热入血室经适断，邪热乘虚血室潜，寒热有时如疟状，小柴胡加归地丹。
【注】《金匮》云∶妇人中风七八日，续来寒热，发作有时，经水适断，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。此言邪热未尽，值经来，乘虚
入于血室之间而潜藏之，故令血结，而寒热有时如疟状也。血室肝主之，肝与胆为表里，
胆因肝受邪而病寒热，故用小柴胡汤主之也。加当归、生地、丹皮者，所以清血分之热也。
小柴胡汤（方见首卷柴胡四物汤注中）
热入血室经适来，昼日明了夜谵妄，无犯胃气上二焦，热随血去自无恙。
刺期门法 清热行血汤
热入血室成结胸，下血谵语头汗出，二者皆当刺期门，随其实取泄而去。清热行血桃红丹，灵脂地草穿山赤。
【注】《金匮》云∶妇人伤寒发热，经水适来，昼日明了，夜则谵语如见鬼状，此为
热入血室。治之无犯胃气及上二焦，必自愈也。此言热虽入于血室，然经行不断，则热
不留结。勿谓谵妄，遂以硝黄犯其胃气刺伤荣血，小柴和解犯上二焦。但俟其热随血去，
病必自愈。《伤寒论》曰∶血自下，下者愈。此之谓也。
经水先闭后病肿，任冲寒湿血壅经；先发水肿后经闭，水溢皮肤泛滥行。血分难医水易治，二者详参要辨明。
【注】妇人经水先闭后病肿者，乃寒湿伤于冲、任，血壅经隧也，名曰血分。若先病
肿，而后经闭者，乃土不制水，水邪泛滥，溢于皮肤也，名曰水分。血分难治，水分易治，
二者须当详辨。
热入血室证，表现为月经刚停止，邪热乘虚潜入血室。症状为定时寒热往来，状如疟疾，治疗用小柴胡汤加当归、生地黄、牡丹皮。
【注】《金匮要略》记载：妇女患中风病七八日，持续出现寒热往来，发作有定时，且月经突然中断，这称为“热入血室”。由于热邪导致血液凝结，所以出现像疟疾一样的症状，发作有定时，主治方剂是小柴胡汤。这里说的是邪热未尽，正值经期，趁虚进入血室并潜伏其中，导致血液凝结，从而出现定时寒热如疟状的症状。血室由肝脏所主，肝与胆互为表里，胆因受肝之邪气影响而发病，出现寒热症状，所以用小柴胡汤为主进行治疗。加入当归、生地黄、牡丹皮的目的，是为了清除血分中的热邪。（小柴胡汤的组成见首卷柴胡四物汤注释中）
热入血室证，若月经正来潮，白天神志清醒，夜间则胡言乱语、谵妄。此时不要侵犯胃气及上、中二焦，待热邪随经血排出，身体自然恢复无恙。
热入血室若形成结胸证，出现下血、谵语、头汗出等症状。这两种情况都应当针刺期门穴，根据实证情况泻去邪气。方用清热行血桃红丹，药物包括五灵脂、生地黄、甘草、穿山甲、赤芍等。
【注】《金匮要略》记载：妇女患伤寒发热，正值月经来潮，白天神志清楚，夜间则谵语，如同看见鬼怪一样，这称为热入血室。治疗时不可侵犯胃气及上、中二焦，疾病必定自愈。这里说的是虽然热邪进入血室，但月经未断，热邪就不会停留凝结。不要因为出现谵妄，就用硝石、大黄等攻下药损伤胃气，或用发汗药伤及营血和上、中二焦。只需等待热邪随经血排出，病必自愈。《伤寒论》说：“血自行下者，病愈。”说的就是这个道理。
月经先闭止后出现水肿，多因任脉、冲脉受寒湿侵袭，导致血行壅滞，此为血分病；若先出现水肿，后月经闭止，则是脾土不能制约水湿，水邪泛滥，溢于皮肤，此为水分病。血分病难治，水分病易治，二者必须详细参详，仔细辨别清楚。
In the syndrome of Heat Entering the Blood Chamber (Re entering the uterus/blood chamber), where menstruation has just ceased, pathogenic heat enters the Blood Chamber (uterus/blood chamber) due to deficiency and lurks there. The symptoms include periodic chills and fever resembling malaria; the treatment is Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Dang Gui (Angelicae Sinensis Radix), Sheng Di Huang (Rehmanniae Radix), and Mu Dan Pi (Moutan Cortex).
[Note] *Jin Gui Yao Lue* states: "When a woman suffers from Wind-Strike for seven or eight days, followed by recurring chills and fever occurring at regular intervals, and her menses suddenly cease, this is called 'Heat Entering the Blood Chamber'. The blood must be congealed, hence the symptoms resemble malaria with regular paroxysms. It should be treated with Xiao Chai Hu Tang." This refers to the situation where pathogenic heat is not yet exhausted, coincides with the menstrual period, and enters the Blood Chamber due to deficiency to lurk therein, causing blood congealment and resulting in periodic chills and fever like malaria. The Blood Chamber is governed by the Liver. The Liver and Gallbladder are interior-exteriorly related. The Gallbladder becomes diseased with chills and fever because it receives pathogenic influence from the Liver. Therefore, Xiao Chai Hu Tang is used as the primary treatment. The addition of Dang Gui, Sheng Di Huang, and Mu Dan Pi serves to clear heat from the Blood level. (The composition of Xiao Chai Hu Tang is found in the notes for Chai Hu Si Wu Tang in the first volume.)
In the syndrome of Heat Entering the Blood Chamber, if menstruation is currently flowing, the patient is lucid during the day but experiences delirium and妄语 (confabulation/delirious speech) at night. One must not injure the Stomach Qi or the Upper and Middle Jiao (Upper and Middle Burners); once the heat follows the blood out, the body will naturally recover without injury.
Method of Needling Qimen (LR14) / Qing Re Xing Xue Tang (Clear Heat and Invigorate Blood Decoction)
If Heat Entering the Blood Chamber leads to Jie Xiong (Chest Binding/Syndrome), presenting with bleeding, delirium, and sweating on the head, both conditions require needling Qimen (LR14). One should follow the excess pattern to drain and eliminate the pathogen. The formula used is Qing Re Xing Xue Tao Hong Dan, containing Ling Zhi (Trogopteri Dung), Sheng Di Huang, Gan Cao (Licorice Root), Shan Jian Jia (Pangolin Scales), and Chi Shao (Red Peony Root).
[Note] *Jin Gui Yao Lue* states: "When a woman suffers from Cold Damage with fever, and her menses happen to be flowing, she is lucid during the day but delirious at night, seeing ghosts as if possessed. This is called Heat Entering the Blood Chamber. In treating it, do not injure the Stomach Qi or the Upper and Middle Jiao; the disease will heal itself." This explains that although heat enters the Blood Chamber, if menstruation does not stop, the heat will not linger and congeal. Do not assume that because of delirium, one should use Shi Hui (Niter) and Da Huang (Rhubarb) to attack the Stomach Qi or cause sweating that injures Ying Blood and the Upper/Middle Jiao. Simply wait for the heat to exit with the blood, and the illness will surely heal. *Shang Han Lun* says: "If the blood flows down spontaneously, the patient recovers." This is what is meant.
If menstruation ceases first and edema appears subsequently, it is due to Cold-Dampness injuring the Ren Mai (Conception Vessel) and Chong Mai (Penetrating Vessel), causing blood stagnation in the meridians; this is named Blood Division (Xue Fen) disease. If edema appears first and menstruation ceases subsequently, it is because Earth (Spleen) fails to control Water, leading to water pathogen flooding and overflowing into the skin; this is named Water Division (Shui Fen) disease. Blood Division disease is difficult to treat, while Water Division disease is easy to treat. These two must be carefully analyzed and clearly differentiated.