宜汗下，必先之以养阴，待其阴化津回，邪多不治自退；设有未退，酌用清利；攻之若早，其病益甚。”在这
里，帮助了“夹劳伤寒”的治法，是∶必须在邪、正、虚、实夹杂的情况下，衡量其轻重缓急，作出“养正以
达邪”“祛邪以安正”的兼筹并顾方法；掌握“邪去而正不伤”的原则，以符合治疗“内伤夹外感”最理想的
要求。绮石理《虚元鉴》说∶“有平素劳倦伤血，瘀积胃络，兼受风寒，病邪迫血，火不得降，以致吐血衄血，
不可以弱证施治；若投凉剂，则寒愈结而血难止。只宜散其风寒，少加调血归经之品。使邪外泄，而火下降，
则血自止矣。”这更是很好的一个启示。
（又名行经伤寒）
【因】吴又可云。妇人伤寒时疫。与男子同。惟经水适来适断。及崩漏产后。与男子迥然不同。
夫经水之来。乃诸经血满。归注于血室。下泄为月水。血室者。一名血海。即冲任脉也。为诸经之总任。
经水适来。疫邪不入于胃。乘势入于血室。故夜发热谵语。盖卫气昼行于阳。不与阴争。故昼则明了。
夜行于阴。与邪相搏。故夜则发热谵语。至夜止发热而不谵语者。亦为热入血室。因有轻重之分。不
必拘于谵语也。《伤寒折衷》云。冲脉为血之海。即血室也。男女皆有此血气。亦均有此冲脉。冲
脉得热。血必妄行。在男子则为下血谵语。邪气传入正阳明府也。在妇人则为寒热如疟。邪随经而入也。
皆为热入血室。逼血下行。挟热而痢。是热入血室。男女皆有之也。
【证】妇人中风。发热恶寒。经水适来。得之七八日。热除。而脉迟身凉。胸胁下满。如结胸状。
谵语者。此为热入血室也。当刺期门。随其实而取之。
妇人中风七八日。续得寒热。发作有时。经水适断者。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。程云、前条之热入血室。由中风在血来之先、邪热乘血空而入之、室中
略无血、而深是邪、故可用刺法、尽泻其实、此条之热入血室、由中风在血来之后、邪乘血半离其
室而内之、血与热搏所以结、正邪争、故如疟状、而休作有时、邪半实而血半虚、故只可用小柴胡汤
为和解法、钱天来云、小柴胡汤中、应量加血药、如牛膝、桃仁、丹皮之药，其脉迟身凉者、或少加姜桂、及酒煮大黄少许，取效尤速、所谓随其实而泻之也、若不应用补者、人参亦
当去取、按热入血室、许叔微小柴胡汤加生地黄、张璧加丹皮、杨士瀛云。小柴胡力不及者。于内加五
灵脂。方氏云、适来者、因热入血室、迫使血来、血出而热随遗也。适断者。热乘血来。而遂入之。
与后血相搏。俱留而不出。故曰血必结也。
妇人伤寒发热。经水适来。昼日明了。夜则谵语如见鬼状者。此为热入血室。无犯胃气。及上二
焦必自愈。（成无己曰、伤寒发热者、寒已成热也、经水适来、则血室空虚、邪热乘虚入于血室、若
昼日谵语、为邪客于府、与阳争也、此昼日明了、夜则谵语如见鬼状、是邪不入府、入于血室、与
阴争也、阳盛谵语则宜下、此热入血室、不可与下药、犯其胃气、热入血室、血结寒热者、与小柴胡
汤散邪发汗、此虽热入血室、而无血结寒热、不可与小柴胡汤发汗、以犯上焦、热入血室、胸胁满如结
胸状者、可刺期门、此虽热入血室、而无满结、不可刺期门、犯其中焦、必自愈者、以经行则热随血
去而下也、已则邪热悉除而愈矣、方中行云、无、禁止之辞、犯胃气、言下也、必自愈者、言伺其经
行血下、则邪热得以随血而俱出、犹之鼻衄红汗、故自愈也、盖警人勿妄攻、以致变乱之意、程林云、
上章以往来寒热如疟、故用小柴胡以解其邪、下章以胸胁下满如结胸状、故刺期门以泻其实、此章则
无上下二证、似待其经行血去、邪热得以随血出而解也。）
许叔微《本事》方、记一妇人患热入血室证。医者不识。用补血调气药。涵养数日。遂成血结胸。或劝
用小柴胡汤。予曰。小柴胡用已迟。不可行也。无已则有一焉。刺期门穴斯可矣。予不能针。请善针
者治之。如言而愈。或者问云。热入血室。何为而成结胸也。予曰。邪气传入经络。与正气相搏。上
下流行。或遇经水适来适断。邪气乘虚而入血室。
为邪迫上入肝经。受肝邪则谵语如见鬼。复入膻中。则血结于胸也。何以言之。妇人平居。水当养于木。
血当养于肝也。方未受孕。则下行以为月事。既妊娠、则中蓄之以养胎。及已产、则上壅之以为乳。皆血也。
今邪逐血并归于肝经。聚于膻中。结于乳下。故手触之则痛。非汤剂可及。故当刺期门也。此语甚确。
即辨证着眼处。
【脉】尺脉洪大。阳陷入阴。寸大尺衰。阴虚阳盛。血虚脉虚。血枯脉涩。涩大血瘀。洪数热蒸。
《折衷》云。挟血之脉。乍涩乍数。或伏或沉。血热交并。则脉洪盛。大抵男多应于左手。女多右手见之。
【治】《伤寒折衷》云。男子热入血室。下血谵语。但头汗出。宜刺期门。妇人热入血室。经水
适断。寒热如疟。发作有时。小柴胡汤加生地、丹皮、桃仁。经水适来。热除身凉。脉迟。胸胁满如结胸。
谵语。刺期门。经水适来。昼日明了。暮则谵语如见鬼状。不须治自愈。陶节庵云。妇人热入血室有三。
经水适来。二条不言药者。盖以经血方来。热气乘虚而入。经血出则热亦出矣。故不可用汗下药。犯
其胃气。及上二焦。如其胸满谵语。此则实也。刺期门以泻之。若经水适断。续得寒热。其血必结。
故用小柴胡汤加丹皮、红花、桃仁。若阳明热入血室。此男子蓄血之症。但当刺以泄热也。又云。太
阳不解。热结膀胱。其人如狂。而血自下者。宜用桂枝汤。阳明下血谵语。胸膈满如结胸。夜则如
见鬼。此为热入血室。小柴胡汤。下焦蓄血。其人如狂。小腹急结。小便自利。大便黑。与夫下利。
无表里证。脉数不解。消谷易饥。多日不大便。此为瘀血。桃仁承气汤下之。吴又可云。无犯胃气。
及上二焦必自愈。言其胸膈并胃无邪。勿以谵语为胃实。而妄攻之。但热随血下则自愈。若有如结胸状者。
血因邪结也。当刺期门以通其结。《活人书》治以柴胡汤。然不若刺期门者之功效。《活人书》治妇
人伤寒解后。热邪内陷。血结胸膈。二便不通。晡夜发热而语妄
如狂等证。用海蛤散。（海蛤、滑石各一两、炙甘草五钱、芒硝一两、上为末、每服以鸡子清调之）、盖小肠通利。则
胸膈血散。膻中血聚。则小肠壅。小肠壅。膻中血不行。宜此方。若因经水适断。血室空虚。其邪乘虚传入。
邪胜正亏。经气不振。不能鼓散其邪为难治。且不从血泄。邪气何由即解。与适来者。则有血虚血实之分。宜柴胡
养荣汤。（柴胡、黄芩、陈皮、甘草、当归、生地、白芍、知母、花粉、生姜、大枣。）凡新产后亡血过多。
冲任空虚。与素善崩漏。经气久虚。皆能受邪。与经水适断同治。
【秀按】冲为血海。即血室也。冲脉得热。血必妄行。在男子则下血谵语。在妇人则月事适来。阳明病下血
谵语。兼男子言。不止谓妇人也。但以妇人经气所虚。邪得乘虚而入。故病热入血室为多。然妇人热入血室。
有须治而愈者。有不须治而愈者。仲景皆有明文。已详证治条下。兹不复赘。云岐子曰。妇人伤寒。身热脉长
而弦。属阳明少阳。往来寒热。夜躁昼静。如见鬼状。经水适断。热入血室。不实满者。小柴胡汤去参枣。加
丹皮、桃仁、归尾、穿山甲以消之。大实满者。桃仁承气汤下之。妇人伤寒。表虚自汗身凉。四肢拘急。脉沉
而迟。太阳表病。少阳本病。经水适断。桂枝加附子红花汤。妇人伤寒汗解表除。热入血室。扰其经水过多。
不受补益。芍药甘草汤治之。徐灵胎曰。妇人伤寒。经水才来。邪入血室。寒热见鬼如狂。脉紧细数者。以姜
桂柴胡汤。（干姜六分、桂枝三分、柴胡六分、牡蛎三钱、栝蒌根三钱、甘草六分、水煎去渣。）热服取汗。
若中风伤寒。表罢后经至。而上犯心包。神明失措。而意志不清。如狂见鬼不已。脉涩微数者。以牛黄丸（牛
黄、郁金、丹皮、朱砂各一钱、冰片三分、生甘草五分、研为末、蜜丸、新汲水化下三分。）治之。
【廉勘】周澹然云。妇人经水适来。温邪恰受。血为邪遏。多致腹痛胀满。治温法中。再加桃仁、红花、元
胡、丹皮、鳖甲之类。经水适去。血室空虚。邪因虚乘入。多致谵妄神昏。舌黑潮热。又当以增损小柴胡。加
养阴之品。如患温时。经自行不间断。热随血泄。只治其经行自已。朱瑞生云。妇人病温。经水适来或适断。
热入血室。耳聋口苦。昼则脉静身凉。夜则发热脉数。柴蒿鳖甲汤。（柴胡二钱、青蒿钱半、生鳖甲三钱、黄
芩二钱、白芍三钱、丹皮三钱、鲜生地四钱、麦冬二钱、栀子二钱、生甘草一钱、水五杯、煎二杯、分两次
服。）渴者、加花粉。胸胁痞满而痛者。加枳实、栝蒌仁、牡蛎各三钱。热入血室。少腹痛硬。大便闭。或通
而色黑。脉沉实。夜热甚时。则脉洪数。昏狂谵语。加减桃仁承气汤（桃仁三钱、生锦纹三钱、芒硝三钱、生
甘草二钱、黑犀角二钱、磨汁冲入、丹皮三钱、鲜生地八钱、水四杯、煎取二杯、纳芒硝煎化服一杯、历三小
时许、当下瘀血、不下再服、得下弗服。）主之。热入血室。邪少正虚。夜微烦热者。柴胡人参汤。（柴胡三
钱、人参一钱、麦冬三钱、白芍二钱、鲜生地三钱、阿胶三钱、炙甘草三钱、水三杯、煎取一杯、顿服之、不
愈再服。）此温病与伤寒不同之异点。有司命之责者。不可不知也。
【炳章按】朱丹溪云。血室。方氏云。血室为营血停留之所。经血集会之处。即冲脉。所谓血海是也。
诸家皆从其说。惟柯氏云。血室、肝也。肝为藏血之藏。故称血室。陈自明云。巢氏《病源》并《产宝方》。
并谓之胞门、子户。张仲景谓之血室。《卫生宝鉴》云。血室者、素问所谓女子胞。即产肠也。程序《医彀》云。
子宫、即血室也。张介宾《类经附翼》云。子户、即子宫。俗谓子肠。医家以冲任之脉盛于此。则月事以时下。
故名曰血室，据最近西医学说。亦名子宫。许叔微所谓方未受孕。则下行之。以为月事。既妊娠。则中蓄之
以养胎。及已产。则上壅之以为乳。皆血也。据炳章意察。为月事、为养胎、皆血是也。其既产以为乳者。乳
非血也。乳者、乃饮食入胃化出之乳糜汁而为乳。实未成血之物也。若不为乳。以此汁再入循环器。则化赤而
为血。再经营运于周身。后清血荣经。其浊血流入血室。下行为月事。已妊娠者以养胎。盖血室即子宫。平时
则蓄血以行经。妊娠则系胎。凡行经时。则子门开张而下泄。故伤寒中风。适值经来。而邪热得直入血室。
亦有经未至期。因热盛蒸迫
血室。则血亦下行。顺则热随血泄。经行后热反化轻。否则热甚冲入胞门。阻拒其行经。下泄之血。留蓄胞门
为瘀。以致血室之热。无从得泄。病必增剧。炳章前治偏门快阁姚性妇伏暑。初病时尚食荤腥肉面。兼服补
品。迨热重胃闭始停。而后身灼热。胸痞便闭。小溲短涩。因热逼血室。经水受迫而来。以致热入血室。俄倾
未净经止。证现耳聋目闭。手足螈 。神昏谵语。便闭溲涩。前医皆遵热入血室例。治多罔效。至病势危殆。
始邀余延医。余诊其脉。弦数搏指。舌底苔灰黑黄焦。浮铺苔上。且腻浓板实。舌尖深绛。边紫兼青。询其前
由。阅其服方。参考现症。断其为热入血室瘀塞胞门。胞门淤阻不除。清血室热之药。无从得进。故诸治不
应。余主先去除胞门积瘀。冀以清热熄风。遂重用蚕砂、鼠粪、蜣螂。化浊道以通胞门之淤塞。硝、黄、攻坚
积。牙皂涤污垢。地鳖、桃仁。逐瘀通络。鲜地合大黄。能化瘀泄热。鲜大青、钩藤、羚羊。清血热而熄肝
风。鲜菖蒲、天竺黄。豁痰而开心窍。服一剂。逾五六句钟。大便即下黑垢瘀血块。成团成颗粒者甚多。热退
其半。螈 即定。神识略清。次晨复诊。脉势已平。而舌苔松腐。黑垢满堆。刮去瓢余。未减其半。超时又
浓。继进桃仁承气汤。加化滞清热之品。服至五剂。苔垢始净。身热亦退。胃纳渐动。调理而痊。考此证先病
伏暑挟湿。继则挟食。再则阻经停瘀。湿蒸热灼。便闭溲涩。血室伏热内灼。胞门凝瘀阻塞。以致邪无出路。
前医以凉血清热之剂。以清血室。然药力不能直入淤塞之胞门。故皆罔效。余之收效。在通瘀导浊。以二矢浊
味。攻胞门之浊道也。前证若用小柴胡汤。则大误矣。盖温暑治法。与正伤寒不同。叶氏温热论。已辨之甚
详。再节录于下。以资参考。叶天士云。经水适来适断。邪将陷入血室。少阳伤寒言之详悉。不复多赘。但数
动（数动、辨脉也、温病之脉数动、与伤寒热入血室之脉迟者不同。）与正伤寒不同。仲景立小柴胡汤。提出
所陷热邪。以参枣扶胃气。冲脉隶属阳明也。此惟虚者为合法。若热邪陷入。与血相结者。（较热入血室、不
It is appropriate to employ sweating and purging methods, but one must first nourish Yin. Wait for the Yin to transform and fluids to return; most pathogens will recede spontaneously without treatment. If the pathogens do not recede, use clearing and draining methods as appropriate. If purging is applied too early, the disease will worsen." This elucidates the treatment principle for "Shanghan complicated with consumption" (consumption-entangled cold damage): under conditions where pathogenic factors, healthy Qi, deficiency, and excess are intermixed, one must weigh their severity and urgency, adopting a method that simultaneously "supports healthy Qi to expel pathogens" and "expels pathogens to pacify healthy Qi"; mastering the principle of "expelling pathogens without injuring healthy Qi" aligns with the ideal requirements for treating "internal injury complicated by external contraction." Qishi stated in *Li Xu Yuan Jian* (Treatise on Managing Deficiency): "For those who have chronically injured Yin blood through overexertion, leading to blood stasis accumulating in the stomach collaterals, and who then contract wind-cold, the pathogenic factors force blood to move recklessly, fire fails to descend, resulting in hematemesis or epistaxis. In such cases, it is inappropriate to treat it as a mere deficiency syndrome; if cooling agents are administered, the cold will further congeal, making hemostasis difficult. One should only disperse wind-cold and add a small amount of herbs that regulate blood and guide it back to its vessels. Once the pathogen is released externally and fire descends, bleeding will stop naturally." This serves as an excellent inspiration.
(Also known as Menstrual Shanghan)
[Etiology] Wu Youke stated: Women contracting Shanghan or seasonal epidemics are similar to men, except when menstruation has just started or just stopped, or during metrorrhagia and postpartum states, which differ significantly from men.
The arrival of menstruation occurs when blood from various meridians fills up and gathers into the Blood Chamber (Xue Shi), flowing downward as menstrual flow. The Blood Chamber, also called the Sea of Blood, refers to the Chong and Ren meridians, which serve as the general reservoir for blood and Qi of all meridians.
When menstruation begins, epidemic pathogens do not enter the Stomach but instead take advantage of the situation to invade the Blood Chamber. Consequently, there is fever and delirium at night. This is because Wei Qi (Defensive Qi) travels through the Yang aspects during the day and does not contend with Yin, so consciousness is clear during the day. At night, it travels through the Yin aspects and contends with pathogens, causing fever and delirium at night. If fever ceases at night without delirium, it is still considered Heat entering the Blood Chamber, due to variations in severity; one should not rigidly adhere to the presence of delirium. *Shanghan Zhezhong* (Compendium of Cold Damage Analysis) states: The Chong Meridian is the Sea of Blood, i.e., the Blood Chamber. Both men and women possess this blood-Qi and Chong Meridian. When the Chong Meridian receives heat, blood will move recklessly. In men, this manifests as lower bleeding and delirium, indicating the pathogen has entered the Yangming Stomach Fu organ. In women, it manifests as alternating chills and fever resembling malaria, indicating the pathogen has entered along the meridians. Both scenarios involve Heat entering the Blood Chamber, forcing blood downward and carrying heat to cause dysentery. Thus, Heat entering the Blood Chamber can occur in both men and women.
[Symptoms] In women suffering from Wind Strike (Zhong Feng), with fever, aversion to cold, and menstruation just beginning, after seven or eight days, if the heat subsides, the pulse becomes slow, the body cools, there is fullness and distension in the chest and hypochondrium resembling Chest Bind (Jie Xiong), and delirium occurs, this is Heat entering the Blood Chamber. One should puncture the Qimen (LR14) acupoint and drain based on the excess condition.
In women suffering from Wind Strike for seven or eight days, who subsequently develop alternating chills and fever occurring at specific times, and whose menstruation has just stopped, this is Heat entering the Blood Chamber, and the blood must be congealed. Hence, symptoms resemble malaria with regular paroxysms. Treat primarily with Xiaochaihu Tang (Minor Bupleurum Decoction). Cheng Yun argued: In the previous case of Heat entering the Blood Chamber, it occurred before menstruation arrived; pathogenic heat invaded while the Blood Chamber was empty, with little blood present, allowing deep pathogen penetration, thus warranting acupuncture to thoroughly drain the excess. In this case, it occurred after menstruation began; the pathogen invaded while half the blood had left the chamber, causing blood and heat to bind and congeal, leading to contention between healthy Qi and pathogens, resulting in malaria-like symptoms with regular timing. Since the pathogen is semi-excess and the blood is semi-deficient, only Xiaochaihu Tang as a harmonizing method is suitable. Qian Tianlai stated: In Xiaochaihu Tang, one should proportionally add blood-regulating herbs such as Achyranthes Root (Niuxi), Peach Kernel (Taoren), and Moutan Bark (Danpi). For those with a slow pulse and cool body, adding small amounts of Ginger (Shengjiang), Cinnamon Twig (Guizhi), or wine-processed Rhubarb (Dahuang) may yield faster results, adhering to the principle of "draining according to excess." If tonification is not indicated, Ginseng (Renshen) should be removed. Regarding Heat entering the Blood Chamber, Xu Shuwei used Xiaochaihu Tang plus Rehmannia Root (Shengdihuang); Zhang Bi added Moutan Bark (Danpi); Yang Shaying noted that if Xiaochaihu Tang's power is insufficient, add Psoralea Fruit (Wulingzhi). Fang Shi explained: When menstruation just starts, Heat enters the Blood Chamber, forcing blood out, and heat follows the blood loss. When menstruation just stops, heat invades as blood arrives, contending with subsequent blood, causing stagnation and preventing exit, hence "blood must congeal."
In women with Shanghan fever and menstruation just starting, who are lucid during the day but experience delirium at night as if seeing ghosts, this is Heat entering the Blood Chamber. Do not violate Stomach Qi or the Upper and Middle Jiao; the condition will resolve spontaneously. (Cheng Wuji stated: Shanghan fever indicates cold has transformed into heat. With menstruation just starting, the Blood Chamber is empty, allowing pathogenic heat to enter vacantly. Daytime delirium indicates pathogen residing in the Fu organs contending with Yang. Here, daytime lucidity and nighttime delirium indicate pathogen entering the Blood Chamber to contend with Yin. Yang excess delirium warrants purgatives, but Heat entering the Blood Chamber prohibits them to avoid violating Stomach Qi. For Heat entering Blood Chamber with blood congealment and chills/fever, Xiaochaihu Tang disperses pathogens and induces sweating. Although this is Heat entering Blood Chamber, without blood congealment/chills-fever, Xiaochaihu Tang should not be used to induce sweating, avoiding violation of the Upper Jiao. For Heat entering Blood Chamber with chest/hypochondriac fullness like Chest Bind, puncture Qimen. Without fullness/congealment, do not puncture Qimen to avoid violating the Middle Jiao. Spontaneous resolution occurs because menstrual flow carries heat downward. Once menstruation ends, pathogenic heat is entirely cleared. Fang Xingzhong stated: "Do not" is prohibitive. "Violate Stomach Qi" refers to purging. "Resolve spontaneously" means waiting for menstrual blood discharge to carry pathogenic heat out, similar to epistaxis or "red sweat," hence spontaneous resolution. This warns against reckless purging to prevent complications. Cheng Lin stated: The previous chapter used Xiaochaihu Tang for alternating chills/fever like malaria; the next chapter used Qimen puncture for chest/hypochondriac fullness like Chest Bind. This chapter lacks these signs, suggesting waiting for menstrual blood discharge to carry pathogenic heat out for resolution.)
Xu Shuwei's *Benshi Fang* records a woman with Heat entering Blood Chamber. The physician failed to recognize it, using blood-tonifying and Qi-regulating herbs for several days, resulting in Blood Chest Bind. Someone suggested Xiaochaihu Tang, but I said: Using Xiaochaihu Tang is too late; it cannot be applied. Alternatively, puncture Qimen. I am not skilled in acupuncture, so I requested a proficient practitioner to treat her. She recovered as instructed. Someone asked: Why does Heat entering Blood Chamber become Chest Bind? I said: Pathogens enter collaterals, contend with healthy Qi, circulate up and down. If coinciding with menstruation start/stop, pathogens invade the Blood Chamber vacantly.
Pathogens force upward into the Liver Meridian; Liver pathogen invasion causes delirium like seeing ghosts. Further entering the Danzhong (Conception Vessel area), blood congeals in the chest. Why? Normally, Water nourishes Wood, and Blood nourishes the Liver. Before pregnancy, blood flows downward as menstruation. During pregnancy, it accumulates centrally to nourish the fetus. After childbirth, it rises upward to form milk. All are forms of blood. Now, pathogens chase blood into the Liver Meridian, gathering at Danzhong, congealing below the breasts, causing pain upon touch. This is beyond the reach of decoctions, hence Qimen puncture is required. This statement is accurate and represents the key to syndrome differentiation.
[Pulse] Chi (Cun Cun) pulse is surging and large. Yang sinks into Yin. Cun pulse large, Chi pulse weak indicates Yin deficiency and Yang excess. Blood deficiency yields a deficient pulse; Blood exhaustion yields a choppy pulse. Choppy and large indicates blood stasis. Surging and rapid indicates steaming heat.
*Zhezhong* states: Pulses associated with blood involvement are intermittently choppy and rapid, or hidden and deep. When blood heat intertwines, the pulse is surging and vigorous. Generally, men show this more on the left hand, women on the right.
[Treatment] *Shanghan Zhezhong* states: For men with Heat entering Blood Chamber, lower bleeding, delirium, and sweating only on the head, puncture Qimen. For women with Heat entering Blood Chamber, menstruation just stopped, chills/fever like malaria with regular timing, use Xiaochaihu Tang plus Rehmannia Root (Shengdihuang), Moutan Bark (Danpi), and Peach Kernel (Taoren). For menstruation just started, heat subsided, body cooled, slow pulse, chest/hypochondriac fullness like Chest Bind, delirium, puncture Qimen. For menstruation just started, lucid during day, delirious like seeing ghosts at dusk, no treatment needed for spontaneous resolution. Tao Jian'an stated: There are three types of Heat entering Blood Chamber in women. The two cases mentioning menstruation just started omitted medication because blood is flowing, heat enters vacantly, and heat exits with blood. Thus, sweating/purging methods should be avoided to prevent violating Stomach Qi and Upper/Middle Jiao. If chest fullness and delirium occur, it is excess; puncture Qimen to drain. If menstruation just stopped, followed by chills/fever, blood must congeal; use Xiaochaihu Tang plus Moutan Bark, Safflower (Honghua), and Peach Kernel. If Yangming Heat enters Blood Chamber, this is male Blood Accumulation (Xu Xue); only puncture to drain heat. Furthermore: If Taiyang unresolved, heat binds Bladder, patient acts like a madman, and blood passes spontaneously, use Guizhi Tang (Cinnamon Twig Decoction). Yangming lower bleeding, delirium, chest/diaphragm fullness like Chest Bind, nighttime hallucinations, this is Heat entering Blood Chamber; use Xiaochaihu Tang. Lower Jiao Blood Accumulation, patient acts like a madman, lower abdomen urgent/knotting, urination normal, black stool, or diarrhea, no exterior/interior signs, rapid pulse unrelenting, easy digestion/hunger, constipation for many days, this is blood stasis; use Taoren Chengqi Tang (Peach Kernel Magnolia Bark Decoction) to purge. Wu Youke stated: Do not violate Stomach Qi or Upper/Middle Jiao; resolve spontaneously. This means no pathogen in chest/diaphragm/stomach; do not mistake delirium for Stomach Excess and purge recklessly. Only when heat passes with blood does it resolve. If Chest Bind-like symptoms exist, blood is bound by pathogen; puncture Qimen to unblock binding. *Heren Shu* treats with Chaihu Tang, but puncturing Qimen is more effective. *Heren Shu* treats post-Shanghan resolution where heat sinks internally, blood binds chest/diaphragm, bowel/bladder obstruction, evening/night fever, and delirious madness, using Haige San (Clam Shell Powder) (Haige [Clam Shell], Talcum [Huashi] 1 liang each, Roasted Licorice [Zhi Gancao] 5 qian, Mirabilite [Mangxiao] 1 liang, powdered, taken with egg white). Because Small Intestine patency disperses chest blood. Danzhong blood accumulation obstructs Small Intestine. Small Intestine obstruction prevents Danzhong blood flow; this formula is suitable. If due to menstruation just stopping, Blood Chamber is empty, pathogen enters vacantly, pathogen exceeds healthy Qi, meridian Qi fails to vent pathogens, it is difficult to treat. Moreover, if not expelled via blood, how can pathogens resolve? This differs from menstruation just starting, involving blood deficiency vs. excess; use Chaihu Yangrong Tang (Bupleurum Nourishing Ying Decoction) (Chaihu, Huangqin, Chenpi, Gancao, Danggui, Shengdihuang, Baishao, Zhimu, Huafen, Shengjiang, Dazao). Any new postpartum excessive blood loss, Chong/Ren emptiness, or chronic metrorrhagia with long-term meridian Qi deficiency, all susceptible to pathogens, treated same as menstruation just stopped.
[Xiu's Commentary] The Chong Meridian is the Sea of Blood, i.e., Blood Chamber. Chong Meridian heat causes reckless blood movement. In men, lower bleeding and delirium; in women, menstruation starts. Yangming disease with lower bleeding/delirium refers to men, not just women. However, women's meridian Qi deficiency allows pathogens to invade vacantly, making Heat entering Blood Chamber common. Yet, some require treatment to resolve, others resolve spontaneously, as detailed by Zhang Zhongjing. Yun Qizi stated: Women with Shanghan, body heat, long/stringy pulse, belonging to Yangming/Shaoyang, alternating chills/fever, nighttime irritability/daytime quietness, hallucinations, menstruation just stopped, Heat entering Blood Chamber without significant fullness: Xiaochaihu Tang minus Renshen/Dazao, plus Danpi, Taoren, Guiwei, Pangolin Scales (Chuanshanjia) to dissipate. Significant fullness: Taoren Chengqi Tang to purge. Women with Shanghan, exterior deficiency, spontaneous sweating, cool body, limb rigidity, deep/slow pulse, Taiyang exterior disease, Shaoyang root disease, menstruation just stopped: Guizhi Jia Fuzi Honghua Tang (Cinnamon Twig Plus Aconite and Safflower Decoction). Women with Shanghan resolved by sweating, exterior removed, Heat enters Blood Chamber, disturbing menstruation excessively, intolerant of tonification: Shaoyao Gancao Tang (Peony and Licorice Decoction). Xu Lingtai stated: Women with Shanghan, menstruation just started, pathogen enters Blood Chamber, chills/fever/hallucinations/madness, tight/fine/rapid pulse: Jianggui Chaihu Tang (Ginger-Cinnamon-Bupleurum Decoction) (Ganjiang 6 fen, Guizhi 3 fen, Chaihu 6 fen, Muli 3 qian, Gualougen 3 qian, Gancao 6 fen, decocted, taken hot to induce sweating). If Wind Strike/Shanghan, exterior resolved, menstruation arrives, pathogen attacks Heart Protector (Xin Bao), confusing spirit/mind, madness/hallucinations persist, choppy/micro-rapid pulse: Niuhuang Wan (Calculus Bovis Pill) (Niuhuang, Yujin, Danmu, Zhusha 1 qian each, Bingpian 3 fen, Sheng Gancao 5 fen, powdered, honey pills, dissolved in fresh water, 1/3 qian dose).
[Lian's Examination] Zhou Dandan stated: Women with menstruation just starting, warm pathogen contracts, blood restrained by pathogen, often causing abdominal pain/distension. In warm disease treatment, add Taoren, Honghua, Yuanhu, Danpi, Biejia. Menstruation just ended, Blood Chamber empty, pathogen enters vacantly, often causing delirium/coma, black tongue, tidal fever: Use modified Xiaochaihu Tang plus Yin-nourishing herbs. If warm disease occurs with uninterrupted menstruation, heat drains with blood; treat menstruation itself for spontaneous resolution. Zhu Ruisheng stated: Women with warm disease, menstruation start/stop, Heat entering Blood Chamber, deafness/bitter taste, daytime quiet/cool pulse, nighttime fever/rapid pulse: Chaihao Biejia Tang (Bupleurum-Artemisia-Cockle Shell Decoction) (Chaihu 2 qian, Qinghao 1.5 qian, Sheng Biejia 3 qian, Huangqin 2 qian, Baishao 3 qian, Danpi 3 qian, Xian Shengdihuang 4 qian, Maidong 2 qian, Zhizi 2 qian, Sheng Gancao 1 qian, 5 cups water, boil to 2 cups, divide twice). Thirst: add Huafen. Chest/hypochondriac stuffiness/pain: add Zhishi, Gualouren, Muli 3 qian each. Heat entering Blood Chamber, lower abdominal hardness/closure, constipation or black stool, deep-solid pulse, intense nighttime fever, surging-rapid pulse, coma/madness/delirium: Modified Taoren Chengqi Tang (Taoren 3 qian, Sheng Dawang/Huanglian stem 3 qian, Mangxiao 3 qian, Sheng Gancao 2 qian, Hei Xijiao 2 qian, ground juice mixed, Danpi 3 qian, Xian Shengdihuang 8 qian, 4 cups water, boil to 2 cups, add Mangxiao, dissolve, drink 1 cup, wait ~3 hours, expect blood stasis evacuation, repeat if none, stop if evacuated). Main indication. Heat entering Blood Chamber, minor pathogen/major deficiency, mild nighttime vexation/fever: Chaihu Renshen Tang (Bupleurum-Ginseng Decoction) (Chaihu 3 qian, Renshen 1 qian, Maidong 3 qian, Baishao 2 qian, Xian Shengdihuang 3 qian, Ejiao 3 qian, Zhi Gancao 3 qian, 3 cups water, boil to 1 cup, take once, repeat if ineffective). This distinguishes warm disease from Shanghan; practitioners must know this.
[Bingzhang's Commentary] Zhu Danxi stated: Blood Chamber. Fang Shi stated: Blood Chamber is where Ying Blood stays and menstrual blood gathers, i.e., Chong Meridian, the Sea of Blood. Most agree. Ke Yi stated: Blood Chamber is the Liver. Liver stores blood, hence named Blood Chamber. Chen Ziming cited Chao Yuanfang's *Bingyuan* and *Chanbao Fang*, calling it Baomen/Zihu. Zhang Zhongjing called it Blood Chamber. *Weisheng Baojian* stated: Blood Chamber is the Female Uterus mentioned in *Suwen*, i.e., birth intestine. Cheng Xu's *Yigou* stated: Uterus is Blood Chamber. Zhang Jiebin's *Leijing Fuyi* stated: Zihu is Uterus, vulgarly "child intestine." Physicians name it Blood Chamber because Chong/Ren meridians flourish here, regulating menstruation. Modern Western medicine also calls it Uterus. Xu Shuwei stated: Before conception, blood flows down as menstruation; during pregnancy, stored centrally to nourish fetus; postpartum, rises to form milk. All are blood. Bingzhang observes: Menstruation and fetal nourishment involve blood. Postpartum milk is not blood; it is chyle from food digested in Stomach. If not converted to milk, it enters circulation, turns red to become blood, nourishes body, and turbid blood flows to Blood Chamber, down as menstruation, or up to nourish fetus. Blood Chamber is Uterus. Normally stores blood for menstruation; during pregnancy, holds fetus. During menstruation, Zi Men opens to discharge. Thus, Shanghan/Wind Strike during menstruation allows direct Heat entry into Blood Chamber. Also, pre-menstrual heat steaming Blood Chamber forces blood down. If smooth, heat drains with blood, fever lightens post-menstruation. Otherwise, intense heat rushes into Baomen, blocking menstruation, leaving discharged blood as stasis in Baomen, trapping Heat in Blood Chamber, worsening disease.
Bingzhang previously treated Yao's wife in Pianmen Kuai Ge with latent summerheat. Initially consumed meat/noodles and tonics until heat intensified and Stomach closed. Then high fever, chest stuffiness, constipation, scanty urine. Heat forced Blood Chamber, inducing menstruation, causing Heat entering Blood Chamber. Quickly, incomplete menstruation stopped. Symptoms: deafness, eye closure, limb convulsions, coma, delirium, constipation, scanty urine. Previous doctors followed Heat entering Blood Chamber protocols, mostly ineffective. Condition became critical before consulting me. Pulse: wiry-rapid, striking finger. Tongue base: grey-black-yellow scorched coating, floating thick greasy hard coating, tip deep crimson, edges purple/green. History and prescriptions reviewed. Diagnosed: Heat entering Blood Chamber, stasis blocking Baomen. Uncleared stasis prevents heat-clearing drugs from reaching Blood Chamber, explaining treatment failure. Strategy: First remove Baomen stasis to clear heat/extinguish wind. Heavy use of Can Sha (Silkworm Sand), Shu Fen (Rat Droppings), Qiang Lang (Beetle) to resolve turbidity and unblock Baomen stasis. Xiaohuang (Niter/Rhubarb) attacks hard accumulations. Yazao (Gleditsia Spine) cleans filth. Dibie (Ground Beetle), Taoren (Peach Kernel) drive stasis/unblock collaterals. Xian Dihuang + Dahuang resolves stasis/drains heat. Xian Daqing, Gouteng, Lingyangjiao clear blood heat/extinguish Liver wind. Xian Changpu, Tianzhuhuang resolve phlegm/open orifices. After one dose, 5-6 hours later, black turbid blood clumps/granules passed in stool. Heat reduced by half, convulsions stopped, consciousness slightly cleared. Next morning: pulse normalized, tongue coating loose/rotten, heavy black residue. Scraping didn't reduce half; reaccumulated quickly. Continued Taoren Chengqi Tang plus stasis-resolving/heat-clearing herbs. After five doses, coating clean, fever gone, appetite returned, recovered with conditioning. Case analysis: Initial latent summerheat-dampness, then food retention, then menstrual blockage/stasis. Damp steaming/heat scorching caused constipation/scanty urine, internal burning Heat in Blood Chamber, Baomen stasis blockage, no pathogen exit. Previous doctors used blood-cooling/heat-clearing drugs, but power couldn't penetrate blocked Baomen, hence failure. My success lay in unblocking stasis/guiding turbidity, using foul-smelling substances to attack Baomen's turbid pathways. Using Xiaochaihu Tang for this case would be a major error. Warm/summerheat treatment differs from standard Shanghan. Ye Tianshi's *Wenre Lun* details this distinction, excerpted below for reference. Ye Tianshi stated: Menstruation start/stop, pathogen about to sink into Blood Chamber, Shaoyang Shanghan discusses this thoroughly, no need to repeat. But "numerous movements" (pulse diagnosis, warm disease pulse numerous/moving differs from Shanghan Heat entering Blood Chamber slow pulse) differs from standard Shanghan. Zhang Zhongjing established Xiaochaihu Tang to extract sunk heat, using Renshen/Dazao to support Stomach Qi, as Chong Meridian belongs to Yangming. This suits only deficiency cases. If heat sinks and binds with blood... (compared to Heat entering Blood Chamber, not...)