结胸证其脉浮大者不可下下之则死结胸证悉具烦躁者亦死阳明病心下硬满者不可攻攻之利遂不止者死直视谵语喘
满者死下利者亦死发汗多重发汗者亡其阳谵语气短者死伤寒若吐若下不解不大便五六日至十余日日晡所发潮热不恶寒
独语如见鬼状者发则不识人循衣摸床惕而不安微喘直视脉涩者死脉浮而芤浮为阳芤为阴浮芤相搏胃气生热其阳即绝少
阳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少阴病恶寒身蜷而利手足厥冷者
不治少阴病六七日息高者死伤寒脉迟六七日而反与黄芩汤彻其热脉迟为寒今与黄芩汤复除其热腹中当冷不能食今反能
食此名除中必死伤寒六七日脉微手足厥冷烦躁灸厥阴脉不还者死伤寒发热下利厥逆躁不得卧者死伤寒发热下利至甚厥
不止者死伤寒六七日不利便发热而利其人汗出不止者死有阴无阳故也伤寒五六日不结胸腹濡脉虚复厥者不可下此为亡
血下之死发热而厥七日下利者为难治伤寒六七日大下后寸脉沉而迟手足厥逆下部脉不至咽喉不利唾脓血泄利不止者为
难治下利手足厥逆无脉者灸之不温若脉不还反微喘者死下利后脉绝手足厥冷 时脉还手足温者生脉不还者死伤寒下利
十余行脉反实者死呕而脉弱小便复利身有微热见厥者为难治湿家下之额上汗出微喘小便利者死若下利不止者亦死
附死证歌
两感伤寒不须治阴阳毒过七朝期黑斑下厥与上竭阳病见阴脉者危舌卷耳聋囊更缩阴阳交及摸寻衣重 除中皆不治
唇吻青兮面黑黧咳逆不已并脏结溲便遗尿便难医汗出虽多不至足口张目陷更何为喘不休与阴阳易离经脉见死当知结胸
证具烦躁甚直视摇头是死时少阳证与阳明合脉弦长大救时迟汗后反加脉躁疾须知脏厥命难追虾游屋漏并雀啄鱼翔弹石
解绳推更有代脉皆不救以上诸证死无疑
附
结胸证如果脉象浮大,不可使用攻下法;若误用攻下法,则会导致死亡。结胸证的症状全部具备,且出现烦躁不安的,也是死证。阳明病中,心下部硬满的,不可使用攻下法;若误用攻下法,导致腹泻不止的,为死证;若出现两眼直视、胡言乱语、气喘且胸腹胀满的,为死证;若出现腹泻的,也是死证。
发汗过多,或者多次发汗,会导致阳气亡失;出现胡言乱语、气息短促的,为死证。伤寒病,如果使用吐法或下法后病情仍未解除,并且五六天到十几天内不大便,在傍晚时分(日晡所)出现潮热,不恶寒,独自说话如同看见鬼怪一样的,发作时不认识人,手循摸衣被床沿,惊恐不安,轻微气喘,两眼直视,脉象涩滞的,为死证。脉象浮而芤,浮脉主阳,芤脉主阴,浮与芤相搏结,胃气产生热邪,阳气即会断绝。
少阳病,仅见四肢厥冷而无汗,若强行发汗,必定扰动血液,不知血液从哪条通道溢出,有的从口鼻出,有的从眼睛出,这称为“下厥上竭”,属于难治之证。少阴病,恶寒、身体蜷缩并伴有腹泻,手足冰冷的,为不治之证。少阴病六七天,呼吸浅表急促(息高)的,为死证。
伤寒脉迟,过了六七天反而给予黄芩汤来清其热。脉迟表明是寒证,现在给予黄芩汤清除其热,腹中应当寒冷不能进食,现在反而能进食,这叫做“除中”,必死。伤寒六七天,脉微细,手足冰冷,烦躁不安,施灸于厥阴经穴位后,脉搏仍不回复的,为死证。伤寒发热,伴有腹泻、四肢厥冷、躁动不安无法躺卧的,为死证。伤寒发热,腹泻严重,四肢厥冷不止的,为死证。
伤寒六七天,原本没有腹泻,突然发热并伴有腹泻,其人出汗不止的,为死证,这是因为有阴无阳的缘故。伤寒五六年,没有形成结胸,腹部柔软,脉象虚弱,又出现四肢厥冷的,不可使用攻下法,这是因为亡血所致,攻下会导致死亡。发热且四肢厥冷,持续七天并伴有腹泻的,属于难治。
伤寒六七天,经过猛烈攻下后,寸脉沉而迟,手足厥冷,下部脉摸不到,咽喉不利,唾脓血,泄泻不止的,属于难治。腹泻,手足厥冷,无脉,施灸后手脚不温暖,如果脉搏不回复,反而出现轻微气喘的,为死证。腹泻后脉象消失,手足冰冷,片刻后脉搏恢复,手足转温的,可生;脉搏不恢复的,为死证。
伤寒下利,一天十余次,脉象反而实大的,为死证。呕吐而脉弱,小便通畅,身体有微热,见到四肢厥冷的,属于难治。湿病患者误用攻下法,额头出汗,轻微气喘,小便利的,为死证;如果腹泻不止的,也是死证。
附:死证歌诀
两感伤寒不需治疗,阴阳毒超过七朝期限,黑斑出现,下厥与上竭,阳病见阴脉者危险,舌卷、耳聋、囊缩,阴阳交及循衣摸床,除中证都不治,唇吻青紫面色黑,咳嗽气逆不止并脏结,大小便失禁难以医治,出汗虽多但不到足部,口张目陷还有何用,喘气不停与阴阳易,离经脉出现当知死。结胸证具烦躁甚,直视摇头是死时,少阳证与阳明合,脉弦长大救时迟,汗后反加脉躁疾,须知脏厥命难追,虾游屋漏并雀啄,鱼翔弹石解绳推,更有代脉皆不救,以上诸证死无疑。
In the syndrome of Jie Xiong (Chest Binding), if the pulse is floating and large, purgation must not be used; if purgation is mistakenly applied, death will ensue. If all symptoms of Jie Xiong are present and restlessness (Fan Zao) occurs, this is also a fatal condition. In Yang Ming disease, if there is hardness and fullness in the epigastrium, attack with purgation is contraindicated; if purgation is mistakenly applied and diarrhea becomes intractable, it is fatal. If the patient presents with fixed gaze (Zhi Shi), delirium (Chan Yu), asthma (Chuan), and abdominal fullness, it is fatal; if diarrhea occurs, it is also fatal.
Excessive sweating, or repeated sweating, leads to the loss of Yang Qi (Yang Qi); if delirium and shortness of breath occur, it is fatal. In Shang Han (Cold Damage) disease, if vomiting or purgation fails to resolve the condition, and no bowel movement occurs for five to ten days, with tidal fever (Chao Re) appearing at dusk (Ri Bu Suo), absence of aversion to cold, solitary speech as if seeing ghosts, unawareness of people during episodes, picking at clothes and bedrails, fearfulness and unrest, slight asthma, fixed gaze, and a choppy pulse (Se Mai), it is fatal. A floating and hollow (Kou) pulse: floating indicates Yang, hollow indicates Yin. When floating and hollow interact, stomach heat generates, and Yang Qi is severed.
In Shao Yang disease, if there is only cold extremities (Jue) without sweat, forcing sweat will inevitably disturb the blood. It is unknown from which channel the blood will escape; it may come from the mouth or nose, or from the eyes. This is called "Lower Jue and Upper Exhaustion" (Xia Jue Shang Jie), which is difficult to treat. In Shao Yin disease, if there is aversion to cold, body curling, diarrhea, and cold extremities, it is incurable. In Shao Yin disease, after six or seven days, if respiration is shallow and rapid (Xi Gao), it is fatal.
In Shang Han disease with a slow pulse (Chi Mai), if after six or seven days Huang Qin Tang (Scutellaria Decoction) is mistakenly given to clear heat: a slow pulse indicates cold. Giving Huang Qin Tang to clear heat should cause abdominal coldness and anorexia. If the patient suddenly can eat, this is called "Chu Zhong" (Removing the Middle), which is fatal. In Shang Han disease after six or seven days, if the pulse is faint, extremities are cold, and there is irritability, moxibustion is applied to the Jue Yin channel; if the pulse does not return, it is fatal. In Shang Han disease with fever, diarrhea, cold extremities, and restlessness preventing lying down, it is fatal. In Shang Han disease with fever, severe diarrhea, and unceasing cold extremities, it is fatal.
In Shang Han disease after six or seven days, if there was previously no diarrhea but suddenly fever and diarrhea appear, accompanied by incessant sweating, it is fatal because there is Yin without Yang. In Shang Han disease after five or six days, if there is no Jie Xiong, the abdomen is soft, the pulse is deficient, and cold extremities recur, purgation is contraindicated because this is due to blood loss; purgation will lead to death. Fever with cold extremities lasting seven days, accompanied by diarrhea, is difficult to treat.
In Shang Han disease after six or seven days, following severe purgation, if the Cun pulse is deep and slow, extremities are cold, the lower pulses are imperceptible, the throat is obstructed, pus and blood are expectorated, and diarrhea is intractable, it is difficult to treat. With diarrhea, cold extremities, and absent pulse, if moxibustion fails to warm the limbs and the pulse does not return, but slight asthma appears, it is fatal. After diarrhea, if the pulse vanishes and extremities are cold, but the pulse returns and extremities become warm, life is preserved; if the pulse does not return, it is fatal.
In Shang Han diarrhea occurring more than ten times a day, if the pulse is unexpectedly excess, it is fatal. Vomiting with a weak pulse, free urination, slight body heat, and cold extremities constitute a difficult-to-treat condition. In dampness patients, if purgation is mistakenly applied, leading to sweating on the forehead, slight asthma, and free urination, it is fatal; if diarrhea is intractable, it is also fatal.
Attached: Song of Fatal Syndromes
Liang Gan Shang Han requires no treatment; Yin-Yang Du beyond seven days expires. Black spots appear, Lower Jue and Upper Exhaustion; Yang disease showing Yin pulse is perilous. Tongue curled, ears deaf, scrotum retracted; Yin-Yang Jiao and picking at clothes are untreatable. Chu Zhong is also untreatable; lips and corners of mouth blue, face black. Cough and regurgitation unceasing, Zang Jie (Organ Knotting); urine and stool incontinence, hard to cure. Sweating profusely but not reaching feet; mouth open, eyes sunken, what use? Unceasing asthma, Yin-Yang Yi (Exchange); Li Jing Mai (Departing Vessel) seen, know death. Jie Xiong syndrome complete with severe restlessness, fixed gaze, shaking head—this is time of death. Shao Yang syndrome combined with Yang Ming, pulse string-like and large—rescue is too late. Post-sweating pulse becomes rapid and restless; know Zang Jue (Organ Cold)—life cannot be pursued. Xia You (Shrimp Floating), Wu Lou (House Leak), Que Zhuo (Sparrow Pecking), Yu Xiang (Fish Swimming), Dan Shi (Stone Tapping), Jie Sheng (Uncoiling Rope)—even Dai Mai (Intermittent Pulse) cannot be saved. All aforementioned syndromes are undoubtedly fatal.