季路问死，圣人示以知生，知从无处而生，则必从有处而死，忽然而生，忽然而死，渐渐而生，渐渐
而死，生有则皆有，无所不有，死无则悉无，一无所有，初生有似乎死而已生，初死尚近乎生而实死，既生
则与死反，既死则与生反，此圣人所以言未知生，焉知死也。而医者掌人生死，必先识得生死，必先识得人
之所以死，而后知人之所以生，于是用药，乃足以起死而回生。识死之法多端，朱文公言气聚则生，气散
则死，是为一言提要。如病者气急不续，气已散；鱼口气粗，气已散；自汗如雨，气随汗散；大吐大利，气
随吐利而散；自利遗尿，呕血脱精，气亦散。气者阳也，气散则由阳而阴。死者阴也，死为鬼，鬼者归也，阴
之灵也。凡病患终日昏寐不语，语而无声，喜暗恶明，面暗向里，手足厥冷，目瞑见鬼，目无精光，绝谷不食，
诸象皆近乎阴者也，皆死之兆也。至若色脉之言死，《内经》、《难经》论之详，而义深词奥，医者每未洞悉。
今约略言之，大抵性情反常者死，男女不知羞耻者死，无脉者死，脉鱼翔虾游者死，脉躁急者死，脉数八九至
者死，脉迟一二至者死，脉结代者死，真脏脉现者死，阳症得阴脉者死，跌阳冲阳无脉者死，病后脉无胃气
者死，形肉已脱，九候虽调者死。天柱骨倒者死，目窠低陷者死，面青者死，口角青者死，面晦黑者死，
久病色赤者死，舌齿枯黑者死，疹黑斑黑者死，目瞪呆，神去者死，内闭外脱者死，鼻息奔喘者死，药大误者
死，阴症下之死，阳症汗之死。中风鼻鼾者死，汗如油者死，手撒者死，遗尿者死，眼合者死。温症霍乱，救
阴不润者死，救阳不温者死，手足厥冷躁扰者死，舌卷囊缩者死，寻衣摸床者死，痉厥不返者死。病久自利
者死，腹馁绝谷者死，劳损声哑者死，劳损喉痛者死，大肉脱者死，上损过中者死，下损过中者死，非肿
胀而腹胀大有形者死，小便不通，高突有形者死，痢下发热不退
者死，痢下除中者死，真头痛，真心痛，肝痛，皆死。妇人产后，内闭者死，风痉者死，汗大泄者死。小
儿慢惊者死，童劳者死，室女经闭者死。高年噎膈者死，衰年卑胀者死。痈疽内陷者死，痈疽不知痛者死。
大抵出者为虚汗，多亡阳，有一分阳气不死，亡阳必死。上脱下脱，阳脱阴脱，皆死。先天离者死，后天绝者
死。凡人将死，喉间痰响有声，以为痰涎闭窒，而致气卒者大谬，乃其真气已离，痰随气浮，而有声也。亦
有实症，气闭窒而死者，如中暑、中 、中寒、中经、中毒、其死后，身体必发青紫，此其大略也。
子路询问关于死亡的事，圣人教导他首先要了解生命。明白了人从虚无中诞生，就必然会在实有中消亡；生命忽然而来，死亡忽然而去；生命逐渐形成，死亡也逐渐消逝。有生命则万物皆备，无所不有；无生命则一切归无，一无所有。刚出生时似乎接近死亡（指胎儿在母体内状态），刚死亡时尚且接近生存但实质已死；既已生存则与死亡相反，既已死亡则与生存相反。这就是圣人所说的“未知生，焉知死”的原因。
而医生掌管人的生死，必须先认清生死之理，必须先识得人之所以死亡的机理，然后才能懂得人之所以生存的机理，这样用药，才足以使死者复生。识别死亡的方法多种多样，朱熹说“气聚则生，气散则死”，这是一句提纲挈领的话。例如：病人呼吸急促接续不上，说明气已散失；呼吸像鱼口一样粗大张合，说明气已散失；自汗如雨下，说明气随汗液散失；剧烈呕吐和腹泻，说明气随吐利而散失；自行腹泻且遗尿，呕血或精气脱失，气也散失了。气属于阳，气散失则从阳转为阴。死者属阴，死后化为鬼，“鬼”即“归”的意思，是阴的灵体。
凡是病患整天昏睡不语，说话没有声音，喜欢黑暗厌恶光亮，面色晦暗头偏向内侧，手脚冰冷，眼睛闭合似见鬼魂，眼神无光彩，断食绝粮，这些现象都接近于阴，都是死亡的征兆。至于通过面色和脉象判断死亡，《黄帝内经》和《难经》论述得很详细，但义理深奥、言辞晦涩，医生往往未能透彻理解。现在简要谈谈，大抵性情反常者死，男女不知羞耻者死，无脉者死，脉象如鱼翔虾游者死，脉象躁急者死，脉率极快（八九至）者死，脉率极慢（一二至）者死，脉象结代者死，真脏脉显现者死，阳证出现阴脉者死，跌阳脉和冲阳脉无脉者死，病后脉象无胃气者死，形体肌肉已经消瘦脱失，即使九候脉象调和也是死症。天柱骨（颈部脊柱）倒伏者死，眼窝深陷者死，面色青者死，嘴角发青者死，面色晦暗黑者死，久病面色反常发红者死，舌齿枯黑者死，疹斑黑者死，眼睛瞪直呆滞，神志丧失者死，内闭外脱者死，鼻息奔喘者死，用药严重错误者死，阴证误用攻下法致死，阳证误用发汗法致死。中风出现鼻鼾声者死，汗出如油者死，手撒不开者死，遗尿者死，眼睑闭合不睁者死。温病霍乱，救阴不能滋润者死，救阳不能温煦者死，手足厥冷且烦躁不安者死，舌头卷缩睾丸上缩者死，伸手寻衣摸床者死，痉厥不能苏醒者死。久病自行腹泻者死，腹部空虚绝食者死，劳损导致声音嘶哑者死，劳损导致咽喉疼痛者死，大肉消瘦脱失者死，上部损伤超过中部者死，下部损伤超过中部者死，非肿胀却腹胀大有形者死，小便不通且小腹高突有形者死，痢疾发热不退者死，痢疾出现除中证者死，真头痛、真心痛、肝痛，皆致死。妇女产后，内闭者死，风痉者死，大汗淋漓者死。小儿慢惊风者死，童男劳损者死，未婚女子经闭者死。高龄患噎膈者死，年老患卑胀者死。痈疽内陷者死，痈疽不知疼痛者死。
大抵出汗为虚汗，多导致亡阳，只要还有一分阳气就不会死，亡阳必死。上脱下脱，阳脱阴脱，都是死症。先天离决者死，后天绝灭者死。凡人将死时，喉间痰响有声，人们以为是痰涎闭塞窒息导致气绝，这是极大的谬误，其实是真气已经离散，痰随着气上浮而有声响。也有实证，因气机闭塞窒息而死的情况，如中暑、中湿、中寒、中经、中毒，这些人死后身体必定发青紫色，这大概就是大概情况。
Zilu asked about death, and the Sage instructed him to first understand life. Understanding that one is born from non-existence implies that one must die into existence; life arises suddenly, death departs suddenly; life forms gradually, death fades gradually. With life, all things are present, nothing is lacking; with death, everything vanishes, leaving nothing. At birth, one seems close to death (as in the womb); at death, one still appears close to life but is实质上 dead. Having lived, one is contrary to death; having died, one is contrary to life. This is why the Sage said, "If you do not yet understand life, how can you understand death?"
Physicians manage human life and death; they must first recognize the principles of life and death, and specifically understand the mechanisms of why people die, before they can comprehend why people live. Only then can their use of medicine be sufficient to revive the seemingly dead and restore life. There are many methods to identify impending death. Zhu Xi stated, "When Qi gathers, there is life; when Qi scatters, there is death," which serves as a concise summary. For instance: if a patient has rapid, uncontinuous breathing, the Qi has scattered; if breathing resembles fish gills opening and closing roughly, the Qi has scattered; spontaneous sweating like rain indicates Qi scattering with sweat; severe vomiting and diarrhea indicate Qi scattering with these evacuations; spontaneous diarrhea with urinary incontinence, hematemesis, or loss of essence also indicate Qi scattering. Qi belongs to Yang; when Qi scatters, it transitions from Yang to Yin. The dead belong to Yin; after death, one becomes a "Gui" (Ghost), where "Gui" means "return," referring to the spirit of Yin.
Generally, if a patient sleeps all day without speaking, speaks without voice, prefers darkness and dislikes light, has a dull complexion with the head turned inward, cold hands and feet, eyes closed as if seeing ghosts, lackluster eyes, abstains from food, these phenomena all approximate Yin and are omens of death. Regarding determining death through complexion and pulse, the *Huangdi Neijing* (Yellow Emperor's Inner Canon) and *Nanjing* (Classic of Difficult Issues) discuss this in detail, but the meaning is profound and language obscure, so physicians often fail to fully grasp it. Now, I will briefly summarize: generally, those with abnormal temperament die; men and women who lose shame die; those without a pulse die; those with a pulse resembling a swimming fish or shrimp die; those with a frantic pulse die; those with a very rapid pulse (8-9 beats per respiration cycle) die; those with a very slow pulse (1-2 beats per respiration cycle) die; those with knotted or intermittent pulses die; those showing Zang-Fu organ pulses (True Visceral Pulse) die; those with Yang syndromes presenting Yin pulses die; those without pulses at the Dizzyang and Chongyang points die; those whose post-illness pulse lacks Stomach Qi die; those whose flesh and muscles have wasted away die even if the nine pulses are harmonious. Those with a collapsed Tianzhu bone (neck spine) die; those with sunken eye sockets die; those with a green face die; those with green corners of the mouth die; those with a dark, blackish face die; those with chronic illness presenting red complexion die; those with dry, black tongue and teeth die; those with black rashes or spots die; those with staring,呆滞 eyes and lost spirit die; those with internal closure and external collapse die; those with rushing panting breath die; those suffering from major medical errors die; Yin syndromes treated with purgatives lead to death; Yang syndromes treated with sweating lead to death. Stroke patients with snoring die; those with sweat like oil die; those with relaxed hands die; those with urinary incontinence die; those with closed eyes die. In warm diseases or cholera, failure to nourish Yin adequately leads to death; failure to warm Yang adequately leads to death; cold extremities with restlessness lead to death; curled tongue and retracted testicles lead to death; groping for clothes and bed leads to death; spasms and convulsions that do not resolve lead to death. Chronic self-diarrhea leads to death; abdominal emptiness with refusal to eat leads to death; consumptive disease with hoarseness leads to death; consumptive disease with sore throat leads to death; wasting of large muscles leads to death; upper damage exceeding the middle leads to death; lower damage exceeding the middle leads to death; abdominal distension with visible form (not edema) leads to death; inability to urinate with high, formed abdominal protrusion leads to death; dysentery with persistent fever leads to death; dysentery presenting Chu Zhong syndrome (appetite returning falsely before death) leads to death; True Headache, True Heartache, and Liver Pain all lead to death. Postpartum women with internal closure die; those with wind-spasm die; those with profuse sweating die. Children with slow convulsive disease die; young males with consumption die; unmarried women with amenorrhea die. Elderly people with dysphagia (Yi Ge) die; aged people with Bei Zhang (abdominal swelling/distension) die. Carbuncles and sores sinking inward lead to death; carbuncles and sores without pain lead to death.
Generally, sweating is deficient sweating, often leading to Collapse of Yang. As long as a fraction of Yang Qi remains, death does not occur; Collapse of Yang inevitably leads to death. Upper collapse and lower collapse, Yang collapse and Yin collapse, all lead to death. Separation of Pre-heaven (Congenital) leads to death; severance of Post-heaven (Acquired) leads to death. When a person is near death, phlegm rattling in the throat is often mistakenly attributed to phlegm-saliva blocking the airway causing sudden Qi cessation; this is a major error. It is actually due to True Qi having already dispersed, with phlegm floating up with the Qi, creating sound. There are also excess syndromes where death results from Qi blockage and suffocation, such as Heatstroke, Dampness strike, Cold strike, Meridian strike, and Poisoning. After death from these causes, the body will likely turn blue-purple. This is the general overview.