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[Song on Fatal Signs and Days] (14th)

When the pustules first appear, if the crown of the head is sunken and connected to surrounding red skin, death occurs by the ninth day. If blood spots with a reddish-purple hue appear, such macular eruptions are fatal within six days. Pustules that turn black may cause death within hours; those that turn green lead to immediate demise. If there is no pus accompanied by itching, the duration is limited to two days; without treatment, lower back pain and rigid extension of the trunk occur. The rash resembles miliaria or silkworm eggs; if the tongue curls and the scrotum retracts, vital energy is depleted. If puncturing purple blisters yields black blood, accompanied by difficulty in eating/drinking and throat obstruction, these are ominous signs. Facial swelling with non-elevated pustules, green-black depressed pustules without pus, free passage of urine and stool but excretion of intestinal filth, combined with vomiting, diarrhea, and expulsion of roundworms, warm head with cold feet, and preference for drinking water, along with convulsions preceding medication which is difficult to administer, indicate severe conditions. Shortness of breath, diarrhea, unquenchable thirst, and lack of spirit in the eyes indicate impending death. Hoarseness, loss of voice, crying, and screaming indicate that even if the pustule color is good, survival is unlikely. Some cases of rapid breathing are also difficult to treat; if mistakenly diagnosed as wind-cold and treated with drenching methods, seeing these signs requires administering Shen Su Yin (Ginseng and Perilla Decoction) to revive the patient.

1. During the initial fever stage, if there is no high fever, or the fever fluctuates, with clear spirit, moist lips and nose, no lower back or abdominal pain, normal diet throughout, solid stools, clear urination, and no other mixed symptoms, this is auspicious; no medicine is needed.

2. At the onset of heat, if convulsions occur once or twice and then stop, this indicates the eruption originates from the Heart Meridian, which is an auspicious sign; no treatment is required. However, if convulsions are severe and persistent, occurring three to five times daily or continuously over several days, with numerous and dense pustules, this is an ominous sign.

3. During the initial fever, if vomiting and diarrhea are mild and cease quickly, this is auspicious.

4. During the main fever stage, if sudden profuse sweating occurs, and after sweating stops the pulse becomes slightly calm, this is auspicious.

5. During the initial fever, if a piece of red paper dipped in sesame oil is used to illuminate the area, and rose-red patches appear on the chest or all over the body, death will occur after eight or nine days.

6. If one day after fever onset, pustules appear all over the body densely like silkworm eggs and feel smooth to the touch, death is certain.

7. During fever, if there is severe abdominal pain and lower back pain as if beaten by a staff, persisting until the eruption phase, death is certain.

8. During fever, if a patch of red like rouge appears on the head and face, death will occur after eight or nine days.

9. During fever, if bleeding occurs from the mouth, nose, or both urine and stool, death is imminent.

10. During fever, if delirium, incoherent speech, and unconsciousness occur, death ensues.

11. During fever, if abdominal distension and pain occur with incessant screaming, death ensues.

12. Within three days of the main fever, if the fever does not subside but instead causes irritability, restlessness, and inability to sit or lie comfortably, indicating internal heat despite external coolness. If cold extremities, abdominal distension, and wheezing are observed, death follows immediately. For all the above conditions, no treatment is necessary.