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。
按语：少阴经是关乎生死的关键部位。因此，张仲景详细论述了各种死证。然而，如果是传经而来的热邪，若兼有阳明病证，还可以采用滋养阴液、消退阳热的方法；若是感受寒邪，且正气尚未溃败，还可以采用温补肾阳、驱散寒邪的方法。这些情况都不属于死证。凡是诊治伤寒热病，诊察到六脉沉细，患者处于似睡非睡的状态，都属于少阴病的征象。治疗时应兼顾少阴经进行调理。
如果兼有咳嗽，说明病邪位于肺与肾之间；如果兼有泄泻，说明病邪位于脾与肾之间；如果兼有神志昏昧，说明病邪位于心与肾之间。这类疾病不在三阳经，而在手足三阴经，这称为三阴经兼症。不能因为身体发热，就一概使用治疗三阳经的药物。
凡是诊治伤寒热病，轻微出现恶寒，发热持续不退，咳嗽且不口渴，六脉沉细，身体安静蜷卧，舌苔微白兼红，或者淡红而湿润，这是肺肾虚寒又感受外邪所致。适宜使用桂枝汤（Cinnamon Twig Decoction），加入陈皮、杏仁、川羌活、半夏、山药、茯苓等药物。通过微微发汗来解表。如果无效，应当立即使用金水六君煎（Jinshui Liujun Decoction），加入杏仁、生姜、胡桃、苏叶等药物投服，没有不奏效的。（此为肺肾虚寒挟带外感）
如果初起时发热恶寒，大便泄泻，舌苔白嫩，并且兼有少阴经脉症状的，这是寒邪客居于脾肾之间。适宜温中散寒，如使用桂枝、紫苏、广陈皮、厚朴、山药、焦神曲、干姜、茯苓、甘草等药物温散之。（此为脾肾俱寒挟带外感）
如果初起时恶寒发热，口渴唇燥，舌苔嫩红而干燥，或者舌底绛红表面浮白，或者兼有咳嗽，或者兼有烦躁，六脉弦数但无力，或者浮洪但无力，这是阴虚津亏又挟带外感。阴虚于下，则阳气亢盛于上，所以出现躁动烦乱。不要用治疗阳明火证的方法处理。也适宜使用金水六君煎，去掉半夏，改用生地黄，加入川石斛、牡丹皮、豆豉、羌活等药物。滋养阴液以助发汗。如果兼有呕吐恶心，应当保留半夏，加入竹茹，以调和胃气。如果兼有咳嗽，加入旋覆花、甜杏仁，以降逆气。如果经过发汗解表，升提太过，导致虚火上冒，出现眼睛发红、颧骨潮红、大渴、烦躁、呕吐恶心不能进食的情况，也适宜使用金水六君煎，加入麦冬、代赭石等药物，滋养阴液、镇压逆气。如果出汗过多，合用生脉散（Shengmai San）。（此为阴虚有火挟带外感）
如果阴虚有火，又挟带外感，导致头痛恶寒，发热不止，因为口燥渴而食用生冷食物，随即导致泄泻，舌苔微白，兼淡红色，舌形虽然湿润但感觉干燥，这是因为脾脏本虚寒，因为津液少而感到口渴，所以一吃生冷食物，就出现泄泻。治疗适宜调和脾胃以补益少阴，如使用生地黄、牡丹皮、茯苓、山药、广陈皮、钗石斛、薏苡仁、甘草、莲子肉等为主药。兼有表证的，加入葱白、豆豉，或者羌活、葛根也可以。如果表证已除，但只有发热口渴，兼有大便稀溏的，在前药基础上加入糯米炒过的麦冬、沙参以生津液，自然口渴解除、热势停止。（此为脾寒肾热挟带外感）
如果初起时呕吐泄利，停止后出现发热，脉象沉细，手脚冰冷，舌形紫绛无苔的，这是少阴病。不要当作霍乱治疗。如果舌润不渴，应当使用金水六君煎，加入丁香、沉香温中以调和之。如果舌燥口渴，也使用金水六君煎，加入麦冬、（糯米粉炒制的）北沙参，益阴和中，以生津液。如果吐泻损伤津液，口大渴，而小便不利者，紧急使用左归饮（Zuogui Yin），加入人参、麦冬、当归、芍药，收敛阴液、生津液，自然口渴解除、二便通利。如果妄用利尿药物则会致死。（此为少阴病起于吐利）
邵评：这是治疗少阴吐利的正法，分为温中、滋液、敛阴生津三种法则。治疗方法极其精妙。
如果初起时发热，神情呆滞不语，六脉沉细短数，似睡非睡，或者烦躁狂言，这是病邪在心肾之间。或者是因为受惊，痰浊乘袭心包络。治疗适宜清心豁痰，如使用茯神、远志、石菖蒲、天竺黄、川贝母、丹参、麦冬、钩藤、薄荷、辰砂等药物，以清除心包络的痰浊，神志自然清明。如果舌形绛燥，口渴唇干，六脉沉数，前方适宜加入生地黄、牡丹皮、淡竹叶等药物，以清心包之火。如果大便秘结，不妨加入犀角数分。（此为心肾热邪）
如果出现神志昏迷、胡言乱语，发热仍然想要盖被子，眼睛向上视，大便不成形，舌色紫绛而圆胖，虽然干燥但没有芒刺，外表虽然躁扰，这是阴气盛而不能兼摄阳气，忌用寒凉药物。不可误认为是阳明病，妄投犀角。适宜使用左归丸、六味地黄丸等汤剂，微加清心的药物，如钩藤、川贝母、麦冬等。这样治疗才恰当。（此用心肾虚邪）
邵评：这是治疗心肾虚邪的正法。这一条与上一条同样是心肾之邪，但有虚实不同。上一条实证多，心经见症多；这一条虚证多，肾经见症多。用药清补不同，应当仔细辨别。
如果身体发热但脚冷，面色赤红如戴阳状，脉象沉细无力，或者数大无力，或者阴阳脉俱紧，其人烦躁欲狂，扬手掷足，或者想坐卧在水中，舌苔紫色少神气，或者阔大胖嫩，或者淡红圆浓，虽然湿润但感觉干燥，这是“躁”，不是“烦”。这是阴盛格阳证。紧急使用八味丸（Bawei Wan）投服，或者使用参附汤加入熟地黄投服。如果得到躁动安定、脉象圆润、舌转微白，才会有生机。（此为阴盛格阳）
以上诸条，都是少阴本经自发的疾病。
如果是阳经的热邪，传入太阴，已经有很多危重征候，到了进入少阴经，存活者少，死亡者多。凡是见到神气昏沉，语言颠倒错乱，牙齿枯槁，牙龈发黑，午后身热，眼睛向上视，舌苔红中有黑点，黑中有红点，头项强直，小便涩痛，虽然醒着却像睡着一样，虽然口渴却不知道喝水，时常发出鼾睡声，形态似死证。但是，如果舌头不卷缩，阴囊不收缩，面色不发青，呼吸不高促，咽喉不僵硬，四肢不厥冷，鼻孔不扇动，耳朵不焦枯，眼球不突出如鱼目，嘴巴不开裂如鸦口，还有可以治疗的道理。如果舌苔干燥有芒刺而且便秘的，适宜兼治阳明病，方剂使用犀角、生地黄、牡丹皮、麦冬、天花粉、川石斛、茯神、钩藤、川贝母、胆南星等药物，以滋养阴液、消退阳热。阴液恢复，外在可以通过发汗而解，内在可以通过排便而解，即使是寒中也有散邪的意义。如果大便不成形，舌面无干燥芒刺，这是阴不兼阳，即属于虚证，为难治。适宜使用右归丸、六味地黄丸加减为当。
邵评：阳经热邪，传入少阴，实证则转属阳明，适宜兼治阴阳；虚证则邪气伏留少阴，仍从本经治疗。话语最为精确。
凡是少阴病，六脉沉细，似睡非睡，其舌色呈现紫色。然而，紫色而鲜润的，可治；紫色而枯晦，像猪肝颜色的，不治。或者紫色而间杂微白苔的，才好。
邵评：从少阴的脉象、症状和舌色，辨别阴液的存亡，以此决定疾病的可治与否，确切的论断。
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.