热入血室经适断，邪热乘虚血室潜，寒热有时如疟状，小柴胡加归地丹。
【注】《金匮》云∶妇人中风七八日，续来寒热，发作有时，经水适断，此为热入血
室，其血必结，故使如疟状，发作有时，小柴胡汤主之。此言邪热未尽，值经来，乘虚
入于血室之间而潜藏之，故令血结，而寒热有时如疟状也。血室肝主之，肝与胆为表里，
胆因肝受邪而病寒热，故用小柴胡汤主之也。加当归、生地、丹皮者，所以清血分之热也。
小柴胡汤（方见首卷柴胡四物汤注中）
热入血室经适来，昼日明了夜谵妄，无犯胃气上二焦，热随血去自无恙。
刺期门法 清热行血汤
热入血室成结胸，下血谵语头汗出，二者皆当刺期门，随其实取泄而去。清热行血桃红丹，灵脂地草穿山赤。
【注】《金匮》云∶妇人伤寒发热，经水适来，昼日明了，夜则谵语如见鬼状，此为
热入血室。治之无犯胃气及上二焦，必自愈也。此言热虽入于血室，然经行不断，则热
不留结。勿谓谵妄，遂以硝黄犯其胃气刺伤荣血，小柴和解犯上二焦。但俟其热随血去，
病必自愈。《伤寒论》曰∶血自下，下者愈。此之谓也。
经水先闭后病肿，任冲寒湿血壅经；先发水肿后经闭，水溢皮肤泛滥行。血分难医水易治，二者详参要辨明。
【注】妇人经水先闭后病肿者，乃寒湿伤于冲、任，血壅经隧也，名曰血分。若先病
肿，而后经闭者，乃土不制水，水邪泛滥，溢于皮肤也，名曰水分。血分难治，水分易治，
二者须当详辨。
In the syndrome of Heat Entering the Blood Chamber (Re entering the uterus/blood chamber), where menstruation has just ceased, pathogenic heat enters the Blood Chamber (uterus/blood chamber) due to deficiency and lurks there. The symptoms include periodic chills and fever resembling malaria; the treatment is Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Dang Gui (Angelicae Sinensis Radix), Sheng Di Huang (Rehmanniae Radix), and Mu Dan Pi (Moutan Cortex).
[Note] *Jin Gui Yao Lue* states: "When a woman suffers from Wind-Strike for seven or eight days, followed by recurring chills and fever occurring at regular intervals, and her menses suddenly cease, this is called 'Heat Entering the Blood Chamber'. The blood must be congealed, hence the symptoms resemble malaria with regular paroxysms. It should be treated with Xiao Chai Hu Tang." This refers to the situation where pathogenic heat is not yet exhausted, coincides with the menstrual period, and enters the Blood Chamber due to deficiency to lurk therein, causing blood congealment and resulting in periodic chills and fever like malaria. The Blood Chamber is governed by the Liver. The Liver and Gallbladder are interior-exteriorly related. The Gallbladder becomes diseased with chills and fever because it receives pathogenic influence from the Liver. Therefore, Xiao Chai Hu Tang is used as the primary treatment. The addition of Dang Gui, Sheng Di Huang, and Mu Dan Pi serves to clear heat from the Blood level. (The composition of Xiao Chai Hu Tang is found in the notes for Chai Hu Si Wu Tang in the first volume.)
In the syndrome of Heat Entering the Blood Chamber, if menstruation is currently flowing, the patient is lucid during the day but experiences delirium and妄语 (confabulation/delirious speech) at night. One must not injure the Stomach Qi or the Upper and Middle Jiao (Upper and Middle Burners); once the heat follows the blood out, the body will naturally recover without injury.
Method of Needling Qimen (LR14) / Qing Re Xing Xue Tang (Clear Heat and Invigorate Blood Decoction)
If Heat Entering the Blood Chamber leads to Jie Xiong (Chest Binding/Syndrome), presenting with bleeding, delirium, and sweating on the head, both conditions require needling Qimen (LR14). One should follow the excess pattern to drain and eliminate the pathogen. The formula used is Qing Re Xing Xue Tao Hong Dan, containing Ling Zhi (Trogopteri Dung), Sheng Di Huang, Gan Cao (Licorice Root), Shan Jian Jia (Pangolin Scales), and Chi Shao (Red Peony Root).
[Note] *Jin Gui Yao Lue* states: "When a woman suffers from Cold Damage with fever, and her menses happen to be flowing, she is lucid during the day but delirious at night, seeing ghosts as if possessed. This is called Heat Entering the Blood Chamber. In treating it, do not injure the Stomach Qi or the Upper and Middle Jiao; the disease will heal itself." This explains that although heat enters the Blood Chamber, if menstruation does not stop, the heat will not linger and congeal. Do not assume that because of delirium, one should use Shi Hui (Niter) and Da Huang (Rhubarb) to attack the Stomach Qi or cause sweating that injures Ying Blood and the Upper/Middle Jiao. Simply wait for the heat to exit with the blood, and the illness will surely heal. *Shang Han Lun* says: "If the blood flows down spontaneously, the patient recovers." This is what is meant.
If menstruation ceases first and edema appears subsequently, it is due to Cold-Dampness injuring the Ren Mai (Conception Vessel) and Chong Mai (Penetrating Vessel), causing blood stagnation in the meridians; this is named Blood Division (Xue Fen) disease. If edema appears first and menstruation ceases subsequently, it is because Earth (Spleen) fails to control Water, leading to water pathogen flooding and overflowing into the skin; this is named Water Division (Shui Fen) disease. Blood Division disease is difficult to treat, while Water Division disease is easy to treat. These two must be carefully analyzed and clearly differentiated.