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Simultaneous existence in one patient of vacuity and repletion. Rich vacuity and evil repletion occurs when a disease is not treated properly or evil qì is excessively exuberant, or when vacuity of right develops while evil repletion is still present. It may also occur when patients suffering from constitutional vacuity contract an evil and display signs of both vacuity and repletion. Plain Questions (素问 sù wèn, tōng píng xū shí lùn) states, When evil qì is exuberant, there is repletion; when essential qì is despoiled, there is vacuity. In most cases, the right vacuity is the root, whereas the evil repletion is the tip.

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