医者。所以治人之生者也。未知死。焉知生。知死之无可救药。则凡稍有一毫之生机。自宜多方调治。以挽
回之。欲辨死生。惟明脉证。高士宗以吐血多者为络血。吐血少者为经血。谓吐多者病轻。吐少者病重。而
其实经散为络。络散为孙络。如干发为枝。枝又有枝。要皆统于一本也。以经络之血分轻重。实则分无可
分。医旨又谓外感吐血易治。内伤吐血难疗。三指禅谓齿衄最轻。鼻衄次之。呕吐稍重。咳咯唾血为最重。
谓其病皆发于五脏。而其血之来最深。不似呕吐之血。其来出于胃间。犹浅近也。此如仲景近血远血之
义。以此分轻重。于理尚不差谬。第鼻衄呕吐血。虽近而轻。而吐衄不止。亦有气随血脱。登时即死者。咳咯
唾血虽远而重。亦有一哈便出。微带数口。不药可愈者。仍不可执以定死生矣。夫载气者。血也。而运血者。
气也。人之生也。全赖乎气。血脱而气不脱。虽危犹生。一线之气不绝。则血可徐生。复还其故。血未伤而气
先脱。虽安必死。以血为魄。而气为魂。魄未绝而魂先绝。未有不死者也。故吾谓定血证之死生者。全在观
气之平否。吐血而不发热者易愈。以荣虽病而卫不病。阳和则阴易守也。发热者难治。以血病气亦蒸。则
交相为虐矣。吐血而不咳逆者易愈。咳为气呛。血伤而气不呛。是肾中之水。能纳其气以归根。故易愈。若
咳不止。是血伤火灼。肾水枯竭。无以含此真气。故上气咳逆为难治。再加喘促。则阳无所附矣。大便不溏
者。犹有转机。可用滋阴之药。以养其阳。若大便溏。则上越下脱。有死无生。再验其脉。脉不数者易治。以其
气尚平。脉数者难治。以其气太疾。浮大革数而无根者。虚阳无根据。沉细涩数而不缓者。真阴损失。皆为难
治。若有一丝缓象。尚可挽回。若无缓象。或兼代散。死不治矣。凡此之类。皆是阴血受伤。而阳气无归。故主
不治。若阴血伤。而阳气不浮越者。脉虽虚微迟弱。亦不难治。但用温补。无不回生。盖阳虚气弱者易治。惟
阴虚气不附者为难治。所谓血伤而气不伤者。即以气之不伤。而知其血尚未尽损。故气犹有所归附。而
易愈也。气之原委。吾于水火血气论已详言之。参看自见。
Physicians are those who treat and save people's lives. If one does not understand death, how can one understand life? Knowing that a condition is beyond remedy, if there remains even the slightest spark of vitality, one should naturally employ various methods of regulation and treatment to restore it. To distinguish between life and death, one must clearly understand the pulse and symptoms. Gao Shizong considered profuse hematemesis as blood from the collaterals (Luo vessels) and scanty hematemesis as blood from the meridians (Jing vessels), asserting that profuse bleeding indicates a lighter disease while scanty bleeding indicates a heavier disease. In reality, meridians disperse into collaterals, and collaterals disperse into sun-collaterals (Sun Luo vessels). Just as a trunk branches out, with branches having further branches, all ultimately stem from a single root. It is impractical to differentiate the severity of blood conditions based on meridians versus collaterals, as they are fundamentally inseparable. *Yi Zhi* also states that hematemesis caused by external contractions is easy to treat, whereas that caused by internal injuries is difficult to cure. *San Zhi Chan* considers gingival bleeding (Chi Nu) the mildest, nasal bleeding (Bi Nu) next, vomiting blood slightly more severe, and coughing up sputum mixed with blood (Ke Ge Tuo Xue) the most severe. This view holds that these ailments originate in the five zang organs, and the source of the blood is deep, unlike vomiting blood which originates from the stomach and is thus shallower. This parallels Zhang Zhongjing's distinction between proximal blood (Jin Xue) and distal blood (Yuan Xue). Using this to gauge severity is theoretically sound. However, although nasal bleeding and vomiting blood are proximal and seemingly mild, persistent hematemesis or epistaxis can lead to Qi collapsing following blood loss, resulting in immediate death. Conversely, although coughing up bloody sputum is distal and seemingly severe, some cases resolve spontaneously with only a few mouthfuls expelled upon a sigh, without medication. Therefore, one cannot rigidly apply these rules to determine life and death. Blood carries Qi, while Qi moves Blood. Human life relies entirely on Qi. If blood is lost but Qi remains intact, the patient may survive despite critical condition; as long as a thread of Qi remains unbroken, blood can gradually regenerate and return to its normal state. If blood is uninjured but Qi collapses first, death is inevitable even if the patient appears stable. Blood is associated with Po (Corporeal Soul), and Qi with Hun (Ethereal Soul); if Po survives but Hun perishes first, death is certain. Thus, I assert that determining the prognosis of blood disorders depends entirely on observing whether the Qi is balanced. Hematemesis without fever is easier to cure because Ying (Nutritive) Qi is diseased but Wei (Defensive) Qi is not; when Yang is harmonious, Yin is easily preserved. Hematemesis with fever is difficult to treat because blood pathology causes Qi to steam and agitate, leading to mutual exacerbation. Hematemesis without coughing or counterflow qi is easier to cure; coughing represents Qi rushing upward. If blood is injured but Qi does not rush upward, it indicates that Kidney Water can grasp and anchor the Qi back to its root, facilitating recovery. If coughing persists, it signifies that blood injury has scorched fire, depleting Kidney Water so it cannot contain True Qi, making upper rebellious Qi and coughing difficult to treat. If accompanied by panting, Yang has no foundation. Normal stools indicate a chance for recovery, allowing the use of yin-nourishing herbs to support Yang. Loose stools indicate Qi escaping upward and downward, signifying death with no hope of survival. Further examine the pulse: a non-rapid pulse is easier to treat as Qi is relatively calm; a rapid pulse is difficult to treat as Qi is too frantic. A floating, large, wiry, and rapid pulse without root indicates deficient Yang lacking foundation; a deep, fine, choppy, and rapid pulse without slowness indicates loss of True Yin; both are difficult to treat. If there is even a hint of a moderate/sluggish quality, recovery is possible. If there is no moderate quality, or if intermittent (Dai) or scattered (San) pulses are present, the case is fatal and untreatable. All such cases involve injured Yin blood and unanchored Yang Qi, hence deemed untreatable. However, if Yin blood is injured but Yang Qi does not float outward, even if the pulse is weak, slow, or thready, the case is not difficult to treat. With warm tonification, recovery is assured. Generally, deficiency of Yang and weakness of Qi are easier to treat; only deficiency of Yin with unanchored Qi is difficult. The phrase "blood injured but Qi unharmed" implies that since Qi is unharmed, we know blood is not completely depleted, allowing Qi to remain anchored, thus facilitating recovery. The origins of Qi were discussed in detail in my chapter "On Water, Fire, Blood, and Qi"; refer to it for clarity.