陶节庵曰∶凡看伤寒，极要识各经中死证死脉，须一一理会过，免致临病疑惑。但见死证，便
当以脉参之，如果有疑，切莫下药，虽至亲俯恳，亦不可治，倘有差失，咎将归于己矣。
一、脉浮而洪，身汗如油，喘而不休，水浆不入，形体不仁，乍静乍乱，此命绝也。汗出发润，
喘而不休，此肺绝也。形如烟煤，直视摇头，此心绝也。唇吻色青，四肢振动，此肝绝也。环口黎
黑，冷汗发黄，此脾绝也。溲便遗失，狂言，反目直视，此肾绝也。
一、少阴病，恶寒身蜷而利，手足逆冷者，不治。少阴病，吐痢躁烦，四逆者死。少阴病，四逆
身蜷，脉不至，不烦而躁者死。少阴病，六七日，息高者死。少阴病，至五六日，自利，烦躁不得
卧寐者死。少阴病，下痢，厥逆无脉，服药后，脉微续者生，脉暴出者死。少阴病，但厥无汗，而
强发之，必动其血，未知从何道出，或从口鼻，或从目出，是名下厥上竭，为难治。
一、阴病见阳脉者生，阳病见阴脉者死。脉纯弦者死。脉阴阳俱虚，热不止者死。脉阴阳俱盛，
大汗出，
热不解者死。手足逆冷，脉沉细，谵言妄语者死。脉证俱虚，而见谵妄者死。伤寒六七日，脉微，
手足厥冷，烦躁，灸厥阴，厥不还者死。寸脉上不至关为阳绝，尺脉下不至关为阴绝，此皆不治，
决死也。伤寒下痢，日十余行，脉反实者死。
一、伤寒，病胁下素有痞气，连于脐傍，痛引少腹入阴筋者，此名脏结，死。发热，下痢厥逆，
躁不得卧者死。发热，下痢至甚，厥不止者死。直视谵语，喘满者死，下痢者，亦死。下痢发热者
亦死。发热而厥，七日，下痢者难治。伤寒六七日，发热而利，汗出不止者死，有阴无阳故也。阳
气前绝，阴气后绝者，阴证也，其人死后，身色必青。阴气前绝，阳气后绝者，阳证也，其人死后
，身色必赤，腋下温，心下热也。
《金匮要略》曰∶六腑气绝于外者，手足寒，五脏气绝于内者，利下不禁。盖伤寒发热，为邪
气独甚，若下痢至甚，厥不止，此以邪未解，而腑脏之气先绝，故死。
《灵枢·热病篇》曰∶热病不可刺者有九∶一曰汗不出，大颧发赤，哕者死。二曰泄而腹满甚
者死。三曰目不明，热不已者死。四曰老人婴儿，热而腹满者死。五曰汗不出，呕下血者死。六曰
舌本烂，热不已者死。七曰咳而衄，汗不出，出不至足者死。八曰髓热者死。九曰热而痉者死，腰
折螈 齿噤 也。
陶节庵说：凡是诊治伤寒，极需识别各经络中的死证和死脉，必须逐一理解透彻，以免在临诊时产生疑惑。只要见到死证，就应当结合脉象来参详，如果仍有疑虑，千万不要用药，即使是至亲恳切请求，也不可治疗，倘若出现差错，罪责将归于医者自身。
一、脉象浮而洪大，身体出汗如油，气喘不停，水浆无法入口，形体麻木不仁，时而安静时而混乱，这是生命终结之兆。汗出后头发湿润，气喘不停，这是肺气绝灭。面色如烟熏煤黑，两眼直视且摇头，这是心气绝灭。口唇周围颜色发青，四肢震颤，这是肝气绝灭。口周发黑，冷汗发黄，这是脾气绝灭。大小便失禁，胡言乱语，眼球上翻直视，这是肾气绝灭。
一、少阴病，恶寒身体蜷缩并伴有腹泻，手足逆冷的，难以治愈。少阴病，呕吐腹泻且烦躁不安，四肢厥逆的，预后不良致死。少阴病，四肢厥逆身体蜷缩，脉搏摸不到，不感到心烦但表现出躁动的，预后不良致死。少阴病，病程六七天，呼吸浅表急促（息高）的，预后不良致死。少阴病，病程至五六天，自发性腹泻，烦躁无法躺卧睡眠的，预后不良致死。少阴病，下痢，四肢厥冷无脉，服药后，脉象微弱逐渐恢复的有生机，脉象突然暴出的预后不良致死。少阴病，仅见厥冷无汗，若强行发汗，必然导致动血出血，不知从哪个部位流出，或从口鼻，或从眼睛流出，这称为“下厥上竭”，属于难治之症。
一、阴病出现阳脉的有生机，阳病出现阴脉的预后不良致死。脉象纯弦硬的预后不良致死。脉象寸关尺三部皆虚弱，发热不止的预后不良致死。脉象寸关尺三部皆盛大，大汗出，热势不退的预后不良致死。手足逆冷，脉象沉细，胡言乱语的预后不良致死。脉象与证候皆虚弱，却出现谵妄的预后不良致死。伤寒六七天，脉微，手足厥冷，烦躁，艾灸厥阴经穴后，厥冷不回复的预后不良致死。寸脉向上不到关部为阳绝，尺脉向下不到关部为阴绝，这些都属于难以治愈，必定死亡。伤寒下痢，一天十多次，脉象反而实大的预后不良致死。
一、伤寒，患者胁下素有痞块，连接至脐旁，疼痛牵引至小腹及阴筋的，这名叫“脏结”，预后不良致死。发热，下痢厥逆，烦躁无法躺卧的预后不良致死。发热，下痢极其严重，厥冷不止的预后不良致死。两眼直视，胡言乱语，喘促胀满的预后不良致死，若伴有下痢的，也预后不良致死。下痢伴发热的也预后不良致死。发热且厥冷，持续七天，又伴有下痢的，难以治疗。伤寒六七天，发热且腹泻，汗出不止的预后不良致死，这是因为有阴无阳的缘故。阳气先绝灭，阴气后绝灭的，属于阴证，其人死后，身体颜色必定发青。阴气先绝灭，阳气后绝灭的，属于阳证，其人死后，身体颜色必定发红，腋下温暖，心下部发热。
《金匮要略》说：六腑之气在外衰竭的，表现为手足寒冷；五脏之气在内衰竭的，表现为泄泻不禁。大概伤寒发热，是邪气独盛，如果下痢极其严重，厥冷不止，这是因为邪气未解，而脏腑之气先已衰竭，所以死亡。
《灵枢·热病篇》说：热病不可针刺的情况有九种：一是汗不出，两颧发赤，呃逆的预后不良致死。二是腹泻且腹部胀满严重的预后不良致死。三是眼睛视物不明，热势不退的预后不良致死。四是老人和婴儿，发热且腹部胀满的预后不良致死。五是汗不出，呕吐并便血的预后不良致死。六是舌根溃烂，热势不退的预后不良致死。七是咳嗽兼鼻出血，汗不出，即使出汗也达不到足部的预后不良致死。八是髓热的预后不良致死。九是发热并发生痉病的预后不良致死，表现为腰背反折抽搐，牙齿紧闭。
Tao Jie'an stated: In the diagnosis of Shanghan (Cold Damage), it is crucial to identify the terminal syndromes and terminal pulses of each meridian. One must thoroughly understand them one by one to avoid confusion during clinical practice. Whenever a terminal syndrome is observed, the pulse should be consulted for confirmation. If there is any doubt, medication must not be administered. Even if close relatives plead earnestly, treatment should not proceed; otherwise, if an error occurs, the blame will fall upon the physician.
1. A floating and surging pulse, with sweat resembling oil on the body, continuous panting, inability to take fluids or food, numbness of the body, and alternating periods of calmness and chaos indicate the exhaustion of life force. Sweat causing hair to become moist, accompanied by continuous panting, indicates the exhaustion of Lung Qi. A complexion dark as soot, with fixed staring eyes and head shaking, indicates the exhaustion of Heart Qi. Cyanosis around the lips and mouth, with tremors in the four limbs, indicates the exhaustion of Liver Qi. Blackening around the mouth, cold sweat, and yellowish discoloration indicate the exhaustion of Spleen Qi. Incontinence of urine and feces, delirious speech, and upward-gazing fixed eyes indicate the exhaustion of Kidney Qi.
2. In Shaoyin disease, characterized by aversion to cold, curling up of the body, diarrhea, and cold reversal of the hands and feet, the condition is incurable. In Shaoyin disease, with vomiting, dysentery, restlessness, and cold reversal of the four limbs, death ensues. In Shaoyin disease, with cold reversal, curling up of the body, absence of pulse, and restlessness without irritability, death ensues. In Shaoyin disease, after six or seven days, shallow and rapid breathing (high respiration) indicates death. In Shaoyin disease, after five or six days, spontaneous diarrhea, restlessness, and inability to lie down and sleep indicate death. In Shaoyin disease, with dysentery, cold reversal, and absence of pulse, if the pulse becomes slightly continuous after taking medicine, there is hope for survival; if the pulse suddenly bursts forth, death ensues. In Shaoyin disease, presenting only with cold reversal and no sweat, forcing sweating will inevitably disturb the blood, causing bleeding from unknown pathways, either from the mouth and nose or from the eyes. This is termed "Lower Cold and Upper Exhaustion" and is difficult to treat.
3. Yin diseases manifesting Yang pulses indicate survival; Yang diseases manifesting Yin pulses indicate death. A purely wiry pulse indicates death. When pulses at the Yin and Yang positions are both deficient, and fever persists, death ensues. When pulses at the Yin and Yang positions are both excessive, accompanied by profuse sweating and unresolved fever, death ensues. Cold reversal of the hands and feet, a deep and fine pulse, and delirious speech indicate death. When both pulse and symptoms are deficient, yet delirium appears, death ensues. In Shanghan, after six or seven days, with a faint pulse, cold reversal of the hands and feet, and irritability, if Moxibustion applied to the Jueyin meridian does not reverse the cold, death ensues. An inch pulse that does not reach the Guan position upwards is called Yang Exhaustion; a cubit pulse that does not reach the Guan position downwards is called Yin Exhaustion. All these are incurable and lead to certain death. In Shanghan with dysentery, occurring more than ten times a day, if the pulse is unexpectedly solid, death ensues.
4. In Shanghan, if there is a pre-existing mass (Pi Qi) under the hypochondrium connected to the side of the umbilicus, with pain radiating to the lower abdomen and yin sinews, this is named Zang Jie (Organ Knotting) and leads to death. Fever, dysentery, cold reversal, and restlessness preventing lying down indicate death. Fever, severe dysentery, and unceasing cold reversal indicate death. Fixed staring eyes, delirium, and wheezing/fullness indicate death; if accompanied by dysentery, it also indicates death. Dysentery accompanied by fever also indicates death. Fever with cold reversal lasting seven days, accompanied by dysentery, is difficult to treat. In Shanghan, after six or seven days, fever with diarrhea and unceasing sweating indicates death, due to the presence of Yin without Yang. If Yang Qi exhausts first and Yin Qi exhausts later, it is a Yin syndrome; after death, the body color will be blue. If Yin Qi exhausts first and Yang Qi exhausts later, it is a Yang syndrome; after death, the body color will be red, with warmth in the axillae and heat in the epigastrium.
The *Jingui Yaolue* states: When the Qi of the Six Fu Organs exhausts externally, the hands and feet become cold; when the Qi of the Five Zang Organs exhausts internally, uncontrollable diarrhea occurs. Generally, fever in Shanghan indicates excessive pathogenic factors alone. If dysentery is severe and cold reversal persists, it means the pathogens have not resolved, and the Qi of the Fu and Zang organs has exhausted first, leading to death.
The *Lingshu · Re Bing Pian* (Spirit Pivot · Chapter on Heat Diseases) states: There are nine conditions in Heat Diseases where acupuncture is contraindicated: First, no sweat, redness of the cheekbones, and hiccups indicate death. Second, diarrhea with severe abdominal fullness indicates death. Third, unclear vision with persistent fever indicates death. Fourth, fever with abdominal fullness in the elderly and infants indicates death. Fifth, no sweat, vomiting, and hematochezia indicate death. Sixth, ulceration of the tongue base with persistent fever indicates death. Seventh, cough with epistaxis, no sweat, or sweat that does not reach the feet indicates death. Eighth, Marrow Heat indicates death. Ninth, Heat Disease with spasms indicates death, characterized by opisthotonos, convulsions, and clenched teeth.