Library

[Qian Yi] Generally speaking, smallpox and measles belong to Yang syndromes. Eruption is considered a favorable course (Shun), so onset in spring and summer is favorable, while onset in autumn and winter is unfavorable (Ni). In winter, when Kidney Qi is prosperous and cold is severe, the disease often relates to the Kidney and manifests as blackening of the lesions. One must also distinguish between eruptions of pustules in spring, black depression in summer, papules in autumn, and macules in winter; these are also not favorable. It is good if the lesions appear in only one type. If pustules appear first followed by macules, it is favorable. If vesicles appear first followed by macules, it is unfavorable. If pustules appear first followed by many vesicles, it is favorable; if few, it is unfavorable. If vesicles appear first followed by many papules, it is unfavorable; if few, it is favorable. If macules appear first followed by papules, it is favorable. If pustules appear first followed by papules, it is unfavorable. (Haizang stated that this sentence suffices to know that mixed eruptions indicate the harmonization of the Five Zang organs but lack uniformity, making medication difficult. The previous assertion states: Each of the five colors corresponds to the Five Zang organs; there may also be two colors combined or three colors, with no fixed rule. This is similar in general intent to the differences in pus/water content, size of macules/papules, and their sequence of favorability/unfavorability.)

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 eruption and retraction. Generally, in spring and summer, Yang Qi arises, and eruption is favorable; in autumn and winter, Yang Qi hides, and eruption is unfavorable. This is the favorability/unfavorability of seasonal timing. Constipation of urine and stool with ability to eat indicates Excess syndrome and is favorable; free passage of urine and stool with inability to eat indicates Deficiency syndrome and is unfavorable. This is the favorability/unfavorability of deficiency and excess. Eruption is favorable; involution (Dao Ye) and depression are unfavorable. This is the favorability/unfavorability of eruption and retraction.

[Wan Quan] Spring and summer being favorable, autumn and winter being unfavorable, this merely discusses the principles of growth and storage. How can it be that all spring and summer cases are favorable and auspicious, while all autumn and winter cases are unfavorable and ominous? If spring fails to support generation and summer fails to support growth, then spring and summer are also unfavorable. If autumn supports gathering and winter supports storing, then autumn and winter are also favorable. Only when smallpox erupts uniformly, with appropriate density and without delay in timing, is it a sign of a favorable course. When smallpox erupts mixedly, accompanied by pustules and macules, densely packed without gaps, and frequently missing the proper timing, it is a sign of an unfavorable course. Alas! The ancients said spring and summer are favorable, autumn and winter are unfavorable. Was this truly rigid adherence to seasonal theories? Essentially, spring and summer are seasons of generation, while autumn and winter are seasons of harvesting and killing. Smallpox that rises and develops obtains the command of spring and summer, hence it is favorable; that which depresses and sinks obtains the command 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 in autumn (Fire overcomes Metal), and macules in winter (Earth overcomes Water) are unfavorable. This is unscientific talk. Black depression is untreatable 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 solid, they are all favorable. If such symptoms occur in season, and Qi is weak and Blood deficient, with Zang-Fu organs exhausted, they are all unfavorable. Ancient authors wrote some works to generalize broadly and others to state facts directly. One should infer the author's intent from their words, not let the words obscure the intent. Qian was the ancestor of pediatric medicine and a sage among physicians, unsurpassed. His writings should theoretically be beyond reproach, 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 macules is favorable, due to the mutual generation of Spleen and Lung." "Macules first, then papules is favorable, due to the mutual generation of Heart and Spleen." "Vesicles first, then macules is unfavorable, due to Liver overcoming Spleen." "Pustules first, then papules is unfavorable, due to Heart overcoming Lung." "Pustules first, then many vesicles is favorable, few is unfavorable, due to Liver excess and Lung deficiency, where Wood attacks weakened Metal." "Vesicles first, then many papules is unfavorable, few is favorable, due to offspring weakness and mother prosperity being favorable, while Fire attacking weakened Wood is unfavorable." These are all broad generalizations.

He stated: "If lesions appear in only one type, it is good." This states the fact directly. The four types of toxins (smallpox, macules, pustules, vesicles) erupt at different times. Pustules are most severe, macules next, vesicles next, and papules lightest. If separated into four stages, the toxin is mild; if erupted together mixedly, the toxin is severe.

Regarding the statement: "Spring and summer are favorable, autumn and winter are unfavorable. Spring pustules, Metal overcomes Wood. Summer black depression, Water overcomes Fire. Autumn papules, Fire overcomes Metal. Winter macules, Earth overcomes Water." This is also a broad generalization. He stated: "Black lesions, regardless of time, ten cases save one or two." This states the fact directly. Generally, the four toxins often erupt driven by abnormal Qi of heaven and earth, resembling epidemic Qi transmission, which seasonal timing cannot control.

It is also said: "In winter, Kidney Qi is prosperous and cold is severe, so 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's statement that "spring and summer are favorable, autumn and winter are unfavorable" is because lesions belong to Yang, spring and summer are Yang, and autumn and winter are Yin. Following the Qi makes it favorable; opposing it makes it unfavorable. He merely wished for people to maintain warmth and follow the transformation of spring and summer, without rigidly stipulating that a specific symptom must be favorable in a specific season. For example, regarding the theory of winter blackening, if all winter eruptions turned black and caused death regardless of severity, the Qi of heaven and earth would not be so narrow-minded, nor would Qian's intent be so rigid. He simply meant that in winter, severe cold closes the pores (Cou Li), stagnates Qi and Blood, and without warmth, the lesions cannot mature. Why attribute blackening solely to the Kidney and exclusively to winter? In summer, heat opens the pores and makes Qi and Blood fluid; there are also cases of blackening returning to the Kidney causing death. Why not speak of summer black depression? If one argues that summer Fire is prosperous 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.