发汗吐下后。虚烦不得眠。若剧者。必反复颠倒。心中懊 。栀子豉汤主之。若少气者。栀子
甘草豉汤主之。若呕者。栀子生姜豉汤主之。
发汗吐下后。正气既虚。邪气亦衰。乃虚烦不得眠。甚则反复颠倒。心中懊 者。未尽之邪
。方入里而未集。已虚之气。欲胜邪而不能。则烦乱不宁。甚则心中懊 郁闷。而不能自已也。栀
子体轻。味苦微寒。豉经蒸 。可升可降。二味相合。能彻散胸中邪气。为除烦止躁之良剂。少
气者。呼吸少气。不足以息也。甘草之甘。可以益气。呕者。气逆而不降也。生姜之辛。可以散逆
。得吐则邪气散而当愈。不可更吐以伤其气。故止后服。
栀子豉汤方
栀子（十四枚擘） 香豉（四合绵裹）
上二味。以水四升。先煮栀子。得二升半。纳豉。煮取一升半。去滓。分二服。温进一服。
得吐。止后服。
栀子甘草豉汤方
于栀子豉汤内加入甘草二两。余根据前法。
栀子生姜豉汤方
于栀子豉汤内。加入生姜五两。余根据前法。
发汗若下之。而烦热胸中窒者。栀子豉汤主之。
伤寒五六日。大下之后。身热不去。心中结痛者。未欲解也。栀子豉汤主之。
烦热者。心烦而身热也。胸中窒者。邪入胸间而气窒不行也。盖亦汗下后。正虚邪入。而犹未
集之证。故亦宜栀子豉汤散邪彻热为主也。心中结痛者。邪结心间而为痛也。然虽结痛而身热不去
。则其邪亦未尽入。与结胸之心下痛而身不热者不同。此栀子豉汤之散邪彻热。所以轻于小陷胸之
荡实除热也。
伤寒下后。心烦腹满。卧起不安者。栀子浓朴汤主之。
下后心烦。证与上同。而加腹满。则邪入较深矣。成氏所谓邪气壅于心腹之间者是也。故去香
豉之升散。而加枳、朴之降泄。若但满而不烦。则邪入更深。又当去栀子之轻清。而加大黄之沉下
矣。此栀子浓朴汤所以重于栀豉而轻于承气也。
栀子浓朴汤方
栀子（十四枚擘） 浓朴（四两姜汁炒） 枳实（四枚水浸去穣炒）
上三味。以水三升半。煮取一升半。去滓。分二服。温进一服。得吐者。止后服。
伤寒。医以丸药大下之。身热不去。微烦者。栀子干姜汤主之。
大下后身热不去。证与前同。乃中无结痛。而烦又微而不甚。知正气虚。不能与邪争。虽争而亦
不能胜之也。故以栀子彻胸中陷入之邪。干姜复下药损伤之气。
栀子干姜汤方
栀子（十四枚） 干姜（二两）
上二味。以水三升半。煮取一升半。去滓。分二服。温进一服。得吐。止后服。
凡用栀子汤。病患旧微溏者。不可与服之。
病患旧微溏者。未病之先。大便本自微溏。为里虚而寒在下也。栀子汤本涌泄胸中客热之剂。
旧微溏者。中气不固。与之。恐药气乘虚下泄。而不能上达。则膈热反因之而深入也。故曰不可与服
之。
发汗、催吐或泻下治疗后，患者出现虚烦、无法入睡的症状。如果病情严重，必定会出现翻来覆去、心中烦闷懊恼的感觉，此时应用栀子豉汤主治。若伴有气短症状的，应用甘草栀子豉汤主治。若有呕吐症状的，应用生姜栀子豉汤主治。
经过发汗、催吐或泻下治疗后，正气已经虚弱，邪气也随之衰退，因此出现虚烦不得眠的情况。严重时翻来覆去，心中烦闷懊恼，这是因为残留的邪气尚未完全清除，刚侵入体内但尚未聚集；而已经虚弱的正气，想要战胜邪气却力不从心，导致心烦意乱、坐卧不宁，严重时心中烦闷郁闷，无法自我控制。栀子质地轻扬，味道苦微寒；香豉经过蒸制，药性可升可降。这两味药配合使用，能够透散胸中的邪气，是清除烦躁、平息躁动的良方。所谓“少气”，是指呼吸气短，气息不足以接续。甘草的甘味可以补益元气。所谓“呕”，是指气机上逆而不下降。生姜的辛味可以发散逆气。服药后如果出现呕吐，说明邪气已散，病应当痊愈，此时应停止服用后续的药量，以免再次催吐损伤正气。
栀子豉汤方剂组成：
栀子（十四枚，掰开） 香豉（四合，用棉布包裹）
以上两味药，用水四升，先煮栀子，煮至剩余二升半时，加入香豉，继续煮取一升半药液，滤去药渣，分两次温服。第一次服用后，若出现呕吐现象，则停止服用剩下的药液。
甘草栀子豉汤方剂组成：
在栀子豉汤的基础上加入甘草二两，其余煎服方法均依照前述方法。
生姜栀子豉汤方剂组成：
在栀子豉汤的基础上加入生姜五两，其余煎服方法均依照前述方法。
经过发汗或泻下治疗后，出现心烦发热、胸部窒塞感的，应用栀子豉汤主治。
伤寒病程到了五六天，经过猛烈泻下之后，身体发热不退，心中结聚疼痛的，说明病邪未解，应用栀子豉汤主治。
所谓“烦热”，是指心中烦乱且身体发热。“胸中窒”是指邪气进入胸膈之间，导致气机阻滞不通。这同样是汗下之后，正气虚弱而邪气内入，但尚未完全聚集的证候，所以也适宜用栀子豉汤来疏散邪气、透达郁热为主。所谓“心中结痛”，是指邪气结聚在心间而导致疼痛。然而虽然结聚疼痛但身体仍然发热，说明邪气也未完全内陷，这与结胸证中心下疼痛但身体不发热的情况不同。这也是为什么栀子豉汤疏散邪气、透达郁热的力度，轻于小陷胸汤荡涤实热的原因。
伤寒经过泻下治疗后，出现心烦、腹部胀满、睡卧起立不安的，应用栀子厚朴汤主治。
泻下后出现心烦，证候与上文相同，但增加了腹部胀满，说明邪气入里较深了。正如成无己所说，这是邪气壅滞于心腹之间的表现。所以去掉香豉的升散作用，加入枳实、厚朴的降泄作用。如果只是腹部胀满而没有心烦，说明邪气入得更深，又应当去掉栀子的轻清之性，而加大黄的沉下之力。这就是栀子厚朴汤的药力重于栀子豉汤而轻于承气汤的原因。
栀子厚朴汤方剂组成：
栀子（十四枚，掰开） 厚朴（四两，姜汁炒） 枳实（四枚，水浸去瓤炒）
以上三味药，用水三升半，煮取一升半药液，滤去药渣，分两次温服。第一次服用后，若出现呕吐，则停止服用剩下的药液。
伤寒过程中，医生误用丸药猛烈泻下，导致身体发热不退，轻微心烦的，应用栀子干姜汤主治。
猛烈泻下后身体发热不退，证候与前文相同，但没有心中结痛，且心烦轻微不严重，这说明正气虚弱，不能与邪气抗争，即使抗争也不能战胜邪气。所以用栀子透达陷入胸中的邪气，用干姜恢复被下药损伤的中气。
栀子干姜汤方剂组成：
栀子（十四枚） 干姜（二两）
以上两味药，用水三升半，煮取一升半药液，滤去药渣，分两次温服。第一次服用后，若出现呕吐，则停止服用剩下的药液。
凡是使用栀子汤，如果患者平素大便稀溏的，不可给予服用。
所谓“旧微溏”，是指患者在患病之前，大便本来就容易轻微稀溏，这是由于里虚且寒气在下焦。栀子汤本是涌泄胸中客热（外来邪热）的药剂。平素大便稀溏的人，中气不固，如果服用此药，恐怕药气乘虚下行泄出，而不能上达胸中以清热，反而会导致膈部的热邪因之中深入体内。所以说不可服用。
After sweating, vomiting, or purging treatments, the patient presents with deficiency vexation (Xu Fan, a type of irritability due to deficiency) and inability to sleep. If the condition is severe, it will inevitably manifest as tossing and turning (Fan Dao Dian Zhuan, restlessness) and inner feeling of stifling depression (Ao Nao). Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary formula for this. If accompanied by shortness of breath (Shao Qi), Gan Cao Zhi Zi Chi Tang (Licorice, Gardenia, and Fermented Soybean Decoction) is indicated. If vomiting occurs, Sheng Jiang Zhi Zi Chi Tang (Fresh Ginger, Gardenia, and Fermented Soybean Decoction) is indicated.
Following sweating, vomiting, or purging, the healthy qi (Zheng Qi) is depleted, and the pathogenic factor (Xie Qi) has also weakened. Thus, deficiency vexation and insomnia occur. In severe cases, the patient tosses and turns, experiencing inner stifling depression. This is because residual pathogenic factors have not yet been fully cleared; they have just entered the interior but have not yet gathered. The already deficient healthy qi desires to overcome the pathogen but lacks strength, leading to restless irritability. In severe cases, the inner stifling depression becomes unbearable. Gardenia (Zhi Zi) is light in texture and bitter with a slightly cold nature. Fermented soybean (Chi Dou, prepared via steaming) has properties that can ascend and descend. Combined, these two herbs can penetrate and disperse pathogenic factors in the chest, making them an excellent remedy for eliminating vexation and calming agitation. "Shortness of breath" refers to insufficient respiration. The sweetness of Licorice (Gan Cao) can tonify qi. "Vomiting" refers to rebellious qi failing to descend. The pungency of Fresh Ginger (Sheng Jiang) can dissipate rebellious qi. If vomiting occurs after administration, it indicates that the pathogen has dispersed and recovery is expected; subsequent doses should be stopped to avoid damaging qi through further vomiting.
**Zhi Zi Chi Tang Formula:**
* Zhi Zi (Gardeniae Fructus): 14 pods, split open
* Xiang Chi (Prepared Fermented Soybean): 4 heaped sheng, wrapped in cotton cloth
Take the above two ingredients, add four sheng of water, first decoct Zhi Zi until half remains (2.5 sheng), then add Xiang Chi. Decoct until one and a half sheng remains. Strain the dregs. Divide into two warm doses. After the first dose, if vomiting occurs, stop taking the remaining medicine.
**Gan Cao Zhi Zi Chi Tang Formula:**
Add two liang of Gan Cao (Glycyrrhizae Radix et Rhizoma) to the Zhi Zi Chi Tang formula. All other preparation and administration methods follow the previous instructions.
**Sheng Jiang Zhi Zi Chi Tang Formula:**
Add five liang of Sheng Jiang (Zingiberis Rhizoma Recens) to the Zhi Zi Chi Tang formula. All other preparation and administration methods follow the previous instructions.
After sweating or purging, if vexation, heat, and a sensation of obstruction in the chest appear, Zhi Zi Chi Tang is indicated.
In Shaoyang disease (Shang Han), on the fifth or sixth day, after vigorous purging, if body heat persists and there is a knotted pain in the heart region, the disease has not yet resolved. Zhi Zi Chi Tang is indicated.
"Vexation and heat" refer to mental irritability accompanied by bodily fever. "Chest obstruction" (Xiong Zhong Zhi) refers to pathogenic factors entering the chest cavity, causing qi stagnation. This is also a syndrome where, after sweating and purging, healthy qi is deficient and pathogens have entered but are not yet fully gathered. Therefore, Zhi Zi Chi Tang is suitable to primarily disperse pathogens and penetrate heat. "Knotted pain in the heart" refers to pain caused by pathogens knotting in the heart region. However, since body heat persists despite the knotted pain, the pathogen has not completely sunk inward. This differs from Jue Yin Jie Xiong (Chest Binding) where there is pain in the epigastrium but no body heat. This explains why the action of Zhi Zi Chi Tang in dispersing pathogens and penetrating heat is milder than Xiao Xian Xiong Tang (Minor Infiltrating Chest Decoction) which sweeps out excess and clears heat.
After purging in Shaoyang disease, if vexation, abdominal fullness, and restlessness (unable to lie down or sit up comfortably) occur, Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction) is indicated.
Vexation after purging is similar to the above case, but the addition of abdominal fullness indicates deeper penetration of pathogens. As Cheng Wuji stated, this is pathogenic qi congested between the heart and abdomen. Therefore, the ascending and dispersing property of Xiang Chi is removed, and the descending and draining properties of Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) are added. If there is only fullness without vexation, the pathogen has penetrated even deeper; in this case, the light and clear nature of Zhi Zi should be removed, and Da Huang (Rhubarb Root and Rhizome) should be added for its heavy and sinking action. This is why Zhi Zi Hou Po Tang is heavier than Zhi Zi Chi Tang but lighter than Cheng Qi Tang (Purgative Decoctions).
**Zhi Zi Hou Po Tang Formula:**
* Zhi Zi (Gardeniae Fructus): 14 pods, split open
* Hou Po (Magnoliae Officinalis Cortex): 4 liang, stir-fried with ginger juice
* Zhi Shi (Aurantii Fructus Immaturus): 4 pieces, soaked in water, pith removed, stir-fried
Take the above three ingredients, add three and a half sheng of water, decoct until one and a half sheng remains. Strain the dregs. Divide into two warm doses. After the first dose, if vomiting occurs, stop taking the remaining medicine.
In Shaoyang disease, if the physician mistakenly uses pill-based purgatives vigorously, resulting in persistent body heat and slight vexation, Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction) is indicated.
After vigorous purging, persistent body heat is similar to previous cases, but without knotted pain and with only slight vexation. This indicates that healthy qi is deficient and cannot contend with the pathogen; even if it contends, it cannot overcome it. Therefore, Zhi Zi is used to penetrate pathogens sunk into the chest, and Gan Jiang (Zingiberis Rhizoma) is used to restore qi damaged by purgatives.
**Zhi Zi Gan Jiang Tang Formula:**
* Zhi Zi (Gardeniae Fructus): 14 pods
* Gan Jiang (Zingiberis Rhizoma): 2 liang
Take the above two ingredients, add three and a half sheng of water, decoct until one and a half sheng remains. Strain the dregs. Divide into two warm doses. After the first dose, if vomiting occurs, stop taking the remaining medicine.
Whenever using Zhi Zi Tang formulas, if the patient has a history of loose stools (Jiu Wei Tang), it should not be administered.
"History of loose stools" means that before illness, the patient's stool was naturally slightly loose, indicating interior deficiency and cold in the lower jiao. Zhi Zi Tang is originally a formula for inducing emesis and draining guest heat from the chest. Patients with a history of loose stools have unstable middle qi. Administering this medication may cause the medicinal qi to sink downward due to deficiency rather than reaching the upper jiao to clear heat, potentially allowing diaphragmatic heat to sink deeper. Therefore, it is contraindicated.