生死之决于脉症者，内经垂训，甚明备矣。而佐以验舌，则尤显而易见也。故并撮素所经验者，附载于
此，以为临症一助。
一、舌如去膜猪腰子者，危。
一、舌如镜面者，危。
一、舌糙刺如沙皮，而干枯燥裂者，危。
一、舌敛束如荔子肉，而绝无津液者，危。
一、舌如火柿者，危。
一、舌如烘糕者，危。
一、舌光无苔，胃气绝也，不治。
一、舌卷而囊缩者，不治。
一、舌本强直，转动不活，而语言蹇涩者，危。
一、舌起白苔如雪花片者，脾冷而闭也，不治。
一、舌因误服芩连，而现出人字纹者，不治。
以上所列，皆垂死危候也。然有不必如此而死者；有即至如此而灼见脏腑阴阳虚实，竭力挽回，则亦得生
者。吾辈果操活人神技，须存寿世婆心，即有百不一活之症，当作万有一生之想。纵使修短有数，彭殇难齐，
破格出奇，终于莫救，致招从旁浮议，同道中伤，病家归咎，然而反之吾心，固无愧也。倘畏避嫌疑，而于此
种危症，再付之庸劣之手，则必无生理矣，讵不痛哉。
上论临症以验舌为准。而验舌以浮胖坚敛分虚实，干燥滑润分阴阳，黑白青黄分脏腑。盖本至中至正之理，
以立至简至易之法。轩岐复起，当不易吾言也。至于阴阳虚实四柱，所配补泻寒热诸方，虽是为临症者举其大
略，然而无一症不从亲身经历；无一方不从亲手试验者。诚以医寄死生，只字不容率笔；理原性命，短语无可
粗心也。惟是加减出入，因病制宜，神明于规矩绳墨之中；得心应手，变化于规矩绳墨之外。运斤成风，则存
乎其人耳。而究之神明变化，仍不离夫规矩绳墨也。临症者，若知赤子元无罪，合有人间父母心。则余此一编
也，虽只望诊中之一节乎，亦未始非切脉审症之证据，回生起死之范围也。倘出厥范围，而不凭此为证据，则
恐其所操以活人者，反以杀人也已。
关于通过脉象和症状判断生死，在《黄帝内经》中已有详尽明确的教诲。如果辅以舌诊，则更加一目了然。因此，我将平日积累的经验整理附载于此，作为临床诊疗的辅助参考。
一、舌头形状像剥了膜的猪腰子，病情危重。
一、舌头表面光滑如镜子，病情危重。
一、舌面粗糙有刺，像沙皮一样，且干枯燥裂，病情危重。
一、舌头收缩紧绷像荔枝肉，且完全没有津液，病情危重。
一、舌头颜色红得像熟透的火柿，病情危重。
一、舌头颜色像烤过的糕饼，病情危重。
一、舌面光亮没有苔垢，说明胃气已绝，无法治疗。
一、舌头卷缩且阴囊收缩，无法治疗。
一、舌根僵硬挺直，转动不灵活，且说话口齿不清，病情危重。
一、舌面上出现像雪花片一样的白苔，这是脾脏寒冷导致气机闭塞，无法治疗。
一、因误服黄芩、黄连等苦寒药物，而舌面出现人字形裂纹，无法治疗。
以上所列，都是濒临死亡的危重征候。然而，也有不需要出现上述症状却死亡的情况；也有即使出现上述症状，但若能明察脏腑阴阳的虚实，竭尽全力进行抢救，也能获得生存机会的。我们行医之人，既然掌握了救人的高超技艺，就必须怀有慈悲济世之心。即使是百人中难救活一个的病症，也要抱着万分之一的希望去争取。纵然寿命长短自有定数，长寿与夭折难以等同，但如果打破常规出奇招，最终仍无法挽救，从而招致旁人的非议、同行的中伤以及病家的责怪，但反躬自省，内心应当无愧。倘若因为畏惧嫌疑，而将这类危重病症交给庸劣的医生处理，那就必定没有生路了，这难道不是令人痛心的吗？
上述论述强调临证以舌诊为准绳。而舌诊通过舌体的浮胖或坚敛来区分虚证与实证，通过干燥或滑润来区分阴证与阳证，通过黑、白、青、黄的颜色来辨别病变所在的脏腑。这本来是依据中正至理，确立极其简单易懂的方法。即使黄帝岐伯复生，也不会改变我的这些言论。至于针对阴阳虚实四柱所配伍的补泻寒热各类方剂，虽然只是为临床医生列举大概原则，但无一症不是从亲身经历得出；无一方不是从亲手试验验证。确实，医学寄托着患者的生死，每个字都不容许轻率下笔；道理关乎人的性命，简短的话语也不可以粗心大意。只是在药物的加减运用上，要根据病情灵活制宜，在规矩法度之中达到神妙境界；得心应手，在规矩法度之外产生变化。如同匠人运斧成风那样纯熟，这取决于医者个人的修养。然而究其根本，神妙变化仍然离不开规矩法度。临床医生，如果知道婴儿原本无罪（比喻患者无辜受苦），就应怀有人间父母般的慈爱之心。那么我这一篇著作，虽然只是望诊中的一小部分，也未尝不能作为切脉审症的证据，以及起死回生的范围准则。如果超出了这个范围，而不以此为证据，恐怕他们用来救人的手段，反而变成了杀人的工具。
Regarding the determination of life and death based on pulse and symptoms, the teachings of the *Neijing* (Yellow Emperor's Inner Canon) are already very clear and comprehensive. By supplementing this with tongue diagnosis, the signs become even more obvious. Therefore, I have compiled my personal experiences and attached them here to assist in clinical practice.
1. If the tongue resembles a pig kidney without its membrane, the condition is critical.
2. If the tongue surface is smooth like a mirror, the condition is critical.
3. If the tongue surface is rough and prickly like sandpaper, and dry and cracked, the condition is critical.
4. If the tongue is contracted and bundled like lychee meat, and completely devoid of fluids, the condition is critical.
5. If the tongue is red like a roasted persimmon, the condition is critical.
6. If the tongue looks like a baked cake, the condition is critical.
7. If the tongue is glossy without coating, it indicates the exhaustion of Stomach Qi (Stomach Vital Energy), which is incurable.
8. If the tongue is curled and the scrotum is retracted, it is incurable.
9. If the root of the tongue is stiff and straight, unable to move freely, accompanied by slurred speech, the condition is critical.
10. If white coating appears on the tongue like snowflakes, it indicates Spleen Cold and closure of Qi mechanisms, which is incurable.
11. If a human-character-shaped crack appears on the tongue due to the mistaken administration of Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma), it is incurable.
The above listed conditions are all terminal critical signs. However, there are cases where patients die without exhibiting such signs; and there are cases where, despite reaching such a state, if one can clearly discern the deficiency or excess of Yin and Yang in the Zang-Fu organs and strive with all efforts to rescue the patient, survival is possible. We practitioners, possessing the divine skill to save lives, must harbor a compassionate heart for saving the world. Even for diseases where only one in a hundred might survive, we should entertain the hope that one in ten thousand will live. Although longevity and lifespan are predetermined, and long life cannot be equated with early death, if we break conventions and use extraordinary measures but ultimately fail to save the patient, thereby attracting criticism from bystanders, slander from colleagues, and blame from patients' families, yet upon introspection, our conscience remains clear. If, out of fear of suspicion, we hand over such critical cases to incompetent physicians, there will certainly be no chance of survival, which is truly painful.
The above discussion emphasizes that clinical judgment should rely primarily on tongue diagnosis. Tongue diagnosis distinguishes deficiency from excess based on whether the tongue is swollen/flaccid or firm/contracted; distinguishes Yin from Yang based on whether it is dry or slippery; and identifies the affected Zang-Fu organs based on black, white, green, or yellow colors. This is based on the most central and upright principles, establishing the simplest and easiest methods. Even if Xuanyuan (Yellow Emperor) and Qibo were to rise again, they would not change my words. As for the various formulas for tonifying, purging, warming, and clearing heat matched to the four pillars of Yin-Yang and Deficiency-Excess, although these are merely general outlines for clinicians, every symptom described comes from personal experience, and every formula has been personally tested. Indeed, medicine entrusts life and death; not a single word should be written carelessly. Principles concern human life; short phrases should not be treated lightly. However, in the addition, subtraction, and modification of treatments, one must adapt to the disease, achieving divinity within the rules and regulations, and mastering skills to bring about changes beyond the rules. The ability to wield the axe like wind depends on the individual. Ultimately, however, divine changes still do not depart from the rules and regulations. Clinicians, knowing that infants are originally innocent (symbolizing patients suffering innocently), should possess the heart of parents in the human world. Thus, this compilation of mine, though only a section of observation (Wang Zhen), may well serve as evidence for pulse-taking and symptom examination, and as a scope for reviving the dead. If one goes beyond this scope and does not rely on it as evidence, the methods used to save people may instead become tools for killing them.