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Li XX from Tianjin, aged thirty-two, contracted Cold Damage Syndrome (Shanghan Bing) in summer.

Etiology: At noon, he indulged in eating melons and fruits. Due to insomnia the previous night, he ate leftover food and fell into a deep sleep. Suddenly, an east wind blew, and the weather turned cold, freezing him awake. While still asleep, he also experienced nocturnal emission. Upon waking, he felt his whole body cold and shivering, with dull pain in his abdomen. Fearing greatly, he urgently summoned me for consultation.

Signs and Symptoms: When I arrived to examine him, his chills and abdominal pain had worsened. His pulse was faint and thin in all six positions, nearly imperceptible. I determined that this had become Direct Invasion of Shaoyin Cold Damage (Zhizhong Shaoyin Shanghan).

Diagnosis: According to the pattern of Direct Invasion of Shaoyin Cold Damage, it falls under the indication for Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite Root and Asarum Decoction). However, since it occurred after nocturnal emission and accompanied by abdominal pain, the internal invasion of cold has penetrated deeper. It is appropriate to add warming and tonifying herbs to Mahuang Fuzi Xixin Tang.

Prescription: Ephedrae Herba (Mahuang, 麻黄) 2 qian; Prepared Aconite Root (Wufuzi, 乌附子) 3 qian; Herba Asari (Xixin, 细辛) 1 qian; Prepared Rehmanniae Radix (Shudihuang, 熟地黄) 1 liang; Fresh Dioscoreae Rhizoma (Sheng Huai Shanyao, 生怀山药) 5 qian; Clean Corni Fructus (Jing Yurou, 净萸肉) 5 qian; Dried Zingiberis Rhizoma (Ganjiang, 干姜) 3 qian; Caryophylli Flos (Gong Dingxiang, 公丁香) 10 buds. Decoct in a large cup of water, take warm, cover to induce sweating, but do not allow excessive sweating.

Outcome: After taking the medicine, within one hour, he sweated slightly all over his body, and both the chills and abdominal pain resolved.

Interrogation: Someone asked, "The pattern for Mahuang Fuzi Xixin Tang typically presents with fever and a deep pulse at the onset of Cold Damage. This case presents with chills and a deep-thin pulse. Chills are distinctly different from fever; why use Mahuang Fuzi Xixin Tang here?" I replied, "The pattern for Mahuang Fuzi Xixin Tang arises when the pathogen transmits from Taiyang to Shaoyin. Because the disease has transmitted to Shaoyin, the pulse is deep. Because it transmits from Taiyang, the Taiyang channel retains its responsive power, resulting in fever. In this case, sleeping during the day and being frozen awake indicates transmission from Taiyang to Shaoyin. Furthermore, due to indulging in cold foods followed by daytime napping and nocturnal emission, cold pathogens directly invaded Shaoyin. Internal and external cold attacked simultaneously, causing external chills and internal abdominal pain. Although Taiyang is the exterior Yang, it lost its responsive power. In the prescription, Ephedrae Herba is used to expel exterior cold, Prepared Aconite Root to resolve interior cold, and Herba Asari to connect the interior and exterior, allowing all interior and exterior cold to transform. Additionally, because Shaoyin is newly deficient, Prepared Rehmanniae Radix, Corni Fructus, and Dioscoreae Rhizoma are added to tonify it; supporting righteous Qi eliminates evil. Because abdominal pain indicates deep cold invasion, Dried Zingiberis Rhizoma and Caryophylli Flos are added to assist Prepared Aconite Root and Herba Asari in dispelling cold, leaving no hiding place for the cold pathogen. The prescription is comprehensive, hence immediate efficacy. Regarding using only 2 qian of Ephedrae Herba for sweating, it is because it is summer; if it were winter, 4 qian would be required to induce sweating. This shows medication varies by season. In southern regions, even in winter, 2 qian of Ephedrae Herba can induce sweating, and there is a saying in the south that 'Ephedra should not exceed 1 qian.' This shows medication varies by location."