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Zilu asked about death, and the Sage instructed him to first understand life. Understanding that one is born from non-existence implies that one must die into existence; life arises suddenly, death departs suddenly; life forms gradually, death fades gradually. With life, all things are present, nothing is lacking; with death, everything vanishes, leaving nothing. At birth, one seems close to death (as in the womb); at death, one still appears close to life but is实质上 dead. Having lived, one is contrary to death; having died, one is contrary to life. This is why the Sage said, "If you do not yet understand life, how can you understand death?"

Physicians manage human life and death; they must first recognize the principles of life and death, and specifically understand the mechanisms of why people die, before they can comprehend why people live. Only then can their use of medicine be sufficient to revive the seemingly dead and restore life. There are many methods to identify impending death. Zhu Xi stated, "When Qi gathers, there is life; when Qi scatters, there is death," which serves as a concise summary. For instance: if a patient has rapid, uncontinuous breathing, the Qi has scattered; if breathing resembles fish gills opening and closing roughly, the Qi has scattered; spontaneous sweating like rain indicates Qi scattering with sweat; severe vomiting and diarrhea indicate Qi scattering with these evacuations; spontaneous diarrhea with urinary incontinence, hematemesis, or loss of essence also indicate Qi scattering. Qi belongs to Yang; when Qi scatters, it transitions from Yang to Yin. The dead belong to Yin; after death, one becomes a "Gui" (Ghost), where "Gui" means "return," referring to the spirit of Yin.

Generally, if a patient sleeps all day without speaking, speaks without voice, prefers darkness and dislikes light, has a dull complexion with the head turned inward, cold hands and feet, eyes closed as if seeing ghosts, lackluster eyes, abstains from food, these phenomena all approximate Yin and are omens of death. Regarding determining death through complexion and pulse, the *Huangdi Neijing* (Yellow Emperor's Inner Canon) and *Nanjing* (Classic of Difficult Issues) discuss this in detail, but the meaning is profound and language obscure, so physicians often fail to fully grasp it. Now, I will briefly summarize: generally, those with abnormal temperament die; men and women who lose shame die; those without a pulse die; those with a pulse resembling a swimming fish or shrimp die; those with a frantic pulse die; those with a very rapid pulse (8-9 beats per respiration cycle) die; those with a very slow pulse (1-2 beats per respiration cycle) die; those with knotted or intermittent pulses die; those showing Zang-Fu organ pulses (True Visceral Pulse) die; those with Yang syndromes presenting Yin pulses die; those without pulses at the Dizzyang and Chongyang points die; those whose post-illness pulse lacks Stomach Qi die; those whose flesh and muscles have wasted away die even if the nine pulses are harmonious. Those with a collapsed Tianzhu bone (neck spine) die; those with sunken eye sockets die; those with a green face die; those with green corners of the mouth die; those with a dark, blackish face die; those with chronic illness presenting red complexion die; those with dry, black tongue and teeth die; those with black rashes or spots die; those with staring,呆滞 eyes and lost spirit die; those with internal closure and external collapse die; those with rushing panting breath die; those suffering from major medical errors die; Yin syndromes treated with purgatives lead to death; Yang syndromes treated with sweating lead to death. Stroke patients with snoring die; those with sweat like oil die; those with relaxed hands die; those with urinary incontinence die; those with closed eyes die. In warm diseases or cholera, failure to nourish Yin adequately leads to death; failure to warm Yang adequately leads to death; cold extremities with restlessness lead to death; curled tongue and retracted testicles lead to death; groping for clothes and bed leads to death; spasms and convulsions that do not resolve lead to death. Chronic self-diarrhea leads to death; abdominal emptiness with refusal to eat leads to death; consumptive disease with hoarseness leads to death; consumptive disease with sore throat leads to death; wasting of large muscles leads to death; upper damage exceeding the middle leads to death; lower damage exceeding the middle leads to death; abdominal distension with visible form (not edema) leads to death; inability to urinate with high, formed abdominal protrusion leads to death; dysentery with persistent fever leads to death; dysentery presenting Chu Zhong syndrome (appetite returning falsely before death) leads to death; True Headache, True Heartache, and Liver Pain all lead to death. Postpartum women with internal closure die; those with wind-spasm die; those with profuse sweating die. Children with slow convulsive disease die; young males with consumption die; unmarried women with amenorrhea die. Elderly people with dysphagia (Yi Ge) die; aged people with Bei Zhang (abdominal swelling/distension) die. Carbuncles and sores sinking inward lead to death; carbuncles and sores without pain lead to death.

Generally, sweating is deficient sweating, often leading to Collapse of Yang. As long as a fraction of Yang Qi remains, death does not occur; Collapse of Yang inevitably leads to death. Upper collapse and lower collapse, Yang collapse and Yin collapse, all lead to death. Separation of Pre-heaven (Congenital) leads to death; severance of Post-heaven (Acquired) leads to death. When a person is near death, phlegm rattling in the throat is often mistakenly attributed to phlegm-saliva blocking the airway causing sudden Qi cessation; this is a major error. It is actually due to True Qi having already dispersed, with phlegm floating up with the Qi, creating sound. There are also excess syndromes where death results from Qi blockage and suffocation, such as Heatstroke, Dampness strike, Cold strike, Meridian strike, and Poisoning. After death from these causes, the body will likely turn blue-purple. This is the general overview.