四失谓精神不专。志意不理。上章论不得病者之情。此章论医者失神志之专一。故曰疏者。谓疏得五中之情。征者
惩创医之四失。
黄帝在明堂。雷公侍坐。黄帝曰。夫子所通书受事众多矣。试言得失之意。所以得之。所以失之。雷公对曰。循经
受业。皆言十全。其时有过失者。请闻其事解也。（谓持诊之道。谨守神志。始得其情。无有过失。方为十全。）帝曰。
子年少。智未及耶。将言以杂合耶。夫经脉十二。络脉三百六十五。此皆人之所明知。工之所循用也。所以不十全者。
精神不专。志意不理。外内相失。故时疑殆。（杂合、言不专一也。持诊者当守其精神。调其志意。内得于心。而外应于
手。如失此精神志意。故时殆而不能十全。）诊不知阴阳逆从之理。此治之一失也。（阴阳之理。有顺有逆。诊者不知。
治之失也。）受师不卒。妄作杂术。谬言为道。更名自功。妄用砭石。为遗身咎。此治之二失也。（此言针砭之道。必得
师传。忌务杂术。若自诩功能。必遗身咎。）不适贫富贵贱之居。坐之薄浓。形之寒温。不适饮食之宜。不别人之勇怯。
不知比类。足以自乱。不足以自明。此治之三失也。（用针之道。当适人贫富贵贱之所居。则知形志之苦乐矣。薄浓。谓
肌
肉之浓薄。针经曰。肌肉瘦者。易于脱气。易损于血。刺此者。浅而疾之。年质壮大。血气充盈。皮革坚固。因加以邪。
刺此者。深而留之。膏者其肉淖。而粗理者身寒。细理者身热。脂者其肉坚。细理者热。粗理者寒。此形之寒温也。又
曰。已饱勿刺。已刺勿饱。已饥勿刺。已刺勿饥。已渴勿刺。已刺勿渴。已醉勿刺。已刺勿醉。故当适饮食之所宜。勇
者谓壮士。真骨坚肉缓节。监监然。刺此者深而留之。多益其数。怯者谓婴儿。其肉脆。血少气弱。刺此者。以毫针浅
刺而疾发。日再可也。比类者。比类天地阴阳日月星辰之道。不明此道。足以自乱。此治之三失也。）诊病不问其始。忧
患饮食之失节。起居之过度。或伤于毒。不失言此。卒持寸口。何病能中。妄言作名。为粗所穷。此治之四失也。（持诊
之道。不得人之志意苦乐。饮食起居。或名伤于五气五味之毒。不审问而失言此数者。卒持寸口。何病能中。妄言作名
医。反为粗工所穷。此治之四失也。）是以世人之语者。驰千里之外。不明尺寸之论。诊无人事。治数之道。从容之葆。
（言世人多夸大其语。而不明寸尺之微。失寸尺之毫厘。而有千里之谬。盖人之日用事物。饮食起居。莫不有理。如失
其和平。皆能为病。诊无人事之审。是忽近而图远也。葆、宝同。言治诊之道。惟天理人事之为葆也。）持其寸口。诊不
中五脉。百病所起。始以自怨。遗师其咎。是故治不能循理。弃术于市。妄治时愈。愚心自得。（上节言不审察病者之情。
此言不明五脉百病之诊。此皆受师不卒。更自为功。精神不转。志意不理。如弃术于市。招众人之所怨恶也。设妄治之。
而或有时愈。庸愚之心。以为自得。此亦行险以侥幸耳。岂真学问之功哉。）呜呼。窈窈冥冥。孰知其道。道之大者。拟
于天地。配于四海。汝不知道之谕受。以明为晦。（此复结真道之合于天道也。窈窈冥冥。天之道也。复叹其延医之道。
若视深渊。若迎浮云。视深渊。尚可测。迎浮云。莫知其极。言道大之难明也。四海、谓地居水之中。天运于地之外。
夫天有日月星辰之晦明。人有昼夜出入之血气。如不受师之传谕。不明道之体原。是以天道之明而为晦矣。）
The "Four Errors" refer to: the spirit is not focused, and the will is not orderly. The previous chapter discussed the condition of those who do not fall ill; this chapter discusses the errors of physicians in maintaining the unity of their spirit and will, hence it is called "Shu" (Negligence), meaning negligence regarding the internal conditions of the five Zang organs. "Zheng" means to punish and warn against the four errors of physicians.
Yellow Emperor was in the Ming Hall, with Lei Gong attending by his side. Yellow Emperor said, "You have mastered numerous books and medical matters. Please discuss the principles of success and failure in diagnosis and treatment—why one succeeds and why one fails." Lei Gong replied, "When following the meridians and receiving instruction, it is always said that one can achieve perfect results (Ten Parts Complete). However, mistakes sometimes occur in practice. May I ask for an explanation?" (This means: To master the way of diagnosis, one must carefully guard one's spirit and will to truly understand the condition; only without error can it be considered perfect.) Yellow Emperor said, "Is it because you are young and your wisdom has not yet matured? Or is your discourse mixed and unfocused? The human body has twelve primary meridians and three hundred and sixty-five collaterals. These are well-known to people and followed by practitioners. The reason for not achieving perfection lies in the lack of focused spirit and unorganized will, leading to a disconnect between the interior and exterior, thus causing frequent doubt and danger." (Mixed and unfocused refers to a lack of concentration. In holding the pulse, one should maintain one's spirit and regulate one's will, comprehending internally and responding externally with the hands. If this spirit and will are lost, danger ensues, preventing perfection.)
Failing to understand the principles of Yin-Yang and their compliance or opposition during diagnosis is the first error in treatment. (The principles of Yin-Yang involve both compliance and opposition. If the diagnostician does not understand these, it constitutes an error in treatment.) Abandoning formal apprenticeship before completion and resorting to miscellaneous techniques, falsely claiming them as the Great Way, changing names to claim credit, and recklessly using Bian stones, thereby bringing blame upon oneself, is the second error in treatment. (This refers to the art of acupuncture and moxibustion/Bian therapy, which must be transmitted by a teacher. One should avoid eclectic methods. Boasting of one's own merits inevitably leads to self-inflicted harm.) Failing to adapt to the living conditions dictated by poverty, wealth, and status; ignoring the thickness of muscles and the cold-heat constitution of the body; failing to consider appropriate dietary choices; and not distinguishing between courageous and timid patients, while lacking the ability to use analogical reasoning, leads to self-confusion rather than clarity. This is the third error in treatment. (The method of needling should adapt to the patient's social status and environment to understand the suffering of form and spirit. 'Thickness' refers to the density of muscles. The *Classic of Acupuncture* states: Those with emaciated muscles easily lose Qi and are prone to blood damage; such patients require shallow and rapid insertion. Those who are young and robust, with abundant Qi and blood, firm skin, and exposed to pathogenic factors, require deep insertion with retention. Those with 'Gao' (fat) type bodies have soft muscles; those with coarse pores feel cold, while those with fine pores feel hot. Those with 'Zhi' (lean/firm) type bodies have firm muscles; those with fine pores feel hot, while those with coarse pores feel cold. This describes the cold-heat constitution. It also states: Do not needle immediately after eating; do not eat immediately after needling; do not needle when hungry; do not eat immediately after needling if hungry; do not needle when thirsty; do not drink immediately after needling if thirsty; do not needle when drunk; do not drink immediately after needling if drunk. Thus, one must adapt to dietary appropriateness. 'Courageous' refers to strong men with solid bones, relaxed muscles, and dignified demeanor; they require deep insertion with retention and increased frequency. 'Timid' refers to infants with fragile flesh, little blood, and weak Qi; they require shallow insertion with rapid withdrawal using fine needles, possibly twice daily. 'Analogical reasoning' involves comparing the principles of Heaven, Earth, Yin-Yang, sun, moon, stars, and planets. Failing to understand this leads to confusion, constituting the third error.)
Failing to inquire about the onset of the disease, such as emotional distress, dietary irregularities, excessive lifestyle habits, or toxic injuries, and neglecting to mention these factors, then abruptly palpating the Cun Kou pulse, makes accurate diagnosis impossible. Fabricating disease names arbitrarily and being confounded by crude practitioners is the fourth error in treatment. (Mastering diagnosis requires understanding the patient's mental state, diet, and lifestyle, or identifying injuries from the toxicity of the Five Qi and Five Flavors. Failing to inquire and neglect these aspects, then suddenly palpating the radial artery, prevents accurate diagnosis. Arbitrarily claiming to be a famous physician leads to being outdone by crude practitioners, constituting the fourth error.)
Therefore, worldly speech often exaggerates to distances of a thousand li, yet fails to understand the subtle theories of measurement (Cun/Cun). Diagnosis ignores human affairs, and treatment lacks the composure and preciousness of proper principles. (This means people tend to exaggerate, ignoring the minutiae of measurements, leading to errors of a thousand li due to slight inaccuracies. Daily activities like diet and起居 have their rational order; losing harmony causes disease. Ignoring human context in diagnosis is neglecting the near for the distant. 'Bao' is synonymous with 'Bao' (Treasure). It implies that the essence of diagnosis and treatment lies in Heavenly principles and human affairs.) Palpating the Cun Kou but failing to align with the variations of the Five Pulses, and misunderstanding the origins of myriad diseases, leads initially to self-reproach and later to blaming one's teacher. Thus, treatment that does not follow principles abandons the art to the marketplace; reckless treatment may occasionally succeed, leading the foolish mind to pride itself. (The previous section discussed failing to examine the patient's condition; this section discusses failing to understand the Five Pulses and the origins of diseases. Both stem from incomplete apprenticeship and self-aggrandizement, with scattered spirit and disordered will, akin to abandoning medicine in the street, inviting public scorn. Even if reckless treatment occasionally works, the ignorant consider it personal merit. This is merely gambling on luck, not true scholarly achievement.)
Alas, profound and obscure, who knows the Way? The great Way mirrors Heaven and Earth and corresponds to the Four Seas. You do not comprehend the teachings of the Way, treating clarity as obscurity. (This concludes that the true Way aligns with Heavenly Dao. 'Yao Yao Ming Ming' describes the nature of Heaven. It sighs that seeking medical help is like gazing into an abyss or chasing floating clouds; the abyss can be measured, but the clouds' limits are unknowable, illustrating the difficulty of grasping the vast Way. 'Four Seas' refers to the earth surrounded by water, with Heaven moving outside the earth. Just as Heaven has the brightness and darkness of celestial bodies, humans have the circulation of Qi and Blood through day and night. Without accepting the teacher's transmission and understanding the origin of the Way, one turns the brightness of Heavenly Dao into obscurity.)