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Chapter 53 of 78
黄帝内经·素问
The Yellow Emperor asked: I would like to hear the essentials of deficiency and excess. Qi Bo replied: When the body's upright qi is replete, the physical form is also replete; when the upright qi is deficient, the physical form is also deficient—this is the normal state. If the two are inconsistent, that is a pathological condition. When food and drink are sufficient, qi is also sufficient; when food and drink are insufficient, qi is also deficient—this is the normal state; the opposite is pathological. When the pulse is replete, the blood is also replete; when the pulse is deficient, the blood is also deficient—this is the normal state; the opposite is pathological.
The Yellow Emperor asked: What counts as the opposite? Qi Bo said: When upright qi is deficient but the body is hot, this is the opposite; when one eats more but qi is scant, this is the opposite; when one eats little but qi is abundant, this is the opposite; when the pulse is replete and forceful but blood is scant, this is the opposite; when the pulse is deficient but blood is abundant, this is the opposite.
When qi is abundant but the body feels cold, this is mostly due to injury from cold pathogenic factors; when qi is deficient but the body is hot, this is mostly due to injury from summer-heat pathogenic factors. Eating more but having scant qi may be due to previous blood loss, with dampness lingering in the lower part of the body. Eating little but having abundant qi indicates pathogenic factors invading the stomach and lungs. A small pulse with abundant blood is mostly related to internal accumulation of wine and fluids with predominant internal heat. A large pulse with scant blood indicates wind qi in the vessels, and fluids and grains cannot be properly ingested—this is what is being described.
What is called excess syndrome means pathogenic qi has invaded the interior; what is called deficiency syndrome means upright qi has leaked outward. When qi is excessive, it generates heat; when qi is deficient, it generates cold. In needling to treat excess syndromes, after withdrawing the needle, the left hand does not press closed the needle hole, allowing pathogenic qi a pathway to escape; in needling to treat deficiency syndromes, after withdrawing the needle, the left hand presses the needle hole closed, preventing the leakage of upright qi. 🌿🩺
(This is an explanation of ancient needling principles and does not constitute modern operational guidance.)
The core of this chapter concerns the "normal" and "opposite" patterns in identifying deficiency and excess syndromes.
Traditional Chinese medicine views the human body as an interconnected whole: qi and form, diet and qi, pulse and blood should normally match one another. For example, when one can eat well and has sufficient strength, and the pulse matches the state of the blood, this is the "normal." Once mismatched phenomena appear—such as "eating much yet qi is scant" or "the body is hot yet qi is deficient"—it indicates that something has gone wrong internally, and this is called the "opposite," meaning a pathological state.
This approach of "measuring change against the normal" is an important diagnostic method in traditional Chinese medicine. It does not look at a single indicator alone but observes whether multiple life activities are coordinated. The latter portion further explains that the essence of deficiency and excess can be understood as: excess is pathogenic qi entering internally, deficiency is upright qi leaking outward; excess of qi often manifests as heat, and deficiency of qi often manifests as cold. Finally, it is applied to needling practice—through "opening the needle hole" to drain excess and "closing the needle hole" to supplement deficiency, embodying the principles of supplementation and draining.
The contrast between "normal and opposite" resembles the modern medical concept of balance among "intake—consumption—reserve." For example, if a person eats normally but loses weight, feels fatigued, or experiences chills or fever, it does suggest possible metabolic, endocrine, or circulatory issues. The holistic observation of the ancients has a certain degree of rationality.
However, one must also recognize historical limitations: the ancients' direct correspondence of "excess qi means heat, deficient qi means cold" was an empirical generalization and cannot be equated with modern pathological mechanisms. Concepts such as "injury from cold," "injury from summer-heat," "wind qi," and "dampness settling below" are traditional etiological categories and should not be simplistically applied to modern infections or rheumatic/autoimmune diseases. The needling technique of "opening and closing the needle hole" for supplementation and draining belongs to traditional acupuncture theory and must be performed by qualified practitioners in formal clinical settings—never attempted on one's own.
In daily life, one can pay attention to the body's sense of "matching":
These are life signals that traditional medicine reminds us to observe. Maintaining moderation in diet, regularity in daily routine, avoiding both overwork and excessive idleness helps reduce states of imbalance where deficiency and excess are intermingled. If noticeably mismatched sensations persist, one should seek professional medical help rather than self-diagnose or self-treat.
The above is compiled by Bugu's study notes. This content is based on classical texts of traditional Chinese medicine and is provided solely for cultural heritage study and research. It does not constitute any medical diagnosis, medication, or treatment advice; if you feel unwell, please seek medical attention promptly.