孙文垣治李氏妇，胸胁大腹作痛，谵语如狂，寅、卯、辰三时稍轻，午后及夜痛甚。（病在血分。）原有痰
火头疼牙疼之疾，又因经行三日后头痛发寒热，医以疟治。因大恶热，三四人交扇之，以两手浸冷水中，口含水而
不咽，鼻有微衄，（热在经络。）又常自悲自哭，（如狂。）痛时欲奔窜，剧则咬人，（蛔厥。）小水直下不固，
（肝热。）喉哽哽吞药不下。脉之，左弦数，右关洪滑，曰∶此热入血室也。误服治疟刚燥之剂，扰动痰火，
以致标本交作。其胸胁痛者，病属少阳也。剧则咬人者，虫行求食而不得，故常觉喉中哽哽然也。以小柴胡
汤加桃仁、丹皮，而谵
狂减。次日，与安蛔汤，痛止、饮食进而愈矣。
元素侄妇，春温后经水适止，余热不退，口中甚渴，胸胁痛而耳重听，（少阳。）脉左弦数，右滑大而数，
小柴胡加石膏、知母、桔梗、枳壳、葛根、栝蒌、半夏、神曲，服下热渴如旧。改用柴胡二钱，人参、甘草、
天花粉、黄芩、（小柴胡汤去半夏，加天花粉，以血家忌半夏也。）白芍、红花、当归、丹皮、知母各八分，
调理而瘳。（此症无谵妄发狂，然以凉解不应，必用诸血药乃应，则仍是热入血室者矣。雄按∶本方渴者去半
夏加栝蒌根，不但为血家所忌也。况此证并非血虚，而仍用行血之药乎？）
缪仲淳治张璇浦内人，患热入血室，发狂欲杀人。医以伤寒治之，煎药未服。邀缪往，缪曰∶误矣。覆其
药，投一剂而安。先与童便，（心主热，邪从血分上乘于心，故发狂。先与童便引热下行，最为元解。）继
与凉血行血安心神药，遂定。
朱氏妇经行一月不止，每黄昏先寒后热，遍身疼痛，胸膈胀闷，必得大喊叫嘶，用手探吐痰涎乃宽，且渴
甚，此痰饮疟疾。今饮食不进，夜如见鬼者，乃热入血室也。用小柴胡加生地、丹皮、桃仁两帖，后以白术三
钱，陈皮、麦芽各一钱，乌梅一个，姜三片，水煎服之，寒热止，诸症皆安。
陆养愚治臧尧山夫人，向有头风症，八月间患腹痛，日轻夜重，痛作昏愦，语言不伦，唇口燥裂而不欲汤
饮，已十日。或投香燥行气益甚，身热如火，饥不能食。脉之，沉数而弦。询之，适经行时感冒，自发寒热，
头大痛。平日服川芎茶调散，今服之，头痛稍止，而身热更甚，遂变为腹痛。再问经行如常否？谓比平素觉微
快。曰∶此必热入血室也。或谓此伤寒症乎？曰∶岂必伤寒，而后热入血室哉？凡病未有无客热者，况初得之
感冒，因头痛而以茶调散遏之，热无从泄，遇经行血室空虚，热乘虚而入，因以成瘀。血瘀下焦，饮食不进而
作痛，亦势使然也。用小柴胡以清其势，丹皮、红花、桃仁以去瘀，人参、麦冬生津止渴。二剂神清，痛减能
食。日服二剂，两日后送润字丸一钱，大便去硬血数枚，痛全愈。减桃仁、红花，加归、芍，调理而安。
薛立斋治一妇人，多怒，手背患疮出血，至夜发热妄语，服清心凉血药不应，乃热入血室而然也。遂以加
味小柴胡汤二剂，血止而热亦清矣。
孙文垣治疗李氏妇人，患者胸胁及大腹部疼痛，胡言乱语如同发狂，在寅时、卯时、辰时这三个时段症状稍轻，午后及夜间疼痛加剧。（病位在血分。）该患者原本就有痰火引起的头痛和牙痛旧疾，又因月经来潮三天后出现头痛、恶寒发热，医生按疟疾治疗。因为患者极度怕热，需要三四人轮流用扇子扇风，并将双手浸泡在冷水中，口中含水但不吞咽，鼻孔有轻微出血，（热邪在经络。）又常常自己悲伤哭泣，（类似发狂的症状。）疼痛发作时想要奔跑逃窜，剧烈时甚至咬人，（蛔厥证的表现。）小便失禁直下无法控制，（肝经有热。）咽喉哽噎感强烈，药物难以咽下。诊脉发现左脉弦数，右关脉洪滑，孙文垣说：这是热入血室证。误服了治疗疟疾的刚燥药物，扰动痰火，导致标本同病。其胸胁疼痛，病属少阳经。剧烈时咬人，是因为虫类行动寻找食物却不得，所以常感觉喉咙中哽噎不适。给予小柴胡汤加入桃仁、丹皮，患者的谵语和狂躁症状减轻。第二天，给予安蛔汤，疼痛停止，饮食增加而痊愈。
元素先生的侄媳妇，春季温病之后月经刚停，余热未退，口中非常口渴，胸胁疼痛且耳朵重听，（病在少阳。）脉象左弦数，右滑大而数。使用小柴胡汤加入石膏、知母、桔梗、枳壳、葛根、栝蒌、半夏、神曲，服用后热渴如故。改用柴胡二钱，人参、甘草、天花粉、黄芩、（小柴胡汤去掉半夏，加入天花粉，因为血证患者忌用半夏。）白芍、红花、当归、丹皮、知母各八分，调理后病愈。（此症没有谵妄发狂，但如果用凉解法无效，必须使用活血药才有效，那么这仍然是热入血室证。雄按：本方中口渴者去半夏加栝蒌根，不仅是因为血家所忌。况且此证并非血虚，为何仍用行血之药呢？）
缪仲淳治疗张璇浦的妻子，患热入血室证，发狂想要杀人。医生按伤寒治疗，药煎好尚未服用。邀请缪仲淳前往，缪仲淳说：误治了。倒掉那副药，投予一剂药后病情安定。先给予童便，（心主热，邪气从血分上乘于心，所以发狂。先给童便引导热邪下行，最为妥善。）随后给予凉血、行血、安心神的药物，症状遂定。
朱氏妇人月经持续一个月不止，每天黄昏先恶寒后发热，全身疼痛，胸膈胀闷，必须大声喊叫嘶吼，用手探吐痰涎后才感到宽舒，并且非常口渴，这是痰饮疟疾。现在饮食不进，夜间像见到鬼怪一样，这是热入血室证。用小柴胡汤加入生地、丹皮、桃仁，连服两帖，后来用白术三钱，陈皮、麦芽各一钱，乌梅一个，生姜三片，水煎服，寒热停止，诸症皆安。
陆养愚治疗臧尧山的夫人，向来有头风症，八月间患腹痛，白天轻晚上重，疼痛发作时昏沉糊涂，言语错乱，嘴唇口角干燥开裂但不想喝水，已经十天了。有人投以香燥行气的药物反而加重，身体热如火烧，饥饿但不能进食。诊脉，脉沉数而弦。询问得知，正值经期感冒，自发寒热，头部剧痛。平时服用川芎茶调散，这次也服用，头痛稍止，但身体热更甚，于是变为腹痛。再问月经是否正常？回答说比平时觉得稍微畅快一些。说：这一定是热入血室证。有人说这是伤寒症吗？说：难道只有伤寒才会热入血室吗？凡是疾病没有没有客热邪气的，何况初得感冒，因为头痛而用茶调散遏制它，热邪无处宣泄，遇到经期血室空虚，热邪乘虚而入，因此形成瘀血。瘀血在下焦，饮食不进并产生疼痛，也是势所必然。用小柴胡汤以清解病势，丹皮、红花、桃仁以去除瘀血，人参、麦冬生津止渴。服用两剂后神志清醒，疼痛减轻能进食。每天服用两剂，两天后送服润字丸一钱，大便排出硬结的血块几枚，疼痛完全痊愈。减少桃仁、红花，加入当归、白芍，调理后平安。
薛立斋治疗一名妇人，易怒，手背患疮出血，到了夜晚发热并胡言乱语，服用清心凉血药物无效，这是热入血室所致。于是使用加味小柴胡汤两剂，血止住了，热邪也清除了。
Sun Wenyuan treated a woman surnamed Li, who suffered from pain in the chest, hypochondrium, and lower abdomen, along with delirium resembling madness. Symptoms were slightly relieved during the Yin, Mao, and Chen hours (3:00 AM–9:00 AM), but worsened in the afternoon and at night. (The pathology is in the Blood aspect.) She had a pre-existing condition of headache and toothache caused by Phlegm-Fire. Subsequently, after menstruation ceased for three days, she developed headache, aversion to cold, and fever. The physician treated her as Malaria. Due to extreme heat intolerance, she required three or four people to fan her continuously, immersed her hands in cold water, held water in her mouth without swallowing, and had slight epistaxis. (Heat is in the Collaterals and Channels.) She also frequently wept and laughed spontaneously, (resembling madness). During pain episodes, she desired to run away; when severe, she would bite others, (a manifestation of Ascaris Colic). Urine flowed uncontrollably, (indicating Liver Heat). She experienced a sensation of obstruction in the throat, making it difficult to swallow medicine. Her pulse was wiry and rapid on the left, and surging and slippery at the Right Guan position. Sun stated: This is Heat entering the Blood Chamber. The erroneous use of acrid-warm agents for treating Malaria disturbed the Phlegm-Fire, causing both root and branch pathologies to manifest simultaneously. The chest and hypochondriac pain indicates involvement of the Shaoyang channel. The biting behavior occurs because parasites move seeking food but cannot find it, causing a constant sensation of throat obstruction. He prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Tao Ren (Peach Kernel) and Dan Pi (Moutan Bark), which reduced her delirium and mania. The next day, An Hui Tang (Ascaris-Calming Decoction) was given, stopping the pain, improving appetite, and leading to recovery.
The niece-in-law of Yuan Su contracted Spring Warmth disease. After her menses stopped, residual heat remained unchecked, accompanied by intense thirst, chest and hypochondriac pain, and heavy hearing loss. (Involving Shaoyang.) Her pulse was wiry and rapid on the left, and surging, large, and rapid on the right. Initially, Xiao Chai Hu Tang (Minor Bupleurum Decoction) was modified with Shi Gao (Gypsum), Zhi Mu (Anemarrhena Rhizome), Jie Geng (Platycodon Root), Zhi Ke (Aurantium Fructus), Ge Gen (Kudzu Root), Gua Lou (Trichosanthes Fruit), Ban Xia (Pinellia Tuber), and Shen Qu (Massa Medicata Fermentata). However, the heat and thirst persisted unchanged. The prescription was changed to Chai Hu (Bupleuri Radix) 2 qian, Ren Shen (Ginseng Radix), Gan Cao (Licorice Root), Tian Hua Fen (Trichosanthes Root), Huang Qin (Scutellaria Root); (Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Ban Xia removed and Tian Hua Fen added, as Ban Xia is contraindicated in blood disorders.), Bai Shao (White Peony Root), Hong Hua (Carthamus Flower), Dang Gui (Angelica Sinensis Radix), Dan Pi (Moutan Bark), and Zhi Mu (Anemarrhena Rhizome) each 8 fen. She recovered after regulation. (This case lacked delirium and mania; however, since cooling and resolving methods failed, and blood-invigorating herbs were necessary for efficacy, it remains a case of Heat entering the Blood Chamber. Xiong’s Note: In this formula, Ban Xia is removed and Gua Lou Gen (Trichosanthes Root) added for thirst, not only because it is contraindicated for blood patients. Moreover, this case is not due to Blood deficiency, so why use blood-moving herbs?)
Miao Zhongchun treated the wife of Zhang Xuanpu, who suffered from Heat entering the Blood Chamber, resulting in mania and an urge to kill. Physicians treated her as Taiyang Cold Damage (Shanghan). Before the decoction could be administered, Miao was invited. Miao said: This is a misdiagnosis. He discarded the prepared medicine and administered one dose, after which the patient calmed down. First, he gave Tong Bian (Child’s Urine). (The Heart governs Heat; pathogenic factors ascend from the Blood aspect to the Heart, causing mania. Administering Child’s Urine first guides the Heat downward, which is most appropriate.) Subsequently, he administered herbs that cool the Blood, invigorate circulation, and calm the Spirit, stabilizing the condition.
A woman surnamed Zhu had menstruation lasting over a month. Every dusk, she experienced chills followed by fever, generalized body pain, chest and diaphragmatic distension. She had to shout hoarsely and induce vomiting to expel phlegm-saliva to find relief, accompanied by intense thirst. This was initially diagnosed as Phlegm-Fluid Malaria. Now, unable to eat, and seeing ghosts at night, it is Heat entering the Blood Chamber. Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Sheng Di Huang (Rehmannia Root), Dan Pi (Moutan Bark), and Tao Ren (Peach Kernel) was given for two doses. Later, Bai Zhu (Atractylodes Macrocephala Rhizome) 3 qian, Chen Pi (Tangerine Peel), Mai Ya (Barley Sprout) each 1 qian, Wu Mei (Mume Fruit) one piece, and Jiang (Zingiberis Rhizoma) three slices were decocted in water. The chills and fever ceased, and all symptoms resolved.
Lu Yangyu treated the wife of Zang Yaoshan, who had a history of Head Wind (Tou Feng). In August, she developed abdominal pain, lighter by day and heavier by night. During pain attacks, she became confused and incoherent. Her lips and mouth were dry and cracked, yet she had no desire for fluids. This persisted for ten days. Administration of acrid-warm Qi-moving herbs exacerbated the condition; her body felt hot as fire, and although hungry, she could not eat. Her pulse was deep, rapid, and wiry. Upon inquiry, she had caught a cold during menstruation, developing spontaneous chills, fever, and severe headache. She usually used Chuan Xiong Cha Tiao San (Ligusticum Tea-Powder for Regulating the Head), which provided slight relief for the headache this time, but intensified the body heat, transforming into abdominal pain. Asked if her menstruation was normal, she replied it felt slightly smoother than usual. Lu stated: This must be Heat entering the Blood Chamber. Someone asked: Is this Shanghan? Lu replied: Must Heat entering the Blood Chamber only occur in Shanghan? All diseases involve external Heat pathogens. Furthermore, the initial cold was suppressed by Chuan Xiong Cha Tiao San for headache, preventing Heat release. When the Blood Chamber was empty during menstruation, Heat entered vacuously, forming Stasis. Lower Jiao Blood Stasis leads to anorexia and pain, which is inevitable. Xiao Chai Hu Tang (Minor Bupleurum Decoction) was used to clear the pathogenic trend; Dan Pi (Moutan Bark), Hong Hua (Carthamus Flower), and Tao Ren (Peach Kernel) removed stasis; Ren Shen (Ginseng Radix) and Mai Dong (Ophiopogon Tuber) generated fluids and stopped thirst. After two doses, her spirit cleared, pain decreased, and she could eat. Taking two doses daily, after two days, Run Zi Wan (Moistening Pill) 1 qian was administered. Hard, bloody stools were passed, and pain completely resolved. Tao Ren and Hong Hua were reduced; Dang Gui (Angelica Sinensis Radix) and Bai Shao (White Peony Root) were added for regulation, leading to stability.
Xue Lizhai treated a woman prone to anger. She had a sore on the back of her hand that bled. At night, she developed fever and delirious speech. Cooling Heart and Blood herbs were ineffective. This was Heat entering the Blood Chamber. Jiawei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) was administered for two doses. Bleeding stopped, and the fever cleared.