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Difficulty 48 states: There are three types of deficiency and three types of excess in the human body. What does this mean?

The answer is: There is the deficiency and excess of pulse, the deficiency and excess of disease progression, and the deficiency and excess of diagnosis. Regarding the deficiency and excess of pulse, a soft (Ru) pulse indicates deficiency, while a tight (Jin) and firm (Lao) pulse indicates excess. Regarding the deficiency and excess of disease progression, outward movement indicates deficiency, and inward penetration indicates excess; ability to speak indicates deficiency, inability to speak indicates excess; a slow onset indicates deficiency, and a rapid onset indicates excess. Regarding the deficiency and excess of diagnosis, softness upon palpation indicates deficiency, and hardness upon palpation indicates excess; itching indicates deficiency, and pain indicates excess. Pain on the exterior with comfort on the interior indicates exterior excess and interior deficiency; pain on the interior with comfort on the exterior indicates interior excess and exterior deficiency. Thus, these are referred to as deficiency and excess.

Deficiency refers to emptiness, where the healthy Qi (Zheng Qi) is insufficient. Excess refers to strength, where the pathogenic factor (Xie Qi) is abundant. Speaking from the perspective of pulse, a soft and fine pulse is therefore considered deficiency. A tight, wiry, and forceful pulse, or a deep and forceful pulse, is therefore considered excess. However, the deficiency and excess of pulses are not limited to this; citing these allows for analogical reasoning. Speaking from the perspective of disease, outward movement implies deficiency, which refers to diseases originating from the five Zang organs, developing from the interior to the exterior, known as internal injury (Nei Shang). Inward penetration implies excess, which refers to being struck by the five pathogenic factors, invading from the exterior to the interior, known as external contraction (Wai Gan). However, outward-moving conditions occasionally present with excess, and inward-penetrating conditions occasionally present with deficiency; this statement covers the general principles. The ability to speak occurs because the pathogenic Qi is deficient internally, allowing the Spirit Qi (Shen Qi) to remain clear, thus maintaining lucidity without hindering speech. The inability to speak occurs because pathogenic factors attack from the exterior and stagnate within, causing confusion of the spirit and mind, leading to silence. A slow onset occurs because the disease develops gradually; when healthy Qi is depleted and pathogenic factors are weak, the disease deepens progressively. A rapid onset occurs because the disease strikes suddenly; when healthy Qi is exhausted and pathogenic factors are vigorous, the disease progresses rapidly.

"Zhen" (Diagnosis/Palpation) means pressing and observing. It refers to understanding the condition through palpating the exterior, not specifically pulse diagnosis. From the perspective of clinical observation, itching indicates deficiency, as insufficient blood and Qi fail to nourish the muscles, causing itching. Pain indicates excess, as the accumulation of pathogenic factors disrupts the harmony of Ying (Nutrient) and Wei (Defensive) Qi, causing pain. Generally, deficiency patterns welcome pressure, while excess patterns reject it; therefore, pain upon pressure indicates excess, and comfort upon pressure indicates deficiency. A soft pulse indicates deficiency, and a firm pulse indicates excess. The *Mai Jing* (Pulse Classic) cites this passage but omits these two sentences, possibly due to repetition from the preceding text. Yang Shi suggested that soft and flaccid flesh upon palpation indicates deficiency, while firm and strong flesh indicates excess, which seems also plausible; this view is preserved for reference.