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(Such a syndrome manifests as) heaviness of the body, resembling Yangming Stomach Excess Syndrome (Yangming Wei Shi). This pathogenesis requires utmost discrimination. In cases of Blood Stasis Accumulation (Xue Jie), the body must be heavy, unlike Yangming disease where movement is light and agile. Why? Because Yin governs heaviness and turbidity; when collaterals are obstructed, Qi stagnation in the sides of the body extends to the chest and back, causing stiffness and inability to move freely. Therefore, dispelling pathogens and unblocking collaterals is precisely the correct treatment. Often, if prolonged, the pathogen may reverse upward to invade the Pericardium (Xin Bao), causing Bi pain in the chest. This is what Tao Jian'an referred to as "Blood Stasis Chest" (Xue Jie Xiong). Using Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), augmented with Dahuang (Rhei Radix et Rhizoma), Taoren (Persicae Semen), Honghua (Carthami Flos), and Zhishi (Aurantii Fructus Immaturus), is most appropriate. Various editions include Wang Haicang's Guizhi Honghua Tang (Cinnamon Twig and Safflower Decoction) under this section, but this formula is certainly not suitable for treating Blood Stasis Chest, so it has been deleted.

[Commentary by Xu Rongzhai] The writing style of this section (Shanghan during Menstruation) differs from other sections. Yu listed previous scholars' theories without adding his own opinions; this is the first example in the entire book. The first item (etiology) cites Wu Youke and Lin Lan; the second item (symptoms) cites the original text of Shanghan Lun and commentaries from ten scholars; the third item (pulse) cites Tao Jian'an and Lin Lan; the fourth item (treatment) cites Lin Lan, Tao Jian'an, Wu Youke, and Zhu Gong; extracting the essence of ancient medicine and integrating it thoroughly is Yu's consistent approach. Fan Xinghuan wrote an extensive discussion on "Re Ru Xue Shi using Xiaochaihu Tang," expressing his complete opinion. He stated: "In Zhang Zhongjing's Shanghan Lun, the three conditions regarding women—Wind Strike, Cold Damage, and Heat Entering the Blood Chamber—have different treatments. If there is fullness in the chest and hypochondrium resembling Chest Binding, puncture Qimen (LR14) to drain blood heat; if there is alternating cold and heat due to blood stasis, use Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize Shaoyang; if there is fever and delirium, both the puncturing Qimen method and the harmonizing method of Xiaochaihu Tang are contraindicated, and one should wait for menstruation to resume naturally. The boundaries are clearly defined and must not be confused. However, later practitioners, upon encountering this syndrome regardless of symptoms, generally used Xiaochaihu Tang, believing it was based on Zhongjing, unaware that they were killing people imperceptibly. Even Mr. Xu Lingtai, a famous physician of his generation, claimed that Chaihu is the eternal standard method for this syndrome; if Yexi (Ye Tianshi) held such views, later generations are even less worthy of blame. They do not realize that contracting this syndrome due to Cold Damage is rare, whereas contracting it due to Warm-Heat diseases is common, often occurring during the intense heat of midsummer. A slight delay makes it incurable. The symptoms generally include rapid pulse, fever, red face, constipation, abdominal pain, coma, and even madness; however, alternating cold and heat are rarely seen. Therefore, medications usually include Xijiao Dihuang Tang, Taoren Chengqi Tang (Peach Kernel and Cathartic Decoction), Daochi San (Guide Out Red Powder), Niuhuang Wan (Calculus Bovis Pill), etc. Wang Mengying said: 'There are three types of Warm Pathogen Heat Entering the Blood Chamber: 1. If menstruation just started, and heat pathogen sank in and caused blood stasis, break the blood stasis. 2. If menstruation just stopped, and pathogen attacked the empty Blood Chamber, nourish Ying and clear heat. 3. If heat pathogen transmitted to Ying, forcing blood to bleed recklessly, causing early menstruation, clear heat and calm Ying.' There is no mention of using Xiaochaihu Tang; this does not contradict Zhongjing. It is because the origin of Warm Pathogens differs from Cold Damage. Generally, the three items listed in Shanghan Lun involve residual pathogen sinking into the Blood Chamber after Wind-Cold transforms into Heat; these are not dangerous syndromes, so treatments are mild; the last item advocates non-treatment. But the method of Xiaochaihu Tang is indeed questionable. By inference, it might be a formula for treating 'Cold Entering the Blood Chamber.' Since all diseases have cold and heat aspects, if Heat can enter the Blood Chamber, why can't Cold? Heat Entering the Blood Chamber is severe in summer; Cold Entering the Blood Chamber is also common in summer. Women's nature tends to prefer coolness and dislike heat. Although they are careful when menstruation starts or stops, in summer they may neglect precautions; seeking cool breezes, eating cold foods, or sitting/lying on cool ground allows pathogens to invade via deficiency. After Cold enters the Blood Chamber, there may be amenorrhea, dysmenorrhea, lower abdominal distension, or persistent diarrhea; while not always the case, many instances occur thus. By the time the pathology is established and treatment is sought, patients forget the cause, and physicians cannot know the root. Thus, some diagnose Qi Stagnation, some Blood Deficiency, some suspect old stasis, some suspect water retention; no one establishes a specific disease name. I propose naming all these 'Cold Entering the Blood Chamber.' Moreover, since these diseases often present with alternating cold and heat, similar to Heat Entering the Blood Chamber, Xiaochaihu Tang can be used. Furthermore, Zhongjing provided modification methods, allowing flexibility combined with Qi-moving, blood-breaking, turbid-draining, and meridian-warming herbs, making it universally applicable. This is why I wrote this treatise to expand the theory." (See Yan Hongji's *Nuke Jiyao*, Vol. II). I believe this paper is very valuable. He first analyzed the three original texts from Shanghan Lun, proposing the empirical view: "Few contract this syndrome due to Cold Damage, many due to Warm-Heat." Simultaneously, citing Wang Mengying's three treatment methods, he pointed out that "the origin of Warm Pathogens differs from Cold Damage," proving that Xiaochaihu Tang is not the definitive primary formula for "Heat Entering the Blood Chamber." Finally, he inferred that the use of Xiaochaihu Tang for Heat Entering the Blood Chamber in Shanghan Lun might actually be for "Cold Entering the Blood Chamber." This spirit of careful research and bold skepticism is admirable. Here, if one refers to Lu Yangyu's case of treating Zang Yaoshan's wife in *Sanshi Yiyan* and Shen Yaofeng's cases in *Nuke Jiyao*, one would gain a deeper understanding of the diagnosis and treatment of this syndrome.