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(Su Wen · Tiao Jing Lun, continuing from the previous chapter)
The Yellow Emperor said: I have already heard of the forms of deficiency and excess, but do not know how they arise? Qi Bo said: When Qi and Blood (Xue, blood) merge and bias towards one side, Yin and Yang (Yin-Yang, the fundamental opposing forces in nature) incline against each other. Qi becomes chaotic in the Wei Qi (Defensive Qi), and Blood reverses in the meridians. When Blood and Qi separate from their proper residence, one side becomes excess and the other deficiency. (Merge means bias towards excess. Inclination means collapse. Qi is Yang, so it disrupts the Defensive Qi. Blood is Yin, so it reverses in the meridians. When Yin and Yang are disharmonious, Blood and Qi separate, thus the excess side becomes relatively more excess, and the deficient side becomes relatively more deficient, leaning against each other.) When Blood biases towards the Yin aspect and Qi biases towards the Yang aspect, it results in fright and mania. (Blood biasing towards Yin constitutes Heavy Yin. Qi biasing towards Yang constitutes Heavy Yang. Heavy Yin leads to manic-depressive psychosis [Dian], and Heavy Yang leads to mania [Kuang], hence fright and mania occur.) When Blood biases towards the Yang aspect and Qi biases towards the Yin aspect, it results in internal heat. (Blood biasing towards Yang implies Yin pathogen on the exterior. Qi biasing towards Yin implies Yang pathogen in the interior. Hence, internal heat occurs. Jiong means heat. Jiong is pronounced Ju Yong.) When Blood biases towards the upper part and Qi biases towards the lower part, there is mental vexation and irritability. (Upper refers to above the diaphragm. Lower refers to below the diaphragm. Blood biasing upwards suppresses the Heart with Yin pathogen, causing vexation. Qi biasing downwards stirs Fire in the Liver, causing irritability. Wan is pronounced Wu Guan.) When Blood biases towards the lower part and Qi biases towards the upper part, confusion and forgetfulness occur. (Blood biasing downwards prevents Yin Qi from ascending; Qi biasing upwards prevents Yang Qi from descending. With Yin and Yang separated, the Spirit becomes disordered and prone to forgetfulness.) The Yellow Emperor said: When Blood biases towards Yin and Qi biases towards Yang, as described, where Blood and Qi separate, which is excess and which is deficiency? (When Blood biases towards Yin, there is no Yin in the Yang aspect; when Qi biases towards Yang, there is no Yang in the Yin aspect. Yin and Yang are disharmonious, hence Blood and Qi separate.) Qi Bo said: Blood and Qi prefer warmth and dislike cold. Cold causes stagnation and inability to flow, while warmth promotes dispersion and circulation. (Although Blood and Qi differ in form, they share the same nature, preferring warmth and disliking cold. Cold causes coagulation and stagnation, while warmth allows for dispersion and movement. Pathogens biasing towards either Blood or Qi stem from this. Qi is synonymous with Se.) Therefore, where Qi biases, Blood becomes deficient; where Blood biases, Qi becomes deficient. (Qi biasing towards Yang leaves no Blood, constituting Blood deficiency. Blood biasing towards Yin leaves no Qi, constituting Qi deficiency.) The Yellow Emperor said: What humans possess is merely Blood and Qi. Now you say that Blood biasing leads to deficiency and Qi biasing leads to deficiency. Does this mean there is no excess? Qi Bo said: That which is present is excess, that which is absent is deficiency. (Presence of Blood without Qi is Blood excess and Qi deficiency. Presence of Qi without Blood is Qi excess and Blood deficiency.) Thus, when Qi biases, there is no Blood; when Blood biases, there is no Qi. Since Blood and Qi now lose mutual support, it manifests as deficiency. (Losing support means failing to assist each other. Loss results in deficiency.) Collaterals and Sun vessels all transport to the main meridians. When Blood and Qi merge, it becomes excess. If Blood and Qi both rush upwards, it results in Great Jue syndrome, leading to sudden death. If Qi returns, life is preserved; if it does not return, death ensues. (The preceding text discussed Blood merging with Blood and Qi merging with Qi, leading to partial deficiency and excess. This section discusses Blood merging with Qi. Merged elements are excess, unmixed elements are deficient. Blood and Qi rushing upwards creates Upper Excess and Lower Deficiency. Lower deficiency leads to Yin collapse. Yin collapse severs the root, causing Lower Jue and Upper exhaustion, known as Great Jue, hence sudden death. If Qi reverses after reaching its extreme, Yin will gradually recover, allowing revival. If it goes and does not return, survival is impossible.) The Yellow Emperor said: From what pathway does excess come? From what pathway does deficiency depart? I wish to hear the essence of excess and deficiency and their causes. Qi Bo said: Both Yin and Yang have Shu points and Hui meetings. Yang flows into Yin, and Yin fills the exterior. When Yin and Yang are balanced, they fill the body, and the Nine Pulses are uniform, called a healthy person. (Shu Hui refers to Shu and Hui points in the meridians. Yang flowing into Yin means returning from meridians to Zang organs; Yin filling the exterior means extending from Zang organs to meridians. Uniformity in the Nine Pulses indicates harmony of Yin and Yang and balance of Blood and Qi, ensuring health, thus termed a healthy person.) Pathogens arise either from Yin or from Yang. Those arising from Yang result from wind, rain, cold, and heat; those arising from Yin result from diet, living conditions, and emotional extremes like joy and anger. (Wind, rain, cold, and heat originate externally, constituting external contraction, hence Yang. Diet, living conditions, and emotions originate internally, constituting internal injury, hence Yin. External contractions often involve surplus, while internal injuries often involve insufficiency. This explains the origin of excess and the departure of deficiency.) The Yellow Emperor said: How do wind and rain injure people? Qi Bo said: Wind and rain first lodge in the skin, then transmit to Sun vessels. When Sun vessels are full, they transmit to Luo vessels; when Luo vessels are full, they transport to the large meridians. Blood and Qi merge with pathogens and lodge between the muscle layers and interstices. The pulse becomes firm and large, hence termed excess. Excess presents as firmness and fullness on the exterior, cannot be pressed, and pressing causes pain. (This is excess generated by external contraction. Excess pain is necessarily firm and full, with lingering pathogens inside. Pressing causes the excess pathogen to resist, intensifying pain. Deficient pain is necessarily soft, hollow, and empty. Pressing brings Qi and warmth, stopping the pain. Therefore, tenderness to pressure indicates deficiency, while resistance to pressure indicates excess. This section is largely consistent with Pi Bu Lun and Miu Ci Lun, appearing in Meridian Category 31 and Acupuncture Category 30 respectively.) The Yellow Emperor said: How do cold and dampness injure people? Qi Bo said: When cold and dampness invade, the skin loses tension, muscles become firm and tight, Ying Blood stagnates, and Wei Qi departs, hence termed deficiency. Deficiency manifests as weak breathing, flaccidity, and insufficient Qi. Pressing restores Qi and provides warmth, resulting in comfort and absence of pain. (This is deficiency generated by external contraction. Cold and dampness invariably injure Wei Qi, causing skin laxity and muscle atrophy due to tightness. Ying Blood stagnates within the vessels, while Wei Qi departs from outside the vessels, creating deficiency. Whispering lightly is called Nie; leg weakness preventing walking is called Pi; both indicate Qi insufficiency. For pain caused by Qi deficiency, pressing can attract Qi. Upon arrival, Yang gathers and Yin disperses, bringing comfort and stopping pain. Nie is pronounced Ni Zhe. Pi is pronounced Bi.) The Yellow Emperor said: Excellent. How does Yin generate excess? Qi Bo said: Unregulated joy and anger cause Yin Qi to reverse upwards. Upward reversal leads to Lower deficiency. Lower deficiency causes Yang Qi to rush towards it, hence termed excess. (This is excess generated by internal injury. Yin reversing upwards causes Lower deficiency. Yin deficiency attracts Yang pathogens, resulting in excess. However, excess stems from deficiency, explaining why internal injuries often involve insufficiency. Note: The following text states that Joy causes Qi to sink, leading to deficiency, whereas this section emphasizes Anger, hence excess. Observing the meaning of Yin Qi reversing upwards clarifies the role of Anger. Also, Ju Tong Lun states Anger causes Qi to ascend, which is precisely this case.) The Yellow Emperor said: How does Yin generate deficiency? Qi Bo said: Joy causes Qi to relax and sink; grief causes Qi to dissipate. Dissipation leads to empty vessels. Combined with consuming cold food and drink, cold qi fills the middle jiao, causing Blood stagnation and Qi departure, hence termed deficiency. (This is deficiency generated by internal injury. Sink means depression. Dissipate means scattering. Ju Tong Lun states Joy causes Qi to relax, slightly different here. Consuming cold food causes cold qi to fill the middle jiao, injuring Yang Qi, leading to Blood stagnation and Qi departure, resulting in Middle Jiao deficiency. If overeating causes retention and indigestion, although also an internal injury, this represents deficiency mixed with excess, requiring careful differentiation.)