上编帝云∶事有五过四德，汝知之乎？公曰不闻五过与四德。故上编疏五过，此篇征四失。盖德者，
行道而有德于心，今不知四德，是为四失，四失之征，所当谨也。
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。
夫，音扶。雷公不闻五过与四德。故帝曰∶夫子所通之书，所受
之事，众多矣。今犹有未闻，试自言得失之意，所以得之，所以失之者何在？
雷公对曰∶循经受业，皆言十全。其时有过失者，愿闻其事解也。
公不明四德，是为四失。故言通书受事，乃循经受业也。循经
受业，皆言十全。其中复有未闻，而时有过失者，愿请闻其事而解之也。
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。
《示从容论》云∶公何年之长而问之少。今日子年少，犹言子岂年少，而智未及耶？抑所得所失，子
将言之。得失并陈，以其杂合而难言耶！夫人身经脉十二，络脉三百六十五，此皆人之所明知，工之
所循用也。所以不能十全者，精神不专一，志意不治理，不能内得
于心，外应于手，外内相失，故时疑殆而未明。帝将语以四失而先为惩戒之。
诊不知阴阳逆从之理，此治之一失也。
试举四失而明言之，诊有阴阳逆从之理，医不知之，治之一失也。
受师不卒，妄作杂术，谬言为道，更名自动，妄用砭石，后遗身咎，此治之二失也。
更，平声。师传者道，自能者术。妄术为道，必遗身咎，治之二失也。
不适贫富贵贱之居，土之薄浓，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。
土，旧本讹坐，今改。别，音逼。贫与富，贵与贱，薄与浓，寒与
温，勇与怯，皆有比类之道。医不知此，自乱不明，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
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。
卒，音促。中，去声，下中同，凡饮食起居，忧患所伤，当未诊
先问。不先言此，而卒持寸口，妄言病名，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，坐持寸口，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。呜
乎！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。
葆，保同。叹世人不明大道之难知，所以惩创其心志也。世人之语，妄自夸张，是
驰骛于千里之外，而不明于尺寸之论。诊无人事，谓昧昧以诊，不知人之病情也。无治数之道，不知救治之法
也。无从容之葆，不知比类从容，而保全其身命也。坐，犹定也。持，即诊也。寸口之脉，一定诊之，虽诊
而不中五脏之脉，以及百病之所起，人孰无良，故始以自怨，咎有所归，故遗师其咎，是故治不能循理，犹
之弃术于市，妄行其志；病或时愈，而愚医之心，即自得也。呜呼！如是之医，深可叹也。精微之道，窈窈
冥冥，而工孰知其道，道之大者，高深可拟于天地，远大可配于四海。今汝不知道之谕受，是犹以明
为晦，汝其勉之。
黄帝在明堂，雷公侍坐。黄帝说：先生所通晓的医书和所经历的事务，非常多啊。试着谈谈其中得与失的道理。之所以得到正确诊断或治疗的原因，以及之所以出现失误的原因。
雷公回答说：我是沿着经脉理论学习医术的，大家都说能达到十全十美的境界。但现实中有时会出现过失，希望听听对这些情况的解释。
黄帝说：是你年纪轻，智慧还没达到吗？还是因为将各种杂乱的方法混合在一起，导致难以言说清楚呢？人体的十二经脉、三百六十五络脉，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，内外不相协调，所以时常产生疑惑和危险。
《示从容论》中说：“您为什么年长却问年少的问题。”这里说“你年纪小”，其实是说“难道你年纪小，智慧就达不到吗？”或者是指所得与所失混杂在一起，因为方法杂乱而难以说清。
第二失：跟随老师学习没有完成，就胡乱使用杂术，把谬误当作正道，随意更改名称和行动，滥用砭石疗法，从而给自己留下祸患，这是治疗上的第二个失误。
第三失：不适应患者贫富贵贱的生活环境，土地环境的厚薄（指地理气候差异），体质的寒温差异，不了解饮食适宜与否，不能分辨患者的勇敢与怯懦，不知道运用类比推理，足以让自己混乱，不足以让自己明白，这是治疗上的第三个失误。
第四失：诊病时不问疾病的起因，如忧患情绪、饮食失节、起居过度，或是否中毒等，不先询问这些情况，就仓促地切按寸口脉，怎么能准确判断疾病呢？胡乱编造病名，被粗疏的诊疗所困窘，这是治疗上的第四个失误。
因此，世人的言论往往夸张到千里之外，却不明白尺寸之间（细微之处）的道理。诊病缺乏对人事背景的了解，没有救治的法度，不知如何从容保全，只是坐着切按寸口脉，诊断不符合五脏脉象及百病起源，开始时自我怨恨，把过错推给老师，这是治疗者无法遵循医理，如同在市井中抛弃医术，胡乱治疗偶尔见效，愚昧的医者便自鸣得意。唉！医学之道深远幽微，谁能真正知晓它！大道的宏大，可与天地相比拟，与四海相配合。如果你不懂得以明示晦的道理，接受教导反而将其视为昏暗，那就太可惜了。
Huangdi was in the Mingtang (Hall of Enlightenment), with Leigong attending. Huangdi said: "The medical texts you have mastered and the clinical experiences you have encountered are numerous. Please discuss the principles of success and failure therein—the reasons for correct diagnosis and treatment, and the reasons for errors."
Leigong replied: "I studied medicine following the meridians, and it is often said that one can achieve perfect outcomes (ten out of ten). However, mistakes sometimes occur in practice. I wish to hear an explanation of these situations."
Huangdi said: "Is it because you are young and your wisdom has not yet matured? Or do you mix various disparate methods, making it difficult to articulate clearly? The twelve primary meridians and three hundred and sixty-five collaterals are well-known to everyone and are followed by practitioners. The reason why perfection is not always achieved is due to a lack of mental focus, disordered will, and a disconnect between internal state and external action, leading to frequent doubt and danger. As stated in the *Shi Congrong Lun* (Treatise on Demonstrating Composure): 'Why do you ask questions suitable for the young despite your seniority?' Here, saying 'you are young' implies asking if your youth prevents your wisdom from reaching the necessary level, or if the confusion arises from mixing successes and failures due to chaotic methods.
First Error: Failing to understand the principles of Yin-Yang and their compliance or opposition (Ni-Zhong) during diagnosis is the first error in treatment.
Second Error: Not completing one's apprenticeship under a master, then recklessly employing miscellaneous techniques, presenting fallacies as the Dao, arbitrarily changing names and actions, and misusing Bian stones (stone scalpels), thereby bringing blame upon oneself, is the second error in treatment.
Third Error: Failing to adapt to the patient's social status (poor, rich, noble, humble), environmental factors (thick or thin soil/climate), constitutional temperature (cold or warm), dietary appropriateness, and inability to distinguish between courage and timidity; failing to use analogical reasoning, which leads to self-confusion rather than clarity, is the third error in treatment.
Fourth Error: Failing to inquire about the onset of the disease, such as emotional distress (worry and grief), dietary irregularities, excessive lifestyle habits, or poisoning. If one does not ask these questions first but hastily palpates the Cun Kou (Radial Artery at the wrist), how can one accurately diagnose the disease? Fabricating disease names and being trapped by crude diagnostic errors is the fourth error in treatment.
Therefore, people's talk often extends thousands of miles away, yet they fail to understand the subtle principles (measured in inches and lines). Diagnosis lacks consideration of human affairs, the methods of treatment, and the composure needed to preserve life. Simply sitting and palpating the Cun Kou without aligning with the five Zang organ pulses or understanding the origins of myriad diseases leads to initial self-reproach and shifting blame to one's teacher. Thus, the practitioner fails to follow logical principles, abandoning technique like trash in the market. If a mistaken treatment occasionally yields results, the foolish doctor feels self-satisfied. Alas! The profound and obscure Dao—who truly knows it? The great Dao resembles Heaven and Earth and matches the Four Seas. If you do not understand the instruction to illuminate darkness with light, accepting teaching only to treat it as obscurity, you must strive harder."