（不得眠者阳明病也胃不和则卧不安也或因汗下而心血亏损或因烦热而辗转不
宁或因瘥后余热未尽阴气未复皆令人不得卧也）
太阳病。二三日不得卧。心下必结。脉微弱者。寒也。（桂枝加浓朴杏子汤）太阳脉浮数。
身疼无汗。烦躁不眠。汗之。（麻黄汤）下后复汗。昼日烦躁。不得眠。夜而安静。不呕不渴。无
表症。脉沉微。身无大热。（ 干姜附子汤）衄家不可汗。汗则额上陷。脉紧急。直视不 。（黄
芩芍药汤）下后心烦复满。卧起不安。（栀子浓朴汤）汗吐下后。虚烦不得眠。心中懊 。（栀子豉
汤）身热。目痛。鼻干。不得卧。尺寸脉俱长。阳明病也。小便不利。大便乍难乍易。微热
。喘冒不卧。有燥屎也。（大承气汤）阳明脉浮紧。咽燥口苦。喘满发热。汗出。不恶寒。反
恶热。烦躁不眠。（栀子豉汤）少阴病欲寐。二三日后。心烦不得卧。（黄连阿胶汤）少阴病。
下利欲寐。六七日后。咳而呕渴。心烦不得眠。（猪苓汤）少阴病。但欲寐。脉沉细。烦欲吐
。至五六日自利。复烦躁不得寐者。死。发热下利。厥逆烦躁不得卧者。死。
按不得眠。皆为热症。夫心为丙丁之主。邪火炎灼。则神不休息。魂气飞扬。不能归肝
而卧也。其在太阳汗下后。昼日烦躁不眠一症。虽用附子干姜汤。盖复其汗下所亡之阳。非治其
所感之寒也。若汗下后。虚烦甚而脉微弱者。加味温胆汤。与栀子乌梅汤。均称要剂。
（无法入睡属于阳明病。胃气不和则睡眠不安。有的因为发汗或攻下导致心血亏损，有的因为烦热而辗转反侧、不得安宁，有的因为病愈后余热未尽、阴气未恢复，这些都会导致人无法入睡。）
太阳病，发病两三天后无法入睡，心下部必然有结滞感。如果脉象微弱，这是寒证。（用桂枝加浓朴杏子汤）太阳病脉象浮数，身体疼痛且无汗，烦躁不眠，应当使用发汗法治疗。（用麻黄汤）经过攻下后又发汗，白天烦躁不安，无法入睡，夜间却安静下来，没有呕吐也没有口渴，表证已解，脉象沉微，身体没有大热。（用干姜附子汤）经常鼻出血的人不可发汗，若误用发汗法，会导致额部动脉凹陷，脉象紧急，眼睛直视不能转动。（用黄芩芍药汤）攻下之后心中烦闷且腹部胀满，坐卧不安。（用栀子厚朴汤）经过发汗、催吐、攻下之后，出现虚烦无法入睡，心中懊恼郁闷。（用栀子豉汤）身体发热，眼睛痛，鼻子干，无法入睡，寸关尺三部脉象都长，这是阳明病。小便不利，大便时而难解时而通畅，轻微发热，气喘头晕无法平卧，这是体内有燥屎。（用大承气汤）阳明病脉象浮紧，咽喉干燥口苦，气喘胸满发热，出汗，不怕冷反而怕热，烦躁不眠。（用栀子豉汤）少阴病想睡觉，两三天后，心烦无法入睡。（用黄连阿胶汤）少阴病，腹泻想睡觉，六七天之后，咳嗽、呕吐、口渴，心烦无法入睡。（用猪苓汤）少阴病，只想睡觉，脉象沉细，心烦想吐，到了五六天出现自发性腹泻，又烦躁无法入睡的，预后不良，属死证。发热、腹泻、四肢厥冷、烦躁无法入睡的，预后不良，属死证。
按语：无法入睡，都属于热证。心是丙丁火之主，邪火炎灼，则神志不能休息，魂气飞扬，不能回归肝脏而安卧。在太阳病发汗或攻下后，出现白天烦躁不眠这一症状，虽然使用附子干姜汤，是为了恢复因汗下所亡失的阳气，并非治疗所感受的寒邪。如果在汗下之后，虚烦严重且脉象微弱，可以使用加味温胆汤，或者栀子乌梅汤，都称为重要的方剂。
(Insomnia belongs to Yangming disease. When the stomach is not harmonious, sleep is unsettled. Some cases result from blood and heart deficiency caused by sweating or purging; some from restlessness due to heat causing tossing and turning; others from residual heat remaining after recovery while yin qi has not yet recovered. All these lead to inability to sleep.)
Taiyang disease (Disease of the Taiyang channel). After two or three days, if one cannot sleep, there must be a sensation of fullness/stagnation in the epigastrium. If the pulse is faint and weak, it indicates cold. (Guizhi Jia Houpo Zixi Tang [Cinnamon Twig Decoction plus Magnolia Bark and Apricot Seed]) In Taiyang disease, if the pulse is floating and rapid, with body pain, absence of sweat, irritability, and insomnia, sweating therapy should be applied. (Mahuang Tang [Ephedra Decoction]) After purging followed by sweating, if there is irritability during the day and inability to sleep, but quietness at night, without vomiting or thirst, no exterior syndrome, and a deep and faint pulse, with no significant fever on the body: (Ganjiang Fuzi Tang [Dried Ginger and Aconite Root Decoction]) Patients prone to nasal hemorrhage should not undergo sweating therapy. If sweating is mistakenly induced, the temporal artery may sink/depress, the pulse becomes tight and urgent, and the eyes stare straight ahead without movement. (Huangqin Shaoyao Tang [Scutellaria and Peony Decoction]) After purging, if there is irritability combined with abdominal fullness, leading to restlessness in sitting and lying down: (Zhizi Houpo Tang [Gardenia and Magnolia Bark Decoction]) After sweating, vomiting, and purging, if there is empty irritability and inability to sleep, with a feeling of stifling discomfort in the chest: (Zhizi Chi Tang [Gardenia and Fermented Soybean Decoction]) With body heat, eye pain, dry nose, and inability to sleep, where the cun, guan, and chi pulses are all long, this is Yangming disease. If there is difficulty in urination, alternating difficulty and ease in defecation, slight fever, wheezing, dizziness, and inability to lie flat, this indicates the presence of dry stool. (Da Chengqi Tang [Major Order the Qi Decoction]) In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, wheezing, chest fullness, fever, sweating, aversion to cold being absent but aversion to heat present, and irritability with insomnia: (Zhizi Chi Tang [Gardenia and Fermented Soybean Decoction]) In Shaoyin disease, if the patient desires to sleep, but after two or three days experiences irritability and inability to sleep: (Huanglian Ejiao Tang [Coptis and Donkey-Hide Gelatin Decoction]) In Shaoyin disease, with diarrhea and desire to sleep, after six or seven days, if cough, vomiting, thirst, irritability, and inability to sleep occur: (Zhuling Tang [Polyporus Decoction]) In Shaoyin disease, if the patient only desires to sleep, with a deep and fine pulse, irritability, and desire to vomit; if spontaneous diarrhea occurs by the fifth or sixth day followed by irritability and inability to sleep, the prognosis is fatal. If there is fever, diarrhea, cold extremities, irritability, and inability to sleep, the prognosis is also fatal.
Note: Insomnia is generally a heat syndrome. The Heart is the master of Bing-Ding (Fire). When pathogenic fire blazes, the spirit cannot rest, and the soul qi flies upward, unable to return to the Liver for sleep. In Taiyang disease after sweating or purging, the symptom of daytime irritability and insomnia, although treated with Fuzi Ganjiang Tang, aims to restore the yang qi lost through sweating and purging, rather than treating the contracted cold. If after sweating and purging, empty irritability is severe and the pulse is faint and weak, Jiawei Wendan Tang [Modified Pinellia Reunion Decoction] or Zhizi Wumei Tang [Gardenia and Mume Fruit Decoction] can be used, both being important formulas.