马云。疏。陈也。内有五过。故名篇。吴云。篇内。论延医五过。为工者。宜疏远之。因以名篇。简按
楚辞九歌。疏石兰兮为芳。注。疏。布陈也。马盖本于此。
闵闵乎 吴云。玄远莫测之貌。高云。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。
论裁志意 吴云。论裁人之志意。必有法则。张云。裁。度也。志云。当先度其志意之得失。
医事 周礼医师职云。医师。掌医之政令。聚毒药以共医事。
脱营 卫生宝鉴。论脱营不治证。当参考。陈氏外科正
宗云。失荣者。先得后失。始富终贫。亦有虽居富贵。其心或因六欲不遂。损伤中气。郁火相凝。隧痰失道。
停结而成。其患多生面项之间。初起微肿。皮色不变。日久渐大。坚硬如石。推之不移。按之不动。半载一年。
方生阴痛。气血渐衰。形容瘦削。破烂紫斑。渗流血水。或肿泛如莲。秽气熏蒸。昼夜不歇。平生疙瘩。愈久
愈大。越溃越坚。犯此俱为不治。此乃脱营之一证也。
五气留连 马云。五气者。五脏之精气也。
洒酒然 熊音。苏浪反。寒貌。
此亦治之一过也 简按据下文例。亦字衍。
毁沮 张云。沮。将鱼切。坏也。高云。沮。音殂。义通。毁沮。犹死亡也。
厥气上行满脉去形 张云。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。
必以比类奇恒 吴云。谓比量类例于奇异。及庸常之证也。高云。奇。异也。恒。常也。异于恒常之
病。必比类相参。从容知之。
三常 张云。即常贵贱。常贫富。常苦乐之义。
封君败伤 吴云。谓尝封君。为事毁败。而中伤者。简按封君。乃封国之君。败伤。谓削除之类。追
悔已往。以致病也。
故贵脱势 吴云。故家贵族也。高云。故。犹昔也。故贵脱势。谓昔者身贵。今则脱势也。马义同。
不能动神 吴云。医不能严戒其非。竦动其神。而令从命。外为柔和萎弱。至于乱失天常。
必知终始 吴云。终始。谓今病及初病也。张云。谓原
其始。要其终也。高云。必知经脉之终始。
有知余绪 吴云。谓有知之后。诸凡余事也。张云。谓察其本知其末也。志云。谓更知灸刺补泻之绪
端。高云。余绪者。经脉虚实之病也。简按今从张注。
当合男女 吴云。谓男女气血不同。其脉与证。亦当符合也。张云。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。志云。谓针刺之要。男内女外。坚拒勿出。谨守勿内。是谓得气。高云。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。简按合字。义未稳妥。
姑仍王注。
离绝菀结 高云。或阴阳血气之离绝。或阴阳血气之郁结。简按此注似是。然与下文血气离守支矣。
不如旧注为得。
尝富大伤 张云。谓甚劳甚苦也。高云。如人尝富。一旦失之。则大伤其神魂。
故伤败结留薄归阳脓积寒炅 张云。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。
从容人事 张云。从容于人事。从容。周详也。
经道 吴云。常道也。张同。高云。明经脉之道也。简按高注非。
诊必副矣 吴云。副。全也。张云。副。称也。简按张本于广雅。
气内为宝 张云。气内者。气之在内者也。即元气也。凡治病。当先求元气之强弱。元气既明。大意见矣。
过在表里 张云。求元气之病。而无所得。然后察其过之在表在里以治之。
菀熟 马吴张并作菀热。简按大奇论。菀熟。亦误。
痈发六腑 志云。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。
与经相明 吴云。经。谓经旨。圣道之所载也。张云。即下文上经下经之谓。上经下经。揆度奇恒。
义见病能论。
五中 吴云。五内也。
决以明堂审于终始 马云。明堂部位之义。详见灵枢五色等篇。张云明堂。面鼻部位也。终始。灵枢
篇名也。吴云。决。取正也。明堂。王者朝诸侯布政之所。人身腔之中。有天君主于其内。十二官分司守职。
与王者向明布政之堂。居然无两。故谓明堂。终始。谓始病及今病也。志云。脏腑经脉之始。三阴三阳已绝之
终。高云。经脉终始。简按张终始之解。吴明堂之释。并误。马云。按帝言五过四德。而今四德不具。亦公不
复问。故帝未之答欤。马说如此。四德未详何义。而吴以治病之道。气内为宝以下。为一德。守数据治以下。
为二德。诊病不审以下。为三德。上经下经以下。为四德。而张则以必知天地一节。为一德。五脏六腑雌雄一
节。为二德。从容人事一节。为三德。审于部分一节。为四德。志高则并不言及。盖以经文不明显。其义难寻也。
Ma Yun stated: "Shu" (to arrange and state) means to set forth. Since the text discusses five errors, it is named "Treatise on the Five Errors in Diagnosis and Treatment". Wu Kun commented: This chapter discusses five errors in seeking medical help; physicians should avoid these pitfalls, hence the title. Jian An noted: In *Chu Ci · Nine Songs*, the line "Shu Shi Lan Xi Wei Fang" (Arranging stone orchids to create fragrance) is annotated as: "Shu means to spread and arrange." Ma's interpretation likely derives from this.
"Minyinhu": Wu Kun described it as a profound and unfathomable appearance. Gao Shishi explained that "Minyin" signifies extreme sorrow. The Emperor lamented the vastness and profundity of the medical Dao, noting that the techniques of sages follow meridians and numerical laws, involving five errors and four virtues. Physicians must understand these, so he instructed Leigong to elucidate them.
On Judging Will and Intent: Wu Kun stated that judging a patient's will and intent requires specific principles. Zhang Jingyue defined "Cai" (judge/cut) as measuring or assessing. Zhang Zhicong added that one must first assess the gains and losses in the patient's mental state.
Medical Affairs: According to the *Rites of Zhou · Office of Physicians*, the Physician-in-Chief manages medical regulations and gathers toxic substances for medical use.
Tuo Ying (Depletion of Essence): The *Health Treasure Mirror* discusses untreatable cases of Tuo Ying. Chen Shigong's *Orthodox Manual of External Surgery* describes "Shi Rong" (Loss of Glory), which typically affects those who were once wealthy but became poor, or those in high status whose desires are unfulfilled, damaging middle Qi, causing stagnant fire and phlegm obstruction. It often appears on the face and neck, starting as slight swelling with unchanged skin color, eventually becoming hard as stone, immobile, and painful after months or years. As Qi and blood decline, the body emaciates, skin ulcerates with purple spots bleeding fluid, or swells like a lotus with foul odor. These are considered untreatable and represent a form of Tuo Ying.
Wu Qi Liulian (Five Qi Lingering): Ma Yun explained that "Wu Qi" refers to the essential Qi of the five Zang organs.
Saxiran (Chilling): Xiong Zongli provided the pronunciation "Su Lang fan," describing a sensation of cold.
This is also one of the treatment errors: Jian An noted that based on the context, the character "Yi" (also) is likely an interpolation.
Hui Ju (Destruction and Ruin): Zhang Jingyue defined "Ju" as destruction. Gao Shishi noted the pronunciation matches "Zu" and the meaning is consistent. "Hui Ju" implies death or ruin.
Jue Qi Shangxing Man Mai Qu Xing (Rebellious Qi Ascends, Filling Pulses, Departing Form): Zhang Jingyue explained that "Jue Qi" is rebellious Qi. Excessive anger or joy damages essence, causing Qi to rebel and ascend. When Qi rebels in the vessels, they become full; when essence depletes internally, the spirit departs from the form. These four phrases appear in the *Treatise on Yin-Yang and Correspondences*.
One must employ Analogy and Extraordinary Methods: Wu Kun stated this means comparing extraordinary cases with ordinary ones. Gao Shishi clarified that "Qi" means abnormal and "Heng" means normal. Diseases differing from the norm require comparative analysis for accurate understanding.
San Chang (Three Constants): Zhang Jingyue identified these as the constants of nobility/lowliness, wealth/poverty, and suffering/happiness.
Feng Jun Bai Shang (Fall of the Enfeoffed Lord): Wu Kun referred to former lords injured by political failure. Jian An clarified that "Feng Jun" refers to feudal lords, and "Bai Shang" refers to loss of rank or position, leading to illness through regret.
Gu Tui Tuo Shi (Former Nobility Losing Power): Wu Kun defined "Gu Jia" as former noble families. Gao Shishi explained "Gu" as "former." Thus, "Gu Tui Tuo Shi" means losing power after previously holding high status. Ma Yun agreed.
Unable to Move the Spirit: Wu Kun stated that if a physician fails to strictly correct errors and stir the patient's spirit to obedience, the patient may appear compliant externally but internally disrupt natural order.
Must Know Beginning and End: Wu Kun defined "Zhong Shi" as current and initial conditions. Zhang Jingyue said it means tracing the origin and examining the outcome. Gao Shishi emphasized knowing the beginning and end of meridians.
Knowing the Remaining Threads: Wu Kun meant understanding subsequent details after grasping the main point. Zhang Jingyue interpreted it as knowing the root to understand the branches. Zhang Zhicong referred to understanding acupuncture tonification and sedation techniques. Gao Shishi linked it to excess and deficiency in meridians. Jian An adopted Zhang Jingyue's view.
Must Combine Male and Female Factors: Wu Kun noted differences in Qi and blood between genders affect pulse and symptoms. Zhang Jingyue highlighted yin-yang distinctions and pulse reversals requiring gender-specific assessment. Zhang Zhicong mentioned acupuncture techniques regarding male/female internal/external approaches. Gao Shishi connected this to yin-yang and blood/qi dynamics, citing the *Treatise on Yin-Yang and Correspondences*. Jian An found the term "He" (combine) ambiguous and retained Wang Bing's annotation.
Li Jue Wan Jie (Separation, Severance, Stagnation, Knotting): Gao Shishi suggested this refers to separation or stagnation of yin-yang and blood/qi. Jian An found this plausible but inconsistent with later text, preferring older annotations.
Chang Fu Da Shang (Great Injury After Former Wealth): Zhang Jingyue attributed this to extreme labor and hardship. Gao Shishi illustrated it as the psychological trauma of losing wealth.
Old Injuries, Destruction, Accumulation, Thinness, Returning to Yang, Pus Accumulation, Cold and Heat: Zhang Jingyue explained "Gu" as old. Old injuries lead to destruction and accumulation where Qi and blood stagnate, generating heat returning to the Yang aspect, causing pus/blood accumulation and alternating chills and fever.
Congrong Renshi (Consider Human Circumstances): Zhang Jingyue defined "Congrong" as being thorough and considerate regarding human affairs.
Jing Dao (The Way of Classics): Wu Kun and Zhang Jingyue defined it as the constant way. Gao Shishi claimed it referred to meridians, but Jian An disagreed.
Diagnosis Must Be Accurate: Wu Kun defined "Fu" as complete. Zhang Jingyue, citing *Guangya*, defined it as matching or corresponding.
Internal Qi is Precious: Zhang Jingyue identified "Qi Nei" as Yuan Qi (Original Qi). Treating disease requires assessing Yuan Qi strength first; once clear, the general principle emerges.
Error in Exterior or Interior: Zhang Jingyue advised that if Yuan Qi pathology is unclear, determine if the error lies in the exterior or interior to guide treatment.
Wen Re (Stagnant Heat): Ma, Wu, and Zhang wrote "Wen Re." Jian An noted *Da Qi Lun* also has this error.
Abscess Erupts in Six Fu Organs: Zhang Zhicong explained that while Zang are Yin and Fu are Yang, internal stagnation-heat can manifest as abscesses in the external flesh/skin associated with Fu organs.
Clarified by the Classics: Wu Kun referred to "Jing" as canonical teachings. Zhang Jingyue linked it to the *Upper Classic* and *Lower Classic*, referencing *Bing Neng Lun* for concepts of measurement and extraordinariness.
Wu Zhong (Five Interiors): Wu Kun equated this with "Wu Nei" (Five Viscera).
Decide Using Mingtang and Examine Beginning and End: Ma Yun referenced *Ling Shu · Se Color* for "Mingtang" (Bright Hall/Face). Zhang Jingyue defined "Mingtang" as the nose/face area and "Zhong Shi" as a chapter title. Wu Kun defined "Jue" as determining correctness and "Mingtang" metaphorically as the emperor's hall within the body governed by Heaven. Zhang Zhicong defined "Zhong Shi" as the start of organs/meridians and the end of San Yin/San Yang exhaustion. Gao Shishi focused on meridian beginnings and ends. Jian An criticized Zhang and Wu's interpretations. Ma Yun speculated that the Emperor omitted discussing the "Four Virtues" because Leigong stopped asking. Wu Kun listed four virtues: 1. Prioritizing Yuan Qi; 2. Following data/rules; 3. Careful diagnosis; 4. Mastery of classics. Zhang Jingyey listed: 1. Understanding Heaven/Earth; 2. Zang-Fu correspondence; 3. Considering human circumstances; 4. Examining anatomical parts. Zhang Zhicong ignored the concept due to textual ambiguity.