五者在内五中之情。而外见于色脉。
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。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。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。心无以对。（此论诊道。亦当合于天道也。夫人之气为阳。精水为阴。卫
为阳。营血为阴。阴阳和平。而后血气乃行。经脉乃匀。故当先度其志意之得失。饮食居处。阴阳喜怒。然后察其色脉。
斯得万举万全。而无过失之咎。视深渊。尚可测。迎浮云。莫知其极。言天道之难明也。惟圣人从容得之。施于仁术。
垂于后世。为万民式。副、功也。四德、谓天之四时。有生长收藏之德化。如不知四时阴阳逆从之理。是谓四失矣。）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。尝富后贫。名曰失精。五气留连。病有所并。医工
诊之。不在脏腑。不变躯形。诊之而疑。不知病名。身体日减。气虚无精。病深无气。洒洒然时惊。病深者。以其外耗
于卫。内夺于营。良工所失。不知病情。此亦治之一过也。（此病生于志意。而不因于外邪也。夫尝贵后贱。尝富后贫。
则伤其志意。故虽不中邪。而病从内生。夫脾藏营。营舍意。肾藏精。精舍志。是以志意失而精营脱也。五气留连。谓
五脏之神气。留郁于内而不能疏达。并者。谓并病于五脏也。五脏之气。外合于皮肉筋骨。是以身体日减。气虚无精。
病深无气。言气生于精。精生于气。精气之并伤也。洒洒、消索貌。盖以为久尝之富贵。不意失之。故时惊也。此病不
在脏腑。不在躯形。精气日虚。营卫日耗。即有良工。不知因名。此治之一过也。闵士先曰。病在情志。当以情志之法
治之。非药石之可能愈。）凡欲诊病者。必问饮食居处。暴乐暴苦。始乐后苦。皆伤精气。精气竭绝。形体毁沮。暴怒伤
阴。暴喜伤阳。厥气上行。满脉去形。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。（此病生
于饮食居处。阴阳喜怒。而不因于外邪也。夫味归形。气归精。味伤形。气伤精。热伤气。寒伤形。乐者必过于温饱。
苦者必失于饥寒。是以饮食失节。寒温失宜。皆伤精气。精气竭绝。则形体毁沮矣。喜怒不中。则阴阳不和。而厥气上
行。脉满去形。盖身半以上为阳。身半以下为阴。肌腠气分为阳。经脉血分为阴。阴阳和平。则营卫血气。上下循环。
外出内入。如暴喜伤阳。则气并于阳而为厥逆。暴怒伤阴。则血并于阴而为脉满。盖肌形之血气。并于脉中。故谓脉满
去形也。盛者泻之。不足者补之。愚医治之。不知补泻。不知病情。致使精华日脱。阴阳寒热之邪气相并。此治之二过
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。（此病生于厥逆。而不因于
邪也。行奇恒之法。以太阴始。五脏相通。移皆有次。神转而不回者也。病则各逆传其所胜。回则不转。乃失其相生之
机。故善为脉者。必以比类奇恒。从容得之。为工不知。治之过也。闵士先曰。比类者。言候五脏脉气之顺逆。以比类
奇恒之脉。或顺或逆也。工以诊脉之顺逆。不必比类奇恒。故曰此诊之不足贵。）诊有三常。必问贵贱。封君败伤。及欲
侯王。故贵脱势。虽不中邪。精神内伤。身必败亡。始富后贫。虽不伤邪。皮焦筋屈。痿 为挛。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。（此言善诊者。当先察其精气神。而后切其血脉也。封君
败伤。故贵脱势。及欲侯王而不可得。此忧患缘于内。是以精神内伤。灵枢经曰。忧恐忿怒伤气。是三者皆不能守。而
失其常矣。始富后贫。则伤其志意。志意者。所以御精神。收魂魄。适寒温。和喜怒者也。是故荣卫调。志意和。则筋
骨健强。腠理致密。故伤其志意。则精神不能内守。外为筋骨挛 之病。荣卫不调。腠理不密。故外为柔弱。而三者亦
失其常矣。严、穷究也。动神、谓运动其神。移者。移精变气也。按上文曰。五气留连。气虚无精。病深无气。又曰。
外耗于卫。内夺于营。是故贵脱势。始富后贫。皆论伤于气。故此节止补出精神二字。莫子瑜曰。精气神三者互相资生。
故上节论伤气而精神自然并伤。此言伤精神而气亦在内。）凡诊者。必知终始。有知余绪。切脉问名。当合男女。（此阴
阳偏盛之为病。而不因于邪也。灵枢终始篇曰。谨奉天道。请言终始。终始者。经脉为纪。持其脉口人迎。以知阴阳有
余不足。平与不平。天道毕矣。所谓平人者不病。不病者。脉口人迎应四时也。上下相应。而俱往来也。六经之脉。不
结动也。本末之。寒温之。相守司也。形肉血气。必相称也。是谓平人。少气者。脉口人迎俱少。而不称尺寸也。如是
者。则阴阳俱不足。补阳则阴竭。泻阴则阳脱。如是者。可将以甘药。不可饮以至剂。如此者弗灸。不已者。因而泻之。
则五脏气坏矣。人迎一盛。病在足少阳。一盛而躁。病在手少阳。人迎二盛。病在足太阳。二盛而躁。病在手太阳。人
迎三盛。病在足阳明。三盛而躁。病在手阳明。人迎四盛。且大且数。名曰溢阳。溢阳为外格。脉口一盛。病在足厥阴。
一盛而躁。在手心主。脉口二盛。病在足少阴。二盛而躁。在手少阴。脉口三盛。病在足太阴。三盛而躁。在手太阴。
脉口四盛。且大且数者。名曰溢阴。溢阴为内关。人迎与脉口俱盛四部以上。命曰关格。关格者。与之短期。故凡诊者。
必知终始。余绪。谓更知灸刺补泻之绪端。当合男女。谓针刺之要。男内女外。坚拒勿出。谨守勿内。是谓得气。）离绝
菀结。忧恐喜怒。五脏空虚。血气离守。不人能知。何术之语。（菀音郁。此言左右血气之各有别也。左为人迎而主血。
右为气口而主气。离绝者。言阴阳血气。各有左右之分别也。是以血气皆病。则气郁于右。而血结于左。盖因忧恐伤右
部之肺肾。喜怒伤左部之心肝。以致五脏空虚。血气各离其所守之本位。工不知人迎气口。有阴阳气血之分。又何术之
语哉。）尝富大伤。斩筋绝脉。身体复行。令泽不息。故伤败结。留薄归阳。脓积寒炅。粗工治之。亟刺阴阳。身体解散。
四肢转筋。死日有期。医不能明。不问所发。唯言死日。亦为粗工。此治之五过也。凡此五者。皆受术不通。人事不明
也。（此言病在左而及于右。令其血气之相乘也。天一生水。肾水生肝木。肝木生心火。肾主藏精。肝主藏血。心主生血。
故左三部皆主血而为阴。地二生火。命门相火生脾土。脾土生肺金。火乃先天元气。脾胃主生气。肺主周身之气。故右
三部主气而为阳。如病在阴者。久则阴病极而归于阳。病在阳者。久则阳病极而归于阴。故终始篇曰。病先起于阴者。
先治其阴。而后治其阳。病先起于阳者。先治其阳。而后治其阴。此左右阴阳之相乘。而医之又不可不知也。如尝富而
一旦丧其资斧。则大伤其神魂。是以心主之脉。肝主之筋。有若斩绝。此伤左之血脉也。然右关之脾脏未伤。故身体尚
复能行。令、命也。泽、液也。谓肺肾所主之精气未伤。而尚生长之不息也。然病虽先起于阴。久则将及于阳。故伤败
心肝之血而结于左。则留薄于气分。而复归于阳。左右血气皆伤。而脓积寒炅也。灵枢经曰。夫痈疽之生。脓血之成也。
不从天下。不从地出。结微之所生也。又曰。寒气化为热。热胜则腐肉而为脓。此因伤阴而流薄归阳。是以脓积于阴阳
寒热之间。夫阴阳血气俱伤。补阳则阴竭。泻阴则阳脱。如是者。止可饮以甘药。而不宜灸刺。粗工不知。亟刺阴阳。
以致身体解散。则脾气伤矣。四肢转筋。则胃气绝矣。夫脾胃者。五脏之生原。生气已绝。丧无日矣。即有良医。不明
阴阳相乘之道。不问受病所发之因。止知阴阳坏而与之死期。此亦为粗工。盖不能审其因而施救治之法也。凡此五者。
皆发于五中。而不因于外感。医者当知天地阴阳之气。日用事物之常。莫不各有当然之理。顺之则志意和调。逆之则苛
疾暴起。此皆受术不通。人事不明。致有五者之责。）故曰。圣人之治病也。不知天地阴阳。四时经纪。五脏六腑。雌雄
表里。刺灸砭石。毒药所主。从容人事。以明经道。贵贱贫富。各异品理。问年少长。勇怯之理。审于分部。知病本始。
八正九候。诊必副矣。（此总结诊脉之道。当外合天地阴阳。四时经纪。内通五脏六腑。雌雄表里。或宜于灸刺砭石。或
当用药食所主。从容人事。以明经道。审贵贱贫富之情。察少长勇怯之理。脉各有分部。病发有原始。候四时八正之气。
明三部九候之理。诊道始备而必副矣。）治病之道。气内为宝。循求其理。与之不得。过在表里。守数据治。无失俞理。
能行此术。终身不殆。不知俞理。五脏菀热。痈发六腑。（内叶讷菀音郁。此论针刺之道。当以内气为宝。循求其脉理。
求之不得。其病在表里之气分矣。针经曰。在外者皮肤为阳。筋骨为阴。盖针刺之道。取皮脉肉筋骨之病而刺之。故求
之俞理不得其过在表里之皮肉筋骨矣。守数、谓血气之多少。及刺浅深之数也。针经曰。刺之害。中而不去则泄精。不
中而去则致气。泄精则病益甚而 。致气则生痈疡。又曰。疾浅针深。内伤良肉。皮肤为痈。病深针浅。病气不泻。支
大为脓。夫在内者。五脏为阴。六腑为阳。谓菀热在内。而痈发于在外之皮肉间也。）诊病不审。是谓失常。谨守此治。
与经相明。上经下经。揆度阴阳。奇恒五中。决以明堂。审于终始。可以横行。（诊病不审。谓不审病者之情。故为失常。
上经言气之通于天。下经言病之变化。揆者。方切求之。言切求其脉理也。度者。得其病处。以四时度之也。奇恒之病。
发于五中。五脏之色。见于明堂。审其脏腑经脉之始。三阴三阳已绝之终。谨守此法。则无往而非道矣。）
五种过失源于内心的情志变化，并外在表现为面色和脉象的变化。
黄帝说：唉，道理深远啊！谨慎小心，如同凝视深渊，又似迎接浮云。凝视深渊，尚且可以测量其深度；迎接浮云，却无法知晓它的边际。圣人的医术，是天下百姓的楷模。论述裁断病人的意志情志，必定有法则可循；遵循经络规律，遵守医疗常理，按照医疗事务进行操作，作为百姓的辅助。所以诊疗中有五种过失和四种美德，你知道吗？雷公离开座位，拜了两拜说：臣下年纪幼小，蒙受愚钝之惑，未曾听闻五种过失和四种美德。运用比类法分析形体与病名，虚妄地引用经典，心中无法应对。（这段论述诊断之道，也应当符合天道。人的气属于阳，精和水属于阴；卫气属于阳，营血属于阴。只有阴阳平和，然后气血才能运行，经脉才能均匀。因此应当先衡量病人意志情志的得失、饮食起居以及阴阳喜怒的变化，然后再观察其面色和脉象，这样才能万无一失，没有过失的罪责。“视深渊，尚可测；迎浮云，莫知其际”，是说天道的难以明了。只有圣人能够从容地掌握它，施用于仁术之中，流传于后世，成为百姓的楷模。“副”意为功效。“四德”指天的四季，具有生长收藏的德化。如果不知道四季阴阳顺逆的道理，这就叫做“四失”。）
黄帝说：凡是未诊察疾病的人，必须询问病人过去是否曾尊贵而后卑贱。即使没有遭受外邪侵袭，病也会从体内产生，名叫“脱营”。曾经富有而后贫穷，名叫“失精”。五脏之气滞留连延，病邪相互搏结。医生诊察时，发现病不在脏腑，身体外形也没有改变，诊察后感到疑惑，不知道是什么病名。病人身体日渐消瘦，气虚无精，病势深重则元气衰败，时常感到寒冷战栗并惊恐。病情深重的原因，是因为外部耗损了卫气，内部剥夺了营气。高明的医生所犯的过失，在于不了解病情。这也是治疗中的一种过失。（这种病生于意志情志，而不是因为外邪。曾经尊贵而后卑贱，曾经富有而后贫穷，就会损伤意志情志。所以虽然不中邪，但病从内生。脾藏营，营舍意；肾藏精，精舍志。因此意志情志丧失会导致精和营的脱失。“五气留连”，是指五脏的神气，郁滞在内而不能疏达通畅。“并”，是指病邪并合于五脏。五脏之气，外部配合皮肉筋骨。所以身体日渐消瘦，气虚无精，病深无气，是说气生于精，精生于气，精气同时受损。“洒洒”形容消索寒冷的样子。大概是因为长久享受富贵，没想到突然失去，所以时常惊恐。这种病不在脏腑，不在躯形，精气日渐虚弱，营卫日渐耗损，即使是良医，也不知道病因名称。这是治疗中的一种过失。闵士先说：病在情志，应当用调理情志的方法治疗，不是药物针石所能治愈的。）
凡是想要诊察疾病的人，必须询问饮食起居。突然的快乐或突然的痛苦，开始快乐后来痛苦，都会损伤精气。精气枯竭绝灭，形体毁败沮丧。暴怒损伤阴气，暴喜损伤阳气。厥逆之气向上运行，充满经脉而脱离形体。愚笨的医生治疗时，不知道补泻原则，不了解病情，精华日渐脱失，邪气于是并合。这是治疗的第二种过失。（这种病生于饮食起居、阴阳喜怒，而不是因为外邪。五味滋养形体，气滋养精；味损伤形体，气损伤精；热损伤气，寒损伤形体。快乐的人必然过度温饱，痛苦的人必然遭受饥寒。因此饮食失节，寒温不适，都会损伤精气。精气枯竭绝灭，形体就会毁败沮丧。喜怒不当，导致阴阳不和，厥逆之气上行，脉满而脱离形体。大概身半以上为阳，身半以下为阴；肌腠气分为阳，经脉血分为阴。阴阳平和，则营卫气血上下循环，外出内入。如果暴喜损伤阳气，则气并于阳而发生厥逆；暴怒损伤阴气，则血并于阴而发生脉满。大概肌形的血气，并聚于脉中，所以叫作脉满去形。盛实的用泻法，不足的用补法。愚笨的医生治疗时，不知道补泻，不了解病情，致使精华日渐脱失，阴阳寒热的邪气相互并合。这是治疗的第二种过失。）
善于诊脉的人，必定运用比类和奇恒（异常）的方法来从容地了解病情。作为医生如果不懂这个道理，这种诊法就不值得珍贵。这是治疗的第三种过失。（这种病生于厥逆，而不是因为邪气。施行奇恒之法，从太阴开始。五脏相通，传变都有次序，神机运转而不回转。生病则是各逆传其所克制的脏器，回转则不能运转，就失去了相生的机制。所以善于诊脉的人，必定运用比类和奇恒的方法，从容地掌握它。医生如果不了解，就是治疗的过失。闵士先说：比类，是说观察五脏脉气的顺逆，来比类奇恒的脉象，或者是顺或者是不顺。医生只根据诊脉的顺逆，不必比类奇恒，所以说这种诊法不值得珍贵。）
诊察有三种常规，必须询问贵贱。封君败伤，以及想要成为侯王却不可得。所以尊贵者失去权势，即使没有中邪，精神内伤，身体必定败亡。开始富有后来贫穷，虽然没有伤邪，但皮肤焦枯，筋脉屈曲，痿软成为挛急。医生不能严肃认真，不能感动病人的神气，外表显得柔弱，扰乱至失常，病不能转移，那么医疗措施就无法实行。这是治疗的第四种过失。（这段话说善于诊察的人，应当先观察病人的精气神，然后切按血脉。封君败伤，尊贵者失去权势，以及想要成为侯王而不可得，这些忧患源于内心，所以精神内伤。《灵枢经》说：忧、恐、忿怒损伤气。这三者都不能守持，而失去常态。开始富有后来贫穷，就会损伤意志情志。意志情志，是用来驾驭精神，收敛魂魄，适应寒温，调和喜怒的。所以营卫调和，意志平和，则筋骨健壮，腠理致密。因此损伤意志情志，则精神不能内守，外部出现筋骨挛急的疾病。营卫不调，腠理不密，所以外表柔弱，而三者也失去常态。“严”，是穷究的意思。“动神”，是说运动其神。“移”，是移精变气。看上文说：五气留连，气虚无精，病深无气；又说：外部耗损于卫，内部剥夺于营。所以贵脱势、始富后贫，都是论述损伤于气。所以这一节只补充出“精神”二字。莫子瑜说：精气神三者互相资生，所以上一节论述伤气，精神自然一并受伤；这里说伤精神，气也在内部受伤。）
凡是诊察疾病的人，必须知道疾病的终始，了解其余绪，切脉问病名，应当结合男女的情况。（这是阴阳偏盛导致的疾病，而不是因为邪气。《灵枢·终始篇》说：恭敬地奉行天道，请允许我谈谈终始。终始，以经脉为纲纪，持取脉口和人迎脉，来知道阴阳有余和不足，平和不平，天道的道理就完备了。所谓平人就是不生病。不生病的人，脉口和人迎应合四时，上下相应，而且共同往来。六经的脉，不结动。本末、寒温，相守司职。形肉血气，必定相称，这叫作平人。少气的人，脉口和人迎都少，而且不与尺寸相称。像这样的人，阴阳都不足。补阳则阴竭，泻阴则阳脱。像这样的人，可以用甘药调理，不可以饮用峻剂。像这样的人不要灸治，如果不愈，因而泻之，则五脏气坏败了。人迎脉大一倍，病在足少阳；大一倍而躁动，病在手少阳。人迎脉大两倍，病在足太阳；大两倍而躁动，病在手太阳。人迎脉大三倍，病在足阳明；大三倍而躁动，病在手阳明。人迎脉大四倍，而且大且数，名叫溢阳。溢阳为外格。脉口脉大一倍，病在足厥阴；大一倍而躁动，在手心主。脉口脉大两倍，病在足少阴；大两倍而躁动，在手少阴。脉口脉大三倍，病在足太阴；大三倍而躁动，在手太阴。脉口脉大四倍，而且大且数的，名叫溢阴。溢阴为内关。人迎和脉口都盛大四倍以上，名叫关格。关格的人，给予他短促的寿命期限。所以凡是诊察疾病的人，必须知道终始。余绪，是说更要知道灸刺补泻的绪端。当合男女，是说针刺的要领，男内女外，坚固拒绝勿出，谨慎守护勿内，这叫做得气。）
离别断绝，郁结不解，忧恐喜怒，导致五脏空虚，血气离散失守。如果不能了解这些，说什么医术呢？（“菀”音郁。这段话说左右血气各有区别。左为人迎而主血，右为气口而主气。离绝，是说阴阳血气，各有左右的分别。所以血气都病，则气郁于右，而血结于左。大概是因为忧恐损伤右部的肺肾，喜怒损伤左部的心肝，以致五脏空虚，血气各自离开它们所守的本位。医生不了解人迎气口有阴阳气血的分别，又有什么医术可谈呢？）
曾经富有而大大受伤，斩断筋脉，身体还能行走，但津液不息。所以伤败凝结，留滞迫近归于阳，积聚脓液，寒热交替。粗劣的医生治疗，急忙刺阴阳，导致身体解散，四肢转筋，死期有定数。医生不能明察，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。这五种情况，都是因为医术不通，不明人事。（这段话说病在左而波及于右，使血气相互乘袭。天一生水，肾水生肝木，肝木生心火。肾主藏精，肝主藏血，心主生血，所以左三部皆主血而为阴。地二生火，命门相火生脾土，脾土生肺金。火乃先天元气，脾胃主生气，肺主周身之气，所以右三部主气而为阳。如病在阴者，久则阴病极而归于阳；病在阳者，久则阳病极而归于阴。所以《终始篇》说：病先起于阴的，先治其阴，而后治其阳；病先起于阳的，先治其阳，而后治其阴。这是左右阴阳的相互乘袭，而医生又不可不知。如曾经富有而一旦丧失资财，则大大损伤神魂。是以心主的脉，肝主的筋，好像被斩断绝离。这是损伤左的血脉。然而右关的脾脏未伤，所以身体尚且还能行走。“令”即“命”。“泽”即“液”，是说肺肾所主的精气未伤，而尚生长不息。然而病虽先起于阴，久则将及于阳。所以伤心肝之血而结于左，则留滞迫近于气分，而复归于阳。左右血气皆伤，而出现脓积寒热。《灵枢经》说：痈疽的产生，脓血的形成，不是从天上落下，也不是从地下生出，而是微细之处结聚而生。又说：寒气化为热，热胜则腐肉而为脓。这是因为伤阴而流薄归阳，所以脓积于阴阳寒热之间。夫阴阳血气俱伤，补阳则阴竭，泻阴则阳脱。像这样的人，只可饮以甘药，而不宜灸刺。粗劣的医生不了解，急忙刺阴阳，以致身体解散，则脾气伤了；四肢转筋，则胃气绝了。夫脾胃，是五脏的生原，生气已绝，丧命无日了。即使有良医，不明白阴阳相乘的道理，不问受病的原因，只知道阴阳坏败而给他死期，这也是粗劣的医生。大概是不能审察病因而实施救治的方法。这五种情况，都发于五中，而不是因为外感。医生应当知道天地阴阳之气，日用事物的常理，无不各有当然的道理。顺应它则意志调和，违背它则苛疾暴发。这都是因为医术不通，不明人事，导致这五种过失的责任。）
所以说：圣人治病，不懂天地阴阳、四时经纪、五脏六腑、雌雄表里，不懂刺灸砭石、毒药的主治，不从容对待人事，以阐明经络大道，不清楚贵贱贫富的不同品性道理，不问年少长、勇怯的道理，不审察分部，不知道病的根本起始，不运用八正九候，诊察就不能相符准确。（这段总结诊脉之道，应当外合天地阴阳、四时经纪，内通五脏六腑、雌雄表里。或适宜于灸刺砭石，或应当用药食主治。从容对待人事，以阐明经络大道。审察贵贱贫富之情，考察少长勇怯之理。脉各有分部，病发有原始，候四时八正之气，明三部九候之理，诊道才具备而必相符准确。）
治病的道理，以内气为宝。遵循探求其理，如果得不到，过错在表里。遵守数据治疗，不失去俞穴的理法。能实行此术，终身不危险。不懂俞穴理法，五脏郁热，痈发于六腑。（“内叶讷”音郁。这段论针刺之道，应当以内气为宝，循求脉理。求之不得，其病在表里之气分了。《针经》说：在外者皮肤为阳，筋骨为阴。大概针刺之道，取皮脉肉筋骨之病而刺之，所以求之于俞理，不得其过在表里的皮肉筋骨了。“守数”，是说血气的多少，以及刺浅深的数量。《针经》说：针刺的危害，中病不去则泄精，不中而去则致气。泄精则病益甚而...，致气则生痈疡。又说：病浅针深，内伤良肉，皮肤为痈；病深针浅，病气不泻，支大为脓。在内者，五脏为阴，六腑为阳。谓郁热在内，而痈发于在外之皮肉间。）
诊察疾病不审慎，这叫作失常。谨守此治法，与经典相明。上经下经，揆度阴阳，奇恒五中，决以明堂，审于终始，可以横行。（诊病不审慎，是说不知审察病人的情志，所以为失常。上经言气之通于天，下经言病之变化。“揆”，是方切求之，是说切求其脉理。“度”，是得其病处，以四时度之。奇恒之病，发于五中，五脏之色，见于明堂。审其脏腑经脉之始，三阴三阳已绝之终。谨守此法，则无往而非道矣。）
The five errors originate from the emotions within the five zang organs and manifest externally in the complexion and pulse.
Huangdi said: Alas, how profound! One must be cautious and careful, as if gazing into an abyss or welcoming floating clouds. Gazing into an abyss, one can still measure its depth; welcoming floating clouds, one cannot know their boundaries. The medical art of the sages serves as a model for all people. In discussing the regulation of patients' wills and intentions, there must be laws to follow; one must adhere to the meridians, observe medical constants, and act according to medical procedures, serving as an assistant to the people. Thus, there are five errors and four virtues in diagnosis and treatment. Do you know them? Leigong stepped back from his seat, bowed twice, and said: "I am young and small, covered by foolishness and confusion. I have never heard of the five errors and four virtues. Using analogy to analyze form and names, and citing classics vacuously, my mind cannot respond." (This discussion on the way of diagnosis should also conform to the Way of Heaven. Human qi belongs to Yang, essence and water belong to Yin; Wei Qi belongs to Yang, Ying Blood belongs to Yin. Only when Yin and Yang are peaceful can Qi and Blood circulate, and meridians become even. Therefore, one must first assess the gains and losses of the patient's will and intention, diet and residence, as well as Yin-Yang and joy-anger, before observing the complexion and pulse. This ensures success in every attempt and avoids the blame of errors. "Gazing into an abyss, one can measure it; welcoming floating clouds, one cannot know their limit" refers to the difficulty of understanding the Way of Heaven. Only sages can grasp it calmly, apply it to benevolent arts, and pass it down to posterity as a model for the people. "Fu" means merit. "Si De" (Four Virtues) refers to the four seasons of Heaven, possessing the transformative virtues of growth, flourishing, harvesting, and storing. If one does not understand the principles of the順逆 (smooth/reverse) of Yin-Yang in the four seasons, this is called "Si Shi" (Four Losses).)
Huangdi said: For those who have not yet diagnosed a disease, one must ask if the patient was once noble and later became humble. Even without invasion by external pathogens, the disease arises from within, named "Tuo Ying" (Depletion of Ying). Once wealthy and later poor, it is named "Shi Jing" (Loss of Jing). The Qi of the five zang organs lingers and connects, and pathogens combine. When physicians diagnose, they find the disease is not in the zang-fu organs, nor has the body shape changed. They feel doubtful after diagnosis and do not know the disease name. The patient's body decreases daily, Qi becomes empty and Jing is lost. In deep disease, Qi is exhausted, and the patient feels chilly and startled at times. The reason for deep disease is that Wei Qi is consumed externally and Ying is deprived internally. The error made by skilled physicians is failing to understand the condition of the disease. This is also one of the treatment errors. (This disease arises from will and intention, not from external pathogens. Being once noble and later humble, or once wealthy and later poor, damages will and intention. Thus, although not invaded by pathogens, the disease arises from within. The Spleen stores Ying, and Ying houses Yi (Intent); the Kidney stores Jing, and Jing houses Zhi (Will). Therefore, the loss of will and intention leads to the depletion of Jing and Ying. "Wu Qi Liu Lian" (Five Qi Lingering) refers to the divine Qi of the five zang organs lingering internally without being able to diffuse smoothly. "Bing" (Combining) refers to pathogens combining with the five zang organs. The Qi of the five zang organs corresponds externally to skin, flesh, sinews, and bones. Hence, the body decreases daily, Qi is empty and Jing is lost, and in deep disease, Qi is absent. This means Qi is born from Jing, and Jing is born from Qi; both Jing and Qi are damaged. "Sha Sha" describes a emaciated and cold appearance. It is likely due to having enjoyed wealth and honor for a long time and unexpectedly losing them, causing frequent startling. This disease is not in the zang-fu organs or body shape; Jing and Qi become increasingly deficient, and Ying and Wei become increasingly depleted. Even good physicians may not know the cause or name. This is one of the treatment errors. Min Shixian said: Diseases in emotions should be treated with methods for emotions, not merely with herbs or needles.)
For those wishing to diagnose diseases, one must ask about diet and residence. Sudden joy or sudden sorrow, starting with joy and ending with sorrow, all damage Essence-Qi. When Essence-Qi is exhausted, the body is ruined and depressed. Violent anger damages Yin, and violent joy damages Yang. Jue Qi (Rebellious Qi) moves upward, filling the vessels and separating from the form. Ignorant physicians, when treating, do not know tonification and sedation, nor do they understand the condition. The essence and brilliance are daily depleted, and pathogenic Qi combines. This is the second treatment error. (This disease arises from diet, residence, Yin-Yang, joy, and anger, not from external pathogens. Flavors nourish form, Qi nourishes essence; flavors damage form, Qi damages essence; heat damages Qi, cold damages form. Those who are joyful tend to overindulge in warmth and fullness; those who suffer tend to suffer from hunger and cold. Thus, irregular diet and inappropriate temperature all damage Essence-Qi. When Essence-Qi is exhausted, the body is ruined. Joy and anger not being moderate lead to Yin-Yang disharmony and Jue Qi moving upward, filling vessels and separating from form. Generally, the upper half of the body is Yang, the lower half is Yin; muscle intervals and Qi divisions are Yang, meridian blood divisions are Yin. When Yin and Yang are peaceful, Ying and Wei, Qi and Blood circulate up and down, out and in. If violent joy damages Yang, Qi combines with Yang leading to Jue Ni (Reversal); if violent anger damages Yin, Blood combines with Yin leading to vessel fullness. Generally, the Qi and Blood of muscles and form combine in the vessels, hence called "Vessel Fullness Separating from Form." Excess is sedated, deficiency is tonified. Ignorant physicians do not know tonification and sedation, nor understand the condition, causing essence to deplete daily and Yin-Yang cold-heat pathogens to combine. This is the second treatment error.)
Those skilled in pulse diagnosis must use analogy and comparison with abnormal conditions (Qi Heng) to understand the situation calmly. If a physician does not know this, such diagnosis is not worthy of respect. This is the third treatment error. (This disease arises from Jue Ni, not from pathogens. Practicing the method of Qi Heng starts with Tai Yin. The five zang organs are interconnected, and transmission follows a sequence; the Shen (Spirit) turns without reversing. Disease occurs when each reverses and transmits to what it overcomes. Reversal means no turning, resulting in the loss of the mechanism of mutual generation. Therefore, those skilled in pulse diagnosis must use analogy and Qi Heng to grasp it calmly. Physicians who do not know this commit a treatment error. Min Shixian said: Analogy refers to observing the smoothness or reversal of the five zang pulse Qi to compare with Qi Heng pulses, which may be smooth or reversed. Physicians rely only on the smoothness or reversal of pulse diagnosis and need not use Qi Heng analogy, hence saying such diagnosis is not worthy.)
There are three constants in diagnosis: one must ask about status (noble/base). Destruction of feudal lords, and desires to become marquises or kings that go unfulfilled. Thus, nobles losing power, even without pathogen invasion, suffer internal spiritual injury, and the body must perish. Starting wealthy and becoming poor, even without pathogen injury, results in scorched skin and bent sinews, leading to flaccidity and contracture. If the physician is not strict, cannot move the spirit, appears weak externally, disrupts until失常 (abnormal), and the disease cannot be shifted, then medical practice fails. This is the fourth treatment error. (This states that good diagnosticians should first observe Jing, Qi, and Shen, then palpate the vessels. Destruction of feudal lords and loss of noble status, or unfulfilled desires to become nobles, create worries originating internally, causing internal spiritual injury. The *Ling Shu* says: Worry, fear, and anger damage Qi. These three fail to maintain constancy. Starting wealthy and becoming poor damages will and intention. Will and intention are used to control spirit, gather soul, adapt to cold/heat, and harmonize joy/anger. Thus, when Ying and Wei are regulated and will is harmonious, sinews and bones are strong, and cou li (pores) are dense. Damaging will and intention causes spirit to fail to stay internal, leading to external sinew/bone contracture. Disharmonious Ying and Wei and loose cou li cause external weakness and loss of constancy. "Yan" means thorough investigation. "Dong Shen" means moving the spirit. "Yi" means shifting Jing and changing Qi. As stated earlier: Five Qi linger, Qi is empty and Jing is lost, deep disease lacks Qi; externally consumed by Wei, internally deprived of Ying. Thus, loss of noble status and wealth-to-poverty both discuss Qi injury. This section adds the words "Jing and Shen". Mo Ziyu said: Jing, Qi, and Shen mutually generate. The previous section discussed Qi injury, naturally injuring Jing and Shen; this section discusses Spirit injury, where Qi is also injured internally.)
In all diagnoses, one must know the beginning and end, understand the details, take pulses, ask for the name, and consider male/female differences. (This refers to diseases caused by Yin-Yang excess/deficiency, not pathogens. The *Ling Shu: Zhong Shi* chapter says: Respectfully following the Way of Heaven, let us speak of Beginning and End. Beginning and End take meridians as the guide. Holding the Pulse Kou and Ren Ying pulses, one knows if Yin-Yang has excess or deficiency, peace or imbalance, completing the Way of Heaven. A "Ping Ren" (Peaceful Person) is not sick. Not sick means Pulse Kou and Ren Ying correspond to the four seasons, match up and down, and come and go together. The six meridians do not knot or move abnormally. Roots and ends, cold and heat, guard and manage. Form, flesh, and Qi/Blood must correspond. This is a Peaceful Person. Those with little Qi have both Pulse Kou and Ren Ying deficient and disproportionate to Cun/Che. In such cases, both Yin and Yang are deficient. Tonifying Yang exhausts Yin; sedating Yang causes Yang collapse. Such cases can be treated with sweet medicines, not harsh formulas. Moxibustion should not be used; if ineffective, sedation causes destruction of five zang Qi. Ren Ying pulse 1x stronger indicates disease in Foot Shaoyang; 1x stronger and rapid indicates Hand Shaoyang. Ren Ying 2x stronger indicates Foot Taiyang; 2x stronger and rapid indicates Hand Taiyang. Ren Ying 3x stronger indicates Foot Yangming; 3x stronger and rapid indicates Hand Yangming. Ren Ying 4x stronger, large and rapid, is called "Yi Yang" (Overflowing Yang), leading to "Wai Ge" (External Grid). Pulse Kou 1x stronger indicates Foot Jueyin; 1x stronger and rapid indicates Hand Jueyin (Pericardium). Pulse Kou 2x stronger indicates Foot Shaoyin; 2x stronger and rapid indicates Hand Shaoyin. Pulse Kou 3x stronger indicates Foot Taiyin; 3x stronger and rapid indicates Hand Taiyin. Pulse Kou 4x stronger, large and rapid, is called "Yi Yin" (Overflowing Yin), leading to "Nei Guan" (Internal Lock). If both Ren Ying and Pulse Kou are 4x stronger in all positions, it is called "Guan Ge" (Grid/Lock). Guan Ge patients are given a short life expectancy. Thus, in diagnosis, one must know Beginning and End. "Yu Xu" (Remaining Threads) refers to knowing the details of moxibustion, acupuncture, tonification, and sedation. "He Nan Nu" (Combine Male/Female) refers to the key of acupuncture: Men internal, Women external; firmly reject exit, carefully guard entry. This is obtaining Qi.)
Separation and interruption, depression and knotting, worry, fear, joy, and anger cause the five zang to become empty and Qi/Blood to scatter and lose their posts. If one cannot understand this, what talk of technique is there? ("Wan" sounds like Yu. This discusses the distinction between left and right Qi/Blood. Left is Ren Ying governing Blood; Right is Qi Kou governing Qi. "Li Jue" means Yin/Yang Qi/Blood have left/right distinctions. Thus, if both Qi and Blood are diseased, Qi stagnates on the right, and Blood knots on the left. Likely due to worry/fear damaging Lung/Kidney on the right, and joy/anger damaging Heart/Liver on the left, causing five zang emptiness and Qi/Blood leaving their posts. Physicians who do not know the Yin/Yang/Qi/Blood distinction of Ren Ying and Qi Kou, what technique can they claim?)
Once wealthy but greatly injured, sinews and vessels severed, the body can still walk, but fluids cease. Injury and ruin knot, lingering and pressing towards Yang, accumulating pus, alternating cold and heat. Crude physicians treat by urgently needling Yin and Yang, causing the body to disintegrate, limbs to cramp, with a fixed death date. Physicians who do not clarify, do not ask the cause, and only speak of the death date are also crude. This is the fifth treatment error. All these five arise from incompetence in technique and ignorance of human affairs. (This discusses disease in the left affecting the right, causing Qi/Blood to attack each other. Heaven generates Water (1), Kidney Water generates Liver Wood, Liver Wood generates Heart Fire. Kidney stores Jing, Liver stores Blood, Heart generates Blood. Thus, the left three positions govern Blood and are Yin. Earth generates Fire (2), Mingmen Minister Fire generates Spleen Earth, Spleen Earth generates Lung Metal. Fire is Primordial Yuan Qi; Spleen/Stomach generate Qi; Lung governs whole-body Qi. Thus, the right three positions govern Qi and are Yang. If disease is in Yin, prolonged illness makes Yin extreme and returns to Yang; if in Yang, prolonged illness makes Yang extreme and returns to Yin. Thus, *Zhong Shi* says: Disease starting in Yin is treated in Yin first, then Yang; disease starting in Yang is treated in Yang first, then Yin. This is the mutual attack of left/right Yin/Yang, which physicians must know. If once wealthy and suddenly losing assets, the Shen/Hun are greatly injured. Thus, Heart vessels and Liver sinews seem severed. This injures left Blood/Vessels. However, the right Guan Spleen is not injured, so the body can still walk. "Ling" means "Ming" (Life/Destiny). "Ze" means "Ye" (Fluids), meaning Lung/Kidney Jing/Qi are not injured and continue to grow. Although disease starts in Yin, it eventually affects Yang. Thus, injuring Heart/Liver Blood and knotting on the left, it lingers in Qi division and returns to Yang. Both left/right Qi/Blood are injured, leading to pus accumulation and cold/heat. *Ling Shu* says: Carbuncles and sores, pus and blood, do not fall from heaven or rise from earth, but form from slight knotting. Cold transforms to Heat; Heat wins and rots flesh into pus. This is Yin injury flowing to Yang, so pus accumulates between Yin/Yang and Cold/Heat. If Yin/Yang Qi/Blood are both injured, tonifying Yang exhausts Yin, sedating Yin causes Yang collapse. Such cases should only use sweet medicines, not moxa/needle. Crude physicians do not know this, urgently needle Yin/Yang, causing body disintegration (Spleen Qi injured) and limb cramping (Stomach Qi exhausted). Spleen/Stomach are the source of the five zang; if Sheng Qi is exhausted, death is imminent. Even good physicians who do not understand Yin/Yang mutual attack, do not ask the cause, and only give a death date for broken Yin/Yang are crude. They fail to examine the cause and apply rescue methods. All five arise from the five internal organs, not external sensations. Physicians must know the Qi of Heaven/Earth Yin/Yang and the constants of daily things, which all have proper principles. Following them harmonizes will/intention; opposing them causes sudden severe disease. These are responsibilities arising from incompetent technique and ignorance of human affairs.)
Therefore it is said: The sage treats disease by understanding Heaven/Earth Yin/Yang, four seasons regulations, five zang/six fu organs, male/female exterior-interior relations, the indications for acupuncture, moxibustion, stone therapy, and drugs. By calmly handling human affairs, clarifying meridian paths, recognizing different principles of nobility/poverty, asking about age and courage/timidity, examining divisions, knowing the disease origin, using Eight Rectitudes and Nine Observations, the diagnosis will be accurate. (This summarizes the way of pulse diagnosis: externally combining with Heaven/Earth Yin/Yang and four seasons; internally connecting with five zang/six fu, male/female, exterior-interior. Suitable for moxa/needle/stone or drugs/food. Calmly handling human affairs clarifies meridian paths. Examining feelings of nobility/poverty, observing principles of age/courage. Pulses have divisions, diseases have origins. Observing Qi of four seasons/eight rectitudes, understanding theory of three parts/nine observations. Only then is the diagnostic way complete and accurate.)
The way of treating disease takes Internal Qi as the treasure. Seek its principle. If not found, the fault lies in Exterior/Interior. Follow numerical data for treatment, do not lose the principles of acupoints. Practicing this technique ensures lifelong safety. Not knowing acupoint principles leads to five zang stagnation-heat and carbuncles in six fu organs. ("Nei Ye Ne Wan" sounds like Yu. This discusses acupuncture: take Internal Qi as treasure, seek pulse principles. If not found, the disease is in Exterior/Interior Qi divisions. *Zhen Jing* says: Outside, skin is Yang, sinews/bones are Yin. Acupuncture targets diseases in skin, vessels, flesh, sinews, bones. Thus, seeking acupoint principles, if the fault in Exterior/Interior skin/flesh/sinews/bones is not found... "Shou Shu" (Keeping Numbers) refers to the quantity of Qi/Blood and depth of needling. *Zhen Jing* says: Harm of needling: hitting and not removing leaks Jing; missing and removing gathers Qi. Leaking Jing worsens disease; gathering Qi causes carbuncles. Also: Shallow disease, deep needle damages good flesh, skin becomes carbuncle; deep disease, shallow needle fails to drain pathogen, causing large swelling and pus. Inside, five zang are Yin, six fu are Yang. Stagnation-heat inside leads to carbuncles outside in skin/flesh.)
Failing to carefully examine disease is called失常 (Abnormality). Strictly adhering to this treatment clarifies with the Classics. Upper and Lower Classics, measuring Yin/Yang, Qi Heng and Wu Zhong, deciding via Ming Tang, examining Beginning and End, allows one to proceed freely. (Failing to carefully examine disease means not assessing the patient's emotions, thus Abnormal. Upper Classic speaks of Qi connecting to Heaven; Lower Classic speaks of disease changes. "Kui" means cutting and seeking, i.e., seeking pulse principles. "Du" means finding the disease location and measuring by four seasons. Qi Heng diseases arise from Wu Zhong; five zang colors appear at Ming Tang. Examining beginnings of zang-fu meridians and ends of Three Yin/Three Yang exhaustion. Strictly following this law leaves no path without Dao.)