标本之道,要而博,小而大。不知标本,是谓妄治。
少阳从本为相火,太阴从中湿土坐,厥阴从
中火是家,阳明从中湿是我,太阳少阴标本从,阴阳二气相包裹。风从火断汗之宜,燥与湿兼下之可;万病能
将火湿分,掣开轩岐无缝锁。
天阳无圆,气上外升,生浮昼动,轻燥六腑;地阴有方,血下内降,杀沉夜静,重湿五脏。
夫治病者,当知标本。以身论之,则外为标,内为本;阳为标,阴为本。故六腑属阳为标,五脏属阴为
本。各脏腑之经络,在外为标,在内为本。更人身之气为标,血为本。以病论之,先发病为本,后传流病为标。
凡治病者,必先治其本,后治其标。若先治其标,后治其本,邪气滋甚,其病益蓄;若先治其本,后治其标,
虽病有十数,证皆去矣。谓如先生轻病,后滋生重病,亦先治轻病,后治重病。如是则邪气乃伏,盖先治本故
也。若有中满,无问标本,先治中满,谓其急也。若中满后有大小便不利,亦无问标本,先治大小便,次治
中满,谓尤急也。又如先病发热,加之吐利大作,粥药难入,略缓治热一节,且先定呕吐,渐进饮食,方兼
治泻;待元气稍复,乃攻热耳。此所谓缓则治其本,急则治其标也。(推其至理,先治其标,亦先治其本也。)
除大小便不利,及中满吐泻之外,其余皆先治其本,不可不慎也。假令肝受火之邪,是从先来者为实邪,实则
泻其子也。然非直泻其火,入肝经药为之引,用泻火为君,是治实邪之病也。假令肝受肾邪,是从后来者为虚
邪,虚则补其母,入肾经药为引,用补肝经药为君是也。又《经》云∶工为标,病为本。但标本已得,邪气乃
服。(治疗不相应者,谓之标本不得。)谓医工无失色脉,用之不惑,治之大则(大法)。若反理到行,所为
弗顺,岂惟治人,而神气受害。病者当去故(医)逆理之人,宜就新(医)明悟之士,乃得至真精晓(之医)
以全已也。此二法乃治病之至理,诚医之良规也。
标本的理论,要点简明而内容广博,看似微小却影响深远。如果不了解标本的关系,就称为盲目治疗。
少阳经以本气(相火)为主,太阴经以中气(湿土)为主,厥阴经以中气(火)为主,阳明经以中气(湿)为主,太阳经和少阴经的标与本是一致的,阴阳二气相互包裹依存。风邪致病应从火论治并适宜发汗,燥邪与湿邪兼夹则适宜用下法;若能分清万病中的火与湿,就能解开黄帝岐伯医学中无缝的锁钥。
天的阳气没有固定的形状,气向上向外升发,产生浮越、白昼活跃的特性,性质轻清干燥,对应六腑;地的阴气有方正之形,血向下向内沉降,产生肃杀、夜晚安静的特性,性质重浊湿润,对应五脏。
大凡治病的人,应当知晓标本的概念。从人体本身来说,外部为标,内部为本;阳为标,阴为本。所以六腑属阳为标,五脏属阴为本。各脏腑的经络,在体表为标,在体内为本。再进一步说,人身之气为标,血为本。从疾病发展过程来说,先发生的病为本,后传变出现的病为标。
凡是治病,必须先治其本,后治其标。如果先治其标,后治其本,邪气会更加旺盛,病情会日益积聚加重;如果先治其本,后治其标,即使有十几种病症,证候都能消除。例如先生了轻病,后来滋生出重病,也应该先治轻病,后治重病。这样邪气才能潜伏消退,这是因为先治本的缘故。如果有中满(脘腹胀满)的情况,无论涉及标本,都要先治中满,因为这是急症。如果中满之后又出现大小便不通利,也无论涉及标本,要先治大小便不通,其次再治中满,因为这更为紧急。又如先病发热,加上呕吐腹泻大作,饮食药物难以入口,此时应暂缓治疗热证,先止住呕吐,逐渐恢复饮食,然后再兼顾治疗腹泻;等到元气稍微恢复,再去攻伐热邪。这就是所谓的“缓则治其本,急则治其标”。(推究其深层道理,先治标,其实也是先治本。)除了大小便不利和中满吐泻之外,其余情况都应先治其本,不可不谨慎。
假设肝受到火邪的侵袭,这是“从前来者”,属于实邪,实证应当泻其子脏(心)。然而不仅仅是直接泻火,需加入入肝经的药物作为引经药,以泻火药为君药,这就是治疗实邪的方法。假设肝受到肾邪的侵袭,这是“从后来者”,属于虚邪,虚证应当补其母脏(水能生木,肾为肝之母),需加入入肾经的药物作为引经药,以补肝经的药物为君药。
另外《内经》说:医生为标,病人为本。只有标本关系处理得当,邪气才能被制服。(如果治疗与病情不相适应,就叫做“标本不得”。)意思是医生不能失去对色诊和脉诊的把握,运用时不迷惑,这是治疗的大法。如果违背常理行事,行为不顺,这不仅伤害病人,也会损害神气。病人应当远离那些违背医理的医生,亲近那些明智领悟的新进良医,这样才能得到真正精通医术的医生来保全自己。这两种方法乃是治病的最高原理,确实是医生的良好规范。
The principle of *Biao* (Branch/Symptom) and *Ben* (Root/Cause) is concise yet comprehensive, seemingly minute yet profound. Not knowing the relationship between *Biao* and *Ben* constitutes reckless treatment.
The Shaoyang channel follows its *Ben* qi (Ministerial Fire), the Taiyin channel follows its Zhong qi (Damp-Soil), the Jueyin channel follows its Zhong qi (Fire), and the Yangming channel follows its Zhong qi (Dampness). The Taiyang and Shaoyin channels share consistent *Biao* and *Ben*, with Yin and Yang Qi enveloping each other. Wind pathogens should be treated by addressing Fire and are suitable for sweating methods; Dryness combined with Dampness is suitable for purgative methods. If one can distinguish between Fire and Dampness in myriad diseases, one can unlock the seamless secrets of Huangdi (Yellow Emperor) and Qibo.
Heavenly Yang has no fixed shape; Qi ascends outward, generating floating and daytime activity, characterized by lightness, dryness, and corresponding to the Six Fu Organs. Earthly Yin has a square form; Blood descends inward, generating heaviness, stillness, and night-time quietude, characterized by dampness and corresponding to the Five Zang Organs.
In treating diseases, one must understand *Biao* and *Ben*. Regarding the human body: the exterior is *Biao*, the interior is *Ben*; Yang is *Biao*, Yin is *Ben*. Thus, the Six Fu Organs, belonging to Yang, are *Biao*; the Five Zang Organs, belonging to Yin, are *Ben*. The meridians of each Zang and Fu organ are *Biao* when external and *Ben* when internal. Furthermore, Qi in the body is *Biao*, while Blood is *Ben*. Regarding the progression of disease: the initially occurring illness is *Ben*, and the subsequently transmitted illness is *Biao*.
Generally, in treating disease, one must first treat the *Ben*, then treat the *Biao*. If one treats the *Biao* first and the *Ben* later, the pathogenic factors will intensify, and the disease will accumulate and worsen. If one treats the *Ben* first and the *Biao* later, even if there are numerous symptoms, they will all resolve. For example, if a mild illness occurs first, followed by a severe illness, one should first treat the mild illness and then the severe illness. In this way, pathogenic factors will subside, precisely because the *Ben* is treated first. However, if there is abdominal fullness (*Zhongman*), regardless of *Biao* or *Ben*, one must first treat the abdominal fullness because it is an urgent condition. If after abdominal fullness, difficulty in urination or defecation arises, regardless of *Biao* or *Ben*, one must first treat the urinary or fecal obstruction, and subsequently treat the abdominal fullness, as this is even more urgent. For instance, if fever occurs first, followed by severe vomiting and diarrhea where food and medicine cannot be retained, one should temporarily delay treating the heat, first stop the vomiting, gradually restore diet, and then address the diarrhea. Only after the Yuan Qi (Primal Qi) recovers slightly should one attack the heat. This is referred to as "treating the *Ben* in slow cases, and treating the *Biao* in urgent cases." (Upon deeper analysis, treating the *Biao* first is essentially also treating the *Ben*.) Except for urinary/fecal obstruction and abdominal fullness with vomiting/diarrhea, all other conditions require treating the *Ben* first; this must not be neglected.
Suppose the Liver receives Fire pathogenic factors; this comes from the preceding element and constitutes Excess Pathogen (*Shi Xie*). In excess conditions, one should drain the Son organ (Heart). However, this does not mean merely draining Fire; one must use herbs entering the Liver channel as guiding agents, with Fire-draining herbs as the Sovereign herb, which constitutes the treatment for Excess Pathogen diseases. Suppose the Liver receives Kidney pathogenic factors; this comes from the succeeding element and constitutes Deficiency Pathogen (*Xu Xie*). In deficiency conditions, one should tonify the Mother organ (Water generates Wood, so the Kidney is the Mother of the Liver); one must use herbs entering the Kidney channel as guiding agents, with Liver-tonifying herbs as the Sovereign herb.
Furthermore, the *Classic* states: The physician is *Biao*, the patient is *Ben*. Only when *Biao* and *Ben* are properly aligned can the pathogenic factors be subdued. (When treatment does not correspond to the condition, it is called "failure to align *Biao* and *Ben*.") This means physicians must not lose sight of complexion and pulse diagnosis, applying them without confusion; this is the great principle of treatment. If one acts contrary to reason, behavior becomes discordant, harming not only the patient but also the Shen Qi (Spiritual Qi). Patients should depart from physicians who violate medical principles and seek out new, insightful practitioners, thereby obtaining truly proficient physicians to ensure their recovery. These two methods represent the highest principles of treating disease and are indeed excellent guidelines for physicians.