Judging Cancer Prognosis by the TCM Surgical Doctrine of the Five Favourable and Seven Adverse Signs

TCM external medicine has long held the doctrine of the "five favourable and seven adverse signs" (wu shan qi e). This was summarized by ancient TCM surgeons in clinical practice to judge the prognosis of patients with abscesses, ulcers, and sores—that is, what we today call various benign and malignant tumors and ulcerative conditions.

The five favourable and seven adverse signs are various physical signs and symptoms presented by the patient. The five favourable signs indicate a favourable course and good prognosis; the seven adverse signs indicate an unfavourable course and poor prognosis.

For ease of memorization, later generations compiled the "five favourable and seven adverse signs" into a mnemonic verse:

"Know well the five favourable and seven adverse signs: The first is heart-favourable—bright spirits; the second is liver-favourable—light body and ease of movement; the third is spleen-favourable—moist lips; the fourth is lung-favourable—strong voice; and kidney-favourable—water and fire ascend and descend of themselves.

Now see what the seven adverse signs are: The first adverse—spirit clouded and heart restless, sore purple-black and muttering speech; the second adverse—stiff neck and squinting eyes, sore bleeding watery fluid and heart palpitations; the third adverse—wasted body and foul-smelling pus, sore sunken and soft with no pain felt; the fourth adverse—withered skin and hoarse voice, much phlegm and wheezing with flaring nostrils; the fifth adverse—thirsty wasting and dry mouth, black face and shrunken scrotum indicating kidney deficiency; the sixth adverse—edema, borborygmus and diarrhea, incontinence of stool showing organ decline; the seventh adverse—sore like a skinned eel, cold limbs and weeping sore.

Discern the five favourable and seven adverse signs clearly; prescribe cautiously and follow the good physician."

In the past, the "five favourable and seven adverse signs" was the gold standard that surgeons had to memorize to judge prognosis and choose treatment. A TCM surgeon had to be thoroughly familiar with it, or he would easily treat recklessly and trigger disputes.

Judging by the five favourable signs summarized by the ancients: in general, tumor and ulcer patients whose spirits are still good, who have little pain all over, whose lips and mouth are moist, whose appetite is decent, whose voice is normal, and whose urination and defecation are regular—such patients have considerable therapeutic value. Even if Western checks classify them as mid-to-late stage cancer, TCM still has many formulas that can help.

But if a patient has begun to show clouded consciousness, irritability, ruptured bleeding tumors, foul-smelling pus, convulsions and squint, rapid weight loss, faint hoarse voice, incessant wheezing, abnormal thirst, black face and shrunken scrotum, limb edema, borborygmic diarrhea, urinary or fecal obstruction, or tumors like skinned eels with cold limbs and weeping ulcers—the prognosis is very poor.

The seven adverse signs correspond to some symptoms we see today in terminal cancer patients—what Western medicine calls cachexia and wasting. Such patients usually have severe complications: pleural effusion and ascites, sharp weight loss, and some even have faces black as charcoal. Once disease has reached this stage, treatment becomes extremely difficult.

Although modern medicine has made some progress against cancer, the "five favourable and seven adverse signs" summarized by traditional TCM external surgeons still apply today for judging prognosis and guiding clinical prescribing.

In general, if fewer than four of the seven adverse signs appear, there is still therapeutic value; if five or more appear, the patient is near death. Both physician and family should understand that, in this situation, futile treatment should not be pursued, because it is simply wasteful—failing to save the patient and instead bringing unnecessary suffering.