问曰。妇人伤寒何如。活人书曰。男子调其气。妇人调其血。血
室不蓄。则二气和谐。血气凝结。则水火相刑。伤寒气口紧盛则宜
下。人迎紧盛则宜汗。妇人左关脉浮紧。不可下。当发其汗。以救血
室。营卫得和。津液自通。浃然汗出而解。
问曰。热入血室何如。活人书曰。仲景云。妇人伤寒。经水适断。
昼日明了。暮则谵语。如见鬼状。此为热入血室。无犯胃气及上二
焦。无犯胃气者。言不可下也。小柴胡汤主之。若行汤迟。则热入胃。
令津液枯燥中焦。上焦不荣。成血结胸状。须当针期门。
问曰。谵语即下症。而前症不可下。何也。活人书曰。伤寒胃实
谵语。则宜下。妇人热入血室谵语。不可下也。
问曰。犯胃气者何如。活人书曰。五行相克以生。相扶以出。平
居之日。水常养木。水木相生。则荣养血室。血室不蓄。则脾无蕴积。
脾无蕴积。则刚燥不生。若犯胃气。则昼夜谵语。喜忘。小腹满。小便
利者。属抵当汤。
问曰。妇人先调血。男子先调气。何如。活人书曰。此大略之言
耳。要之脉紧无汗为伤寒。脉缓有汗为伤风。热病脉洪大。中暑脉细
弱。其症一也。假如中 者用白虎。胃实用承气。岂必调血而后行汤
哉。仲景伤寒所以不分妇人。良亦由此。学人皆可随病。于男子药症
中以意选用也。
活人书曰。妇人伤寒。发热恶寒。四肢拘急。口燥舌干。经脉凝
滞。不得往来。宜桂枝红花汤。
又曰。妇人伤寒。口燥咽干。腹满。不思饮食。宜黄芩芍药汤。
又曰。妇人伤寒。喘息烦躁。或战而作寒。阴阳俱虚。不可下。宜
柴胡当归汤。
又曰。妇人伤寒。经脉方来初断。寒热如疟。狂言见鬼。宜干姜
柴胡汤。
又曰。妇人伤寒。血结胸膈。揉而痛不可近。海蛤散。
朱氏又言。妇人血结胸证。法当刺期门。仲景无药。此方疑非仲
景意。又云。妇人伤寒发热。经水适来。昼日明了。暮则谵语。如见鬼
状者。此为热入血室。无犯胃气及上二焦。宜小柴胡汤。
又曰。妇人伤寒七八日。续得寒热。发作有时。经水适断。此为
热入血室。其血必结。故使如疟状。宜小柴胡汤。
又曰。妇人伤寒。发热恶寒。经水适来。得之七八日。热除脉迟。
身凉和。胸胁下满。如结胸状。谵语者。此为热入血室也。当刺期门。
随其实而取之。
又曰。妇人伤寒六七日。胃中有燥粪。大便难。烦躁谵语。目赤。
毒瓦斯闭塞不得通。宜三黄泻心汤。（原本是泻心三黄汤）
又曰。妇人伤寒。瘥后。犹有余热不去。谓之遗热。宜干地黄汤。
又曰。妇人伤寒未平复。因交合里急。腰胯连腹内痛。名阴阳易。宜烧 散。
又曰。妇人病未平复。因有所动。致热气上冲胸。手足拘急搐
搦。如中风状。宜青竹茹汤。
又曰。妇人病未平复。因有所动。小腹急痛。腰胯痛。四肢不任。
举动无力。发热者。宜当归白术汤。
Question: How does a woman contract Shaoyin Cold Damage (Taiyang Cold Damage)? The *Huoren Shu* (Book of Vitality) states: For men, regulate Qi; for women, regulate Blood. If the Blood Chamber is not stagnant, Yin and Yang Qi harmonize; if Blood and Qi coagulate, Water and Fire clash. In Cold Damage, if the Qi Kou pulse is tight and vigorous, purgation is indicated; if the Ren Ying pulse is tight and vigorous, diaphoresis is indicated. For a woman, if the left Guan pulse is floating and tight, purgation is contraindicated; one should induce sweating to rescue the Blood Chamber. Once Ying and Wei are harmonized, body fluids flow naturally, sweat appears profusely, and the disease resolves.
Question: What constitutes "Heat Entering the Blood Chamber"? The *Huoren Shu* cites Zhang Zhongjing: When a woman contracts Cold Damage and her menses happen to cease, she is lucid during the day but delirious at night, seeing visions as if of ghosts. This is Heat Entering the Blood Chamber. Do not injure Stomach Qi or the Upper and Middle Jiao. "Do not injure Stomach Qi" means do not use purgation. The primary formula is Xiao Chai Hu Tang (Minor Bupleurum Decoction). If treatment is delayed, heat enters the Stomach, drying out fluids in the Middle Jiao and failing to nourish the Upper Jiao, resulting in symptoms resembling Blood Binding in the Chest. In such cases, one must puncture the Qimen acupoint.
Question: Delirium is usually an indication for purgation, yet the preceding symptoms contraindicate it. Why? The *Huoren Shu* explains: In Cold Damage, if Stomach excess causes delirium, purgation is indicated. However, if delirium results from Heat Entering the Blood Chamber in a woman, purgation is contraindicated.
Question: What is meant by "injuring Stomach Qi"? The *Huoren Shu* states: Five Elements interact through generation and restriction, supporting each other to maintain balance. Normally, Water nourishes Wood; Water and Wood generate each other, thereby nourishing the Blood Chamber. If the Blood Chamber is not stagnant, the Spleen has no accumulation. If the Spleen has no accumulation, dryness does not arise. If Stomach Qi is injured, one may experience day-and-night delirium, forgetfulness, and lower abdominal fullness. If urination is free, this belongs to the Dang Gui Tang (Tribulus Decoction) pattern. [Note: Text says Didang Tang, translation adjusted to context of blood stasis patterns often associated with similar descriptions, but strictly adhering to text: Didang Tang].
Question: Women regulate Blood first, men regulate Qi first. What does this mean? The *Huoren Shu* replies: This is a generalization. Essentially, a tight pulse without sweat indicates Cold Damage; a slow pulse with sweat indicates Wind Injury; a flooding pulse indicates Heat Disease; a fine and weak pulse indicates Summerheat. Their symptoms are essentially the same. For example, Summerheat is treated with Bai Hu Tang (White Tiger Decoction), and Stomach excess with Cheng Qi Tang (Order the Qi Decoction). Must one necessarily regulate Blood before administering medicine? Zhang Zhongjing’s *Shanghan Lun* does not distinguish women specifically, likely for this reason. Practitioners can select treatments based on the disease presentation, adapting male formulas as appropriate.
The *Huoren Shu* states: For a woman with Cold Damage presenting fever, aversion to cold, limb rigidity and spasms, dry mouth and tongue, stagnant meridians, and impaired circulation, Gui Zhi Hong Hua Tang (Cinnamon Twig and Safflower Decoction) is indicated.
It further states: For a woman with Cold Damage presenting dry mouth and throat, abdominal fullness, and loss of appetite, Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) is indicated.
It further states: For a woman with Cold Damage presenting panting, irritability, or chills following shivering, indicating deficiency of both Yin and Yang, purgation is contraindicated. Chai Hu Dang Gui Tang (Bupleurum and Angelica Decoction) is indicated.
It further states: For a woman with Cold Damage where menses have just begun and then stopped, accompanied by alternating chills and fever like malaria, delirium, and visual hallucinations, Gan Jiang Chai Hu Tang (Dried Ginger and Bupleurum Decoction) is indicated.
It further states: For a woman with Cold Damage presenting Blood Binding in the Chest, pain upon pressure that cannot be tolerated, Hai Ge San (Clam Shell Powder) may be used.
Zhu Shi adds: For Blood Binding in the Chest in women, puncturing Qimen is the method. Zhang Zhongjing provides no formula for this, so this prescription is suspected not to be his intent. He also states: For a woman with Cold Damage fever, where menses happen to arrive, who is lucid during the day but delirious at night seeing visions, this is Heat Entering the Blood Chamber. Do not injure Stomach Qi or the Upper and Middle Jiao; Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
It further states: For a woman with Cold Damage for seven or eight days, continuously experiencing chills and fever at regular intervals, with menses having just ceased, this is Heat Entering the Blood Chamber. The blood must be bound, causing symptoms resembling malaria. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
It further states: For a woman with Cold Damage, fever and aversion to cold, where menses happen to arrive. After seven or eight days, the fever subsides, the pulse becomes slow, the body feels cool and peaceful, but there is fullness below the chest and hypochondrium resembling Chest Binding, along with delirium. This is Heat Entering the Blood Chamber. One should puncture Qimen and drain the excess according to the pattern.
It further states: For a woman with Cold Damage after six or seven days, presenting dry feces in the stomach, difficulty defecating, irritability, delirium, red eyes, and blockage of toxic heat preventing passage, San Huang Xie Xin Tang (Three Yellows Heart-Draining Decoction) is indicated. (Original note: Originally Xie Xin San Huang Tang).
It further states: For a woman with Cold Damage, after recovery, if residual heat remains, it is called Lingering Heat. Gan Di Huang Tang (Rehmannia Decoction) is indicated.
It further states: For a woman whose Cold Damage has not fully resolved, if intercourse leads to internal urgency, pain in the waist, hips, and abdomen, it is named Yin-Yang Exchange. Shao Kun San (Burned Underwear Powder) is indicated.
It further states: For a woman whose illness has not fully resolved, if movement causes heat qi to rush upward to the chest, leading to rigidity and spasms of hands and feet resembling Wind Stroke, Qing Zhu Ru Tang (Green Bamboo Sap Decoction) is indicated.
It further states: For a woman whose illness has not fully resolved, if movement leads to acute pain in the lower abdomen, pain in the waist and hips, inability to bear weight on limbs, weakness in movement, and fever, Dang Gui Bai Zhu Tang (Angelica and Atractylodes Macrocephala Decoction) is indicated.