典藏书目

Diseases have distinctions between the *biao* (branch/symptom) and the *ben* (root/cause), and treatment has a sequence of priority. Therefore, some cases are treated by addressing the *biao*, some by addressing the *ben*, some treat the *biao* first and then the *ben*, some treat the *ben* first and then the *biao*, and some employ simultaneous treatment of both *biao* and *ben*. In all instances, one must carefully assess the urgency of the condition to determine the appropriate sequence.

For example, in the case of smallpox (*dou chuang*), if viewed from the perspective of the human body as a whole, then Qi and Blood (*Qi Xue*) constitute the *ben*, while the pustules/rash constitute the *biao*; however, if viewed from the perspective of the rash itself, then the rash is the *ben*, and other accompanying symptoms are the *biao*. If the pustules are densely packed, this is indeed a disease of the *biao*. Yet, if observation reveals uneven Qi flow or incomplete Blood circulation, one should employ methods to harmonize Qi, invigorate Blood, and simultaneously detoxify. When diarrhea persists for a long time and gradually evolves into a critical syndrome (*huai zheng*), one should employ methods to rescue the interior (*jiu li*) and release the exterior (*biao biao*), treating both simultaneously. These two scenarios exemplify "simultaneous treatment of *biao* and *ben*."

If Qi and Blood are sufficient, but the toxin is stagnant and obstructed, preventing eruption, one should solely employ methods to support the interior (*tuo li*) and detoxify. If the disease severity is extreme, with severe swelling and pain in the throat, one should solely focus on clearing and benefiting the throat. If there is constipation of both urine and stool, restlessness, thirst, and wheezing/calling out, one should solely focus on purging the bowels/bladder. These four scenarios exemplify "treating the *biao* in acute situations" (*ji ze zhi qi biao*).

If the pustules have already begun to rise, but there is Qi deficiency, one should tonify Qi; if there is Blood deficiency, one should tonify Blood. This exemplifies "treating the *ben* in chronic or non-acute situations" (*huan ze zhi qi ben*).

If the disease severity is extreme with persistent restlessness and thirst, one should primarily detoxify while simultaneously addressing the thirst; this is "treating the *ben* first and then the *biao*." If the pustules sink inward accompanied by diarrhea, one should first rescue the interior and later attack the exterior; this is "treating the *biao* first and then the *ben*." The principles of *biao* and *ben* can be thus expanded upon, ensuring clarity and order.

The method for treating smallpox emphasizes caution at the beginning and foresight regarding the outcome, thereby avoiding future regret. Thus it is said: The superior physician treats disease before it arises; the average physician treats disease as it is about to arise; the inferior physician treats disease after it has arisen. Treating disease before it arises yields success in 80-90% of cases; treating disease as it is about to arise yields success in 40-50% of cases; treating disease after it has arisen leaves little room for efficacy.

Therefore, at the initial stage of fever, when high fever, severe thirst, constipation, abdominal and lower back pain, dry nose, dry lips, palpitations, and delirium occur, this indicates that toxic factors (*du wa*) are stagnated internally. One must prevent them from remaining latent and failing to erupt. If vomiting and diarrhea persist, one must prevent weakness of the Middle Jiao (*Zhong Qi*), which would fail to assist in the maturation of the pustules, potentially leading to sinking or inversion (*dao xian*). Thus, fever is resolved via releasing methods, constipation is relieved via purgation, palpitations are calmed, and vomiting/diarrhea are stopped.

Furthermore, the emergence of a small amount of blood initially corresponds to the Spring Qi, representing the command of generation. The rising of the pustules corresponds to the Summer Qi, representing the command of growth, where fluids transform into pus. The maturation of the lesions corresponds to the Autumn Qi, representing the command of completion. The drying and crusting of pus corresponds to the Winter Qi, representing the command of storage.

If fluid appears immediately upon eruption, or if the pustules fill with pus before fully rising, or if they crust over immediately after forming pus, this represents "arrival before the proper time," termed "excess" (*tai guo*). One must guard against inevitable sinking, inversion, or premature crusting, as these are not normal signs. Urgent use of exterior-releasing and interior-supporting detoxification methods is required.

Conversely, if eruption fails to occur when expected, rising fails to occur, filling with pus fails to occur, or crusting fails to occur, this represents "failure to arrive when expected," termed "deficiency" (*bu ji*). This necessarily indicates deficient Blood and weak Qi. One must immediately prevent failure to erupt, rise, or form pus, and avoid ulcerative lesions. Urgent use of exterior-releasing methods to promote rapid rising, along with tonifying and supporting methods to restore pus formation, combined with harmonizing Qi, invigorating Blood, assisting pus formation, and detoxifying, is required.

Moreover, if the color is bright upon initial eruption, the skin is likely tender; tender skin breaks easily, so one must prevent collapse due to itching. If lesions cluster into masses, this should not be mistaken for sparsity; one must prevent internal latent pathogens. If the pus is clear and thin, even if scabs form, one must prevent subsequent carbuncles or swellings. If the face and head swell prematurely, one must prevent easy resolution and sinking/inversion. If the throat hurts, one must resolve the heat to prevent loss of voice and choking. If defecation is frequent, one must prevent inverted crusting. If many vesicles appear in the center, one must prevent spontaneous diarrhea. If eyes are dry with tearing, one must prevent corneal nebula (*fu yi*). Preventing subtle signs and halting gradual progression is an excellent method for treating disease before it manifests.