妇人病温热症,悉与男子同;惟当妊娠、及经期前后,则治法略异,以其关乎血室子宫也。兹特先提其要,
而分病论治。
一、妊娠感伏邪 必须治之于早,则热不深入而伤胎。当汗当清之症,固当速治不待言;尤以速清为首
要,如黄芩、白虎、栀豉、芩葛等汤皆宜酌用,石膏大青汤尤捷。而当下之症,尤不可迟;若因妊娠忌下伤胎
之说,因循迟误,则胎受热蒸,其胎必堕。故一见里症,必用拔萃犀角地黄汤速清下之,以安其胎。胎既因邪
不安,去邪即是安胎。但宜加清养血分药,如生地、白芍、白薇、茅根之类,盖有病则病受之,内经所谓有故
无殒亦无殒也。于此有历验不诬者。若失下而至舌黑腰痛,少腹下坠至急,左尺脉伏,则其胎将死腹中,且不
止于堕矣!此时下亦堕,不下亦堕。然下之而胎堕,母犹可救十中二三∶不下则母无生理,胎亦不能独存。同
一堕胎,而此善于彼,况速下而胎未必死乎。当明言于病家而后施治。下药,虽犀连承气汤、玉烛散、拔萃犀
角地黄汤等皆可采用,惟芒硝当慎,以其专主伤胎,非大实、大热、大燥,不可轻试也。
二、产后发热 每多苔前伏邪,娩后陡发者。其症不寒,兼头疼鼻塞,其脉亦有不即显露者。惟舌苔颇
有可征,或浓白
而腻,或黄腻黄燥,或有赤点,或微苔舌赤。或口苦,或口渴,或胸闷,或溲热,惟胸腹必按之热甚。此皆温
热之伏邪内蕴。世人不察,仍循俗例,饮以姜糖酒、生化汤之类,每见有酿成郁冒、痉厥、大便难三大证者。
盖血虚则厥,阳孤则冒,液枯则大便难。郁冒者,则脉多洪大而芤;痉者、厥者,脉则弦数。三者不同,其亡
血伤津则一,叶氏皆谓之肝风内动。余每用阿胶鸡子黄汤、桑麻六味汤、三甲复脉汤、加味猪肤汤、大小定风
珠六方,斟酌浅深次第而施治,盖此六方皆能增液、润筋、守神故也。若尚未见此三大重症,但病温热伏邪者,
仍宜速去其邪,兼护其虚;无粮之师,贵在速战,又不可拘于产后宜温不宜凉之说。徐洄溪所谓产后热盛,虽
犀角、石膏对症亦不禁用者是也。其有败血乘伏火上攻,冲心则喜笑怒骂,甚欲逾墙上屋者,十难救一;冲胃
则饱闷呕恶,腹满胀痛者,五死五生;冲肺则面赤气喘,痰涎壅盛,甚则神昏口噤者,十全一二。此三证不论
虚实,急用热童便灌之。实症必有腹痛拒按情形,轻者用当归、丹参、炙草和血,加桃仁、童便、白薇、黑神
丸等,导瘀下行,以镇冲逆。气血虚极者,必兼心虚气短、头眩多汗,须于前方加沙参、枣仁、熟地、玉竹滋
养之;重者用回生丹最妙,叶氏神犀丹、犀珀至宝丹、无极丸亦可参用。亦有不因败血上冲,而神昏谵语,甚
则癫狂者,此属痰迷,沈氏六神汤最效,新定牛黄清心丸亦可用。至于用药,不可过轻,须用多备少服法,中
病即已。热势退而伏邪轻,即复其虚。若畏产后虚怯,用药过轻,延至三四日后,反不能胜药矣。
三、热入血室 其症旦明夕昧,夜更神昏,低声呓语,如见鬼状;甚有当面与言,若罔闻知,而户外之
事,反能闻之见之者。盖因温热烁血,血液耗尽;肝为藏血之脏,最恶血燥,肝血既燥,又加水竭金枯,肾水
不足以涵濡,肺金不足以灌溉,肝
遂不能自藏其魂,而飞扬外越,名曰离魂。离魂则出入无时,故户外之事,皆能闻且见之也。又有病者自觉己
身化作两人并卧者,亦离魂所致。仲景治初病热入血室,尝用小柴胡汤领邪外出。余尝以青蒿易柴胡,加生地、
当归、元参、麦冬,养血救阴,山栀、泽泻,导血室之邪下行膀胱,以为出路;有瘀少腹按痛者,加赤芍、桃
仁、鳖甲、龟板,化瘀滋阴。但必分经适来因受病而止,经适来受病而自行,经适断而受病三种,则实与虚自
见。如经水适来,因热邪陷入而搏结不行者,必有瘀血,再察其腰胁及少腹有牵引作痛、拒按者,必以清热消
瘀为治。便通者,小柴胡汤去参、枣,加鲜生地、桃仁、楂肉、丹皮或犀角之类;便闭者,用桃仁承气汤加穿
山甲、 虫等下之,尤须加生地、当归、元参、麦冬,养血滋阴,以固其本。如因邪热传营,逼血妄行,致经
未当期而至者,必有身热、烦躁、不卧等证,宜清热以安营,如白虎加生地黄汤、羚地清营汤,甚则犀角地黄
汤加黄连、琥珀,皆可随症酌用。如经水适断而受邪者,经行已尽,则血海空虚,邪必乘虚而陷,宜养营以清
热;宜生地四物汤去川芎,加白薇、丹皮、桑叶、银胡、地骨皮等,轻清濡润之。若兼心跳肢厥,昏厥如尸者,
四逆散合白薇汤主之。若兼神识如狂者,牛黄散最妙。若兼腰胁及少腹满痛者,大柴胡汤加桃仁、赤芍,逐其
血室之邪,始愈。若延久不愈,上逆心包,胸中痹痛,即陶氏所谓血结胸也,桂枝红花汤加海蛤壳、桃仁,辛
润温通之。若下结血室,少腹胀痛者,新加绛复汤,再加乌贼骨、茜根、延胡索、川楝子等,辛润通络以逐之。
如伏邪病发,而经水自行者,不必治经水,但治其伏邪,而病自愈。盖病本未犯血室,故经行如常,仲景所谓
勿犯胃气及上二焦,必自愈者,正指此,非谓总不用药也。总之,妇人温热,但见昼日明了,至夜谵语,即当
询其经期,以杜热入血室之渐。
妇女患温热病,其病情与男子基本相同;只是在妊娠期间以及月经来潮前后,治疗方法略有不同,因为这关系到血室和子宫。现在特别先提出要点,并分病症论述治疗。
一、妊娠期感受伏邪
必须尽早治疗,这样热邪就不会深入而伤及胎儿。需要发汗或清热的病症,固然应当迅速治疗,不言而喻;尤其以快速清热为首要任务,如黄芩汤、白虎汤、栀子豉汤、黄芩葛根汤等方剂都适宜酌情使用,石膏大青汤尤为见效。而对于需要攻下的病症,尤其不可拖延;如果因为“妊娠忌用下药以免伤胎”的说法,因循守旧、延误时机,那么胎儿受热邪熏蒸,必然导致流产。所以一旦见到里证,必须立即使用拔萃犀角地黄汤快速清热攻下,以安定胎儿。既然胎儿因邪气而不安,去除邪气就是安胎的方法。但应当加入清养血分的药物,如生地、白芍、白薇、茅根之类,正如《内经》所说“有病则病受之”,即有病因存在时用药不会伤害人体(有故无殒)。这一点我有许多验证过的经验,确凿无疑。如果错过攻下时机,发展到舌苔黑、腰痛、少腹下坠感非常急迫、左尺脉伏匿的程度,那么胎儿将在腹中死亡,而且不仅仅是流产那么简单了!此时即使攻下也会流产,不攻下也会流产。然而攻下后若流产,母亲还有十分之二三的生还机会;若不攻下,则母亲没有生路,胎儿也不能单独存活。同样是流产,前者优于后者,何况迅速攻下胎儿未必会死呢。应当在向病人家属说明清楚后再进行治疗。攻下药方面,虽然犀连承气汤、玉烛散、拔萃犀角地黄汤等都可采用,但芒硝应当谨慎使用,因为它专门容易伤胎,除非是大实、大热、大燥的证候,否则不可轻易尝试。
二、产后发热
多由产前潜伏的邪气,在分娩后突然发作引起。症状表现为不恶寒,兼有头痛鼻塞,脉象有时也不立即显露。只有舌苔很有参考价值,或者浓白而腻,或者黄腻黄燥,或者有赤点,或者微苔且舌质红。或者口苦,或者口渴,或者胸闷,或者小便热,但胸腹部必定按压时感觉灼热。这些都是温热伏邪内蕴的表现。世人如果不加考察,仍沿袭世俗惯例,饮用姜糖酒、生化汤之类的药物,常常导致酿成郁冒、痉厥、大便难这三大重症。大概是因为血虚导致厥逆,阳气孤危导致昏冒,津液枯竭导致大便困难。郁冒的,脉象多洪大而中空(芤);发生痉症或厥症的,脉象则弦数。这三种情况虽然不同,但其亡血伤津的本质是一致的,叶天士都称之为肝风内动。我常用阿胶鸡子黄汤、桑麻六味汤、三甲复脉汤、加味猪肤汤、大小定风珠这六个方剂,根据病情的深浅次第斟酌施治,因为这六个方剂都能增液、润筋、守神。如果尚未出现这三大重症,只是患有温热伏邪的,仍然应当迅速祛除邪气,同时保护正气;如同没有粮草的军队,贵在速战速决,也不可拘泥于“产后宜温不宜凉”的说法。这正是徐灵胎所说的产后热盛,即使是犀角、石膏对症也应当禁用的反面例证(意指该用时必须用)。如果有败血乘着伏火上攻,冲击心脏则喜笑怒骂,甚至想跳墙爬屋的,十难救一;冲击胃腑则饱闷呕恶,腹胀满疼痛的,五死五生;冲击肺脏则面赤气喘,痰涎壅盛,甚至神昏口噤的,十能救一二。这三种证候不论虚实,紧急时用热童便灌服。实证必定伴有腹痛拒按的情况,轻的用当归、丹参、炙甘草调和血液,加桃仁、童便、白薇、黑神丸等,引导瘀血下行,以平抑冲逆之气。气血极度虚弱者,必定兼有心虚气短、头晕多汗,必须在前方中加入沙参、枣仁、熟地、玉竹来滋养;重的用回生丹最妙,叶天士的神犀丹、犀珀至宝丹、无极丸也可以参考使用。也有不是因败血上冲,而是神昏谵语,甚至癫狂的,这属于痰迷心窍,沈氏六神汤最有效,新定牛黄清心丸也可以使用。至于用药,不可过轻,必须采用多备少服的方法,中病即止。热势退去而伏邪减轻,就恢复对正气的补养。如果畏惧产后体虚怯弱,用药过轻,拖延到三四天后,反而不能耐受药力了。
三、热入血室
症状表现为白天清醒,傍晚迷糊,夜间更加神昏,低声说梦话,像看见鬼怪一样;甚至有当面与人说话,好像没听见没看见,但门外的事情,反而能听见看见的。这是因为温热灼烧血液,血液耗尽;肝是藏血的脏器,最厌恶血燥,肝血既已干燥,又加上肾水枯竭、肺金干枯,肾水不足以涵养滋润,肺金不足以灌溉,肝遂不能自藏其魂,而飞扬外越,名叫离魂。离魂则出入没有定时,所以门外的事情,都能听见看见。又有病人自觉自己身体化作两人并卧的,也是离魂所致。张仲景治疗初病热入血室,曾用小柴胡汤引领邪气外出。我曾以青蒿代替柴胡,加生地、当归、元参、麦冬,以养血救阴,山栀、泽泻,引导血室的邪气下行至膀胱,作为出路;如果少腹有瘀血且按压疼痛的,加赤芍、桃仁、鳖甲、龟板,以化瘀滋阴。但必须区分三种情况:经期适逢来潮时因病、经期适逢来潮时受病、经期刚断绝时受病,这样虚实自然显现。如经水正好来潮,因热邪陷入而搏结不通的,必定有瘀血,再观察其腰胁及少腹有牵引作痛、拒按的情况,必须以清热消瘀为治法。大便通畅的,用小柴胡汤去掉人参、大枣,加鲜生地、桃仁、山楂肉、丹皮或犀角之类;大便闭结的,用桃仁承气汤加穿山甲、䗪虫等攻下,尤其须加生地、当归、元参、麦冬,以养血滋阴,巩固根本。如因邪热传入营分,逼迫血液妄行,导致月经未到预期时间而至的,必定有身热、烦躁、不能卧床等症状,宜清热以安营,如白虎加生地黄汤、羚地清营汤,甚则犀角地黄汤加黄连、琥珀,都可以随症酌情使用。如经水刚断绝而受邪的,经行已尽,则血海空虚,邪气必乘虚而陷,宜养营以清热;宜用地黄四物汤去掉川芎,加白薇、丹皮、桑叶、银胡、地骨皮等,性质轻清濡润的。如果兼有心跳肢冷,昏厥如尸体的,用四逆散合白薇汤主治。如果兼有神志如狂的,牛黄散最妙。如果兼有腰胁及少腹满痛的,用大柴胡汤加桃仁、赤芍,驱逐血室的邪气,才能痊愈。如果拖延日久不愈,邪气上逆心包,胸中痹痛,就是陶节庵所说的血结胸,用桂枝红花汤加海蛤壳、桃仁,辛润温通。如果下结血室,少腹胀痛的,用新加绛复汤,再加乌贼骨、茜根、延胡索、川楝子等,辛润通络以驱逐邪气。如果伏邪发病,而经水自行正常的,不必治疗经水,只要治疗伏邪,病就会自愈。因为病本未侵犯血室,所以经行如常,张仲景所说的“勿犯胃气及上二焦,必自愈”,正是指这种情况,并非谓总不用药。总之,妇人患温热病,只要见到白天清醒,到了晚上说胡话,就应当询问其经期情况,以杜绝热入血室的萌芽。
Women suffering from warm-heat diseases present similarly to men; however, during pregnancy and around the menstrual period, treatment methods differ slightly due to their involvement with the Blood Chamber (Xueshi) and uterus. Here, I will first outline the key points and discuss treatments according to specific conditions.
1. Pregnancy complicated by latent pathogenic factors
Treatment must be initiated early so that heat does not penetrate deeply and damage the fetus. For conditions requiring sweating or clearing, prompt treatment is obviously necessary; however, rapid clearing of heat is paramount. Decoctions such as Huangqin Tang (Scutellaria Decoction), Baihu Tang (White Tiger Decoction), Zhizi Chidao Tang (Gardenia and Fermented Soybean Decoction), and Qin Ge Tang (Scutellaria and Pueraria Decoction) should be used judiciously, while Shigao Daqing Tang (Gypsum and Isatis Decoction) is particularly effective. For conditions requiring purgation, delay is especially inadvisable. If one hesitates due to the belief that "purgatives are contraindicated in pregnancy to avoid harming the fetus," leading to procrastination and missed opportunities, the fetus will be steamed by heat and inevitably miscarry. Therefore, once interior signs appear, Bichui Xijiao Dihuang Tang (Bichui Rhinoceros Horn and Rehmannia Decoction) must be used immediately to clear heat and purge rapidly to stabilize the fetus. Since the fetus is unsettled by pathogens, eliminating pathogens is equivalent to stabilizing the fetus. However, herbs that clear and nourish the blood level, such as Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Baiwei (Cynanchi Atrati Radix), and Maogen (Imperatae Rhizoma), should be added. As stated in the *Neijing* (Classic of Internal Medicine): "When there is a disease, the disease receives the effect; thus, there is no injury" (Yougu wu yun). I have verified this repeatedly without error. If purgation is delayed until black tongue coating, lower back pain, urgent bearing-down sensation in the lower abdomen, and a submerged pulse at the left Chi position occur, the fetus will die within the womb, extending beyond simple miscarriage. At this stage, whether purged or not, miscarriage occurs. Yet, if purged and miscarriage ensues, the mother still has a two-in-ten chance of survival; if not purged, the mother has no hope, nor can the fetus survive alone. Between these two outcomes, the former is superior, let alone rapid purgation where the fetus may not die. This must be explained clearly to the family before treatment. Regarding purgatives, although Xilian Chengqi Tang (Rhizoma Coptidis and Rhei Decoction for Stagnation), Yuzhu San (Jade Candle Powder), and Bichui Xijiao Dihuang Tang can be adopted, Mangxiao (Natrii Sulfas) must be used with caution as it specifically tends to harm the fetus; it should not be lightly tried unless there is extreme excess, extreme heat, and extreme dryness.
2. Postpartum fever
This often results from latent pathogens present before delivery that suddenly erupt after birth. Symptoms include absence of aversion to cold, accompanied by headache and nasal congestion; the pulse may not manifest immediately. The tongue coating offers significant diagnostic value: it may be thick white and greasy, yellow greasy or yellow dry, dotted with red spots, or have a thin coating with a red tongue body. Symptoms may include bitter taste, thirst, chest stuffiness, or hot urination, but the chest and abdomen will definitely feel hot upon palpation. These indicate internal accumulation of latent warm-heat pathogens. Laypeople, failing to investigate, often follow common practices by administering Ginger-Sugar-Wine or Huasheng Tang (Blood Generation Decoction), which frequently leads to three major syndromes: Yu Mao (Depression and Dizziness), Jing Jue (Spasm and Convulsion), and Bian Nan (Difficulty in Defecation). Generally, blood deficiency leads to Jue (reversal/collapse), isolated Yang leads to Mao (dizziness/fainting), and fluid depletion leads to difficulty in defecation. In Yu Mao, the pulse is typically flooding and hollow (Kou); in Jing and Jue, the pulse is wiry and rapid. Although these three differ, they share the common pathology of blood loss and fluid injury. Ye Tianshi attributed them all to "internal stirring of Liver Wind." I commonly use Ejiao Ji Zi Huang Tang (Donkey-Hide Gelatin and Chicken Egg Yolk Decoction), Sangma Liuwei Tang (Mulberry Leaf and Sesame Seed Six-Ingredient Decoction), Sanjia Fumai Tang (Three-Shelled Pulse-Recovering Decoction), Jia Wei Zhufu Tang (Modified Pig Skin Decoction), and Da/Xiao Dingfeng Zhu (Great/Small Wind-Calming Pills), applying them according to the depth and sequence of the disease, as these six formulas can increase fluids, moisten sinews, and anchor the spirit. If these three severe syndromes have not yet appeared, and only latent warm-heat pathogens are present, one should still rapidly eliminate pathogens while protecting deficiency. Like an army without supplies, speed in battle is crucial; one must not be bound by the saying "postpartum treatment should be warming rather than cooling." This aligns with Xu Huixi’s view that when postpartum heat is intense, even Rhinoceros Horn or Gypsum should be used if indicated. If lochia combines with latent fire to attack upward: attacking the Heart causes laughter, cursing, and attempts to climb walls or jump over roofs (one in ten survives); attacking the Stomach causes fullness, oppression, vomiting, abdominal distension, and pain (five die, five survive); attacking the Lungs causes red face, panting, profuse phlegm-saliva, and even coma with locked jaw (two in ten survive). Regardless of excess or deficiency, these three syndromes require immediate administration of hot Tongbian (Child's Urine). Excess syndromes must present with abdominal pain and refusal to press; mild cases use Danggui (Angelicae Sinensis Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), and Zhi Gancao (Prepared Licorice Root) to harmonize blood, plus Taoren (Persicae Semen), Tongbian, Baiwei, and Heishen Wan (Black Divine Pill) to guide stasis downward and suppress rebellious Qi. For extreme Qi and Blood deficiency, accompanied by Heart deficiency, shortness of breath, dizziness, and excessive sweating, add Shashen (Glehniae Radix), Zaoren (Ziziphi Spinosae Semen), Shudi (Rehmanniae Radix Preparata), and Yuzhu (Polygonati Odorati Rhizoma) to nourish. Severe cases benefit most from Huisheng Dan (Life-Restoring Pill); Ye Tianshi’s Shenxi Dan (Divine Calamity Pill), Xi Po Zhibao Dan (Rhinoceros Horn and Amber Precious Treasure Pill), and Wuji Wan (Limitless Pill) can also be considered. Cases not caused by lochia attacking upward but presenting with coma, delirium, or even mania belong to Phlegm Confusion; Shen Shi Liushen Tang (Shen's Six-Spirit Decoction) is most effective, and Xinding Niuhuang Qingxin Wan (Newly Formulated Cow-bezoar Heart-Clearing Pill) is also usable. Medication dosage must not be too light; prepare ample amounts but administer small doses frequently, stopping when the disease is addressed. Once heat subsides and latent pathogens lighten, restore deficiency. If one fears postpartum weakness and uses overly light medication, delaying three to four days may render the patient unable to tolerate the medicine.
3. Heat entering the Blood Chamber
Symptoms include clarity in the morning and confusion in the evening, worsening mental confusion at night, whispering in sleep, appearing to see ghosts; some may ignore direct conversation but hear and see events outside the door. This is because warm-heat scorches blood, exhausting it. The Liver stores blood and detests blood dryness; once Liver blood is dry, combined with Kidney Water exhaustion and Lung Metal dryness, Kidney Water fails to nourish, and Lung Metal fails to irrigate. Consequently, the Liver cannot store its Hun (Ethereal Soul), which flies outward, termed "Li Hun" (Departed Soul). With Li Hun, entry and exit lack timing, hence awareness of external events. Some patients feel their body has split into two lying together, also due to Li Hun. Zhang Zhongjing treated initial heat entering the Blood Chamber using Xiaochaihu Tang (Minor Bupleurum Decoction) to lead pathogens out. I have replaced Chaihu (Bupleuri Radix) with Qinghao (Artemisiae Annuae Herba), adding Shengdi, Danggui (Angelicae Sinensis Radix), Yuan Shen (Scrophulariae Radix), and Maidong (Ophiopogonis Radix) to nourish blood and rescue Yin; Shan Zhi (Gardeniae Fructus) and Zexie (Alismatis Rhizoma) guide Blood Chamber pathogens down to the Bladder as an exit route. For stasis in the lower abdomen with tenderness on pressure, add Chishao (Paeoniae Radix Rubra), Taoren, Biejia (Trionycis Carapax), and Guiban (Testudinis Carapax et Plastrum) to resolve stasis and nourish Yin. One must distinguish three scenarios: illness contracted during menstruation onset, illness contracted while menstruating, and illness contracted after menstruation ends, revealing excess or deficiency. If menstruation starts and heat traps blood causing stagnation, stasis is certain; observing pulling pain and tenderness in the waist, hypochondrium, and lower abdomen confirms the need for clearing heat and resolving stasis. If bowels move freely, use Xiaochaihu Tang removing Renshen (Ginseng Radix) and Dazao (Jujubae Fructus), adding fresh Shengdi, Taoren, Shanzha (Crataegi Fructus), Danpi (Moutan Cortex), or Xijiao (Rhinocerotis Cornu). If bowels are closed, use Tao Ren Cheng Qi Tang (Persicae Seed Rheum Decoction) adding Chuan Shan Jia (Manis Squama) and E Chong (Eupolyphaga Segmented Worm) to purge, especially adding Shengdi, Danggui, Yuan Shen, and Maidong to nourish blood and Yin, securing the root. If pathogenic heat transmits to the Ying (Nutrient) level, forcing reckless bleeding causing premature menstruation, symptoms include fever, irritability, and inability to lie down; clear heat to calm the Ying using Baihu Jia Shengdi Tang (White Tiger Plus Rehmannia Decoction), Ling Di Qingying Tang (Antelope Horn and Rehmannia Clearing Ying Decoction), or even Xijiao Dihuang Tang adding Huanglian (Coptidis Rhizoma) and Hupo (Electri Corium) as appropriate. If illness is contracted after menstruation ends, the Sea of Blood is empty, allowing pathogens to sink into deficiency; nourish Ying and clear heat using Dihuang Siwu Tang (Rehmannia Four-Substance Decoction) removing Chuanxiong (Ligustici Chuanxiong Rhizoma), adding Baiwei, Danpi, Sangye (Mori Folium), Yinhua/Hu (Lonicerae Japonicae Flos), and Digupi (Lycii Cortex) for light, clear, and moistening action. If accompanied by palpitations, cold limbs, and coma resembling death, use Sizini San combined with Baiwei Tang. If accompanied by manic-like mental state, Niuhuang San (Cow-bezoar Powder) is best. If accompanied by fullness and pain in the waist, hypochondrium, and lower abdomen, use Dachaihu Tang adding Taoren and Chishao to drive out Blood Chamber pathogens. If prolonged and unresolved, pathogens reverse to the Pericardium causing chest bi-pain (Blood Bi), known as Tao Shi's "Blood Binding Chest"; use Guizhi Honghua Tang (Cinnamon Twig and Carthamus Decoction) adding Haige Qiao (Concha Meretricis) and Taoren for acrid-warm unblocking. If binding below in the Blood Chamber causing lower abdominal distension and pain, use Xinjia Jiangfu Tang (Newly Added Crimson Recovery Decoction) adding Haihe Gu (Sepiae Endoconcha), Qian Gen (Rubiae Radix et Rhizoma), Yanhusuo (Corydalis Rhizoma), and Chuanlianzi (Toosendan Fructus) for acrid-moistening meridian unblocking. If latent pathogens erupt but menstruation proceeds normally, do not treat menstruation; treat only the latent pathogens, and the disease will resolve spontaneously. Since the disease did not invade the Blood Chamber, menstruation remains normal. Zhang Zhongjing’s statement "Do not violate Stomach Qi and the Upper Two Jiaos, and it will heal itself" refers precisely to this, not implying total abstinence from medication. In summary, for women with warm-heat diseases, if daytime clarity turns to nighttime delirium, inquire about the menstrual cycle to prevent the onset of Heat Entering the Blood Chamber.