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Chapter 74 of 78
黄帝内经·素问
Vernacular Interpretation of Suwen·Discourse on the Five Errors (Chapter 77)
Overall Paraphrase
The Yellow Emperor lamented that the Way of medicine is profound: it is like looking down into an abyss—one can still measure its depth; it is also like gazing at drifting clouds—one cannot perceive its bounds. The医术 of sages should serve as the standard for all people; their reasoning and decisions must follow established principles, adhering to the classics and upholding regularity, undertaking medical duties and assisting all beings. Thus, in medical practice, there are "Five Errors and Four Virtues"—do you understand them? Lei Gong stepped aside from his mat and bowed twice, saying: I am young and ignorant, and have never heard of the Five Errors and Four Virtues. I can only analogize forms and names and cite passages emptily, but in my heart I cannot respond accordingly.
The Yellow Emperor then explained the five types of diagnostic errors layer by layer.
First Error: Neglecting changes in social circumstances.
Before examining the patient, one must first ask whether the person "was once honored but later fell into humility." Such a person, even without contracting external pathogens, will develop illness from within, termed loss of nutrient (tuō yíng) —the depletion of essence due to loss of status and emotional distress. Those who were once wealthy and later became poor are said to suffer from loss of essence (shī jīng) —the draining of the five viscera's qi due to loss of wealth and excessive worry. When the qi of the five viscera stagnates and fails to flow smoothly, pathogens may take advantage and combine with it. When the physician examines such a patient, if the disease is not in the viscera and the external appearance shows no obvious change, he may become confused and fail to identify the condition. Yet the patient's body gradually withers, with qi deficiency and scant essence; when the disease deepens, there is shortness of breath, chills, and frequent fright. The reason the disease becomes severe is that externally the defensive qi (the qi that circulates on the body surface and governs protection) is consumed, and internally the nutrient blood (the blood that circulates within the vessels and governs nourishment) is depleted. The error of even a good physician lies precisely in failing to understand such a condition—this is the first error.
Second Error: Not asking about diet, daily life, and dramatic emotional changes.
Examining a patient requires asking about diet and daily routine, as well as whether there have been sudden great joys or great sorrows, joy followed by suffering, and similar experiences. These all injure essence and qi; when essence and qi are exhausted, the physical body becomes ruined. Violent anger injures yin; violent joy injures yang. Rebellious qi rushes upward, the pulse pathways become congested and full, and the alignment between form and qi is lost. Ignorant physicians do not understand supplementation and drainage (the therapeutic principle of reinforcing deficiency and reducing excess), do not understand the condition, and as essence and qi increasingly drain away, pathogens take advantage of weakness and enter—this is the second error.
Third Error: Not understanding the methods of comparison and anomaly-permanence in pulse diagnosis.
Those skilled in pulse diagnosis must employ the methods of comparison and classification (bǐ lèi) and anomaly versus constancy (qí héng) to grasp the condition with composure. If a physician does not understand these principles, his diagnostic methods are not worthy of esteem—this is the third error.
Fourth Error: Not asking about rank, wealth, or poverty, and maintaining an improper attitude as a physician.
In diagnosis, there are three essential questions regarding common human circumstances: the person's social standing, whether one has fallen from an enfeoffed position and suffered injury, and whether there are ambitions craving nobility and power. Therefore, when the honored lose their authority, even without contracting external pathogens, the spirit is already injured internally, and the body will inevitably decline toward ruin. Those who were formerly wealthy and later became poor, even without external pathogens, will develop withered, scorched skin and contorted sinews, manifesting as atrophy and lameness (wěi bì) —weakness of the limbs and difficulty walking—and spasmodic contracture. If the physician cannot solemnize his spirit, cannot stir the patient's mind, appears weak in demeanor, and treats chaotically and abnormally, the disease will not be resolved, and the medical endeavor cannot be carried forth—this is the fourth error.
Fifth Error: Disregarding the beginning and end of disease, not inquiring about emotional stagnation and old injuries, and treating rashly.
Diagnosis requires knowing the full course of the disease—its origin and outcome—and must also grasp other related details. When taking the pulse and asking about the illness, one must account for differences between male and female. Experiences of separation and severance, emotional stagnation, excessive grief, fear, anger, or joy cause the five viscera to become empty and the blood and qi to depart from their proper residence. If the physician does not understand these matters, what medical skill can he claim? Those who were once wealthy and then suffered great losses have sinews and vessels as though severed; although the body may still move, the fluids and moisture cannot easily generate and transform normally. Old injuries and accumulated masses linger and bind, drifting and stagnating toward the yang aspects, generating purulent accumulations and alternating cold-heat patterns. Crude physicians hastily needle the yin and yang meridians, causing the body to become lax and dispersed, the four limbs to cramp, and even to recklessly announce the time of death. When the physician fails to investigate clearly, does not ask where the disease originated, and merely names the day of death, this too qualifies as crude practice—this is the fifth error.
All five errors stem from insufficient mastery of medicine and lack of understanding regarding human affairs. Therefore, when a sage treats illness, he must know heaven, earth, yin and yang, the laws of the four seasons, the five viscera and six bowels, and the yin-yang and exterior-interior relationships. He must understand the principles governing acupuncture, moxibustion, stone needling, and medicinal substances, calmly understanding human circumstances in order to comprehend the subtle ways of the meridian system. People of noble or humble, rich or poor standing each have their own distinct qualities and patterns. One must ask about age—old or young—and whether the person is courageous or timid; examine the facial color divisions to discern the disease's origin; and combine the eight cardinal conformations (bā zhèng) —the rectifying qi of the eight seasonal nodes—with the nine indicators (jiǔ hòu) —the nine-sector pulse method—only then can the diagnosis match the condition.
The root of treating disease lies in valuing the body's own rectifying qi as the treasure, following and investigating its principles; if the investigation does not yield results, the problem often lies in failing to distinguish exterior from interior. Hold to the standards, treat according to principle, and do not violate the principles of acupoints (shù xué) —the points addressed in acupuncture. One who can practice this way will never err throughout life. Not knowing the principles of acupoints causes the five viscera to develop pent-up heat and the six bowels to form abscesses. Diagnosis that is not careful and thorough constitutes failure. Heed these rules and cross-reference the classics; consult the Upper Canon and Lower Canon, assess yin and yang, examine the five viscera by the method of anomaly-permanence, adjudicate by observing the bright hall (míng táng) —the nose, a key site in classical facial diagnosis—scrutinizing beginning and end, and one may then achieve unhindered mastery.
Note: The opening of the text raises the "Five Errors and Four Virtues," but the main body elaborates on the Five Errors; the "Four Virtues" are not presented as a separate list, so they are not supplemented here beyond the original wording.
The central teaching of this chapter is: diagnosis must not look only at the viscera and physical form; "human affairs—emotions—social circumstances—natural laws" must be treated as an integrated whole.
On the surface, the Five Errors are criticisms of physician shortcomings, but collectively they point to a single medical principle—inquiry must be thorough, observation of the person must be deep, pulse principles must be clear, attitude must be proper, and treatment must have a basis in evidence. Above all, the concepts of "loss of nutrient" and "loss of essence" show that ancient physicians already recognized how drastic changes in social position and economic status can drain essence and qi internally—so that even without external pathogens, disease arises from within. This reflects a mature form-spirit unity and a mind-body integrated approach to medicine.
Modern psychosomatic medicine demonstrates that chronic social stress, financial hardship, declining status, and intense emotional upheaval can indeed—through pathways such as chronic stress responses, autonomic dysregulation, and endocrine changes—lead to fatigue, weight loss, palpitations, fearfulness, and mood disturbances. "Loss of nutrient" and "loss of essence" can be viewed as early psychosomatic observations of lasting value.
At the same time, formulations such as "violent anger injures yin, violent joy injures yang" are ancient model-based expressions of the relationship between emotions and physiology; they cannot be simplified into modern pathological mechanisms. As for the criticism of "announcing only the day of death," it strongly resonates with the modern medical mandate that prognoses must be communicated with rigor, not recklessly asserted.
Historical limitations include the chapter's color of aristocratic rank and feudalism, as well as certain pathomechanical descriptions like "purulent accumulations and alternating cold-heat" that lack clear modern pathological counterparts and should be assessed judiciously.
Bǔguā Note: This content is based on classical Chinese medical texts and is provided solely for the study of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please consult a physician promptly.