眼上赤脉下贯瞳人。
池氏曰。赤脉属心。瞳人属肾。乃心火胜肾水。水干则不能生木。致肾肝皆绝故也。
囟门肿起兼及作坑。
曾氏曰。囟肿皆以为热。殊不知有阴阳二证。切宜详辨。坚硬为阴。红软
为阳。故婴孩宝书曰。寒气上冲则牢HT 。热气上冲则柔软。正此之谓。若
阴证以匀气散。理中汤主之。阳证用玉露饮。当归散。防风汤为治。玉环
集歌曰。囟门肿起定为便。此候应须也不中。或若加坑如盏足。七日之
间命必终。曾氏又曰。囟陷者。虚之极也。胃气虚寒。则囟陷。慢惊中有之。
胃寒脾困。吐泻者为虚极。急以金液丹固真阳。及诸般救元等药治之。
外贴以乌附膏。有后枕陷者。其证尤重。治法与陷囟药同。不效亦为难
疗。此大虚极。百无一活耳。
鼻干黑燥。
勿听子曰。鼻乃肺之窍。黑燥而干。是为肺绝。云岐子云。火克金也。愚曰。即所谓人病鼻如烟煤者。死也。
肚大青筋。
肚胀腹大。脾虚也。肝主筋。其色青。今肚大而现青筋。是肝木克脾土也。目多直视。睹不转睛。
热入于目。牵其筋脉。两 俱紧。不能转视。故直视也。勿听子曰。睛不能
转动而直视。是太阳已绝也。云岐子曰。经云。回则不转是也。
指甲黑色。
勿听子曰。爪甲。肝之荣。华于外者也。肝绝则不能荫。故色现黑。愚谓肝
主血。其华在爪。爪甲而现。黑色是血先死。故其色现如是。忽作鸦声。
勿听子曰。肺主气发声为言。肺既绝。故声如鸦叫。虚舌退场门。
准绳作舒舌退场门。乃心绝。并壬葵日死。或曰。舌乃心之苗。心气散。则出不得收。
啮齿咬人。
肾主骨。齿乃骨之余。虚则痒。实则痛。肾水虚竭。则无以荣养其齿。而齿痒。故欲啮齿咬人也。准绳云。咬乳戛
齿。此肾绝也。并戊己日死。又小儿欲生齿亦然。不在其例。
鱼口气急。
勿听子曰。口是脾之窍气。是肺所主。脾败而见。鱼口。肺绝而息喘急。啼不作声。
云岐子谓哭而无声。是谓肺绝。据准绳云。肝病重啼哭无泪。及病不哭下泪。乃肝绝。并庚辛日死。
蛔虫既出。必是死形。
李 范曰。蛔虫生于脾胃之间。全赖谷气以为养。故逆出于口鼻。是胃绝也。愚谓人身之有蛔虫。犹天地间之有龙
也。故蛔虫谓之人龙。夫龙何以秋冬则伏藏。而春夏则升腾也。盖以龙之性。喜暖而畏寒。秋冬则阴气在上。阳气在下。
故龙乐其暖。而伏藏于九渊。春夏则阳气在上。阴气在下。故龙畏其冷。而不能安其身。故升腾而上也，夫蛔虫亦然。
人身中之元阳足。则蛔乐其暖。以安其身。而无扰动之患。脏腑之阳气衰。而阴气盛。则蛔畏冷。而不能安其身。故逼
迫而出于口鼻之上。倘仁人用心求生于万一。切勿峻用苦寒之药。以速其亡焉可也。
用药速救。百无一生。
Red vessels appear on the eyes, extending downwards through the pupils.
Chi Shi said: Red vessels belong to the Heart (Xin), and the pupils belong to the Kidney (Shen). This indicates that Heart Fire overcomes Kidney Water. When Kidney Water is exhausted, it cannot generate Liver Wood, leading to the exhaustion of both the Kidney and Liver.
The fontanelle swells and protrudes, or even sinks into a pit.
Zeng Shi said: Fontanelle swelling is generally considered a Heat syndrome, but one must not ignore the distinction between Yin and Yang syndromes; careful differentiation is essential. Hardness indicates a Yin syndrome, while redness and softness indicate a Yang syndrome. Therefore, *Yinghan Baoshu* states: "Cold Qi rushing upward causes hardness; Hot Qi rushing upward causes softness." This is precisely what is meant. For Yin syndromes, treat with Yunqi San and Lizhong Tang as the primary formula. For Yang syndromes, use Yulu Yin, Danggui San, and Fangfeng Tang. The song in *Huanjuji* says: "Fontanelle swelling fixedly indicates stool retention; this sign should be deemed untreatable. If accompanied by a pit like a cup bottom, life will end within seven days." Zeng Shi further stated: Fontanelle depression signifies extreme deficiency. Stomach Qi deficiency and Cold lead to fontanelle depression, seen in slow convulsions. Stomach Cold and Spleen stagnation with vomiting and diarrhea represent extreme deficiency; urgently administer Jin Ye Dan to consolidate True Yang, along with various Yuan-saving medicines. Externally apply Wufu Gao. Depression at the back of the occiput indicates an even more severe condition; the treatment method is the same as for fontanelle depression. If ineffective, it is difficult to treat, representing extreme deficiency where survival is unlikely.
Nose dry and black.
Wuting Zi said: The nose is the aperture of the Lung (Fei). Blackness, dryness, and roughness indicate Lung Qi exhaustion. Yunqizi said: This is Fire overcoming Metal. I say: This refers to the case where a patient's nostrils look like soot from smoke, which is a death sign.
Abdominal distension with visible blue veins.
Abdominal distension and enlargement are due to Spleen deficiency. The Liver governs sinews, and its color is blue. Now, the abdomen is large with visible blue veins, indicating Liver Wood overcoming Spleen Earth.
Eyes staring straight ahead without moving.
Heat enters the eyes, pulling the sinews, causing both eyes to become tight and unable to turn, resulting in staring. Wuting Zi said: Eyes unable to rotate and staring straight indicates the exhaustion of the Taiyang channel. Yunqizi said: As the classics state, "reversal leads to immobility," which is exactly this.
Nails turning black.
Wuting Zi said: Nails are the flourishing aspect of the Liver, manifesting externally. When Liver Qi exhausts, it fails to nourish the nails, hence the black color appears. I believe the Liver governs Blood, and its flourishing aspect is in the nails. Black nails indicate that Blood has died first, hence the color appears thus.
Sudden crow-like voice.
Wuting Zi said: The Lung governs Qi and produces speech. Since Lung Qi is exhausted, the voice sounds like a crow's caw.
Tongue protruding out of the mouth (Changmen).
*Zhunsheng* describes it as "tongue extending out of the mouth gate," indicating Heart Qi exhaustion, with death occurring on Ren or Gui days. Some say: The tongue is the sprout of the Heart. When Heart Qi scatters, the tongue extends and cannot retract.
Teeth gnashing and biting.
The Kidneys govern bones, and teeth are the surplus of bones. Deficiency causes itching, excess causes pain. When Kidney Water is exhausted, it cannot nourish the teeth, causing itching, hence the desire to gnash teeth and bite. *Zhunsheng* states: Biting the nipple or grinding teeth indicates Kidney Qi exhaustion, with death occurring on Wu or Ji days. Additionally, infants teething may show similar signs, which are not included in this category.
Mouth open like a fish's gills, rapid breathing.
Wuting Zi said: The mouth is the aperture of the Spleen, and Qi is governed by the Lung. Spleen failure manifests as a mouth open like a fish's gill; Lung exhaustion manifests as panting breath. Crying without sound indicates Lung exhaustion according to Yunqizi. According to *Zhunsheng*: Severe Liver disease involves crying without tears, or illness with no crying and no tearing, indicating Liver Qi exhaustion, with death occurring on Geng or Xin days.
Roundworms expelled, necessarily in a dead state.
Li Fan said: Roundworms live between the Spleen and Stomach, relying entirely on grain Qi for nourishment. Thus, if they reverse and exit through the mouth or nose, it indicates Stomach Qi exhaustion. I consider roundworms in the human body akin to dragons in the world. Hence, roundworms are called "human dragons." Why do dragons hide in autumn and winter and rise in spring and summer? It is because dragons prefer warmth and fear cold. In autumn and winter, Yin Qi is above and Yang Qi is below, so dragons enjoy the warmth and hide in deep abysses. In spring and summer, Yang Qi is above and Yin Qi is below, so dragons fear the cold and cannot settle, thus rising upwards. Roundworms are the same. When the original Yang Qi in the body is sufficient, roundworms enjoy the warmth and remain settled without disturbance. When Zang-Fu Yang Qi declines and Yin Qi prevails, roundworms fear the cold and cannot settle, thus being forced out through the mouth and nose. If benevolent physicians seek salvation in a million chances, they must never harshly use bitter-cold medicines to hasten death.
Medicines administered hastily for rescue: less than one in a hundred survives.