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The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: When a woman suffers from Shanghan (Cold Damage) with fever, and her menses happen to arrive, she is clear-minded during the day but experiences delirium (confused speech) at dusk, as if seeing ghosts. This is termed Re Ru Xue Shi (Heat entering the Blood Chamber). In treatment, one must not harm the Stomach Qi or the Upper and Middle Jiao; the condition will heal itself.

Xu Zhongke commented: This refers to Heat entering the Blood Chamber, which does not necessarily involve blood stasis binding; initially, it is the pathogenic factor clumping together to cause disease. "Shanghan" here refers to the absence of sweating and aversion to cold. "Fever" indicates the beginning of the illness. "Menses happening to arrive" means the menstrual flow has just begun. When the pathogen is strong, the Jing Qi (Meridian Qi) is also strong; they meet exactly. The Cold pathogen inevitably damages Ying Blood (Nutritive Blood), so sweat and blood bind together. Since blood belongs to Yin and governs the night, although fever occurs during the day, the mind remains clear. At dusk, the pathogen enters the Yin aspect, and the pathogen, carrying Yin Qi, causes delirium. "As if seeing ghosts" describes severe delirium. This is called Heat entering the Blood Chamber, meaning that although the Blood Chamber is located internally, the exterior pathogen has not actually invaded the Stomach Qi or the Upper and Middle Jiao. Therefore, the treatment method only needs to harmonize the exterior pathogen and slightly clear the heat in the Blood Chamber. If mistakenly treated as an internal invading pathogen using purgatives, the damage would be significant. Hence, it is said not to harm the Stomach Qi or the Upper and Middle Jiao, and the condition will heal itself.

Note: This clause discusses continuous menstruation, where heat does not linger and condense. One should not use harsh purgatives such as Mangxiao (Natrii Sulfas) and Huanglian (Coptidis Rhizoma) [Note: Text says Xiao/Huang, likely referring to Mangxiao and Dahuang] due to delirium. Doing so harms Stomach Qi, disturbs Ying Blood, and invades the Middle Jiao; using Chaihu (Bupleuri Radix) to harmonize Shaoyang invades the Upper Jiao. As long as one does not recklessly interfere, the heat dissipates with the blood, and the disease heals spontaneously.

The *Jingui Yaolue* also states: When a woman suffers from Fengzhong (Wind Strike) with fever and aversion to cold, and her menses happen to arrive, after seven or eight days, the fever subsides, the pulse becomes slow, the body cools down, there is fullness in the chest and hypochondrium resembling Jie Xiong (Chest Binding syndrome), and delirium occurs. This is Heat entering the Blood Chamber. One should puncture Qimen (Liv 14) and treat according to the excess pattern by draining.

Xu Zhongke commented: This refers to the coincidence of menstruation and illness, which does not immediately cause harm. After the illness resolves, the pathogen instead binds in the chest and hypochondrium causing pain, referring to Fengzhong. Although slightly different from the previous Shanghan case, the presence of fever, aversion to cold, and coincident menstruation shares the same mechanism as the previous case where both pathogen and Jing Qi were strong. After seven or eight days, the fever subsides, the pulse slows, and the body cools, indicating that menstruation proceeded through the illness without obstruction. However, after these seven or eight days, fullness in the chest and hypochondrium appears, resembling Jie Xiong, accompanied by delirium. This is because the heat entering the Blood Chamber did not wander into the meridians but condensed in the Liver's mansion (Liver Meridian area). Thus, the areas traversed by the pulse feel full, and severely, it resembles Jie Xiong. Excessive Yin fire leads to delirium. Although there is chest and hypochondriac fullness, it is not Shaoyang exterior pathogen; although it resembles Jie Xiong, it is not Taiyang exterior pathogen entering the interior; although there is delirium, it is not Stomach Excess. Therefore, this is Heat entering the Blood Chamber, indicating that one must not mistakenly attack the Stomach or the Upper and Middle Jiao. One should puncture Qimen. Qimen is the sector of the Liver. This is a Liver Excess pattern; drain the excess to cure it.

Note: This clause discusses menstruation that stops upon arrival, where blood stasis condenses internally forming an Excess pattern. Therefore, puncturing Qimen drains the excess. Those unskilled in acupuncture may use Xiaochaihu Tang (Minor Bupleurum Decoction) minus Renshen (Ginseng Radix), adding Taoren (Prunus Semen), Danpi (Moutan Cortex), Guiwei (Angelicae Sinensis Radix), and Shanjiya (Squama Manis) to promote blood circulation.