加味小柴胡汤
1.热入血室经适断, 邪热乘虚血室潜, 寒热有时如疟状, 小柴胡加
归地丹.
【注】『金匮』云: 妇人中风七, 八日, 续来寒热, 发作有时, 经水
适断, 此为热入血室, 其血必结, 故使如疟状, 发作有时, 小柴胡汤
主之. 此言邪热未尽, 值经来, 乘虚入于血室之间而潜藏之, 故令血
结,而寒热有时如疟状也. 血室肝主之, 肝与胆为表里, 胆因肝受邪
而病寒热, 故用小柴胡汤主之也. 加当归, 生地, 丹皮者, 所以清血
分之热也.
小柴胡汤 方见首卷柴胡四物汤注中
2.热入血室经适来, 昼日明了夜谵妄, 无犯胃气上二焦, 热随血去
自无恙.
【注】『金匮』: 妇人伤寒发热, 经水适来, 昼日明了, 夜则谵语,
如见鬼状, 此为热入血室. 治之, 无犯胃气及上二焦, 必自愈也. 此
言热虽入于血室, 然经行不断, 则热不留结, 勿谓谵妄, 遂以硝黄犯
其胃气刺伤荣血; 小柴和解犯上二焦, 但俟其热随血去, 病必自愈.
『伤寒论』曰: 血自下, 下者愈. 此之谓也.
刺期门法 清热行血汤
3.热入血室成结胸, 下血谵语头汗出, 二者皆当刺期门, 随其实取
泄而去, 清热行血桃红丹, 灵脂地草穿山赤.
【注】『金匮』云: 妇人中风发热恶寒, 经水适来, 得七, 八日热除
,脉迟身凉, 胸胁满, 如结胸状, 谵语者, 此为热入血室也, 当刺期
门,随其实而取之. 又云: 阳明病下血谵语者, 此为热入血室, 但头
汗出, 当刺期门, 随其实而泻之, 濈然汗出者愈. 此二条, 一言适来
即断, 血结在里为实证; 一言阳明病亦有热入血室, 但下血头汗出为
不同, 故为热入血室, 亦由肝实, 故均谓当刺期门也. 不能刺者, 以
清热行血汤治之, 其方即桃仁, 红花, 丹皮, 五灵脂, 生地, 甘草 ,
穿山甲, 赤芍也. 合四证观之, 大抵有寒热如疟之证, 方可用小柴胡
.否则或不药自愈, 或刺期门而清热行血, 以随其实而泻之, 此仲景
心法也, 不得概以小柴甘胡治之也.
1. 热入血室（邪热侵入胞宫）且月经刚刚停止，邪热乘虚潜入血室潜伏。寒热往来有定时，症状像疟疾一样，用小柴胡汤加入当归、生地黄、牡丹皮。
【注】《金匮要略》说：妇女患中风病七、八天后，持续出现寒热往来，发作有定时，月经刚好中断，这是热入血室证，体内的血液必然凝结，所以导致症状像疟疾一样，发作有定时，应当用小柴胡汤主治。这里说的是邪热未尽，正值经期，邪气乘虚进入血室之间并潜伏下来，所以导致血液凝结，而寒热往来有定时，像疟疾状。血室由肝脏所主，肝与胆互为表里，胆因受肝的影响而患病，出现寒热往来，所以用小柴胡汤主治。加入当归、生地黄、牡丹皮的原因，是为了清除血分中的热邪。
小柴胡汤 方剂见首卷柴胡四物汤注释中
2. 热入血室且月经刚来，白天神志清醒，夜晚胡言乱语，不要损伤胃气及上、中二焦，热邪随经血排出，身体自然无恙。
【注】《金匮要略》：妇女患伤寒发热，月经刚好来潮，白天神志清楚，夜晚则胡言乱语，像看见鬼怪一样的幻觉，这是热入血室证。治疗时，不要损伤胃气及上、中二焦，疾病必定自愈。这里说的是热邪虽然进入血室，但月经通畅未断，则热邪不会停留凝结，不要因为出现胡言乱语，就用芒硝、大黄等攻下药损伤其胃气，或针刺损伤营血；也不要用小柴胡汤去和解上、中二焦的邪气，只需等待热邪随经血排出，疾病必定自愈。《伤寒论》说：血液自行下行，下行的就会痊愈。说的就是这个道理。
刺期门穴法 清热行血汤
3. 热入血室形成结胸证，出现下血、胡言乱语、头部出汗，这两种情况都应当针刺期门穴，根据其实证情况泻除邪气。使用清热行血汤，药物包括桃仁、红花、牡丹皮、五灵脂、生地黄、甘草、穿山甲、赤芍。
【注】《金匮要略》说：妇女患中风病，发热恶寒，月经刚好来潮，过了七、八天热退，脉迟身凉，胸胁胀满，像结胸证的样子，胡言乱语的，这是热入血室证，应当针刺期门穴，根据其实证情况泻除邪气。又说：阳明病出现下血、胡言乱语的，这是热入血室证，只有头部出汗，应当针刺期门穴，根据其实证情况泻除邪气，全身濈然汗出者即愈。这两条经文，一条说的是月经刚来就中断，血液凝结在体内属于实证；一条说的是阳明病也有热入血室的情况，只是以下血、头汗出为不同表现，所以都属于热入血室证，也是由于肝实所致，因此都说应当针刺期门穴。不能进行针刺治疗的，用清热行血汤治疗，该方的药物即桃仁、红花、牡丹皮、五灵脂、生地黄、甘草、穿山甲、赤芍。综合这四种证候来看，大抵是有寒热往来像疟疾一样的症状，才可以用小柴胡汤。否则或者不服药自愈，或者针刺期门穴配合清热行血汤，以根据其实证情况泻除邪气，这是张仲景的心法，不能一概用小柴胡汤治疗。
Modified Xiaochaihu Decoction (Minor Bupleurum Decoction)
1. When Heat Enters the Blood Chamber (the uterus) and menstruation has just ceased, pathogenic heat enters vacuity and lurks in the blood chamber. Chills and fever occur at regular intervals, resembling malaria; treat with Xiaochaihu Decoction (Minor Bupleurum Decoction) added with Danggui (Angelicae Sinensis Radix), Shengdihuang (Rehmanniae Radix Recens), and Danpi (Moutan Cortex).
[Note] The *Jingui Yaolue* states: "When a woman suffers from Wind-stroke for seven or eight days, followed by continuous chills and fever occurring at regular intervals, and her menses happen to cease, this is Heat entering the Blood Chamber. The blood must be congealed, hence the symptoms resemble malaria with regular paroxysms. It should be treated with Xiaochaihu Decoction." This refers to the situation where pathogenic heat is not yet exhausted, and coinciding with the menstrual period, it enters the blood chamber due to vacuity and lurks there, causing blood congealment and resulting in chills and fever at regular intervals like malaria. The Blood Chamber is governed by the Liver. The Liver and Gallbladder are exterior-interiorly related. The Gallbladder becomes diseased with chills and fever due to the influence of the Liver's pathogen; therefore, Xiaochaihu Decoction is used as the primary treatment. Danggui, Shengdihuang, and Danpi are added to clear heat from the blood level.
Xiaochaihu Decoction is found in the notes of Chaihu Siwu Tang in the first volume.
2. When Heat Enters the Blood Chamber and menstruation has just begun, the patient is lucid during the day but delirious at night. Do not injure the Stomach Qi or the Upper and Middle Jiao; the heat will depart with the blood, and the body will remain unharmed.
[Note] The *Jingui Yaolue*: "When a woman suffers from Cold damage with fever, and her menses happen to begin, she is lucid during the day but speaks deliriously at night, seeing things as if ghosts were present. This is Heat entering the Blood Chamber. In treating it, do not injure the Stomach Qi or the Upper and Middle Jiao; the disease will surely heal itself." This indicates that although heat has entered the Blood Chamber, since menstruation continues without interruption, the heat does not linger and congeal. One should not assume that because of delirium, one should use Xie (Mirabilite) and Huanglian (Coptidis Rhizoma) or similar purgatives to injure Stomach Qi, nor prick to injure Ying-blood. Nor should Xiaochaihu Decoction be used to harmonize the Upper and Middle Jiao. Simply wait for the heat to depart with the blood, and the disease will surely heal itself. The *Shanghan Lun* states: "If the blood descends naturally, those who descend will recover." This is what is meant.
Method of Pricking Qimen (Liv 14); Qingre Xingxue Decoction (Heat-Clearing and Blood-Invigorating Decoction)
3. When Heat Enters the Blood Chamber and forms Jie-Xiong (Chest Binding), presenting with bleeding, delirium, and sweating only on the head, both conditions require pricking Qimen (Liv 14). Follow the excess pattern to drain and eliminate the pathogen. Use Qingre Xingxue Decoction composed of Taoren (Persicae Semen), Honghua (Carthami Flos), Danpi (Moutan Cortex), Wulingzhi (Trogopterori Faeces), Shengdihuang (Rehmanniae Radix Recens), Gancao (Glycyrrhizae Radix et Rhizoma), Chuanshanjia (Manis Squama), and Chishao (Paeoniae Radix Rubra).
[Note] The *Jingui Yaolue* states: "When a woman suffers from Wind-stroke with fever and aversion to cold, and her menses happen to begin, after seven or eight days the fever subsides, the pulse becomes slow, the body feels cool, there is fullness in the chest and hypochondrium resembling Jie-Xiong (Chest Binding), and she speaks deliriously; this is Heat entering the Blood Chamber. One should prick Qimen (Liv 14) and drain according to the excess pattern." It also states: "In Yangming disease, if there is bleeding and delirium, this is Heat entering the Blood Chamber. If there is sweating only on the head, one should prick Qimen (Liv 14) and drain according to the excess pattern. Recovery occurs when profuse sweating ensues throughout the body." These two passages discuss different scenarios: one describes menses ceasing immediately upon onset, with blood congealing internally constituting an Excess pattern; the other describes Heat entering the Blood Chamber in the context of Yangming disease, distinguished by bleeding and head sweating. Thus, both are classified as Heat entering the Blood Chamber caused by Liver Excess, so both indicate pricking Qimen (Liv 14). If acupuncture is not feasible, treat with Qingre Xingxue Decoction. The formula consists of Taoren, Honghua, Danpi, Wulingzhi, Shengdihuang, Gancao, Chuanshanjia, and Chishao. Observing these four syndromes generally, Xiaochaihu Decoction is applicable only when there are symptoms of chills and fever resembling malaria. Otherwise, the condition may resolve spontaneously without medication, or be treated by pricking Qimen (Liv 14) combined with Qingre Xingxue Decoction to drain based on the excess pattern. This is the core method of Zhang Zhongjing; one must not indiscriminately treat all cases with Xiaochaihu Decoction.