Excess or Deficient
The Rule that Decides How to Treat


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Excess or Deficient! What a silly phrase! Yet Excess and Deficiency are two of the vital 8 Principles in Chinese medicine that help acupuncturists decide how to treat patients.

Classifying a condition as one of excess or deficiency hugely increases the likelihood of treating it successfully.

Another way describing the same principle, is ‘full’ or ‘empty’, or ‘fullness’ or ‘emptiness’.

Just as, in life, you feel full of energy in the morning and exhausted by the evening, or you know someone who has more money than sense (excess) and someone else who is spendthrift and impoverished (deficiency), so disease conditions can be classified the same way.

A very important Distinction

For any health professional, whether a doctor, herbalist, homoeopath or acupuncturist, learning how to distinguish between a Full and an Empty condition or a mixed Full/Empty condition will be vital for the continuing health of the patient, the reputation of the therapist and his continuation in business. It really is that important.

Excess or Fullness

Suppose you have a cold! Your nose is blocked with phlegm, your throat hot and sore, you have a fever, a throbbing 'don't-touch-me!' headache, and you feel tired.

Lying down to rest or sleep doesn’t help because your symptoms prevent easy sleep: you’re too hot and bothered.

Don’t be confused by that tiredness! If you didn’t have the other symptoms which show you have a cold, you wouldn’t feel tired.

So the tiredness is a consequence not a cause – but see below for more about this.

The other symptoms, the blocked nose, the phlegm, the sore throat, fever and headache? Between excess or deficient, all these signs point to excess or fullness.

Why? Because there is fullness of phlegm, your sore throat is hot (excess), your headache is excess because it dislikes being touched or held. So, between excess or deficient, this is definitely Excess, or Full.

These symptoms are like something bursting outwards or upwards.

In practice, the existence of the bug – technically called the 'external pathogenic factor' – trying to invade your body, together with a strong response (fever, headache, sore throat etc) by your body, defines the condition as Full or Excess.

Definition of Full If you have a pathogenic factor (internal or external) with a strong Upright Qi (your body's immune system) defending itself, you have a Full or Excess condition.

Internal or External? By the way, the fact that the invading pathogenic factor came from outside makes it an external pathogenic factor rather than an internal pathogenic factor. But many pathogenic factors arise internally. Read more under Internal-External, two more of these special 8 Principles.

A Pathogenic Factor but No Bug?

So, between these excess or deficient conditions, you could easily have a Full condition when there was no preceding pathogenic factor - in other words, no bug.

For instance, poor circulation can lead to Blood Stasis, which may manifest as severe pains in the heart region, and if so could mean a heart attack. This is also a Full or Excess condition, but an internal one. As with an external Full condition, the aim is to clear the Blood Stasis before trying to harmonise or ‘tonify’ the circulation.

Full conditions are often thought of as being acute, but they can be chronic, as for example with a long-term invasion of Damp.

Damp is a Yin factor. So is Phlegm. So is Cold. (So is Blood.)

So you can also have a Full Yin condition. For example, this could be a condition of Full Cold, where someone feels freezing cold even though they have a fever.

Full Yin conditions must be cleared before attempting to strengthen the system. (In practice, if the Damp occurs because of deficiency of Spleen Yang or Kidney Yang, clearing Damp might be done at the same time as strengthening Spleen and Kidney Yang.)

Deficiency or Emptiness

Take an author, struggling to meet a deadline for his book. He also has a job from 9 – 5 daily so he writes in the morning before going to work and again after supper in the evening.

Often he works far into the night. Guess what? His sleep suffers.

As the weeks go by he begins to get, every day, a headache. It starts, mildly, as the day progresses and later in the evening, when his headache is more severe, his eyes begin to hurt too. He’s always tired!

Knowing some authors, as I do, he probably isn’t eating properly nor taking enough exercise. And he certainly doesn’t get much fresh air, let alone sunlight. (These bad habits and lack of exercise often lead to Qi stagnation which may turn into Heat, exhausting his Yin energy.)

He complains about all this to his acupuncturist. He wants to know, will acupuncture help his headache and sore eyes?

He says that when his eyes are hurting he just wants to close his eyes and rub them. For his headache, he likes massage but better still, if he can rest his eyes for a while the headache may go. Both head and eyes feel better in the morning after a good sleep. Good food perks him up for a while.

Here, in deciding between excess or deficient, you should be able to see that it's a deficient or empty condition.

He’s run out of Qi (energy) and Liver Blood (for his eyes)! He likes being massaged and resting and feels better after eating.

If resting, massaging, warming or holding a painful part makes it feel better, it's almost certainly deficient.

The individual with the cold we mentioned above could have been like this before he caught his cold.

You might not think that a deficient condition (the tired eyes and head) could turn into an excess condition (like the cold with the throbbing headache, sore throat etc) but this is a very typical story: it happens often. (For more on this read about Yin and Yang, and how, although opposites, they can turn into one another.) Acupuncturists see it happening time and again.

So emptiness or deficiency means emptiness in the body’s ability to cope, in its Upright Qi including its Blood.

Empty conditions tend to be chronic

Empty or deficient conditions tend to be chronic. However, they could be acute. How come?

Suppose you had a healthy child, with strong Upright Qi, (ie a strong immune system) who falls prey to a disease with a high fever.

Suppose that it takes many days for the child’s Upright Qi to fight it off and overcome the disease. During that time, the child has been too ill to eat or drink much, so it has ‘fed’ on its 'inner' resources.

In Chinese terms, feeding on its inner resources here means that to combat the Heat of the fever it has used up body fluids and resources - its Yin resources - to combat the external Full condition.

In so doing it has become deficient in Yin. Deficient Yin symptoms include having flushed cheeks over the malar bones in the face, a dry throat or mouth, night sweats, sleeplessness, touchiness, slight thirst and so on.

These might, to a doctor, look like a continuing infection of some kind. But they’re not: they’re signs of deficient Yin. The child will recover, given plenty of rest and the right foods and love – and time. It would recover faster if given some acupuncture, though it would still need rest, food and love.

Deficient conditions are often chronic. For example, a woman who has passed her menopause may continue to sweat copiously at night even when the weather isn’t hot and she’s not suffering from a fever, suggesting an ongoing Yin deficiency.

Definition of Emptiness or Deficiency: these occur when the Upright Qi is weak and there is no pathogenic factor.

But not Always ...

Once you've decided, between excess or deficient, that it's deficient, don't assume it will always be chronic. Rest, food, warmth, support and encouragement - and don't let's forget good acupuncture - have returned many deficient conditions to complete health.

Excess or Deficient?
What about both at the same time?

It is possible to have both together. In other words, it might not be excess OR deficient, but excess AND deficient. In fact, this is for most acupuncturists by far the most common condition seen in practice.

The author we described above might now have caught the cold, with the throbbing headache and blocked nose etc. He was tired before and he’s even more tired now. So on top of the deficiency of Upright Qi there is also now an External invasion of Wind-Heat, a Full condition.

Because he was so exhausted before he caught the cold, his fever will probably be mild.

Why? Because his body lacks the energy, the 'oomph', the energy, to raise a proper fever that could quickly defeat the invading bug.

So now he has both the excess or fullness (the external invasion of Wind-Heat, being the cold virus that he’s caught) and the underlying Emptiness or Deficiency, which is internal (because it arose from his body’s internal inability to maintain his health in the face of the working demands he made on it).

The Manuscript

And still, there is the manuscript to complete!

Perhaps if he’d worked less hard, taken more exercise and slept and eaten better he might never have got so tired, his immune system might have been stronger and being stronger might then have prevented the cold from beginning.

Of course, the author might say that in that case he wouldn’t have completed the book in time. Anyway, he is as he is.

Let’s hope he meets his publisher’s deadline.

Definition of a combined Excess/Deficient or Full/Empty condition: this occurs when there is both a weak state of Upright Qi (the immune force) and a remaining pathogenic factor - one that remains despite the attempts of the Upright Qi to dislodge it.

Excess or Deficient Syndromes in TCM

Syndromes in Chinese medicine are full or empty, excess or deficient.

For example, Liver Yang (an ascending energy) gives headaches, often throbbing, much like a migraine. This is an excess or full condition, but it arises because there is also a deficiency somewhere, in this case usually emptiness or deficiency of Liver Yin. So, in this case, there is both a fullness and an emptiness: a full/empty state.

Some syndromes are nearly always deficient. For example what is called the 'Kidney Yin' syndrome is one of deficiency. That doesn’t mean that Kidney Yin excess doesn’t occur, though it’s very rare. But if it occurs many acupuncturists might give it another name because if someone is said to have Kidney Yin syndrome, it’s assumed to be deficient, because it (nearly) always is.

Distinguishing between Full, Empty, and Full/Empty

... or between Excess or Deficient!

Full conditions are plethoric:

  • They start suddenly (usually) or very quickly
  • with loudness
  • Heavy breathing
  • Restlessness
  • Irritability
  • Tension
  • (often) loud tinnitus (noises in the ear)
  • Urination is reduced
  • Constipation is likely
  • Pulse  Full and/or fast

You often see these symptoms in healthy children when they get sick.

Read more about Full conditions under Full Hot and Cold.

Empty heat and cold conditions arise usually over time. Click HERE for a whole page on the subject.

Transformation between Yin and Yang

Excess or Deficient might seem fixed. It isn't. Deficiency of Yin can lead to Excess of Yang, as in the example just given.

Equally, a deficiency of Yang can lead to Excess of Yin.

For example this could happen when, because of overwork, Kidney Yang is exhausted and becomes deficient: this often leads to deficiency of Spleen Yang. These two deficiencies together might lead to the development of Damp or Phlegm, both full Yin conditions.

Want to Understand More about how Energy Behaves?

Chinese medicine is all about energy and how it is represented in the body and behaves. But Chinese medicine has no final authority on the subject! Engineers grapple with energy all the time. If you want to understand the ideas behind thermodynamics and enjoy discovering how the Laws of Thermodynamics were discovered, I know of no better introduction than 'Warmth Disperses and Time Passes' by Hans Christian von Baeyer - see left.

It's elegant, interesting and beautifully explained. And there's not one mathematical formula in it!

(Sadly, modern medicine, Western medicine, doesn't seem to have yet grasped that health is about energy.)

The rest of the 8 Principles

Whether a condition is Excess or Deficient is only part of the 8 Principles. There are six more, or if you prefer, three more pairs.

Click to read about Yin and Yang.

But don't forget to look up Full Hot and Cold together with Empty Heat and Cold.

And you definitely should know about Internal or External.

Return to 8 Principles from Excess or Deficient.

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If you live elsewhere, click on BAcC.


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