Korean Herbal Formulation [Part 5] Is Your Energy “Excessive” or “Insufficient”? — The Logic of Deficiency (虛) and Excess (實)

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Korean Herbal Formulation [Part 5]

Is Your Energy “Excessive” or “Insufficient”? — The Logic of Deficiency (虛) and Excess (實)

Part 1: Eight Principles — Your Inner Compass (Foundational Understanding)

Lesson 3: Understanding Deficiency and Excess

In the Eight Principles (八綱) diagnostic system, the order of assessment is always:
Exterior–Interior (表裏) → Cold–Heat (寒熱) → Deficiency–Excess (虛實).

Among these, Deficiency (虛) and Excess (實) form the final and decisive step, because they determine the fundamental therapeutic direction—whether the body needs to be supplemented (補) or drained (瀉).

Deficiency and Excess describe not only the strength of the disease but also the strength of the body’s Genuine Qi (正氣) in relation to the pathogenic factors (邪氣).

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1. Deficiency (虛): A State of Depleted Genuine Qi

1.1 Definition and Origins of Deficiency

• Definition:
  Deficiency (虛) refers to a weakened state of the body in which Genuine Qi (正氣) is insufficient. The body lacks the strength to overcome illness.

• Yin–Yang Classification:
  Deficiency belongs to Yin (陰).

• Etiology:
  Primarily internal origins: emotional strain (七情), overwork (勞慾), improper diet (飮食), or constitutional weakness.

• Relationship with Cold–Heat:
  Cold patterns are often accompanied by Deficiency (寒者多虛).

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1.2 Types and Symptoms of Deficiency Patterns

Deficiency patterns fall broadly into Qi Deficiency and Blood Deficiency.

🔹 Qi Deficiency (氣虛)

Primary Symptoms:

• Shortness of breath or low vitality (少氣)

• Pain, tightness, or hardness around the navel (臍中悸痛牢)

Accompanying Signs:
Spontaneous sweating, pale/soft physique, excessive sleepiness, aversion to cold.

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🔹 Blood Deficiency (血虛)

Primary Symptoms:

• Emaciation or thin body type (瘦瘠)

• Abdominal muscle spasm/tightness (腹直筋攣急)

• Sunken lower abdomen (臍下陷沒)

• Cracked tongue (舌裂)

Accompanying Signs:
Night sweating, internal heat or irritability, insomnia, dry or rough skin.

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2. Excess (實): A State of Strong Pathogenic Qi

2.1 Definition and Origins of Excess

• Definition:
  Excess (實) refers to the presence of strong pathogenic Qi (邪氣) that obstructs or accumulates within the body.

• Yin–Yang Classification:
  Excess belongs to Yang (陽).

• Etiology:
  Largely external origins—when pathogenic factors (風, 寒, 暑, 濕, 燥, 火) invade and stagnate.

• Relationship with Cold–Heat:
  Heat patterns are often Excess conditions (熱者多實).

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2.2 Major Categories of Excess Patterns

🔸 Qi Stagnation (氣滯)

Blockage of Qi movement caused by:

• Food stagnation → epigastric pain, fullness, loss of appetite

• Emotional constraint → oppressive sensation or irritability

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🔸 Phlegm–Fluid Accumulation (痰飮)

Abnormal transformation of body fluids leading to:
Dizziness, nausea, palpitations, migrating pain, or visible phlegm.

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🔸 Blood Stasis (血滯) / Stagnated Blood (瘀血)

• Fixed and localized pain

• Worse at night

• Dark spots or stasis marks on the tongue

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🔸 Six Stagnations (六鬱) / Mass Formations (積聚)

Severe accumulation of Qi, Blood, Dampness, Heat, Phlegm, or Food
→ abdominal masses, distention, or persistent pain.

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3. Why Deficiency vs. Excess Matters: Core Therapeutic Principles

The distinction determines the primary method of treatment.

✔ If Deficient → Supplement (虛則補之)

Strengthen Genuine Qi.
Examples: tonifying herbs (e.g., ginseng), formulas like Sagunja-tang or Samul-tang.

✔ If Excess → Drain or Purge (實則瀉之)

Remove or disperse pathogenic Qi.
Examples: purging herbs like Rhubarb (大黃), magnesium sulfate (芒硝), or formulas that regulate Qi or eliminate phlegm.

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⚠ Misdiagnosis Can Be Dangerous

• Applying draining methods to a Deficient patient → damages Genuine Qi

• Applying supplementing methods to an Excess condition → worsens accumulation

Proper differentiation of Deficiency–Excess is therefore essential to safe and effective treatment.

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4. Preview of the Next Lesson: The Framework of Yin and Yang

Up to now we have explored:

• Location of disease: Exterior–Interior (表裏)

• Nature of disease: Cold–Heat (寒熱)

• Strength of disease: Deficiency–Excess (虛實)

Next, we turn to the overarching foundation that unifies all three pairs:
Yin (陰) and Yang (陽).

Korean Herbal Formulation Studies [Part 6]
The Beginning and End of All Principles — Understanding Health Through Yin and Yang

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