治脉。据证治证也。
脉浮者。必结胸。王日休云。桂枝去芍药汤。脉紧者。必咽痛者。王日休云。甘草汤。汪氏云。桔梗汤。
更妙。脉弦者。两胁拘急者。王日休云。小柴胡加桂枝。脉细数者。头痛未止。王日休云。当归四逆汤。常器
之云。可葱须汤。脉沉紧者。必欲呕。王日休云。甘草干姜汤。常器之云。七物黄连汤。脉沉滑者协热利。王
日休云。白头翁汤。脉浮滑者。必下血。芍药甘草汤。加秦皮。常氏云。可与类要柏皮汤。汪氏云。愚以临证
用药。亦当活变。古方不宜执也。
金鉴曰。脉促当是脉浮。始与不结胸为欲解之文义相属。脉浮当是脉促。始与论中结胸胸满同义。脉紧当
是脉细数。脉细数。当是脉紧。始合论中二经本脉。脉浮滑。当是脉数滑。浮滑。是论中白虎汤证之脉。数滑。
是论中下脓血之脉。
细玩诸篇自知。○案金鉴所改。未知旧文果如是否。然此条。以脉断证。文势略与辨平二脉相似。疑非仲景原文。
柯氏删之。可谓有所见矣。
病在阳。应以汗解之。反以冷水 之。若灌之。其热被劫不得去。弥更益烦。肉上粟起。意欲得水。反不
渴者。服文蛤散。若不瘥者。与五苓散。（ 。全书。脉经。千金翼。作 。程。钱。亦同。玉函。脉经。无
冷字。脉经。外台。无被字。劫。作却。玉函。脉经。外台。无弥更二字。肉。作皮。○此条。旧与小陷胸白散。
合为一条。今从张氏周氏柯氏及金鉴。分为二条。喻氏魏氏。并缺此条及白散条。可疑。）
〔汪〕病在阳者。为邪热在表也。法当以汗解之。医反以冷水 之。 者。口含水喷也。若灌之。灌。浇
也。灌则更甚于 矣。表热被水止劫。则不得去。阳邪无出路。其烦热。必更甚于未用水之前矣。弥更益者。
犹言甚之极也。水寒之气。客于皮肤。则汗孔闭。故肉上起粒如粟也。意欲饮水不渴者。邪热虽甚。反为水寒
所制也。先与文蛤散。以解烦导水。若不瘥者。水寒与热相搏。下传太阳之腑。与五苓散。内以消之。外以散
之。乃表里两解之法也。
伤寒类方曰。此热结在皮肤肌肉之中。不在胃口。故欲饮而不渴。文蛤取其软坚逐水。
文蛤散方
文蛤（五两）
上一味。为散。以沸汤。和一方寸匕服。汤用五合。（一方寸匕。成本。作一钱匕。玉函。和下。有服
字。无服以下五字。）
〔方〕文蛤。即海蛤之有文理者。〔王〕文蛤。即海蛤粉也。河间丹溪多用之。大能治痰。〔钱〕文蛤。似
蛤而背有紫斑。即今吴中所食花蛤。俗误呼为苍蠃。或昌蛾者。是也。
案沈括梦溪笔谈曰。文蛤。即今吴人所食花蛤也。其形
一头小一头大。壳有花斑的便是。王氏以海蛤粉。为文蛤。恐不然也。李时珍本草附方。收此方于文蛤条。而
不载于海蛤条。其意可见也。又案。文蛤。海蛤。其实无大分别。神农本经。海蛤。主治咳逆上气。喘息烦满。
唐本。云主十二水满急痛。利膀胱大小肠。甄权云。治水气浮肿。下小便。本方所用。皆取于此义。
古方选注曰。文蛤。取用紫斑纹者。得阴阳之气。若黯色无纹者。饵之令人狂走赴水。
金鉴曰。文蛤。即五倍子也。○案三因方云。文蛤。即五倍子。最能回津。本草在海蛤文。甚失其性。识者
当知之。金鉴乃袭其误耳。
案柯氏云。文蛤一味为散。以沸汤和方寸匕。服满五合。此等轻剂。恐难散湿热之重邪。弥更益烦者。金
匮要略云。渴欲得水而贪饮者。文蛤汤主之。兼治微风脉紧头痛。审症用方。则移彼方。而补入于此。而可也。
其方。麻黄汤。去桂枝。盖文蛤石膏姜枣。此亦大青龙之变局也。此说颇有理。故附载此。文蛤汤。出呕吐哕
下利篇。又消渴篇。渴欲饮水不止者。文蛤散主之。即与本方同。
寒实结胸。无热证者。与三物小陷胸汤。白散亦可服。（【原注】一云。与三物小白散。○玉函。千金翼。
无陷胸汤。及亦可服三字。作与三物小白散。金鉴云。无热证之下。与三物小陷胸汤。当是三物白散。小陷胸
汤四字。必是传写之误。桔梗贝母巴豆三物。其色皆白。有三物白散之义。温而能攻。与寒实之理相属。小陷
胸汤。乃性寒之品。岂可以治寒实结胸之证乎。亦可服三字。亦衍文也。柯氏。改作三白小陷胸汤。为散亦可
服。案金鉴改订为是。）
〔鉴〕结胸证。身无大热。口不燥渴。则为无热实证。乃寒实也。与三物白散。然此证脉必当沉紧。若脉沉
迟。或证见三阴。则又非寒实结胸可比。当以枳实理中丸治之矣。〔郑〕
水寒结实在胸。则心阳被据。自非细故。用三物白散。下寒而破结。皆不得已之兵也。
总病论曰。寒实结胸。无热症者。与三物白散。注云。小陷胸者。非也。伤寒类方曰。结胸。皆系热陷之
症。此云寒实。乃水气寒冷所结之痰饮也。活人书云。与三物白散。无小陷胸汤亦可用七字。盖小陷胸寒剂。
非无热之所宜也。
医方考曰。此证或由表解里热之时。过食冷物。故令寒实结胸。然必无热证者为是。
白散方
桔梗（三分） 巴豆（一分去皮心熬黑研如脂○玉函。作六铢。无如脂字。） 贝母（三分○玉函。桔梗。
贝母。各十八铢）
上三味为散。纳巴豆。更于臼中杵之。以白饮和服。强人半钱匕。羸者减之。病在膈上必吐。在膈下必利。
不利进热粥一杯。利过不止。进冷粥一杯。身热皮粟不解。欲引衣自覆。若以水 之洗之。益令热劫不得出。
当汗而不汗则烦。假令汗出已。腹中痛。与芍药三两如上法。（冷粥一杯。千金翼注。一云。冷水一杯。身热皮
粟以下四十九字。玉函。外台。并无。钱本。柯本。亦删之。为是。锡驹亦同。志聪。删病在膈上以下七十六字。）
〔钱〕寒实结于胸中。水寒伤肺。必有喘咳气逆。故以苦梗开之。贝母入肺解结。又以巴豆之辛热有毒。斩
关夺门之将。以破胸中之坚结。盖非热不足以开其水寒。非峻不足以破其实结耳。〔柯〕白饮和服者。甘以缓
之。取其留恋于胸。不使速下耳。散者。散其结塞。比汤以荡之更精也。身热皮粟一段。使人难解。今从删。
〔汪〕不利进热粥。利不止进冷粥者。以热能助药力。冷能解药力也。〔锡〕巴豆性大热。进热粥者。助其热
性。以行之也。进冷粥者。制其热势。以止之也。俱用粥者。助胃气也。
案本草。徐子才云。中巴豆毒者。用冷水。
外台秘要。仲景桔梗白散。治咳而胸满。振寒脉数。咽干不渴。时出浊唾腥臭。久久吐脓。如米粥者。
为肺痈。即本方。分两同。方后云。若利不止者。饮冷水一杯则定。
伤寒类方曰。古法二钱五分为一分。○案此宋以降事。今以一两为一钱。则一分为二分五厘。类方又云。半
钱匕。今秤约重三分。
太阳与少阳并病。头项强痛。或眩冒。时如结胸。心下痞硬者。当刺大椎第一间。肺俞。肝俞。慎不可
发汗。发汗则谵语脉弦。五日谵语不止。当刺期门。（五下。成本。玉函。有六字。）
〔鉴〕太阳与少阳并病。故见头项强痛。或眩冒。时如结胸。心下痞硬之证。而曰或。曰时如者。谓两阳归
并未定之病状也。病状未定。不可以药。当刺肺俞。以泻太阳。以太阳与肺通也。当刺肝俞。以泻少阳。以肝
与胆合也。故刺而俟之。以待其机也。苟不如此。而发其汗。两阳之邪。乘燥入胃。则发谵语。设脉长大。则
犹为顺。可以下之。今脉不大而弦。五六日谵语不止。是土病而见木脉也。慎不可下。当刺期门。以直泻其肝
可也。〔汪〕当刺大椎第一间者。谓当刺大椎一穴。在第一椎之间。为背部中行之穴。乃手足三阳督脉之会。
先刺之以泻太少并病之邪。
案金鉴。以大椎第一间为肺俞。其说原于成氏。果然则当曰第三间。又金鉴。载林澜说云。第一间。疑
即商阳。在手食指内侧。此乃根据有二间三间穴。而云尔者。尤属牵强。又案后条云。太阳少阳并病。心下硬。
颈项强。而眩者。当刺大椎肺俞肝俞。慎勿下之。正与此条同义。
本事方曰。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。肝受邪。则谵言而见鬼。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。今邪逐血。并归肝经。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。活人
书。海蛤散。治血结胸。
海蛤 滑石 甘草（炙各一两） 芒硝（半两）
上为末。每服二钱。鸡子清调下。小肠通利。则胸膈血散。膻中血聚。则小肠壅。小肠壅。膻中血不流行。
宜此方。小便血数行。更宜桂枝红花汤。发其汗则愈。
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。（其实间。玉函。脉经。有虚字。取。成本。作写。脉经。取之下。有
平病云。热入血室。无犯胃气及上三焦。与此相反。岂谓药不谓针耶。二十六字。）
〔程〕妇人中风。发热恶寒。自是表证。无关于里。乃经水适来。且七八日之久。于是血室空虚。阳热之
表邪。乘虚而内据之。阳入里。是以热除。而脉迟身凉。经停邪。是以胸胁满如结胸状。阴被阳扰。是以如见
鬼状而谵语。凡此热入血室故也。邪热入而居之。实非其所实矣。刺期门以泻之。实者去。而虚者回。即泻法
为补法耳。〔汪〕热入血室。而瘀积必归于肝。故随其经之实。而用刺法以泻之也。成注反云。审看何经气实。
更随其实而泻之。殊出不解。邪传少阳。热
入血室。故作谵语等证。仲景恐人误认为阳明腑实证。轻用三承气。以伐胃气。故特出一刺期门法疗之。
案血室。方氏云。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。只柯氏云。
血室者。肝也。肝为藏血之脏。故称血室。以上并未见明据。陈自明妇人良方云。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。子户者。即子宫也。俗名子肠。医家以冲任之脉盛于此。则月事以时下。故名之曰
血室。又案方注。原于明理论。
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〕前条之热入血室。由中风在血来之前。邪 容血空尽其室而入之。室中略无血。而浑是邪。故可用
刺法。尽泻其实。此条之热入血室。由中风在血来之后。邪乘血半离其室而入之。血与热搏所以结。正邪争。
所以如疟状而休作有时。邪半实而血半虚。故只可用小柴胡为和解法。〔方〕适来者。因热入室。迫使血来。
血出而热遂遗也。适断者。热乘血来。而遂入之。与后血相搏。俱留而不出。故曰其血必结也。〔志〕案经水适
断四字。当在七八日之下。〔钱〕小柴胡汤中。应量加血药。如牛膝桃仁丹皮之类。其脉迟身凉者。或少加姜
桂。及酒制大黄少许。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。尤未可执方以为治也。
案热入血室。许叔微小柴胡汤。加地黄。张璧加牡丹皮。杨士瀛云。小柴胡汤。力不及者。于内加五灵脂。
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。必自愈。（明了。脉经。作了了。必下。玉函。脉经。有当字。
脉经注云。二字疑。）
〔成〕伤寒发热者。寒已成热也。经水适来。则血室虚空。邪热乘虚。入于血室。若昼日谵语。为邪客于
腑而阳争也。此昼日明了。暮则谵语。如见鬼状。是邪不入腑。入于血室。而阴争也。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。所为发汗为犯上焦者。发
汗则动卫气。卫气出上焦故也。刺期门为犯中焦者。刺期门则动营气。营气出中焦故也。〔方〕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。
治疗脉象，应当依据证候来制定治疗方案。
脉浮的，必定会出现结胸证。王日休说：用桂枝去芍药汤。脉紧的，必定出现咽痛。王日休说：用甘草汤。汪氏说：桔梗汤更妙。脉弦的，两胁拘急。王日休说：用小柴胡加桂枝。脉细数的，头痛未止。王日休说：用当归四逆汤。常器之说：可用葱须汤。脉沉紧的，必定想呕吐。王日休说：用甘草干姜汤。常器之说：七物黄连汤。脉沉滑的，伴有协热下利。王日休说：白头翁汤。脉浮滑的，必定便血。芍药甘草汤，加秦皮。常氏说：可与类要柏皮汤。汪氏说：我认为临证用药，也应当灵活变通，古方不宜拘执。
《医宗金鉴》说：脉促应当是脉浮，这才与“不结胸”为欲解的文义相衔接。脉浮应当是脉促，这才与《伤寒论》中结胸、胸满同义。脉紧应当是脉细数，脉细数应当是脉紧，这才符合《伤寒论》中二经的本脉。脉浮滑，应当是脉数滑。浮滑，是《伤寒论》中白虎汤证的脉象；数滑，是《伤寒论》中下脓血的脉象。
仔细研读各篇自然明白。○按语：《金鉴》所改，不知旧文果然是否如此。然而此条，以脉断证，文势略与辨平二脉相似，怀疑不是张仲景原文。柯琴删去了它，可以说是有见地的。
病在阳分，应当用发汗法解除，反而用冷水喷洒或浇灌，热气被遏制不能散发，更加烦闷，皮肤上起粟粒状疙瘩，心里想要喝水，反而不渴的，服用文蛤散。如果不好转，给予五苓散。（注：全书、《脉经》、《千金翼方》作“潠”。程林、钱潢也相同。《玉函经》、《脉经》无“冷”字。《脉经》、《外台秘要》无“被”字。“劫”作“却”。《玉函经》、《脉经》、《外台秘要》无“弥更”二字。“肉”作“皮”。○此条，旧本与小陷胸汤、白散合为一条，现在遵从张隐庵、周扬俊、柯琴及《金鉴》，分为两条。喻嘉言、魏荔彤并缺此条及白散条，可疑。）
〔汪〕病在阳分，是指邪热在表。治法应当用发汗解除。医生反而用冷水喷洒。“潠”，是口含水喷的意思。若浇灌，“灌”是浇的意思。浇灌比喷洒更严重。表热被水遏制，就不能散发，阳邪没有出路，其烦热，一定比用水之前更严重。“弥更益”就是极其严重的意思。水寒之气客于皮肤，汗孔闭塞，所以皮肤上起粒如粟。心里想喝水却不渴，是因为邪热虽盛，反被水寒所制约。先给文蛤散，以解烦导水。如果不好转，是水寒与热相搏，下传太阳之腑，给五苓散，内以消除，外以发散，这是表里双解的方法。
《伤寒类方》说：这是热结在皮肤肌肉之中，不在胃口，所以想喝而不渴。文蛤取其软坚逐水。
文蛤散方
文蛤（五两）
以上一味，研为散，用沸水和一方寸匕服用。汤用五合。（一方寸匕，成本本作一钱匕。《玉函经》在“和”下有“服”字，无“服以下五字”。）
〔方〕文蛤，就是有纹理的海蛤。〔王〕文蛤，就是海蛤粉。河间、丹溪多用它，大能治痰。〔钱〕文蛤，像蛤蜊但背有紫斑，就是现在吴地吃的花蛤，俗误称为苍蠃，或昌蛾的，就是这个。
按语：沈括《梦溪笔谈》说：文蛤，就是现在吴地人吃的花蛤。它的形状一头小一头大，壳上有花斑的就是。王氏把海蛤粉当作文蛤，恐怕不对。李时珍《本草纲目》附方，收录此方于文蛤条，而不载于海蛤条，其意图可见。又按语：文蛤、海蛤，其实没有太大分别。《神农本草经》，海蛤主治咳逆上气，喘息烦满。《唐本草》说主十二种水气满急痛，利膀胱大小肠。甄权说治水气浮肿，下小便。本方所用，都是取于此义。
《古方选注》说：文蛤，取用有紫斑纹的，得阴阳之气，如果颜色暗无纹的，服用会让人狂走投水。
《金鉴》说：文蛤，就是五倍子。○按语：《三因方》说：文蛤，就是五倍子，最能生津液。《本草》将其列在海蛤文中，很失其本性，识者应当知道。《金鉴》是沿袭这个错误罢了。
按语：柯琴说：文蛤一味为散，用沸水和方寸匕，服满五合。这种轻剂，恐怕难以散湿热之重邪。“弥更益烦”，《金匮要略》说：渴欲得水而贪饮者，文蛤汤主之。兼治微风脉紧头痛。审症用方，则移彼方，补入于此，是可以的。其方，麻黄汤去桂枝，盖文蛤石膏姜枣，这也是大青龙汤的变局。此说颇有道理，故附载于此。文蛤汤，出呕吐哕下利篇。又消渴篇，渴欲饮水不止者，文蛤散主之，即与本方同。
寒实结胸，没有热证的，给予三物小陷胸汤，白散也可以服用。（【原注】一说，给予三物小白散。○《玉函经》、《千金翼方》无“陷胸汤”及“亦可服”三字，作“与三物小白散”。《金鉴》说：无热证之下，与三物小陷胸汤，应当是三物白散。“小陷胸汤”四字，必是传写之误。桔梗、贝母、巴豆三物，其色皆白，有三物白散之义。温而能攻，与寒实之理相属。小陷胸汤，乃性寒之品，岂可以用来治寒实结胸之证呢？“亦可服”三字，也是衍文。柯氏，改作“三白小陷胸汤，为散亦可服”。按语：《金鉴》改订是正确的。）
〔鉴〕结胸证，身无大热，口不燥渴，则为无热实证，乃是寒实。给予三物白散。然而此证脉必当沉紧，若脉沉迟，或证见三阴，则又不是寒实结胸可比，应当用枳实理中丸治疗。〔郑〕
水寒结实在胸，则心阳被占据，自不是小事。用三物白散，下寒而破结，都是不得已的兵家手段。
《总病论》说：寒实结胸，无热症者，与三物白散。注云：小陷胸者，非也。《伤寒类方》说：结胸，皆是热陷之症，此云寒实，乃是水气寒冷所结之痰饮也。《活人书》说：与三物白散，无“小陷胸汤亦可用”七字，盖小陷胸是寒剂，非无热之所宜也。
《医方考》说：此证或由表解里热之时，过食冷物，故令寒实结胸。然必无热证者为是。
白散方
桔梗（三分） 巴豆（一分去皮心熬黑研如脂○《玉函经》作六铢，无“如脂”字。） 贝母（三分○《玉函经》桔梗、贝母各十八铢）
以上三味研为散，纳入巴豆，再在臼中杵匀，用白饮调和服用。强壮人半钱匕，瘦弱者减量。病在膈上必定呕吐，在膈下必定腹泻。不腹泻进热粥一杯，腹泻不止进冷粥一杯。身热、皮肤起粟粒不解，想拉衣服覆盖自己，如果用冷水喷洒清洗它，更加令热气被遏制不能外出，应当出汗而不出汗则烦闷。假如汗出后，腹中痛，给芍药三两如上法。（冷粥一杯，《千金翼方》注：一说冷水一杯。身热皮粟以下四十九字，《玉函经》、《外台秘要》并无。钱本、柯本也删去，认为是正确的。锡驹也相同。志聪，删去病在膈上以下七十六字。）
〔钱〕寒实结于胸中，水寒伤肺，必有喘咳气逆，故以苦梗开之，贝母入肺解结，又以巴豆之辛热有毒，如斩关夺门之将，以破胸中之坚结。盖非热不足以开水寒，非峻不足以破其实结耳。〔柯〕白饮和服者，甘以缓之，取其留恋于胸，不使速下耳。散者，散其结塞，比汤以荡之更精也。身热皮粟一段，使人难解，今从删。〔汪〕不利进热粥，利不止进冷粥者，以热能助药力，冷能解药力也。〔锡〕巴豆性大热，进热粥者，助其热性以行之也。进冷粥者，制其热势以止之也。俱用粥者，助胃气也。
《外台秘要》，仲景桔梗白散，治咳而胸满，振寒脉数，咽干不渴，时出浊唾腥臭，久久吐脓如米粥者，为肺痈，即本方，分两同。方后云：若利不止者，饮冷水一杯则定。
《伤寒类方》说：古法二钱五分为一分。○按语：这是宋代以后的事，现在以一两为一钱，则一分为二分五厘。《类方》又说：半钱匕，今秤约重三分。
太阳与少阳并病，头项强痛，或眩冒，有时像结胸，心下痞硬的，应当刺大椎第一间、肺俞、肝俞，千万不要发汗。发汗则谵语、脉弦。五日谵语不止，应当刺期门。（“五下”，成本、《玉函经》有“六”字。）
〔鉴〕太阳与少阳并病，所以见头项强痛，或眩冒，有时像结胸，心下痞硬之证，而说“或”、“时如”，是说两阳归并未定的病状。病状未定，不可以用药，应当刺肺俞，以泻太阳，因为太阳与肺通也。应当刺肝俞，以泻少阳，因为肝与胆合也。所以刺而等待，以等待时机。如果不这样，而发其汗，两阳之邪，乘燥入胃，则发谵语。设脉长大，则犹为顺，可以下之。今脉不大而弦，五六日谵语不止，是土病而见木脉也，慎不可下，应当刺期门，以直泻其肝可也。〔汪〕当刺大椎第一间者，谓当刺大椎一穴，在第一椎之间，为背部中行之穴，乃手足三阳督脉之会，先刺之以泻太少并病之邪。
按语：《金鉴》以大椎第一间为肺俞，其说原于成无己，果然则应当说第三间。又《金鉴》载林澜说云：第一间，疑即商阳，在手食指内侧，这是根据有二间、三间穴，而这样说，尤其属牵强。又按语后条云：太阳少阳并病，心下硬，颈项强，而眩者，当刺大椎、肺俞、肝俞，慎勿下之，正与此条同义。
《本事方》说：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。有人劝用小柴胡汤，我说：小柴胡用已迟，不可行也。无已则有一焉，刺期门穴，斯可矣。我不能针，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？我说：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，肝受邪，则谵言而见鬼，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。今邪逐血，并归肝经，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。《活人书》，海蛤散，治血结胸。
海蛤 滑石 甘草（炙各一两） 芒硝（半两）
以上为末，每服二钱，鸡子清调下。小肠通利，则胸膈血散。膻中血聚，则小肠壅。小肠壅，膻中血不流行，宜此方。小便血数行，更宜桂枝红花汤，发其汗则愈。
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。应当刺期门，随其实而取之。（“其实间”，《玉函经》、《脉经》有“虚”字。“取”，成本作“写”。《脉经》“取”之下，有“平病云：热入血室，无犯胃气及上三焦，与此相反，岂谓药不谓针耶。”二十六字。）
〔程〕妇人中风，发热恶寒，自是表证，无关于里，乃经水适来，且七八日之久，于是血室空虚，阳热之表邪，乘虚而内据之。阳入里，是以热除，而脉迟身凉。经停邪，是以胸胁满如结胸状。阴被阳扰，是以如见鬼状而谵语。凡此热入血室故也。邪热入而居之，实非其所实矣。刺期门以泻之，实者去，而虚者回，即泻法为补法耳。〔汪〕热入血室，而瘀积必归于肝，故随其经之实，而用刺法以泻之也。成注反云：审看何经气实，更随其实而泻之，殊出不解。邪传少阳，热入血室，故作谵语等证，仲景恐人误认为阳明腑实证，轻用三承气，以伐胃气，故特出一刺期门法疗之。
按语：血室，方有执说：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，只柯琴说：血室者，肝也。肝为藏血之脏，故称血室。以上并未见明据。陈自明《妇人良方》说：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》说：血室者，《素问》所谓女子胞，即产肠也。《程序医彀》说：子宫，即血室也。张介宾《类经附翼》说：子户者，即子宫也，俗名子肠。医家以冲任之脉盛于此，则月事以时下，故名之曰血室。又按语：方注，原于《明理论》。
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〕前条的热入血室，由中风在血来之前，邪气容纳血空尽其室而入之，室中略无血，而浑是邪，故可用刺法，尽泻其实。此条的热入血室，由中风在血来之后，邪乘血半离其室而入之，血与热搏所以结，正邪争，所以如疟状而休作有时。邪半实而血半虚，故只可用小柴胡为和解法。〔方〕适来者，因热入室，迫使血来，血出而热遂遗也。适断者，热乘血来，而遂入之，与后血相搏，俱留而不出，故曰其血必结也。〔志〕按语：经水适断四字，当在七八日之下。〔钱〕小柴胡汤中，应量加血药，如牛膝、桃仁、丹皮之类。其脉迟身凉者，或少加姜桂，及酒制大黄少许，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，尤未可执方以为治也。
按语：热入血室，许叔微用小柴胡汤加地黄，张璧加牡丹皮，杨士瀛说：小柴胡汤，力不及者，于内加五灵脂。
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，必自愈。（“明了”，《脉经》作“了了”。“必”下，《玉函经》、《脉经》有“当”字。《脉经》注云：“二”字疑。）
〔成〕伤寒发热者，寒已成热也。经水适来，则血室虚空，邪热乘虚，入于血室。若昼日谵语，为邪客于腑而阳争也。此昼日明了，暮则谵语，如见鬼状，是邪不入腑，入于血室，而阴争也。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。所为发汗为犯上焦者，发汗则动卫气，卫气出上焦故也。刺期门为犯中焦者，刺期门则动营气，营气出中焦故也。〔方〕“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。
Treatment of pulse should be based on the syndrome.
If the pulse is floating, chest binding (Jie Xiong) will definitely occur. Wang Rixiu said: Use Guizhi Qu Shaoyao Tang (Cinnamon Twig Decoction without Peony). If the pulse is tight, throat pain will definitely occur. Wang Rixiu said: Use Gancao Tang (Licorice Decoction). Wang Shi said: Jiegeng Tang (Platycodon Decoction) is more effective. If the pulse is wiry, there is stiffness and tension in both hypochondria. Wang Rixiu said: Use Xiaochaihu Tang (Minor Bupleurum Decoction) with added Guizhi (Cinnamon Twig). If the pulse is fine and rapid, headache has not ceased. Wang Rixiu said: Use Danggui Sini Tang (Angelica Decoction for Cold Extremities). Chang Qizhi said: Congxu Tang (Scallion Stalk Decoction) can be used. If the pulse is deep and tight, there is a desire to vomit. Wang Rixiu said: Use Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction). Chang Qizhi said: Qiwu Huanglian Tang (Seven-Ingredient Coptis Decoction). If the pulse is deep and slippery, there is diarrhea with accompanying heat. Wang Rixiu said: Baitouweng Tang (Pulsatilla Decoction). If the pulse is floating and slippery, hematochezia (blood in stool) will definitely occur. Shaoyao Gancao Tang (Peony and Licorice Decoction) with added Qinpi (Ash Bark). Chang Shi said: Leyao Bo Pi Tang (Leyao Phellodendron Bark Decoction) can be given. Wang Shi said: I believe that in clinical practice, medication should be flexible; ancient formulas should not be rigidly adhered to.
*Yizong Jinjian* (Golden Mirror of Medicine) states: "Pulse cu" (surging/rapid) should likely be "pulse fu" (floating), which aligns with the text stating that the absence of chest binding indicates resolution. "Pulse fu" (floating) should likely be "pulse cu" (surging), which aligns with the meaning of chest binding and chest fullness in the *Shanghan Lun*. "Pulse jin" (tight) should likely be "pulse xi shu" (fine and rapid); "pulse xi shu" (fine and rapid) should likely be "pulse jin" (tight), which fits the primary pulses of the two meridians in the *Shanghan Lun*. "Pulse fu hua" (floating and slippery) should likely be "pulse shu hua" (rapid and slippery). Floating and slippery is the pulse for Baihu Tang (White Tiger Decoction) syndrome in the *Shanghan Lun*; rapid and slippery is the pulse for passing pus and blood. Careful study of the various chapters will make this clear. ○ Note: The corrections in *Jinjian* are uncertain regarding the original text. However, this section diagnoses syndromes by pulse, resembling the style of differentiating Ping Mai (Normal Pulses). It is suspected not to be Zhang Zhongjing's original text. Ke Qin deleted it, which shows insight.
When the disease is in the Yang level, it should be resolved through sweating. Instead, cold water was sprayed or poured on the patient. The heat was trapped and could not escape, causing increased irritability and gooseflesh on the skin. The patient desires water but does not feel thirsty. In such cases, Wenli San (Clam Shell Powder) should be administered. If there is no improvement, Wuling San (Five-Ingredient Powder with Poria) should be given. (Note: The complete book, *Mai Jing*, and *Qianjin Yi Fang* read "Xuan" (spray). Cheng Lin and Qian Huang agree. *Yu Han Jing* and *Mai Jing* omit the character "cold". *Mai Jing* and *Waitai Miyao* omit the character "bei" (passively). "Jie" (rob/trap) is written as "Que" (return). *Yu Han Jing*, *Mai Jing*, and *Waitai Miyao* omit "migeng" (even more). "Rou" (flesh) is written as "Pi" (skin). ○ This section was previously combined with Xiao Xianxiong Tang and Baix San into one section. Following Zhang Yinzhan, Zhou Yangjun, Ke Qin, and *Jinjian*, it is divided into two sections. Yu Jiayan and Wei Liting omit this section and the Baix San section, which is suspicious.)
[Wang] Disease at the Yang level refers to pathogenic heat in the exterior. The method should be to resolve it via sweating. The physician instead sprayed cold water. "Xuan" means holding water in the mouth and spraying. "Guan" means pouring. Pouring is worse than spraying. The exterior heat is trapped by the water and cannot dissipate. With no outlet for the Yang pathogen, the irritability and heat will be more severe than before using the water. "Migeng yi" means extremely severe. The cold energy of the water resides in the skin, closing the sweat pores, hence the gooseflesh-like bumps on the skin. The desire to drink but lack of thirst occurs because the intense pathogenic heat is constrained by the cold water. First, give Wenli San to relieve irritability and guide out the water. If there is no improvement, it indicates cold water and heat clashing, transmitting downward to the Fu organ of the Taiyang. Give Wuling San to eliminate internally and disperse externally, a method of resolving both exterior and interior.
*Shanghan Leifang* (Classified Formulas for Cold Damage) states: The heat is bound in the skin and muscles, not in the stomach cavity, hence the desire to drink but lack of thirst. Wenli (Clam Shell) softens hardness and expels water.
**Wenli San Formula**
Wenli (Clam Shell) (5 liang)
Grind the single ingredient into powder. Mix one fangcun bi (measure) with boiling water and take. Use five he of water. (One fangcun bi, Bencao edition makes it one qian bi. *Yu Han Jing* adds "take" after "mix", omitting the last five characters.)
[Fang] Wenli is the clam shell with visible grain patterns. [Wang] Wenli is clam shell powder. Hehuan and Danxi used it frequently; it greatly treats phlegm. [Qian] Wenli resembles a clam but has purple spots on its back. It is the flower clam eaten in Wu today, mistakenly called Cangluo or Chang'e.
Note: Shen Kuo in *Mengxi Bitan* says: Wenli is the flower clam eaten in Wu today. It is larger at one end and smaller at the other, with floral patterns on the shell. Wang's identification of Wenli as clam shell powder is likely incorrect. Li Shizhen's *Bencao Gangmu* includes this formula under the Wenli entry, not the Haige (Sea Clam) entry, revealing his intent. Another note: There is little difference between Wenli and Haige. *Shennong Bencao Jing* states Haige treats cough with rebellious Qi, wheezing, irritability, and fullness. *Tang Bencao* states it treats twelve types of water retention with urgent pain, promoting urination from the bladder and intestines. Zhen Quan states it treats edema due to water qi and promotes urination. The use in this formula derives from these properties.
*Gufang Xuanzhu* (Selected Ancient Formulas) states: Use Wenli with purple spots, which possesses Yin and Yang energies. If dark and patternless, ingestion causes madness and jumping into water.
*Jinjian* states: Wenli is Wubeizi (Chinese Gallnut). ○ Note: *Sanyin Fang* states: Wenli is Wubeizi, which best generates fluids. Placing it under Haige in the Materia Medica loses its nature; those who know should be aware. *Jinjian* merely repeats this error.
Note: Ke Qin says: One ingredient of Wenli ground into powder, mixed with boiling water, taken as one fangcun bi, totaling five he. Such a light dose may hardly disperse heavy damp-heat. "Increased irritability": *Jinkui Yaolue* states: For those desiring water and drinking greedily, Wenli Tang governs. It also treats slight wind, tight pulse, and headache. Examining symptoms to select formulas allows transferring this formula here. Its composition is Mahuang Tang minus Guizhi, containing Wenli, Shigao, Jiang, and Zao. This is a variation of Da Qinglong Tang. This explanation is reasonable, so it is attached here. Wenli Tang appears in the Vomiting, Hiccup, Diarrhea chapter. Also, in the Xiao Ke (Wasting-Thirst) chapter, for continuous thirst and desire to drink, Wenli San governs, identical to this formula.
For Cold-Excess Chest Binding with no heat signs, give Sanwu Xiao Xianxiong Tang; Baix San can also be taken. ([Original Note] Alternatively, give Sanwu Xiaobai San. ○ *Yu Han Jing* and *Qianjin Yi Fang* omit "Xianxiong Tang" and "can also be taken", reading "give Sanwu Xiaobai San". *Jinjian* says: Under "no heat signs", giving Sanwu Xiao Xianxiong Tang should be Sanwu Baix San. "Xiao Xianxiong Tang" is a transcription error. Jiegeng, Beimu, and Badou are all white, fitting the meaning of Sanwu Baix San. Warm and attacking, it aligns with the logic of cold-excess. Xiao Xianxiong Tang is cold-natured; how can it treat cold-excess chest binding? "Can also be taken" is a superfluous addition. Ke Qin changed it to "Sanbai Xiao Xianxiong Tang, taken as powder". Note: *Jinjian*'s correction is correct.)
[Jian] Chest binding syndrome with no significant fever and no dry mouth/thirst is a non-heat excess syndrome, i.e., cold-excess. Give Sanwu Baix San. However, the pulse must be deep and tight. If the pulse is deep and slow, or if signs of the Three Yin appear, it is not comparable to cold-excess chest binding; Zhishi Lizhong Wan (Immortelle Pill with Immortelle Root) should be used. [Zheng]
Cold-water binding in the chest occupies the Heart Yang, which is serious. Using Sanwu Baix San to purge cold and break binding is a desperate military measure.
*Zongbing Lun* (General Discussion of Diseases) states: For cold-excess chest binding with no heat signs, give Sanwu Baix San. Annotation: Xiao Xianxiong is incorrect. *Shanghan Leifang* states: Chest binding is always heat sinking. This mentions cold-excess, which is phlegm-fluid bound by cold water qi. *Haren Shu* states: Give Sanwu Baix San, omitting "Xiao Xianxiong Tang can also be used," because Xiao Xianxiong is a cold agent, unsuitable for non-heat conditions.
*Yifang Kao* states: This syndrome may arise when, after resolving the exterior and clearing interior heat, excessive consumption of cold foods causes cold-excess chest binding. However, it must present without heat signs.
**Baix San Formula**
Jiegeng (Platycodon Root) (3 fen)
Badou (Croton Seed) (1 fen, peeled, heart removed, roasted black, ground to paste. ○ *Yu Han Jing* reads 6 zhu, omits "ground to paste".)
Beimu (Fritillaria Bulb) (3 fen. ○ *Yu Han Jing*: Jiegeng and Beimu each 18 zhu.)
Grind the three ingredients into powder. Add Badou and pound further in a mortar. Mix with Baiyin (plain rice water) and take. Strong individuals take half a qian bi; weak individuals reduce the dose. If the disease is above the diaphragm, vomiting will occur; if below, diarrhea will occur. If no diarrhea, take one cup of hot porridge. If diarrhea persists, take one cup of cold porridge. If body heat and gooseflesh persist, and the patient desires to cover themselves with clothes, and washing with water traps the heat preventing release, leading to irritability due to failed sweating: If sweating occurs and abdominal pain follows, give Shaoyao (Peony Root) 3 liang as above. (Cold porridge, *Qianjin Yi Fang* notes: alternatively cold water. The 49 characters from "body heat..." are omitted in *Yu Han Jing* and *Waitai Miyao*. Qian Ben and Ke Ben also delete them, considering it correct. Xi Ju agrees. Zhicong deletes the 76 characters from "disease above diaphragm...").
[Qian] Cold-excess binds in the chest; cold water injures the Lung, causing wheezing, cough, and rebellious Qi. Jiegeng opens this; Beimu enters the Lung to resolve binding. Badou, pungent, hot, and toxic, is like a general breaking gates to destroy the firm binding in the chest. Heat is insufficient to open cold-water binding; harshness is insufficient to break excess binding. [Ke] Mixing with Baiyin (rice water) uses sweetness to moderate action, keeping it in the chest to prevent rapid purging. Powder disperses binding better than decoctions which sweep. The section on body heat and gooseflesh is difficult to understand; I follow deletion. [Wang] Taking hot porridge if no diarrhea, and cold porridge if diarrhea persists: heat assists drug power; cold resolves drug power. Porridge is used to support Stomach Qi. [Xi] Badou is intensely hot. Hot porridge enhances its heat to promote action; cold porridge restricts its heat to stop action. Both use porridge to support Stomach Qi.
Note: *Bencao* states Xu Zicai says: For Badou poisoning, use cold water.
*Waitai Miyao* cites Zhang Zhongjing's Jiegeng Baix San for cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional foul-smelling purulent sputum, and long-term expectoration of pus like rice gruel, diagnosing Fei Yong (Lung Abscess). This is the same formula with identical dosages. Post-formula note: If diarrhea persists, one cup of cold water settles it.
*Shanghan Leifang* states: Ancient method: 2 qian 5 fen equals 1 fen. ○ Note: This is post-Song practice. Now 1 liang = 1 qian, so 1 fen = 2.5 li. *Leifang* also states: Half qian bi weighs approx 3 fen today.
When Taiyang and Shaoyang diseases occur together, with stiffness and pain in the head and neck, or dizziness, sometimes resembling chest binding, and fullness/hardness below the heart, one should puncture Dayui (GV14) at the first interspace, Feishu (BL13), and Ganshu (BL18). Sweating must be strictly avoided. Sweating leads to delirium and wiry pulse. If delirium persists for five days, puncture Qimen (LR14). ("Five down", Bencao and *Yu Han Jing* have "six".)
[Jian] Taiyang and Shaoyang concurrent disease presents with stiffness/pain in head/neck, dizziness, intermittent chest-binding-like sensations, and epigastric fullness. "Or" and "sometimes like" indicate indeterminate pathology of combined Yang diseases. Indeterminate pathology cannot be treated with herbs. Puncture Feishu to drain Taiyang (Taiyang connects to Lung). Puncture Ganshu to drain Shaoyang (Liver combines with Gallbladder). Puncture and wait for the opportune moment. If not done so, and sweating is induced, Yang pathogens enter the Stomach due to dryness, causing delirium. If the pulse is large and long, it is favorable and purgatives can be used. Now the pulse is not large but wiry, and delirium persists for 5-6 days. This is Earth disease showing Wood pulse. Purges must be strictly avoided. Puncture Qimen to directly drain the Liver. [Wang] "Dayui first interspace" means puncturing the Dayui acupoint, located between the first vertebrae. It is the meeting point of the Hand and Foot Three Yang meridians and the Du Meridian. Puncturing it first drains the concurrent pathogens of Taiyang and Shaoyang.
Note: *Jinjian* identifies Dayui first interspace as Feishu, originating from Cheng Wuji. If true, it should be the third interspace. *Jinjian* also cites Lin Lan: First interspace might be Shangyang (LI1) on the radial side of the index finger, based on Erjian and Sanjian points, which is forced. Another note: The next section states: Taiyang-Shaoyang concurrent disease, epigastric hardness, neck stiffness, and dizziness require puncturing Dayui, Feishu, Ganshu, and avoiding purges. This shares the same meaning.
*Benshi Fang* records a woman with Re Ru Xue Shi (Heat Entering Blood Chamber) misdiagnosed. Treated with blood-nourishing and Qi-regulating herbs for days, she developed Blood Chest Binding. Someone suggested Xiaochaihu Tang. I said: Xiaochaihu is too late. The only option is puncturing Qimen. I cannot needle; please ask a skilled practitioner. She recovered. Question: How does Heat Entering Blood Chamber become Chest Binding? Answer: Pathogen enters collaterals, clashes with Zheng Qi, moves up and down. If menstruation arrives or stops abruptly, pathogen enters the Blood Chamber due to deficiency. Pathogen forces upward into the Liver channel. Liver pathogen causes delirium and hallucinations. Returning to Danzhong, blood binds in the chest. Why? Women normally nourish Wood with Water and Liver with Blood. Before pregnancy, blood flows down as menses. During pregnancy, it nourishes the fetus. After birth, it rises as milk. All are blood. Now pathogen follows blood to the Liver, gathering at Danzhong and binding below the breasts. Touching causes pain; herbs cannot reach it, so puncture Qimen. *Haren Shu*: Haige San treats Blood Chest Binding.
Haige (Sea Clam) Huashi (Talcum) Gancao (Roasted, 1 liang each) Mangxiao (Mirabilite, 0.5 liang)
Grind to powder. Take 2 qian per dose, mixed with egg white. When the Small Intestine becomes unblocked, chest blood disperses. If blood gathers at Danzhong, Small Intestine becomes blocked. If Small Intestine is blocked, Danzhong blood does not flow; this formula is suitable. If frequent bloody urine occurs, Guizhi Honghua Tang (Cinnamon Twig and Safflower Decoction) is better; sweating resolves it.
In women with Wind Strike, fever and aversion to cold, menstruation arriving, after 7-8 days, heat disappears, pulse becomes slow, body cools, hypochondriac fullness, resembling chest binding, and delirium: This is Heat Entering Blood Chamber. Puncture Qimen, draining according to excess. ("Its excess space", *Yu Han Jing* and *Mai Jing* have "deficiency". "Qu" (take/draining), Bencao writes "Xie" (drain). *Mai Jing* after "Qu" has 26 characters: "Ping Bing Yun: Heat entering blood chamber, do not violate Stomach Qi and Upper Jiao, contrary to this. Does it refer to medicine or acupuncture?")
[Cheng] Wind Strike in women with fever/aversion to cold is an exterior syndrome, unrelated to interior. Menstruation arriving for 7-8 days leaves the Blood Chamber empty. Yang-heat exterior pathogen enters due to deficiency. Yang entering interior causes heat disappearance, slow pulse, and cool body. Menstrual cessation traps pathogen, causing hypochondriac fullness like chest binding. Yin disturbed by Yang causes hallucinations and delirium. This is Heat Entering Blood Chamber. Pathogen occupies the chamber, making it falsely full. Puncture Qimen to drain. Removing excess restores deficiency; draining becomes tonifying. [Wang] Heat Entering Blood Chamber leads to stasis returning to the Liver. Thus, puncture drains the meridian's excess. Cheng's annotation saying "examine which meridian is excess and drain accordingly" is confusing. Pathogen transmits to Shaoyang, Heat Enters Blood Chamber, causing delirium. Zhang Zhongjing fears misdiagnosis as Yangming Fu Excess and inappropriate use of Three Chengqi Decoctions damaging Stomach Qi, thus offering Qimen puncture.
Note: Blood Chamber: Fang Youzhi says: Residence of Ying Blood, gathering place of menstrual blood, i.e., Chong Mai, the Sea of Blood. Most agree. Only Ke Qin says: Blood Chamber is the Liver. Liver stores blood, hence the name. No clear evidence above. Chen Ziming's *Furen Liangfang* cites Chao Yuanfang's *Bingyuan* and *Chanbao Fang* calling it Baomen Zihu. Zhang Zhongjing calls it Xueshi. *Weisheng Baojian* says: Blood Chamber is the Female Uterus mentioned in *Suwen*, i.e., Chan Chang. *Chengxu Yigou* says: Uterus is Blood Chamber. Zhang Jiebín's *Leijing Fuyi* says: Zihu is Uterus, commonly called Zichang. Physicians name it Blood Chamber because Chong and Ren meridians flourish here, allowing monthly menses. Note: Fang's annotation originates from *Mingli Lun*.
In women with Wind Strike for 7-8 days, developing alternating chills and fever at specific times, menstruation stopping: This is Heat Entering Blood Chamber. The blood must bind, causing malaria-like symptoms at specific times. Xiaochaihu Tang governs.
[Cheng] Previous section: Heat Entering Blood Chamber occurred before menstruation. Pathogen entered the empty chamber. Chamber had no blood, only pathogen. Puncture drains excess. This section: Heat Entering Blood Chamber occurred after menstruation began. Pathogen entered while blood was half-leaving. Blood and heat clash, causing binding. Righteous and pathogenic Qi struggle, causing malaria-like paroxysms. Pathogen is semi-excess, blood is semi-deficient. Only Xiaochaihu for harmonizing is suitable. [Fang] "Arriving": Heat enters room, forcing blood out; blood exits, heat lingers. "Stopping": Heat takes advantage of blood arrival, entering and clashing with subsequent blood, staying inside. Hence "blood binds". [Zhi] Note: "Menstruation stopping" should follow "7-8 days". [Qian] In Xiaochaihu Tang, add blood-invigorating herbs like Niuxi (Achyranthes), Taoren (Peach Kernel), Danpi (Moutan). If pulse is slow and body cool, add small amounts of Jiang (Ginger), Gui (Cinnamon), or wine-processed Dahuang (Rhubarb) for faster effect. This is "draining according to excess". If tonification is not needed, Renshen (Ginseng) should be removed. Do not rigidly adhere to formulas.
Note: Xu Shumi used Xiaochaihu Tang plus Dihuang (Rehmannia). Zhang Bi added Mudanpi (Moutan). Yang Shaying said: If Xiaochaihu is insufficient, add Wulingzi (Trogopterus Dung) internally.
In women with Cold Damage fever, menstruation arriving, clear-minded during day, delirious at night seeing ghosts: This is Heat Entering Blood Chamber. Do not violate Stomach Qi and Upper/Middle Jiao; it will self-resolve. ("Clear-minded", *Mai Jing* writes "Liaoliao". "Bi" (must), *Yu Han Jing* and *Mai Jing* add "Dang" (should). *Mai Jing* note: "Er" (two) character is doubtful.)
[Cheng] Cold Damage fever means cold has turned to heat. Menstruation arriving empties Blood Chamber. Pathogenic heat enters due to deficiency. Daytime delirium indicates pathogen in Fu organs and Yang struggle. Here, daytime clarity and nighttime delirium/hallucinations indicate pathogen not in Fu organs, but in Blood Chamber, causing Yin struggle. Yang excess delirium requires purging. Heat Entering Blood Chamber prohibits purgatives to avoid violating Stomach Qi. For Heat Entering Blood Chamber with blood binding and chills/fever, Xiaochaihu Tang disperses pathogen and induces sweating. Although Heat Enters Blood Chamber, without blood binding/chills-fever, Xiaochaihu is contraindicated to avoid violating Upper Jiao. For Heat Entering Blood Chamber with hypochondriac fullness like chest binding, puncture Qimen. Although Heat Enters Blood Chamber, without fullness/binding, puncturing Qimen violates Middle Jiao. "Self-resolving" means heat exits with menstrual blood. Once cleared, pathogenic heat is eliminated. Sweating violates Upper Jiao because it moves Wei Qi, which emerges from Upper Jiao. Puncturing Qimen violates Middle Jiao because it moves Ying Qi, which emerges from Middle Jiao. [Fang] "Wu" (No) is prohibitive. "Violate Stomach Qi" refers to purging. "Self-resolving" means waiting for menstruation to expel pathogenic heat with blood, similar to nasal bleeding (red sweat). This warns against reckless attacking causing chaos.