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。如大热不止，邪盛脉失神为正虚，正虚邪盛，定主死也。如阴毒阳毒，亢极不能生化也。如色枯声败内
外两夺也。如形若烟熏，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，无胃气，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。面黑枯垢，齿长，溲便遗失者，此为肾绝也。或水浆不入，生无所赖也。或脉见代散，真气衰散也。
或呃逆无休，元气不藏也，或误发风温之汗，因而成痉。或误发湿温之汗，名曰重 。或强发少阴汗，动其经
血，从口鼻目出，名曰下厥上竭。或汗后狂言不食，仍复发热，不为汗衰，脉躁疾者，名曰阴阳交。以上各证，
均主
死候。如厥逆不回，至七八日即通身肤冷而躁，无暂宁时者，名曰脏厥，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，回光返照也。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。
疾病有生死之分，治疗有难易之别。轻病即使不服药也能痊愈，重病即便用药也难以挽救。为什么呢？这是因为阴阳、邪气与正气的盛衰不同。正气旺盛而邪气衰弱则生，阴气旺盛而阳气衰弱则死。
伤寒病的阳证，如果见到浮、大、数、动、滑等阳脉，则容易痊愈而生；如果见到沉、微、涩、弱、弦等阴脉，则难治而死。例如高热不退，邪气盛而脉象失去神气，这是正气虚弱、邪气亢盛的表现，必定主死。例如阴毒和阳毒，亢盛至极导致无法生化。例如面色枯槁、声音嘶败，内外精气双重耗竭。例如形体如烟熏般晦暗，神志昏迷、两眼直视、摇头不止，这是阳邪独留攻心而导致绝症。例如口唇周围发黑，腹部胀满、下利不止，手足冷汗、身黄如橘色，这是脾脏功能衰竭（脾绝）。例如脉象仅见浮象，没有胃气，汗出如油，喘息不停，这是肺脏功能衰竭（肺绝）。例如嘴唇和嘴角发青，四肢冷汗，舌头卷缩、睾丸上缩，这是肝脏功能衰竭（肝绝）。例如面色黑而干枯垢腻，牙齿显得变长，大小便失禁，这是肾脏功能衰竭（肾绝）。或者水浆不能入口，生命失去依赖。或者脉象出现代脉或散脉，真气衰败涣散。或者呃逆不止，元气不能内藏。或者误用发汗法治疗风温病，因而导致痉病。或者误用发汗法治疗湿温病，称为重暍。或者强行对少阴病发汗，扰动经血，血液从口、鼻、眼中流出，称为下厥上竭。或者发汗后胡言乱语、不能进食，仍然发热，且发热不因出汗而减退，脉象躁动疾速，称为阴阳交。以上各种证候，均主死候。
如果四肢厥冷不回，到了七八天全身皮肤冰冷且烦躁不安，没有片刻安宁，称为脏厥，这是阴邪极盛、真阳飞越所致。凡是厥逆严重的，大多无脉，服用四逆汤、白通汤等方剂。如果脉象微微续接，说明真阳逐渐恢复。如果脉象突然暴出，是回光返照的现象。凡是厥逆多伴有下利，应当不能进食，现在反而能进食，称为除中。“中”指胃，“除”指去除，意思是胃气已去，虽然反而能进食，也对胃气没有补益作用。所以张仲景说：“除中证者死。”凡是各种久病不能进食的人，忽然变得非常能吃随即死亡的，也属于此类。
Diseases have distinctions between life and death, and treatments vary in difficulty. Mild illnesses may heal without medication, while critical illnesses may remain incurable even with treatment. Why is this? It lies in the prosperity or decline of Yin and Yang, as well as the balance between pathogenic factors (Xie) and healthy Qi (Zheng). When healthy Qi is prosperous and pathogenic factors are weak, life is sustained; when Yin is prosperous and Yang is weak, death ensues.
In Taiyang disease (Taiyang syndrome), if Yang-pattern pulses such as Floating (Fu), Large (Da), Rapid (Shu), Agitated (Dong), or Slippery (Hua) are observed, recovery is likely and life is preserved; however, if Yin-pattern pulses such as Deep (Chen), Minute (Wei), Choppy (Se), Weak (Ruo), or Taut (Xian) are seen, the condition is difficult to treat and leads to death. For instance, persistent high fever where pathogenic factors are excessive and the pulse loses its "spirit" indicates deficiency of healthy Qi and excess of pathogens, which invariably signifies death. Similarly, in severe Yin-toxin or Yang-toxin conditions, hyperactivity reaches an extreme, preventing normal physiological transformation. Cases where complexion is withered and voice is hoarse indicate a dual depletion of internal and external essence. A form resembling smoke-darkened soot, accompanied by coma, fixed staring, and head shaking, indicates that Yang-pathogens alone remain and attack the Heart, leading to extinction. Blackening around the mouth, abdominal distension, unremitting diarrhea, soft sweating, and yellowish discoloration of the skin indicate failure of the Spleen (Pi Jue). A pulse that is merely floating, lacking Stomach Qi, accompanied by sweat like oil and ceaseless panting, indicates failure of the Lung (Fei Jue). Cyanosis of the lips and corners of the mouth, cold sweat on the four limbs, curled tongue, and retracted testicles indicate failure of the Liver (Gan Jue). A black, withered, and dirty facial complexion, elongated teeth, and incontinence of urine and feces indicate failure of the Kidney (Shen Jue). Other signs include the inability to ingest water or gruel, indicating loss of vital support; a Dai (intermittent) or San (scattered) pulse, indicating dispersion of true Qi; or incessant hiccups, indicating the failure of Yuan Qi to be contained.
Errors in treatment can also lead to fatal outcomes: mistakenly inducing sweat in Wind-Warmth diseases may result in Spasm (Jing); mistakenly inducing sweat in Damp-Warmth diseases results in Zhong Yue (severe heat stroke); forcibly inducing sweat in Shaoyin disease may disturb channel blood, causing bleeding from the mouth, nose, and eyes, termed Xia Jue Shang Jie (Lower Cold and Upper Exhaustion). Post-sweat delirium, refusal to eat, persistent fever unrelieved by sweating, and a rapid, restless pulse constitute Yang-Jiao-Yin (Yin-Yang Intersection), all of which are ominous signs of death.
If cold extremities do not recover, and after seven or eight days the entire body becomes cold with restlessness and no moment of peace, it is called Zang Jue (Visceral Cold Extremity), caused by extreme excess of Yin pathogens and flight of True Yang. In cases of severe cold extremities where the pulse is absent, formulas such as Sini Tang (Frigid Extremities Decoction) or Baitong Tang (White Cinnamon and Egg Yolk Decoction) are administered. If the pulse gradually returns, it indicates the gradual recovery of True Yang; if the pulse suddenly bursts forth, it is a sign of terminal lucidity (returning light before death).
Typically, cold extremities are accompanied by diarrhea and an inability to eat. If the patient suddenly gains the ability to eat, it is called Chu Zhong (Removal of the Middle). "Zhong" refers to the Stomach, and "Chu" means removal; this implies that Stomach Qi has been exhausted. Although the patient can eat, it does not nourish the Stomach. Thus, Zhang Zhongjing stated: "Death follows the Chu Zhong pattern." Any chronic illness where the patient cannot eat, but suddenly eats voraciously only to die shortly after, belongs to this category.