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Huangdi said: "Alas, how profound! It appears obscure and subtle, like gazing into a deep abyss or welcoming floating clouds. While the depth of an abyss can be measured, the boundaries of floating clouds are unknowable. The medical art of the sages serves as a model for all people. When discussing and judging patients' wills and intentions, there must be laws to follow; one must adhere to the meridians, observe the numerical principles (of diagnosis), and act according to medical procedures, serving as an assistant to the people. Therefore, there are five errors and four virtues in treatment. Do you know them?"

Leigong stepped out of his seat and bowed twice, saying: "I am young and immature, confused by my own ignorance. I have never heard of the five errors and four virtues. Although I attempt to use analogy to deduce physical forms and names, and vainly cite classical texts, my mind remains at a loss."

The Emperor said: "In general, before diagnosing a disease, one must ask if the patient was formerly noble and has since become humble. Even without invasion by external pathogens, the disease arises from within, named 'Tuoying' (Depletion of Ying/Nutritive Qi). If the patient was formerly wealthy and has since become poor, it is named 'Shijing' (Loss of Jing/Essence), where the qi of the five zang organs lingers and connects, causing diseases to combine. When physicians diagnose, they find the disease is not in the zang-fu organs, nor does it change the body's form. They diagnose with doubt, unaware of the disease name. The body wastes away daily, qi becomes deficient and essence depleted. In deep disease, qi is exhausted, and the patient feels chilly and startled occasionally. The reason for deep disease is external consumption of Wei (Defensive) qi and internal depletion of Ying (Nutritive) blood. If a skilled physician errs by not understanding the condition, this is the first error in treatment.

"When intending to diagnose, one must inquire about diet and living conditions. Sudden joy or sudden sorrow, starting with joy and ending with sorrow, all damage Jingqi (Essence-Qi). When Jingqi is exhausted, the physical form is ruined. Sudden anger damages Yin, sudden joy damages Yang. Rebellious qi ascends, filling the vessels and separating from the form. Ignorant physicians, when treating, do not know tonification and sedation, nor do they understand the condition. The essence and brilliance of the body are daily depleted, and pathogenic factors then combine. This is the second error in treatment.

"Those skilled in pulse diagnosis must use analogy and distinguish between normal and abnormal states calmly. If a practitioner does not understand these principles, their diagnosis is not worthy of respect. This is the third error in treatment.

"One must understand three constants in diagnosis, specifically asking about social status. For example, lords who have suffered defeat or injury, or those desiring to become lords. Thus, if a person of high status loses power, even without external pathogens, spiritual injury occurs internally, leading to physical decline and death. If one starts wealthy and ends poor, even without external pathogens, the skin becomes scorched, tendons contract, and flaccidity with spasms may occur. If the physician cannot be strict, cannot move the spirit, and appears externally weak, causing chaos and deviation from norms, the disease cannot be moved/cured, and medical practice fails. This is the fourth error in treatment.

"In general, the diagnostician must know the beginning and end of the disease, understand its remaining threads. Taking pulses and asking names should correspond to male and female characteristics. Separation, interruption, depression, worry, fear, anger, and joy cause the five zang organs to become empty, and blood and qi to scatter and lose their guarding position. If the physician does not know this, what talk of medical skill is there? A formerly wealthy person suffers great damage; sinews are severed, and pulses are cut off. Although the body may move again, its luster and moisture cease. Injury and decay consolidate; lingering pathogens return to Yang, accumulating pus and causing alternating cold and heat. Crude physicians treat this by urgently needling yin and yang channels, causing the body to disintegrate, limbs to spasm, and death to approach. The physician fails to clarify, does not ask the cause, and only speaks of the day of death. Such a crude physician commits the fifth error in treatment.

"All these five cases stem from unmastered techniques and unclear understanding of human affairs. Therefore it is said: The sage treats disease by knowing heaven and earth, yin and yang, the regulations of the four seasons, the yin-yang and exterior-interior relationships of the five zang and six fu organs, and the indications for acupuncture, moxibustion, stone needles, and drugs. One calmly considers human affairs to illuminate the Dao of medicine. Noble and base, rich and poor, each has different pathological principles. One asks about age, and the principles of courage and timidity. By examining the divisions and knowing the root and origin of the disease, using the Eight Regularities (seasonal solar terms) and Nine Palms (pulse positions), the diagnosis will be accurate.

"The way of treating disease values the internal qi as precious. Follow and seek its principles; if not found, the fault lies in the exterior or interior. Adhere to data and treat, do not lose the principles of acupoints. Those who can practice this art will remain safe for life. Not knowing acupoint principles leads to stagnation and heat in the five zang, causing carbuncles to erupt in the six fu organs. Diagnosing disease without careful examination is called deviation. Strictly adhering to this treatment aligns with the classics. Using the *Shangjing* (Classic on High) and *Xiajing* (Classic on Low) to measure yin and yang, distinguishing abnormal conditions, and deciding based on the Mingtang (face), while examining the beginning and end, allows one to proceed freely and successfully."