The Six Excesses can act independently on the body to cause disease, or two or three types of pathogenic factors can simultaneously invade the human body, leading to conditions such as wind-cold ganmao (common cold), wind-heat ganmao, damp-heat jaundice, and wind-cold-damp bi syndrome, among others. They can also transform into one another, such as when unresolved wind-cold transforms into internal heat; unresolved heat can consume body fluids and lead to dryness; extreme heat can generate wind, etc.
In Traditional Chinese Medicine (TCM), in addition to identifying the Six Excesses as causes of disease, the characteristics of these six qi are also linked to the symptoms of the disease, forming diagnostic names such as wind syndrome, cold syndrome, damp syndrome, fire syndrome, dryness syndrome, etc. These syndromes have a certain causal relationship with the Six Excesses. For example, invasion by wind evil can lead to external wind-cold, but some conditions do not require an external pathogenic disease yet exhibit similar symptoms to wind, cold, damp, and dryness, such as fengzhengkuai (urticaria), which typically presents with sudden onset, rapid resolution, and itching, resembling the characteristic of wind’s “ability to move and change frequently.” It is generally believed to be caused by wind evil, but due to the dysfunction of the yin-yang and qi-blood of the organs, it can also produce certain similar properties and symptom characteristics to those of external Six Excesses. TCM distinguishes these as internal wind, internal cold, internal dryness, internal heat, and internal dampness. The following discussion primarily focuses on the external Six Excesses, including the characteristics of pathogenic factors and related syndromes.
The Six Excesses: a pathological term referring to the six types of pathogenic evils: wind, cold, heat, dampness, dryness, and fire. Excess or deficiency of these six qi, or their inappropriate timing, affects the body’s regulatory and adaptive functions and the propagation of pathogens, becoming pathogenic evils that belong to external diseases (including some epidemic and infectious diseases). The Six Excesses cause disease from the outside in, referred to as external causes. As stated in the San Yin Ji Yi Bing Zheng Fang Lun: “The Six Excesses are the common qi of heaven; when they invade, they first flow into the meridians and internally combine with the organs, being caused by external factors.”
In TCM, it is believed that among the external Six Excesses, wind is the foremost. This means that wind evil is the primary pathogenic factor among the Six Excesses. Why is this? Because wind is a yang evil, it is mobile and does not settle, possessing characteristics of rising, moving outward, and dispersing. Its nature is to open and leak, easily causing the skin and pores of the body to become loose and open, leading to the leakage of body fluids and subsequently weakening the body’s protective functions, allowing external evils to invade. Therefore, cold, dampness, dryness, and heat often attach themselves to wind evil and invade the body, such as external wind-cold, wind-heat, and wind-damp. Wind is the leader of all diseases; it often precedes other evils in causing disease and frequently accompanies other pathogenic factors. External diseases caused by the Six Excesses are commonly referred to as catching a cold or being exposed to wind. Thus, to resist and avoid the invasion of wind evil, it is necessary to strengthen the body’s defensive capabilities, ensuring that the skin and pores are tightly closed to ward off the invasion of wind evil. For example, regularly participating in outdoor exercise; elderly individuals and those with weaker constitutions should pay attention to adjusting their clothing according to seasonal changes and significant climate variations; maintaining a balanced diet and correcting picky eating habits; and having a regular daily routine are all good methods to enhance the body’s defensive capabilities. Additionally, wind evil is known for its ability to move and change frequently, which refers to the characteristic of wind evil causing disease with a migratory nature and an unpredictable location. “Frequent changes” refers to the unpredictable and rapid onset of wind evil. For instance, fengzhengkuai (urticaria) presents with skin swelling and itching in patches, occurring unpredictably and fluctuating. Generally, the onset is often acute, and the transformation is relatively quick. Wind evil often affects the upper part of the body (i.e., the head and face), the yang meridians, and the skin surface, causing the skin and pores to become loose and open, leading to the leakage of body fluids, often resulting in symptoms such as headache, sweating, and aversion to wind.