马云。本篇前二节。论标本。后八节。论病传。故名篇。灵枢。以病本篇。论标本。以病传篇。论病之所
传。分为二篇。其义全同。
病有标本刺有逆从 马云。标者。病之后生。本者。病之先成。此乃病体之不同也。逆者。如病在
本。而求之于标。病在标。而求之本。从者。如在本求本。在标求标。此乃治法之不同也。
必别阴阳 马云。必别病在阴经阳经。吴同。张云。阴阳二字。所包者广。如经络时令。气血疾病。
无所不在。
前后相应 马云。前后者。背腹也。其经络互相为应。吴云。谓经穴前后。刺之气相应也。志云。
有先病后病也。
逆从得施 吴云。逆者反治。从者正治。得施。谓施治无失也。
标本相移 马云。施逆从之法。以移标本之病。吴云。刺者。或取于标。或取于本。互相移易。
有逆取而得者 吴云。言标本逆从之刺。各有所宜。治非一途取也。高云。有逆取而得者。即在本
求标。在标求本也。有从取而得者。即在标求标。在本求本也。
正行无问 马云。乃正行之法。而不必问之于人也。吴本。问。改作间。注云。标本得施。无间可
议也。诸注同马义。
言一而知百病之害 吴云。一者。本也。百者。标也。马云。言一病而遂知百病之害。高云。言一
标本逆从。而知百病之害。
治得为从 吴云。此释逆从二字之义。张云。得。相得
也。犹言顺也。志云。如热与热相得。寒与寒相得也。高云。不知标本。治之相反。则为逆。识其标本。治之
得宜。始为从。简按张注稳贴。
先病而后逆者治其本 马云。凡先生病。而后病势逆者。必先治其初病之为本。若先病势之逆。而后
生他病者。则又以病势逆之为本。而先治之也。吴云。此二逆字。皆是呕逆。张云。有因病而致血气之逆者。
有因逆而致变生之病者。有因寒热而生为病者。有因病而生为寒热者。但治其所因之本原。则后生之标病。可
不治而自愈矣。
先热而后生中满者治其标 灵枢。热。作病。滑云。此句。当作先病而后生热者治其标。盖以下文自
有先病而后生中满者治其标之句矣。此误无疑。
先病而后泄者治其本 高云。必且调之。乃治其他病。所以重其中土也。简按本。疑标误。泄者。脾
胃虚败所致。故宜治其标。下文云。先泄而后生他病者。治其本。且调之。乃治其他病。其义自明。
先病而后生中满者治其标 张云。诸病皆先治本。而惟中满者。先治其标。盖以中满为病。其邪在胃。
胃者。脏腑之本也。胃满则药食之气不能行。而脏腑皆失其所禀。故先治此者。亦所以治本也。
人有客气有同气 马云。盖以人之病气有二。病本不同。而彼此相传者。谓之客气。有二病之气。本
相同类。而彼此相传者。谓之同气。简按全本。同。作司。似是。盖客气谓邪气。司气谓真气欤。
小大不利治其标 本病篇。作小大便。下同。吴云。小大二便不利。危急之候也。虽为标。亦先治之。
病发而有余 高云。病发而邪气有余。则本而标之。申
明本而标之者。先治其邪气之本。后治正气之标。此治有余之法也。
谨察间甚 吴云。间。差间也。甚。益甚也。张云。间者。言病之浅。甚者。言病之重也。
间者并行甚者独行 张云。间者。言病之浅。甚者。言病之重也。病浅者可以兼治。故曰并行。病甚
者难容杂乱。故曰独行。高云。如邪正之有余不足。叠胜而相间者。则并行其治。并行者。补泻兼施。寒热互
用也。如但邪气有余。但正气不足。而偏甚者。则独行其治。独行者。专补专泻。专寒专热也。
先小大不利而后生病者治其本 吴。十三字。移于上文小大利治其本之下。是。
冬夜半夏日中 张注病传篇云。心火畏水。故冬则死于夜半。阳邪亢极。故夏则死于日中。盖衰极亦
死。盛极亦死。
五日而胀 病传篇云。五日而之胃。吴云。胀。胃病也。胀者。由于闭塞不通使然。此土气败绝。升
降之机息。即痞胀也。
冬日入夏日出 马云。冬之日入在申。申虽属金。金衰不能扶也。夏之日出在寅。木旺火将生。肺气
已绝。不待火之生也。志云。日出气始生。日入气收引。肺主气。故终于气之出入也。高云。冬日入。气不内
归也。夏日出。气不外达也。
冬日入夏早食 早。病传篇。作蚤。张本亦作蚤。马云。蚤。与早同。冬之日入在申。以金旺木衰也。
夏之早食在卯。以木旺气反绝也。
背KT 马云。KT 。膂同。肾自传于膀胱腑。故背KT 筋痛。小便自闭。
冬人定夏晏食 高云。冬之人定在戌。夏之晏食亦在戌。皆土不生旺而死也。简按晏。晚也。淮南天文
训。日至于桑野。是谓晏食。未详王注何据。
三日腹胀 吴云。腹胀。由肾与膀胱俱病。中宫无能化气。且肾中相火虚衰。不生胃土使然也。简按
马张并仍王注。盖五脏相传。皆以相克传之。则旧注为是。
三日两胁支痛 张云。即三日而上之心也。手心主之别。下渊腋三寸。入胸中。故两胁支痛。简按吴
云。土败而乘之。故两胁支痛。志高并同。今从王注。
冬大晨夏晏晡 马云。冬之大明在寅末。木旺水衰也。夏之晏晡以向昏。土能克水也。吴云。冬大晨。
辰也。夏晏晡。戌也。土主四季。水之畏也。
五日身体重 马云。据理当以灵枢五日。而上之心者为正。乃水克火也。张云。病传篇曰。五日而上
之心。此云身体重者。疑误。简按志高并仍原文而释之。非。
冬夜半后夏日 马云。冬夜半在子。土不胜水也。夏之日 在未。土正衰也。日 者。日晏也。志
云。夜半后者。土败而水胜也。夏日 者。乃阳明所主之时。土绝而不能生也。
一日腹胀一日身体痛 吴云。腹胀。胃病也。身体痛。脾病也。马云。肾复传于小肠。故为腹胀。小
肠传于脾。故身体痛。病传篇。一日而上之心。乃腑传于脏。其理为正。张云。即一日而之小肠。一日而之心。
腑传脏也。心主血脉。故为身体痛。简按据上文。吴注为正。然如本节。以腹胀为胃病。以身体痛为脾病。则
义不相协。今仍张注。
冬鸡鸣夏下晡 马云。冬之鸡鸣在丑。丑。土克水也。夏之下晡在申。金衰不能生水也。吴云。冬鸡
鸣。丑也。夏
下晡。未也。太阴主丑未。乃土气也。膀胱壬水。畏其克制。张同。
间一脏止 病传篇。甲乙。并无止字。志云。以上诸病。如是相胜克而传者。皆有速死之期。非刺之
可能救也。或间一脏。相传而止。不复再传别脏者。乃可刺也。假如心病传肝。肺病传脾。此乃子行乘母。至
肝脏脾脏而止。不复再胜克。相传于他脏者。可刺也。假如心病传脾。肺病传肾。乃母行乘子。得母脏之生气。
不死之证也。如心病传肾。肺病传心。肝病传肺。此从所不胜来者。为微邪。乃可刺也。
Ma Yun states: The first two sections of this chapter discuss the Biao (Branch) and Ben (Root), while the subsequent eight sections discuss the transmission of diseases. Hence, it is titled "Treatise on Biao-Ben and Disease Transmission." In the *Ling Shu* (Spiritual Pivot), the discussion on Biao-Ben is placed in the "Disease Root" chapter, and the discussion on disease transmission is in the "Disease Transmission" chapter. Although divided into two chapters, their underlying principles are identical.
Diseases have Biao (Branch) and Ben (Root); acupuncture treatment involves Ni (Reverse) and Cong (Following) approaches.
Ma Yun explains: Biao refers to symptoms or secondary conditions that arise after the onset of a disease; Ben refers to the initial cause or primary pathology. This distinction lies in the nature of the disease entity. Ni (Reverse) treatment involves treating the Biao when the root is in the Ben, or treating the Ben when the root is in the Biao. Cong (Following) treatment involves treating the Ben when the pathology is rooted in the Ben, and treating the Biao when the pathology manifests as Biao. This distinction lies in the therapeutic methods.
One must distinguish Yin and Yang.
Ma Yun states: One must determine whether the disease resides in Yin meridians or Yang meridians. Wu Kun adds: Zhang Jingyue points out that the term "Yin and Yang" encompasses a broad range, including meridians, seasons, Qi and Blood, and diseases, permeating all aspects.
Anterior and posterior correspondences.
Ma Yun explains: Anterior and posterior refer to the abdomen and back, respectively, whose meridians correspond to each other. Wu Kun states: This refers to the anterior and posterior acupoints, where the Qi responds upon needling. Zhang Zhicong notes: It also refers to the correspondence between antecedent and consequent diseases.
Ni (Reverse) and Cong (Following) treatments are appropriately applied.
Wu Kun explains: Ni refers to contrary treatment (treating the appearance rather than the essence in specific contexts, often associated with paradoxical therapy for complex patterns), while Cong refers to direct treatment ("following" the nature of the disease). "De Shi" means the application of treatment is without error.
Biao and Ben can be shifted through intervention.
Ma Yun states: By applying Ni and Cong methods, one alters the state of Biao and Ben diseases. Wu Kun explains: In acupuncture, one may select Biao points or Ben points, shifting between them.
There are cases where Ni (Reverse) treatment yields results.
Wu Kun states: This implies that the needling techniques of Ni and Cong have their respective indications; treatment is not limited to a single approach. Gao Shixi clarifies: "Ni Qu Er De" refers to treating the Biao when the root is in the Ben, or treating the Ben when the root is in the Biao. "Cong Qu Er De" refers to treating the Biao with Biao methods, and the Ben with Ben methods.
Apply the correct method without hesitation.
Ma Yun states: This is the standard method, requiring no external consultation. Wu Kun, citing a variant text, changes "Wen" (ask) to "Jian" (gap/interval), noting that when Biao and Ben treatments are appropriate, there is no room for debate. Most commentators agree with Ma Yun's interpretation.
Understanding one principle allows one to comprehend the harm of a hundred diseases.
Wu Kun states: "One" refers to the Ben (Root), and "Hundred" refers to the Biao (Branch). Ma Yun says: Knowing the pattern of one disease enables one to understand the harms of a hundred diseases. Gao Shixi adds: Understanding the relationship of Biao-Ben and Ni-Cong for one case allows comprehension of the harms of a hundred diseases.
Treatment that achieves harmony is considered Cong (Following).
Wu Kun states: This sentence explains the meaning of "Ni" and "Cong." Zhang Jingyue explains: "De" means harmonious agreement, implying compliance. Zhang Zhicong elaborates: For example, using heat for heat patterns (heat agreeing with heat) or cold for cold patterns. Gao Shixi states: Ignoring Biao and Ben leads to contrary (Ni) treatment; recognizing them and treating appropriately constitutes Cong (Following) treatment. The commentary considers Zhang Jingyue's explanation to be accurate and fitting.
If a disease arises first, followed by rebellious Qi (Ni), treat the Ben (Root).
Ma Yun states: If a disease occurs initially, followed by rebellious manifestations (such as vomiting or hiccup), one must first treat the initial disease as the Ben. Conversely, if rebellious Qi precedes other symptoms, the rebellion itself becomes the Ben and should be treated first. Wu Kun notes: Both instances of "Ni" here refer to rebellious Qi like vomiting. Zhang Jingyue expands: There are cases where pathology causes Qi rebellion, cases where Qi rebellion causes secondary diseases, cases where cold/heat generate disease, and cases where disease generates cold/heat symptoms. Treating the original cause allows secondary Biao diseases to resolve spontaneously.
If fever arises first, followed by middle-jiao fullness, treat the Biao (Branch).
In the *Ling Shu*, the character "Re" (fever) is written as "Bing" (disease). Hua Shou suggests this sentence should read "If disease arises first, followed by fever, treat the Biao," because the following sentence already covers "If disease arises first, followed by middle-jiao fullness, treat the Biao." This is clearly an textual error.
If disease arises first, followed by diarrhea, treat the Ben (Root).
Gao Shixi states: One must regulate the Spleen and Stomach first before treating other diseases, emphasizing the importance of the Middle Jiao. The commentary suspects that "Ben" here is a typo for "Biao." Diarrhea is caused by Spleen-Stomach deficiency; thus, treating the Biao is appropriate. The subsequent text states, "If diarrhea arises first, followed by other diseases, treat the Ben," and emphasizes regulating the Middle Jiao first, which clarifies the logic.
If disease arises first, followed by middle-jiao fullness, treat the Biao (Branch).
Zhang Jingyue states: Generally, diseases are treated by addressing the Ben first, except for middle-jiao fullness, which requires treating the Biao first. Since fullness involves the Stomach, and the Stomach is the root of the Zang-Fu organs, Stomach fullness prevents the movement of food and medicine, depriving the organs of nourishment. Therefore, treating this condition is effectively treating the Ben.
The body's pathological Qi includes Ke Qi (Guest Qi) and Tong Qi (Same Qi).
Ma Yun explains: Pathological Qi comes in two types. When the etiology differs but transmits between individuals, it is called Ke Qi (Guest Qi/Epidemic Qi). When the etiologies are similar and transmit, it is called Tong Qi (Same Qi). The commentary notes that the Quan Yuanqi edition writes "Tong" as "Si" (Situational/Controlling). It is plausible that "Ke Qi" refers to pathogenic factors, while "Si Qi" refers to True Qi.
For dysfunction of urination and defecation, treat the Biao (Branch).
The *Su Wen* (likely referring to related chapters) uses the term "small and large excretion." Wu Kun states: Dysfunction of urination and defecation is a critical emergency. Although it is a Biao symptom, it must be treated first.
When disease manifests with excess pathogens.
Gao Shixi states: When disease manifests with excess pathogens, apply the "Ben then Biao" method. This means treating the root of the pathogen first, then addressing the manifestation regarding the healthy Qi. This is the method for treating excess conditions.
Carefully observe the severity and mildness of the disease.
Wu Kun states: "Jian" refers to mild or intermittent conditions; "Shen" refers to severe conditions. Zhang Jingyue clarifies: "Jian" indicates superficial or mild disease; "Shen" indicates deep or severe disease.
Mild conditions can be treated concurrently; severe conditions require isolated treatment.
Zhang Jingyue states: Mild conditions allow for combined treatment, hence "parallel action." Severe conditions cannot tolerate mixed therapies, hence "isolated action." Gao Shixi elaborates: If both pathogenic and healthy Qi are involved in alternating excess/deficiency with mild presentation, use parallel treatment (simultaneous tonification and purging, mixing cold and hot herbs). If only one aspect is excessive or deficient and the condition is severe, use isolated treatment (exclusive tonification or purging, exclusive cold or hot herbs).
If dysfunction of urination/defecation arises first, followed by other diseases, treat the Ben (Root).
Wu Kun argues that these thirteen characters should be moved below "Treat the Biao for dysfunction of urination/defecation," which is logically sound.
Death in winter occurs at midnight; death in summer occurs at noon.
Zhang Jingyue, in his commentary on the "Disease Transmission" chapter, states: Heart Fire fears Water; thus, in winter, death occurs at midnight (Zi hour, when Water is prosperous). Yang pathogens reach extreme peak; thus, in summer, death occurs at noon (Wu hour, when Fire is prosperous). Extremes of decline lead to death, just as extremes of prosperity do.
Five days later, abdominal distension occurs.
The "Disease Transmission" chapter states: Five days later, the disease reaches the Stomach. Wu Kun explains: Distension is a Stomach disease. It results from blockage and obstruction. This signifies the exhaustion of Earth Qi and the cessation of ascending-descending mechanisms, resulting in stagnation and distension.
Death in winter occurs at sunset; death in summer occurs at sunrise.
Ma Yun states: Winter sunset corresponds to the Shen hour. Although Shen belongs to Metal, Metal is weak and cannot support Water (Kidney). Summer sunrise corresponds to the Yin hour. Wood is prosperous, and Fire is about to rise; Lung Qi is already exhausted, dying before Fire rises. Zhang Zhicong states: At sunrise, Qi begins to generate; at sunset, Qi gathers. The Lungs govern Qi; thus, death occurs at the transition of Qi generation and gathering. Gao Shixi adds: Winter sunset prevents Qi from returning inward; summer sunrise prevents Qi from reaching outward.
Death in winter occurs before dawn; death in summer occurs during early meal time.
The character "Zao" (early) is written as "Zao" (fleas/early) in the "Disease Transmission" chapter. Zhang Jingyue's version also uses "Zao." Ma Yun states: "Zao" is synonymous with "Early." Winter sunset (contextually referring to the critical time) is in the Shen hour; however, regarding the "Chicken Crowing" (Chou hour), Metal is prosperous and Wood is weak. Summer early meal is in the Mao hour; Wood is prosperous, causing Qi to abruptly fail.
Pain in the back muscles (Lv Jin).
Ma Yun states: "KT" is synonymous with "Lv" (spinal muscles). Kidney disease transmits to the Bladder Fu organ, causing pain in the spinal muscles and spontaneous closure of urination.
Death in winter occurs at Ren Ding (9-11 PM); death in summer occurs at Wan Shi (late meal time).
Gao Shixi states: Winter Ren Ding is in the Xu hour; summer late meal is also in the Xu hour. In both cases, Earth fails to generate and prosper, leading to death. The commentary notes: "Yan" means late. *Huainanzi* states: When the sun reaches the Sangye region, it is called Yan Shi. The basis for Wang Bing's annotation is unclear.
Three days later, abdominal distension occurs.
Wu Kun states: Abdominal distension results from simultaneous disease of the Kidney and Bladder, inability of the Central Palace (Spleen/Stomach) to transform Qi, and deficiency of Ministerial Fire in the Kidney failing to generate Stomach Earth. The commentary notes: Ma Shi and Zhang Jingyue follow Wang Bing's annotation. Generally, Zang-Zang transmission follows the overcoming cycle, making the old annotation correct.
Three days later, pain extends across the hypochondrium.
Zhang Jingyue states: This refers to the disease transmitting upward to the Heart three days later. The divergent channel of the Pericardium descends three cun below the axilla and enters the chest, causing pain across the hypochondrium. The commentary notes: Wu Kun argues that Spleen Earth failure allows Liver Wood to overact, causing hypochondriac pain. Zhang Zhicong and Gao Shixi agree. We follow Wang Bing's annotation here.
Death in winter occurs at Da Chen (early morning); death in summer occurs at Yan Bu (late afternoon).
Ma Yun states: Winter Da Chen is at the end of Yin hour; Wood is prosperous, Water is weak. Summer Yan Bu is near dusk; Earth overcomes Water. Wu Kun states: Winter Da Chen is the Chen hour; Summer Yan Bu is the Xu hour. Earth governs the four seasons and is feared by Water.
Five days later, the body feels heavy.
Ma Yun states: Logically, the *Ling Shu* statement "Five days later, transmitting to the Heart" is correct, representing Water overcoming Fire. Zhang Jingyue notes: The "Disease Transmission" chapter says "Five days later, transmitting to the Heart." The phrase "body feels heavy" here is suspected to be an error. The commentary states: Zhang Zhicong and Gao Shixi follow the original text, which is incorrect.
Death in winter occurs after midnight; death in summer occurs at Ri Die (afternoon).
Ma Yun states: Winter midnight is Zi hour; Earth cannot overcome Water. Summer Ri Die is Wei hour; Earth is declining. Ri Die refers to late day. Zhang Zhicong states: After midnight, Earth fails and Water prevails. Summer Ri Die is governed by Yangming; Earth is exhausted and cannot generate.
One day abdominal distension, one day body pain.
Wu Kun states: Abdominal distension is a Stomach disease; body pain is a Spleen disease. Ma Yun states: Kidney transmits to Small Intestine, causing distension; Small Intestine transmits to Spleen, causing body pain. The "Disease Transmission" chapter states "One day transmitting to the Heart," which represents Fu-to-Zang transmission and is logically correct. Zhang Jingyue states: It refers to one day to Small Intestine, one day to Heart. Fu-to-Zang transmission. The Heart governs Blood vessels, causing body pain. The commentary notes: Based on the preceding text, Wu Kun's annotation is correct. However, interpreting distension as Stomach disease and body pain as Spleen disease creates inconsistency. We retain Zhang Jingyue's annotation.
Death in winter occurs at Ji Ming (cockcrow); death in summer occurs at Xia Bu (late afternoon).
Ma Yun states: Winter Ji Ming is Chou hour; Chou is Earth overcoming Water. Summer Xia Bu is Shen hour; Metal is weak and cannot generate Water. Wu Kun states: Winter Ji Ming is Chou hour; Summer Xia Bu is Wei hour. Taiyin governs Chou and Wei, representing Earth Qi. Bladder Ren Water fears this overcoming. Zhang Jingyue agrees.
Transmission stops after skipping one Zang organ.
The "Disease Transmission" chapter and *Jia Yi Jing* omit the character "Zhi" (stop). Zhang Zhicong states: The aforementioned diseases transmitted via overcoming cycles have rapid fatal outcomes and cannot be saved by acupuncture. However, if transmission skips one Zang organ and stops, without further transmission to other organs, acupuncture is applicable. For example, Heart disease transmitting to Liver, or Lung to Spleen, represents Child overcoming Mother. Transmission stops at Liver and Spleen without further overcoming; this is treatable. If Heart disease transmits to Spleen, or Lung to Kidney, it represents Mother overcoming Child. Receiving the generating Qi of the Mother organ indicates a non-fatal prognosis. If Heart disease transmits to Kidney, Lung to Heart, or Liver to Lung, it comes from the "so-not-overcoming" direction, constituting minor pathogens, and is treatable.