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According to the “Zuo Zhuan, Zhao Gong, Year One of Zhao Gong”, the Duke of Jin sought medical advice from Qin. The physician He from Qin bluntly stated, “The disease cannot be treated; it is said: approaching a woman’s chamber, the disease is like a curse. It is neither a ghost nor food, but confuses and causes loss of will. A good minister is about to die, and heaven’s mandate does not favor him.” He also proposed the theory of the six qi causing disease: “Heaven has six qi, which give rise to five flavors, manifest in five colors, and correspond to five sounds; the six excesses give rise to six diseases. The six qi are yin, yang, wind, rain, darkness, and brightness.”
From the ancient view of “ghosts and gods causing disease” to the theory of “six qi causing disease” by Yi He during the Shang and Zhou dynasties, it opened the path for TCM etiology from ignorance to rationality.
The Daoist perspective of “the Dao follows nature” emphasizes that all things are the result of natural creation, and humans should conform to nature, achieving harmony with heaven and earth. The “Huangdi Neijing” (Inner Canon of Huangdi) builds upon the understanding of “the unity of heaven and man” from various schools, forming a relatively systematic theory of climatic disease causation, discussed in different chapters. It was not until the Song dynasty that Chen Wuze first collectively referred to the six qi that cause disease as the six excesses (liuxin). Since then, the term six excesses has become a specialized term in TCM etiology.
The six excesses refer to the six climatic characteristics of wind, cold, heat, dampness, dryness, and fire, which are collectively known as the six pathogenic factors, and are the most common external causes of disease in TCM.
The “Shang Han Lun” (Treatise on Cold Damage) is named for profound reasons. In the classical formula system, taking external diseases as an example, diseases generally begin with the Taiyang (Greater Yang) stage, which can be categorized into cold damage and wind stroke. Under normal circumstances, when the body is affected by wind or cold pathogenic qi, it responds by first raising body temperature to kill pathogenic microorganisms, increasing heat production and reducing heat dissipation. In terms of reducing heat dissipation, even if the surface blood vessels spasm and sweat glands close, forming a standard Ma Huang Tang (Ephedra Decoction) syndrome, individuals with loose pores may have weak fascial contraction ability, unable to fully close sweat glands, resulting in a Gui Zhi Tang (Cinnamon Twig Decoction) syndrome, which is also named Taiyang wind stroke syndrome. The Ma Huang Tang syndrome has complete closure of sweat glands and adequate blood vessel spasm, referred to as Taiyang cold damage syndrome.
Wind is a natural phenomenon caused by the movement of air due to solar heat radiation. Since humans are warm-blooded animals, when the skin perceives the stimulation of wind, it instinctively causes spasm of subcutaneous capillaries and micro-capillaries, closing glands, thus reducing heat dissipation to maintain warmth. In TCM, any disease that causes blood vessel spasm and gland closure is termed wind. After the Tang and Song dynasties, especially during the Jin and Yuan dynasties, many physicians proposed the concept of “internal wind”, marking a significant turning point in the etiology of wind stroke. However, fundamentally, both external and internal wind manifest as changes in the vascular system and glands, and there is no essential difference.
For the body, there are countless conditions involving vascular and glandular changes, hence TCM has many diseases named after wind, such as pediatric lung wind, acute fright wind, head wind, intestinal wind, rheumatism, wind-heat, wind-bi, gout, and even cerebrovascular diseases like stroke. The “Huangdi Neijing” repeatedly mentions that “wind is the chief of all diseases”, which highlights its significance. Tang physician Sun Simiao in the “Qian Jin Yao Fang” (Essential Prescriptions Worth a Thousand Gold) emphasizes the diseases caused by various winds and provides formulas for prolonging life. For internal injuries and miscellaneous diseases, any condition involving pathological changes in blood vessels and glands, such as cerebrovascular diseases, diabetes, hypertension, coronary heart disease, and even depression, can be treated with wind-dispelling therapies within the framework of syndrome differentiation and treatment, which is a targeted treatment based on the body’s response to disease.
Wind and cold are often mentioned together; cold manifests in the body as spasm of large blood vessels. External cold arises from exposure to cold, while internal cold occurs without exposure, leading to vascular spasms. Internal cold is due to reduced effective blood circulation and decreased cellular function, thus deficiency cold often coexists. Clinically, deficiency cold represents a state of reduced body function.
Written by | Zhao Jie, Shanxi Integrated Traditional Chinese and Western Medicine Hospital Editor | Li Rui Review | Hai Xia, Bai Xiaoyun