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(From *Suwen: Tongping Xushi Lun* [Plain Questions: Discussion on Uniformly Evaluating Deficiency and Excess])

The Yellow Emperor asked, "What are deficiency (Xu) and excess (Shi)?"
Qibo replied, "When pathogenic factors are flourishing, it is excess; when essence and qi are depleted, it is deficiency."
*(Pathogenic factors vary in degree; thus, flourishing pathogens constitute excess. Zhengqi [healthy qi] varies in strength; thus, depletion of essence constitutes deficiency. 'Duo' means loss.)*

My commentary: The statements "pathogens flourish leading to excess" and "essence depletes leading to deficiency" serve as the general principles for disease treatment and differentiation. Although their wording appears straightforward, their meaning is subtle and warrants detailed analysis. However, why is this analysis particularly difficult? It is because "excess" refers to pathogens, and excess conditions are suitable for purgative methods; "deficiency" refers to healthy qi, and deficiency conditions are suitable for tonifying methods. In any disease caused by the struggle between pathogens and healthy qi, both pathological excess and healthy deficiency can be described. Therefore, those advocating purgation say "pathogens flourish leading to excess," implying purgation is needed; those advocating tonification say "essence depletes leading to deficiency," implying tonification is needed. Each adheres to one phrase without a clear perspective, using rhetorical embellishments to justify their views, making it hard to say who is wrong. Consequently, this profound teaching has instead brewed great harm. The underlying principle involves immutable laws, yet contemporary physicians fail to perceive them. I propose analyzing this into four aspects: urgency (which is slow or urgent) and presence/absence.

Regarding urgency: One must assess the urgency of deficiency and excess. In cases with no deficiency, the urgency lies in the pathogens; if they are not removed quickly, complications may arise. In cases with significant deficiency, the urgency lies in healthy qi; if tonification is not initiated early, it will be too late when the crisis hits. For mild deficiency and mild excess, treating the excess component can resolve the issue swiftly. For severe deficiency and severe excess, the fear lies in the deficiency; by consolidating the root to ensure invincibility first, the pathogens will inevitably recede. In cases of two deficiencies and one excess, treat the excess while opening a pathway; in cases of two excesses and one deficiency, treat the deficiency to prevent unpredictable changes. In summary, mistakenly tonifying an excess condition will inevitably increase pathogens, but it can still be remedied, resulting in lesser harm. Mistakenly purging a deficiency condition causes sudden loss of true qi, which cannot be recovered, resulting in greater harm. Thus, the urgency of deficiency and excess must be carefully observed.

Regarding presence and absence: One must assess the presence or absence of pathogens. Wind, cold, summer-heat, dampness, fire, and dryness can all become pathogens. Whether pathogens reside in the exterior, interior, fu organs, or zang organs, they have a specific location. Identifying the root allows for direct treatment; this is referred to as "presence," where pathogens are excessive. If there are no six climatic pathogens, but disease arises from the three yin meridians, it is due to emotional desires damaging the interior or fatigue damaging the exterior. This resembles pathogens but is not truly pathogens, resembling excess but is not true excess; this is referred to as "absence," where the disease lies in the primordial qi. Failing to understand the meaning of deficiency/excess and presence/absence leads to mistaking reversal for compliance and symptoms for root causes, shortening lives and causing great moral detriment. Must one not be fearful and cautious?

The Yellow Emperor asked, "How do deficiency and excess manifest?" *(Asking about the general patterns of deficiency and excess in the five zang organs.)*
Qibo said, "Qi deficiency corresponds to lung deficiency. Qi rebellion results in cold feet."
*(The lungs govern qi, so qi deficiency is lung deficiency. When qi rebels and fails to circulate, it does not reach the four limbs. Yang deficiency in the lower body causes cold feet.)* "If it occurs during non-clashing seasons, life is preserved; if it occurs during clashing seasons, death ensues."
*(Lung deficiency occurring in autumn or winter avoids the season of mutual destruction, so life is preserved. If it occurs in spring, metal and wood clash, worsening the disease; if in summer, weak metal is overcome by fire, leading to death. Another view states the lungs prosper in autumn; if qi is deficient then, metal is severely depleted, leading to death. This interpretation is also logically sound.)* "The other zang organs follow this pattern."
*(The heart, spleen, liver, and kidneys each have their governing functions and respective times of decline and prosperity. Using the lungs as an example, this can be extrapolated.)*

The Yellow Emperor asked, "What is called 'Chong Shi' [Double Excess]?"
Qibo said, "By 'Chong Shi,' we mean a high-fever illness where qi is hot and the pulse is full. This is called Chong Shi."
*(Both symptoms and pulse indicate excess, hence 'double excess.' 'Chong' is pronounced with a level tone, same below.)*

The Yellow Emperor asked, "What if both meridians and collaterals are excess? How should they be treated?"
Qibo said, "When both meridians and collaterals are excess, the cun pulse at the wrist is rapid/tense while the chi pulse is relaxed. Both require treatment."
*(Meridians refer to the twelve primary channels; collaterals refer to the fifteen distinct collaterals. Here, the cun and chi positions of the radial artery are used to generally assess the excess or deficiency of meridians and collaterals. The vertical course of the cun pulse relates to the Taiyin meridian; the Lieque point at the chi position connects to the Yangming channel. Viewing vertically, cun is yang and chi is yin; viewing internally/externally, collaterals are yang and meridians are yin. Thus, a tense cun pulse indicates pathogens residing in the meridians, while a relaxed chi pulse indicates heat flourishing in the collaterals, constituting double excess of meridians and collaterals, requiring treatment. 'Treatment' here implies purgation. Note: Pingren Qixiang Lun states 'relaxed and slippery indicates internal heat.' Xieqi Zangfu Bingxing Pian states 'relaxed pulses often indicate heat.' Hence, chi relaxation is interpreted as excess here. See Pulse and Color categories 16 and 19.)* "Therefore, slippery indicates compliance, while choppy indicates reversal."
*(Slippery is a yang pulse; choppy is a yin pulse. Excess combined with slipperiness indicates yang predominance, hence compliance. If choppy, yin pathogens predominate and yang qi departs, hence reversal.)*

Deficiency and excess originate from the nature of things. Therefore, if the five zang organs and bones/flesh are smooth and free-flowing, longevity is possible.
*(Living things are smooth and free-flowing; dead things are withered and choppy, determined by the presence or absence of yang qi. The compliance or reversal of pulses follows this same logic.)*

The Yellow Emperor asked, "What if collateral qi is deficient and meridian qi is excess?"
Qibo said, "When collateral qi is deficient and meridian qi is excess, the pulse at the wrist (maikou) is hot while the chi position is cold. This is reversal in autumn and winter, but compliance in spring and summer. Treat the primary disease."
*(Collaterals are superficial and govern yang. Meridians penetrate inward and govern yin. Excess meridian qi causes heat at the maikou, indicating flourishing yin-pathogens. Deficient collateral qi causes cold at the chi position, indicating deficient yang qi. Those with yang deficiency fear yin-dominant times, hence reversal in autumn/winter and compliance in spring/summer. 'Treating the primary disease' refers to the moxibustion and acupuncture methods discussed below. Note: This section interprets maikou heat as meridian excess and chi cold as collateral deficiency. Wang Bing’s commentary uses cun/chi to discuss yin/yang, noting yin governs collaterals and yang governs meridians. However, Jingmai and Maidu chapters state meridians are deep/internal and collaterals are shallow/superficial. Meridians are fundamentally yin, collaterals fundamentally yang; reversing this is problematic. Cun and chi merely divide yin/yang positions, but yin/yang qi exists everywhere in the five zang organs. For instance, lung metal is at cun (yin above); Mingmen is at chi (yang below). Thus, reversing cun/chi is acceptable, but reversing meridians/collaterals is not. Moreover, the focus is on meridians/collaterals, not just cun/chi. Readers should analyze this carefully.)*

The Yellow Emperor asked, "What if meridians are deficient and collaterals are full?"
Qibo said, "When meridians are deficient and collaterals are full, the chi position is hot and full, while the maikou is cold and choppy. Death occurs in spring and summer; life occurs in autumn and winter."
*(Meridian deficiency and collateral fullness indicate insufficient yin qi and excessive yang pathogens. Yin deficiency fears yang-dominant times, hence death in spring/summer and life in autumn/winter. Note: Wang Bing’s commentary on these two sections suggests that since yang qi is high in spring/summer, maikou heat and chi cold are compliant. Since yang qi descends in autumn/winter, chi heat and maikou cold are compliant. While this seems plausible, it is actually incorrect. Reviewing Nei Jing chapters on pulses, only floating/sinking of yin/yang according to climate is mentioned; never the use of cun/chi fluctuation to distinguish four seasons. Scholars failing to differentiate here may cause further confusion.)*

The Yellow Emperor asked, "How to treat these?"
Qibo said, "For collateral fullness and meridian deficiency, apply moxibustion to yin points and needle yang points. For meridian fullness and collateral deficiency, needle yin points and apply moxibustion to yang points."
*(This correctly aligns collaterals with yang and meridians with yin; moxibustion tonifies, needling reduces.)*

The Yellow Emperor asked, "What is called 'Chong Xu' [Double Deficiency]?"
Qibo said, "When upper pulse qi is deficient and chi pulse is deficient, this is called Chong Xu."
*(Both yin and yang are deficient, hence 'double deficiency.')*

The Yellow Emperor asked, "How to treat it?"
Qibo said, "By 'qi deficiency,' we mean erratic speech. By 'chi deficiency,' we mean unsteady gait."
*(Qi deficiency is upper deficiency; qi deficiency in the upper body causes chaotic speech. As stated in Maiyao Jingwei Lun: 'Speaking faintly, taking all day to speak again' indicates qi depletion. Chi deficiency is lower deficiency, causing unsteady and timid walking. 'Qiang' sounds like 'Kuang'.)* "Pulse deficiency manifests as lacking yin characteristics."
*(The air port [radial artery] alone governs the five zang organs and is the convergence of pulses. The five zang are yin; organ deficiency leads to pulse deficiency. Pulse deficiency is a sign of yin depletion, hence described as 'not resembling yin'.)* "In such cases, a slippery pulse indicates life, while a choppy pulse indicates death."
*(Meaning is consistent with the previous discussion.)*

The Yellow Emperor asked, "What if cold qi suddenly ascends, and the pulse is full and excess?"
*(Referring to conditions like Shanghan [Cold Damage].)*
Qibo said, "Excess with slipperiness indicates life; excess with reversal indicates death."
*(When pathogens are flourishing, the pulse should be excess. Excess combined with slipperiness yields a yang pulse, hence life. If a yin pulse appears, it is reversal, hence death. Note: Yuji Zhenzang Lun states: 'Weak and slippery pulses indicate Stomach qi, termed easy to treat. Pulses reversing the four seasons are untreatable.' See Pulse and Color category 12.)*

The Yellow Emperor asked, "What if the pulse is full and solid, hands and feet are cold, and the head is hot?"
Qibo said, "Life in spring and autumn; death in winter and summer."
*(Full and solid pulse indicates excess pathogens. Cold hands and feet indicate yin rebellion in the lower body. Hot head indicates yang pathogens in the upper body. Yin-yang disconnection results in upper excess and lower deficiency. Spring and autumn represent balanced yin-yang, obtaining harmonious qi, hence survival. Winter and summer represent yin-yang imbalance; extreme yang in summer and extreme yin in winter lead to death.)* "A floating and choppy pulse, with choppy quality and body heat, indicates death."
*(Floating with body heat indicates flourishing yang pathogens. Choppy indicates blood/qi deficiency and insufficient yin. Exterior excess and interior deficiency cause lone yang to lose its anchor, hence death.)*

The Yellow Emperor asked, "What if the entire body is fully distended?"
Qibo said, "When the entire body is fully distended, the pulse is rapid, large, and firm, while the chi position is choppy and unresponsive."
*(This describes the pattern of yang excess and yin deficiency. Yang excess causes full bodily distension and a rapid, large, firm pulse. Yin deficiency results in a choppy, unresponsive chi pulse.)* "In such cases, compliance indicates life, reversal indicates death."

The Yellow Emperor asked, "What defines compliance leading to life and reversal leading to death?"
Qibo said, "Compliance means warm hands and feet. Reversal means cold hands and feet."
*(The four limbs are the root of all yang. Therefore, when yang pathogens are flourishing, warm hands and feet indicate compliance. If hands and feet are cold, it signifies pathogens flourishing externally and qi deficiency internally, where healthy qi cannot overcome pathogens, hence reversal.)*