伤寒阳明病，有热入血室证。妇人伤寒，经水适来适断，血室空虚，邪易陷入，有热入
血室
证。其证皆谵言妄语，甚或狂走见鬼，午前明了，午后昏瞀，入夜尤甚，倦卧，不知饮食，
不能转侧。其病之轻重，固由热之微甚，而亦有血虚、血实之分。血实，则邪热之浊气有所
聚而见重；血虚，则津枯神散，邪不得聚，反能略知人事。其治法亦有偏重攻血，偏重养津
之殊矣。
赵晴初曰∶凡外感之病涉心者，皆在心包络与血脉也。邪入包络则神昏，邪入血脉亦神
昏，
但所入之邪有浅深，所现之证有轻重。如邪入包络，包络离心较近，故神昏全然不知人事；
如入血脉，血脉离心较远，故呼之能觉，与之言亦知人事。若任其自睡而心放，即昏沉矣。
有邪在血脉，因失治而渐入包络者，此由浅而入深也；有邪在包络，因治得其法，而渐归血
脉者，此由深而出浅也。又有邪盛势锐，不从气分转入，不由血脉渐入，而直入心包络者，
陡然昏厥，其证缓则不过一日，速则不及一时告毙，以其直入包络，而内犯心也。(此论血
脉，心包邪有浅深，证有微甚也。)
李东垣曰∶伤寒传至五六日间，渐变神昏不语，或睡中独语；一二日，目赤，唇焦，舌
干，
不饮水，稀粥与之则咽，不与则不思，六脉细数而不洪大，心下不痞，腹中不满，大小便如
常；或传至十日以来，形貌如醉人状，虚见，神昏，不得已，用承气下之，误矣。不知此热
邪传手少阴经也，导赤泻心汤主之。与食则咽者，邪不在胃也；不与则不思，以其神昏也。
既不在胃，误与承气下之必死。伤寒温热传变，多有此证，不可不察也。
张石顽曰∶有一种舌苔，中黑而枯，或略有微刺，色虽黑而无积苔，舌形枯瘦而不甚赤
。其
证烦渴，耳聋，身热不止，大便五六日或十余日不行，腹不硬满，按之不痛，神识不昏，昼
夜不得睡，稍睡或呢喃一二句，或带笑，或叹息。此为津枯血燥之候，急宜炙甘草汤，或生
料六味丸，换生地，合生脉散，加桂，滋其化源，庶或可生，误与承气必死，误与四逆亦死
。(此与上条，皆论血干之证也。)
伤寒阳明病中，存在热入血室的证候。妇女患伤寒，正值月经来潮或刚结束，此时血室空虚，邪气容易陷入，形成热入血室证。其症状均为胡言乱语、妄自言语，严重时甚至狂跑乱走、看见鬼怪，午前神志尚清，午后则昏沉迷糊，入夜后症状更加严重，疲倦卧床，不知进食，身体无法转动。疾病的轻重程度，固然取决于热邪的轻微或剧烈，但也分为血虚和血实两种情况。若为血实，则邪热产生的浊气有所聚集，导致病情加重；若为血虚，则津液枯竭、神气涣散，邪气无法聚集，反而能稍微知晓人事。其治疗方法也有偏重于攻逐瘀血和偏重于滋养津液的区别。
赵晴初说：凡是外感疾病涉及心脏的，都在于心包络与血脉。邪气侵入包络则神志昏迷，邪气侵入血脉也导致神志昏迷，只是所侵入的邪气有浅深之分，所表现的症状有轻重之别。例如邪气侵入包络，因为包络离心脏较近，所以神志完全昏迷，不知晓人事；如果邪气侵入血脉，因为血脉离心脏较远，所以呼唤时能够觉醒，与其说话也能知晓人事。如果任由患者自行睡眠而心神放纵，就会陷入昏沉。有的邪气在血脉，因失治而逐渐侵入包络，这是由浅入深；有的邪气在包络，因治疗得当，而逐渐回归血脉，这是由深出浅。又有邪气盛势猛烈，不从气分转入，不由血脉渐入，而是直接侵入心包络的，突然昏厥，病情缓和者不超过一天，迅速者不到一个时辰就死亡，因为其直接侵入包络，进而内犯心脏。（此论述血脉与心包邪气的浅深，以及症状的微甚。）
李东垣说：伤寒传变至五六日间，逐渐出现神志昏迷、不语，或者睡中独自说话；一二日后，眼睛发红，嘴唇焦枯，舌头干燥，不想要喝水，给予稀粥则吞咽，不给则不想吃，六脉细数而不洪大，心下没有痞塞感，腹部没有胀满感，大小便正常；或者传变至十天左右，形貌像醉酒的人一样，呈现虚象，神志昏迷，不得已使用承气汤攻下，这是错误的。不知道这是热邪传入手少阴经，应用导赤泻心汤主治。给食物则吞咽，是因为邪气不在胃中；不给则不想吃，是因为神志昏迷。既然邪气不在胃中，误用承气汤攻下必然致死。伤寒温热病的传变，多有此类证候，不可不仔细辨别。
张石顽说：有一种舌苔，中间发黑且干枯，或者略有微刺，颜色虽黑但没有积滞的厚苔，舌体形状枯瘦而不怎么红赤。其症状表现为烦躁口渴，耳聋，身体发热不止，大便五到六天或十多天不通行，腹部不硬满，按压不疼痛，神志清醒不昏迷，白天黑夜都无法入睡，稍微睡着可能呢喃一两句，或者带着笑意，或者叹息。这是津液枯竭、血液燥热的征候，急需使用炙甘草汤，或者生料六味丸更换生地黄，合用生脉散，加入桂枝，以滋养化源，或许还有生机，误用承气汤必然致死，误用四逆汤也会致死。（这与上一条，都是论述血干证的。）
In Yangming disease of Shanghan (Cold Damage), there exists the syndrome of Heat Entering the Blood Chamber. When a woman contracts Shanghan and her menstruation is just beginning or has just ceased, the Blood Chamber becomes empty, making it easy for pathogenic factors to sink in, resulting in the syndrome of Heat Entering the Blood Chamber. The symptoms include delirious speech and妄语 (hallucinations/irrational talk); in severe cases, the patient may run wildly and see ghosts. Consciousness is clear before noon but becomes drowsy and confused in the afternoon, worsening at night. The patient lies fatigued, ignores food intake, and cannot turn their body. The severity of the illness depends not only on the intensity of the heat but also on the differentiation between blood excess (Xue Shi) and blood deficiency (Xue Xu). In blood excess, turbid qi generated by pathogenic heat accumulates, aggravating the condition; in blood deficiency, fluids are depleted and spirit scatters, preventing pathogenic factors from accumulating, so the patient retains some awareness of reality. Treatment methods differ, focusing either on attacking blood stasis or nourishing fluids.
Zhao Qingchu stated: For external contraction diseases involving the heart, the pathology lies in Xin Bao Luo (Pericardium) and Xue Mai (Blood Vessels). When pathogens enter the Pericardium, consciousness is lost; when they enter the Blood Vessels, consciousness is also impaired. However, the depth of invasion varies, as do the severity of symptoms. If pathogens enter the Pericardium, which is close to the Heart, complete loss of consciousness occurs with no awareness of surroundings. If pathogens enter the Blood Vessels, which are farther from the Heart, the patient can awaken upon calling and respond to speech. If left to sleep freely without guarding the mind, deep stupor ensues. Pathogens moving from Blood Vessels into the Pericardium due to mismanagement represent progression from superficial to deep; conversely, pathogens retreating from the Pericardium to Blood Vessels due to correct treatment represent regression from deep to superficial. Additionally, when pathogenic factors are vigorous and penetrate directly into the Pericardium without passing through Qi division or gradually entering via Blood Vessels, sudden syncope occurs. Death may occur within a day if slow, or within an hour if rapid, because direct invasion of the Pericardium leads to internal violation of the Heart. (This discusses the depth of pathogens in Blood Vessels and Pericardium, and the variation in symptom severity.)
Li Dongyuan stated: When Shanghan transmits to the fifth or sixth day, gradual onset of coma and muteness, or talking alone during sleep, may occur. After one or two days, red eyes, cracked lips, dry tongue, and lack of thirst appear. The patient swallows thin porridge if offered but refuses it if not. The six pulses are fine and rapid but not surging. There is no epigastric fullness (Pi), abdominal distension, and bowel/bladder functions remain normal. Or, after ten days, the patient resembles a drunkard, presenting deficiency signs and coma. Using Chengqi Tang (Gut-Draining Decoction) to purge under such circumstances is erroneous. This is actually heat transmitting to the Hand Shaoyin Meridian, treated with Daochi Xiexin Tang (Led-Chi Heart-Draining Decoction). Swallowing food indicates the pathogen is not in the Stomach; refusal to eat is due to coma. Since the pathogen is not in the Stomach, purging with Chengqi Tang will inevitably cause death. Such syndromes are common in the transmission of Shanghan and warm diseases and must be carefully distinguished.
Zhang Shiweng stated: There is a type of tongue coating that is black and dry in the center, possibly with slight prickles, but lacking thick accumulated coating despite the black color. The tongue body is withered and thin, not overly red. Symptoms include irritability and thirst, deafness, persistent fever, constipation for five to six days or even over ten days, soft abdomen without hardness or pain on pressure, clear consciousness without coma, inability to sleep day or night, occasional mumbling, smiling, or sighing when dozing. This is a sign of fluid depletion and blood dryness. Immediate treatment with Zhigancao Tang (Licorice Decoction) or Shengli Liuwei Wan (Six-Ingredient Pill with Added Herbs) modified with Sheng Di Huang (Rehmanniae Radix), combined with Shengmai San (Generate the Pulse Powder) and Gui Zhi (Cinnamon Twig), is required to nourish the source of transformation. Survival is possible; mistaking this for a case requiring Chengqi Tang leads to death, as does mistaking it for Si Ni Tang (Frigid Extremities Decoction). (These two passages both discuss the syndrome of blood dryness.)