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A woman suffering from Shanghan (Cold Damage) disease, at the time when her menses are just beginning or have just ceased. The pathogenic heat enters the Blood Chamber (Chong Mai, the sea of blood) taking advantage of the deficiency. Her symptoms present as lucidity during the day, but delirium at night.
She sees things as if ghosts were present. If accompanied by fever and aversion to cold, with symptoms lighter during the day and heavier at night, and fullness in the lower abdomen, this indicates blood stasis due to heat. One should use herbs such as Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Zi Su Ye (Perillae Folium), Jing Jie (Schizonepetae Spica), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Yi Mu Cao (Leonuri Herba), Xiang Fu (Cyperi Rhizoma), Shan Zha (Crataegi Fructus), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), and Mu Dan Pi (Moutan Cortex). These are herbs that harmonize the blood and scatter pathogens. After ingestion, sweating occurs immediately, and the disease resolves. If there is already sweating, it indicates exterior deficiency. Remove Zi Su Ye from the previous formula. Add Gui Zhi (Cinnamomi Ramulus) to harmonize the exterior and interior. If chills and fever alternate like malaria, add Gui Zhi to the previous formula to harmonize. If there is cold extremities with diarrhea, this is not due to pathogenic heat, but rather an invasion by cold pathogens. Remove Huang Qin from the previous formula. Add Gui Zhi and Gan Jiang (Zingiberis Rhizoma) to warm and disperse. If there is irritability and thirst, it belongs to interior heat. Remove Zi Su Ye and Xiang Fu. Add Hei Zhi Zi (Gardeniae Fructus, stir-fried black) to clear heat. If the lower abdomen is hard, full, and painful, removing stasis should be the urgent priority. Remove Zi Su Ye from the previous formula. Add Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Yan Hu Suo (Corydalis Rhizoma), and Niu Xi (Achyranthis Bidentatae Radix). Attack the stasis to promote movement. (Referenced from *Yi Zong Jin Jian*)

Shao's Commentary: The Blood Chamber is where Ying Blood (Nutritive Blood) stays and where meridians converge; it is what Chong Mai refers to as the Sea of Blood. Its vessel originates at Qi Jie (the groin area where the femoral artery pulses), runs parallel to the Foot-Shaoyin Kidney Meridian, ascends flanking the navel, and disperses in the chest. When a woman’s menses arrive, blood flows downward; as blood descends, the meridians become empty, allowing pathogenic heat to enter the Blood Chamber taking advantage of the deficiency. Day belongs to Yang and governs Qi; night belongs to Yin and governs Blood. Since pathogenic heat enters the Blood Chamber to cause illness, symptoms are lighter during the day and heavier at night. Although the Blood Chamber is associated with Chong Mai, the Heart (Emperor Mind) governs Blood and is the master of the Blood Chamber. When heat enters its chamber, the master must become confused, hence delirium occurs. The Liver stores Blood and houses the Hun (Ethereal Soul); loss of blood and entry of heat lead to Liver deficiency. With the Hun unsettled, hallucinations occur, hence seeing things as if ghosts were present. The lower abdomen is the region governed by Chong Mai. Pathogens enter the Wei (Defensive) level and assault the Blood Chamber; blood and heat accumulate within, causing lower abdominal fullness. Using agents that scatter pathogens and move blood, once pathogens are eliminated and meridians regulated, the disease resolves spontaneously.

Further Commentary: Delirium caused by heat entering the Blood Chamber stems from the Liver; therefore, Zhang Zhongjing prescribed needling the Qimen (LR14) acupoint to drain the Front-Mu point of the Liver. This is done to prevent people from mistaking delirium for a Yangming Stomach-Fu syndrome. Hence, he warns: Do not damage the Stomach Qi and the Upper Jiao; the disease will heal itself.