五过四失，皆指医者而言也。医之为教，拯济危难，接续真元，是非上智之士，不能胜其任，岂仅求免于
过失而已也。然荒陋者多，则五过不可以不疏，而四失不可以不征。疏，分疏也。征，犹惩也。
黄帝曰∶呜呼远哉！闵闵乎若视深渊，若迎浮云，视深渊尚可测，迎浮云莫知其际。（按∶此与六微旨论
同，皆叹道妙之无穷极也。）圣人之术，为万民式，论裁志意，必有法则，循经守数，……为万民副，故事有
五过四德，汝知之乎？（按∶杨上善云∶“副，助也。”）雷公避席再拜曰∶臣年幼小，蒙愚以惑，不闻五过
与四德，比类形名，虚引其经，心无所对。（经未师受，心匪生知，故卑辞也。）
帝曰∶凡未诊病者，必问尝贵后贱，……病从内生，名曰脱营。（神屈故也，贵之尊荣，贱之屈辱，心怀
眷慕，志
结忧惶，故虽不中邪而病从内生，血脉虚减，故曰脱营。）尝富后贫，名曰失精，五气留连，病有所并。（富
而从欲，贫夺丰财，内结忧煎，外悲过物。然则心从想慕，神随往计，营卫之道，闭以迟留，血气不行，积并
为病。）医工诊之，不在脏腑，不变躯形，诊之而疑，不知病名。（言病之初也，病由想恋所为，故未居脏腑；
事因情念所起，故不变躯形。医不悉之，故诊而疑也。）身体日减，气虚无精。（言病之次也，气血相逼，
形肉消烁，故身体日减。阴阳应象大论曰∶“气归精，精食气。”今气虚不化，精无所滋故也。）病深无气，
洒洒然时惊。（言病之深也，病气深，谷气尽，阳气内薄，故恶寒而惊。洒洒，寒貌。）病深者，以其外耗于
卫，内夺于荣。（按∶此承上而言，盖推原所以病深之故也。气虚无精，是内夺也；洒洒时惊，是外耗也。
内夺外耗，病所由深，为此故尔。）良工所失，不知病情，此亦治之一过也。（失谓失问其所始也。）凡欲诊
病者，必问饮食居处，（按∶饮食有多寡好恶之别，居处有昼夜动静之分。）暴乐暴苦，后乐后苦，（按∶王本
始乐后苦，太素作始乐始苦，夫始犹暴也，不苦后乐后苦为确，后以对暴，今正之。）皆伤精气，精气竭绝，
形体毁沮，暴怒伤阴，暴喜伤阳，（按∶伤阴者，怒伤肝血也；伤阳者，喜散心气也。注以逆缓解，似犹未确。）
厥气上行，满脉去形。（厥，气逆也。逆气上行，满于经络，则神气溃散，去离形骸矣。按∶暴怒四句，妙义
精绝，然已见阴阳应象大论中。）愚医治之，不知补泻，……精华日脱，邪气乃并，此治之二过也。（按∶邪盛者
宜先泻邪，正虚者宜先补正，宜泻反补，宜补反泻，则正愈虚而邪愈盛。）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。（奇恒谓奇异于恒常之候也。从容谓分别脏气虚实，脉
见高下几相似也。按∶道即比类从容之道。）诊有三常，必问贵贱，封君败伤，及欲侯王，（贵则形乐志乐，
贱则形苦志苦，苦乐殊贯，故宜先问也。封君败伤，降君之位，为公卿也。及欲侯王，谓情慕尊贵，而妄为不已
也。）故贵脱势，虽不中邪，精神内伤，身必败亡，始富后贫，虽不伤邪，皮焦筋屈，痿 为挛。（按∶富贵
精神爽，贫贱志气卑，有病无病，于是乎分矣。）医不能严，不能动神，外为柔弱，乱至失常，病不能移，……此治
之四过也。（严谓戒，所以禁非也；动，所以令从命也。外为柔弱，言委随而顺从也。然戒不足以禁非，动
不足以从令，委随任物，乱失天常，病且不移，何医之有。）凡诊者必知终始，……切脉问名，当合男女。（终
始谓气色也，脉要精微论曰∶“知外者终而始之。”明知五气色象，终而复始也。切谓以指按脉也。问名谓问
病证之名也。男子阳气多而左脉大为顺，女子阴气多而右脉大为顺，故宜以候常先合之也。）离绝菀结，忧恐
喜怒，五脏空虚，血气离守，工不能知，何术之语，……唯言死日，亦为粗工，此治之五过也。（离谓离间亲爱，
绝谓绝念所怀，菀谓菀积思虑，结谓结固余怨。夫间亲爱者魂游，绝所怀者意丧，积所虑者神劳，结余怨者志苦。
忧愁者闭塞而不行，恐惧者荡惮而失守，盛忿者迷惑而不治，喜乐者惮散而不藏，由是八者，故五脏空虚，血
气离守，工不思晓，又何言哉。按∶夫所贵乎医者，以其能审脉辨证，去死回生也。若补救之术全无，而唯预
期其死日，后即有验，亦不足贵也。）凡此五者，皆受术不通，人事不明也。
故曰∶圣人之治病也，必知天地阴阳，四时经纪，五脏六腑，雌雄表里，刺灸砭石，毒药所主，从客人事，
以明经道，贵贱贫富，各异品理，问年少长勇怯之理，
审于分部，知病本始，八正九候，诊必副矣。（……圣人之备识也如此，工宜勉之。）
“五过”和“四失”，都是针对医生而言的。医学这一教化，旨在拯救救济危难，接续人体的真元之气，如果不是具有上等智慧的人，是不能胜任这一重任的，哪里仅仅是为了避免过失罢了呢？然而，荒疏浅陋的医生很多，所以不能不详细阐述“五过”，也不能不征引（警示）“四失”。“疏”，是分条陈述的意思；“征”，通“惩”，是惩戒、警戒的意思。
黄帝说：“唉，道理深远啊！谨慎小心，好像看着深渊，又好像迎接浮云。看深渊还可以测量其深浅，迎接浮云却不知它的边际。”（按：这与《六微旨大论》相同，都是在感叹医道奥妙的无穷无尽。）圣人的医术，作为万民的典范，论述并裁断病人的意志情志，必定有法则可循，遵循经络规律，坚守诊法数量……作为万民的辅佐，所以事情有“五过”和“四德”，你知道吗？（按：杨上善说：“副，是辅助的意思。”）
雷公离开座位，拜了两拜说：“臣年纪幼小，蒙受愚钝而困惑，没有听说过‘五过’与‘四德’，即使进行类比推演、辨别形体名称，也是虚妄地引用经典，心中没有确切的应对之策。”（因为未曾从老师那里系统接受教导，心并非天生知晓，所以用谦卑的词句回答。）
黄帝说：“凡是还没有诊断病情的，必须询问病人过去是否曾经尊贵而后变得卑贱……疾病从体内产生，名叫‘脱营’。（这是因为神气屈辱的缘故。曾经地位尊贵荣耀，后来变得卑贱屈辱，心中怀着眷恋羡慕，意志郁结忧愁惶恐，所以虽然没有被外邪侵袭，但疾病从体内产生，血脉虚弱减少，所以叫‘脱营’。）曾经富有而后变得贫穷，名叫‘失精’，五脏之气留滞连延，各种病邪相互搏结。（因为富有时放纵欲望，贫穷时剥夺了丰厚的财物，内心郁结忧虑煎熬，对外界事物过度悲伤。这样心意随着想慕而动，神气随着往事而计算，营卫运行的道路，闭塞而迟滞停留，血气不能运行，积聚合并成为疾病。）医生诊断这种病，不在脏腑之中，外表形体也没有变化，诊断时感到疑惑，不知道这是什么病。（这是说疾病的初期，疾病由思恋引起，所以尚未居于脏腑；事情因情念而起，所以外形没有改变。医生不了解这些，所以诊断时感到疑惑。）身体一天天消瘦，气虚无精。（这是说疾病的进展阶段，气血相互逼迫，形体肌肉消烁，所以身体一天天减少。《阴阳应象大论》说：‘气归于精，精依赖气滋养。’现在气虚不能化生，精无所滋生的缘故。）病情深入，正气衰竭，经常感到寒冷战栗并惊恐。（这是说疾病的深重阶段，病气深入，谷气耗尽，阳气在内迫击，所以恶寒而惊恐。‘洒洒’，是寒冷的样子。）病情深重，是因为外部耗损了卫气，内部掠夺了营血。（按：这是承接上文来说，大概是推究导致病情深重的原因。气虚无精，就是内夺；洒洒然时常惊恐，就是外耗。内夺外耗，是病情加深的缘由，正因为如此。）高明的医生如果失误，在于不了解病情，这也是治疗中的一个过失。（‘失’是指未能询问清楚疾病的起始原因。）凡是想要诊断疾病的，必须询问病人的饮食起居，（按：饮食有多寡、好恶的区别，居所有昼夜、动静的不同。）突然快乐或突然痛苦，开始快乐后来痛苦，（按：王冰本原作‘始乐后苦’，《太素》作‘始乐始苦’，‘始’通‘暴’，即突然。不应该是‘后乐后苦’，用‘后’对‘暴’，现在予以纠正。）这些都损伤精气，精气枯竭断绝，形体毁坏沮丧，暴怒损伤阴气，暴喜损伤阳气，（按：伤阴的是因为怒伤肝血；伤阳的是因为喜散心气。注释用逆乱来解释缓解，似乎还不够确切。）厥逆之气向上运行，充满脉道，神气离形。（厥，是气逆。逆气上行，充满经络，则神气溃散，离开形骸了。按：暴怒这四句，意义精妙绝伦，但已经见于《阴阳应象大论》中。）愚笨的医生治疗它，不懂得补泻原则……精华日益脱失，邪气于是乘虚结合，这是治疗的第二个过失。（按：邪气盛者应当先泻邪，正气虚者应当先补正，该泻反补，该补反泻，则正气更虚而邪气更盛。）善于切脉的医生，必定运用比类法和奇恒之法，从容不迫地了解病情，作为医生如果不通晓这些道理，这就不足以被尊重，这是治疗的第三个过失。（‘奇恒’指奇异于平常的证候。‘从容’指分别脏气的虚实，脉象出现高低几近相似的情况。按：‘道’即比类从容的方法。）诊断要考察三种常情，必须询问病人的贵贱身份，封君败伤（地位下降），以及想要谋求侯王之位的人，（尊贵时形体安逸、意志快乐，卑贱时形体劳苦、意志痛苦，苦乐截然不同，所以应该先询问。封君败伤，指降低君主之位，沦为公卿。以及想要侯王，指情慕尊贵，而妄为不止。）所以贵族失去权势，虽然没有中邪，精神内伤，身体必然败亡；起初富有后来贫穷，虽然没有受伤邪，皮肤焦枯、筋脉屈曲，形成痿证和挛缩。（按：富贵时精神爽朗，贫贱时志气卑微，有病无病，由此区分。）医生如果不能严厉（约束病人），不能动摇其神志，外表显得柔弱顺从，扰乱了正常的诊疗秩序，疾病不能转移……这是治疗的第四个过失。（‘严’指告诫，用来禁止非分行为；‘动’，用来使病人听从命令。外表柔弱，指委随顺从。然而告诫不足以禁止非分，感动不足以使病人服从，委随任物，混乱失去了天常，疾病尚且不能好转，算什么医生呢？）凡是诊断疾病的，必须知道疾病的始终……切脉问名，应当符合男女的差异。（‘终始’指气色，《脉要精微论》说：‘知外者终而始之。’明确知道五色气象，终结而又开始。切，是用手指按压脉搏。问名是询问病证的名字。男子阳气多，左脉大为顺；女子阴气多，右脉大为顺，所以应当以此作为常规先合参。）分离隔绝、郁结思虑、忧愁恐惧喜怒，导致五脏空虚，血气离散守持，医生不能知晓，还能说什么医术……只预言死期，也是粗劣的医生，这是治疗的第五个过失。（‘离’指离间亲爱之情，‘绝’指断绝所怀之念，‘菀’指郁积思虑，‘结’指固结余怨。离间亲爱的人魂游，断绝所怀的人意丧，积累思虑的人神劳，固结余怨的人志苦。忧愁的人闭塞而不行，恐惧的人荡惮而失守，盛怒的人迷惑而不治，喜乐的人惮散而不藏，由于这八种情况，所以五脏空虚，血气离散守持，医生不思考明白，又有什么话可说呢。按：医生之所以可贵，是因为能审脉辨证，去死回生。如果补救的方法全无，只是预先期待他的死期，即使后来应验，也不值得尊重。）所有这些，都是因为医术不通达，人情事理不明白的缘故。
所以说：圣人治病，必定通晓天地阴阳，四季的纲纪，五脏六腑，雌雄表里关系，刺灸砭石、药物各自的主治功能，顺应人事，以阐明经络大道。贵贱贫富，各有不同的病理，询问年少长幼、勇敢怯懦的道理，审察分部脉象，了解疾病的根本起因，参照八正九候，诊断必定相符了。（……圣人的完备见识如此，医生应当努力。）
The "Five Errors" and the "Four Failures" both refer to physicians. The teaching of medicine aims to rescue and relieve crises, and to continue the true primordial qi (Zhen Yuan). Only those with superior wisdom can bear this responsibility; it is not merely about avoiding faults. However, since there are many who are ignorant and shallow, one must not fail to explicate the "Five Errors" nor to cite warnings regarding the "Four Failures." "Explicate" (Shu) means to state item by item; "cite/warn" (Zheng) implies admonition or caution.
Yellow Emperor said: "Ah, how profound! One must be cautious and attentive, as if gazing into an abyss, or as if welcoming floating clouds. Gazing into an abyss allows one to measure its depth, but welcoming floating clouds makes one unable to know its boundaries." (Note: This corresponds to the *Liu Wei Zhi Da Lun*, both sighing at the boundless profundity of the Dao.) The art of the sage serves as a model for all people. In discussing and regulating patients' wills and intentions, there must be laws to follow, adhering to meridians and observing diagnostic numbers... serving as a deputy/assistant to all people. Thus, matters involve the "Five Errors" and the "Four Virtues," do you understand them? (Note: Yang Shangshan stated: "'Fu' means to assist.")
Lei Gong stepped down from his seat and bowed twice, saying: "This subject is young and small in age, covered by foolishness and confused, having never heard of the 'Five Errors' and 'Four Virtues.' Even when using analogy and distinguishing forms and names, I vainly cite classics, with no firm response in my heart." (Since he had not received systematic instruction from a teacher, and his mind was not born with knowledge, he used humble words.)
Yellow Emperor said: "Whenever diagnosing a disease before examination, one must ask if the patient once held high status and later became low... Diseases arising from within are named 'Tuo Ying' (Depletion of Camp/Nutritive Qi). (This is due to the humiliation of the spirit. Having been noble and glorious, then becoming low and humiliated, the heart harbors attachment and envy, the will knots with worry and fear. Thus, although not struck by external pathogens, disease arises internally, blood vessels become deficient and reduced, hence called 'Tuo Ying'.) Once wealthy and later poor is named 'Shi Jing' (Loss of Essence), where the qi of the five zang organs lingers and connects, and diseases combine. (Being wealthy allowed following desires; poverty strips away abundance. Internally, knots form with worry and torment; externally, grief exceeds what things warrant. Thus, the mind follows longing, the spirit calculates past events. The pathways of Ying and Wei (Nutritive and Defensive Qi) close and linger slowly, blood and qi do not circulate, accumulating and combining to cause disease.) When physicians diagnose this, it is not in the zang-fu organs, nor does the body shape change. Diagnosis raises doubts, and the disease name is unknown. (This refers to the early stage of disease. Since the disease originates from longing, it has not yet settled in the zang-fu; since the event arises from emotional thoughts, the physical form remains unchanged. Physicians do not fully understand this, hence they doubt during diagnosis.) The body decreases day by day, qi becomes deficient without essence. (This refers to the intermediate stage. Blood and qi press against each other, flesh and muscles emaciate, so the body diminishes daily. As stated in the *Yin Yang Ying Xiang Da Lun*: 'Qi returns to essence, essence feeds on qi.' Now, because qi is deficient and cannot transform, essence has no nourishment.) The disease goes deep, qi is exhausted, and the patient feels chilly and startled occasionally. (This refers to the deep stage. Disease qi is deep, grain qi is exhausted, yang qi presses inward, causing aversion to cold and fright. 'Sa Sa' describes a cold sensation.) Deep disease occurs because the exterior consumes Wei Qi, and the interior deprives Ying Qi. (Note: This continues the previous discussion, inferring the root cause of deepening disease. Qi deficiency and lack of essence represent internal deprivation; feeling chilly and startled represents external consumption. Internal deprivation and external consumption are why the disease deepens.) If skilled physicians err, it is due to not knowing the condition of the disease; this is also one error in treatment. ('Error' refers to failing to inquire about the origin of the disease.) Whenever intending to diagnose disease, one must ask about diet and living conditions. (Note: Diet varies in quantity and preference; living conditions vary by day/night and activity/rest.) Sudden joy or sudden sorrow, starting with joy and ending with sorrow... All these damage the essential qi. When essential qi is exhausted and cut off, the physical form is ruined and collapsed. Violent anger damages yin, violent joy damages yang. (Note: Damaging yin refers to anger injuring liver blood; damaging yang refers to joy scattering heart qi. The commentary's explanation via reversal seems insufficient.) Jue (rebellious) qi moves upward, filling the vessels and separating from the form. (Jue means rebellious qi. Rebellious qi moves upward, filling the meridians, causing spiritual energy to scatter and leave the body. Note: These four lines on violent anger and joy are exquisitely meaningful, but already appear in the *Yin Yang Ying Xiang Da Lun*.) Ignorant physicians treating this do not know tonification and sedation... Essence and brilliance are daily depleted, and pathogenic qi combines. This is the second error in treatment. (Note: Where pathogenic qi is excess, sedation should precede tonification; where healthy qi is deficient, tonification should precede sedation. Sedating when tonification is needed, or tonifying when sedation is needed, causes healthy qi to become more deficient and pathogenic qi to become more excessive.) Those skilled in pulse diagnosis must use analogy and the method of the extraordinary (Qi Heng), calmly understanding the condition. If a physician does not understand this Dao, their practice is not worthy of respect; this is the third error in treatment. ('Qi Heng' refers to signs that are extraordinary compared to the constant norm. 'Cong Rong' refers to distinguishing the deficiency and excess of zang qi, where pulses appear similar in height and position. Note: 'Dao' here refers to the methods of analogy and calm discernment.') Diagnosis involves examining three constants, necessarily asking about nobility and baseness, such as fallen lords or those aspiring to be marquises and kings. (Nobles have comfortable bodies and happy minds; commoners have arduous bodies and distressed minds. Since hardship and comfort differ greatly, inquiry should come first. Fallen lords refer to demoted rulers becoming ministers. Aspirants to nobility refer to those coveting high status and acting recklessly.) Thus, when nobles lose power, although not struck by pathogens, spiritual injury occurs internally, and the body must perish. When starting rich and ending poor, although not injured by pathogens, skin becomes dry and tendons contract, leading to flaccidity and spasms. (Note: The wealthy and noble have bright spirits; the poor and lowly have inferior ambitions. Whether one is sick or healthy is distinguished here.) If physicians cannot be strict, cannot move the spirit, and appear outwardly weak and compliant, disrupting normal order, and the disease cannot be moved... this is the fourth error in treatment. ('Strict' means admonishing to forbid improper acts; 'Move' means to make them obey. Outward compliance means yielding and following. Yet if admonition fails to forbid impropriety, and moving fails to ensure obedience, yielding to circumstances leads to chaos and loss of natural order. If the disease does not improve, what kind of physician is this?) Any diagnostician must know the beginning and end... Pulse palpation and asking for the name must accord with male and female differences. ('Beginning and End' refers to complexion. The *Mai Yao Jing Wei Lun* states: 'Knowing the exterior begins with the end and returns to the start.' Clearly knowing the five qi and color images, ending and restarting. 'Qie' means pressing the pulse with fingers. 'Asking for the name' means asking for the name of the syndrome. Men have more yang qi, so a large left pulse is favorable; women have more yin qi, so a large right pulse is favorable. Hence, this should be checked first as a norm.) Separation, severance, stagnation, knotting, worry, fear, anger, and joy lead to emptiness of the five zang organs and separation of blood and qi from their guardianship. If physicians do not understand this, what talk of technique is there... Merely predicting the day of death also makes one a crude physician; this is the fifth error in treatment. ('Separation' refers to alienating loved ones; 'Severance' refers to cutting off cherished hopes; 'Stagnation' refers to accumulated overthinking; 'Knotting' refers to fixed resentment. Alienating loved ones causes the soul to wander; severing hopes causes the intent to be lost; accumulating worries exhausts the spirit; fixing resentment distresses the will. Worry causes blockage; fear causes instability and loss of control; intense anger causes confusion and lack of regulation; joy causes dispersion and inability to store. Due to these eight factors, the five zang organs become empty, and blood and qi separate from their posts. If physicians do not ponder and understand, what can they say? Note: The value of a physician lies in assessing pulses, differentiating syndromes, and saving lives from death. If remedial techniques are entirely absent, and only the day of death is predicted, even if accurate later, it is not worthy of respect.) All these five arise from unmastered skills and ignorance of human affairs.
Therefore it is said: The sage treating disease must know heaven and earth, yin and yang, the regulations of the four seasons, the five zang and six fu organs, their yin-yang and exterior-interior relationships, the indications for acupuncture, moxibustion, stone needles, and drugs. Following human affairs, clarifying the Dao of the meridians, recognizing that nobility and poverty, wealth and destitution have different pathological principles, inquiring into the principles of youth, age, courage, and timidity, examining the divisions, knowing the root and origin of the disease, referencing the Eight Rectitudes and Nine Pulses, diagnosis will be perfectly aligned. (...Such is the comprehensive knowledge of the sage; physicians should strive for this.)