The first three installments in this series covered the general characteristics of yang and yin deficiency and yin deficiency in depth, including treatment. You can refer back to those articles online if necessary (www.massagetoday.com/columnists/esher/articles).

As previously discussed, a person with yin deficiency manifests less of yin's cooling, nourishing and relaxing qualities. Heat symptoms are present, but in a milder form than with a full-heat condition. After a general assessment, you can fine-tune your course of care by determining which primary meridians are involved, and specifically treating the problem.

As you would imagine, a person with yang deficiency lacks yang's energizing, warming and transporting functions. Yang deficiency symptoms appear mostly cold, but of small magnitude. This is called Empty-Cold because the cold is caused not by excess yin, but by the relative lack of yang. So if you look at the figure below, you will see that it is only because there is less yang that the symptoms appear yin.

An Excess Cold condition will give you symptoms showing the cold is predominant, whereas the cold caused by Yang Deficiency will be fairly mild in comparison.

Notice that the horizontal line in the figure signifies "normal balance." In the yang deficiency diagram, the yin is not excess, meaning, above normal. Instead, there is only more yin because there is relatively less yang.

The figure below shows a true Full Cold condition -- yin consuming yang.

Chilliness and aversion to cold obviously are key symptoms of both yang deficiency and full cold, but you may find it more localized in a full cold condition like in a joint, the stomach, abdomen, intestines or testicles. Either way, when there is pain caused by cold or yang deficiency, heat will improve it. If it is a yang deficiency, touch will make it feel better; if it is a full cold, pressing will make it feel worse.

Both have symptoms of no thirst, but clear, abundant urination. With yang deficiency, urination can be more frequent, particularly at night, because the yang is not strong enough to hold the urine in the bladder for a long time. For the same reason, sweating with no exertion is a symptom of yang deficiency. The yang is so weak, that it can't hold the moisture in the skin. Since heat/yang is needed to transform food, either can have symptoms of loose stools. If it's an excess, getting rid of it will make you feel better, but if it is a deficiency and you are not getting the nutrients you need from the food, you will feel worse.

Again, think of yang as energetic in nature. If yang is deficient, the person doesn't have energy, and feels tired, listless, apathetic, and possibly unconfident. There may be no "get up and go" in the morning. Yang deficiency is common after people retire; they may feel they haven't accomplished anything important and that their lives have no purpose.

Symptoms such as a slow, deep pulse signifies cold if it's full, but if it's weak or empty, it indicates yang deficiency. The complexion is pale with both an excess cold and an empty-cold condition, but it tends to be brighter with the former and duller with the latter. The tongue is pale in both cases, but has a tendency to be swollen with yang deficiency. This is because the yang is unable to transport the fluids resulting in accumulation. The tongue coating is thick and white for a full cold, and wet, thin and white for an empty cold.

These are all symptoms of a general yang deficiency, but you certainly don't need all of them to be yang-deficient. Always look at the big picture to see what the overall predominant assessment is, and then look more deeply to find the involvement of the zang-fu and treat accordingly. In the next column, I'll differentiate between four common types of yang deficiency and three types of full cold, then discuss how to treat each one of them.

References

• Flaws, Bob and Finney, Daniel, A Handbook of TCM Patterns & Their Treatments. Blue Poppy Press, © 1996, Boulder, CO.
• Maciocia, Giovanni, Foundations of Chinese Medicine. Churchill Livingston, © 1989, Edinburgh, UK.
• Xinnong, Chen, Chinese Acupuncture and Moxibustion. Foreign Language Press, ©1987, Beijing, China.