妇人伤寒，或劳役，或怒气发热，适遇经行，以致热入血室；或血不行，或血不止，令人昼
则明了安静，夜则谵语如见鬼状，用小柴胡加生地黄；血虚者，用四物加生地、柴胡。切不
可犯胃气。若病既愈而血未止，或热未已，元气素弱，用补中益气。脾气素郁，用济生归脾
。血气素弱，用十全大补，庶无误矣。
治验
一妇人经行，感冒风寒，日间安静，至夜谵语，用小柴胡加生地，治之顿安。但内热头晕，
用补中益气加蔓荆子而愈。后因怒恼，寒热谵语，胸胁胀痛，小便频数，月经先期，此是肝
火血热妄行，用加味逍遥加生地而愈。
一妇人因怒，寒热头痛，谵言妄语，日晡至夜益甚，而经暴至。盖肝藏血，此怒动火，而血
妄行。用加味逍遥散加生地，治之神思顿清，但食少体倦，月经未已，盖脾统血，此脾气虚
不能摄，用补中益气治之，月经渐止。
一妇人怀抱素郁，感冒经行谵语，服发散之剂，不应，用寒凉降火，前症益甚，更加月经不
止，肚腹作痛，呕吐不食，痰涎自出，此脾胃虚寒，用香砂六君，脾胃渐健，诸症渐退，又
用归脾汤而痊愈。
宋褚氏疗师尼寡妇，别制方药，谓独阴无阳，致血气交争，乍寒乍热如疟，或腰背作痛而寒
热，其肝脉弦出寸口，是其症也。若室女出嫁，愆期而寒热亦然。盖男子精盛，则思室，女
子血盛以怀胎，此天地自然之理也，治以小柴胡加生地；久而血虚，佐以四物；若兼怒动肝
火而寒热者，佐以加味逍遥散；若兼亏损肝经而寒热者，佐以八珍汤；若兼亏损元气而寒热
者，佐以补中益气汤；若兼郁伤脾气而寒热者，佐以济生归脾汤。此症多兼经候不调，当详
孰为缓急而治之。
治验
一寡妇因怒，致不时寒热，久而不已，肝脉弦紧，用小柴胡加生地，治之而愈。但见风寒热
仍作，此是脾胃气虚，用加味归脾、补中益气二汤，兼服而止。
一妇人因夫经商久不归，发寒热，月经旬日方止。服降火凉血，反潮热内热，自汗盗汗，月
经频数。余曰∶热汗，气血虚也；经频，肝脾虚也。用归脾汤、六味丸而愈，常治兼症既愈
一室女寒热，左手脉弦长而出寸口，用小柴胡加生地、乌梅，治之而愈，既嫁而诸症悉痊。
一室女久患寒热，月经不调，先以小柴胡加生地，治之少愈，更以生地黄丸而痊。
一放出宫女，年逾三十，两胯作痛，肉色不变，大小便中作痛如淋，登厕尤痛，此瘀血渍入
隧道为患，乃男女失合之症也，难治。后溃不敛，又患瘰 而殁。此妇为吾乡汤氏外家，汤为
商常在外，可见此妇在内久怀忧郁，及出外又不能如愿，是以致生此疾。愈见瘰 流注，乃
七情气血损伤，不可用攻伐皎然矣。按《精血篇》云∶女人天癸既至，逾十年无男子合，则
不调。未逾十年，思男子合，亦不调。不调则旧血不出，新血误行，或渍而入骨，或变而为
肿，或虽合而难子，合多则沥枯虚人，产乳众则血枯杀人。观其精血，思过半矣。
一室女年十七， 久不愈，天癸未通，发热咳嗽，饮食少思，或欲用通经丸。余曰∶此症潮
热经候不调者，不治，所喜脉不涩，且不潮热，尚可治。但养气血，益津液，其经自行。惑
于速效，仍用之。余曰∶非其治也，此乃 悍之剂，大助阳火，阴血得之则妄行，脾胃得之
则愈虚。经果通而不止，饮食愈少，更加潮热，遂致不救。
【背景信息】
书名：女科撮要 作者：薛立斋 朝代：明 章节：热入血室 / 师尼寡妇寒热 类别：妇儿
【原文翻译】
妇女患伤寒，或因过度劳累，或因愤怒导致发热，恰逢月经来潮，致使热邪陷入血室（子宫及冲脉等与月经相关的部位）；或者经血排出不畅，或者经血淋漓不止，使人白天神志清醒安静，夜晚则胡言乱语，如同看见鬼怪一般。治疗用小柴胡汤加生地黄；若属血虚者，用四物汤加生地黄、柴胡。切记不可损伤胃气。如果病邪已退但经血仍未停止，或发热未止，且患者元气素来虚弱，使用补中益气汤。若脾气素来郁结，使用济生归脾汤。若气血素来虚弱，使用十全大补汤，这样就不会有误治了。
治验案例：
一位妇女在月经期间，感冒风寒，白天安静，到了夜晚便胡言乱语，医生用小柴胡汤加生地黄治疗，病情立刻缓解。但她仍有内热和头晕症状，医生用补中益气汤加蔓荆子治疗而痊愈。后来因愤怒恼怒，出现寒热交替、胡言乱语、胸胁胀痛、小便频数、月经提前等症状，这是肝火旺盛导致血热妄行，医生用加味逍遥散加生地黄治疗而痊愈。
另一位妇女因愤怒，出现寒热交替、头痛、胡言乱语，傍晚到夜间症状加重，且月经突然大量来潮。因为肝藏血，这是愤怒引动肝火，导致血液妄行。医生用加味逍遥散加生地黄治疗，患者神思立刻清醒，但饮食减少、身体疲倦，月经仍未停止，这是因为脾统血，脾气虚弱不能固摄血液，医生用补中益气汤治疗，月经逐渐停止。
第三位妇女平素情怀抑郁，感冒且在月经期间出现胡言乱语，服用发散表邪的药物无效，又用寒凉降火的药物，前面的症状更加严重，加上月经不止、肚腹疼痛、呕吐不进食、痰涎自出，这是脾胃虚寒，医生用香砂六君子汤治疗，脾胃功能逐渐恢复，各种症状逐渐消退，后又用归脾汤治疗而痊愈。
宋代褚氏治疗师姑、尼姑、寡妇，另外制定方药，认为她们独阴无阳，导致血气交争，忽冷忽热像疟疾一样，或者腰背疼痛伴寒热，其肝脉弦象超出寸口，这就是她们的病症。如果是未婚女子出嫁后，月经延期而出现寒热也是如此。大概男子精气盛，就会思念房事；女子血液盛以准备怀孕，这是天地自然的道理。治疗用小柴胡汤加生地黄；时间久了导致血虚，辅助以四物汤；如果兼有愤怒引动肝火而导致寒热的，辅助以加味逍遥散；如果兼有亏损肝经而导致寒热的，辅助以八珍汤；如果兼有亏损元气而导致寒热的，辅助以补中益气汤；如果兼有郁结损伤脾气而导致寒热的，辅助以济生归脾汤。这种病症多兼有月经不调，应当详细辨别孰缓孰急而进行治疗。
治验案例：
一位寡妇因愤怒，导致不时出现寒热，时间久了也不愈，肝脉弦紧，医生用小柴胡汤加生地黄治疗而痊愈。但遇到风寒时发热仍然发作，这是脾胃气虚，医生用加味归脾汤、补中益气汤两方兼服而停止。
一位妇女因丈夫经商长期不归，出现寒热，月经十天才能停止。服用降火凉血的药物后，反而出现潮热、内热、自汗盗汗、月经频繁。我说：热汗是气血虚的表现；月经频繁是肝脾虚的表现。医生用归脾汤、六味地黄丸治疗而痊愈。
常治兼症既愈：
一位未婚女子寒热，左手脉弦长而出寸口，医生用小柴胡汤加生地黄、乌梅治疗而痊愈，出嫁后各种症状全部痊愈。
一位未婚女子长期患有寒热，月经不调，先用小柴胡汤加生地黄治疗，病情稍有好转，后用生地黄丸治疗而痊愈。
一位被放出的宫女，年过三十，两胯作痛，皮肤颜色不变，大小便中疼痛如淋证，上厕所时尤其疼痛，这是瘀血渗入隧道（指尿道、阴道等通道）造成的祸患，属于男女失合的病症，难以治疗。后来溃烂不愈合，又患瘰疬而死亡。这位妇女是我乡汤家的外亲，汤某经商经常在外，可见这位妇女在内宅长期怀抱忧郁，以及出外又不能如愿，因此导致生了此病。这更证明瘰疬流注，乃是七情（喜、怒、忧、思、悲、恐、惊）损伤气血所致，不可使用攻伐之法，这是显而易见的。按《精血篇》说：女人天癸（指月经）已经到来，超过十年没有男子交合，则月经不调。未满十年，思念男子交合，也月经不调。月经不调则旧血不出，新血误行，或者渗入骨头，或者变为肿块，或者虽然交合但难怀孕，交合过多则精液枯竭使人体虚弱，生育众多则血液枯竭致人死亡。观察她的精血状况，思考其中道理也就过半了。
一位十七岁的未婚女子，瘰疬长久不愈，天癸未通，发热咳嗽，饮食少想，有人想用通经丸。我说：这种病症如果是潮热且月经不调的，是不治之症，所幸她脉象不涩，且不潮热，还可以治疗。只要滋养气血，补充津液，月经自然会来。患者被速效迷惑，仍然使用了通经丸。我说：这不是正确的治疗方法，这是峻猛之剂，大大助长阳火，阴血得到它则会妄行，脾胃得到它则会更加虚弱。结果月经果然通了但不止，饮食更少，更加潮热，最终导致无法挽救。
[Background Information]
Book: *Nüke Suoyao* (Essentials of Gynecology)
Author: Xue Lizhai (Xue Ji)
Dynasty: Ming
Chapter: Heat Entering the Blood Chamber / Chills and Fever in Nuns, Widows, and Courtesans
Category: Women's and Children's Diseases
[Translation]
Women suffering from cold damage (Shanghan), or due to overexertion, or anger-induced fever, who happen to be menstruating, may cause heat to enter the blood chamber (the uterus and related channels governing menstruation); or if blood flow is obstructed, or bleeding persists uncontrollably, it causes the patient to be clear and quiet during the day, but delirious as if seeing ghosts at night. Treat with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Sheng Di Huang (Rehmannia Root). If there is blood deficiency, use Si Wu Tang (Four Substance Decoction) plus Sheng Di Huang and Chai Hu (Bupleurum Root). Do not injure the Stomach Qi. If the pathogenic factor has resolved but bleeding continues, or fever persists, and the patient’s Yuan Qi (Original Qi) is inherently weak, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If Spleen Qi is inherently stagnant, use Ji Sheng Gui Pi Tang (Ji Sheng's Heart-Spleen Tonic Decoction). If Qi and Blood are inherently weak, use Shi Quan Da Bu Tang (Complete Great Tonifying Decoction). In this way, errors will be avoided.
Clinical Cases:
A woman, while menstruating, contracted wind-cold. She was quiet during the day but delirious at night. The physician treated her with Xiao Chai Hu Tang plus Sheng Di Huang, resulting in immediate relief. However, she still had internal heat and dizziness. The physician treated her with Bu Zhong Yi Qi Tang plus Man Jing Zi (Vernonia Seed), leading to recovery. Later, due to anger and frustration, she experienced alternating chills and fever, delirium, distending pain in the chest and hypochondrium, frequent urination, and early menstruation. This was Liver Fire causing reckless movement of hot blood. The physician treated her with Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) plus Sheng Di Huang, resulting in recovery.
Another woman, due to anger, experienced alternating chills and fever, headache, and delirious speech. Symptoms worsened from late afternoon into the night, accompanied by sudden heavy menstruation. Since the Liver stores blood, this anger stirred fire, causing blood to move recklessly. The physician treated her with Jia Wei Xiao Yao San plus Sheng Di Huang. Her mental clarity returned immediately, but she had poor appetite and fatigue, and menstruation had not stopped. This was because the Spleen governs blood containment; Spleen Qi deficiency failed to hold the blood. The physician treated her with Bu Zhong Yi Qi Tang, and menstruation gradually ceased.
A third woman, who was chronically depressed, contracted a cold and became delirious during menstruation. Treatment with diaphoretic agents was ineffective. Treatment with cold-natured fire-clearing agents exacerbated previous symptoms, adding continuous menstruation, abdominal pain, vomiting, anorexia, and spontaneous salivation. This indicated Spleen and Stomach deficiency-cold. The physician treated her with Xiang Sha Liu Jun Zi Tang (Aucklandia and Amomum Six Gentlemen Decoction). As Spleen and Stomach function improved, symptoms receded. Subsequently, treatment with Gui Pi Tang led to full recovery.
In the Song Dynasty, Chu Shi treated nuns, Buddhist sisters, and widows with specially formulated prescriptions, stating that their state of "exclusive Yin without Yang" caused a struggle between Qi and Blood, resulting in alternating chills and fever resembling malaria, or back pain with chills and fever. Their Liver pulse would appear wiry and extend beyond the Cun (inch) position, which is diagnostic for these conditions. Similarly, if an unmarried girl experiences delayed menstruation followed by chills and fever after marriage, the mechanism is the same. Generally, when men have abundant essence, they desire sexual intercourse; when women have abundant blood, they prepare for pregnancy. This is the natural law of Heaven and Earth. Treatment involves Xiao Chai Hu Tang plus Sheng Di Huang; if prolonged deficiency of blood occurs, supplement with Si Wu Tang; if accompanied by anger-stirred Liver Fire causing chills and fever, supplement with Jia Wei Xiao Yao San; if accompanied by Liver Channel depletion causing chills and fever, supplement with Ba Zhen Tang (Eight Treasure Decoction); if accompanied by Yuan Qi depletion causing chills and fever, supplement with Bu Zhong Yi Qi Tang; if accompanied by emotional stagnation injuring Spleen Qi causing chills and fever, supplement with Ji Sheng Gui Pi Tang. These conditions often involve irregular menstruation; one must carefully distinguish urgency and treat accordingly.
Clinical Cases:
A widow, due to anger, developed intermittent chills and fever that persisted for a long time. Her Liver pulse was wiry and tight. The physician treated her with Xiao Chai Hu Tang plus Sheng Di Huang, resulting in recovery. However, fever still occurred upon exposure to wind-cold. This indicated Spleen and Stomach Qi deficiency. The physician used Ji Sheng Gui Pi Tang and Bu Zhong Yi Qi Tang concurrently, stopping the symptoms.
A woman, because her husband traveled far for business for a long time, developed chills and fever, with menstruation lasting ten days before stopping. After taking fire-clearing and blood-cooling herbs, she instead developed tidal fever, internal heat, spontaneous sweating, night sweats, and frequent menstruation. I said: Hot sweat indicates Qi and Blood deficiency; frequent menstruation indicates Liver and Spleen deficiency. The physician treated her with Gui Pi Tang and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), resulting in recovery.
Regarding the treatment of concurrent symptoms:
An unmarried girl with chills and fever had a wiry and long Left hand pulse extending beyond the Cun position. The physician treated her with Xiao Chai Hu Tang plus Sheng Di Huang and Wu Mei (Mume Fruit), resulting in recovery. After marriage, all symptoms disappeared.
An unmarried girl suffered from chronic chills and fever and irregular menstruation. Initially treated with Xiao Chai Hu Tang plus Sheng Di Huang, symptoms improved slightly. She was then cured with Sheng Di Huang Wan (Rehmannia Pill).
A released palace maid, over thirty years old, suffered from pain in both hips with normal skin color. Pain in urination and defecation resembled strangury, worsening during toilet visits. This was caused by stasis blood infiltrating the tunnels (urethra/vagina), a condition of sexual incompatibility, which is difficult to treat. She later developed non-healing ulcers and scrofula, eventually dying. This woman was related to my hometown's Tang family. Mr. Tang was often away for business. It is evident that she harbored long-term depression indoors and could not fulfill her desires outdoors, leading to this disease. This further proves that scrofula and flowing abscesses result from injury to Qi and Blood by the Seven Emotions. It is obvious that attacking methods should not be used. According to the *Jing Xue Pian* (Chapter on Essence and Blood): When a woman's Tian Gui (menstrual menses) arrives, if more than ten years pass without male union, menstruation becomes irregular. If less than ten years pass, longing for male union also causes irregularity. Irregularity means old blood does not exit, and new blood moves wrongly, either infiltrating bones or becoming masses. Even with union, conception may be difficult. Excessive union depletes essence, weakening the person; excessive childbirth depletes blood, killing the person. Observing her essence and blood, half the understanding is gained.
An seventeen-year-old unmarried girl had persistent scrofula, unopened Tian Gui, fever, cough, and poor appetite. Someone suggested using Tong Jing Wan (Menstruation-Unblocking Pill). I said: If this condition involves tidal fever and irregular menstruation, it is incurable. Fortunately, her pulse is not choppy, and she lacks tidal fever, so it is treatable. Nourish Qi and Blood, benefit Jin Ye (Body Fluids), and menstruation will come naturally. Bewitched by quick results, she still used the pill. I said: This is incorrect treatment. This is a harsh agent that greatly assists Yang Fire. Yin Blood will move recklessly upon contact; Spleen and Stomach will become weaker. Indeed, menstruation started but did not stop, appetite decreased further, tidal fever worsened, leading to death.