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。
天津张姓患者，三十八岁，在冬季末尾患上伤寒证，并且出现无脉象的情况。
病因：十天前曾感冒风寒，经过医生治愈后，又出门办事，再次感受风寒，于是得了这个病。
证候：身体内外都感觉寒冷，头痛，气息轻微喘息，身体有轻微的怕冷和颤抖，六部脉象全部摸不到。
诊断：大概是因为他身体向来虚弱，又在再次感受外邪之后，风寒深入并阻塞了经络，所以导致脉闭。打算用麻黄汤治疗，再大量加入补气药物，通过补益正气来驱除邪气外出，应当可以见效。
处方：麻黄（三钱），生黄芪（一两），桂枝尖（二钱），杏仁（二钱，去皮），甘草（二钱）。
先煎煮麻黄几滚，撇去浮沫，再加入其余药物同煎成一大盅药汤，温服，服药后覆盖被子以取得微微出汗的效果。
效果：服药后周身出汗，脉象随即出现，各种病症都痊愈了。
按语：对于这个证候，有人或许怀疑是少阴伤寒，因为少阴伤寒的脉象原本就是微细的，微细到了极点就可以达到无脉的状态。但我从太阳经论治，是因为他的头痛、微喘、寒战，都是太阳经的症状表现，而没有出现少阴证中蜷缩卧倒、只想睡觉的症状。因此，我在麻黄汤中大量加入生黄芪一两，以辅助麻黄、桂枝发挥作用，这就是扶助正气即为了驱逐邪气。
病因：他左肋下向来有郁结之气，发作时就会疼痛，有一天发作疼痛剧烈，头上出汗，汗出后尚未完全缓解，就出去冒犯了风寒，于是得了这个证候。
证候：头痛、身体发冷、怕冷、无汗、心中发热，六部脉象全部闭塞。
诊断：因为他向来有肋下疼痛的毛病，身形瘦弱；又在出汗的时候感冒风寒，那么风寒侵入必然很深，所以导致脉闭身寒；另外肋下向来有郁结之气，肝胆之火必然郁滞，因为被外感束缚而激动了他素来郁积的火气，所以心中觉得热。治疗方法应当以发表的药物为主，而以清热、理气解郁兼补正气的药物作为辅助。
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）。
先煎煮麻黄几滚，撇去浮沫，再加入所有药物同煎成一大盅药汤，温服以取汗，如果不出汗，适宜再服用西药阿斯匹林一瓦以帮助发汗。
效果：服药两个小时后，周身微微发热，汗欲出而未出，于是服下了阿斯匹林，片刻间全身出汗，第二天复诊，脉象已经出现，脉搏跳动五次但无力，已经不害怕寒冷，心中仍然觉得发热，于是去掉麻黄，将玄参、山药都改为一两，服用至三剂后，心中已不发热，于是将玄参、天花粉各减半，再服用数剂以善后调理。
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.