The “Six Excesses” (Liu Yin) refer to the six external pathogenic factors: Wind (Feng), Cold (Han), Summer Heat (Shu), Dampness (Shi), Dryness (Zao), and Fire (Huo). Under normal circumstances, these six factors represent different climatic changes in nature, which are essential for the growth and survival of all living things, known as the “Six Qi”. When abnormal climatic changes occur in nature that exceed the human body’s ability to adapt, or when the body’s righteous Qi is insufficient, leading to a decreased ability to resist disease, these six Qi become the Six Excesses, also referred to as the “Six Evils”. For instance, the outbreak of the novel coronavirus pneumonia in Wuhan last year was also attributed to abnormal climatic conditions, falling under the category of the Six Excesses.

Common Pathogenic Characteristics of the Six Excesses

1. External Pathogenicity. The Six Excesses typically invade the body through the skin or the mouth and nose, or both simultaneously. For example, Wind, Cold, and Dampness easily invade the skin, while Warmth and Dryness can enter through the mouth and nose. Since the Six Excesses are external factors that invade the human body, they are classified as external pathogenic factors, and the diseases they cause are termed “external diseases”.
2. Seasonality. The diseases caused by the Six Excesses often exhibit significant seasonality. For instance, Wind diseases are more common in spring, Heat diseases in summer, Dampness diseases in late summer, Dryness diseases in autumn, and Cold diseases in winter. The diseases caused by the Six Excesses are closely related to seasonal climatic changes, hence they are also referred to as “seasonal diseases”. Due to the peculiarities of abnormal climatic changes, Cold diseases can also occur in summer, and Heat diseases can appear in winter.
3. Regionality. The diseases caused by the Six Excesses are closely related to the environmental conditions of one’s living and working areas. For example, the northwest region is prone to Dryness diseases, the northeast to Cold diseases, the Jiangnan region to Damp-Heat diseases, prolonged exposure to damp environments can lead to Damp diseases, and those working in high-temperature environments may suffer from Dryness or Fire diseases.
4. Combination. The Six Excesses can cause diseases either individually or in combination, with two or more simultaneously invading the body. For example, Wind-Heat colds, Summer-Damp colds, Damp-Heat diarrhea, and Wind-Cold-Damp bi syndrome. As stated in the “Su Wen: Bi Lun”, “When Wind, Cold, and Dampness combine, they form bi syndrome. If Wind predominates, it is called ‘Xing Bi’; if Cold predominates, it is ‘Tong Bi’; if Dampness predominates, it is ‘Zhang Bi’.”

Characteristics and Pathogenic Features of Each Excess

1. Characteristics and Pathogenic Features of Wind Excess(1) Wind is light and Yang, easily invading Yang positions: Wind has the characteristics of being light, upward-moving, and outward-expanding. It can cause the pores to open, leading to sweating, hence Wind invasion often affects the upper parts of the body (head, face) and the skin, resulting in symptoms such as headaches, sweating, aversion to wind, throat itching, and coughing.(2) Wind is mobile and changes frequently: “Mobile” indicates that Wind is active and does not stay in one place, hence diseases caused by Wind often exhibit wandering symptoms. For instance, bi syndrome caused by the combination of Wind, Cold, and Dampness may present with migratory joint pain, which is a manifestation of Wind predominance, termed “Xing Bi” or “Feng Bi”. “Frequent changes” refers to the unpredictable nature of Wind-induced diseases, which can develop rapidly. For example, Wind rash often presents with skin itching that appears and disappears unpredictably.(3) Wind is proactive: This means that Wind-induced diseases often exhibit unstable characteristics. For instance, Wind invasion can lead to facial muscle spasms, dizziness, tremors, convulsions, stiff neck, opisthotonos, and upward gaze.(4) Wind is the leader of all diseases: This has two implications: first, Wind often accompanies other evils to cause disease. Therefore, Cold, Dampness, Summer Heat, Dryness, and Heat often attach to Wind to invade the body, resulting in external diseases such as Wind-Cold, Wind-Damp, Wind-Heat, and Wind-Dryness; second, Wind is the most common pathogenic factor, present throughout the year, and can invade both the exterior and interior of the body, leading to various diseases. Thus, Wind is also referred to as the general term for external pathogenic factors.2. Characteristics and Pathogenic Features of Cold Excess(1) Cold is a Yin pathogen that easily injures Yang Qi: Cold represents an excess of Yin, hence it is termed a Yin pathogen. When Cold invades, it most easily damages the body’s Yang Qi. Cold can invade the skin, causing the defensive Yang to be obstructed, leading to symptoms such as aversion to cold, fever, no sweating, nasal congestion, and clear nasal discharge; if Cold invades the spleen and stomach, it can cause abdominal pain, vomiting, and diarrhea; if there is a deficiency of Heart and Kidney Yang, Cold can directly invade the Shaoyin, leading to symptoms such as aversion to cold, curled posture, cold extremities, clear diarrhea, frequent clear urination, mental fatigue, and a thin pulse.(2) Cold is stagnant: This means that Cold can cause stagnation of Qi, blood, and fluids in the affected area, leading to obstruction of the meridians. Cold can damage Yang Qi, impairing its warming function, which can lead to poor circulation of Qi and blood, and even stagnation, resulting in pain. Therefore, Cold is the most likely external pathogen to cause pain. For instance, if Cold invades the skin and meridians, it can lead to pain in the head, body, and joints, and if joint pain is primarily cold, it is termed “Han Bi” or “Tong Bi”; if Cold invades the spleen and stomach, it can cause severe abdominal pain; if Cold invades the liver meridian, it can lead to lower abdominal or external genitalia pain.(3) Cold contracts: This means that Cold can cause the Qi mechanism to contract, leading to tightness and spasms in the pores and meridians. For instance, if Cold invades the skin, the defensive Yang is obstructed and cannot be released, leading to no sweating; if Cold invades the blood vessels, Qi and blood stagnate, leading to pain and a tight pulse.3. Characteristics and Pathogenic Features of Summer Heat Excess(1) Summer Heat is a Yang pathogen, characterized by its heat: Summer Heat is derived from the hot air of midsummer, hence it is a Yang pathogen. Summer Heat often manifests as a series of Yang heat symptoms, such as high fever, irritability, flushed face, and a rapid pulse.(2) Summer Heat is ascending and dispersing, easily disturbing the mind and injuring fluids: As a Yang pathogen, Summer Heat tends to rise and disturb the mind, leading to symptoms such as chest discomfort, dizziness, flushed face, and irritability. Summer Heat can also cause the pores to open and lead to excessive sweating. Excessive sweating not only injures fluids but also causes Qi to be lost with the fluids, leading to symptoms such as thirst, short urination, and fatigue. In severe cases, excessive loss of fluids can lead to sudden fainting and loss of consciousness.(3) Summer Heat often combines with Dampness: The hot and humid climate of summer often leads to the combination of Summer Heat and Dampness, resulting in clinical manifestations that include fever, thirst, and symptoms of Dampness such as heaviness, fatigue, chest discomfort, nausea, and loose stools.4. Characteristics and Pathogenic Features of Dampness Excess(1) Dampness is a Yin pathogen that easily injures Yang Qi: Dampness is similar to water, hence it is classified as a Yin pathogen. When Yin pathogens invade, the body’s Yang Qi rises to resist, making it easy for Dampness to injure Yang Qi. The spleen governs the transformation and transportation of fluids and prefers dryness over Dampness; therefore, when Dampness invades, it can easily obstruct the spleen, leading to spleen Yang deficiency and dysfunction, resulting in internal accumulation of fluids, causing diarrhea, edema, and phlegm. Thus, Dampness is known to damage spleen Yang.(2) Dampness is heavy and turbid: Dampness often presents with clinical manifestations characterized by a sense of heaviness and difficulty in movement, such as heaviness in the head and body, and heaviness and soreness in the limbs. When Dampness invades the skin, it obstructs the clear Yang, leading to a heavy head; when Dampness obstructs the meridians and joints, the Yang Qi cannot circulate, leading to numbness in the skin and joint pain that is heavy and difficult to move, termed “Shi Bi” or “Zhang Bi”; when Dampness is present, it often leads to foul-smelling secretions and excretions. For instance, if Dampness is in the upper body, it can lead to facial dirt and excessive eye discharge; if it descends, it can lead to turbid or difficult urination, excessive vaginal discharge in women; if it obstructs the large intestine, it can lead to diarrhea with pus and blood; if it invades the skin, it can lead to eczema and weeping sores.(3) Dampness is sticky and can obstruct Qi: Dampness can cause stagnation, which is reflected in three aspects: first, the stickiness of symptoms. When Dampness is present, it often presents with sticky secretions and excretions, such as unsatisfactory bowel movements in Damp-Heat diarrhea, difficult urination in Lin syndrome, and sticky sweat, sticky mouth, and thick, slippery tongue coating; second, the chronicity of the disease. Due to the sticky nature of Dampness, it can obstruct Qi, leading to prolonged illness, recurrent episodes, or lingering conditions such as eczema, Damp-Heat, and Damp Bi, which are difficult to resolve quickly; third, it can obstruct Qi. Because Dampness is a heavy and turbid pathogen, it is most likely to linger in the organs and meridians, obstructing the Qi mechanism and causing abnormal ascension and descent of Qi, leading to obstruction of the meridians.(4) Dampness tends to descend and easily invades the lower parts of the body: Dampness, being similar to water and Yin, tends to descend, hence it often injures the lower parts of the body, leading to conditions such as edema, eczema, and athlete’s foot, which are more common in the lower extremities.5. Characteristics and Pathogenic Features of Dryness Excess(1) Dryness is characterized by dryness and easily injures fluids: Dryness often occurs in autumn and can easily deplete fluids, leading to various symptoms of dryness, such as dry mouth and throat, dry nose, dry lips, dry eyes, dry skin, and even cracking, as well as dry stools and scanty urination.(2) Dryness easily injures the lungs: The lungs are delicate organs that prefer moisture and dislike dryness. Dryness can easily enter through the mouth and nose, leading to damage to lung fluids, affecting the lung’s ability to descend and disperse Qi, and may even dry out the lung collaterals, resulting in dry cough with little phlegm, or phlegm that is sticky and difficult to expectorate, or even coughing up blood, and in severe cases, wheezing and chest pain. Since the lungs and large intestine are interrelated, depletion of lung fluids can lead to dryness in the large intestine, resulting in constipation.6. Characteristics and Pathogenic Features of Fire (Heat) Excess(1) Fire Heat is a Yang pathogen, characterized by burning and ascending: Fire Heat is burning and rising, hence it is a Yang pathogen. Yang pathogens cause diseases characterized by excess heat, commonly presenting with high fever, aversion to heat, thirst, sweating, and a rapid pulse; Fire Heat tends to invade the upper parts of the body, hence diseases caused by Fire Heat often occur in the upper body, especially the head and face, leading to symptoms such as red, swollen, and painful eyes, sore throat, mouth ulcers, bitter taste, dry throat, swollen gums, headaches, dizziness, and ear pain or discharge.(2) Fire Heat easily disturbs the mind: Fire’s ascending and disturbing nature can easily affect the mind, leading to symptoms such as restlessness, insomnia, or severe disturbances of the mind, resulting in delirium or confusion.(3) Fire Heat easily injures fluids and depletes Qi: Fire Heat can not only force fluids to leak out, causing Qi to be lost with the fluids, but it can also directly consume fluids, depleting the body’s Yin. Therefore, diseases caused by Fire Heat often present with symptoms of heat along with signs of fluid depletion, such as thirst with a preference for cold drinks, dry throat, short and red urination, and constipation. When there is excessive depletion of fluids, it can lead to fatigue, shortness of breath, and in severe cases, a collapse due to total loss of fluids.(4) Fire easily generates Wind and stirs the blood: “Generates Wind” means that Fire can easily injure the liver Yin, leading to a lack of nourishment and moisture in the tendons and meridians, which can cause symptoms of internal Wind, such as high fever, confusion, convulsions, upward gaze, and opisthotonos. “Stirs the blood” means that Fire can invade the blood vessels, causing chaotic movement of blood and damaging blood vessels, leading to various bleeding disorders such as hemoptysis, epistaxis, hematochezia, hematuria, skin purpura, excessive menstruation, and uterine bleeding.(5) Fire can easily cause sores and abscesses: When Fire invades the blood level, it can accumulate in local areas, burning and damaging flesh, leading to the formation of abscesses characterized by local redness, swelling, heat, and pain.· The End · Warm Reminder: The formulas and treatments mentioned in this article are for the purpose of popularizing TCM knowledge or for learning reference. 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