[General Principles] Zhang Zhongjing stated: In Yangming disease, the pulse is floating and tight, with dryness in the throat and bitter taste in the mouth, abdominal fullness accompanied by panting, fever with sweating, aversion to cold absent but aversion to heat present, and a heavy sensation in the body.
If moxibustion via burning needles (Shao Zhen) is mistakenly applied, the patient will experience palpitations, fright, irritability, and insomnia; this should be treated primarily with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). After treatment with diaphoresis, emesis, or purgation, if deficiency-heat causes irritability and insomnia; if severe, it manifests as tossing and turning and restlessness, with a feeling of stifling oppression in the chest; this should also be treated primarily with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). Following purgation for Cold Damage (Shanghan), if there is irritability, abdominal fullness, and restlessness in both rising and lying down, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) should be used.

[Annotations] Zhu Gong said: Sweat is the fluid of fire; excessive sweating leads to clouded spirit, hence insomnia. High fever leads to unclear spirit, hence insomnia. Severe purgation disturbs blood; since the Heart governs blood, this leads to insomnia. After recovery, if pathogenic heat has not dissipated and Yin Qi has not recovered, this leads to insomnia.
Wu Shou said: When the exterior aspect of the Yangming channel is affected, symptoms include pain in the forehead and temples, eye pain, body heat, and nasal dryness, leading to insomnia; if the pulse is long, Gegen Jieji Tang (Pueraria Decoction to Release the Muscle Layer) should be used. If there is spontaneous sweating, a flooding and rapid pulse, heat in both interior and exterior, irritability, thirst, dry tongue desiring water, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be used. If there is steaming fever and hard, constipated stool, Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction) should be used. If external Cold Damage has resolved but recurrence due to dietary indiscretion causes severe irritability, dry retching, dry mouth, groaning, delirious speech, and insomnia, Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxicity) should be used. For severe heat in both interior and exterior with dry tongue desiring water, Ren Shen Baihu Tang (Ginseng White Tiger Decoction) combined with Jiedu Tang (Decoction to Resolve Toxicity) should be used. If the Taiyang pulse is floating and rapid, with body pain, absence of sweat, irritability, and insomnia, resolution through diaphoresis will lead to cure. For Shaoyang disease with fever, bitter taste, irritability, and insomnia, with a wiry and rapid pulse, Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardeniae Fructus) and Huanglian (Coptidis Rhizoma) should be used. For those with deficiency and insufficient fluids, Maidong (Ophiopogonis Radix) and Zaoren (Ziziphi Spinosae Semen) should be added. For irritability and insomnia following diaphoresis or purgation, Jiawei Wendan Tang (Modified Phlegm-Resolving Decoction), Suanzaoren Tang (Sour Jujube Seed Decoction), Zhizi Wumei Tang (Gardenia and Mume Fruit Decoction), or Zhusha Anshen Wan (Cinnabar Calming Spirit Pill) may be selected and used according to the condition.
Ke Qin said: Regarding the three preceding cases: irritability makes lying down difficult; abdominal fullness makes rising difficult. Restlessness in rising and lying down indicates Heart heat transferring to the Stomach, which differs from the tossing and turning of deficiency-heat. Zhizi treats irritability, while Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) relieve fullness; this is an excellent formula resolving both Heart and abdominal issues simultaneously. Since heat has entered the Stomach, vomiting should not be induced; since the stool is not yet dry and hard, purgation should not be forced. This serves as a preliminary step before using Xiaochengqi Tang (Minor Directing Downward Decoction).

[General Principles] Zhang Zhongjing stated: If a patient has difficulty urinating, bowel movements that are alternately difficult and easy, occasional slight fever, panting, dizziness, and inability to lie down, this indicates the presence of dry fecal impaction; Da Chengqi Tang (Major Directing Downward Decoction) is appropriate.

[Annotations] Wang Kentang said: Insomnia can result from imbalances in both Yin and Yang. It may arise from diaphoresis or purgation, or from other causes, or from adverse effects of fire therapy. However, insomnia generally belongs to heat syndromes. There is a specific case after Taiyang diaphoresis and purgation where the patient experiences daytime irritability and insomnia; although Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) is used, its purpose is to restore Yang Qi lost through sweating and purging, not to treat contracted cold.
Wei Litong said: Difficulty urinating and alternating difficulty/ease in bowel movements suggest the Stomach Fu organ is not fully solidified, so purgation is not initially indicated. However, if dry fecal impaction becomes increasingly severe, it cannot be ignored. Coupled with occasional slight fever, this signals periodic onset of irritability. The obstruction below leads to upward rebellion causing panting; Yin fails to descend while Yang rises causing dizziness. Lying down brings discomfort, while sitting offers slight relief. This clearly indicates dry fecal impaction in the intestines and stomach. Regardless of whether the Stomach Fu contains excess heat or not, if the root cause is dry fecal impaction, purgation is permissible. Using Da Chengqi Tang (Major Directing Downward Decoction) aims to sweep away turbidity and filth, allowing clear Qi to circulate freely.