伏暑烦热，舌赤神昏谵妄，此邪巳入营。宜用玉
女煎加羚角、元参、沙参、鲜石斜、鲜菖蒲、牛黄丸
等味，清营透邪也。
上条将欲传营，此条已传营分。故热而烦乱，舌赤昏谵，
非用玉女煎之生地、石膏、知母，麦冬、沙参，元参。菖
蒲、郁金、牛黄丸清营透邪，必致热陷入血，而成痉厥之险
焉。 ，
颤，此邪已入血，热动风生。宜用犀角地黄汤加元参
心、连翘心、鲜石斛、鲜菖蒲，紫草、竹叶，至宝丹
等味，凉血化邪也。
凡营熟不解，必致入血。舌黑尖绎，斑紫昏谵，血热己
极，热极则阴损阳亢，风由振动，故肢体颤摇，将欲便痉。
必用犀角、生地、丹皮，赤芍、紫草凉血清热，合连翘、元
参、菖莆，石斛化斑养津，兼竹叶，至宝清心镇神，不致痉
厥，便为佳兆。
伏暑妇女，舌绎□渴，脉数而涩，经水适来适
断，寒热如疟，昼则明了，夜则谵语，此热入血室。
宜用小柴胡汤加山楂、归尾、赤芍，桃仁、丹皮等
味，破血透邪也。
几热入血室，（金柜）论之最详。血室者，即血海也。
本厉冲脉，隶于阳明。（内经）所谓冲为血海，任主胞胎。
又谓冲脉起于中极底，循少腹，上至胸中而散。任脉亦起于
中极底，循毛际，绕阴器，入少旗，上环口唇，荣于髭须。
故妇女无须者，以任脉之血下泄，不能上荣于口唇也。督脉
亦由中极挟腰循脊，上至巅顶。此冲、督、任三脉，皆会于
下极，而分行于背腹。故督脉行于身之背，任脉行于身之
腹，冲脉行于背腹之中。其天癸盈余，诸路之血，皆伫于血
海。而能蓄泄有常者，以任脉为之担任，督脉为之总督，带
脉为之收束。更有阳维、阴维，维持阴阳于身之前。阳跷，
阴跷，跷健机关于身之左右。故能蓄则有度，泄则有期，与
月盈亏，循序流行，不失其常，谓之为经。若血海无权，任
督失司，则或崩漏无休，或蓄结不行。至于血之蓄泄，或寒
或热，皆能为患。故伤寒蓄血，六经皆有，不独膀胱与胸腹
间也。盖凡风寒暑湿之来，必先阳经，而后他传。阳经者，
在表、在卫、在气，渐传于血。故妇女之病，有值经水适
来，病发适断者，因热与血冱，反不得行也。如太阳初起之
头痛发热，恶寒无汗，便奇鼻衄、肌衄，此太阳经之邪干血
分也。宜以开泄透汗，不可因见血而遽用寒凉，反成血结胸
等症。若少腹硬痛，小便自利，大便黑色，身热烦躁，谵语
如狂，此太阳腑病，而蓄血膀胱也。仲景先师，恐后人误认
热结膀胱，故以小便不利者为热结，小便自利者为蓄血。例
用桃仁承气汤，一解太阳;一破瘀血。又阳明初起之目痛。
鼻干、不得卧，而致鼻衄吐血，此阳明经之邪干血分也，宜
以两清气血，不可因汗少而更大发之。如少腹硬痛，小便自
利，上为结胸，或吐血，下为腹痛，或便血，身热狂妄，状
如神附，此阳明腑病，而蓄血冲脉也。宜用犀角地黄汤，一
清阳明，一祛瘀血。又少阳之额痛胁疼，寒热耳聋，呕苦，
而致鼻衄咳血，此少阳经之邪干血分也。宜以小柴胡汤清泄
胆络，不可因见血而妄投滋腻。如有少腹痛，小便自利，大
便黑色，昼则明了，夜则谵语，寒热如疟，此少阳腑病，而
蓄血肝络也。宜用陶氏小柴胡汤加生地，归尾、桃仁、山楂、
丹皮，一清少阳，一破瘀血。以上皆论三阳经之经病腑病
蓄血见症也。至热邪传入三阴，则少阴心主血，太阴脾统
血，厥阴肝藏血。邪既入血，则热与血凝，势难清化，必致
舌绎神昏，昼明夜剧，状如邪祟，宜用犀角地黄汤加郁金、
菖蒲。甚则腹痛便黑，仲景用抵当汤，以攻热破瘀，庶几可
以两解矣。然此症不特妇女，即男子亦有诸。至于治法，大
约相等。以蓄血一症，概用小柴胡加破血之品，如或不应，
视为无法，竟置束手，医者咎焉、愿有鉴于是者。予于道光
十九年春，有舵工张姓者，自三月间温病愈后，饮食如常，
惟腰间作痛，始疑病后肾虚，投以补肾，其痛益甚，转邀外
科，认为肾俞发，而投阳和汤数剂，病仍不减，且无肿形。
其痛每甚于午后，剧于戌亥，呼号不绝，直至天明，其痛若
失。一月以来，无所不至，而痛仍不减。此时阅喻氏（医门
法律），至（寓意草）中，有病腰痛，将成偻废一案。嘉言
谓热邪逗留太阳经脉，与血凝滞，结于腰间，即用桃仁承气
数服而安。读之恍然大悟，如法投治，果获痛愈。此太阳经
血结之一症也。后有外甥范姓者，湿温病后，亦腰痛异常，
曾服补肾不应。予却用安桂、桃仁、山甲、归须、旋复、新
绎等味，二剂顿愈。此可见为医者，必旁搜博采，以广见
闻，则勿贻管窥之消矣。
伏暑病出现心烦发热，舌质红赤，神志昏迷并胡言乱语，这是邪气已经传入营分。适宜使用玉女煎加入羚羊角、玄参、沙参、鲜石斛、鲜石菖蒲、牛黄丸等药物，以清解营分热邪并透达邪气外出。
上一条论述的是邪气即将传入营分，这一条论述的是邪气已经传入营分。因此出现发热且烦躁混乱，舌质红赤、神志昏蒙胡言乱语，如果不使用玉女煎中的生地、石膏、知母、麦冬、沙参，以及玄参、石菖蒲、郁金、牛黄丸来清解营分热邪并透达邪气，必然会导致热邪陷入血分，形成痉厥（抽搐昏厥）的危险局面。
伏暑病表现为舌面干燥焦裂，舌尖红绛，神志昏迷胡言乱语或嬉笑无常，脉象急促，皮肤出现紫黑色斑疹，肢体震颤，这是邪气已经传入血分，热盛动风所致。适宜使用犀角地黄汤加入玄参心、连翘心、鲜石斛、鲜石菖蒲、紫草、竹叶，配合至宝丹等药物，以凉血化解毒邪。
凡是营分热邪不解，必然会导致邪气深入血分。舌色黑而舌尖红绛，斑疹紫黑，神志昏迷胡言乱语，说明血分热毒已至极点。热极则损伤阴液导致阳气亢盛，风气由内而生引起振动，所以肢体颤摇，即将发生痉证。必须使用犀角、生地、丹皮、赤芍、紫草来凉血清热，配合连翘、玄参、石菖蒲、石斛来化斑滋养津液，兼用竹叶、至宝丹清心镇惊安神，这样才不会发生痉厥，算是佳兆。
伏暑病妇女，舌面红绛口渴，脉象数而涩，月经刚来或刚断，寒热往来像疟疾一样，白天神志清醒，夜晚胡言乱语，这是热邪陷入血室。适宜使用小柴胡汤加入山楂、当归尾、赤芍、桃仁、丹皮等药物，以破血透达邪气。
凡是热邪陷入血室，《金匮要略》论述得最为详细。血室，就是血海。隶属于冲脉，归属于阳明经。《内经》所谓“冲为血海，任主胞胎”。又说冲脉起于中极穴底部，沿着小腹上行，到达胸中散开。任脉也起于中极穴底部，沿着阴毛际，环绕生殖器，进入少腹，上环口唇，滋养胡须。所以妇女没有胡须，是因为任脉之血下行泄出，不能上荣于口唇。督脉也从中极穴挟腰沿脊柱上行，到达头顶。这三条脉：冲脉、督脉、任脉，都交会于下极，然后分别行于背部和腹部。所以督脉行于身体背面，任脉行于身体腹面，冲脉行于背腹之间。当月事盈余时，各路血液都汇聚于血海。能够蓄积和排泄有常度的，是因为任脉担任统领，督脉担任总督，带脉负责收束。更有阳维脉、阴维脉，维持身体前面的阴阳平衡；阳跷脉、阴跷脉，调节身体左右的机关。所以能够蓄积有度，排泄有期，随着月亮的盈亏，循序流行，不失常态，这就称为月经。如果血海无权能，任督二脉失去调控，那么就会要么崩漏不止，要么瘀血蓄结不行。至于血的蓄积与排泄，无论是寒是热，都能成为病患。所以伤寒蓄血证，六经都有，不仅仅局限于膀胱和胸腹之间。大凡风寒暑湿等外邪侵袭，必先侵犯阳经，然后传变他处。阳经位于体表、卫分、气分，逐渐传入血分。所以妇女患病，正值月经刚来或刚断之时，因为热邪与血液凝滞，反而导致经血不得正常运行。如太阳病初起的头痛发热、恶寒无汗，或者出现鼻衄、肌衄，这是太阳经的邪气干扰血分。应当用开泄透汗的方法治疗，不可因为见血就立即使用寒凉药物，否则反成血结胸等病症。如果少腹硬痛，小便自利，大便黑色，身热烦躁，胡言乱语如狂，这是太阳腑病，蓄血在膀胱。张仲景先师，担心后人误认为热结膀胱，所以以小便不利者为热结，小便自利者为蓄血。通常使用桃仁承气汤，一方解太阳表邪，一方破除瘀血。又如阳明病初起的目痛、鼻干、不得安卧，进而导致鼻衄吐血，这是阳明经的邪气干扰血分。应当用两清气血的方法治疗，不可因为汗少而大发其汗。如果少腹硬痛，小便自利，上部出现结胸，或者吐血，下部出现腹痛，或者便血，身热狂妄，状如神灵附体，这是阳明腑病，蓄血在冲脉。适宜使用犀角地黄汤，一方清阳明热，一方祛除瘀血。又或少阳病的额痛胁疼、寒热耳聋、口苦呕吐，进而导致鼻衄咳血，这是少阳经的邪气干扰血分。应当用小柴胡汤清泄胆络，不可因为见血就妄投滋腻药物。如果有少腹痛，小便自利，大便黑色，白天神志清醒，夜晚胡言乱语，寒热像疟疾，这是少阳腑病，蓄血在肝络。适宜使用陶氏小柴胡汤加入生地、当归尾、桃仁、山楂、丹皮，一方清少阳，一方破瘀血。以上都是论述三阳经的经病和腑病中出现蓄血的见证。至于热邪传入三阴经，则少阴心主血，太阴脾统血，厥阴肝藏血。邪气既然入血，则热与血凝结，势难清化解散，必然导致舌红绛、神志昏迷，白天轻晚上重，状如邪祟作怪，适宜使用犀角地黄汤加入郁金、石菖蒲。严重时腹痛便黑，张仲景使用抵当汤，以攻逐热邪破除瘀血，才可以两解。然而此症不仅妇女有，男子也有这种情况。至于治疗方法，大体相等。如果将蓄血一症，一概只用小柴胡汤加破血药，如果无效，就视为无法可治，竟然束手无策，这是医者的过错。希望以此为鉴。我在道光十九年春天，遇到一个姓张的舵工，从三月间温病痊愈后，饮食正常，只是腰部疼痛，起初怀疑病后肾虚，投以补肾药，疼痛反而加剧，转而邀请外科医生，认为是肾俞发，投以阳和汤数剂，病情仍不减轻，且没有肿胀形态。他的疼痛每天午后加重，戌亥时（晚上7-11点）最剧，呼号不停，直到天明，疼痛才消失。一个月以来，无所不用其极，但疼痛仍不减轻。此时我阅读喻嘉言的《医门法律》，看到《寓意草》中有一案，关于腰痛将成偻废的患者。喻嘉言认为热邪逗留太阳经脉，与血凝滞，结于腰间，即用桃仁承气汤数服而安。读后恍然大悟，依法投药治疗，果然疼痛痊愈。这是太阳经血结的一症。后来又有外甥姓范的，湿温病后，也腰痛异常，曾服用补肾药无效。我却用安桂、桃仁、山甲、归须、旋复、新绎等药物，两剂即愈。这可见作为医者，必须旁搜博采，以广见闻，否则就会贻笑于管窥蠡测之人。
Fushu (Lingering Summerheat) presenting with irritability and fever, red tongue, coma, and delirium indicates that the pathogen has entered the Ying (Nutritive) level. It is appropriate to use Yunu Jians (Jade Woman Decoction) added with Lingjiao (Antelope Horn), Xuanshen (Scrophulariae Radix), Shashen (Glehniae Radix), Xian Shihu (Fresh Dendrobii Caulis), Xian Changpu (Fresh Acori Tatarinowii Rhizoma), and Niuhuang Wan (Calculus Bovis Pill) to clear the Ying level and vent the pathogen outward.
The previous clause discussed the pathogen about to transmit to the Ying level; this clause discusses the pathogen having already transmitted to the Ying level. Therefore, heat with irritability, a red tongue, coma, and delirium occur. Without using Shengdi (Rehmanniae Radix), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Radix), Shashen (Glehniae Radix) from Yunu Jians, along with Xuanshen (Scrophulariae Radix), Changpu (Acori Tatarinowii Rhizoma), Yujin (Curcumae Radix), and Niuhuang Wan (Calculus Bovis Pill) to clear the Ying level and vent the pathogen, the heat will inevitably sink into the Xue (Blood) level, leading to the danger of Jingjue (convulsions and coma).
Fushu (Lingering Summerheat) presenting with a dry, scorched tongue tip, crimson tongue tip, coma, delirium, manic laughter, rapid pulse, purple macules, and limb tremors indicates that the pathogen has entered the Xue (Blood) level, where extreme heat generates wind. It is appropriate to use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Xuanshenxin (Center of Scrophulariae Radix), Lianqiaoxin (Center of Forsythiae Fructus), Xian Shihu (Fresh Dendrobii Caulis), Xian Changpu (Fresh Acori Tatarinowii Rhizoma), Zicao (Arnebiae Radix), Zhuyeh (Bambusae Folium), and Zhibao Dan (Precious Treasure Pill) to cool the blood and resolve the pathogen.
Whenever Ying-level heat fails to resolve, it inevitably transmits to the Xue (Blood) level. A black tongue with a crimson tip, purple macules, coma, and delirium indicate that blood heat has reached its extreme. Extreme heat damages Yin and causes Yang hyperactivity, generating internal wind that causes vibration; thus, limbs tremble, approaching the state of convulsions. One must use Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Chishao (Paeoniae Radix Rubra), and Zicao (Arnebiae Radix) to cool the blood and clear heat, combined with Lianqiao (Forsythiae Fructus), Xuanshen (Scrophulariae Radix), Changpu (Acori Tatarinowii Rhizoma), and Shihu (Dendrobii Caulis) to resolve macules and nourish fluids, alongside Zhuye (Bambusae Folium) and Zhibao Dan (Precious Treasure Pill) to clear the heart and calm the spirit. This prevents convulsions and coma, which is a favorable sign.
In women with Fushu (Lingering Summerheat), a crimson tongue, thirst, rapid and choppy pulse, menstruation just starting or stopping, chills and fever alternating like malaria, clarity during the day, and delirium at night indicate Re Ru Xueshi (Heat Entering the Blood Chamber). It is appropriate to use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Shanzha (Crataegi Fructus), Guiwei (Angelicae Sinensis Radix Caudex), Chishao (Paeoniae Radix Rubra), Taoren (Pruni Semen), and Danpi (Moutan Cortex) to break blood stasis and vent the pathogen.
Regarding Heat Entering the Blood Chamber, the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) discusses it most thoroughly. The Blood Chamber is the Sea of Blood. It belongs to the Chong Mai (Penetrating Vessel) and is subordinate to the Yangming channel. As stated in the *Neijing* (Inner Canon): "The Chong Mai is the Sea of Blood, and the Ren Mai (Conception Vessel) governs the uterus." Furthermore, the Chong Mai originates from the bottom of the Zhongji point, runs along the lower abdomen, ascends to the chest, and disperses. The Ren Mai also originates from the bottom of the Zhongji point, runs along the pubic region, surrounds the genitalia, enters the lower abdomen, circles the lips, and nourishes the beard. Thus, women do not grow beards because the blood of the Ren Mai flows downward and cannot ascend to nourish the lips. The Du Mai (Governing Vessel) also arises from the Zhongji point, flanks the waist, follows the spine, and ascends to the vertex. These three vessels—Chong, Du, and Ren—all converge at the Xiaguan (Lower Extremity) and branch out to the back and abdomen. Thus, the Du Mai runs on the dorsal side of the body, the Ren Mai on the ventral side, and the Chong Mai between the back and abdomen. When menstrual blood is abundant, blood from all channels gathers in the Sea of Blood. Its regulated storage and discharge are managed by the Ren Mai as commander, the Du Mai as supervisor, and the Dai Mai (Girdle Vessel) as binder. Additionally, the Yang Wei Mai and Yin Wei Mai maintain Yin and Yang on the anterior body; the Yang Qiao Mai and Yin Qiao Mai regulate mechanisms on the lateral sides. Thus, storage is measured, discharge is timed, following the waxing and waning of the moon, flowing in order without deviation, which is termed menstruation. If the Sea of Blood lacks authority and the Ren and Du vessels lose control, there may be unceasing metrorrhagia or stagnant blood failing to move. Regarding the storage and discharge of blood, whether cold or heat can cause pathology. Therefore, blood stasis in Shanghan (Cold Damage) occurs in all six channels, not only in the Bladder and between the chest and abdomen. Generally, pathogens such as wind, cold, summerheat, and dampness first attack the Yang channels, then transmit elsewhere. Yang channels are located in the exterior, Wei (Defensive) level, and Qi level, gradually transmitting to the blood. Thus, when women fall ill during menstruation (just starting or stopping), heat and blood coagulate, preventing normal flow. For example, initial Taiyang disease presents with headache, fever, aversion to cold, and anhidrosis, or epistaxis and cutaneous bleeding; this is Taiyang channel pathogen interfering with the blood level. Treatment should employ methods to open pores and induce sweating. One must not immediately use cold-natured herbs upon seeing bleeding, lest it form Xuejie Xiong (Blood Stagnation in the Chest) syndrome. If there is hardness and pain in the lower abdomen, free urination, black stool, fever, irritability, and delirium resembling madness, this is a Taiyang Fu (Organ) disease with blood stasis in the Bladder. Master Zhang Zhongjing feared later generations would mistake heat binding in the Bladder for this condition; thus, he distinguished heat binding by difficult urination and blood stasis by free urination. He typically used Tao Ren Chengqi Tang (Persicae Semen and Rheum Decoction) to release the Taiyang exterior and break blood stasis. Similarly, initial Yangming disease presents with eye pain, nasal dryness, insomnia, leading to epistaxis and hematemesis; this is Yangming channel pathogen interfering with the blood level. Treatment should clear both Qi and Blood levels. One must not induce heavy sweating due to scant sweat. If there is hardness and pain in the lower abdomen, free urination, upper Jiao chest binding or hematemesis, lower Jiao abdominal pain or hematochezia, fever, mania resembling possession, this is a Yangming Fu disease with blood stasis in the Chong Mai. It is appropriate to use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) to clear Yangming heat and remove blood stasis. Also, Shaoyang disease presents with frontal headache, hypochondriac pain, chills and fever, deafness, bitter taste, vomiting, leading to epistaxis and hemoptysis; this is Shaoyang channel pathogen interfering with the blood level. Treatment should use Xiaochaihu Tang (Minor Bupleurum Decoction) to clear and drain the Gallbladder collaterals. One must not recklessly administer cloying herbs upon seeing bleeding. If there is lower abdominal pain, free urination, black stool, clarity during the day, delirium at night, and chills/fever like malaria, this is a Shaoyang Fu disease with blood stasis in the Liver collaterals. It is appropriate to use Tao Shi Xiaochaihu Tang (Tao's Minor Bupleurum Decoction) added with Shengdi (Rehmanniae Radix), Guiwei (Angelicae Sinensis Radix Caudex), Taoren (Pruni Semen), Shanzha (Crataegi Fructus), and Danpi (Moutan Cortex) to clear Shaoyang and break blood stasis. The above discusses the manifestations of blood stasis in the Jing (Channel) and Fu (Organ) diseases of the Three Yang channels. When heat pathogens transmit to the Three Yin channels, the Shaoyin Heart governs blood, the Taiyin Spleen controls blood, and the Jueyin Liver stores blood. Once the pathogen enters the blood, heat and blood coagulate, making clearance and resolution difficult. This inevitably leads to a crimson tongue, coma, symptoms worsening at night compared to the day, and a state resembling demonic possession. It is appropriate to use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Yujin (Curcumae Radix) and Changpu (Acori Tatarinowii Rhizoma). In severe cases with abdominal pain and black stool, Zhang Zhongjing used Didang Tang (Should-Enter Decoction) to attack heat and break stasis, achieving dual resolution. However, this condition occurs not only in women but also in men. The treatment principles are roughly similar. If one universally applies Xiaochaihu Tang (Minor Bupleurum Decoction) with blood-breaking herbs for blood stasis and finds no effect, regarding it as untreatable and giving up is the physician's fault. Let this serve as a warning. In the spring of the 19th year of Daoguang, I treated a rudder named Zhang who, after recovering from a warm disease in March, had normal appetite but suffered from lower back pain. Initially suspecting kidney deficiency post-illness, I administered kidney-tonifying herbs, but the pain intensified. An external medicine specialist diagnosed it as Shenshu Fa (abscess at the Shenshu acupoint) and prescribed Yanghe Tang (Yang-Harmonizing Decoction) for several doses, but the condition did not improve, nor was there swelling. The pain worsened in the afternoon, peaked during the Xu-Hai hours (7 PM–11 PM), with continuous crying until dawn when the pain subsided. After a month of various treatments, the pain persisted. At this time, I read Yu Jiayan's *Yimen Falü* (Legal Principles of Medicine Gate) and saw a case in *Yuyi Cao* (Grass of Meaningful Intent) regarding lower back pain progressing to kyphosis. Yu Jiayan stated that lingering heat pathogens in the Taiyang channels coagulate with blood, knotting in the waist; treating with Tao Ren Chengqi Tang (Persicae Semen and Rheum Decoction) for several doses brought relief. Reading this, I had a sudden enlightenment and treated according to this method, resulting in complete pain relief. This was a case of blood stagnation in the Taiyang channel. Later, my nephew surnamed Fan, after a damp-warm disease, also suffered from severe lower back pain. Kidney-tonifying herbs had failed. I instead used Angui (Cinnamomi Ramulus prepared with sugar), Taoren (Pruni Semen), Shan Jia (Manis Squama), Guixu (Angelicae Sinensis Radix Caudex), Xuanfu (Inulae Flos), and Xinyi (Magnoliae Flos). Two doses resulted in immediate cure. This demonstrates that physicians must search widely and collect extensively to broaden their knowledge, lest they be ridiculed for their narrow vision.