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Chapter 7 of 10
难经
Question: What do people commonly mean by the "three deficiencies and three excesses"?
Answer: Deficiency and excess can be distinguished at three levels: deficiency/excess of the pulse, deficiency/excess of the disease, and deficiency/excess of the examination findings.
This difficult issue presents a three-dimensional diagnostic approach of "three deficiencies and three excesses," emphasizing comprehensive judgment from the pulse, disease, and examination — not relying on any single symptom alone. Deficiency generally manifests as reduced function, insufficiency of healthy qi, and a moderate disease tendency; excess generally manifests as exuberant pathogenic qi, obstruction and stagnation, and an acute disease tendency. The phrase "itching is deficiency, pain is excess" suggests: pain is often related to obstruction of qi and blood and retention of pathogenic excess, while itching is often related to depletion of qi and blood and loss of nourishment to the skin.
The "soft" and "firm" pulse qualities may be roughly correlated with circulatory status, vascular tone, and the like, but pulse diagnosis in Chinese medicine constitutes an overall functional assessment and cannot be mechanically mapped to modern medical indicators. The statement "pain is mostly excess, itching is mostly deficiency" has a certain phenomenological basis, yet in many diseases pain and itching coexist, and one cannot determine deficiency or excess on this basis alone. Modern clinical practice emphasizes multi-dimensional evidence such as etiology, pathology, and imaging.
Learn to observe the body's signals: if there is fixed, unmoving pain or continuously worsening itching, do not judge deficiency or excess on your own — seek medical attention promptly. In daily life, balance work and rest, and avoid long-term excessive depletion to protect healthy qi.
Question: There are "diseases of the primary channels themselves" and "injuries by the five pathogenic factors." How are they distinguished?
Answer: The classics say: Worry, anxiety, and overthinking injure the heart; exposure of the body to cold and consumption of cold food injure the lungs; anger causing qi to counterflow upward without descending injures the liver; immoderate diet and overexertion injure the spleen; prolonged sitting on damp ground and forceful entry into water while strong injure the kidneys. These are diseases of the five viscera from their own primary channels (the organ itself being directly harmed).
The five pathogenic factors refer to: wind stroke, heat injury (summerheat), dietary and fatigue injury, cold injury, and damp injury — five types of pathogenic causes.
Taking heart disease as an example, determining which pathogenic factor caused it:
This difficult issue classifies disease causes into two major categories — diseases of the five viscera themselves and injury by the five pathogenic factors — and uses five-phase categorization (color, odor, flavor, sound, fluid) for deductive analysis. Diseases of the five viscera themselves emphasize internal injuries from emotions, diet, fatigue, and environment; the five pathogenic factors emphasize external contraction of wind, summerheat, cold, and dampness as well as internal injuries from diet and fatigue. Taking heart disease as an example, the source of pathogenic qi is inferred retroactively through abnormalities in complexion, smell, taste, voice, sweat, and the like. This reflects the diagnostic principle that "what is within necessarily manifests without."
Emotional dysregulation, cold and cold-fluid intake, overexertion, and prolonged residence in damp places do indeed affect health, but the correspondences between the "five colors, five odors, five flavors, five sounds, five fluids" and the five viscera belong to ancient philosophical deduction and cannot serve as the basis for modern etiological diagnosis. In this difficult issue, "wind stroke" refers to external contraction of wind pathogen and is completely different from modern "cerebral stroke"; "cold injury" refers to external contraction of cold pathogen and is not equivalent to Western medicine's "typhoid fever." Manifestations such as high fever, unconsciousness with delirium, and intractable sweating may, in modern medicine, suggest infection, shock, or neurological disorders — prompt medical attention is essential.
This difficult issue reminds us: emotional equanimity, avoiding cold and keeping warm, moderate diet, balanced work and rest, and dry living conditions are all important for the health of the five viscera. Reducing worry, anger, overexertion, and prolonged sitting or lying in damp places can reduce many discomforts.
Question: Diseases involve deficiency pathogen, excess pathogen, thief pathogen, minor pathogen, and upright pathogen. How are they distinguished?
Answer: Viewed from the five-phase generating and controlling relationships:
This difficult issue classifies the sources of pathogenic qi into five categories according to the five-phase generating and controlling relationships. The core is to judge the relative strength and favorable/unfavorable direction of the pathogenic qi.
The generating and controlling transmissions of the five phases constitute an ancient systems-theory model that can aid understanding of interconnections between diseases, but it belongs to philosophical deduction rather than modern etiology. Modern medicine relies far more on empirical evidence from etiology, pathophysiology, and imaging. Do not use concepts such as "deficiency pathogen" or "excess pathogen" to independently judge disease severity or prognosis.
Regardless of the type of "pathogen," the key to prevention is strengthening upright qi: regular routine, balanced diet, moderate exercise, and avoiding invasion by the six climatic excesses. If symptoms caused by external pathogens persist, seek medical attention without delay.
Question: Some diseases make one crave warmth, and others make one crave cold; some patients wish to see people, and others do not wish to see people. What do these differences indicate about the location of the disease in the viscera and bowels?
Answer: Those who desire cold and are willing to see people have disease in the bowels (fu); those who desire warmth and do not wish to see people have disease in the viscera (zang).
The reason is: the bowels pertain to yang, and yang diseases mostly crave cold and like seeing people; the viscera pertain to yin, and yin diseases mostly crave warmth, prefer closing the door and staying alone, and dislike hearing the sound of people.
Therefore, visceral and bowel diseases can be distinguished on this basis.
This difficult issue uses yin-yang to explain patients' preferences for cold and warmth and their social inclinations. When yang heat is exuberant, patients tend to fear heat, prefer cold, and feel restless with a desire to see people; when yin cold is exuberant, patients tend to fear cold, prefer warmth, and favor quiet while disliking people. This is a method of judging the cold-heat nature of the disease and the depth of the disease location through the patient's subjective sensations and overt behaviors.
Patients with febrile diseases do often fear heat and feel restless; those with deficiency-cold constitutions often fear cold and prefer quiet. But these are general phenomena, and one cannot distinguish visceral from bowel diseases simply by asking "whether the patient wants to see people." Modern medicine pays greater attention to objective evidence such as body temperature, infection markers, and mental status.
Pay attention to changes in your own preferences for cold and warmth: if you suddenly become unusually fearful of cold or heat, or your mood shifts from enjoying quiet to feeling restless, these may be signals from the body. Consult a physician promptly rather than self-supplementing.
Question: Is the "root" (fundamental nature) of disease onset in the viscera and bowels the same?
Answer: It is not the same.
Visceral disease is characterized by being fixed and unmoving — the disease location does not leave its original place; bowel disease is characterized by seeming audible movement within the abdomen, flowing upward and downward without a fixed location.
Therefore, one can know that the fundamental natures of the viscera and bowels differ.
This difficult issue distinguishes visceral from bowel disease by whether the disease location is fixed. The five viscera store essential qi, so their diseases tend to be fixed, substantial, and deep; the six bowels transport and transform food and water, so their diseases tend to involve movement of qi, wandering, and intermittent attacks. Clinically, fixed pain tends to suggest visceral disease or substantive lesions, while wandering distension and borborygmus tend to suggest bowel disease or qi-mechanism dysregulation.
This distinction has a certain phenomenological value: diseases of solid organs (such as the liver, spleen, kidneys) often manifest as fixed pain or masses; functional disorders of hollow organs (such as the stomach, intestines, gallbladder) often manifest as wandering discomfort, borborygmus, and distension. However, modern diseases are complex, and one cannot lightly conclude visceral or bowel location simply from the "fixed/wandering" character — imaging and endoscopic examination must be combined.
If you experience wandering distension and borborygmus in the abdomen, first review your diet and emotions and adjust your eating rhythm; but if you have fixed, unmoving pain, especially progressively worsening, seek medical evaluation as early as possible.
Question: The medical classics say "sevenfold transmission leads to death; alternate-organ transmission leads to life." What does this mean?
Answer: Sevenfold transmission refers to disease transmission following the controlling (overcoming) order; alternate-organ transmission refers to transmission following the generating order.
Taking heart disease as an example:
This difficult issue uses five-phase generating and controlling relationships to model disease transmission: controlling transmission (sevenfold) indicates pathogen invasion deepening, all five viscera injured, and an adverse disease course; generating transmission (alternate-organ) indicates the pathogen has an outlet and mother-child continuity, reflecting a favorable course. This is an ancient theoretical judgment about the favorable or adverse evolution of disease.
"Sevenfold transmission leads to death; alternate-organ transmission leads to life" is an ancient prognostic model, and "death" and "life" should be understood as the favorable/unfavorable direction and criticality of the disease process, not literal mortality. Modern medicine bases prognosis on pathology, staging, organ function, treatment response, and the like — one cannot impose five-phase transmission on it. Any disease should be treated medically as early as possible; do not delay treatment because of "transmission direction."
The core lesson of this difficult issue is early intervention to prevent disease from progressing from superficial to deep. Do not ignore minor health problems — promptly adjust lifestyle and seek professional help, which often can block the disease from transmitting deeper.
Question: Why is it said that visceral disease is difficult to treat and bowel disease is easy to treat?
Answer: Visceral disease is difficult to treat because it mostly transmits along the controlling order; bowel disease is easy to treat because it mostly transmits along the generating order. This is the same principle as the sevenfold and alternate-organ transmission discussed above.
This difficult issue extends the Fifty-Third Difficult Issue: visceral disease is deep-seated and mostly involves controlling transmission, hence difficult to treat; bowel disease is more superficial and mostly involves generating transmission, hence easy to treat. This reflects the ancients' emphasis on depth of disease location and direction of transmission.
From a modern clinical standpoint, some bowel diseases (such as acute appendicitis or cholecystitis) can be cured with timely surgery or antibiotics, while certain visceral diseases (such as chronic renal failure or cirrhosis) are indeed difficult to treat. But this is not absolute: some bowel diseases can be fatal, and some visceral diseases can be well controlled. One should not use "visceral disease is difficult, bowel disease is easy" as a reason to abandon treatment or to dismiss illness lightly.
The key to protecting visceral and bowel function lies in daily nurturing: avoid staying up late, avoid overexertion, quit smoking and limit alcohol, maintain dietary moderation, and particularly avoid long-term damage to substantive organs such as the liver and kidneys.
Question: Diseases involve "accumulation" (ji) and "gathering" (ju). How are they distinguished?
Answer: Accumulation pertains to yin qi; gathering pertains to yang qi. Yin qi is sunken and hidden; yang qi is active and floating. When qi accumulates and assumes form, it is called "accumulation"; when qi gathers but remains formless, it is called "gathering."
Accumulation is generated by the five viscera; gathering is formed by the six bowels.
Specific manifestations:
This difficult issue distinguishes visceral from bowel disease by whether the disease location is fixed. The five viscera store essential qi, so their diseases tend to be fixed, substantial, and deep; the six bowels transport and transform food and water, so their diseases tend to involve movement of qi, flowing, and intermittent attacks. Clinically, fixed pain tends to suggest visceral disease or substantive lesions, while wandering distension and audible borborygmus tend to suggest bowel disease or qi-mechanism disorder.
This difficult issue distinguishes accumulations and gatherings through yin-yang, motion-stillness, and zang-fu organs:
Accumulations and gatherings cannot be simplistically equated with tumors, but "fixed, immovable masses that gradually enlarge" warrant high clinical vigilance for organic pathology in modern medicine—especially the possibility of tumors. If a patient detects a painless or painful fixed mass anywhere on the body, prompt medical evaluation with ultrasound, CT, or other imaging is advised. Migratory distending pain is often related to gastrointestinal functional disorders and qi-movement stagnation, but other diseases should also be ruled out.
Maintaining emotional well-being, moderate diet, and appropriate exercise helps reduce qi stagnation and the accumulation of phlegm and stasis. For any mass appearing on the body or any long-standing unhealed pain, do not self-massage or self-medicate—seek medical attention promptly to determine its nature.
This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and reflection. It does not constitute any medical diagnosis, medication, or treatment advice; please consult a healthcare professional promptly if you feel unwell.