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In Yangming disease of Shanghan (Cold Damage), there exists the syndrome of Heat Entering the Blood Chamber. When a woman contracts Shanghan and her menstruation is just beginning or has just ceased, the Blood Chamber becomes empty, making it easy for pathogenic factors to sink in, resulting in the syndrome of Heat Entering the Blood Chamber. The symptoms include delirious speech and妄语 (hallucinations/irrational talk); in severe cases, the patient may run wildly and see ghosts. Consciousness is clear before noon but becomes drowsy and confused in the afternoon, worsening at night. The patient lies fatigued, ignores food intake, and cannot turn their body. The severity of the illness depends not only on the intensity of the heat but also on the differentiation between blood excess (Xue Shi) and blood deficiency (Xue Xu). In blood excess, turbid qi generated by pathogenic heat accumulates, aggravating the condition; in blood deficiency, fluids are depleted and spirit scatters, preventing pathogenic factors from accumulating, so the patient retains some awareness of reality. Treatment methods differ, focusing either on attacking blood stasis or nourishing fluids.

Zhao Qingchu stated: For external contraction diseases involving the heart, the pathology lies in Xin Bao Luo (Pericardium) and Xue Mai (Blood Vessels). When pathogens enter the Pericardium, consciousness is lost; when they enter the Blood Vessels, consciousness is also impaired. However, the depth of invasion varies, as do the severity of symptoms. If pathogens enter the Pericardium, which is close to the Heart, complete loss of consciousness occurs with no awareness of surroundings. If pathogens enter the Blood Vessels, which are farther from the Heart, the patient can awaken upon calling and respond to speech. If left to sleep freely without guarding the mind, deep stupor ensues. Pathogens moving from Blood Vessels into the Pericardium due to mismanagement represent progression from superficial to deep; conversely, pathogens retreating from the Pericardium to Blood Vessels due to correct treatment represent regression from deep to superficial. Additionally, when pathogenic factors are vigorous and penetrate directly into the Pericardium without passing through Qi division or gradually entering via Blood Vessels, sudden syncope occurs. Death may occur within a day if slow, or within an hour if rapid, because direct invasion of the Pericardium leads to internal violation of the Heart. (This discusses the depth of pathogens in Blood Vessels and Pericardium, and the variation in symptom severity.)

Li Dongyuan stated: When Shanghan transmits to the fifth or sixth day, gradual onset of coma and muteness, or talking alone during sleep, may occur. After one or two days, red eyes, cracked lips, dry tongue, and lack of thirst appear. The patient swallows thin porridge if offered but refuses it if not. The six pulses are fine and rapid but not surging. There is no epigastric fullness (Pi), abdominal distension, and bowel/bladder functions remain normal. Or, after ten days, the patient resembles a drunkard, presenting deficiency signs and coma. Using Chengqi Tang (Gut-Draining Decoction) to purge under such circumstances is erroneous. This is actually heat transmitting to the Hand Shaoyin Meridian, treated with Daochi Xiexin Tang (Led-Chi Heart-Draining Decoction). Swallowing food indicates the pathogen is not in the Stomach; refusal to eat is due to coma. Since the pathogen is not in the Stomach, purging with Chengqi Tang will inevitably cause death. Such syndromes are common in the transmission of Shanghan and warm diseases and must be carefully distinguished.

Zhang Shiweng stated: There is a type of tongue coating that is black and dry in the center, possibly with slight prickles, but lacking thick accumulated coating despite the black color. The tongue body is withered and thin, not overly red. Symptoms include irritability and thirst, deafness, persistent fever, constipation for five to six days or even over ten days, soft abdomen without hardness or pain on pressure, clear consciousness without coma, inability to sleep day or night, occasional mumbling, smiling, or sighing when dozing. This is a sign of fluid depletion and blood dryness. Immediate treatment with Zhigancao Tang (Licorice Decoction) or Shengli Liuwei Wan (Six-Ingredient Pill with Added Herbs) modified with Sheng Di Huang (Rehmanniae Radix), combined with Shengmai San (Generate the Pulse Powder) and Gui Zhi (Cinnamon Twig), is required to nourish the source of transformation. Survival is possible; mistaking this for a case requiring Chengqi Tang leads to death, as does mistaking it for Si Ni Tang (Frigid Extremities Decoction). (These two passages both discuss the syndrome of blood dryness.)