How Do the Six Excesses Affect Muscles, Flesh, Tendons, and Bones?

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,” which 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 where others may be brief and vice versa.

Wind causes rashes on the skin and itching in the muscles: Wind rashes between the skin and muscles cause itching, treated with the Si Wu Xiao Feng San (Four Substance Wind Dispelling Powder) — Sheng Di (Rehmannia), Dang Gui (Angelica), Chi Shao (Red Peony), Chuan Xiong (Ligusticum), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Bai Xian Pi (Dictamnus), Chan Yi (Cicada Slough), Bo He (Mint), Du Huo (Angelica Pubescens), Chai Hu (Bupleurum), Hong Zao (Red Dates); remove Du Huo, add Sang Ye (Mulberry Leaf), and avoid cold and spicy herbs.

In the tendons, it causes spasms: When Wind prevails, it causes movement; when Wind affects the tendons, it leads to spasms, which is an inevitable 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 (Selfheal Spike), Ye Jiao Teng (Fleeceflower Stem), 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.

Cold causes shivering on the skin: Shivering is a cold sensation, and cold and shivering 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 are quite effective. If not resolved, consider other factors.

In the muscles, it causes stiffness: When Cold affects the muscles, there is a sensation of stiffness in the local muscles, commonly treated with Ma Huang (Ephedra), Fu Zi (Aconite), and Xi Xin (Asarum) to expel Cold pathogens and warm the Qi and blood. If it persists, use Da Huo Luo Wan (Major Activating Collaterals Pill). However, local muscle stiffness may also belong to stubborn phlegm and stagnant blood, requiring differentiation.

In the tendons, it causes soreness: When Cold affects the tendons and muscles, use Gui Zhi (Cinnamon Twig), Qiang Huo (Notopterygium), Fang Feng (Saposhnikovia), Qin Jiao (Gentiana), Bai Zhi (Angelica Dahurica), and Lu Shi Teng (Clematis) for general effectiveness, which can be enhanced with self-massage.

In the bones, it causes pain: Cold pathogens causing painful obstruction are often treated with Xiao Huo Luo Wan (Minor Activating Collaterals Pill) to relieve pain and dispel Cold, which is highly effective.

Heat on the skin causes burning without sweating: Use Ji Su San (Perilla Powder) with Qing Hao (Artemisia Annua), Xiang Ru (Elsholtzia), Lian Qiao (Forsythia), 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 Root), 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 (Bamboo Leaf), He Ye (Lotus Leaf), and Xigua Cui Yi (Watermelon Peel) with Gou Teng (Uncaria) and Sang Zhi (Mulberry Branch).

In the bones, it causes weakness and lack of strength: This condition is a progression from superficial to deep, from gradual to severe. Treatment is divided into two steps: first use Cang Zhu Bai Hu Tang (Atractylodes White Tiger Decoction) with Huang Bai (Phellodendron), then use Hu Qian Wan (Tiger Hidden Pill) as a decoction, but add Chen Pi (Tangerine Peel) to regulate.

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 (Artemisia Yin Chen Aconite Decoction) or Yin Chen Wu Ling San (Artemisia Yin Chen Five Ling Powder). According to clinical experience, after the yellowing subsides, it is necessary to use Gui Shao Liu Jun Tang (Return to Shao Six Gentlemen Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Benefit 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 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: Dampness weakness and heat weakness have different causes and treatment methods. 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 (Angelica Pubescens), Sang Ji Sheng (Mulberry Mistletoe), Fang Feng (Saposhnikovia), Qin Jiao (Gentiana), Xi Xin (Asarum), Chuan Xiong (Ligusticum), Gan Cao (Licorice), Rou Gui (Cinnamon), Dang Gui (Angelica), Shu Di (Rehmannia), Bai Shao (White Peony), Fu Ling (Poria), Du Zhong (Eucommia), Niuxi (Achyranthes), and Dang Shen (Codonopsis), removing Rou Gui and Shu Di, and appropriately adding 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 (Aconite Decoction); if it persists, add Chuan Xu Duan (Chuan Xuduan), Gou Ji (Cibotium), and Xi Xian Cao (Siegesbeckia).

Dryness on the skin causes dryness, and in the muscles, it causes stiffness: 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 thin and dry. For the former, use Sheng Xue Run Fu Yin (Blood Generating and Skin Moistening Decoction) — Er Di (Rehmannia), Er Dong (Rehmannia), Gui (Angelica), Qi (Astragalus), Tao Ren (Peach Kernel), Hong Hua (Safflower), Huang Qin (Scutellaria), Gua Lou (Trichosanthes), and Wu Wei Zi (Schisandra), removing Huang Qin and Wu Wei Zi, and adding 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 causes relaxation, while dryness causes rigidity, which is a common pathological change. This condition should be treated with Zi Zao Yang Rong Tang (Nourish Dryness and Support Vitality Decoction) — Sheng Shu Di (Raw Rehmannia), Gui (Angelica), Bai Shao (White Peony), Huang Qin (Scutellaria), Gan Cao (Licorice), Qin Jiao (Gentiana), Fang Feng (Saposhnikovia), adding Sang Zhi (Mulberry Branch) and Gua Lou Gen (Trichosanthes Root) to clear and moisten, softening rigidity, which is quite effective. If it develops into spasms, use A Jiao Ji Zi Huang Tang (Donkey Hide Gel and Egg Yolk Decoction) as the main formula, adding Qi Zi (Goji Berries), Cong Rong (Cistanche), Shu Di (Rehmannia), and Lu Jiao Jiao (Deer Antler Glue).

In the bones, it causes soreness: Soreness indicates a need to nourish blood and benefit essence. Nourishing blood can be achieved with Sheng Di (Rehmannia), Gui (Angelica), Bai Shao (White Peony), and Ji Xue Teng (Sanguisorba); benefiting essence can be achieved with Shu Di (Rehmannia), Qi Zi (Goji Berries), Gui Ban (Tortoise Shell), Yu Piao (Fish Bladder), and Yang Rou (Lamb).

Fire on the skin causes burning: Burning indicates dryness and heat, with a sensation of hair being scorched. Treat with Qing Xin Tang (Clear Heart Decoction) — Lian Qiao (Forsythia), Zhi Zi (Gardenia), Sheng Gan Cao (Raw Licorice), Bo He (Mint), Huang Qin (Scutellaria), Huang Lian (Coptis), Zhu Ye (Bamboo Leaf), Da Huang (Rhubarb), and Mang Xiao (Mirabilite), removing Mang Xiao and Huang, and adding Sheng Di (Rehmannia) 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 abscesses, treated with Jin Jian (Golden Mirror) Five Flavor Disinfecting Decoction — Yin Hua (Honeysuckle), Ye Ju Hua (Wild Chrysanthemum), Pu Gong Ying (Dandelion), Zihua Diding (Viola), and Zhi Bei Tian Kui (Ziziphus);

If the pain is systemic in the tendon areas, consider the onset of heat obstruction, treated with Sheng Di (Rehmannia), Gao (Glycyrrhiza), Zhi (Zingiber), Huang Qin (Scutellaria), Bai Shao (White Peony), Hu Zhang Gen (Polygonum), Xi He Liu (Willow), and Da Qing Ye (Isatis).

In the tendons, it causes pain: Pain indicates soreness, treated with methods for heat obstruction. Over time, prevent the condition from transitioning from excess to deficiency, using Qing Yang Tong Luo (Clear Nourishing and Unblocking Decoction) — Sheng Di (Rehmannia), Bai Shao (White Peony), Yu Zhu (Polygonatum), Tian Mai Dong (Ophiopogon), Sang Ji Sheng (Mulberry Mistletoe), Shen Jin Cao (Stretching Grass), Gou Teng (Uncaria), and Zhu Li (Bamboo Juice).

In the bones, it causes steaming: Fire in the bones often indicates deficiency fire or hidden heat, with heat rising from within, termed “steaming,” which is a critical symptom. Treat with Wu Zheng Wan (Five Steaming Pill) — Qing Hao (Artemisia Annua), Di Gu Pi (Lycium), Sheng Di (Rehmannia), Dang Gui (Angelica), Shi Gao (Gypsum), Hu Lian (Corydalis), and Bie Jia (Soft-shelled Turtle Shell), or Da Bu Yin Wan (Great Tonifying Yin Pill) — Zhi Mu (Anemarrhena), Huang Bai (Phellodendron), Shu Di (Rehmannia), Gui Ban (Tortoise Shell), and Yang Rou (Lamb). Choose appropriately and take as a decoction. This condition has transitioned from the Six Excesses to internal injury, so medication should be gradually effective.

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