太阳证发汗，大汗出，胃中干，烦燥不得眠，欲饮水者，当少少与之，胃中和即
愈
；若脉浮，小便不利，发渴者，五苓散（正六十六）主之。下后复发汗，
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，干姜附子汤主之。（正七十三）
若发汗，若吐，若下后，虚烦不得眠，剧则反复颠倒，心中懊 者，
宜栀子豉汤（正四十五）吐之
（栀子豉汤一盏半为一剂，分再服，一服得吐，止后服）。伤寒大热，干
呕，呻
吟错语，不得眠，黄连解毒汤主之（杂八十七）。伤寒吐下后，心烦乏气
，昼夜不得眠，酸枣汤主之（杂八十八）。少阴病，得之二三日以上，心中
烦，不得眠，黄连阿胶汤主之（杂一百四）。若少阴病，下利而渴，不得眠
猪苓汤主之。（正六十七）又问伤寒瘥后不得眠，何也？盖热气与诸阳
相并，阴气未复，所以病后仍不得睡也，栀子乌梅汤主之。（杂八十九）
（八十五）问多眠
多眠有四证∶有风温证，有小柴胡证，有少阴证，有狐惑证。病患尺寸脉俱浮
，头疼身热，常自汗出，体重，其息必喘，四肢不收，默默但欲眠者，风温证也。风温
不可发汗，宜葳蕤汤。（杂四十五）（在第六卷中第四十五问）病患脉
浮，头项强痛而恶寒者，太阳证也。十日已去，脉浮细而嗜卧者，外已解也；设胸满胁痛者
，与小柴胡汤。（正二十九）脉但浮者，麻黄汤主之（正二十）。病患尺寸脉俱沉细，但欲寐者，少阴证也，
急作四逆汤，（正七十五）复其阳，不可缓也。若状如伤寒，四肢沉重，忽忽喜眠，须看上下唇
，上唇有疮，虫蚀五脏；下唇有疮，虫蚀下部，当作狐惑治之。（在第十一卷中第九十九问）
（八十六）问身凉汗出两胁疼痛或干呕
此十枣汤证也。仲景云∶太阳中风，下利呕逆，表解者乃可攻之。其人
，发作有时，头痛，心中痞硬满，引胁下痛，干呕短
气，汗出不恶寒者，此表解里未和也，十枣汤主之。（正八十九）大抵胁
下痛者，此为有饮，须分表里，干呕微利，发热而咳，为表有水，小青龙汤加荛花主之；
身体凉，表证罢，干呕而胁下痛，为里有水，十枣汤主之。十枣
汤非小青龙汤之比，须量人虚实，不可妄投。
太阳病证候使用发汗法治疗后，若出汗过多，导致胃中津液干燥，出现烦躁、无法入睡的症状，想要喝水时，应当少量多次地给予饮水，待胃气调和即可痊愈；如果脉象浮，小便不通利，且伴有口渴症状的，由五苓散（正六十六）主治。经过泻下法后又再次发汗，白天烦躁不安无法入睡，夜间则安静，没有呕吐和口渴，也没有表证，脉象沉而微弱，身体没有大热的，由干姜附子汤主治。（正七十三）
如果是经过发汗、催吐或泻下法治疗后，出现虚烦无法入睡，严重时辗转反侧，心中懊恼不适的，适宜用栀子豉汤（正四十五）进行催吐（栀子豉汤一盏半为一剂，分两次服用，一次服药后如果引起呕吐，就停止后续服用）。伤寒病高热，干呕，呻吟，胡言乱语，无法入睡的，由黄连解毒汤主治（杂八十七）。伤寒病经过吐法或下法治疗后，心烦气短，昼夜无法入睡的，由酸枣汤主治（杂八十八）。少阴病，患病两三天以上，心中烦躁，无法入睡的，由黄连阿胶汤主治（杂一百四）。如果是少阴病，腹泻且口渴，无法入睡的，由猪苓汤主治。（正六十七）
又问：伤寒病愈后无法入睡，是什么原因呢？这是因为余热与诸阳之气相搏结，阴气尚未恢复，所以病后仍然无法睡眠，由栀子乌梅汤主治。（杂八十九）
（八十五）问：多眠症
多眠症有四种证型：有风温证，有小柴胡证，有少阴证，有狐惑证。患者寸关尺三部脉象都浮，头痛身热，经常自汗出，身体沉重，呼吸必定气喘，四肢无力收持，沉默寡言只想睡觉的，是风温证。风温证不可发汗，适宜用葳蕤汤。（杂四十五）（在第六卷中第四十五问）患者脉象浮，头项强痛且恶寒的，是太阳证。病程已过十天，脉象浮细且嗜睡的，说明表邪已解；如果出现胸满胁痛的，给予小柴胡汤。（正二十九）脉象仅见浮象的，由麻黄汤主治（正二十）。患者寸关尺三部脉象都沉细，只想睡觉的，是少阴证，需紧急制作四逆汤，（正七十五）以回复阳气，不可迟缓。如果症状像伤寒，四肢沉重，恍惚喜睡，需要查看上下嘴唇，上唇有疮疡，是虫蚀五脏；下唇有疮疡，是虫蚀下部，当作狐惑病治疗。（在第十一卷中第九十九问）
这是十枣汤证。张仲景说：太阳中风病，伴有下利、呕吐逆气，表证解除后才能攻里。患者发作有时，头痛，心下痞硬胀满，牵引胁下疼痛，干呕短气，汗出且不恶寒的，这是表证已解而里气未和，由十枣汤主治。（正八十九）大体而言，胁下疼痛的，这是因为体内有水饮，必须分辨表里。干呕、轻微腹泻、发热且咳嗽的，为表有水饮，用小青龙汤加荛花主治；身体凉爽，表证已罢，干呕且胁下疼痛的，为里有水饮，由十枣汤主治。十枣汤与小青龙汤不同，必须衡量病人的虚实情况，不可随意投药。
When the Taiyang syndrome is treated with sweating methods, and excessive sweating occurs, leading to dryness in the stomach, irritability, and inability to sleep, if the patient desires water, it should be given in small amounts frequently. Once the stomach qi harmonizes, the condition will resolve. If the pulse is floating, urination is difficult, and thirst is present, Wuling San (Five-Ingredient Powder with Poria) [Zheng 66] is indicated. After purgation followed by re-sweating, if there is restlessness and insomnia during the day but quietness at night, without vomiting or thirst, without exterior syndrome, with a deep and faint pulse, and no significant heat on the body, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) [Zheng 73] is indicated.
If, after sweating, emesis, or purgation, there is empty irritability and insomnia, which becomes severe with tossing and turning and mental depression (Ao Nao), Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) [Zheng 45] is suitable for inducing emesis. (One dose of Zhizi Chi Tang consists of one and a half cups; divide into two doses. If emesis occurs after the first dose, stop subsequent doses.) In severe cold damage with high fever, dry retching, groaning, delirium, and insomnia, Huanglian Jiedu Tang (Coptis Decoction for Detoxification) [Za 87] is indicated. After emesis or purgation in cold damage, if there is heart vexation, fatigue, and insomnia day and night, Suanzao Tang (Sour Jujube Decoction) [Za 88] is indicated. In Shaoyin disease, if after two or three days there is heart vexation and insomnia, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) [Za 104] is indicated. If Shaoyin disease presents with diarrhea, thirst, and insomnia, Zhuling Tang (Poria Decoction) [Zheng 67] is indicated.
Another question asks: Why does insomnia occur after recovery from cold damage? This is because residual heat combines with the Yang qi, while Yin qi has not yet recovered, thus causing insomnia post-illness. Zhi Zi Wu Mei Tang (Gardenia and Mume Fruit Decoction) [Za 89] is indicated.
(85) Question: Hypersomnia
Hypersomnia has four syndromes: Fengwen (Wind-Warmth) syndrome, Xiao Chaihu Tang syndrome, Shaoyin syndrome, and Huhe (Fox Confusion) syndrome. If the pulses at Cun, Guan, and Chi positions are all floating, accompanied by headache, fever, spontaneous sweating, heaviness of the body, panting, flaccidity of the four limbs, and a desire to sleep silently, this is Fengwen syndrome. Fengwen syndrome should not be treated with sweating methods; Weirui Tang (Jade Bamboo Decoction) [Za 45] is indicated. (See Question 45 in Volume 6). If the pulse is floating, accompanied by stiffness and pain in the head and neck, and aversion to cold, this is Taiyang syndrome. If ten days have passed, the pulse is floating and fine, and the patient desires sleep, the exterior pathogen has resolved. If chest fullness and hypochondriac pain occur, Xiao Chaihu Tang (Minor Bupleurum Decoction) [Zheng 29] is given. If the pulse is merely floating, Mahuang Tang (Ephedra Decoction) [Zheng 20] is indicated. If the pulses at Cun, Guan, and Chi positions are all deep and fine, and the patient only desires sleep, this is Shaoyin syndrome. Si Ni Tang (Frigid Extremities Decoction) [Zheng 75] must be prepared urgently to restore Yang qi; delay is not permissible. If the presentation resembles cold damage, with heavy limbs, drowsiness, and a desire to sleep, examine the lips. Sores on the upper lip indicate worms eroding the five zang organs; sores on the lower lip indicate worms eroding the lower parts. This should be treated as Huhe syndrome. (See Question 99 in Volume 11).
(86) Question: Cool body with sweating, pain in both hypochondria, or dry retching
This is a Shizao Tang (Ten Jujubes Decoction) syndrome. Zhang Zhongjing stated: In Taiyang Wind-Strike with diarrhea and vomiting/retching, interior attack is permissible only after the exterior is resolved. If attacks occur at specific times, with headache, epigastric hardness and fullness, pain radiating to the hypochondrium, dry retching, shortness of breath, sweating, and no aversion to cold, this indicates the exterior is resolved but the interior is unharmonized. Shizao Tang [Zheng 89] is indicated. Generally, hypochondriac pain indicates fluid retention (Yin), requiring differentiation between exterior and interior. Dry retching, mild diarrhea, fever, and cough indicate exterior fluid retention, treated with Xiao Qinglong Tang (Minor Green Dragon Decoction) plus Wanghua (Stellerae Radix Cortex). A cool body, resolved exterior syndrome, dry retching, and hypochondriac pain indicate interior fluid retention, treated with Shizao Tang. Shizao Tang differs significantly from Xiao Qinglong Tang; one must assess the patient's deficiency and excess before administration, and never prescribe recklessly.