Library

Hunmao (dizziness and confusion) refers to a state of mental confusion and unconsciousness. If internal injury progresses to Hunmao, death ensues. If cold-heat diseases progress to Hunmao, the condition is also severe. Medical texts all claim it is due to deficiency, which is mistaken. Zhang Zhongjing stated: "When Taiyang and Shaoyang diseases occur simultaneously, with stiffness and pain in the head and neck, or dizziness and confusion, one should needle the Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) acupoints." He also said: "In Yangming disease, if urination is difficult, defecation alternates between difficulty and ease, there is occasional fever, panting, and confusion preventing lying down, Da Chengqi Tang (Major Order the Qi Decoction) is appropriate." This describes 'Mao' (dizziness/confusion) before it reaches 'Hun' (coma). The following text discusses Hunmao. Li Dongyuan (styled Haicang) said: "When cold-heat disease transmits to the fifth or sixth day, it gradually changes into mental confusion and silence, or talking in sleep, red eyes, and a withered spirit. Porridge is swallowed when offered, but not desired when not offered. This indicates that pathogenic heat has transmitted internally into the Hand-Shaoyin Heart Meridian. Heart fire steams upward to the Lung, causing mental confusion. If the pulse is floating and rapid, the heat is in the Small Intestine, use Daochi San (Guide Out Redness Powder); if the pulse is fine and rapid, the heat is in the Heart Meridian, use Xiexin Tang (Drain the Epigastrium Decoction); if both floating and deep pulses are rapid, indicating heat in both meridians, use Daochi Gehan Tang (Half-Half Guide Out Redness Decoction)." *Shanghan Zhi Ge* states: "When pathogenic heat transmits inward causing Hunmao, the pulse should be rapid. If heat is extreme and severe internally, the pulse may instead be deep, fine, and nearly imperceptible. Without understanding the transformation of life forces, this might be mistaken for a Yin syndrome. Some patients, upon initial onset, have sudden intense Yang heat and present with Hunmao from the start. Some with simultaneous exterior-interior contraction and intense heat also present with lethargy and confusion. Some, due to failure to purge when indicated, reach extreme heat, resulting in cold body and faint pulse, nearing death from Hunmao. If purged urgently, residual Yin fluids will abruptly perish, leading to death; if not purged, death also occurs. In such cases, Liangge San (Cool the Diaphragm Powder) and Huanglian Jiedu Tang (Coptis Detoxification Decoction) are suitable. Wait until accumulated heat dissipates, the chest and heart feel warm, and the pulse gradually emerges. If there are signs requiring purgation, use Da Chengqi Tang. Thus, coma symptoms cannot be generalized as deficiency. I have now determined methods such as releasing the exterior and clearing the interior, resolving phlegm and promoting digestion. For sha-yi (plague/toxin) pathogens, use ascending and dispersing methods; for suppression by cold-cooling herbs, use warming and dispersing methods; for heat binding in the Large Intestine, use purgative methods; for excessive sweating and purging leading to empty pulse and diarrhea/collapse, use tonifying Yuan Qi (Original Qi)."

Re entering the Blood Chamber, as divided into four clauses in *Shanghan Lun*. The first clause discusses Yangming disease with bleeding and delirium, generally stating that both men and women can suffer this disease, hence it says "bleeding" rather than "menstruation," with only sweat on the head, treated by needling Qimen (LR14). The subsequent three clauses specifically discuss women. The first discusses menstruation occurring just then. After seven or eight days, heat subsides and body cools, with fullness below the chest and hypochondrium resembling Jie Xiong (chest binding) syndrome. It implies a resemblance to Taiyang disease mishandled by purgation, where the body is no longer feverish, and exterior pathogens enter the interior due to deficiency, forming Jie Xiong. However, that case results from mishandled purgation transmitting heat to Yangming stomach and intestines, forming Jie Xiong. This case involves heat transmitting naturally to the Jueyin Blood Chamber, hence needling Qimen. The second clause discusses menstruation having just ceased, with paroxysmal chills and fever resembling Shaoyang malaria-like syndrome. However, that case involves pathogens entering the Shaoyang chest and heart region, forming a malaria-like state. This case involves pathogenic heat entering the Jueyin Blood Chamber, forming Re Ru Xue Shi (Heat Entering the Blood Chamber). Although the diseases differ, both use Xiao Chaihu Tang (Minor Bupleurum Decoction) because their chills and fever paroxysms resemble malaria identically, treating Liver and Gallbladder together, thus using Xiao Chaihu Tang for harmonization. The third clause discusses having exterior signs of Shanghan fever and interior signs of delirium seeing ghosts, yet not using sweating, vomiting, or purging methods to avoid damaging Stomach Qi, but only needling Qimen to drain interior heat, and taking Xiao Chaihu Tang to harmonize exterior and interior. Generally, fever has distinctions between Qi and Blood. Fever during the day is Qi heat; fever at night is Blood heat. Therefore, quietness by day and fever by night is named Heat Entering the Blood Chamber. However, Blood heat symptoms vary by deficiency and excess. Blood deficiency fever, due to insufficient Ying and Blood, resembles Yin deficiency internal heat, so the pulse must be fine and rapid; treatment involves tonifying Blood and cooling Blood, such as Haicang's Siwu Tang (Four Substances Decoction), with added Chai Hu (Bupleuri Radix) and Huang Qin (Scutellariae Radix) to stabilize chills and fever. Blood excess fever, where pathogenic heat enters Blood, i.e., Heat Entering the Blood Chamber, etc., so the pulse must be rapid and large; treatment should cool Blood without tonifying it, using Guishao Chaihu Tang (Angelica and Peony Bupleurum Decoction) or Daochi Gehan Tang, with increased Chai Hu, Shao Yao (Paeoniae Radix), Sheng Di Huang (Rehmanniae Radix), Huang Qin, and Mu Dan Pi (Moutan Cortex), guiding them into the Blood level. However, their symptoms differ. Those with Blood deficiency have inherent Yin-Blood deficiency, gradually developing night fever while remaining active during the day; their heat is mild, and pulse fine, rapid, and lacking spirit. Those with Blood excess have no inherent deficiency, occasionally contracting external cold with internal accumulated heat, unresolved exterior pathogens, and unclarified interior heat, or eating rich flavors too early, or taking tonics too early, resulting in nightly fever; their heat is severe, and pulse rapid, large, and forceful.

Yangming disease with bleeding and delirium is Heat Entering the Blood Chamber. With only head sweating, needle Qimen, draining according to the heat; general sweating leads to recovery. This clause details the Head Sweating and Bleeding section,宜互看 (should be cross-referenced). Yangming exterior pathogens transmit to Shaoyang and internally lodge in Jueyin, unable to vent outward, steaming upward causing head sweat. Needling Qimen, a Liver acupoint, unblocks meridians and collaterals, general sweating leads to recovery.

A woman with Fengzhong (Wind Strike), fever and aversion to cold, menstruation occurring just then, after seven or eight days, heat subsides, pulse becomes slow, body cools, fullness below chest and hypochondrium resembling Jie Xiong, and delirium, is Heat Entering the Blood Chamber. One should needle Qimen, draining according to its excess.

Fengzhong with fever and aversion to cold for seven or eight days, heat subsides, pulse slow, body cools, should heal spontaneously. Now instead presenting with fullness below chest and hypochondrium resembling Jie Xiong, and delirium, this is because menstruation occurred just then, the Sea of Blood was open, and pathogenic heat entered the Jueyin storage chamber of Blood due to deficiency. The Liver governs Hun (Ethereal Soul); heat disturbing internally confounds Shen Ming (Spiritual Consciousness), hence hypochondriac fullness and delirium. Therefore, needle Qimen, the Jing-River point of the Jueyin meridian, to drain its actual heat and allow it to vent outward.

A woman with Fengzhong, after seven or eight days, subsequently develops chills and fever occurring at times, menstruation having just ceased, is Heat Entering the Blood Chamber. Her blood must be bound, thus causing a malaria-like state occurring at times. Xiao Chaihu Tang (Minor Bupleurum Decoction) is the main treatment.

The previous clause discussed body cooling and slow pulse, not using exterior release, only needling Qimen; this clause discusses seven or eight days, subsequent chills and fever occurring at times, menstruation ceased, Blood Chamber not closed, heat entering and binding blood like malaria, suitable for Xiao Chaihu Tang.

A woman with Shanghan fever, menstruation occurring just then, clear-minded during the day, delirious at night as if seeing ghosts, is Heat Entering the Blood Chamber. Do not violate Stomach Qi or the Upper Two Jiaos; she will surely heal herself.

The previous clause mentioned resembling Jie Xiong, another resembling malaria; this clause mentions seeing ghosts, mutually confirming Heat Entering the Blood Chamber presents differently. Two clauses mention needling Qimen, one mentions Xiao Chaihu Tang; this clause mentions not violating Stomach Qi and Upper Two Jiaos, summarizing the above on Heat Entering the Blood Chamber, having only two methods: needling Qimen and Xiao Chaihu Tang.

Xiao Chaihu Tang (Minor Bupleurum Decoction) see Chills/Fever and Dizziness/Vertigo entries.

This formula clears heat from the Blood Chamber. My family secret adds Dang Gui (Angelicae Sinensis Radix) and Shao Yao (Paeoniae Radix) to guide it into the Blood level. Li Zhai used this formula with Sheng Di Huang (Rehmanniae Radix) and Mu Dan Pi (Moutan Cortex), sharing this intent.

Chaiqin Siwu Tang (Bupleurum and Scutellaria Four Substances Decoction)
Chai Hu (Bupleuri Radix) Huang Qin (Scutellariae Radix) Sheng Di Huang (Rehmanniae Radix) Dang Gui (Angelicae Sinensis Radix) Bai Shao Yao (White Paeonia Root) Mu Dan Pi (Moutan Cortex)

This is Haicang's Siwu Tang (Four Substances Decoction). My family secret adds Chai Hu and Huang Qin to treat Blood deficiency fever. Now used to treat Heat Entering the Blood Chamber, it is most effective.

Guishao Chaihu Tang (Angelica and Peony Bupleurum Decoction)
Gui Shen (Angelicae Sinensis Radix) Bai Shao (White Paeonia Root) Chai Hu (Bupleuri Radix) Sheng Di Huang (Rehmanniae Radix) Mu Dan Pi (Moutan Cortex) Di Gu Pi (Lycii Cortex) Qin Jiao (Gentianae Macrophyllae Radix) Huang Qin (Scutellariae Radix) Guang Pi (Citri Reticulatae Pericarpium) Gan Cao (Glycyrrhizae Radix et Rhizoma)

This formula cools Blood and nourishes Blood. My family secret uses it most effectively for Blood deficiency, night fever, Heat Entering the Blood Chamber, Yin deficiency bone-steaming, etc.

Daochi Gehan Tang (Half-Half Guide Out Redness Decoction)

Blood is stored in the Liver and generated by the Heart. Thus, when Heart Fire is vigorous, Blood is also hot. This formula clears Heart Fire and generates Heart Blood. My family secret adds Chai Hu, Dang Gui, and Shao Yao to concurrently treat Liver heat.