经曰∶得神者昌，失神者亡。善乎神之为义，此死生之本，不可不察也。以脉言之，则
脉贵有神。《脉法》曰∶脉中有力，即为有神。夫有力者，非强健之谓，谓中和之力也。大
抵有力中不失和缓，柔软中不失有力，此方是脉中之神。若其不及，即微弱脱绝之无力也。
若其太过，即弦强真藏之有力也。二者均属无神，皆危兆也。
以形证言之，则目光精彩，言语清亮，神思不乱，肌肉不削，气息如常，大小便不脱，
若此者，虽其脉有可疑，尚无足虑，以其形之神在也。若目暗睛迷，形羸色败，喘急异常，
泄泻不止，或通身大肉已脱，或两手寻衣摸床，或无邪而言语失伦，或无病而虚空见鬼，或
病胀满而补泻皆不可施，或病寒热而温凉皆不可用，或忽然暴病，即沉迷烦躁，昏不知人，
或一时卒倒，即眼闭口开，手撒遗尿。若此者，虽其脉无凶候，必死无疑，以其形之神去也
。
再以治法言之，凡药食入胃，所以能胜邪者，必赖胃气施布药力，始能温吐汗下以逐其
邪。若邪气胜，胃气竭者，汤药纵下，胃气不能施化，虽有神丹，其将奈之何哉。所以有用
寒不寒，用热不热者，有发其汗而表不应，行其滞而里不应者，有虚不受补，实不可攻者，
有药食不能下咽，或下咽即呕者。若此者，呼之不应，遣之不动，此以脏气元神尽去，无可
得而使也，是又在脉证之外亦死无疑者。
虽然，脉证之神，若尽乎此，然有脉重证轻而知其可生者，有脉轻证重而知其必死者，
此取证不取脉也。有证重脉轻而必其可生者，有证轻脉重而谓其必死者，此取脉不取证也。
取舍疑似之间，自有一种玄妙。甚矣，神之难言也。能知神之缓急者，其即医之神者乎。
《黄帝内经》说：得到“神”的就会昌盛，失去“神”的就会死亡。“神”的含义真是精妙啊，这是生死的关键所在，不可不仔细考察。
从脉象来说，脉象贵在具有“神”。《脉法》说：脉中有力，就是具有“神”。所谓有力，并不是指强健的意思，而是指中和之力。大抵在有力之中不失和缓，在柔软之中不失有力，这才是脉中的“神”。如果力量不足，就是微弱、脱绝那种无力；如果力量太过，就是弦硬强直、真脏脉那种有力。这两种情况都属于无“神”，都是危险的征兆。
从形体征候来说，目光有神采，言语清晰响亮，神志思维不乱，肌肉没有消瘦，气息正常，大小便不失控，像这样的情况，即使脉象有可疑之处，也无需担忧，因为形体的“神”还在。如果目光昏暗、眼神迷离，形体消瘦、气色败坏，喘息急促异常，泄泻不止，或者全身大块肌肉已经脱陷，或者两手无意识地寻衣摸床，或者没有外邪却言语错乱失伦，或者没有疾病却看见虚幻的鬼怪，或者患胀满病而补法和泻法都不能施用，或者患寒热病而温法和凉法都不能使用，或者突然暴病，随即陷入昏迷烦躁、昏不知人，或者一时突然晕倒，随即眼睛闭合、嘴巴张开、手松撒尿失禁。像这样的情况，即使脉象没有凶险的征候，也必定死亡无疑，因为形体的“神”已经离去。
再从治疗方法来说，凡是药物食物进入胃中，之所以能战胜病邪，必须依赖胃气来布散药力，才能通过温、吐、汗、下等方法驱逐病邪。如果病邪强盛，胃气衰竭，那么汤药即使服下，胃气也不能运化施效，即使是神丹妙药，又能拿它怎么办呢？所以有用寒凉药却不显寒凉效果，用温热药却不显温热效果的情况；有发汗而表证不应、行滞气而里证不应的情况；有虚证不能受补、实证不可攻下的情况；有药物食物不能咽下，或咽下即呕吐的情况。像这样的情况，呼叫他不答应，推搡他不动，这是因为脏腑之气和元神已经完全离去，没有什么可以驱使的了，这又是在脉证之外也必定死亡无疑的情况。
虽然如此，脉证之“神”，如果完全像上述那样，然而也有脉象重（凶）但证候轻而知道可以生存的，也有脉象轻（吉）但证候重而知道必定死亡的，这是取证候而不取脉象。也有证候重但脉象轻而断定可以生存的，也有证候轻但脉象重而断定必定死亡的，这是取脉象而不取证候。在取舍疑似之间，自有一种玄妙的道理。“神”是难以言说的啊。能够懂得“神”的缓急变化的人，大概就是医术通神的医生吧。
The *Classic of Difficult Issues* (referring to *Huangdi Neijing*) states: "One who possesses Shen (Spirit/Vitality) prospers; one who loses Shen perishes." The significance of Shen is indeed profound; it is the root of life and death, and must be carefully examined.
Regarding pulse diagnosis, the pulse must possess Shen. The *Pulse Methods* state: "Strength within the pulse indicates the presence of Shen." By strength, it does not mean robustness or excessive force, but rather a moderate and harmonious power. Generally, if there is strength without losing softness and moderation, and softness without losing underlying strength, this constitutes the Shen of the pulse. If the strength is insufficient, it manifests as weak, faint, or severed—lacking force. If the strength is excessive, it manifests as wiry, hard, and rigid—the force of the True Zang pulses. Both conditions indicate an absence of Shen and are ominous signs of danger.
Regarding physical manifestations, if the eyes are bright and lustrous, speech is clear and resonant, mental clarity is intact, muscles are not emaciated, respiration is normal, and urination and defecation are controlled, such cases, even if the pulse is questionable, need not be feared, because the Shen of the form remains. However, if the eyes are dim and gaze is confused, the body is emaciated and complexion is ruined, panting is abnormally urgent, diarrhea is unceasing, or the large muscles of the whole body have wasted away, or the hands involuntarily grasp at clothes and beds, or there is incoherent speech without external pathogens, or hallucinations of ghosts without disease, or abdominal distension where neither tonification nor purgation can be applied, or cold-heat disorders where neither warming nor cooling therapies are suitable, or sudden acute illness leading to deep coma and irritability with loss of consciousness, or sudden collapse with closed eyes, open mouth, relaxed hands, and urinary incontinence—in such cases, even if the pulse shows no ominous signs, death is certain because the Shen of the form has departed.
Regarding treatment methods, when herbs and food enter the Stomach, their ability to overcome pathogens depends on the Stomach Qi distributing the medicinal power, thereby enabling warm, emetic, diaphoretic, or purgative actions to expel the pathogen. If the pathogen is strong and Stomach Qi is exhausted, even if decoctions are ingested, the Stomach Qi cannot transform and distribute them. In such a case, what could be done even with miraculous elixirs? Therefore, there are instances where cold-natured herbs fail to produce a cooling effect, and heat-natured herbs fail to produce a warming effect; where sweating fails to resolve exterior symptoms, and moving stagnation fails to address interior symptoms; where deficiency patterns cannot tolerate tonification, and excess patterns cannot tolerate attack; where herbs and food cannot be swallowed, or are vomited immediately upon swallowing. In such cases, the patient does not respond to calls and cannot be moved by pushing, indicating that the Zang organ Qi and Yuan Shen (Primal Spirit) have completely departed, leaving nothing to direct. This represents another category of certain death beyond the scope of pulse and symptom analysis.
Nevertheless, although the Shen of pulses and symptoms may seem fully described above, there are cases where a heavy (ominous) pulse but light (mild) symptoms suggest survival, and cases where a light (auspicious) pulse but heavy (severe) symptoms suggest death; these rely on symptoms rather than the pulse. Conversely, there are cases where severe symptoms but a light pulse suggest survival, and cases where mild symptoms but a heavy pulse suggest death; these rely on the pulse rather than symptoms. Between these ambiguous choices lies a profound subtlety. Indeed, the concept of Shen is difficult to articulate. One who understands the nuances of Shen’s urgency and timing is likely a physician of divine skill.