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(Su Wen, Chapter on the Theory of Fullness and Emptiness, continuing from the previous chapter)

Therefore, in diagnosis there are fundamental principles; sitting and rising have their regularities. (The "fundamental principle" refers to the major laws of medical practice. Regularity in sitting and rising implies that movements are not frivolous but first correct one's own body; when the body is corrected externally, the mind follows suit. Thus, the fundamental principle of diagnosis must begin with this.) Entrance and exit should be guided by virtue, to transform and illuminate the spirit. ("Xing" here denotes virtue. The physician takes saving lives as their heart's intent; during times of coming and going, every thought is sincere, without any lack of reverence. When virtue can move Heaven and sincerity can penetrate the mind, one can navigate all situations with divine efficacy.) One must be clear and quiet, observing above and below. (Being clear and quiet allows the mind to focus and the spirit to manifest, enabling observation upwards to examine complexion, expression, voice, and sound, and downwards to examine the physical form for compliance or deviation.) Manage the pathogens of the Eight Normals, distinguish the locations of the Five Zang organs. ("Si" means to monitor. "Bie" means to discern. Monitor the righteous and evil influences of the Eight Solar Terms and Eight Winds to examine the exterior; discern the positions of the Five Zang organs and Five Elements to examine the interior.) Press the pulse to observe its dynamics, and trace the meanings of slipperiness, roughness, cold, and warmth at the Cun position. (Pressing the pulse to observe dynamics distinguishes Yin and Yang. Slipperiness and roughness, cold and warmth indicate Deficiency and Excess. Generally, if the pulse is slippery, the skin at the Cun position is also slippery; if rough, then rough; if cold, then cold; if warm, then warm. Thus, tracing the Cun position reveals these states. "Xun" means to feel or trace.) Observe urination and defecation, combining them with the disease's presentation. (Urine and stool are the gates of constraint. If the gates are not secure, the granaries cannot store; those who maintain security live, those who lose it die. Thus, observing urine and stool helps understand the disease's state. "Neng" refers to the condition or manifestation.) Through understanding reversal and compliance, one determines the diagnosis and knows the disease name. (Reversal is "Ni", compliance is "Cong". One must grasp both to know the disease name, ensuring certainty and avoiding error.) Diagnosis can achieve perfection, without failing to account for human circumstances. (Diagnosing according to the above methods allows for perfection; however, human circumstances must not be overlooked. I note: Failing to account for human circumstances is the most difficult aspect for physicians. There are three types of human circumstances: the patient's situation, the bystander's situation, and the colleague's situation. The patient's situation includes constitutional predispositions, such as each Zang organ having biases and each emotion having counteracting forces. Those with Yang constitutions prefer cooling, while those with Yin constitutions prefer warming. For those tolerant of toxicity, mild treatment fails; for those intolerant, harsh treatment causes harm—this is the difference in Zang Qi. There are preferences and aversions: dietary likes and dislikes extend to daily actions. Those favoring auspiciousness reject alarming words; those prone to worry find comfort false; those untrusting find advice hard to accept; those suspicious avoid deep discussion—this is the difference in temperament. There are circumstances of wealth and nobility: the rich often act willfully, the noble often value self-esteem. The willful consider themselves always right, making truth seem wrong; the noble may treat scholars with disdain, the self-respecting refuse to lower themselves—this is the difference in social interaction. There are circumstances of poverty and low status: the poor struggle for food and clothing, let alone medicine; the lowly suffer anxiety and toil—this is the difference in care management. Furthermore, some believe good advice only to update erroneous views later, like losing sheep on many paths, ending up with a painted cake—this is the harm of being leaderless and easily confused. Some fear novelty, seeking only stability, like using a cart of firewood or a cup of water to extinguish a fire, preferring defeat—this is the harm of excessive caution due to inner fear. Some suffer from loss of wealth or status, or deep emotional attachments, causing mental distress that no physical medicine can cure—this is the harm of gain and loss. Some with acute conditions face chronic diseases, or cause chaos by changing doctors and mixing treatments, rushing for speed leading to rapid decline—this is the harm of urgency. Some are dogmatic, claiming "our region does not use tonification," harming the deficient, or "our region does not use purgation," injuring the excess. Even ten households have loyalty and trust; how can an entire village conform? This is the harm of local customs. Some fear tonics like Ginseng and Atractylodes causing chest fullness, or purgatives like Niter and Rhubarb causing mental agitation; like fearing shadows in a cup, excessive suspicion is not a good method—this is the harm of preconceived notions. Some hide illness and refuse to speak, ultimately harming themselves; some have hidden feelings they dare not reveal, preventing detailed inquiry. Yet some deliberately conceal symptoms to test the doctor with pulses; if the doctor guesses correctly, they are deemed wise; if not, mediocre. Who knows that pulse patterns are limited to twenty-four, while disease manifestations number in the thousands? Thus, one pulse does not correspond to one disease, nor one disease to one pulse. When pulse and disease correspond, it is auspicious; when they conflict, it is ominous. Although the logic of auspiciousness and omen resides in the mind, how can the myriad variations of disease be fully described by pulse alone? Hence, knowing one, two, or three, the sages earnestly teach the method of comparison; calling oneself a worker, a spirit, or a sage, precision is not merely in the fingertips. The shallow views of commoners are unsurprising, yet even enlightened scholars often fall into this trap. Those who shun inspection and listening claim there are no visible signs or sounds to distinguish; those who dislike detailed questioning avoid the shame of talking too much. In doing so, they discard three of the four diagnostic methods, and many fail to even master one, yet expect to know the disease—I know this is impossible. Thus, if the mind is not clear, the physician is troubled by the patient; if guessing blindly, the patient is troubled by the physician. All these are patient circumstances that must be examined. The bystander's circumstances involve rumors related to benefit and harm, which people rarely check. Some make arrogant claims beyond medical wisdom; some insist on seemingly evidence-based arguments where the disease presentation is confused, making it hard to know. Some wield power over right and wrong, approving what agrees with them and rejecting what differs, leaving true truth unrecognized by non-experts. Some cling to immediate views, saying "headache needs head treatment, leg pain needs leg treatment," ignoring root and branch relationships as pedantic talk. Some debate between high and low status; the noble insist on their words, which cannot be resisted, so prudent physicians become yes-men. Some argue based on intimacy; relatives hold sway and are unyielding, forcing even skilled physicians to retreat. Recommendations for doctors affect life and death, yet people are careless. Some recommend based on a layperson's lucky guess, personal bias, eloquent speech, or superficial appearance—not true knowledge. Some recommend for greed, seeking secret rewards; others for personal favors, hoping for future gains. Some petty people, arrogant and fond of flattery, cannot distinguish fragrant herbs from foul ones, yet freely judge, praising villains as sages or destroying phoenixes as owls, digging for faults endlessly, excluding virtuous men. Such people, though speaking lightly and unaffected by joy or sorrow, cause the greatest confusion, driving away good doctors and creating deep suspicion in families. This is why right and wrong remain unclear for millennia, disturbed by mediocrity. Thus, those striving to serve others face great danger. These are bystander circumstances that must be examined. Colleague circumstances are particularly elusive and subtle. Those with narrow views, like looking at the sky through a tube or measuring the sea with a gourd, are unworthy of mention; nor are those with stubborn, unchangeable biases. Some rely on eloquence, making excuses, speaking nonsense, using clichés to deceive, sweet words to please, strong arguments to trick, or scary tales to frighten, posing as gentlemen of investigation—these are the flatterers. Some focus on social connections, ignorant of classics, spreading hearsay, busy day and night, flattering to win favor—these are the sycophants. Some pursue novelty, uneducated yet claiming divine revelation or secret transmission, predicting fortune via pulse or playing tricks to disrupt norms, appearing novel and captivating—these are the frauds. Some decorate appearances, boasting like a tiger-skin sheep, ignoring inspection, listening, and questioning, prescribing after one glance, thinking themselves superior—these are the reckless. Some engage in exclusion, feigning unity while plotting behind the scenes. While distinguishing right from wrong avoids hiding evil, in life-and-death matters, distinction is necessary for true gentlemen. But confusing right and wrong, overturning Yin and Yang, and misjudging fortune and doom out of ignorance or malice shows lost conscience and jealousy—these are the villains. Some are greedy and ignorant, disregarding life. In critical cases, even gods might fail, requiring careful medication and strategy. Suddenly encountering those who seek quick success and merit, making reckless errors like losing an oar mid-stream, leads to incurable situations. They then shift blame and bite back, confusing colors and harming the innocent—these are the greedy and ignorant. Those with different paths do not plan together, holding divergent opinions. Minor errors are tolerable in light cases, but fatal in heavy ones. Extraordinary diseases require extraordinary physicians and treatments, unknown to the masses. Thus, unique insights differ from the crowd; high art has few followers. Many slander the virtuous; high songs have few singers. A single teacher from Qi cannot withstand the noise of Chu; failure comes, then everyone scatters, leaving one person to deal with the aftermath—these are the incompetent. Some follow bad habits, perfunctorily fulfilling duties, indifferent to illness, caring only for profit. Patients who don't understand medicine switch doctors randomly; physicians unwilling to bear responsibility prescribe only mild herbs like Scutellaria and Platycodon. When many doctors are consulted, they watch each other; when stakes are high, they avoid suspicion. Treating symptoms without addressing causes, doctors call it "safe," but miss opportunities for timely treatment. This stems from imperfect knowledge of medicine and lack of dedicated appointment. As the Classic says: "Words fill the court, but who bears the blame? Building a house by the road, it never gets finished." These are common flaws today. Are these not human circumstances? Details are endless. Confucius said: "I hate purple usurping red, Zheng music disrupting elegant music, and glib tongues overthrowing states." Human circumstances are feared not just now, but since ancient times. Sages warn against failing to account for them, yet "not failing" is hardest. Trying not to fail leads to compromise; compromising hinders treatment; not compromising offends people. With uncompromising disease states and unavoidable human pressures, what then? Human circumstances are hard to discuss. I write this for practitioners to examine carefully. If these three groups reflect on my words, they may avoid pitfalls, preserve natural lifespan, and reach longevity. Only the wise will heed this.) Therefore, diagnosis sometimes involves observing breathing and intent, thus maintaining order. (Observing breathing examines Qi; observing intent examines emotions and expressions. These methods are part of the fundamental principles and perfect diagnosis. Knowing them ensures order. "Tiao" is like branches on a trunk; "Li" is like veins in an object, referring to the network and guidelines.) The Way is clearly observed, thus lasting long. Not knowing this Way, abandoning classics and severing principles, speaking falsely and expecting wrongly, is called losing the Way. (Not knowing this Way leads to false speech and expectations, inevitably resulting in danger.)