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Module 5   Lesson 1   Xu Shi

Excess and Deficiency: the mechanics

Who is winning, your own strength or the invader, and how do you see that in someone who has been ill for months?

Module 1, lesson 2 gave you the city with its army; this lesson turns it into mechanics. After this lesson you weigh two forces separately, you know the three forms of Excess and the five of Deficiency, you predict what the battle will show, you follow how Full turns Empty and Empty turns Full, and you choose the order of expelling and tonifying.

no Xie Qi little Xie Qi much Xie Qi Xie Qi: what has been added Zheng Qi strong Zheng Qi weak Healthy no battle nothing to treat Mild Excess short and mild often clears by itself All-out battle acute, fierce, loud high fever, full pulse thick coating Deficiency chronic, tired pulse without strength no coating, or thin Lingering mix low-grade, long, recurs thin sticky coating slippery but weak Dangerous mix few signs, yet serious penetrates inwards Excess that stays consumes Zheng Qi Deficiency that stays makes Xie Qi
Schematic, an arrangement of our own after Maciocia ch. 27 (the interaction between pathogenic factor and Zheng Qi, p. 415). Red field: Excess; blue field: Deficiency; dashed border: mixed picture. An all-out battle can also end to the left: the pathogenic factor has been expelled.

Know by heart

  • Two questions, not one. Has Xie Qi been added? How strong is the Zheng Qi still? Excess: Xie Qi present and the Zheng Qi fights. Deficiency: Zheng Qi falls short, no Xie Qi. Mixed picture: both. Su Wen 28: an abundance of pathogenic Qi is Excess, the taking away of essential Qi is Deficiency. mnemonic: not "how bad is it?", but "what has been added, and what is left?"
  • Three forms of Excess. An invader from outside (Wind, Cold, Summer-Heat, Dampness, Dryness, Fire); a product from inside (Dampness, Phlegm, Blood stasis, Heat and Fire, internal Wind, food); Qi that is stuck or goes the wrong way. mnemonic: break-in, build-up, blockage.
  • Five forms of Deficiency. Qi, Yang, Blood, Yin, Essence (Jing). Yang deficiency is Qi deficiency with cold; Yin deficiency is Blood deficiency with dryness and Empty-Heat. Empty-Heat is Deficiency: nothing has been added, the Yin has run out. mnemonic: Qi is the engine, Yang the engine plus the heater; Blood is the oil, Yin the oil plus the coolant.
  • The battle makes the signs. Strong against strong: fierce and acute. Strong against weak: short and mild. Weak against weak: lingering. Weak against strong: few signs, yet serious. mnemonic: the noise comes from the fight, not from the invader.
  • Two transitions. Excess that stays consumes: Heat consumes Yin, Dampness smothers the Spleen. Deficiency that stays produces: Spleen-Qi deficiency gives Dampness, Qi deficiency gives Blood stasis, Wei-Qi deficiency lets Wind in. mnemonic: Full turns Empty, Empty turns Full; together it is called an Empty Root with a Full Manifestation.
  • The principle follows the balance. Excess: expel; Deficiency: tonify; mixed picture: whatever predominates first, or both at once. Never tonify with the invader inside. mnemonic: don't lock the door with the robber inside.
  • Weighing at the bedside. A pulse that keeps its strength under deep pressure: Full; one that fades: Empty. Pain worse with pressure: Full; better with pressure and with eating: Empty. The coating shows the Xie Qi, the tongue body the Zheng Qi. mnemonic: the coating is the guest, the body is the host.

The rest of this lesson is reference.

Excess and Deficiency: the mechanics: Who is winning, your own strength or the invader, and how do you see that in someone who has been ill for months?
The chart as an image, to save or share

Three practice questions from this lesson

What defines Excess according to Su Wen 28?
  1. A severe complaint with high fever and a loud voice
  2. The taking away of essential Qi
  3. An abundance of pathogenic Qi

Answer: An abundance of pathogenic Qi. Su Wen 28: an abundance of pathogenic Qi is Excess, the taking away of essential Qi is Deficiency. Severity, fever and a loud voice say something about the battle, not about the definition.

Liver-Qi stagnation is called Excess, although there is no invader and no product. Why?
  1. There is always Heat with it
  2. The Qi is there, but it is stuck
  3. The liver enzymes are raised

Answer: The Qi is there, but it is stuck. The third form of Excess: movement that fails. That is why the principle is to move, not to tonify.

Empty-Heat: Excess or Deficiency?
  1. Deficiency: the Yin has run out
  2. Excess: Heat is a pathogenic factor
  3. Always a mixed picture

Answer: Deficiency: the Yin has run out. In Empty-Heat nothing is added and there is no Xie Qi; the Yang looks like too much because the Yin falls short. After long-standing Full-Heat it can be a mixed picture, but not always.

The rest of this lesson

In the course you get the step-by-step explanation, 16 case-based practice questions, 19 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 5: Patterns.

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