烦热者病在外。虚烦者病在内。至所称烦躁者。谓心中郁郁而烦。又加以手足躁扰。则
谓之烦躁。有属于阳者。有属于阴者。其中表里殊因。温凉异用。宜细辨之。
有邪热在表。欲汗不汗。因作烦躁者。经云。太阳中风。脉浮紧。发热恶寒。身疼痛不
汗出
而烦躁。大青龙汤主之。此乃发汗之峻剂。必辨其无少阴证相杂。方可大发其汗。盖少阴病
之烦躁。由于阳气微，故忌发汗。太阳病之烦躁。由于阳气盛。故宜发汗。何以辨之。则以
太阳之脉或浮缓或浮紧。而少阴之脉必沉细也。
经云当汗不汗。其人躁烦。病在太阳。宜以汗解矣。然有发汗之后而烦躁者。则以津液
被夺
。胃中水竭。如经云。太阳病发汗后。大汗出。胃中干躁。烦躁不得眠。欲得饮水者。少少
与饮之。令胃气和则愈者也。至于胃已实者。如经云。阳明病若发汗则躁。又云。病患不
大便五日。绕脐痛。烦躁发作有时。此有燥屎。是又不宜汗而宜下矣。
烦躁属热者。为邪热传里之候。然有自表而传里者。又有自里而传表者。大约湿热之邪
。往
往先里后表。其病起即胸膈痞满。口渴谵语。种种里证悉具。其里邪欲出于表。而又不能出
。因烦躁发热者。此等证便不可发汗。发汗则津液被夺。里邪愈锢。宜先与疏里。佐以透表
。使里气先和。自然得汗而解。盖其病传之先后有不同。第就仲景汗下诸法。随其证之先后
而错综之。其治法可微会矣。
若风寒之邪。其病初起不烦躁。其后渐烦躁而身热反去者。如经云伤寒六七日。无大热
。其人躁烦。此为阳去入阴故也。病至此增剧矣。
凡邪入三阴而烦躁者。虽所传渐深。始终总归于热。其有阴盛阳微而作烦躁者。经云阳
微发
汗。躁不得眠。则深以发汗为戒矣。盖其人阳气本微而阴盛又迫阳于外。则外显假热。内实
真寒。其脉必沉细。口虽渴。但欲漱水不欲咽者。此其候也。然其中有病本阴寒而致阳微者
。又误施汗下而致阳微者。如经云。少阴病吐利。手足逆冷。烦躁欲死者。吴茱萸汤主之。
是
此病本阴寒而阳微者也。又如经云。下之后。昼日烦躁不得眠。夜而安静。不呕不渴。无表
证。脉沉微。身无大热者。干姜附子汤主之。又云。发汗若下之。病仍不解。烦躁者。茯苓
四逆汤主之。是误施汗下而阳微者也。然阳气微者。尚可施回阳之力。其阴盛逼阳于外。而
阳已外脱者。如经云。少阴病吐利躁烦四逆者死。少阴病四逆。恶寒而身蜷。脉不至。不
烦而躁者死。少阴病脉微细沉。但欲卧。汗出。不烦。自欲吐。至五六日自利。复烦躁。不
得卧寐者死。伤寒六七日。脉微手足厥冷烦躁灸厥阴灸不还者死。伤寒发热下利厥逆躁不得
卧者死。如此之烦躁。是阳已垂脱。救亦无及矣。
又有因水气而烦躁者。金匮云。肺胀咳而上气。烦躁而喘。脉浮者。心下有水。小青龙
加石
膏汤主之。盖心下有水。上射及肺。肺为之胀。故烦躁而喘。乃立此泄肺行水之法。然此病
不独风寒之从外入者。足以与内饮相合。即湿热之在里者。或因热甚而恣啖生冷。或湿邪未
解。误投寒凉。皆能停饮于胸膈之间。寒饮怫郁其邪。外不能达表。内不能传胃。故烦躁转
甚。必先消其水气。则邪得有出路。而烦躁自能渐除。又治法之变也。
烦热，是病邪在体表。虚烦，是病邪在体内。至于所说的“烦躁”，是指心中郁闷烦乱，再加上手足躁动不安，这就称为烦躁。烦躁有属于阳证的，也有属于阴证的。其表里病因不同，温凉治法各异，应当仔细辨别。
如果有邪热在体表，想要出汗却出不来，因而产生烦躁的，《伤寒论》说：太阳中风证，脉象浮紧，发热恶寒，身体疼痛，无汗而烦躁，用大青龙汤主治。这是发汗的峻猛方剂，必须辨别没有少阴证夹杂其中，才可以大发其汗。因为少阴病的烦躁，是由于阳气微弱，所以忌讳发汗；太阳病的烦躁，是由于阳气亢盛，所以适宜发汗。如何辨别呢？看脉象，太阳病的脉象或浮缓或浮紧，而少阴病的脉象必定沉细。
《伤寒论》说：应当发汗而未发汗，病人躁动烦乱，病位在太阳经，适宜用发汗法解除。然而，有些人在发汗之后出现烦躁，这是因为津液被耗伤，胃中津液枯竭。如《伤寒论》所说：太阳病发汗后，大汗出，胃中干燥，烦躁不得安眠，想喝水的，少量多次给予饮水，使胃气调和就会痊愈。至于胃腑已经实热的情况，如《伤寒论》所说：阳明病如果误用发汗则会出现躁动；又说：病人五天不大便，绕脐疼痛，烦躁发作有定时，这是有燥屎内结，这种情况就不宜发汗而适宜用泻下法了。
烦躁属于热证的，是邪热传入体内的征候。然而，有从体表传入体内的，又有从体内透达体表的。大致而言，湿热之邪往往先影响内部再波及外部，发病之初就出现胸膈痞满、口渴、胡言乱语等种种里证俱全。体内的邪气想要向外透达，却又无法透出，因而出现烦躁发热，这类证候不可发汗，发汗则会耗伤津液，使里邪更加固结。适宜先用疏利里邪的方法，佐以透达表邪，使里气先调和，自然就能通过出汗而解。大概是因为疾病传变的先后顺序有所不同，只需根据张仲景的发汗和泻下诸法，随着证候的先后变化而灵活运用，治疗原则就可以大致领会了。
如果是风寒之邪，发病初期不烦躁，后来逐渐出现烦躁且身热反而消退的，如《伤寒论》所说：伤寒六七天，身上没有大热，病人躁动烦乱，这是阳气衰退、病邪入里的缘故。病情到这里加重了。
凡是邪气侵入三阴经而出现烦躁的，虽然传变逐渐深入，但始终总归属于热证。但有因阴寒盛极、阳气微弱而产生烦躁的，《伤寒论》说：阳气微弱而误用发汗，导致躁动不得安眠，对此深以发汗为戒。大概是因为病人本身阳气微弱，阴寒又逼迫阳气外越，于是外表显现假热，内里实际上是真寒。其脉象必定沉细，口虽渴，但只想含水漱口而不想咽下，这就是其征候。然而其中有原本就是阴寒病导致阳气微弱的，又有误用发汗、泻下导致阳气微弱的。如《伤寒论》所说：少阴病呕吐腹泻，手足逆冷，烦躁欲死的，用吴茱萸汤主治。这是病本为阴寒而阳气微弱的情况。又如《伤寒论》所说：泻下之后，白天烦躁不得安眠，夜间安静，不呕吐不口渴，没有表证，脉象沉微，身上没有大热的，用干姜附子汤主治。又说：发汗或者泻下后，病仍未解除，出现烦躁的，用茯苓四逆汤主治。这是误用发汗、泻下而导致阳气微弱的情况。然而，对于阳气微弱者，还可以施用回阳救逆的方法。如果是阴寒盛极逼迫阳气外越，而阳气已经外脱的，如《伤寒论》所说：少阴病呕吐腹泻、躁动烦乱、四肢厥冷的，预后不良（死）；少阴病四肢厥冷，恶寒且身体蜷缩，脉搏摸不到，不烦躁但躁动的，预后不良（死）；少阴病脉象微细沉，只想睡觉，出汗，不烦躁，自己想去吐，到了五六天又出现下利，再次烦躁，不能卧睡的，预后不良（死）；伤寒六七天，脉微，手足厥冷，烦躁，艾灸厥阴穴后反应不好的，预后不良（死）；伤寒发热，下利，四肢厥冷，躁动不得卧睡的，预后不良（死）。这样的烦躁，是阳气即将脱绝，即使救治也来不及了。
又有因为水气停聚而导致烦躁的，《金匮要略》说：肺胀，咳嗽且气逆，烦躁且气喘，脉象浮的，是心下有停水，用小青龙加石膏汤主治。大概是因为心下有停水，上射于肺，肺因此胀满，所以出现烦躁且气喘，为此设立这种宣泄肺气、行除水饮的方法。然而，这种病不仅限于风寒之邪从外侵入，足以与体内的水饮相合；即使是湿热之邪在体内，也可能因为热甚而恣意吃生冷食物，或者湿邪未解，误投寒凉药物，都能导致水饮停滞在胸膈之间。寒饮郁遏邪气，外不能达表，内不能传胃，所以烦躁更加严重。必须先消除水气，那么邪气才有出路，烦躁自然能逐渐消除。这也是治法的变通。
Heat with vexation indicates the pathogen is in the exterior. Empty vexation indicates the pathogen is in the interior. The term "restlessness and vexation" (Fan Zao) refers to a state of mental depression and irritability, compounded by restless tossing of the hands and feet. Restlessness and vexation may belong to Yang patterns or Yin patterns. Their etiologies in the interior and exterior differ, and their treatments involve different warming and cooling applications; thus, they must be carefully distinguished.
If pathogenic heat remains in the exterior, and sweating is desired but cannot occur, resulting in restlessness and vexation, the *Jing* (Classic) states: In Taiyang Wind Strike pattern, with a floating-tight pulse, fever, aversion to cold, body pain, absence of sweat, and restlessness and vexation, Da Qing Long Tang (Great Blue Dragon Decoction) should be administered. This is a potent diaphoretic formula. One must ensure that there are no signs of Shaoyin disease mixed in before administering strong diaphoresis. This is because restlessness and vexation in Shaoyin disease stem from deficient Yang Qi, making diaphoresis contraindicated. Conversely, restlessness and vexation in Taiyang disease stems from abundant Yang Qi, making diaphoresis appropriate. How to distinguish them? By the pulse: Taiyang pulses may be floating-slow or floating-tight, whereas Shaoyin pulses are invariably deep-thin.
The *Jing* states: When diaphoresis is indicated but not performed, and the patient becomes restless and vexed, the disease is in Taiyang, and diaphoresis is the appropriate treatment. However, some patients develop restlessness and vexation after diaphoresis due to the depletion of Body Fluids and exhaustion of stomach fluids. As stated in the *Jing*: After treating a Taiyang disease with diaphoresis, if excessive sweating occurs, leading to a dry stomach, restlessness, insomnia, and thirst for water, one should provide small amounts of water frequently. When the Stomach Qi harmonizes, the patient will recover. In cases where the Stomach has become full/excess, as stated in the *Jing*: If Yangming disease is mistakenly treated with diaphoresis, restlessness ensues. It also states: If a patient has not had a bowel movement for five days, experiences periumbilical pain, and has periodic episodes of restlessness and vexation, this indicates the presence of dry feces. In such cases, diaphoresis is inappropriate, and purgation is required.
Restlessness and vexation belonging to Heat patterns indicate that pathogenic heat has transmitted to the interior. However, transmission can occur from the exterior to the interior, or from the interior to the exterior. Generally, Damp-Heat pathogens tend to affect the interior first and then the exterior. The disease begins with chest and epigastric fullness, thirst, delirium, and other interior symptoms fully present. When interior pathogens attempt to emerge to the exterior but fail, resulting in restlessness, vexation, and fever, diaphoresis must not be used. Diaphoresis would deplete Body Fluids and further entrap the interior pathogens. Instead, one should first resolve the interior pathology, assisted by methods that vent the exterior, allowing the interior Qi to harmonize first, so that sweating naturally occurs and the disease resolves. Since the sequence of disease transmission varies, by applying Zhang Zhongjing’s methods of diaphoresis and purgation flexibly according to the sequence of symptoms, the therapeutic principles can be roughly understood.
If Wind-Cold pathogens are involved, and the initial stage lacks restlessness, but later develops restlessness while body heat subsides, as stated in the *Jing*: In Cold Damage lasting six or seven days, with no significant fever, yet the patient is restless and vexed, this indicates the departure of Yang and entry into the Yin. The condition has worsened at this stage.
In all cases where pathogens enter the Three Yin meridians causing restlessness and vexation, although the transmission deepens, it ultimately归于 Heat. However, there are cases of restlessness and vexation caused by extreme Yin Cold and deficient Yang. The *Jing* states: If Yang is deficient and diaphoresis is mistakenly applied, resulting in restlessness and insomnia, diaphoresis must be strictly avoided. This is because the patient’s Yang Qi is inherently weak, and extreme Yin forces Yang to float outward, creating false heat on the exterior while true cold exists within. The pulse will be deep-thin. Although the mouth feels thirsty, the patient only desires to rinse the mouth without swallowing. This is the characteristic presentation. Among these, some cases originate from inherent Yin Cold leading to Yang deficiency, while others result from erroneous application of diaphoresis or purgation leading to Yang deficiency. For example, the *Jing* states: In Shaoyin disease with vomiting, diarrhea, cold extremities, and severe restlessness, Wu Zhu Yu Tang (Evodia Decoction) should be administered. This represents a case of inherent Yin Cold with Yang deficiency. Similarly, the *Jing* states: After purgation, if the patient is restless during the day but quiet at night, without vomiting or thirst, lacking exterior signs, with a deep-micro pulse and no significant fever, Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction) should be administered. It also states: If after diaphoresis or purgation the disease persists and restlessness occurs, Fu Ling Si Ni Tang (Poria Four Reversal Decoction) should be administered. These represent cases of Yang deficiency caused by erroneous treatment. For patients with deficient Yang, restoring Yang is still possible. However, in cases where extreme Yin forces Yang outward and Yang has already collapsed externally, as stated in the *Jing*: In Shaoyin disease with vomiting, diarrhea, restlessness, and cold extremities, the prognosis is fatal. In Shaoyin disease with cold extremities, aversion to cold, body curling, absent pulse, restlessness without vexation, the prognosis is fatal. In Shaoyin disease with micro-thin-deep pulse, desire to sleep, sweating, lack of vexation, desire to vomit, progressing to five or six days with diarrhea, recurrent restlessness, and inability to sleep, the prognosis is fatal. In Cold Damage lasting six or seven days, with micro pulse, cold extremities, and restlessness, if moxibustion at Jueyin fails to restore warmth, the prognosis is fatal. In Cold Damage with fever, diarrhea, cold extremities, and restlessness preventing lying down, the prognosis is fatal. Such restlessness indicates impending Yang collapse, and rescue is futile.
There are also cases of restlessness and vexation caused by Water-Qi retention. The *Jin Gui Yao Lue* states: In Lung Distension with cough, qi rebellion, restlessness, wheezing, and a floating pulse, there is water retention below the heart. Xiao Qing Long Jia Shi Gao Tang (Minor Green Dragon Decoction plus Gypsum) should be administered. This is because water retention below the heart affects the lungs upward, causing lung distension, leading to restlessness and wheezing. Thus, a method to vent the Lungs and promote water metabolism was established. However, this condition is not limited to external Wind-Cold combining with internal fluid retention. Even Damp-Heat in the interior can lead to fluid retention if, due to intense heat, one consumes excessive cold/raw foods, or if Dampness is unresolved and cold-natured herbs are mistakenly administered. This causes fluid retention in the chest and diaphragm. Cold-fluid retention stifles the pathogen, preventing it from reaching the exterior or transmitting to the Stomach, thereby exacerbating restlessness. One must first eliminate the Water-Qi so that the pathogen has an exit route, and restlessness will gradually subside. This represents a variation in therapeutic methods.