许叔微曰∶或问热入血室，何为成结胸？曰∶邪气传入经络，与正气相搏，上下流通，遇经水适来适断，
邪气乘虚入于血室，血为邪所迫，上入肝经，脉受邪则谵语见鬼，复入膻中，则血结于胸矣。何以言之，妇人
平居，水养木，方未受孕则为月水，既孕则蓄以养胎，已产上壅为乳，皆血也。今邪逐血并，归于肝经，聚于膻
中，结于乳下，故手触之则痛，非药可及，当刺期门也。
武叔卿曰∶小柴胡汤，治太阳传经病。盖脏血适来，则血室虚，邪气乘虚入，而为越经证。然血室与胃腑，
有气血之分，故谵语有昼夜之别。曰如见鬼者，以肝脏邪客而魂不安，本神自病也。用小柴胡解表里之邪，用
地黄凉血中之热。没有不愈，又有刺期门法。其加桃仁、红花，与承气、抵当等汤者，各因其微甚而泻之也。
杨仁斋曰∶凡大小产，热入血室，小柴胡汤力所不及者，于内加五灵脂，乃以黄连、赤茯苓佐之。盖心主
血，黄连、茯苓皆清心凉血之剂，所以收功也。若疏利血毒，则《活人书》桃仁承气有余勇矣。
张路玉曰∶冲为血海，即是血室。冲脉得热，则逼血下行，男子亦有是证，不独妇人也。
慎斋按∶以上五条，序妇人伤寒有热入
血室之证也。血室即血海，冲任之脉所系，为藏精受胎之所。因妇人血海有余，遇经行之期，而犯伤寒之邪，
则热邪乘血室之虚，袭入而与血相抟。夫肝藏魂，血室虚，则肝无所根据。肝受热邪，则为谵语，为见鬼，肝
之魂不能安也。故治法，唯有清热行血，甚则桃仁承气，微则生地、丹皮、桃仁、红花、赤芍、五灵脂、甘草、
木通、丹参，可以通治之，不可拘执小柴胡汤，为治伤寒热入血室之定例也。夫小柴胡方，为伤寒传少阳，和
解表里之药，必欲用之于热入血室之证。岂知柴胡发表，黄芩退热，半夏行痰，为血家所忌。人参补气助邪，非
血热所宜。今人一遇热入血室之证，便用小柴胡汤定法，曰我遵仲景书也。岂知仲景第一条云，妇人中风，
寒热发作有时，如疟状，明属少阳经证，故曰小柴胡汤主之。则小柴胡汤，原为少阳经设也。至后四条，但云
必自愈，云当刺期门，又云随其实而泻之。实者，热血结于胸也。泻之者，泻其实邪也。并无小柴胡汤主之一
语，则知小柴胡汤，只因妇人伤寒，有续寒热如疟状之证，故以之治少阳如疟之病，而本非治热入血室之证也。
今人不玩仲景前后原文，漫谓妇人热入血室，动辄用小柴胡主之，岂不大可嗤耶。故凡妇人病热入血室，有续
得寒热，发作有时，如疟状者，小柴胡汤可用也。亦必加桃仁、丹皮、五灵脂，以行其血。如热入血室，而无有
寒热如疟之证，则小柴胡汤断不可用也。举世懵懵，特表而出之。
许叔微说：有人问，热邪侵入血室，为什么会形成结胸证？回答说：邪气传入经络，与正气相互搏结，上下流通，恰逢月经来潮或刚断之时，邪气乘虚侵入血室，血液被邪气逼迫，向上进入肝经，脉象受邪则出现谵语、看见鬼怪的症状；邪气再次进入膻中，则血液凝结于胸部。为什么这样说呢？妇女平时，水滋养木（肝），在未受孕时表现为月经，怀孕后蓄积以滋养胎儿，分娩后上壅化为乳汁，这些都是血的转化。如今邪气追逐血液并合，归于肝经，聚集于膻中，凝结在乳下，所以用手触摸就会疼痛，药物难以到达，应当针刺期门穴。
武叔卿说：小柴胡汤，治疗太阳病传经而来的病症。因为脏血适逢来潮，则血室空虚，邪气乘虚而入，形成越经证。然而血室与胃腑，有气血的区别，所以谵语有白天和夜晚的不同。所谓“如见鬼者”，是因为肝脏受到邪气客居而魂不安定，是本神自病的表现。使用小柴胡汤解除表里之邪，用地黄凉血中之热。没有不痊愈的，还有针刺期门的方法。其中加入桃仁、红花，或者使用承气汤、抵当汤等方剂的，都是根据病情的轻重程度来进行泻下的。
杨仁斋说：凡是流产或小产，热邪侵入血室，小柴胡汤力量所不及的，在里面加入五灵脂，并用黄连、赤茯苓辅助。因为心主血，黄连、茯苓都是清心凉血的药剂，所以能取得疗效。如果要疏利血毒，那么《活人书》中的桃仁承气汤就足够有力了。
张路玉说：冲脉为血海，也就是血室。冲脉受热，就会逼迫血液下行，男子也有这种证候，并不只是妇女才有。
慎斋按语：以上五条，叙述了妇人伤寒伴有热入血室的证候。血室即血海，由冲脉和任脉所系，是藏精和受孕的地方。因为妇人血海有余，遇到行经期间，感染了伤寒邪气，则热邪乘血室之虚，袭入并与血相搏结。肝藏魂，血室空虚，则肝无所依托。肝受热邪，就会出现谵语、见鬼的症状，这是因为肝之魂不能安定。所以治疗方法，只有清热行血，严重的用桃仁承气汤，轻微的用地黄、丹皮、桃仁、红花、赤芍、五灵脂、甘草、木通、丹参，可以通用治疗，不可拘泥于小柴胡汤作为治疗伤寒热入血室的固定法则。小柴胡汤这个方子，是为伤寒传入少阳经，和解表里的药物，如果一定要把它用于热入血室的证候。哪里知道柴胡发表，黄芩退热，半夏行痰，都是血病患者所忌讳的。人参补气助长邪气，不适合血热证。现在的人一遇到热入血室的证候，就用小柴胡汤的固定方法，说我是遵循仲景的书。哪里知道仲景第一条说，妇人中风，寒热发作有时，像疟疾一样，明确属于少阳经证，所以说用小柴胡汤主治。那么小柴胡汤，原本就是为少阳经设立的。至于后面四条，只说一定会自愈，说应当针刺期门，又说随着其实证而泻之。实者，是指热血凝结于胸部。泻之，是泻其真实邪气。并没有“小柴胡汤主之”这句话，由此可知小柴胡汤，只是因为妇人伤寒，有持续寒热像疟疾一样的症状，所以用它来治疗少阳经像疟疾一样的病，而本来就不是治疗热入血室的证候。现在的人不玩味仲景前后的原文，随意说妇人热入血室，动不动就用小柴胡汤主治，难道不是大可嘲笑吗？所以凡是妇人病热入血室，有持续得到寒热，发作有时，像疟疾一样的，小柴胡汤可以使用。也一定要加入桃仁、丹皮、五灵脂，以运行其血。如果热入血室，而没有寒热像疟疾一样的症状，那么小柴胡汤绝对不可以使用。举世之人懵懂无知，特此表明并指出这一点。
Xu Shuwei said: Someone asked, why does heat entering the Blood Chamber (Xue Shi) result in Jie Xiong (Chest Binding)? The answer is: Pathogenic factors enter the meridians and struggle with healthy Qi, circulating up and down. When menstruation is just starting or has just stopped, pathogenic factors take advantage of the deficiency to enter the Blood Chamber. The blood is forced by the pathogens to move upward into the Liver Meridian. When the vessels are affected by pathogens, delirium and hallucinations occur. If the pathogens re-enter the Dan Zhong (Chest Center), blood coagulates in the chest. Why is this so? In women, Water nourishes Wood (Liver). Before pregnancy, this manifests as menstrual blood; during pregnancy, it is retained to nourish the fetus; after childbirth, it rises to become milk. All these are transformations of blood. Now, pathogens chase the blood and merge with it, returning to the Liver Meridian, gathering at Dan Zhong, and knotting below the breasts. Therefore, touching it causes pain, which medicine cannot reach; one should puncture the Qimen (LR14) acupoint.
Wu Shuqing said: Xiao Chai Hu Tang (Minor Bupleurum Decoction) treats diseases transmitted from the Taiyang (Greater Yang) stage. Since visceral blood arrives, the Blood Chamber becomes empty, allowing pathogens to enter due to deficiency, forming a Yue Jing Zheng (Transgressing Meridian Syndrome). However, the Blood Chamber and the Stomach Fu have distinctions between Qi and Blood; thus, delirium differs between day and night. "Seeing ghosts" occurs because the Liver is invaded by pathogens, causing the Hun (Ethereal Soul) to be unsettled, which is a disease of the Ben Shen (Root Spirit). Using Xiao Chai Hu Tang resolves exterior and interior pathogens, while Di Huang (Rehmanniae Radix) cools heat within the blood. Recovery is assured, along with the method of puncturing Qimen. Adding Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos), or using Cheng Qi Tangs (Bowel-Regulating Decoctions) and Di Dang Tang, depends on the severity to purge accordingly.
Yang Renzhai said: For any miscarriage or abortion where heat enters the Blood Chamber, if Xiao Chai Hu Tang is insufficient, add Wu Ling Zhi (Trogopteri Dung) internally, assisted by Huang Lian (Coptidis Rhizoma) and Chi Fu Ling (Poria with Red Coir). Since the Heart governs blood, Huang Lian and Fu Ling are agents that clear the Heart and cool the blood, thereby achieving success. To drain blood toxins, Tao Ren Cheng Qi Tang from *Huo Ren Shu* (Book of Saving Lives) is sufficiently potent.
Zhang Luyu said: Chong Mai (Penetrating Vessel) is the Sea of Blood, which is the Blood Chamber. When Chong Mai receives heat, it forces blood downward. Men can also have this syndrome, not just women.
Shen Zhai commented: The above five passages describe the syndrome of heat entering the Blood Chamber in women suffering from Shang Han (Cold Damage). The Blood Chamber is the Sea of Blood, connected to the Chong and Ren vessels, serving as the place for storing essence and conceiving the fetus. Because women have an abundance in the Sea of Blood, when contracting Shang Han pathogens during menstruation, heat pathogens take advantage of the Blood Chamber's emptiness to invade and contend with the blood. The Liver stores the Hun; when the Blood Chamber is empty, the Liver lacks support. When the Liver receives heat pathogens, it causes delirium and hallucinations because the Hun cannot settle. Therefore, the treatment method is solely to clear heat and promote blood circulation. Severe cases use Tao Ren Cheng Qi Tang; mild cases use Di Huang, Mu Dan Pi (Moutan Cortex), Tao Ren, Hong Hua, Chi Shao Yao (Red Peony Root), Wu Ling Zhi, Gan Cao (Licorice), Mu Tong (Akebia Caulis), and Dan Shen (Salvia Miltiorrhiza), which can be used universally. One must not rigidly adhere to Xiao Chai Hu Tang as the fixed prescription for treating heat entering the Blood Chamber in Shang Han. Xiao Chai Hu Tang is a formula for resolving exterior and interior conditions when Shang Han transmits to the Shaoyang (Lesser Yang) stage. If one insists on using it for heat entering the Blood Chamber, do they not know that Chai Hu releases the exterior, Huang Qin (Scutellariae Radix) clears heat, and Ban Xia (Pinelliae Tuber) moves phlegm—all contraindicated for blood disorders? Ren Shen (Ginseng Radix) tonifies Qi and aids pathogens, unsuitable for blood heat. Nowadays, upon encountering heat entering the Blood Chamber, people immediately apply Xiao Chai Hu Tang as a fixed rule, claiming to follow Zhang Zhongjing's writings. Do they not know that Zhang Zhongjing's first case states: "In women with Wind Strike, chills and fever occur intermittently, resembling malaria," which clearly belongs to the Shaoyang Meridian syndrome, hence "Xiao Chai Hu Tang governs it." Thus, Xiao Chai Hu Tang was originally established for the Shaoyang Meridian. As for the subsequent four cases, it only says "will heal itself," "should puncture Qimen," and "purge according to its excess." Excess refers to hot blood knotting in the chest. Purging means draining the excess pathogen. There is no mention of "Xiao Chai Hu Tang governs it." Therefore, we know Xiao Chai Hu Tang is used only because women with Shang Han have persistent chills and fever resembling malaria, so it treats the Shaoyang malaria-like condition, but it is not originally for treating heat entering the Blood Chamber. People today who do not carefully study Zhang Zhongjing's original texts casually claim that for women with heat entering the Blood Chamber, Xiao Chai Hu Tang should always be used. Is this not laughable? Therefore, for women with heat entering the Blood Chamber who have persistent chills and fever occurring intermittently like malaria, Xiao Chai Hu Tang can be used. It must also include Tao Ren, Mu Dan Pi, and Wu Ling Zhi to promote blood circulation. If heat enters the Blood Chamber without chills and fever resembling malaria, Xiao Chai Hu Tang absolutely must not be used. The world is ignorant of this; I hereby highlight and clarify it.