（素问方盛衰论 连前篇）
是以诊有大方，坐起有常，（大方者，医家之大法也。坐起有常，则举动不苟而先正其身，身正于外，心必随之，故
诊之大方必先乎此。）出入有行，以转神明，（行，德行也。医以活人为心，其于出入之时，念念皆真，无一不敬，则德
能动天，诚能格心，故可以转运周旋，而无往弗神矣。行，去声。）必清必静，上观下观，（必清必净，则心专志一而神
明见，然后上观之以察其神色声音，下观之以察其形体逆顺。）司八正邪，别五中部，（司，候也。别，审也。候八节八
风之正邪以察其表，审五脏五行之部位以察其里。）按脉动静，循尺滑涩寒温之意，（按脉动静，可别阴阳。滑涩寒温，
可知虚实。凡脉滑则尺之皮肤亦滑，脉涩则尺之皮肤亦涩，脉寒则尺之皮肤亦寒，脉温则尺之皮肤亦温，故循尺即可以
知之。循，揣摩也。）视其大小，合之病能，（大小，二便也。二便为约束之门户，门户不要则仓廪不藏，得守者生，失
守者死，故视其大小以合病能。能，情状之谓。）逆从以得，复知病名，（反者为逆，顺者为从，必得逆从，必知病名，
庶有定见而无差谬。）诊可十全，不失人情。（诊如上法，庶可十全，其于人情，尤不可失也。愚按∶不失人情，为医家
最一难事，而人情之说有三∶一曰病患之情，二曰旁人之情，三曰同道人之情。所谓病患之情者，有素禀之情，如五脏
各有所偏，七情各有所胜，阳脏者偏宜于凉，阴脏者偏宜于热，耐毒者缓之无功，不耐毒者峻之为害，此脏气之有不同
也。有好恶之情者，不惟饮食有憎爱，抑且举动皆关心，性好吉者危言见非，意多忧者慰安云伪，未信者忠告难行，善
疑者深言则忌，此情性之有不同也。有富贵之情者，富多任性，贵多自尊，任性者自是其是，真是者反成非是，自尊者
遇士或慢，自重者安肯自轻，此交际之有不同也。有贫贱之情者，贫者衣食不能周，况乎药饵，贱者焦劳不能释，怀抱
可知，此调摄之有不同也。又若有良言甫信，谬说更新，多岐亡羊，终成画饼，此中无主而易乱者之为害也。有最畏出
奇，惟求稳当，车薪杯水，宁甘败亡，此内多惧而过慎者之为害也。有以富贵而贫贱，或深情而挂牵，戚戚于心，心病
焉能心药，此得失之情为害也。有以急性而遭迟病，以更医而致杂投，皇皇求速，速变所以速亡，此缓急之情为害也。
有偏执者，曰吾乡不宜补，则虚者受其祸，曰吾乡不宜泻，则实者被其伤，夫十室且有忠信，一乡焉得皆符，此习俗之
情为害也。有参术入唇，惧补心先痞塞，硝黄沾口，畏攻神即飘扬，夫杯影亦能为祟，多疑岂法之良，此成心之情为害
也。有讳疾而不肯言者，终当自误，有隐情而不敢露者，安得其详？然尚有故隐病情、试医以脉者，使其言而偶中，则
信为明良；言有弗合，则目为庸劣。抑孰知脉之常体，仅二十四，病之变象，何啻百千？是以一脉所主非一病，一病所
见非一脉。脉病相应者，如某病得某脉则吉；脉病相逆者，某脉值某病则凶。然则理之吉凶，虽融会在心；而病之变态，
又安能以脉尽言哉？故知一知二知三，神圣谆谆于参伍；曰工曰神曰明，精详岂独于指端？彼俗人之浅见，固无足怪，
而士夫之明慧，亦每有蹈此弊者。故忌望闻者，诊无声色之可辨；恶详问者，医避多言之自惭。是于望闻问切，已舍三
而取一，且多有并一未明，而欲得夫病情者，吾知其必不能也。所以志意未通，医不免为病困，而朦胧猜摸，病不多为
医困乎？凡此皆病患之情，不可不察也。所谓旁人之情者，如浮言为利害所关，而人多不知检。故或为自负之狂言，则
医中有神理，岂其能测？或执有据之凿论，而病情多亥豕，最所难知。或操是非之柄，则同于我者是之，异于我者非之，
而真是真非，不是真人不识；或执见在之见，则头疼者云救头，脚疼者云救脚，而本标纲目，反为迂远庸谈。或议论于
贵贱之间，而尊贵执言，孰堪违抗，故明哲保身之士，宁为好好先生；或辩析于亲疏之际，而亲者主持，牢不可拔，虽
真才实学之师，亦当唯唯而退。又若荐医为死生之攸系，而人多不知慎，有或见轻浅之偶中而为之荐者，有意气之私浓
而为之荐者，有信其便便之谈而为之荐者，有见其外饰之貌而为之荐者，皆非知之真者也。又或有贪得而荐者，阴利其
酬；关情而荐者，别图冀望。甚有斗筲之辈者，妄自骄矜，好人趋奉，薰莸不辨，擅肆品评，誉之则盗跖可为尧舜，毁
之则鸾凤可为鸱 ，洗垢索瘢，无所不至，而怀真抱德之士，必其不侔。若此流者，虽其发言容易，欣戚无关，其于淆
乱人情，莫此为甚，多致明医有掣肘之去，病家起刻骨之疑，此所以千古是非之不明，总为庸人扰之耳。故竭力为人任
事者，岂不岌岌其危哉！凡此皆旁人之情，不可不察也。所谓同道人之情者，尤为闪灼，更多隐微。如管窥蠡测，醯鸡
笑天者，固不足道；而见偏性拗，必不可移者，又安足论？有专恃口给者，牵合支吾，无稽信口，或为套语以诳人，或
为甘言以悦人，或为强辩以欺人，或为危词以吓人，俨然格物君子，此便佞之流也。有专务人事者，典籍经书，不知何
物，道听途说，拾人唾余，然而终日营营，绰风求售，不邀自赴，儇媚取容，偏投好者之心，此阿谄之流也。有专务奇
异者，腹无藏墨，眼不识丁，乃诡言神授，伪托秘传，或假脉以言祸福，或弄巧以乱经常，最觉新奇，动人甚易，此欺
诈之流也。有务饰外观者，夸张侈口，羊质虎皮，不望色，不闻声，不详问，一诊而药，若谓人浅我深，人愚我明，此
粗疏孟浪之流也。有专务排挤者，阳若同心，阴为浸润。夫是曰是，非曰非，犹避隐恶之嫌；第以死生之际，有不得不
辨者，固未失为真诚之君子。若以非为是，以是为非，颠倒阴阳，掀翻祸福，不知而然，庸庸不免，知而故言，此其良
心已丧，谗妒之小人也。有贪得无知，藐人性命者，如事已疑难，死生反掌，斯时也，虽在神良，未必其活，故一药不
敢苟，一着不敢乱，而仅仅冀于挽回；忽遭若辈，求速贪功，谬妄一投，中流失楫，以致必不可救，因而嫁谤自文，极
口反噬，虽朱紫或被混淆，而苍赤何辜受害，此贪幸无知之流也。有道不同不相为谋者，意见各持，异同不决。夫轻者
不妨少谬，重者难以略差。故凡非常之病，非非常之医不能察，用非常之治，又岂常人之所知。故独闻者不侔于众，独
见者不合于人，大都行高者谤多，曲高者和寡。所以一齐之傅，何当众楚之咻，直至于败，而后群然退散，付之一人，
则事已无及矣，此庸庸不揣之流也。又有久习成风，苟且应命者，病不关心，些须惟利。盖病家既不识医，则倏赵倏钱；
医家莫肯任怨，则惟芩惟梗。或延医务多，则互为观望；或利害攸系，则彼此避嫌。故爬之不痒，挝之不痛，医称隐当，
诚然得矣；其于坐失机宜，奚堪耽误乎！此无他，亦惟知医者不真，而任医者不专耳。诗云∶发言盈庭，谁执其咎？筑
室于道，不溃于成。此病家医家近日之通弊也。凡若此者，孰非人情？而人情之详，尚多难尽。故孔子曰∶恶紫之夺朱
也，恶郑声之乱雅乐也，恶利口之覆邦家者。然则人情之可畏，匪今若是，振古如兹矣。故圣人以不失人情为戒，而不
失二字最难措力。必期不失，未免迁就；但迁就则碍于病情，不迁就则碍于人情。有必不可迁就之病情，而复有不得不
迁就之人情，其将奈之何哉？甚矣人情之难言也。故余发此，以为当局者详察之备。设彼三人者，倘亦有因余言而各为
儆省，非惟人情不难于不失，而相与共保天年，同登寿域之地，端从此始，惟明者鉴之。）故诊之或视息视意，故不失条
理。（视息者，察呼吸以观其气。视意者，察形色以观其情。凡此诸法，皆诊有大方、诊可十全之道，知之者故能不失条
理。条者犹干之有枝，理者犹物之有脉，即脉络纲纪之谓。）道甚明察，故能长久。不知此道，失经绝理，亡言妄期，此
谓失道。（不知此道，则亡言妄期，未有不殆者矣。）
（《素问·方盛衰论》承接上一篇）
因此，诊察疾病有基本的法度，坐立起居要有常规。（所谓“大方”，是医家的根本大法。坐立起居有常规，意味着举止不轻率而先端正自身，身体在外端正，内心必然随之端正，所以诊察的大法必须先从这方面做起。）出入行为要有德行，以培养神明。（“行”指德行。医生以救活人为心志，在出入往来之时，念念真诚，无一不恭敬，那么德行就能感动上天，诚意能通达心灵，所以可以周旋应对，无处不显神妙。“行”读去声。）必须清静，上观下察。（必须清净，才能心神专一而神明显现，然后向上观察以考察患者的神色声音，向下观察以考察形体的顺逆。）掌管八正邪气，辨别五脏部位。（“司”是候察的意思。“别”是审辨的意思。候察八节八风之正气与邪气以了解表证，审辨五脏五行之部位以了解里证。）按压脉搏察其动静，揣摩尺肤滑涩寒温的意旨。（按压脉搏察其动静，可以辨别阴阳。滑涩寒温，可以知道虚实。凡是脉滑，尺部的皮肤也滑；脉涩，尺部的皮肤也涩；脉寒，尺部的皮肤也寒；脉温，尺部的皮肤也温，所以抚摸尺部就可以知道这些情况。“循”意为揣摩。）观察大小便，结合病状表现。（大小便，即二便。二便是约束的门户，门户不坚固则仓廪无法储藏，能守住者生，失守者死，所以观察大小便以合于病状表现。“能”指情状。）通过逆从关系得出判断，进而知晓病名。（相反者为逆，顺从者为从，必须明了逆从，必须知晓病名，这样才有定见而没有差错。）诊察可以十全十美，不违背人情。（诊察像上述方法，才可以十全十美，对于人情，尤其不可违背。我按语道：不违背人情，是医家最难的一件事，而人情的说法有三种：一是病患的情状，二是旁人的情状，三是同道人的情状。所谓病患的情状，有素体禀赋的情状，如五脏各有偏颇，七情各有克制，阳脏的人偏宜于凉，阴脏的人偏宜于热，耐毒性的人缓治无效，不耐毒性的人峻治为害，这是脏气不同。有好恶的情状，不仅饮食有憎爱，而且举动都关心，喜好吉利的人认为危言耸听是不对的，多忧虑的人觉得安慰是虚伪的，未信任的人难以接受忠告，多疑的人忌讳深谈，这是性情不同。有富贵的情状，富人大多任性，贵人大多自尊，任性的人自以为是，真正正确反而被当成错误，自尊的人对待士人或傲慢，自重的人怎肯自轻，这是交际不同。有贫贱的情状，穷人衣食不能周全，何况药物，贱者焦虑劳苦不能解脱，怀抱可知，这是调摄不同。又有刚相信良言，又更新谬说，像多歧路亡羊一样，最终成画饼充饥，这是心中无主而易受扰乱的危害。有最怕出奇，只求稳当，像用车薪杯水灭火一样，宁愿失败灭亡，这是内心多惧而过慎的危害。有为富贵变贫贱，或深情牵挂，心中忧愁，心病怎能用心药治愈，这是得失之情的危害。有为急性病遭遇慢性病，因更换医生导致杂投药物，慌忙求快，变化迅速导致迅速死亡，这是缓急之情的危害。有偏执的人，说我们家乡不宜补，则虚者受害，说我们家乡不宜泻，则实者受伤，十户人家尚且有忠信，一个乡里怎能都符合，这是习俗之情的危害。有人参、白术入口，害怕补益导致心先痞塞，硝石、大黄沾口，畏惧攻伐导致精神飘扬，杯弓蛇影也能成为祸祟，多疑岂是良法，这是成见之情的危害。有隐瞒病情不肯说的，最终会自己耽误自己，有隐情不敢暴露的，怎么能得到详细情况？然而还有故意隐瞒病情、用脉象试探医生的，如果他说得偶然中肯，就相信他是明良；说得不合，就认为是庸劣。殊不知脉的常体只有二十四种，病的变象何止千百？所以一脉所主并非一种病，一病所见并非一脉。脉病相应的，如某病得某脉则吉；脉病相逆的，某脉值某病则凶。然而理的吉凶，虽融会于心；而病的变态，又怎能仅凭脉象尽言呢？所以知一知二知三，神圣之人谆谆教导于参伍之法；曰工曰神曰明，精详难道只在指尖吗？那些俗人的浅见，本来不值得奇怪，而士大夫的明慧，也常有蹈此弊病的。所以忌讳望闻的，是因为诊察没有声色可辨；厌恶详问的，是医生避免多言的自惭。这对于望闻问切，已经舍弃三种而取一种，且多有连一种都没弄明白，就想得知病情的，我知道他一定不能做到。所以意志不通，医生不免被病人困扰，而朦胧猜测，病人不就多被医生困扰吗？凡此都是病患的情状，不可不考察。所谓旁人的情状，如浮言关乎利害，而人们大多不知检点。所以有的出于自负的狂言，医中的神理，岂是他们能测度的？有的执着有据的凿论，而病情多有错乱，最难知晓。有的操持是非之柄，同于我的就是对的，异于我的就是错的，而真正的真非，不是真人不识；有的执着眼前的见解，头疼的说救头，脚疼的说救脚，而本标纲目，反被视为迂腐庸谈。有的在贵贱之间议论，而尊贵者坚持己见，谁能违抗，所以明哲保身之士，宁愿做好好先生；有的在亲疏之际辨析，而亲者主持，牢不可拔，虽有真才实学之师，也应当唯唯退让。又有推荐医生关乎生死，而人们大多不知慎重，有的因为见到浅薄之人的偶然中肯而推荐，有的因为意气私厚而推荐，有的相信其滔滔不绝的谈论而推荐，有的见到其外表修饰的容貌而推荐，都不是真正了解的人。又有贪得而推荐的，暗中图利酬谢；关情而推荐的，另图希望。甚至有见识短浅之辈，妄自尊大，喜欢别人趋炎附势，香草臭草不辨，擅自肆意品评，赞誉则盗跖可为尧舜，诋毁则鸾凤可为鸱枭，洗垢索瘢，无所不至，而怀真抱德之士，必定不相匹配。像这类人，虽然发言容易，喜怒无关，但对于淆乱人情，没有比这更严重的了，多导致明医有掣肘而去，病家起刻骨之疑，这就是千古是非不明，总归是被庸人扰乱罢了。所以竭力为人任事的人，岂不岌岌可危吗！凡此都是旁人的情状，不可不考察。所谓同道人的情状，尤为闪烁，更多隐微。如管窥蠡测、醯鸡笑天的人，本来不值一提；而见解偏执拗硬，必不可移的人，又哪里值得讨论？有专门倚仗口才的人，牵强附会支吾其词，无稽之谈信口开河，或用套语欺骗人，或用甜言蜜语取悦人，或用强辩欺瞒人，或用危言耸听吓人，俨然一副格物君子模样，这是巧言令色之流。有专门从事人事的人，典籍经书，不知是什么东西，道听途说，拾人牙慧，然而终日忙碌，招摇撞骗，不邀自来，谄媚取容，偏投好者之心，这是阿谀奉承之流。有专门追求奇异的人，腹无藏书，眼不识丁，却诡称神授，伪托秘传，或假借脉象预言祸福，或卖弄技巧扰乱常规，最觉新奇，动人很容易，这是欺诈之流。有致力于装饰外观的人，夸张侈口，羊质虎皮，不看面色，不听声音，不详加询问，一诊完就开药，似乎认为人浅我深，人愚我明，这是粗疏孟浪之流。有专门排挤的人，表面看似同心，暗中进谗言。说是说是，非说非，还避开隐藏恶意的嫌疑；只是到了生死关头，有不得不辨别的，固然未失为真诚的君子。如果把非当作是，把是当作非，颠倒阴阳，掀翻祸福，不知道却如此，平庸难免，知道却故意这样说，这是良心已丧，嫉妒的小人。有贪得无知，轻视人性命的，如事情已经疑难，生死反掌，这时候，即使是神医良医，未必能救活，所以不敢随便用药，不敢乱出主意，仅仅希望挽回；忽然遇到这类人，求快贪功，谬妄一投，如同船在中流失去船桨，以致不可挽救，因而推卸诽谤自我掩饰，极口反咬一口，虽然朱紫可能被混淆，但百姓何辜受害，这是贪幸无知之流。有道不同不相为谋的人，意见各持，异同不决。轻症不妨少谬，重症难以略差。所以非常之病，非常之医才能察觉，用非常之治，又岂是常人所能知晓。所以独闻者不同于众人，独见者不合于人，大都品行高者谤议多，曲高和寡。所以齐国的老师教不好一个学生，抵挡不住楚国人众口的喧哗，直到失败，然后群然退散，交付给一个人，则事情已来不及了，这是平庸不揣之流。又有久习成风，苟且应命的人，对病不关心，只图小利。盖病家既不懂医，则忽赵忽钱；医家不肯任怨，则只选黄芩桔梗。或延请医生务多，则互相观望；或利害攸关，则彼此避嫌。所以抓之不痒，打之不痛，医生称为稳妥，确实得到了；但对于坐失良机，怎么经得起耽误呢！这没有别的，也只是因为懂医的不真，任用医的不专罢了。《诗经》说：发言盈庭，谁执其咎？筑室于道，不溃于成。这是病家医家近日的通病。凡像这样的，哪个人情不是如此？而人情的详细，尚多难尽述。所以孔子说：厌恶紫色夺去红色，厌恶郑声扰乱雅乐，厌恶利口颠覆邦家的人。然而人情的可怕，不只是现在这样，自古以来就是这样了。所以圣人以不失人情为戒，而“不失”二字最难着力。必期不失，未免迁就；但迁就则碍于病情，不迁就则碍于人情。有必不可迁就的病情，而复有不得不迁就的人情，将怎么办呢？人情之难言啊。所以我发表这些言论，作为当局者详细考察的准备。假如那三个人，倘若也有因为我的话而各自警醒反省，不仅人情不难于不失，而且共同保全天年，同登寿域之地，端从此开始，只有明智者鉴察。）所以诊察有时观察呼吸观察意向，所以不失条理。（视息，是察呼吸以观其气。视意，是察形色以观其情。凡此诸法，都是诊有大方、诊可十全之道，知之者所以能不失条理。条就像树干有树枝，理就像物体有脉络，即脉络纲纪的意思。）道理非常明察，所以能长久。不知此道，背离经典断绝理法，妄言妄期，这叫失道。（不知此道，则妄言妄期，没有不危险的。）
(Su Wen, Chapter on the Theory of Fullness and Emptiness, continuing from the previous chapter)
Therefore, in diagnosis there are fundamental principles; sitting and rising have their regularities. (The "fundamental principle" refers to the major laws of medical practice. Regularity in sitting and rising implies that movements are not frivolous but first correct one's own body; when the body is corrected externally, the mind follows suit. Thus, the fundamental principle of diagnosis must begin with this.) Entrance and exit should be guided by virtue, to transform and illuminate the spirit. ("Xing" here denotes virtue. The physician takes saving lives as their heart's intent; during times of coming and going, every thought is sincere, without any lack of reverence. When virtue can move Heaven and sincerity can penetrate the mind, one can navigate all situations with divine efficacy.) One must be clear and quiet, observing above and below. (Being clear and quiet allows the mind to focus and the spirit to manifest, enabling observation upwards to examine complexion, expression, voice, and sound, and downwards to examine the physical form for compliance or deviation.) Manage the pathogens of the Eight Normals, distinguish the locations of the Five Zang organs. ("Si" means to monitor. "Bie" means to discern. Monitor the righteous and evil influences of the Eight Solar Terms and Eight Winds to examine the exterior; discern the positions of the Five Zang organs and Five Elements to examine the interior.) Press the pulse to observe its dynamics, and trace the meanings of slipperiness, roughness, cold, and warmth at the Cun position. (Pressing the pulse to observe dynamics distinguishes Yin and Yang. Slipperiness and roughness, cold and warmth indicate Deficiency and Excess. Generally, if the pulse is slippery, the skin at the Cun position is also slippery; if rough, then rough; if cold, then cold; if warm, then warm. Thus, tracing the Cun position reveals these states. "Xun" means to feel or trace.) Observe urination and defecation, combining them with the disease's presentation. (Urine and stool are the gates of constraint. If the gates are not secure, the granaries cannot store; those who maintain security live, those who lose it die. Thus, observing urine and stool helps understand the disease's state. "Neng" refers to the condition or manifestation.) Through understanding reversal and compliance, one determines the diagnosis and knows the disease name. (Reversal is "Ni", compliance is "Cong". One must grasp both to know the disease name, ensuring certainty and avoiding error.) Diagnosis can achieve perfection, without failing to account for human circumstances. (Diagnosing according to the above methods allows for perfection; however, human circumstances must not be overlooked. I note: Failing to account for human circumstances is the most difficult aspect for physicians. There are three types of human circumstances: the patient's situation, the bystander's situation, and the colleague's situation. The patient's situation includes constitutional predispositions, such as each Zang organ having biases and each emotion having counteracting forces. Those with Yang constitutions prefer cooling, while those with Yin constitutions prefer warming. For those tolerant of toxicity, mild treatment fails; for those intolerant, harsh treatment causes harm—this is the difference in Zang Qi. There are preferences and aversions: dietary likes and dislikes extend to daily actions. Those favoring auspiciousness reject alarming words; those prone to worry find comfort false; those untrusting find advice hard to accept; those suspicious avoid deep discussion—this is the difference in temperament. There are circumstances of wealth and nobility: the rich often act willfully, the noble often value self-esteem. The willful consider themselves always right, making truth seem wrong; the noble may treat scholars with disdain, the self-respecting refuse to lower themselves—this is the difference in social interaction. There are circumstances of poverty and low status: the poor struggle for food and clothing, let alone medicine; the lowly suffer anxiety and toil—this is the difference in care management. Furthermore, some believe good advice only to update erroneous views later, like losing sheep on many paths, ending up with a painted cake—this is the harm of being leaderless and easily confused. Some fear novelty, seeking only stability, like using a cart of firewood or a cup of water to extinguish a fire, preferring defeat—this is the harm of excessive caution due to inner fear. Some suffer from loss of wealth or status, or deep emotional attachments, causing mental distress that no physical medicine can cure—this is the harm of gain and loss. Some with acute conditions face chronic diseases, or cause chaos by changing doctors and mixing treatments, rushing for speed leading to rapid decline—this is the harm of urgency. Some are dogmatic, claiming "our region does not use tonification," harming the deficient, or "our region does not use purgation," injuring the excess. Even ten households have loyalty and trust; how can an entire village conform? This is the harm of local customs. Some fear tonics like Ginseng and Atractylodes causing chest fullness, or purgatives like Niter and Rhubarb causing mental agitation; like fearing shadows in a cup, excessive suspicion is not a good method—this is the harm of preconceived notions. Some hide illness and refuse to speak, ultimately harming themselves; some have hidden feelings they dare not reveal, preventing detailed inquiry. Yet some deliberately conceal symptoms to test the doctor with pulses; if the doctor guesses correctly, they are deemed wise; if not, mediocre. Who knows that pulse patterns are limited to twenty-four, while disease manifestations number in the thousands? Thus, one pulse does not correspond to one disease, nor one disease to one pulse. When pulse and disease correspond, it is auspicious; when they conflict, it is ominous. Although the logic of auspiciousness and omen resides in the mind, how can the myriad variations of disease be fully described by pulse alone? Hence, knowing one, two, or three, the sages earnestly teach the method of comparison; calling oneself a worker, a spirit, or a sage, precision is not merely in the fingertips. The shallow views of commoners are unsurprising, yet even enlightened scholars often fall into this trap. Those who shun inspection and listening claim there are no visible signs or sounds to distinguish; those who dislike detailed questioning avoid the shame of talking too much. In doing so, they discard three of the four diagnostic methods, and many fail to even master one, yet expect to know the disease—I know this is impossible. Thus, if the mind is not clear, the physician is troubled by the patient; if guessing blindly, the patient is troubled by the physician. All these are patient circumstances that must be examined. The bystander's circumstances involve rumors related to benefit and harm, which people rarely check. Some make arrogant claims beyond medical wisdom; some insist on seemingly evidence-based arguments where the disease presentation is confused, making it hard to know. Some wield power over right and wrong, approving what agrees with them and rejecting what differs, leaving true truth unrecognized by non-experts. Some cling to immediate views, saying "headache needs head treatment, leg pain needs leg treatment," ignoring root and branch relationships as pedantic talk. Some debate between high and low status; the noble insist on their words, which cannot be resisted, so prudent physicians become yes-men. Some argue based on intimacy; relatives hold sway and are unyielding, forcing even skilled physicians to retreat. Recommendations for doctors affect life and death, yet people are careless. Some recommend based on a layperson's lucky guess, personal bias, eloquent speech, or superficial appearance—not true knowledge. Some recommend for greed, seeking secret rewards; others for personal favors, hoping for future gains. Some petty people, arrogant and fond of flattery, cannot distinguish fragrant herbs from foul ones, yet freely judge, praising villains as sages or destroying phoenixes as owls, digging for faults endlessly, excluding virtuous men. Such people, though speaking lightly and unaffected by joy or sorrow, cause the greatest confusion, driving away good doctors and creating deep suspicion in families. This is why right and wrong remain unclear for millennia, disturbed by mediocrity. Thus, those striving to serve others face great danger. These are bystander circumstances that must be examined. Colleague circumstances are particularly elusive and subtle. Those with narrow views, like looking at the sky through a tube or measuring the sea with a gourd, are unworthy of mention; nor are those with stubborn, unchangeable biases. Some rely on eloquence, making excuses, speaking nonsense, using clichés to deceive, sweet words to please, strong arguments to trick, or scary tales to frighten, posing as gentlemen of investigation—these are the flatterers. Some focus on social connections, ignorant of classics, spreading hearsay, busy day and night, flattering to win favor—these are the sycophants. Some pursue novelty, uneducated yet claiming divine revelation or secret transmission, predicting fortune via pulse or playing tricks to disrupt norms, appearing novel and captivating—these are the frauds. Some decorate appearances, boasting like a tiger-skin sheep, ignoring inspection, listening, and questioning, prescribing after one glance, thinking themselves superior—these are the reckless. Some engage in exclusion, feigning unity while plotting behind the scenes. While distinguishing right from wrong avoids hiding evil, in life-and-death matters, distinction is necessary for true gentlemen. But confusing right and wrong, overturning Yin and Yang, and misjudging fortune and doom out of ignorance or malice shows lost conscience and jealousy—these are the villains. Some are greedy and ignorant, disregarding life. In critical cases, even gods might fail, requiring careful medication and strategy. Suddenly encountering those who seek quick success and merit, making reckless errors like losing an oar mid-stream, leads to incurable situations. They then shift blame and bite back, confusing colors and harming the innocent—these are the greedy and ignorant. Those with different paths do not plan together, holding divergent opinions. Minor errors are tolerable in light cases, but fatal in heavy ones. Extraordinary diseases require extraordinary physicians and treatments, unknown to the masses. Thus, unique insights differ from the crowd; high art has few followers. Many slander the virtuous; high songs have few singers. A single teacher from Qi cannot withstand the noise of Chu; failure comes, then everyone scatters, leaving one person to deal with the aftermath—these are the incompetent. Some follow bad habits, perfunctorily fulfilling duties, indifferent to illness, caring only for profit. Patients who don't understand medicine switch doctors randomly; physicians unwilling to bear responsibility prescribe only mild herbs like Scutellaria and Platycodon. When many doctors are consulted, they watch each other; when stakes are high, they avoid suspicion. Treating symptoms without addressing causes, doctors call it "safe," but miss opportunities for timely treatment. This stems from imperfect knowledge of medicine and lack of dedicated appointment. As the Classic says: "Words fill the court, but who bears the blame? Building a house by the road, it never gets finished." These are common flaws today. Are these not human circumstances? Details are endless. Confucius said: "I hate purple usurping red, Zheng music disrupting elegant music, and glib tongues overthrowing states." Human circumstances are feared not just now, but since ancient times. Sages warn against failing to account for them, yet "not failing" is hardest. Trying not to fail leads to compromise; compromising hinders treatment; not compromising offends people. With uncompromising disease states and unavoidable human pressures, what then? Human circumstances are hard to discuss. I write this for practitioners to examine carefully. If these three groups reflect on my words, they may avoid pitfalls, preserve natural lifespan, and reach longevity. Only the wise will heed this.) Therefore, diagnosis sometimes involves observing breathing and intent, thus maintaining order. (Observing breathing examines Qi; observing intent examines emotions and expressions. These methods are part of the fundamental principles and perfect diagnosis. Knowing them ensures order. "Tiao" is like branches on a trunk; "Li" is like veins in an object, referring to the network and guidelines.) The Way is clearly observed, thus lasting long. Not knowing this Way, abandoning classics and severing principles, speaking falsely and expecting wrongly, is called losing the Way. (Not knowing this Way leads to false speech and expectations, inevitably resulting in danger.)