喻嘉言曰。夫人之身。阴阳相抱而不相离。是以百年有常。故阳欲上脱。阴下吸之。不能脱
也。阴欲下脱。阳上吸之。不能脱也。即病因非一。阴阳时有亢战。旋必两协其平。惟大醉大劳。
乱其常度。使魂魄不能自主。精神上下离决矣。盖上脱者。皆是思虑伤神。其人多汗。面如渥丹。
妄见妄闻。如有神灵。闭目转盼。觉身非己有。恍若离魂者然。下脱者。多缘房劳伤精。其人翕
翕少气。不能饮食。大便滑泄无度。小便清利倍常。或梦寐走泄。昼夜遗精。或精血并脱。不能
自主。复有上下俱脱者。良由上盛下虚。精华外脱。其人必嗜肥甘。好酒色。而体肥痰盛。往往
有类中之虞。尝见有壮岁无病。一笑而逝者。此上脱也。少年交合。一注而倾者。此下脱也。颠
仆遗尿。喘鸣大汗者。此上下俱脱也。治法。要在未脱之先。寻其罅漏缄固之。若不识病因。而
搏搜以冀弋获。虽日服人参。徒竭重资。究鲜实益。总不解阴阳离决之机。何脏使然。若能洞鉴
隔垣。随上下援救。使阴平阳秘。精神乃治。乌有暴脱之患乎。
石顽曰。脱之一证。内经虽有精脱者耳袭。气脱者目不明。难经又有脱阳者见鬼。脱阴者目盲等说。咸非喻子所言
之暴脱也。夫暴脱之患。每尝见于膏粱充饫之家。藜藿艰虞之辈。未之有也。其于百艺之中。惟
鸣于医者。殚心竭力。以博虚声。非他伎术。但劳形而神气无伤之比。昔沈朗仲先生。抱病赴高
澹游之招。归即喘汗而脱。儿科赵蕙田。轻舟应鸣先项公之请。比及到崖。舟子呼之不应。脱然
而逝。吴羽仁先生。先予而候如农姜公。适予踵至。时方瘀血大下。气乱脉喘。难以议药。姑待
平旦气清之时诊决。庶无差误。握手言别。切切嘱予。归当谨察病机。毋失气宜。订期明晨早至。
共图竭厥之治。诘朝坐候。吴子不至。询之姜使。云是昨暮复过半塘。坐脱肩舆之中。因思所嘱
之言。乃知仁人之用心。直至形离神散而不自觉。又安能于未脱之先。寻罅漏而为缄固耶。嗟予
朽落。一息仅存。尚不能谢此烦劳。因书以为前车之鉴。并为同人保生之劝。
喻嘉言说：人的身体，阴阳相互抱持而不分离，因此能享有百年的正常寿命。所以，当阳气想要向上脱失时，阴气会向下吸引它，使其不能脱失；当阴气想要向下脱失时，阳气会向上吸引它，使其不能脱失。即使病因不一，阴阳有时会出现亢盛与抗争的情况，但随即必定两者协同恢复平衡。只有在大醉或过度劳累的情况下，才会扰乱这种常态，使魂魄无法自主，精神上下离决。
所谓上脱，都是由于思虑过度损伤了神志。这类人多汗，面色红润如涂丹砂，出现幻觉（妄见妄闻），好像有神灵附体一样。闭眼转动眼球时，感觉身体不属于自己，恍惚如同灵魂出窍一般。
下脱，多因房事劳损损伤了精气。这类人呼吸微弱短促，不能进食，大便滑泄无度，小便清长且次数倍于平常，或者在睡梦中遗精，昼夜频繁遗精，甚至精血同时脱失，无法自主控制。
又有上下同时脱失的情况，这大多是由于上实下虚，精华外泄所致。这类人一定嗜好肥甘厚味，喜好酒色，而且体型肥胖、痰湿壅盛，往往有患中风（类中）的危险。我曾见过壮年时无病，却因一笑而逝世的，这是上脱；少年时行房事，一次射精后便倾覆死亡的，这是下脱；跌倒后遗尿、喘息有声、大汗淋漓的，这是上下俱脱。
治疗的方法，关键在于在脱证发生之前，寻找其漏洞并加以固摄封闭。如果不识别病因，只是盲目搜求药物以期捕获病邪，虽然每天服用参汤（人参制剂），白白耗费巨资，最终却很少得到实际益处。这总归是不理解阴阳离决的机理，也不知道是哪一脏腑导致了这种情况。如果能洞察秋毫，根据上脱或下脱分别进行救援，使阴平阳秘，精神才能调和，哪里还会有突然脱失的祸患呢？
石顽（张璐自号）说：关于“脱”这一证候，《内经》中虽然有“精脱者耳聋”、“气脱者目不明”的说法，《难经》又有“脱阳者见鬼”、“脱阴者目盲”等论述，但这些都不是喻嘉言所说的暴脱证。
暴脱之患，常常出现在饮食膏粱厚味、生活优裕的人家中，而在饮食粗劣艰难的人群中却很少见到。在这些行业中，只有医生殚心竭力，以博取虚名，不像其他技艺那样仅仅劳损形体而神气不受伤害。
从前沈朗仲先生，带着病去赴高澹游的邀请，回来后就气喘出汗而脱证发作去世。儿科医生赵蕙田，轻舟前往应鸣先项公的请求，等到到达崖边时，船夫呼喊他不应答，他已安然离世（脱证而亡）。吴羽仁先生，在我之前去问候农姜公，恰好我也随后赶到。当时病人瘀血大量排出，气机紊乱，脉象急促喘息，难以议定用药。姑且等待清晨平旦、气机清静之时再诊察决断，以免出差错。我们握手告别，我恳切地嘱咐他回去后要谨慎考察病机，不要违背气宜的原则，约定好第二天早晨早点到来，共同谋划救治厥逆之症。然而第二天早上坐等，吴先生没有来。询问姜家的仆人，说是昨天傍晚又经过半塘，在轿子中脱证发作而亡。回想他所嘱托的话，才知道这位仁人的用心，直到形体离开、神气消散都不自知，又怎么能在他脱证发生之前，寻找漏洞并进行固摄呢？
唉，我年老朽落，仅存一口气，尚且不能推辞这份烦劳，于是写下这些文字作为前车之鉴，并以此劝勉同仁保养生命。
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.