Deficiency and Excess

Deficiency and excess are the two principles which are used to generalize and distinguish the relative strength of the antipathogenic qi and pathogenic factor. According to the twenty - eighth chapter of Plain Questions, " hyperactivity of the pathogenic factor causes excess ; consumption of essential qi causes deficiency. " Distinguishing whether a syndrome is of deficiency type or of excess type forms the basis for the determination of promoting the antipathogenic qi or eliminating the pathogenic factor in the treatment.

Deficiency refers to insufficiency of the antipathogenic qi, and therefore syndromes of deficiency type refer to pathological conditions resulted from deficiency of the antipathogenic qi. Excess refers to hyperactivity of the pathogenic factor, and therefore syndromes of excess type refer to pathological conditions in which the pathogenic factor is hyperactive, while the antipathogenic qi remains strong.

Syndromes of deficiency type. Insufficiency of the antipathogenic qi of the human body may manifest as deficiency of yin, deficiency of yang, deficiency of qi or deficiency of blood, which may form different syndromes. For syndromes of qi deficiency and blood deficiency, refer to differentiation of syndromes according to the theory of qi and blood.

Syndromes of deficiency type - Emaciation, listlessness, lassitude, feeble breathing, dislike of speaking, pallor, palpitations, shortness of breath, insomnia, poor memory, spontaneous and night sweating, nocturnal emission, nocturnal enuresis, pain alleviated by pressure. Dry tongue with no coating or little coating. Pulse of deficiency type.

Syndromes of yang deficiency and syndromes of yin in deficiency. They generalize pathological conditions resulted from deficiency of yang and yin of the body. According to the inter - consuming - supporting relationship of yin and yang, deficiency of yang leads to a relative excess of yin, and deficiency of yin leads to a relative excess of yang. In addition to the clinical manifestations of deficiency type, cold signs are seen in deficiency of yang, and heat signs are seen in deficiency of yin. However, they are essentially different from cold and heat syndromes caused respectively by excess of yin and excess of yang.

Deficiency of yin - Afternoon fever, malar flush, heat sensation in the palms and soles, night sweating, dryness of the throat and mouth, yellow urine, dry stools. Red tongue with little coating. Thready and rapid pulse.

Deficiency of yang - Chills, cold limbs, listlessness, lassitude, spontaneous sweating, absence of thirst, clear urine increased in volume, loose stools. Pale tongue with white coating. Weak pulse.

Syndromes of excess type. In syndromes of excess type, the clinical manifestations vary with the nature of the invading exogenous pathogenic factors and areas of the human body they invade. The following factors are mainly considered in distinguishing syndromes of deficiency type from those of excess type : Body shape, spirit, strength of voice and breath, response to pressure on painful areas, tongue coating and pulse.

Syndromes of excess type - Sturdiness, agitation, sonorous voice, coarse breathing, distension and fullness in the chest and abdomen, pain aggravated by pressure, constipation or tenesmus, dysuria. Thick and sticky tongue coating. Pulse of excess type.

The relationship between syndromes of deficiency type and syndromes of excess type. While syndromes of deficiency type and syndromes of excess type are essentially different, they are also interconnected, and one may affect the other. The clinical manifestations are described as follows.

Complication of deficiency and excess. When deficiency of the antipathogenic qi and excess of the pathogenic factor manifest at the same time, this is known as a syndrome complicated with deficiency and excess. Either deficiency of the antipathogenic qi or excess of the pathogenic factor may predominate in complicated syndromes. There are also complicated syndromes in which deficiency of the antipathogenic qi and excess of the pathogenic factor are on equal terms. Appropriate methods of treatment are determined on the basis of distinguishing which predominates and which is more urgent.

Transformation of deficiency and excess. Although the pathogenic factor in syndromes of excess type may gradually subside, the antipathogenic qi is already injured due to delayed or incorrect treatment, thus transforming syndromes of excess type into syndromes of deficiency type. An example is a heat syndrome of excess type which manifests as high fever, thirst, sweating and superficial and rapid pulse. If the disease persists for a long time and consumes body fluid, this may transform into a syndrome of deficiency type showing emaciation, pallor, feebleness, little tongue coating or no coating, and thready and weak pulse. In syndromes of deficiency type, insufficiency of the antipathogenic qi may impair the functions of certain zang - fu organs in distribution and transformation, and produce endogenous pathogenic factors, thus eliciting various syndromes of excess type. Excess resulting from deficiency like this is also known as deficiency complicated with excess, or as deficiency of the root cause with excess of manifestations. In deficiency of qi of the spleen and lung, for example, dysfunction in transportation, transformation, dispersing and descending may produce endogenous pathogenic factors such as phlegm, retained fluid, harmful water or damp.

True and false phenomena in deficiency and excess. False phenomena may appear in syndromes of deficiency type and those of excess type. Special care should be taken to distinguish them. True excess with false deficiency refers to a syndrome of excess type which is accompanied by symptoms and signs similar to a syndrome of deficiency type. An example is accumulation of dryness and heat in the intestines and stomach, which binders circulation of qi and blood, and elicits such symptoms and signs as indifference, a cold sensation of the body, cold limbs, and deep and slow pulse. But further examination of the patient will show a sonorous voice, coarse breathing, deep, slow but forceful pulse, distension and fullness in the abdomen, constipation, and red tongue with burnt - yellow coating. All this reveals that the accumulation of dryness and heat is the underlying cause of the pathological changes, while the symptoms and signs indicating the syndrome of deficiency type are false phenomena.

True deficiency with false excess refers to a syndrome of deficiency type which is accompanied by symptoms and signs similar to a syndrome of excess type. Deficiency of qi of the spleen and stomach, for example, may lead to weakness in transportation and transformation and give rise to distension, fullness and pain in the abdomen and string - taut pulse. However, the distension and fullness in the abdomen may be improved at times, while they usually persist in syndromes of excess type. In addition, the abdominal pain is not aggravated by pressure, and is sometimes alleviated by pressure. The pulse is string - taut, but it is also weak on heavy palpation. So deficiency of the middle jiao leading to dysfunction in transportation is the underlying cause of the pathological changes, while the distension, fullness and pain in the abdomen indicating a syndrome of excess type are false phenomena. Distinguishing between true and false phenomena in deficiency and excess requires careful examination of the patient ' s pulse, tongue and other symptoms and signs. Factors such as the strength of the pulse, toughness of the tongue and response to pressure on the painful area must be assessed. In addition, the causative factors of the disease and medication taken before should be considered.