Diagnosis of the Six Excesses
Six Excesses refers to the six pathogenic factors: Wind, Cold, Heat, Dampness, Dryness, and Fire. The diagnosis of the Six Excesses involves analyzing and summarizing various clinical data collected through the four diagnostic methods based on the nature and pathogenic characteristics of the Six Excesses to determine whether the current pathological essence of the disease corresponds to the syndromes of the Six Excesses.
The occurrence of syndromes related to the Six Excesses is often associated with seasonal climate and environmental conditions. For example, Wind diseases are more common in spring, Heat diseases in summer, Dampness diseases in late summer, Dryness diseases in autumn, and Cold diseases in winter. Prolonged exposure to damp environments can lead to Dampness diseases, while working in high-temperature conditions can often result in Dryness and Heat diseases. Since the occurrence of syndromes related to the Six Excesses is due to the invasion of external pathogens, these syndromes can exist independently, overlap with each other, or transform under certain conditions.
1. Wind Syndrome
Wind Syndrome refers to the invasion of Wind pathogens affecting the skin and meridians, leading to dysfunction of the defensive Qi, manifesting symptoms characteristic of “Wind”.
[Symptoms] Aversion to Wind, slight fever, sweating, thin white tongue coating, floating and slow pulse; may also include nasal congestion, clear nasal discharge, sneezing, or accompanied by throat itching, coughing; or sudden appearance of hives, skin itching, urticaria; or sudden numbness of the skin, facial drooping; or muscle stiffness, spasms, convulsions; or wandering pain in limbs and joints; or sudden facial and limb swelling.
[Symptom Analysis] Caused by sudden climate changes, environmental discomfort, or physical weakness leading to the invasion of Wind pathogens. Wind is a Yang pathogen, characterized by its ability to disperse and invade Yang positions, easily combining with other pathogenic factors. Therefore, Wind Syndrome is characterized by rapid onset, quick changes, and unpredictable symptoms. Wind Syndrome can present different symptoms depending on the affected area.
When Wind invades the exterior, it harms the defensive Qi, leading to symptoms such as aversion to Wind, fever, sweating, and a floating pulse; when Wind invades the lungs, it disrupts lung Qi, causing nasal congestion, throat itching, and coughing; when Wind invades the skin and muscles, it disrupts the harmony of Ying and Wei, leading to hives and skin itching; when Wind or Wind toxins invade the meridians, it can cause numbness, facial drooping, or severe muscle stiffness, spasms, and convulsions; when Wind combines with Cold and Dampness, it can invade the muscles and joints, causing wandering pain; when Wind invades the lung’s defensive Qi, it can lead to facial and limb swelling.
Cold, Heat, Fire, Dampness, Phlegm, Water, and Toxins often attach to Wind and invade the body, forming various syndromes such as Wind-Cold Syndrome, Wind-Heat Syndrome, Wind-Fire Syndrome, Wind-Damp Syndrome, Wind-Phlegm Syndrome, Wind-Water Syndrome, and Wind-Toxin Syndrome.
[Key Diagnostic Points] Aversion to Wind, slight fever, sweating, floating and slow pulse; or sudden hives, itching, numbness, wandering pain in limbs and joints, facial swelling are the main manifestations.
2. Cold Syndrome
Cold Syndrome refers to the invasion of Cold pathogens, which restrain Yang Qi, primarily manifesting as aversion to cold, absence of sweating, localized cold pain, and tight pulse.
[Symptoms] Severe aversion to cold, possibly accompanied by fever, absence of sweating, pain in the head and body, nasal congestion, clear nasal discharge, floating and tight pulse; may also present with coughing, wheezing, and expectoration of thin white phlegm; or abdominal pain, borborygmus, diarrhea, vomiting; or coldness and pain in the limbs; no thirst or preference for hot drinks, clear and long urine, pale complexion, white tongue coating, tight or deep and forceful pulse.
[Symptom Analysis] Often caused by exposure to rain, water, wearing thin clothing, sleeping outdoors, staying in extremely cold environments, or consuming raw and cold foods. Cold is a Yin pathogen, characterized by its ability to stagnate, constrict, and easily harm Yang Qi.
Cold Syndrome can be divided into Exterior Cold Syndrome and Interior Cold Syndrome. Exterior Cold Syndrome refers to the invasion of Cold pathogens at the skin level, obstructing the defensive Yang, presenting as exterior excess Cold syndrome, also known as Wind-Cold exterior syndrome. When Cold obstructs the exterior, the pores are closed, and the lung’s defensive Qi fails to disperse, leading to symptoms such as aversion to cold, absence of sweating, nasal congestion, and clear nasal discharge; when Cold stagnates the meridians, it obstructs Qi flow, leading to head and body pain. Interior Cold Syndrome refers to Cold pathogens penetrating internally, harming the organs and blood, restraining and damaging Yang Qi, obstructing the Qi and blood flow, presenting as interior excess Cold syndrome, also known as internal Cold syndrome. Cold can affect different organs, leading to various symptom characteristics; for example, Cold in the lungs can cause coughing, wheezing, and expectoration of thin white phlegm; Cold stagnating in the stomach and intestines can lead to abdominal pain, borborygmus, and diarrhea.
Additionally, there are various types of Cold Syndrome in clinical practice, such as Cold stagnation in the liver meridian, Cold stagnation in the heart meridian, Cold congealing in the uterus, and Cold causing painful obstruction, all of which can present with cold limbs, localized cold pain, absence of sweating, pale complexion, white tongue coating, and tight or deep and forceful pulse.
[Key Diagnostic Points] Aversion to cold, cold limbs, absence of sweating, localized cold pain, white tongue coating, tight or deep and forceful pulse are the main manifestations.
3. Heat Syndrome
Heat Syndrome refers to the invasion of Heat pathogens, which consume Qi and injure fluids, primarily manifesting as fever, sweating, thirst, and fatigue.
[Symptoms] Fever with aversion to heat, irritability, sweating, thirst with a preference for drinking, shortness of breath, fatigue, heaviness in limbs, short yellow urine, red tongue, white or yellow tongue coating, weak and rapid pulse; may also present with fever, chest tightness, abdominal distension, pain, nausea, absence of sweating, yellow and greasy tongue coating, and slippery rapid pulse; or fever, sudden fainting, profuse sweating, shortness of breath; even coma, convulsions, red and dry tongue, and thin rapid pulse.
[Symptom Analysis] Caused by exposure to external Heat during the hot summer months. The pathogenic nature of Heat has strict seasonal characteristics. Heat is a Yang pathogen, characterized by its ability to disperse, consume Qi, injure fluids, and easily combine with Dampness.
Heat Syndrome can be divided into Heat injury and Heat stroke. Heat injury occurs when the body is exposed to Heat and Dampness, leading to excessive sweating, Qi consumption, and fluid injury. Due to the nature of Heat, it evaporates fluids, leading to symptoms such as fever, aversion to heat, irritability, and sweating; Heat consumes Qi and fluids, leading to thirst with a preference for drinking, short yellow urine, and fatigue; when combined with Dampness, it obstructs Qi flow, leading to heaviness in limbs and a white or yellow tongue coating; if Dampness is severe, it can obstruct the middle burner, leading to chest tightness, abdominal distension, and nausea; if the pathogenic Qi obstructs the channels, it can lead to absence of sweating, yellow and greasy tongue coating, and slippery rapid pulse. Heat stroke occurs when a person works too long under the scorching sun in summer, causing Heat to disturb the mind, leading to symptoms such as fever, sudden fainting, coma, convulsions, and dry red tongue.
[Key Diagnostic Points] History of exposure to Heat in summer, fever, sweating, thirst, fatigue, and yellow urine are the main manifestations.
Comparison: Differences and Similarities between Fire and Heat
Similarities: Both are predominant pathogens in summer. According to the “Su Wen: On the Five Movements”, “In the sky, it is Heat; on the ground, it is Fire; its nature is Heat.” “The south produces Heat, Heat generates Fire” and “July brings Fire”.
Differences: Heat — excessive sweating, Qi and Yin are both harmed, treated with clearing Heat and tonifying Qi (Qing Shu Yi Qi Tang); Fire — internal invasion of Fire toxins, or burns the skin, treated with clearing Heat and detoxifying (Wu Wei Xiao Du Yin).
4. Dampness Syndrome
Dampness Syndrome refers to the invasion of external Dampness, obstructing the body’s Qi and clear Yang, primarily manifesting as heaviness in the head and body, fatigue, and joint pain.
[Symptoms] Heaviness in the head, fatigue, drowsiness, possibly accompanied by aversion to cold and fever, joint and muscle pain, localized leakage of damp fluid, or skin eczema and itching; chest tightness, abdominal distension, poor appetite, nausea, abdominal pain, loose stools, cloudy urine; women may experience excessive vaginal discharge; dull complexion, slippery and greasy tongue coating, and a slow or thin pulse.
[Symptom Analysis] Often caused by humid weather, exposure to rain, or mist. Dampness Syndrome is also known as external Dampness syndrome. Dampness is a Yin pathogen, characterized by its ability to obstruct Qi, injure Yang, and cause heaviness and stagnation.
Dampness obstructs the meridians, muscles, and bones, leading to symptoms such as heaviness in the head and body, fatigue, and joint pain; when Dampness obstructs the skin, it can lead to aversion to cold and fever; when Dampness penetrates the skin, it can cause localized leakage of damp fluid, skin eczema, and itching; when Dampness obstructs Qi, it can lead to dull complexion, fatigue, and drowsiness; when Dampness obstructs the spleen and stomach, it can lead to abdominal distension, nausea, and loose stools; Dampness tends to descend and is heavy, leading to excessive vaginal discharge and cloudy urine; when exposed to Dampness, the tongue coating is slippery and greasy, and the pulse is slow or thin.
Additionally, Dampness can combine with Wind, Heat, Water, Phlegm, and Toxins to form various syndromes, such as Wind-Damp Syndrome, Heat-Damp Syndrome, Water-Damp Syndrome, Phlegm-Damp Syndrome, and Damp-Toxin Syndrome, each with different symptom presentations.
[Key Diagnostic Points] Heaviness in the body, soreness, fullness, and a slippery pulse are characteristic symptoms.
5. Dryness Syndrome
Dryness Syndrome refers to the invasion of Dry pathogens, which consume fluids, primarily manifesting as dryness of the mouth, nose, throat, and skin.
[Symptoms] Dryness of the lips, nasal cavity, throat, and skin, thirst, dry tongue coating, dry stools, short yellow urine, or dry cough with little phlegm, difficult to expectorate. In cases of warm dryness, symptoms may include slight fever, aversion to Wind and Cold, sweating, throat pain, red tongue edges, and rapid pulse; in cases of cool dryness, symptoms may include aversion to cold and fever, absence of sweating, headache, and tight pulse.
[Symptom Analysis] Caused by dry autumn weather or living in arid environments, leading to the invasion of external Dryness. Dryness Syndrome has distinct seasonal or regional characteristics. Dryness is characterized by its ability to dry out, injure fluids, and easily harm the lungs.
Dryness often enters through the mouth and nose, easily damaging lung fluids, affecting the lung’s ability to disperse and descend, leading to symptoms such as dryness of the skin, lips, nasal cavity, throat, and dry cough; dry stools, short yellow urine, and thirst are manifestations of fluid injury.
Dryness Syndrome can be classified into warm dryness and cool dryness. Warm dryness is common in early autumn when the weather is still hot, and residual heat invades the lung’s defensive Qi, leading to symptoms of slight fever, aversion to Wind and Cold, sweating, throat pain, red tongue edges, and rapid pulse; cool dryness is common in late autumn when the weather is cool and dry, leading to symptoms of aversion to cold and fever, absence of sweating, headache, and tight pulse.
Common types of Dryness Syndrome include Dryness invading the exterior, Dryness invading the lungs, and Dryness affecting the clear orifices.
[Key Diagnostic Points] Occurring in autumn or in dry environments, characterized by symptoms of dryness and lack of moisture.
6. Fire Syndrome
Fire Syndrome refers to the invasion of warm and hot Fire pathogens, leading to internal heat, primarily manifesting as fever, thirst, red face, constipation, yellow urine, red tongue, yellow tongue coating, and rapid pulse.
[Symptoms] Slight fever with aversion to cold, headache, throat pain, nasal congestion with thick nasal discharge, red tongue edges, thin yellow tongue coating, and rapid pulse; high fever with preference for cold, red face and eyes, thirst with a preference for cold drinks, profuse sweating, irritability or confusion, vomiting blood, nosebleeds, abscesses, and boils, short red urine, constipation, red or crimson tongue, yellow or dry tongue coating, and rapid slippery pulse.
[Symptom Analysis] Often caused by the invasion of warm and hot Fire pathogens or the accumulation of other external pathogens transforming into heat. Fire, Heat, and Warm pathogens belong to the same category, differing only in severity. Warm is a gradual increase of heat, while Fire is the extreme of heat, hence they are often referred to together. Fire, Heat, and Warm pathogens are Yang pathogens, characterized by their burning and urgent nature, injuring fluids, consuming Qi, and easily causing wind, blood movement, and ulcers.
When Heat invades the exterior, it disrupts the harmony of the defensive Qi, leading to slight fever with aversion to cold; when Fire disturbs the mind, it can cause headache, throat pain, and nasal congestion; red tongue edges and rapid pulse indicate the presence of Heat in the exterior; when Fire is intense, it can lead to high fever with preference for cold; when Fire disturbs the heart, it can lead to irritability or confusion; when pathogenic Heat forces fluids to leak, it can lead to profuse sweating; when Heat injures fluids, it can lead to thirst with a preference for cold drinks, constipation, and short red urine; when Heat causes blood movement, it can lead to vomiting blood and nosebleeds; when Heat accumulates and obstructs Qi and blood, it can lead to abscesses and boils; red or crimson tongue, yellow or dry tongue coating, and rapid slippery pulse indicate the presence of intense Fire.
Common types of Fire Syndrome include Wind-Heat invading the exterior, Lung Heat excess, Heart Fire excess, Stomach Heat excess, Heat disturbing the chest, Intestinal Heat excess, Liver Fire rising, Liver Fire invading the lungs, Heat obstructing the heart, and Heat entering the Ying and blood. [Key Diagnostic Points] Sudden onset of new illness, severe symptoms, with fever, thirst, constipation, yellow urine, bleeding, red tongue, yellow tongue coating, and rapid pulse as the main manifestations.
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