四失谓精神不专。志意不理。上章论不得病者之情。此章论医者失神志之专一。故曰疏者。谓疏得五中之情。征者
惩创医之四失。
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。雷公对曰。循经
受业。皆言十全。其时有过失者。请闻其事解也。（谓持诊之道。谨守神志。始得其情。无有过失。方为十全。）帝曰。
子年少。智未及耶。将言以杂合耶。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。所以不十全者。
精神不专。志意不理。外内相失。故时疑殆。（杂合、言不专一也。持诊者当守其精神。调其志意。内得于心。而外应于
手。如失此精神志意。故时殆而不能十全。）诊不知阴阳逆从之理。此治之一失也。（阴阳之理。有顺有逆。诊者不知。
治之失也。）受师不卒。妄作杂术。谬言为道。更名自功。妄用砭石。为遗身咎。此治之二失也。（此言针砭之道。必得
师传。忌务杂术。若自诩功能。必遗身咎。）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。（用针之道。当适人贫富贵贱之所居。则知形志之苦乐矣。薄浓。谓
肌
肉之浓薄。针经曰。肌肉瘦者。易于脱气。易损于血。刺此者。浅而疾之。年质壮大。血气充盈。皮革坚固。因加以邪。
刺此者。深而留之。膏者其肉淖。而粗理者身寒。细理者身热。脂者其肉坚。细理者热。粗理者寒。此形之寒温也。又
曰。已饱勿刺。已刺勿饱。已饥勿刺。已刺勿饥。已渴勿刺。已刺勿渴。已醉勿刺。已刺勿醉。故当适饮食之所宜。勇
者谓壮士。真骨坚肉缓节。监监然。刺此者深而留之。多益其数。怯者谓婴儿。其肉脆。血少气弱。刺此者。以毫针浅
刺而疾发。日再可也。比类者。比类天地阴阳日月星辰之道。不明此道。足以自乱。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。不失言此。卒持寸口。何病能中。妄言作名。为粗所穷。此治之四失也。（持诊
之道。不得人之志意苦乐。饮食起居。或名伤于五气五味之毒。不审问而失言此数者。卒持寸口。何病能中。妄言作名
医。反为粗工所穷。此治之四失也。）是以世人之语者。驰千里之外。不明尺寸之论。诊无人事。治数之道。从容之葆。
（言世人多夸大其语。而不明寸尺之微。失寸尺之毫厘。而有千里之谬。盖人之日用事物。饮食起居。莫不有理。如失
其和平。皆能为病。诊无人事之审。是忽近而图远也。葆、宝同。言治诊之道。惟天理人事之为葆也。）持其寸口。诊不
中五脉。百病所起。始以自怨。遗师其咎。是故治不能循理。弃术于市。妄治时愈。愚心自得。（上节言不审察病者之情。
此言不明五脉百病之诊。此皆受师不卒。更自为功。精神不转。志意不理。如弃术于市。招众人之所怨恶也。设妄治之。
而或有时愈。庸愚之心。以为自得。此亦行险以侥幸耳。岂真学问之功哉。）呜呼。窈窈冥冥。孰知其道。道之大者。拟
于天地。配于四海。汝不知道之谕受。以明为晦。（此复结真道之合于天道也。窈窈冥冥。天之道也。复叹其延医之道。
若视深渊。若迎浮云。视深渊。尚可测。迎浮云。莫知其极。言道大之难明也。四海、谓地居水之中。天运于地之外。
夫天有日月星辰之晦明。人有昼夜出入之血气。如不受师之传谕。不明道之体原。是以天道之明而为晦矣。）
四失是指：精神不专注，意志不条理。上一章论述了那些不得病的人的情况，这一章论述医生在神志专一方面的失误，所以称为“疏”，意思是疏忽了五脏内部的实情。“征”的意思是惩戒并警示医生的四种失误。
黄帝在明堂，雷公侍坐在一旁。黄帝说：“先生所通晓的书籍和接受的医事很多，试着谈谈诊疗中的得失之意，即为什么成功，又为什么失败。”雷公回答说：“遵循经脉接受学业时，都说能取得十全的效果，但现实中有时会出现过失，请问这是什么原因造成的？”（意思是：掌握诊察之道，必须谨慎守护神志，才能了解病情，没有过失，这才算是十全。）黄帝说：“是你年纪轻，智慧还没达到吗？还是因为你的言论杂乱无章呢？人体的经脉有十二条，络脉有三百六十五条，这些都是人们所熟知的，也是医生所遵循使用的。之所以不能做到十全十美，是因为精神不专注，意志不条理，内外失调，所以时常产生疑惑和危险。”（杂乱无章，指不专一。持诊者应当守住自己的精神，调理自己的意志，内心领悟于己，外部反应于手，如果失去了这种精神和意志，所以时常危险而不能十全。）
诊察时不了解阴阳顺逆的道理，这是治疗上的第一种失误。（阴阳的道理，有顺行有逆行，诊察者如果不了解，就是治疗的失误。）师承学业没有完成，就胡乱采用杂乱的医术，谬误地称之为大道，改名换姓以自夸功效，妄用砭石，给自己留下祸患，这是治疗上的第二种失误。（这里说的是针砭之道，必须得到老师的真传，忌讳追求杂术，如果自夸功能，必然给自己留下祸患。）不根据病人贫富贵贱的生活环境来调整，不考虑肌肉的厚薄、体形的寒温，不适宜饮食的选择，不区分病人的勇敢与怯懦，不知道运用比类推理的方法，足以使自己混乱，不足以让自己明白，这是治疗上的第三种失误。（使用针法之道，应当适合人的贫富贵贱所处的环境，从而知道形志的苦乐。厚薄，指的是肌肉的浓薄。《针经》说：肌肉消瘦的人，容易脱气，容易损伤血液。针刺这样的人，要浅刺且快出。年壮质强的人，血气充盈，皮肤坚固，再加上邪气侵袭，针刺这样的人，要深刺且留针。膏型的人肌肉柔润，纹理粗的怕冷，纹理细的怕热；脂型的人肌肉坚实，纹理细的怕热，纹理粗的怕冷，这就是体形的寒温。又说：已经吃饱不要针刺，已经针刺过不要马上吃饱，已经饥饿不要针刺，已经针刺过不要马上饥饿，已经口渴不要针刺，已经针刺过不要马上解渴，已经醉酒不要针刺，已经针刺过不要马上醉酒。所以应当适应饮食的适宜情况。勇敢的人指壮士，骨骼真实坚硬，肌肉松弛而关节舒缓，神态威严。针刺这样的人要深刺且留针，增加针刺次数。怯懦的人指婴儿，他们肉脆，血少气弱。针刺这样的人，用毫针浅刺且快出，一天可以两次。比类，是指类比天地阴阳日月星辰的道理，不明白这个道理，足以使自己混乱，这是治疗上的第三种失误。）
诊病时不问起病的起因，如忧患、饮食失节、起居过度，或者中毒，如果不陈述这些情况，突然切按寸口脉，怎么能诊断准确？胡乱编造病名，被粗陋的医生所困窘，这是治疗上的第四种失误。（掌握诊察之道，不了解病人的意志苦乐、饮食起居，或者因五气五味之毒而受伤，不仔细询问而忽略这些情况，突然切按寸口脉，怎么能诊断准确？胡乱自称名医，反而被粗工所困窘，这是治疗上的第四种失误。）
因此世人的言语，往往夸张到千里之外，却不明白尺寸微妙的理论，诊察不顾及人事，治疗缺乏从容的态度和宝贵的原则。（意思是世人多夸大其词，而不明白寸尺的细微之处，失之毫厘而有千里之谬。大概人们日常的事物，饮食起居，无不有理，如果失去和平，都能成为疾病。诊察如果不审问人事，就是忽视近处而图谋远处。葆，同宝。意思是诊治之道，只有天理人事才是宝贵的。）切按寸口脉，诊察不符合五脉的变化，百病产生的根源，开始是自己怨恨，后来遗留给老师过错。所以治疗不能遵循道理，把医术抛弃在街头，胡乱治疗有时痊愈，愚昧的心自以为得意。（上一节说不审察病人的情况，这一节说不明白五脉百病的诊察，这都是师承学业未完成，自己另立功劳，精神不转，意志不条理，如同把医术抛弃在街头，招致众人的怨恨厌恶。假设胡乱治疗，而有时痊愈，庸俗愚昧的心，以为是自己得意的成果，这也是冒险侥幸罢了，难道是真正的学问功夫吗？）
唉，深远幽暗，谁知道其中的道理？道的宏大者，比拟于天地，配合于四海。你不理解道的教诲，把明白当作昏暗。（这里再次总结真道符合天道。窈窈冥冥，是天道的样子。又感叹求医之道，好像看深渊，好像迎浮云，看深渊还可以测量，迎浮云不知道它的尽头，说道之大难以明白。四海，指地居水中，天运行在地之外。天有日月星辰的晦明，人有昼夜出入的血气，如果不接受老师的传授教诲，不明白道的本体源头，就把天道的明亮变成了昏暗。）
The "Four Errors" refer to: the spirit is not focused, and the will is not orderly. The previous chapter discussed the condition of those who do not fall ill; this chapter discusses the errors of physicians in maintaining the unity of their spirit and will, hence it is called "Shu" (Negligence), meaning negligence regarding the internal conditions of the five Zang organs. "Zheng" means to punish and warn against the four errors of physicians.
Yellow Emperor was in the Ming Hall, with Lei Gong attending by his side. Yellow Emperor said, "You have mastered numerous books and medical matters. Please discuss the principles of success and failure in diagnosis and treatment—why one succeeds and why one fails." Lei Gong replied, "When following the meridians and receiving instruction, it is always said that one can achieve perfect results (Ten Parts Complete). However, mistakes sometimes occur in practice. May I ask for an explanation?" (This means: To master the way of diagnosis, one must carefully guard one's spirit and will to truly understand the condition; only without error can it be considered perfect.) Yellow Emperor said, "Is it because you are young and your wisdom has not yet matured? Or is your discourse mixed and unfocused? The human body has twelve primary meridians and three hundred and sixty-five collaterals. These are well-known to people and followed by practitioners. The reason for not achieving perfection lies in the lack of focused spirit and unorganized will, leading to a disconnect between the interior and exterior, thus causing frequent doubt and danger." (Mixed and unfocused refers to a lack of concentration. In holding the pulse, one should maintain one's spirit and regulate one's will, comprehending internally and responding externally with the hands. If this spirit and will are lost, danger ensues, preventing perfection.)
Failing to understand the principles of Yin-Yang and their compliance or opposition during diagnosis is the first error in treatment. (The principles of Yin-Yang involve both compliance and opposition. If the diagnostician does not understand these, it constitutes an error in treatment.) Abandoning formal apprenticeship before completion and resorting to miscellaneous techniques, falsely claiming them as the Great Way, changing names to claim credit, and recklessly using Bian stones, thereby bringing blame upon oneself, is the second error in treatment. (This refers to the art of acupuncture and moxibustion/Bian therapy, which must be transmitted by a teacher. One should avoid eclectic methods. Boasting of one's own merits inevitably leads to self-inflicted harm.) Failing to adapt to the living conditions dictated by poverty, wealth, and status; ignoring the thickness of muscles and the cold-heat constitution of the body; failing to consider appropriate dietary choices; and not distinguishing between courageous and timid patients, while lacking the ability to use analogical reasoning, leads to self-confusion rather than clarity. This is the third error in treatment. (The method of needling should adapt to the patient's social status and environment to understand the suffering of form and spirit. 'Thickness' refers to the density of muscles. The *Classic of Acupuncture* states: Those with emaciated muscles easily lose Qi and are prone to blood damage; such patients require shallow and rapid insertion. Those who are young and robust, with abundant Qi and blood, firm skin, and exposed to pathogenic factors, require deep insertion with retention. Those with 'Gao' (fat) type bodies have soft muscles; those with coarse pores feel cold, while those with fine pores feel hot. Those with 'Zhi' (lean/firm) type bodies have firm muscles; those with fine pores feel hot, while those with coarse pores feel cold. This describes the cold-heat constitution. It also states: Do not needle immediately after eating; do not eat immediately after needling; do not needle when hungry; do not eat immediately after needling if hungry; do not needle when thirsty; do not drink immediately after needling if thirsty; do not needle when drunk; do not drink immediately after needling if drunk. Thus, one must adapt to dietary appropriateness. 'Courageous' refers to strong men with solid bones, relaxed muscles, and dignified demeanor; they require deep insertion with retention and increased frequency. 'Timid' refers to infants with fragile flesh, little blood, and weak Qi; they require shallow insertion with rapid withdrawal using fine needles, possibly twice daily. 'Analogical reasoning' involves comparing the principles of Heaven, Earth, Yin-Yang, sun, moon, stars, and planets. Failing to understand this leads to confusion, constituting the third error.)
Failing to inquire about the onset of the disease, such as emotional distress, dietary irregularities, excessive lifestyle habits, or toxic injuries, and neglecting to mention these factors, then abruptly palpating the Cun Kou pulse, makes accurate diagnosis impossible. Fabricating disease names arbitrarily and being confounded by crude practitioners is the fourth error in treatment. (Mastering diagnosis requires understanding the patient's mental state, diet, and lifestyle, or identifying injuries from the toxicity of the Five Qi and Five Flavors. Failing to inquire and neglect these aspects, then suddenly palpating the radial artery, prevents accurate diagnosis. Arbitrarily claiming to be a famous physician leads to being outdone by crude practitioners, constituting the fourth error.)
Therefore, worldly speech often exaggerates to distances of a thousand li, yet fails to understand the subtle theories of measurement (Cun/Cun). Diagnosis ignores human affairs, and treatment lacks the composure and preciousness of proper principles. (This means people tend to exaggerate, ignoring the minutiae of measurements, leading to errors of a thousand li due to slight inaccuracies. Daily activities like diet and起居 have their rational order; losing harmony causes disease. Ignoring human context in diagnosis is neglecting the near for the distant. 'Bao' is synonymous with 'Bao' (Treasure). It implies that the essence of diagnosis and treatment lies in Heavenly principles and human affairs.) Palpating the Cun Kou but failing to align with the variations of the Five Pulses, and misunderstanding the origins of myriad diseases, leads initially to self-reproach and later to blaming one's teacher. Thus, treatment that does not follow principles abandons the art to the marketplace; reckless treatment may occasionally succeed, leading the foolish mind to pride itself. (The previous section discussed failing to examine the patient's condition; this section discusses failing to understand the Five Pulses and the origins of diseases. Both stem from incomplete apprenticeship and self-aggrandizement, with scattered spirit and disordered will, akin to abandoning medicine in the street, inviting public scorn. Even if reckless treatment occasionally works, the ignorant consider it personal merit. This is merely gambling on luck, not true scholarly achievement.)
Alas, profound and obscure, who knows the Way? The great Way mirrors Heaven and Earth and corresponds to the Four Seas. You do not comprehend the teachings of the Way, treating clarity as obscurity. (This concludes that the true Way aligns with Heavenly Dao. 'Yao Yao Ming Ming' describes the nature of Heaven. It sighs that seeking medical help is like gazing into an abyss or chasing floating clouds; the abyss can be measured, but the clouds' limits are unknowable, illustrating the difficulty of grasping the vast Way. 'Four Seas' refers to the earth surrounded by water, with Heaven moving outside the earth. Just as Heaven has the brightness and darkness of celestial bodies, humans have the circulation of Qi and Blood through day and night. Without accepting the teacher's transmission and understanding the origin of the Way, one turns the brightness of Heavenly Dao into obscurity.)