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Deficiency refers to insufficiency of healthy qi, while excess refers to exuberance of pathogenic factors. All patterns can be categorized into deficiency or excess. Deficiency excess pattern differentiation is very important because excess pattern needs to be treated by elimination*, while deficiency pattern needs to be treated by reinforcement*.

Deficiency pattern is a general term for patterns caused by deficiency of the healthy qi (including deficiency of yin, yang, qi and blood). Deficiency pattern is usually manifested by fatigue, lack of strength, shortness of breath, no desire to speak, spontaneous sweating, loose stool, emaciation, pain alleviated by pressure, vexing heat in the chest, palms and soles, tidal fever, flushed cheeks, night sweating, pale or sallow complexion, palpitation, withered skin, tender tongue with scanty fur, and weak pulse.

Healthy qi comes from all normal functions of the human body. Therefore, any factors that can cause damage to viscera and bowels, qi and blood, fluid and essence can result in healthy qi deficiency, and then deficiency pattern arises.

The cause of deficiency pattern is either innate or acquired. The acquired causes include improper diet, excessive thought, sexual overindulgence, chronic disease, overstrain, improper treatment, vomiting, diarrhea, sweat, and bleeding. Improper diet can result in insufficiency production of qi and blood; excessive thought may injure the spleen and damage qi, blood and yin fluid; sexual overindulgence deprives the body of kidney essence; chronic disease, overstrain and improper treatment can damage viscera and bowels, qi and blood or body fluid; and vomiting, diarrhea, sweat, and bleeding cause direct loss of yin fluid, qi and blood.

Excess pattern is a general term for patterns caused by external pathogenic factors such as six excesses, pestilential pathogens, worms and toxins. Excess pattern can also be caused by accumulated pathological products due to dysfunction of internal organs, such as phlegm, retained fluid, water, dampness, pus, static blood and retained food, and usually manifested by high fever, delirium, chest oppression, heavy breathing, profuse sputum and drool, abdominal pain and /or tenderness and refusal of pressure, tenesmus of dysentery, stranguria, tough tongue with thick or slimy fur and replete pulse.

The clinical manifestations of excess patterns are also extremely various because a great number of pathogenic factors can cause these patterns, for example, six excesses and pathological products. If the body healthy qi is not deficient, external pathogenic factors usually cause excess patterns, for example, cold pathogen causes excess cold pattern, while heat pathogen results in excess heat pattern. Interior excess patterns are caused by pathological products, such as phlegm, retained fluid, water, dampness, pus, static blood and retained food, due to dysfunction of viscera and bowels.

Differentiating deficiency and excess patterns is mainly performed from the course of disease, constitution, symptoms and signs. The main points of differentiating deficiency and excess patterns are listed in Table 9-3.

Table 9-3 Deficiency and excess pattern differentiation