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Capítulo 53 de 78
黄帝内经·素问
The Yellow Emperor asked: I wish to hear the essentials of deficiency and excess. Qibo replied: When the body's vital qi (zhèng qì) is full, the physical body is also full; when the vital qi is weak, the physical body is also weak — this is the normal state. If the two do not correspond, that is a pathological condition. When food and water intake is abundant, qi is also abundant; when food and water intake is insufficient, qi is also weak — this is normal; the opposite is pathological. When the pulse is full, the blood is also full; when the pulse is weak, the blood is also weak — this is normal; the opposite is pathological.
The Yellow Emperor asked: What counts as "opposite"? Qibo said: When vital qi is weak but the body develops heat, this is opposite; when eating is increased but qi is diminished, this is opposite; when eating is reduced but qi is increased, this is opposite; when the pulse is full and forceful but blood is scant, this is opposite; when the pulse is weak but blood is abundant, this is opposite.
When qi is excessive yet the body feels cold, it is mostly due to injury from cold pathogens. When qi is deficient yet the body feels hot, it is mostly due to injury from summer-heat pathogens. Eating more but having less qi may result from past blood loss, with dampness stagnating in the lower body. Eating less but having more qi indicates pathogens invading the stomach and lungs. A small pulse with abundant blood is often related to internal retention of alcohol and fluids with exuberant internal heat. A large pulse with scant blood indicates wind pathogen in the vessels, and water and fluids cannot be properly ingested — these are the conditions being described.
What is called excess (shí) means pathogens have invaded the interior; what is called deficiency (xū) means vital qi has leaked outward. When qi is in excess, heat arises; when qi is deficient, cold arises. In needling excess conditions, after withdrawing the needle, the left hand does not press closed the puncture hole, allowing pathogens a route to escape outward; in needling deficiency conditions, after withdrawing the needle, the left hand presses the puncture hole closed, preventing vital qi from leaking outward. 🌿🩺
(This is an explanation of ancient needling principles and does not constitute modern operational guidance.)
The core of this chapter is the distinction between "normal (cháng)" and "opposite (fǎn)" in deficiency–excess differentiation (xū shí biàn zhèng).
Chinese medicine views the human body as an interconnected whole: between qi and form, between diet and qi, and between pulse and blood, there should normally be mutual correspondence. For example, being able to eat well, having ample strength, and having pulse and blood states that match each other — this is "normal." Once there appears a mismatched phenomenon such as "eating more but having less qi" or "the body feels hot but qi is deficient," it indicates an internal problem, which is called "opposite," i.e., a pathological state.
This approach of "measuring change against the normal" is an important diagnostic method in Chinese medicine. It does not look only at a single indicator but observes whether multiple life activities are coordinated. The latter part further explains that the essence of deficiency and excess can be understood as: excess means pathogens entering within; deficiency means vital qi leaking outward; excess of qi often manifests as heat, and deficiency of qi often manifests as cold. Finally, this is applied to needling practice, where "opening the puncture hole" drains excess and "closing the puncture hole" tonifies deficiency, reflecting the principles of supplementation and draining.
The contrast between "normal and opposite" is similar to the balancing concept of "intake—consumption—reserve" in modern medicine. For example, if a person eats normally but loses weight, feels fatigued, or experiences chills or fever, it may indeed suggest underlying issues with metabolism, endocrine function, or circulation. The holistic observation of the ancients has a certain rationality.
However, historical limitations should also be recognized: the ancient assumption that "excess of qi means heat, deficiency of qi means cold" is an empirical generalization and cannot be equated with modern pathological mechanisms. Concepts such as "injury by cold," "injury by summer-heat," "wind qi," and "dampness residing below" are traditional etiological ideas and should not be simplistically applied to modern infectious or rheumatic diseases. The needling method of "opening and closing the puncture hole" for supplementation and draining belongs to traditional acupuncture theory and must be used by licensed practitioners in a proper clinical setting — never attempted on one's own.
In daily life, one can pay attention to the "sense of match" in the body:
These are life signals that traditional medicine reminds us to notice. Maintaining moderation in diet, regularity in daily routine, neither excessive exertion nor excessive idleness helps reduce states of "intermingled deficiency and excess." If there is a persistent and obvious sense of mismatch, one should seek the help of a professional physician rather than self-diagnosing or self-treating.
The above is compiled by Buguā for study purposes. This content is based on classical Chinese medicine texts and is intended solely for traditional cultural learning and study. It does not constitute any medical diagnosis, medication, or treatment advice; if you feel unwell, please consult a qualified physician promptly.