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Tao Jie'an stated: In the diagnosis of Shanghan (Cold Damage), it is crucial to identify the terminal syndromes and terminal pulses of each meridian. One must thoroughly understand them one by one to avoid confusion during clinical practice. Whenever a terminal syndrome is observed, the pulse should be consulted for confirmation. If there is any doubt, medication must not be administered. Even if close relatives plead earnestly, treatment should not proceed; otherwise, if an error occurs, the blame will fall upon the physician.

1. A floating and surging pulse, with sweat resembling oil on the body, continuous panting, inability to take fluids or food, numbness of the body, and alternating periods of calmness and chaos indicate the exhaustion of life force. Sweat causing hair to become moist, accompanied by continuous panting, indicates the exhaustion of Lung Qi. A complexion dark as soot, with fixed staring eyes and head shaking, indicates the exhaustion of Heart Qi. Cyanosis around the lips and mouth, with tremors in the four limbs, indicates the exhaustion of Liver Qi. Blackening around the mouth, cold sweat, and yellowish discoloration indicate the exhaustion of Spleen Qi. Incontinence of urine and feces, delirious speech, and upward-gazing fixed eyes indicate the exhaustion of Kidney Qi.

2. In Shaoyin disease, characterized by aversion to cold, curling up of the body, diarrhea, and cold reversal of the hands and feet, the condition is incurable. In Shaoyin disease, with vomiting, dysentery, restlessness, and cold reversal of the four limbs, death ensues. In Shaoyin disease, with cold reversal, curling up of the body, absence of pulse, and restlessness without irritability, death ensues. In Shaoyin disease, after six or seven days, shallow and rapid breathing (high respiration) indicates death. In Shaoyin disease, after five or six days, spontaneous diarrhea, restlessness, and inability to lie down and sleep indicate death. In Shaoyin disease, with dysentery, cold reversal, and absence of pulse, if the pulse becomes slightly continuous after taking medicine, there is hope for survival; if the pulse suddenly bursts forth, death ensues. In Shaoyin disease, presenting only with cold reversal and no sweat, forcing sweating will inevitably disturb the blood, causing bleeding from unknown pathways, either from the mouth and nose or from the eyes. This is termed "Lower Cold and Upper Exhaustion" and is difficult to treat.

3. Yin diseases manifesting Yang pulses indicate survival; Yang diseases manifesting Yin pulses indicate death. A purely wiry pulse indicates death. When pulses at the Yin and Yang positions are both deficient, and fever persists, death ensues. When pulses at the Yin and Yang positions are both excessive, accompanied by profuse sweating and unresolved fever, death ensues. Cold reversal of the hands and feet, a deep and fine pulse, and delirious speech indicate death. When both pulse and symptoms are deficient, yet delirium appears, death ensues. In Shanghan, after six or seven days, with a faint pulse, cold reversal of the hands and feet, and irritability, if Moxibustion applied to the Jueyin meridian does not reverse the cold, death ensues. An inch pulse that does not reach the Guan position upwards is called Yang Exhaustion; a cubit pulse that does not reach the Guan position downwards is called Yin Exhaustion. All these are incurable and lead to certain death. In Shanghan with dysentery, occurring more than ten times a day, if the pulse is unexpectedly solid, death ensues.

4. In Shanghan, if there is a pre-existing mass (Pi Qi) under the hypochondrium connected to the side of the umbilicus, with pain radiating to the lower abdomen and yin sinews, this is named Zang Jie (Organ Knotting) and leads to death. Fever, dysentery, cold reversal, and restlessness preventing lying down indicate death. Fever, severe dysentery, and unceasing cold reversal indicate death. Fixed staring eyes, delirium, and wheezing/fullness indicate death; if accompanied by dysentery, it also indicates death. Dysentery accompanied by fever also indicates death. Fever with cold reversal lasting seven days, accompanied by dysentery, is difficult to treat. In Shanghan, after six or seven days, fever with diarrhea and unceasing sweating indicates death, due to the presence of Yin without Yang. If Yang Qi exhausts first and Yin Qi exhausts later, it is a Yin syndrome; after death, the body color will be blue. If Yin Qi exhausts first and Yang Qi exhausts later, it is a Yang syndrome; after death, the body color will be red, with warmth in the axillae and heat in the epigastrium.

The *Jingui Yaolue* states: When the Qi of the Six Fu Organs exhausts externally, the hands and feet become cold; when the Qi of the Five Zang Organs exhausts internally, uncontrollable diarrhea occurs. Generally, fever in Shanghan indicates excessive pathogenic factors alone. If dysentery is severe and cold reversal persists, it means the pathogens have not resolved, and the Qi of the Fu and Zang organs has exhausted first, leading to death.

The *Lingshu · Re Bing Pian* (Spirit Pivot · Chapter on Heat Diseases) states: There are nine conditions in Heat Diseases where acupuncture is contraindicated: First, no sweat, redness of the cheekbones, and hiccups indicate death. Second, diarrhea with severe abdominal fullness indicates death. Third, unclear vision with persistent fever indicates death. Fourth, fever with abdominal fullness in the elderly and infants indicates death. Fifth, no sweat, vomiting, and hematochezia indicate death. Sixth, ulceration of the tongue base with persistent fever indicates death. Seventh, cough with epistaxis, no sweat, or sweat that does not reach the feet indicates death. Eighth, Marrow Heat indicates death. Ninth, Heat Disease with spasms indicates death, characterized by opisthotonos, convulsions, and clenched teeth.