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In the *Ling Shu: Yu Ban Pian* (Spiritual Pivot: Chapter on the Jade Tablet), the Yellow Emperor asked, "All diseases have favorable and unfavorable prognoses; may I hear about them?" Qibo replied, "Abdominal distension accompanied by fever and a large pulse is the first unfavorable prognosis; borborygmus with abdominal fullness, cold extremities, diarrhea, and a large pulse is the second unfavorable prognosis; epistaxis that does not stop, with a large pulse, is the third unfavorable prognosis; coughing with hematuria, emaciation, and a small yet forceful pulse is the fourth unfavorable prognosis; coughing, emaciation, fever, and a small and rapid pulse are called the fifth unfavorable prognosis. In such cases, death will occur within fifteen days. If the abdomen is massively distended, the four extremities are cold, there is severe emaciation, and profuse diarrhea, this is the first unfavorable prognosis; abdominal distension with hematochezia, a large pulse or an absent pulse, is the second unfavorable prognosis; coughing with hematuria, wasting of flesh, and a pounding pulse is the third unfavorable prognosis; hematemesis with chest fullness radiating to the back, and a small and rapid pulse, is the fourth unfavorable prognosis; coughing, vomiting, abdominal distension, and undigested food in the stool (canjie diarrhea), with an absent pulse, is the fifth unfavorable prognosis. In such cases, death will occur within one shichen (two hours). If physicians do not observe these conditions and proceed with acupuncture, it is called 'treating against the nature' (mistreatment)."

"Abdominal distension with fever and a large pulse indicates that pathogenic factors in both the interior and exterior are exuberant and cannot be vented; borborygmus with abdominal fullness, cold extremities, and diarrhea indicate deficiency-cold and failure of Yang Qi, while the pulse being surprisingly large suggests the external shedding of the root Yuan Qi; epistaxis that does not stop with a large pulse indicates the upward and outward shedding of solitary Yang; coughing indicates deficient fire flaming upward, and hematuria indicates the downward leakage of Yin fluids. In cases of chronic internal injury leading to emaciation, if the pulse is small and weak, it is still treatable; however, if it is small and forceful, it indicates the failure of righteous Qi and the dominance of pathogenic factors; coughing with emaciation indicates the joint failure of the Spleen and Lung, and a small and rapid pulse indicates that blood and fluids are exhausted. In such cases, death will occur within fifteen days. Five days constitute one hou (decad); three hous constitute one qi (solar term/phase). When the qi changes, the fundamental Yuan Qi of the human body is severed. Massive abdominal distension with cold extremities, severe emaciation, and profuse diarrhea indicate the failure of middle Jiao Yang Qi and the imminent exhaustion of Yuan Qi; abdominal distension with hematochezia and a surprisingly large pulse indicate damage to both Yin and Yang, the manifestation of Zang-Fu pulses (True Organ Pulses), where pulse absence signifies Qi cessation; coughing with hematuria and wasting of flesh indicate the exhaustion of Yin fluids, while a surprisingly pounding pulse indicates the impending departure of solitary Yang; hematemesis with chest fullness radiating to the back indicates rebellious pathogenic Qi, and a small and rapid pulse indicates the exhaustion of both Yin and Yang; coughing, vomiting, abdominal distension, and canjie diarrhea indicate the knotting of pathogenic factors and the failure of the root Yuan Qi, where pulse absence signifies Qi cessation. In such cases, death will occur within one shichen. The above all describe untreatable syndromes. One must familiarize oneself with them thoroughly and avoid reckless treatment, as treating them may instead invite blame and regret."

In the *Ling Shu: Wu Jin Pian* (Spiritual Pivot: Chapter on the Five Prohibitions), the Yellow Emperor asked, "What is meant by the 'Five Deprivations'?" Qibo replied, "Severe emaciation of form and flesh is the first deprivation; after massive blood loss, it is the second deprivation; after profuse sweating, it is the third deprivation; after severe diarrhea, it is the fourth deprivation; after recent childbirth and massive blood loss, it is the fifth deprivation. In all these cases, purgative methods (Xie) must not be used."

"Deprivation" refers to severe injury. When Qi and Blood are severely damaged, even if external pathogens are present, purgative methods must not be used, because purging would cause the already depleted Yuan Qi to escape further. Therefore, Zhang Zhongjing's discussions contain clauses prohibiting sweating and purging, establishing many proper methods for treatment.

The Yellow Emperor asked, "What is meant by the 'Five Unfavorable Prognoses'?" Qibo replied, "In heat diseases, the pulse should be surging and rapid but is instead quiet; after sweating, the pulse should become quiet but is instead surging and restless—this is the first unfavorable prognosis; in cases of diarrhea, the pulse is surging and large—this is the second unfavorable prognosis; in Zhuo Bi (a type of Bi syndrome characterized by heaviness and immobility), the symptoms do not shift, muscles are ulcerated, there is fever, and the pulse is absent on one side—this is the third unfavorable prognosis; due to excessive indulgence depleting the form, there is fever, a sallow white complexion, and subsequent severe hematochezia—this is called the fourth unfavorable prognosis; in cases of alternating chills and fever with emaciation, the pulse is firm and pounding—this is called the fifth unfavorable prognosis."

"In heat diseases, the pulse should be surging and rapid but is instead quiet, indicating the failure of Yuan Qi while pathogenic heat remains; after sweating, the pulse should be quiet but is instead surging and restless, indicating that essence has retreated while pathogens have gained strength; in diarrhea, Qi sinks, so the pulse should be small and weak but is instead surging and large, indicating the collapse of the root; in Zhuo Bi with immobility, Qi and Blood are stagnant; with muscle ulceration and fever, Earth (Spleen) fails and Yin fluids dry up, hence the pulse is absent on one side, indicating that Qi and Blood do not circulate fully throughout the body; prolonged pathogenic invasion damages the form, and with fever and a sallow white complexion, both Yin and Yang are damaged; furthermore, severe hematochezia exhausts the root Yuan Qi; when alternating chills and fever accompany emaciation, Ying and Wei, Yin and Yang are all injured, and a firm, pounding pulse indicates the manifestation of Zang-Fu pulses devoid of Stomach Qi. Therefore, all these are fatal signs of the Five Unfavorable Prognoses."