Understanding the Balance of Deficiency and Excess in Traditional Chinese Medicine

The Yellow Emperor’s Inquiry into Deficiency and Excess

The Yellow Emperor inquired, “What is meant by deficiency and excess?” To this, Qi Bo replied, “When pernicious energy is rampant, it is an excess condition; when the body’s righteous energy is damaged, it results in a deficiency condition.”

The Emperor further asked, “What are the manifestations of deficiency and excess?” Qi Bo explained, “The lungs govern qi. Qi deficiency essentially means lung deficiency, leading to symptoms like rebellious qi and cold limbs. If this occurs outside the season of lung dominance, it’s easier to treat. However, during the controlling season, the patient may face grave outcomes. The same principles apply to other organs.”

When asked about severe excess, Qi Bo mentioned, “Severe excess is characterized by a high fever and an extremely abundant pulse.”

The Emperor continued, “What about the condition of excess in both channels and collaterals? How should it be treated?” Qi Bo answered, “When the inch pulse is rapid and the cubit pulse is slow, both the channels and collaterals should be treated. A smooth pulse indicates flourishing qi and blood, which is termed as ‘顺’ (shùn) or smooth. Conversely, a rough pulse indicates qi and blood stagnation, termed as ‘逆’ (nì) or contrary. The general principle is that smoothness represents life, and roughness indicates death. If a person’s organs and tissues are smooth, their life can be prolonged.”

Regarding the insufficiency of collaterals but an excess of channel qi, Qi Bo stated, “This is observed when the inch pulse is warm and the cubit pulse is cold. In autumn and winter, it is contrary; in spring and summer, it is smooth. The focus should be on treating the contrary symptoms of the main disease.”

For the condition where the channels are deficient but the collaterals are excess, Qi Bo explained, “This is noted when the cubit pulse is warm and full while the inch pulse is cold and rough. In spring and summer, it indicates death; in autumn and winter, it indicates life.”

On treating such conditions, Qi Bo advised, “For excess in collaterals and deficiency in channels, moxibustion should be applied to yin and needling to yang; for excess in channels and deficiency in collaterals, needling should be applied to yin and moxibustion to yang.”

When asked about severe deficiency, Qi Bo explained that it encompasses deficiency in pulse, qi, and cubit. Distinguishing severe deficiency, he noted, “Qi deficiency is characterized by a lack of qi in the chest, leading to broken speech. Cubit deficiency is seen in weak and unsteady steps. Pulse deficiency is marked by weak qi and blood, and imbalance of yin and yang. Patients with smooth pulses may survive; those with rough pulses are at risk of death.”

When the Emperor inquired about cold qi attacking upwards with a full pulse, Qi Bo responded, “If the pulse is full and smooth, survival is likely; if full and rough, death is imminent.”

The Emperor asked about a full pulse with cold hands and feet but a hot head. Qi Bo explained, “Survival is possible in spring and autumn; death is likely in winter and summer. Floating and rough pulses with fever indicate potential death.”

Addressing the condition of swelling and bloating, Qi Bo described, “A floating body with swelling is identified by a rapid and solid inch pulse but a rough cubit pulse. Survival is possible if smooth; death if contrary.”

The Emperor questioned, “How is life sustained when smooth, and death when contrary?” Qi Bo replied, “Warm hands and feet indicate life; cold hands and feet indicate death.”

For postnatal fever with a suspended small pulse, Qi Bo mentioned, “Warm hands and feet indicate survival; cold hands and feet, death.”

In cases of stroke in infants with audible breathing and shoulder lifting, Qi Bo indicated, “A floating and moderate pulse with stomach qi signifies survival; a small and urgent pulse signifies death.”

Regarding intestinal dysentery, Qi Bo noted, “Fever with dysentery indicates death; cold body without fever indicates life.”

On white foamy discharge with diarrhea, Qi Bo mentioned, “Sinking pulses indicate life; floating pulses indicate death.”

For pus and blood discharge with diarrhea, Qi Bo stated, “Small and rough pulses indicate death; smooth and large pulses indicate life.”

The Emperor inquired about survival with heat and non-small rough pulses. Qi Bo explained, “Smooth and large pulses indicate survival; rough and small pulses indicate death. The timing of death depends on the overcoming day.”

In cases of epilepsy, Qi Bo mentioned, “If the pulse is pounding but smooth and large, treatment can be effective over time; if small and tense, the condition is incurable and leads to death.”

The Emperor inquired about the deficiency and excess of epilepsy pulses. Qi Bo responded, “Slow and relaxed pulses are treatable; tense and solid pulses indicate death.”

For wasting-thirst disease, Qi Bo explained, “Solid and large pulses, though chronic, can be cured; suspended, small, and tense pulses in chronic cases are untreatable.”

The Emperor advised on seasonal treatments: “Treating diseases in spring with collateral points, in summer with meridian points, and in autumn with the six-fu harmonizing points. In winter, using more medications and less needle therapy due to the closing season. Needle therapy is not avoided in cases of abscesses, which require immediate treatment. If the abscess is unidentified and the pain is not localized, use triple points beside the hand’s taiyin, and two points on the neck. For axillary abscesses with high fever, apply five needles to the foot’s shaoyin, and if the fever persists, needle three times on the hand’s pericardium and taiyin collateral points. For acute abscesses with severe pain due to insufficient bladder channel qi, needle its points.”

Addressing sudden abdominal distension, Qi Bo advised using the collateral points of the hand’s taiyang, stomach’s back points, and the kidney’s back points five times with rounded needles. For cholera, needle the bladder’s back points five times and the stomach’s and bladder’s surrounding points three times.

For epilepsy, the needling approach includes: five times on the hand’s taiyin, five times on the hand’s taiyang small intestine, once on the hand’s shaoyin collateral, once on the foot’s yangming, and thrice on a point five inches above the ankle.

For diagnosis and treatment of wasting-thirst, sudden collapse, hemiplegia, rebellious qi, and fullness, the differentiation between rich, well-nourished individuals consuming excess meat and refined grains is crucial. Blocked qi due to anger or worry causes esophageal obstruction, leading to upper and lower qi obstruction. Sudden reversal, unconsciousness, deafness, and urinary and bowel obstruction are caused by internal qi surging upwards. Some diseases originate externally, from wind-cold invasion, prolonged stagnation turning into heat, leading to emaciation. Limping due to cold or dampness is also recognized.”

The Emperor concluded, “Jaundice, sudden severe pain, mania, and rebellious qi are caused by long-term reversal of meridian qi. Disharmony of the five viscera is due to obstruction of the six fu organs. Headache, tinnitus, and blockage of the nine orifices result from intestinal and stomach disorders.”