如至四五六日，狂言直视，小便遗失者，肾绝也。直视摇头，形体甚黑者，肾克
火而心绝也。大小肠痛极者，小肠为心腑，大肠为肺腑，火克金而肺将绝，因乃汗出如
油，喘而不休矣。爪甲青黑，不知人事，面青作搐，舌卷囊缩者，肝绝也。大便似死血
甚黑者，或水谷不化，药食直下，环口黧黑，唇反者，脾绝也。伤寒以阳为主，如手
冷如冰，足冷过膝，皮肉 动，自汗无度，是阳已脱也。阳先绝色青，阴先绝色赤，并
为不治。若头重视身，天柱骨倒，元气已败，必死。大便浊气极臭者，死。阴阳毒过
六七日者，死。但欲寐，息高，死。汗油发润，喘不休，死。尺寸俱虚热不止者，死。
大发湿家汗则痉，热而痉者，死。目睛正圆者，死。卵缩入腹，脉见离经者，死。瘥后
小便涩有血，名内外疮。若黑靥不出脓者，死。热盛躁急不得汗出，是阳脉极，死。舌
上黑苔，生芒刺，刮不去易生者，死。鼻衄自汗者，死。胃寒发呃，丁香、茴香、柿蒂
良姜汤调服。如脉不出，加胆汁合生脉散，其脉又出，或暴出者，皆死。大肉脱去者，死。
凡胸膈赤肿疼痛，头疼身痛，发热恶寒，此名赤膈伤寒，宜防荆败毒散，加栝蒌
子、黄连、寅芩、紫金皮、玄参、赤芍、升麻、白芷。如症有表复有里，胸膈赤肿疼痛
者，防风通圣散加栝蒌子、黄连、紫金皮。如表症已退，大便燥实，胸膈肿痛者，凉膈
解毒，加栝蒌子、枳壳、桔梗、紫金皮、赤芍药；又宜棱针刺肿处出血。如半表半里，
胸膈肿痛者，柴胡枳桔汤，加栝蒌子、柴金皮、赤芍药。
If, by the fourth, fifth, or sixth day, the patient exhibits incoherent speech, fixed staring gaze, and urinary incontinence, this indicates the exhaustion of Kidney Qi (Shen Jue). If the eyes are fixed with head shaking and the body appears dark/black, it signifies that Kidney Water (Shui) overacts on Heart Fire (Huo), leading to the exhaustion of Heart Qi (Xin Jue). Severe pain in the large and small intestines: since the Small Intestine is the Fu organ of the Heart and the Large Intestine is the Fu organ of the Lung, Metal being controlled by Fire leads to the impending exhaustion of Lung Qi (Fei Jue), followed by sweat like oil and unceasing panting. Cyanotic and black nails, loss of consciousness, bluish complexion with convulsions, curled tongue, and retracted scrotum indicate the exhaustion of Liver Qi (Gan Jue). Stool resembling clotted blood, very dark; or undigested food and water passing directly through; darkening around the mouth and everting lips indicate the exhaustion of Spleen Qi (Pi Jue). In Shanghan (Cold Damage) disease, Yang Qi is paramount. Cold hands and feet like ice, coldness extending past the knees, twitching of skin and muscles, and profuse spontaneous sweating indicate the collapse of Yang Qi (Yang Tuo). Exhaustion of Yang first manifests as a bluish complexion; exhaustion of Yin first manifests as a reddish complexion; both are incurable. If the head is heavy and cannot be lifted, and the Tianzhu bone (cervical support) collapses, Yuan Qi (Original Qi) has failed, and death is certain. Extremely foul-smelling turbid stool indicates death. Yin-Yang Du (Poison) persisting beyond six or seven days indicates death. Somnolence and high-pitched respiration indicate death. Sweat like oil, moist hair, and unceasing panting indicate death. Deficient pulses at both Cun and Chi positions with unremitting fever indicate death. Profuse sweating in damp-pattern patients leading to Jing (Spasm); heat combined with Jing spasm indicates death. Eyes fixed straight forward indicate death. Testes retracting into the abdomen and pulse deviating from its normal channel pattern indicate death. After recovery, painful urination with blood, termed Neiwai Chuang (Internal and External Sores): if black crusts form without pus discharge, it indicates death. Excessive heat with irritability and inability to sweat indicates extreme excess of Yang pulses, which is fatal. Black coating on the tongue with prickles that cannot be scraped off and regenerate easily indicates death. Epistaxis accompanied by spontaneous sweating indicates death. Hiccups due to Stomach Cold can be treated with Dingxiang, Huixiang, Shidi, and Liangjiang Tang (Clove, Fennel, Persimmon Calyx, and Galangal Decoction). If the pulse is imperceptible, add Gallbladder bile combined with Shengmai San (Generate Pulse Powder); if the pulse returns, or suddenly surges forth, these are all signs of death. Emaciation with severe muscle wasting indicates death.
Whenever there is redness, swelling, and pain in the chest and diaphragm, headache, body ache, fever, and aversion to cold, this is named Chige Shanghan (Red Diaphragm Cold Damage). It is appropriate to use Fangjing Baidu San (Saposhnikovia and Angelica Decoction for Resolving Toxins) added with Gualouzi (Trichosanthes Seed), Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Zijianpi (Bark of Ziziphus Spinosa), Xuanshen (Scrophularia Root), Chishao (Red Peony Root), Shengma (Cimicifuga Rhizome), and Baizhi (Angelica Dahurica). If symptoms present both exterior and interior aspects, with redness, swelling, and pain in the chest and diaphragm, use Fangfeng Tongsheng San (Saposhnikovia and Magnolia Decoction for Unblocking the Interior) added with Gualouzi, Huanglian, and Zijianpi. If the exterior syndrome has resolved, but the stool is dry and solid, with swelling and pain in the chest and diaphragm, employ Liangge Jiedu (Cooling the Diaphragm and Resolving Toxins) method, adding Gualouzi, Zhike (Aurantium Fruit), Jiegeng (Platycodon Root), Zijianpi, and Chishao; additionally, it is suitable to puncture the swollen area with a three-edged needle to bleed. If the condition is in the half-exterior half-interior stage, with swelling and pain in the chest and diaphragm, use Chaihu Zhijie Tang (Bupleurum and Aurantium Decoction) added with Gualouzi, Chaijinpi (Bark of Bupleurum), and Chishao.