（素问疏五过论 全）
黄帝曰∶呜呼远哉！闵闵乎若视深渊，若迎浮云，视深渊尚可测，迎浮云莫知其际。（闵闵，玄远无穷之谓。深渊有
底，故可测。浮云无定，故莫知其际。六微旨大论亦有此数句，盖此言医道，彼言天道也。见运气类六。）圣人之术，为
万民式，论裁志意，必有法则，循经守数，按循医事，为万民副，故事有五过四德，汝知之乎？（裁，度也。循经之循，
因也。按循之循，察也。副，助也。医辨贤愚，愚者误多，故有五过。贤者道全，故有四德。王氏曰∶德者，道之用，
生之本，故不可不敬慎也。）雷公避席再拜曰∶臣年幼小，蒙愚以惑，不闻五过与四德，比类形名，虚引其经，心无所对。
（比类形名，公自言虽能比类形证名目，然亦皆虚引经义，而心则未明其深远，故无以对也。）帝曰∶凡未诊病者，必问
尝贵后贱，虽不中邪，病从内生，名曰脱营。（尝贵后贱者，其心屈辱，神气不伸，虽不中邪而病生于内。营者，阴气也。
营行脉中，心之所主，心志不舒则血无以生，脉日以竭，故为脱营。中，去声。）尝富后贫，名曰失精，五气留连，病有
所并。（尝富后贫者，忧煎日切，奉养日廉，故其五脏之精，日加消败，是为失精。精失则气衰，气衰则不运，故为留聚
而病有所并矣。）医工诊之，不在脏腑，不变躯形，诊之而疑，不知病名。（如前二病者，求之内证则脏腑无可凭，求之
外证则形躯无所据，诊者不明其故，则未有不疑而莫识其为何病也。）身体日减，气虚无精，（其病渐深，则体为瘦减；
其气日虚，则精无以生。阴阳应象大论曰，气归精，精食气故也。）病深无气，洒洒然时惊。（及其病深，则真气消索，
故曰无气。无气则阳虚，故洒然畏寒也。阳虚则神不足，故心怯而惊也。病深者，以其外耗于卫，内夺于荣。（精气俱损，
则表里俱困，故外耗于卫，内夺于荣，此其所以为深也。）良工所失，不知病情，此亦治之一过也。（虽曰良工，而不能
察此，则不得其情，焉知其本，此过误之一也。）
凡欲诊病者，必问饮食居处，（饮食有膏粱藜藿之殊，居处有寒温燥湿之异，因常知变，必详问而察之。）暴乐暴苦，
始乐后苦，皆伤精气，精气竭绝，形体毁沮。（乐则喜，喜则气缓，苦则悲，悲则气消，故苦乐失常皆伤精气，甚至竭绝，
则形体毁沮。沮，坏也。乐音洛。沮，将鱼切。）暴怒伤阴，暴喜伤阳，（怒伤肝，肝藏血，故伤阴。喜伤心，心藏神，
故伤阳。）厥气上行，满脉去形。（厥气，逆气也。凡喜怒过度而伤其精气者，皆能令人气厥逆而上行。气逆于脉，故满
脉。精脱于中，故去形。阴阳应象大论有此四句，见阴阳类一。）愚医治之，不知补泻，不知病情，精华日脱，邪气乃并，
此治之二过也。（不明虚实，故不知补泻。不察所因，故不知病情。以致阴阳败竭，故精华日脱。阳脱者邪并于阴，阴脱
者邪并于阳，故曰邪气乃并。此愚医之所误，过之二也。）
善为脉者，必以比类奇恒，从容知之，为工而不知道，此诊之不足贵，此治之三过也。（比类，比别例类也。奇恒，
异常也。从容，古经篇名，盖法在安详静察也。凡善诊者，必比类相求，故能因阴察阳，因表察里，因正察邪，因此察
彼，是以奇恒异常之脉证，皆自从容之法而知之矣。易曰∶引而伸之，触类而长之，天下之能事毕矣。其即比类之谓欤。
工不知此，何诊之有，此过误之三也。又示从容论曰∶脾虚浮似肺，肾小浮似脾，肝急沉散似肾，此皆工之所时乱也，
然从容得之。详疾病类九。）
诊有三常，必问贵贱，封君败伤，及欲侯王。（三常，即常贵贱，常贫富，常苦乐之义。封君败伤者，追悔已往。及
欲侯王者，妄想将来。皆致病之因。）故贵脱势，虽不中邪，精神内伤，身必败亡。（抑郁不伸，故精神内伤。迷而不达，
不亡不已也。）始富后贫，虽不伤邪，皮焦筋屈，痿 为挛。（忧愁思虑，则心肺俱伤，气血俱损，故为是病。 音璧，
足不能行也。）医不能严，不能动神，外为柔弱，乱至失常，病不能移，则医事不行，此治之四过也。（戒不严，则无以
禁其欲。言不切，则无以动其神。又其词色外为柔弱，而委随从顺，任其好恶，则未有不乱而至失其常者。如是则病不
能移，其于医也何有？此过误之四也。）
凡诊者，必知终始，有知余绪，切脉问名，当合男女。（必知终始，谓原其始，要其终也。有知余绪，谓察其本，知
其末也。切其脉必问其名，欲得其素履之详也。男女有阴阳之殊，脉色有逆顺之别，故必辨男女而察其所合也。）离绝菀
结，忧恐喜怒，五脏空虚，血气离守，工不能知，何术之语。（离者失其亲爱，绝者断其所怀，菀谓思虑抑郁，结谓深情
难解，忧则气沉，恐则气怯，喜则气缓，恚则气逆，凡此皆伤其内，故令五脏空虚，血气离守。医不知此，何术之有。 菀，
郁同。）尝富大伤，斩筋绝脉，身体复行，令泽不息。（大伤，谓甚劳甚苦也。故其筋如斩，脉如绝，以耗伤之过也。虽
身体犹能复旧而行，然令泽不息矣。泽，精液也。息，生长也。）故伤败结，留薄归阳，脓积寒炅。（故，旧也。言旧之
所伤，有所败结，血气留薄不散，则郁而成热，归于阳分，故脓血蓄积，令人寒炅交作也。炅，居永切，热也。）粗工治
之，亟刺阴阳，身体解散，四肢转筋，死日有期。（粗工不知寒热为脓积所生，脓积以劳伤所致，乃治以常法，急刺阴阳，
夺而又夺，以致血气复伤，故身体解散，四肢转筋，则死日有期，谓非粗工之误之者耶？！亟音棘。）医不能明，不问所
发，唯言死日，亦为粗工，此治之五过也。（但知死日，而不知致死者，由于施治之不当，此过误之五也。）凡此五者，
皆受术不通，人事不明也。（不通者，不通于理也。物理不通，焉知人事。以上五条，所不可不知也。）
故曰圣人之治病也，必知天地阴阳，四时经纪；（阴阳气候之变，人身应之，以为消长，此天道之不可不知也。）五
脏六腑，雌雄表里，刺灸砭石、毒药所主；（脏腑有雌雄，经络有表里，刺灸石药各有所宜，此脏象之不可不知也。）从
容人事，以明经道，贵贱贫富，各异品理，问年少长，勇怯之理；（经道，常道也。不从容于人事，则不知常道，不能知
常，焉能知变？人事有不齐，品类有同异，知之则随方就圆，因变而施，此人事之不可不知也。）审于部分，知病本始，
八正九候，诊必副矣。（八正，八节之正气也。副，称也。能察形色于分部，则病之本始可知；能察邪正于九侯，则脉之
顺逆可据，明斯二者，诊必称矣。此色脉之不可不知也。按∶本篇详言五过，未明四德，而此四节一言天道，一言脏象，
一言人事，一言脉色，即四德也。明此四者，医道全矣，诚缺一不可也。）治病之道，气内为宝，循求其理，求之不得，
过在表里。（气内者，气之在内者也，即元气也。凡治病者，当先求元气之强弱，元气既明，大意见矣。求元气之病而无
所得，然后察其过之在表在里以治之，斯无误也。此下五节，亦皆四德内事。愚按∶气有外气，天地之六气也。有内气，
人身之元气也。气失其和则为邪气，气得其和则为正气，亦曰真气。但真气所在，其义有三，曰上中下也。上者所受于
天，以通呼吸者也；中者生于水谷，以养荣卫者也；下者气化于精，藏于命门，以为三焦之根本者也。故上有气海，曰
膻中也，其治在肺；中有水谷气血之海，曰中气也，其治在脾胃；下有气海，曰丹田也，其治在肾。人之所赖，惟此气
耳，气聚则生，气散则死，故帝曰气内为宝，此诚最重之辞，医家最切之旨也。即如本篇始末所言，及终始等篇，皆
以精气重虚为念，先圣惜人元气至意，于此可见。奈何今之医家，但知见病治病，初不识人根本。凡天下之理，亦焉
有根本受伤而能无败者，伐绝生机，其谁之咎？所以余之治人，既察其邪，必观其正，因而百不失一，存活无算。故于
诸章之注，亦必以元气为首务，实本诸此篇，非亿见也。凡心存仁爱者，其毋忽于是焉。又真气义，见疾病类四。）守数
据治，无失俞理，能行此术，终身不殆。（此承上文而言表里阴阳，经络脏腑，皆有其数，不可失也。俞理，周身俞穴之
理也。殆，危也。）不知俞理，五脏菀热，痈发六腑。（菀，积也。不知俞穴之理，妄施刺灸，则五脏菀积，其热痈乃发
于六腑矣。是亦上文故伤败结、留薄归阳之义。）诊病不审，是为失常，谨守此治，与经相明。（若不详加审察，必失经
常中正之道，故欲谨守治法者，在求经旨以相明也。经，即下文上经下经之谓。）上经下经，揆度阴阳，奇恒五中，决以
明堂，审于终始，可以横行。（上经下经，古经名也。病能论曰∶上经者，言气之通天。下经者，言病之变化也。揆度，
切度之也。奇恒，言奇病也。五中，五内也。明堂，面鼻部位也。终始，灵枢篇名也。凡诊病者，能明上经下经之理以
揆度阴阳，能察奇恒五中之色而决于明堂，能审脉候针刺之法于终始等篇之义；夫如是则心通一贯，应用不穷，目牛无
全，万举万当，斯则高明无敌于天下，故可横行矣。）
《素问·疏五过论》（全文）
黄帝说：唉，医道真是深远啊！幽深玄妙得好像凝视深渊，又好像迎接浮云。凝视深渊还可以测量其深度，但迎接浮云却不知它的边际。（“闵闵”，是形容玄远无穷的意思。深渊有底，所以可以测量；浮云没有定形，所以不知道它的边际。在《六微旨大论》中也有这几句话，那是谈论医道的，而这里说的是天道。参见运气类第六篇。）圣人的医术，成为万民的典范，衡量和裁度病人的情志意志，必定有法则可循；遵循经络的规律，把握治疗的法度，按照医疗事务进行考察，作为万民的辅佐。因此，治病有五种过失和四种美德，你知道吗？（“裁”，是度量的意思。“循经”的“循”，是因循、依据的意思；“按循”的“循”，是考察的意思。“副”，是辅助的意思。医生辨别贤愚，愚笨的医生错误多，所以有五种过失；贤能的医生道德完备，所以有四种美德。王冰说：德，是道的运用，生命的根本，所以不可不恭敬谨慎。）雷公离开座位，拜了两拜说：臣年纪幼小，蒙受愚钝而被困惑，没听说过五种过失和四种美德，虽然能类比形体名目，虚引经典经文，但心中并不明白其中的深远含义，所以无法回答。（“比类形名”，是雷公自谦的话，说自己虽然能类比形体证候的名目，但也只是虚引经义，内心并未明白其深远之处，所以没有应对之策。）
黄帝说：凡是还没有诊察病人时，必须询问病人过去是否曾经尊贵而后变得卑贱，即使没有遭受外邪侵袭，病也会从内生发，名叫“脱营”。（曾经尊贵后来卑贱的人，内心感到屈辱，神气不能舒展，虽然没有中邪，但病生于内部。营，指阴气。营气行于脉中，由心所主，心志不舒畅则血液无法生成，脉气日益枯竭，所以称为脱营。“中”，读去声。）曾经富有后来贫穷的人，名叫“失精”，五脏之气留滞连结，病情相互兼并。（曾经富有后来贫穷的人，忧虑煎熬日益迫切，供养日益减少，所以五脏的精气日益消败，这叫做失精。精气丧失则气衰，气衰则运行不畅，所以气留聚而病情有所兼并。）医生诊察这种病，发现它不在脏腑，形体也没有变化，诊察时产生疑惑，不知道这是什么病。（像前面所说的两种病，向内求索内证，脏腑无可凭借；向外求索外证，形体无所依据，医生不明白其中的缘故，就会怀疑而认不出是什么病。）身体日渐消瘦，气虚无精，（病情逐渐加深，身体就会消瘦；气日渐虚弱，精就无法生成。《阴阳应象大论》说：“气归精，精食气”，就是这个道理。）病情深入则真气消散，时常感到畏寒战栗并惊恐。（到了病情深重的时候，真气消耗殆尽，所以说“无气”。无气则阳虚，所以畏寒战栗。阳虚则神不足，所以心怯而惊恐。病情深重，是因为外在耗损了卫气，内在剥夺了营气。（精气都受损，表里都困顿，所以外在耗损卫气，内在剥夺营气，这就是病情深重的原因。）这是高明医生的失误，不了解病情，这也是治疗中的一种过失。（即使是高明医生，如果不能察觉这些，就不能了解实情，怎么知道病根呢？这是过失之一。）
凡是要诊察疾病，必须询问饮食和居住情况，（饮食有膏粱美味和藜藿粗食的差别，居住有寒温燥湿的不同，因为要常知变化，必须详细询问并加以考察。）突然的大乐或突然的大苦，开始快乐后来痛苦，都会损伤精气，精气竭绝，形体毁败沮丧。（乐则喜，喜则气缓散；苦则悲，悲则气消亡，所以苦乐失常都会损伤精气，甚至竭绝，导致形体毁败沮丧。“沮”，是坏的意思。“乐”音洛，“沮”音将鱼切。）暴怒伤阴，暴喜伤阳，（怒伤肝，肝藏血，所以伤阴；喜伤心，心藏神，所以伤阳。）逆乱之气上行，充满经脉，脱离形体。（厥气，就是逆气。凡是喜怒过度而损伤精气的人，都能让人气机厥逆而上行。气逆于脉中，所以充满经脉；精脱于体内，所以脱离形体。《阴阳应象大论》中有这四句，参见阴阳类第一篇。）愚笨的医生治疗这种病，不知道补泻之法，不了解病情，精华日渐脱失，邪气于是兼并，这是治疗的第二种过失。（不明白虚实，所以不知道补泻；不考察病因，所以不了解病情。导致阴阳败竭，所以精华日渐脱失。阳脱者邪气并入阴分，阴脱者邪气并入阳分，所以说“邪气乃并”。这是愚笨医生的误治，过失之二。）
善于诊脉的人，一定运用比类和奇恒的方法，从容安详地知晓病情，如果作为医生却不知道这些，这种诊察就不值得尊重，这是治疗的第三种过失。（“比类”，是比较区别同类事物；“奇恒”，指异常的情况；“从容”，是古经篇名，大概指法度在于安详静察。凡是善于诊察的人，一定通过比类来寻求对应，所以能因阴察阳，因表察里，因正察邪，因彼察此，因此异常的脉证，都能通过从容的方法知晓。《易经》说：“引申触类而长之，天下的能事就完备了。”说的就是比类吧。医生不知道这些，算什么诊察呢？这是过失之三。又在《示从容论》中说：脾虚浮似肺，肾小浮似脾，肝急沉散似肾，这些都是医生时常混淆的，但通过从容之法就能分辨清楚。详见疾病类第九篇。）
诊察有三项常规，必须询问病人的贵贱地位、封君败伤以及想要成为侯王的心态。（“三常”，即常贵贱、常贫富、常苦乐的含义。封君败伤者，是追悔过往；想要成为侯王者，是妄想未来。这都是致病的因素。）所以贵族失去权势，即使没有中邪，精神也会内伤，身体必然败亡。（抑郁不得伸展，所以精神内伤。迷惑而不通达，不死亡不止。）起初富有后来贫穷，即使没有伤邪，也会出现皮肤焦枯、筋脉拘屈，形成痿痹和挛缩。（忧愁思虑，会同时损伤心肺，气血俱损，所以出现这些病。“ ”音璧，指足不能行走。）医生不能严厉告诫，不能触动病人的心神，外表显得柔弱顺从，扰乱了正常的秩序，使病情不能转移，那么医疗措施就无法施行，这是治疗的第四种过失。（告诫不严，就无法禁止病人的欲望；言语不恳切，就无法触动病人的心神。如果言辞神色外表柔弱，委曲顺从，任凭病人好恶，就会混乱而失去常态。像这样病情就不能好转，对医疗又有什么帮助呢？这是过失之四。）
凡诊察疾病，必须知道疾病的始终，了解其余绪，切脉时要询问姓名，应当结合男女差异。（“必知终始”，是说推究其起始，概括其结局；“有知余绪”，是说考察其本源，了解其末节。切脉时必须询问姓名，是为了获取患者平素的详细情况。男女有阴阳的区别，脉色有逆顺的不同，所以必须辨别男女并观察其相合之处。）离异绝交、郁结不解，忧恐喜怒，会导致五脏空虚，血气离散守位，医生如果不了解这些，还能说什么医术呢。（“离”是失去亲爱，“绝”是断绝所怀，“菀”指思虑抑郁，“结”指深情难解。忧则气沉，恐则气怯，喜则气缓，恚怒则气逆，凡是这些都损伤内部，所以导致五脏空虚，血气离散守位。医生不知道这些，有什么医术可言呢？“菀”同“郁”。）曾经富有而受到极大伤害，筋如被斩断，脉如被隔绝，身体虽然还能活动，但津液不再生长。（“大伤”，指极度劳苦。所以筋像被斩断，脉像被隔绝，是由于耗伤过度的缘故。虽然身体还能恢复旧态行走，但津液不再生长了。“泽”，指精液；“息”，指生长。）所以旧的创伤败坏凝结，留滞迫近归于阳分，积聚脓血，令人寒热交替发作。（“故”，通“旧”。意思是旧的创伤有所败坏凝结，血气留滞不散，郁积而成热，归于阳分，所以脓血蓄积，使人寒热交作。“炅”，音居永切，指热。）粗劣的医生治疗这种病，急忙针刺阴阳穴位，导致身体解散，四肢转筋，死期将至。（粗劣的医生不知道寒热是由脓积产生的，脓积是由劳伤引起的，却用常规方法治疗，急忙针刺阴阳，一再夺气，导致血气再次受伤，所以身体解散，四肢转筋，死期将至，这难道不是粗劣医生的误治吗？“亟”，音棘。）医生如果不明理，不问发病原因，只说死期，也是粗劣的医生，这是治疗的第五种过失。（只知道死期，而不知道致死的原因是由于治疗不当，这是过失之五。）以上这五种情况，都是因为医术不通达，不懂人事道理。（“不通”，是不通晓道理。物理不通，怎么能懂人事。以上五条，是不可不知道的。）
所以说圣人治病，必须知晓天地阴阳、四季纲纪；（阴阳气候的变化，人体随之响应，产生消长，这是天道不可不知。）五脏六腑的雌雄表里关系，以及刺灸砭石、毒药的主治作用；（脏腑有雌雄，经络有表里，刺灸石药各有适宜之处，这是脏象不可不知。）从容地考察人事，以阐明医学常道，贵贱贫富有不同的品性条理，询问年少年长、勇敢怯懦的道理；（“经道”，是常道。不从容于人事，就不知道常道，不能知常，怎么能知变？人事有不齐，品类有同异，知道了就能随方就圆，因变施治，这是人事不可不知。）审察分部，了解病之本源，八正九候，诊察必定相符。（“八正”，是八节的正气。“副”，是称职、相符。能在分部察形色，则病之本源可知；能在九侯察邪正，则脉之顺逆可据，明了这两点，诊察必定称职。这是色脉不可不知。按：本篇详言五过，未明言四德，但这四节分别讲了天道、脏象、人事、脉色，这就是四德。明了这四点，医道就完备了，确实缺一不可。）治病之道，以体内的元气为宝，遵循探求其理，如果求之不得，过错就在表里。（“气内”，指体内的气，即元气。凡是治病，应当先探求元气的强弱，元气既明，大体意见也就出来了。探求元气的病变而无所得，然后察看过错是在表还是在里来治疗，这样才无误。以下五节，也都是四德范围内的事。我按：气有外气，是天地的六气；有内气，是人身的元气。气失其和则为邪气，气得其和则为正气，也叫真气。但真气的所在，意义有三处：上者受之于天，用来通呼吸；中者生于水谷，用来养荣卫；下者气化于精，藏于命门，作为三焦的根本。所以上有气海，叫膻中，主治在肺；中有水谷气血之海，叫中气，主治在脾胃；下有气海，叫丹田，主治在肾。人所依赖的，只有这个气罢了，气聚则生，气散则死，所以黄帝说“气内为宝”，这确实是极重要的话，是医家最关键的宗旨。就像本篇始末所言，以及《终始》等篇，都以精气重虚为念，先圣爱惜人元气的深意，于此可见。奈何现在的医生，只知道见病治病，根本不识人的根本。天下之理，哪有根本受伤而能不败坏的？伐绝生机，是谁的罪过？所以我治疗病人，既察邪气，必观正气，因而百不失一，存活无数。所以在各章注释中，也必以元气为首务，确实基于本篇，并非臆见。凡心存仁爱者，不要忽视这一点。另外关于真气的义理，参见疾病类第四篇。）遵守法度进行治疗，不丢失腧穴的道理，能实行这种医术，终身没有危险。（这是承接上文而言表里阴阳、经络脏腑，都有其数，不可丢失。“俞理”，是周身腧穴的道理。“殆”，是危险的意思。）不知道腧穴的道理，五脏郁热，痈肿发于六腑。（“菀”，是积聚的意思。不知道腧穴的道理，妄加刺灸，则五脏郁积，其热痈就会发于六腑了。这也是上文所说的旧伤败结、留薄归阳的意思。）诊察疾病不审慎，这叫失常，谨守这种治法，与经典相明。（如果不详细审察，必失经典中正之道，所以想谨守治法的人，在于探求经旨以互相阐明。“经”，即下文所说的《上经》《下经》。）《上经》《下经》，揆度阴阳，奇恒五中，决断于明堂，审察终始，就可以横行天下。（《上经》《下经》是古书名。《病能论》说：《上经》讲气通天，《下经》讲病的变化。“揆度”，是切度之意。“奇恒”，指奇病。“五中”，指五脏。“明堂”，指面鼻部位。“终始”，是《灵枢》篇名。凡诊病的人，能明《上经》《下经》之理以揆度阴阳，能察奇恒五脏之色而决断于明堂，能审察脉候针刺之法于《终始》等篇之义；像这样则心通一贯，应用不穷，目无全牛，万举万当，这就高明无敌于天下，所以可以横行了。）
*Suwen: Shu Wu Guo Lun* (Complete Text)
Huangdi said: Alas, how profound and distant is the medical art! It is as obscure and profound as gazing into a deep abyss, or as elusive as welcoming floating clouds. Gazing into a deep abyss, one can still measure its depth; but welcoming floating clouds, one cannot know its boundaries. ("Minmin" refers to something profound, distant, and infinite. The abyss has a bottom, so it can be measured; floating clouds have no fixed form, so their boundaries are unknown. These same phrases appear in *Liuzhi Da Lun*, where they discuss the Dao of Heaven, whereas here they discuss the Dao of Medicine. See Category on Yunqi, Chapter 6.) The techniques of the sages serve as models for all people. They evaluate and regulate patients' wills and intentions, adhering strictly to principles. They follow the meridians, observe the laws of treatment, and examine medical practices to assist the populace. Therefore, there are five errors and four virtues in treatment. Do you understand them? ("Cai" means to measure or estimate. The "xun" in "following the meridians" implies adherence or basis; the "xun" in "examining" implies investigation. "Fu" means to assist. Physicians distinguish between the wise and the foolish; the foolish make many mistakes, hence the five errors. The virtuous possess complete Dao, hence the four virtues. Wang Bing stated: Virtue is the application of the Dao and the root of life, so it must be treated with reverence and caution.) Leigong stepped down from his seat and bowed twice, saying: "I am young and inexperienced, confused by my own ignorance. I have never heard of the five errors and four virtues. Although I can compare forms and names, I merely cite scriptures vacuously, and my mind does not grasp their profound meaning, so I cannot respond." ("Bilei xingming" is Leigong's self-deprecation, admitting that while he can compare physical manifestations and disease names, he only superficially cites classics without understanding their depth, thus lacking a proper response.)
Huangdi said: When diagnosing a patient who has not yet been examined, one must ask if they were once noble but have since become lowly. Even if not attacked by external pathogens, disease arises internally, termed "Tuo Ying" (Depletion of Ying). (Those who were once noble but became lowly feel humiliated, and their Shen spirit cannot extend freely. Though not struck by evil, disease originates within. Ying refers to Yin Qi. Ying Qi circulates within the vessels and is governed by the Heart. If the Heart's will is unexpressed, blood fails to generate, and vessel Qi depletes daily, resulting in Tuo Ying. "Zhong" is pronounced with the departing tone.) Those who were once wealthy but became poor are termed "Shi Jing" (Loss of Jing), where the Five Qi remain stagnant and diseases combine. (Those who were once wealthy but became poor face increasing anxiety and reduced nourishment, causing the essence of the Five Zang organs to deteriorate daily, known as Shi Jing. Loss of Jing leads to Qi deficiency; Qi deficiency leads to stagnation, causing Qi to accumulate and diseases to merge.) When physicians diagnose such conditions, they find no abnormality in the Zang-Fu organs, nor changes in the body shape. Diagnosing with doubt, they do not know the disease name. (For the aforementioned two diseases, seeking internal signs reveals nothing in the Zang-Fu; seeking external signs reveals nothing in the body shape. If the physician does not understand the cause, they will inevitably doubt and fail to identify the disease.) The body diminishes daily, Qi becomes deficient, and Jing is lost. (As the disease deepens, the body emaciates; as Qi becomes deficient daily, Jing cannot be generated. As *Yinyang Yingxiang Dalun* states: "Qi returns to Jing, and Jing feeds on Qi.") In advanced stages, there is no Qi, accompanied by shivering and occasional fright. (In advanced disease, True Qi is exhausted, hence "no Qi." Lack of Qi implies Yang deficiency, leading to chills. Yang deficiency implies insufficient Shen, leading to timidity and fright. Advanced disease occurs because Wei Qi is consumed externally and Ying Qi is deprived internally. (When both Essence and Qi are damaged, both exterior and interior are distressed; thus, Wei is consumed externally and Ying is deprived internally, marking the depth of the disease.) This is an error even for skilled physicians who fail to understand the condition, constituting the first error in treatment. (Even a skilled physician who fails to perceive this cannot grasp the true nature of the illness or its root, representing one of these errors.)
When diagnosing any disease, one must inquire about diet and living conditions. (Diet varies between rich foods and coarse grains; living conditions vary in cold, heat, dryness, and dampness. To adapt to these variables, one must ask in detail and observe carefully.) Sudden joy or sudden sorrow, starting with joy and ending in sorrow, all damage Essence and Qi. If Essence and Qi are exhausted, the body is destroyed and collapsed. (Joy leads to Xi, which relaxes Qi; sorrow leads to Bei, which dissipates Qi. Thus, irregularities in joy and sorrow damage Essence and Qi, potentially leading to exhaustion and bodily collapse. "Ju" means destruction. "Le" is pronounced Luo; "Ju" is pronounced Jiangyu.) Violent anger damages Yin, and violent joy damages Yang. (Anger damages the Liver, which stores Blood, thus damaging Yin. Joy damages the Heart, which houses Shen, thus damaging Yang.) Rebellious Qi ascends, filling the vessels and separating from the form. (Jue Qi refers to rebellious Qi. Excessive anger or joy damages Essence and Qi, causing Qi to rebel and ascend. Qi rebelling in the vessels fills them; Essence escaping internally separates from the form. These four lines appear in *Yinyang Yingxiang Dalun*; see Category on Yinyang, Part 1.) Foolish physicians treat this without knowing tonification or sedation, failing to understand the condition. Essence and Qi deplete daily, and pathogenic Qi combines. This constitutes the second error in treatment. (Not understanding deficiency and excess, they do not know when to tonify or sedate. Not investigating the cause, they do not understand the condition. This leads to the depletion of Yin and Yang, causing Essence and Qi to deplete daily. When Yang depletes, pathogenic Qi merges into Yin; when Yin depletes, pathogenic Qi merges into Yang, hence "pathogenic Qi combines." This is the error of the foolish physician, the second error.)
A proficient pulse-reader must use comparison (Bilei) and analysis of the extraordinary (Qiheng), discerning calmly. If a physician does not understand this, their diagnosis is worthless, constituting the third error in treatment. ("Bilei" means comparing and categorizing similar phenomena. "Qiheng" refers to abnormal conditions. "Congrong" is the title of an ancient chapter, implying a method based on calm observation. Proficient diagnosticians use comparison to find correspondences, allowing them to observe Yang through Yin, exterior through interior, normal through abnormal, and one aspect through another. Thus, abnormal pulses and symptoms are understood through the method of Congrong. The *I Ching* says: "Extend and expand, touch upon categories and grow," which refers to Bilei. A physician who lacks this knowledge performs no real diagnosis; this is the third error. Also, *Shi Congrong Lun* states: Spleen deficiency floating resembles Lung; Kidney slight floating resembles Spleen; Liver urgent, sunken, and scattered resembles Kidney. These are often confused by physicians, but resolved through Congrong. See Category on Diseases, Chapter 9.)
There are three constants in diagnosis: one must ask about status (noble/base), wealth (rich/poor), and emotional state (joy/sorrow). (The "Three Constants" refer to constant nobility/base-ness, richness/poverty, and joy/sorrow. Those whose titles are lost regret the past; those aspiring to lordship fantasize about the future. All are causes of disease.) Thus, when a noble person loses power, even without external pathogens, spiritual injury occurs internally, leading to physical decline and death. (Depression prevents expression, causing internal spiritual injury. Confusion and lack of clarity lead to death if not resolved.) When one starts rich but ends poor, even without pathogenic invasion, the skin becomes dry, tendons contract, and atrophy and spasms develop. (Worry and thought damage both Heart and Lungs, depleting Qi and Blood, leading to these conditions. "Bi" is pronounced Bi, referring to inability to walk.) If the physician is not strict, cannot move the patient's Shen, appears weak externally, and allows chaos to disrupt normalcy, the disease cannot be moved, and medical intervention fails. This is the fourth error in treatment. (If admonitions are not strict, desires cannot be restrained. If words are not earnest, Shen cannot be moved. If demeanor is outwardly weak and compliant, indulging the patient's preferences, chaos ensues, and normalcy is lost. In such cases, the disease cannot improve, rendering medical efforts futile. This is the fourth error.)
In all diagnoses, one must know the beginning and end, understand residual threads, take pulses, ask names, and consider gender differences. ("Knowing beginning and end" means tracing the origin and summarizing the outcome. "Understanding residual threads" means examining the root and knowing the branches. Taking pulses requires asking the name to ascertain the patient's habitual state. Men and women differ in Yin and Yang; pulses and colors differ in reversal and smoothness. Thus, gender must be distinguished to observe compatibility.) Separation, severance, depression, and knotting, along with worry, fear, joy, and anger, empty the Five Zang organs and scatter Qi and Blood. If the physician does not understand this, what medical skill can they claim? ("Li" is losing loved ones; "Jue" is cutting off attachments; "Wan" is depressive thought; "Jie" is deep-seated unresolved emotion. Worry sinks Qi; fear makes Qi timid; joy relaxes Qi; resentment reverses Qi. All these damage the interior, emptying the Five Zang and scattering Qi and Blood. Without this knowledge, there is no medical skill. "Wan" is synonymous with "Yu".) Those who were once wealthy suffer great injury; tendons seem severed, vessels seem cut. Although the body may still function, fluids cease to regenerate. ("Great injury" refers to extreme labor and hardship. Tendons feel severed, vessels feel cut due to excessive consumption. Although the body may resume movement, fluids (Ze) cease to grow (Xi). Ze refers to essential fluids; Xi refers to regeneration.) Thus, old injuries and decay consolidate, lingering and invading the Yang level, accumulating pus and blood, causing alternating chills and heat. ("Gu" means old. Old injuries with decay and consolidation cause Qi and Blood to linger and disperse, generating heat that invades the Yang level, accumulating pus and blood, causing alternating chills and heat. "Jiong" is pronounced Jiyong, meaning heat.) Crude physicians treat this by urgently needling Yin and Yang points, causing the body to dissolve, limbs to spasm, and death to approach. (Crude physicians do not realize that chills and heat arise from pus accumulation caused by labor injury. Treating with standard methods and urgently needling Yin and Yang depletes Qi repeatedly, injuring Qi and Blood further, leading to bodily dissolution and limb spasms, heralding death. Is this not the error of crude physicians? "Ji" is pronounced Ji.) If physicians lack clarity, do not ask about the onset, and only predict the day of death, they are also crude physicians. This is the fifth error in treatment. (Knowing only the day of death without understanding that improper treatment caused it is the fifth error.) These five cases stem from incomplete mastery of technique and ignorance of human affairs. ("Not thorough" means not understanding principles. If natural principles are not understood, how can human affairs be known? The above five points must be understood.)
Therefore, the sages, when treating disease, must understand Heaven and Earth, Yin and Yang, and the regulations of the Four Seasons. (Changes in Yin-Yang climate affect the body, causing growth and decline; this Heavenly Dao must be known.) They must understand the Yin-Yang and exterior-interior relationships of the Five Zang and Six Fu organs, and the indications for acupuncture, moxibustion, stone therapy, and herbal medicines. (Zang-Fu have Yin-Yang aspects; meridians have exterior-interior relations; acupuncture, moxa, stones, and drugs have specific indications. This Zang-Xiang knowledge must be understood.) They must calmly assess human affairs to clarify the Dao of Medicine, recognizing that nobility, poverty, age, courage, and timidity involve different principles. ("Jingdao" refers to constant principles. Without calmly assessing human affairs, one cannot know constant principles; without knowing constancy, one cannot know change. Human affairs vary, and categories differ; understanding this allows flexible application. This knowledge of human affairs is indispensable.) They must examine body parts to know the origin of disease, and using the Eight Regularities and Nine Pulses, ensure diagnosis is accurate. ("Eight Regularities" refer to the correct Qi of the eight solar terms. "Fu" means matching or appropriate. Observing color and shape in body parts reveals the disease's origin; observing pathogenic and righteous Qi in the Nine Pulses determines pulse regularity. Mastering these ensures accurate diagnosis. This knowledge of color and pulse is essential. Note: This chapter details the Five Errors but does not explicitly define the Four Virtues. However, these four sections cover Heavenly Dao, Zang-Xiang, Human Affairs, and Pulse/Color, which constitute the Four Virtues. Understanding these completes the medical Dao; none can be omitted.) The way of treating disease prioritizes internal Qi as precious. One must seek its principles; if unsuccessful, the fault lies in the exterior or interior. ("Qi Nei" refers to internal Qi, i.e., Yuan Qi. In treatment, one must first assess the strength of Yuan Qi. Once Yuan Qi is clear, the general picture emerges. If Yuan Qi pathology is unclear, then investigate whether the fault lies in the exterior or interior for treatment, avoiding error. The following five sections are also part of the Four Virtues. My commentary: Qi includes External Qi (Heavenly-Earthly Six Qi) and Internal Qi (Human Yuan Qi). When Qi loses harmony, it becomes Pathogenic Qi; when harmonious, it becomes Righteous Qi, also called True Qi. True Qi resides in three places: Upper (received from Heaven, governs respiration, located in Danzhong/Chest); Middle (generated from food/water, nourishes Ying-Wei, located in Zhong Qi/Spleen-Stomach); Lower (Qi transforms from Essence, stored in Mingmen, root of Sanjiao, located in Dantian/Kidney). Humans rely solely on this Qi; Qi gathers for life, scatters for death. Hence Huangdi said "Internal Qi is precious," a weighty statement and crucial maxim for physicians. As seen throughout this chapter and others like *Zhongshi*, the emphasis on preventing severe deficiency of Essence and Qi reveals the ancients' value of Yuan Qi. Regrettably, modern physicians only treat symptoms, ignoring the root. How can anything thrive if the root is damaged? Destroying vitality is whose fault? Therefore, in my practice, after examining pathogenic factors, I always observe righteous factors, ensuring high success rates and saving countless lives. Thus, in my annotations, I prioritize Yuan Qi, based on this chapter, not mere speculation. Those with benevolent hearts should not ignore this. For the theory of True Qi, see Category on Diseases, Part 4.) Adhere to methods and treat without violating acupoint principles. Practicing this technique ensures safety for life. (This follows the previous discussion: Exterior-Interior, Yin-Yang, meridians, and Zang-Fu have rules that must not be violated. "Yu Li" refers to the principles of acupoints throughout the body. "Dai" means danger.) Ignoring acupoint principles leads to heat accumulation in the Five Zang and carbuncles in the Six Fu. ("Wan" means accumulation. Ignoring acupoint principles and practicing reckless acupuncture/moxibustion causes heat accumulation in the Five Zang, leading to carbuncles in the Six Fu. This aligns with the earlier concept of old injuries consolidating and invading Yang.) Failure to carefully examine during diagnosis is a violation of norms. Strictly adhering to this treatment clarifies the Classics. (Failure to examine carefully violates the orthodox Dao of the Classics. Thus, those who strictly adhere to treatment must seek clarification from the Classics. "Jing" refers to the *Shangjing* and *Xiajing* mentioned below.) *Shangjing* and *Xiajing* gauge Yin and Yang; Qiheng and Wuzhong are decided via Mingtang; examining Zhongshi allows one to "move freely" (excel universally). (*Shangjing* and *Xiajing* are ancient texts. *Bingneng Lun* states: *Shangjing* discusses Qi connecting to Heaven; *Xiajing* discusses disease changes. "Kuidu" means measuring. "Qiheng" refers to rare diseases. "Wuzhong" refers to the Five Zang. "Mingtang" refers to the nose and face area. "Zhongshi" is a chapter in *Lingshu*. A diagnostician who understands *Shangjing* and *Xiajing* to gauge Yin-Yang, observes colors of Qiheng and Wuzhong via Mingtang, and studies pulse/acupuncture methods in *Zhongshi* etc., achieves comprehensive understanding and flawless application. Such a physician is peerless and can excel universally.)