辨脉脱 六脉俱脱者，大命垂危矣（神昏脉脱者死，神清脉脱者亦死。）通脉四逆急服之，还怕脉因暴出死。
但得脉来微续生，更需附子四五枚，人参小半斤，周时服尽休间断，随进米粥始回春；参力偶不继，前功必尽弃，平时
无学力，到此滋疑惧。每见虚寒之极服温补，躁乱不宁呕且吐，此为药力尚未全，切莫心疑换别路。大约三阴病症露危
剧，急则六日或三日，缓则行期十二日。幸而君火未全衰，反见舌干等症出，更须姜、附助其阳，渐得阳回舌生液。若
见舌干投凉剂，坏乃百年人寿事，起手果然认得真，断不朝三与暮四。君不见《景岳全书》用法精，十补一清巧相济；
又不见嘉言《寓意》重叮咛，阴症转阳必自愈，济困扶颠道在斯，一有游移便错去。更有虚寒服药来，温补不安凉适意，
两寒相得从其类，正气败坏决不治。至于实热失汗下，脉伏似脱君休怕，大承、十枣用即安，神气分明现真假。须知实
热治可缓，凉泻一投拨便转，不比虚寒救济难，仁术全凭思与辨。
自古三皇画卦而分阴阳，辨药而作《本草》，论病而垂《内经》，吾医开教于《三坟》，至今尚读其传书，内而医院，
外而医学，并奉为主祀，列入条编者也。至唐而有韦氏名讯，道号慈藏者，施药济人，世人共仰为药王，医史可考。则
是药王之距三皇，已隔唐、虞、夏、商、周、秦、汉、晋、及南北朝十余代矣。今有无知僧道，以药王之像，塑为卉服，
与神农之像无异，借以通书所载，每年四月二十八日药王诞之语，影射混淆，惑人酬款，以致庸俗之人，误称三皇为药
王，殊为可笑。查《钦定礼科则例》，现载京师先医庙，奉三皇于南向，配句芒等四位于东西向，又分列僦贷季等二十
四位于两庑，由上古而递次及唐药王韦慈藏，现与启元子王冰东西对列，则例彰彰。吾医之有三皇，犹儒者之有孔子也；
若夫药王，较之程朱诸子，尚有间焉，譬诸范、欧诸儒，庶儿相近。今以若贤若神之号，而与开物成务之大圣人相混，
亵慢甚矣，故特考而辩之。
辨别脉象中的“脱”证：如果六部脉象全部消失，说明生命垂危（神志昏迷且脉象消失的会死亡，神志清醒但脉象消失的也会死亡）。此时应紧急服用通脉四逆汤，但仍担心脉搏突然暴出后导致死亡。
只要脉象微弱而连续出现，说明生机尚存，这时更需要用附子四五枚，人参小半斤，在一周内服完不得间断，同时配合饮用米粥才能回春；如果人参的药力不能持续接续，之前的治疗努力必将前功尽弃，平时如果没有扎实的医学功底，到了这个时候就会充满疑虑和恐惧。
经常见到极度虚寒的患者服用温补药物后，出现躁动不安、呕吐的症状，这是因为药力尚未完全发挥作用，千万不要心里怀疑而更换治疗方案。
大抵三阴病症显露危急严重的情况，急症可能在三天或六天内发作，缓症则病程可能长达十二天。幸好心阳（君火）没有完全衰竭，反而出现了舌干等症状，这时更需要生姜、附子来辅助阳气，逐渐使阳气回复，舌面重新生出津液。如果看到舌干就投用寒凉药剂，那将会毁掉人的百年寿命。起手诊断如果能准确识别病机，绝不会朝三暮四、犹豫不决。
难道没看见《景岳全书》中用药的精妙之处吗？十份补药配一份清药，巧妙相辅相成；又没听见嘉言在《寓意草》中反复叮咛的吗？阴证转阳必然自愈，救济困境、扶持危局之道就在于此，一旦犹豫动摇就会出错。
更有甚者，虚寒患者服药后，觉得温补药不舒服而觉得凉药舒适，这是两种寒性相互感应，属于同类相从，正气已经败坏，注定无法救治。
至于实热证因失于发汗或攻下，脉象伏匿看似“脱”证，你不要害怕，使用大承气汤或十枣汤即可安定，神气的真假分明可见。须知实热证的治疗可以稍缓，凉泻剂一投用就能扭转局面，不像虚寒证救济那样困难，仁术全凭思考与辨证。
自古以来，三皇绘制卦象从而区分阴阳，辨别药材从而编写《本草》，论述疾病从而留下《内经》，我们的医学教育源于《三坟》，至今人们仍阅读其传世书籍，无论是内部的医院还是外部的医学界，都奉他们为主祀对象，列入典章制度之中。
到了唐代，有一位名叫韦讯、道号慈藏的人，施药救人，世人共同敬仰他为药王，医史中有据可查。那么药王距离三皇，已经隔了唐、虞、夏、商、周、秦、汉、晋以及南北朝等十余代了。
如今有一些无知的僧侣道士，将药王的塑像画成穿着花草服饰的样子，与神农的塑像无异，借以混淆通书所载每年四月二十八日为药王诞辰的说法，迷惑人进行酬神捐款，以至于庸俗之人误称三皇为药王，实在可笑。
查阅《钦定礼科则例》，现在记载京师先医庙中，南向供奉三皇，东西向配享句芒等四位神位，两廊又分列僦贷季等二十四位神位，由上古依次排列至唐代药王韦慈藏，现与启元子王冰东西相对列置，典章制度清晰明确。
我们医学界有三皇，就像儒家有孔子一样；至于药王，比起程颢、程颐、朱熹等诸子，还有差距，好比范仲淹、欧阳修等儒者，才稍微接近一些。如今若用贤人、神明的称号，与开物成务的大圣人混为一谈，是对圣人的亵渎和轻慢，所以我特意考证并辨析此事。
Differentiating the Pulse Condition of "Tuō" (Collapse): When all six pulse positions are imperceptible, it indicates that life is in critical danger (death occurs if consciousness is lost and the pulse vanishes; death also occurs if consciousness is retained but the pulse vanishes). In such cases, Tongmai Sini Decoction (Unblocking the Pulse Four Reversal Decoction) should be administered urgently, yet one must still fear that a sudden, violent emergence of the pulse may lead to death.
If the pulse returns weakly and continuously, it indicates that vitality is preserved. At this stage, four or five pieces of Fuzi (Prepared Aconite Root) and half a jin (approx. 300g) of Renshen (Ginseng Root) are required. The medication should be consumed completely within one week without interruption. Only by concurrently consuming rice gruel can spring-like recovery be achieved. If the therapeutic power of Ginseng fails to sustain itself, all previous efforts will be wasted. Without solid medical foundation in daily practice, physicians will inevitably feel doubt and fear at this juncture.
It is often observed that patients with extreme deficiency-cold conditions, after taking warming and tonifying herbs, exhibit restlessness and vomiting. This is because the medicinal force has not yet fully taken effect. Physicians must not harbor doubts or change the treatment strategy.
Generally, when San Yin (Three Yin) diseases manifest critically, acute cases may develop within three or six days, while chronic cases may have a course extending to twelve days. Fortunately, if the Ministerial Fire (Heart Yang) has not completely declined, symptoms such as dry tongue may appear. In such instances, Shengjiang (Fresh Ginger Rhizome) and Fuzi (Prepared Aconite Root) are needed to assist Yang Qi, gradually restoring Yang and generating fluids on the tongue. If cooling agents are administered merely because of a dry tongue, it would ruin a person's lifespan. If the initial diagnosis is accurate, one will never hesitate or vacillate.
Have you not seen the exquisite application of formulas in *Jingyue Quanshu* (Complete Works of Jingyue), where ten parts of tonification are balanced with one part of clearing? Have you not heard Jiayan’s repeated admonitions in *Yuyi Cao* (Notes on Meaning)? When a Yin syndrome transforms into a Yang syndrome, self-healing is inevitable. The way to rescue those in distress lies here; any hesitation leads to error.
Furthermore, there are cases where patients with deficiency-cold take medications but find warming and tonifying agents uncomfortable, preferring cooling agents. This is due to two cold pathogens interacting according to their nature (like attracts like). With the righteous Qi thoroughly depleted, the condition is incurable.
Regarding excess-heat syndromes resulting from failure to induce sweating or purge, the pulse may be hidden and resemble collapse. Do not be afraid; administering Dachengqi Tang (Major Order the Qi Decoction) or Shizao Tang (Ten Date Palm Decoction) will stabilize the patient. The true versus false nature of Shen Qi (Spiritual Qi) becomes clearly distinguishable. It must be understood that the treatment of excess-heat can be somewhat delayed, as a single dose of cooling purgatives can reverse the condition. This contrasts with the difficulty of rescuing deficiency-cold. The benevolent art of medicine relies entirely on reflection and differentiation.
Since ancient times, the Three Sovereigns drew trigrams to differentiate Yin and Yang, distinguished medicinal substances to compile the *Bencao* (Materia Medica), and discussed diseases to leave behind the *Neijing* (Inner Canon). Our medical education originates from the *Sanfen* (Three Ancient Books). To this day, these texts are still read. Both internal hospitals and external medical circles revere them as primary deities and include them in statutory regulations.
During the Tang Dynasty, a man named Wei Xun, with the Daoist name Cizang, distributed medicine to help people. The world revered him as the Medicine King, and his history is verifiable in medical records. Thus, the Medicine King is separated from the Three Sovereigns by more than ten dynasties, including Tang, Yu, Xia, Shang, Zhou, Qin, Han, Jin, and the Northern and Southern Dynasties.
Currently, some ignorant monks and Daoists sculpt the image of the Medicine King wearing floral garments, making it indistinguishable from the image of Shennong. They exploit the popular belief recorded in almanacs that April 28th is the birthday of the Medicine King to confuse the public and solicit donations. Consequently, vulgar people mistakenly refer to the Three Sovereigns as the Medicine King, which is truly ridiculous.
According to the *Qinding Like Zeli* (Imperially Approved Regulations of the Court of Judicature and Revision), the First Physician Temple in the capital currently enshrines the Three Sovereigns facing south, with Goumang and four other deities positioned east and west. Twenty-four other deities, including Jiu Daiji, are arranged in the side corridors. From ancient times, they are listed sequentially up to the Tang Dynasty Medicine King Wei Cizang, who is now positioned opposite Wang Bing (Posthumous Title Qiyuanzi) to the east and west. These regulations are clear and evident.
The Three Sovereigns in our medical field are akin to Confucius in Confucianism. As for the Medicine King, compared to Cheng Hao, Cheng Yi, and Zhu Xi, there is still a gap; he is closer to scholars like Fan Zhongyan and Ouyang Xiu. To equate titles of sages and gods with the Great Sage who created civilization and accomplished great tasks is an act of profound disrespect. Therefore, I have specifically conducted research and clarification on this matter.