Causes of Illness - 6 Evils or 6 Pernicious Influences

Causes of Illness - 6 Evils or 6 Pernicious Influences

The evils are external in origin, but can penetrate deeply into the body.

The Six Evils are:


(Associated with Liver, Wood, Spring, Yang evil)

Wind is involved with movement and activity, and brings other evil Qi in with it. It is the most important evil as it is the cause of the "100 diseases".

Disperses Qi upward and outward

  • Yang energy wants to rise and expand
  • Illnesses manifest in upper and outer parts of the body in early stage: head, sense organs and skin
  • Rashes Common: itchy, come and go quickly, spread quickly
  • Sweating common: causes opening of pores (Qi and fluids lost)

Rapid onset and rapid changes

  • Acute illnesses with rapid progression such as fever, infectious diseases

Creates abnormal or sudden movement

  • spasms, convulsions, twitches

Creates abnormal positions

  • Stroke
  • Stiff neck with flu

Most common in spring

Wind Syndromes - External Wind

1.) Wind-Cold

  • chills more than fever
  • aversion to cold
  • occipital headache
  • stiff neck
  • sneezing
  • mucous will be clear and copious
  • runny nose
  • body aches that move around
  • tongue: slightly pale, thin white coat

Excess Type External Wind

  • Little or no sweating
  • pulse: floating, slow, tight
  • Wei Qi is strong so pores are held closed
  • warm relieve surface treatment is used to sweat
  • out evil and excess Wind and Cold
  • Ma Huang Tang

Xu Type External Wind

  • Sweating
  • Pulse: floating, slow, Xu
  • Wei Qi is weak. There is sweating but it does not release the Exterior
  • Harmonize Ying and Wei Qi. Ying nourishes Wei to gently strengthen it, without tonifying Evil Qi
  • Gui Zhi Tang

2.) Wind-Heat

  • fever more than chills
  • sore throat
  • cough with thick, yellow mucous
  • thirst for cold drinks
  • frontal headache; can be stronger, pounding (Yang Ming)
  • redness or inflammation of eyes
  • sinusitis
  • earache
  • red face
  • Pulse: Floating, rapid
  • Tongue: slightly red in early stage, yellow coat, thorns on lung area

3.) Wind-Damp

  • sensitivity to wind
  • fever and chills with fever more pronounced in the afternoon
  • strong body aches
  • body and head feel heavy
  • copious phlegm - runny nose, congestion, stuffiness, sinusitis
  • sinus headache
  • foggy headed, difficult thinking
  • Pulse: slippery
  • Tongue: swollen, likely to be a thick coat, could be greasy

4.) Wind-Damp Bi Pain

  • Arthritis, nerve pain, and numbness that is worse with cold and damp
  • weather
  • Pulse: slippery
  • Tongue: swollen, thick coat
  • Treat by opening channels and mildly relieving surface

5.) Wind-Water

  • disruption of Jin-Ye
  • anything with sudden Edema
  • acute onset
  • frequently occurs in the face
  • Treat by relieving surface, eliminating water
  • causes include allergic reaction, rash, acute nephritis
  • Pulse: slippery
  • Tongue: swollen, greasy coat

6) Wind-Rash

  • acute onset
  • moves around to different parts of body
  • will appear and disappear
  • Pulse: floating, rapid
  • Tongue: red with yellow coat

Wind Syndromes - Internal Wind

  • Associated with the Liver, and causes diseases of shaking and abnormal body positions.
  • It is usually chronic, where external wind is usually acute.
  • It combines easily with phlegm, as in Deviation (Wind blows it out of position and the phlegm makes it stick in an abnormal position).

Symptoms of Internal Wind

  • spasms and abnormal muscle contractions
  • convulsions
  • Parkinson's
  • post-stroke sequelae
  • seizures(epilepsy)
  • shaking from anger
  • migraine (Wind blowing in head)
  • Pulse: wiry usually rapid
  • Tongue: shaking or deviated

Causes of Liver Wind

Excess fire affecting the Liver

  • Fire creates Wind
  • enters the Blood level
  • high fever (diseases such as meningitis)
  • poisons, toxins, radiation, drugs, alcohol
  • constitutional Liver Fire
  • Pulse: rapid, wiry, excess
  • Tongue: red, yellow coat; shaking or stiff

Liver Yin Xu, Yang Kan - Long-standing Yin deficiency with Heat

  • long term use of drugs, alcohol
  • chronic Yin Xu fevers
  • Pulse: Wiry, rapid, thin
  • Tongue: red, no coat, shaking

Liver Blood Deficiency

1) Blood Xu makes Heat
2) Blood not nourishing the "General"

  • Numbness of limbs common
  • Pulse: thready or hollow
  • Tongue: pale with white or yellow coat

Liver wind mixing with Phlegm

Wind blows it into an abnormal position and phlegm makes it stick. It affects Liver (Wind) and Heart (Phlegm misting). There is rigidity especially of limbs, neck, tongue, and stiffness in tongue (May affect the Speech)

Neurological conditions

  • brain disorders
  • Alzheimer's, senility
  • Stroke
  • brain tumors

Fire and Phlegm occurring together

  • more sweating than with internal wind alone
  • rapidly changing emotions
  • commonly occurs with long term alcohol and drug use
  • red face
  • Pulse: Rapid, slippery, full
  • Tongue: red, particularly at tip, may be skewed to one side


(Associated with Kidney, Winter, Water element, Yin evil)
  • Damages the Yang
  • Impairs ability to maintain body temp
  • Weakens and slows life activities
  • Feeling of cold
  • Symptoms better with warmth
  • causes Qi and Blood to contract and congeal which creates stagnation, pain, stiffness
  • Easily effects the low back and knees, joints
  • Easily effects the Stomach, Intestines, Liver
  • Thin, watery, pale, cold discharges urine, stools, blood etc.

Syndromes of Cold

Wind Cold
  • chills more than fever
  • aversion to cold
  • occipital headache
  • stiff neck
  • clear copious phlegm
  • runny nose
  • sneezing
  • mild body aches

    Excess type

    • little or no sweating
    • Pulse: Floating, slow, tight
    • Tongue: slightly pale, thin white coat

    Deficiency type

    • sweating
    • Pulse: Floating, slow, Xu
    • Tongue: slightly pale, thin white coat

Cold attacking the Spleen and Stomach

Looks like spleen Qi Xu but the cause is external (Examples are living by the ocean or eating cold foods). Phlegm and Dampness can also collect and cause dizziness.

  • diarrhea
  • loose stools
  • watery stools
  • bloating
  • poor digestion
  • nausea
  • vomiting
  • stomach or abdominal pain that is worse with cold
  • loss of appetite
  • fatigue
  • Pulse: slow
  • Tongue: pale

Cold evil damaging both spleen and Kidney Yang

Can be acute, as in hypothermia, or chronic, as in a cold climate damaging spleen and kidneys.

Symptoms as in previous syndrome with:

  • watery stools
  • undigested food in stools
  • bird stools
  • aversion to cold
  • feeling of cold in entire body
  • profuse urination or edema
  • strong fatigue
  • pale face
  • possibly green or purple lips
  • Purple or black under eyes if the Kidney Yang is damaged
  • Pulse: slow, weak
  • Tongue: pale, white coat, tooth marks

Cold contracting the Qi and Blood

Cold slows circulation, contracts, congeals, stagnates

Liver Qi Stagnation

  • abdominal bloating
  • depression, irritability
  • Pulse: wiry
  • Tongue: light purple

Blood stagnation

  • pain that is sharp, stabbing, needle-like, constant
  • purple lips, complexion etc.
  • Pulse: choppy
  • Tongue: deep purple, possibly purple spots

Wind cold damp Bi pain

  • arthritis (more commonly Osteoarthritis) with cold, stiff, contracted joints
  • sensitivity to cold is strongest symptom
  • can be nerve or muscle involvement
  • symptoms better with warm weather, heat therapy, saunas

Cold contracting the liver meridian

  • pain on inside of legs, genital area along liver meridian
  • severe menstrual pain
  • endometriosis
  • hernia
  • muscular problems i.e. groin pull
  • testicular problems
  • sperm production
  • may be infertility
  • will exhibit signs of liver blood stagnation
  • Pulse: choppy
  • Tongue: pale and purple


(Associated with spleen, late summer, Earth element, Yin evil)

Dampness is heavy, tenacious, difficult to treat, and lasts a long time. It tends to move downwards in the body.

Sticky, greasy, oily, dirty, bad smell

  • "looks like water or mud, "looks and smells dirty
  • greasy hair and face
  • greasy skin: acne, pus, oozing wound
  • mucous or discharge anywhere in body
  • bad body odor, bad breath, smelly perspiration
  • bad smelling diarrhea with mucous (if mixed with heat, there can be cloudy urine)
  • thick or bad smelling vaginal discharge as in STD
  • copious nasal discharge
  • edema or swelling
  • arthritis with swollen joints
  • fluid coming out of anywhere
  • candida, fungus, yeast

Damages the Yang of body

  • worse in cold, damp weather
  • Spleen works to transform Damp; Kidney supports Spleen

Creates stagnation

  • Stagnate fluids will also stagnate Qi and Blood

Syndromes of Damp

Acute condition, but has the slowest onset of all winds. It is affected by damp and cold weather. Symptoms can reflect a respiratory infection with copious phlegm or a gastrointestinal flu.

  • strong generalized body aches
  • heavy feeling in head and body
  • foggy headed, unclear thinking, band headache
  • copious phlegm, can be runny or thick
  • sneezing
  • afternoon fever
  • nausea, vomiting
  • diarrhea, possibly with mucous
  • Pulse: slippery, slowing down pulse
  • Tongue: swollen with thick, greasy coat

Wind-Damp Bi pain

  • swelling of joints
  • edema
  • Pulse: slippery
  • Tongue: swollen with thick, greasy coat

Damp poison in skin

  • discharge: pus, carbuncles, boils, acne, oozing
  • infection after wound
  • warts, fungus, yeast

Damp heat

Infection or inflammation that can affect many places, such as the Liver, Gallbladder, Urinary Bladder, Intestines, Sinuses, etc.

"itis" Diseases

  • Bronchitis
  • Hepatitis
  • Vaginitis
  • Prostatitis
  • Colitis
  • Pulse: slippery, rapid (which quality is greater?)
  • Tongue: red, thick yellow coat, swollen (how thick, how swollen, how red?)

Internal dampness arising in the body

Dampness arising from Spleen Xu: Dampness is the main factor, the Xu is secondary. It often compromises immunity due to congestion of lymphatic system, autoimmune conditions in particular. If severe, it becomes Phlegm. A long term chronic situation is often due to damp, cold, raw foods.

Symptoms may be associated with a wide variety of diseases: Chronic Fatigue, Fibromyalgia, Candida, Lymphoma, Etc.

  • bloating
  • nausea
  • vomiting
  • diarrhea
  • heaviness of head and body
  • dizziness
  • low appetite


(Associated with the Heart, summertime, Fire element, Yang Evil)

Damages Yin

  • dries fluids, easily leads to Yin Xu

Heat rises

  • diseases most common on face, eyes, and nose

Causes redness

  • the more red, the more heat

Easily produces wind

  • when heat affects the Liver

Speeds things up

  • agitation, restlessness
  • can be bleeding: Blood moves so fast it leaves the vessels

Easily affects the skin

  • red, itchy, painful rashes

Syndromes of Heat


  • fever more than chills
  • sore throat
  • frontal headache (yang Ming channels)
  • big thirst
  • sinus infection
  • red eyes, conjunctivitis
  • cough with yellow, green or brown phlegm
  • Tongue: red and raised dots in lung area (thorns)
  • Pulse: rapid, floating

Damp Heat

  • Upper Jiao - Affects face and chest
  • Middle Jiao - Affects Spleen and Liver
  • Lower Jiao - Intestines, bladder, genitals, etc.

Excess Fire

Strong heat that reaches deep in to organs. It can have an external or internal origin.


  • big thirst
  • redness
  • restlessness
  • symptoms are loud and forceful (cough, diarrhea etc.)

Syndromes of Fire

Lung fire

  • can be loud, forceful cough with blood (fire has burnt off protection of mucous membranes so capillaries have burst)
  • mucous is yellow, green , brown
  • red, painful rash

Stomach fire

  • burning ulcer, heartburn)
  • Stomach channel problems: toothache (infection), frontal headache strong pain or burning on channel

Heart fire

  • strong anxiety
  • restlessness
  • insomnia
  • mania

Liver fire

  • anger
  • shingles in costal region
  • burning pain in genital area as from STD's

Large Intestine fire

  • dysentery
  • toothache (channel pain) -> Kidney fire
  • long term alcohol or drug abuse
  • bone infection
  • meningitis (affects Marrow)

Deficient Fire

Yin Xu, Yang Kan, Heat is deep in the body: Ying level. Pattern of mixed Xu and excess. Treatment must include quelling fire as well as nourishing yin

  • smoldering heat especially at night
  • low grade rashes
  • severe restlessness
  • slight bleeding
  • Tongue: scarlet
  • Pulse: thready, rapid

Summer Heat

(Associated with the Heart, Fire Element, Summer, Yang Evil)

Syndromes of Summer Heat

Summer heat

  • high fever
  • restlessness
  • thirst with strong desire to drink
  • can go up and affect the head
  • dizziness
  • blurred vision
  • headache
  • constipation
  • scant yellow urine
  • coma
  • Yin collapse
  • profuse sweating
  • Tongue: dry, red
  • Pulse: surging (flooding - strong, big waves)

Summer Heat combined with Dampness

A person with a Damp constitution experiencing Summer Heat, or a person who eats Damp foods in summer (ice cream, cold soda).

Dampness turns into phlegm because of heat

  • nausea
  • vomiting
  • loose stools or diarrhea
  • poor appetite and fatigue
  • phlegm can rise to head
  • dizziness
  • heavy head
  • foggy thinking
  • suffocating feeling in chest
  • tightness in chest
  • sweating, but not as much as Summer Heat without Dampness


(Associated with the Lung, Autumn, Metal Element, Yang evil)

Exterior in origin (not yin Xu, not internal)

Easily damages body fluids

  • Dry skin
  • Dry hair
  • Dry eyes
  • Dry lips
  • Dry throat or low grade sore throat
  • Dry stools
  • Scant urine
  • Thirst

Easily damages lungs

  • Could be from dry climate or smoking
  • Dry cough and dry phlegm (thick, sticky, hard to expel)

Syndromes of Dryness

Warm Dryness


  • Fever
  • Headache
  • Thirst
  • Dry Mouth
  • Dry Nasal Passages
  • Dry cough with Dry Phlegm
  • Tongue: red with thin or no coat
  • Pulse: rapid


  • acute: treat as wind-heat
  • chronic: tonify yin

Cool dryness (Example: Dried out from air conditioning)


  • Dry phlegm (thick, doesn't move)
  • Sensitive to cold
  • Chills
  • Mild fever
  • Headache
  • Dry cough
  • Dry mouth
  • Dry nasal passages with stuffiness
  • Tongue: thin, white
  • Pulse: tight, slow


  • Acute: Treat as wind-cold

References Used

The TCM information presented here has been referenced from numerous sources; including teachers, practitioners, class notes from Five Branches University, the following books, as well as other sources. If you have benefited from this information, please consider supporting the authors and their works by purchasing the books below.

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