病有标本者,本为病之源,标为病之变。病本唯一,隐而难明,病变甚多,显而易见。
故今之治病者,多有不知本末,而惟据目前,则最为斯道之大病。且近闻时医有云∶急则治
其标,缓则治其本,互相传诵,奉为格言,以为得其要矣。予闻此说而详察之,则本属不经
而亦有可取。所谓不经者,谓其以治标治本对待为言,则或此或彼,乃可相参为用矣。若然
,则《内经》曰∶治病必求其本,亦何谓耶?又经曰∶夫阴阳逆从,标本之为道也。小而大
,浅而博,可以言一而知百病之害也。以浅而知深,察近而知远,言标与本,易而勿及。又
曰∶先病而后逆者治其本,先逆而后病者治其本。先寒而后生病者治其本,先病而后生寒者
治其本。先热而后生病者治其本,先病而后生热者治其本。先病而后泄者治其本,先泄而后
生他病者治其本。先热而后生中满者治其标,先病而后生中满者治其标,先中满而后生烦心
者治其本。小大不利治其标,小大利治其本,先小大不利而后生病者治其本。由此观之,则
诸病皆当治本,而惟中满与小大不利两证当治标耳。盖中满则上焦不通,小大不利则下焦不
通,此不得不为治标以开通道路,而为升降之所由。是则虽曰治标,而实亦所以治本也。自
此以外,若以标本对待为言,则治标治本当相半矣。故予谓其为不经者此也。然亦谓其可取
者,则在缓急二字,诚所当辨。然即中满及小大不利二证,亦各有缓急。盖急者不可从缓,
缓者不可从急。此中亦自有标本之辨,万不可以误认而一概论也。今见时情,非但不知标本
,而且不知缓急。不知标本,则但见其形,不见其情。不知缓急,则所急在病,而不知所急
在命。故每致认标作本,认缓作急,而颠倒错乱,全失四者之大义,重命君子,不可不慎察
于此。
疾病有本与标之分,本是指疾病的根源,标是指疾病的表现变化。病的根本只有一个,隐蔽而难以明了;病的变化表现很多,明显而易于看见。
因此,现在治病的人,大多不知道本末的关系,只根据眼前的症状来处理,这是医学道路上最大的弊病。况且近来听说有些医生常说:“急则治其标,缓则治其本”,互相传诵,奉为格言,认为已经掌握了治疗的要领。我听到这种说法后仔细考察,觉得这种说法虽然有不严谨之处,但也有可取的地方。所谓不严谨,是指他们将“治标”和“治本”作为对立的两个方面来谈论,似乎只能选择其中一种或两者配合使用。如果真是这样,那么《黄帝内经》中说:“治病必求其本”,又作何解释呢?另外,《内经》还说:“阴阳的逆从、标本的道理,看似微小却影响巨大,看似浅显却内容广博,可以由此推知百种疾病的危害;由浅入深,察近知远,谈论标与本,道理简单但不可忽略。”又说:“先发病而后出现气机逆乱的,治疗其本;先出现气机逆乱而后发病的,治疗其本。先感到寒冷而后生病的,治疗其本;先生病而后感到寒冷的,治疗其本。先发热而后生病的,治疗其本;先生病而后发热的,治疗其本。先生病而后腹泻的,治疗其本;先腹泻而后产生其他病症的,治疗其本。先发热而后出现胸腹胀满的,治疗其标;先生病而后出现胸腹胀满的,治疗其标;先出现胸腹胀满而后产生心烦的,治疗其本。大小便不通利的,治疗其标;大小便通利的,治疗其本;先大小便不通利而后生病的,治疗其本。”由此看来,各种疾病都应当治本,只有胸腹胀满和大小便不通利这两种情况才应当治标。因为胸腹胀满会导致上焦气机不通,大小便不通利会导致下焦气机不通,这不得不通过治标来疏通道路,作为气机升降的途径。既然如此,虽然说是治标,但实际上也是为了治本。除此之外,如果把标和本看作对立的两个方面,那么治标和治本应该各占一半。所以我称这种说法不严谨的原因就在这里。然而,我也认为它可取的地方,在于“缓”和“急”这两个字,确实需要辨别。即使是胸腹胀满和大小便不通利这两种情况,也各有缓急之分。紧急的情况不能按缓慢处理,缓慢的情况不能按紧急处理。这其中也有标与本的区别,千万不要误认而一概而论。如今看到当时的风气,人们不仅不知道标和本,而且也不知道缓和急。不知道标和本,就只能看到表象,看不到本质;不知道缓和急,就知道病情紧急,却不知道生命安危更紧急。所以常常导致把标当作本,把缓当作急,从而颠倒错乱,完全失去了这四者(标、本、缓、急)的大义,对于珍重生命的君子来说,对此不可不慎重考察。
Diseases have a "root" (Ben, the fundamental cause) and a "branch" (Biao, the manifest symptoms). The root is the source of the disease, while the branch represents its variations. There is only one root to a disease, which is hidden and difficult to discern; however, there are many manifestations of the disease, which are obvious and easy to see.
Therefore, many contemporary practitioners do not understand the relationship between the root and the branch, relying solely on immediate symptoms for treatment, which constitutes a major flaw in the medical art. Furthermore, I have recently heard some physicians frequently recite the maxim: "In acute cases, treat the branch; in chronic or mild cases, treat the root." They pass this saying among themselves, regard it as an immutable principle, and believe they have grasped the essence of treatment. Upon hearing this view and examining it closely, I find that while the statement has imprecise aspects, it also has merit. The imprecision lies in treating "treating the branch" and "treating the root" as mutually exclusive opposites, suggesting one must choose either one or combine them arbitrarily. If this were true, what would be the meaning of the statement in the *Neijing* (Classic of Internal Medicine): "In treating diseases, one must seek the root"? Moreover, the *Neijing* states: "The principles of Yin and Yang, their deviation and compliance, and the concepts of Root and Branch appear small yet have vast implications, and seem shallow yet are profound; from these, one can understand the harms of hundreds of diseases. By understanding the shallow, one comprehends the deep; by observing the near, one knows the far. Discussing the Branch and the Root involves simple principles that must not be neglected." It further says: "If a disease occurs first and then leads to Qi reversal, treat the root. If Qi reversal occurs first and then leads to disease, treat the root. If cold sensation occurs first and then disease arises, treat the root. If disease arises first and then cold sensation appears, treat the root. If heat occurs first and then disease arises, treat the root. If disease arises first and then heat appears, treat the root. If disease arises first and then diarrhea ensues, treat the root. If diarrhea occurs first and then other diseases arise, treat the root. If heat occurs first and then epigastric fullness develops, treat the branch. If disease arises first and then epigastric fullness develops, treat the branch. If epigastric fullness occurs first and then irritability arises, treat the root. In cases of difficulty in urination and defecation, treat the branch; if urination and defecation are unobstructed, treat the root. If difficulty in urination and defecation occurs first and then disease arises, treat the root." From this, we can see that all diseases should be treated by addressing the root, with the exception of epigastric fullness and difficulty in urination/defecation, which require treating the branch. This is because epigastric fullness obstructs the Upper Jiao (Upper Burner), and difficulty in urination/defecation obstructs the Lower Jiao (Lower Burner); thus, it is necessary to treat the branch to clear the pathways, facilitating the ascending and descending of Qi. Therefore, although it is called treating the branch, it is essentially serving to treat the root. Apart from these instances, if Root and Branch are viewed as strict opposites, then treating the branch and treating the root should be balanced equally. Hence, I consider the statement imprecise for this reason. However, I acknowledge its merit lies in the distinction between "acute" (Ji) and "chronic/mild" (Huan), which indeed requires careful differentiation. Even in the cases of epigastric fullness and difficulty in urination/defecation, there are distinctions of acuteness and chronicity. Acute conditions cannot be managed as chronic, and chronic conditions cannot be managed as acute. Within this, there is also a distinction of Root and Branch; one must not mistakenly generalize these matters. Currently, I observe that people not only fail to understand Root and Branch but also fail to distinguish between Acute and Chronic. Not understanding Root and Branch means seeing only the form/symptoms without perceiving the nature/essence. Not distinguishing Acute and Chronic means focusing urgency on the disease itself while ignoring the greater urgency of preserving life. Consequently, people often mistake the branch for the root and the chronic for the acute, leading to confusion and disorder, completely losing the grand principles of these four concepts. For gentlemen who value life, such matters must be examined with utmost caution.