天津张××，年三十八岁，于季冬得伤寒证，且无脉。
病因 旬日前曾感冒风寒，经医治愈，继出门作事，又感风寒遂得斯病。
证候 内外俱觉寒凉，头疼，气息微喘，身体微形寒战，六脉皆无。
诊断 盖其身体素弱，又在重感之余，风寒深入阻塞经络，是以脉闭。拟治以麻黄汤，再重加补
气之药，补其正气以逐邪外出，当可奏效。
处方 麻黄（三钱） 生箭 （一两） 桂枝尖（二钱） 杏仁（二钱去皮） 甘草（二钱）
先煎麻黄数沸，吹去浮沫，再入余药同煎汤一大盅，温服，被复取微汗。
效果 服药后周身得汗，其脉即出，诸病皆愈。
帮助 按此证或疑系少阴伤寒，因少阴伤寒脉原微细，微细之至可至于无也。而愚从太阳治者，因
其头疼、微喘、寒战，皆为太阳经之现象，而无少阴证蜷卧、但欲寐之现象也。是以
于麻黄汤中，重加生黄 一两，以助麻、桂成功，此扶正即以逐邪也。
天津李姓童子，年十四岁，得伤寒脉闭证。
病因 其左肋下素有郁气，发动时辄作疼，一日发动疼剧，头上汗出，其汗未解，出冒风寒，
遂得斯证。
证候 头疼、身冷、恶寒、无汗、心中发热，六脉皆闭。
诊断 因其素有肋下作疼之病，身形羸弱；又当汗出之时感冒风寒，则风寒之入者必深，是
以脉闭身寒；又肋下素有郁气，其肝胆之火必然郁滞，因外感所束激动其素郁之火，所以心
中觉热。法当以发表之药为主，而以清热理郁兼补正之药佐之。
处方 麻黄（二钱） 玄参（六钱） 生怀山药（六钱） 野台参（二钱）
生鸡内金（二钱） 天花粉（五钱） 甘草（钱半）
先煎麻黄数沸，吹去浮沫，再入诸药同煎一大盅，温服取汗，若不出汗时，宜再服西药阿斯匹林一瓦以助其汗。
效果 服药两点钟，周身微发热，汗欲出不出，遂将阿斯匹林服下，须臾汗出遍体，翌日复诊，其
脉已出，五至无力，已不恶寒，心中仍觉发热，遂去麻黄，将玄参、山药皆改用一两，
服至三剂后；心中已不发热，遂将玄参、天花粉各减半，再服数剂以善其后。
Zhang from Tianjin, aged 38, contracted Cold Damage (Shanghan) at the end of winter and presented with an absent pulse.
Etiology: Ten days prior, he had caught wind-cold, which was cured by a physician. Subsequently, while going out for work, he was exposed to wind-cold again, leading to this illness.
Symptoms: He felt cold inside and outside his body, suffered from headache, slight panting, mild aversion to cold with shivering, and all six pulses were imperceptible.
Diagnosis: It is likely that due to his constitutionally weak body and subsequent double exposure to pathogenic factors, wind-cold penetrated deeply and blocked the meridians, resulting in pulse closure. The proposed treatment is Mahuang Tang (Ephedra Decoction), heavily supplemented with Qi-tonifying herbs. By tonifying the healthy Qi to expel the pathogen outward, efficacy can be expected.
Prescription: Ephedrae Herba (Mahuang, 麻黄) - 3 qian; Raw Astragali Radix (Sheng Huangqi, 生黄芪) - 1 liang; Cinnamomi Ramulus Acumen (Guizhi Jian, 桂枝尖); Semen Armeniacae Amarum (Xingren, 杏仁) - 2 qian, peeled; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 2 qian.
First, boil Ephedrae Herba for a few minutes, skim off the foam, then add the remaining herbs and decoct together into one large cup of liquid. Take warm, cover with blankets to induce slight sweating.
Outcome: After taking the medicine, sweat appeared over the whole body, the pulse immediately became palpable, and all symptoms resolved.
Commentary: Regarding this case, some might suspect Shaoyin Cold Damage (Shaoyin Shanghan), as the pulse in Shaoyin Cold Damage is originally fine and faint; when extremely fine and faint, it may become imperceptible. However, I treated it via the Taiyang channel because headache, slight panting, and shivering are manifestations of the Taiyang meridian, whereas there were no signs of Shaoyin syndrome such as curling up in bed or drowsiness. Therefore, I added a heavy dose of Raw Astragali Radix (1 liang) to Mahuang Tang to assist Mahuang and Guizhi in their action. This exemplifies supporting the righteous Qi to expel the pathogen.
A boy surnamed Li from Tianjin, aged 14, contracted Cold Damage with pulse closure.
Etiology: He had long-standing stagnant Qi under his left hypochondrium, which caused pain upon activation. One day, the pain was severe, accompanied by sweating on the head. Before the sweating subsided, he went out and was exposed to wind-cold, thus contracting this condition.
Symptoms: Headache, cold body, aversion to cold, absence of sweat, heat sensation in the heart region, and all six pulses were closed/imperceptible.
Diagnosis: Due to his chronic hypochondriac pain and emaciated physique, combined with exposure to wind-cold during sweating, the pathogenic invasion must have been deep, causing pulse closure and body coldness. Furthermore, the pre-existing stagnant Qi under the hypochondrium implies stagnation of Liver-Gallbladder fire. Constrained by the external contraction, this latent fire was agitated, resulting in a sensation of heat in the heart. The method should prioritize releasing-the-exterior herbs, assisted by herbs that clear heat, regulate Qi, resolve stagnation, and tonify the healthy Qi.
Prescription: Ephedrae Herba (Mahuang, 麻黄) - 2 qian; Scrophulariae Radix (Xuanshen, 玄参) - 6 qian; Raw Dioscoreae Rhizoma (Sheng Huai Shanyao, 生怀山药) - 6 qian; Wild Codonopsis Radix (Yetaishen, 野台参) - 2 qian; Raw Gavis Endothelium Corneum (Sheng Jineijin, 生鸡内金) - 2 qian; Trichosanthis Radix (Tianhuafen, 天花粉) - 5 qian; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) - 1.5 qian.
First, boil Ephedrae Herba for a few minutes, skim off the foam, then add all other herbs and decoct together into one large cup. Take warm to induce sweating. If sweating does not occur, administer Aspirin (1 grain) to assist diaphoresis.
Outcome: Two hours after ingestion, the body felt slightly hot, and sweat was about to appear but did not. Aspirin was then administered, and within moments, profuse sweating covered the body. On the next day's follow-up, the pulse was palpable but weak (five beats per respiration). Aversion to cold had ceased, but heat sensation in the heart persisted. Mahuang was removed, and Xuanshen and Shanyao were increased to 1 liang each. After three doses, the heat sensation in the heart disappeared. Xuanshen and Tianhuafen were then halved, and several more doses were taken to conclude the treatment.