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The "Five Errors" and the "Four Failures" both refer to physicians. The teaching of medicine aims to rescue and relieve crises, and to continue the true primordial qi (Zhen Yuan). Only those with superior wisdom can bear this responsibility; it is not merely about avoiding faults. However, since there are many who are ignorant and shallow, one must not fail to explicate the "Five Errors" nor to cite warnings regarding the "Four Failures." "Explicate" (Shu) means to state item by item; "cite/warn" (Zheng) implies admonition or caution.

Yellow Emperor said: "Ah, how profound! One must be cautious and attentive, as if gazing into an abyss, or as if welcoming floating clouds. Gazing into an abyss allows one to measure its depth, but welcoming floating clouds makes one unable to know its boundaries." (Note: This corresponds to the *Liu Wei Zhi Da Lun*, both sighing at the boundless profundity of the Dao.) The art of the sage serves as a model for all people. In discussing and regulating patients' wills and intentions, there must be laws to follow, adhering to meridians and observing diagnostic numbers... serving as a deputy/assistant to all people. Thus, matters involve the "Five Errors" and the "Four Virtues," do you understand them? (Note: Yang Shangshan stated: "'Fu' means to assist.")

Lei Gong stepped down from his seat and bowed twice, saying: "This subject is young and small in age, covered by foolishness and confused, having never heard of the 'Five Errors' and 'Four Virtues.' Even when using analogy and distinguishing forms and names, I vainly cite classics, with no firm response in my heart." (Since he had not received systematic instruction from a teacher, and his mind was not born with knowledge, he used humble words.)

Yellow Emperor said: "Whenever diagnosing a disease before examination, one must ask if the patient once held high status and later became low... Diseases arising from within are named 'Tuo Ying' (Depletion of Camp/Nutritive Qi). (This is due to the humiliation of the spirit. Having been noble and glorious, then becoming low and humiliated, the heart harbors attachment and envy, the will knots with worry and fear. Thus, although not struck by external pathogens, disease arises internally, blood vessels become deficient and reduced, hence called 'Tuo Ying'.) Once wealthy and later poor is named 'Shi Jing' (Loss of Essence), where the qi of the five zang organs lingers and connects, and diseases combine. (Being wealthy allowed following desires; poverty strips away abundance. Internally, knots form with worry and torment; externally, grief exceeds what things warrant. Thus, the mind follows longing, the spirit calculates past events. The pathways of Ying and Wei (Nutritive and Defensive Qi) close and linger slowly, blood and qi do not circulate, accumulating and combining to cause disease.) When physicians diagnose this, it is not in the zang-fu organs, nor does the body shape change. Diagnosis raises doubts, and the disease name is unknown. (This refers to the early stage of disease. Since the disease originates from longing, it has not yet settled in the zang-fu; since the event arises from emotional thoughts, the physical form remains unchanged. Physicians do not fully understand this, hence they doubt during diagnosis.) The body decreases day by day, qi becomes deficient without essence. (This refers to the intermediate stage. Blood and qi press against each other, flesh and muscles emaciate, so the body diminishes daily. As stated in the *Yin Yang Ying Xiang Da Lun*: 'Qi returns to essence, essence feeds on qi.' Now, because qi is deficient and cannot transform, essence has no nourishment.) The disease goes deep, qi is exhausted, and the patient feels chilly and startled occasionally. (This refers to the deep stage. Disease qi is deep, grain qi is exhausted, yang qi presses inward, causing aversion to cold and fright. 'Sa Sa' describes a cold sensation.) Deep disease occurs because the exterior consumes Wei Qi, and the interior deprives Ying Qi. (Note: This continues the previous discussion, inferring the root cause of deepening disease. Qi deficiency and lack of essence represent internal deprivation; feeling chilly and startled represents external consumption. Internal deprivation and external consumption are why the disease deepens.) If skilled physicians err, it is due to not knowing the condition of the disease; this is also one error in treatment. ('Error' refers to failing to inquire about the origin of the disease.) Whenever intending to diagnose disease, one must ask about diet and living conditions. (Note: Diet varies in quantity and preference; living conditions vary by day/night and activity/rest.) Sudden joy or sudden sorrow, starting with joy and ending with sorrow... All these damage the essential qi. When essential qi is exhausted and cut off, the physical form is ruined and collapsed. Violent anger damages yin, violent joy damages yang. (Note: Damaging yin refers to anger injuring liver blood; damaging yang refers to joy scattering heart qi. The commentary's explanation via reversal seems insufficient.) Jue (rebellious) qi moves upward, filling the vessels and separating from the form. (Jue means rebellious qi. Rebellious qi moves upward, filling the meridians, causing spiritual energy to scatter and leave the body. Note: These four lines on violent anger and joy are exquisitely meaningful, but already appear in the *Yin Yang Ying Xiang Da Lun*.) Ignorant physicians treating this do not know tonification and sedation... Essence and brilliance are daily depleted, and pathogenic qi combines. This is the second error in treatment. (Note: Where pathogenic qi is excess, sedation should precede tonification; where healthy qi is deficient, tonification should precede sedation. Sedating when tonification is needed, or tonifying when sedation is needed, causes healthy qi to become more deficient and pathogenic qi to become more excessive.) Those skilled in pulse diagnosis must use analogy and the method of the extraordinary (Qi Heng), calmly understanding the condition. If a physician does not understand this Dao, their practice is not worthy of respect; this is the third error in treatment. ('Qi Heng' refers to signs that are extraordinary compared to the constant norm. 'Cong Rong' refers to distinguishing the deficiency and excess of zang qi, where pulses appear similar in height and position. Note: 'Dao' here refers to the methods of analogy and calm discernment.') Diagnosis involves examining three constants, necessarily asking about nobility and baseness, such as fallen lords or those aspiring to be marquises and kings. (Nobles have comfortable bodies and happy minds; commoners have arduous bodies and distressed minds. Since hardship and comfort differ greatly, inquiry should come first. Fallen lords refer to demoted rulers becoming ministers. Aspirants to nobility refer to those coveting high status and acting recklessly.) Thus, when nobles lose power, although not struck by pathogens, spiritual injury occurs internally, and the body must perish. When starting rich and ending poor, although not injured by pathogens, skin becomes dry and tendons contract, leading to flaccidity and spasms. (Note: The wealthy and noble have bright spirits; the poor and lowly have inferior ambitions. Whether one is sick or healthy is distinguished here.) If physicians cannot be strict, cannot move the spirit, and appear outwardly weak and compliant, disrupting normal order, and the disease cannot be moved... this is the fourth error in treatment. ('Strict' means admonishing to forbid improper acts; 'Move' means to make them obey. Outward compliance means yielding and following. Yet if admonition fails to forbid impropriety, and moving fails to ensure obedience, yielding to circumstances leads to chaos and loss of natural order. If the disease does not improve, what kind of physician is this?) Any diagnostician must know the beginning and end... Pulse palpation and asking for the name must accord with male and female differences. ('Beginning and End' refers to complexion. The *Mai Yao Jing Wei Lun* states: 'Knowing the exterior begins with the end and returns to the start.' Clearly knowing the five qi and color images, ending and restarting. 'Qie' means pressing the pulse with fingers. 'Asking for the name' means asking for the name of the syndrome. Men have more yang qi, so a large left pulse is favorable; women have more yin qi, so a large right pulse is favorable. Hence, this should be checked first as a norm.) Separation, severance, stagnation, knotting, worry, fear, anger, and joy lead to emptiness of the five zang organs and separation of blood and qi from their guardianship. If physicians do not understand this, what talk of technique is there... Merely predicting the day of death also makes one a crude physician; this is the fifth error in treatment. ('Separation' refers to alienating loved ones; 'Severance' refers to cutting off cherished hopes; 'Stagnation' refers to accumulated overthinking; 'Knotting' refers to fixed resentment. Alienating loved ones causes the soul to wander; severing hopes causes the intent to be lost; accumulating worries exhausts the spirit; fixing resentment distresses the will. Worry causes blockage; fear causes instability and loss of control; intense anger causes confusion and lack of regulation; joy causes dispersion and inability to store. Due to these eight factors, the five zang organs become empty, and blood and qi separate from their posts. If physicians do not ponder and understand, what can they say? Note: The value of a physician lies in assessing pulses, differentiating syndromes, and saving lives from death. If remedial techniques are entirely absent, and only the day of death is predicted, even if accurate later, it is not worthy of respect.) All these five arise from unmastered skills and ignorance of human affairs.

Therefore it is said: The sage treating disease must know heaven and earth, yin and yang, the regulations of the four seasons, the five zang and six fu organs, their yin-yang and exterior-interior relationships, the indications for acupuncture, moxibustion, stone needles, and drugs. Following human affairs, clarifying the Dao of the meridians, recognizing that nobility and poverty, wealth and destitution have different pathological principles, inquiring into the principles of youth, age, courage, and timidity, examining the divisions, knowing the root and origin of the disease, referencing the Eight Rectitudes and Nine Pulses, diagnosis will be perfectly aligned. (...Such is the comprehensive knowledge of the sage; physicians should strive for this.)