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"Shu" (疏) means to state or elaborate. When medical practitioners diagnose and treat diseases by examining the pulse, there are five types of errors. The first error is failing to inquire about the patient's history before diagnosis and yet being unaware of the condition after diagnosis. The second error is not understanding the principles of tonification and sedation (Bu-Xie, 补泻) and the progression of the disease. The third error is not knowing how to use analogy (Bilei, 比类) and distinguishing between normal and abnormal states (Qiheng, 奇恒). The fourth error is not knowing the three constants of diagnosis (Zhen San Chang, 诊有三常). The fifth error is not understanding the beginning and end (Zhongshi, 终始) of meridians and failing to ask about the onset of the disease. These all stem from a lack of mastery in medical techniques, ignorance of human affairs, and failure to comprehend the Yin and Yang of Heaven and Earth, the regulations of the four seasons, the yin-yang and exterior-interior relationships of the Zang-Fu organs (脏腑), and the methods of the Eight Regularities (Bazheng, 八正) and Nine Probes (Jiuhou, 九候). Thus, these five errors are unavoidable. Emperor Huangdi summoned Leigong and said to him: "There are five errors and four virtues in practice; do you know them?"

Therefore, this chapter elaborates on the five errors, and the following section penalizes the four losses. Generally speaking, knowledge is a virtue, and ignorance is a loss.

Emperor Huangdi said: "Alas, how profound and distant the Dao is! It causes deep anxiety, like gazing into an abyss or welcoming floating clouds. While an abyss can still be measured, the boundaries of floating clouds are unknowable. The art of the sage serves as a model for all people. By discussing and regulating will and intent, there must be laws and rules. Following the meridians and adhering to numerical principles, and managing medical affairs according to standards, one acts as a support for all people. Therefore, there are five errors and four virtues in practice; do you know them?"

"Minyin" (闵闵) refers to extreme worry. Emperor Huangdi sighed at the vastness and profundity of the Dao, noting that the sage's art follows meridians and adheres to principles. Since practice involves five errors and four virtues, medical practitioners must understand this. Hence, he spoke to Leigong to elucidate it.

Leigong stepped down from his seat and bowed twice, saying: "I am young and inexperienced, confused by my own ignorance, having never heard of the five errors and four virtues. Regarding analogies of form and name, I cite classics vacuously, with nothing in my heart to correspond."

The five errors and four virtues, which you have not heard of, if you cite classics vacuously regarding analogies of form and name, but your heart truly has no correspondence, it means you do not know.

Emperor Huangdi said: "For those who have not yet diagnosed a patient, they must ask if the patient was once noble and later became humble. Even without external pathogenic invasion, the disease arises internally, named 'Tuo Ying' (脱营, Depletion of Ying). If the patient was once rich and later became poor, it is named 'Shi Jing' (失精, Loss of Jing). The Qi of the five Zang organs lingers and stagnates, and pathogens combine. When medical practitioners diagnose, they find the disease is not in the Zang-Fu organs, nor does the body shape change. They diagnose with doubt and do not know the disease name. The body wastes away daily, Qi becomes deficient and Jing is lost. In deep disease, Qi is exhausted; the patient feels chilly and startled intermittently. The reason for deep disease is external depletion of Wei Qi (卫气) and internal deprivation of Ying Qi (营气). The mistake made by skilled doctors is not understanding the condition. This is also one of the errors in treatment."

"Qu" (去) is pronounced with the initial sound 'ch', same below. "Ying" (营) sounds like "Rong" (荣), meaning is connected. "Zai" (在) means to inspect. "Bian" (变) means to understand. This describes the error of medical practitioners who do not inquire before diagnosis and do not understand after diagnosis. Generally, when intending to diagnose a patient, one should know their status of nobility/poverty. One must ask if they were once noble and later became humble. Being once noble and later humble causes internal injury to will and intent; even without external pathogens, disease arises internally, named Tuo Ying. Ying is akin to Rong. One must also ask if they were once rich and later became poor. Being once rich and later poor leads to a lack of rich and sweet foods, named Shi Jing. The Qi of the five Zang organs originates from Yin Jing. Now, with loss of Jing, the Qi of the five Zang organs lingers and fails to reach. With lingering of the five Qi, diseases combine. Medical practitioners diagnose only by pulse, not inquiry. Thus, they do not inspect the Zang-Fu organs, do not understand the body shape, diagnose with doubt, and do not know the disease name. For those named Shi Jing due to being once rich and later poor, by this time, the body wastes away daily, and Qi is deficient without Jing. For those with lingering five Qi and combined diseases, by this time, the disease is deep with no Qi, only feeling chilly and startled. This is the result of medical practitioners' diagnostic error in cases of being once rich and later poor. Disease arising internally, if not treated correctly, becomes deep. Deep disease occurs because of external depletion of Wei and internal deprivation of Ying. Disease arising internally, named Tuo Rong (脱荣), by this time, both Ying and Wei are depleted and deprived. This is the result of medical practitioners' diagnostic error in cases of being once noble and later humble. This diagnostic error of not inquiring before diagnosis and not understanding after diagnosis is also one of the errors in treatment.

Generally, when intending to diagnose a patient, one must ask about diet and living conditions, sudden joy or sudden sorrow, starting with joy and ending with sorrow. All these injure Essence-Qi (Jingqi, 精气). When Essence-Qi is exhausted, the body is ruined and depressed. Sudden anger injures Yin; sudden joy injures Yang. Jue Qi (厥气) moves upward, filling the meridians and separating from the form. Foolish doctors treating this do not know tonification and sedation, nor the condition. The essence and vitality are daily depleted, and pathogenic factors combine. This is the second error in treatment.

"Ju" (沮) sounds like "Cu" (殂), meaning is connected. This describes the error of foolish doctors who do not understand tonification/sedation and the condition. Generally, when intending to diagnose, one must ask about diet and living conditions, sudden joy/sorrow, or starting joy/ending sorrow. All such sudden changes internally injure Essence-Qi. When Essence-Qi is exhausted, the body is ruined. Ruined means death. Sudden anger injures Yin; sudden joy injures Yang. True Qi is injured, causing Jue Qi to move upward. Jue Qi moving upward fills the meridians, causing Spirit to depart from the form. Departing form also means death. Body ruin and meridian fullness leading to spirit departure are due to late treatment. Then foolish doctors treat it, not knowing tonification/sedation or the condition, causing essence to deplete daily and pathogens to combine. This is the second error of foolish doctors not understanding tonification/sedation and the condition.

Those skilled in pulse diagnosis must use analogy and distinguish between normal and abnormal, comprehending calmly. If a practitioner does not know this, their diagnosis is not worthy of respect. This is the third error in treatment.

This describes the error of medical practitioners not knowing analogy and Qiheng. Those skilled in pulse diagnosis value knowing the constant and variable. They must use analogy and Qiheng. Qi (奇) means abnormal; Heng (恒) means constant. Abnormal and constant diseases must be compared and referenced, comprehended calmly. If a practitioner does not know the way of analogy and Qiheng, their diagnosis is not worthy of respect. This is the third error of medical practitioners not knowing analogy and Qiheng.

Diagnosis has three constants: one must ask about nobility/humility, the fall of feudal lords, and those seeking kingship. Thus, if a noble person loses power, even without external pathogens, spiritual injury occurs internally, and the body will surely perish. If one starts rich and ends poor, even without pathogenic injury, the skin becomes dry, tendons contract, and flaccidity turns into spasms. If the doctor is not strict, cannot move the Spirit, appears weak externally, and chaos reaches disorder, the disease cannot be moved, and medical practice fails. This is the fourth error in treatment.

This describes the error of not knowing the three constants of diagnosis. There are three common principles for medical consultation. First, one must ask about nobility/humility: from feudal lord to fallen status, i.e., once noble then humble. Second, asking about those seeking kingship: already noble but seeking more nobility, which is impossible. "Gu" (故) means former. "Gu Gui Tuo Shi" (故贵脱势) means formerly noble but now losing power. Such people, even without external pathogens, suffer internal spiritual injury, and if sick, the body will perish. Third, one must ask about wealth/poverty: starting rich and ending poor, losing rich foods, even without pathogenic injury, the body suffers, leading to dry skin, contracted tendons, and flaccidity turning into spasms. Fourth, the doctor must be strict and rectify, changing the disease. If the doctor's mind is not strict, cannot stimulate the Spirit internally, appears weak externally, disaster arrives, norms are lost, the disease cannot be moved, and medical practice fails. This is the fourth error of not knowing the three constants of diagnosis.

In general, diagnosis requires knowing the beginning and end, understanding residual threads, combining pulse-taking with questioning names, considering male/female distinctions, separation/seclusion, depression/knotting, worry/fear/joy/anger. The five Zang organs become empty, ruling Qi leaves its post. If the practitioner does not know this, what technique can be discussed? Once rich but greatly injured, tendons severed, vessels cut, the body walks again, fluids flow incessantly. Thus, injury and knotting remain, thin pathogens return to Yang, pus accumulates with cold and heat. Crude doctors treat by urgently puncturing Yin and Yang. The body that walked again now disintegrates; limbs turn cramps, water fluids cease. Disease reaches this point, death has a date. If the doctor cannot clarify, does not ask about the onset, and only speaks of the death date, they are also crude doctors. This is the fifth error in treatment.

This describes the error of not knowing Zhongshi and not asking about onset. Pulse diagnosticians must know the beginning and end of meridians. For example, the Lung Meridian ends at the index finger, and the Large Intestine Meridian begins there; the twelve meridians connect in sequence. Knowing Zhongshi allows knowing residual threads; residual threads refer to deficiency/excess diseases of meridians. Knowing Zhongshi and residual threads, one then takes the pulse and questions to name the disease. Pulse-taking and questioning should consider male/female distinctions. Male/female refer to Yin/Yang Blood and Qi. The Treatise on Images and Correspondences says: Yin and Yang are the male and female of Blood and Qi. This is the meaning. Separation/extinction of Yin/Yang Blood and Qi, or depression/knotting, along with worry/fear/joy/anger, lead to empty Zang organs and departing Blood/Qi. If the practitioner does not know this, they cannot take the pulse or question, so what technique is there? If a person was once rich and suddenly loses it, the Hun and Shen are greatly injured. Thus, Liver-controlled tendons and Heart-controlled vessels seem severed. Spleen is not injured, so the body walks; Lungs/Kidneys are not diseased, so fluids flow incessantly. Fluids flowing incessantly means Water Qi connects to Heaven and circulates endlessly. Severed tendons and vessels mean Yin Blood is injured and knotted. Initially injuring Yin Blood, then injuring Yang Qi, pathogens linger and return to Yang. Both Yin/Yang Blood and Qi injured leads to pus accumulation and coexistence of cold/heat. "Jiong" (炅) means heat. Crude doctors treat by urgently puncturing Yin/Yang. The body that walked now disintegrates; limbs cramp, water fluids do not distribute. Disease reaches this point, death has a date. If the doctor cannot clarify, does not ask about meridian onset, and only speaks of the death date, they are crude doctors. This is the fifth error of not knowing Zhongshi and not asking about onset.

All these five cases stem from unmastered techniques and unclear human affairs. Therefore, it is said: The sage treats disease by knowing Heaven and Earth Yin/Yang, seasonal regulations, Five Zang and Six Fu organs, yin-yang and exterior-interior relations, the uses of acupuncture, moxibustion, stone needles, and drugs. Handling human affairs calmly to clarify the Dao of meridians. Nobility and poverty have different principles; ask about age and courage/timidity. Examine parts, know the origin of disease, use Bazheng and Jiuhou, diagnosis will be accurate. The way of treating disease values internal Qi. Follow and seek its principle. If sought and not found, the error is in exterior-interior. Adhere to numbers for treatment, do not lose Shu points principles. Practicing this art ensures lifelong safety. Not knowing Shu point principles leads to heat stagnation in Five Zang and abscesses in Six Fu. Unexamined diagnosis is called失常 (abnormality). Strictly observing this treatment clarifies the Classics. Upper and Lower Classics, measuring Yin/Yang, distinguishing normal/abnormal and central states, deciding by the bright hall (face), examining beginning/end, allows one to proceed freely.

"Fen" (分) is falling tone. "Nei" (内) and "Duo" (度) are entering tones. Summarizing the above: These five errors result from unmastered techniques and unclear human affairs. Thus, it is said: The sage treats disease by knowing Heaven and Earth Yin/Yang, seasonal regulations, harmonizing with human Five Zang/Six Fu, yin-yang, exterior-interior. Then applying acupuncture, moxibustion, stone needles, and drugs. Handling human affairs calmly to clarify meridian Dao. Treating nobility/poverty differently, categorizing and reasoning, asking about age and courage/timidity. Examining Three Yin/Three Yang parts to know disease origin. Clarifying Heaven and Earth's Eight Regularities and Three Powers' Nine Probes. Heaven-human unity, diagnosis will be accurate. This is the sage's treatment. The way of treating disease values internal Qi. Internal Qi must follow its principle; the principle is Shu point principle. If not found, exterior-interior is unclear, error lies in exterior-interior. Must adhere to Three Yin/Three Yang numbers. Apply treatment based on meridian Dao. Only then not losing Shu point principles. Practicing this ensures lifelong safety. Not knowing Shu point principles leads to heat in Five Zang and abscesses in Six Fu. Unexamined diagnosis of exterior-interior/Shu parts is abnormality. Strictly observing this clarifies the Classics. Upper/Lower Classics, measuring Yin/Yang, distinguishing normal/abnormal, deciding by face, examining beginning/end. Doing so, mastering techniques and clarifying human affairs allows free progress, avoiding the five errors.