The earliest references to the Six Excesses can be found in the “Zuo Zhuan”:“Yin excess cold disease, Yang excess heat disease, Wind excess end disease, Rain excess damp disease, Bright excess heart disease, Dark excess confusion disease.”.
(1) Wind: It causes skin rashes and itching in the muscles. Wind rashes present with itching sensations between the skin and flesh, treated with 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 (Siler), Bai Xian Pi (Dictamnus), Chan Yi (Cicada Slough), Bo He (Mint), Du Huo (Angelica Pubescens), Chai Hu (Bupleurum), Hong Zao (Red Dates), removing Du Huo and adding Sang Ye (Mulberry Leaf). Avoid using cold, cooling, or spicy hot herbs.
In the tendons, it causes spasms (wind predominates causing movement; when wind affects the tendons, it leads to convulsions, which is its pathology). There are distinctions between wind-cold and wind-heat; wind-cold leads to spasms with rigidity as the main symptom, while wind-heat leads to spasms with movement as the main symptom. 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), Fu Shen (Poria), removing Zhi Zi, Huang Qin, Niuxi and adding Gui Zhi (Cinnamon Twig), Qiang Huo (Notopterygium). For wind-heat, remove Du Zhong, Niuxi and add Ling Yang Jiao (Antelope Horn), Sang Zhi (Mulberry Branch).
In the bones, it causes cracking sounds; wind in the joints can make them creak during movement. Medical texts mention that Bai Fu Zi (Typhonium) may be effective, but this requires further exploration.(2) Cold: In the skin, it causes a sensation of chill. Chill, with cold sensations, often occurs together with coldness. For mild cases, use Su Ye (Perilla Leaf), Fang Feng (Siler); for severe cases, use Ma Huang (Ephedra), Qiang Huo (Notopterygium), which can have a significant effect. If not resolved, consider other factors.Cold in the muscles causes stiffness. When cold affects the muscles, it leads to local muscle stiffness, commonly treated with Ma Huang (Ephedra), Fu Zi (Aconite), Xi Xin (Asarum) to dispel cold evil and warm the Qi and blood. If it persists, use Da Huo Luo Dan (Great Activating Collaterals Pill). However, for local numbness with stubborn phlegm and stagnant blood, differentiation is necessary.Cold in the tendons causes soreness. Soreness in the muscles can be treated with Gui Zhi (Cinnamon Twig), Qiang Huo (Notopterygium), Fang Feng (Siler), Qin Jiao (Gentiana), Bai Zhi (Angelica Dahurica), Luo Shi Teng (Clematis), Xi He Liu (Salix) which are generally effective, and can be combined with massage therapy for better results.Cold in the bones causes pain. Pain due to cold evil is often treated with Xiao Huo Luo Wan (Minor Activating Collaterals Pill) to relieve pain and dispel cold, which is very effective. Later, it can be adjusted with Shi Guo Gong Jiu (Historical State Public Wine) as a remedy for ineffectiveness.(3) Heat: In the skin, it 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), He Ye (Lotus Leaf).Heat in the muscles causes irritability with sweating. Use Bai Hu Tang (White Tiger Decoction) with Bei Sha Shen (North American Ginseng), Lu Gen (Reed), Xigua Zhi (Watermelon Rind), Lv Dou Yi (Mung Bean Husk).Heat in the tendons causes weakness. Heat must be accompanied by dampness; this condition is a gradual weakness, treated with Wu Shi Qing Luo Yin (Wu Shi Clear Collaterals Decoction) — Jin Yin Hua (Honeysuckle), Bian Dou Hua (Lima Bean Flower), Si Gua Luo (Luffa), Zhu Ye (Bamboo Leaf), He Ye (Lotus Leaf), Xigua Cui Yi (Watermelon Rind) with Gou Teng (Uncaria), Sang Zhi (Mulberry Branch).Heat in the bones leads to weakness. This condition progresses from mild to severe, treated first with Cang Zhu Bai Hu (Atractylodes White Tiger) plus Huang Bai (Phellodendron), followed by Hu Qian Wan (Tiger Hidden Pill) as a decoction, and adding Chen Pi (Tangerine Peel) for dispersing.(4) Dampness: In the skin, it causes yellowing. 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 Poria Powder). Clinical experience shows that for jaundice to recede, Gui Shao Liu Jun Zi Tang (Return to Health Six Gentlemen Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Boost Qi Decoction) is used for regulation.Dampness in the muscles causes swelling. For upper body swelling, induce sweating to dispel dampness, primarily using Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction); for lower body swelling, promote urination to dispel dampness, primarily using Wei Ling Tang (Stomach Poria Decoction).Dampness in the tendons causes weakness. Dampness weakness differs from heat weakness in etiology and treatment; this condition belongs to damp stagnation in the tendons, commonly treated with Du Huo Ji Sheng Tang (Angelica Pubescens and Mistletoe Decoction) — Du Huo (Angelica Pubescens), Sang Ji Sheng (Mulberry Mistletoe), Fang Feng (Siler), Qin Jiao (Gentiana), Xi Xin (Asarum), Chuan Xiong (Ligusticum), Gan Cao (Licorice), Rou Gui (Cinnamon), Dang Gui (Angelica Sinensis), Shu Di (Rehmannia), Bai Shao (White Peony), Fu Ling (Poria), Du Zhong (Eucommia), Niuxi (Achyranthes), Dang Shen (Codonopsis), removing Rou Gui, Shu Di, and appropriately adding Er Miao Wan (Two Marvels Pill).Dampness in the bones causes heaviness. This is primarily characterized by sluggish movement, not light and agile, indicative of internal dampness; generally treated with Ping Wei San (Calm the Stomach Powder) and Shu Fu Tang (Atractylodes Decoction), with chronic cases adding Chuan Xu Duan (Chinese Teasel), Gou Ji (Cibotium), Xi Xian Cao (Siegesbeckia).(5) Dryness: In the skin, it causes dryness; in the muscles, it causes a feeling of being like firewood. Autumn dryness generally injures lung fluids, then stomach fluids, and finally affects liver blood and kidney yin. Lung fluid injury leads to dry skin, while stomach fluid depletion leads to emaciated muscles. The former is treated with Sheng Xue Run Fu Yin (Blood Generating and Skin Moistening Decoction) — Sheng Shu Di (Raw Rehmannia), Tian Dong (Asparagus), Dang Gui (Angelica Sinensis), Huang Qi (Astragalus), Tao Ren (Peach Kernel), Hong Hua (Safflower), Huang Qin (Scutellaria), Gua Lou (Trichosanthes), Wu Wei Zi (Schisandra) removing Huang Qin, Wu Wei Zi and adding Bai Zi Ren (Platycladus) and Ma Zi Ren (Hemp Seed); the latter, in addition to the above herbs, drink a cup of milk with a tablespoon of honey every morning.Dryness in the tendons causes rigidity. Dampness relaxes, while dryness causes rigidity, leading to prolonged pathological changes. Treated with Zi Zao Yang Rong Tang (Nourishing and Moistening Decoction) — Sheng Shu Di (Raw Rehmannia), Dang Gui (Angelica Sinensis), Bai Shao (White Peony), Huang Qin (Scutellaria), Gan Cao (Licorice), Qin Jiao (Gentiana), Fang Feng (Siler) adding Sang Zhi (Mulberry Branch), Gua Lou Gen (Trichosanthes Root), to clear and moisten, softening rigidity, which is quite effective. If it develops into tendon spasms, use Ejiao Ji Zi Huang Tang (Donkey-hide Gel and Egg Yolk Decoction) as the main treatment, supplemented with Gou Qi Zi (Goji Berry), Rou Cong Rong (Cistanche), Shu Di (Rehmannia), Lu Jiao Jiao (Deer Antler Glue).Dryness in the bones causes pain. Pain is characterized by a feeling of soreness; nourishing blood and benefiting essence is essential. For nourishing blood, use Sheng Di (Raw Rehmannia), Dang Gui (Angelica Sinensis), Bai Shao (White Peony), Ji Xue Teng (Spatholobus), and for benefiting essence, use Shu Di (Rehmannia), Gou Qi Zi (Goji Berry), Gui Ban (Tortoise Shell), Yu Piao (Fish Bladder), Zhuyin (Pig and Sheep Bone Marrow).(6) Fire: In the skin, it causes burning sensations. Burning, dryness, and heat lead to a feeling of hair being scorched, treated 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), Mang Xiao (Mirabilite), removing Mang Xiao and Da Huang and adding Sheng Di (Raw Rehmannia), Shi Gao (Gypsum).Fire in the muscles causes pain. This pain should be observed from both local and systemic tendon areas. If local pain is considered heat bi, treat with Sheng Di (Raw Rehmannia), Shi Gao (Gypsum), Zhi Mu (Anemarrhena), Huang Qin (Scutellaria), Chi Shao (Red Peony), Hu Zhang Gen (Reynoutria), Xi He Liu (Salix), Da Qing Ye (Isatis). Fire in the tendons causes pain. Pain is characterized by soreness; treated with methods for heat bi, preventing the condition from transitioning from excess to deficiency over time, using Qing Yang Tong Luo (Clear Yang and Open Collaterals) — Sheng Di (Raw Rehmannia), Bai Shao (White Peony), Yu Zhu (Polygonatum), Tian Dong (Asparagus), Mai Dong (Ophiopogon), Sang Ji Sheng (Mulberry Mistletoe), Shen Jin Cao (Stretching Grass), Gou Teng (Uncaria), Zhu Li (Bamboo Juice).Fire in the bones causes steaming sensations. Fire in the bones often belongs to deficiency fire or hidden heat, where heat rises from within, termed steaming, with very acute symptoms. Treated with Wu Zheng Wan (Five Steaming Pill) — Qing Hao (Artemisia), Di Gu Pi (Lycium), Sheng Di (Raw Rehmannia), Dang Gui (Angelica Sinensis), Shi Gao (Gypsum), Hu Lian (Corydalis), 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), Zhuyin (Pig and Sheep Bone Marrow) as a decoction. This condition has already transitioned from the Six Excesses to internal injury, so medication should be gradually effective.
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