沈（氏） 温邪初发。经水即至。寒热耳聋。干呕。烦渴饮。见症已属热入血室。前医见咳嗽脉数舌白。
为温邪在肺。用辛凉轻剂。而烦渴愈甚。拙见热深十三日不解。不独气分受病。况体质素虚。
面色黯惨。恐其邪陷痉厥。三日前已经发痉。五液暗耗。内风掀旋。岂得视为渺小之恙。议用
玉女煎两清气血邪热。仍有救阴之能。（热邪内陷液伤发痉）玉女煎加竹叶心。武火煎五分。
又 脉数。色黯。舌上转红。寒热消渴俱缓。前主两清气血。伏邪已得效验。大凡体质素虚。驱
邪及半。必兼护养元气。仍佐清邪。腹痛便溏。和阴是急。
白芍 炙草 人参 炒麦冬 炒生地
又 脉右数左虚。临晚微寒热。复脉汤去姜桂。
吴（氏） 热病十七日。脉右长左沉。舌痿饮冷。心烦热。神气忽清忽乱。经来三日患病。血舍内之热
气。乘空内陷。当以瘀热在里论病。但病已至危。从蓄血如狂例。（蓄血）
细生地 丹皮 制大黄 炒桃仁 泽兰 人中白
考热入血室。金匮有五法。第一条主小柴胡。因寒热而用。虽经水适断。急提少阳之邪。
勿令下陷为最。第二条。伤寒发热。经水适来。已现昼明夜剧。谵语妄见。恐人误认阳明实
病。故有无犯胃气。及上二焦之戒。第三条。中风寒热。经水适来。七八日。脉迟身凉。胸胁
满如结胸状。谵语者。显无表症。全露热入血室之候。自当急刺期门。使人知针力比药力
尤捷。第四条。阳明病。下血谵语。但头汗出。亦为热入血室。亦刺期门。汗出而愈。仲景无
非推展其义。教人当知通变。第五条。明其一症。而有别因为害。如痰潮上脘。昏冒不知。当
先化其痰。后除其热等语。所谓急者先除也。乃今人一遇是症。不辨热入之轻重。血室之
盈亏。遽与小柴胡汤。贻害必多。要之热甚而血瘀者。与桃仁承气。及山甲归尾之属。血舍
空而热陷者。用犀角地黄汤。加丹参木通之属。表邪未尽。而表症仍兼者。当合乎和解。热
轻而清药过投。气机致钝者。不妨借温通为使。血结胸有桂枝红花汤。参入海蛤桃仁之
治。昏狂甚。进牛黄膏。调入清气化结之煎。再观案中。有两解气血燔蒸之玉女法。热甚阴
伤。有育阴养气之复脉法。又有护阴涤热之缓攻法。先圣后贤。其治总条分缕析。学人审
症制方。慎毋拘乎柴胡一法也。（邵新甫）
徐评 向时阅此老亲笔医案。每多假借偏造之谈。而文理亦有不贯串处。今所刻诸案不但
文理通达。兼之笔力简净明达。近日时文家亦不能望其万一。不知原文本来如是。抑编辑之
人为之笔削也。
沈氏：温邪刚刚发作，月经随即来潮。出现恶寒发热、耳聋、干呕、心烦口渴想喝水的症状。这些表现已经属于热入血室证。前一位医生看到患者咳嗽、脉数、舌苔白，认为是温邪在肺，使用了辛凉轻剂治疗，结果导致心烦口渴更加严重。我认为热邪深入已十三天未解，不仅气分受病，况且患者体质素来虚弱，面色晦暗惨败，恐怕邪气内陷会导致痉厥。三天前已经发生过痉挛抽搐。体内的津液暗中耗损，内风旋动，怎么能把这看作是小毛病呢？建议用玉女煎两清气分和血分的邪热，同时具有救阴的功效。（热邪内陷，津液损伤引发痉挛）玉女煎加竹叶心。用武火煎煮，取五分药汁服用。
又诊：脉象数，面色晦暗，舌色转为红色，寒热、消渴症状都减轻了。之前主治两清气血，伏邪已经见效。大凡体质素虚的人，驱除一半邪气时，必须兼顾护养元气，仍辅以清解邪气。现在出现腹痛、大便溏稀，调和阴液是当务之急。
处方：白芍、炙甘草、人参、炒麦冬、炒生地。
又诊：右脉数，左脉虚，傍晚时有轻微寒热。用复脉汤去掉生姜、肉桂。
吴氏：热病十七天。右脉长，左脉沉。舌体痿软，喜饮冷水。心烦发热，神志时而清醒时而混乱。患病前三天月经来潮，血舍内的热气乘虚内陷。应当按瘀热在里的病机来论治。但病情已经危重，参照蓄血如狂的病例处理。（蓄血证）
处方：细生地、丹皮、制大黄、炒桃仁、泽兰、人中白。
考证热入血室证，《金匮要略》中有五种治法。第一条主用小柴胡汤，因有寒热往来而使用，虽然月经刚断，急提少阳之邪，不让其下陷最为关键。第二条，伤寒发热，月经正来，已经出现白天清醒晚上加重、谵语妄见的症状，恐人误认为阳明实证，所以有无犯胃气及上二焦的戒律。第三条，中风寒热，月经正来，七八天后脉迟身凉，胸胁满闷像结胸状，有谵语的，明显没有表证，完全显露热入血室的征候，自然应当急刺期门穴，让人知道针刺的力量比药力更快捷。第四条，阳明病，下血谵语，只有头部出汗，也是热入血室，也刺期门穴，汗出而愈。仲景无非是推展其义理，教导人们应当懂得通变。第五条，明确其中一种症状，而有其他病因危害，比如痰涎涌盛于上脘，昏冒不知人事，应当先化解痰涎，后清除热邪等话语。所谓紧急者先处理。然而如今的人一遇到这种病症，不辨别热入的轻重、血室的盈亏，就匆忙给予小柴胡汤，贻害必然很多。总之，热盛而血瘀的，用桃仁承气汤及穿山甲、当归尾之类；血舍空虚而热邪内陷的，用犀角地黄汤，加丹参、木通之类；表邪未尽，表证仍兼有的，应当合乎和解之法；热轻而清热药过投，导致气机迟钝的，不妨借用温通药作为引导。血结胸可用桂枝红花汤，参入海蛤、桃仁的治疗；昏狂严重的，进服牛黄膏，调入清气化结的煎剂。再观察医案中，有两解气血燔蒸的玉女煎法；热盛阴伤的，有育阴养气的复脉汤法；又有护阴涤热的缓攻法。先圣后贤，他们的治疗总归条理分明。学习的人审察症状制定方剂，千万不要拘泥于柴胡这一种方法啊。（邵新甫评）
徐灵胎评：以前阅读这位老先生的亲笔医案，往往多有假借偏造之谈，而且文理也有不通顺的地方。现在刊刻的这些医案不但文理通达，而且笔力简净明达，近日写八股文的人也赶不上他万一。不知道原文本来就是这样，还是编辑的人进行了删改润色。
Shen (Case): When the warm pathogen initially manifested, menstruation arrived simultaneously. Symptoms included chills and fever, deafness, dry retching, irritability, thirst with desire to drink. These manifestations already belong to Heat Entering the Blood Chamber (Re Ru Xue Shi). The previous physician observed cough, rapid pulse, and white tongue coating, diagnosing Warm Pathogen in the Lung, and used a mild acrid-cool formula (Xin Liang Qing Ji), which exacerbated the irritability and thirst. My opinion is that deep heat has persisted for thirteen days without resolution; not only is the Qi level affected, but the patient also has a constitutionally weak physique, with a dark and sallow complexion. There is fear of pathogen sinking leading to spasms and syncope (Jing Jue). Spasms occurred three days ago. Body fluids are secretly consumed, stirring internal wind (Nei Feng). How can this be regarded as a trivial ailment? It is proposed to use Yujun Decoction (Yujun Jian) to clear both Qi and Blood levels of pathogenic heat, while possessing the ability to rescue Yin. (Heat pathogen sinking internally, fluid injury causing spasms). Yujun Decoction plus Zhu Ye Xin (Bamboo Leaf Heart). Decoct with vigorous fire, take 5 fen of the decoction.
Second visit: Pulse is rapid, complexion is dark, tongue turns red. Chills, fever, and excessive thirst have all alleviated. Previously treating both Qi and Blood clearing showed efficacy against latent pathogens. Generally, for those constitutionally weak, when expelling half the pathogen, one must concurrently protect Yuan Qi (Original Qi), still assisting with clearing pathogens. Now presenting with abdominal pain and loose stools, harmonizing Yin is urgent.
Prescription: Bai Shao (Radix Paeoniae Alba), Zhi Cao (Prepared Licorice Root), Ren Shen (Ginseng Radix), Chao Mai Dong (Fried Ophiopogon Tuber), Chao Sheng Di (Fried Rehmannia Root).
Third visit: Right pulse rapid, left pulse deficient. Slight chills and fever in the late afternoon. Use Fumai Decoction (Fumai Tang) removing Jiang (Ginger) and Gui (Cinnamon Twig).
Wu (Case): After seventeen days of febrile disease. Right pulse long, left pulse sunken. Tongue flaccid, preference for cold drinks. Irritability and heat. Spirit fluctuates between clarity and confusion. Menstruation began three days prior to illness onset. Heat within the Blood Chamber took advantage of the void to sink inward. This should be discussed as Stasis-Heat residing inside. However, the condition is critical; follow the example of Accumulated Blood (Xu Xue) with mania. (Accumulated Blood Syndrome)
Prescription: Xi Sheng Di (Fine Rehmannia Root), Dan Pi (Moutan Cortex), Zhi Da Huang (Prepared Rhubarb Rhizome), Chao Tao Ren (Fried Peach Seed), Ze Lan (Herba Lycopi), Ren Zhong Bai (Calcinatus Human Bone Ash).
Examining Heat Entering the Blood Chamber, *Jin Gui Yao Lue* presents five methods. The first primarily uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) due to alternating chills and fever. Although menstruation has just ceased, urgently extracting Shaoyang pathogen to prevent downward sinking is paramount. The second: Taiyang cold damage with fever, menstruation arriving, already showing daytime lucidity and nighttime exacerbation, delirium and hallucinations. To avoid misdiagnosing as Yangming excess, there are warnings against violating Wei Qi and the Upper Two Jiao. The third: Wind-stroke with chills and fever, menstruation arriving, after seven to eight days, slow pulse, cool body, chest and hypochondriac fullness resembling Jie Xiong syndrome, with delirium. Clearly no exterior syndrome remains, fully revealing Heat Entering the Blood Chamber signs. One should urgently puncture Qi Men (LR14), demonstrating acupuncture's superiority over herbal medicine. The fourth: Yangming disease, bleeding, delirium, only head sweating, also Heat Entering the Blood Chamber, also puncturing Qi Men, resolving with sweating. Zhang Zhongjing merely expanded the meaning, teaching adaptability. The fifth: Clarifying one symptom while addressing other harmful causes, such as phlegm flooding the upper Jiao causing coma, requiring phlegm resolution before heat clearance. This is "treating the urgent first." Yet today's physicians, upon encountering this syndrome, do not distinguish the severity of heat entry or the fullness/emptiness of the Blood Chamber, rashly administering Xiao Chai Hu Tang, inevitably causing harm. In summary, for severe heat with blood stasis, use Tao Ren Cheng Qi Tang (Peach Kernel Major Order the Middle Decoction) and species like Shan Jia (Pangolin Scale) and Gui Wei (Angelica Sinensis Tail); for empty Blood Chamber with heat sinking, use Xi Jiao Di Huang Tang (Rhinoceros Horn Rehmannia Decoction) adding Dan Shen (Salvia Miltiorrhiza Root) and Mu Tong (Akebia Caulis); for incomplete exterior pathogen with remaining exterior symptoms, adhere to Harmonizing methods; for mild heat with overuse of cooling herbs causing sluggish Qi mechanism, borrowing warm-acrid agents as guides is acceptable. For Blood Stasis Chest, Guizhi Hong Hua Tang (Cinnamon Twig and Safflower Decoction) added with Hai Ge (Clam Shell) and Tao Ren; for severe coma and mania, administer Niu Huang Gao (Calculus Bovis Paste) mixed with Qi Qing Hua Jie decoctions. Observing the cases, there is the Yujun method for dual-clearing Qi and Blood blazing heat; for severe heat injuring Yin, the Fumai method for nourishing Yin and supporting Qi; and the gentle purging method for protecting Yin and washing away heat. Ancient sages and later worthies, their treatments are always meticulously analyzed. Students examining symptoms and prescribing must not be confined to the single method of Chai Hu (Bupleurum). (Comment by Shao Xinpu)
Xu's Commentary: In the past, reading this old master's handwritten medical cases, I often found borrowed or fabricated discussions, and the literary flow was sometimes disjointed. The currently published cases not only have coherent prose but also concise and clear writing style, surpassing even recent essayists. I wonder if the original text was thus, or if the editor performed revisions.