treat deficiency, what need is there to ask about anything else? This is what is meant.)