Introduction: Have you ever considered 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 in the “Huangdi Neijing” (Yellow Emperor’s Inner Canon).
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 progression from exterior to 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 affecting the skin causing rashes and itching in the muscles: Wind rashes between the skin and muscles can cause itching. The 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), 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 causing spasms: When wind prevails, it causes movement; if wind affects the tendons, spasms are an inevitable pathological change.
There are two types: Wind Cold characterized by rigidity, and Wind Heat 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 (Polygonum), 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 causing creaking sounds: Wind in the joints can cause creaking sounds during movement. Medical texts mention that Bai Fu Zi (Typhonium) can be used for treatment. I have no experience with this, so I will not comment further.
Cold affecting the skin causing shivering: Shivering, a sensation of cold, often occurs with chills. Mild cases can be treated with Su Ye (Perilla) and Fang Feng (Saposhnikovia), while severe cases may require Ma Huang (Ephedra) and Qiang Huo (Notopterygium), which can have a significant effect. If not resolved, consider other factors.
In the muscles causing stiffness: Cold in the muscles can lead to localized stiffness, commonly treated with Ma Huang, 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, localized stiffness may also be due to phlegm or stagnant blood, requiring differentiation.
In the tendons causing soreness: Cold in the tendons and muscles can be treated with Gui Zhi, Qiang Huo, Fang Feng, Qin Jiao (Gentiana), Bai Zhi (Angelica Dahurica), Lu Shi Teng (Clematis), and Xi He Liu (Salix), which are generally effective, especially when combined with self-massage for better results.
In the bones causing pain: Painful obstruction due to cold pathogens is often treated with Xiao Huo Luo Wan (Minor Activating Collaterals Pill) to relieve pain and dispel cold, which is highly effective.
Heat affecting the skin causing burning without sweating: Use Ji Su San (Chicken Su Powder) with Qing Hao (Artemisia Annua), Xiang Ru (Elsholtzia), Lian Qiao (Forsythia), Zhu Ye (Bamboo Leaf), and He Ye (Lotus Leaf).
In the muscles causing restlessness with sweating: Use Bai Hu Tang (White Tiger Decoction) with Bei Sha Shen (North American Ginseng), Lu Gen (Reed Root), and Xigua (Watermelon Juice) with Lv Dou Yi (Mung Bean Skin).
In the tendons causing 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 and Sang Zhi.
In the bones causing weakness: This condition progresses from mild to severe, requiring a two-step treatment: first use 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 add Chen Pi (Tangerine Peel) to regulate.
Dampness affecting the skin causing jaundice: For Yang jaundice, use Yin Chen Hao Tang (Artemisia Decoction); for Yin jaundice, use Yin Chen Shu Fu Tang (Artemisia and Atractylodes Decoction) or Yin Chen Wu Ling San (Artemisia and Five Ingredients Powder). According to clinical experience, after jaundice subsides, it is necessary to use Gui Shao Liu Jun Tang (Return to Health Six Gentlemen Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Benefit Qi Decoction) for regulation.
In the muscles causing swelling: For swelling in the upper body, induce sweating to expel 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 expel dampness, primarily using Wei Ling Tang (Stomach and Poria Decoction).
In the tendons causing atrophy: Damp atrophy differs from heat atrophy in etiology and treatment; 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 (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 causing 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 Aconite Decoction); if it persists, add Chuan Xu Duan (Chinese Teasel) and Gou Ji (Cibotium) and Xi Xian Cao (Siegesbeckia).
Dryness affecting the skin causing dryness, and in the muscles causing stiffness: Autumn dryness typically first injures the lungs, 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. The former can be treated with Sheng Xue Run Fu Yin (Blood Generating and Skin Moistening Decoction) — Er Di (Two Rehmannias), Er Dong (Two Winters), Gui (Rehmannia), 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 causing 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 (Nourish Dryness and Benefit Vitality Decoction) — Sheng Shu Di, Gui, Sha, 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 Gel 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 causing soreness: Soreness indicates a sensation of aching, which should be nourished with blood and essence. To nourish blood, use Sheng Di, Gui, Sha, and Ji Xue Teng (Spatholobus); to benefit essence, use Shu Di, Qi Zi, Gui Ban (Tortoise Shell), Yu Piao (Fish Bladder), and Zhu Yang Pi (Pig and Sheep Bone Marrow).
Fire affecting the skin causing burning: Burning sensations, dryness, and a feeling of scorched hair can be treated with Qing Xin Tang (Clear Heart Decoction) — Lian Qiao, Zhi Zi, Sheng Gan Cao (Raw Licorice), Bo He, Huang Qin, Huang Lian, Zhu Ye, Da Huang (Rhubarb), and Mang Xiao (Mirabilite); remove Mang Xiao and Huang, and add fresh Sheng Di and Shi Gao (Gypsum).
In the muscles causing pain: This pain should be observed from both local and systemic tendon areas; if localized pain occurs, consider the initial onset of sores or abscesses, treated with Jin Jian (Five Flavor Disinfecting Decoction) — Yin Hua, Ye Ju Hua (Wild Chrysanthemum), Pugongying (Dandelion), Zihua Diding (Viola), and Zhibei Tian Kui (Viola). If pain occurs in the systemic tendon areas, consider the onset of heat bi, treated with Sheng Di, Gao, Zhi, Huang Qin, Sha, Hu Zhang Gen (Reynoutria), Xi He Liu, and Da Qing Ye (Isatis).
In the tendons causing pain: Pain, characterized by soreness, should be treated with methods for heat bi, preventing the condition from transitioning from excess to deficiency over time, 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 Grass), Gou Teng, and Zhu Li (Bamboo Juice).
In the bones causing steaming: Fire in the bones often indicates either deficiency fire or hidden heat, with heat emerging from within, termed “steaming,” which is a critical symptom. Treat with Wu Zheng Wan (Five Steaming Pill) — Qing Hao, Di Gu Pi (Lycium), Sheng Di, Dang Gui, Shi Gao, and Hu Lian (Corydalis), or Da Bu Yin Wan (Great Tonifying Yin Pill) — Zhi Mu (Anemarrhena), Huang Bai, Shu Di, Gui Ban, and Yu Pi (Fish Bladder). Choose appropriately and take as a decoction. This condition has transitioned from the Six Excesses to internal injury, so medication should be gradually effective.
Note: This article is excerpted from “Reading, Teaching, and Clinical Practice,” published by the People’s Health Publishing House in October 1985. This public account is used solely for academic exchange; if there is any infringement, please contact us for deletion, and please indicate the source when reprinting.
Cover image source: Shetu Network.
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