【廉勘】热入血室。当分经适来因受病而止。经适来受病而自行。经适断而受病三种。则实与虚自见。如经
水适来。因热邪陷入而搏结不行者。必有瘀血。察其腰胁及少腹。有牵引作痛拒按者。必以清热消瘀为治。如
因邪热传营。逼血妄行。致经水未当期而至者。必有身热烦躁不卧等证。治宜凉血以安营。如经水适断而受邪
者。经行已净。则血室空虚。邪必乘虚而陷。治宜养营以清热。如伏邪病发。而经水自行者。不必治经水。但
治其伏邪。而病自愈。临证必须询其经期。以杜热入血室。
【荣斋按】程钟龄说∶“伤寒在表者可汗，在里者可下，其在半表半里者，惟有和之一法焉！仲景用小柴
胡汤加减是已。然有当和不和误人者，有不当和而和以误人者，有当和而和，而不知寒热之多寡，禀质之虚实
脏腑之燥湿，邪气之兼并以误人者，是不可不辨也。夫病当耳聋胁痛，寒热往来之际，应用柴胡汤和解之，而
或以麻黄桂枝发表误矣！或以大黄芒硝攻里，则尤误矣！又或因其胸满胁痛而吐之，则亦误矣！盖病在少阳，
有三禁焉！汗吐下是也。且非惟汗吐下有所当禁，即舍此三法，而妄用他药，均为无益而反有害。古人有言∶
‘少阳胆为清净之府，无出入之路，只有和解一法；柴胡一方，最为切当。’何其所见明确，而立法精微，其
至此乎？此所谓当和而和者也。然亦有不当和而和者，如病邪在表，未入少阳误用柴胡，谓之引贼入门，轻则
为疟，重则传入心胞，渐变神昏不语之候；亦有邪已入里，燥渴谵语，诸症业集，而医者仅以柴胡汤治之，则
病不解；至于内伤劳倦，内伤饮食，气虚血虚，痈肿瘀血诸症，皆令寒热往来，似疟非疟，均非柴胡汤所能去
者；若不辨明症候，切实用药，而借此平稳之法，巧为藏拙，误人匪浅！所谓不当和而和者此也。然亦有当和
而和，而不知寒热之多寡者，何也？夫伤寒之邪，在表为寒，在里为热，在半表半里，则为寒热交界之所；然
有偏于表者则寒多，偏于里者则热多，而用药须与之相称，庶阴阳和平，而邪气顿解；否则寒多而益其寒，热
多而助其热，药既不平，病益增剧，此非不和也，知和而不得寒热多寡之宜者也。然又有当和而和，而不知禀
质之虚实者何也？夫客邪在表，譬如贼甫入门，岂敢遽登吾堂而入吾室，必窥其堂奥空虚，乃乘隙而进，是以
小柴胡用人参者，所以补正气，使正气旺则邪无所容，自然得汗而解。亦有表邪失汗，腠理致密，贼无出路，
由此而传入少阳，热气渐盛，此不关本气之虚，故有不用人参而和解自愈者。是知病有虚实，法在变通，不
可误也。然又有当和而和，而不知脏腑之燥湿者何也？如病在少阳而口不渴，大便如常，是津液未伤，清润之
药，不宜太过，而半夏生姜皆可用也；若口大渴，大便渐结，是邪气将入于阴，津液渐少，则辛燥之药可除，
而花粉栝蒌，有必用矣；所谓脏腑有燥湿之不同者此也。然又有当和而和，而不知邪之兼并者何也？假如邪在
少阳，而太阳阳明症未罢，是少阳兼表邪也，小柴胡中须兼表药，仲景有柴胡加桂枝之例矣；又如邪在少阳兼
里热，则便闭谵语燥渴之症生，小柴胡中须兼里药，仲景有柴胡加芒硝之例矣；又三阳合病阖目则汗，面垢谵
语遗尿者，用白虎汤和解之；盖三阳同病，必连胃腑，故以辛凉之药，内清本腑，外彻肌肤，令三经之邪，一
同解散，是又专以清剂为和矣。所谓邪有兼并者此也。由是推之，有清而和者，有温而和者，有消而和者，有
补而和者，有燥而和者，有润而和者，有兼表而和者，有兼攻而和者，和之义则一，而和之法变化无穷焉。”
【廉勘】热邪侵入血室。应当根据月经适逢来潮时因受病而停止、月经适逢来潮时受病而自行停止、月经刚断绝时受病这三种情况来区分。那么实证与虚证自然显现。如果月经正来潮，因热邪陷入而搏结阻滞不通的，必定有瘀血。观察其腰胁及少腹部，如有牵引作痛且拒按的症状，治疗必须以清热消瘀为主。如果因邪热传入营分，逼迫血液妄行，导致月经未到预期时间就提前来的，必定伴有身热、烦躁、不能安卧等症状。治疗宜用凉血法以安定营气。如果月经刚断绝时感受邪气的，因为经期已净，血室空虚，邪气必定乘虚而入。治疗宜用养营法以清除余热。如果是伏邪发病，而月经自行正常来潮的，不必专门治疗月经，只需治疗伏邪，病自然痊愈。临证时必须询问患者的经期情况，以防患热入血室之变。
【荣斋按】程钟龄说：“伤寒病在表位的可以用发汗法，在里位的可以用攻下法，在半表半里位的，只有和解这一种方法！张仲景使用小柴胡汤进行加减就是这种方法。然而，有应当和解而未和解误人的，有不应当和解却和解了误人的，有应当和解和解了，但不知道寒热药比例多少、体质虚实、脏腑燥湿、邪气兼夹等情况而误人的，这些是不可不辨别的。当病人出现耳聋、胁痛、寒热往来等症状时，应用柴胡汤进行和解，但如果用麻黄、桂枝发表，就错了！如果用大黄、芒硝攻里，那就更错了！或者因为胸满胁痛而使用吐法，也是错误的。大概病在少阳经，有三禁：汗法、吐法、下法是也。而且不仅汗、吐、下三法有所禁忌，即使舍弃这三法，胡乱使用其他药物，也都是无益反而有害。古人有话说：‘少阳胆是清净之府，没有出入的路径，只有和解一法；柴胡一方，最为恰当。’他们的见解如此明确，立法如此精微，难道不是到了这种地步吗？这就是所谓的“当和而和”。然而也有“不当和而和”的情况，比如病邪在表，未传入少阳却误用柴胡，这叫引贼入门，轻则变成疟疾，重则传入心包，逐渐变为神志昏迷、不能言语的症状；也有邪气已经入里，出现燥渴、谵语，各种症状都已具备，而医生仅用柴胡汤治疗，则病不会解除；至于内伤劳倦、内伤饮食、气虚、血虚、痈肿、瘀血等各种病症，都表现为寒热往来，似疟非疟，都不是柴胡汤所能治愈的；如果不辨别清楚症候，切实用药，却借这平稳的方法，巧妙地掩饰自己的无能，误人不浅！这就是所谓的“不当和而和”。然而也有“当和而和”，但不知道寒热药比例多少的情况，为什么呢？伤寒的邪气，在表为寒，在里为热，在半表半里，则是寒热交界之处；然而有偏于表位的则寒多，偏于里位的则热多，用药必须与之相称，这样阴阳才能平和，邪气才能顿然解除；否则寒多而增加其寒，热多而助长其热，药性既然不平，病情就会更加严重，这不是不和，而是知道要和解却不得寒热比例适宜的原因。然而又有“当和而和”，但不知道体质虚实的情况，为什么呢？外感邪气在表，譬如盗贼刚进门，怎么敢立刻登上厅堂进入卧室，一定要窥探厅堂内部空虚，才趁机进入，所以小柴胡汤用人参，是为了补益正气，使正气旺盛则邪气无处容身，自然得汗而解。也有表邪失于发汗，腠理致密，邪气无路可出，由此传入少阳，热气逐渐旺盛，这不关乎本身体质的虚弱，所以有不用人参而通过和解自愈的情况。由此可知疾病有虚实之分，治法在于变通，不可错误。然而又有“当和而和”，但不知道脏腑燥湿的情况，为什么呢？如病在少阳而口不渴，大便正常，说明津液未受损，清润的药物不宜太过，半夏、生姜都可以使用；如果口大渴，大便逐渐干结，说明邪气将要入阴，津液逐渐减少，那么辛燥的药物可以去除，而天花粉、瓜蒌则是必须使用的；这就是所谓脏腑有燥湿不同的情况。然而又有“当和而和”，但不知道邪气兼夹的情况，为什么呢？假如邪气在少阳，而太阳、阳明症状尚未罢除，这是少阳兼有表邪，小柴胡汤中须兼用解表药，张仲景有柴胡加桂枝汤的例子；又如邪气在少阳兼有里热，则出现便秘、谵语、燥渴等症状，小柴胡汤中须兼用治里药，张仲景有柴胡加芒硝汤的例子；又比如三阳合病，闭目则出汗，面色垢浊、谵语、遗尿的，用白虎汤进行和解；大概三阳同病，必然牵连胃腑，所以用辛凉的药物，内清本腑，外透肌肤，令三经的邪气一同解散，这又是专以清热剂作为和解的方法。这就是所谓邪气有兼夹的情况。由此推演，有清热而和解的，有温阳而和解的，有消导而和解的，有补益而和解的，有燥湿而和解的，有润燥而和解的，有兼解表而和解的，有兼攻里而和解的，和解的含义是一致的，但和解的方法变化无穷。”
[Comment by Lian] When heat enters the Blood Chamber (Xue Shi, a concept related to the uterus and liver channel), one must distinguish between three scenarios: illness contracted when menstruation is just starting and then stopping spontaneously; illness contracted when menstruation is just starting and continuing until it stops naturally; and illness contracted immediately after menstruation has ceased. In these cases, excess (Shi) and deficiency (Xu) patterns will become apparent. If menstruation is in progress and heat pathogens invade and cause blood stasis with obstruction, there must be blood stasis. Observing the lower abdomen and hypochondrium for pulling pain that worsens with pressure confirms this; treatment should focus on clearing heat and resolving stasis. If heat pathogens transmit to the Ying (Nutrient) level, forcing blood to move recklessly and causing premature menstruation, symptoms such as fever, restlessness, and insomnia will likely occur; treatment should employ cooling blood methods to calm the Ying level. If illness is contracted immediately after menstruation has ceased, the Blood Chamber is empty due to the completion of the menstrual flow, allowing pathogens to sink in due to deficiency; treatment should nourish the Ying level while clearing residual heat. If latent pathogens manifest while menstruation proceeds normally, there is no need to treat the menstruation specifically; treating the latent pathogens alone will lead to spontaneous recovery. Clinically, one must inquire about the menstrual cycle to prevent complications from heat entering the Blood Chamber.
[Comment by Rongzhai] Cheng Zhongling stated: "For Taiyang exterior syndrome, sweating is indicated; for Yangming interior syndrome, purgation is indicated; for Shaoyang half-exterior half-interior syndrome, only harmonization is applicable. Zhang Zhongjing's use of Xiao Chai Hu Tang (Minor Bupleurum Decoction) with modifications exemplifies this. However, errors occur when harmonization is omitted when needed, applied when not needed, or applied without considering the balance of cold and hot herbs, the constitution's deficiency or excess, the dryness or dampness of the zang-fu organs, and the combination of pathogens. These distinctions are crucial. When a patient presents with deafness, hypochondriac pain, and alternating chills and fever, Chai Hu Tang should be used to harmonize. Using Ma Huang Tang (Ephedra Decoction) or Gui Zhi Tang (Cinnamon Twig Decoction) to release the exterior is an error. Using Da Huang (Rhubarb Root and Rhizome) and Mang Xiao (Mirabilite) to purge the interior is a greater error. Using emetics due to chest fullness and hypochondriac pain is also wrong. There are three prohibitions for Shaoyang disorders: sweating, vomiting, and purging. Moreover, beyond these three, indiscriminate use of other remedies is harmful. As the ancients said, 'The Gallbladder is a pure and clear organ with no direct exit or entry pathways; harmonization is the only method. The Chai Hu formula is most appropriate.' This demonstrates their clear insight and refined methodology, representing the principle of 'harmonizing when appropriate.'
However, there are instances of 'harmonizing when inappropriate.' For example, if pathogens are still in the exterior and have not entered Shaoyang, using Chai Hu Tang is like inviting thieves into the house; mild cases may develop into malaria, while severe cases may transmit to the Pericardium, leading to coma and mutism. Conversely, if pathogens have entered the interior, presenting with dry mouth, thirst, and delirious speech, using only Chai Hu Tang will fail to resolve the disease. Furthermore, internal injuries from overwork, dietary indiscretion, Qi deficiency, Blood deficiency, abscesses, and blood stasis can all present with alternating chills and fever resembling malaria; these are not cured by Chai Hu Tang. Failing to differentiate symptoms and prescribing accurately, yet hiding incompetence behind the 'safe' reputation of harmonization, causes significant harm. This is 'harmonizing when inappropriate.'
There are also cases of 'harmonizing when appropriate' but failing to adjust the ratio of cold and hot herbs. Pathogens in the exterior are cold; in the interior, they are hot; in the half-exterior half-interior zone, they represent a boundary of cold and heat. If the pathogen leans toward the exterior, cold predominates; if it leans toward the interior, heat predominates. Herbs must be balanced accordingly to restore Yin-Yang harmony and expel pathogens. Otherwise, adding cold to cold or heat to heat exacerbates the condition. This is not a failure of harmonization per se, but a failure to master the appropriate balance of cold and hot properties.
There are also cases where one fails to consider the patient's constitutional deficiency or excess. An external pathogen is like a thief at the door; it cannot easily enter the inner chambers unless it finds them empty. Thus, Ren Shen (Ginseng Root and Rhizome) is included in Xiao Chai Hu Tang to tonify healthy Qi; when healthy Qi is strong, pathogens cannot reside, and resolution through sweating occurs naturally. However, if exterior pathogens were not properly released, causing dense pores and trapping heat that transmits to Shaoyang, this heat accumulation is not due to constitutional deficiency, and harmonization may succeed without Ren Shen. Thus, treatments must adapt to deficiency and excess.
Furthermore, one must consider the dryness or dampness of the zang-fu. If Shaoyang disorder presents with no thirst and normal stools, fluids are intact; moistening herbs should be used sparingly, while Ban Xia (Pinellia Tuber) and Sheng Jiang (Fresh Ginger Rhizome) are suitable. If there is intense thirst and constipation, indicating pathogens moving toward the Yin levels and fluid depletion, drying aromatic herbs should be reduced, and Hua Fen (Trichosanthes Root) and Gua Lou (Trichosanthes Fruit) become necessary. This reflects the variation in zang-fu dryness and dampness.
Finally, one must consider combined pathogens. If Shaoyang disorder coexists with Taiyang and Yangming symptoms, it is a Shaoyang disorder with exterior involvement; Xiao Chai Hu Tang should be modified with exterior-releasing herbs, as seen in Chai Hu Jia Gui Zhi Tang (Bupleurum Decoction plus Cinnamon Twig). If Shaoyang disorder combines with interior heat, causing constipation, delirium, and thirst, interior-purging herbs are needed, as seen in Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction plus Mirabilite). In San Yang He Bing (Combined Disorder of the Three Yang) presenting with sweating upon closing eyes, facial greasiness, delirium, and urinary incontinence, Bai Hu Tang (White Tiger Decoction) is used to harmonize. Since the Three Yang channels connect to the Stomach,辛凉 (pungent-cool) herbs clear the interior and vent the exterior, resolving pathogens in all three channels simultaneously. This represents using a clearing agent as a harmonizing method.
From this, we see harmonization can involve clearing, warming, reducing, tonifying, drying, moistening, releasing the exterior, or purging the interior. While the essence of harmonization is one, its applications are infinite."