(附虚劳将死，其人反清)
凡人周身百脉之血，发源于心，亦归宿于心，循环不已。热入血脉，必致遗毒于心，故
、谵妄也。前论患温热者，津枯血少，则神明不昏，昼夜不寐。何也?盖血实则浊聚，血虚
则神散也。更有津血全无，神明全散，温毒之极，至于发斑，而人清反异于平日者，此为不
治。前人未道，独车质中曰∶温病发斑，独有阳证人清者，见洪滑之脉，宜细心参酌，勿可
轻许妄治。又曰∶发斑证，神气清楚，仰卧不能屈伸者不治，神气昏沉者可生。张石顽曰∶
温热之病，外感与正气相搏，则神气昏瞀；内伤正气本虚，则神志清明，至死不惑。此皆阅
历深到之言，昔贤所未齿及也。曾忆某年秋月，天津盛疫，温毒发斑，患者身如釜蟹，鼻准
独白，其人倦卧难动，神清语朗，临死犹委婉言谈。起病即属不治，且专在幼童，传染至速
，其死在五六日之间。不过一月，死者数千，真奇惨也。夫邪攻包络，或入血脉，与夫血液
燔灼干涩，神机既息，清气全无，自应昏昧，反见向导，能知门外之事，与人言皆曲尽情理
，甚于平日，总由血虚津枯，菁华已竭，元神离根而外越，不较之元气离根而上越者，更危
乎?故凡病伤寒、温热、痘疹、斑痧、痈疽，为日稍久，转见神气清明，长卧难动者，即为
心绝，是命尽也。每见读书苦思之士，一病温热，阳明未实，血室未热，即见谵妄者，心虚
气怯，望风先靡也。又见孤臣、寡妇，忧愁郁结，饮食不甘，夜不成眠，渐见肌肉消瘦，毛
发、面色转见鲜美，目光外射，直视不瞬，及至临死，谈论欷 ，拱谢而逝。观者莫不异之
，此皆元神离根而外越也。
（附注：虚劳病将死时，患者反而神志清醒的情况）
凡是人体周身百脉之血，发源于心，也归宿于心，循环往复不停。热邪侵入血脉，必定导致毒邪遗留在心，所以会出现谵语和妄言的症状。前文论述患温热病的人，如果津液枯竭、血液稀少，那么神明就不会昏乱，表现为昼夜无法入睡。为什么呢？因为血液充实则浊气聚集，血液虚弱则神明涣散。更有甚者，津液和血液完全耗尽，神明彻底涣散，温毒达到极致，以至于出现发斑症状，而人反而比平日更清醒，这属于不治之症。前人未曾提及这一点，只有车质中说：“温病发斑，唯独阳证患者神志清醒的，见到洪大滑利的脉象，应当仔细参详斟酌，不可轻易许诺治愈或妄加治疗。”又说：“发斑证，如果神气清楚，仰卧不能屈伸的，属于不治；神气昏沉的，尚可生存。”张石顽说：“温热病，如果是外感邪气与正气相搏，则神气昏蒙；如果是内伤导致正气本虚，则神志清明，直到死亡也不会迷惑。”这些都是阅历深厚之言，是昔日贤者所未曾涉及的。
我曾记得某年秋天，天津爆发瘟疫，温毒发斑，患者身体像蒸锅里的螃蟹一样红赤，只有鼻准独白，其人疲倦卧倒难以移动，但神志清醒，言语明朗，临死时还委婉地交谈。起病即属不治，且专门发生在幼童身上，传染速度极快，死亡时间在五六天之间。不过一个月，死者数千人，真是极其悲惨啊。邪气攻犯心包络，或者进入血脉，以及血液被燔灼干涩，神机已经停止，清气全无，理应昏昧，反而看见能引导方向，知道门外的事情，与人交谈都曲尽情理，甚至比平日更好，这总归是因为血虚津枯，精华已竭，元神离开根基而向外飘越，这不比元气离开根基而上越的情况更加危险吗？所以凡是患有伤寒、温热、痘疹、斑痧、痈疽等疾病，病程稍久，反而出现神气清明，长卧难以移动的，就是心绝，这是生命终结的迹象。我常常见到读书苦思的人，一旦患上温热病，阳明经尚未结实，血室未热，就出现谵妄的，这是心虚气怯，望风先溃败的表现。又见到孤臣、寡妇，忧愁郁结，饮食不甘，夜晚不能安眠，逐渐肌肉消瘦，毛发、面色反而变得鲜美，目光外射，直视不眨眼，等到临死时，谈论唏嘘，拱手致谢而逝。旁观者无不感到奇异，这都是元神离开根基而向外飘越的表现。
(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.