疏，陈也。医工诊脉治病，其过有五。未诊不问，诊而不知，其过一也。不知补泻病情，其过二也。不知
比类奇恒，其过三也。不知诊有三常，其过四也。不知终始，不问所发，其过五也。此皆受术不通，人事不
明，不知天地阴阳，四时经纪，脏腑雌雄表里，八正九候之道，是以五过不免。帝召雷公而语之曰∶事有
五过四德，汝知之乎？
故此篇疏五过，下编惩四失。盖知之为德，不知为失也。
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？
闵闵，忧之至也。帝叹道之远大幽深，而圣人之术，循经守数，事有五过四德，医工
不可不知。故语雷公以发明之。
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。
五过四德，公未之闻，若比类形名，虚引其经，而心实无所对。心无所对，言不知也。
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，内夺于荣，良工所失，不知病情。此亦治之一过也。
中去声，下同。营音荣，义通。在，察也。变通也。此言医工未诊不问，诊而不知，治之过也。大凡未
诊病者，当知其贵贱贫富。必问尝贵后贱，尝贵后贱，志意内伤，虽不中邪，病从内生，名曰脱营。营犹
荣也。又必问尝富后贫，尝富后贫，则肥甘不足，名曰失精。五脏之气，本于阴精。今失精，则五脏之气，
留连不及。五气留连，则病有所并。医工诊之，但诊不问。故不察脏腑，不通躯形，诊之而疑，不知病名。
尝富后贫，名曰失精者，至此，则身体日减，而气虚无精矣。五气留连，病有所并者，至此，则病
深无气，但洒洒然而时惊矣。此尝富后贫，工失其诊，而有如是之病也。病从内生，不得其治，则病深，病
深者，以其外耗于卫，内夺于荣，病生于内，名曰脱荣者，至此，则并荣卫而耗夺矣。此尝
贵后贱，工失其诊，而有如是之病也。此医工未诊不问，诊而不知，亦治之一过也。
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。
沮，音殂，义通。此言愚医不知补泻病情，治之过也。大凡欲诊病者，必问人之饮食居处，或暴乐
暴苦，或始乐后苦，凡暴乐暴苦，始乐后苦，皆内伤精气，精气竭绝，则形体毁沮，毁沮，犹死
亡也。凡人卒暴而怒，则伤阴；卒暴而喜，则伤阳。真气有伤，则厥气上行；厥气上行，满于经脉，则神
绝而去形。去形，亦死亡也。形体毁沮，满脉去形，皆由治之不早。乃愚医治之，不知补
泻，不知病情，致使精华日脱，而邪气乃并，此愚医不知补泻病情，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。
此言医工不知比类奇恒，治之过也。凡善为脉者，贵知常变，必以比类奇恒。奇，
异也，恒，常也。异与恒常之病，必比类相
参，从容知之。为工而不知比类奇恒之道，此虽诊之，不足为贵。此医工不知比类奇恒，治之三过也。
诊有三常，必问贵贱，封君败伤，及欲候王。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。
此言不知诊有三常，治之过也。医工延医常理有三，其一必问其贵贱，始封君而既败伤，先贵后贱也。
及欲候王，已贵而益求其贵，不可得也。故，犹昔也，故贵脱势。谓昔者身贵，今则脱势也。
如是之人，虽不中邪，而精神内伤，若身有病，身必败亡。其一必问其贫富，始富后贫，失其肥甘，虽不
伤邪，其身有病，必至皮焦筋屈，而痿 为挛。其一医必严厉整饬，移易其病，若医之心志，不能严厉，内不
能鼓动其神明，外为柔弱而不振，祸乱已至，失其常度，医工延医，病不能移，则医事不行。此不知三常
之诊，治之四过也。
凡诊者，必知终始，有知余绪，切脉问名，当合男女，离绝菀
结，忧恐喜怒，五脏空虚，主气离守，工不能知，何术之语，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，惟言死日，亦为粗工。此治之五过也。
此言医工不知终始，不问所发，治之过也。凡诊脉者，心知经脉之终始。如肺脉终于手次指，大肠之脉
即始于手次指，十二经脉终始相继者是也。知终始，更有以知其余绪；余绪者，经脉虚实之病也。知终始，
知余绪，然后切脉审问而名其病。切脉问名，当合男女而并论之。男女者，阴阳血气也。应象大论云∶阴阳
者，血气之男女。此其义也。或阴阳血气之离绝，或阴阳血气之郁结，以及忧恐喜怒，而五脏空虚，以至血
气离守。工不能知，则不能切脉问名，又何术之足语。如人尝富，一旦失之，则大伤其神魂，是以
肝主之筋，心主之脉，有若斩绝也。脾脏未伤，故身体复行，肺肾
无病，故令泽不息；泽不息者，水气上通于天，而营运不息也。斩筋绝脉，则阴血故伤而败结。始伤阴血，后
伤阳气，则留薄归阳。阴阳血气皆伤，则脓积而寒热并陈。炅，犹热也。粗工治之，但亟刺其阴阳，始之身
体复行者，至此，则身体解散矣。始之令泽不息者，至此，则四肢转筋，而水津不布矣。病至于是，则死日有
期。医不能明，不问经脉之所发，而惟言死日之病，亦为粗工，此不知终始，不问所发，治之五过也。
凡此五者，皆受术不通，人事不明也。故曰。圣人之治病也，必知天地阴阳，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，审于部分，知病本始，八正九候，诊必副矣。治病之道，
气内为宝，循求其理，求之不得，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，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。
分，去声。内，度，皆入声。总结上文而言。凡此五过者，皆由受术不通，人事不明之所致也。故曰∶
圣人之治病也，必知天地之阴阳，四时之经纪，而合于人之五脏六腑，雌雄表里，然后施以刺灸砭石，以
及毒药所主，能从容于人事，以明经脉之道，凡贵贱贫富，各异其治。而品之理之，问年之少长，及人
之勇怯之理，审于三阴三阳之部分，而知病之本始。更明天地之八正，三才之九候，天人合一，诊必副矣。
此圣人之治为然也。凡治病之道，必以气内为宝。气之内也，必循求其理，理即俞理也。若求之不得，则雌
雄表里不明，故过在表里，必守三阴三阳之数。据经脉之道以施治。始能无失俞理，若人能行此术，则终身
不殆。苟不知俞理之道，病在五脏，则五脏菀热；病在六腑，则痈发六腑。诊病而不审表里俞理之部，是谓
失常。若能谨守此理以为治，自能与经相明，则《灵枢》之上经下经，凡揆度阴阳，以及奇恒之异，五中
之常，皆可决以面王之明堂，而审于经脉之终始。能如是也，受术通而人事
明，可以横行，又何五过之有哉！
“疏”，意为陈述。医工在诊脉治病时，其过失有五种。未诊察前不询问病史，诊察后却不知病情，这是第一种过失。不懂得补泻原则及病情变化，这是第二种过失。不懂得运用比类法和奇恒法（比较正常与异常病证），这是第三种过失。不懂得诊病的三种常规（贵贱、贫富、心态），这是第四种过失。不懂得经脉的终始规律，不询问发病原因，这是第五种过失。这些都是因为医术不通晓，人情世故不明白，不了解天地阴阳、四季运行规律、脏腑的雌雄表里关系以及八正九候的诊断方法，因此难免犯这五种过失。黄帝召见雷公并对他说：“事情有五种过失和四种美德，你知道吗？”
所以本篇阐述五种过失，下篇惩戒四种失误。大概知道就是美德，不知道就是失误。
黄帝说：“唉，道多么深远啊！令人忧思深切，如同注视深渊，又如同迎接浮云。注视深渊尚且可以测量深度，迎接浮云却不知其边际。圣人的医术，是万民的典范，论述并裁断意志，必有法则，遵循经络，坚守数度，按照医疗事务办事，作为万民的辅佐。所以事情有五种过失和四种美德，你知道吗？”
“闵闵”，是极度忧虑的样子。黄帝感叹道的远大幽深，而圣人的医术，遵循经络，坚守数度，事情有五种过失和四种美德，医工不可不知道。所以告诉雷公以阐明它。
雷公离开座位再拜说：“臣年幼无知，蒙受愚钝而被迷惑，未曾听闻五过与四德，对于比类形名，虚引经典，心中没有对应的理解。”
五过四德，你未曾听闻，如果比类形名，虚引经典，而心中确实没有对应理解。心中没有对应理解，就是不知道的意思。
黄帝说：“大凡未诊察病人的人，必须询问患者曾经尊贵后来卑贱的经历，即使没有遭受外邪侵袭，病也从内部产生，名叫‘脱营’。曾经富有后来贫穷，名叫‘失精’。五脏之气留滞连延，病邪有所合并，医工诊察时，发现不在脏腑，形体也没有改变，诊察后感到疑惑，不知道病名。身体日渐消瘦，气虚无精，病深入则无气，身体洒洒然寒冷且时常惊恐。病深入的缘故，是因为外在耗损卫气，内在掠夺营气。高明的医生所犯的失误，是不了解病情。这也是治疗中的一种过失。”
“去”读作声母为ch的音，下同。“营”音同“荣”，义相通。“在”，意为察视。“变”，意为通晓。这里说的是医工未诊不问，诊而不知，治疗的过失。大凡想要诊察病人，应当知晓其贵贱贫富。必须问是否曾经尊贵后来卑贱，曾经尊贵后来卑贱，志意内伤，即使没有中邪，病从内生，名叫脱营。营犹荣也。又必须问是否曾经富有后来贫穷，曾经富有后来贫穷，则肥甘厚味不足，名叫失精。五脏之气，本源于阴精。如今失精，则五脏之气留滞不及。五气留滞，则病有所并。医工诊察时，只诊不问。所以不察脏腑，不通晓形体，诊察后疑惑，不知道病名。曾经富有后来贫穷，名叫失精的，到了这时，身体日渐消瘦，气虚无精了。五气留滞，病有所并的，到了这时，病深入无气，只是洒洒然而时常惊恐罢了。这是曾经富有后来贫穷，医工失误其诊察，而有这样的病。病从内生，不得其治，则病深入，病深入的缘故，是因为外在耗损于卫，内在掠夺于荣，病生于内，名叫脱荣的，到了这时，则并荣卫而耗夺了。这是曾经尊贵后来卑贱，医工失误其诊察，而有这样的病。这是医工未诊不问，诊而不知，也是治疗的一种过失。
大凡想要诊察病人，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，精气竭绝，形体毁败沮丧，暴怒损伤阴，暴喜损伤阳，厥气上行，充满经脉而去离形体，愚笨的医生治疗它，不知道补泻，不知道病情，精华日益脱落，邪气于是合并。这是治疗的第二种过失。
“沮”音同“殂”，义相通。这里说的是愚医不知道补泻病情，治疗的过失。大凡想要诊察病人，必须询问人的饮食起居，或者突然快乐突然痛苦，或者开始快乐后来痛苦，凡是突然快乐突然痛苦，开始快乐后来痛苦，都内伤精气，精气竭绝，则形体毁败沮丧，毁沮，犹死亡也。凡人突然愤怒，则伤阴；突然高兴，则伤阳。真气受伤，则厥气上行；厥气上行，充满经脉，则神绝而去离形体。去形，也是死亡。形体毁败，满脉去形，都是因为治疗不早。于是愚医治疗它，不知道补泻，不知道病情，致使精华日益脱落，而邪气于是合并，这是愚医不知道补泻病情，治疗的第二种过失。
善于诊脉的人，必须以比类奇恒的方法，从容地知晓它，作为医工却不知道这个，这种诊察就不值得珍贵。这是治疗的第三种过失。
这里说的是医工不知道比类奇恒，治疗的过失。大凡善于诊脉的人，贵在知晓常变，必须以比类奇恒。奇，是异常；恒，是常态。异与恒常之病，必须比类参照，从容地知晓。作为医工却不知道比类奇恒的道理，这种虽然诊察，不值得珍贵。这是医工不知道比类奇恒，治疗的第三种过失。
诊察有三种常规，必须询问贵贱，封君败伤，以及想求王侯之位。所以尊贵者失去权势，即使没有中邪，精神内伤，身体必然败亡。开始富有后来贫穷，即使不伤邪，皮肤焦枯筋脉屈曲，痿变成挛缩。医生不能严厉，不能感动神明，外表柔弱，混乱至于失常，病不能移动，那么医事就不能施行。这是治疗的第四种过失。
这里说的是不知道诊有三常，治疗的过失。医工延医常理有三，其一必须问其贵贱，始封君而既败伤，先贵后贱也。以及想求王侯之位，已贵而益求其贵，不可得也。故，犹昔也，故贵脱势。谓昔者身贵，今则脱势也。像这样的人，即使没有中邪，而精神内伤，若身有病，身体必然败亡。其二必须问其贫富，始富后贫，失其肥甘，即使不伤邪，其身有病，必至皮焦筋屈，而痿变为挛。其三医必须严厉整饬，移易其病，若医之心志，不能严厉，内不能鼓动其神明，外为柔弱而不振，祸乱已至，失其常度，医工延医，病不能移，则医事不行。这是不知道三常之诊，治疗的第四种过失。
大凡诊察的人，必须知道终始，有知余绪，切脉问名，应当结合男女，离绝郁结，忧恐喜怒，五脏空虚，主气离守，医工不能知道，说什么技术呢？曾经富有大伤，斩筋绝脉，身体复行，令泽不息。所以伤败结，留薄归阳，脓积寒热。粗工治疗它，急刺阴阳，身体解散，四肢转筋，死日有期，医工不能明察，不问所发，只说死日，也是粗工。这是治疗的第五种过失。
这里说的是医工不知道终始，不问所发，治疗的过失。凡诊脉者，心知经脉之终始。如肺脉终于手次指，大肠之脉即始于手次指，十二经脉终始相继者是也。知终始，更有以知其余绪；余绪者，经脉虚实之病也。知终始，知余绪，然后切脉审问而名其病。切脉问名，当合男女而并论之。男女者，阴阳血气也。应象大论云：阴阳者，血气之男女。此其义也。或阴阳血气之离绝，或阴阳血气之郁结，以及忧恐喜怒，而五脏空虚，以至血气离守。工不能知，则不能切脉问名，又何术之足语。如人曾经富有，一旦失去，则大伤其神魂，是以肝主之筋，心主之脉，有若斩绝也。脾脏未伤，故身体复行，肺肾无病，故令泽不息；泽不息者，水气上通于天，而营运不息也。斩筋绝脉，则阴血故伤而败结。始伤阴血，后伤阳气，则留薄归阳。阴阳血气皆伤，则脓积而寒热并陈。炅，犹热也。粗工治疗它，但急刺其阴阳，始之身体复行者，至此，则身体解散矣。始之令泽不息者，至此，则四肢转筋，而水津不布矣。病至于是，则死日有期。医工不能明察，不问经脉之所发，而只说死日的病，也是粗工，这是不知道终始，不问所发，治疗的第五种过失。
大凡这五种情况，都是医术不通晓，人情世故不明白的缘故。所以说：圣人治病，必须知道天地阴阳，四季运行规律，五脏六腑，雌雄表里，刺灸砭石，毒药所主治，从容对待人事，以明经道。贵贱贫富，各异品理，询问年少长，勇怯之理，审于部分，知病本始，八正九候，诊必副矣。治病之道，气内为宝，循求其理，求之不得，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，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。
“分”读去声。“内”、“度”皆入声。总结上文而言。凡此五过者，皆由受术不通，人事不明之所致也。所以说：圣人治病，必须知道天地之阴阳，四季之经纪，而合于人之五脏六腑，雌雄表里，然后施以刺灸砭石，以及毒药所主治，能从容于人事，以明经脉之道，凡贵贱贫富，各异其治。而品之理之，问年之少长，及人之勇怯之理，审于三阴三阳之部分，而知病之本始。更明天地之八正，三才之九候，天人合一，诊必副矣。此圣人之治为然也。凡治病之道，必以气内为宝。气之内也，必循求其理，理即俞理也。若求之不得，则雌雄表里不明，故过在表里，必守三阴三阳之数。据经脉之道以施治。始能无失俞理，若人能行此术，则终身不殆。苟不知俞理之道，病在五脏，则五脏菀热；病在六腑，则痈发六腑。诊病而不审表里俞理之部，是谓失常。若能谨守此理以为治，自能与经相明，则《灵枢》之上经下经，凡揆度阴阳，以及奇恒之异，五中之常，皆可决以面王之明堂，而审于经脉之终始。能如是也，受术通而人事明，可以横行，又何五过之有哉！
"Shu" (疏) means to state or elaborate. When medical practitioners diagnose and treat diseases by examining the pulse, there are five types of errors. The first error is failing to inquire about the patient's history before diagnosis and yet being unaware of the condition after diagnosis. The second error is not understanding the principles of tonification and sedation (Bu-Xie, 补泻) and the progression of the disease. The third error is not knowing how to use analogy (Bilei, 比类) and distinguishing between normal and abnormal states (Qiheng, 奇恒). The fourth error is not knowing the three constants of diagnosis (Zhen San Chang, 诊有三常). The fifth error is not understanding the beginning and end (Zhongshi, 终始) of meridians and failing to ask about the onset of the disease. These all stem from a lack of mastery in medical techniques, ignorance of human affairs, and failure to comprehend the Yin and Yang of Heaven and Earth, the regulations of the four seasons, the yin-yang and exterior-interior relationships of the Zang-Fu organs (脏腑), and the methods of the Eight Regularities (Bazheng, 八正) and Nine Probes (Jiuhou, 九候). Thus, these five errors are unavoidable. Emperor Huangdi summoned Leigong and said to him: "There are five errors and four virtues in practice; do you know them?"
Therefore, this chapter elaborates on the five errors, and the following section penalizes the four losses. Generally speaking, knowledge is a virtue, and ignorance is a loss.
Emperor Huangdi said: "Alas, how profound and distant the Dao is! It causes deep anxiety, like gazing into an abyss or welcoming floating clouds. While an abyss can still be measured, the boundaries of floating clouds are unknowable. The art of the sage serves as a model for all people. By discussing and regulating will and intent, there must be laws and rules. Following the meridians and adhering to numerical principles, and managing medical affairs according to standards, one acts as a support for all people. Therefore, there are five errors and four virtues in practice; do you know them?"
"Minyin" (闵闵) refers to extreme worry. Emperor Huangdi sighed at the vastness and profundity of the Dao, noting that the sage's art follows meridians and adheres to principles. Since practice involves five errors and four virtues, medical practitioners must understand this. Hence, he spoke to Leigong to elucidate it.
Leigong stepped down from his seat and bowed twice, saying: "I am young and inexperienced, confused by my own ignorance, having never heard of the five errors and four virtues. Regarding analogies of form and name, I cite classics vacuously, with nothing in my heart to correspond."
The five errors and four virtues, which you have not heard of, if you cite classics vacuously regarding analogies of form and name, but your heart truly has no correspondence, it means you do not know.
Emperor Huangdi said: "For those who have not yet diagnosed a patient, they must ask if the patient was once noble and later became humble. Even without external pathogenic invasion, the disease arises internally, named 'Tuo Ying' (脱营, Depletion of Ying). If the patient was once rich and later became poor, it is named 'Shi Jing' (失精, Loss of Jing). The Qi of the five Zang organs lingers and stagnates, and pathogens combine. When medical practitioners diagnose, they find the disease is not in the Zang-Fu organs, nor does the body shape change. They diagnose with doubt and do not know the disease name. The body wastes away daily, Qi becomes deficient and Jing is lost. In deep disease, Qi is exhausted; the patient feels chilly and startled intermittently. The reason for deep disease is external depletion of Wei Qi (卫气) and internal deprivation of Ying Qi (营气). The mistake made by skilled doctors is not understanding the condition. This is also one of the errors in treatment."
"Qu" (去) is pronounced with the initial sound 'ch', same below. "Ying" (营) sounds like "Rong" (荣), meaning is connected. "Zai" (在) means to inspect. "Bian" (变) means to understand. This describes the error of medical practitioners who do not inquire before diagnosis and do not understand after diagnosis. Generally, when intending to diagnose a patient, one should know their status of nobility/poverty. One must ask if they were once noble and later became humble. Being once noble and later humble causes internal injury to will and intent; even without external pathogens, disease arises internally, named Tuo Ying. Ying is akin to Rong. One must also ask if they were once rich and later became poor. Being once rich and later poor leads to a lack of rich and sweet foods, named Shi Jing. The Qi of the five Zang organs originates from Yin Jing. Now, with loss of Jing, the Qi of the five Zang organs lingers and fails to reach. With lingering of the five Qi, diseases combine. Medical practitioners diagnose only by pulse, not inquiry. Thus, they do not inspect the Zang-Fu organs, do not understand the body shape, diagnose with doubt, and do not know the disease name. For those named Shi Jing due to being once rich and later poor, by this time, the body wastes away daily, and Qi is deficient without Jing. For those with lingering five Qi and combined diseases, by this time, the disease is deep with no Qi, only feeling chilly and startled. This is the result of medical practitioners' diagnostic error in cases of being once rich and later poor. Disease arising internally, if not treated correctly, becomes deep. Deep disease occurs because of external depletion of Wei and internal deprivation of Ying. Disease arising internally, named Tuo Rong (脱荣), by this time, both Ying and Wei are depleted and deprived. This is the result of medical practitioners' diagnostic error in cases of being once noble and later humble. This diagnostic error of not inquiring before diagnosis and not understanding after diagnosis is also one of the errors in treatment.
Generally, when intending to diagnose a patient, one must ask about diet and living conditions, sudden joy or sudden sorrow, starting with joy and ending with sorrow. All these injure Essence-Qi (Jingqi, 精气). When Essence-Qi is exhausted, the body is ruined and depressed. Sudden anger injures Yin; sudden joy injures Yang. Jue Qi (厥气) moves upward, filling the meridians and separating from the form. Foolish doctors treating this do not know tonification and sedation, nor the condition. The essence and vitality are daily depleted, and pathogenic factors combine. This is the second error in treatment.
"Ju" (沮) sounds like "Cu" (殂), meaning is connected. This describes the error of foolish doctors who do not understand tonification/sedation and the condition. Generally, when intending to diagnose, one must ask about diet and living conditions, sudden joy/sorrow, or starting joy/ending sorrow. All such sudden changes internally injure Essence-Qi. When Essence-Qi is exhausted, the body is ruined. Ruined means death. Sudden anger injures Yin; sudden joy injures Yang. True Qi is injured, causing Jue Qi to move upward. Jue Qi moving upward fills the meridians, causing Spirit to depart from the form. Departing form also means death. Body ruin and meridian fullness leading to spirit departure are due to late treatment. Then foolish doctors treat it, not knowing tonification/sedation or the condition, causing essence to deplete daily and pathogens to combine. This is the second error of foolish doctors not understanding tonification/sedation and the condition.
Those skilled in pulse diagnosis must use analogy and distinguish between normal and abnormal, comprehending calmly. If a practitioner does not know this, their diagnosis is not worthy of respect. This is the third error in treatment.
This describes the error of medical practitioners not knowing analogy and Qiheng. Those skilled in pulse diagnosis value knowing the constant and variable. They must use analogy and Qiheng. Qi (奇) means abnormal; Heng (恒) means constant. Abnormal and constant diseases must be compared and referenced, comprehended calmly. If a practitioner does not know the way of analogy and Qiheng, their diagnosis is not worthy of respect. This is the third error of medical practitioners not knowing analogy and Qiheng.
Diagnosis has three constants: one must ask about nobility/humility, the fall of feudal lords, and those seeking kingship. Thus, if a noble person loses power, even without external pathogens, spiritual injury occurs internally, and the body will surely perish. If one starts rich and ends poor, even without pathogenic injury, the skin becomes dry, tendons contract, and flaccidity turns into spasms. If the doctor is not strict, cannot move the Spirit, appears weak externally, and chaos reaches disorder, the disease cannot be moved, and medical practice fails. This is the fourth error in treatment.
This describes the error of not knowing the three constants of diagnosis. There are three common principles for medical consultation. First, one must ask about nobility/humility: from feudal lord to fallen status, i.e., once noble then humble. Second, asking about those seeking kingship: already noble but seeking more nobility, which is impossible. "Gu" (故) means former. "Gu Gui Tuo Shi" (故贵脱势) means formerly noble but now losing power. Such people, even without external pathogens, suffer internal spiritual injury, and if sick, the body will perish. Third, one must ask about wealth/poverty: starting rich and ending poor, losing rich foods, even without pathogenic injury, the body suffers, leading to dry skin, contracted tendons, and flaccidity turning into spasms. Fourth, the doctor must be strict and rectify, changing the disease. If the doctor's mind is not strict, cannot stimulate the Spirit internally, appears weak externally, disaster arrives, norms are lost, the disease cannot be moved, and medical practice fails. This is the fourth error of not knowing the three constants of diagnosis.
In general, diagnosis requires knowing the beginning and end, understanding residual threads, combining pulse-taking with questioning names, considering male/female distinctions, separation/seclusion, depression/knotting, worry/fear/joy/anger. The five Zang organs become empty, ruling Qi leaves its post. If the practitioner does not know this, what technique can be discussed? Once rich but greatly injured, tendons severed, vessels cut, the body walks again, fluids flow incessantly. Thus, injury and knotting remain, thin pathogens return to Yang, pus accumulates with cold and heat. Crude doctors treat by urgently puncturing Yin and Yang. The body that walked again now disintegrates; limbs turn cramps, water fluids cease. Disease reaches this point, death has a date. If the doctor cannot clarify, does not ask about the onset, and only speaks of the death date, they are also crude doctors. This is the fifth error in treatment.
This describes the error of not knowing Zhongshi and not asking about onset. Pulse diagnosticians must know the beginning and end of meridians. For example, the Lung Meridian ends at the index finger, and the Large Intestine Meridian begins there; the twelve meridians connect in sequence. Knowing Zhongshi allows knowing residual threads; residual threads refer to deficiency/excess diseases of meridians. Knowing Zhongshi and residual threads, one then takes the pulse and questions to name the disease. Pulse-taking and questioning should consider male/female distinctions. Male/female refer to Yin/Yang Blood and Qi. The Treatise on Images and Correspondences says: Yin and Yang are the male and female of Blood and Qi. This is the meaning. Separation/extinction of Yin/Yang Blood and Qi, or depression/knotting, along with worry/fear/joy/anger, lead to empty Zang organs and departing Blood/Qi. If the practitioner does not know this, they cannot take the pulse or question, so what technique is there? If a person was once rich and suddenly loses it, the Hun and Shen are greatly injured. Thus, Liver-controlled tendons and Heart-controlled vessels seem severed. Spleen is not injured, so the body walks; Lungs/Kidneys are not diseased, so fluids flow incessantly. Fluids flowing incessantly means Water Qi connects to Heaven and circulates endlessly. Severed tendons and vessels mean Yin Blood is injured and knotted. Initially injuring Yin Blood, then injuring Yang Qi, pathogens linger and return to Yang. Both Yin/Yang Blood and Qi injured leads to pus accumulation and coexistence of cold/heat. "Jiong" (炅) means heat. Crude doctors treat by urgently puncturing Yin/Yang. The body that walked now disintegrates; limbs cramp, water fluids do not distribute. Disease reaches this point, death has a date. If the doctor cannot clarify, does not ask about meridian onset, and only speaks of the death date, they are crude doctors. This is the fifth error of not knowing Zhongshi and not asking about onset.
All these five cases stem from unmastered techniques and unclear human affairs. Therefore, it is said: The sage treats disease by knowing Heaven and Earth Yin/Yang, seasonal regulations, Five Zang and Six Fu organs, yin-yang and exterior-interior relations, the uses of acupuncture, moxibustion, stone needles, and drugs. Handling human affairs calmly to clarify the Dao of meridians. Nobility and poverty have different principles; ask about age and courage/timidity. Examine parts, know the origin of disease, use Bazheng and Jiuhou, diagnosis will be accurate. The way of treating disease values internal Qi. Follow and seek its principle. If sought and not found, the error is in exterior-interior. Adhere to numbers for treatment, do not lose Shu points principles. Practicing this art ensures lifelong safety. Not knowing Shu point principles leads to heat stagnation in Five Zang and abscesses in Six Fu. Unexamined diagnosis is called失常 (abnormality). Strictly observing this treatment clarifies the Classics. Upper and Lower Classics, measuring Yin/Yang, distinguishing normal/abnormal and central states, deciding by the bright hall (face), examining beginning/end, allows one to proceed freely.
"Fen" (分) is falling tone. "Nei" (内) and "Duo" (度) are entering tones. Summarizing the above: These five errors result from unmastered techniques and unclear human affairs. Thus, it is said: The sage treats disease by knowing Heaven and Earth Yin/Yang, seasonal regulations, harmonizing with human Five Zang/Six Fu, yin-yang, exterior-interior. Then applying acupuncture, moxibustion, stone needles, and drugs. Handling human affairs calmly to clarify meridian Dao. Treating nobility/poverty differently, categorizing and reasoning, asking about age and courage/timidity. Examining Three Yin/Three Yang parts to know disease origin. Clarifying Heaven and Earth's Eight Regularities and Three Powers' Nine Probes. Heaven-human unity, diagnosis will be accurate. This is the sage's treatment. The way of treating disease values internal Qi. Internal Qi must follow its principle; the principle is Shu point principle. If not found, exterior-interior is unclear, error lies in exterior-interior. Must adhere to Three Yin/Three Yang numbers. Apply treatment based on meridian Dao. Only then not losing Shu point principles. Practicing this ensures lifelong safety. Not knowing Shu point principles leads to heat in Five Zang and abscesses in Six Fu. Unexamined diagnosis of exterior-interior/Shu parts is abnormality. Strictly observing this clarifies the Classics. Upper/Lower Classics, measuring Yin/Yang, distinguishing normal/abnormal, deciding by face, examining beginning/end. Doing so, mastering techniques and clarifying human affairs allows free progress, avoiding the five errors.