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In typhoid fever (Shanghan), the appearance of death pulses indicates that recovery is destined to be difficult. When a Yang syndrome presents with Yin pulses, the outcome is pitiable. (Zhang Zhongjing stated: Death occurs when a Yang syndrome presents with Yin pulses.) Upper qi rebellion accompanied by a scattered pulse indicates damage to the physical form; deafness accompanied by a floating and choppy pulse makes life difficult to preserve. (Zhang Zhongjing stated: In typhoid fever, coughing and upper qi rebellion with a scattered pulse indicate death, due to the damage of the physical form. Bian Que stated: If a patient suffers from deafness and the pulse is conversely floating, large, and choppy, it indicates death.) Delirious speech accompanied by body heat should present with a洪大 (Hongda, large and surging) pulse; if the pulse is deep, fine, and minute, life will not extend. Abdominal distension with diarrhea should present with a micro-fine pulse; if the pulse is tight, large, and slippery, it signifies death (returning to the underworld). Hematemesis or epistaxis should present with a deep and fine pulse for a favorable prognosis; if the pulse is floating, large, and firm, it sighs like passing water (indicating death). (Bian Que stated: If a patient speaks deliriously and falsely, with body heat, the pulse should be Hongda; conversely, if the limbs are cold and the pulse is deep, fine, and minute, it indicates death. If a patient has abdominal distension and diarrhea, the pulse should be micro-fine and choppy; conversely, if the pulse is tight, large, and slippery, it indicates death. If a patient has hematemesis and epistaxis, the pulse should be deep and fine; conversely, if the pulse is floating, large, and firm, it indicates death.) When both Yin and Yang are deficient and heat persists, and the pulse is intermittently rapid and slow, death arrives. (Zhang Zhongjing stated: Death occurs when both Yin and Yang are deficient and heat persists. Death also occurs when the pulse is intermittently rapid and slow.) The pulse resembles leaking roof water or a sparrow pecking; coming like a striking stone and going like an untying rope. (Medical classics state: Death occurs when the pulse resembles leaking roof water or a sparrow pecking. Death occurs when the pulse comes like a striking stone and goes like an untying rope. "Striking stone" refers to a pulse that is abrupt and urgent. "Untying rope" refers to a pulse that is frequent and then scatters chaotically without order.) Shrimp swimming (Xiayou) and fish gliding (Yuxiang) pulses contradict the symptoms; turning bean (Zhuan Dou) and inverted knife (Yan Dao) pulses present ominous forms. (Medical classics state: Death occurs when the patient's pulse resembles shrimp swimming or fish gliding. Death occurs when the pulse resembles a turning bean or an inverted knife.) If the Cun pulse does not reach down to the Guan position, it is the extinction of Yang Qi; if the Chi pulse does not reach up to the Guan position, it is the depletion of Yin Qi. (Medical classics state: The Cun pulse not reaching down to the Guan position is Yang extinction; the Chi pulse not reaching up to the Guan position is Yin exhaustion. Both indicate death and are untreatable.) When the Dai pulse (Intermittent Pulse) appears, medical intervention is unnecessary, as the condition is definitely critical and difficult to save with medicine. (Zhang Zhongjing stated: The Dai pulse is Yin in nature; obtaining this pulse indicates a condition that is difficult to treat.)

The signs of death in typhoid fever must be known. Diarrhea accompanied by severe abdominal distension and enlargement is difficult to treat. Rotting of the tongue root with persistent heat is fatal. (Qianjin Fang states: There are nine signs of death in typhoid fever. The second is death from severe diarrhea and abdominal distension. The sixth is death from rotting of the tongue root with persistent heat.) After sweating, if the pulse remains restless, the patient faces danger. (Tai Su states: In heat diseases, if sweating has occurred but the pulse remains restless, this is the pulse of extreme Yin, indicating death. Qianjin Fang states: In typhoid fever, if sweating has occurred and the pulse is quiet, the patient lives; if the pulse is restless, the patient dies.) Sweating profusely but not reaching the feet indicates death. (Qianjin Fang states: Death occurs if sweating does not reach the feet.) Hand unconsciously grasping at clothing seams indicates incurability. (Hua Tuo stated: A patient grasping at clothing seams cannot be saved.) Retraction of the testes and curling of the tongue are ominous signs. (Hua Tuo stated: Retraction of the testes and curling of the tongue indicate certain death.) Mouth gaping and sunken eyes indicate imminent death. (Hua Tuo stated: A mouth open like a fish's and unable to close, along with sunken eye sockets, all indicate death.) Eruption of red macules carries a five-to-one mortality rate; eruption of black macules carries a ten-to-zero mortality rate without doubt. (Macule eruptions occur when heat enters the Stomach vacuously, causing the Stomach to rot. Red macules indicate a five-to-one survival rate; black macules indicate no survival.) Lianggan Shanghan (Simultaneous involvement of Taiyang and Shaoyin meridians) is the greatest contraindication; death occurs within six days, making life irretrievable. (Zhang Zhongjing stated: Severe heat alone may not cause death, but if Lianggan Shanghan occurs, death is certain.)