Excess as part of the Eight Principles

Treatment Principle—Drain the Excess: The fundamental treatment approach for Excess patterns is "泻法" (xiè fǎ), which means draining, dispersing, or purging. This includes various methods depending on the type of Excess: inducing sweating (汗法) for exterior pathogens, purging (下法) for interior accumulations, clearing heat (清法), promoting urination, resolving phlegm, activating blood circulation to remove stasis, and promoting digestion for food stagnation.

Treatment Sequence: When Excess and Deficiency coexist, TCM generally recommends addressing Excess elements first before supplementing Deficiency. Attempting to tonify when pathogenic factors are still present is like "closing the door with the thief inside"—it can trap the pathogen and worsen the condition. Once the Excess is cleared, tonifying treatments can safely restore the body's depleted resources.

Acupuncture Application: In needling technique, Excess patterns call for reducing/sedating methods (泻法): strong stimulation, manipulating needles with dispersing techniques, and selecting points that drain and clear. The choice of points depends on what type of Excess is present—points that clear Heat for Heat-Excess, points that transform Phlegm for Phlegm accumulation, etc.

Clinical Signs of Excess: Practitioners look for specific signs that indicate an Excess pattern: loud and strong voice, acute disease onset, restlessness and irritability, severe pain that worsens with pressure (拒按, jù àn), coarse or labored breathing, high-pitched tinnitus, profuse sweating, scanty dark urine, constipation, a red flushed face, desire to throw off bedclothes, a thick tongue coating, and a full/forceful pulse (实脉).

Distinguishing from Deficiency: The contrast with Deficiency patterns is essential for correct treatment. Deficiency shows: weak voice, chronic disease course, listlessness, preference for lying curled up, weak respiration, dull lingering pain relieved by pressure (喜按), slight sweating, frequent urination, loose stools, and a weak/empty pulse. Misdiagnosing Excess as Deficiency—and tonifying when draining is needed—can seriously worsen the condition.

Mixed Presentations: Clinically, pure Excess or pure Deficiency is relatively uncommon. Many patients present with mixed patterns (虚实夹杂), where underlying Deficiency has allowed pathogenic accumulation, or prolonged Excess has depleted the body's resources. Skilled practitioners must identify which aspect predominates and address conditions in the proper sequence—generally treating the Excess first before tonifying the Deficiency.