（素问征四失论）
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。（明堂，王者南面
以朝诸侯、布政令之所，非前篇明堂之谓。得失之意，言学力功用之何如也。夫音扶。）雷公对曰∶循经受业，皆言十全，
其时有过失者，愿闻其事解也。（言根据经受学，谓已十全，而用以延医，则时有过失，莫知所以，愿闻其事之解说也。）
帝曰∶子年少智未及邪？将言以杂合邪？（智未及，谓计虑之未周也。言以杂合，谓己无定见，故杂合众说而不能独断
也。然则皆言十全者，正以其未全耳。邪，耶同。）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，谁不能知？即循经受业之谓耳。）所以不十全者，精神不专，志意不理，外内相失，故时疑殆。
（既已循经受业，而犹不能十全者何也？盖道统之传，载由经籍，圆通运用，妙出吾心。使必欲按图索骥，则后先易辙，
未有不失者矣。故精神不能专一者，以中无主而杂合也。志意不分条理者，以心不明而纷乱也。外内相失者，以彼我之
神不交，心手之用不应也。故时有疑惑，致乎危殆。孟子曰∶梓匠轮舆，能与人规矩，不能使人巧。然则循经受业，徒
读父书奚益哉？此过失之解也。）诊不知阴阳逆从之理，此治之一失也。（阴阳逆从之理，脉色证治，无不赖之。不知此
者，恶足言诊？此一失也。）受师不卒，妄作离术，谬言为道，更名自功，妄用砭石，后遗身咎，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，侈口妄谭，巧立名色
以欺人也。及有不宜砭石而妄用者，是不明针灸之理，安得免于灾咎？此二失也。）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。（适，察其所便也。坐，处也。
察贫富贵贱之常，则情志劳佚可知。察处之薄浓，则奉养丰俭可知。察形之寒温，则强弱坚脆、受邪微甚可知。察饮食
之宜否，则五味之损益、用药之寒热可知。凡此者，使不能比别例类以求其详，则未免自乱矣，明者固如是乎？此三失
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。（凡诊病之道，必先察其致病之因，而后参合以脉，则其阴阳虚实，显然自明。使不问其始，是不求其本
也。又若忧患饮食之失节，内因也。起居之过度，外因也。或伤于毒，不内外因也。不先察其因而卒持寸口，自谓脉神，
无待于问，亦焉知真假逆从，脉证原有不合，仓卒一诊，安能尽中病情？心无定见，故妄言作名。误治伤生，损德孰甚，
人己皆为所穷，盖粗疏不精所致，此四失也。）是以世人之语者，驰千里之外。（工之得失，则毁誉之远闻也。）不明尺寸
之论，诊无人事治数之道，从容之葆，坐持寸口，诊不中五脉，百病所起，始以自怨，遗师其咎。（人事治数之道，即前
篇贵贱贫富守数据治之谓。从容，周详也。葆，韬藏也。知周学富，即从容之葆也。若理数未明而徒持寸口，则五脏之
脉且不能中，又焉知百病之所起？是以动多过失，乃始知自怨其无术，而归咎于师传之未尽，岂其然哉？！语云∶学到
知羞处，方知艺不精。今之人多有终身不知羞者，果何如其人也？葆音保。）是故治不能循理，弃术于市，妄治时愈，愚
心自得。（市，多人处也。不能循理，焉能济人？人不相信，如弃术于市，言见弃于众人也。然亦有妄施治疗，偶或一愈，
愚者不知为侥幸，而忻然信为心得，则未免以非为是，而后人踵其害矣。）呜呼！窈窈冥冥，熟知其道？道之大者，拟于
天地，配于四海。（窈窈冥冥，道深玄也。熟当作孰。拟于天地，言高浓之无穷，配于四海，言深广之难测，见不可以易
言也。）汝不知道之谕，受以明为晦。（不知道之谕，不得其旨也。失其旨则未免因辞害意，反因明训而为晦，此医家之
大戒也。晦，不明之谓。）
《素问·征四失论》
黄帝在明堂（古代帝王宣明政教、接见诸侯的场所），雷公在一旁侍奉陪坐。黄帝说：“先生所通晓的书籍和接受的医事知识非常多，试着谈谈你在医术上的得失心得，即你是如何取得成功的，又是如何出现失误的。”（注：这里的明堂是指王者南面而坐以朝见诸侯、颁布政令的地方，并非前文提到的针灸穴位明堂。得失之意，指的是学习能力和医疗功用的水平如何。）雷公回答说：“我遵循经脉理论接受学业教导，大家都说我医术十全十美，但实际在延请行医时，却时常出现过失，不知道原因所在，希望听听对此事的解释。”（注：意思是依据经典受学，自认为已精通医术，但在实际应用治病时，却常有失误，不知所以然，希望能听到对这种情况的解说。）
黄帝说：“是因为你年纪轻、智慧尚未成熟吗？还是因为你的见解杂乱无章、缺乏主见呢？”（注：智慧未及，指思虑不周全。言以杂合，指自己没有定见，因此混杂各家学说而不能独立决断。既然大家都说你十全十美，恰恰说明你并不全面。邪，同“耶”，语气词。）“十二经脉和三百六十五络脉，这些都是人们所熟知的，也是医生所依据使用的。（注：循，意为根据、顺从。这里说的是经络的大概常识，谁不知道呢？这就是所谓遵循经典受学的意思。）之所以不能做到十全十美，是因为精神不专注，意志条理不清，内外不相协调，所以时常产生疑惑和危险。（注：既然已经遵循经典受学，为什么还不能做到十全十美呢？大概医学道统的传承，虽然记载于经籍，但要圆通运用，妙处在于内心。如果一定要按图索骥，那么前后就会偏离正轨，没有不出错的。所以精神不能专一，是因为心中没有主宰而杂合众说；意志不分条理，是因为心不明朗而纷乱；内外相失，是因为彼此的神意不交感，心意与手法不相呼应。所以时常有疑惑，导致危殆。孟子说：‘木匠车轮工匠能给人规矩，但不能使人灵巧。’既然如此，仅仅遵循经典受学，徒然读父亲的书有什么益处呢？这就是对过失的解释。）”
“诊断时不了解阴阳逆从的道理，这是治疗上的第一种失误。（注：阴阳逆从的道理，脉象、面色、证候、治疗无不依赖于此。不知道这些，哪里配谈诊断？这是第一种失误。）”
“跟随老师学习未能完成学业，就胡乱创立离奇的术法，谬误地宣称是大道，改名换姓以夸耀自己的功劳，滥用砭石疗法，给自身留下祸患，这是治疗上的第二种失误。（注：受师不卒，指学业不精，苟且自以为是。妄作离术，指不明白正道，假借异端。谬言为道、更名自功，指夸大其词，巧立名目来欺骗人。以及在不该用砭石时滥用，这是不明白针灸的原理，怎么能避免灾祸呢？这是第二种失误。）”
“不考察患者贫富贵贱的生活环境，不观察居住环境的简陋或豪华，不辨别体质的寒温强弱，不适宜饮食的选择，不区分人的勇敢与怯懦，不懂得类比推理，足以让自己混乱，不足以让自己明白，这是治疗上的第三种失误。（注：适，指观察其适宜之处。坐，指居所。观察贫富贵贱的常态，可知情志劳逸的情况；观察居所的简陋或豪华，可知供养的丰俭；观察体质的寒温，可知强弱坚脆、受邪的轻重；观察饮食是否适宜，可知五味的损益、用药的寒热。凡此种种，如果不能通过比类分析来求得详细情况，就未免会自我混乱，明智的人难道是这样吗？这是第三种失误。）”
“诊断疾病时不问起发病的起因，如忧患、饮食失节、起居过度，或者中毒等，不先了解这些情况，就仓促地切按寸口脉，能准确判断是什么病吗？胡乱命名病症，被粗疏之人所困窘，这是治疗上的第四种失误。（注：凡是诊断疾病的道理，必须先察知致病的原因，然后结合脉象参合判断，那么阴阳虚实就显然明白了。如果不问起因，就是不求根本。又如忧患饮食失节，属于内因；起居过度，属于外因；或者中毒，属于不内外因。不先察知病因就仓促切脉，自诩为脉神，不需要问诊，又怎么知道真假逆从？脉证原本可能不合，仓促一诊，怎么能完全符合病情？心中没有定见，所以胡乱命名。误治伤生，损害德行莫过于此，己人都陷入困境，这都是因为粗疏不精所致，这是第四种失误。）”
“因此世人的言论，往往传播到千里之外。（医生的得失，会导致声誉远播。）如果不明了尺寸脉诊的理论，诊断中不考虑人事因素和治疗法则，缺乏从容周详的涵养，只是坐着切按寸口脉，诊断不符合五脏脉象，不知道百病的起源，开始时自我怨恨，归咎于老师的过错。（人事治数之道，即前篇所说的贵贱贫富守数据治疗的原则。从容，指周详。葆，指韬藏。知识渊博，就是从容的涵养。如果理数不明而只靠切脉，那么五脏之脉尚且不能准确判断，又怎么知道百病的起源？所以动不动就出错，才开始怨恨自己没本事，归咎于老师传授不全，难道真是这样吗？俗话说：学到感到羞愧的地方，才知道技艺不精。现在的人有很多终身不知羞愧的，究竟是什么样的人呢？葆音保。）”
“因此，治疗不能遵循医理，将医术抛弃在闹市（无人问津），胡乱治疗偶尔痊愈，愚昧的人自以为得意。（市，人多之处。不能遵循医理，怎能救人？别人不相信，就像把医术抛弃在闹市，意指被众人抛弃。然而也有胡乱施治，偶然治愈一例，愚者不知是侥幸，反而欣然相信是自己的心得，这就未免以非为是，后来人便追随这种危害了。）”
“唉！道深远玄奥，谁能熟知其道？道的宏大者，比拟于天地，配合于四海。（道深远玄奥，熟当作孰。比拟于天地，指高度无穷，配合于四海，指深度广博难测，说明不可以轻易谈论。汝不知道之谕，接受教诲却将其视为晦涩不明。（不知道之谕，指不得其旨意。失去旨意就难免因辞害意，反而将明确的训诫视为晦涩，这是医家的大戒。晦，指不明。）”
*Suwen: On the Four Failures in Medical Practice*
The Yellow Emperor was in the Mingtang (an ancient hall where kings held court and issued decrees), with Lei Gong attending him. The Yellow Emperor said, "You have mastered numerous books and medical matters. Please discuss your experiences of success and failure in medicine—how you achieved success and how errors occurred." (Note: The Mingtang here refers to the place where the king faced south to receive vassals and issue political orders, not the acupuncture point Mingtang mentioned earlier. 'Success and failure' refers to one's level of learning and clinical efficacy.) Lei Gong replied, "I studied according to the meridians, and everyone says my skills are perfect. However, when I practice medicine, I sometimes make mistakes without knowing why. I wish to hear an explanation of this." (Note: This means that although I claim perfection based on classical study, I often err in actual treatment and do not know the reason; I hope for an explanation.)
The Yellow Emperor asked, "Is it because you are young and your wisdom is not yet mature? Or is it because your views are mixed and lack independent judgment?" (Note: 'Wisdom not mature' means incomplete deliberation. 'Mixed views' means lacking a firm stance and thus blending various theories without independent decision-making. The fact that others say you are perfect actually indicates incompleteness. 'Xie' is a particle equivalent to 'ye'.) "The twelve primary meridians and the three hundred and sixty-five collaterals are well-known to people and are used by physicians as a basis. (Note: 'Xun' means to follow or base upon. This refers to basic knowledge of meridians, which anyone can know, as implied by studying according to classics.) The reason one cannot achieve perfection is that the spirit is not focused, the will lacks order, and there is a disconnect between internal and external factors, leading to frequent doubt and danger. (Note: Why does one fail despite studying classics? Although medical traditions are recorded in texts, true mastery requires mental flexibility. Rigidly following diagrams leads to deviation. Lack of focus stems from having no inner core and mixing theories; lack of order stems from mental confusion; internal-external disconnect stems from a lack of resonance between mind and hand. Mencius said, 'Carpenters can give rules but cannot impart skill.' Thus, merely reading books is insufficient. This explains the causes of error.)"
"Failing to understand the principles of Yin-Yang and their reversal or compliance during diagnosis is the first failure in treatment. (Note: Principles of Yin-Yang are fundamental to pulse, complexion, symptoms, and treatment. Without them, diagnosis is impossible. This is the first failure.)"
"Not completing one's studies under a teacher, then arbitrarily creating bizarre techniques, falsely claiming them as the Great Dao, changing names to boast of one's own merit, and recklessly using bian stones (stone scalpels), thereby bringing blame upon oneself, is the second failure in treatment. (Note: 'Not completing studies' implies superficial learning and self-righteousness. 'Arbitrary techniques' means deviating from the correct path. 'Falsely claiming' involves deceitful boasting. Reckless use of bian stones shows ignorance of acupuncture principles, inviting disaster. This is the second failure.)"
"Failing to consider the living conditions of patients based on their poverty, wealth, or nobility; failing to observe whether their dwellings are humble or luxurious; failing to distinguish their physical constitution regarding cold or warmth; failing to assess dietary suitability; failing to differentiate between courage and timidity; and failing to employ analogical reasoning, leading to self-confusion rather than clarity, is the third failure in treatment. (Note: 'Shi' means to observe appropriateness. Observing social status reveals emotional labor/stress; observing dwelling quality reveals nutritional abundance/scarcity; observing physical constitution reveals strength/fragility and severity of pathogenic invasion; observing diet reveals balance of flavors and appropriate herb properties. Without analogical analysis, one becomes confused. Wise practitioners avoid this. This is the third failure.)"
"Failing to inquire about the onset of illness—such as emotional distress, dietary irregularities, excessive lifestyle habits, or toxic exposure—and instead abruptly palpating the cunkou (radial artery) pulse without prior context, how can one accurately diagnose the disease? Making arbitrary diagnoses and being confounded by crude methods is the fourth failure in treatment. (Note: Diagnosis must begin with identifying etiology before correlating with pulses to determine Yin-Yang deficiency/excess. Ignoring etiology ignores the root. Emotional/dietary issues are internal causes; lifestyle excesses are external causes; toxins are neither-internal-nor-external causes. Palpating without inquiry relies on false confidence in pulse reading alone. Lack of firm judgment leads to arbitrary naming. Misdiagnosis harms life and virtue, causing distress to both patient and doctor due to carelessness. This is the fourth failure.)"
"Therefore, public opinion spreads far and wide. (A physician's success or failure affects their reputation over long distances.) If one does not understand the theory of pulse measurement (cun/cchi), fails to consider humanistic factors and therapeutic laws, lacks composure and thoroughness, and merely sits palpating the cunkou, failing to align with the five zang organ pulses and understanding the origins of myriad diseases, one begins by blaming oneself and then blames the teacher. (Note: 'Humanistic factors' refer to socioeconomic data discussed earlier. 'Composure' implies thoroughness and depth. Knowledge and breadth constitute composure. Without understanding principles, relying solely on pulse reading leads to misdiagnosis of zang pulses and disease origins. Errors lead to self-blame and blaming the teacher. As the saying goes, 'One realizes their inadequacy only when feeling shame.' Many remain unashamed throughout their lives. What kind of people are they?)"
"Thus, if treatment does not follow medical principles, the art is abandoned like trash in the market. Reckless treatments may occasionally succeed, and the ignorant may mistakenly believe it is their own insight. (Note: 'Market' refers to a crowded place. Failing to follow principles makes healing impossible. Lack of trust is like abandoning art in the market. Some reckless treatments happen to work; fools mistake luck for skill and spread harmful practices.)"
"Alas! The Dao is profound and obscure; who truly knows its way? The great Dao resembles Heaven and Earth and matches the Four Seas. (Note: 'Profound' means deep and mysterious. 'Resembling Heaven and Earth' implies infinite height; 'Matching Four Seas' implies immeasurable depth. It cannot be spoken of lightly. If you do not understand the instruction, accepting it as obscurity... (Note: 'Not understanding the instruction' means missing the intent. Missing the intent leads to literalism obscuring meaning, turning clear teachings into obscurity. This is a major taboo for physicians. 'Obscurity' means lack of clarity.)"