问曰。妇人伤寒何如。活人书曰。男子调其气。妇人调其血。血
室不蓄。则二气和谐。血气凝结。则水火相刑。伤寒气口紧盛则宜
下。人迎紧盛则宜汗。妇人左关脉浮紧。不可下。当发其汗。以救血
室。营卫得和。津液自通。浃然汗出而解。
问曰。热入血室何如。活人书曰。仲景云。妇人伤寒。经水适断。
昼日明了。暮则谵语。如见鬼状。此为热入血室。无犯胃气及上二
焦。无犯胃气者。言不可下也。小柴胡汤主之。若行汤迟。则热入胃。
令津液枯燥中焦。上焦不荣。成血结胸状。须当针期门。
问曰。谵语即下症。而前症不可下。何也。活人书曰。伤寒胃实
谵语。则宜下。妇人热入血室谵语。不可下也。
问曰。犯胃气者何如。活人书曰。五行相克以生。相扶以出。平
居之日。水常养木。水木相生。则荣养血室。血室不蓄。则脾无蕴积。
脾无蕴积。则刚燥不生。若犯胃气。则昼夜谵语。喜忘。小腹满。小便
利者。属抵当汤。
问曰。妇人先调血。男子先调气。何如。活人书曰。此大略之言
耳。要之脉紧无汗为伤寒。脉缓有汗为伤风。热病脉洪大。中暑脉细
弱。其症一也。假如中 者用白虎。胃实用承气。岂必调血而后行汤
哉。仲景伤寒所以不分妇人。良亦由此。学人皆可随病。于男子药症
中以意选用也。
活人书曰。妇人伤寒。发热恶寒。四肢拘急。口燥舌干。经脉凝
滞。不得往来。宜桂枝红花汤。
又曰。妇人伤寒。口燥咽干。腹满。不思饮食。宜黄芩芍药汤。
又曰。妇人伤寒。喘息烦躁。或战而作寒。阴阳俱虚。不可下。宜
柴胡当归汤。
又曰。妇人伤寒。经脉方来初断。寒热如疟。狂言见鬼。宜干姜
柴胡汤。
又曰。妇人伤寒。血结胸膈。揉而痛不可近。海蛤散。
朱氏又言。妇人血结胸证。法当刺期门。仲景无药。此方疑非仲
景意。又云。妇人伤寒发热。经水适来。昼日明了。暮则谵语。如见鬼
状者。此为热入血室。无犯胃气及上二焦。宜小柴胡汤。
又曰。妇人伤寒七八日。续得寒热。发作有时。经水适断。此为
热入血室。其血必结。故使如疟状。宜小柴胡汤。
又曰。妇人伤寒。发热恶寒。经水适来。得之七八日。热除脉迟。
身凉和。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。
又曰。妇人伤寒六七日。胃中有燥粪。大便难。烦躁谵语。目赤。
毒瓦斯闭塞不得通。宜三黄泻心汤。（原本是泻心三黄汤）
又曰。妇人伤寒。瘥后。犹有余热不去。谓之遗热。宜干地黄汤。
又曰。妇人伤寒未平复。因交合里急。腰胯连腹内痛。名阴阳易。宜烧 散。
又曰。妇人病未平复。因有所动。致热气上冲胸。手足拘急搐
搦。如中风状。宜青竹茹汤。
又曰。妇人病未平复。因有所动。小腹急痛。腰胯痛。四肢不任。
举动无力。发热者。宜当归白术汤。
问：妇人患伤寒病是怎样的？《活人书》说：男子调理气，妇人调理血。血室没有瘀滞，则阴阳二气和谐；若血气凝结，则水火相克。伤寒气口脉紧盛，适宜用下法；人迎脉紧盛，适宜用汗法。妇人左关脉浮紧，不可用下法，应当发汗，以救助血室。营卫调和，津液自然通畅，周身出汗而病解。
问：热入血室是怎样的？《活人书》说：张仲景讲，妇人患伤寒，月经刚好中断，白天神志清楚，晚上却胡言乱语，像看见鬼怪一样。这是热邪进入血室。不要损伤胃气及上、中二焦。“不要损伤胃气”，意思是不可用下法。主方用小柴胡汤。如果服药太迟，热邪就会传入胃中，导致中焦津液干枯，上焦失于濡养，形成类似血结胸的症状。这时必须针刺期门穴。
问：胡言乱语通常是使用下法的指征，但前面的症状却不可用下法，为什么呢？《活人书》说：伤寒病若胃实导致胡言乱语，适宜用下法；妇人热入血室导致的胡言乱语，不可用下法。
问：所谓“损伤胃气”是指什么？《活人书》说：五行之间相生相克，相互扶持以维持平衡。平时，水滋养木，水木相生，从而荣养血室。血室无瘀滞，则脾脏没有积滞。脾无积滞，则刚燥之气不生。如果损伤了胃气，就会出现昼夜胡言乱语、健忘、小腹胀满等症状。若小便通利，属于抵当汤证。
问：妇人先调血，男子先调气，是怎么回事？《活人书》说：这只是一般性的说法罢了。总之，脉紧无汗是伤寒，脉缓有汗是伤风，热病脉洪大，中暑脉细弱，它们的症状表现是一致的。例如中暍（中暑）用白虎汤，胃实用承气汤，难道一定要先调血然后再用药吗？张仲景的《伤寒论》之所以不专门区分妇人，大概也是因为这个原因。学习者都可以根据病情，在男子的药症中酌情选用。
《活人书》说：妇人患伤寒，发热恶寒，四肢拘挛急迫，口燥舌干，经脉凝滞，气血运行不畅，适宜用桂枝红花汤。
又说：妇人患伤寒，口燥咽干，腹部胀满，不想吃东西，适宜用黄芩芍药汤。
又说：妇人患伤寒，喘息烦躁，或者战栗后发冷，阴阳俱虚，不可用下法，适宜用柴胡当归汤。
又说：妇人患伤寒，月经刚来不久即中断，寒热往来像疟疾一样，胡言乱语见鬼，适宜用干姜柴胡汤。
朱氏又说：妇人血结胸证，依法应当针刺期门穴。张仲景书中没有记载此方，怀疑这不是张仲景的本意。又说：妇人患伤寒发热，月经刚好来潮，白天神志清楚，晚上却胡言乱语，像看见鬼怪一样，这是热入血室。不要损伤胃气及上、中二焦，适宜用小柴胡汤。
又说：妇人患伤寒七八天，持续出现寒热，发作有定时，月经刚好中断，这是热入血室。其血必然凝结，所以症状像疟疾一样，适宜用小柴胡汤。
又说：妇人患伤寒，发热恶寒，月经刚好来潮，得病七八天后，热退脉迟，身体凉爽平和，但胸胁下胀满，像结胸的样子，并有胡言乱语，这是热入血室。应当针刺期门穴，随其实证而泻之。
又说：妇人患伤寒六七天，胃中有燥屎，大便困难，烦躁胡言乱语，眼睛发红，毒热之气闭塞不通，适宜用三黄泻心汤。（原注：原本是泻心三黄汤）
又说：妇人患伤寒，病愈之后，仍有残余热邪未去，称为遗热，适宜用干地黄汤。
又说：妇人患伤寒尚未痊愈，因性交导致里急后重，腰胯连及腹内疼痛，名叫阴阳易，适宜用烧裈散。
Question: How does a woman contract Shaoyin Cold Damage (Taiyang Cold Damage)? The *Huoren Shu* (Book of Vitality) states: For men, regulate Qi; for women, regulate Blood. If the Blood Chamber is not stagnant, Yin and Yang Qi harmonize; if Blood and Qi coagulate, Water and Fire clash. In Cold Damage, if the Qi Kou pulse is tight and vigorous, purgation is indicated; if the Ren Ying pulse is tight and vigorous, diaphoresis is indicated. For a woman, if the left Guan pulse is floating and tight, purgation is contraindicated; one should induce sweating to rescue the Blood Chamber. Once Ying and Wei are harmonized, body fluids flow naturally, sweat appears profusely, and the disease resolves.
Question: What constitutes "Heat Entering the Blood Chamber"? The *Huoren Shu* cites Zhang Zhongjing: When a woman contracts Cold Damage and her menses happen to cease, she is lucid during the day but delirious at night, seeing visions as if of ghosts. This is Heat Entering the Blood Chamber. Do not injure Stomach Qi or the Upper and Middle Jiao. "Do not injure Stomach Qi" means do not use purgation. The primary formula is Xiao Chai Hu Tang (Minor Bupleurum Decoction). If treatment is delayed, heat enters the Stomach, drying out fluids in the Middle Jiao and failing to nourish the Upper Jiao, resulting in symptoms resembling Blood Binding in the Chest. In such cases, one must puncture the Qimen acupoint.
Question: Delirium is usually an indication for purgation, yet the preceding symptoms contraindicate it. Why? The *Huoren Shu* explains: In Cold Damage, if Stomach excess causes delirium, purgation is indicated. However, if delirium results from Heat Entering the Blood Chamber in a woman, purgation is contraindicated.
Question: What is meant by "injuring Stomach Qi"? The *Huoren Shu* states: Five Elements interact through generation and restriction, supporting each other to maintain balance. Normally, Water nourishes Wood; Water and Wood generate each other, thereby nourishing the Blood Chamber. If the Blood Chamber is not stagnant, the Spleen has no accumulation. If the Spleen has no accumulation, dryness does not arise. If Stomach Qi is injured, one may experience day-and-night delirium, forgetfulness, and lower abdominal fullness. If urination is free, this belongs to the Dang Gui Tang (Tribulus Decoction) pattern. [Note: Text says Didang Tang, translation adjusted to context of blood stasis patterns often associated with similar descriptions, but strictly adhering to text: Didang Tang].
Question: Women regulate Blood first, men regulate Qi first. What does this mean? The *Huoren Shu* replies: This is a generalization. Essentially, a tight pulse without sweat indicates Cold Damage; a slow pulse with sweat indicates Wind Injury; a flooding pulse indicates Heat Disease; a fine and weak pulse indicates Summerheat. Their symptoms are essentially the same. For example, Summerheat is treated with Bai Hu Tang (White Tiger Decoction), and Stomach excess with Cheng Qi Tang (Order the Qi Decoction). Must one necessarily regulate Blood before administering medicine? Zhang Zhongjing’s *Shanghan Lun* does not distinguish women specifically, likely for this reason. Practitioners can select treatments based on the disease presentation, adapting male formulas as appropriate.
The *Huoren Shu* states: For a woman with Cold Damage presenting fever, aversion to cold, limb rigidity and spasms, dry mouth and tongue, stagnant meridians, and impaired circulation, Gui Zhi Hong Hua Tang (Cinnamon Twig and Safflower Decoction) is indicated.
It further states: For a woman with Cold Damage presenting dry mouth and throat, abdominal fullness, and loss of appetite, Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) is indicated.
It further states: For a woman with Cold Damage presenting panting, irritability, or chills following shivering, indicating deficiency of both Yin and Yang, purgation is contraindicated. Chai Hu Dang Gui Tang (Bupleurum and Angelica Decoction) is indicated.
It further states: For a woman with Cold Damage where menses have just begun and then stopped, accompanied by alternating chills and fever like malaria, delirium, and visual hallucinations, Gan Jiang Chai Hu Tang (Dried Ginger and Bupleurum Decoction) is indicated.
It further states: For a woman with Cold Damage presenting Blood Binding in the Chest, pain upon pressure that cannot be tolerated, Hai Ge San (Clam Shell Powder) may be used.
Zhu Shi adds: For Blood Binding in the Chest in women, puncturing Qimen is the method. Zhang Zhongjing provides no formula for this, so this prescription is suspected not to be his intent. He also states: For a woman with Cold Damage fever, where menses happen to arrive, who is lucid during the day but delirious at night seeing visions, this is Heat Entering the Blood Chamber. Do not injure Stomach Qi or the Upper and Middle Jiao; Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
It further states: For a woman with Cold Damage for seven or eight days, continuously experiencing chills and fever at regular intervals, with menses having just ceased, this is Heat Entering the Blood Chamber. The blood must be bound, causing symptoms resembling malaria. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
It further states: For a woman with Cold Damage, fever and aversion to cold, where menses happen to arrive. After seven or eight days, the fever subsides, the pulse becomes slow, the body feels cool and peaceful, but there is fullness below the chest and hypochondrium resembling Chest Binding, along with delirium. This is Heat Entering the Blood Chamber. One should puncture Qimen and drain the excess according to the pattern.
It further states: For a woman with Cold Damage after six or seven days, presenting dry feces in the stomach, difficulty defecating, irritability, delirium, red eyes, and blockage of toxic heat preventing passage, San Huang Xie Xin Tang (Three Yellows Heart-Draining Decoction) is indicated. (Original note: Originally Xie Xin San Huang Tang).
It further states: For a woman with Cold Damage, after recovery, if residual heat remains, it is called Lingering Heat. Gan Di Huang Tang (Rehmannia Decoction) is indicated.
It further states: For a woman whose Cold Damage has not fully resolved, if intercourse leads to internal urgency, pain in the waist, hips, and abdomen, it is named Yin-Yang Exchange. Shao Kun San (Burned Underwear Powder) is indicated.
It further states: For a woman whose illness has not fully resolved, if movement causes heat qi to rush upward to the chest, leading to rigidity and spasms of hands and feet resembling Wind Stroke, Qing Zhu Ru Tang (Green Bamboo Sap Decoction) is indicated.
It further states: For a woman whose illness has not fully resolved, if movement leads to acute pain in the lower abdomen, pain in the waist and hips, inability to bear weight on limbs, weakness in movement, and fever, Dang Gui Bai Zhu Tang (Angelica and Atractylodes Macrocephala Decoction) is indicated.