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Modified Xiaochaihu Decoction (Minor Bupleurum Decoction)

1. When Heat Enters the Blood Chamber (the uterus) and menstruation has just ceased, pathogenic heat enters vacuity and lurks in the blood chamber. Chills and fever occur at regular intervals, resembling malaria; treat with Xiaochaihu Decoction (Minor Bupleurum Decoction) added with Danggui (Angelicae Sinensis Radix), Shengdihuang (Rehmanniae Radix Recens), and Danpi (Moutan Cortex).
[Note] The *Jingui Yaolue* states: "When a woman suffers from Wind-stroke for seven or eight days, followed by continuous chills and fever occurring at regular intervals, and her menses happen to cease, this is Heat entering the Blood Chamber. The blood must be congealed, hence the symptoms resemble malaria with regular paroxysms. It should be treated with Xiaochaihu Decoction." This refers to the situation where pathogenic heat is not yet exhausted, and coinciding with the menstrual period, it enters the blood chamber due to vacuity and lurks there, causing blood congealment and resulting in chills and fever at regular intervals like malaria. The Blood Chamber is governed by the Liver. The Liver and Gallbladder are exterior-interiorly related. The Gallbladder becomes diseased with chills and fever due to the influence of the Liver's pathogen; therefore, Xiaochaihu Decoction is used as the primary treatment. Danggui, Shengdihuang, and Danpi are added to clear heat from the blood level.
Xiaochaihu Decoction is found in the notes of Chaihu Siwu Tang in the first volume.

2. When Heat Enters the Blood Chamber and menstruation has just begun, the patient is lucid during the day but delirious at night. Do not injure the Stomach Qi or the Upper and Middle Jiao; the heat will depart with the blood, and the body will remain unharmed.
[Note] The *Jingui Yaolue*: "When a woman suffers from Cold damage with fever, and her menses happen to begin, she is lucid during the day but speaks deliriously at night, seeing things as if ghosts were present. This is Heat entering the Blood Chamber. In treating it, do not injure the Stomach Qi or the Upper and Middle Jiao; the disease will surely heal itself." This indicates that although heat has entered the Blood Chamber, since menstruation continues without interruption, the heat does not linger and congeal. One should not assume that because of delirium, one should use Xie (Mirabilite) and Huanglian (Coptidis Rhizoma) or similar purgatives to injure Stomach Qi, nor prick to injure Ying-blood. Nor should Xiaochaihu Decoction be used to harmonize the Upper and Middle Jiao. Simply wait for the heat to depart with the blood, and the disease will surely heal itself. The *Shanghan Lun* states: "If the blood descends naturally, those who descend will recover." This is what is meant.
Method of Pricking Qimen (Liv 14); Qingre Xingxue Decoction (Heat-Clearing and Blood-Invigorating Decoction)

3. When Heat Enters the Blood Chamber and forms Jie-Xiong (Chest Binding), presenting with bleeding, delirium, and sweating only on the head, both conditions require pricking Qimen (Liv 14). Follow the excess pattern to drain and eliminate the pathogen. Use Qingre Xingxue Decoction composed of Taoren (Persicae Semen), Honghua (Carthami Flos), Danpi (Moutan Cortex), Wulingzhi (Trogopterori Faeces), Shengdihuang (Rehmanniae Radix Recens), Gancao (Glycyrrhizae Radix et Rhizoma), Chuanshanjia (Manis Squama), and Chishao (Paeoniae Radix Rubra).
[Note] The *Jingui Yaolue* states: "When a woman suffers from Wind-stroke with fever and aversion to cold, and her menses happen to begin, after seven or eight days the fever subsides, the pulse becomes slow, the body feels cool, there is fullness in the chest and hypochondrium resembling Jie-Xiong (Chest Binding), and she speaks deliriously; this is Heat entering the Blood Chamber. One should prick Qimen (Liv 14) and drain according to the excess pattern." It also states: "In Yangming disease, if there is bleeding and delirium, this is Heat entering the Blood Chamber. If there is sweating only on the head, one should prick Qimen (Liv 14) and drain according to the excess pattern. Recovery occurs when profuse sweating ensues throughout the body." These two passages discuss different scenarios: one describes menses ceasing immediately upon onset, with blood congealing internally constituting an Excess pattern; the other describes Heat entering the Blood Chamber in the context of Yangming disease, distinguished by bleeding and head sweating. Thus, both are classified as Heat entering the Blood Chamber caused by Liver Excess, so both indicate pricking Qimen (Liv 14). If acupuncture is not feasible, treat with Qingre Xingxue Decoction. The formula consists of Taoren, Honghua, Danpi, Wulingzhi, Shengdihuang, Gancao, Chuanshanjia, and Chishao. Observing these four syndromes generally, Xiaochaihu Decoction is applicable only when there are symptoms of chills and fever resembling malaria. Otherwise, the condition may resolve spontaneously without medication, or be treated by pricking Qimen (Liv 14) combined with Qingre Xingxue Decoction to drain based on the excess pattern. This is the core method of Zhang Zhongjing; one must not indiscriminately treat all cases with Xiaochaihu Decoction.