干明僧人。病伤寒。目赤。颇渴。咽干。饮水无 。腰疼。身热。脉沉而微细。此少阴证也。
恣纵不慎忌。乃饮水。遂致痞气。痞气结聚。身如被杖。数日变为阴毒矣。脉见于皮肤上。大而且
虚。鼻中如烟煤。甲青。须臾发喘。是夕死。
论曰。扁鹊云手足爪下青黑者死。宋迪阴证诀云。阴毒盛。则指甲黑青。病至此则为不治。
田仲容得伤寒。数日。身热。手足时厥。腹满。瞪目直视。狂言不识人。予诊之曰。不可治
也。心肾俱绝矣。夜死。
论曰。仲景云直视摇头。此为心绝也。又曰狂言。反目直视。此为肾绝也。目者五脏精华之
所聚。今直视而不 。则知五脏有死绝矣。故不治。
句容县豪子李姓。初得伤寒。手足冷。气上冲心。饥不欲食。脉紧而弦。予诊曰。厥阴悉具。
脉有刑克。最忌舌卷囊缩。翌日卷舌而死。
论曰。内经云。厥阴者肝也。肝者筋合之。筋者聚于阴器。络于舌本。厥阴之气。故舌卷而
囊缩也。
仪真一妇。病伤寒。八九日。发热。昏闷不识人。手循衣缝。摸床。谵语。不识人事。他医
不识。或汗或利。旬日增甚。予诊之曰。此脉涩而小便不利。不可治也。翌日死。
论曰。华佗云。病患循衣摸床谵语。不可治。仲景云伤寒。吐下后不解。不大便。五六日。
发潮热不识人。循衣。撮空。微喘。直视。脉弦者生。脉涩者死。又云小便利者可治。今脉涩。
小便不利。见其两死。不见一生。吾莫能为也。
干明寺的僧人，患伤寒病。眼睛发红，非常口渴，咽喉干燥，喝水后没有缓解（或：饮水无度/饮水不解渴），腰部疼痛，身体发热，脉象沉而微细。这是少阴证。
由于放纵不谨慎忌口，于是大量饮水，导致痞气形成。痞气结聚，身体感觉像被棍棒打过一样疼痛，几天后转变为阴毒证。脉象浮现在皮肤表面，大而虚，鼻孔中如烟煤般黑灰，指甲青黑，一会儿出现气喘，当天晚上死亡。
论述说：扁鹊说手足爪甲下呈现青黑色的是死证。宋迪在《阴证诀》中说，阴毒炽盛，则指甲黑青，病发展到这种程度就是不治之症。
田仲容患上伤寒，几天后，身体发热，手脚时常发凉，腹部胀满，瞪眼直视，胡言乱语不认识人。我诊断说，无法治疗了。心肾两脏都已衰竭，当夜死亡。
论述说：张仲景说，眼睛直视且摇头，这是心气绝的表现。又说胡言乱语，反目直视，这是肾气绝的表现。眼睛是五脏精华汇聚的地方，现在眼睛直视而不能转动（或：不能顾盼），就知道五脏有死绝之象。所以无法治疗。
句容县豪绅家的李姓子弟，初患伤寒，手脚冰冷，气向上冲撞心脏，感到饥饿但不想吃东西，脉象紧而弦。我诊断说，厥阴病的症状全部具备。脉象显示相刑相克，最忌讳舌卷缩和睾丸上缩。第二天舌头卷缩而死。
论述说：《内经》说，厥阴经对应肝脏。肝主筋，筋汇聚于生殖器，联络于舌根。厥阴经的气机病变，所以会出现舌卷缩和睾丸上缩的症状。
仪真县的一位妇女，患伤寒，八九天后，发热，神志昏闷不认识人，手抓衣缝，摸床沿，说胡话，不识人事。其他医生不认识此证，有的用发汗法，有的用泻下法，十天后病情加重。我诊断说，此人脉象涩滞且小便不利，无法治疗。第二天死亡。
论述说：华佗说，病人循衣摸床、说胡话，属于不治之症。张仲景说，伤寒经过吐法、下法治疗后病不解，不大便，五到六天，出现潮热、不认识人、循衣、撮空、微喘、直视，如果脉象弦，还有生机；如果脉象涩，则死。又说小便利的可以治。现在脉象涩，小便不利，看到了两种死征，看不到一丝生机，我也无能为力了。
The monk of Ganming Temple suffered from Shanghan (Cold Damage). His eyes were red, he was extremely thirsty, his throat was dry, and drinking water did not relieve the thirst. He had lower back pain, body heat, and a pulse that was deep, faint, and fine. This is Shaoyin syndrome (a pattern of disease involving the Kidney and Heart channels).
Due to indulgence and lack of caution regarding dietary restrictions, he drank excessive amounts of water, which led to the formation of Pi Qi (epigastric fullness/stagnation). The stagnation of Pi Qi caused his body to feel as if beaten with a stick. After several days, it transformed into Yin Du (Yin Toxin). The pulse appeared on the skin surface, large and deficient. His nostrils looked like soot or coal dust, his fingernails turned blue-black, and he suddenly developed panting. He died that evening.
Commentary: Bian Que stated that cyanosis under the fingernails and toenails indicates death. Song Di in "Jue of Yin Syndrome" stated that when Yin Toxin is rampant, the nails turn black and blue; once the disease reaches this stage, it is incurable.
Tian Zhongrong contracted Shanghan. After several days, he had body heat, intermittent coldness of the hands and feet, abdominal fullness, staring fixedly with wide eyes, delirious speech, and inability to recognize people. I diagnosed him as untreatable. Both the Heart and Kidney organs had exhausted their vital energy. He died that night.
Commentary: Zhang Zhongjing stated that fixed staring and head shaking indicate the exhaustion of Heart Qi. He also stated that delirious speech and reversed gaze with fixed staring indicate the exhaustion of Kidney Qi. The eyes are the gathering place of the essence of the five Zang organs. Now, since he stares fixedly without ability to move his eyes, we know that the five Zang organs are facing exhaustion and death. Therefore, it is untreatable.
A young man surnamed Li from a wealthy family in Jurong County initially contracted Shanghan. His hands and feet were cold, Qi rushed upward to strike his heart, he felt hungry but had no desire to eat, and his pulse was tight and wiry. I diagnosed that all symptoms of Jueyin syndrome (the final stage of Cold Damage) were present. The pulse indicated mutual punishment and restriction. The most feared signs are curled tongue and retracted testicles. The next day, his tongue curled up, and he died.
Commentary: The "Neijing" (Inner Canon) states that Jueyin corresponds to the Liver. The Liver governs the sinews (tendons), which gather at the genitalia and connect to the root of the tongue. The pathological Qi of the Jueyin channel causes the curling of the tongue and retraction of the testicles.
A woman in Yizhen contracted Shanghan. After eight or nine days, she had fever, mental confusion, and inability to recognize people. She picked at her clothes and touched the bed frame, spoke deliriously, and was unaware of her surroundings. Other physicians did not recognize the condition; some used sweating methods, others purgative methods. After ten days, the condition worsened. I diagnosed that her pulse was choppy and urination was difficult. It was untreatable. She died the next day.
Commentary: Hua Tuo stated that patients who pick at clothes and touch the air while speaking deliriously are untreatable. Zhang Zhongjing stated that after Shanghan is treated with vomiting or purging, if the disease persists, there is no bowel movement for five to six days, tidal fever occurs, the patient does not recognize people, picks at clothes, grasps at empty space, has slight panting, and fixed staring: if the pulse is wiry, there is life; if the pulse is choppy, there is death. He also stated that if urination is free, the condition is treatable. Now, with a choppy pulse and difficulty in urination, two signs of death are seen, and no sign of life is visible. I can do nothing more.