伤寒烦躁证如何。阳明证与少阴科。阳明脉长大便秘。（仲景云。阳明脉长。自汗出。医复重发其汗。其人微烦不了
了者。此大便坚也。）伤风之候太阳多。（仲景云。太阳病。服桂枝汤。烦不解者。宜刺风池风府。却与桂枝汤。又云。
服桂枝汤。复大烦。渴不解。脉洪大者。白虎汤。）阴盛阳虚亦烦躁。少阴之证莫令讹。（大抵阴盛阳虚亦烦故。少阴证
多烦躁。少阴肾也。肾恶燥。故热邪传入肾经。则烦躁宜矣。仲景云。少阴病恶寒而倦。则自烦。欲去其衣者可治。又
云。自利烦躁不得眠者死。）汗下而烦医者误。（仲景云。伤寒吐下。发汗。虚烦。脉甚微。八九日心下坚痞。经脉动惕
者。久而成萎。）病解而烦气未和。更有虚烦宜竹叶。莫作伤寒致误佗。（孙兆云。虚烦热疾。与伤寒相似。得病二三日。
脉不浮不恶寒。身不疼痛。但热而烦。非表候。不可发汗。如脉不紧。实病。但热。或不烦。非里实。不可下。汗下必
危损。但用竹叶汤主之。其病自然而愈也。）
伤寒懊 意忡忡。（懊、于告反。 、千金音作农。外台云奴冻切。）或实或虚病胃中。结胸下早阳内陷。阳明误下
胃虚空。（懊 证有三。此一证。胃中因下空虚。而致也。仲景云。胃中空虚。客气动膈。短气烦躁。心中懊 。阳气内
陷。心下因硬。则为结胸。又云。阳明证。其脉浮紧。下之则胃中空虚。客气动膈。心中懊 。舌上白苔者。栀子汤主
之。若渴欲饮水者。白虎汤主之。）客气动膈心中躁。栀子汤兼大陷胸。（结胸。陷胸汤主之。白苔。栀子汤主之。）胃中
燥屎宜承气。腹满头坚不可攻。（此一证。胃中下后有燥屎也。仲景云。阳明病。下之。心下懊 微烦。胃中有燥屎者。
可攻。其人腹微满。头硬。后溏者。不可下之。有燥屎者。宜承气汤主之。）
伤寒病出现烦躁症状，该如何辨证？主要涉及阳明证与少阴证。阳明病的脉象长大且大便秘结。（张仲景说：阳明脉长，伴有自汗出，医生又重复发汗，导致患者轻微烦闷不止，这是大便坚硬所致。）伤风引起的症状多见于太阳经。（张仲景说：太阳病，服用桂枝汤后烦闷不解的，适宜针刺风池穴和风府穴，然后再给予桂枝汤。又说：服用桂枝汤后，反而出现严重烦闷、口渴不解，且脉象洪大的，用白虎汤治疗。）阴气盛而阳气虚也会导致烦躁。少阴证的诊断不要弄错。（大概阴盛阳虚也会引起烦闷，所以少阴证多伴有烦躁。少阴对应肾脏，肾厌恶燥热，因此热邪传入肾经，就会出现烦躁，这是理所当然的。张仲景说：少阴病恶寒且疲倦，如果自行感到烦闷，想要脱去衣服，这种是可以治疗的。又说：如果出现自发性腹泻、烦躁且无法入睡的，属于死证。）因误用发汗或攻下法导致的烦闷是医生的失误。（张仲景说：伤寒经过吐法、下法、发汗治疗后，出现虚烦，脉象非常微弱，八九天后心下部坚硬痞块，经脉跳动惕然不安的，时间久了会发展成萎痹证。）病势已解但仍感烦闷，是因为体内气机尚未调和。此时若有虚烦症状，适宜使用竹叶汤，不要将其误认为伤寒实证而导致错误治疗。（孙兆说：虚烦热疾，与伤寒相似。患病二三天，脉象不浮且不恶寒，身体不疼痛，只有发热和烦闷，这不是表证的表现，不可发汗。如果脉象不紧实，不是里实证，只是发热或不烦闷，也不是里实，不可攻下。若误用汗下法必然造成危险损害。只需用竹叶汤主治，疾病自然会痊愈。）
伤寒懊侬（ào náo）的症状表现为心中郁郁不舒、意绪忡忡。（“懊”音同“告”，“侬”在《千金方》中音作“农”，《外台秘要》中音作“奴冻切”。）这种病症有实证也有虚证，病位主要在胃中。如果是结胸证，是因为过早攻下导致阳气内陷；如果是阳明病误下，则导致胃中空虚。（懊侬证有三种情况，这里讲的是其中一种，即因为攻下后胃中空虚而引起的。张仲景说：胃中空虚，客气扰动膈部，出现短气、烦躁、心中懊侬。阳气内陷，心下部因此变硬，这就形成了结胸。又说：阳明病，脉象浮紧，如果误用攻下法，会导致胃中空虚，客气扰动膈部，心中懊侬，舌上有白苔的，用栀子汤主治。如果有口渴想喝水的症状，用白虎汤主治。）客气扰动膈部导致心中躁动，可用栀子汤兼治大陷胸汤。（结胸证用陷胸汤主治。舌苔白者用栀子汤主治。）胃中有干燥粪便的应当用承气汤，但如果腹部微满、头部僵硬（指大便初头硬后必溏），则不可攻下。（这一种情况，是攻下后胃中形成燥屎。张仲景说：阳明病，经过攻下后，心下部懊侬且轻微烦闷，如果胃中有燥屎的，可以攻下。如果患者腹部微满，大便初头硬而后溏的，不可攻下。确有燥屎存在的，适宜用承气汤主治。）
The manifestation of irritability and restlessness (Fan Zao) in cold damage diseases: how should it be differentiated? It primarily involves the Yangming syndrome and the Shaoyin syndrome. The Yangming presentation features a long and large pulse accompanied by constipation. (Zhang Zhongjing stated: A Yangming pulse is long; with spontaneous sweating, if the physician repeatedly induces sweating, leading to persistent mild irritability in the patient, this indicates hardened stool.) Wind-strike symptoms are commonly seen in the Taiyang channel. (Zhang Zhongjing stated: In Taiyang disease, if irritability persists after administering Guizhi Tang, it is appropriate to puncture Fengchi [GB20] and Fengfu [GV16], then administer Guizhi Tang again. He also stated: If severe irritability and unquenchable thirst occur with a flooding pulse after taking Guizhi Tang, Baihu Tang should be used.) Excess Yin and deficiency of Yang can also cause irritability. One must not misdiagnose the Shaoyin syndrome. (Generally, excess Yin and deficiency of Yang lead to irritability; thus, Shaoyin syndromes often present with irritability. Shaoyin corresponds to the Kidney, which dislikes dryness. Therefore, when pathogenic heat transmits to the Kidney meridian, irritability naturally ensues. Zhang Zhongjing stated: In Shaoyin disease, if there is aversion to cold and fatigue, and the patient spontaneously feels irritable and wishes to remove clothing, the prognosis is treatable. He also stated: Spontaneous diarrhea accompanied by irritability and inability to sleep indicates a fatal condition.) Irritability resulting from erroneous use of emesis, purgation, or diaphoresis is due to medical error. (Zhang Zhongjing stated: After vomiting, purging, or sweating in cold damage, if empty irritability occurs with a very faint pulse, and after eight or nine days, hardness and stagnation appear in the epigastrium with trembling of the meridians, it will eventually develop into Wei Bi syndrome over time.) When the disease resolves but irritability remains, it is because the Qi mechanism has not yet harmonized. If empty irritability is present, Zhuye Tang is appropriate; do not mistake it for a cold damage excess pattern to avoid treatment errors. (Sun Zhao stated: Empty irritability and heat disorders resemble cold damage. Within two or three days of onset, if the pulse is neither floating nor associated with aversion to cold, and the body is not painful, but only fever and irritability are present, this is not a exterior syndrome, and diaphoresis is contraindicated. If the pulse is not tight and solid, indicating no interior excess, and there is only fever or no irritability, purgation is contraindicated. Erroneous use of sweating or purging will inevitably cause danger and damage. Only Zhuye Tang should be administered, and the illness will resolve naturally.)
In cold damage, Ao Nao (restless discomfort) manifests as a feeling of郁 (depression) and anxiety. ("Ao" is pronounced like "gao"; "Nao" is pronounced "nong" in *Qianjin Fang*, and "nudongqie" in *Waitai Mi Yao*.) This condition can be either excess or deficiency, with the pathology located in the Stomach. Jie Xiong (Chest Binding) results from premature purgation causing Yang to sink inward; erroneous purgation in Yangming syndrome leads to an empty Stomach. (There are three types of Ao Nao syndromes; this one arises from emptiness in the Stomach following purgation. Zhang Zhongjing stated: Emptiness in the Stomach allows hostile Qi to disturb the Diaphragm, causing shortness of breath, irritability, and central Ao Nao. If Yang Qi sinks inward and the epigastrium becomes hard, it forms Jie Xiong. He also stated: In Yangming syndrome, if the pulse is floating and tight, and purgation is erroneously applied, leading to Stomach emptiness where hostile Qi disturbs the Diaphragm causing central Ao Nao, and the tongue has a white coating, Zhizi Tang should be used. If there is thirst and desire to drink water, Baihu Tang should be used.) Hostile Qi disturbing the Diaphragm causes central agitation; Zhizi Tang may be combined with Daxiexiong Tang. (Jie Xiong is treated with Xiexiong Tang. A white tongue coating indicates Zhizi Tang.) Dry feces in the Stomach require Chengqi Tang, but if the abdomen is slightly full and the head [stool] is hard [initially], it cannot be aggressively purged. (This case refers to dry feces formed in the Stomach after purgation. Zhang Zhongjing stated: In Yangming disease, after purgation, if there is central Ao Nao and slight irritability, and dry feces are present in the Stomach, purgation is permissible. However, if the abdomen is slightly full and the initial stool is hard followed by loose stool, purgation is contraindicated. Where dry feces are confirmed, Chengqi Tang is appropriate.)