Deficiency and excess
Deiciency and excess are terms used to describe the relationship between the strength of a pathogen and the proportional strength of anti-pathogenic qi. An excess condition exists when a pathogenic factor is hyperactive compared to normal anti-pathogenic qi. In contrast deficiency is present when anti-pathogenic qi is being consumed. Treatment will aim at either promoting anti-pathogenic qi in the case of deiciency,or eliminating the pathogenic factor in the case of excess.
Deiciency may be of either yin,yang,blood,or qi. Deiciency of yin gives heat symptoms while deiciency of yang gives cold symptoms. Deficiency of qi is seen after a long illness especially and shows as general lassitude. There may be spontaneous sweating due to the inability of qi to control the pores. Deiciency of blood is normally due to weakness in the spleen and stomach. Because blood is unable to reach the head the patient often experiences dizziness,and lack of blood to the heart may give palpitations.
General signs of deficiency include lassitude and weight loss,weak breathing,pallor,and night sweats. Where pain is present it is alleviated by pressure (see Chapter 4). The tongue is dry with little coating. Excess shows as agitation,rapid breathing,distension and fullness in the chest. Where pain is present it is aggravated by pressure. The tongue coating is thick and sticky.
The six pathogens
The six pathogens are wind,cold,summer heat,damp,dryness and ire (representing warmth and heat). Under normal circumstances these climatic changes do not pose a threat and are seen simply as six types of qi found in the natural environment (Xinnong,1999). However,if the factors are particularly strong,or the change from one factor to another is sudden and unexpected,or if the body's ability to produce anti-pathogenic qi to combat the factors is weak,the pathogens can invade the body and cause harm. Each of the factors invades the exterior of the body (skin,mouth and nose) and may act in isolation or combination. In the case of musculoskeletal pain,the factors produce the bi syndromes (see page 54).
Wind is the main pathogen,as all the other pathogens depend on it for transport into the body. It is yang in nature and has two important characteristics in TCM. Firstly,wind is characterised by 'upward and outward dispersion' and is therefore likely to invade the upper part of the body and the external surface. Wind therefore attacks the head and face,and the lungs and skin. Secondly,wind by nature 'moves'. Conditions resulting from wind therefore show movement as part of their symptoms. Pains which change position,skin marking which appears and disappears,convulsions, spasms and tremors are all wind signs. Points such as GB-20 (wind pool), GV-16 (palace of wind),and BL-12 (wind gate) are used to treat wind-related conditions by needeling with Acupuncture needles
Cold is yin in nature,and is characterised by contraction and stagnation. Exposure to cold after sweating or when wearing thin clothing allows the cold to invade the body. Cold will consume the yang qi of the body and the warming function of the body is therefore impaired. Symptoms are cold limbs,stiffness,cold pain and contractions. There is a dislike of cold and lack of sweating. Treatment often involves moxibustion and warm needling,and reinforcing techniques.
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