一、瘥后昏沉 伤寒后无寒热杂症。但渐变神昏不语。或睡中独语一二句。目赤唇焦舌干。不饮水。
将稀粥与之。则咽。不与。则不思。心下无痞。心中不满。大小便如常。形貌如醉人。此热传手
少阴心经也。心火熏肺。所以神昏。名曰越经症。宜陶氏导赤各半汤。胃口有热。虚烦有热者。竹
叶石膏汤加生姜。
一、余热不退 伤寒余热不退。通用小柴胡调之。尿赤涩者。柴芩汤。
刘河间云。伤寒后虚热不已。白虎加苍术、人参。一服如神。汗止身凉。此通神之法也。如此
则汗下后热不退。不问有汗无汗。俱宜白虎加苍术、人参解之。最妙。伤寒后六经余热不退。宜加
减凉膈散。余热盛。或发狂言。辰砂益元散。
发热后。热不解。脉尚浮者。苍术白虎汤。
【纲】仲景曰。妇人中风。发热恶寒。经水适来。得之七八日。热深而脉迟。身凉。胸胁下满。
如结胸状。谵语者。此为热入血室也。当刺期门。随其实而泻之。
【目】许叔微曰。一妇人患热入血室。医者不识。用补血调气药。延养数日。遂成血结胸。或
劝用前药。予曰。小柴胡已
迟。不可行也。无已。则有一焉。剌期门穴。果愈。或问。热入血室何为而成血结胸也。曰。邪气
传入经络。与正气相搏。上下流行。或遇经水适来适断。邪气乘虚而入血室。血为邪逼。上入肝经。
肝受邪则谵语而见鬼。复入膻中。则血结于胸也。何则。妇人平居。水当养木。血当养肝。方未
受孕。则下行以为经水。既妊。则中蓄以养胎。既产。上壅以为乳。皆此血也。今肝气蓄血。并归
肝经。聚于膻中。结于乳下。故手触之则痛。非汤剂可及。故当刺期门也。
【纲】仲景曰。妇人伤寒发热。经水适来。昼日明了。暮则谵语。如见鬼状。此为热入血室。
无犯胃气。及上中二焦。必自愈。
【目】成无己曰。此则不须治而自愈者也。盖经水适来。以里无留邪。但不妄犯。热随血散。
故自愈。经曰。血自下。下者愈。故只须无犯胃气及上中焦也。所谓妄犯者。盖恐以谵语为阳明内
实。攻之。犯其胃气也。此无胸胁之邪。刺期门。恐犯其中焦也。此无血结。与小柴胡。恐犯其上
焦也。小柴胡解散。则动卫气。卫出上焦。动卫气是犯上焦也。刺期门。则动荣气。荣出中焦。动
荣气是犯中焦也。
楼英曰。一妇人温病已十二日。诊其脉六七至而涩。寸稍大。尺稍小。发寒热。颊赤口干。不
了了。耳聋。病数日。经水乃行。此属少阳热入血室也。若治不对病。则必死。用按其症。与小柴
胡服之。二日。又与此汤加桂、干姜。寒热遂止。又云。我脐下急痛。又与抵当丸微利。脐下痛痊。
身渐凉。脉渐匀。尚不了了。仍与小柴胡。次日又云。我但胸中热燥。口鼻干。又少与调胃承气汤。
不得利。次日。又与大陷胸丸半服。利三行。次日。虚烦不乐。亦有所见。时复狂言。虽知其尚有
燥屎。以极虚不敢攻。遂与竹叶汤去其烦热。其夜大便通。下燥屎数枚。而狂言虚烦尽解。但咳唾。
此肺虚也。恐乘虚而成肺痿。遂与小柴胡。去人参、姜、枣。加干姜、五味而愈。以上皆用仲景方。
柯琴曰。前言中风。此言伤寒。见妇人伤寒中风。皆有热入血室症也。
【纲】仲景曰。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。
【目】成无己曰。此须治而愈者也。夫谵语为病邪之甚者。何不类治而愈耶。且胸胁满如结胸
状。谵语。是邪气留结于胸胁而不去者。故必刺期门。随其实而泻也。寒热如疟。是邪留于内。故
血结不行。故须散之也。
张云岐曰。妇人伤寒中风。自汗头痛。项背强。发热恶寒。脉浮而缓。恐热入血室。故倍加芍
药。宜桂枝加芍药汤。妇人伤寒。脉浮而紧。头痛身热。恶寒无汗。发汗。恐热入血室。宜麻黄加
生地黄汤。妇人伤寒身热。脉长而弦。属阳明少阳。往来寒热。夜躁昼宁。如见鬼状。经水适断。
热入血室。不实满者。小柴胡加牡丹皮汤。大实满者。桃仁承气汤。妇人伤寒。头痛脉浮。医反下
之。邪气乘虚而传于里。经水闭不行。心下结硬。口燥舌干。寒热往来。狂言如见鬼状。脉沉而数
者。当下之。宜小柴胡加芒硝大黄汤。
楼英曰。妇人伤寒。经水适来初断。寒热如疟。狂言见鬼。干姜柴胡汤。
庞安常曰。妇人室女。伤寒发热。经水适来适断。昼日明了。夜则谵语。如见鬼状。宜小柴胡
加生地黄汤。亦治产后恶露方来。忽间断欲死。妇人伤寒表虚自汗。身凉。四肢拘急。脉沉而迟。
太阳标病。少阳本病。经水适断。宜桂枝加附子红花汤。
一、瘥后昏沉：伤寒病痊愈后，没有寒热等夹杂症状。只是逐渐出现神志昏迷、不能言语，或者在睡眠中独自说一两句话，眼睛发红、嘴唇焦裂、舌头干燥，但不想喝水。如果给喝稀粥，就会吞咽；如果不给，就不想吃。心窝下没有痞塞感，心中也没有胀满感，大小便正常，外貌神态像喝醉的人。这是热邪传入手少阴心经所致。心火熏蒸肺脏，所以导致神志昏迷，这种病症称为“越经症”。适宜使用陶华（陶节庵）的导赤各半汤。如果是胃口有热、因虚而烦热的情况，可用竹叶石膏汤加生姜。
二、余热不退：伤寒病后余热未清不退，通用小柴胡汤来调理。小便赤红涩痛者，用柴芩汤。刘完素（刘河间）说：伤寒后虚热不止，用白虎加苍术人参汤，服一次如神效，汗止身凉，这是通神的妙法。像这样，发汗或攻下后热仍不退，无论有汗无汗，都适宜用白虎加苍术人参汤来解热，最为精妙。伤寒后六经余热不退，适宜用加减凉膈散。如果余热炽盛，或者出现胡言乱语，用辰砂益元散。发热后，热势不解，脉象仍然浮的，用苍术白虎汤。
【纲】张仲景说：妇女患中风，发热恶寒，月经适来，患病七八天，热邪深入而脉迟，身体凉爽，胸胁下胀满，像结胸证的样子，伴有谵语，这是热入血室证。应当针刺期门穴，根据其实证情况泻其邪气。
【目】许叔微说：有一位妇人患热入血室证，医生不认识，用了补血调气的药物，拖延调养数日，最终形成了血结胸。有人劝我用前面的药方，我说：用小柴胡汤已经太迟，不可行不通了。不得已，只有一个办法，就是刺期门穴，果然治愈。有人问：热入血室为什么会形成血结胸呢？回答说：邪气传入经络，与正气相搏，上下流行，如果遇到月经适来或适断，邪气乘虚进入血室。血液被邪气逼迫，向上进入肝经。肝受邪气则出现谵语和见鬼的症状，再进入膻中，则血液结于胸部。为什么呢？妇女平时，水应当滋养木（肝），血应当滋养肝。在未受孕时，血液下行成为月经；怀孕后，血液蓄积在中焦以养胎；分娩后，血液上壅成为乳汁，都是这些血。现在肝气蓄积血液，一并归入肝经，聚于膻中，结于乳下，所以手触摸时会疼痛，这不是汤剂可以达到的，所以应当针刺期门穴。
【纲】张仲景说：妇女患伤寒发热，月经适来，白天神志清楚，晚上则谵语，像看见鬼怪一样，这是热入血室证。不要侵犯胃气，以及上焦和中焦，必定自愈。
【目】成无己说：这属于不需要治疗而能自愈的病证。因为月经适来，体内没有留滞的邪气，只要不妄加干预，热随血液消散，所以自愈。医经说：血自行下泄，下泄者自愈。所以只需不侵犯胃气及上中焦即可。所谓妄犯，是担心把谵语误认为是阳明腑实证而攻下，从而侵犯胃气。这里没有胸胁部的邪气，若刺期门穴，恐怕侵犯其中焦。这里没有血结，若与小柴胡汤，恐怕侵犯其上焦。小柴胡汤具有解散作用，会扰动卫气，卫气出于上焦，扰动卫气就是侵犯上焦。刺期门穴，会扰动营气，营气出于中焦，扰动营气就是侵犯中焦。
楼英说：一位妇人患温病已十二天，诊察其脉搏六七至且涩，寸脉稍大，尺脉稍小，发寒热，脸颊红赤口干，神志不清，耳聋。患病数日后，月经才来。这属于少阳热入血室证。如果治疗不对症，必然死亡。根据其症状，给予小柴胡汤服用。两天后，又给予此汤加桂枝、干姜，寒热随即停止。又说：“我脐下急痛。”又给予抵当丸轻微通便，脐下疼痛痊愈，身体逐渐变凉，脉象逐渐均匀，但神志仍不清爽。仍给予小柴胡汤。第二天又说：“我只觉得胸中热燥，口鼻干燥。”又少量给予调胃承气汤，未能通便。第二天，又给予大陷胸丸半服，排便三次。第三天，出现虚烦不乐，偶尔有所幻觉，时而胡言乱语。虽然知道体内还有燥屎，但因极度虚弱不敢攻下，于是给予竹叶汤去除其烦热。当晚大便通畅，排出数枚燥屎，胡言乱语和虚烦全部解除，只剩下咳嗽吐痰，这是肺气虚的表现，恐怕趁虚发展成肺痿，于是给予小柴胡汤，去掉人参、生姜、大枣，加入干姜、五味子而痊愈。以上均使用张仲景的方剂。
柯琴说：前面说的是中风，这里说的是伤寒，说明妇女患伤寒和中风，都有热入血室的证候。
【纲】张仲景说：妇女患中风，七八天后，持续出现寒热，发作有定时，月经刚断绝，这是热入血室证。其血液必然凝结，所以使病情像疟疾一样，发作有定时，以小柴胡汤主治。
【目】成无己说：这属于需要治疗才能痊愈的病证。谵语是病邪严重的表现，为什么不归类治疗而自愈呢？况且胸胁胀满像结胸状，伴有谵语，是邪气留结于胸胁而不散去，所以必须刺期门穴，随其实证而泻之。寒热像疟疾，是邪气留于内，所以血液凝结不行，所以必须疏散它。
张云岐说：妇女患伤寒中风，自汗头痛，项背强直，发热恶寒，脉浮而缓，恐热入血室，所以加倍芍药，适宜用桂枝加芍药汤。妇女患伤寒，脉浮而紧，头痛身热，恶寒无汗，发汗后，恐热入血室，适宜用麻黄加生地黄汤。妇女患伤寒身热，脉长而弦，属阳明少阳，往来寒热，夜间烦躁白天安宁，像看见鬼怪一样，月经刚断绝，热入血室，腹部不实满的，用小柴胡加牡丹皮汤。腹部大实满的，用桃仁承气汤。妇女患伤寒，头痛脉浮，医生反而用攻下法，邪气乘虚传入里部，月经闭止不行，心下结硬，口燥舌干，寒热往来，胡言乱语像看见鬼怪一样，脉沉而数的，应当攻下，适宜用小柴胡加芒硝大黄汤。
楼英说：妇女患伤寒，月经适来初断，寒热像疟疾，胡言乱语见鬼，用干姜柴胡汤。
庞安常说：妇女少女，患伤寒发热，月经适来适断，白天神志清楚，夜晚则谵语，像看见鬼怪一样，适宜用小柴胡加生地黄汤。也治疗产后恶露方来，忽然间断欲死的症状。妇女患伤寒表虚自汗，身体凉爽，四肢拘急，脉沉而迟，太阳标病，少阳本病，月经刚断绝，适宜用桂枝加附子红花汤。
1. Post-recovery Drowsiness: After the recovery from Shanghan (Cold Damage), there are no mixed symptoms of chills and fever. Instead, there is a gradual onset of mental confusion and mutism, or speaking alone for one or two sentences during sleep. The eyes are red, lips are cracked and dry, and the tongue is dry, yet there is no desire to drink water. If thin rice gruel is offered, it will be swallowed; if not, there is no desire to eat. There is no epigastric fullness or oppression, nor chest distension. Bowel and bladder functions are normal. The appearance resembles that of a drunk person. This indicates that heat has transmitted to the Hand-Shaoyin Heart Meridian (Hand-Shaoyin Heart Channel). Heart fire steaming the Lungs causes mental confusion. This condition is named "Yuejing Syndrome" (Cross-Meridian Syndrome). It is appropriate to use Tao's Daodi Geban Decoction (Half-Guide-Heart-Decoction by Tao Hua). For cases with heat in the stomach appetite and deficiency-related vexation due to heat, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) with added fresh ginger is indicated.
2. Lingering Residual Heat: For residual heat after Shanghan that does not subside, Xiaochaihu Tang (Minor Bupleurum Decoction) is generally used to regulate. If urine is dark and painful/difficult to pass, Chaiqin Tang (Bupleurum and Scutellaria Decoction) is used. Liu Wansu (Liu Hejian) stated: For persistent deficiency-heat after Shanghan, Baihu Jia Cangzhu Renshen Tang (White Tiger Decoction plus Atractylodes Macrocephala and Ginseng) acts miraculously after one dose, stopping sweating and cooling the body. This is a divine method. In such cases, whether sweating or non-sweating, if heat persists after diaphoresis or purgation, Baihu Jia Cangzhu Renshen Tang should be used to resolve the heat, which is most excellent. For lingering residual heat in the Six Channels after Shanghan, Jiajian Liangge San (Modified Cool Chest Powder) is indicated. If residual heat is severe or delirium occurs, Chensha Yiyuan San (Cinnabar and Yi Yuan Powder) is used. If fever persists without resolution and the pulse remains floating, Cangzhu Baihu Tang (Atractylodes Macrocephala White Tiger Decoction) is indicated.
[Gang] Zhang Zhongjing said: When a woman suffers from Fengzhong (Wind Strike) with fever and aversion to cold, and her menses happen to commence, after seven or eight days, if the heat is deep and the pulse is slow, the body is cool, there is fullness below the chest and hypochondrium resembling Jiechesth (Binding Chest Syndrome), accompanied by delirium, this is Re Ru Xu Shi (Heat Entering the Blood Chamber). One should puncture Qimen (LR 14) acupoint and drain according to the excess pattern.
[Mu] Xu Shuaiwei said: A woman suffered from Heat Entering the Blood Chamber. The physician failed to recognize it and administered blood-nourishing and qi-regulating herbs. After several days of nursing care, it developed into Blood Binding Chest. Someone advised using the aforementioned formula. I said: Using Xiaochaihu Tang is now too late and ineffective. If forced, there is only one option: puncture the Qimen acupoint. Indeed, she recovered. Asked why Heat Entering the Blood Chamber becomes Blood Binding Chest, I replied: Pathogenic factors enter the meridians and contend with healthy Qi, circulating up and down. If coinciding with menstruation commencing or ceasing, pathogens enter the Blood Chamber vacuously. Blood is forced by pathogens upward into the Liver Meridian. The Liver receiving pathogens causes delirium and hallucinations of seeing ghosts. Further entering the Danzhong (Conception Vessel/Center of Chest), blood binds in the chest. Why? Normally, Water nourishes Wood (Liver), and Blood nourishes the Liver. Before pregnancy, blood descends as menstruation; during pregnancy, it accumulates centrally to nourish the fetus; after childbirth, it rises to become milk. All are this blood. Now, Liver Qi and accumulated blood return to the Liver Meridian, gathering at Danzhong and binding below the breasts, causing pain upon touch. This cannot be reached by decoctions, hence puncturing Qimen is necessary.
[Gang] Zhang Zhongjing said: When a woman suffers from Shanghan with fever, and her menses happen to commence, she is clear-minded during the day but delirious at night, appearing to see ghosts. This is Heat Entering the Blood Chamber. Do not violate the Stomach Qi, nor the Upper and Middle Jiao (Burners); it will heal itself.
[Mu] Cheng Wuji said: This is a condition that heals without treatment. Because menstruation has commenced, there is no stagnant pathogen internally. As long as one does not act rashly, the heat dissipates with the blood, thus healing itself. The Classic states: "If blood flows downward, the patient heals." Therefore, one need only avoid violating Stomach Qi and the Upper/Middle Jiao. What constitutes rash violation? Fearing delirium indicates Yangming Interior Excess and attacking it would violate Stomach Qi. Here, there is no pathogen in the chest/hypochondrium; puncturing Qimen might violate the Middle Jiao. Here, there is no blood binding; giving Xiaochaihu Tang might violate the Upper Jiao. Xiaochaihu Tang disperses and moves Wei Qi (Defensive Qi), which originates from the Upper Jiao; moving Wei Qi violates the Upper Jiao. Puncturing Qimen moves Ying Qi (Nutritive Qi), which originates from the Middle Jiao; moving Ying Qi violates the Middle Jiao.
Lou Ying said: A woman suffered from Wenbing (Warm Disease) for twelve days. Her pulse was rapid (6-7 beats per breath) and choppy, Cun slightly large, Chi slightly small. She had alternating chills and fever, red cheeks, dry mouth, unclear consciousness, and deafness. Several days later, her menses began. This belongs to Shaoyang Heat Entering the Blood Chamber. If treated incorrectly, death is certain. Based on symptoms, Xiaochaihu Tang was given. Two days later, Gui Zhi (Cinnamon Twig) and Gan Jiang (Dried Ginger) were added to the same decoction, and chills/fever stopped. She then complained of urgent pain below the umbilicus. Didang Wan (Marquis Dang Pill) was given to induce mild purgation, curing the pain. Body temperature gradually normalized, pulse became even, but consciousness remained unclear. Xiaochaihu Tang was continued. The next day, she reported heat and dryness in the chest, and dry nose/mouth. A small amount of Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) was given, but no stool passed. The next day, half a dose of Daxiexiong Wan (Major Binding Chest Pill) was given, resulting in three bowel movements. The next day, she exhibited deficiency-vexation, unhappiness, occasional hallucinations, and intermittent delirium. Although dry feces were suspected, aggressive purgation was avoided due to extreme deficiency. Zhuye Tang (Bamboo Leaf Decoction) was given to remove vexation and heat. That night, bowels moved freely, passing several pieces of dry feces. Delirium and vexation resolved completely. Only coughing and sputum remained, indicating Lung Deficiency. To prevent progression to Fei Wei (Lung Atrophy) due to deficiency, Xiaochaihu Tang was modified by removing Renshen (Ginseng), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube), adding Gan Jiang (Dried Ginger) and Wu Wei Zi (Schisandra) until cure. All above used formulas from Zhang Zhongjing.
Ke Qin said: The previous text mentioned Fengzhong, this mentions Shanghan, indicating that both Wind Strike and Cold Damage in women can present with Heat Entering the Blood Chamber.
[Gang] Zhang Zhongjing said: When a woman suffers from Fengzhong, after seven or eight days, if she continues to experience chills and fever occurring at specific times, and her menses have just ceased, this is Heat Entering the Blood Chamber. The blood must be bound, causing symptoms resembling malaria with periodic occurrence. Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary treatment.
[Mu] Cheng Wuji said: This requires treatment to heal. Delirium indicates severe pathogenic invasion; why does it not follow similar treatment patterns to heal? Fullness in the chest/hypochondrium resembling Jiechesth and delirium indicate pathogens lingering and binding in the chest/hypochondrium, necessitating puncture of Qimen to drain excess. Chills and fever resembling malaria indicate pathogens lingering internally, causing blood binding and stagnation, requiring dispersion.
Zhang Yunqi said: For women with Shanghan/Fengzhong presenting with spontaneous sweating, headache, stiffness of neck/back, fever, aversion to cold, and floating/slow pulse, fearing Heat Entering the Blood Chamber, increase Baishao (White Peony Root) dosage. Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony) is indicated. For women with Shanghan, floating/tight pulse, headache, fever, aversion to cold, anhidrosis, after inducing sweating, fearing Heat Entering the Blood Chamber, Mahuang Jia Shengdihuang Tang (Ephedra Decoction plus Rehmannia) is indicated. For women with Shanghan, fever, long/chord-like pulse, belonging to Yangming/Shaoyang, with alternating chills/fever, nighttime irritability/daytime calm, hallucinations, ceased menses, Heat Entering the Blood Chamber, if abdomen is not full/excess, Xiaochaihu Tang plus Mudanpi (Tree Peony Bark) is indicated. If abdomen is significantly full/excess, Taoren Chengqi Tang (Peach Kernel Decoction to Order the Qi) is indicated. For women with Shanghan, headache, floating pulse, mistakenly treated with purgation, pathogens enter interior vacuously, menses stop, epigastric hardness, dry mouth/tongue, alternating chills/fever, delirium/hallucinations, sinking/rapid pulse, purgation is required. Xiaochaihu Tang plus Mangxiao (Mirabilite) and Dahuang (Rhubarb) is indicated.
Lou Ying said: For women with Shanghan, menses just commencing/ceasing, chills/fever like malaria, delirium/hallucinations, Ganjiang Chaihu Tang (Dried Ginger and Bupleurum Decoction) is used.
Pang Anchang said: For young unmarried women with Shanghan fever, menses commencing/ceasing, clear-minded by day, delirious by night, hallucinations, Xiaochaihu Tang plus Shengdihuang (Rehmannia) is indicated. It also treats postpartum lochia that suddenly stops dangerously. For women with Shanghan, exterior deficiency with spontaneous sweating, cool body, limb rigidity, sinking/slow pulse, Taiyang Mark Disease, Shaoyang Root Disease, ceased menses, Guizhi Jia Fuzi Honghua Tang (Cinnamon Twig Decoction plus Aconite and Safflower) is indicated.