烦为烦扰之烦躁为愤躁之躁俗谓焦躁是也合而言之烦躁为热也析而分之烦阳也为热之轻躁阴也为热之甚先烦而渐
至躁者谓之烦躁先躁而后复烦者谓之躁烦有不烦而躁者此为阴盛格阳也（虽大躁欲于泥水中卧但饮水不得入口者是也活
人用霹雳散）又有邪气在表而躁烦者（太阳中风脉浮而紧不汗出而烦躁大青龙汤是也）有邪气在里而烦躁者（病患不大
便六七日绕脐痛烦躁发作有时此有躁屎是也）有因火劫而烦躁者（太阳病以火熏之不得汗其人必躁太阳病二三日反躁火
熨其背令大汗出火热入胃躁烦者是也）有阳虚而烦躁者（阳微发汗躁不得眠与下之后复发汗昼日烦躁不得眠夜而安静不
呕不渴无表证脉沉微身无大热者干姜附子汤及发汗若下之病仍不去烦躁者茯苓四逆汤是也）有阴盛而烦躁者（少阳病吐
利手足厥冷烦躁欲死者吴茱萸汤是也）此皆证之常也又有诸不治证详附于后不可不知
太阳 中风（汗）脉浮紧发热恶寒身痛无汗烦躁者大青龙汤发汗不彻太阳证不罢其人面赤躁烦不知痛处更发汗则愈
（详短气）太阳病（和）大发汗后胃中干烦躁不得眠欲饮者少与之若脉浮小便不利微热消渴者五苓散因下之心下痞与泻
心汤痞不解渴而口躁烦小便不利者五苓散
得病（下）二三日脉弱无太阳柴胡证烦躁心下硬至四五日虽能食以小承气汤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次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（王注云无
太阳证为无表证也无柴胡证为无半表半里证也）烦躁不大便绕脐痛发作有时者有燥屎也下之后（温）复发汗昼日烦躁不
得安眠夜而安静不呕不渴无表证脉沉微身无大热者干姜附子汤（不呕不喝里无热也身无大热表无热也而脉又沉微故宜温
此当与栀子豉汤证参看盖下后烦不得眠一也而药有寒热不同故尔）
干姜附子汤方
干姜（一两） 附子（一枚去皮破八片生用）上二味以水三升煮取一升去滓顿服（内经曰寒淫所胜平以辛热虚寒太
甚是以辛热剂胜之也）
海 服姜附汤有二法一法当热服手少阴心也水包火热服以接心火身表寒盛外火少也寒从外生热从内消譬如冻死寒
在外也一法当寒服作少阴肾也寒邪入水冷服以类肾水身表微热内水多也热从外生寒从内消譬如饮冷寒在内也
发汗若下之病仍不解烦躁者茯苓四逆汤主之（成 发汗若下病宜解也若病仍不解则发汗外虚阳气下之内虚阴气阴阳
俱虚邪独不解故生烦躁与茯苓四逆汤以复阴阳之气）
茯苓四逆汤方（四逆汤以补阳加茯苓人参以益阴）
茯苓（六两） 甘草（炙二两） 干姜（一两半） 人参（一两） 附子（一枚生用去皮破八片）上五味以水五升
煮取三升去滓温服七合日三服
烦躁心下硬若未曾下者即前条无太阳柴胡证以小承气少少微和之也若已曾下心下硬痛短气烦躁者大陷胸也若结胸
证悉具烦躁者死也（方论见结胸）
火逆下之因烧针烦躁者桂枝甘草龙骨牡蛎汤主之
桂枝甘草龙骨牡蛎汤方
桂枝（去粗皮一两） 甘草（炙） 牡蛎（熬） 龙骨（各二两）上为末以水五升煮取二升半去滓服温八合日三（辛
甘发散桂枝甘草之辛甘以发散经中火邪涩可去脱龙骨牡蛎之涩以收敛浮越之正气）
太阳病以火熏之不得汗其人必躁到不解必清血名为火邪（成 此火邪迫血而血下行者也太阳病用火熏之不得汗则热
无从出阴虚被火必发躁也六日传经尽至七日再到太阳经则热气当解若不解热气迫血下行必清血清厕也按到与倒通反也
到不解者犹云反不解而加甚也本文称太阳病则不可便注为传经尽也止言太阳病则不传他经可知矣况于上下文别无承接
照应之词上文言二日及十余日下文言一二日三四日亦是论日数不言传经到也成氏解到字不彻）太阳病火熨其背大汗出火
热入胃胃中水竭躁烦必发谵语十余日振栗下利者欲解也（论见谵语）
活人云大抵阴气少阳气胜则热而烦故太阳经伤风多烦而躁也
阳明 病患不大便五六日绕脐痛烦躁发作有时者此有躁屎也宜承气汤大抵得病二三日脉弱无大柴胡证烦躁心下热
小便利心下硬以小承气汤少少微和之然有病已瘥面赤微烦必大便硬当问其小便日几行若小便少津液当还入胃不须攻也
少阳 伤寒六七日无大热其人躁烦者此为阳去入阴也
少阴 病吐利手足厥冷烦躁欲死者吴茱萸汤（方见吐）少阴病吐利烦躁四逆者死少阴病四逆恶寒身蜷脉不至不烦而
躁者死少阴病脉微沉细但欲卧汗出不烦自欲吐至五六日自利复烦躁不得卧寐者死
厥阴 伤寒热少厥微指头寒默默不欲食烦躁数日小便利色白者热除也欲得食其病为愈若厥而呕胸胁烦满者必便血
伤寒脉微而厥至七八日肤冷其人躁无暂安者为脏结死蛔厥虽厥而烦吐蛔已则静非若脏厥躁无暂安时也伤寒六七日脉微
手足厥冷烦躁灸厥阴厥不还者死伤寒发热下利厥逆躁不得卧者死伤寒得病无热但狂者烦躁不安者五苓散服之二钱新汲
水一升许则以指探喉去之随手愈
成 所谓烦躁者谓先烦渐至躁也所谓躁烦者谓先发躁而迤逦复烦者也从烦至躁为热未有不渐烦而躁者也先躁后烦
谓怫怫然更作躁闷此为阴盛隔阳也虽大躁欲于泥水中卧但饮水不得入口是也此气欲脱而争譬如灯将灭而暴明矣盖内热
曰烦谓心中郁烦也外热曰躁谓气外热躁也内热为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
附
活 病患身冷脉沉细疾烦躁而不饮水者阴盛隔阳也宜服霹雳散须臾躁止得睡汗出即瘥火焰散丹砂丸并主之
霹雳散 火焰散（二方并见阴毒） 丹砂丸（方见活人书）
海 已寒丸 此丸不僭上阳生于下治阴证服四逆辈胸中发躁而渴者或数日大便秘小便涩亦服此丸上不躁大小
便自利
肉桂（去粗皮） 茯苓（各五钱） 良姜 乌头（炮各七钱） 附子（炮） 干姜（炮） 芍药 茴香（炒各一两）
上为细末糊为丸如梧桐子大温酒空心下五七十丸八九十丸亦得酒醋为糊俱可
本 破阴丹 治阴中伏阳烦躁六脉沉伏（方论见阴毒）
顷年乡人李信道得疾六脉沉伏不见深按至骨则若有力头疼身温烦躁指末皆冷胸中满恶心更两医矣皆不识止用调气
药予诊之曰此阴中伏阳也仲景法中无此证世人患此者多若用热药以助之则为阴所隔绝不能导引真阳反生客气用冷药则
所伏真火愈见消烁非其治也须用破散阴气导达真火之药使水升火降然后得汗而解矣乃授此药二百粒作一服冷盐汤下不
时烦躁狂热手足躁扰其家大惊予曰俗所谓换阳也须臾稍定略睡身已中汗自昏达旦方止身凉而病除矣
戴 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宜小柴胡汤阴烦少
阴为多由阳气传入阴经阴得阳而烦自利而渴烦不眠者辰砂五苓散若非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证乃是病愈后阴阳未复时发热烦竹叶
石膏汤痰多睡不宁者温胆汤呕者橘皮汤
烦躁：烦是指内心的烦扰，躁是指外在的愤激躁动，通俗说法称为焦躁。合而言之，烦躁属于热证。分析而言，烦属阳，是轻度的热；躁属阴，是严重的热。先出现烦然后逐渐发展为躁的，称为“烦躁”；先出现躁随后又转为烦的，称为“躁烦”。有不烦而仅见躁的情况，这是阴寒内盛、格拒阳气于外所致（表现为虽然极度躁动想要躺在泥水中，但水却无法入口饮用，此时可用《活人书》中的霹雳散）。又有邪气在表而出现躁烦的（如太阳中风证，脉象浮紧，发热恶寒，身体疼痛，无汗且烦躁，适用大青龙汤发汗）；有邪气在里而出现烦躁的（如患者多日不大便，六七天绕脐疼痛，烦躁发作有定时，这是有燥屎内结）；有因火疗误治而导致烦躁的（如太阳病用火熏法治疗，未能出汗，病人必然躁动；或太阳病二三天后反而出现躁动，用火熨背部导致大汗出，火热之邪入胃，引起躁烦）；有因阳虚而导致烦躁的（如脉微细而发汗，导致躁动不得安眠；或在攻下后又发汗，白天烦躁不得安眠，夜间安静，不呕吐、不口渴、无表证，脉象沉微，身体没有大热的，适用干姜附子汤；或者发汗、攻下后病仍不愈，出现烦躁的，适用茯苓四逆汤）；有因阴盛而导致烦躁的（如少阳病出现呕吐腹泻，手足冰冷，烦躁欲死的，适用吴茱萸汤）。这些都是常见的证候。另有各种不治之证，详见附录，不可不知。
太阳中风证：若脉象浮紧，发热恶寒，身体疼痛，无汗且烦躁的，适用大青龙汤发汗。若发汗不彻底，太阳证未罢，病人面部发红，躁烦不知痛处所在，再次发汗则可痊愈（详情参考短气条）。
太阳病：大发汗后，胃中干燥，烦躁不得安眠，想喝水的，应少量给予饮水。如果脉浮，小便不利，微热，消渴的，适用五苓散。因误下导致心下痞满，服用泻心汤后痞满不解，口渴且口舌干燥烦躁，小便不利的，适用五苓散。
得病二三天后，脉弱，无太阳表和少阳半表半里的证候，出现烦躁，心下硬满，到四五天时虽能进食，可少量给予小承气汤以轻微调和，使病情稍安。到六天再给予承气汤一升。如果六七天不大便，小便少的，虽然不能进食，但只要初次大便硬而后必溏，未确定完全变硬前，攻下必致溏泄。必须待小便通利，大便确定变硬后，方可攻下，宜用大承气汤。（王肯堂注：无太阳证即无表证；无柴胡证即无半表半里证。）
烦躁，不大便，绕脐痛，发作有定时的，是有燥屎。攻下之后，又发汗，白天烦躁不得安眠，夜间安静，不呕吐，不口渴，无表证，脉沉微，身体无大热的，适用干姜附子汤。（不呕吐、不口渴说明里无热；身体无大热说明表无热；脉沉微故宜温补。此证应与栀子豉汤证参看，因为都是下后烦不得眠，但药物寒热不同。）
干姜附子汤方：
干姜（一两），附子（一枚，去皮，破成八片，生用）。以上两味药，用水三升，煮取一升，去渣，一次顿服。（《内经》说：寒淫所胜，用辛热平之。虚寒太甚，所以用辛热剂来克制它。）
海藏认为服用姜附汤有两种方法：一种方法是热服，对应手少阴心经。水包火，热服可以接续心火。身表寒盛，外火少，寒从外生，热从内消，如同冻死之人寒气在外。另一种方法是冷服，对应足少阴肾经。寒邪入里水冷，冷服以类比肾水。身表微热，内水多，热从外生，寒从内消，如同饮冷之人寒气在内。
发汗或攻下后，病仍不解除，出现烦躁的，主用茯苓四逆汤。（成无己注：发汗和攻下后病应当解除。如果病仍不解，则是发汗导致外虚阳气，攻下导致内虚阴气，阴阳俱虚，邪气独留不解，故生烦躁。给予茯苓四逆汤以恢复阴阳之气。）
茯苓四逆汤方：（四逆汤用于补阳，加茯苓、人参以益阴）
茯苓（六两），甘草（炙，二两），干姜（一两半），人参（一两），附子（一枚，生用，去皮，破成八片）。以上五味药，用水五升，煮取三升，去渣，温服七合，每日三次。
烦躁，心下硬满。如果未曾攻下的，即前条所述无太阳、柴胡证，用小承气汤少量轻微调和。如果已经攻下，心下硬满疼痛，短气烦躁的，是大陷胸汤证。如果是结胸证症状全部具备却出现烦躁的，为死证（方论见结胸条）。
桂枝甘草龙骨牡蛎汤方：
桂枝（去粗皮，一两），甘草（炙），牡蛎（熬），龙骨（各二两）。以上四味药研为末，用水五升，煮取二升半，去渣，温服八合，每日三次。（辛甘发散，桂枝、甘草的辛甘之性以发散经络中的火邪；涩可固脱，龙骨、牡蛎的涩性以收敛浮越的正气。）
太阳病用火熏法治疗，不得汗，病人必然躁动。如果不解，必然出现便血，名为火邪。（成无己注：这是火邪迫血下行。太阳病用火熏，不得汗则热无从出，阴虚被火必发躁。六日传经尽，至七日再到太阳经，热气当解。若不解，热气迫血下行，必然便血，清厕也。按，“到”与“倒”通假，反也。“到不解”犹言“反不解而加甚”。本文称太阳病，则不可便注为传经尽，只言太阳病则不传他经可知。况于上下文别无承接照应之词，上文言二日及十余日，下文言一二日、三四日，亦是论日数，不言传经到。成氏解释“到”字不透彻。）
太阳病用火熨背部，大汗出，火热入胃，胃中津液枯竭，躁烦必然发生谵语。十余日后，振栗下利的，是欲解之兆（论见谵语条）。
《活人书》说：大抵阴气少，阳气胜则热而烦，所以太阳经伤风多烦而躁。
阳明病：患者不大便五六日，绕脐痛，烦躁发作有定时的，这是有燥屎，宜用承气汤。大抵得病二三天，脉弱，无大柴胡证，烦躁，心下热，小便利，心下硬，用小承气汤少量轻微调和。然而有病已愈，面赤微烦，必然大便硬，应当问其小便一天几次。如果小便少，津液当还入胃中，不须攻下。
少阴病：病见呕吐腹泻，手足厥冷，烦躁欲死的，用吴茱萸汤（方见吐利条）。少阴病呕吐腹泻，烦躁，四肢逆冷的，为死证。少阴病四肢逆冷，恶寒，身体蜷缩，脉不至，不烦而躁的，为死证。少阴病脉微沉细，只想睡觉，汗出，不烦，自欲吐，到五六日自利，复烦躁不得卧寐的，为死证。
厥阴病：伤寒热少厥微，指头寒冷，默默不欲食，烦躁数日，小便利，尿色白的，是热除，想进食，病将愈。如果厥逆而呕，胸胁烦满的，必然便血。
伤寒脉微而厥，至七八日，皮肤冷，其人躁动无片刻安宁的，为脏结，死证。蛔厥虽然厥逆而烦，吐蛔虫后即静，不是像脏厥那样躁动无片刻安宁。伤寒六七天，脉微，手足厥冷，烦躁，灸厥阴经穴后厥逆不还的，死证。伤寒发热，下利，厥逆，躁不得卧的，死证。伤寒得病，无热但狂，烦躁不安的，服五苓散二钱，新汲水一升左右，用手指探喉催吐，随手而愈。
成无己注：所谓烦躁，是先烦渐至躁。所谓躁烦，是先发躁而逐渐复烦。从烦至躁为热，无不先烦而躁的。先躁后烦，谓怫怫然更作躁闷，此为阴盛隔阳。虽然极度躁动想要躺在泥水中，但饮水不得入口，这是气欲脱而争，譬如灯将灭而暴明。盖内热曰烦，谓心中郁烦也；外热曰躁，谓气外热躁也。内热为有根之火，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。
附录：
《活人书》云：病患身冷，脉沉细疾，烦躁而不饮水的，是阴盛隔阳，宜服霹雳散。须臾躁止得睡，汗出即瘥。火焰散、丹砂丸并主之。
霹雳散、火焰散（二方并见阴毒条）、丹砂丸（方见《活人书》）。
海藏：已寒丸。此丸不僭上，阳生于下，治阴证。服四逆辈药后胸中发躁而渴的，或数日大便秘、小便涩，亦服此丸，上不躁，大小便自利。
肉桂（去粗皮），茯苓（各五钱），良姜，乌头（炮，各七钱），附子（炮），干姜（炮），芍药，茴香（炒，各一两）。以上为细末，糊为丸如梧桐子大，温酒空心服五七十丸，八九十丸亦可。酒醋为糊均可。
近年乡人李信道患病，六脉沉伏不见，深按至骨则若有力，头疼身温，烦躁，指末皆冷，胸中满，恶心，求医两位都不识。只用调气药。我诊之曰：此阴中伏阳也。仲景法中无此证，世人患此者多。若用热药以助之，则为阴所隔绝，不能导引真阳，反生客气；用冷药则所伏真火愈见消烁，非其治也。须用破散阴气、导达真火之药，使水升火降，然后得汗而解矣。乃授此药二百粒作一服，冷盐汤下。不时烦躁狂热，手足躁扰，其家大惊。予曰：俗所谓换阳也。须臾稍定，略睡，身已中汗，自昏达旦方止，身凉而病除矣。
戴元礼：烦躁在阴阳经皆有之。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，宜小柴胡汤。阴烦少阴为多，由阳气传入阴经，阴得阳而烦，自利而渴，烦不眠者，辰砂五苓散。若非是阳气传阴，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。外有虚烦一证，乃是病愈后阴阳未复时发热烦，竹叶石膏汤。痰多睡不宁者，温胆汤。呕者，橘皮汤。
Fan (restlessness) refers to inner disturbance, while Zao (agitation) refers to outer irritability and restlessness; colloquially known as anxiety. Combined, Fan-Zao belongs to Heat syndromes. Analytically, Fan is Yang and represents mild heat; Zao is Yin and represents severe heat. When Fan appears first and gradually progresses to Zao, it is called "Fan-Zao"; when Zao appears first and later reverts to Fan, it is called "Zao-Fan". There are cases of Zao without Fan, which indicates Yin excess repelling Yang outward (manifesting as extreme agitation desiring to lie in mud or water, yet unable to drink water; in such cases, Pili San from *Ren Jian Shu* may be used). There are also cases where pathogenic factors are in the Exterior causing Zao-Fan (such as Taiyang Wind Strike syndrome with floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and restlessness, treated by inducing sweating with Da Qing Long Tang); cases where pathogenic factors are in the Interior causing Fan-Zao (such as a patient not having bowel movements for six or seven days, with periumbilical pain, and periodic episodes of restlessness, indicating dry fecal matter accumulation); cases caused by erroneous fire therapy leading to restlessness (such as Taiyang disease treated with moxibustion/fire fumigation without sweating, inevitably causing agitation; or Taiyang disease on the second or third day presenting with sudden agitation, treated by ironing the back causing profuse sweating, allowing fire-heat to enter the Stomach and cause agitation); cases caused by Yang deficiency leading to restlessness (such as faint pulse followed by sweating causing agitation and insomnia; or after purgation and subsequent sweating, daytime agitation with nighttime quietness, no vomiting, no thirst, no exterior syndrome, deep-faint pulse, and no significant body heat, treated with Gan Jiang Fu Zi Tang; or persistent agitation after sweating and purgation, treated with Fu Ling Si Ni Tang); and cases caused by Yin excess leading to restlessness (such as Shaoyang disease with vomiting, diarrhea, cold extremities, and severe restlessness, treated with Wu Zhu Yu Tang). These are all common syndromes. Other untreatable syndromes are detailed in the appendix and must be known.
Taiyang Wind Strike Syndrome: If the pulse is floating-tight, with fever, aversion to cold, body pain, anhidrosis, and restlessness, use Da Qing Long Tang to induce sweating. If sweating is incomplete and Taiyang syndrome persists, with facial redness, agitation, and unknown pain locations, resuming sweating will cure it (see Shortness of Breath section).
Taiyang Disease: After excessive sweating, if the Stomach is dry causing restlessness and insomnia with desire for water, give small amounts of water. If there is a floating pulse, difficulty urinating, slight fever, and polydipsia, use Wu Ling San. If epigastric fullness persists after treating with Xie Xin Tang following erroneous purgation, accompanied by thirst, dry mouth, restlessness, and difficulty urinating, use Wu Ling San.
Two to three days after illness onset, if the pulse is weak, without Taiyang exterior or Shaoyang half-exterior/half-interior symptoms, but with restlessness and epigastric hardness, wait until the fourth or fifth day. Even if the patient can eat, give Xiao Cheng Qi Tang in small amounts to gently harmonize and provide slight relief. By the sixth day, administer one sheng of Cheng Qi Tang. If there is no bowel movement for six or seven days and urine output is low, even if the patient cannot eat, if the initial stool was hard but subsequent stools are loose, do not purge prematurely as it will cause loose stools. Only purge when urine is clear and stool is confirmed hard, using Da Cheng Qi Tang. (Wang Ken-tang notes: No Taiyang syndrome means no exterior syndrome; no Chai Hu syndrome means no half-exterior/half-interior syndrome.)
Restlessness, constipation, periumbilical pain, and periodic episodes indicate dry fecal matter. After purgation, if sweating is induced again, causing daytime agitation with nighttime quietness, no vomiting, no thirst, no exterior syndrome, deep-faint pulse, and no significant body heat, use Gan Jiang Fu Zi Tang. (No vomiting/thirst indicates no interior heat; no significant body heat indicates no exterior heat; deep-faint pulse warrants warming. Compare this with Zhi Zi Chi Tang syndrome, as both involve post-purgation insomnia, but differ in herbal properties.)
Gan Jiang Fu Zi Tang Formula:
Gan Jiang (Rhizoma Zingiberis, 1 liang), Fu Zi (Radix Aconiti Lateralis Preparata, 1 piece, peeled, broken into eight pieces, raw). Boil these two ingredients in 3 sheng of water to obtain 1 sheng, remove dregs, and take in one dose. (*Nei Jing* states: For excess cold, use pungent-hot herbs to neutralize. For severe deficiency-cold, pungent-hot agents overcome it.)
Hai Zang suggests two methods for taking Jiang Fu Tang: One method is hot administration, corresponding to the Hand-Shaoyin Heart meridian. Water envelops fire; hot administration connects to Heart fire. With severe exterior cold and weak external fire, cold generates externally and heat dissipates internally, like freezing to death with cold outside. The other method is cold administration, corresponding to the Foot-Shaoyin Kidney meridian. Cold pathogen enters cold water; cold administration mimics Kidney water. With slight exterior heat and abundant internal water, heat generates externally and cold dissipates internally, like ingesting cold with internal cold.
If illness persists after sweating or purgation with restlessness, treat primarily with Fu Ling Si Ni Tang. (Cheng Wu-ji notes: Illness should resolve after sweating/purgation. Persistence implies exterior Yang deficiency from sweating and interior Yin deficiency from purgation, leaving pathogenic factors unresolved, causing restlessness. Fu Ling Si Ni Tang restores Yin and Yang.)
Fu Ling Si Ni Tang Formula: (Si Ni Tonifies Yang; adding Fu Ling and Ren Shen tonifies Yin)
Fu Ling (Poria, 6 liang), Gan Cao (Radix Glycyrrhizae Preparata, 2 liang), Gan Jiang (Rhizoma Zingiberis, 1.5 liang), Ren Shen (Radix Ginseng, 1 liang), Fu Zi (Radix Aconiti Lateralis Preparata, 1 piece, raw, peeled, broken into eight pieces). Boil these five ingredients in 5 sheng of water to obtain 3 sheng, remove dregs, and take 7 ge warm, three times daily.
Restlessness with epigastric hardness: If not previously purged, referring to the previous case without Taiyang/Chai Hu symptoms, use small amounts of Xiao Cheng Qi Tang to gently harmonize. If already purged and epigastric hardness/pain with shortness of breath and restlessness occur, it is Da Xian Xiong Tang syndrome. If all Jie Xiong (Chest Binding) symptoms are present with restlessness, it is fatal (see Chest Binding section).
For Fire Reversal syndrome caused by burning needles leading to restlessness, use Gui Zhi Gan Cao Long Gu Mu Li Tang.
Gui Zhi Gan Cao Long Gu Mu Li Tang Formula:
Gui Zhi (Ramulus Cinnamomi, 1 liang, bark removed), Gan Cao (Radix Glycyrrhizae Preparata), Mu Li (Concha Ostreae, roasted), Long Gu (Os Draconis, each 2 liang). Grind to powder, boil in 5 sheng of water to obtain 2.5 sheng, remove dregs, and take 8 he warm, three times daily. (Pungent-sweet disperses; Gui Zhi and Gan Cao disperse fire-pathogens in meridians. Astringent prevents collapse; Long Gu and Mu Li consolidate floating Yang.)
Taiyang disease treated with fire fumigation without sweating causes inevitable agitation. If unresolved, hematochezia occurs, termed Fire Pathogen. (Cheng Wu-ji notes: Fire pathogen forces blood downward. Taiyang disease with fire fumigation prevents sweat release, trapping heat; Yin deficiency with fire causes agitation. On the sixth day, transmission completes; on the seventh day, returning to Taiyang, heat should resolve. If not, heat forces blood downward causing hematochezia. 'Dao' is synonymous with 'Dao' (reverse); 'Dao bu jie' means worsening. The text specifies Taiyang disease, implying no transmission to other meridians. Cheng's interpretation of 'Dao' is insufficient.)
Taiyang disease with back ironing causing profuse sweating allows fire-heat to enter the Stomach, depleting fluids, causing agitation, delirium. After ten-plus days, chills and diarrhea indicate resolution (see Delirium section).
*Ren Jian Shu* states: Generally, less Yin and more Yang causes heat and Fan, so Taiyang Wind Strike often presents with Fan and Zao.
Yangming Disease: Patients with no bowel movements for five-six days, periumbilical pain, and periodic restlessness have dry fecal matter; use Cheng Qi Tang. Generally, two-three days after onset, weak pulse, no Da Chai Hu syndrome, restlessness, epigastric heat, free urination, and epigastric hardness are treated with small amounts of Xiao Cheng Qi Tang to gently harmonize. However, if illness has resolved with facial redness and slight Fan, constipation is likely. Ask about urine frequency. If urine is scant, fluids return to the Stomach; do not purge.
Shaoyang Disease: Six-seven days after Shang Han, with no significant heat but restlessness, indicates Yang moving into Yin.
Shaoyin Disease: Vomiting, diarrhea, cold extremities, and severe restlessness are treated with Wu Zhu Yu Tang (see Vomiting section). Shaoyin disease with vomiting, diarrhea, restlessness, and cold extremities is fatal. Shaoyin disease with cold extremities, aversion to cold, curled posture, absent pulse, no Fan but Zao is fatal. Shaoyin disease with faint-deep-thin pulse, desire to sleep, sweating, no Fan, spontaneous vomiting, progressing to self-diarrhea and restlessness with inability to sleep by the fifth-sixth day is fatal.
Jueyin Disease: Shang Han with slight heat and mild cold extremities (cold fingertips), silent demeanor, anorexia, and restlessness for several days, with free urination and white urine, indicates heat elimination and recovery if appetite returns. If cold extremities with vomiting and chest/hypochondriac fullness occur, hematochezia is likely.
Shang Han with faint pulse and cold extremities persisting seven-eight days, with cold skin and constant agitation without rest, indicates Zang Jie (Organ Binding) and is fatal. Hui Jue (Roundworm Revulsion) involves cold extremities and Fan, but calms after vomiting roundworms, unlike Zang Jue's constant agitation. Shang Han with faint pulse, cold extremities, and restlessness unrelieved by moxibustion at Jueyin points is fatal. Shang Han with fever, diarrhea, cold extremities, and agitation preventing lying down is fatal. Shang Han presenting with no fever but mania and restlessness is treated with Wu Ling San (2 qian) taken with fresh well water, inducing vomiting for immediate cure.
Cheng Wu-ji notes: Fan-Zao is Fan progressing to Zao; Zao-Fan is Zao reverting to Fan. Progression from Fan to Zao indicates Heat, always starting with Fan. Preceding Zao with Fan indicates Fu Fu Ran agitation due to Yin excess repelling Yang. Extreme agitation desiring mud/water but unable to drink indicates Qi exhaustion and struggle, like a dying lamp flaring up. Inner heat is Fan (mental distress); outer heat is Zao (physical agitation). Inner heat is rooted fire, treatable if only Fan or Fan precedes Zao. Outer heat is rootless fire, untreatable if only Zao or Zao precedes Fan.
Appendix:
*Ren Jian Shu* states: Patients with cold body, deep-thin-rapid pulse, restlessness, and no desire for water have Yin excess repelling Yang; use Pili San. Agitation stops, sleep ensues, sweating occurs, and recovery follows. Huo Yan San and Dan Sha Wan are also indicated.
Pili San, Huo Yan San (see Yin Du section), Dan Sha Wan (see *Ren Jian Shu*).
Hai Zang: Yi Han Wan. This pill does not ascend excessively; Yang generates from below, treating Yin syndromes. After Si Ni class herbs, if chest agitation and thirst occur, or constipation/difficult urination for days, take this pill to stop upper agitation and normalize bowels/bladder.
Rou Gui (Cortex Cinnamomi), Fu Ling (Poria, each 5 qian), Liang Jiang (Rhizoma Alpiniae Officinarum), Wu Tou (Radix Aconiti Carmichaelii, prepared, each 7 qian), Fu Zi (Radix Aconiti Lateralis Preparata), Gan Jiang (Rhizoma Zingiberis, prepared), Shao Yao (Radix Paeoniae Alba), Hui Xiang (Fructus Foeniculi, stir-fried, each 1 liang). Grind to fine powder, make pills with paste size of Sophora seeds. Take 50-70 pills with warm wine on an empty stomach; 80-90 is acceptable. Wine or vinegar paste is suitable.
Ben Cao: Po Yin Dan. Treats hidden Yang within Yin, restlessness, deep-hidden six pulses (see Yin Du section).
Recently, a villager named Li Xin Dao suffered from deep-hidden six pulses, strong force upon deep pressure, headache, warm body, restlessness, cold fingertips, chest fullness, and nausea. Two physicians failed to diagnose, prescribing only Qi-regulating herbs. I diagnosed: Hidden Yang within Yin. This syndrome is absent in Zhang Zhongjing's texts but common. Hot herbs would be blocked by Yin, failing to guide True Yang and generating false pathogens; cold herbs would extinguish hidden True Fire. Treatment requires breaking Yin and guiding True Fire to allow water-fire balance and sweating resolution. Prescribed 200 pills of this medicine in one dose with cold salt water. Soon, intense agitation, fever, and limb restlessness occurred, alarming the family. I explained: This is colloquially "changing Yang." Shortly after, calmness returned, slight sleep ensued, sweating began from dusk till dawn, body cooled, and illness resolved.
Dai Yuanli: Restlessness occurs in both Yin and Yang meridians. Yangming Meridian Stomach dry fecal matter causes Fan, requiring purgation. Taiyang Meridian restlessness after sweating is treated with Wu Ling San. Shaoyang may have Fan, treated with Xiao Chai Hu Tang. Yin Fan is mostly Shaoyin, caused by Yang transmitting to Yin, Yin receiving Yang causing Fan, with diarrhea, thirst, insomnia, treated with Chen Sha Wu Ling San. If not Yang transmitting to Yin, but Yin invading Yin meridians with vomiting, diarrhea, cold extremities, and Fan, classics state "Yang deficiency, Yin invasion causes Fan" and "Yin excess causes agitation, desiring to sit in wells," treated with Wu Zhu Yu Tang. Severe cases use Si Ni Tang plus Cong Bai (Scallion Stem). Additionally, Xu Fan (Deficiency Fan) occurs during recovery when Yin-Yang are unbalanced, with fever and Fan, treated with Zhu Ye Shi Gao Tang. Phlegm causing restless sleep is treated with Wen Dan Tang. Vomiting is treated with Ju Pi Tang.