天津李××，年三十二岁，于夏季得伤寒证。
病因 午间恣食瓜果，因夜间失眠，遂食余酣睡，值东风骤至天气忽变寒凉，因而冻醒，其未醒
之时又复梦中遗精，醒后遂觉周身寒凉抖战，腹中又复隐隐作疼，惧甚，遂急延为诊视。
证候 迨愚至为诊视时，其寒战腹疼益甚，其脉六部皆微细欲无，知其已成直中少阴之伤寒也。
诊断 按直中少阴伤寒为麻黄附子细辛汤证，而因在梦遗之后，
腹中作疼，则寒凉之内侵者益深入也，是宜于麻黄附子细辛汤中再加温暖补益之品。
处方 麻黄（二钱） 乌附子（三钱） 细辛（一钱） 熟地黄（一两）
生怀山药（五钱） 净萸肉（五钱） 干姜（三钱） 公丁香（十粒）
煎汤一大盅，温服，温复取汗，勿令过度。
效果 将药服后，过一点钟，周身微汗，寒战与腹疼皆愈。
或问 麻黄附子细辛汤证，伤寒始得发热脉沉也，今斯证寒战脉沉细，夫寒战与发热迥异矣，
何以亦用麻黄附子细辛汤乎？答曰∶麻黄附子细辛汤证，是由太阳传少阴也，为其病传少阴是以
脉沉，为其自太阳传少阴是以太阳有响应之力而发热。此证昼眠冻醒，是自太阳传少阴，又因恣食寒凉
继而昼寝梦遗，其寒凉又直中少阴，内外寒凉夹攻，是以外寒战而内腹疼，太阳虽为表阳亦无响应之
力也。方中用麻黄以逐表寒，用附子以解里寒，用细辛以通融表里，使表里之寒尽化；又因其少阴新
虚，加熟地黄、萸肉、山药以补之，养正即以除邪也，又因其腹疼知寒侵太深，又加干姜、丁香助附
子、细辛以除之，寒邪自无遁藏也。方中用意周匝，是以服之即效。至于麻黄发汗止二钱者，因当
夏令也，若当冬令则此证必须用四钱方能出汗，此用药因时令而有异也。至若在南方虽当冬令用麻
黄二钱亦能发汗，且南方又有麻黄不过钱之说，此又用药因地点而有异也。
天津的李××，三十二岁，在夏季患上了伤寒证。
病因：中午时放纵饮食瓜果，因为夜间失眠，于是吃了剩下的食物后酣睡，恰逢东风骤起，天气突然变得寒凉，因此被冻醒；在他未醒的时候又再次梦中遗精，醒来后便觉得全身寒凉颤抖，腹部又隐隐作痛，非常恐惧，于是急忙请我为他诊治。
证候：等我到达为他诊视时，他的寒战和腹痛更加严重，六部脉象都微细得几乎摸不到，我知道这已经成了直中少阴的伤寒病。
诊断：按照直中少阴伤寒属于麻黄附子细辛汤（Mahuang Fuzi Xixin Tang, Ephedra, Prepared Aconite Root and Asarum Decoction）的证候，但因为是在梦遗之后，且腹部作痛，说明寒凉之邪内侵得更加深入，适宜在麻黄附子细辛汤中再加入温暖补益的药物。
处方：麻黄（二钱） 乌附子（三钱） 细辛（一钱） 熟地黄（一两） 生怀山药（五钱） 净萸肉（五钱） 干姜（三钱） 公丁香（十粒）。煎取一大盅汤药，温服，服药后盖被保暖以取汗，不要令出汗过度。
效果：服药后，过了一小时，周身微微出汗，寒战与腹痛都痊愈了。
有人问：麻黄附子细辛汤证，通常是伤寒初起发热而脉沉。如今这个病例是寒战而脉沉细，寒战与发热截然不同，为什么也使用麻黄附子细辛汤呢？我回答说：麻黄附子细辛汤证，是由太阳经传入少阴经所致，因为病传少阴所以脉沉，因为从太阳传入少阴，所以太阳经仍有响应之力而发热。此病例白天睡觉被冻醒，是从太阳传入少阴，又因放纵食用寒凉食物继而昼寝梦遗，寒凉之邪又直中少阴，内外寒凉夹攻，所以外见寒战而内见腹痛，太阳经虽然是表阳，但也失去了响应之力。方中使用麻黄来驱逐表寒，使用附子来解除里寒，使用细辛来通融表里，使表里的寒邪全部化解；又因为患者少阴经新近虚弱，加入熟地黄、山茱萸、山药来补益，扶助正气即是为了祛除邪气；又因为腹痛知道寒邪侵入太深，又加入干姜、丁香辅助附子、细辛来驱除寒邪，寒邪自然无处遁藏。方中的用意周全严密，所以服用后立即见效。至于麻黄发汗只用二钱，是因为正值夏令；如果正值冬令，此证必须用四钱才能出汗，这是用药随季节不同而有差异。如果在南方，即使正值冬令，用麻黄二钱也能发汗，而且南方又有“麻黄不过钱”的说法，这是用药随地点不同而有差异。
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."