Have you ever thought about the impact of the Six Excesses on muscles and bones?
The earliest mention of the Six Excesses can be found in the “Zuo Zhuan”: “Yin excess leads to cold diseases, Yang excess leads to heat diseases, Wind excess leads to minor diseases, Rain excess leads to damp diseases, Bright excess leads to heart diseases, and Dark excess leads to confusion diseases.” This opened the discussion of the Six Excesses of Wind, Cold, Heat, Dampness, Dryness, and Fire in the “Huangdi Neijing”.
Through the continuous elaboration by physicians over the ages, our understanding of the differentiation and treatment of diseases caused by the Six Excesses has greatly advanced, and with recent case reports, there are even more methods to draw from.
However, there are relatively few discussions regarding the impact of the Six Excesses on muscles and bones; the insights provided by Qing Dynasty physician Wang Yanchang, who discussed the issue from the surface to the interior, are quite reasonable and refreshing. I often compile his insights and supplement them with effective empirical formulas, serving as a detailed account of what is often overlooked and a brief summary of what is often elaborated upon in medical discourse.
1
Wind causes rashes on the skin and itching in the muscles: Wind rashes appear between the skin and muscles, causing itching. Treatment involves the use of the Si Wu Xiao Feng San (Four Substance Wind Dispelling Powder) — Sheng Di (Rehmannia), Dang Gui (Angelica Sinensis), Chi Shao (Red Peony), Chuan Xiong (Ligusticum Chuanxiong), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Bai Xian Pi (Dictamnus), Chan Yi (Cicada Slough), Bo He (Mint), Du Huo (Angelica Pubescens), Chai Hu (Bupleurum), and Hong Zao (Red Dates); remove Du Huo and add Sang Ye (Mulberry Leaf), avoiding cold and spicy heat herbs.
In the tendons, it causes spasms: When Wind prevails, it causes movement; when Wind affects the tendons, it leads to spasms, which is a natural pathological change.
There are two types: Wind Cold and Wind Heat. Wind Cold spasms are characterized by rigidity, while Wind Heat spasms are characterized by twitching. Both can be treated with Tian Ma Gou Teng Yin (Gastrodia and Uncaria Decoction) — Tian Ma (Gastrodia), Gou Teng (Uncaria), Zhi Zi (Gardenia), Huang Qin (Scutellaria), Shi Jue Ming (Haliotis), Du Zhong (Eucommia), Niuxi (Achyranthes), Sang Ji Sheng (Mulberry Mistletoe), Xia Ku Cao (Prunella), Ye Jiao Teng (Fleeceflower Stem), and Fu Ling (Poria).
For Wind Cold, remove Zhi Zi, Huang Qin, and Niuxi, and add Gui Zhi (Cinnamon Twig) and Qiang Huo (Notopterygium). For Wind Heat, remove Du Zhong and Niuxi, and add Ling Jiao (Antelope Horn) and Sang Zhi (Mulberry Branch).
In the bones, it causes creaking: When Wind affects the joints, it can cause a creaking sound during movement. Medical texts mention that Bai Fu Zi (Typhonium) can treat this, but I have no experience and will not speculate.
2
Cold causes trembling in the skin: Trembling is a sensation of cold, and cold and trembling often occur together. For mild cases, use Su Ye (Perilla) and Fang Feng (Saposhnikovia); for severe cases, use Ma Huang (Ephedra) and Qiang Huo (Notopterygium), which have a significant effect. If not resolved, consider other factors.
In the muscles, it causes stiffness: When Cold affects the muscles, it leads to localized stiffness. Common treatments include Ma Huang, Fu Zi (Aconite), and Xi Xin (Asarum) to expel Cold evil and warm the Qi and blood. If it persists, use Da Huo Luo Wan (Major Activating Collaterals Pill). However, localized stiffness can also be due to phlegm or stagnant blood, requiring differentiation.
In the tendons, it causes soreness: Cold in the tendons and muscles can be treated with Gui Zhi, Qiang Huo, Fang Feng, Qin Jiao (Gentiana), Bai Zhi (Angelica Dahurica), Luo Shi Teng (Clematis), and Xi He Liu (Salix). Combining with self-massage can enhance the effect.
In the bones, it causes pain: Painful Bi syndrome caused by Cold evil is often treated with Xiao Huo Luo Wan (Minor Activating Collaterals Pill) to relieve pain and dispel Cold, which is highly effective.
3
Heat on the skin causes burning without sweating: Use Ji Su San (Perilla Powder) with Qing Hao (Artemisia Annua), Xiang Ru (Elsholtzia), Lian Qiao Pi (Forsythia Pod), Zhu Ye (Bamboo Leaf), and He Ye (Lotus Leaf).
In the muscles, it causes restlessness with sweating: Use Bai Hu Tang (White Tiger Decoction) with Bei Sha Shen (North American Ginseng), Lu Gen (Reed Rhizome), Xigua Zhi (Watermelon Peel), and Lv Dou Yi (Mung Bean Skin).
In the tendons, it causes weakness: Heat must be accompanied by dampness; this condition is a gradual weakness. Use Wu Shi Qing Luo Yin (Wu’s Clear Collaterals Decoction) — Yin Hua (Honeysuckle), Bian Dou Hua (Lima Bean Flower), Si Gua Luo (Luffa), Zhu Ye, He Ye, and Xigua Cui Yi (Watermelon Rind) with Gou Teng and Sang Zhi.
In the bones, it causes weakness and lack of strength: This condition is a progression from mild to severe, treated in two steps: first with Cang Zhu Bai Hu Tang (Atractylodes White Tiger Decoction) with Huang Bai (Phellodendron), followed by Hu Qian Wan (Tiger Hidden Pill) as a decoction, but must add Chen Pi (Tangerine Peel) to disperse.
4
Dampness on the skin causes yellowing: For Yang jaundice, use Yin Chen Hao Tang (Artemisia Yin Chen Decoction); for Yin jaundice, use Yin Chen Shu Fu Tang (Yin Chen Decoction with Atractylodes) or Yin Chen Wu Ling San (Yin Chen Five Poria Powder). According to clinical experience, after the yellowing subsides, it is necessary to use Gui Shao Liu Jun Tang (Gui and Shao Six Gentlemen Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) for regulation.
In the muscles, it causes swelling: For swelling in the upper body, induce sweating to dispel dampness, primarily using Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction); for swelling in the lower body, promote urination to dispel dampness, primarily using Wei Ling Tang (Stomach and Poria Decoction).
In the tendons, it causes weakness: The causes of damp weakness and heat weakness are different, and the treatment methods vary. This condition belongs to damp stagnation in the tendons, commonly treated with Du Huo Ji Sheng Tang (Angelica Pubescens and Mulberry Mistletoe Decoction) — Du Huo, Sang Ji Sheng, Fang Feng, Qin Jiao, Xi Xin, Chuan Xiong, Gan Cao (Licorice), Rou Gui (Cinnamon), Dang Gui, Shu Di (Prepared Rehmannia), Bai Shao (White Peony), Fu Ling, Du Zhong, Niuxi, and Dang Shen (Codonopsis). Remove Rou Gui and Shu Di, and appropriately add Er Miao Wan (Two Marvels Pill).
In the bones, it causes heaviness: Heaviness primarily refers to sluggish movement, a characteristic of internal dampness. Generally, use Ping Wei San (Harmonize the Stomach Powder) combined with Shu Fu Tang (Atractylodes and Prepared Rehmannia Decoction). If it persists, add Chuan Xu Duan (Chuanxiong) and Gou Ji (Cibotium) and Xi Xian Cao (Siegesbeckia).
5
Dryness on the skin causes dryness, and in the muscles, it leads to emaciation: Dryness generally first injures the lung fluids, then the stomach fluids, and finally affects the liver blood and kidney yin.
When lung fluids are injured, the skin becomes dry; when stomach fluids are depleted, the muscles become emaciated like wood. For the former, use Sheng Xue Run Fu Yin (Blood Generating and Skin Moistening Decoction) — Er Di (Two Rehmannia), Er Dong (Two Winters), Gui (Cinnamon), Qi (Astragalus), Tao Ren (Peach Kernel), Hong Hua (Safflower), Huang Qin, Gua Lou (Trichosanthes), and Wu Wei Zi (Schisandra). Remove Huang Qin and Wu Wei Zi, and add Bai Zi Ren (Biota Seed) and Ma Zi Ren (Hemp Seed). For the latter, in addition to the above herbs, drink a cup of milk with a tablespoon of honey every morning.
In the tendons, it causes rigidity: Dampness leads to relaxation, while dryness leads to rigidity, a common pathological change. This condition should be treated with Zi Zao Yang Rong Tang (Nourishing Dryness and Supporting Vitality Decoction) — Sheng Shu Di, Gui, Bai Shao, Huang Qin, Gan Cao, Qin Jiao, Fang Feng, and add Sang Zhi and Gua Lou Gen (Trichosanthes Root) to clear and moisten, softening rigidity, which is quite effective. If it develops into spasms, use Ejiao Ji Zi Huang Tang (Donkey-hide Gelatin and Egg Yolk Decoction) as the main formula, adding Qi Zi (Goji Berries), Cong Rong (Cistanche), Shu Di, and Lu Jiao Jiao (Deer Antler Gel).
In the bones, it causes soreness: Soreness is a sensation of aching, which should be nourished with blood and essence. Nourishing blood can be achieved with Sheng Di, Gui, Bai Shao, and Ji Xue Teng (Spatholobus); nourishing essence can be achieved with Shu Di, Qi Zi, Gui Ban (Tortoise Shell), Yu Piao (Fish Bladder), and Zhu Yang Sui (Pig and Sheep Bone Marrow).
6
Fire on the skin causes burning: Burning is a sensation of dryness and heat, often accompanied by a feeling of scorched hair. Treatment involves Qing Xin Tang (Clear Heart Decoction) — Lian Qiao (Forsythia), Zhi Zi (Gardenia), Sheng Gan Cao (Raw Licorice), Bo He (Mint), Huang Qin, Huang Lian (Coptis), Zhu Ye, Da Huang (Rhubarb), and Mang Xiao (Mirabilite); remove Mang Xiao and Huang, and add Sheng Di and Shi Gao (Gypsum).
In the muscles, it causes pain: This pain should be observed from both local and systemic tendon areas. If the pain is localized, consider the initial onset of sores or heat boils, treated with Jin Jian (Five Flavor Disinfecting Decoction) — Yin Hua, Ye Ju Hua (Wild Chrysanthemum), Pugongying (Dandelion), Zihua Diting (Viola), and Zhibei Tian Kui (Zhibei Tian Kui);
If the pain is in the systemic tendon areas, consider the onset of heat Bi syndrome, treated with Sheng Di, Gao, Zhi, Huang Qin, Bai Shao, Hu Zhang Gen (Polygonum Cuspidatum), Xi He Liu, and Da Qing Ye (Isatis Leaf).
In the tendons, it causes pain: Pain is a sensation of aching, treated with methods for heat Bi syndrome. Over time, prevent the condition from transitioning from excess to deficiency, using Qing Yang Tong Luo (Clear Nourishing and Unblocking Decoction) — Sheng Di, Bai Shao, Yu Zhu (Polygonatum), Tian Mai Dong (Ophiopogon), Sang Ji Sheng, Shen Jin Cao (Stretching Muscle Grass), Gou Teng, and Zhu Li (Bamboo Juice).
In the bones, it causes steaming: Fire in the bones often indicates either empty fire or hidden heat, with heat emerging from within, termed “steaming,” which is a critical symptom. Treatment involves Wu Zheng Wan (Five Steaming Pill) — Qing Hao, Di Gu Pi (Lycium), Sheng Di, Dang Gui, Shi Gao, Hu Lian (Corydalis), and Bie Jia (Soft-shelled Turtle Shell), or Da Bu Yin Wan (Great Tonifying Yin Pill) — Zhi Mu (Anemarrhena), Huang Bai, Shu Di, Gui Ban, and Yu Piao. Choose appropriately and take as a decoction. This condition has transitioned from the Six Excesses to internal injury, and medication should be gradually effective.
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