Nov 14 2009
On Excess and Deficiency
One of the first concepts we hear upon walking through the gate of Chinese medicine is that of excess and deficiency (xu虛 & shi實). Deceptively simple at first glance, this is one of the foundations of accurate diagnosis that tends to become more slippery as time goes on and we see patients in the clinic with strange mixes of symptoms. All the practitioners here in Nanjing have at least 10 years of experience, and like anyone seeking mastery, some of us are still working on refining the basics as a way to sharpen our clinical eye.
Today’s guest post comes from one of the participants of the Nanjing seminar. It gives us a fresh insight into issues of excess and deficiency and the use of Ma Huang.
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The single most important thing I learned in the first week of studying with Dr. Huang in Nanjing is his explanation of “shi”and “xu”, most often translated as”excess” and “deficiency”. The usual translation to German is “Fülle” and “Leere”, which literally brought into English is expressed as “fullness” and “emptiness”.
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Even though we are used to the relational nature of terminology in Chinese medicine, it never was really satisfying when teachers spoke about a Gui Zhi Tang situation as “exterior deficiency”, while at the same time saying that there was no “real deficiency”, but only compared to the Ma Huang Tang situation, which is “exterior excess”. And on the other hand both the Ma Huang Tang and Gui Zhi Tang situations are “excess” in relation to, lets say: Yu Ping Feng San or Gui Zhi Jia Fu Zi tang conditions.
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Dr. Huang provided us with a new perspective by switching the focus to movement and function. On every level of the body there are doors, which have to open and close in appropriate ways, for example at the exterior of the body, the doors are the pores. If they stuck close (in other words don’t open properly) this is “shi”, if they stuck open (in other words: don’t close properly) this is “xu”. So in a Gui Zhi Tang Situation “Xu” means: the exterior doors are stuck open, and in a Ma Huang Situation “Shi” means: the exterior doors are stuck close.
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Ma huang is the primary herb used to open glands, which are considered to be one kind of door, like the sweat glands of the skin. Therefore it is used for acne to open the pores which are clogged shut. It can be used as well as to help release eggs of the ovaries, or for insufficient lactation. Whether a formula (like Gegen tang) is appropriate, depends on the constitutional body type and if the formula presentation fits with the disease presentation. Another example of how Dr. Huang uses Ma Huang for problems with glands is Zhen Wu Tang together with Ma Huang Fu Zi Gan Cao Tang and Dang Gui Shao Yao San for hypothyroidism.
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Furthermore the opening function of Ma Huang is also used for other “closed” types of problems, for example Bi-Syndrome. Dr. Huang even uses it together with Wen Dan Tang for patients with schizophrenia, who are mentally locked in by the use of anti-psychotic drugs.
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I’m sure that the new perspectives provided by Dr. Huang will allow us to expand the use of herbs and formulas even further.
3 responses so far
Michael,
Glad to hear of the new Nanjing course. So how is fullness and emptiness for shih and xu different from Wiseman’s repletion and vacuity? Nigel has been making the point for years that ‘excess and deficiency’ were not really accurate translations for the Chinese technical terms. Glad to see this discussion, and glad to see Huang Huang ‘opening up closed doors’ in clinical practice. Fascinating stuff, looking forward to hearing more. .
Z’ev
I am not a linguist like Nigel, and so I don’t have much to say on this matter.
Like so much in Chinese medicine the shi/xu- excess/repletion- deficiency/vacuity issue is not about words, it is about understanding the clinical manifestations to which these terms point toward. I think it is a waste of time and energy to argue over the meanings of these terms. We need to take them as indicators, and craft our own clinical understanding. We need to unfixate on the words themselves and strive to grasp the meaning they encode.
When moving between languages and cultures, I think it is useful to consider the various ways a term gets translated, and how it might shift with various contexts. Mostly I think we should stop arguing about who has the right meaning and focus instead on what these things look like in clinic.
“…On every level of the body there are doors, which have to open and close in appropriate ways…”
This is a very insightful metaphor. Thank you.