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Capítulo 28 de 78
黄帝内经·素问
The Yellow Emperor asked: What is meant by deficiency syndrome and excess syndrome?
Qi Bo replied: When pathogenic qi (external disease-causing factors or hyperactive harmful qi within the body) is exuberant, that is excess; when essence qi (the subtle substances that sustain life) is consumed and depleted, that is deficiency.
This is the overarching principle of the entire chapter: The fundamental distinction between deficiency and excess syndromes lies in the relative strength of pathogenic factors versus healthy qi.
The Yellow Emperor further asked: How do the manifestations of deficiency and excess specifically present?
Qi Bo said: In qi deficiency, the typical manifestation is lung qi weakness (as the lungs govern the qi of the whole body); in qi counterflow, yang qi fails to descend normally, resulting in cold feet. If this condition does not occur during the season that overcomes it, the patient may survive; but if it occurs precisely during the overcoming season, death is likely. The deficiency and excess of all other organs can be reasoned by analogy in the same way.
The Yellow Emperor asked: What is meant by double excess?
Qi Bo said: So-called double excess means that in a condition of severe heat disease, there is heat in the qi aspect, while simultaneously the pulse is full and replete — both exterior and interior being excess — hence the term "double excess."
The Yellow Emperor asked: What about cases where both the primary channels and collaterals are in excess? How should they be treated?
Qi Bo said: When both primary channels and collaterals are in excess, the manifestation is rapid pulse at the cun position with relaxed pulse at the chi position; both should be treated. Generally speaking, a smooth, flowing pulse indicates "favorable" (congruence), signifying smooth flow of qi and blood; a rough, hesitant pulse indicates "unfavorable" (incongruence), signifying impeded flow of qi and blood. The principles of deficiency and excess are all derived by seeking from the nature of similar things, so when the five viscera, bones, and flesh are smooth and flowing, one may live long.
The Yellow Emperor asked: What about insufficiency of collateral qi with excess of channel qi?
Qi Bo said: In those with collateral qi insufficiency and channel qi excess, the manifestation is excessive and hot pulse at the cun opening, with cold at the chi region. This state is unfavorable in autumn and winter, but favorable in spring and summer; treatment should focus primarily on the channel where the disease resides.
The Yellow Emperor asked: What about channel deficiency with collateral fullness?
Qi Bo said: In those with channel deficiency and collateral fullness, the manifestation is heat and fullness at the chi region, with cold and rough pulse at the cun opening. This condition tends toward death in spring and summer, and survival in autumn and winter.
The Yellow Emperor asked: How are such conditions treated?
Qi Bo said: For collateral fullness with channel deficiency, apply moxibustion to supplement the yin channels and acupuncture to drain the yang channels; for channel fullness with collateral deficiency, apply acupuncture to drain the yin channels and moxibustion to supplement the yang channels.
📌 The "acupuncture" and "moxibustion" principles mentioned here are classical therapeutic guidelines from ancient times, emphasizing "supplement for deficiency, drain for excess." Specific procedures must be determined by professional practitioners and should not be attempted on one's own.
The Yellow Emperor asked: What is meant by double deficiency?
Qi Bo said: Deficiency at the upper part of the pulse qi and deficiency at the chi region — this constitutes double deficiency.
The Yellow Emperor asked: How is it identified and treated?
Qi Bo said: So-called qi deficiency manifests as weak speech with hesitancy and inconsistency; chi deficiency manifests as timid, unsteady gait while walking; pulse deficiency means the pulse does not show the normal yin pulse pattern. In these conditions, a smooth, flowing pulse suggests hope for survival, while a rough, hesitant pulse indicates grave danger.
The Yellow Emperor asked: When cold qi suddenly rushes upward and the pulse is full and replete, what happens?
Qi Bo said: If the replete pulse is smooth and flowing, recovery is likely; if the replete pulse shows chaotic counterflow patterns, death is more likely.
The Yellow Emperor asked: When the pulse is replete and full, the hands and feet are cold, and the head is hot, what happens?
Qi Bo said: This condition may survive in spring and autumn, but tends toward death in winter and summer. If the pulse is floating and rough, accompanied by body heat, death is generally indicated.
The Yellow Emperor asked: When the body is completely swollen and edematous, what happens?
Qi Bo said: In those with generalized swelling and fullness, the pulse is rapid, large, and hard, while the chi region is rough and unresponsive. In such cases, warm hands and feet indicate "favorable" — survival; cold hands and feet indicate "unfavorable" — death is more likely.
The Yellow Emperor asked: When a nursing infant has fever with a thin, small, and faint pulse, what happens?
Qi Bo said: If the hands and feet are warm, survival is possible; if the hands and feet are cold, death is more likely.
The Yellow Emperor asked: When an infant suffers wind-heat with labored breathing with raised shoulders and rapid respiration, what about the pulse?
Qi Bo said: In labored breathing with raised shoulders, the pulse is mostly replete and large. A moderate (slow) pulse permits survival; a rapid, tense pulse tends toward death.
The Yellow Emperor asked: In intestinal dysentery (ancient term for bowel disorders resembling dysentery) with blood in the stool, what happens?
Qi Bo said: Those with body heat mostly die; those with body cold may survive.
The Yellow Emperor asked: In intestinal dysentery with white frothy discharge, what happens?
Qi Bo said: A deep pulse permits survival; a floating pulse tends toward death.
The Yellow Emperor asked: In intestinal dysentery with pus and blood discharge, what happens?
Qi Bo said: A pulse that is faint and thready to the point of vanishing (suspended and severed) tends toward death; a smooth and large pulse permits survival.
The Yellow Emperor asked: In dysentery-type disorders, if the body is not hot and the pulse is not suspended and severed, what happens?
Qi Bo said: A smooth and large pulse favors survival; a suspended and rough pulse tends toward death, and the time of death can be inferred in conjunction with the seasonal correspondences of the five viscera.
The Yellow Emperor asked: How is epilepsy (ancient term for seizure disorders or certain head-related mental conditions) assessed?
Qi Bo said: If the pulse is large and smooth, the condition may resolve itself over time; if the pulse is small, firm, and tense, the prognosis is poor and the condition is difficult to treat.
The Yellow Emperor asked: How are the deficiency and excess of epilepsy determined?
Qi Bo said: A deficient (weak) pulse is treatable; a replete (excess) pulse tends toward death.
The Yellow Emperor asked: What about the deficiency and excess of wasting-thirst disorder (ancient term for diabetes-like conditions)?
Qi Bo said: If the pulse is replete and large, the condition may still be treatable despite long duration; if the pulse is suspended, small, and firm, long-standing cases are difficult to treat.
The Yellow Emperor asked: With regard to body measurements, bone measurements, pulse measurements, and sinew measurements, by what means can their degrees be determined?
📌 The original text appears to have textual corruption here. The preceding question asks about "measurements," yet the following passage proceeds to seasonal acupuncture principles; hence, the passage is paraphrased according to the received version without inserting content not present in the original.
The Yellow Emperor said: In spring, one should promptly regulate the channels and collaterals; in summer, one should promptly regulate the channel transport points; in autumn, one should promptly regulate the six bowels; in winter, when all things are closed and stored, one should rely more on medication and less on needle and stone therapy. What is meant by less use of needle and stone does not include acute conditions such as abscesses; abscesses count as emergencies and must not be delayed even for a moment.
When an abscess first arises and its exact location is unknown — pressing finds no responsive spot, pain comes and goes — the ancients considered it permissible to needle the side of the Hand Major Yin channel three times, as well as the neck-related vessels (ying mai) two times on each side. For axillary abscesses with high fever, one may needle the Foot Minor Yang channel five times; if fever does not subside after needling, needle the Hand Pericardium (heart minister) three times, and the meeting of major bones at the Hand Major Yin collateral three times on each side.
In sudden onset of abscesses with limp sinews, pain along the intermuscular striations, profuse sweating, and insufficiency of the uterine/bladder qi, treatment should select channel transport points.
For sudden abdominal fullness that does not diminish with pressure, one may select the front-mu point of the stomach on the Hand Major Yang channel collateral, as well as the Minor Yin transport points beside the spine at three cun lateral , five insertions, using the round-sharp needle.
For cholera, one may needle beside the Kidney transport points five times, and the Foot Yang Bright channel and points above it laterally three times.
In treating seizures and fright, needle the five channels: Hand Major Yin five times, Major Yang channel five times, beside the Hand Minor Yin collateral once, Foot Yang Bright channel once, and at a point five cun above the medial malleolus, three needles.
⚠️ The above acupuncture content represents ancient needling principles and is intended solely for scholarly study; it does not constitute any modern procedural guidance.
In treating all cases of wasting-thirst disorder, sudden collapse (apoplexy), hemiplegia (unilateral paralysis), atrophy and reversed coldness of the limbs, and fullness with qi counterflow, if the patients are obese people of wealth and status, the conditions mostly result from prolonged consumption of rich, fatty, and sweet foods (sumptuous diets).
Obstruction and blockage with no communication between upper and lower, mostly results from sudden profound grief or worry (violent emotional distress).
Sudden syncope with deafness, with blockage on one side and no communication, results from internal qi suddenly rushing upward.
If the disease does not arise from internal causes but rather from external attack of wind pathogens, there will be emaciation with pathogenic qi lingering. Lameness mostly results from cold, dampness, and wind pathogens.
The Yellow Emperor said: Jaundice, sudden pain, epilepsy, mania, and reversal syndromes mostly arise from prolonged upward counterflow of qi. Disharmony among the five viscera and obstruction of the six bowels are the internal causes of many diseases. Headache, tinnitus, and obstruction of the nine orifices mostly arise from disorders of the stomach and intestines.
General Framework of Deficiency and Excess: Comparison of Pathogenic Qi and Healthy Qi
The most important idea of this chapter is "when pathogenic qi is exuberant, there is excess; when essence qi is depleted, there is deficiency." This is not merely a classification of symptoms but an assessment of the condition from two dimensions: the disease-causing factors and the body's healthy qi. Whenever pathogenic qi is exuberant and healthy qi is not yet weakened, the condition is mostly excess; whenever healthy qi is consumed and the essence qi of the viscera is insufficient, the condition is mostly deficiency. This is one of the core principles of syndrome differentiation and treatment in Chinese medicine.
Pulse-Syndrome Favorability Determines Prognosis
The chapter extensively discusses "favorable leads to survival; unfavorable leads to death."
Acupuncture Principles for Deficiency/Excess in Primary Channels and Collaterals
"For collateral fullness with channel deficiency, apply moxibustion on yin and acupuncture on yang; for channel fullness with collateral deficiency, apply acupuncture on yin and moxibustion on yang" — the core idea is "supplement for deficiency, drain for excess." The yang channels govern the exterior and external aspects, while the yin channels govern the interior and internal aspects; by applying acupuncture or moxibustion to different channels, the balance between primary channels and collaterals can be restored.
Disease Etiology Closely Tied to Lifestyle
The end of the chapter points out: rich, fatty diets lead to wasting-thirst, hemiplegia, and atrophy-reversal conditions; sudden grief leads to obstruction of the diaphragm; wind-cold-dampness leads to lameness; disharmony of the stomach and intestines leads to headache, tinnitus, and obstruction of the nine orifices. This already connects diseases with diet, emotions, external pathogens, and visceral function, reflecting the TCM concept that "interior and exterior factors interact" in disease onset.
A Modern View of Deficiency-Excess Theory
"Excess due to exuberant pathogenic qi" may be roughly analogous to conditions where infectious, inflammatory, or metabolic products are strongly active; "deficiency due to depletion of essence qi" may be analogous to low immune function, depleted nutritional reserves, or declining organ function. However, such analogies cannot be equated directly — TCM's "deficiency and excess" is a judgment system based on whole-body syndromes with its own unique logic.
Historical Limitations of Prognostic Judgments
Many judgments of "death" or "survival" in the chapter — such as "with body heat, death; with cold, survival" or "unfavorable in autumn and winter, favorable in spring and summer" — are experiences summarized in antiquity without access to modern emergency care, anti-infection measures, or fluid replacement. Modern medicine has substantially changed the prognosis of many conditions. For example, dysentery with blood in the stool and fever can now be treated with antibiotics, fluid replacement, and hemostatic measures. Ancient prognostic conclusions should not be directly applied today. These should be viewed rationally as historical value, not as substitutes for modern diagnosis.
Historical Value and Safety Boundaries of Acupuncture and Moxibustion
Ancient needling and moxibustion techniques do have clinical value, but the point selection, methods, and needles discussed in this chapter must be performed by qualified TCM practitioners based on actual clinical syndrome differentiation. Attempting to self-administer could cause harm — especially abscesses, cholera, and seizure conditions, which are acute and severe and require immediate medical attention.
Rational Core of Etiological Concepts
"The obese and wealthy suffer from diseases of rich foods" resonates with the modern medical understanding of how high-fat, high-calorie diets relate to metabolic syndrome and cardiovascular disease. "Sudden grief leads to disease" is essentially consistent with psychosomatic medicine's emphasis on how emotions affect digestive and cardiovascular function. This shows that the ancients already held a plain understanding of the relationship between lifestyle and disease.
Related Concepts
Further Reading
Collated and studied by Bu Gua
This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and reflection. It does not constitute any form of medical diagnosis, medication guidance, or treatment recommendation. Please seek prompt medical attention for any health concerns.