马云。疏。陈也。内有五过。故名篇。吴云。篇内。论延医五过。为工者。宜疏远之。因以名篇。简按
楚辞九歌。疏石兰兮为芳。注。疏。布陈也。马盖本于此。
闵闵乎 吴云。玄远莫测之貌。高云。闵闵。忧之至也。帝叹道之远大幽深。而圣人之术。循经守
数。事有五过四德。医工不可不知。故语雷公。以发明之。
论裁志意 吴云。论裁人之志意。必有法则。张云。裁。度也。志云。当先度其志意之得失。
医事 周礼医师职云。医师。掌医之政令。聚毒药以共医事。
脱营 卫生宝鉴。论脱营不治证。当参考。陈氏外科正
宗云。失荣者。先得后失。始富终贫。亦有虽居富贵。其心或因六欲不遂。损伤中气。郁火相凝。隧痰失道。
停结而成。其患多生面项之间。初起微肿。皮色不变。日久渐大。坚硬如石。推之不移。按之不动。半载一年。
方生阴痛。气血渐衰。形容瘦削。破烂紫斑。渗流血水。或肿泛如莲。秽气熏蒸。昼夜不歇。平生疙瘩。愈久
愈大。越溃越坚。犯此俱为不治。此乃脱营之一证也。
五气留连 马云。五气者。五脏之精气也。
洒酒然 熊音。苏浪反。寒貌。
此亦治之一过也 简按据下文例。亦字衍。
毁沮 张云。沮。将鱼切。坏也。高云。沮。音殂。义通。毁沮。犹死亡也。
厥气上行满脉去形 张云。厥气。逆气也。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。阴阳应象大论。有此四句。
必以比类奇恒 吴云。谓比量类例于奇异。及庸常之证也。高云。奇。异也。恒。常也。异于恒常之
病。必比类相参。从容知之。
三常 张云。即常贵贱。常贫富。常苦乐之义。
封君败伤 吴云。谓尝封君。为事毁败。而中伤者。简按封君。乃封国之君。败伤。谓削除之类。追
悔已往。以致病也。
故贵脱势 吴云。故家贵族也。高云。故。犹昔也。故贵脱势。谓昔者身贵。今则脱势也。马义同。
不能动神 吴云。医不能严戒其非。竦动其神。而令从命。外为柔和萎弱。至于乱失天常。
必知终始 吴云。终始。谓今病及初病也。张云。谓原
其始。要其终也。高云。必知经脉之终始。
有知余绪 吴云。谓有知之后。诸凡余事也。张云。谓察其本知其末也。志云。谓更知灸刺补泻之绪
端。高云。余绪者。经脉虚实之病也。简按今从张注。
当合男女 吴云。谓男女气血不同。其脉与证。亦当符合也。张云。男女有阴阳之殊。脉色有逆顺之
别。故必辨男女。而察其所合也。志云。谓针刺之要。男内女外。坚拒勿出。谨守勿内。是谓得气。高云。当
合男女而并论之。男女者。阴阳血气也。应象大论云。阴阳者。血气之男女。此其义也。简按合字。义未稳妥。
姑仍王注。
离绝菀结 高云。或阴阳血气之离绝。或阴阳血气之郁结。简按此注似是。然与下文血气离守支矣。
不如旧注为得。
尝富大伤 张云。谓甚劳甚苦也。高云。如人尝富。一旦失之。则大伤其神魂。
故伤败结留薄归阳脓积寒炅 张云。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。
从容人事 张云。从容于人事。从容。周详也。
经道 吴云。常道也。张同。高云。明经脉之道也。简按高注非。
诊必副矣 吴云。副。全也。张云。副。称也。简按张本于广雅。
气内为宝 张云。气内者。气之在内者也。即元气也。凡治病。当先求元气之强弱。元气既明。大意见矣。
过在表里 张云。求元气之病。而无所得。然后察其过之在表在里以治之。
菀熟 马吴张并作菀热。简按大奇论。菀熟。亦误。
痈发六腑 志云。在内者。五脏为阴。六腑为阳。谓菀热在内。而痈发于在外之皮肉间也。
与经相明 吴云。经。谓经旨。圣道之所载也。张云。即下文上经下经之谓。上经下经。揆度奇恒。
义见病能论。
五中 吴云。五内也。
决以明堂审于终始 马云。明堂部位之义。详见灵枢五色等篇。张云明堂。面鼻部位也。终始。灵枢
篇名也。吴云。决。取正也。明堂。王者朝诸侯布政之所。人身腔之中。有天君主于其内。十二官分司守职。
与王者向明布政之堂。居然无两。故谓明堂。终始。谓始病及今病也。志云。脏腑经脉之始。三阴三阳已绝之
终。高云。经脉终始。简按张终始之解。吴明堂之释。并误。马云。按帝言五过四德。而今四德不具。亦公不
复问。故帝未之答欤。马说如此。四德未详何义。而吴以治病之道。气内为宝以下。为一德。守数据治以下。
为二德。诊病不审以下。为三德。上经下经以下。为四德。而张则以必知天地一节。为一德。五脏六腑雌雄一
节。为二德。从容人事一节。为三德。审于部分一节。为四德。志高则并不言及。盖以经文不明显。其义难寻也。
马云说：“疏”，意思是陈列、陈述。文中论述了五种过失，所以篇名叫做《疏五过论》。吴崑说：本篇论述了就医过程中的五种过失，作为医生应当疏远并避免这些错误，因此以“疏”命名此篇。简按：《楚辞·九歌》中有“疏石兰兮为芳”一句，注解说：“疏，布陈也。”马云的解释大概源于此。
闵闵乎：吴崑说：玄远莫测的样子。高世栻说：“闵闵”，是忧愁至极的样子。黄帝感叹医道远大幽深，而圣人的医术遵循经络和法度，行事有五种过失和四种德行，医生不可不知道，所以告诫雷公，以此来阐明其中的道理。
论裁志意：吴崑说：论述裁断病人的意志心意，必须有法则。张景岳说：“裁”，是度量的意思。张志聪说：应当先度量病人意志心意的得失。
医事：《周礼·医师职》说：医师掌管医疗政令，聚集毒药以供医疗使用。
脱营：《卫生宝鉴》论述脱营不治之证，当参考。陈实功《外科正宗》说：失荣症，是先富后贫，开始富贵最终贫穷；也有虽然身处富贵，但内心因为六欲不遂，损伤中气，郁火凝结，痰浊阻塞通道，停留结聚而成。这种病多生于面项之间，初起微肿，皮色不变，日久逐渐变大，坚硬如石，推之不移，按之不动。半年一年之后，才产生阴痛，气血逐渐衰弱，形体消瘦，皮肤破烂出现紫斑，渗出流血水，或者肿胀泛发如莲花状，秽气熏蒸，昼夜不停。平生疙瘩，越久越大，越溃破越坚硬。患此病都属于不治之症。这是脱营的一种证候。
洒淅然：熊宗立注音：苏浪反，寒冷貌。
这也是治疗中的一种过失：简按根据下文体例，“亦”字为衍文。
毁沮：张景岳说：“沮”，音将鱼切，毁坏的意思。高世栻说：“沮”，音殂，意义相通。“毁沮”，犹言死亡。
厥气上行满脉去形：张景岳说：厥气，即逆气。凡是喜怒过度而损伤精气的人，都能导致气厥逆而上行。气逆于脉中，所以脉满；精气脱失于体内，所以身形离去（神形分离）。《阴阳应象大论》中有这四句话。
必须运用比类和奇恒之法：吴崑说：意为比较衡量奇异与平常的病例。高世栻说：“奇”，是异常；“恒”，是平常。不同于平常的疾病，必须通过类比参照，从容地加以认识。
封君败伤：吴崑说：指曾经被封为君侯的人，因事情败坏而内心受伤。简按：“封君”是指受封国的君主，“败伤”指被削除爵位之类，追悔过往而导致生病。
故贵脱势：吴崑说：“故家贵族”。高世栻说：“故”，通“昔”，指过去。“故贵脱势”指过去身份尊贵，现在则失去了权势。马云的观点相同。
不能动神：吴崑说：医生不能严厉戒止病人的错误，使其精神受到震动而听从医嘱，外表表现为柔和萎弱，以至于扰乱丧失自然常理。
必须知晓疾病的终始：吴崑说：“终始”，指现在的病症和最初的病症。张景岳说：指推究其起始，考察其结局。高世栻说：必须知晓经脉的终始。
有知余绪：吴崑说：指在有所认知之后，对于其他杂事也能知晓。张景岳说：指察知根本从而知晓末节。张志聪说：指进一步知晓针灸补泻的头绪。高世栻说：“余绪”指经脉虚实相关的疾病。简按：现在采纳张景岳的注释。
应当结合男女情况：吴崑说：指男女气血不同，其脉象与证候，也应当符合相应特点。张景岳说：男女有阴阳的区别，脉色有逆顺的不同，所以必须辨别男女，并察知其相合之处。张志聪说：针刺的要领，男内女外，坚固拒勿出，谨慎守勿内，这叫做得气。高世栻说：应当结合男女一起讨论。男女代表阴阳血气。《阴阳应象大论》说：阴阳是血气的男女属性。这就是其中的含义。简按：“合”字的含义尚不稳妥，暂且保留王冰的注释。
离绝菀结：高世栻说：或者是阴阳血气的离绝，或者是阴阳血气的郁结。简按：这个注释似乎合理，但与下文“血气离守支矣”不符，不如旧注恰当。
尝富大伤：张景岳说：指极度劳苦。高世栻说：比如人曾经富有，一旦失去，就会大大伤害其神魂。
故伤败结留薄归阳脓积寒炅：张景岳说：“故”，通“旧”。指旧有的损伤，有所败坏结聚，血气停留迫近不散，于是郁结化热，归于阳分，所以脓血蓄积，使人寒热交替发作。
从容人事：张景岳说：从容对待人事，“从容”意为周详。
经道：吴崑说：常道。张景岳同。高世栻说：阐明经脉的道理。简按：高注不对。
诊必副矣：吴崑说：“副”，全备的意思。张景岳说：“副”，称合的意思。简按：张氏本于《广雅》。
气内为宝：张景岳说：“气内”，指内在的气，即元气。凡治病，应当先探求元气的强弱。元气状况明确后，大的治疗原则也就清楚了。
过在表里：张景岳说：探求元气的病变而无所得时，然后察知过失在于表还是在里，以此进行治疗。
菀熟：马云、吴崑、张景岳都写作“菀热”。简按：《大奇论》中的“菀熟”也是误字。
痈发六腑：张志聪说：在内者，五脏属阴，六腑属阳。指郁热在内，而痈疽发于外在的皮肉之间。
与经相明：吴崑说：“经”，指经旨，圣道所记载的内容。张景岳说：即下文的《上经》《下经》。《上经》《下经》涉及揆度和奇恒，义理见《病能论》。
五中：吴崑说：五内。
决以明堂审于终始：马云说：“明堂”部位的意义，详见《灵枢·五色》等篇。张景岳说：“明堂”，指面鼻部位。“终始”，是《灵枢》的一篇篇名。吴崑说：“决”，取正之意。“明堂”，是王者朝见诸侯布行政教之所。人身腔体之中，有天君主导于内，十二官分司职守，与王者向明布政之堂，竟然没有两样，所以称为明堂。“终始”，指发病之初和现在的病症。张志聪说：脏腑经脉的开始，三阴三阳已绝的终结。高世栻说：经脉的终始。简按：张景岳对“终始”的解释、吴崑对“明堂”的解释，都是错误的。马云认为：黄帝谈论五过四德，而现在四德不完整，也是雷公不再提问，所以黄帝没有回答吗？马云的说法如此。“四德”的具体含义不详。吴崑将“治病之道，气内为宝”以下作为一德，“守数据治”以下作为二德，“诊病不审”以下作为三德，“上经下经”以下作为四德。张景岳则将“必知天地”一节作为一德，“五脏六腑雌雄”一节作为二德，“从容人事”一节作为三德，“审于部分”一节作为四德。张志聪则根本不提及此事，大概是因为经文不明显，其含义难以寻找。
Ma Yun stated: "Shu" (to arrange and state) means to set forth. Since the text discusses five errors, it is named "Treatise on the Five Errors in Diagnosis and Treatment". Wu Kun commented: This chapter discusses five errors in seeking medical help; physicians should avoid these pitfalls, hence the title. Jian An noted: In *Chu Ci · Nine Songs*, the line "Shu Shi Lan Xi Wei Fang" (Arranging stone orchids to create fragrance) is annotated as: "Shu means to spread and arrange." Ma's interpretation likely derives from this.
"Minyinhu": Wu Kun described it as a profound and unfathomable appearance. Gao Shishi explained that "Minyin" signifies extreme sorrow. The Emperor lamented the vastness and profundity of the medical Dao, noting that the techniques of sages follow meridians and numerical laws, involving five errors and four virtues. Physicians must understand these, so he instructed Leigong to elucidate them.
On Judging Will and Intent: Wu Kun stated that judging a patient's will and intent requires specific principles. Zhang Jingyue defined "Cai" (judge/cut) as measuring or assessing. Zhang Zhicong added that one must first assess the gains and losses in the patient's mental state.
Medical Affairs: According to the *Rites of Zhou · Office of Physicians*, the Physician-in-Chief manages medical regulations and gathers toxic substances for medical use.
Tuo Ying (Depletion of Essence): The *Health Treasure Mirror* discusses untreatable cases of Tuo Ying. Chen Shigong's *Orthodox Manual of External Surgery* describes "Shi Rong" (Loss of Glory), which typically affects those who were once wealthy but became poor, or those in high status whose desires are unfulfilled, damaging middle Qi, causing stagnant fire and phlegm obstruction. It often appears on the face and neck, starting as slight swelling with unchanged skin color, eventually becoming hard as stone, immobile, and painful after months or years. As Qi and blood decline, the body emaciates, skin ulcerates with purple spots bleeding fluid, or swells like a lotus with foul odor. These are considered untreatable and represent a form of Tuo Ying.
Wu Qi Liulian (Five Qi Lingering): Ma Yun explained that "Wu Qi" refers to the essential Qi of the five Zang organs.
Saxiran (Chilling): Xiong Zongli provided the pronunciation "Su Lang fan," describing a sensation of cold.
This is also one of the treatment errors: Jian An noted that based on the context, the character "Yi" (also) is likely an interpolation.
Hui Ju (Destruction and Ruin): Zhang Jingyue defined "Ju" as destruction. Gao Shishi noted the pronunciation matches "Zu" and the meaning is consistent. "Hui Ju" implies death or ruin.
Jue Qi Shangxing Man Mai Qu Xing (Rebellious Qi Ascends, Filling Pulses, Departing Form): Zhang Jingyue explained that "Jue Qi" is rebellious Qi. Excessive anger or joy damages essence, causing Qi to rebel and ascend. When Qi rebels in the vessels, they become full; when essence depletes internally, the spirit departs from the form. These four phrases appear in the *Treatise on Yin-Yang and Correspondences*.
One must employ Analogy and Extraordinary Methods: Wu Kun stated this means comparing extraordinary cases with ordinary ones. Gao Shishi clarified that "Qi" means abnormal and "Heng" means normal. Diseases differing from the norm require comparative analysis for accurate understanding.
San Chang (Three Constants): Zhang Jingyue identified these as the constants of nobility/lowliness, wealth/poverty, and suffering/happiness.
Feng Jun Bai Shang (Fall of the Enfeoffed Lord): Wu Kun referred to former lords injured by political failure. Jian An clarified that "Feng Jun" refers to feudal lords, and "Bai Shang" refers to loss of rank or position, leading to illness through regret.
Gu Tui Tuo Shi (Former Nobility Losing Power): Wu Kun defined "Gu Jia" as former noble families. Gao Shishi explained "Gu" as "former." Thus, "Gu Tui Tuo Shi" means losing power after previously holding high status. Ma Yun agreed.
Unable to Move the Spirit: Wu Kun stated that if a physician fails to strictly correct errors and stir the patient's spirit to obedience, the patient may appear compliant externally but internally disrupt natural order.
Must Know Beginning and End: Wu Kun defined "Zhong Shi" as current and initial conditions. Zhang Jingyue said it means tracing the origin and examining the outcome. Gao Shishi emphasized knowing the beginning and end of meridians.
Knowing the Remaining Threads: Wu Kun meant understanding subsequent details after grasping the main point. Zhang Jingyue interpreted it as knowing the root to understand the branches. Zhang Zhicong referred to understanding acupuncture tonification and sedation techniques. Gao Shishi linked it to excess and deficiency in meridians. Jian An adopted Zhang Jingyue's view.
Must Combine Male and Female Factors: Wu Kun noted differences in Qi and blood between genders affect pulse and symptoms. Zhang Jingyue highlighted yin-yang distinctions and pulse reversals requiring gender-specific assessment. Zhang Zhicong mentioned acupuncture techniques regarding male/female internal/external approaches. Gao Shishi connected this to yin-yang and blood/qi dynamics, citing the *Treatise on Yin-Yang and Correspondences*. Jian An found the term "He" (combine) ambiguous and retained Wang Bing's annotation.
Li Jue Wan Jie (Separation, Severance, Stagnation, Knotting): Gao Shishi suggested this refers to separation or stagnation of yin-yang and blood/qi. Jian An found this plausible but inconsistent with later text, preferring older annotations.
Chang Fu Da Shang (Great Injury After Former Wealth): Zhang Jingyue attributed this to extreme labor and hardship. Gao Shishi illustrated it as the psychological trauma of losing wealth.
Old Injuries, Destruction, Accumulation, Thinness, Returning to Yang, Pus Accumulation, Cold and Heat: Zhang Jingyue explained "Gu" as old. Old injuries lead to destruction and accumulation where Qi and blood stagnate, generating heat returning to the Yang aspect, causing pus/blood accumulation and alternating chills and fever.
Congrong Renshi (Consider Human Circumstances): Zhang Jingyue defined "Congrong" as being thorough and considerate regarding human affairs.
Jing Dao (The Way of Classics): Wu Kun and Zhang Jingyue defined it as the constant way. Gao Shishi claimed it referred to meridians, but Jian An disagreed.
Diagnosis Must Be Accurate: Wu Kun defined "Fu" as complete. Zhang Jingyue, citing *Guangya*, defined it as matching or corresponding.
Internal Qi is Precious: Zhang Jingyue identified "Qi Nei" as Yuan Qi (Original Qi). Treating disease requires assessing Yuan Qi strength first; once clear, the general principle emerges.
Error in Exterior or Interior: Zhang Jingyue advised that if Yuan Qi pathology is unclear, determine if the error lies in the exterior or interior to guide treatment.
Wen Re (Stagnant Heat): Ma, Wu, and Zhang wrote "Wen Re." Jian An noted *Da Qi Lun* also has this error.
Abscess Erupts in Six Fu Organs: Zhang Zhicong explained that while Zang are Yin and Fu are Yang, internal stagnation-heat can manifest as abscesses in the external flesh/skin associated with Fu organs.
Clarified by the Classics: Wu Kun referred to "Jing" as canonical teachings. Zhang Jingyue linked it to the *Upper Classic* and *Lower Classic*, referencing *Bing Neng Lun* for concepts of measurement and extraordinariness.
Wu Zhong (Five Interiors): Wu Kun equated this with "Wu Nei" (Five Viscera).
Decide Using Mingtang and Examine Beginning and End: Ma Yun referenced *Ling Shu · Se Color* for "Mingtang" (Bright Hall/Face). Zhang Jingyue defined "Mingtang" as the nose/face area and "Zhong Shi" as a chapter title. Wu Kun defined "Jue" as determining correctness and "Mingtang" metaphorically as the emperor's hall within the body governed by Heaven. Zhang Zhicong defined "Zhong Shi" as the start of organs/meridians and the end of San Yin/San Yang exhaustion. Gao Shishi focused on meridian beginnings and ends. Jian An criticized Zhang and Wu's interpretations. Ma Yun speculated that the Emperor omitted discussing the "Four Virtues" because Leigong stopped asking. Wu Kun listed four virtues: 1. Prioritizing Yuan Qi; 2. Following data/rules; 3. Careful diagnosis; 4. Mastery of classics. Zhang Jingyey listed: 1. Understanding Heaven/Earth; 2. Zang-Fu correspondence; 3. Considering human circumstances; 4. Examining anatomical parts. Zhang Zhicong ignored the concept due to textual ambiguity.