Little Bai Langzhong: TCM Case Studies / Medical Discussions / Clinical Reference Articles for Learning TCM
Introduction: Have you ever thought about 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 on 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 Six Excess diseases has greatly advanced, and with recent case reports, there are even more methods to draw from. However, there are relatively few discussions on the impact of the Six Excesses on muscles and bones; Qing Dynasty physician Wang Yanchang’s description from the surface to the interior is 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.1Wind inthe skin causes rashes and itching in the muscles: Wind rashes between the skin and muscles cause itching, treated with 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 Chuanxiong), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Bai Xian Pi (Dictamnus), Chan Yi (Cicada Slough), Bo He (Mint), Du Huo (Angelica Pubescens), Chai Hu (Bupleurum), Hong Zao (Red Dates); remove Du Huo, add Sang Ye (Mulberry Leaf), and avoid cold and spicy heat herbs.In the tendons, it causes spasms: When wind prevails, it causes movement; when wind affects the tendons, it leads to spasms, which is an inevitable pathological change. There are two types: Wind Cold spasms are characterized by rigidity, while Wind Heat spasms are 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 (Selfheal Spike), Ye Jiao Teng (Fleeceflower Stem), 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, it causes creaking: Wind in the joints can cause creaking sounds during movement; medical texts mention that Bai Fu Zi (Typhonium) can treat this. I have no experience and will not speculate.2Cold in the skin causes shivering: Shivering, a cold sensation, often occurs with chills. For mild cases, use Su Ye (Perilla) and Fang Feng (Saposhnikovia); for severe cases, use Ma Huang (Ephedra) and Qiang Huo (Notopterygium), which can have a significant effect; if not resolved, consider other factors.In the muscles, it causes stiffness: Cold in the muscles can lead to localized stiffness, commonly treated with Ma Huang (Ephedra), Fu Zi (Aconite), and Xi Xin (Asarum) to expel cold evil and warm the Qi and blood. If it persists, use Da Huo Luo Wan (Major Activating Collaterals Pill). However, localized stiffness can also be due to stubborn phlegm or stagnant blood, requiring differentiation.In the tendons, it causes soreness: Cold in the tendons and muscles can be treated with Gui Zhi (Cinnamon Twig), Qiang Huo (Notopterygium), Fang Feng (Saposhnikovia), Qin Jiao (Gentiana), Bai Zhi (Angelica Dahurica), Lu Shi Teng (Lonicera), which are generally effective, especially when combined with self-massage for better results.In the bones, it causes pain: Cold evil causing painful obstruction is often treated with Xiao Huo Luo Wan (Minor Activating Collaterals Pill) to relieve pain and dispel cold, which is very effective.3Heat in the skin 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).In the muscles, it causes restlessness with sweating: Use Bai Hu Tang (White Tiger Decoction) with Bei Sha Shen (North American Ginseng), Lu Gen (Reed Rhizome), Xigua Zhi (Watermelon Peel), Lv Dou Yi (Mung Bean Pod).In the tendons, it causes weakness: Heat must be accompanied by dampness; this condition is a gradual weakness, treated with 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), Xigua Cui Yi (Watermelon Peel) with Gou Teng (Uncaria) and Sang Zhi (Mulberry Branch).In the bones, it causes weakness: This condition is a progression from mild to severe, treated in two steps: first with 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 Chen Pi (Tangerine Peel) must be added to disperse.4Dampness in the skin causes jaundice: For Yang Jaundice, use Yin Chen Hao Tang (Artemisia Yin Chen Decoction); for Yin Jaundice, use Yin Chen Shu Fu Tang (Artemisia Yin Chen Atractylodes Decoction) or Yin Chen Wu Ling San (Artemisia Yin Chen Five Poria Powder). According to clinical experience, after jaundice resolves, 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 Augment the Qi Decoction) for regulation.In the muscles, it causes swelling: For upper body swelling, induce sweating to dispel dampness, primarily using Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra Forsythia Red Bean Decoction); for lower body swelling, promote urination to dispel dampness, primarily using Wei Ling Tang (Stomach Poria Decoction).In the tendons, it causes 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 (Angelica Pubescens), Sang Ji Sheng (Mulberry Mistletoe), Fang Feng (Saposhnikovia), Qin Jiao (Gentiana), Xi Xin (Asarum), Chuan Xiong (Ligusticum Chuanxiong), 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 and Shu Di, and appropriately adding Er Miao Wan (Two Marvels Pill).In the bones, it causes heaviness: Heaviness primarily refers to sluggish movement, a characteristic of internal dampness. Generally treated with Ping Wei San (Harmonize the Stomach Powder) combined with Shu Di Tang (Atractylodes Decoction); if it persists, add Chuan Xu Duan (Chuan Xuduan), Gou Ji (Cibotium), Xi Xian Cao (Siegesbeckia).5Dryness in the skin causes dryness, in the muscles it causes stiffness: Autumn dryness generally first injures the lung, then the stomach fluids, and finally affects the liver blood and kidney yin. Lung fluid injury leads to dry skin, while stomach fluid depletion leads to muscle atrophy; for the former, use Sheng Xue Run Fu Yin (Blood Generating and Skin Moistening Decoction) — Er Di (Rehmannia), Er Dong (Dioscorea), Gui (Cinnamon), Qi (Astragalus), Tao Ren (Peach Kernel), Hong Hua (Safflower), Huang Qin (Scutellaria), Gua Lou (Trichosanthes), 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, it causes rigidity: Dampness leads to relaxation, while dryness leads to rigidity, a common pathological change; this condition should be treated with Zhi Zao Yang Rong Tang (Nourishing and Moistening Decoction) — Sheng Shu Di (Raw Rehmannia), Gui (Cinnamon), Shao (Peony), Huang Qin (Scutellaria), Gan Cao (Licorice), Qin Jiao (Gentiana), adding Sang Zhi (Mulberry Branch) 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 Berry), Cong Rong (Cistanche), Shu Di (Rehmannia), and Lu Jiao Jiao (Deer Antler Glue).In the bones, it causes soreness: Soreness indicates a feeling of aching pain, treated with blood nourishing and essence benefiting herbs. For nourishing blood, use Sheng Di (Rehmannia), Gui (Cinnamon), Shao (Peony), Ji Xue Teng (Spatholobus), and for benefiting essence, use Shu Di (Rehmannia), Qi Zi (Goji Berry), Gui Ban (Tortoise Shell), Yu Piao (Fish Bladder), Pig and Sheep Bone Marrow.6Fire in the skin causes burning: Burning, dryness, and a feeling of scorched hair are 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); remove Mang Xiao and Huang, and add fresh Sheng Di and Shi Gao (Gypsum).In the muscles, it causes pain: This pain should be observed from both local and systemic tendon areas; if localized, consider the initial onset of sores or heat boils, treated with Jin Jian (Five Flavor Disinfecting Decoction) — Yin Hua (Honeysuckle), Ye Ju Hua (Wild Chrysanthemum), Pugongying (Dandelion), Zihua Diding (Viola), Zibei Tian Kui (Purple Backed Tian Kui); if the pain is systemic, consider the onset of heat obstruction, treated with Sheng Di (Rehmannia), Gao (Glycyrrhiza), Zhi (Ziziphus), Huang (Scutellaria), Shao (Peony), Hu Zhang Gen (Polygonum Cuspidatum), Xihe Liu (Willow).In the tendons, it causes pain: Pain, a feeling of aching, is treated with heat obstruction methods; over time, prevent the condition from shifting from excess to deficiency, treated with Qing Yang Tong Luo (Clear and Nourish Collaterals) — Sheng Di (Rehmannia), Bai Shao (White Peony), Yu Zhu (Polygonatum), Tian Mai Dong (Ophiopogon), Sang Ji Sheng (Mulberry Mistletoe), Shen Jin Cao (Stretching Grass), Gou Teng (Uncaria), Zhu Li (Bamboo Juice).In the bones, it causes steaming: Fire in the bones often indicates either deficiency fire or hidden heat, with heat rising from within, termed “steaming,” which is a critical symptom; treated with Wu Zheng Wan (Five Steaming Pills) — Qing Hao (Artemisia Annua), Di Gu Pi (Lycium), Sheng Di (Rehmannia), Dang Gui (Angelica Sinensis), Shi Gao (Gypsum), Hu Lian (Corydalis), Gui Ban (Tortoise Shell); or Da Bu Yin Wan (Great Tonifying Yin Pill) — Zhi Mu (Anemarrhena), Huang Bai (Phellodendron), Shu Di (Rehmannia), Gui Ban (Tortoise Shell), Pig and Sheep Bone Marrow. Choose appropriately and take as a decoction. This condition has transitioned from the Six Excesses to internal injury, and 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. 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