陈紫山曰∶眼生赤脉贯瞳人，（水火两绝也）囟门凸起又作坑，指甲
黑色（肝绝也）。鼻干燥（肺绝），鸦声（肺绝）忽作肚青筋（脾绝），虚舌退场门（心绝），切牙齿（咬人肾绝），目多直
视不转睛，（肝绝），鱼口（脾绝），气急啼不得，（肺绝），蛔虫既出（脾胃俱绝），死形真，手足掷摇直手节，
灵丹妙剂也无生。
涂蔚生曰∶赤脉属火，瞳人属肾。赤脉贯于瞳人，乃火盛水枯，水被火克也。然赤脉其苗叶，肝肾其根本，必
根本萎败，而后始有此现象也。囟门肾之属，而肾之阴液，所以能至于囟门者，则又全赖督脉真阳之气，输达于
上。囟门凸起者，阴虚而阳无所附也。然使真阳能以久存，则其幸免之望，犹可设想。今凸起而又作坑，是阴竭
而阳亦陷，其为坏症可知矣。甲黑固属肝绝，然病非有素，设为暴得中恶霍乱等症，犹未可断其即为坏证。因感受
疫疠不正之气，或暑热之毒，每多血脉凝聚，而见甲
爪黑色也。经云∶手足为诸阳之本。然手足三阳，实根据于脏腑，脏腑之血液虚竭，则筋络无所滋养，故掷摇而有节
直也。然犹恐系猝得之中风等症，此等危症，最宜审慎。
陈紫山曰∶齿如黄豆骨气绝，一日死。面青目陷肝气绝，二日死。鼻入奇轮肺气绝，三日死。面黑耳黄呻吟肾气
绝，四日死。面上死筋心气绝，五日死。口张唇青色枯脉绝，六日死。面白四肢肿脾绝，九日死。大凡病耳足跌
肿，大小便不禁，皆死候也。忽作鸦声者大肠绝，不治。鱼口气粗，出而不返者，是肺绝，不治。肝藏血，目乃是
肝之外应，爪甲青黑，血脉不荫，及目无光彩，筋缩则两手抱头，是肝绝，不治。眼睛属肾，肾有两筋，自脊背至
脑门，贯其二睛，肾绝两目向上，目不动者，不
治。肾乃骨之主，肾绝则齿痒，切牙咬人者不治。鼻乃肺之外应，孔干黑燥，是肺绝，不治。唇乃脾之外应，唇缩而不
盖齿者，是脾绝，不治。胃主肌肤四肢，胃绝则毛发竖，手足不能收
管者，不治。四肢汗出如油，是荣卫俱绝，阴阳离，津液散，四肢如粘胶者不治。头偃于后，天柱骨痿，心绝，颈
骨不载，不治，或以为五软非也。心主血，舌乃心之外应，舌短则语不明，心绝则血不流行，身不温暖，及囟门凸
起，或陷作坑，目多直视，是皆不治。饮食不歇，是肺胃俱绝，其水直下大肠中去，必死。痢如死鹅血者是心绝，
或臭秽如糟汤血水者不治。凡有顽涎退场门鼻者是风痰，以塞关窍，血脉不行，不纳汤药者不治。心寒者脉绝也，故
令肺胀不治。喉如曳锯，口吐白沫，是风痰闭窍，面色青黑，五孔干燥不治。
以上诸症，是脏腑俱败，荣卫相离，气脉不生，皆不治之症。同有其症而救之，十或一二者也。
涂蔚生曰∶鼻入奇轮，究系何状，义未详，当缺以待考。面黑者为水被火克，血质败绝而现余烬，如物质被焚，
只见其焦黑之色也。口属于脾，口张即是鱼口，脾绝之征，非脉绝与肺绝也。眼本肝系，而瞳人则属于肾，若谓肾
有二系贯睛则误。唇虽为脾所属，然上唇之人中，则为督脉结穴，下唇之承浆，则为任脉结穴。若上唇缩而口开，则
督脉绝，下唇缩而口张则任脉绝，俱非脾绝者也。至头偃于后，在平时则为五软，若在大病久病之后，则为督脉绝，
因脊属于督，而肾阳则假督脉贯脊髓以上行也。
Chen Zishan said: When red vessels penetrate the pupil, (this indicates the severance of Water and Fire) when the fontanelle protrudes and then sinks into a pit, and when the fingernails turn black (this indicates the exhaustion of Liver Qi). Dryness of the nose (indicates exhaustion of Lung Qi), sudden onset of a crow-like voice (indicates exhaustion of Lung Qi), sudden appearance of green veins on the abdomen (indicates exhaustion of Spleen Qi), a flaccid tongue retreating towards the anus (indicates exhaustion of Heart Qi), teeth grinding or biting (indicates exhaustion of Kidney Qi), eyes staring straight without moving (indicates exhaustion of Liver Qi), "fish mouth" (indicates exhaustion of Spleen Qi),急促 breathing with inability to cry out (indicates exhaustion of Lung Qi), expulsion of roundworms (indicates exhaustion of both Stomach and Spleen Qi). These are true signs of death; if the limbs thrash and shake with joints extending straight, even miraculous elixirs cannot save them.
Tu Weisheng said: Red vessels belong to Fire, and the pupils belong to the Kidney. When red vessels penetrate the pupils, it signifies excessive Fire and depleted Water, where Water is overcome by Fire. However, the vessels are the sprouts and leaves, while the Liver and Kidney are the roots. Only when the roots wither and fail will such phenomena appear. The fontanelle belongs to the Kidney. The reason why Yin fluids of the Kidney can reach the fontanelle is entirely dependent on the True Yang Qi of the Du Meridian transporting it upwards. Protrusion of the fontanelle indicates Yin deficiency with Yang having no attachment. If True Yang could persist for long, there would still be hope for survival. Now, since it protrudes and then becomes a pit, this indicates exhaustion of Yin and sinking of Yang, which confirms it as a deteriorated condition. Black nails certainly indicate exhaustion of Liver Qi. However, if the illness was not pre-existing, but rather a sudden onset of conditions like Zhong'e (acute poisoning/collapse) or Huoluan (cholera), one cannot immediately conclude it is a deteriorated condition. Contracting pathogenic Qi from epidemics or toxic heat from summer-heat often causes blood vessels to coagulate, resulting in black nails and claws. The Classics state: The hands and feet are the root of all Yang meridians. However, the three Yang meridians of the hands and feet are actually rooted in the Zang-Fu organs. When the blood and essence of the Zang-Fu organs are exhausted, the sinews and collaterals lack nourishment, causing thrashing, shaking, and stiff joints. Nevertheless, one must fear that this might be a sudden onset of stroke or similar conditions; such critical symptoms require utmost prudence.
Chen Zishan said: Teeth becoming loose like soybeans indicates exhaustion of Bone Qi, leading to death within one day. Cyan complexion and sunken eyes indicate exhaustion of Liver Qi, leading to death within two days. Nostrils collapsing inward ("Qi Lun") indicates exhaustion of Lung Qi, leading to death within three days. Black complexion, yellow ears, and groaning indicate exhaustion of Kidney Qi, leading to death within four days. Dead tendons appearing on the face indicate exhaustion of Heart Qi, leading to death within five days. Open mouth, cyan and withered lips, and exhaustion of Pulse indicate death within six days. White complexion and swollen limbs indicate exhaustion of Spleen Qi, leading to death within nine days. Generally, swelling of the ears, feet, and ankles during illness, along with incontinence of urine and feces, are all signs of impending death. Sudden onset of a crow-like voice indicates exhaustion of Large Intestine Qi, which is untreatable. "Fish mouth" with rough breathing where air exits but does not return indicates exhaustion of Lung Qi, which is untreatable. The Liver stores Blood, and the eyes are the external manifestation of the Liver. Cyan-black nails, lack of blood nourishment, dull eyes, and contracted sinews causing the hands to clutch the head indicate exhaustion of Liver Qi, which is untreatable. The eyes belong to the Kidney. There are two sinews of the Kidney running from the spine to the forehead, penetrating the two eyes. Upward deviation of the eyes with immobility indicates exhaustion of Kidney Qi, which is untreatable. The Kidney governs bones. Itching teeth and grinding/biting indicate exhaustion of Kidney Qi, which is untreatable. The nose is the external manifestation of the Lung. Dry, black, and crusted nostrils indicate exhaustion of Lung Qi, which is untreatable. The lips are the external manifestation of the Spleen. Retracted lips unable to cover the teeth indicate exhaustion of Spleen Qi, which is untreatable. The Stomach governs skin, muscles, and limbs. Upright hair and inability to control the limbs indicate exhaustion of Stomach Qi, which is untreatable. Oily sweat on the limbs indicates exhaustion of Ying and Wei Qi, separation of Yin and Yang, dispersion of Jin-Ye fluids, and sticky limbs, which is untreatable. Head retracted backwards, withering of the Tianzhu bone (neck), and inability of the cervical vertebrae to support the head indicate exhaustion of Heart Qi, which is untreatable. Some consider this "Wu Ruan" (Five Softnesses), which is incorrect. The Heart governs Blood, and the tongue is its external manifestation. Short tongue and unclear speech indicate Heart issues; exhaustion of Heart Qi leads to stagnant blood, cold body, protruding or sunken fontanelle, and fixed staring eyes, all of which are untreatable. Unceasing eating/drinking indicates exhaustion of both Lung and Stomach Qi, with fluids passing directly to the Large Intestine, leading to certain death. Dysentery resembling dead goose blood indicates exhaustion of Heart Qi; foul-smelling dysentery like dregs or bloody water is untreatable. Phlegm mucus exiting the anus and nostrils indicates Wind-Phlegm blocking the orifices, obstructing blood flow, and inability to accept decoctions, which is untreatable. Cold Heart indicates exhaustion of Pulse, leading to Lung distension, which is untreatable. Sawing sound in the throat and frothy saliva indicate Wind-Phlegm blocking the orifices; cyan-black complexion and dry orifices are untreatable.
All the above symptoms indicate total failure of Zang-Fu organs, separation of Ying and Wei, and cessation of Qi and Pulse generation; they are all untreatable conditions. Among those presenting these symptoms who receive treatment, only one or two out of ten may survive.
Tu Weisheng said: Regarding "Nostrils collapsing inward ('Qi Lun')", the exact appearance is unknown, so the meaning remains obscure and should be left for future verification. A black complexion results from Water being overcome by Fire, causing blood quality to fail and leave behind embers, similar to burnt material showing only charred black color. The mouth belongs to the Spleen; an open mouth is "Fish Mouth," a sign of Spleen Qi exhaustion, not Pulse or Lung exhaustion. The eyes are inherently linked to the Liver, while the pupils belong to the Kidney; therefore, claiming the Kidney has two systems penetrating the eyeballs is erroneous. Although lips belong to the Spleen, the Renzhong point on the upper lip is the convergence point of the Du Meridian, and the Chengjiang point on the lower lip is the convergence point of the Ren Meridian. If the upper lip retracts and the mouth opens, it indicates exhaustion of the Du Meridian; if the lower lip retracts and the mouth opens, it indicates exhaustion of the Ren Meridian; neither is Spleen exhaustion. As for the head retracted backwards, in normal times it refers to "Wu Ruan" (Five Softnesses), but after severe or chronic illness, it indicates exhaustion of the Du Meridian, because the spine belongs to the Du, and Kidney Yang travels up through the Du Meridian via the spinal cord.