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Whenever a child presents with swelling or depression of the fontanelle, sweating where the sweat does not flow but clings like pearls or oil, protrusion of the tongue and prolapse of the rectum (Changmen), swollen tongue accompanied by frightful crying, passage of black and dark bloody stools, hair standing erect like hemp fibers, and skin lacking luster, this indicates Heart Qi exhaustion (Xin Jue). Death will occur on Ren or Gui days. When the illness is severe, the child cries without tears, or ceases to cry but sheds tears; nails are cyanotic and black; eyes are sunken deeply; the tongue is curled and the scrotum retracted; convulsions occur with strabismus; the lips and mouth twitch; hands assume a posture as if holding the head, or the dorsum of the feet becomes rigid. As stated in *Su Wen* (Plain Questions): "Its brilliance manifests in the nails, and its substance fills the sinews." This indicates Liver Qi exhaustion (Gan Jue). Death will occur suddenly on Geng days. If the philtrum is full or black, lips are contracted or retracted backwards, lips are scorched, dry, or purple-black, lips fail to cover the teeth, there is blood swelling or hematuria, the tongue is shortened or curled, nostrils are dilated, teeth are locked (trismus) with cold saliva flowing like oil, the mouth is puckered like a purse, the complexion is earthy, limbs are cold and wet like stones, milk intake is unsuccessful, and stools are red-black, this indicates Spleen Qi exhaustion (Pi Jue). Death will occur on Jia or Yi days. If there is heat, and wheezing sounds are heard in the throat when swallowing soups, medicines, or food, it is because the Stomach is brittle and unable to nourish the Lung. This syndrome is rarely recorded in medical texts, likely due to repeated clinical verification confirming its fatal nature; it is incurable and leads to death. Eyes are fixed and bright green/cyan, asthma is unremitting, eating causes choking and coughing, phlegm and saliva block the mouth, wheezing is audible in the throat, nasal congestion is present, the nose is dry and black, lung distension and diaphragmatic obstruction occur, with sweating on the head and cold limbs, this indicates Lung Qi exhaustion (Fei Jue). Death will occur on Bing or Ding days. A black complexion with unconsciousness, black and swollen eyes, lackluster gaze, yellow-green scorched and dry earlobes, tooth loss due to malnutrition (Gan disease), sparse yellow-dry hair, black-dry skin, biting at the breast during fright-wind, grinding teeth and passing gas, and a black ring around the mouth indicate Kidney Qi exhaustion (Shen Jue). Death will occur on Wu or Ji days.

Fifteen signs of death in children: Red vessels on the upper eyelids extending downward through the pupil; swelling and subsequent depression of the fontanelle; dry and black nose; abdominal distension with visible blue veins; fixed staring eyes that do not move; black fingernails; sudden crow-like vocalization; protruding tongue with rectal prolapse; teeth grinding and biting at the corners of the mouth; rapid breathing with silent crying; expulsion of roundworms indicating a terminal state. Even with urgent medication rescue, fewer than one in ten survives. For critically ill children, sweat forming beads that adhere to the body without flowing indicates death. If all hair stands erect in an ill child, death is certain. If a child has a depressed fontanelle, dry lips, inverted eyelids, cold breath from the mouth, hanging limbs, a bound-like lying posture, and cold palms, these are untreatable conditions. In children suffering from wind-heat stroke, wheezing with shoulder movement (shoulder breathing), a slow pulse indicates survival, while a rapid pulse indicates death. In children with dysentery, a floating and large pulse accompanied by abdominal pain indicates certain death. In infants with febrile diseases, a suspended and small pulse with warm hands and feet indicates survival, while cold hands and feet indicate death.