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(Note: The condition where a patient with consumptive disease (Xu Lao) becomes clear-minded shortly before death)

The blood of all the hundred vessels throughout the human body originates from the Heart and returns to the Heart, circulating endlessly. When heat pathogens enter the blood vessels, they inevitably leave toxic residues in the Heart, leading to delirious speech (Chan Wang). In previous discussions on warm-heat diseases, it was stated that if fluids are depleted and blood is scant, the Spirit (Shen) will not be confused, resulting in insomnia day and night. Why? Because when blood is substantial, turbid qi accumulates; when blood is deficient, the Spirit scatters. Furthermore, when both fluids and blood are completely exhausted, and the Spirit is entirely scattered, reaching the extreme of warm-toxin causing macules (Fa Ban), yet the person appears clearer than usual, this is an untreatable condition. This point had not been mentioned by predecessors. Only Che Zhizhong stated: "In warm-macule diseases, only those with Yang-patterns presenting with clear consciousness, showing a surging-slippery pulse (Hong Hua Mai), should be carefully evaluated; do not lightly promise cure or treat recklessly." He further said: "In macule presentations, if the spirit is clear but the patient lies supine unable to bend or stretch, it is untreatable; if the spirit is dull and heavy, survival is possible." Zhang Shiwang stated: "In warm-heat diseases, if external pathogens struggle with healthy qi, the spirit becomes confused; if internal injury causes inherent deficiency of healthy qi, the mind remains clear, unconfused until death." These are profound insights from extensive experience, previously unmentioned by ancient sages.

I recall one autumn in Tianjin, where a plague broke out, causing warm-toxin macules. Patients' bodies were red like crabs in a steamer, with only the tip of the nose remaining white. They lay exhausted and immobile, yet their consciousness was clear, speech distinct, and even at the moment of death, they conversed gently and logically. This onset indicated an untreatable condition, occurring specifically in young children, spreading rapidly, with death occurring within five to six days. Within a month, thousands died; it was truly tragic. When evil attacks the Pericardium (Bao Luo) or enters the blood vessels, and blood is scorched, dry, and viscous, while the Spirit mechanism ceases and clear qi vanishes, confusion should naturally ensue. Instead, if the patient shows guidance, knows events outside the door, and speaks with perfect logic, better than usual, it is due to blood deficiency and fluid depletion, exhaustion of essence, and the Yuan Shen (Original Spirit) detaching from its root and floating outward. Is this not more critical than the Yuan Qi detaching and floating upward? Therefore, for any disease such as Cold Damage (Shang Han), Warm-Heat, Smallpox, Macules/Sha, or Carbuncles, if after a few days the spirit suddenly becomes clear and the patient lies long and immobile, this indicates Heart Exhaustion (Xin Jue) and the end of life. I often see scholars who study hard; once infected with warm-heat, before the Yangming stage is solidified and the Blood Chamber is heated, they exhibit delirium. This is due to Heart deficiency and timid qi, collapsing at the first sign. I also see widowers and widows burdened by sorrow and depression, losing appetite, suffering insomnia, gradually wasting away, yet their hair and complexion become surprisingly lustrous, eyes staring fixedly without blinking. At death, they talk with sighs, bow in thanks, and pass away. Observers find this strange, but it is all due to the Yuan Shen detaching from its root and floating outward.