Chapter 12: Preservation and Perishing of the Spirit Qì from Complete Compendium of Zhang Jingyue

When there are dull and confounded eyes, emaciated and weak form, decaying physical body, abnormal rapid panting and incessant diarrhea; or possibly the loss of the major muscles all over the body, picking at bedclothes,(7) incoherent speech without the presence of evil, vision of ghosts in the vacant space without the presence of disease; or suffering from distension and fullness when neither supplementing nor draining [method] can be carried out, suffering from [aversion to] cold and heat [effusion] when neither warming nor cooling [medicinals] can be utilised; or sudden fulminant disease that results in deep confounding, vexation, agitation, clouded [spirit] and inability to recognise people; or sudden collapse with eyes shut, open mouth, limp hands and enuresis; for such a person, even if the pulse may be absent of unfavorable indicators, the person will die without a doubt, as there is no longer the presence of spirit in the physical form.

Furthermore, from the perspective of treatment methods, for the medicinals and food to enter the stomach and prevail over evils, one must depend on the stomach qì to distribute the medicinal effects; it is only then that one can be warmed, induced to vomit and precipitated, in order to expel the evil. When one is overcome by the evil qì, if the stomach qì is exhausted, then even with the administration of a medicinal decoction, the stomach qì will not be able to distribute it; as a result, even if one has the divine elixir, what can one hope to achieve?

Thus, there are those who fail to cool down after consuming cold [medicinals], those who fail to warm up after consuming hot [medicinals], those whose exterior has no response after [attempting to] promote sweating, those whose interior has no response after [attempting to] move the stagnation, those whose vacuity cannot tolerate supplementation, those whose repletion cannot be attacked, those who cannot swallow medicinals or food, and those who vomit upon ingesting [medicinals or food]. For this lack of response after being called and this lack of movement after being dispatched(8), this is due to the complete exhaustion of the visceral qì and original spirit; thus, there is nothing left that can be employed. Regardless of the pulse and signs, these people will die without any doubt.

Although the [discussion regarding] the presence of spirit in the pulse and [physical] signs appears to conclude here, there are still those with critical pulse [indicators] and mild signs, whom one knows can survive; and there are those with mild pulse [indicators] and critical signs, whom one knows will certainly die. For [these people], one considers the signs but disregards the pulse. [Nonetheless], there are also those with critical signs and mild pulse [indicators], whom one knows can survive; and there are those with mild signs and critical pulse [indicators], whom one knows will certainly die. For [these people], one considers the pulse but disregards the signs.

Between choices, at the moment of doubt, there is naturally a sense of profundity and ingenuity. Verily so! Such is the difficulty of explaining the spirit! For those who can understand the urgent and non-urgent [signs] of the spirit, they are certainly the divine ones among physicians.