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
结胸证如果脉象浮大，不可使用攻下法，误用攻下法会导致死亡。结胸证的症状全部具备，且出现烦躁不安的，也是死证。阳明病若心下部位硬满，不可使用攻下法，若误攻导致腹泻不止的，会死亡；若出现两眼直视、说胡话、气喘、胸满的，会死亡；若腹泻的，也会死亡。发汗过多，或者多次发汗，会导致亡阳，出现说胡话、气短的，会死亡。伤寒病经过吐法或下法治疗后，病邪未解，大便不通，从五六天到十几天，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，发作时不认识人，手循摸衣被和床沿，惊恐不安，轻微气喘，两眼直视，脉象涩滞的，是死证。脉象浮而芤，浮脉主阳，芤脉主阴，浮芤相搏，胃气生热，阳气就会断绝。少阳病只表现为四肢厥冷而无汗，如果强行发汗，必定引起动血，不知道血液会从哪个通道流出，或者从口鼻出，或者从眼睛出，这叫做“下厥上竭”，属于难治之证。少阴病，恶寒，身体蜷缩，并且腹泻，手足冰冷的，属于不治之证。少阴病六七天，呼吸浅表（息高）的，是死证。伤寒脉迟，过了六七天反而给予黄芩汤来清热，脉迟说明体内有寒，现在又用黄芩汤清除其热，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，手足冰冷，烦躁，艾灸厥阴经穴位后脉搏不恢复的，是死证。伤寒发热，腹泻，四肢厥冷，躁动不安无法躺卧的，是死证。伤寒发热，腹泻严重，四肢厥冷不止的，是死证。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，是死证，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，再次出现厥冷的，不可使用攻下法，这是因为亡血所致，误下会导致死亡。发热且四肢厥冷，到了第七天出现腹泻的，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，艾灸后手脚不温暖，如果脉搏不恢复，反而轻微气喘的，是死证。腹泻后脉象消失，手足冰冷，偶尔脉搏恢复，手足温暖的，可生；脉搏不恢复的，死。伤寒腹泻，一天十几次，脉象反而实大的，是死证。呕吐，脉弱，小便通畅，身体有微热，出现厥冷的，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，是死证；如果腹泻不止的，也是死证。
附：死证歌诀
两感伤寒不需要治疗，阴阳毒超过七天的期限。黑斑出现，下厥与上竭。阳病见到阴脉者危险。舌卷、耳聋、囊缩。阴阳交争及循衣摸床。除中证都不治。嘴唇发青，面色黑黯。咳嗽逆气不止以及脏结。大小便失禁，难以医治。出汗虽多但不到脚底。口张目陷还有什么办法。喘气不停以及与阴阳易。离经脉见到死亡应当知晓。结胸证症状具备，烦躁严重，直视摇头是死的时候。少阳证与阳明合病，脉弦长大，救治时已迟。发汗后反而脉搏躁疾，须知是脏厥，命难追回。虾游脉、屋漏脉、雀啄脉、鱼翔脉、弹石脉、解绳推脉，更有代脉，都是无法救治。以上诸证，死亡无疑。
In the syndrome of Jie Xiong (Chest Binding), if the pulse is floating and large, purgation must not be used; using it will lead to death. If all symptoms of Jie Xiong are present and irritability arises, this is also a fatal condition. In Yangming disease, if there is hardness and fullness in the epigastrium, attacking with purgatives is contraindicated; if purgation leads to diarrhea that does not stop, death ensues. If the patient presents with fixed gaze, delirium, asthma, and chest fullness, death ensues; if diarrhea occurs, death also ensues. Excessive sweating, or repeated sweating, leads to the loss of Yang Qi (Vital Energy); if accompanied by delirium and shortness of breath, death ensues. In Shanghan (Cold Damage) disease, if vomiting or purgation fails to resolve the pathogen, and constipation persists for five to ten days, followed by tidal fever at dusk (Ri Bu Suo), aversion to cold disappearing, solitary speech resembling hallucinations of seeing ghosts, unconsciousness during episodes, picking at clothes and bedrails, restlessness, slight asthma, fixed gaze, and a choppy pulse, this is a fatal condition. A floating and hollow (Kou) pulse: floating indicates Yang, hollow indicates Yin. The interaction of floating and hollow pulses generates heat in the Stomach Qi, leading to the exhaustion of Yang. In Shaoyang disease, if there is only cold extremities without sweat, forcing sweat will inevitably disturb the blood; the bleeding may exit from the mouth or nose, or from the eyes. This is called "Lower Jue and Upper Exhaustion," which is difficult to treat. In Shaoyin disease, if there is aversion to cold, curling up of the body, diarrhea, and cold extremities, it is incurable. In Shaoyin disease, if after six or seven days the respiration becomes shallow and high (Xi Gao), it is a fatal condition. In Shanghan, if the pulse is slow and after six or seven days one incorrectly administers Huang Qin Tang (Scutellaria Decoction) to clear heat, noting that a slow pulse indicates cold, clearing heat further will cause abdominal coldness and anorexia. If the patient suddenly gains appetite, this is called Chu Zhong (Removing the Middle), which is fatal. In Shanghan, if after six or seven days the pulse is faint, extremities are cold, and there is irritability, and moxibustion on the Jueyin meridian fails to restore the pulse, it is fatal. In Shanghan, if there is fever, diarrhea, cold extremities, and restlessness preventing lying down, it is fatal. In Shanghan, if there is fever, severe diarrhea, and unceasing cold extremities, it is fatal. In Shanghan, if after six or seven days, without prior diarrhea, sudden fever and diarrhea occur with unceasing sweating, it is fatal due to the presence of Yin without Yang. In Shanghan, if after five or six days there is no Jie Xiong, the abdomen is soft, the pulse is deficient, and cold extremities recur, purgation is contraindicated as this indicates blood depletion; incorrect purgation leads to death. If there is fever and cold extremities, and diarrhea occurs on the seventh day, it is difficult to treat. In Shanghan, after severe purgation on the sixth or seventh day, if the Cun (Inch) pulse is deep and slow, extremities are cold, lower pulses are absent, throat is obstructed, pus and blood are expectorated, and diarrhea is unceasing, it is difficult to treat. In diarrhea with cold extremities and absent pulse, if moxibustion does not warm the limbs and the pulse does not return but slight asthma appears, it is fatal. After diarrhea, if the pulse disappears and extremities are cold, but the pulse occasionally returns and extremities become warm, life is possible; if the pulse does not return, death ensues. In Shanghan diarrhea occurring more than ten times a day, if the pulse becomes excessive and solid, it is fatal. In vomiting with a weak pulse, free urination, slight body heat, and cold extremities, it is difficult to treat. In patients with Dampness, if purgation causes sweating on the forehead, slight asthma, and free urination, it is fatal; if diarrhea is unceasing, it is also fatal.
Appendix: Song of Fatal Syndromes
Liang Gan (Double Exposure) Shanghan requires no treatment; Yin-Yang Du (Poison) beyond seven days is doomed. Appearance of black spots, Lower Jue and Upper Exhaustion. Yang diseases showing Yin pulses are critical. Tongue rolling, deafness, and testicular retraction. Yin-Yang Jiao (Intersection) and picking at clothes. Chu Zhong is untreatable. Cyan lips and dark face. Unremitting cough and Zang Jie (Organ Knotting). Incontinence of urine and stool is hard to cure. Sweating not reaching the feet. Open mouth and sunken eyes, what hope remains? Unremitting asthma and Yin-Yang Yi (Exchange). Li Jing Mai (Departing Vessel) indicates death. When Jie Xiong symptoms are complete with severe irritability, fixed gaze, and shaking head, it is time of death. Shaoyang combined with Yangming, pulse string-like and large, rescue is too late. Post-sweating rapid pulse indicates Zang Jue, life cannot be saved. Xia You (Shrimp Swimming), Wu Lou (House Leak), Que Zhuo (Sparrow Pecking), Yu Xiang (Fish Gliding), Dan Shi (Stone Bouncing), Jie Sheng Tui (Unraveling Rope) pulses, along with Dai Pulse (Intermittent), are all incurable. All aforementioned syndromes undoubtedly lead to death.