完固，气血坚实，邪不能入，故无事于毒药针石，但以祝由即可移易精气而愈其病也。祝、咒同；
由，病所由生也，故曰“祝由”。）今之世不然，忧患缘其内，苦形伤其外，又失四时之从，逆寒暑之宜，贼
风数至，虚邪朝夕，内至五脏骨髓，外伤空窍肌肤，所以小病必甚，大病必死，故祝由不能已也。（内伤五
脏，外逆四时，则表里俱伤，为病必甚，故不能以祝由治之也。）临病患，观死生，决嫌疑，知其要，如日月
之光，上古僦贷季，理色脉而通神明，合之金木水火土、四时、八风、六合，不离其常。（理色脉，察内外
之精微也。通神明，色脉辨而神明见也。色脉之应，无往不合，如五行之衰王，四时之往来，八
风之变，六合之气，消长相根据，无不有常度也。）变化相移，以观其妙，则色脉是矣。（五行、四时、八风
之气迭有盛衰，则变化相移，色脉随之而应，故可以观其妙。凡人之五脏六腑，百骸九窍，脉必由乎气，
气必合乎天，虽其深微难测，而惟于色脉足以察之，故曰∶“知其要，则色脉是矣”。）色以应日，脉
以应月，常求其要，则其要也。（色分五行，而明晦是其变，日有十干，而阴晴是其变，故色以应日。脉有十二
经，而虚实是其变，月有十二建，而盈缩是其变，故脉以应月。常求色脉之要，则明如日月而得其变化之要矣。）
夫色之变化，以应四时之脉，此上古之所以合于神明，远死而近生，生道以长。（上古知色脉之
应，故能见机察微，合于神明，常远于死，常近于生，生道永昌。）中古之治病，至而治之，汤液十日，
以去八风五痹之病；十日不已，治以草苏草 之枝，本末为助。标本已得，邪气乃服。（中古之治病，必病
至而后治之。其治也先以汤液，汤液者，五谷所制而非药也。服之十日，八风五痹之病可以去矣。使十日
不已，则治以草苏草 之枝。苏，叶也。 ，根也。枝，茎也。根枝相佐，故云“本末为助”，即
后世之煎剂也。病源为本，病变为标，得其标木，邪无不服，此中古之治，虽不若上古之见于未然，而犹
未若后世之误也。 ，音该。）莫世之治病也则不然，治不本四时，不知日月，不审逆从，病形已
成，乃欲微针治其外，汤液治其内，（既不能防于未然，又不能察其见在，心粗见浅，针药乱施也。）所谓粗
工凶凶，以为可攻，故病未已，新病复起。（粗工，学不精而庸浅也。凶凶，好自用而孟浪也。若
辈者，意其为实而攻之，则假实未去而真虚至；意其为热而寒之，则故热未除而新寒起。是不足以治人，
而适足以害人耳。）必也治之极于一，一者因得之。（因者，所因也。得其所因，又何所而不得哉！）凡诊病
者，必问尝贵后贱，虽不中邪，病从内生，名曰“脱营”。（尝贵后贱者，其心屈辱，神气不伸，虽不中邪，
而病生于内。营者，阴气也。营行脉中，心之所主，心志不舒则血无以生，脉日以竭，故为脱营。）
尝富后贫，名曰“失精”，五气留连，病有所并。（尝富后贫者，忧煎日切，奉养日廉，故其五脏之精日加
消败，是为失精。精失则气衰，气衰则不运，故为留聚而病有所并矣。）不在脏腑，不变躯形，诊之
而疑，不知病名。（如前二病者，求之内证，则脏腑无可凭，求之外证，则形躯无所据。诊者不明其故，
则未有不疑而莫识其为何病也。）身体
日减，气虚无精。（其病渐深，则体为瘦减；其气日虚，则精无以生。）病深无气，洒洒然时惊。（及其
病深，则真气消索，故曰“无气”。无气则阳虚，故洒然畏寒也。阳虚则神不足，故心怯而惊也。）
病深者，以其外耗于卫，内夺于荣。（精气俱损，则表里受困，故外耗于卫，内夺于荣，此其所以为深也。）
良工所失，不知病情，此亦治之一过也。（虽曰良工，而不能察此，则不得其情，焉知其本，此过误之一也。）
凡诊病者，必问饮食居处，（饮食有膏粱藜藿之殊，居处有寒温燥湿之异，因常知变，必详问而察之。）
暴乐暴苦，始乐后苦，皆伤精气。精气竭绝，形体毁沮。（乐则喜，喜则气缓；苦则悲，悲则气消。
故苦乐失常，皆伤精气，甚至竭绝，则形体毁沮。沮，坏也。）暴怒伤阴，暴喜伤阳。（怒伤肝，肝藏血，
故伤阴；喜伤心，心藏神，故伤阳。）厥气上行，满脉去形。（厥气，逆气化。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。）愚医治之，不知补泻，不知病情，
精华日脱，邪气乃并，此治之二过也。（不明虚实，故不知补泻；不察所因，故不知病情；以致
阴阳败竭，故精华日脱。阳脱者，邪并于阴；阴脱者，邪并于阳，故曰“邪气乃并”。此愚医之所误过之二也。）
善为脉者，必以比类奇恒，从容知之。为工而不知道，此诊之不足贵，此治之三过也。（比类，比别例类也。
奇恒，异常也。从容，安详静察也。凡善诊者，必比类相求，故能因阴察阳，因表察里，因正察邪，因此
察彼，是以奇恒异常之脉证，皆自从容之法而知之矣。引而伸之，触类而长之，天下之能事
毕矣。工不知此，何证之有？此过误之三也。又如脾虚浮似肺，肾小浮似脾，肝急沉散似肾，此皆工之所时
乱也，惟从容而后得之。）诊有三常，必问贵贱，封君败伤，及欲侯王。（三常，即常贵贱，常贫富，常
苦乐之义。封君败伤者，追悔已往，及欲侯王者，妄想将来，皆致病之因。）
故贵脱势，虽不中邪，精神内伤，身必败亡。（抑郁不伸，故精
神内伤。迷而不达，不亡不已也。）始富后贫，虽不伤邪，皮焦筋屈，痿 为挛。（忧愁思虑则心肺俱伤，
气血俱损，故为是病。）医不能严，不能动神，外为柔弱，乱至失常，病不能移，则医事
不行，此治之四过也。（戒不严，则无以禁其欲；言不切，则无以动其神。又其词色外为柔弱而委随从顺，
任其好恶，则未有不乱而至失其常者。如是则病不能移，其于医也何有？此过误之四也。）凡诊者，必知
终始，有知余绪，切脉问名，当合男女。（“必知终始”，谓原其始，要其终也。“有知余绪”，谓察其本，
知其末也。切其脉必问其名，欲得其素履之详也。男女有阴阳之殊，脉色有逆顺之别，必辨男女而察其所
合也。）离绝菀结，忧恐喜怒，五脏空虚，血气离守，工不能知，何术之语？（离者，失其亲爱。绝者，断
其所怀。菀，谓思虑抑郁。结谓深情难解。忧则气沉，恐则气怯，喜则气缓，恚则气逆，凡此皆伤
其内，故令五脏空虚，血气离守。医不知此，何术之有？）尝富大伤，斩筋绝脉，身体复行，令泽不息。（
大伤，谓甚劳甚苦也，故其筋如斩，脉如绝，以耗伤之过也。虽身体犹能复旧而行，然令泽不息矣。
泽，精液也。息，生长也。）故伤败结，留薄归阳，脓积寒炅。（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。炅，居永切，热也。）粗工治之，
亟刺阴阳，身体解散，四肢转筋，死日有期。（粗工不知寒热为脓积所生，脓积以劳伤所致，乃治以常法，
急刺阴阳，夺而又夺，以致血气复伤，故身体解散，四肢转筋，则死日有期。谓非粗工之误之者耶？）
医不能明，不问所发，惟言死日，亦为粗工，此治之五过也。（但知死日而不知致死者，由于施治之不当，
此过误之五也。）凡此五者，皆受术不通，人事不明也。（不通者，不通于理也。物理不通，焉知
人事？以上五条，所不可不知也。）故治病也，必知天地阴阳，四时经纪，（阴阳气候之变，人身应
之以为消长，此天道之不可不知也。）五脏
六腑，雌雄表里，刺灸砭石，毒药所主。（脏腑有雌雄，经络有表里，刺灸石药，各有所宜，此脏象之不
可不知也。）从容人事，以明经道，贵贱贫富，各异品理，问年少长，勇怯之理。（经道，常道
也。不从容于人事，则不知常道。不能知常，焉能知变？人事有不齐，品类有同异，知之则随方就圆，因变
而施，此人事之不可不知也。）审于部分，知病本始，八正九候，诊必副矣。（八正，八节之正气也。
副，称也。能察形色于分部，则病之本始可知；能察邪正于九候，则脉之顺逆可据。明斯二者，诊必称矣。此
色脉之不可不知也。上言“五过”，未明“四德”。而此四节，一言天道，一言脏象，一言人事，一言脉色，
即“四德”也。明此四者，医道全矣，诚缺一不可也。）治病之道，气内为宝，循求其理，求之不得，过在
表里。（气内者，气之在内者也。即元气也。凡治病者，当先求元气之强弱。元气既明，大意见矣。求元气
之病而无所得，然后察其过之在表在里以治之，斯无误也。此下五节，亦皆四德内事。按气有外气，天地之
六气也；有内气，人身之元气也。气失其和，则为邪气；气得其和，则为正气，亦曰真气。但真气所在，其义
有三∶上有气海，曰膻中也，其治在肺；中有水谷气血之海，曰中气也，其治在脾胃；下有气海，曰丹田也，
其治在肾。人之所赖，惟此气耳。气聚则生，气散则死，故曰“气内为宝”，此诚最重之辞，医家最切之旨也。）
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。（循，根据顺也。此言经络之略，人所知也。）
所以不十全者，精神不专，志意不理，外内相失，故时疑殆。不知阴阳逆从之理，此治之一失也；受师不卒，
妄作离术，谬言为道，更名自功，此治之二失也；（受师不卒者，学业未精，苟且自是也。妄作
离术者，不明正道，假借异端也。谬言为道，更名自功者，侈口妄谈，巧立名色以欺人也。）不适贫富贵贱之
居，坐之浓薄，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；诊病不问其始。忧患饮食之失节，起居之过度，或伤于毒，不先言此，卒持寸口，
何病能中？妄言作名，为粗所穷，此治之四失也。世人之语，驰千里之外。（工之得失，则毁誉之远闻也。）
不明不中，弃术于市，自遗其咎。
五疫之至，皆相染易，无问大小，病状相似，不施救疗，如何可得不相移易？（五疫，即五运疫疠之气。
移易，传染也。）正气存内，邪不可干，避其毒瓦斯，天牝从来，复得其往，气出于脑，即不邪干。（疫疠乃
天之邪气，若吾身正气内固，则邪不可干，故不相染也。天牝，鼻也。鼻受天之气，故曰“天牝”。气自空虚而
来，亦欲其自空虚而去，故曰“避其毒瓦斯，天牝从来，复得其往”也，盖以气通于鼻，鼻连于脑中，流布
诸经，令人相染矣。气出于脑为嚏，或张鼻泄之，则邪从鼻出，毒瓦斯可令散也。）气出于脑，即先想心如日。
（日为太阳之气，应人之心。想心如日，即所以存吾之气，壮吾之神，使邪气不能犯也。）将欲入于疫室，
先想青气自肝而出，左行于东，化作林木；（心之所至，气必至焉，故存想之则神有所注而气可王矣，左
行于东，化作林木之状，所以壮肝气也。）次想白气自肺而出，右行于西，化作戈甲；（所以壮肺气也。）
次想赤气自心而出，南行于上，化作焰明；（所以壮心气也。）次想黑气自肾而出，北行于下，化
作水；（所以壮肾气也。）次想黄气自脾而出，存于中央，化作土。（所以壮脾气也。）五气护身之毕，
以想头上。如北斗之煌煌，然后可入于疫室。（煌煌，辉耀貌。天行疫疠，传染最速，凡入病家，男
病坐其床尾，女病坐其床头，盖疠气男从上出，女从下出也。故当谨避之耳。）
身体完固，气血坚实，邪气不能侵入，所以不需要使用毒药和针石治疗，只需通过祝由（一种通过祝说病由来转移患者精气以治愈疾病的方法）就可以使精气调和而痊愈。（“祝”与“咒”同义；“由”，指疾病产生的原因，所以称为“祝由”。）现在的世道却不是这样，内心的忧患导致内伤，身体的劳苦损伤外表，又违背了四季的规律，逆反寒暑的变化，贼风频繁到来，虚邪早晚侵袭，向内深入五脏骨髓，向外伤害空窍肌肤，因此小病必定加重，大病必定致死，所以祝由也不能治愈疾病了。（内伤五脏，外违四时，则表里俱伤，生病必然严重，所以不能用祝由来治疗。）面对病患，观察生死，决断疑难，掌握关键，就像日月之光一样明亮。上古时代的僦贷季，通过调理色脉来通晓神明，结合金木水火土五行、四季、八风、六合的道理，不脱离常规。（调理色脉，是察究内外精微的道理；通晓神明，是通过色脉辨别而使神明显现。色脉的对应，无处不合，如同五行的旺衰、四季的往来、八风的变幻、六合之气的消长，都有固定的规律。）变化相互推移，以此观察其奥妙，那么色脉就可以了。（五行、四季、八风之气交替盛衰，变化相互推移，色脉随之响应，所以可以观察其奥妙。凡是人的五脏六腑、百骸九窍，脉必由气所主，气必合乎天道，虽然深微难测，但只有通过色脉足以察知，所以说：“掌握了关键，那么色脉就可以了”。）面色应合于日，脉象应合于月，经常探求其关键，就能掌握关键。（面色分属五行，明晦是其变化，日有十天干，阴晴是其变化，所以面色应合于日。脉有十二经脉，虚实是其变化，月有十二月建，盈缩是其变化，所以脉象应合于月。经常探求色脉的关键，就能像日月一样光明而掌握其变化的关键。）面色的变化，应合于四季的脉象，这是上古时代之所以能合于神明，远离死亡而接近生命，生命之道得以长久昌盛的原因。（上古时代知晓色脉的对应关系，所以能洞察先机、察知细微，合于神明，常远离死亡，常接近生命，生命之道永远昌盛。）中古时代治病，等到病来了才去治疗，用汤液治疗十天，以去除八风五痹的疾病；如果十天不好，就用草叶草根的枝条治疗，根茎相佐，标本互助。标本已得，邪气乃服。（中古时代治病，一定是病到了才去治疗。治疗时先用汤液，汤液是用五谷制成的，而不是药物。服用十天，八风五痹的疾病可以去除了。如果十天不好，就用草苏草荄的枝条治疗。苏，指叶；荄，指根。枝，指茎。根茎相佐，所以说“本末为助”，即后世的煎剂。病源为本，病变为标，得到标本，邪气没有不服从的，这是中古时代的治疗，虽然不如上古时代在病未发时就预见，但还不像后世那样误人。荄，音gāi。）现代的世人治病却不是这样，治疗不根据四季，不懂日月规律，不审察逆顺，病形已经形成，才想用微针治其外表，汤液治其内部，（既然不能在病未发时预防，又不能察知现有的病情，心粗见浅，乱用针药。）所谓粗工凶凶，认为可以攻伐，所以病没好，新病又起。（粗工，医术不精而庸浅的人。凶凶，自以为是而鲁莽的人。这类人，心里认为是实证而攻伐它，那么假实未去真虚已到；心里认为是热证而寒凉它，那么旧热未除新寒又起。这不足以治人，而恰恰足以害人。）一定要把治疗的极端归结于一个根本，这个根本在于探究病因。（因，就是起因。得到了它的起因，还有什么得不到呢！）凡是诊病的人，必须询问曾经尊贵后来卑贱的经历，即使没有中邪，病也从内生，名叫“脱营”。（曾经尊贵后来卑贱，内心屈辱，神气不伸，即使没有中邪，病也生于内部。营，是阴气。营行于脉中，由心所主，心志不舒则血无法生成，脉日渐枯竭，所以称为脱营。）曾经富有后来贫穷，名叫“失精”，五脏之气留连不去，病症有所合并。（曾经富有后来贫穷，忧愁煎熬日益迫切，供养日益减少，所以五脏之精日渐消败，这就是失精。精失则气衰，气衰则不运，所以留聚而病症合并。）不在脏腑，不改变躯形，诊察时感到疑惑，不知道病名。（像前两种病，向内求内脏证据，则脏腑无可凭借；向外求外在证据，则形体无所依据。医生不明白其中的缘故，就没有不疑惑而认不出是什么病的。）身体日渐消瘦，气虚无精。（病情渐深，则身体瘦减；气日渐虚弱，则精无法生成。）病深无气，时时感到畏寒惊悸。（到了病深阶段，则真气消索，所以叫“无气”。无气则阳虚，所以畏寒。阳虚则神不足，所以心怯而惊。）病深，是因为外部耗损卫气，内部剥夺营气。（精气俱损，则表里受困，所以外部耗损卫气，内部剥夺营气，这就是病深的原因。）良工所犯的过失，在于不了解病情，这也是治疗的一个过失。（虽然是良工，如果不能察知这些，就不得其情，怎么知道本源，这是过失之一。）凡是诊病的人，必须询问饮食居处，（饮食有膏粱藜藿的不同，居所有寒温燥湿的差异，因为常而知变，必须详细询问并察知。）突然快乐突然痛苦，开始快乐后来痛苦，都损伤精气。精气竭绝，形体毁坏。（乐则喜，喜则气缓；苦则悲，悲则气消。所以苦乐失常，都损伤精气，甚至竭绝，则形体毁坏。沮，坏的意思。）暴怒伤阴，暴喜伤阳。（怒伤肝，肝藏血，所以伤阴；喜伤心，心藏神，所以伤阳。）厥气上行，充满脉道，脱离形体。（厥气，逆乱之气。凡是喜怒过度而损伤精气的人，都能让人气厥逆而上行。气逆于脉，所以充满脉道；精脱于中，所以脱离形体。）愚医治疗他们，不知道补泻，不了解病情，精华日渐脱落，邪气于是合并，这是治疗的第二个过失。（不明虚实，所以不知道补泻；不察病因，所以不了解病情；导致阴阳败竭，所以精华日渐脱落。阳脱者，邪并于阴；阴脱者，邪并于阳，所以说“邪气乃并”。这是愚医的第二个过失。）善于诊脉的人，一定运用比类奇恒的方法，从容地知晓。作为医生如果不懂得这个道理，这种诊法就不值得珍贵，这是治疗的第三个过失。（比类，是比较区别类别。奇恒，是异常。从容，是安详静察。凡是善于诊察的人，一定比较同类以求证，所以能因阴察阳，因表察里，因正察邪，因彼察此，因此奇恒异常的脉证，都能从从容之法中知晓。引而伸之，触类旁通，天下的能事就完备了。医生不知道这个，有什么证候可查？这是过失之三。又如脾虚浮似肺，肾小浮似脾，肝急沉散似肾，这些都是医生时常混乱的，只有从容之后才能得知。）诊察有三常，必须询问贵贱，封君败伤，以及想当侯王的心愿。（三常，即常贵贱、常贫富、常苦乐的含义。封君败伤者，追悔过去；想当侯王者，妄想将来，都是致病的因素。）所以贵族失去权势，即使没有中邪，精神内伤，身体必然败亡。（抑郁不伸，所以精神内伤。迷而不达，不亡不止。）开始富有后来贫穷，即使不伤邪，皮焦筋屈，痿弱成为挛缩。（忧愁思虑则心肺俱伤，气血俱损，所以产生这些病。）医生不能严厉，不能打动神灵，外表柔弱，扰乱至失常，病不能移动，那么医事不行，这是治疗的第四个过失。（戒不严，就无法禁止欲望；言不切，就无法打动神灵。又言辞神色外表柔弱而委随从顺，任其好恶，就没有不乱而至失其常的。像这样病就不能移动，对医事有什么帮助？这是过失之四。）凡是诊察的人，必须知道终始，了解余绪，切脉问名，应当结合男女。（“必知终始”，谓推究其开始，概括其结果。“有知余绪”，谓察知其根本，了解其末节。切脉必须问其名，想要得其素履的详细情况。男女有阴阳的区别，脉色有逆顺的不同，必须辨别男女并察知其所合。）离绝菀结，忧恐喜怒，五脏空虚，血气离守，医生不能知晓，说什么医术？（离，是失去亲爱。绝，是断绝所怀。菀，谓思虑抑郁。结谓深情难解。忧则气沉，恐则气怯，喜则气缓，恚则气逆，凡此都损伤内部，所以令五脏空虚，血气离守。医生不知道这些，有什么医术？）曾经富有大伤，斩筋绝脉，身体恢复行走，但津液不再生长。（大伤，谓甚劳甚苦，所以筋如斩，脉如绝，由于耗伤过度。虽然身体还能恢复旧状而行，但津液不再生长了。泽，精液。息，生长。）所以旧的损伤败结，留滞薄积归于阳分，脓积寒热交作。（故，旧也。言旧的损伤，有所败结，血气留滞不散，则郁而成热，归于阳分，所以脓血蓄积，令人寒热交作。炅，居永切，热也。）粗工治疗它，急忙刺阴阳，身体解散，四肢转筋，死期有定数。（粗工不知道寒热是由脓积产生，脓积是由劳伤所致，却用常法治疗，急刺阴阳，夺而又夺，以致血气再伤，所以身体解散，四肢转筋，则死期有定数。说不是粗工的失误吗？）医生不能明察，不问发病原因，只说死期，也是粗工，这是治疗的第五个过失。（只知道死期而不知道导致死亡的原因，是由于施治不当，这是过失之五。）以上五种情况，都是因为医术不通，人事不明。（不通，是不通于理。物理不通，怎么知道人事？以上五条，是不可不知的。）所以治病，必须知晓天地阴阳，四季纲纪，（阴阳气候的变化，人身应之以为消长，这是天道不可不知。）五脏六腑，雌雄表里，刺灸砭石，毒药所主。（脏腑有雌雄，经络有表里，刺灸石药，各有所宜，这是脏象不可不知。）从容人事，以明经道，贵贱贫富，各异品理，问年少长，勇怯之理。（经道，常道也。不从容于人事，则不知常道。不能知常，怎么能知变？人事有不齐，品类有同异，知之则随方就圆，因变而施，这是人事不可不知。）审于部分，知病本始，八正九候，诊必副矣。（八正，八节之正气也。副，称也。能察形色于分部，则病之本始可知；能察邪正于九候，则脉之顺逆可据。明斯二者，诊必称矣。此色脉之不可不知也。上言“五过”，未明“四德”。而此四节，一言天道，一言脏象，一言人事，一言脉色，即“四德”也。明此四者，医道全矣，诚缺一不可也。）治病之道，气内为宝，循求其理，求之不得，过在表里。（气内者，气之在内者也。即元气也。凡治病者，当先求元气之强弱。元气既明，大意见矣。求元气之病而无所得，然后察其过之在表在里以治之，斯无误也。此下五节，亦皆四德内事。按气有外气，天地之六气也；有内气，人身之元气也。气失其和，则为邪气；气得其和，则为正气，亦曰真气。但真气所在，其义有三∶上有气海，曰膻中也，其治在肺；中有水谷气血之海，曰中气也，其治在脾胃；下有气海，曰丹田也，其治在肾。人之所赖，惟此气耳。气聚则生，气散则死，故曰“气内为宝”，此诚最重之辞，医家最切之旨也。）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。（循，根据顺也。此言经络之略，人所知也。）所以不十全者，精神不专，志意不理，外内相失，故时疑殆。不知阴阳逆从之理，此治之一失也；受师不卒，妄作离术，谬言为道，更名自功，此治之二失也；（受师不卒者，学业未精，苟且自是也。妄作离术者，不明正道，假借异端也。谬言为道，更名自功者，侈口妄谈，巧立名色以欺人也。）不适贫富贵贱之居，坐之浓薄，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；诊病不问其始。忧患饮食之失节，起居之过度，或伤于毒，不先言此，卒持寸口，何病能中？妄言作名，为粗所穷，此治之四失也。世人之语，驰千里之外。（工之得失，则毁誉之远闻也。）不明不中，弃术于市，自遗其咎。
五疫之至，皆相染易，无问大小，病状相似，不施救疗，如何可得不相移易？（五疫，即五运疫疠之气。移易，传染也。）正气存内，邪不可干，避其毒瓦斯，天牝从来，复得其往，气出于脑，即不邪干。（疫疠乃天之邪气，若吾身正气内固，则邪不可干，故不相染也。天牝，鼻也。鼻受天之气，故曰“天牝”。气自空虚而来，亦欲其自空虚而去，故曰“避其毒瓦斯，天牝从来，复得其往”也，盖以气通于鼻，鼻连于脑中，流布诸经，令人相染矣。气出于脑为嚏，或张鼻泄之，则邪从鼻出，毒瓦斯可令散也。）气出于脑，即先想心如日。（日为太阳之气，应人之心。想心如日，即所以存吾之气，壮吾之神，使邪气不能犯也。）将欲入于疫室，先想青气自肝而出，左行于东，化作林木；（心之所至，气必至焉，故存想之则神有所注而气可王矣，左行于东，化作林木之状，所以壮肝气也。）次想白气自肺而出，右行于西，化作戈甲；（所以壮肺气也。）次想赤气自心而出，南行于上，化作焰明；（所以壮心气也。）次想黑气自肾而出，北行于下，化作水；（所以壮肾气也。）次想黄气自脾而出，存于中央，化作土。（所以壮脾气也。）五气护身之毕，以想头上。如北斗之煌煌，然后可入于疫室。（煌煌，辉耀貌。天行疫疠，传染最速，凡入病家，男病坐其床尾，女病坐其床头，盖疠气男从上出，女从下出也。故当谨避之耳。）
The body is complete and solid, Qi and Blood are firm, so pathogenic factors cannot enter; therefore, there is no need for toxic drugs or needles and stones, but only by Zhu You (a method of curing disease by transferring the patient's Jing-Qi through incantation regarding the origin of the illness) can the Jing-Qi be harmonized and the illness cured. ("Zhu" is synonymous with "Zhou" [incantation]; "You" refers to the cause from which the illness arises, hence it is called "Zhu You".) The world today is not like this; worries and anxieties originate internally, physical suffering damages the exterior, and one fails to follow the changes of the four seasons, going against the适宜ness of cold and heat. Treacherous winds arrive frequently, empty pathogens invade morning and night, penetrating inwardly to the five Zang organs and bone marrow, and damaging outwardly the hollow orifices and skin. Thus, minor illnesses must become severe, and major illnesses must lead to death, so Zhu You cannot cure them either. (Internal injury to the five Zang organs and external violation of the four seasons result in damage to both interior and exterior, making the illness severe, thus it cannot be treated by Zhu You.) When facing patients, observing life and death, resolving doubts, grasping the essentials is like the light of the sun and moon. In ancient times, Qiu Dai Ji regulated the complexion and pulse to understand the divine, integrating the Five Elements (Metal, Wood, Water, Fire, Earth), the four seasons, the eight winds, and the six directions, never departing from the constant principles. (Regulating complexion and pulse involves investigating the subtleties of the interior and exterior; understanding the divine means that through distinguishing complexion and pulse, the divine becomes manifest. The correspondence of complexion and pulse aligns everywhere, just as the waxing and waning of the Five Elements, the coming and going of the four seasons, the variations of the eight winds, and the increase and decrease of the Qi of the six directions all have fixed measures.) Changes shift mutually; by observing their mysteries, one relies on the complexion and pulse. (The Qi of the Five Elements, four seasons, and eight winds alternates in prosperity and decline, causing mutual shifts in change, and the complexion and pulse respond accordingly, allowing one to observe their mysteries. For all people, the five Zang and six Fu organs, hundred bones and nine orifices, the pulse is governed by Qi, and Qi conforms to Heaven. Although profound and difficult to measure, only through complexion and pulse can they be examined; hence it is said: "Grasping the essence, the complexion and pulse suffice.") Complexion corresponds to the Sun, and the pulse corresponds to the Moon; constantly seeking their essence allows one to grasp the key. (Complexion is divided into the Five Elements, with brightness and darkness as its variations; the Sun has ten Heavenly Stems, with cloudy and clear weather as its variations, so complexion corresponds to the Sun. The pulse has twelve Meridians, with deficiency and excess as its variations; the Moon has twelve Earthly Branches, with waxing and waning as its variations, so the pulse corresponds to the Moon. Constantly seeking the essence of complexion and pulse makes one bright as the sun and moon and able to grasp the key of their changes.) The changes of complexion correspond to the pulses of the four seasons; this is why the ancients could align with the divine, stay far from death and close to life, allowing the Way of Life to flourish long. (The ancients knew the correspondence of complexion and pulse, so they could perceive opportunities and observe subtleties, aligning with the divine, always staying far from death and close to life, ensuring the eternal prosperity of the Way of Life.) In middle antiquity, treating diseases involved waiting for the illness to arrive before treating it, using Tang Ye (grain-based decoctions) for ten days to eliminate diseases of the Eight Winds and Five Bi; if not cured after ten days, treatment would use branches of grass leaves and roots, assisting the root and the tip together. Once root and branch are obtained, the pathogenic factor submits. (In middle antiquity, treatment began only after the illness arrived. Initially, Tang Ye, made from grains rather than herbs, was taken for ten days to eliminate diseases of the Eight Winds and Five Bi. If not cured after ten days, grass leaves [Su] and grass roots [Gai] were used. Su refers to leaves; Gai refers to roots. Branch refers to stems. Roots and stems assist each other, hence "root and tip assist," which is the decoction of later generations. The disease source is the root, the disease manifestation is the branch; obtaining both ensures the submission of pathogens. This treatment of middle antiquity, while not as prophetic as that of high antiquity, was still not as erroneous as that of later generations. Gai is pronounced 'gai'.) Modern people treat diseases differently; treatment does not follow the four seasons, ignores the laws of the sun and moon, and fails to examine reversal and compliance. Only when the disease form has already formed do they attempt to treat the exterior with fine needles and the interior with Tang Ye. (Since they cannot prevent it before it occurs, nor observe the existing condition, their minds are coarse and vision shallow, indiscriminately applying needles and drugs.) Such are the crude physicians who act recklessly, believing attack is appropriate, so the old illness remains, and new illnesses arise. (Crude physicians are those with unrefined and mediocre skills. Reckless implies self-opinionated and rash behavior. These individuals, assuming excess and attacking it, leave false excess unresolved while true deficiency arrives; assuming heat and cooling it, leaving old heat unresolved while new cold arises. This is insufficient to heal people and merely sufficient to harm them.) One must trace the extreme of treatment back to a single origin; this origin lies in identifying the cause. (Cause refers to the etiology. Having found the cause, what else could be missed?) Whenever diagnosing an illness, one must ask about experiences of losing status from nobility to baseness. Even without contracting external pathogens, the illness arises internally, named "Tuo Ying" (Depletion of Ying). (Losing status from nobility to baseness causes mental humiliation and stifled Shen-Qi. Even without external pathogens, illness arises internally. Ying is Yin Qi. Ying circulates within the vessels, governed by the Heart. If the Heart's will is not舒展, blood cannot be generated, and vessels deplete daily, hence "Tuo Ying".) Experiencing wealth then poverty is named "Shi Jing" (Loss of Jing). The Qi of the five Zang organs lingers, and illnesses combine. (Experiencing wealth then poverty brings increasing worry and anxiety, while provisions decrease, causing the Jing of the five Zang organs to deteriorate daily, known as "Shi Jing". Loss of Jing leads to Qi deficiency; Qi deficiency leads to stagnation, causing lingering and combined illnesses.) These do not affect the Zang-Fu organs visibly, nor alter the body shape; diagnosis raises doubts, and the disease name is unknown. (For the aforementioned two illnesses, seeking internal signs yields no basis in the Zang-Fu organs; seeking external signs yields no basis in the body shape. If the physician does not understand the cause, doubt inevitably arises, and the disease remains unrecognized.) The body diminishes daily, Qi becomes deficient, and Jing is lost. (As the illness deepens, the body emaciates; as Qi becomes deficient daily, Jing cannot be generated.) In deep illness, there is no Qi, accompanied by shivering and occasional fright. (When the illness is deep, True Qi is exhausted, hence "no Qi". No Qi implies Yang deficiency, leading to aversion to cold. Yang deficiency implies insufficiency of Shen, leading to timidity and fright.) Deep illness occurs because the exterior consumes Wei Qi, and the interior deprives Ying Qi. (Both Jing and Qi are damaged, confining both interior and exterior; thus, the exterior consumes Wei Qi, and the interior deprives Ying Qi, which is why the illness is deep.) The error of a good physician lies in not knowing the condition of the illness; this is also one error in treatment. (Even if a good physician, failing to observe these aspects, cannot grasp the situation, how can they know the root? This is one error.) Whenever diagnosing, one must inquire about diet and dwelling. (Diet varies between rich foods and coarse grains; dwellings vary in cold, warmth, dryness, and dampness. To know change through constancy, one must ask in detail and observe.) Sudden joy followed by sudden sorrow, or initial joy turning to sorrow, all damage Jing-Qi. Exhaustion of Jing-Qi leads to the destruction of the形体 (body form). (Joy brings delight, delight relaxes Qi; sorrow brings grief, grief dissipates Qi. Thus, abnormal joy and sorrow damage Jing-Qi, even to the point of exhaustion, leading to bodily destruction. Ju means ruin.) Sudden anger injures Yin, sudden joy injures Yang. (Anger injures the Liver, which stores Blood, thus injuring Yin; Joy injures the Heart, which houses Shen, thus injuring Yang.) Jue Qi rises upward, filling the vessels and separating from the form. (Jue Qi is rebellious Qi. Any excessive anger or joy that damages Jing-Qi can cause Qi to rebel and rise. Qi rebelling in the vessels fills them; Jing depletion within separates it from the form.) Foolish physicians treat them without knowing tonification or purgation, and without understanding the condition; essence and brilliance deplete daily, and pathogenic factors combine; this is the second error in treatment. (Not understanding deficiency and excess, they do not know tonification or purgation; not examining the cause, they do not understand the condition; leading to the collapse of Yin and Yang, essence depletes daily. When Yang depletes, pathogens combine with Yin; when Yin depletes, pathogens combine with Yang, hence "pathogenic factors combine." This is the second error of foolish physicians.) Those skilled in pulse diagnosis must use analogy and comparison with the extraordinary (Qi Heng), knowing calmly. A physician who does not understand this Dao renders diagnosis worthless; this is the third error in treatment. (Analogy involves comparing and categorizing. Extraordinary refers to abnormalities. Calmly implies serene observation. Skilled diagnosticians compare similar cases to verify, allowing them to observe Yang through Yin, exterior through interior, normal through pathogenic, and one through another. Thus, extraordinary pulse and symptom patterns are understood through calm methods. Extending and applying these principles completes the art. Without this, what symptoms can be diagnosed? This is the third error. For example, Spleen deficiency floating resembles Lung; Kidney small floating resembles Spleen; Liver urgent, deep, and scattered resembles Kidney. These are often confused by physicians; only through calm observation can they be distinguished.) Diagnosis has three constants: one must ask about status (noble/base), loss of title/honor, and desires for lordship. (The three constants refer to constant noble/base, rich/poor, and joyful/sorrowful states. Loss of title involves regretting the past; desire for lordship involves delusions of the future; both are causes of disease.) Thus, when a noble loses power, even without external pathogens, internal spiritual injury occurs, and the body must perish. (Depression and stifling cause internal spiritual injury. Confusion and lack of clarity lead inexorably to death.) Starting rich then becoming poor, even without pathogenic injury, results in dry skin, contracted sinews, flaccidity, and contracture. (Worry and thought injure both Heart and Lung, damaging both Qi and Blood, causing these illnesses.) If the physician is not strict, cannot move the Shen, appears weak externally, and allows chaos to disrupt normalcy, the illness cannot be moved, and medical practice fails; this is the fourth error in treatment. (Without strict warnings, desires cannot be forbidden; without earnest words, Shen cannot be moved. Appearing weak and compliant externally, indulging preferences, leads to chaos and loss of normalcy. If the illness cannot be moved, what use is medicine? This is the fourth error.) All diagnosticians must know the beginning and end, understand residual threads, take pulses and ask names, considering male and female distinctions. ("Know beginning and end" means tracing the origin and summarizing the outcome. "Understand residual threads" means observing the root and knowing the branches. Taking the pulse requires asking the name to obtain detailed personal history. Males and females differ in Yin-Yang; pulses and complexions differ in reversal/compliance; one must distinguish gender and observe correspondences.) Separation, severance, depression, and knotting, along with worry, fear, joy, and anger, empty the five Zang organs and separate Blood and Qi. If the physician does not know this, what technique can be spoken of? (Separation is losing loved ones; severance is cutting off attachments. Depression refers to brooding; knotting refers to deep, hard-to-resolve emotions. Worry sinks Qi, fear makes Qi timid, joy relaxes Qi, anger reverses Qi. All these injure the interior, emptying the five Zang organs and separating Blood and Qi. If the physician does not know this, what technique exists?) Former wealth greatly damaged, tendons severed and vessels cut, the body may walk again, but fluids cease to grow. (Great damage refers to extreme labor and suffering, so tendons seem severed and vessels cut due to excessive consumption. Although the body may resume walking, fluids no longer grow. Ze refers to essences/fluids; Xi refers to growth.) Old injuries and败结 (decayed knots) linger and thin, returning to the Yang aspect, accumulating pus and alternating chills and heat. (Old injuries involve decayed knots where Qi and Blood linger and do not disperse,郁 transforming into heat, returning to the Yang aspect, accumulating pus and blood, causing alternating chills and heat. Jiong means heat.) Crude physicians treat this by urgently puncturing Yin and Yang; the body dissolves, limbs convulse, and the day of death is fixed. (Crude physicians do not know that chills and heat arise from pus accumulation caused by labor injury. Using standard methods, urgently puncturing Yin and Yang, depleting again and again, further damages Qi and Blood, causing body dissolution and limb convulsions, fixing the date of death. Is this not the error of crude physicians?) Physicians who fail to clarify, do not ask the cause, and only predict the day of death are also crude; this is the fifth error in treatment. (Knowing only the day of death without understanding the cause of death due to improper treatment is the fifth error.) All these five situations stem from不通 (lack of understanding) of techniques and ignorance of human affairs. (Lack of understanding means failure to comprehend principles. If physical principles are not understood, how can human affairs be known? The above five points must be known.) Therefore, treating illness requires knowing Heaven and Earth Yin-Yang and the regulations of the four seasons. (Changes in Yin-Yang climate cause corresponding fluctuations in the human body; this Heavenly Dao must be known.) It requires knowledge of the five Zang and six Fu organs, Yin-Yang pairing, interior-exterior relationships, and the indications for acupuncture, moxibustion, stone needles, and drugs. (Zang-Fu have Yin-Yang pairings; meridians have interior-exterior relationships; acupuncture, moxibustion, stones, and drugs have specific indications; this Zang-Xiang theory must be known.) One must calmly consider human affairs to clarify the constant Dao. Nobility and poverty, richness and poverty, have different categorical principles; asking about age and courage/weakness reveals their logic. (Constant Dao refers to regular principles. Not considering human affairs means not knowing the constant Dao. Without knowing the constant, how can change be known? Human affairs are uneven, categories have similarities and differences; knowing them allows adapting methods and changing treatments accordingly; human affairs must be known.) Examining the parts allows knowing the origin and beginning of the illness; the Eight Regularities and Nine Palpations ensure accurate diagnosis. (Eight Regularities refer to the correct Qi of the eight solar terms. Fu means matching. Observing color and shape in specific parts reveals the origin and beginning of illness; observing pathogenic and correct Qi in the Nine Palpations determines pulse compliance/reversal. Understanding these two ensures accurate diagnosis. This concerns complexion and pulse, which must be known. The previous section mentioned "Five Errors" but did not clarify the "Four Virtues". These four sections discuss Heavenly Dao, Zang-Xiang, Human Affairs, and Pulse-Complexion, constituting the "Four Virtues". Understanding these four completes the medical Dao; none can be omitted.) The way of treating illness holds Inner Qi as precious; following its principles, if not found, the error lies in exterior or interior. (Inner Qi refers to Qi within, i.e., Yuan Qi. In treating illness, one must first seek the strength of Yuan Qi. Once Yuan Qi is clear, the general idea is established. If searching for Yuan Qi pathology yields nothing, then examine whether the error lies in the exterior or interior to treat it, avoiding mistakes. The following five sections also belong to the Four Virtues. Qi includes External Qi (Six Qi of Heaven and Earth) and Internal Qi (Yuan Qi of the body). When Qi loses harmony, it becomes Pathogenic Qi; when it gains harmony, it becomes Correct Qi, also called True Qi. True Qi has three locations: Upper Qi Sea, called Dan Zhong, governed by the Lung; Middle Qi Sea of water and grain, called Middle Qi, governed by Spleen and Stomach; Lower Qi Sea, called Dan Tian, governed by the Kidney. Humans rely solely on this Qi. Qi gathering brings life; Qi scattering brings death, hence "Inner Qi is precious," truly the most important term and the closest intent of physicians.) There are twelve Main Meridians and 365 Collateral Vessels, all well-known to people and used by physicians. (Xun means following according to. This states the outline of meridians, which is known to people.) The reason for not achieving full success is lack of spiritual focus and unruly intention, causing interior-exterior disconnection, leading to frequent doubt and danger. Not knowing the principles of Yin-Yang reversal and compliance is the first failure in treatment; incomplete apprenticeship, reckless deviation from orthodoxy, false claims as Dao, renaming to claim credit is the second failure. (Incomplete apprenticeship means unrefined studies and arbitrary self-righteousness. Reckless deviation means ignoring the right path and borrowing heterodox methods. False claims and renaming mean boasting and inventing names to deceive.) Failing to adapt to the living conditions of nobility, poverty, wealth, and base status; seat thickness; body temperature; failing to adapt to dietary appropriateness; failing to distinguish courage and weakness; not knowing analogy, enough to confuse oneself, insufficient to clarify oneself, is the third failure in treatment. Diagnosing without asking the beginning—whether due to worry, dietary irregularities, excessive起居 (daily routine), or toxic injury—if these are not stated first, and suddenly holding the Cun Kou (radial artery), how can the illness be identified? Speaking falsely and creating names, being overwhelmed by crude methods, is the fourth failure. Words of the world travel a thousand miles. (Physician's gains and losses spread far through praise and blame.) Unclear and inaccurate, abandoning technique in the market, inviting blame upon oneself.
When the Five Epidemics arrive, they infect each other, regardless of age, with similar symptoms. Without rescue and treatment, how can transmission be prevented? (Five Epidemics refer to the epidemic Qi of the Five Movements. Yi means transmission/infection.) If Correct Qi resides within, pathogens cannot interfere; avoid the toxic miasma entering from the Tian Pin (nose), allowing it to exit as it came; Qi emerging from the brain prevents pathogenic interference. (Epidemic Qi is Heavenly pathogenic Qi. If our Correct Qi is solid internally, pathogens cannot interfere, hence no infection. Tian Pin refers to the nose. The nose receives Heavenly Qi, hence "Tian Pin". Qi comes from emptiness and should return to emptiness, hence "avoid toxic miasma coming from Tian Pin, returning to where it went," as Qi connects to the nose, the nose connects to the brain, circulating through meridians, causing infection. Qi emerging from the brain causes sneezing; opening the nose to vent it allows pathogens to exit and miasma to disperse.) Qi emerging from the brain begins with visualizing the Heart as the Sun. (The Sun represents Tai Yang Qi, corresponding to the Heart. Visualizing the Heart as the Sun preserves our Qi and strengthens our Shen, preventing pathogenic invasion.) Before entering an epidemic room, first visualize Green Qi emerging from the Liver, moving left to the East, transforming into forests and trees. (Wherever the mind goes, Qi follows; visualization focuses Shen and strengthens Qi. Moving left to the East, transforming into forests, strengthens Liver Qi.) Next, visualize White Qi emerging from the Lungs, moving right to the West, transforming into weapons and armor. (This strengthens Lung Qi.) Next, visualize Red Qi emerging from the Heart, moving south and upward, transforming into flames. (This strengthens Heart Qi.) Next, visualize Black Qi emerging from the Kidneys, moving north and downward, transforming into water. (This strengthens Kidney Qi.) Next, visualize Yellow Qi emerging from the Spleen, residing in the Center, transforming into earth. (This strengthens Spleen Qi.) After completing the protection of the five Qi, visualize it at the head, shining brightly like the Big Dipper, then one can enter the epidemic room. (Huang Huang means shining brightly. Heavenly epidemics transmit fastest. When entering a sickroom, sit at the foot of the bed for male patients and at the head for female patients, as epidemic Qi exits males from above and females from below. Thus, one must carefully avoid it.)