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【Daily Practice】1What are the Six Excesses??2.What are the common pathogenic characteristics of the Six Excesses?
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What are the Six Excesses?
Today we discuss the Six Excesses. The Six Excesses (Liù Yín) are one of the external pathogenic factors. When there are abnormal changes in the climate of the natural world, or when the body’s resistance decreases, the Six Excesses—Wind (Fēng), Cold (Hán), Heat (Shǔ), Dampness (Shī), Dryness (Zào), and Fire (Huǒ)—become pathogenic factors that harm the body, leading to the occurrence of external diseases.
The term Six Excesses first appeared in the Song Dynasty in Chen Wuzhe’s “San Yin Ji Yi Bian Zheng Fang Lun” (Three Causes and Extreme One Discussion on Formulas), Volume Two, with the original text stating, “The Six Excesses are Cold, Heat, Dryness, Dampness, Wind, and Fire.” It is also stated, “The Six Excesses are the common Qi of heaven; when they invade, they first enter the meridians and then combine with the organs, causing external diseases.” The term ‘excess’ here implies both excessiveness and infiltration. The Six Excesses can also be understood as the six types of Qi that can cause disease when they are excessive. This name may have originated from the “Zuo Zhuan” (Commentary of Zuo) in the first year of Duke Zhao, where it was mentioned. Additionally, the “Huang Di Nei Jing” (Yellow Emperor’s Inner Canon) also refers to the concept of excess, such as Wind excess, Heat excess, Dampness excess, Fire excess, Dryness excess, and Cold excess. In summary, the Six Excesses are as follows.
The Six Excesses refer to Wind (Fēng), Cold (Hán), Heat (Shǔ), Dampness (Shī), Dryness (Zào), and Fire (Huǒ)—a collective term for six types of external pathogenic factors. Under normal circumstances, these six types of Qi are different climatic changes in nature, essential for the growth and survival of all living things, referred to as ‘Six Qi’. Humans have developed a certain adaptability to the alternating environment of these Six Qi and generally do not become ill. However, when there are abnormal changes in the climate that exceed the body’s adaptability, or when the body’s righteous Qi is insufficient, leading to a decreased ability to resist disease, the Six Qi can become pathogenic factors. At this time, the harmful Six Qi are referred to as the “Six Excesses”. Since the Six Excesses are pathogenic evil Qi, they are also called “Six Evils”.
The abnormality of climate change in the natural world is relative. This relativity manifests in two aspects: first, in comparison to the usual climate changes in that region, it may be excessive, insufficient, or occur at the wrong time, such as warmth in winter when it should be cold. Or the climate change may be too intense and abrupt, such as extreme cold or heat, which the body cannot adapt to, leading to disease; at this time, the Six Qi are excessive, thus becoming the Six Excesses. Second, climate change as a pathogenic condition is relative to the strength of the body’s righteous Qi and adaptability. If there is a dramatic climate change, those with strong righteous Qi can self-regulate and remain healthy, while those with weak righteous Qi may become ill; furthermore, even if the climate changes normally, individuals with insufficient righteous Qi and weaker constitutions may still become ill, thus the Six Qi become pathogenic Qi for patients, and the resulting diseases fall under the category of Six Excesses. Zhang Zhongjing stated in the “Jin Kui Yao Lue” (Essentials of the Golden Chamber) that “humans are nourished by the Five Constants (the Five Elements), and grow due to the Wind Qi; although the Wind Qi gives life to all things, it can also harm them, just as water can carry a boat but can also capsize it. If the five organs are functioning smoothly, the person is at peace; if the evil Wind Qi invades, many will perish.” This passage illustrates that while the changes in climate are conditions for human growth and development, they are also one of the factors that cause diseases. Water can carry a boat but can also capsize it, as mentioned in the “Jin Kui Yao Lue”. The famous advisor Wei Zheng from the Tang Dynasty once told Emperor Li Shimin: “Water can carry a boat but can also capsize it,” referencing the original text from the “Jin Kui Yao Lue”. This indicates that Wei Zheng had read the “Jin Kui Yao Lue” and further illustrates that ancient Confucian scholars were well-versed in medicine. It is said that “scholars studying medicine are like catching chickens in a cage.” The analogy of water carrying a boat but also capsizing it serves to illustrate that humans grow due to the Wind Qi. While the Wind Qi gives life to all things, it can also harm them. Therefore, changes in climate can promote human growth and development while also causing diseases, and the two are interdependent, just like the analogy of water carrying a boat and capsizing it (Wei Zheng advised Li Shimin to treat the common people well, as they can support the Tang Dynasty but can also overthrow it). This is the same principle.
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The Common Pathogenic Characteristics of the Six Excesses
First, they are externally contracted; second, they are seasonal; third, they are regional; fourth, they can coexist.
First, let’s look at external contraction. The Six Excesses cause disease primarily by invading through the skin and the mouth and nose, or both simultaneously. For example, Wind, Cold, and Dampness can easily invade the skin, while Warmth and Dryness can enter through the mouth and nose. Since the evil Qi of the Six Excesses invade the body from the outside, they are referred to as external pathogenic factors, and the diseases they cause are termed “external diseases”. Therefore, since they are externally contracted, their initial symptoms often manifest as aversion to Wind and Cold, fever, thin white tongue coating, and floating pulse, which are all exterior symptoms.
Next, we consider seasonality. The diseases caused by the Six Excesses often have distinct seasonal characteristics. For example, Wind diseases are more common in spring, Heat diseases in summer, Damp diseases in late summer, Dry diseases in autumn, and Cold diseases in winter. The diseases caused by the Six Excesses are closely related to seasonal climate changes, hence they are also referred to as “seasonal diseases”. Due to the peculiarities of abnormal climate changes, Cold diseases can also occur in summer, and Heat diseases can occur in winter. The seasonal changes of the Six Qi can be exemplified by Wind; for instance, in spring, there are more easterly winds, in summer, southerly winds, in autumn, westerly winds, and in winter, northerly winds, with more southeasterly winds in spring and summer and more northwesterly winds in autumn and winter. When we specifically discuss the Wind evil of the Six Excesses, we will also mention that Wind is the leader of all diseases. Since the Wind varies in direction with each season, the pathogenic factors it carries also differ. We should note that while the Six Excesses have certain seasonal characteristics, they are not absolute; as mentioned earlier, Cold diseases can occur in summer, and Cold can also be felt in winter. In the same season, we may see a predominance of certain types of diseases, but other types of external diseases can also occur. Cold diseases can occur in winter, and Cold can also be affected by Heat. Among the Six Excesses, only Heat has strict seasonality, occurring between the summer solstice and the beginning of autumn; the others do not have very strict seasonality but follow general patterns.
The third characteristic is regionality. The diseases caused by the Six Excesses are closely related to the environmental conditions of the areas where people live and work. For example, the northwest is prone to Dry diseases, the northeast to Cold diseases, and the Jiangnan region to Damp-Heat diseases; those who live in damp environments are more likely to suffer from Damp diseases; those who work in high-temperature environments are more likely to suffer from Dry-Heat or Fire diseases. For instance, the “Su Wen” (Plain Questions) states, “The sky is insufficient in the northwest, with Cold on the left and Cool on the right; the earth is not full in the southeast, with Heat on the right and Warm on the left; thus, the earth has highs and lows, and the Qi has Warmth and Coolness; the high areas have Cold Qi, and the low areas have Heat Qi.” Generally speaking, the climate in the northwest is often Dry and Cold, hence there are more Cold and Dry diseases; in the southeast, the climate is often Damp and Warm, hence there are more Damp and Heat diseases.
The fourth characteristic is coexistence. The evil Qi of the Six Excesses can harm the body individually or can invade simultaneously in combinations. For example, Wind-Heat colds, Damp-Heat colds, and Wind-Cold-Damp Bi syndrome are all examples of two or more types of evil Qi. For instance, the “Su Wen” states: “When Wind, Cold, and Damp Qi arrive together, they combine to form Bi syndrome. If the Wind Qi is dominant, it is called Xing Bi; if the Cold Qi is dominant, it is called Tong Bi; if the Damp Qi is dominant, it is called Zhuang Bi.” At this point, we can review what we discussed earlier in the “Foundations of TCM” regarding Bi syndrome, where the combination of Wind, Cold, and Damp Qi leads to Bi syndrome, with Wind Qi being dominant represented by the Fang Feng Tang (Siler Decoction); if Cold Qi is dominant, it is represented by the Wu Tou Tang (Aconite Decoction); if Damp Qi is dominant, it is represented by the Yi Yi Ren Tang (Job’s Tears Decoction). Let’s review what we have discussed previously.
Additionally, during the disease process, the nature of the disease can transform. For example, one of the four great masters of Warm diseases, Wang Mengying, mentioned in the “Wen Bing Jing Wei” (Essentials of Warm Diseases) that “the evil of the Six Qi has different Yin and Yang, and its harm to humans varies according to the Yin and Yang strength of the individual.” For instance, the Qing Dynasty physician Shi Shoutang stated in the “Yi Yuan” (Medical Origins) that “the Six Qi harm people and transform according to the individual; those with Yin deficiency are most prone to transform into Dryness, while Dryness solidifies into Dryness, and accumulated Dampness easily transforms into Dryness; those with Yang deficiency are most prone to transform into Dampness, while Dampness solidifies into Dampness, and accumulated Dryness must add Dampness.” Additionally, Cold evil entering the interior can transform into Heat; Zhang Zhongjing mentioned this in the “Shang Han Lun” (Treatise on Cold Damage), for example, in the case of the Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction). Liu Wansu emphasized the relationship between Heat and Wind, Dampness, Dryness, and Cold Qi, stating that all these Qi can transform into Heat and generate Fire during pathological changes. We should point out that the transformation of the nature of the disease occurs under certain conditions, often related to the constitution and the nature of the evil Qi; the so-called transformation refers to the change in the characteristics of the disease from the initial evil Qi that caused the disease.
The Six Excesses cause disease not only due to climatic factors but also include bacteria, viruses, or physical and chemical factors, which can lead to pathological reactions in the body. Bacteria and viruses, or physical and chemical factors, are classified by modern medicine; some belong to the Six Excesses, and we can attribute them to the Six Excesses and refer to the principles of the Six Excesses in diagnosis and treatment.
The characteristics and pathogenic features of Wind, Cold, Heat, Dampness, Dryness, and Fire are primarily derived from comparative and deductive reasoning, comparing the phenomena of nature and the clinical manifestations of human diseases through repeated clinical practice, leading to continuous deduction, induction, and summarization.
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Zhang Shengbing
Famous TCM Physician from Wuhan
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