伤寒死证阳见阴，大热不止脉失神，阴毒阳毒六七日，色枯声败死多闻。心绝烟熏
阳独留，神昏直视及摇头。环口黧黑腹满利，柔汗阴黄脾败由。肺绝脉浮而无胃，汗出如
油喘不休。唇吻反青肢冷汗，舌卷囊缩是肝忧。面黑齿长且枯垢，溲便遗失肾可愁。水
浆不入脉代散，呃逆不已命难留。大发风温而成痉，湿温重 促命终。强发少阴动经血，
口鼻目出厥竭名。汗后狂言不食热，脉躁阴阳交死形。厥冷不及七八日，肤冷而躁暂难
宁，此病名之曰脏厥，厥而无脉暴出凶，厥
而下利当不食，反能食者名除中。
【注】病有生死，治有难易。生病不药可愈，死病虽药莫救，何则？以阴阳邪正有盛
衰也，正盛邪衰则生，阴盛阳衰则死。伤寒阳证，见浮大数动滑之阳脉，则易愈而生，见
沉微涩弱弦之阴脉，则难治而死。故阴病见阳脉者生，阳病见阴脉者死也。大热不止，邪
盛脉失神正虚，正虚邪盛，故死也。阴毒阳毒，亢极不生化也。色枯声败，内外两夺也，
故均主死。形若烟熏，神昏直视摇头者，此阳邪独留，攻心而绝也。环口黧黑，腹满下
利不止，柔汗阳黄者，此为脾绝也。脉但浮无胃，汗出如油，喘息不休者，此为肺绝也。
唇吻反青，四肢冷汗，舌卷囊缩，此为肝绝也。面黑齿长枯垢，溲便遗失者，此为肾绝
也，水浆不入，生无所赖也。脉代散，真气衰散也。呃逆无休，元气不藏也。误发风温
之汗，因而成痉。误发湿温之汗，名曰重 ，皆促人命也。强发少阴汗，动其经血，从口
鼻目出，名曰下厥上竭。以上皆死之候也。汗后狂言不食，仍复发热，不为汗衰，脉躁疾
者，名曰阴阳交，死之形也。厥逆不回，至七、八日即通，身肤冷而躁，无暂宁时者，名
为脏厥，为阴邪盛极，真阳飞越也，凡厥逆而甚者，多无脉，服四逆、白通等汤，脉微
续者，真阳渐复也，脉暴出者，回光反照也。凡厥逆多下利，当不能食，今反能食，名曰
除中。中者，胃也，除者，去也，谓胃气已去，即反能食，亦无补于胃也。故仲景曰∶除
中者死。凡诸病久不能食，忽然大能食而即死者，亦此类也。
伤寒死证中，阳证出现阴脉，高热持续不退且脉象失去神气，阴毒与阳毒病至六七日，面色枯槁、声音嘶败，多预示死亡。心绝表现为面色如烟熏般晦暗而阳气独留，神志昏迷、两眼直视及头部摇动。环口周围发黑、腹部胀满伴下利不止，以及冷汗出（柔汗）和阴黄，皆由脾脏败坏所致。肺绝表现为脉象浮取而无胃气，汗出如油且喘息不停。嘴唇吻部反青、四肢冰冷出汗、舌头卷缩及睾丸上缩，是肝脏忧危之象。面色黧黑、牙齿显得长且干枯垢秽、大小便失禁，是肾脏可忧之征。水浆不能入口、脉象代散、呃逆不止，生命难以挽留。大发风温之汗而成痉病，湿温病重者促使命终。强行发少阴经之汗导致动血，血液从口、鼻、目而出，称为厥竭（或下厥上竭）。发汗后出现狂言、不进食且发热，脉象躁疾，此为阴阳交，属死证形态。厥冷超过七八日，全身皮肤寒冷且躁动不安，暂时难以平静，此病名为脏厥；厥逆而无脉，若脉象突然暴出则凶险；厥逆而下利本不应进食，若反而能进食，名为除中。
【注】疾病有生死之分，治疗有难易之别。生病若不药可愈，死病虽用药亦难救治，为什么呢？因为阴阳邪正有盛衰之分，正气盛而邪气衰则生，阴气盛而阳气衰则死。伤寒阳证，若见浮、大、数、动、滑等阳脉，则易愈而生；若见沉、微、涩、弱、弦等阴脉，则难治而死。所以阴病见阳脉者生，阳病见阴脉者死。高热持续不退，是邪气盛而脉象失神、正气虚的表现，正气虚而邪气盛，故主死。阴毒与阳毒，是亢极而不能生化所致。面色枯槁、声音嘶败，是内外精气两夺，故均主死。形体如烟熏，神志昏迷、两眼直视、摇头，这是阳邪独留，攻心而致心绝。环口发黑，腹部胀满、下利不止，冷汗出、阳黄，这是脾绝。脉象但浮无胃气，汗出如油，喘息不休，这是肺绝。嘴唇吻部反青，四肢冷汗，舌卷囊缩，这是肝绝。面色黑，牙齿长且枯垢，大小便失禁，这是肾绝。水浆不入，说明生机无所依赖。脉象代散，说明真气衰散。呃逆不休，说明元气不藏。误发风温之汗，因而成痉。误发湿温之汗，名为重暍，皆促人命。强行发少阴汗，动其经血，从口鼻目出，名为下厥上竭。以上皆为死候。发汗后狂言不食，仍复发热，不为汗衰，脉躁疾者，名为阴阳交，是死之形也。厥逆不回，至七八日即通，身肤冷而躁，无暂宁时者，名为脏厥，为阴邪盛极，真阳飞越也。凡厥逆而甚者，多无脉，服四逆汤、白通汤等，脉微续者，是真阳渐复也；脉暴出者，是回光返照也。凡厥逆多下利，当不能食，今反能食，名为除中。中者，胃也；除者，去也。谓胃气已去，即反能食，亦无补于胃也。故仲景曰：除中者死。凡诸病久不能食，忽然大能食而即死者，亦此类也。
In the fatal syndromes of Cold Damage (Shanghan), when Yang syndromes present with Yin pulses, persistent high fever accompanied by a pulse lacking spirit indicates death. For Yin Poison and Yang Poison, if symptoms persist for six to seven days, withered complexion and hoarse voice indicate a high mortality rate. Heart exhaustion manifests as a face darkened like soot with residual Yang, unconsciousness, fixed gaze, and head shaking. Blackening around the mouth, abdominal distension with intractable diarrhea, soft sweating (Yin sweat), and Yin jaundice are caused by Spleen failure. Lung exhaustion presents with a floating pulse devoid of Stomach Qi, oily sweat, and ceaseless panting. Reversed cyanosis of the lips and corners of the mouth, cold limbs with sweat, curled tongue, and retracted testicles indicate Liver peril. Black face, elongated and dry/dirty teeth, and incontinence of urine and stool indicate Kidney distress. Inability to take fluids, intermittent or scattered pulses, and incessant hiccups suggest life is hard to retain. Excessive sweating in Wind-Warmth leads to spasms; severe Damp-Warmth shortens life. Forced sweating in Shaoyin disturbs channel blood, causing bleeding from the mouth, nose, and eyes, termed Jue-Jie (or Lower Jue and Upper Exhaustion). Post-sweating delirium, anorexia, persistent fever unrelieved by sweating, and rapid/agitated pulse constitute Yang-Jiao (interaction of Yin and Yang), a form of death. Cold extremities lasting more than seven to eight days, with whole-body cold skin and restlessness that cannot be temporarily calmed, is named Zang-Jue (Viscera Cold); sudden emergence of pulse after Jue without pulse is ominous; Jue with diarrhea should preclude eating, but if the patient can suddenly eat, it is named Chu-Zhong (Elimination of the Middle).
[Note] Diseases have life-and-death outcomes, and treatments vary in difficulty. Some illnesses heal without medicine, while terminal diseases cannot be saved even with medicine. Why? Because Yin-Yang, pathogenic factors, and healthy Qi have waxing and waning states. When Healthy Qi is strong and Pathogenic Factors are weak, there is life; when Yin is strong and Yang is weak, there is death. In Yang syndromes of Cold Damage, seeing Yang pulses such as Floating, Large, Rapid, Agitated, or Slippery indicates easy recovery and life; seeing Yin pulses such as Deep, Fine, Choppy, Weak, or Taut indicates difficult treatment and death. Therefore, Yin syndromes presenting with Yang pulses indicate life, while Yang syndromes presenting with Yin pulses indicate death. Persistent high fever indicates excess Pathogenic Factors, loss of pulse spirit, and deficiency of Healthy Qi; deficiency of Healthy Qi and excess of Pathogenic Factors lead to death. Yin Poison and Yang Poison result from hyperactivity preventing transformation and generation. Withered complexion and hoarse voice indicate depletion of internal and external essence, both indicating death. A body resembling soot, unconsciousness, fixed gaze, and head shaking indicate lone residual Yang attacking the Heart leading to exhaustion. Blackening around the mouth, abdominal distension, intractable diarrhea, soft sweating, and Yang jaundice indicate Spleen exhaustion. A pulse that is merely floating without Stomach Qi, oily sweat, and ceaseless panting indicate Lung exhaustion. Reversed cyanosis of lips, cold limbs with sweat, curled tongue, and retracted testicles indicate Liver exhaustion. Black face, long/dry/dirty teeth, and incontinence indicate Kidney exhaustion. Inability to ingest fluids means no reliance for life. Intermittent/scattered pulses indicate dispersion of True Qi. Incessant hiccups indicate failure of Yuan Qi to store. Mistakenly inducing sweat in Wind-Warmth causes spasms. Mistakenly inducing sweat in Damp-Warmth is called Heavy Heat (Chong Yue), both shortening life. Forcing sweat in Shaoyin disturbs channel blood, causing bleeding from mouth, nose, and eyes, termed Lower Jue and Upper Exhaustion. All above are signs of death. Delirium, anorexia, persistent fever unrelieved by sweat, and rapid/agitated pulse after sweating are named Yang-Jiao, a form of death. Unremitting Jue, reaching seven or eight days with whole-body cold skin and restlessness without respite, is named Zang-Jue, caused by extreme Yin Pathogen and flying away of True Yang. Severe Jue often lacks a pulse; after taking Sini Decoction or Baitong Decoction, if the pulse slowly continues, True Yang is gradually recovering; if the pulse suddenly emerges, it is a flash of light before extinction (terminal lucidity). Jue often involves diarrhea and inability to eat; if the patient suddenly can eat, it is named Chu-Zhong. 'Zhong' refers to the Stomach; 'Chu' means removal. It signifies that Stomach Qi has been removed; even if the patient can eat, it does not benefit the Stomach. Thus, Zhang Zhongjing said: Chu-Zhong indicates death. Any chronic illness where inability to eat is suddenly followed by great appetite and immediate death is of this category.