仲景《伤寒论》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，必自愈。
又云∶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，随其实泻之。
又云∶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。
沈尧封曰∶论言勿犯胃气及上二焦者，谓不可攻下，并不可吐汗也。然有似是实非之证，不可不辨。
陈良甫曰∶脉迟身凉而胸胁下满，如结胸状，谵语者，当刺期门穴。下针病患五吸，停针良久，徐徐
出针。凡针期门穴，必泻勿补。肥人二寸，瘦人寸半。
许学士治一妇，病伤寒，发寒热，遇夜则如见鬼状，经六七日，忽然昏塞，涎响如引锯，牙关紧急，
瞑目不知人，病势危困。许视之曰∶得病之初，曾值月经来否？其家云∶经水方来，病作而经遂止，后一
二日发寒热，昼虽静，夜则见鬼，昨日不省人事。许曰∶此是热入血室证，医者不晓，以刚剂与之，故致
此。当先化痰，后治其热。乃急以一呷散投之，两时许，涎下得睡，即省人事；次投以小柴胡汤加生地，
二服而热遂除，不汗而自解。
又一热入血室证，医用补血调气药，治之数日，
遂成血结胸，或劝用前药。许曰∶小柴胡已迟不可行矣，刺期门则可。请善针者治之，如言而愈。或问何
为而成血结胸？许曰∶邪气乘虚入于血室，血为邪所迫，上入肝经，则谵语见鬼；复入膻中，则血结于胸
中矣。故触之则痛，非药可及，当用刺法。
沈尧封曰∶一妇热多寒少，谵语夜甚，经水来三日，病发而止。本家亦知热入血室，医用小柴胡数帖，
病增∶舌色黄燥，上下齿俱是干血。余用生地、丹皮、麦冬等药，不应。药入则干呕，脉象弱而不大。因思
弱脉多火，胃液干燥，所以作呕，遂用白虎汤加生地、麦冬，二剂热退神清。唯二十余日不大便为苦，与麻
仁丸三服，得便而安。
一室女，发热经来，医用表散药增剧，谵语夜甚。投小柴胡汤，不应，夜起如狂；或疑蓄血，投凉血消
瘀药，亦不应。左关脉弦硬搏指，询知病从怒起。因用胆草、黄芩、山栀、丹皮、羚羊角、芦荟、甘草、归
身等药煎服，一剂知，四剂愈。
尧封又曰∶张仪表令爱，发热经来，昏夜谵语，如见鬼状，投小柴胡增剧。询其病情，云醒时下体恶寒
即愦时亦常牵被敛衣。因悟此证平素必患带下，且完姻未久，隐曲之事，未免过当；复值经来过多，精血两
亏，阴阳并竭。其恶寒发热，由阴阳相乘所致，非外感热邪深入也。误投发散清热，证同亡阳。《伤寒论》
云∶亡阳则谵语。《内经》云∶脱阳者，见鬼是也。因用肾气丸，早晚各二钱，神气即清。随以苁蓉易附、
桂，数剂全愈。（沈氏自注∶此即前所云似是实非之证，不可不辨。）
张仲景在《伤寒论》中说：妇女患伤寒发热，月经正好来潮，白天神志清楚，傍晚则胡言乱语，像看见鬼怪一样的症状，这是热邪侵入血室（子宫及肝经），不要损伤胃气以及上、中二焦的功能，病一定会自行痊愈。
又说：妇女患中风，发热恶寒，月经正好来潮，患病七八天后，热度退去而脉搏变慢、身体发凉，胸胁部胀满，像结胸证（痰水互结于胸膈）的样子，伴有胡言乱语的，这是热邪侵入血室。应当针刺期门穴，根据实证的情况进行泻法治疗。
又说：妇女患中风，过了七八天，持续出现忽冷忽热的症状，且发作有定时，月经正好停止的，这是热邪侵入血室，血液必然凝结，所以症状像疟疾一样，发作有定时，用小柴胡汤主治。
沈尧封说：经文说“不要损伤胃气以及上、中二焦”，意思是不可使用攻下法，也不可使用催吐和发汗法。然而存在似是而非的证候，不能不加以辨别。
陈良甫说：脉象迟缓、身体发凉且胸胁部胀满，像结胸证的样子，伴有胡言乱语的，应当针刺期门穴。进针时让病人呼吸五次，留针较长时间，然后慢慢出针。凡是针刺期门穴，必须用泻法，不可用补法。肥胖者进针深度为二寸，消瘦者为寸半。
许学士治疗一位妇人，患伤寒，出现寒热往来，每到夜间就像看见鬼怪一样，病程六七天，突然昏厥堵塞，喉间痰声如拉锯，牙关紧闭，闭眼不知人事，病情危急困顿。许学士诊视后说：“得病之初，是否正值月经来潮？”家属说：“月经刚来，发病后月经就停止了，之后一两天出现寒热，白天虽然安静，夜里却见鬼，昨天已不省人事。”许学士说：“这是热入血室的证候，医生不懂，用了药性刚烈的药物给她，导致如此后果。应当先化痰，再治其热。”于是急忙服用一呷散，约两小时后，痰液下行得以入睡，随即恢复意识；接着投以小柴胡汤加生地黄，服两剂后热势消除，未出汗而病自愈。
又有一例热入血室证，医生用补血调气的药物治疗数日，最终形成血结胸（瘀血结于胸中）。有人建议使用前一种方法（刺期门）。许学士说：“此时再用小柴胡汤已经太迟，不可行，针刺期门还可以。”请擅长针灸的人治疗，照做后痊愈。有人问为什么会形成血结胸？许学士说：“邪气乘虚进入血室，血液被邪气逼迫，向上进入肝经，就会胡言乱语、见鬼；再次进入膻中，血液就凝结在胸中了。所以触碰会疼痛，药物无法到达，应当使用针刺疗法。”
沈尧封说：一位妇人热多寒少，夜间胡言乱语加重，月经来了三天，发病后月经停止。家属也知道是热入血室，医生用小柴胡汤连服数帖，病情反而加重：舌苔黄燥，上下牙齿都有干血。我用生地黄、牡丹皮、麦冬等药治疗，没有效果。服药后发生干呕，脉象虚弱而不盛大。我想到弱脉多因火盛，胃液干燥，所以引起呕吐，于是改用白虎汤加生地黄、麦冬，服两剂后热退神清。只是二十多天不大便成为痛苦，给予麻仁丸三服，大便通畅后安愈。
一位未婚女子，发热且月经来潮，医生用解表发散药治疗后病情加剧，夜间胡言乱语严重。投用小柴胡汤，无效，夜间起来像发狂一样；有人怀疑是蓄血证，投用凉血消瘀药，也无效。左关脉弦硬搏指，询问得知病从愤怒而起。于是用龙胆草、黄芩、山栀、牡丹皮、羚羊角、芦荟、甘草、当归身等药煎服，一剂见效，四剂痊愈。
尧封又说：张仪表令爱（女儿），发热且月经来潮，深夜胡言乱语，像看见鬼怪一样，投用小柴胡汤后病情加重。询问病情，她说清醒时下体怕冷，昏睡时也常常拉扯被子收敛衣物。我由此领悟到此证平素必定患有带下病，且结婚不久，房事未免过度；又正值月经量过多，精血两亏，阴阳俱竭。她的恶寒发热，是由阴阳相互乘侮所致，并非外感热邪深入体内。误用发散清热药，证候如同亡阳（阳气暴脱）。《伤寒论》说：亡阳则胡言乱语。《内经》说：脱阳的人，会看见鬼怪。于是用肾气丸，早晚各二钱，神气立即清醒。随后以肉苁蓉替换附子、桂枝，数剂后完全痊愈。（沈氏自注：这就是前面所说的似是而非的证候，不能不辨别。）
Zhang Zhongjing stated in the *Shanghan Lun* (Treatise on Cold Damage): "When a woman suffers from cold damage with fever, and her menses happen to arrive; if she is lucid during the day but delirious at dusk, seeing phantoms as if witnessing ghosts, this is termed 'Heat Entering the Blood Chamber' (Re Ru Xue Shi). Do not injure the Stomach Qi or the Upper and Middle Jiao; the condition will resolve spontaneously."
He further stated: "When a woman suffers from wind strike with fever and aversion to cold, and her menses happen to arrive. After seven or eight days, if the heat subsides, the pulse becomes slow, and the body feels cool, accompanied by fullness in the chest and hypochondrium resembling Jie Xiong syndrome (Chest Binding), and delirium, this is Heat Enting the Blood Chamber. One should puncture Qimen (LR14) and apply the reducing method according to the excess pattern."
He also stated: "When a woman suffers from wind strike for seven or eight days, continuously experiencing alternating chills and fever that occur at specific times, and her menses have just ceased, this is Heat Entering the Blood Chamber. The blood must be congealed, hence the symptoms resemble malaria with periodic occurrences. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment."
Shen Yaofeng commented: "The text states 'do not injure the Stomach Qi and the Upper and Middle Jiao,' meaning one must not use purgative methods, nor emetic or diaphoretic methods. However, there are patterns that appear similar but are fundamentally different, which must not fail to be distinguished."
Chen Liangfu stated: "In cases of slow pulse, cool body, fullness in the chest and hypochondrium resembling Jie Xiong syndrome, and delirium, one should puncture the Qimen acupoint. Upon needle insertion, allow the patient to take five breaths, retain the needle for a considerable time, and then withdraw it slowly. Whenever puncturing Qimen, one must always use the reducing method, never the tonifying method. For obese individuals, insert to a depth of two cun; for thin individuals, one and a half cun."
Scholar Xu treated a female patient who suffered from cold damage, presenting with alternating chills and fever, and nightly episodes of seeing phantoms. After six or seven days, she suddenly became comatose and obstructed, with rattling phlegm sounds like sawing, locked jaws, closed eyes, and loss of consciousness, indicating a critical condition. Scholar Xu examined her and asked, "At the onset of the illness, did your menstruation begin?" The family replied, "Her menses had just started, but ceased when the illness struck. A day or two later, chills and fever developed. She was quiet during the day but saw ghosts at night, and yesterday lost consciousness." Scholar Xu said, "This is a case of Heat Entering the Blood Chamber. The physicians were ignorant and administered harsh medicines, causing this state. We must first resolve the phlegm, then treat the heat." He urgently administered Yi Ha San (One Swallow Powder). After about two hours, the phlegm drained, she fell asleep, and regained consciousness. Subsequently, he administered Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Sheng Di Huang (Radix Rehmanniae Preparata). After two doses, the fever subsided, and the disease resolved spontaneously without sweating.
In another case of Heat Entering the Blood Chamber, a physician used blood-tonifying and qi-regulating herbs for several days, resulting in Xue Jie Xiong (Blood Binding in the Chest). Someone advised using the previous method (puncturing Qimen). Scholar Xu said, "It is now too late to use Xiao Chai Hu Tang; puncturing Qimen is still viable." He requested a skilled acupuncturist to treat her, and she recovered as instructed. When asked why Blood Binding in the Chest formed, Scholar Xu explained, "Pathogenic factors entered the Blood Chamber due to deficiency. The blood was forced upward by the pathogens into the Liver Meridian, causing delirium and hallucinations; upon entering the Dan Zhong (Chest Center), the blood coagulated in the chest. Thus, palpation causes pain, which medication cannot reach; acupuncture is required."
Shen Yaofeng recorded: A woman presented with more heat than chills, worsening delirium at night. Her menses had lasted three days and stopped upon the onset of illness. The family knew it was Heat Entering the Blood Chamber, but after several doses of Xiao Chai Hu Tang (Minor Bupleurum Decoction) prescribed by other doctors, the condition worsened: the tongue coating was yellow and dry, and dry blood adhered to the teeth. I used Sheng Di Huang (Radix Rehmanniae Preparata), Mu Dan Pi (Cortex Moutan), and Mai Dong (Radix Ophiopogonis), but it was ineffective. The medicine induced dry retching, and the pulse was weak and not large. I reasoned that a weak pulse often indicates fire hyperactivity; dry stomach fluids cause retching. Therefore, I switched to Bai Hu Tang (White Tiger Decoction) with added Sheng Di Huang and Mai Dong. After two doses, the fever receded and spirit cleared. However, constipation for over twenty days remained distressing. I administered Ma Ren Wan (Hemp Seed Pill) three times, leading to bowel movement and recovery.
A maiden presented with fever and menstruation. Treatment with exterior-releasing herbs exacerbated the condition, causing severe nightly delirium. Xiao Chai Hu Tang (Minor Bupleurum Decoction) was administered but failed; she rose at night acting maniacally. Suspecting Blood Accumulation (Xu Xue), cooling-blood and blood-invigorating herbs were given, also without effect. The left Guan pulse was wiry, hard, and forceful. Inquiry revealed the illness originated from anger. I therefore used Long Dan Cao (Radix Gentianae), Huang Qin (Scutellariae Radix), Shan Zhi (Fructus Gardeniae), Mu Dan Pi (Cortex Moutan), Ling Yang Jiao (Cornu Saigae Tataricae), Lu Hui (Aloe), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Dang Gui Shen (Radix Angelicae Sinensis Radix) decocted together. One dose showed improvement, and four doses resulted in cure.
Yaofeng further noted: The daughter of Magistrate Zhang presented with fever and menstruation, delirious at night, seeing phantoms. Administration of Xiao Chai Hu Tang (Minor Bupleurum Decoction) worsened the condition. Inquiry revealed that when awake, she felt cold in the lower body, and even when drowsy, she constantly pulled blankets and gathered clothes. I realized she likely suffered from leukorrhea normally, and having married recently, sexual activity may have been excessive. Coupled with heavy menstruation, both essence and blood were depleted, and yin and yang were exhausted. Her chills and fever were caused by mutual assault between yin and yang, not by deep invasion of external heat pathogens. Mistaken use of dispersing and clearing-heat herbs led to a pattern resembling Wang Yang (Yang Collapse). The *Shanghan Lun* states: "Wang Yang leads to delirium." The *Neijing* states: "Those with Yang collapse see ghosts." I administered Shen Qi Wan (Kidney Qi Pill), two qian morning and evening, after which her spirit cleared. Subsequently, I replaced Fu Zi (Radix Aconiti Lateralis Preparata) and Gui Zhi (Ramulus Cinnamomi) with Rou Cong Rong (Herba Cistanche) for several doses, resulting in complete recovery. (Shen's self-note: This is the aforementioned pattern that appears similar but is distinct, which must not fail to be distinguished.)