【纲】仲景曰。太阳发汗后。其人脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤主之。
烧针令其汗。针处被寒。核起而赤者。必发奔豚。气从少腹上冲心者。灸其核上各一壮。桂枝
加桂汤。更加桂二两。
【目】魏荔彤曰。烧针令汗。其人阴必素虚。则火邪易入。其人阳必素虚。则汗易出。今汗出。
阳愈虚矣。其虚者。以阳性浮而易升于上。故阴得动于下。于是乘针孔风寒一入。起核发赤而肾
家阴邪从少腹上冲心。寒水之势直犯天君。如豚忽奔。岂不危哉。崇明何氏云。奔豚一症。乃寒邪
从针孔入。风邪不能外出。直犯太阳本府。引动肾中素有阴寒。因发而上冲。亦似有理。
杨士瀛曰。夫奔豚者。如豕突之状。气从少腹上冲心而痛。凡作奔豚者。其气在脐下。筑然而
动也。宜茯苓大枣汤。或理中汤去术加桂。痛甚。加吴萸亦佳。烧针条。用桂枝加桂汤。若痛甚。
手足厥逆。当归四逆汤加桂、萸。惟桂大能泄奔豚。凡药中不可缺也。
【纲】仲景曰。伤寒一日。太阳受之。脉若静者为不传。颇欲吐。若躁烦。脉数急者。为传也。
【目】朱肱曰。伤寒烦躁。太阳与少阴经居多。盖太阳少阴为表里也。
赵嗣真曰。烦为扰扰。躁为愤躁。合言之。烦躁为热。分言之。烦与躁有阴阳之别。烦阳而躁
阴也。烦为热之轻。躁为热之重。更有烦疼烦闷烦渴虚烦。皆以烦为热也。有不烦而躁者。怫怫然
便作躁闷。此为阴盛格阳也。虽大躁欲于泥
水中卧。但饮水不得入口者是矣。若烦躁。是先烦渐至躁也。若躁烦。是发躁而渐复烦也。
柯琴曰。太阳主表。故寒邪伤人。即太阳先受。太阳脉浮。若见浮不见伤寒之紧。即静也。欲
吐。呕逆之机。烦躁。是阳气重。脉急数。阴阳俱紧之互文。传者。即内经人伤于寒。而传为热之
传。乃太阳之气生热而传于表。即发于阳者传七日之谓。非太阳与阳明少阳经络相传也。
【纲】仲景曰。伤寒六七日。无大热。其人烦躁者。此为阳去入阴故也。
【目】张云岐曰。阴气少。阳气胜。则热而烦。故太阳经伤寒。多烦而躁也。阳虚阴盛。亦发烦
躁。阳气弱。为阴所乘而躁。故少阴病亦烦躁。学人当以外症与脉别之。有汗之而烦者。有下之而
烦者。有病已解而反微烦者。此由病新愈不胜谷。损谷则愈。
柯氏曰。此论阳邪自表入里症也。伤寒一日即见烦躁。是阳邪外发之机。六七日。乃阴阳自和
之际。反见烦躁。是阳邪内陷之兆。阴者。指里而言。非指三阴也。
【纲】仲景曰。太阳病。关节疼痛而烦。脉沉而细者。此名湿痹。
【目】鳌按。烦本阳重湿病不宜烦而曰烦者。太阳之气。为湿所遏。不能宣畅。故烦也。
【纲】仲景曰。欲自解者。必当先烦。乃有汗而解。何以知之。脉浮。故知汗出解也。伤寒发
汗。解半日许。复烦。脉浮数者。可更发汗。宜桂枝汤。
【目】王肯堂曰。烦者。热也。谓烦热也。与发热若同而异。烦热为热所烦。无时而歇。非若
发热时发时止也。经有烦。有微烦。有烦热、复烦、反烦、烦满、烦渴、胸中烦、心中烦、内烦、虚
烦、大烦欲解。皆以烦为热也。然阴寒而烦者。亦不少也。盖在表而烦者。则有脉浮。恶风寒。体
强痛之症。在里而烦者。则有潮热。谵语。腹满不大便。小便赤涩之症。在半表半里
而烦者。则有往来寒热。胸胁疼痛之症。其邪在胸膈以上而烦者。则有胸满懊 。可吐之症。其阴
寒而烦者。则有恶寒而蜷。下利厥逆。脉微。与吐蛔之症。大烦欲解者。其脉必和。但脉不应者难
治。若足冷脉沉细而微者。此阴症之类也。急用参、附温之。若内伤劳役。阴虚火动而烦者。其人
身倦无力。自汗。尺脉浮虚也。宜补中益气汤加炒黄连、知、柏、生地、麦冬之类。若不得睡而心
烦者。兼服朱砂安神丸。纳其浮溜之火。而安神明也。此特大概耳。虚烦。胸中烦。心中烦三者。不因汗吐下而烦。则
是传经之邪。不作膈实。但多和解而已。经
用小柴胡汤、黄连阿胶汤、猪肤汤是也。若经汗吐下而烦。则是热邪内陷。以为虚烦。心中 然
欲吐。愦愦然无奈者是也。但多涌吐而已。经用栀子豉汤、栀子干姜汤、栀子浓朴汤是也。盖有不
经汗吐下。邪结胸中。则为膈实。与瓜蒂散。及阳明心烦。与调胃承气汤。此又烦之实者也。伤寒
二三日悸而烦者。虚也。建中汤。少阳之邪入腑烦而悸者。热也。大抵先烦而后悸是热。先悸而后
烦是虚。胃实不大便心烦。若吐下后者。大小承气症也。若不曾吐下者。调胃承气症也。
闵芝庆曰。诸经皆有烦。惟太阳独甚耳。盖烦者内邪内扰。汗者阳气外发。浮者阳盛之脉也。
夫脉浮则阳自内发。故可必其先烦。见其烦。必当待其有汗。勿遽妄投汤剂也。
鳌按。二条。言伤寒后余热。卫解而营未解者。浮数本麻黄脉。仲景却与桂枝者。因发汗解。
麻黄症已罢。脉浮数者。因内烦而然。不得仍拘为麻黄脉。况麻黄纯阳。不可治烦。桂枝有芍药。
能安营分。正以治烦也。夫桂枝本治烦。服之而外热因汗解。内热又发。故曰复烦也。
【纲】仲景曰。一服汗者。（服麻黄汤也）停后服。汗多亡阳。遂虚。恶风。烦躁。不得眠也。
汗多者。温粉扑之。
伤寒脉浮缓。发热恶寒。无汗烦躁。身不疼。但重。乍有轻时。无少阴症者。大青龙汤发之。
【目】柯琴曰。首条。麻黄汤禁也。麻黄为发汗重剂。故慎重如此。二条。发热恶寒与桂枝同。
身疼不汗与麻黄同。惟烦
躁是本症所独。故制此方。以治风热相搏耳。
【纲】仲景曰。太阳中风。脉浮紧。发热恶寒。身疼痛。不汗出而烦躁者。大青龙汤主之。
【目】成无己曰。烦躁之由。各有不同。有因邪在表。有因邪在里。有因火劫。有因阳虚。有
因阴盛。皆不同也。经曰。当汗不汗。其人烦躁。如本条。太阳中风脉浮紧不汗出而烦躁。是邪
在表也。不大便五六日。绕脐痛。烦躁。发作有时。此有燥屎也。是邪在里也。以火熏之不得汗。
其人必躁。太阳病二日反躁。火熨其背。令大汗出。大热入胃烦躁者。是火劫也。阳微发躁。不得
与之。下后复发汗。昼日烦躁不得眠。夜则安静。及发汗若下之。病仍不去。烦躁者。是阳虚也
少阴病吐利。手足冷。烦躁欲死。是阴盛也。诸如此者。症之常也。非逆也。设或结胸症悉具。烦
躁者死。发热下利。厥逆。躁不得卧者死。少阴病吐利。烦躁四逆者死。少阴病四逆。恶寒而身蜷。
脉不至。不烦而躁者死。少阴病五六日自利。复烦躁。不得卧寐者死。是数者。又皆为不治之症。
【纲】仲景曰。太阳病。发汗后。大汗出。胃中干。烦躁不得眠。欲得饮水者。少少与饮之。
令胃气和则愈。若脉浮。小便不利。微热消渴者。五苓散主之。
【目】危亦林曰。汗为心液。汗多则离中水亏无以济火。故烦。肾中水衰不能制火。故躁。
【纲】仲景曰。太阳病。以火熏之。不得汗。其人必躁。过经不解。必圊血。名为火邪。
【目】方中行曰。火熏不得汗而圊血。是阳邪下陷入阴分。故在过经不解时。夫不得汗。过经
圊血而犹不解。可知劫汗而得汗。其患速。不得汗者。其患迟。名为火邪。则但治其火。而不虑前
此之风寒矣。劫汗得汗而患速者。指伤寒脉浮。医以火迫劫之。亡阳。必惊狂起卧不安一条言也。
【纲】仲景曰。火逆。下之。因烧针。烦躁者。桂枝甘草龙骨牡蛎汤主之。其脉沉者。营气微
也。营气微者。加烧针。则血凝
不行。更发热而烦躁也。
【目】戴原礼曰。烦躁。阴阳经皆有之。阳明经胃有燥屎。故烦。此当下之。太阳经已得汗而
烦者。五苓散。少阳亦或有烦。小柴胡汤。阴烦。少阴为多。由阳气传入阴经。阴得阳而烦。自利
而渴。烦不得眠者。辰砂五苓散。若不是阳气传阴。阴气犯阴经。吐利手足厥冷而烦。经云。阳虚
阴乘之。故烦。又云。阴盛发躁。欲坐井中。吴茱萸汤。甚者。四逆汤加葱白二茎。
外有虚烦一症。乃是病愈后阴阳未复。时发烦热。竹叶石膏汤。痰多睡不宁者。温胆汤。呕者。
橘皮汤。
李杲曰。治阴虚发热。烦渴引饮。肌热躁热。至夜尤甚。其脉洪大。按之无力者。此血虚发躁。
当归补血汤主之。若以白虎与之。则误矣。如轻手脉来浮大。按之即无者。乃无根蒂之脉为散脉
也。此虚极而元气将脱也。切不可发表攻热。如误治之。则死。须用大剂人参生脉散。
柯琴曰。以火误治。阴阳俱虚竭矣。烦躁者。惊狂之渐。起卧不安之象也。急用此汤以安神救
逆。
【纲】仲景曰。太阳病二日。烦躁。反熨其背。而大汗出。大热入胃。胃中水竭。躁烦。必发
谵语。十余日。振栗。自下利者。此为欲解也。故其汗从腰以下不得汗。欲小便不得。反呕。欲失
溲。足下恶风。大便硬。小盒饭数而反不数。及多。大便已。头卓然而痛。其人足心必热。谷气下
流故也。
【目】柯琴曰。此火逆之轻者。太阳病经二日。不汗出而烦躁。本大青龙症。乃不发汗而反以
火熨。火邪入胃。胃中水竭。躁烦不止。此时必用调胃承气汤下之。庶胃气不至于绝也。
【纲】仲景曰。结胸症悉具。烦躁者亦死。
【目】魏荔彤曰。结胸症具备。而烦躁独甚。津液内枯。驱之使透表。汗即出而阳必尽。下之
虽病去。阴随脱而阳亦亡。故不下亦将死也。下则速其死而已。此条。乃跟上条脉见浮大而言。必
结胸症具。脉兼见浮大。而又烦躁。必不同
胸初结之烦躁也。且合数者。方可卜其死。不然。烦躁亦前条结胸诸症中之一也。何遽云死也。其
浮大之脉。必无根方为死征。若有根仍宜从表治。即烦躁亦未必死。既云结胸症具。则脉已变迟。
迟则难言兼浮。更难言兼大。忽而浮大。非阳邪欲透表。则正阳上越耳。
鳌按。亦字。承上条结胸症。其脉浮大者。不可下。下之则死来。故曰亦也。
【纲领】张仲景说：太阳病经过发汗治疗后，如果患者感到脐下部位跳动不安，这是即将发作奔豚病的征兆。应当用茯苓桂枝甘草大枣汤来主治。
如果用烧针（一种温热疗法）强迫出汗，而针刺的部位受寒，出现红肿如核状且发红的情况，必定会引发奔豚病。如果有气从少腹向上冲击心脏的症状，应当在红肿的核上各灸一壮艾炷，并服用桂枝加桂汤，即在原方基础上再增加桂枝二两。
【注释】魏荔彤说：使用烧针强迫出汗，患者的阴气必然原本虚弱，所以火邪容易侵入；患者的阳气必然原本虚弱，所以汗液容易外泄。现在汗出之后，阳气更加虚弱了。因为阳气性质轻浮而易于升腾于上，所以阴气得以在下方躁动。于是趁着针孔风寒入侵，导致局部起核发红，肾中的阴寒邪气从少腹向上冲击心脏。寒水之势直接侵犯心君（心脏），就像猪突然奔跑一样剧烈，这难道不危险吗？崇明何氏说：奔豚这一病症，是寒邪从针孔进入，风邪不能外出，直接侵犯太阳经的本府，引动肾中素有的阴寒之气，因而发作并向上冲逆，这种说法也似乎有道理。
杨士瀛说：奔豚病，其状像野猪冲撞，气从少腹向上冲击心脏并引起疼痛。凡是发作奔豚病的，其气机位于脐下，筑筑然跳动不安。适宜用茯苓大枣汤，或者理中汤去掉白术加入桂枝。如果疼痛剧烈，加入吴茱萸也很好。关于烧针条文中提到的，使用桂枝加桂汤。如果疼痛剧烈，伴有手足厥冷，应用当归四逆汤加入桂枝、吴茱萸。只有桂枝能很好地缓解奔豚，凡是在药方中不可缺少它。
【纲领】张仲景说：伤寒第一天，邪气侵袭太阳经。如果脉象平静，说明病邪没有传变。如果患者很想呕吐，或者出现躁动心烦，脉象数而急促，说明病邪已经传变。
【注释】朱肱说：伤寒引起的烦躁，多见于太阳经和少阴经。这是因为太阳与少阴互为表里关系。
赵嗣真说：“烦”是指内心的扰攘不安，“躁”是指肢体的愤懑躁动。合起来说，烦躁属于热证；分开来说，烦与躁有阴阳的区别。烦属阳，躁属阴。烦是热证较轻的表现，躁是热证较重的表现。还有烦疼、烦闷、烦渴、虚烦等，都是以“烦”为热证。也有不烦而仅见躁动的，表现为怫怫然便作躁闷，这是由于阴盛格阳所致。虽然极度躁动想要睡在泥水中，但连水都喝不进去，就是这种情况。如果是“烦躁”，是先感到烦然后逐渐发展到躁；如果是“躁烦”，是先发生躁动然后逐渐恢复为烦。
柯琴说：太阳主表，所以寒邪伤人，首先由太阳经受邪。太阳脉象应浮，如果只见浮脉而不见伤寒典型的紧脉，即为“静”。想吐，是呕逆的先兆；烦躁，表示阳气重；脉象急数，是阴阳俱紧的互文表达。所谓“传”，即《内经》所说的“人伤于寒，而传为热”，是太阳之气生热而传于体表，也就是“发于阳者传七日”的说法，并非指太阳经与阳明、少阳经络之间的相传。
【纲领】张仲景说：伤寒六七天，身体没有明显的大热，但患者出现烦躁，这是因为阳邪离开表入里所致。
【注释】张云岐说：阴气少，阳气胜，就会发热而烦，所以太阳经伤寒，多表现为烦和躁。阳虚阴盛，也会引发烦躁。阳气虚弱，被阴气所乘袭而导致躁动，所以少阴病也会出现烦躁。学习者应当通过外在症状和脉象来辨别。有发汗后出现烦的，有攻下后出现烦的，有病已解除反而轻微烦的，这是由于病刚痊愈不胜受纳谷气所致，减少饮食即可痊愈。
柯氏说：这段论述的是阳邪从表入里的症状。伤寒第一天就见到烦躁，是阳邪向外发的机转；六七天，本是阴阳自和的时期，反而出现烦躁，是阳邪内陷的征兆。“阴”这里指里，并非专指三阴经。
【纲领】张仲景说：太阳病，关节疼痛且伴有烦躁，脉象沉而细的，这称为湿痹。
【注释】沈金鳌按语：烦本属阳重，湿病通常不应见烦，这里说“烦”，是因为太阳之气被湿气遏制，不能宣畅，所以产生烦。
【纲领】张仲景说：疾病想要自行解除时，必定先出现烦躁，随后会有汗出而病解。怎么知道呢？因为脉象浮，所以知道会通过出汗而解除。伤寒发汗后，过了半天左右，又出现烦躁，脉象浮数的，可以再次发汗，适宜用桂枝汤。
【注释】王肯堂说：烦，就是热。指烦热。与发热看似相同实则不同。烦热是被热所困扰，无时不歇；不像发热那样时发时止。经文中有烦、微烦、烦热、复烦、反烦、烦满、烦渴、胸中烦、心中烦、内烦、虚烦、大烦欲解等，都是以“烦”为热证。然而因阴寒而致烦的情况也不少。如果在表而烦，则有脉浮、恶风寒、身体强痛等症状；如果在里而烦，则有潮热、谵语、腹部胀满不大便、小便赤涩等症状；在半表半里而烦，则有往来寒热、胸胁疼痛等症状；邪气在胸膈以上而烦，则有胸满懊憹、可吐的症状；因阴寒而烦，则有恶寒蜷卧、下利厥逆、脉微、吐蛔等症状。大烦欲解时，其脉必平和，但如果脉象不合常理则难治。如果脚冷、脉沉细而微，这是阴症之类，急需用人参、附子温补。如果是内伤劳役，阴虚火动而烦，其人身体疲倦无力，自汗，尺脉浮虚，适宜用补中益气汤加炒黄连、知母、黄柏、生地、麦冬等。如果睡不着且心烦，兼服朱砂安神丸，以收敛浮游之火，安定神明。这只是一般概况。虚烦、胸中烦、心中烦这三种，不因汗、吐、下法而致烦，则是传经之邪，未形成膈实，多用和解法。经文用小柴胡汤、黄连阿胶汤、猪肤汤等。如果经过汗、吐、下法后出现烦，则是热邪内陷，成为虚烦，心中愦愦然想吐，无可奈何，多用涌吐法。经文用栀子豉汤、栀子干姜汤、栀子厚朴汤等。大概有不经过汗、吐、下，邪气结于胸中，形成膈实，用瓜蒂散；以及阳明心烦，用调胃承气汤，这又是烦的实证。伤寒二三日悸而烦，属虚，用建中汤。少阳之邪入腑，烦而悸，属热。大体上前烦后悸是热，前悸后烦是虚。胃实不大便心烦，若经过吐下后的，属大小承气汤证。若未曾吐下的，属调胃承气汤证。
闵芝庆说：各经都有烦，唯独太阳经最严重。盖因烦是内邪内扰，汗是阳气外发，浮是阳盛的脉象。脉浮则阳气自然从内发出，所以可以断定必先见烦。见到烦，必须等待其有汗出，不要急于妄投汤剂。
沈金鳌按语：这两条讲的是伤寒后余热，卫分已解而营分未解的情况。浮数脉本是麻黄汤证的脉象，张仲景却给予桂枝汤，是因为发汗后，麻黄汤证已罢。脉浮数是由于内烦所致，不能仍拘泥为麻黄汤脉。况且麻黄纯阳，不可治疗烦证；桂枝汤中有芍药，能安护营分，正是用来治疗烦证的。桂枝本就能治烦，服用后外热因汗而解，内热又发，所以说“复烦”。
【纲领】张仲景说：服用一次药后出汗的（服用的是麻黄汤），停止后续服药。如果汗多导致亡阳，遂致虚损，出现恶风、烦躁、不得睡眠等症状。汗多的，用温粉扑身。
伤寒脉浮缓，发热恶寒，无汗烦躁，身体不疼，只是沉重，偶尔有减轻的时候，且没有少阴病症状的，用大青龙汤发散。
【注释】柯琴说：第一条是麻黄汤的禁忌。麻黄是发汗的重剂，所以要如此慎重。第二条，发热恶寒与桂枝汤证相同，身疼无汗与麻黄汤证相同，唯独烦躁是本证所独有的，所以制定此方，以治疗风热相搏。
【纲领】张仲景说：太阳中风，脉浮紧，发热恶寒，身体疼痛，无汗且烦躁的，用大青龙汤主治。
【注释】成无己说：烦躁的原因各不相同。有因邪气在表的，有因邪气在里的，有因火劫导致的，有因阳虚导致的，有因阴盛导致的，都不相同。经文说：应当发汗而未发汗，其人烦躁，如本条所述，太阳中风脉浮紧无汗出而烦躁，是邪气在表。不大便五六日，绕脐痛，烦躁，发作有时，这是有燥屎，是邪气在里。用火熏蒸不得汗，其人必躁。太阳病第二天反而躁，火熨其背令大汗出，大热入胃导致烦躁，这是火劫。阳气微弱而发躁，不可与之攻下。攻下后又发汗，白天烦躁不得眠，夜间安静，以及发汗或攻下后病仍不去而烦躁，这是阳虚。少阴病吐利，手足冷，烦躁欲死，这是阴盛。诸如此类，是病症的常态，并非逆证。假如结胸证全部具备，出现烦躁的，预后不良（死）。发热下利，厥逆，躁不得卧的，预后不良（死）。少阴病吐利，烦躁伴四肢厥冷的，预后不良（死）。少阴病四肢厥冷，恶寒而身体蜷缩，脉不至，不烦而躁的，预后不良（死）。少阴病五六天自利，又烦躁，不得卧寐的，预后不良（死）。这些情况，又都是不治之症。
【纲领】张仲景说：太阳病，发汗后，大汗出，胃中干燥，烦躁不得眠，想要喝水的，少量多次给予饮水，使胃气调和则痊愈。如果脉浮，小便不利，微热消渴的，用五苓散主治。
【注释】危亦林说：汗为心液，汗多则心阴亏虚无法济助心火，故烦；肾中水衰不能制约心火，故躁。
【纲领】张仲景说：太阳病，用火熏法治疗，不得汗出，其人必定躁动。过了病程阶段仍未解，必定出现便血，这称为火邪。
【注释】方中行说：火熏不得汗而出便血，是阳邪下陷入阴分，所以在过经不解的时候。夫不得汗，过经便血而犹不解，可知劫汗得汗者，其患来得快；不得汗者，其患来得慢。名为火邪，则只需治疗火邪，而不必顾虑之前的风寒了。劫汗得汗而患来得快的，指伤寒脉浮，医生用火迫劫之，亡阳，必惊狂起卧不安那条条文所说。
【纲领】张仲景说：误用火法，又用攻下法，接着又用烧针，出现烦躁的，用桂枝甘草龙骨牡蛎汤主治。如果脉象沉，说明营气微弱。营气微弱的人，再加烧针，则血液凝滞不行，更会出现发热而烦躁。
【注释】戴原礼说：烦躁，阴阳经都有。阳明经胃中有燥屎，故烦，这应当攻下。太阳经已得汗而烦的，用五苓散。少阳经也可能有烦，用小柴胡汤。阴烦，少阴经居多。由阳气传入阴经，阴得阳而烦，自利而渴，烦不得眠的，用辰砂五苓散。如果不是阳气传阴，而是阴气犯阴经，吐利手足厥冷而烦，经文说：阳虚阴乘之，故烦。又说：阴盛发躁，欲坐井中，用吴茱萸汤。严重的，用四逆汤加葱白两根。
此外有虚烦一症，乃是病愈后阴阳未恢复，时而发作烦热，用竹叶石膏汤。痰多睡不宁的，用温胆汤。呕吐的，用橘皮汤。
李杲说：治疗阴虚发热，烦渴引饮，肌热躁热，至夜尤甚，其脉洪大，按之无力的，这是血虚发躁，用当归补血汤主治。如果用白虎汤，就错了。如果轻手脉来浮大，按之即无的，乃是无根蒂的脉为散脉，这是虚极而元气将脱，切不可发表攻热，如误治则死。须用大剂量人参生脉散。
柯琴说：以火误治，阴阳俱虚竭了。烦躁是惊狂的渐兆，起卧不安的现象。急需用此汤以安神救逆。
【纲领】张仲景说：太阳病第二天，烦躁，反而熨其背部，而大汗出，大热入胃，胃中津液枯竭，躁烦，必定发谵语。十余日后，振栗，自下利的，这是将要解除的迹象。所以其汗从腰以下不得出，想小便却排不出，反而呕吐，想失禁，脚下怕风，大便硬，小便利频而反不急迫，及次数多。大便通后，头突然疼痛，其人足心必定发热，这是谷气下流所致。
【注释】柯琴说：这是火逆证中较轻的。太阳病经过两天，不汗出而烦躁，本是大青龙汤证，却不发汗反而用火熨，火邪入胃，胃中津液枯竭，躁烦不止，此时必须用调胃承气汤攻下，才能使胃气不至于绝灭。
【注释】魏荔彤说：结胸证具备，而烦躁特别严重，津液内枯。驱使其透表，汗即出而阳气必尽；攻下虽病去，阴随脱而阳亦亡，所以不下也将死。下则加速死亡而已。这一条，是承接上一条脉见浮大而言。必定结胸证具，脉兼见浮大，而又烦躁，必定不同于胸初结时的烦躁。且综合这几项，才可推断其死，不然，烦躁也只是前条结胸诸症中的一症，何必遽然说是死证呢？其浮大的脉，必无根才为死征，若有根仍应从表治，即使烦躁也未必死。既然说结胸证具，则脉已变迟，迟则难言兼浮，更难言兼大。忽而浮大，非阳邪欲透表，则正阳上越耳。
[General Principle] Zhang Zhongjing stated: After the treatment of sweating for a Taiyang disease, if the patient experiences palpitations below the umbilicus, this indicates an impending onset of Ben Tun (Rushing Pig Syndrome). It should be primarily treated with Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction).
If burning needle therapy is used to induce sweating, and the puncture site becomes cold, resulting in nodular swelling and redness, Ben Tun will inevitably occur. If there is a sensation of Qi rushing from the lower abdomen up to the heart, moxibustion should be applied once on each nodule, followed by the administration of Guizhi Jia Gui Tang (Cinnamon Twig Decoction with Additional Cinnamon Twig), which involves adding two liang of Guizhi (Cinnamon Twig) to the original formula.
[Commentary] Wei Litong stated: The use of burning needles to induce sweating implies that the patient's Yin is inherently deficient, making it susceptible to Fire Evil invasion; their Yang is also inherently deficient, leading to easy sweating. Now, after sweating, Yang is further depleted. Since Yang nature is light and floating, tending to rise upward, Yin is thus agitated below. Taking advantage of the wind-cold entering through the needle pores, nodules form and turn red, while Kidney Yin-Cold evil rushes from the lower abdomen up to the heart. The momentum of Cold Water directly assaults the Heart Mind (Heart), resembling a pig suddenly charging. Is this not dangerous? He Shi from Chongming stated: Ben Tun syndrome occurs when Cold Evil enters through the needle pore, Wind Evil cannot exit, directly invading the Taiyang organ system, stirring up pre-existing Yin-Cold in the Kidneys, causing it to flare up and rush upward. This explanation also seems reasonable.
Yang Shiyin stated: Ben Tun resembles the sudden charge of a wild boar, with Qi rushing from the lower abdomen to the heart causing pain. In cases of Ben Tun, the Qi is located below the umbilicus, throbbing intensely. One should use Fuling Dazao Tang (Poria and Jujube Decoction), or Lizhong Tang (Regulate the Middle Decoction) with Baizhu (Atractylodes Macrocephala Rhizome) removed and Guizhi added. If pain is severe, adding Wuyu (Evodia Fruit) is also good. Regarding the burning needle clause, Guizhi Jia Gui Tang is used. If pain is severe accompanied by cold limbs, Danggui Sini Tang (Angelica Sinensis Decoction to Nourish the Extremities) with added Guizhi and Wuyu should be used. Only Guizhi can effectively relieve Ben Tun; it must not be omitted from any prescription.
[General Principle] Zhang Zhongjing stated: On the first day of Shanghan (Cold Damage), the pathogen affects the Taiyang channel. If the pulse is calm, it indicates no transmission. If the patient desires to vomit, or exhibits restlessness and irritability with a rapid and urgent pulse, it indicates transmission of the disease.
[Commentary] Zhu Gong stated: Restlessness and irritability caused by Shanghan are most common in the Taiyang and Shaoyin channels because Taiyang and Shaoyin are exterior-interior pairs.
Zhao Sizhen stated: "Fan" refers to internal mental agitation, while "Zao" refers to physical restlessness. Together, Fan-Zao indicates Heat. Separately, Fan and Zao have Yin-Yang distinctions: Fan is Yang, and Zao is Yin. Fan represents mild Heat, while Zao represents severe Heat. There are also Fan Teng (painful agitation), Fan Men (oppressive agitation), Fan Ke (thirsty agitation), and Xu Fan (deficiency agitation), all indicating Heat. However, there are cases of Zao without Fan, characterized by a sense of stifling restlessness, caused by Yin Excess repelling Yang. Although the patient may feel extreme restlessness wanting to lie in mud, yet unable to swallow water, this is the case. "Fan-Zao" means starting with Fan and progressing to Zao. "Zao-Fan" means starting with Zao and gradually returning to Fan.
Ke Qin stated: Taiyang governs the exterior, so when Cold Evil attacks, it first affects Taiyang. The Taiyang pulse should be Floating. If only a Floating pulse is seen without the Tight pulse typical of Cold Damage, it is considered "calm." Desire to vomit is a precursor to retching; irritability indicates heavy Yang; a rapid and urgent pulse is a rhetorical variation of both Yin and Yang being Tight. "Transmission" refers to the concept in Neijing: "When humans are injured by Cold, it transmits as Heat." This is Taiyang Qi generating Heat and transmitting to the exterior, referring to the seven-day transmission of "manifesting in Yang," not necessarily transmission between Taiyang, Yangming, and Shaoyang meridians.
[General Principle] Zhang Zhongjing stated: After six or seven days of Shanghan, if there is no significant high fever but the patient exhibits irritability, this is because Yang Evil has left the exterior and entered the interior.
[Commentary] Zhang Yunqi stated: When Yin is scant and Yang prevails, heat and irritability occur; thus, Taiyang Shanghan often presents with Fan and Zao. Yang deficiency with Yin excess also causes irritability. When Yang Qi is weak and overwhelmed by Yin, restlessness occurs; hence, Shaoyin disease also presents with irritability. Students should distinguish these based on external symptoms and pulses. Irritability can occur after sweating, after purgation, or after recovery when slight irritability returns due to the stomach's inability to handle food immediately; reducing food intake leads to recovery.
Mr. Ke stated: This discusses symptoms where Yang Evil moves from exterior to interior. Irritability appearing on the first day of Shanghan indicates Yang Evil emerging outward. By day six or seven, when Yin and Yang should naturally harmonize, the appearance of irritability signals the inward sinking of Yang Evil. "Yin" here refers to the interior, not specifically the Three Yin channels.
[General Principle] Zhang Zhongjing stated: In Taiyang disease, if joint pain is accompanied by irritability, and the pulse is Deep and Thin, this is named Shi Bi (Dampness Bi Syndrome).
[Commentary] Shen Jin'ao noted: Irritability typically belongs to excessive Yang. Dampness diseases usually do not present with irritability. Here, "irritability" occurs because Taiyang Qi is constrained by Dampness and cannot circulate freely.
[General Principle] Zhang Zhongjing stated: When a disease is about to resolve spontaneously, it must first present with irritability, followed by sweating and resolution. How do we know this? Because the pulse is Floating, indicating resolution through sweating. After treating Shanghan with sweating, if irritability recurs after half a day and the pulse is Floating and Rapid, another sweating treatment may be administered using Guizhi Tang (Cinnamon Twig Decoction).
[Commentary] Wang Kentang stated: "Fan" refers to Heat, specifically Fan Re (Heat Agitation). It differs from Fa Re (Fever). Fan Re is persistent distress caused by heat, whereas Fa Re comes and goes. The classics mention various forms of Fan such as slight Fan, Fan Re, recurrent Fan, reverse Fan, fullness Fan, thirst Fan, chest Fan, heart Fan, internal Fan, deficiency Fan, and great Fan desiring resolution, all indicating Heat. However, Fan caused by Yin-Cold is also common. If Fan is at the exterior, symptoms include Floating pulse, aversion to wind-cold, and body stiffness/pain. If Fan is at the interior, symptoms include tidal fever, delirium, abdominal fullness with constipation, and dark/scanty urination. If Fan is at half-exterior/half-interior, symptoms include alternating chills and fever, and chest/hypochondriac pain. If pathogen is above the chest/diaphragm causing Fan, symptoms include chest fullness and oppression, suitable for emesis. If Fan is due to Yin-Cold, symptoms include aversion to cold with curling up, diarrhea, cold limbs, faint pulse, and vomiting of roundworms. For Great Fan desiring resolution, the pulse must be Harmonious; if the pulse does not match, prognosis is poor. Cold feet with Deep/Thin/Faint pulse indicate Yin Syndrome, requiring immediate warming with Renshen (Ginseng) and Fuzi (Aconite Root). If Fan is due to internal injury, overwork, Yin deficiency with fire hyperactivity, symptoms include fatigue, spontaneous sweating, and Floating/Empty Chi pulse; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with fried Huanglian (Coptis Rhizome), Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Shengdi (Rehmannia Root), and Maidong (Ophiopogon Tuber) is appropriate. For insomnia with heart Fan, Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) helps settle floating fire and calm the spirit. Generally, Xu Fan, Chest Fan, and Heart Fan not caused by sweating, emesis, or purgation indicate transmitted pathogenic factors without forming Diaphragm Solidity, treated with harmonizing methods like Xiaochaihu Tang (Minor Bupleurum Decoction), Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction), or Zhufu Tang (Pig Skin Decoction). If Fan occurs after sweating/emesis/purgation, it indicates Heat Evil sinking inward becoming Xu Fan, with a sensation of nausea and helplessness; emetic methods like Zhizi Chi Tang (Gardenia and Soybean Decoction), Zhizi Jiang Tang (Gardenia and Ginger Decoction), or Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) are used. If pathogen knots in the chest without prior treatment, forming Diaphragm Solidity, Gengti San (Melon Spume Powder) is used. Yangming heart Fan is treated with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction); these are Excess Fan cases. Palpitations and Fan after two or three days of Shanghan indicate Deficiency, treated with Jianzhong Tang (Establish the Middle Decoction). Shaoyang pathogen entering the Fu organs causing Fan and palpitations indicates Heat. Generally, Fan then palpitations is Heat; palpitations then Fan is Deficiency. Heart Fan with constipation depends on prior treatment: if after emesis/purgation, consider Da/Xiao Chengqi Tang; if not, consider Tiaowei Chengqi Tang.
Min Ziqing stated: All channels can have Fan, but Taiyang is most severe. Fan is internal disturbance; sweating is Yang Qi emitting outward; Floating is a pulse of Yang abundance. A Floating pulse indicates Yang emitting from within, guaranteeing prior Fan. Upon seeing Fan, one must wait for sweating and avoid rashly administering decoctions.
Shen Jin'ao noted: These two clauses discuss residual heat after Shanghan, where Wei (Defensive) level is resolved but Ying (Nutritive) level is not. Floating-Rapid pulse is typical of Mahuang Tang syndrome, but Zhongjing prescribed Guizhi Tang because the Mahuang Tang syndrome had passed after sweating. The Floating-Rapid pulse here results from internal Fan, not Mahuang pulse. Moreover, Mahuang is purely Yang and cannot treat Fan; Guizhi Tang contains Shaoyao (Peony Root) to soothe the Ying level, specifically treating Fan. Guizhi treats Fan; after taking it, exterior heat resolves via sweat, but interior heat flares again, hence "recurrent Fan."
[General Principle] Zhang Zhongjing stated: After one dose induces sweating (taking Mahuang Tang), stop subsequent doses. Excessive sweating leads to Yang collapse, resulting in deficiency, aversion to wind, irritability, and insomnia. For excessive sweating, apply warm powder to the body.
In Shanghan with Floating-Slow pulse, fever, aversion to cold, no sweating, irritability, body ache absent but heaviness present (occasionally alleviated), and absence of Shaoyin symptoms, Da Qinglong Tang (Major Blue Dragon Decoction) should be used to disperse.
[Commentary] Ke Qin stated: The first clause is a contraindication for Mahuang Tang. Mahuang is a potent diaphoretic, requiring caution. The second clause shares fever/aversion to cold with Guizhi Tang and body ache/no-sweat with Mahuang Tang, but irritability is unique to this syndrome, hence this formula was created to treat Wind-Heat conflict.
[General Principle] Zhang Zhongjing stated: In Taiyang Wind Strike, with Floating-Tight pulse, fever, aversion to cold, body pain, no sweating, and irritability, Da Qinglong Tang is the primary treatment.
[Commentary] Cheng Wuji stated: Causes of Fan-Zao vary: pathogen at exterior, pathogen at interior, fire coercion, Yang deficiency, or Yin excess. As stated in the classics: Failure to sweat when indicated causes irritability, as in Taiyang Wind Strike with Floating-Tight pulse, no sweat, and irritability—pathogen at exterior. Constipation for 5-6 days, periumbilical pain, intermittent irritability—dry stool, pathogen at interior. Fire fumigation failing to induce sweat causes restlessness. Taiyang disease on day 2 showing reverse restlessness, back fanning causing profuse sweat, heat entering stomach causing irritability—fire coercion. Mild Yang causing restlessness requires avoiding purgation. Post-purgation sweating causing daytime irritability and nighttime quietness, or persistent irritability post-sweating/purgation—Yang deficiency. Shaoyin disease with vomiting/diarrhea, cold limbs, extreme irritability—Yin excess. These are normal pathological states, not terminal signs. However, if all Jie Xiong (Knotting Chest) symptoms are present with irritability, it is fatal. Fever with diarrhea, cold limbs, and inability to lie down due to restlessness is fatal. Shaoyin vomiting/diarrhea with irritability and cold limbs is fatal. Shaoyin cold limbs, aversion to cold, curling up, absent pulse, restlessness without Fan is fatal. Shaoyin day 5-6 spontaneous diarrhea with irritability and insomnia is fatal. These are untreatable conditions.
[General Principle] Zhang Zhongjing stated: After Taiyang disease sweating treatment, profuse sweating dries the Stomach, causing irritability and insomnia. If the patient desires water, give small amounts frequently to harmonize Stomach Qi and restore health. If the pulse is Floating, urination is difficult, there is slight fever and polydipsia, Wuling San (Five-Ingredient Powder with Poria) is indicated.
[Commentary] Wei Yilin stated: Sweat is the fluid of the Heart. Profuse sweating depletes Heart Yin, failing to control Heart Fire, causing Fan. Kidney Water decline fails to control Fire, causing Zao.
[General Principle] Zhang Zhongjing stated: In Taiyang disease, if fire fumigation fails to induce sweat, the patient will inevitably become restless. If the disease persists beyond its stage, rectal bleeding will occur, termed Huo Xie (Fire Evil).
[Commentary] Fang Zhongxing stated: Fire fumigation failing to induce sweat but causing rectal bleeding indicates Yang Evil sinking into Yin levels. During the prolonged unresolved stage, failure to sweat and subsequent bleeding show that coercing sweat yields rapid complications, while failure to sweat yields delayed complications. Named "Fire Evil," treatment focuses solely on the fire, ignoring previous wind-cold. Coercing sweat yielding rapid complications refers to Shanghan with Floating pulse treated by fire coercion, causing Yang collapse,惊狂 (fright/manic behavior), and tossing/restlessness.
[General Principle] Zhang Zhongjing stated: Following erroneous fire treatment, purgation, and burning needle therapy, if irritability occurs, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is indicated. If the pulse is Deep, Ying Qi is weak. In cases of weak Ying Qi, adding burning needle therapy causes blood coagulation and stagnation, leading to fever and irritability.
[Commentary] Dai Yuanli stated: Fan-Zao occurs in both Yin and Yang channels. Yangming channel Stomach dry stool causes Fan, requiring purgation. Taiyang channel Fan after sweating uses Wuling San. Shaoyang channel may have Fan, treated with Xiaochaihu Tang. Yin Fan is common in Shaoyin. Yang transmitting to Yin causes Yin to become Fan with self-diarrhea, thirst, and insomnia; Chen Sha Wuling San (Cinnabar Five-Ingredient Powder) is used. If Yin Qi invades Yin channels causing vomiting/diarrhea, cold limbs, and Fan due to Yang deficiency allowing Yin invasion, Wuzhuyu Tang (Evodia Decoction) is used. Severe cases use Sini Tang (Frigid Extremities Decoction) with Scallion White. Additionally, Xu Fan (Deficiency Fan) occurs post-recovery during Yin-Yang non-restoration, presenting as intermittent heat; Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is used. Phlegm causing sleeplessness uses Wendan Tang (Warm Gallbladder Decoction). Vomiting uses Chupi Tang (Tangerine Peel Decoction).
Li Gao stated: Treating Yin deficiency fever, thirst, muscle heat, worse at night, with Large pulse empty upon pressure indicates Blood deficiency causing restlessness; Danggui Buxue Tang (Angelica Tonifying Blood Decoction) is used. Baihu Tang (White Tiger Decoction) would be a mistake. Floating-Large pulse empty upon pressure indicates scattered pulse, extreme deficiency with impending Yuan Qi collapse; do not use diaphoresis or heat-clearing. Use large doses of Rensheng Maishan San (Ginseng Pulse-Nourishing Powder).
Ke Qin stated: Erroneous fire treatment exhausts Yin and Yang. Irritability is a precursor to mania and tossing/restlessness. This decoction must be urgently used to calm the spirit and rescue from reversal.
[General Principle] Zhang Zhongjing stated: On the second day of Taiyang disease, irritability occurs. Instead of sweating, the back was fanned, causing profuse sweat. Intense heat enters the Stomach, exhausting Stomach fluids, causing restlessness and delirium. After ten-plus days, shaking chills and spontaneous diarrhea indicate impending resolution. Sweat stops below the waist; desire to urinate but inability; reverse vomiting; desire for incontinence; fear of wind on feet; hard stool; frequent but not urgent urination; increased frequency. After defecation, sudden head pain occurs; sole warmth indicates Grain Qi flowing downward.
[Commentary] Ke Qin stated: This is a mild case of Fire Reversal. Taiyang disease on day 2 with no sweat and irritability is originally Da Qinglong Tang syndrome. Fanning instead of sweating drives Fire Evil into the Stomach, exhausting fluids and causing persistent restlessness. Tiaowei Chengqi Tang should be used immediately to prevent Stomach Qi exhaustion.
[General Principle] Zhang Zhongjing stated: If all Jie Xiong (Knotting Chest) symptoms are present and irritability occurs, it is a fatal sign.
[Commentary] Wei Litong stated: With complete Jie Xiong symptoms and severe irritability, internal fluids are dried. Driving to the exterior causes sweating and total Yang loss; purging removes disease but causes Yin collapse and Yang death. Thus, neither action saves the patient. This clause follows the previous mention of Floating-Large pulse. Complete Jie Xiong with Floating-Large pulse and irritability differs from initial Jie Xiong irritability. Only combining these signs predicts death; otherwise, irritability is just one symptom. Floating-Large pulse must be rootless to be fatal; if rooted, treat from exterior, and irritability may not be fatal. Given complete Jie Xiong, pulse should be Slow; a sudden Floating-Large pulse indicates either Yang Evil trying to exit or True Yang rising.
Shen Jin'ao noted: The character "Yi" (also) connects to the previous clause regarding Jie Xiong with Floating-Large pulse, stating that purging leads to death, hence "also."