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Zhang Zhongjing stated in the *Shanghan Lun* (Treatise on Cold Damage): "When a woman suffers from cold damage with fever, and her menses happen to arrive; if she is lucid during the day but delirious at dusk, seeing phantoms as if witnessing ghosts, this is termed 'Heat Entering the Blood Chamber' (Re Ru Xue Shi). Do not injure the Stomach Qi or the Upper and Middle Jiao; the condition will resolve spontaneously."

He further stated: "When a woman suffers from wind strike with fever and aversion to cold, and her menses happen to arrive. After seven or eight days, if the heat subsides, the pulse becomes slow, and the body feels cool, accompanied by fullness in the chest and hypochondrium resembling Jie Xiong syndrome (Chest Binding), and delirium, this is Heat Enting the Blood Chamber. One should puncture Qimen (LR14) and apply the reducing method according to the excess pattern."

He also stated: "When a woman suffers from wind strike for seven or eight days, continuously experiencing alternating chills and fever that occur at specific times, and her menses have just ceased, this is Heat Entering the Blood Chamber. The blood must be congealed, hence the symptoms resemble malaria with periodic occurrences. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment."

Shen Yaofeng commented: "The text states 'do not injure the Stomach Qi and the Upper and Middle Jiao,' meaning one must not use purgative methods, nor emetic or diaphoretic methods. However, there are patterns that appear similar but are fundamentally different, which must not fail to be distinguished."

Chen Liangfu stated: "In cases of slow pulse, cool body, fullness in the chest and hypochondrium resembling Jie Xiong syndrome, and delirium, one should puncture the Qimen acupoint. Upon needle insertion, allow the patient to take five breaths, retain the needle for a considerable time, and then withdraw it slowly. Whenever puncturing Qimen, one must always use the reducing method, never the tonifying method. For obese individuals, insert to a depth of two cun; for thin individuals, one and a half cun."

Scholar Xu treated a female patient who suffered from cold damage, presenting with alternating chills and fever, and nightly episodes of seeing phantoms. After six or seven days, she suddenly became comatose and obstructed, with rattling phlegm sounds like sawing, locked jaws, closed eyes, and loss of consciousness, indicating a critical condition. Scholar Xu examined her and asked, "At the onset of the illness, did your menstruation begin?" The family replied, "Her menses had just started, but ceased when the illness struck. A day or two later, chills and fever developed. She was quiet during the day but saw ghosts at night, and yesterday lost consciousness." Scholar Xu said, "This is a case of Heat Entering the Blood Chamber. The physicians were ignorant and administered harsh medicines, causing this state. We must first resolve the phlegm, then treat the heat." He urgently administered Yi Ha San (One Swallow Powder). After about two hours, the phlegm drained, she fell asleep, and regained consciousness. Subsequently, he administered Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Sheng Di Huang (Radix Rehmanniae Preparata). After two doses, the fever subsided, and the disease resolved spontaneously without sweating.

In another case of Heat Entering the Blood Chamber, a physician used blood-tonifying and qi-regulating herbs for several days, resulting in Xue Jie Xiong (Blood Binding in the Chest). Someone advised using the previous method (puncturing Qimen). Scholar Xu said, "It is now too late to use Xiao Chai Hu Tang; puncturing Qimen is still viable." He requested a skilled acupuncturist to treat her, and she recovered as instructed. When asked why Blood Binding in the Chest formed, Scholar Xu explained, "Pathogenic factors entered the Blood Chamber due to deficiency. The blood was forced upward by the pathogens into the Liver Meridian, causing delirium and hallucinations; upon entering the Dan Zhong (Chest Center), the blood coagulated in the chest. Thus, palpation causes pain, which medication cannot reach; acupuncture is required."

Shen Yaofeng recorded: A woman presented with more heat than chills, worsening delirium at night. Her menses had lasted three days and stopped upon the onset of illness. The family knew it was Heat Entering the Blood Chamber, but after several doses of Xiao Chai Hu Tang (Minor Bupleurum Decoction) prescribed by other doctors, the condition worsened: the tongue coating was yellow and dry, and dry blood adhered to the teeth. I used Sheng Di Huang (Radix Rehmanniae Preparata), Mu Dan Pi (Cortex Moutan), and Mai Dong (Radix Ophiopogonis), but it was ineffective. The medicine induced dry retching, and the pulse was weak and not large. I reasoned that a weak pulse often indicates fire hyperactivity; dry stomach fluids cause retching. Therefore, I switched to Bai Hu Tang (White Tiger Decoction) with added Sheng Di Huang and Mai Dong. After two doses, the fever receded and spirit cleared. However, constipation for over twenty days remained distressing. I administered Ma Ren Wan (Hemp Seed Pill) three times, leading to bowel movement and recovery.

A maiden presented with fever and menstruation. Treatment with exterior-releasing herbs exacerbated the condition, causing severe nightly delirium. Xiao Chai Hu Tang (Minor Bupleurum Decoction) was administered but failed; she rose at night acting maniacally. Suspecting Blood Accumulation (Xu Xue), cooling-blood and blood-invigorating herbs were given, also without effect. The left Guan pulse was wiry, hard, and forceful. Inquiry revealed the illness originated from anger. I therefore used Long Dan Cao (Radix Gentianae), Huang Qin (Scutellariae Radix), Shan Zhi (Fructus Gardeniae), Mu Dan Pi (Cortex Moutan), Ling Yang Jiao (Cornu Saigae Tataricae), Lu Hui (Aloe), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Dang Gui Shen (Radix Angelicae Sinensis Radix) decocted together. One dose showed improvement, and four doses resulted in cure.

Yaofeng further noted: The daughter of Magistrate Zhang presented with fever and menstruation, delirious at night, seeing phantoms. Administration of Xiao Chai Hu Tang (Minor Bupleurum Decoction) worsened the condition. Inquiry revealed that when awake, she felt cold in the lower body, and even when drowsy, she constantly pulled blankets and gathered clothes. I realized she likely suffered from leukorrhea normally, and having married recently, sexual activity may have been excessive. Coupled with heavy menstruation, both essence and blood were depleted, and yin and yang were exhausted. Her chills and fever were caused by mutual assault between yin and yang, not by deep invasion of external heat pathogens. Mistaken use of dispersing and clearing-heat herbs led to a pattern resembling Wang Yang (Yang Collapse). The *Shanghan Lun* states: "Wang Yang leads to delirium." The *Neijing* states: "Those with Yang collapse see ghosts." I administered Shen Qi Wan (Kidney Qi Pill), two qian morning and evening, after which her spirit cleared. Subsequently, I replaced Fu Zi (Radix Aconiti Lateralis Preparata) and Gui Zhi (Ramulus Cinnamomi) with Rou Cong Rong (Herba Cistanche) for several doses, resulting in complete recovery. (Shen's self-note: This is the aforementioned pattern that appears similar but is distinct, which must not fail to be distinguished.)