Suwen · Explaining the Five Faults

The text

The Yellow Emperor said: How distant it is. How fine — as if looking into a deep pool, as if meeting a floating cloud. A deep pool can still be sounded; a floating cloud, no one knows its far edge. The arts of the sage are a pattern for the ten thousand people. To weigh will and intention, there must be a method. Follow the classic, keep the numbers, take up the affairs of medicine, and be a help to the ten thousand people. Therefore there are five faults and four virtues in the work. Do you know them? Lei Gong left his mat, bowed again, and said: I am young and small, dull and confused. I have not heard of the five faults and the four virtues. Comparing kinds of form and name, I draw the classic in vain; the heart has nothing to answer. The Emperor said: Before you examine an illness, you must ask whether the person was once honored and is now low. Though the stray has not struck, illness is born within — this is named the ying slipping. Once rich and now poor: this is named loss of jing. The five qi linger and join; illness has that in which it gathers. The medical worker examines: it is not in the zang and fu; the form of the body has not changed. The examination is in doubt; one does not know the name of the illness. The body lessens day by day; qi is vacant and without jing. When the illness is deep there is no qi; a shivering, and at times startle. Those whose illness is deep: without, it is spent in the wei; within, it is robbed from the ying. What the good worker misses is not knowing the circumstance of the illness. This is also the first fault in putting in order. Whoever would examine an illness must ask of drink and food and of dwelling; of sudden joy and sudden bitterness; of joy first and bitterness after — all these injure jing-qi. When jing-qi is exhausted and cut off, the form of the body is ruined. Sudden anger injures yin; sudden joy injures yang. Reversal-qi travels upward, fills the vessels, and leaves the form. A dull physician putting it in order does not know filling and draining, does not know the circumstance of the illness. The refined flower slips day by day; the stray qi then joins. This is the second fault in putting in order. Those who are good with the pulse must know by comparing kinds, by the strange and the constant, by ease and measure. To be a worker and not know the Dao — this examination is not worth honoring. This is the third fault in putting in order. Examination has three constants: you must ask of honor and lowliness — a lord whose fief is ruined, and those who would be lords and kings. Therefore those once honored who have slipped from power: though the stray has not struck, jing and spirit are injured within, and the body must decline and perish. Once rich and now poor: though the stray has not injured, the skin is scorched, the sinews bent; wilting and lameness become cramp. If the physician cannot be strict, cannot move the spirit, and is outwardly soft and weak, disorder reaches the loss of the constant; the illness cannot be shifted, and the work of medicine does not walk. This is the fourth fault in putting in order. Whoever examines must know the end and the beginning, and know the leftover thread. Press the pulse and ask the name; join them to man and woman. Parting and cutting off, packed knotting, worry, fear, joy, anger: the five zang are vacant and empty; blood and qi leave their keep. If the worker cannot know this, of what art is the speech? Once rich and then greatly injured: sinews cut, vessels broken; the body walks again, yet the moisture does not grow. Therefore injury, ruin, and knotting linger and press, return to yang; pus gathers, cold and heat. A coarse worker putting it in order urgently needles yin and yang; the body comes apart; the four limbs cramp; the day of death has a term. The physician cannot make it clear, does not ask where it arose, and only speaks the day of death — this too is a coarse heart. This is the fifth fault in putting in order. All these five: they have received the arts and not passed through them; the affairs of persons are not clear. Therefore it is said: the sage putting illness in order must know the yin and yang of Heaven and Earth, the warp and record of the four seasons, the five zang and six fu, female and male, surface and interior, what needling, moxa, stone, and toxic herbs govern; and, with ease and measure in the affairs of persons, make the Dao of the classic clear. Honor and lowliness, poor and rich, each differ in rank and pattern. Ask the years, young or old, the pattern of courage and fear; examine the divided regions; know the root and beginning of the illness. The eight corrects and the nine assessments: the examination will then answer. The Dao of putting illness in order: qi within is the treasure. Follow and seek its pattern. If you seek and do not obtain it, the fault is in surface and interior. Keep the numbers and put it in order by them; do not lose the pattern of the transports. Those who can walk this art will to the end of their years be without peril. Not to know the pattern of the transports: the five zang pack heat; sores arise in the six fu. To examine illness without care is called losing the constant. Keep this putting-in-order carefully, and it is bright with the classic. The Upper Classic and the Lower Classic, the measuring of yin and yang, the strange and the constant of the five interiors, decided at the Bright Hall: examine the end and the beginning, and you can walk across the realm.

The line

The Emperor said: Before you examine an illness, you must ask whether the person was once honored and is now low. Though the stray has not struck, illness is born within — this is named the ying slipping.

The note

Before you examine, first ask whether the person was once honored and is now low. The five faults are all a failure to ask how the person arrived. To explain them is to stitch the seams that were left open.