如至四五六日，狂言直视，小便遗失者，肾绝也。直视摇头，形体甚黑者，肾克
火而心绝也。大小肠痛极者，小肠为心腑，大肠为肺腑，火克金而肺将绝，因乃汗出如
油，喘而不休矣。爪甲青黑，不知人事，面青作搐，舌卷囊缩者，肝绝也。大便似死血
甚黑者，或水谷不化，药食直下，环口黧黑，唇反者，脾绝也。伤寒以阳为主，如手
冷如冰，足冷过膝，皮肉 动，自汗无度，是阳已脱也。阳先绝色青，阴先绝色赤，并
为不治。若头重视身，天柱骨倒，元气已败，必死。大便浊气极臭者，死。阴阳毒过
六七日者，死。但欲寐，息高，死。汗油发润，喘不休，死。尺寸俱虚热不止者，死。
大发湿家汗则痉，热而痉者，死。目睛正圆者，死。卵缩入腹，脉见离经者，死。瘥后
小便涩有血，名内外疮。若黑靥不出脓者，死。热盛躁急不得汗出，是阳脉极，死。舌
上黑苔，生芒刺，刮不去易生者，死。鼻衄自汗者，死。胃寒发呃，丁香、茴香、柿蒂
良姜汤调服。如脉不出，加胆汁合生脉散，其脉又出，或暴出者，皆死。大肉脱去者，死。
凡胸膈赤肿疼痛，头疼身痛，发热恶寒，此名赤膈伤寒，宜防荆败毒散，加栝蒌
子、黄连、寅芩、紫金皮、玄参、赤芍、升麻、白芷。如症有表复有里，胸膈赤肿疼痛
者，防风通圣散加栝蒌子、黄连、紫金皮。如表症已退，大便燥实，胸膈肿痛者，凉膈
解毒，加栝蒌子、枳壳、桔梗、紫金皮、赤芍药；又宜棱针刺肿处出血。如半表半里，
胸膈肿痛者，柴胡枳桔汤，加栝蒌子、柴金皮、赤芍药。
如果到了第四、五、六天，出现胡言乱语、两眼直视、小便失禁的症状，这是肾气绝的表现。如果眼睛直视且摇头，身体颜色发黑，这是肾水克制心火导致心气绝的表现。大小肠剧烈疼痛的，因为小肠是心的腑，大肠是肺的腑，火克金导致肺气即将衰竭，随后就会汗出如油、喘息不止。指甲青黑、神志不清、面色青紫并伴有抽搐、舌头卷缩、阴囊收缩的，这是肝气绝的表现。大便像死血一样非常黑的，或者食物和水谷无法消化，药物和食物直接排出，口周颜色黧黑、嘴唇外翻的，这是脾气绝的表现。伤寒病以阳气为主，如果手脚冷得像冰一样，脚冷超过膝盖，皮肉跳动，自汗不止，这是阳气已经脱失的表现。阳气先绝时面色发青，阴气先绝时面色发赤，这两种情况都属于不治之症。如果头重不能抬起、天柱骨（颈部支撑骨）倒塌，说明元气已经败坏，必然死亡。大便浊气极臭的，主死。阴阳毒证超过六七天不愈的，主死。只想睡觉、呼吸浅表高促的，主死。汗出如油、头发湿润、喘息不止的，主死。寸脉尺脉都虚弱但发热不止的，主死。大发汗导致湿病患者发生痉病，热盛而发痉的，主死。眼球固定不动正视前方的，主死。睾丸上缩入腹、脉象离经的，主死。病愈后小便涩痛带血，称为内外疮。如果黑色痂皮下不出脓的，主死。热势亢盛、烦躁急迫却无汗出的，这是阳脉极度亢盛，主死。舌上有黑苔，长出芒刺，刮不掉又容易再生的，主死。鼻出血伴自汗的，主死。胃寒引起的呃逆，可用丁香、茴香、柿蒂、良姜汤调服。如果脉搏摸不到，加用胆汁配合生脉散，如果脉搏又能出现，或者是突然暴出的，都是死证。肌肉严重消瘦脱落的，主死。
凡是胸膈部红肿疼痛，头痛身痛，发热恶寒的，这叫做赤膈伤寒，适宜使用荆防败毒散，加入栝蒌子、黄连、黄芩、紫金皮、玄参、赤芍、升麻、白芷。如果症状既有表证又有里证，胸膈红肿疼痛的，使用防风通圣散加入栝蒌子、黄连、紫金皮。如果表证已经消退，大便燥结坚实，胸膈肿痛的，采用凉膈解毒法，加入栝蒌子、枳壳、桔梗、紫金皮、赤芍药；同时也适宜用棱针刺破肿胀处出血。如果处于半表半里阶段，胸膈肿痛的，使用柴胡枳桔汤，加入栝蒌子、柴金皮、赤芍药。
If, by the fourth, fifth, or sixth day, the patient exhibits incoherent speech, fixed staring gaze, and urinary incontinence, this indicates the exhaustion of Kidney Qi (Shen Jue). If the eyes are fixed with head shaking and the body appears dark/black, it signifies that Kidney Water (Shui) overacts on Heart Fire (Huo), leading to the exhaustion of Heart Qi (Xin Jue). Severe pain in the large and small intestines: since the Small Intestine is the Fu organ of the Heart and the Large Intestine is the Fu organ of the Lung, Metal being controlled by Fire leads to the impending exhaustion of Lung Qi (Fei Jue), followed by sweat like oil and unceasing panting. Cyanotic and black nails, loss of consciousness, bluish complexion with convulsions, curled tongue, and retracted scrotum indicate the exhaustion of Liver Qi (Gan Jue). Stool resembling clotted blood, very dark; or undigested food and water passing directly through; darkening around the mouth and everting lips indicate the exhaustion of Spleen Qi (Pi Jue). In Shanghan (Cold Damage) disease, Yang Qi is paramount. Cold hands and feet like ice, coldness extending past the knees, twitching of skin and muscles, and profuse spontaneous sweating indicate the collapse of Yang Qi (Yang Tuo). Exhaustion of Yang first manifests as a bluish complexion; exhaustion of Yin first manifests as a reddish complexion; both are incurable. If the head is heavy and cannot be lifted, and the Tianzhu bone (cervical support) collapses, Yuan Qi (Original Qi) has failed, and death is certain. Extremely foul-smelling turbid stool indicates death. Yin-Yang Du (Poison) persisting beyond six or seven days indicates death. Somnolence and high-pitched respiration indicate death. Sweat like oil, moist hair, and unceasing panting indicate death. Deficient pulses at both Cun and Chi positions with unremitting fever indicate death. Profuse sweating in damp-pattern patients leading to Jing (Spasm); heat combined with Jing spasm indicates death. Eyes fixed straight forward indicate death. Testes retracting into the abdomen and pulse deviating from its normal channel pattern indicate death. After recovery, painful urination with blood, termed Neiwai Chuang (Internal and External Sores): if black crusts form without pus discharge, it indicates death. Excessive heat with irritability and inability to sweat indicates extreme excess of Yang pulses, which is fatal. Black coating on the tongue with prickles that cannot be scraped off and regenerate easily indicates death. Epistaxis accompanied by spontaneous sweating indicates death. Hiccups due to Stomach Cold can be treated with Dingxiang, Huixiang, Shidi, and Liangjiang Tang (Clove, Fennel, Persimmon Calyx, and Galangal Decoction). If the pulse is imperceptible, add Gallbladder bile combined with Shengmai San (Generate Pulse Powder); if the pulse returns, or suddenly surges forth, these are all signs of death. Emaciation with severe muscle wasting indicates death.
Whenever there is redness, swelling, and pain in the chest and diaphragm, headache, body ache, fever, and aversion to cold, this is named Chige Shanghan (Red Diaphragm Cold Damage). It is appropriate to use Fangjing Baidu San (Saposhnikovia and Angelica Decoction for Resolving Toxins) added with Gualouzi (Trichosanthes Seed), Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Zijianpi (Bark of Ziziphus Spinosa), Xuanshen (Scrophularia Root), Chishao (Red Peony Root), Shengma (Cimicifuga Rhizome), and Baizhi (Angelica Dahurica). If symptoms present both exterior and interior aspects, with redness, swelling, and pain in the chest and diaphragm, use Fangfeng Tongsheng San (Saposhnikovia and Magnolia Decoction for Unblocking the Interior) added with Gualouzi, Huanglian, and Zijianpi. If the exterior syndrome has resolved, but the stool is dry and solid, with swelling and pain in the chest and diaphragm, employ Liangge Jiedu (Cooling the Diaphragm and Resolving Toxins) method, adding Gualouzi, Zhike (Aurantium Fruit), Jiegeng (Platycodon Root), Zijianpi, and Chishao; additionally, it is suitable to puncture the swollen area with a three-edged needle to bleed. If the condition is in the half-exterior half-interior stage, with swelling and pain in the chest and diaphragm, use Chaihu Zhijie Tang (Bupleurum and Aurantium Decoction) added with Gualouzi, Chaijinpi (Bark of Bupleurum), and Chishao.