Six Excesses (六淫) Variable Yang External & Internal

Wind as a pathogen

风邪 Fēng Xié · Wind as a Pathogen
Also known as: External Wind · Wind Evil · Pathogenic Wind · Feng · Wind Pathogen · Exogenous Wind

Wind (Feng) is the most important of the Six Excesses in TCM, considered the 'leader of all pathogens' due to its ability to invade the body rapidly and carry other pathogenic factors. It is characterized by sudden onset, rapid change, and movement-like symptoms such as tremors, itching, and wandering pain.

Key Properties

Light and Rising (轻扬) Opening and Dispersing (开泄) Rapid Movement (善行) Constant Change (数变) Causes Movement (主动)

Season

Spring

Body Layers

Wei (Defensive)

风邪

Fēng Xié

Wind as a Pathogen

Nature & Properties

Thermal Nature

Variable

Yin-Yang

Yang

Season

Spring

Educational content · Consult qualified TCM practitioners for diagnosis and treatment

Overview

Wind (Fēng 风) holds a unique position in Traditional Chinese Medicine as the most significant of the Six Excesses (六淫, Liù Yín) — the six climatic factors that can cause disease when excessive. TCM regards Wind as the "leader of the hundred diseases" (百病之长) because it serves as the primary vehicle through which other pathogenic factors enter the body.

In nature, wind is invisible yet powerful, moving rapidly and unpredictably. TCM applies this same understanding to Wind as a pathogen: it invades quickly, changes constantly, and affects the body in ways that mirror wind in the natural world — causing symptoms that move, shift, and fluctuate.

Wind can be either External Wind (外风, wài fēng), which invades from outside through the skin and pores, or Internal Wind (内风, nèi fēng), which arises from internal imbalances, particularly involving the Liver. Both share the characteristic of causing movement-related symptoms such as tremors, spasms, and wandering symptoms.

Historical Context

The concept of Wind as a pathogenic factor dates back to the foundational texts of Chinese medicine. The Huangdi Neijing (Yellow Emperor's Classic of Internal Medicine) established Wind's primacy, stating in the Suwen: "Wind is the leader of the hundred diseases." During the Han Dynasty (206 BCE–220 CE), the six pathogenic factors were formally categorized together.

Initially, physicians attributed most acute illnesses, including what we now call stroke (中风, zhōng fēng, literally "Wind Strike"), to external Wind invasion. However, during the Song (960-1279 CE) and Yuan (1279-1368 CE) dynasties, clinical experience revealed that external Wind treatment alone was insufficient for stroke. This led to the development of the theory of Internal Wind — the idea that the body can generate its own "wind" from internal imbalances, fitting the ancient Chinese view of the body as a microcosm of the universe.

Defining Characteristics

Yang Pathogen

阳邪

Wind is classified as a Yang pathogen due to its ascending, outward-moving, and dispersing nature. It naturally rises upward, which is why Wind-related symptoms often affect the upper body first — the head, face, and upper back.

Opening and Dispersing

开泄

Wind has the ability to "open" the pores of the skin, disrupting the body's protective barrier (Wei Qi). This explains why Wind invasion commonly causes sweating and sensitivity to drafts — the pores lose their normal regulation.

Rapid Movement and Change

善行数变

"Shan xing" (善行) means Wind moves quickly through the body with no fixed location. "Shu bian" (数变) means symptoms change rapidly and unpredictably. This explains wandering joint pain, rashes that appear and disappear, and conditions that evolve quickly.

Causes Movement

主动

Wind causes things to move that should be still. In the body, this manifests as tremors, twitching, spasms, convulsions, and dizziness — symptoms characterized by involuntary movement or a sensation of movement.

Leader of Pathogens

百病之长

Wind rarely acts alone. It serves as the "carrier" or "vehicle" for other pathogenic factors like Cold, Heat, Dampness, and Dryness, facilitating their entry into the body. This is why most external invasions are named "Wind-Cold," "Wind-Heat," etc.

Entry Routes

Wind enters the body primarily through two routes:

  • Skin and Pores (皮毛腠理): Wind penetrates through the skin surface, particularly when the pores are open (after sweating, during sleep, or when Wei Qi is weak)
  • Nose and Mouth (口鼻): Wind can enter through the respiratory passages

Certain areas are especially vulnerable to Wind invasion: the back of the neck, upper back, and the acupoints with "Wind" (风) in their names — Fengchi GB-20 (Wind Pool), Fengfu DU-16 (Wind Mansion), and Fengmen BL-12 (Wind Gate). These points are located where the body's defenses are considered thinnest.

Progression Pattern

Body Layers Affected

Wei (Defensive)

External Wind typically progresses through the body in stages if not expelled:

  1. Surface/Wei Level: Initial invasion affects the exterior — mild fever, chills, headache, nasal symptoms
  2. Deeper Penetration: If not resolved, Wind can carry pathogens deeper into the channels and eventually the organs
  3. Latent Pathogen: Wind (especially with Cold) can remain dormant in the body, emerging later when conditions favor its activation

Internal Wind follows a different course, typically arising from:

  • Liver Yang Rising transforming into Wind
  • Extreme Heat generating Wind (热极生风)
  • Blood or Yin Deficiency failing to nourish and anchor, allowing Wind to stir

Clinical Relevance

Understanding Wind as a pathogen has immediate practical applications in clinical TCM:

Acute Conditions: Wind is central to understanding and treating the common cold, flu, and acute respiratory infections. Determining whether a patient presents with Wind-Cold or Wind-Heat guides formula selection and treatment timing — these conditions require prompt treatment before the pathogen penetrates deeper.

Chronic Conditions: Many chronic diseases have a Wind component. Allergic conditions (asthma, eczema, urticaria), autoimmune disorders, and neurological conditions often involve Wind patterns. The wandering, unpredictable nature of symptoms in conditions like rheumatoid arthritis or multiple sclerosis reflects Wind's influence.

Stroke Prevention: The Chinese term for stroke (中风, zhōng fēng, "Wind Strike") reveals the traditional understanding of this condition as Internal Wind. Managing Liver Yang, nourishing Yin, and calming Wind are key strategies for patients at risk of stroke.

Dermatology: Skin conditions with itching, rashes that move or appear suddenly, and urticaria (literally called 风疹, fēng zhěn, "wind rash") are treated with Wind-expelling formulas.

Common Manifestations

Aversion to Wind

A characteristic discomfort or sensitivity when exposed to drafts or breezes, often accompanied by a desire to cover up

Sweating

Spontaneous sweating due to Wind opening the pores and disrupting the body's ability to regulate perspiration

Headache

Head pain, especially in the occipital region or vertex, as Wind naturally rises to affect the upper body

Nasal Congestion

Stuffy nose, runny nose, or sneezing as Wind affects the Lung's opening (the nose)

Itching

Skin itching, especially with rashes that move around or appear suddenly — Wind "stirring" in the skin

Wandering Pain

Joint or muscle pain that moves from place to place rather than staying fixed — characteristic of Wind Bi (painful obstruction)

Tremors and Spasms

Muscle twitching, facial tics, convulsions, or trembling due to Wind's "stirring" nature

Dizziness

A sensation of spinning or unsteadiness, as if moved by wind — especially in Internal Wind patterns

Tongue Manifestations

Wind itself does not typically cause distinctive tongue changes. The tongue presentation depends primarily on what Wind is combined with:

  • Wind-Cold: Thin white coating, pale tongue body
  • Wind-Heat: Thin yellow coating, red tongue tip and edges
  • Internal Wind (Liver Wind): Red tongue, especially on the sides; may be trembling or deviated

A trembling tongue is particularly significant, as it reflects the movement characteristic of Wind affecting the body.

Pulse Manifestations

The characteristic pulse for Wind patterns is floating (浮脉, fú mài), indicating the pathogen is at the surface level. As Wind combines with other pathogens, the pulse quality varies:

  • Wind-Cold: Floating and tight (浮紧)
  • Wind-Heat: Floating and rapid (浮数)
  • Internal Wind: Wiry (弦脉) — the classic Liver pulse, often combined with rapid if Heat is present

Common Pathogen Combinations

The most common combination in external invasions. Wind carries Cold through the open pores into the body. Presents with strong chills, mild fever, no sweating, headache, body aches, and stiff neck. Treated with warm, acrid herbs to release the exterior.

Wind combines with Heat, often in warm seasons or transforming from Wind-Cold. Presents with fever greater than chills, sore throat, slight sweating, thirst, and headache. Treated with cool, acrid herbs to disperse Wind and clear Heat.

When Wind carries Dampness, it often lodges in the muscles and joints, causing the type of painful obstruction syndrome (Bi) with heavy, achy, wandering joint pain. Also causes skin conditions with oozing and itching.

Common in autumn. Wind combines with Dryness to affect the Lungs and skin. Manifests as dry cough, dry throat, dry skin, and cracked lips. The Lungs are particularly vulnerable to this combination.

Differentiation from Similar Pathogens

External Wind vs. Internal Wind:

  • External Wind involves acute onset, exterior symptoms (aversion to wind, fever, chills), and signs of pathogen invasion. It responds to releasing/expelling treatment methods.
  • Internal Wind arises from chronic internal imbalance (Liver Yang, Blood/Yin deficiency, extreme Heat). Symptoms focus on movement disorders: tremors, convulsions, paralysis, dizziness. Treatment focuses on the underlying deficiency or excess.

Wind vs. Heat:

  • Both can cause symptoms that appear suddenly, but Heat causes sustained fever, thirst, and redness, while pure Wind causes changing symptoms and movement

Wind-Cold vs. Wind-Heat:

  • Wind-Cold: Chills predominate over fever, no sweating, no sore throat, clear nasal discharge
  • Wind-Heat: Fever predominates, some sweating, sore throat, yellow nasal discharge

Treatment Principles

The fundamental principle for treating External Wind is to release the exterior and expel Wind (解表祛风). The specific approach depends on what Wind has combined with:

  • Wind-Cold: Use warm, acrid herbs to release the exterior (辛温解表) — promote sweating to drive out the pathogen
  • Wind-Heat: Use cool, acrid herbs to disperse Wind-Heat (辛凉解表)
  • Wind-Dampness: Expel Wind and resolve Dampness (祛风除湿)

For Internal Wind, treatment addresses the root cause:

  • Liver Yang Rising: Subdue Liver Yang, nourish Yin
  • Extreme Heat: Clear Heat to extinguish Wind
  • Blood/Yin Deficiency: Nourish Blood and Yin to anchor Wind

Key additional principles include strengthening Wei Qi (defensive energy) to prevent re-invasion and avoiding exposure to wind during recovery.

Representative Formulas

Gui Zhi Tang

Cinnamon Twig Decoction — classic formula for Wind-Cold invasion with sweating; harmonizes Ying and Wei

Ma Huang Tang

Ephedra Decoction — for stronger Wind-Cold invasion without sweating; opens the exterior to expel pathogen

Sang Ju Yin

Mulberry Leaf and Chrysanthemum Drink — for mild Wind-Heat affecting the Lungs with cough

Yin Qiao San

Honeysuckle and Forsythia Powder — primary formula for Wind-Heat invasion with sore throat

Tian Ma Gou Teng Yin

Gastrodia and Uncaria Drink — subdues Liver Yang and extinguishes Internal Wind

Representative Points

GB-20

Fengchi

Wind Pool — primary point for expelling Wind from the head and neck; treats headache, stiff neck, common cold, and dizziness
DU-16

Fengfu

Wind Mansion — where Wind enters the brain; expels Wind, benefits the head and neck
BL-12

Fengmen

Wind Gate — releases the exterior and expels Wind; often treated with moxa for prevention
LI-4

Hegu

Joining Valley — command point for the face and head; releases the exterior, expels Wind-Heat
SJ-5

Waiguan

Outer Pass — releases the exterior, expels Wind-Heat; often combined with GB-20

Classical Sources

Huangdi Neijing (黄帝内经)

Suwen, Chapter 42 - Feng Lun (Wind Treatise)

风者，善行而数变

Wind is characterized by constant movement and frequent change

Huangdi Neijing (黄帝内经)

Suwen, Chapter 60 - Gu Kong Lun

风者，百病之长也

Wind is the leader of the hundred diseases

Huangdi Neijing (黄帝内经)

Suwen, Chapter 29 - Tai Yin Yang Ming Lun

伤于风者，上先受之

When injured by Wind, the upper body is affected first

Shanghan Lun (伤寒论)

Tai Yang Bing (Greater Yang Disease)

太阳病，发热，汗出，恶风，脉缓者，名为中风

Tai Yang disease with fever, sweating, aversion to wind, and moderate pulse is called 'Wind Strike'

Modern References

The Concept of Wind in Traditional Chinese Medicine

Dashtdar M, et al. (2016)

Comprehensive review of Wind theory published in Journal of Pharmacopuncture; examines historical development and clinical applications

Chinese Acupuncture and Moxibustion

Cheng Xinnong (2010)

Standard textbook covering Wind pathology in the context of external pathogens and treatment strategies

The Foundations of Chinese Medicine

Giovanni Maciocia (2015)

Detailed explanation of External and Internal Wind, their differentiation, and clinical relevance for Western practitioners