〔万〕烦者，扰扰而烦。躁者，愦躁之躁。合而言之，烦躁皆热也，析而分之，
烦阳也热之轻者，躁阴也热之甚者。《难知集》曰∶火入于肺烦也，火入于肾躁也，疮疹烦躁，须宜忌之。若吐利厥
逆，腹胀喘促而烦躁者，昏不知人，谵妄狂扰而烦躁者，谓之闷乱，皆不治之证。凡痘疮出不快，发不透，靥不
齐有烦躁者，此有二证，如面黄，大便色黑，烦躁喘渴，或如狂，或喜忘，腹胀或痛，此为有瘀血在里也，宜当
归丸（痘便闷）或四顺清凉饮（发热）并加桃仁泥、红花，甚者桃仁承气汤主之（失血）。如便血下
黑粪，而又睡不醒，心为血之主，睡不醒则心之神昏矣，玄参地黄汤（失血）加木通、麦门冬。若无面黄屎黑、如
狂喜忘之证，只大便不通、烦躁腹胀者，此有燥屎也，此却真狂谵妄，以三黄丸、四顺清凉饮（俱发热）、三乙承
气汤、当归丸、胆导法（俱便闷）看病轻重，择而用之，如偏执不可下之说，以致陷伏而死者，医之咎也。〔薛〕
东垣云∶火入于心则烦，入于肾则躁，皆心火为之。盖火旺则金烁水亏，故心肾合而为躁，宜用栀子豆豉汤。凡痘
疮盛作之时，必令心火有所导引，苟或毒瓦斯出而未尽，遂生烦躁，以生黑豆煎汤，或生犀磨汁饮之亦可。若津液不
足，虚烦不得卧者《活人》酸枣仁汤。此证多因脾胃气虚，或服克伐之剂所致，但当调补中气为善。
〔万〕如肺热而烦者，坐卧不安，审于何时，若初发热便烦者，此毒火内郁，人
参白虎汤（发热）加栀子仁主之。若疮发见犹烦者，此毒伏于内，未尽出也，消毒饮（见形）、夺命丹（起发）合而服
之。若疮出尽，又已起发犹烦者，此内热也，牛黄清心丸主之。如肾热而躁者，必曾自利，轻则陈氏木香散（泻
），甚则陈氏异功散（见形）主之。如扬手掷足，欲去衣被者，此热甚于表也，羌活汤主之，泻青丸去大黄、加甘
草。如神识昏迷、反复颠倒者，此热甚于里也，导赤散（心）牛黄清心丸合而治之。吐利不食而烦躁者，正气虚也
，陈氏木香散主之。如昼日烦躁，夜则安静者，此阳盛于昼，至夜则阳气退而安静也，人参白虎汤加栀子仁主之。
如昼日明了，夜则烦躁者，此阳陷入于阴，夜则阴盛，阴阳交争，故烦躁也，四物汤加栀子仁主之。
《活人》酸枣仁汤 治痘疹，虚烦惊悸不得眠。
酸枣仁（炒） 甘草（炙） 知母（炒） 白茯苓 麦门冬（去心） 川芎 干姜（炒各三分）
上，水煎，温服。儿大倍之。
栀子豆豉汤
山栀（四个） 豆豉（半两）
上，水二盏，先煮栀子一盏，内豆豉煎至七分，去滓温服。得快吐即止。
黄连解毒汤 治发 ，热甚心烦不得眠。
黄连 黄芩 黄柏 山栀（各等分）
上，每服四钱，水二钟，煎五分，温服。若 毒甚者，加青黛一钱，调入汤内
服之。凡脉弦数，内外热甚谵语者，合小柴胡汤主之。若脉洪数，内外热甚，舌燥烦渴者，合化 汤主之。
牛黄清心丸
黄连（五钱，生） 黄芩 山栀仁（各三钱） 郁金（二钱） 辰砂（一钱半） 牛黄（二分半）
共研细末，腊雪调面糊，丸如黍米大。每服七八丸，灯心汤送下。
人参蝉蜕散 治小便不利，痘疮不发，烦躁作渴，切牙喘满。
人参 蝉蜕 白芍药 木通 赤茯苓 甘草 紫草茸
上，每服三四钱，水煎。
人参竹叶汤 治虚烦不得寐，或兼自汗。
人参 竹叶 甘草（各二钱） 半夏（二钱五分） 小麦 麦门冬（各一钱五分）
上，每服二三钱，姜二片，粳米一撮，水煎服。
〔万全〕烦，是指心中扰乱不安。躁，是指肢体躁动不宁。合起来说，烦躁都属于热证；分开来看，烦属阳，是热邪较轻的表现；躁属阴，是热邪严重的表现。《难知集》说：火邪侵入肺脏则出现烦，火邪侵入肾脏则出现躁。痘疮疹病中出现烦躁，必须加以鉴别禁忌。如果出现呕吐、腹泻、四肢厥冷逆乱，腹部胀满、气喘急促而烦躁的，或者神志昏迷、不认识人，胡言乱语、狂乱躁扰而烦躁的，这叫做“闷乱”，都是无法治愈的死证。凡是痘疮发出迟缓、透发不透、结痂不齐而出现烦躁的，这有两种证候：如果面色发黄，大便颜色黑，烦躁气喘口渴，或者像发狂一样，或者喜欢忘事，腹部胀满或疼痛，这是体内有瘀血，应当用当归丸（治疗痘便闷）或四顺清凉饮（治疗发热），并加入桃仁泥、红花；病情严重的，用桃仁承气汤主治（针对失血或瘀血）。如果便血排出黑色粪便，并且嗜睡叫不醒，因为心主血脉，嗜睡不醒说明心神昏昧了，用玄参地黄汤（针对失血）加木通、麦门冬。如果没有面色黄、大便黑、像发狂、喜欢忘事这些症状，只是大便不通、烦躁腹胀的，这是体内有燥屎，这确实是真正的狂乱谵妄，根据病情的轻重，选择使用三黄丸、四顺清凉饮（均治发热）、三乙承气汤、当归丸、胆导法（均治大便闭塞闷痛），如果固执地认为不可攻下，导致邪气内陷而死，这是医生的过错。
〔薛己〕李东垣说：火邪侵入心脏则烦，侵入肾脏则躁，这都是心火在起作用。大概是因为火旺则灼伤肺金，导致肾水亏虚，所以心肾同病表现为躁，适宜用栀子豆豉汤。凡是痘疮发作旺盛的时候，必定要让心火有所疏导，如果毒气发出而不彻底，于是产生烦躁，可以用生黑豆煎汤，或者磨生犀角汁饮用也可以。如果是津液不足，虚烦不能入睡的，用《活人书》中的酸枣仁汤。这个证候多因脾胃气虚，或者服用克伐损伤正气的药物所致，只应当调补中气为好。
〔万全〕如果是肺热导致的烦，坐卧不安，要审察发病的时间，如果在刚开始发热时就烦，这是毒火内郁，用人参白虎汤（治发热）加栀子仁主治。如果痘疮发出后仍然烦，这是毒邪伏于体内，没有完全透发出来，将消毒饮（见形期用）、夺命丹（起发期用）合起来服用。如果痘疮出尽，已经起发但仍然烦，这是内热，用牛黄清心丸主治。如果是肾热导致的躁，必定曾经有过自发性腹泻，轻的用陈氏木香散（治泻），重的用陈氏异功散（见形期用）主治。如果扬手掷足，想要去掉衣被，这是热邪盛于体表，用羌活汤主治，泻青丸去掉大黄、加入甘草。如果神识昏迷、身体反复翻动颠倒，这是热邪盛于体内，用导赤散（治心经热）和牛黄清心丸合起来治疗。呕吐腹泻、不能进食而烦躁的，这是正气虚弱，用陈氏木香散主治。如果白天烦躁，晚上安静，这是阳气盛于白天，到了夜晚阳气衰退所以安静，用人参白虎汤加栀子仁主治。如果白天神志清楚，晚上烦躁，这是阳气陷入阴分，夜晚阴气盛，阴阳交争，所以烦躁，用四物汤加栀子仁主治。
《活人书》酸枣仁汤：治疗痘疹，虚烦惊悸不能安眠。
酸枣仁（炒） 甘草（炙） 知母（炒） 白茯苓 麦门冬（去心） 川芎 干姜（炒，各三分）
以上药材，用水煎煮，温服。儿童剂量加倍。
栀子豆豉汤：
山栀（四个） 豆豉（半两）
以上药材，用水二盏，先煮栀子至一盏水，再加入豆豉煎至七分，去渣温服。如果引起快速呕吐就停止服药。
黄连解毒汤：治疗痘疮，热甚心烦不能安眠。
黄连 黄芩 黄柏 山栀（各等分）
以上药材，每次服用四钱，用水二钟，煎至五分，温服。如果痘毒严重，加入青黛一钱，调入汤内服用。凡是脉象弦数，内外热甚胡言乱语的，合用小柴胡汤主治。如果脉象洪数，内外热甚，舌干烦躁口渴的，合用化斑汤主治。
牛黄清心丸：
黄连（五钱，生用） 黄芩 山栀仁（各三钱） 郁金（二钱） 辰砂（一钱半） 牛黄（二分半）
共同研成细末，用腊雪调和面糊，制成如黍米大小的丸药。每次服用七八丸，用灯心草汤送下。
人参蝉蜕散：治疗小便不利，痘疮不发，烦躁作渴，咬牙气喘胸闷。
人参 蝉蜕 白芍药 木通 赤茯苓 甘草 紫草茸
以上药材，每次服用三四钱，用水煎煮。
人参竹叶汤：治疗虚烦不能安睡，或者兼有自汗。
人参 竹叶 甘草（各二钱） 半夏（二钱五分） 小麦 麦门冬（各一钱五分）
以上药材，每次服用二三钱，加生姜两片，粳米一撮，用水煎服。
[Wan] "Fan" (restlessness of mind) refers to a state of mental disturbance and agitation. "Zao" (restlessness of body) refers to physical tossing and turning. In general terms, both Fan and Zao belong to heat syndromes; however, when analyzed separately, Fan is associated with Yang and represents a milder form of heat, whereas Zao is associated with Yin and represents a more severe form of heat. The *Nan Zhi Ji* states: "When Fire enters the Lung, Fan occurs; when Fire enters the Kidney, Zao occurs." In cases of smallpox or measles accompanied by Fan and Zao, careful differentiation and contraindications are required. If vomiting, diarrhea, cold limbs, abdominal distension, panting, and rapid breathing occur alongside Fan and Zao, or if there is unconsciousness, incoherent speech, mania, and wild agitation, this is termed "Men Luan" (stifling confusion), which indicates an incurable condition. If smallpox lesions emerge slowly, fail to fully erupt, or have uneven scabbing, and are accompanied by Fan and Zao, there are two possible patterns: 1) If the complexion is yellow, stool is black, and there is Fan, Zao, panting, thirst, manic behavior, or forgetfulness, along with abdominal distension or pain, this indicates blood stasis in the interior. The appropriate treatment is Dang Gui Wan (for stifled smallpox) or Si Shun Qing Liang Yin (for fever), added with Tao Ren Ni (Peach Kernel Paste) and Hong Hua (Safflower). For severe cases, Tao Ren Cheng Qi Tang is indicated. 2) If there is hematochezia with black stools, accompanied by excessive sleepiness that is difficult to rouse, this indicates clouding of the Heart spirit, as the Heart governs blood. Xuan Shen Di Huang Tang (for blood loss) added with Mu Tong (Akebia Caulis) and Mai Men Dong (Ophiopogon Tuber) should be used. If there are no signs of yellow complexion, black stool, mania, or forgetfulness, but only constipation, Fan, and abdominal distension, this indicates dry fecal matter in the intestines, representing true mania and delirium. Depending on the severity, one may choose San Huang Wan, Si Shun Qing Liang Yin, San Yi Cheng Qi Tang, Dang Gui Wan, or Dan Dao Fa (biliary enema). Insisting on the theory that purgation is forbidden, leading to death from pathogenic sinking, is the physician's fault.
[Xue] Li Dongyuan stated: "Fire entering the Heart causes Fan; Fire entering the Kidney causes Zao." Both are driven by Heart Fire. Generally, excessive Fire scorches Metal (Lung) and depletes Water (Kidney), causing the Heart and Kidney to interact pathologically resulting in Zao. Zhizi Dou Chi Tang is suitable. During the peak eruption of smallpox, it is essential to guide the Heart Fire appropriately. If toxins are not fully expelled, leading to Fan and Zao, decocting raw black soybeans or drinking fresh rhinoceros horn juice (now substituted with water buffalo horn in practice) can be effective. For deficiency-heat causing restlessness and insomnia, Suan Zao Ren Tang from the *Huo Ren Shu* is indicated. This syndrome often results from Spleen-Stomach Qi deficiency or the use of harsh draining medicines; thus, tonifying Middle Qi is the best approach.
[Wan] If Fan is caused by Lung Heat, characterized by restlessness in sitting and lying, observe the timing. If Fan appears at the onset of fever, it indicates internal depression of toxic fire; Ren Shen Bai Hu Tang added with Zhi Zi Ren (Gardenia Seed) is indicated. If Fan persists after lesions appear, it indicates latent toxins not yet fully erupted; Xiao Du Yin combined with Duo Ming Dan should be taken. If Fan persists after lesions have fully erupted and risen, it indicates internal heat; Niu Huang Qing Xin Wan is indicated. If Zao is caused by Kidney Heat, usually following spontaneous diarrhea, Chen Shi Mu Xiang San is for mild cases, and Chen Shi Yi Gong San is for severe cases. If the patient throws hands and feet about and desires to remove clothing/bedding, this indicates excess heat in the exterior; Qiang Huo Tang is indicated, or Xie Qing Wan without Da Huang and with added Gan Cao. If there is coma, confusion, and restless tossing, this indicates excess heat in the interior; Dao Chi San combined with Niu Huang Qing Xin Wan is indicated. Vomiting, diarrhea, anorexia, and Fan/Zao indicate deficiency of Righteous Qi; Chen Shi Mu Xiang San is indicated. If the patient is restless during the day but quiet at night, this is due to Yang abundance during the day and decline at night; Ren Shen Bai Hu Tang added with Zhi Zi Ren is indicated. If the patient is clear-minded during the day but restless at night, this is due to Yang sinking into Yin, with Yin abundance at night causing Yin-Yang conflict; Si Wu Tang added with Zhi Zi Ren is indicated.
*Suan Zao Ren Tang* from the *Huo Ren Shu*: Treats smallpox/measles with deficiency-heat, palpitations, and insomnia.
Suan Zao Ren (fried), Gan Cao (roasted), Zhi Mu (fried), Bai Fu Ling, Mai Men Dong (core removed), Chuan Xiong, Gan Jiang (fried, each 3 fen).
Decoct in water and take warm. Double the dose for older children.
*Zhizi Dou Chi Tang*:
Shan Zhi (4 pods), Dou Chi (0.5 liang).
Decoct Shan Zhi in 2 cups of water until 1 cup remains, add Dou Chi, and simmer until 0.7 cups remain. Strain and take warm. Stop taking if vomiting occurs.
*Huang Lian Jie Du Tang*: Treats smallpox with severe heat,心烦 (mental restlessness), and insomnia.
Huang Lian, Huang Qin, Huang Bo, Shan Zhi (equal parts).
Take 4 qian per dose, decoct in 2 zhong of water until 0.5 zhong remains. Take warm. If toxin is severe, add 1 qian of Qing Dai mixed into the decoction. For wiry-rapid pulse with severe internal/external heat and delirium, combine with Xiao Chai Hu Tang. For flooding-rapid pulse with severe internal/external heat, dry tongue, restlessness, and thirst, combine with Hua Ban Tang.
*Niu Huang Qing Xin Wan*:
Huang Lian (5 qian, raw), Huang Qin, Zhi Zi Ren (each 3 qian), Yu Jin (2 qian), Chen Sha (1.5 qian), Niu Huang (0.25 fen).
Grind into fine powder, mix with wax snow and wheat paste to form pills the size of millet seeds. Take 7-8 pills per dose, washed down with Deng Xin Tang (Juncus Decoction).
*Ren Shen Chan Tui San*: Treats difficulty urinating, non-erupting smallpox, restlessness with thirst, teeth grinding, panting, and chest fullness.
Ren Shen, Chan Tui, Bai Shao Yao, Mu Tong, Chi Fu Ling, Gan Cao, Zi Cao Rong.
Take 3-4 qian per dose, decoct in water.
*Ren Shen Zhu Ye Tang*: Treats deficiency-heat restlessness and insomnia, possibly with spontaneous sweating.
Ren Shen, Zhu Ye, Gan Cao (each 2 qian), Ban Xia (2.5 qian), Xiao Mai, Mai Men Dong (each 1.5 qian).
Take 2-3 qian per dose, add 2 slices of fresh ginger and a pinch of Jing Mi (rice), decoct in water, and take.