True vacuity and false repletion

Any disease pattern characterized by signs of both vacuity and repletion, in which the vacuity signs represent its true nature, whereas the repletion signs are deceptive. For example, vacuity panting that occurs when the kidney’s function of governing qì absorption fails may be characterized by exuberant phlegm, panting and fullness, rapid breathing and inability to lie flat, as well as a slippery stringlike pulse, and a slimy tongue fur. These signs may easily be misinterpreted as repletion panting. Although there is lower body vacuity and upper body repletion, the pattern is, at root, one of vacuity. The exuberant phlegm congesting the upper body represents only the tip.

Careful examination leads to the correct diagnosis. Respiration is short, rapid, and distressed, hence different from the rough breathing and strident voice typifying repletion panting; the slippery, stringlike pulse has no strength when firm pressure is applied; and finally, although the tongue fur is slimy, the body of the tongue usually has a slightly blue-green or purple hue. These signs all indicate vacuity falsely presenting as repletion, and the additional presence of cold limbs and cold sweating on the head provides further confirmation that vacuity panting is the correct diagnosis. Treatment should focus on restoring qì absorption.

Generally speaking, when faced with a confusing array of signs, all the information derived from the four examinations should be carefully synthesized, paying special attention to such factors as age, constitution, and duration of the disease. Misidentifying vacuity or repletion as its opposite or as a vacuity-repletion complex may lead to grave errors in treatment.