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[Qian Yi's Discussion] Generally speaking, smallpox and measles belong to Yang syndromes; when they erupt outwardly, it is considered a favorable course (Shun). Therefore, contracting the disease in spring and summer is favorable, while contracting it in autumn and winter is unfavorable. In winter, when the Kidney (Zang organ) is at its peak and cold is severe, the disease often turns inward to the Kidney, manifesting as blackening (black eschar/depression). One must also distinguish between pustules appearing in spring, black depression in summer, papules/pustules in autumn, and maculopapular rash in winter; these are also not favorable courses. It is good if the eruption consists of only one type of lesion. If pustules appear first, followed by a maculopapular rash, it is a favorable course. If vesicles appear first, followed by a maculopapular rash, it is an unfavorable course. If pustules appear first, followed by many vesicles, it is favorable; if few, it is unfavorable. If vesicles appear first, followed by many papules/pustules, it is unfavorable; if few, it is favorable. If a maculopapular rash appears first, followed by papules/pustules, it is favorable. If pustules appear first, followed by papules/pustules, it is unfavorable. (Zhang Yuansu [Haizang] said: This statement alone is sufficient to know that mixed eruptions indicate the harmonization of various Zang organs but lacks uniformity, making medication difficult. The previous text stated: Each of the five colors corresponds to the five Zang organs; there may also be combinations of two colors or three colors, with no fixed pattern. This is similar in general intent to the differences in pus/water content, size of lesions, and their sequential favorable/unfavorable nature.) Once smallpox and measles have erupted, there are three aspects of favorable and unfavorable courses: those related to seasonal timing, those related to deficiency and excess, and those related to emergence and involution. Generally, in spring and summer, when Yang Qi arises, the eruption is favorable; in autumn and winter, when Yang Qi hides, the eruption is unfavorable. This refers to the favorable/unfavorable nature of seasonal timing. Constipation of urine and stool combined with the ability to eat indicates Excess (Shi), which is favorable; free urination and defecation combined with inability to eat indicates Deficiency (Xu), which is unfavorable. This refers to the favorable/unfavorable nature of deficiency and excess. Eruption outwardly is favorable; involution failure (Dao Ye, where pustules fail to crust properly and sink inward) and depression are unfavorable. This refers to the favorable/unfavorable nature of emergence and involution.

[Wan Quan's Discussion] Spring and summer are favorable, autumn and winter are unfavorable; this merely expounds the principles of growth, flourishing, harvesting, and storing. How can it be that all cases in spring and summer are favorable and auspicious, while all in autumn and winter are unfavorable and ominous? If one fails to nourish growth in spring and fails to nourish flourishing in summer, then spring and summer become unfavorable. If one can accommodate harvesting in autumn and accommodating storing in winter, then autumn and winter become favorable. Only when the eruption is uniform in type, with appropriate density, and does not miss its expected timing, is it a favorable syndrome. When the eruption is mixed, containing both pustules and rashes, dense without gaps, and frequently missing its timing, it is an unfavorable syndrome. Alas! The ancients' statement that "spring and summer are favorable, autumn and winter are unfavorable"—did they truly adhere rigidly to seasonal theories? Spring and summer are seasons of generation; autumn and winter are seasons of destruction. The eruption of smallpox, when it rises and develops, aligns with the energy of spring and summer, hence it is favorable; when it sinks and involutes, it aligns with the energy of autumn and winter, hence it is unfavorable. Is this not what is meant? Some say that pustules in spring (Metal overcomes Wood), black depression in summer (Water overcomes Fire), papules/pustules in autumn (Fire overcomes Metal), and rashes in winter (Earth overcomes Water) are unfavorable. This is unscientific talk. Black depression is difficult to treat in all four seasons, not just in summer. Therefore, if such symptoms occur out of season, and Qi and Blood are harmonious and Zang-Fu organs are robust, everything is favorable. However, if such symptoms occur in season, and Qi is weak and Blood deficient, with Zang-Fu organs exhausted, everything is unfavorable. Ancient authors wrote some texts to generalize broadly and others to state facts directly. One should infer the author's intent from the meaning, not let the words distort the intent. Qian Yi is the ancestor of pediatric medicine and a sage among physicians; none surpass him. His writings seem impeccable, yet there are parts that cannot be fully trusted, either because they are broad generalizations or additions by later generations. For instance, he stated: Pustules first, then rash is favorable, because Spleen and Lung generate each other. Rash first, then papules/pustules is favorable, because Heart and Spleen generate each other. Vesicles first, then rash is unfavorable, because Liver overcomes Spleen. Pustules first, then papules/pustules is unfavorable, because Heart overcomes Lung. Pustules first, then many vesicles is favorable, few is unfavorable, because excessive Liver (Wood) overcomes deficient Lung (Metal). Vesicles first, then many papules/pustules is unfavorable, few is favorable, because weak offspring (Fire) and strong mother (Wood) is favorable, while Fire overcoming weak Wood is unfavorable. These are all broad generalizations. He stated: "If the eruption consists of only one type, it is good." This states the fact directly. The four types of toxins (smallpox, rash, pustules, vesicles) erupt at different times; pustules are the most severe, rashes next, vesicles next, and papules/pustules the mildest. If they erupt in four separate waves, the toxin is mild; if they erupt together mixed, the toxin is severe. Regarding the statement "Spring and summer are favorable, autumn and winter are unfavorable": Pustules in spring represent Metal overcoming Wood; black depression in summer represents Water overcoming Fire; papules/pustules in autumn represent Fire overcoming Metal; rashes in winter represent Earth overcoming Water. This is also a broad generalization. He stated: "Black coloration, regardless of the time, saves one or two out of ten," which states the fact directly. Generally, the four toxins often erupt by taking advantage of abnormal seasonal Qi, resembling epidemic pathogens; seasonal Qi cannot control them. He also said: "In winter, when the Kidney is strong and cold is severe, the disease often returns to the Kidney and turns black." This was fabricated by later generations to supplement the idea that autumn and winter are unfavorable. Qian Yi said spring and summer are favorable, autumn and winter are unfavorable, because smallpox/measles belong to Yang, spring/summer are Yang, and autumn/winter are Yin. Following the Qi makes it favorable; opposing it makes it unfavorable. He merely wished for people to keep warm and follow the transformation of spring and summer, never rigidly stipulating that a specific syndrome must be favorable in a specific season. Take the theory of winter blackening: if all winter eruptions turned black and caused death regardless of severity, the Qi of Heaven and Earth would be too narrow. Qian Yi's intent was not so rigid. He simply meant that in winter, severe cold closes the pores, stagnates Qi and Blood, and without warmth, the eruption cannot mature. Why attribute blackening solely to the Kidney and winter? In summer, heat opens the pores and moistens Qi and Blood; there are also cases of blackening returning to the Kidney causing death. Why not mention summer black depression? If one argues that summer Fire is strong and the Kidney does not govern, then where does the statement "summer black depression is unfavorable" come from? Moreover, black depression as unfavorable applies to all four seasons, not just summer.