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.