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Yu Jiayan said: In the human body, Yin and Yang embrace each other and do not separate; thus, one can enjoy a normal lifespan of a hundred years. Therefore, when Yang Qi desires to detach upwards, Yin Qi draws it downwards, preventing detachment; when Yin Qi desires to detach downwards, Yang Qi draws it upwards, preventing detachment. Even if the causes of disease vary and Yin and Yang sometimes experience hyperactivity and conflict, they will inevitably coordinate to restore balance shortly thereafter. Only excessive drunkenness or severe fatigue disrupts this normal state, causing the Hun (Ethereal Soul) and Po (Corporeal Soul) to lose autonomy, resulting in the separation of Spirit (Shen) above and below.

"Upper detachment" is always caused by excessive worry injuring the Shen (Spirit). Such individuals sweat profusely, their faces are red and lustrous like applied cinnabar, and they experience hallucinations (seeing and hearing things that are not there), as if possessed by spirits. When closing their eyes and moving them, they feel their body does not belong to them,恍惚 (huangruo) as if their soul has left the body.

"Lower detachment" is mostly due to sexual exhaustion injuring the Jing (Essence). Such individuals have shortness of breath and weak respiration, cannot eat, suffer from uncontrolled loose stools, have clear urine with frequency double the normal amount, or experience nocturnal emissions during sleep, frequent daytime seminal emissions, or simultaneous loss of Jing and Blood, losing self-control.

There is also simultaneous upper and lower detachment, which is largely due to excess above and deficiency below, causing the essence to leak outward. Such individuals must be fond of rich, sweet, and greasy foods, indulgent in alcohol and lust, and typically obese with abundant phlegm-dampness. They often face the risk of stroke (Lei Zhong / Apoplexy-like syndrome). I have witnessed young adults without illness who died simply from laughing; this is upper detachment. I have witnessed youths who collapsed and died after a single ejaculation during intercourse; this is lower detachment. Those who fall, suffer urinary incontinence, wheezing, and profuse sweating; this is simultaneous upper and lower detachment.

The treatment method lies in identifying vulnerabilities and securing them before the detachment occurs. If one fails to recognize the cause and blindly searches for remedies hoping to capture the pathogen, even daily administration of Ren Shen (Ginseng) decoctions, wasting immense wealth, will yield little practical benefit. This stems from a failure to understand the mechanism of Yin-Yang separation and which Zang-Fu organ is responsible. If one could perceive clearly and rescue according to whether it is upper or lower detachment, restoring Yin-Ping and Yang-Mi (balance), so that the Spirit is regulated, how could sudden detachment occur?

Shiwan (Zhang Lu's pseudonym) said: Regarding the syndrome of "detachment," although *Nei Jing* mentions "Jing detachment leads to deafness" and "Qi detachment leads to blurred vision," and *Nan Jing* discusses "Yang detachment leads to seeing ghosts" and "Yin detachment leads to blindness," these are not the sudden detachment described by Yu Jiayan.

Sudden detachment often occurs among those who consume rich, fatty foods and live in luxury, but rarely among those struggling with coarse food and hardship. Among various professions, only physicians exert themselves heart and soul to gain a reputation for emptiness, unlike other arts which merely strain the form without injuring the Spirit and Qi.

Previously, Mr. Shen Langzhong, while ill, accepted an invitation from Gao Danyou. Upon returning, he suffered from panting, sweating, and detachment, leading to his death. Pediatrician Zhao Huitian took a light boat to respond to the request of Mr. Ming Xianxiang. Upon arriving at the cliff, the boatman called out to him but received no answer; he had passed away peacefully (due to detachment). Mr. Wu Yuren visited me prior to my own visit to Lord Nong Jiang. At that time, the patient was expelling large amounts of blood stasis, with chaotic Qi, rapid pulse, and panting, making medication difficult. We decided to wait until dawn when the Qi would be clear for diagnosis to avoid error. We shook hands and parted; I earnestly advised him to carefully examine the pathogenesis upon return and not miss the appropriateness of Qi. We scheduled to meet early the next morning to jointly plan the treatment for Jue (reversal cold/heat) syndrome. The next morning, I waited, but Mr. Wu did not arrive. Inquiring of Lord Jiang's servant, I learned that he had passed Ban Tang the previous evening and died suddenly in his sedan chair. Recalling his advice, I realized that even a benevolent person's intention persists until the form separates and the spirit scatters, unaware of it. How then could one identify vulnerabilities and secure them before detachment occurs?

Alas, I am old and decaying, with only a breath remaining, yet unable to decline this labor. Thus, I write this as a warning from past mistakes and as encouragement for colleagues to preserve life.