The Six Excesses refer to the six types of external pathogenic factors: Wind, Cold, Heat, Dampness, Dryness, and Fire. Wind, Cold, Heat, Dampness, Dryness, and Fire are six different climatic changes in nature, which under normal circumstances are referred to as “Six Qi.” When the body’s righteous Qi is insufficient and resistance decreases, the Six Qi can become pathogenic factors that invade the body and cause disease. The abnormal “Six Qi” is referred to as “Six Excesses,” also known as the Six Evils, which belong to a category of pathogenic factors that cause external diseases. Key Points:(1) Common pathogenic characteristics of the Six Excesses The main manifestations include external pathogenicity, seasonality, regionality, compatibility, and transformation of certain natures. For example: 1. When the Six Excesses cause disease, their pathways often invade the muscle surface, either entering through the mouth and nose or both simultaneously. 2. The pathogenicity of the Six Excesses is often related to seasonal climate, regional areas, and environmental conditions, such as more Wind diseases in spring, more Heat diseases in summer, more Damp diseases in long-term wet areas, and more Dryness or Fire diseases in high-temperature work environments. 3. The Six Excesses can invade the body individually or in combination with two or more evils. 4. During the disease process, the Six Excesses can not only influence each other but can also transform into one another under certain conditions, such as Cold evil transforming into Heat internally; prolonged Heat and Dampness can transform into Dryness and injure Yin, etc. (2) Nature and pathogenic characteristics of Wind Evil 1. Wind is a Yang evil, characterized by its ability to disperse and easily invade Yang positions. Wind evil is active and does not settle, possessing characteristics of rising, upward movement, and outward dispersion, thus classified as a Yang evil. Its dispersive nature means it can easily cause the pores to loosen and sweat to be released. It commonly affects the upper part of the body (i.e., head and face), Yang meridians, and muscle surface, causing symptoms such as headache, sweating, and aversion to wind. 2. Wind evil is mobile and changes frequently. The pathogenicity of Wind: “Mobile” refers to the characteristic of Wind evil causing disease, which has a tendency to shift locations and lacks a fixed place. “Frequent changes” indicates that Wind evil can cause disease rapidly and unpredictably, as seen in Wind rash (urticaria). 3. Wind is the leader of all diseases. Wind evil often precedes other external evils in causing disease and frequently combines with other evils. For example, external Wind-Cold, Wind-Heat, Wind-Damp, etc. Therefore, Wind evil is often the precursor to external evils causing disease and frequently combines with other evils.(3) Nature and pathogenic characteristics of Cold Evil 1. Cold is a Yin evil that easily injures Yang Qi. “When Yin is excessive, it leads to Cold,” thus Cold is a manifestation of excessive Yin Qi, making it inherently Yin. Furthermore, “excessive Yin leads to Yang diseases,” so exposure to Cold evil most easily damages the body’s Yang Qi. When Yang Qi is damaged, the warming and transforming functions are weakened, leading to a manifestation of Cold syndrome. 2. Cold is characterized by stagnation and pain: “Stagnation” means to congeal and obstruct. Cold evil harms the body, leading to an excess of Yin Qi and damage to Yang Qi, causing the meridians and blood to stagnate due to Cold evil, resulting in pain. Therefore, Cold evil often presents with painful symptoms, such as in Cold-dominant Bi syndrome, where severe pain is common. 3. Cold has a constricting nature: Constricting means to shrink and pull. When Cold evil invades the body, it can cause the Qi mechanism to contract, leading to the contraction of pores, meridians, and tendons. For instance, if Cold evil invades the muscle surface, the pores may close, and the defensive Yang is obstructed, leading to symptoms such as aversion to cold, fever, no sweating, and if Cold obstructs the blood vessels, it can lead to head and body pain, tight pulse, and if Cold invades the meridians and joints, it can cause limbs to be stiff and unresponsive or cold and numb.(4) Nature and pathogenic characteristics of Heat Evil 1. Heat is a Yang evil, characterized by its inflammatory nature: Heat is the transformation of the fiery Qi of summer, and since Fire and Heat belong to Yang, Heat is classified as a Yang evil. Heat evil harms the body, often presenting with symptoms of excessive Yang heat. 2. Heat is characterized by rising and dispersing, easily injuring fluids and consuming Qi: As a Yang evil, Heat has the characteristic of rising, thus when Heat evil invades the body, it often directly enters the Qi level, causing the pores to open and leading to excessive sweating. 3. Heat often carries Dampness: In the hot summer climate, with increased rainfall, the heat stirs the Dampness, leading to increased humidity in the air, thus Heat evil often combines with Damp evil, causing disease.(5) Nature and pathogenic characteristics of Damp Evil 1. Dampness is a Yin evil that easily obstructs the Qi mechanism and injures Yang Qi: When Damp evil invades the body, it lingers in the organs and meridians, easily obstructing the Qi mechanism, leading to abnormal rising and falling of Qi, and often presenting with symptoms such as chest tightness, epigastric fullness, short and scanty urination, and unsatisfactory bowel movements. Additionally, Dampness, being a Yin evil, easily injures Yang Qi. The Spleen governs the transformation of water and Dampness, preferring dryness and disliking Dampness, thus when Damp evil invades from outside and lingers within, it often first obstructs the Spleen Qi, leading to Spleen Yang deficiency, impaired transformation of water and Dampness, and resulting in symptoms such as diarrhea, scanty urination, edema, and ascites. 2. Dampness is heavy and turbid: “Heavy” means heavy or burdensome. When experiencing Damp evil, one often feels a heavy head, general heaviness, and heaviness and fatigue in the limbs. If Damp evil lingers in the meridians and joints, it obstructs the distribution of Yang Qi, leading to numbness of the skin and heavy joint pain, also known as “Damp Bi” or “Zhuo Bi.” “Turbid” refers to filth and murkiness, often indicating unclean secretions. Clinical symptoms such as facial dirtiness, excessive phlegm, loose stools, mucous blood in diarrhea, turbid urination, excessive vaginal discharge in women, and eczema with oozing are all clinical manifestations of Damp evil’s turbidity. 3. Dampness is sticky and stagnant:“Sticky” means viscous, and “stagnant” means to stop.Damp evil is sticky and stagnant, primarily manifesting in two aspects: one is that the clinical manifestations of Damp evil are often sticky and unsatisfactory, such as secretions being thick and difficult to expel; the second is that diseases caused by Damp evil are often lingering and difficult to cure, with prolonged courses or recurrent episodes. 4. Dampness tends to descend and easily injures Yin positions:Damp evil harms the body, often seen in the lower parts, such as significant edema in the lower limbs. Additionally, conditions such as turbid urination, vaginal discharge, and diarrhea are often caused by Damp evil descending.(6) Nature and pathogenic characteristics of Dry Evil 1. Dryness is characterized by dryness and easily injures body fluids: Dry evil most easily consumes the body’s fluids, leading to deficiencies in Yin fluids, commonly presenting with symptoms such as dry mouth and nose, dry throat and thirst, dry skin, and in severe cases, cracking, hair loss, scanty urination, and dry stools. 2. Dryness easily injures the lungs: The lungs are delicate organs that prefer moisture and dislike dryness, thus they cannot tolerate dry heat or dryness. If there is excessive humidity, it leads to phlegm and fluid retention; if there is excessive dryness, it injures fluids. The lungs govern respiration and connect with the external atmosphere, opening to the skin and nose, thus Dry evil often enters through the mouth and nose, making it most likely to injure lung fluids, affecting the lung’s functions of dispersing and descending, leading to symptoms such as dry cough with little phlegm, or phlegm that is sticky and difficult to expel, or blood-streaked phlegm, as well as wheezing and chest pain.(7) Nature and pathogenic characteristics of Fire and Heat Evil (1) Heat is a Yang evil, characterized by its inflammatory nature: Yang is associated with dryness and upward movement, and the nature of Fire and Heat is to rise and inflame, thus classified as a Yang evil. Therefore, Fire and Heat harm the body, often presenting with high fever, thirst, sweating, and a rapid pulse. (2) Fire and Heat easily injure fluids and consume Qi: Fire and Heat evils most easily force fluids to leak out, scorching body fluids, leading to fluid depletion. Thus, when Fire and Heat evils cause disease, in addition to high fever, they often accompany symptoms of thirst, dry mouth, dry tongue and throat, short and red urination, and dry stools due to fluid depletion. Furthermore, it is believed that excessive Fire and Heat can easily damage the righteous Qi, leading to a weakening of overall body functions. Hence, there is a saying, “Strong Fire consumes Qi.” “Strong Fire” here refers to Fire and Heat evils. (3) Fire and Heat easily generate Wind and move blood: When Fire and Heat evils invade the body, they often consume Yin fluids, causing the tendons to lose their nourishment and moisture, leading to liver wind movement, termed “Heat extreme generates Wind.” Clinical manifestations include high fever, confusion, convulsions, upward eye movement, stiff neck, and opisthotonos. Additionally, Fire and Heat evils can accelerate blood flow, scorch blood vessels, and even force blood to leak out of the vessels, leading to various types of bleeding, such as hemoptysis, epistaxis, hematochezia, hematuria, skin purpura, excessive menstruation, and metrorrhagia. (4) Fire easily causes swelling and ulcers: When Fire and Heat evils enter the blood level, they can accumulate locally, corrupting blood and flesh, leading to abscesses and ulcers.(8) Nature and pathogenic characteristics of Epidemic and Pestilential Evils
Among the external pathogenic evils, there is a category known as epidemic and pestilential evils, which are highly infectious external pathogenic factors. In ancient TCM literature, they are also referred to as “pestilential Qi,” “malignant Qi,” “strange Qi,” “toxic Qi,” and “perverse Qi.” Epidemic and pestilential evils differ from the general Six Excesses, as they are a special pathogenic factor existing in the world. Epidemic and pestilential evils typically invade the body through the mouth and nose. In populations, they can occur sporadically or form large-scale epidemics. Common diseases include major head plague, toad plague, epidemic dysentery, diphtheria, rotten throat, smallpox, cholera, and plague. The occurrence and spread of epidemic and pestilential evils.
Characteristics of epidemic and pestilential evils: sudden onset, severe condition; one Qi one disease, similar symptoms; highly infectious and prone to spread.
Practice Questions: 1. (Multiple Choice) The pathogenic characteristics of Fire and Heat evils include
A. Easily forces fluids to leak out
B. Easily forces blood to move erratically
C. Easily corrupts blood and flesh
D. Easily generates internal liver wind
E. Easily causes sticky phlegm that is difficult to expel
2. A 36-year-old male presents with chest tightness, epigastric fullness, short and scanty urination, and unsatisfactory bowel movements, which are attributed to Damp evil. The nature of the cause of his condition is
A. Congealing and obstructing
B. Sticky and stagnant
C. Heavy and turbid
D. Obstructing the Qi mechanism
E. Constricting and pulling
3. (Multiple Choice) The nature and pathogenic characteristics of Damp evil include
A. Heavy and turbid
B. Sticky and viscous
C. Easily invades Yin positions
D. Easily obstructs the Qi mechanism
E. Easily obstructs the Spleen Qi
4. The evil with the most obvious seasonality among the Six Excesses is
A. Wind
B. Cold
C. Heat
D. Dampness
E. Dryness
5. According to the characteristics of the Six Evils, the symptoms that Cold evil is likely to cause are:
A. Sweating and aversion to wind
B. Tight and spasmodic pulse
C. Heaviness and fatigue
D. Hemoptysis and epistaxis
E. Dry cough with little phlegm
Answers and Explanations:
1. ABCD
This question examines the pathogenic characteristics of Fire and Heat evils. The pathogenic characteristics of Fire and Heat evils include: Fire and Heat evils most easily force fluids to leak out, scorching body fluids, leading to fluid depletion (A correct). Fire and Heat evils can accelerate blood flow, scorch blood vessels, and even force blood to leak out (B correct), leading to various types of bleeding, such as hemoptysis, epistaxis, hematochezia, hematuria, skin purpura, excessive menstruation, and metrorrhagia. Fire and Heat evils entering the blood level can accumulate locally, corrupting blood and flesh (C correct), leading to abscesses and ulcers. The clinical manifestations are characterized by localized redness, swelling, heat, and pain. When Fire and Heat evils invade the body, they scorch the liver meridian, consume Yin fluids, causing the tendons to lose their nourishment and moisture, leading to movement disorders, termed “liver wind movement” (D correct), known as “Heat extreme generates Wind.” The tendency to cause sticky phlegm that is difficult to expel is a characteristic of Dry evil (E incorrect).
2. D
This question examines the nature and pathogenic characteristics of Damp evil. Damp evil invades the body, lingers in the organs and meridians, and easily obstructs the Qi mechanism (D correct), leading to abnormal rising and falling of Qi, often presenting with symptoms such as chest tightness, epigastric fullness, short and scanty urination, and unsatisfactory bowel movements.
3. ABCDE
This question examines the nature and pathogenic characteristics of Damp evil.Damp evil has the following characteristics: (1) Dampness is a Yin evil that easily obstructs the Qi mechanism (E correct), injuring Yang Qi. The Spleen governs the transformation of water and Dampness, preferring dryness and disliking Dampness, thus when Damp evil invades from outside and lingers within, it often first obstructs the Spleen Qi, leading to Spleen Yang deficiency, impaired transformation of water and Dampness, and resulting in symptoms such as diarrhea, scanty urination, edema, and ascites. (2) Dampness is heavy and turbid (A correct); (3) Dampness is sticky and viscous (B correct); (4) Dampness tends to descend and easily injures Yin positions (C correct).
4. C
This question examines the characteristics of the Six Evils. The Six Evils often have obvious seasonality, and the evil with the most obvious seasonality is Heat (C correct). Heat is the transformation of the fiery Qi of summer, and since Fire and Heat belong to Yang, Heat is classified as a Yang evil. Wind (A incorrect) is more common in spring. Cold (B incorrect) is more common in winter. Dampness (D incorrect) is more common in late summer. Dryness (E incorrect) is more common in autumn.
5. B
This question examines the pathogenic characteristics of Cold evil. Cold has a constricting nature: constricting means to shrink and pull. Cold evil invades the body, causing the Qi mechanism to contract, leading to tight and spasmodic pulse (B correct). Sweating and aversion to wind (A incorrect) are symptoms easily caused by Wind evil. Heaviness and fatigue (C incorrect) are symptoms easily caused by Damp evil. Hemoptysis and epistaxis (D incorrect) are symptoms easily caused by Fire evil. Dry cough with little phlegm (E incorrect) is a symptom easily caused by Dry evil.
Little Zhou, the pharmacist, says:
The content covered in this section on the Six Excesses is extensive, including the nature and pathogenic characteristics of the six external pathogenic factors: Wind, Cold, Heat, Dampness, Dryness, Fire, and the nature and pathogenic characteristics of epidemic and pestilential evils, including the pathological features of the diseases they cause, which must be thoroughly understood.
1. Wind is a Yang evil, characterized by its ability to disperse and easily invade Yang positions, possessing migratory characteristics, and is the leader of all diseases;
2. Cold is a Yin evil that easily injures Yang Qi, presenting as Cold syndrome; it manifests as congealing and obstructing, leading to pain. At the same time, Cold has a constricting nature, which can make limbs difficult to extend or cause coldness and numbness;
3. Heat is a Yang evil, characterized by its inflammatory nature, with a tendency to rise and disperse, easily injuring fluids and consuming Qi, leading to excessive sweating, and often carries Dampness;
4. Dampness is a Yin evil that easily obstructs the Qi mechanism and injures Yang Qi, presenting with symptoms such as chest tightness, epigastric fullness, short and scanty urination, and unsatisfactory bowel movements. Dampness is heavy and turbid, often causing general heaviness and fatigue in the limbs. Dampness is sticky and stagnant, often leading to lingering and difficult-to-cure diseases, with prolonged courses or recurrent episodes. Dampness tends to descend and easily injures Yin positions;
5. Dryness is characterized by dryness and easily injures body fluids, commonly presenting with dry mouth and nose, dry throat and thirst, dry skin, and in severe cases, cracking, hair loss, scanty urination, and dry stools. Dryness easily injures the lungs, leading to dry cough with little phlegm, or sticky phlegm that is difficult to expel, or blood-streaked phlegm, as well as wheezing and chest pain;
6. Heat is a Yang evil, characterized by its inflammatory nature, easily injuring fluids and consuming Qi, easily generating Wind and moving blood, and can accelerate blood flow, scorch blood vessels, leading to various types of bleeding, and can easily cause swelling and ulcers, corrupting blood and flesh, leading to abscesses and ulcers;
7. The characteristics of epidemic and pestilential evils include sudden onset, severe condition; one Qi one disease, similar symptoms; highly infectious and prone to spread.