【纲】仲景曰。阳明病。下血。谵语者。此为热入血室。但头汗出者。刺期门。随其实而泻之。
然汗出则愈。
【目】成无己曰。此热入血室。盖言男子。不止谓妇人也。
室者。可停止之处。血室者。荣血停止之所。经脉留会之处。即冲脉也。起于肾下。出于气冲。
并足阳明经。挟脐上行。至胸中而散。为十二经脉之海。王冰曰。冲为血海。言诸经之血。朝会
于此。男子则营运生精。女子则上为乳汁。下为月水。内经曰。任脉通。冲脉盛。月事以时下者是
也。王冰又曰。阴静海满而去血。谓冲脉盛为血海满也。即是观之。冲为血室可知矣。伤寒之邪。
妇人则随经而入。男子由阳明而传。以冲之脉。与少阴之络起于肾。女子邪感。太阳随经。便得入
冲之经。并足阳明。男子阳明内热。方得而入也。冲之得热。血必妄行。在男子则下血谵语。在女
子则月事适来适断。皆以经气所虚。宫室不辟。邪得乘虚而入。针经曰。邪气不得其虚。不能独伤
人者是矣。
柯琴曰。血室者。肝也。肝为藏血之脏。故称血室。女以血用事。故下血之病最多。若男子非
损伤。则无下血之病。惟阳明主血所生病。其经多血多气。行身之前。邻于冲任。阳明热甚。侵及
血室。血室不藏。溢出前阴。故男女俱有是症。必刺肝之募。（即期门穴）引血上归经络。推陈
致新。使热有所泄。则肝得所藏。血不妄行矣。按蓄血便脓血。总是热入血室。入于肠胃。从肛门
而下者。为便脓血。盖女子经血。出自子户。与溺道不同门。男子精血溺三物。内异道而外同门。
精道由肾。血道由肝。溺道由膀胱。其源各别。而皆出自前阴也。
鳌按。肝藏血。肾生血。心主血。脾统血。而其源则汇于冲。冲起肾下。与肾贴近。血之由冲
而出者。即如由肾而生。故曰肾生血。言肾所生。以冲即在肾下也。由是上行至脾。脾之为地宽广。
故得而统之。再上行至肝。为营气凝聚之处。一身之血皆归焉。故曰藏也。心为君主。血脉皆朝
宗而听命。故曰主也。然则血室之说。成氏主冲。柯氏主肝。二说虽异。其实则同。主冲者就其源
头处言。主肝者就其藏聚处言。血必由源而出。不有源。则无根。血必聚处而藏。不有聚。则散漫无
所收。于此二处而为血之室。其旨同也。假如脾而曰统。统者。属也。不过为其所属。非根源处。
非藏聚处。故不得曰室。即心为营血之主。亦非根源处。非聚藏处。故亦不得曰室也。兹故并录二
人之说。复为发明之。阅者亦可知其言之皆是而无背。而读古人书。贵有融会贯通处者。此类是也。
若执一家言。以为此是彼非。则毋论不能寻究古人之书。即人一身之脏腑经络。先不得明。又何
以治人之病矣。
【纲】张仲景说：阳明病，出现下血、谵语的症状，这是热邪侵入血室。如果只有头部出汗，应当针刺期门穴，根据实证的情况进行泻法治疗。这样汗出之后，病就会痊愈。
【目】成无己说：这里所说的“热入血室”，是指男子而言，并不只限于妇女。所谓“室”，是可以停留的地方。“血室”是营血停留之处，也是经脉汇聚之所，即冲脉。冲脉起于肾下，出于气冲穴，与足阳明经并行，挟脐上行，至胸中而散开，被称为十二经脉之海。王冰说：冲脉为血海，意思是各经之血都朝会于此。男子在此营运生成精气，女子则上化为乳汁，下变为月经。《内经》说：“任脉通畅，冲脉旺盛，月经按时来潮。”这就是指这种情况。王冰又说：“阴静海满而去血”，意思是冲脉旺盛如同血海充盈。由此可知，冲脉就是血室。伤寒的邪气，在妇人身上随经络传入；在男子身上则由阳明经传变而来。因为冲脉与少阴肾络起于肾，女子感受邪气，太阳经邪随经内传，便进入冲脉，并与足阳明经相连。男子则是阳明内热炽盛，邪气才能侵入。冲脉受热，血液必然妄行。在男子表现为下血和谵语，在女子表现为月经适来或适断。这都是因为经气虚弱，血室门户不固，邪气得以乘虚而入。《针经》说：“邪气不能在没有虚损的情况下单独伤人。”就是这个道理。
柯琴说：血室就是肝。肝是藏血的脏器，所以称为血室。女子以血为本，所以下血类的疾病最多。如果男子没有损伤，就不会有下血的病。只有阳明经主司血所生的病变，其经多气多血，行于身前，邻近冲脉和任脉。阳明热势极盛，侵及血室，导致血室不能藏血，溢出前阴。因此男女都会出现这种症状。必须针刺肝的募穴（即期门穴），引导血液向上回归经络，推陈出新，使热邪有所宣泄，那么肝就能正常藏血，血液就不会妄行了。按蓄血证导致便脓血，总是热入血室，深入肠胃，从肛门排出的，称为便脓血。女子的经血出自子户，与尿道不同门；男子的精、血、尿三物，内部通道不同，外部出口相同。精道由肾主管，血道由肝主管，尿道由膀胱主管，它们的源头各不相同，但都出自前阴。
沈金鳌按：肝藏血，肾生血，心主血，脾统血，而血的源头汇聚于冲脉。冲脉起于肾下，与肾贴近，血由冲脉而出，就如同由肾所生，所以说“肾生血”，意指肾所生之血，是因为冲脉就在肾下。由此上行至脾，脾的地域宽广，所以能统摄血液。再上行至肝，这里是营气凝聚之处，一身的血液都归聚于此，所以叫“藏”。心为君主，血脉都朝宗于心并听命于它，所以叫“主”。既然这样，关于血室的说法，成无己主张是冲脉，柯琴主张是肝。这两种说法虽然不同，其实质是一样的。主张冲脉是从源头角度说的，主张肝是从藏聚角度说的。血必须由源头流出，没有源头就没有根基；血必须在聚处收藏，没有聚处就会散漫无处收摄。在这两处作为血的“室”，其旨意是相同的。假如说脾“统”血，“统”属于隶属的意思，不过是归属于它管辖，并非根源处，也非藏聚处，所以不能称为“室”。即使心是营血之主，也不是根源处，不是聚藏处，所以也不能称为“室”。因此我同时记录这两个人的说法，并加以阐发说明。读者也可以知道他们的言论都是正确的且互不违背。读古人的书，贵在融会贯通，这类情况就是如此。如果固执于某一家的言论，认为此是彼非，那么不仅无法探究古人的书籍，就连人体自身的脏腑经络都无法先弄明白，又怎么能治疗人的疾病呢？
<translation>
[Gang] Zhang Zhongjing stated: In Yangming disease, if there is bleeding from the lower orifice and delirium, this is due to Heat entering the Blood Chamber (Xue Shi). If sweating occurs only on the head, puncture Qimen (LR14) and apply the reducing method according to the excess condition. When sweat emerges, the disease will be cured.
[Mu] Cheng Wuji said: The term "Heat entering the Blood Chamber" here refers to men, not just women. "Chamber" refers to a place where things can stop. The "Blood Chamber" is the location where Ying Blood (Nutritive Blood) stops and where meridians converge, which is the Chong Mai (Penetrating Vessel). It originates below the Kidney, emerges at Qichong (ST30), runs parallel with the Foot-Yangming Stomach Meridian, ascends flanking the umbilicus, and disperses in the chest. It is known as the Sea of the Twelve Meridians. Wang Bing said: The Chong Mai is the Sea of Blood, meaning that blood from all meridians converges here. In men, it circulates to generate essence; in women, it transforms upward into milk and downward into menstruation. The *Neijing* states: "When the Ren Mai is unobstructed and the Chong Mai is vigorous, menstruation arrives on time." This describes such a situation. Wang Bing further stated: "Yin remains still, the sea fills, and blood departs," meaning that when the Chong Mai is vigorous, the Sea of Blood is full. From this, it can be understood that the Chong Mai is the Blood Chamber. Pathogenic factors of Cold Damage enter women along the meridians, while in men, they transmit via the Yangming channel. Since the Chong Mai and the collateral of Shaoyin Kidney originate from the Kidney, when women are affected by pathogens, Taiyang pathogenic factors follow the meridians and enter the Chong Mai, connecting with the Foot-Yangming. In men, internal heat in the Yangming must be intense for the pathogen to enter. Once the Chong Mai receives heat, blood will flow recklessly. In men, this manifests as lower bleeding and delirium; in women, as menstruation arriving or stopping abruptly. These occur because the meridian Qi is deficient, and the chamber's gate is not secure, allowing pathogens to invade due to deficiency. The *Ling Shu* states: "Pathogenic factors cannot injure people alone without finding deficiency." This is the principle.
Ke Qin said: The Blood Chamber is the Liver. The Liver is the zang organ that stores blood, hence it is called the Blood Chamber. Women rely on blood for their physiological functions, so diseases involving lower bleeding are most common. If men do not suffer trauma, they do not have diseases of lower bleeding. Only the Yangming Meridian governs diseases generated by blood issues; its meridian is abundant in both Qi and Blood, running along the anterior aspect of the body, adjacent to the Chong and Ren Mai. When Yangming heat is severe, it invades the Blood Chamber, causing the chamber to fail in storing blood, which overflows through the anterior orifice. Therefore, both men and women present with these symptoms. One must puncture the Front-Mu point of the Liver (which is Qimen [LR14]) to guide blood back up to the meridians, eliminate the old and generate the new, allowing heat to dissipate. Then the Liver can store blood properly, and blood will not flow recklessly. Regarding stasis-blood leading to pus and blood in stool, this is always Heat entering the Blood Chamber, penetrating into the intestines and rectum, and exiting from the anus, termed pus and blood in stool. Women's menstrual blood comes from the Zi Hu (uterus), which has a different exit from the urinary tract. Men's semen, blood, and urine have different internal pathways but share an external opening. The pathway for semen is governed by the Kidney, for blood by the Liver, and for urine by the Bladder. Their sources are distinct, yet all emerge from the anterior orifice.
Shen Jin'ao commented: The Liver stores blood, the Kidney generates blood, the Heart commands blood, and the Spleen controls blood, but their source converges in the Chong Mai. The Chong Mai originates below the Kidney, close to the Kidney. Blood emerging from the Chong Mai is like being generated by the Kidney, hence it is said that "the Kidney generates blood," implying blood generated by the Kidney because the Chong Mai is located below the Kidney. From there, it ascends to the Spleen. The Spleen's domain is vast, so it can control the blood. Ascending further to the Liver, this is where Ying Qi condenses, and all blood in the body returns here, hence it is called "storing." The Heart is the sovereign ruler; blood vessels all pay homage to it and obey its command, hence it is called "commanding." Thus, regarding the concept of the Blood Chamber, Cheng Wuji advocated the Chong Mai, while Ke Qin advocated the Liver. Although these two theories differ, their essence is the same. Advocating the Chong Mai speaks from the perspective of the source; advocating the Liver speaks from the perspective of storage and accumulation. Blood must flow from the source; without a source, there is no root. Blood must gather in a storage place; without a gathering place, it scatters without containment. Designating these two locations as the "chamber" of blood shares the same intent. If one says the Spleen "controls" blood, "control" implies belonging/subordination. It merely belongs to its jurisdiction, not being the source nor the storage place, so it cannot be called a "chamber." Even though the Heart is the master of Ying and Blood, it is not the source nor the storage place, so it also cannot be called a "chamber." Therefore, I record both scholars' views and elaborate upon them. Readers can see that their statements are correct and consistent. Reading ancient texts requires integration and thorough understanding; this is such a case. If one adheres rigidly to one school's view, considering one right and the other wrong, then not only can one not investigate ancient books, but one would first fail to understand the human body's zang-fu organs and meridians, let alone treat diseases.
</translation>