身热,目疼,鼻干,不得卧,尺寸脉俱长者,阳明受病也。病患小便不利,大便乍难乍易,时有微热,喘
冒不能卧者,有燥屎也,宜大承气汤。汗后大汗出,烦躁不得眠,欲饮水者,少少与之愈。(论见渴。)
汗下后,不得眠,若反复颠倒,心中懊 者,栀子豉汤。(方论见烦。)若但昼不得眠,夜安静,不
呕不渴,无表症,脉沉微,无大热者,宜干姜附子汤。(论见烦躁。)
少阴病欲寐,二三日后,烦心不得卧者,黄连阿胶汤主之。(论见烦躁。)
黄连阿胶汤
黄连 阿胶(各一两) 黄芩(五钱) 芍药(一两) 鸡子(一个)
上 咀,水二盏,煎八分,去渣,纳胶消尽,又纳鸡子黄搅匀,温服,日三。
少阴病,下利欲寐,六七日后,咳而呕渴,心烦不得眠者,宜猪苓汤。(论见下利。)少阴病,但欲
寐,脉沉细,不烦,五六日变自利,烦躁不寐者死。(论见不得寐。)发热下利,厥逆烦躁,不得卧
者死。(论见下利。)
〔《活》〕伤寒吐下后,心烦乏气,日夜不得眠者,酸枣仁汤主之。
酸枣仁汤
酸枣仁(一升) 麦门冬(去心,一合) 甘草(炙,二钱半) 知母(半两) 茯苓 川芎
干姜(各一两)
上 咀,每服四钱,水煎服。
伤寒大热,干呕,呻吟错语,不得眠者,黄连解毒汤主之。
黄连 黄芩 黄柏(各半两) 山栀(二钱)
一方有阿胶(二钱)
上 咀,每服五钱,水煎服。如未知,再服,进粥,以此渐瘥。
伤寒瘥后,虚烦不得眠,心中懊 者,乌梅汤主之。
栀子(炒,半两) 乌梅(去核,四个) 黄芩 甘草(炙。各半两) 柴胡(一两)
上 咀,每服四钱,姜三片,豉五十粒,煎至七分,去渣,温服。
一本有竹叶七片。
身体发热,眼睛疼痛,鼻子干燥,无法安卧,寸脉和尺脉都呈现长脉象的,是阳明经受邪所致。如果病人小便不通畅,大便时而困难时而容易,偶尔有轻微发热,气喘且头昏目眩不能安卧的,是因为体内有燥结的粪便,适宜使用大承气汤。发汗之后大汗淋漓,烦躁不安无法入睡,想要喝水的,少量给予饮水即可痊愈。(相关论述见“渴”条。)
发汗和攻下之后,出现无法入睡,若翻来覆去,心中烦闷懊恼的,使用栀子豉汤。(方剂论述见“烦”条。)如果只是白天无法入睡,夜晚安静,没有呕吐,没有口渴,没有表证,脉象沉微,没有高热症状的,适宜使用干姜附子汤。(相关论述见“烦躁”条。)
少阴病出现想睡觉的症状,过了两三天后,心烦意乱无法安卧的,主治方剂为黄连阿胶汤。(相关论述见“烦躁”条。)
黄连阿胶汤
黄连、阿胶(各一两)、黄芩(五钱)、芍药(一两)、鸡蛋(一个)
将药材切碎,用水两盏,煎煮至八分,滤去药渣,加入阿胶使其完全溶化,再放入鸡蛋黄搅拌均匀,温服,每日三次。
少阴病,伴有腹泻且想睡觉,过了六七天,出现咳嗽、呕吐、口渴,心烦意乱无法安卧的,适宜使用猪苓汤。(相关论述见“下利”条。)少阴病,只想睡觉,脉象沉细,不感到烦躁,到了第五六天转变为自发性腹泻,出现烦躁失眠症状的,预后不良,属死证。(相关论述见“不得寐”条。)出现发热、腹泻、四肢厥冷、烦躁不安、无法安卧的,属死证。(相关论述见“下利”条。)
〔《活》〕伤寒经过催吐或攻下治疗后,心烦气短,日夜都无法安卧的,使用酸枣仁汤主治。
酸枣仁汤
酸枣仁(一升)、麦门冬(去心,一合)、甘草(炙,二钱半)、知母(半两)、茯苓、川芎、干姜(各一两)
将药材切碎,每次服用四钱,加水煎煮后服用。
伤寒高热,干呕,痛苦呻吟,胡言乱语,无法安卧的,使用黄连解毒汤主治。
黄连、黄芩、黄柏(各半两)、山栀(二钱)
另一配方中有阿胶(二钱)
将药材切碎,每次服用五钱,加水煎煮后服用。如果症状未缓解,可再次服用,并进食粥食,以此逐渐痊愈。
伤寒病愈后,因虚热导致心烦无法安卧,心中烦闷懊恼的,使用乌梅汤主治。
栀子(炒,半两)、乌梅(去核,四个)、黄芩、甘草(炙,各半两)、柴胡(一两)
将药材切碎,每次服用四钱,加生姜三片、豆豉五十粒,煎煮至七分,滤去药渣,温服。
另一个版本中有竹叶七片。
Body heat, eye pain, nasal dryness, inability to sleep, with both the cun (inch) and chi (foot) pulses appearing long: this indicates pathogenic invasion of the Yangming channel. If a patient has difficulty urinating, bowel movements that are alternately difficult and easy, occasional slight fever, panting, dizziness, and inability to sleep, this is due to the presence of dry fecal impaction; Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate. After sweating, if there is profuse perspiration, restlessness, insomnia, and a desire for water, giving small amounts of water will lead to recovery. (See discussion under "Thirst".)
After sweating and purging, if insomnia occurs, characterized by tossing and turning and mental restlessness/agonized feeling (Ao Nao), Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. (See formula discussion under "Restlessness".) If the patient can only sleep during the day but is quiet at night, without vomiting or thirst, without exterior symptoms, with a deep and faint pulse, and no high fever, Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Root Decoction) is appropriate. (See discussion under "Restlessness and Irritability".)
In Shaoyin disease, where the patient desires to sleep, if after two or three days they experience heart vexation and inability to sleep, Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is the primary treatment. (See discussion under "Restlessness and Irritability".)
Huang Lian E Jiao Tang
Huang Lian (Coptidis Rhizoma, 1 liang), E Jiao (Asini Corii Colla, 1 liang), Huang Qin (Scutellariae Radix, 5 qian), Shao Yao (Paeoniae Radix Alba, 1 liang), Ji Zi (Galli Ovum, 1 unit).
Chop the herbs, add two zhan of water, decoct until reduced to eight fen, strain the dregs, dissolve the E Jiao completely, then add the egg yolk and stir evenly. Take warm, three times daily.
In Shaoyin disease, accompanied by diarrhea and desire to sleep, if after six or seven days the patient develops cough, vomiting, thirst, heart vexation, and insomnia, Zhu Ling Tang (Polyporus Decoction) is appropriate. (See discussion under "Diarrhea".) In Shaoyin disease, if the patient merely desires to sleep, with a deep and fine pulse, no irritability, but on the fifth or sixth day develops spontaneous diarrhea, irritability, and insomnia, the prognosis is fatal. (See discussion under "Insomnia".) If there is fever, diarrhea, cold extremities, irritability, and inability to sleep, the prognosis is fatal. (See discussion under "Diarrhea".)
[From *Huo*] After emesis or purgation in Shang Han (Cold Damage), if the patient experiences heart vexation, qi deficiency, and inability to sleep day and night, Suan Zao Ren Tang (Sour Jujube Seed Decoction) is the primary treatment.
Suan Zao Ren Tang
Suan Zao Ren (Ziziphi Spinosae Semen, 1 sheng), Mai Men Dong (Ophiopogonis Tuber, dehearted, 1 he), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2.5 qian), Zhi Mu (Anemarrhenae Rhizoma, 0.5 liang), Fu Ling (Poria, 1 liang), Chuan Xiong (Ligustici Chuanxiong Rhizoma, 1 liang), Gan Jiang (Zingiberis Rhizoma, 1 liang).
Chop the herbs, take 4 qian per dose, decoct in water and administer.
In Shang Han (Cold Damage) with high fever, dry retching, groaning, delirious speech, and insomnia, Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxicity) is the primary treatment.
Huang Lian (Coptidis Rhizoma, 0.5 liang), Huang Qin (Scutellariae Radix, 0.5 liang), Huang Bo (Phellodendri Cortex, 0.5 liang), Shan Zhi (Gardeniae Fructus, 2 qian).
Another prescription includes E Jiao (Asini Corii Colla, 2 qian).
Chop the herbs, take 5 qian per dose, decoct in water and administer. If symptoms persist, administer again, and consume congee to gradually recover.
After recovery from Shang Han (Cold Damage), if there is deficiency-heat causing heart vexation and insomnia, with a mental agonized feeling (Ao Nao), Wu Mei Tang (Mume Fruit Decoction) is the primary treatment.
Shan Zhi (Gardeniae Fructus, stir-fried, 0.5 liang), Wu Mei (Mume Fructus, pitted, 4 units), Huang Qin (Scutellariae Radix, 0.5 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, 0.5 liang), Chai Hu (Bupleuri Radix, 1 liang).
Chop the herbs, take 4 qian per dose, add 3 slices of fresh ginger and 50 grains of Chi Xiao Dou (or Dan Dou Chi - fermented soybean), decoct until reduced to seven fen, strain, and take warm.
Another version includes 7 slices of Zhu Ye (Bambusae Folium).