（附怫郁）
【纲】仲景曰。阳明病。脉浮而紧。咽燥口苦。腹满而喘。发热汗出。不恶寒。反恶热。身重。
若发汗。则躁。心愦愦而谵语。若加烧针。心怵惕。烦躁不得眠。若下之。则胃中空虚。客气动膈。
心中懊 。舌上苔者。栀子豉汤主之。
【目】成无己曰。内热曰烦。谓心中郁烦也。外热曰躁。谓气外热躁也。内热谓有根之火。故
但烦不躁。及先烦后躁者。皆可治。外热为无根之火。故但躁不烦。及先躁后烦者。皆不可治也。所
谓烦躁者。谓先烦渐至躁也。所谓躁烦者。谓先发躁。迤逦复烦也。从烦至躁为热。未有不渐烦
而躁者也。先躁后烦谓怫郁。怫然更作烦闷。此为阴盛格阳。大躁若欲于泥水中卧。水不得入口是
也。此气欲绝而争。如灯将灭而暴明。
黄仲理曰。烦躁者。懊 不得眠也。懊 者。郁闷不舒之貌。烦者。气也。火入于肺也。躁者。
血也。火入于肾也。
李 曰。心热则烦。肾热则躁。烦轻躁重。先烦渐躁为阳症。不烦便躁为阴症。烦主气。躁主血。肺主皮毛。气热
则烦。肾主津液。血热则躁。故仲景用栀子以治肺。豆豉以
治肾也。
【纲】仲景曰。伤寒下后。心烦腹满。起卧不安者。栀子浓朴汤主之。
【目】朱震亨曰。烦躁者。气随火而升也。
陶华曰。伤寒烦躁。有阴阳虚实之别。心热则烦。阳实阴虚。肾热则躁。阴实阳虚。烦乃热轻。
躁乃热重也。
【纲】仲景曰。得病二三日。脉弱。无太阳柴胡症。烦躁。心下硬。至四五日。虽能食。以小
承气少少与微和之。令小安。至六
日。与承气汤一升。若不大便。六七日小便少者。虽不能食。但初头硬。后必溏。未定成硬。攻之必
溏。须小便利。屎定硬。乃可攻之。宜大承气汤。
【目】李杲曰。栀子治肺烦。香豉治肾躁。少气虚满者。加甘草。呕哕者。加生姜、橘皮。下后
腹满而烦。栀子浓朴枳实汤。身热微烦。栀子甘草干姜汤。火入肺。烦也。火入肾。躁也。烦躁俱在
上者。肾子通于肺母也。发润如油。喘而不休。总言肺绝。鼻者。肺之外候。肺气通于鼻。鼻中气
出粗大。是肺热也。发者。血之余。肾气主之。发润如油。火迫肾水至高之分。是水将绝也。仲景
以发润喘大为肺绝。兼其肾而言之。发在高巅之上。虽属肾。肺为五脏之至高。故言肺绝兼肾也。大
抵肺肾相通。肺既已绝。肾不言而知其绝矣。或曰。烦者心为之烦。躁者心为之躁。何烦为肺躁为
肾耶。夫心者君火也。与邪热相接。上下通热。金以之而躁。水以之而亏。独存者火耳。故肺肾与
心合而为烦躁焉。此烦虽肺。躁虽肾。实心火为之也。若有宿食而烦躁者。栀子大黄汤。
陶华曰。有人伤寒八九日。无汗身热。时时谵语。因下后大便不通。已三日矣。非躁非烦。非寒
非痛。终夜不得卧。但心中无晓会处。许学士诊之曰。此懊 怫郁二症俱作也。胃中有燥屎。服承气
汤。下燥屎二十枚。得利而解。故仲景云。小便不利。大便难。时有微热怫郁。有燥屎也。怫郁者。
阳气蒸越。形于头面体肤之间。聚赤而不散也。其症有分别。如大便硬而气短燥渴者。实也。大柴胡
汤。汗下后有此症。饮水而哕者。胃虚也。桂苓人参汤加茯苓。初得病发汗不彻。并于阳明。续自
微汗出。面色赤者。阳气怫郁也。解肌汤。或汗不彻。其脉浮紧者。麻黄汤。或小便不利。时有微热。
大便作难。怫郁不得卧。此有燥屎作实也。承气汤。
（附怫郁）
【纲】张仲景说：阳明病，脉象浮而紧，咽喉干燥、口苦，腹部胀满且喘息，发热出汗，不恶寒，反而怕热，身体沉重。
如果误用发汗法，就会出现躁动不安，心中烦乱模糊并出现胡言乱语；如果误用烧针疗法，会出现惊恐不安，烦躁无法入睡；如果误用攻下法，则会导致胃中空虚，外邪之气扰动胸膈，心中懊恼郁闷，舌上有苔的，主治方剂为栀子豉汤。
【目】成无己说：体内的热称为“烦”，是指心中郁结烦闷；体表的热称为“躁”，是指气息向外浮躁。体内的热是有根之火，所以只烦不躁，以及先烦后躁的情况，都是可治的；体表的热是无根之火，所以只躁不烦，以及先躁后烦的情况，都不可治。所谓的“烦躁”，是指先烦逐渐发展到躁；所谓的“躁烦”，是指先发躁，随后又转为烦。从烦发展到躁属于热证，没有不先烦而直接躁的。先躁后烦称为“怫郁”，是突然再次发作烦闷，这是阴盛格阳的表现，表现为极度躁动想要卧在泥水中，但水却无法入口，这是气将断绝而抗争，如同灯将熄灭时突然变亮。
黄仲理说：烦躁，就是懊恼郁闷无法入睡。懊恼，是郁闷不舒展的样子。烦，属于气，是火进入肺脏；躁，属于血，是火进入肾脏。
李珣说：心热则烦，肾热则躁。烦轻躁重，先烦渐至躁为阳证，不烦便躁为阴证。烦主气，躁主血。肺主皮毛，气热则烦；肾主津液，血热则躁。所以张仲景用栀子来治疗肺热，用豆豉来治疗肾热。
【纲】张仲景说：伤寒经过攻下治疗后，出现心烦、腹部胀满，坐卧不安的，主治方剂为栀子厚朴汤。
【目】朱震亨说：烦躁，是气随着火而上升。
陶华说：伤寒引起的烦躁，有阴阳虚实的区别。心热则烦，属于阳实阴虚；肾热则躁，属于阴实阳虚。烦是热轻，躁是热重。
【纲】张仲景说：患病二三天，脉象弱，没有太阳病或少阳病的症状，出现烦躁，心下部硬满，到了四五天，虽然能进食，应少量给予小承气汤以轻微调和肠胃，使其稍得安宁。到了第六天，给予一升承气汤。如果不大便，六七天小便少的，虽然不能进食，但大便开头硬，后面一定稀溏，尚未完全形成硬便，攻下必然导致腹泻。必须等到小便通利，大便确定变硬，才可以攻下，适宜使用大承气汤。
【目】李杲说：栀子治疗肺热之烦，香豉治疗肾热之躁。少气虚满的，加甘草；呕吐呃逆的，加生姜、橘皮。攻下后腹满而烦的，用栀子厚朴枳实汤；身热微烦的，用栀子甘草干姜汤。火入肺为烦，火入肾为躁。烦躁都在上部的，是因为肾子通于肺母。头发湿润如油，喘促不停，总归是肺气绝的表现。鼻是肺的外候，肺气通于鼻，鼻中呼吸粗大，是肺热。头发是血的余绪，由肾气主宰。头发湿润如油，是火逼迫肾水至高之处，是水气将绝。张仲景认为发润喘大为肺绝，同时也兼及肾脏而言。头发位于高巅之上，虽属肾，但肺为五脏中最高的脏器，所以说肺绝兼肾。大体上肺肾相通，肺既然已绝，肾不言自明也已绝了。有人问：烦是心感到烦，躁是心感到躁，为什么说是肺烦肾躁呢？心是君火，与邪热相接，上下通热，金（肺）因此躁动，水（肾）因此亏损，只剩下火独存。所以肺、肾与心合而为烦躁。这烦虽涉及肺，躁虽涉及肾，实质上是心火造成的。如果有宿食而烦躁的，用栀子大黄汤。
陶华说：有人患伤寒八九日，无汗身热，时常胡言乱语，因攻下后大便不通，已经三天了。既不是躁也不是烦，既不是寒也不是痛，整夜无法躺卧，只是心中不知何处难受。许学士诊断说：这是懊恼和怫郁两种症状同时发作。胃中有燥屎，服用承气汤，排出燥屎二十枚，得利后病解。所以张仲景说：小便不利，大便难，时有微热怫郁，是有燥屎。怫郁，是阳气蒸腾越出，表现于头面体肤之间，聚集红色而不消散。其症状有分别，如大便硬而气短燥渴的，属实证，用大柴胡汤；汗下后有此症状，饮水而呃逆的，是胃虚，用桂苓人参汤加茯苓；初得病发汗不彻底，邪并入阳明，继续自微汗出，面色赤红的，是阳气怫郁，用解肌汤；或者发汗不彻底，脉象浮紧的，用麻黄汤；或者小便不利，时有微热，大便困难，怫郁无法躺卧，这是有燥屎作实，用承气汤。
(Attached: Fu Yu [Oppression and Stagnation])
[General Principle] 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 and wheezing, fever and sweating, aversion to cold absent but aversion to heat present, and heaviness of the body.
If diaphoresis (sweating therapy) is mistakenly applied, restlessness (Zao), mental confusion with delirious speech will occur; if burning needle therapy is mistakenly applied, fearfulness and palpitations with irritability (Fan Zao) and insomnia will occur; if purgation is mistakenly applied, the stomach becomes empty, pathogenic qi disturbs the diaphragm, causing inner frustration (Ao Nu), and if there is a coating on the tongue, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.
[Commentary] Cheng Wuji stated: Internal heat is called Fan (Irritability/Mental Restlessness), referring to mental depression and vexation. External heat is called Zao (Physical Restlessness), referring to restless breathing and movement. Internal heat is fire with a root, so one may have only Fan without Zao, or Fan preceding Zao; both are treatable. External heat is fire without a root, so one may have only Zao without Fan, or Zao preceding Fan; both are untreatable. The term "Fan Zao" refers to Fan gradually progressing to Zao. The term "Zao Fan" refers to Zao occurring first, followed by Fan. Progression from Fan to Zao indicates Heat; there is no case of Zao occurring without preceding Fan. Zao preceding Fan is called "Fu Yu" (Oppression and Stagnation), characterized by sudden recurrence of vexation. This is Yin excess repelling Yang, manifesting as extreme restlessness desiring to lie in mud or water, yet unable to drink water. This indicates Qi about to perish struggling against itself, like a lamp flickering brightly before extinguishing.
Huang Zhongli stated: Fan Zao is frustration and inability to sleep. Ao Nu is the appearance of depression and discomfort. Fan belongs to Qi, representing Fire entering the Lung. Zao belongs to Blood, representing Fire entering the Kidney.
Li Xun stated: Heart heat causes Fan, Kidney heat causes Zao. Fan is mild, Zao is severe. Fan progressing to Zao is a Yang syndrome; Zao without Fan is a Yin syndrome. Fan governs Qi, Zao governs Blood. The Lung governs skin and hair; Qi heat causes Fan. The Kidney governs body fluids; Blood heat causes Zao. Therefore, Zhang Zhongjing uses Zhi Zi (Fructus Gardeniae) to treat the Lung, and Dou Chi (Semen Sojae Praeparatum) to treat the Kidney.
[General Principle] Zhang Zhongjing stated: After purgation for Cold Damage, if there is mental vexation, abdominal fullness, and restlessness in sitting and lying down, Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction) is the primary treatment.
[Commentary] Zhu Zhenheng stated: Fan Zao is Qi rising along with Fire.
Tao Hua stated: Fan Zao caused by Cold Damage has distinctions of Yin/Yang and Deficiency/Excess. Heart heat causes Fan, indicating Excess of Yang and Deficiency of Yin. Kidney heat causes Zao, indicating Excess of Yin and Deficiency of Yang. Fan is mild heat, Zao is severe heat.
[General Principle] Zhang Zhongjing stated: On the second or third day of illness, with a weak pulse, absence of Taiyang or Shaoyang symptoms, presence of Fan Zao, and hardness below the heart. By the fourth or fifth day, even if the patient can eat, give Xiao Cheng Qi Tang (Minor Order the Qi Decoction) in small amounts to mildly harmonize, allowing slight relief. By the sixth day, give one sheng of Cheng Qi Tang. If there is no bowel movement, and on the sixth or seventh day urine output is low, even if the patient cannot eat, if the stool is hard at the beginning but loose at the end, it has not definitively become hard; purging will cause looseness. One must wait for free urination and definitive hardening of the stool before purging; Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
[Commentary] Li Gao stated: Zhi Zi treats Lung-related Fan, Xiang Chi treats Kidney-related Zao. For shortness of breath and deficiency-type fullness, add Gan Cao (Radix Glycyrrhizae). For vomiting and hiccups, add Sheng Jiang (Rhizoma Zingiberis Recens) and Ju Pi (Pericarpium Citri Reticulatae). For post-purgation abdominal fullness and vexation, use Zhi Zi Hou Po Zhi Shi Tang. For body heat and mild vexation, use Zhi Zi Gan Jiang Gan Jiang Tang. Fire entering the Lung causes Fan; Fire entering the Kidney causes Zao. When Fan and Zao are both located superiorly, it is because the Kidney (Water) connects to the Lung (Metal/Mother). Oily sweat on the head, continuous wheezing, generally indicates Lung Qi exhaustion. The nose is the external manifestation of the Lung; Lung Qi connects to the nose. Coarse breathing from the nose indicates Lung Heat. Hair is the surplus of Blood, governed by Kidney Qi. Oily sweat on the head indicates Fire forcing Kidney Water to the highest point, suggesting Water Qi is perishing. Zhang Zhongjing considers oily sweat and severe wheezing as signs of Lung exhaustion, also mentioning the Kidney. Although hair is at the crown (Kidney domain), the Lung is the highest of the five Zang organs, hence "Lung exhaustion" implies Kidney exhaustion as well. Generally, Lung and Kidney are connected; if the Lung is exhausted, the Kidney is implicitly exhausted. Some ask: Fan is Heart vexation, Zao is Heart restlessness, why attribute Fan to Lung and Zao to Kidney? The Heart is Ministerial Fire; when interacting with pathogenic heat, heat circulates up and down. Metal (Lung) becomes restless due to this, Water (Kidney) becomes deficient, leaving only Fire. Thus, Lung, Kidney, and Heart combine to produce Fan Zao. Although Fan involves the Lung and Zao involves the Kidney, the substance is Heart Fire. If Fan Zao is caused by retained food, Zhi Zi Da Huang Tang (Gardenia and Rhubarb Decoction) is used.
Tao Hua stated: A person suffered from Cold Damage for eight or nine days, with no sweat, body heat, and occasional delirium. After purgation, constipation persisted for three days. It was neither Zao nor Fan, neither Cold nor Pain. The patient could not lie down all night, feeling an indescribable discomfort in the chest. Physician Xu diagnosed this as simultaneous occurrence of Ao Nu and Fu Yu. There were dry feces in the stomach. Administration of Cheng Qi Tang resulted in the passage of twenty pieces of dry feces, leading to recovery through diarrhea. Thus, Zhang Zhongjing stated: Urinary difficulty, difficult defecation, occasional mild heat and Fu Yu indicate dry feces. Fu Yu is the steaming and overflowing of Yang Qi, manifesting as redness gathering on the head, face, and body without dissipating. Symptoms vary: Hard stool with shortness of breath and dry thirst indicates Excess; use Da Chai Hu Tang. Post-diaphoresis/purgation with this symptom, drinking water causing hiccups indicates Stomach Deficiency; use Gui Ling Ren Shen Tang plus Fu Ling. Initial illness with incomplete diaphoresis, pathogen merging into Yangming, subsequent spontaneous mild sweating, and red facial complexion indicate Yang Qi Fu Yu; use Jie Ji Tang. Or, incomplete diaphoresis with floating-tight pulse; use Ma Huang Tang. Or, urinary difficulty, occasional mild heat, difficult defecation, Fu Yu preventing sleep, indicating dry feces causing Excess; use Cheng Qi Tang.