按少阴为生死之关。故仲景历言死证。然于传经热邪。若兼阳明。犹可养阴退阳。自感寒邪。正气未溃。
犹可温肾散寒。均非死证。凡看伤寒热病。诊得六脉沉细。似寐非寐。皆属少阴见象。宜兼少阴以治。
如兼咳嗽。邪在肺肾之间。如兼泄
泻。邪在脾肾之间。如兼昏昧。邪在心肾之间。此病不在三阳。而在手足三阴。是为三阴兼症。不得
因身热。概以三阳经药治之。
凡诊伤寒热病。微见恶寒。发热不已。咳嗽不渴。六脉沉细。身静蜷卧。舌苔微白兼
红。或淡红而润。此肺肾虚寒而感外邪也。宜桂枝汤。加陈皮、杏仁、川羌、半夏、山药、茯苓之类。
微汗之。如不应。急当以金水六君煎。加杏仁、生姜、胡桃、苏叶之类投之。无不取效。（肺肾虚寒挟感）
如初起发热恶寒。大便泄泻。舌苔白嫩。而兼少阴脉症者。此寒邪客于脾肾之间。
宜温中散寒。如桂枝、紫苏、广皮、浓朴、山药、焦曲、干姜、茯苓、甘草之类温散之。（脾肾俱寒挟感）
若初起恶寒发热。口渴唇燥。舌苔嫩红而干。或绛底浮白。或兼咳嗽。或兼烦躁。六
脉弦数无力。或浮洪无力。此阴虚水亏而挟外感也。阴虚于下。则阳亢于上。故见
躁烦。勿以阳明火症治之。亦宜金水六君。去半夏。用生地。加川斛、丹皮、豆豉、羌活
之类。滋养阴液以汗之。如兼呕恶。当留半夏。加竹茹。以和胃。如兼咳嗽。加旋复花、
甜杏仁。以降气。如经汗表。升提太过。以致虚火上冒。目赤颧红。大渴烦躁。呕恶不
纳者。亦宜金水六君煎。加麦冬、代赭之类。养阴镇逆。汗多合生脉。（阴虚有火挟感）
如阴虚有火。而挟外感。以致头疼恶寒。发热不止。因口燥渴。而食生冷。遂致泄泻。
舌苔微白。兼淡红。舌形虽湿而干。此脾本虚寒。因津液少而渴。故一食生冷。即见
泄泻。治宜和脾以益少阴。如生地、丹皮、茯苓、山药、广皮、钗斛、苡仁、甘草、莲肉等主
之。兼表症者。加葱白、豆豉、或羌活、葛根亦可。如表症已除。而但发热口渴。兼便溏者。前药加糯米
炒麦冬、沙参以生津液。自然渴解热止。（脾寒肾热挟感）
如初起吐利。止后发热。脉沉细。手足冷。舌形紫绛无苔者。此少阴症也。勿以霍乱
治之。舌润不渴。当以金水六君煎。加丁沉温以和之。舌燥口渴。亦以金水六君。加
麦冬、（糯米粉炒）北参。益阴和中。以生津液。如吐泻伤津。口大渴。而小水不利者。急以左
归饮。加参、麦、归、芍。敛阴生津。自然渴解便利。若妄利小便则死矣。（少阴病起吐利）
邵评∶此少阴吐利之正法。分温中、滋液、敛阴生津三则。治法极精。
如初起发热。神呆不语。六脉沉细短数。似寐非寐。或烦躁狂言。此邪在心肾之间。
或因受惊。痰乘包络。治宜清心豁痰。如茯神、小草、菖蒲、天竺黄、川贝、丹参、麦冬、钩
丁、薄荷、辰砂之类。以清包络之痰。神自清矣。如舌形绛燥。口渴唇干。六脉沉数。前
方。宜加生地、丹皮、淡竹叶之类。以清心包之火。如大便秘结。不妨加犀角数分。（心肾热邪）
若神昏谵语。发热仍欲暖盖。目睛上视。大便不实。舌色紫绛而圆。虽干无刺。外虽
躁扰。此阴不兼阳。忌用寒凉。不可误认阳明。妄投犀角。宜左归。六味等汤。微加清心之品。如钩藤、
川贝、麦冬之类。治之为当。（心肾虚邪）
邵评∶此心肾虚邪之正法。此条与上条同是心肾之邪。然有虚实之不同。上条实而心经见症多。此条虚
而肾经见症多。用药清补不同。当细辨之。
若身热足冷。面赤戴阳。脉来沉细无力。或数大无力。或阴阳俱紧。其人烦躁欲狂。
扬手掷足。或欲坐卧水中。舌苔紫色少神。或阔大胖嫩。或淡红圆浓。虽湿而干。此躁也。非烦也。
阴盛格阳也。急以八味投之。或参附汤加熟地投之。如得躁定脉圆。舌转微白。庶有生机。（阴盛格阳）
以上诸条。皆少阴本经自病。
若是阳经热邪。传至太阴。已多危候。至入少阴。生者少。死者多矣。凡见神气昏沉。
语言颠倒。齿枯龈黑。午后身热。目睛上视。舌苔红中有黑点。黑中有红点。头项强。
小便涩。虽醒似睡。虽渴不知消水。时作鼾睡声。形似死证。然舌不卷。囊不缩。面不
青。息不高。喉颡不直。四肢不厥。鼻不扇。耳不焦。不鱼目。不鸦口。尚有可治之理。如
舌苔燥刺而便秘者。宜兼阳明以治。方用犀角、生地、丹皮、麦冬、花粉、川斛、茯神、钩
丁、川贝、胆星之类。以养阴退阳。阴液复。外可得汗而解。内可得便而解。即寒中亦
有散邪之义也。若大便不实。舌无燥刺。此阴不兼阳。即属虚症。为难治。宜右归六味出入为当。
邵评∶阳经热邪。传入少阴。实则转属阳明。宜兼阴阳治之。虚则邪伏少阴。仍从本经治之。语最精确。
凡少阴症。六脉沉细。似寐非寐。其舌紫色是也。然紫而鲜润者。可治。紫而枯晦。如
猪肝色者。不治。或紫色而间微白苔者方佳。
邵评∶从少阴脉症舌色。辨其阴液之存亡。以决病之可治不可治。的论也。
有初起吐泻。如霍乱。陡然变重昏昧者。少阴症也。
邵评∶少阴症似霍乱。戒勿误认。此条最须着眼。
Note: The Shaoyin (Lesser Yin) channel is the critical juncture between life and death. Therefore, Zhang Zhongjing has extensively discussed fatal syndromes. However, if it is a heat pathogen transmitted through the channels, and accompanied by Yangming disease, one can still nourish Yin to subdue Yang. If it is a cold pathogen contracted, and the healthy Qi has not yet collapsed, one can still warm the Kidney to disperse Cold. Neither of these constitutes a fatal syndrome. In all cases of diagnosing and treating Shanghan (Cold Damage) febrile diseases, if the six pulses are deep and fine, and the patient appears to be in a state of sleep but not quite asleep, this belongs to the manifestations of Shaoyin disease. Treatment should address the Shaoyin channel concurrently.
If accompanied by coughing, the pathogen is located between the Lung and Kidney. If accompanied by diarrhea, the pathogen is located between the Spleen and Kidney. If accompanied by mental confusion, the pathogen is located between the Heart and Kidney. This disease is not in the Three Yang channels, but in the Hand and Foot Three Yin channels; this is called a concurrent syndrome of the Three Yin channels. One must not, simply because of body heat, indiscriminately use medicines for the Three Yang channels.
In all cases of diagnosing and treating Shanghan febrile diseases, if there is slight aversion to cold, persistent fever, cough without thirst, deep and fine six pulses, quiet curled-up posture, a tongue coating that is slightly white with redness, or pale red and moist, this indicates Lung and Kidney deficiency-cold contracting an external pathogen. It is appropriate to use Guizhi Tang (Cinnamon Twig Decoction), adding Chenpi (Tangerine Peel), Xingren (Apricot Seed), Chuan Qianghuo (Notopterygii Rhizoma et Radix), Banxia (Pinelliae Tuber), Shanyao (Dioscoreae Rhizoma), Fuling (Poria), etc. Induce slight sweating. If ineffective, immediately administer Jinshui Liujun Decoction (Six Gentlemen Decoction for Metal and Water), adding Xingren (Apricot Seed), Shengjiang (Fresh Ginger), Hetao (Walnut Kernel), Zisu (Perillae Folium), etc. There will be no failure of efficacy. (This is Lung-Kidney deficiency-cold with concurrent external contraction)
If at the onset there is fever and aversion to cold, loose stools, tender white tongue coating, and concurrent Shaoyin pulse and symptoms, this is Cold pathogen lodging between the Spleen and Kidney. It is appropriate to warm the middle and disperse Cold, using herbs such as Guizhi (Cinnamomi Ramulus), Zisu (Perillae Folium), Guangchenpi (Aurantii Pericarpium), Houpo (Magnoliae Officinalis Cortex), Shanyao (Dioscoreae Rhizoma), Jiaoqu (Fomentatio), Ganjiang (Zingiberis Rhizoma), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), etc., to warm and disperse. (This is Spleen-Kidney dual cold with concurrent external contraction)
If at the onset there is aversion to cold and fever, thirst and dry lips, tender red and dry tongue coating, or crimson base with floating white surface, or accompanied by cough, or accompanied by irritability, the six pulses are wiry and rapid but forceless, or floating and large but forceless, this is Yin deficiency with fluid depletion concurrent with external contraction. Yin deficiency below causes Yang hyperactivity above, hence the irritability. Do not treat this as a Yangming Fire syndrome. It is also appropriate to use Jinshui Liujun Decoction, removing Banxia (Pinelliae Tuber), using Shengdi Huang (Rehmanniae Radix), and adding Chuan Shihu (Dendrobii Caulis), Danpi (Moutan Cortex), Douchi (Sojae Semen Praeparatum), Qianghuo (Notopterygii Rhizoma et Radix), etc. Nourish Yin fluids to assist sweating. If accompanied by vomiting and nausea, retain Banxia (Pinelliae Tuber) and add Zhuru (Bambusae Caulis in Taenia) to harmonize the Stomach. If accompanied by cough, add Xuanfuhua (Inulae Flos) and Tian Xingren (Sweet Apricot Seed) to descend Qi. If sweating therapy was used excessively, causing ascending floating fire, resulting in red eyes, malar flush, severe thirst, irritability, vomiting, and inability to eat, Jinshui Liujun Decoction should also be used, adding Maidong (Ophiopogonis Radix) and Daizhe Shi (Haematitum), to nourish Yin and suppress rebellion. If sweating is excessive, combine with Shengmai San (Generate the Pulse Powder). (This is Yin deficiency with fire concurrent with external contraction)
If there is Yin deficiency with fire, concurrent with external contraction, leading to headache, aversion to cold, and persistent fever, and due to oral dryness and thirst, consuming raw/cold foods leads to diarrhea. The tongue coating is slightly white, mixed with pale red. Although the tongue shape is moist, it feels dry. This is because the Spleen is originally deficient and cold; due to scant fluids, there is thirst, so consuming raw/cold food immediately triggers diarrhea. Treatment should harmonize the Spleen to benefit the Shaoyin, using primarily Shengdi Huang (Rehmanniae Radix), Danpi (Moutan Cortex), Fuling (Poria), Shanyao (Dioscoreae Rhizoma), Guangchenpi (Aurantii Pericarpium), Chaihu (note: text says 钗斛 likely Dendrobium, here interpreted as Chaihu/Dendrobium contextually, but strictly Dendrobii Caulis based on previous mention, let's stick to Dendrobii Caulis/Chihuhu or just Dendrobium), Yiyiren (Coicis Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Lianrou (Nelumbinis Semen), etc. If exterior symptoms exist, add Congbai (Allii Macrostemonis Bulbus), Douchi (Sojae Semen Praeparatum), or Qianghuo (Notopterygii Rhizoma et Radix), Gegen (Puerariae Lobatae Radix) are also acceptable. If exterior symptoms are resolved, but only fever and thirst remain, accompanied by loose stools, add Nuomifan chao Maidong (Stir-fried Ophiopogonis Radix with glutinous rice flour) and Shashen (Glehniae Radix) to the previous formula to generate fluids; naturally, thirst will resolve and heat will cease. (This is Spleen cold with Kidney heat concurrent with external contraction)
If at the onset there is vomiting and diarrhea, followed by fever after cessation, deep and fine pulses, cold hands and feet, and a purple-crimson tongue without coating, this is a Shaoyin syndrome. Do not treat it as Huoluan (Cholera-like disorder). If the tongue is moist and there is no thirst, use Jinshui Liujun Decoction, adding Dingxiang (Caryophylli Flos) and Chenxiang (Aquilariae Lignum Resinatum) to warm and harmonize. If the tongue is dry and there is thirst, also use Jinshui Liujun Decoction, adding Maidong (Ophiopogonis Radix) and Beishashen (Glehniae Radix stir-fried with glutinous rice flour) to benefit Yin and harmonize the middle, generating fluids. If vomiting and diarrhea have damaged fluids, causing severe thirst and difficult urination, urgently use Zuogui Yin (Left Restoring Drink), adding Renshen (Ginseng Radix), Maidong (Ophiopogonis Radix), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), to astringe Yin and generate fluids; naturally, thirst will resolve and urination/stool will normalize. If diuretics are wrongly used, death will ensue. (This is Shaoyin disease arising from vomiting and diarrhea)
Shaoshao Commentary: This is the correct method for treating Shaoyin vomiting and diarrhea, divided into three principles: warming the middle, nourishing fluids, and astringing Yin to generate fluids. The treatment methods are extremely refined.
If at the onset there is fever, mental dullness and muteness, deep, fine, short, and rapid six pulses, appearing to sleep but not quite asleep, or irritability and delirious speech, this indicates pathogen between the Heart and Kidney. Or it may be due to fright, where phlegm invades the Pericardium. Treatment should clear the Heart and resolve phlegm, using Fushen (Poria with Hostwood), Xiaocao (Polygalae Radix), Changpu (Acori Tatarinowii Rhizoma), Tianzhuhuang (Calami Spira), Chuanbeimu (Fritillariae Cirrhosae Bulbus), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Maidong (Ophiopogonis Radix), Gouding (Uncariae Ramulus cum Uncis), Bohe (Menthae Haplocalycis Herba), Chencha (Cinnabaris), etc., to clear phlegm from the Pericardium; the spirit will naturally become clear. If the tongue is crimson and dry, with thirst and dry lips, and deep, rapid six pulses, add Shengdi Huang (Rehmanniae Radix), Danpi (Moutan Cortex), Dazhuye (Phyllostachidis Folium) to the previous formula to clear Fire from the Pericardium. If constipation exists, adding Xijiao (Rhinocerotis Cornu - note: substitute with water buffalo horn in modern practice, but term remains) in small doses is permissible. (This is Heat pathogen in Heart and Kidney)
If there is coma and delirious speech, fever with desire to cover up with warmth, upward deviation of the eyes, loose stools, a purple-crimson and round tongue, dry but without prickles, and although externally restless, this is Yin excess failing to support Yang. Cold-natured drugs are contraindicated. Do not mistake it for Yangming disease and recklessly administer Xijiao (Rhinocerotis Cornu). It is appropriate to use Zuogui Wan (Left Restoring Pill), Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), and other decoctions, slightly adding heart-clearing herbs like Gouteng (Uncariae Ramulus cum Uncis), Chuanbeimu (Fritillariae Cirrhosae Bulbus), Maidong (Ophiopogonis Radix). This treatment is proper. (This is Deficient-Cold Pathogen in Heart and Kidney)
Shaoshao Commentary: This is the correct method for treating deficient-cold pathogen in Heart and Kidney. This clause and the previous one both involve Heart-Kidney pathogens, but differ in deficiency and excess. The previous one is excess with more Heart meridian symptoms; this one is deficiency with more Kidney meridian symptoms. The clearing and tonifying medications differ; careful differentiation is required.
If there is body heat but cold feet, facial flushing resembling Daiyang (floating Yang), deep, fine, and forceless pulses, or rapid/large and forceless pulses, or tight pulses in both Yin and Yang positions, the person is irritable and nearly mad, throwing hands and feet about, or desiring to sit/lie in water. The tongue coating is purple and lacks vitality, or broad, large, and tender, or pale red, round, and thick. Although moist, it feels dry. This is "Zao" (restlessness/agitation), not "Fan" (irritability). This is Yin excess repelling Yang. Urgently administer Bawei Wan (Eight-Ingredient Pill), or Shenfu Tang (Ginseng and Aconite Decoction) with Shudi Huang (Prepared Rehmanniae Radix). If agitation settles, pulses become round, and the tongue turns slightly white, there is hope for survival. (This is Yin Excess Repelling Yang)
The above clauses all describe diseases originating within the Shaoyin channel itself.
If heat pathogen from the Yang channels transmits to Taiyin, many critical signs already appear; upon entering Shaoyin, few survive, many die. Whenever one sees mental dullness, inverted speech, withered teeth, black gums, afternoon fever, upward deviation of the eyes, tongue coating red with black spots and black with red spots, stiffness of head and neck, astringent urination, waking but seeming asleep, thirst but inability to consume water, occasional snoring sounds, and appearance resembling death... However, if the tongue does not curl, the scrotum does not retract, the face is not blue, respiration is not high/panting, the throat is not rigid, limbs are not cold, nostrils do not flap, ears are not scorched, eyes do not protrude like fish eyes, and the mouth does not gape like a crow's beak, there is still a possibility of treatment. If the tongue coating is dry with prickles and there is constipation, treat concurrently with Yangming. Use formulas containing Xijiao (Rhinocerotis Cornu), Shengdi Huang (Rehmanniae Radix), Danpi (Moutan Cortex), Maidong (Ophiopogonis Radix), Huafen (Trichosanthis Radix), Chuan Shihu (Dendrobii Caulis), Fushen (Poria with Hostwood), Goudeng (Uncariae Ramulus cum Uncis), Chuanbeimu (Fritillariae Cirrhosae Bulbus), Danning (Arisaematis Cum Bile), etc., to nourish Yin and subdue Yang. Once Yin fluids are restored, resolution can occur via sweating externally or stool internally; even in cold conditions, there is a principle of dispersing pathogens. If stools are loose and the tongue lacks dry prickles, this is Yin failing to support Yang, constituting a deficiency syndrome, which is difficult to treat. It is appropriate to modify Yougui Wan (Right Restoring Pill) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia).
Shaoshao Commentary: When heat pathogen from Yang channels transmits to Shaoyin, excess transforms to Yangming, requiring concurrent Yin-Yang treatment; deficiency means pathogen lingers in Shaoyin, requiring treatment from the primary channel. The words are most precise.
In all Shaoyin syndromes, the six pulses are deep and fine, and the patient appears to sleep but not quite asleep; the tongue color is purple. However, if purple and fresh/moist, it is treatable; if purple and withered/dull, resembling pig liver color, it is untreatable. Or if purple with interspersed slight white coating, that is favorable.
Shaoshao Commentary: Differentiating the preservation or loss of Yin fluids from Shaoyin pulse, symptoms, and tongue color to determine treatability is an accurate argument.
There are cases where vomiting and diarrhea begin suddenly, resembling Huoluan (Cholera), abruptly worsening into severe mental confusion; this is a Shaoyin syndrome.
Shaoshao Commentary: Shaoyin syndrome resembles Huoluan; caution against misdiagnosis. This clause requires utmost attention.