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Chapter 75 of 78
黄帝内经·素问
The Yellow Emperor was in the Mingtang (the ancient hall for discussing governance and the Way), with Lei Gong seated beside him. The Yellow Emperor said: The books you have read and the studies you have received are already extensive. Try now to discuss the principles of success and failure in treatment—why one can cure, and why errors occur. Lei Gong replied: I have studied according to the classical theories, and all say that perfect results can be achieved, yet in actual practice there are still failures. I wish to hear Your Majesty explain the reasons.
The Yellow Emperor said: You are still young—is it that your intellect has not yet reached full maturity, or is it that you intend to fob me off with confused and miscellaneous talk? The human body has twelve meridians and three hundred and sixty-five collateral vessels, knowledge that is clear to all and commonly followed by physicians. The reason one cannot achieve perfect results lies in lack of focused spirit and unclear will and intention, where the external manifestations and internal pathological mechanisms become disconnected from each other, leading to constant doubt and peril. In diagnosis, one fails to understand the principle of yin-yang obedience and rebellion (the规律 of growth and decline, obedience and reversal between yin and yang)—this is the first kind of error in diagnosis and treatment. 🌗
If one leaves the teacher before completing one's studies, and then recklessly applies various miscellaneous techniques, presenting erroneous theories as the great Way, changing names and claiming credit for oneself, lightly employing bian stones (ancient stone external-treatment tools), one brings disaster upon oneself—this is the second kind of error. 🔥
If one does not investigate the patient's circumstances of poverty or wealth, nobility or lowliness, does not pay attention to the quality of their sitting and lying environment, the cold or heat bias of their constitution, does not adapt to dietary suitability and restrictions, does not distinguish bravery or timidity of temperament, and does not know how to use analogical reasoning for comprehensive judgment, then one will only bring confusion upon oneself and be insufficient to achieve discernment—this is the third kind of error. 🏠
In diagnosis, if one does not first ask about the cause of the illness—such as grief and anxiety, dietary indiscretion, excessive exertion in daily life, or injury from toxic substances—and fails to clarify these matters first, then hastily feels only the cun-kou (the radial artery pulse at the wrist, the key location for pulse diagnosis in ancient times), how could one possibly hit upon the true condition? Recklessly fabricating disease names is bound to lead one into difficulty—this is the fourth kind of error. 🩺
Therefore there is a saying among the people: one may speak as if one could reach a thousand li away, yet still not understand the principles of the cun and chi pulses (the diagnostic method of integrating cun and chi pulse readings). In diagnosis, one does not examine human affairs and reason. The method of diagnosis lies in grasping it with calmness and composure; if one merely sits and presses the cun-kou without discerning the five-organ pulses (the pulse manifestations corresponding to the five viscera), when the hundred diseases break out, one can only blame oneself in regret and even shift the fault onto one's teacher. Thus, if treatment does not follow established principles, it is equivalent to throwing the medical art into the marketplace; if reckless treatment happens to produce occasional results, one foolishly becomes self-satisfied. Alas! Deep and obscure—who can truly understand the medical Way? The greatness of the Way can be compared to heaven and earth, matched to the four seas. You do not understand the teachings of the Way, yet you take what is clear and turn it into darkness. 🌫️
This chapter is the companion piece to Discourse on the Five Major Errors. Its focus is not on the difficulty of treating disease, but on the physician's own failures. The so-called "Four Losses" are four common diagnostic and treatment errors:
Behind these four critiques lie two great principles of Chinese medicine diagnosis: holistic perspective and integration of the four diagnostic methods. Particular emphasis is placed on inquiry preceding pulse examination, with the physician's mindset needing to be "calm and composed" and the spirit focused—otherwise, no matter how skilled the technique, errors are difficult to avoid.
This text still offers inspiration for modern medical learners. Modern medicine equally emphasizes that history-taking is the cornerstone of diagnosis—many misdiagnoses are not due to lack of advanced tests but to incomplete history-taking and neglect of lifestyle context. The references to "not distinguishing courage from timidity in others" and "not adapting to poverty and wealth, nobility and lowliness in residence" share common ground with modern medicine's emphasis on psychological factors, social factors, and individual differences. 🌍
At the same time, it should be candidly acknowledged that concepts such as yin-yang obedience and rebellion, the twelve meridians, the three hundred and sixty-five collateral vessels, and the five-organ pulses belong to the products of ancient systems theory and empirical observation, and cannot be entirely mapped one-to-one onto modern anatomy and physiology. They serve more as theoretical models used by the ancients to explain life phenomena and diagnostic-treatment patterns, carrying historical value while also having limitations. As for ancient external-treatment methods such as bian stones, they should be viewed rationally—modern people should not casually imitate such practices. 🧪
Note from Bugu: This content is based on classical texts of traditional Chinese medicine and is provided solely for the study and research of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.