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（成 伤寒五六日邪气在里之时若大下后身热去心
胸空者为欲解若大下后身热去而心结痛者结胸也身热不去心中结痛者虚烦也结胸为热结胸中为实是热气已收敛于内则
外身热去虚烦为热客胸中未结为实散漫为烦是以身热不去六七日为欲解之时以热为虚烦故云未欲解也与栀子豉汤以吐
除之身热不去四字要玩结胸而身不热知热不在表故可用大小陷胸汤丸以逐下之今热仍在表故宜越之也成注未透）
阳明中风脉弦浮大短气腹满胁下心痛鼻干无汗嗜卧身黄小便难有潮热时时哕者小柴胡汤（详胃实）
少阴病自利清水色纯青心下必痛口干燥者急下之宜大承气汤（成 少阴肾水也青肝色也自利色青为肝邪乘肾难经曰
从前来者为实邪以肾蕴实邪必心下痛口干燥也与大承气汤以下实邪）
厥阴为病消渴气上冲心心中疼热饥不欲食食则吐蛔下之利不止（桂枝茯苓白术汤）
附
灸 伤寒饮水过多腹胀气喘心下痛不可忍宜灸中腕气海二穴如小腹有气上冲者宜灸天枢气冲三里三阴交（如无
此证
只用前穴）
（旧以烦痛亦类入之今详烦疼者谓身体四肢疼痛烦冤与心烦不同不宜滥入故去之）
烦者热也谓烦扰也与发热若同而异也烦热为热所烦无时而歇非若发热而时发时止也经有烦有微烦有烦热复烦反烦
烦满烦痛烦渴胸中烦心中烦内烦虚烦大烦欲解皆以烦为热也然阴寒而烦者亦不少也盖在表而烦者则有脉浮恶风寒体强
痛之证在里而烦者则有潮热谵语不大便腹满小便赤涩之证在半表半里而烦者则有往来寒热胸胁疼痛之证其邪在胸膈以
上而烦者则有胸满懊 可吐之证其阴寒而烦者则有恶寒而蜷及下利厥逆脉微与夫吐蛔之证大烦欲解者其脉必和但脉不
应者为难治若是足冷脉沉细而微者此阴证之烦也急用人参附子热剂温之若内伤劳役阴虚火动而烦者其人身倦无力自汗
尺脉浮虚也宜补中益气汤加炒黄连生地黄麦门冬黄柏知母之类也若不得睡而心烦者兼服朱砂安神丸纳其浮溜之火而安
神明也此特其大概耳善治病者当以诸证互考之可也
虚烦胸中烦心中烦三者不因汗吐下而烦则是传经之邪不作膈实但多和解而已经用小柴胡汤黄连阿胶汤猪肤汤是也
若经汗吐下而烦则是邪热内陷以为虚烦心中 然欲吐愦愦然无奈者是也但多涌吐而已经用栀子豉汤栀子干姜汤栀子
浓朴汤是也盖有不因汗下吐邪结胸中则为膈实与瓜蒂散及阳明心烦与调胃承气汤此又烦之实者也伤寒二三日悸而烦者
虚也建中汤少阳之邪入腑烦而悸者热也大抵先烦而后悸是热先悸而后烦是虚治病必求其本者此也
太阳 伤寒发汗解半日许复烦脉浮数者可更发汗宜桂枝汤（发汗身凉为已解至半日许身复热者邪不尽也故当再汗）
太阳病初服桂枝汤反烦不解者先刺风池风府却与桂枝汤则愈（风池是少阳之经阳维之会不针天柱而取风池者阳维维于诸
阳巨阳与诸阳主气故也）发汗已脉浮数烦渴者五苓散中风发热六七日不解而烦有表里证渴饮欲水水入则吐曰水逆五苓散
病在阳应以汗解反以冷水 之若灌之其热不得去弥更益烦肉上粟起意欲饮水反不渴者服文蛤散若不瘥者与五苓散（方见
渴）伤寒吐下后七八日不解热结在里表里俱热时时恶风大渴舌上干燥而烦者白虎加人参汤服桂枝汤大汗出后大烦渴不解
脉洪大者白虎加人参汤主之
垣 治阴虚发热烦渴引饥热躁热至夜尤甚其脉洪大按之无力者此血虚发躁当以当归补血汤主之若以白虎汤与之
则
误矣如轻手脉来浮大按之即无者乃无根蒂之脉为散脉也此虚极而元气将脱也切不可发表攻热如误治之则死须用大剂人
参生脉汤救之（当归补血汤方见杂病发热门）
太阳病发汗若下之而烦热胸中窒者栀子豉汤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发汗吐下
后其人心烦不得眠若剧者必反复颠倒心中懊 栀子豉汤若少气者栀子甘草豉汤若呕者栀子生姜豉汤
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为二服温进一服得
吐者止后服
经曰其高者因而越之其下者引而竭之中满者泻之于内其有邪者渍形以为汗其在皮者汗而发之治伤寒之妙虽有变通
终不越此数法也伤寒邪气自表而传里留于胸中为邪在高分则可吐之所吐之证亦自不同如不经汗下邪气蕴郁于膈则谓之
实也应以瓜蒂吐之瓜蒂散吐胸中之实邪也若发汗吐下后邪气乘虚留于胸中则谓之虚烦应以栀子豉汤吐之此吐胸中虚烦
者也栀子味苦寒内经曰酸苦涌泄为阴涌者吐也涌吐虚烦必以苦为主是以栀子为君烦为热胜也涌热者必以苦胜热者必以
寒香豉苦寒助栀子以吐虚烦故以为臣内经曰气有高下病有远近证有中外治有轻重各适其所果能根据而行之所谓良矣
栀子甘草豉汤 于栀子豉汤中加甘草一两余根据前法得吐止服
栀子生姜豉汤 于栀子豉汤中加生姜二两余根据前法得吐止后服
伤寒下后心烦腹满卧起不安者栀子浓朴汤主之（成 下后但腹满而不心烦即邪气入里为里实但心烦而不腹满即邪气
在胸中为虚烦既烦且满则邪气壅于心腹之间也满则不能坐烦则不能卧故卧起不安与栀子浓朴汤吐烦泄满）
栀子浓朴汤方（酸苦涌泄栀子之苦以涌虚烦浓朴枳实之苦以泄腹满）
栀子（十四枚擘） 浓朴（四两姜炙） 枳实（四枚水浸去苏炒）以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（成 丸药不能除热但损正气邪气乘虚留于胸中而未入深者则
身热不去而微烦与栀子干姜汤吐烦正气按丸药所谓神丹甘遂也或作巴豆）
栀子干姜汤方（苦以涌之栀子之苦以吐烦辛以润之干姜之辛以益气）
栀子（十四枚擘） 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者止后服凡用栀子汤病患
旧微溏者不可与服之（病患旧微溏者里虚而寒在下也虽烦则非蕴热故不可与栀子汤越之内经曰先泄而后生他病者治其本
必且调之后乃治其他病）太阳病若吐若下若发汗微烦小便数大便因硬者与小承气汤和之则愈上发汗吐下后心中懊 而烦
若无燥屎大便软者栀子等汤证也若有燥屎不大便者小承气汤证也
痞结胸心烦（详二门）心烦而渴（详渴）
伤寒二三日心中悸而烦者小建中汤主之（成 伤寒二三日邪气在表未当传里之时心中悸而烦是非邪气搏所致心悸者
气虚也烦者血虚也以气血内虚与小建中汤先建其里）太阳病脉浮紧无汗发热身疼八九日表证仍在此当发汗服药已微除其
人发烦目瞑剧者必衄乃解病欲解者必当先烦乃有汗而解太阳病过经十余日心下 欲吐而胸中痛大便反溏微满郁郁微
烦（详胸病）伤寒脉浮自汗小便数心烦微恶寒脚挛急反与桂枝汤欲攻其表此误也得之便厥咽中干烦躁吐逆者甘草干姜汤
（详厥）太阳病吐之但太阳当恶寒今反不恶寒不欲近衣此为吐之内烦也微数之脉慎不可灸因火为邪则为烦逆追虚逐实血
散脉中火气虽微内攻有力焦骨伤筋血难复也吐利汗后脉平小烦者以胃虚不胜谷气也
阳明 病下之其外有热手足温不结胸心下懊 饥不能食但头汗出者栀子豉汤主之阳明病脉浮紧若下之则胃中空虚
客气动膈心中懊 舌上白苔者宜栀子豉汤（论见自汗）下利后烦按之心下濡者为虚烦也宜栀子豉汤阳明病脉迟食难用饱
饱则微烦头眩必小便难此欲作谷疸（详眩）阳明病下之心下懊 而烦胃中有燥屎者可攻腹微满初头硬后必溏不可攻之若
有燥屎者宜大承气汤大下后六七日不大便烦不解腹满痛者本有宿食故也大承气汤阳明病不吐不下心烦者可与调胃承气
汤（成 吐后心烦谓之内烦下后心烦谓之虚烦今阳明病不吐不下心烦则是胃有有郁热也与调胃承气汤以下郁热）阳明病
本自汗更重发汗病已瘥尚微烦不了了者以亡津液胃中干燥故令大便硬问其小便日几行小便少津液当还胃中故知不久必
大便也病患烦热汗出则解又如疟状日晡发热属阳明也
上胃实不大便心烦若吐下后者大小承气证也若不曾吐下者调胃承气汤证也
许 有人病伤寒八九日身热无汗时时谵语时因下后大便不通三日矣非燥非烦非寒非痛终夜不得卧但心中没晓会
处
或时发一声如叹息之状医者不知是何证予诊之曰此懊 怫郁二证俱作也胃中有燥屎者服承气汤下燥屎二十余得利而解
仲景云阳明病下之心中懊 微烦胃中有燥屎者可攻又云小便不利大便乍难乍易时有微热怫郁不卧者有燥屎也承气汤主
之素问云胃不和则卧不安此夜所以不得眠也仲景云胃中燥大便硬者必谵语此所以有时发谵语也非烦非燥非寒非痛所以
心中懊 也声如叹息而发一声所谓外气怫郁也燥屎得除大便通利胃中安和故其病悉去也
少阳 伤寒脉弦细头痛发热者属少阳不可汗汗之则谵语此属胃胃和则愈胃不和则烦而悸（活人用调胃承气汤）胸满
而烦若不轻汗下无往来寒热者小柴胡汤（详往来寒热）若汗下后往来寒热者柴胡桂梗干姜汤（详往来寒热）兼惊小便不
利谵语身重不可转侧者柴胡桂枝龙骨牡蛎汤（详惊）呕时郁郁微烦若与小柴胡汤呕不止者大柴胡汤证也若极吐下后胸满
便溏腹痛者调胃承气汤证也
太阴 伤寒脉浮而缓手足自温者系在太阴当发身黄小便利者身不发黄至七八日虽暴烦下利十余行必自止以脾家实
腐秽当去故也（成 太阴病至七八日大便硬者为太阴入腑传阳明也今至七八日暴烦下利十余行者脾家实腐秽去也下利烦
躁者死此以脾气和逐邪下泄故虽暴烦下利日十余行而利必自止宜栀子柏皮汤或用平胃散加穿山甲以主之）
少阴 病但欲寐而烦若自利而渴小便白者活人用四逆汤（论见欲寐）若与白通汤后下利不止厥逆无脉干呕烦者白通
汤加猪胆汁（或云明知阴证附子温之干呕而烦格拒不通加人尿猪胆汁妙在于此热因寒用）少阴病得之二三日心中烦不得
卧黄连阿胶汤若下利六七日咳而呕心烦不得卧者猪苓汤下利咽痛胸满心烦者猪肤汤若恶寒而蜷时自烦欲去衣被者可治
脉紧至七八日自下利脉暴微手足反温脉紧反去为欲解虽烦下利必自止
厥阴手足厥冷而烦若脉乍结乍紧及心中满饥不欲食者宜瓜蒂散吐之蛔厥静而复时烦（详吐蛔）病六七日手足三部脉
皆至大烦而噤不能言其人躁扰者欲解也若脉和其人大烦目内际黄者欲解也
【背景信息】
书名：证治准绳·伤寒 作者：王肯堂 朝代：明 章节：心痛心下痛 / 烦 类别：伤寒
【原文翻译】
伤寒病经过五六天，经过猛烈攻下之后，身体发热仍然没有消退，心中感觉郁结疼痛的，这是病邪尚未解除的表现，应当用栀子豉汤（Cissus Decoction）主治。（成无己注：伤寒病经过五六天，是邪气在里的时期。如果经过猛烈攻下后，身体发热消退，心胸空阔舒爽，这是病欲解除的表现；如果经过猛烈攻下后，身体发热消退但心中郁结疼痛，这是结胸病（Jie Xiong, Chest Binding）；如果身体发热不退且心中郁结疼痛，这是虚烦（Xu Fan, Deficiency Heat Agitation）。结胸病是热邪结聚于胸中，属于实证，说明热气已经收敛在内，所以体表发热会消退；虚烦是热邪客居胸中，未结成实邪，散漫而为烦，所以身体发热不退。第六七天本是病欲解除的时候，但因为热邪表现为虚烦，所以说“未欲解”。给予栀子豉汤以涌吐除之。其中“身热不去”这四个字值得仔细玩味。结胸病而身体不热的，知道热邪不在表，所以可以用大陷胸汤（Da Xianxiong Tang, Great Inward-Draining Decoction）或小陷胸汤（Xiao Xianxiong Tang, Small Inward-Draining Decoction）来逐水泻下。如今热邪仍在表，所以适宜用涌吐法发散它。成无己的注解不够透彻。）
阳明病（Yangming Disease, Yangming Channel Disease）兼有中风症状，脉象弦、浮、大，短气，腹部胀满，胁下心部疼痛，鼻干，无汗，嗜睡，身体发黄，小便困难，有潮热（Chao Re, Tidal Fever），时时呃逆的，用小柴胡汤（Xiao Chaihu Tang, Minor Bupleurum Decoction）主治。（详见胃实证章节）
少阴病（Shaoyin Disease, Shaoyin Channel Disease）自利清水，颜色纯青，心下必然疼痛，口干燥的，应当急用攻下法，宜用大承气汤（Da Chengqi Tang, Major Order the Qi Decoction）。（成无己注：少阴属肾水，青色属肝色。自利颜色发青，是肝邪乘袭肾脏。《难经》说：“从前来者为实邪。”因为肾蕴藏了实邪，必然导致心下痛和口干燥。给予大承气汤以攻下实邪。）
厥阴病（Jueyin Disease, Jueyin Channel Disease）的症状包括：消渴（Xiao Ke, Wasting-Thirst），气上冲心，心中疼热，饥饿但不想进食，进食则会吐出蛔虫，如果使用攻下法，会导致腹泻不止。（此处方剂误作桂枝茯苓白术汤，据理应为其他方或仅列症状）
附：灸法。伤寒病饮水过多，导致腹胀气喘，心下疼痛不可忍受的，适宜灸中脘穴（Zhongwan, CV12）和气海穴（Qihai, CV6）两个穴位。如果小腹部有气上冲的，适宜灸天枢穴（Tianshu, ST25）、气冲穴（Qichong, ST30）、足三里穴（Zusanli, ST36）、三阴交穴（Sanyinjiao, SP6）。（如果没有上述气上冲的症状，只使用前两个穴位即可）
（旧版将烦痛也归类于此，现在详细辨析，“烦疼”是指身体四肢疼痛且烦闷冤屈，与心烦不同，不宜滥入，故去除。）
烦（Fan, Agitation/Restlessness）这种症状，本质是热。所谓烦，就是烦扰不安。它与发热相似但有区别。烦热是被热邪所烦扰，没有间歇时间；不像发热那样有时发作有时停止。经典中有烦、微烦、烦热、复烦、反烦、烦满、烦痛、烦渴、胸中烦、心中烦、内烦、虚烦、大烦欲解等描述，都是以“烦”作为热的表现。然而，因阴寒而致烦的情况也不少。如果在表而烦，则有脉浮、恶风寒、身体强痛的证候；如果在里而烦，则有潮热、谵语、不大便、腹部胀满、小便赤涩的证候；如果在半表半里而烦，则有往来寒热、胸胁疼痛的证候；如果邪气在胸膈以上而烦，则有胸满、懊憹（Ao Nao, Oppressive Discomfort）可用吐法的证候；如果是阴寒而烦，则有恶寒蜷卧及下利厥逆、脉微以及吐蛔的证候。大烦欲解时，其脉必调和，但如果脉象不应者则难治。如果是脚冷、脉沉细而微的，这是阴证的烦，急需用人参附子等热性药剂温补。如果是内伤劳役、阴虚火动而致的烦，其人身体疲倦无力、自汗、尺脉浮虚，宜用补中益气汤（Buzhong Yiqi Tang, Tonify the Middle and Augment the Qi Decoction）加炒黄连、生地黄、麦门冬、黄柏、知母之类。如果睡不着且心烦的，兼服朱砂安神丸（Zhusha Anshen Wan, Cinnabar Calm-the-Spirit Pill）以收纳浮游之火而安神明。这只是一般情况。善于治病的人，应当综合各种证候互相参考，就可以了。
虚烦、胸中烦、心中烦这三种，如果不是因为发汗、催吐、攻下而出现的烦，则是传经之邪，不属于膈实，大多采用和解法，例如已经使用过小柴胡汤、黄连阿胶汤（Huanglian Ejiao Tang, Coptis and Donkey-Hide Gelatin Decoction）、猪肤汤（Zhufu Tang, Pig Skin Decoction）等。如果是经过发汗、催吐、攻下之后出现的烦，则是邪热内陷成为虚烦，心中懊憹，想要呕吐却无可奈何，大多采用涌吐法，例如已经使用过栀子豉汤、栀子干姜汤（Zhizi Ganjiang Tang, Gardenia and Dried Ginger Decoction）、栀子厚朴汤（Zhizi Houpo Tang, Gardenia and Magnolia Bark Decoction）等。大概有不因汗、吐、下，邪气结聚于胸中成为膈实的，应用瓜蒂散（Gua Di San, Melon Seed Powder）；以及阳明病心烦，应用调胃承气汤（Tiaowei Chengqi Tang, Regulate the Stomach and Order the Qi Decoction），这又是烦的实证。伤寒病两三天，心悸而烦的，属于虚证，用小建中汤（Xiao Jianzhong Tang, Minor Construct the Middle Decoction）；少阳病（Shaoyang Disease, Shaoyang Channel Disease）的邪气传入腑，烦而心悸的，属于热证。大抵先烦而后悸的是热，先悸而后烦的是虚。治病必须探究根本，说的就是这个道理。
太阳病（Taiyang Disease, Taiyang Channel Disease）伤寒，发汗后解除了，过了半天左右又出现烦，脉浮数的，可以再次发汗，宜用桂枝汤（Guizhi Tang, Cinnamon Twig Decoction）。（发汗后身体凉爽为已解除，到了半天左右身体又发热，说明邪气未尽，所以应当再次发汗。）
太阳病初服桂枝汤后反而烦闷不解的，先针刺风池穴（Fengchi, GB20）和风府穴（Fengfu, GV16），然后再给予桂枝汤，就会痊愈。（风池穴是少阳经与阳维脉的交会穴。不针天柱穴而取风池穴，是因为阳维脉维系诸阳，巨阳与诸阳主气，所以如此。）发汗后，脉浮数，烦渴的，用五苓散（Wuling San, Five-Ingredient Powder with Poria）；中风发热，六七天未解且出现烦，有表证和里证，口渴想喝水，水入则吐，称为水逆（Shui Ni, Water Reversal），用五苓散；病在阳分，本应以汗解，反而用冷水喷洒或浇洗，导致热不得去，更加烦闷，皮肤起粟粒状疙瘩，想喝水但实际上不渴的，服用文蛤散（Wenge San, Clam Shell Powder）；如果不愈，再给五苓散。（方剂见渴证章节）伤寒吐下后七八天，病邪未解，热结在里，表里俱热，时时恶风，大渴，舌上干燥而烦的，用白虎加人参汤（Baitu Jia Renshen Tang, White Tiger Decoction plus Ginseng）；服用桂枝汤大汗出后，大烦渴不解，脉洪大的，用白虎加人参汤主治。
垣（某医家）治疗阴虚发热，烦渴引饮，饥热躁热，夜间尤其严重，脉象洪大但按之无力的，这是血虚发躁，应当用当归补血汤（Danggui Buxue Tang, Angelica Sinensis Decoction to Tonify Blood）主治。如果用白虎汤治疗就错了。如果轻手脉来浮大，按之即无，这是无根蒂的散脉，这是虚极而元气将脱，切不可发表攻热，如果误治则会死亡，必须用大剂量人参生脉汤（Renshen Shengmai Tang, Ginseng Generate the Pulse Decoction）救治。（当归补血汤方见杂病发热门）
太阳病发汗或攻下后，出现烦热、胸中窒塞感的，用栀子豉汤；伤寒五六天，猛烈攻下后，身体发热不退，心中郁结疼痛的，病未解，用栀子豉汤；发汗、催吐、攻下后，其人心中烦闷不得睡眠，如果严重的一定会反复颠倒，心中懊憹，用栀子豉汤；如果少气的，用栀子甘草豉汤（Zhizi Gancao Dish Tang, Gardenia, Licorice and Fermented Soybean Decoction）；如果呕吐的，用栀子生姜豉汤（Zhizi Shengjiang Dish Tang, Gardenia, Ginger and Fermented Soybean Decoction）。
栀子豉汤方：栀子（十四枚，掰开），香豉（四合，绵布包裹）。以上两味，用水四升，先煮栀子，取二升半，纳入香豉，煮取一升半，去渣，分为两次服用，温服一次。如果服药后引起呕吐的，停止后服。
经典说：病位高的，因而用涌吐法发散它；病位低的，用引导排泄法竭尽它；中焦痞满的，从内部泻下它；有邪气的，浸泡形体以发汗；邪在皮表的，用发汗法发散。治疗伤寒的奥妙，虽然有变通，最终不离这几法。伤寒邪气由表传里，留于胸中，为邪在高处，可以吐。所吐的证候也不同。如不经汗下，邪气蕴郁于膈，称为实，应用瓜蒂散吐胸中之实邪。如果发汗、吐、下后，邪气乘虚留于胸中，称为虚烦，应用栀子豉汤吐之，这是吐胸中虚烦的方法。栀子味苦寒，《内经》说：“酸苦涌泄为阴”，涌就是吐。涌吐虚烦必须以苦为主，所以以栀子为君药。烦是由于热胜，涌热者必须以苦胜热，热者必须以寒制。香豉苦寒，助栀子以吐虚烦，所以为臣药。《内经》说：气有高下，病有远近，证有中外，治有轻重，各适其所，如果能据此而行，就是良医了。
栀子甘草豉汤：在栀子豉汤中加入甘草一两，其余按照前法，得吐则停服。
栀子生姜豉汤：在栀子豉汤中加入生姜二两，其余按照前法，得吐则停服。
伤寒攻下后，心烦、腹部胀满、卧起不安的，用栀子厚朴汤主治。（成无己注：攻下后只有腹满而不心烦，就是邪气入里成为里实；只有心烦而不腹满，就是邪气在胸中成为虚烦。既烦且满，就是邪气壅滞于心腹之间。满则不能坐，烦则不能卧，所以卧起不安。给予栀子厚朴汤以吐烦泄满。）
栀子厚朴汤方（酸苦涌泄：栀子之苦以涌吐虚烦，厚朴、枳实之苦以泻除腹满）：栀子（十四枚，掰开），厚朴（四两，姜炙），枳实（四枚，水浸去瓤炒）。以上三味，用水三升半，煮取一升半，去渣，分两次服用，温服一次。如果服药后引起呕吐的，停止后服。
伤寒医生用丸药猛烈攻下，身体发热不退，轻微心烦的，用栀子干姜汤主治。（成无己注：丸药不能除热，只损伤正气。邪气乘虚留于胸中而未深入，则身体发热不退而轻微心烦。给予栀子干姜汤以吐烦。正气得以安守。丸药所谓神丹甘遂，有的说是巴豆。）
栀子干姜汤方（苦以涌之：栀子之苦以吐烦；辛以润之：干姜之辛以益气）：栀子（十四枚，掰开），干姜（二两）。以上两味，用水三升半，煮取一升半，去渣，分两次服用，温服一次。如果服药后引起呕吐的，停止后服。凡是用栀子汤，如果病患平时大便稀溏的，不可给予服用。（病患平时大便稀溏，说明里虚寒在下，虽然烦也不是蕴热，所以不可与栀子汤发散。《内经》说：先泄泻而后生其他病的，治疗其本，必须先调理脾胃，然后才治疗其他病。）太阳病，如果吐、如果下、如果发汗，轻微心烦，小便频数，大便因此硬结的，给与小承气汤（Xiao Chengqi Tang, Minor Order the Qi Decoction）调和即可痊愈。上发汗、吐、下后，心中懊憹而烦，如果没有燥屎、大便软的，是栀子类汤证的范畴；如果有燥屎、不大便的，是小承气汤证的范畴。
伤寒二三天，心中悸而烦的，用小建中汤主治。（成无己注：伤寒二三天，邪气在表，未到传里的时期。心中悸而烦，不是邪气搏结所致。心悸者是气虚，烦者是血虚。因为气血内虚，给予小建中汤先建立其里气。）太阳病，脉浮紧，无汗，发热，身体疼痛，八九天后表证仍在，此时应当发汗。服药后症状稍减，其人发烦，眼睛闭合，严重的必定衄血（Ni Xue, Nasal Hemorrhage）才能解除。病欲解除者，必定先出现烦，然后才有汗而解。太阳病超过经界十余日，心下痞硬，想吐而胸中痛，大便反而溏薄，微满，郁郁微烦（详见胸病）。伤寒脉浮，自汗，小便数，心烦，轻微恶寒，脚挛急，反而给予桂枝汤想攻其表，这是错误。得此误治便出现四肢厥冷，咽中干燥，烦躁，呕吐逆气，用甘草干姜汤（Gancao Ganjiang Tang, Licorice and Dried Ginger Decoction）主治（详见厥证）。太阳病用吐法，本来太阳病应当恶寒，现在反而不恶寒，不想穿衣，这是因为吐之后产生的内烦。脉象微数的，千万不要用灸法，因为火邪会成为致病因素，导致烦逆，追虚逐实，血液散乱于脉中，火气虽然微弱，内攻有力，会焦骨伤筋，血液难以恢复。吐利汗后，脉象平和，轻微烦的，是因为胃虚不能耐受谷气。
阳明病攻下后，体外有热，手足温暖，不结胸，心中懊憹，饥饿但不能进食，只有头部出汗的，用栀子豉汤主治。阳明病脉浮紧，如果攻下，则胃中空虚，客气动膈，心中懊憹，舌上有白苔的，宜用栀子豉汤。（论见自汗章节）下利后心烦，按压心下柔软的，是虚烦，宜用栀子豉汤。阳明病脉迟，饮食难以吃饱，饱则轻微心烦，头眩，必定小便难，这是将要发生谷疸（Gu Dan, Grain Jaundice）（详见眩证）。阳明病攻下，心中懊憹而烦，胃中有燥屎的，可以攻下；腹部微满，初头硬后必溏的，不可攻下。如果有燥屎的，宜用大承气汤。大下后六七天不大便，烦不解，腹部胀满疼痛的，是因为原本就有宿食，所以用大承气汤。阳明病不吐不下而心烦的，可与调胃承气汤。（成无己注：吐后心烦称为内烦，下后心烦称为虚烦。如今阳明病不吐不下而心烦，则是胃有郁热，给予调胃承气汤以泻下郁热。）阳明病本来自汗，更重发汗，病已瘥尚微烦，不了了之的，是因为亡失津液，胃中干燥所以令大便硬。问其小便一天几次，如果小便少，津液当还胃中，所以知道不久必大便通。病患烦热，汗出则解，又如疟状，日晡（Ribb Wu, Afternoon）发热，属于阳明。
上面提到的胃实不大便心烦，如果经过吐下的，是大、小承气汤证；如果没有经过吐下的，是调胃承气汤证。
许（某医家）有人患伤寒八九天，身体发热无汗，时时谵语，因为攻下后大便不通三天了，非燥、非烦、非寒、非痛，整夜不能卧，只是心中没来由地难受，有时发出一声像叹息的声音。医者不知道是什么证。我诊察后说：这是懊憹和怫郁（Fu Yu, Depression/Stagnation）两种证候同时发作。胃中有燥屎的，服用承气汤下燥屎二十余行，得利而解。仲景说：阳明病攻下，心中懊憹，微烦，胃中有燥屎的，可以攻下。又说：小便不利，大便乍难乍易，时有微热，怫郁不卧的，有燥屎，用承气汤主治。《素问》说：胃不和则卧不安，这就是夜里不能睡觉的原因。仲景说：胃中燥，大便硬的，必定谵语，这就是有时发谵语的原因。非烦非燥非寒非痛，所以心中懊憹。声如叹息而发一声，所谓外气怫郁。燥屎得除，大便通利，胃中安和，所以病悉去。
少阳病伤寒，脉弦细，头痛发热的，属于少阳，不可发汗，发汗则谵语，这属于胃，胃和则愈，胃不和则烦而悸（《活人书》用调胃承气汤）。胸满而烦，如果不轻微发汗攻下，没有往来寒热的，用小柴胡汤（详见往来寒热）。如果汗下后往来寒热的，用柴胡桂枝干姜汤（Chaihu Guizhi Ganjiang Tang, Bupleurum, Cinnamon Twig and Dried Ginger Decoction）（详见往来寒热）。兼惊悸，小便不利，谵语，身体沉重不可转侧的，用柴胡桂枝龙骨牡蛎汤（Chaihu Guizhi Longgu Muli Tang, Bupleurum, Cinnamon Twig, Dragon Bone and Oyster Shell Decoction）（详见惊证）。呕吐，时时郁郁微烦，如果给小柴胡汤，呕吐不止的，是大柴胡汤（Da Chaihu Tang, Major Bupleurum Decoction）证。如果极吐下后，胸满，便溏，腹痛的，是调胃承气汤证。
太阴病伤寒，脉浮而缓，手足自温的，系在太阴，应当发身黄，小便利的，身不发黄。到七八天，虽然暴烦，下利十余行，必定自止，因为脾家实，腐秽当去。（成无己注：太阴病到七八天，大便硬的，是太阴入腑传阳明。如今到七八天，暴烦下利十余行的，是脾家实，腐秽去也。下利烦躁的是死证。此以脾气和，逐邪下泄，所以虽然暴烦下利日十余行而利必自止。宜用栀子柏皮汤（Zhizi Bopi Tang, Gardenia and Phellodendron Bark Decoction）或用平胃散（Pingwei San, Peaceful Stomach Powder）加穿山甲以主治。）
少阴病但欲寐而烦，如果自利而渴，小便白的，活人用四逆汤（Sini Tang, Counterflow Decoction）（论见欲寐）。如果与白通汤（Baitong Tang, Bai Tong Decoction）后，下利不止，厥逆无脉，干呕烦的，用白通汤加猪胆汁（Baotong Tang plus Pig Bile）。（有人说：明知是阴证用附子温之，干呕而烦，格拒不通，加入人尿猪胆汁，妙在于此，热因寒用。）少阴病得之二三天，心中烦不得卧，用黄连阿胶汤。如果下利六七天，咳而呕，心烦不得卧的，用猪苓汤（Zhuling Tang, Polyporus Decoction）。下利，咽痛，胸满，心烦的，用猪肤汤。如果恶寒而蜷缩，时常自烦，想除去衣被的，可治。脉紧，到七八天自下利，脉突然变微，手足反而温暖，脉紧反而消失的，是欲解，虽然烦下利，必定自止。
厥阴病手足厥冷而烦，如果脉乍结乍紧及心中满，饥饿不欲食的，宜用瓜蒂散吐之。蛔厥（Hui Jue, Roundworm Cold Reversal）静而复时烦（详见吐蛔）。病六七天，手足三部脉皆至，大烦而噤不能言，其人躁扰的，欲解。如果脉和其人大烦，目内眦黄的，欲解。
[Background Information]
Book: Zhengzhi Zhunsheng · Shanghan (Standardized Treatment of Cold Damage)
Author: Wang Kentang
Dynasty: Ming
Chapter: Heart Pain, Epigastric Pain / Agitation (Fan)
Category: Shanghan (Cold Damage)
[English Translation]
After five or six days of a Shanghan (Cold Damage) disease, following severe purgation, if body heat persists and there is a sensation of painful constriction in the chest/epigastrium, the pathogen has not yet resolved. Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) should be administered as the primary treatment. (Cheng Wuji's commentary: When Shanghan reaches the fifth or sixth day, the pathogen is in the interior. If after severe purgation the body heat subsides and the chest/epigastrium feels empty and comfortable, the disease is about to resolve. However, if after severe purgation the body heat subsides but pain and constriction remain in the chest/epigastrium, this is Jie Xiong (Chest Binding). If body heat persists with painful constriction in the chest/epigastrium, this is Xu Fan (Deficiency Heat Agitation). Jie Xiong involves heat binding in the chest, constituting an excess syndrome; thus, external heat subsides as heat converges internally. Xu Fan involves heat lodging in the chest without forming excess, scattering to cause agitation; thus, body heat persists. The fifth to seventh day is typically when resolution occurs, but because the heat manifests as Xu Fan, it is stated as "not yet resolving." Zhi Zi Chi Tang is given to induce vomiting and expel the pathogen. The phrase "body heat persists" requires careful consideration. In Jie Xiong where body heat is absent, knowing the heat is not in the exterior, Da Xianxiong Tang (Great Inward-Draining Decoction) or Xiao Xianxiong Tang (Small Inward-Draining Decoction) can be used to purge downward. Since heat remains in the exterior here, inducing vomiting to disperse it is appropriate. Cheng Wuji's annotation is not thorough enough.)
In Yangming Disease (Yangming Channel Disease) complicated by Wind Strike, with a wiry, floating, and large pulse, shortness of breath, abdominal fullness, pain under the ribs and in the heart region, dry nose, absence of sweating, lethargy, jaundice, difficult urination, tidal fever (Chao Re), and occasional hiccups, Xiao Chaihu Tang (Minor Bupleurum Decoction) should be used. (See chapter on Stomach Excess Syndrome.)
In Shaoyin Disease (Shaoyin Channel Disease), spontaneous diarrhea of clear water with pure green color, accompanied by inevitable pain in the epigastrium and dry mouth/throat, requires urgent purgation. Da Chengqi Tang (Major Order the Qi Decoction) is indicated. (Cheng Wuji's commentary: Shaoyin corresponds to Kidney Water, and green corresponds to Liver Color. Green diarrhea indicates Liver pathogen attacking Kidney. The *Nanjing* states: "Coming from the preceding organ constitutes an Excess Pathogen." Because the Kidney harbors excess pathogen, epigastric pain and dry mouth/throat occur. Da Chengqi Tang is given to purge the excess pathogen.)
Jueyin Disease (Jueyin Channel Disease) presents with Xiao Ke (Wasting-Thirst), qi rushing up to the heart, painful heat in the heart, hunger without desire to eat, and vomiting roundworms upon eating. If purged, diarrhea will persist uncontrollably. (Note: The text lists Guizhi Fuling Baizhu Tang here, which may be an error or specific context).
Appendix: Moxibustion. For Shanghan caused by excessive water intake leading to abdominal distension, wheezing, and unbearable epigastric pain, moxibustion should be applied to Zhongwan (CV12) and Qihai (CV6). If qi rushes upward from the lower abdomen, apply moxibustion to Tianshu (ST25), Qichong (ST30), Zusanli (ST36), and Sanyinjiao (SP6). (If these symptoms are absent, only use the first two acupoints.)
(Old texts included "painful agitation" here. Upon detailed analysis, "painful agitation" refers to body and limb pain with mental distress, distinct from mental agitation, so it has been removed.)
Agitation (Fan) is essentially heat. "Fan" denotes restlessness and disturbance. It resembles fever but differs: Fan-heat is agitation caused by heat without cessation, unlike fever which comes and goes. Classics mention various forms such as Fan, Wei Fan (Mild Agitation), Fan Re (Agitating Heat), Fu Fan (Recurring Agitation), Fan Man (Agitating Fullness), Fan Tong (Agitating Pain), Fan Ke (Agitating Thirst), Xiong Zhong Fan (Chest Agitation), Xin Zhong Fan (Heart Agitation), Nei Fan (Internal Agitation), Xu Fan (Deficiency Agitation), and Da Fan Yu Jie (Severe Agitation before Resolution), all attributing Fan to heat. However, agitation due to Yin-Cold is also common.
If agitation is in the Exterior, symptoms include floating pulse, aversion to wind/cold, and stiff body pain.
If in the Interior, symptoms include tidal fever, delirium, constipation, abdominal fullness, and dark/scanty urine.
If at Half-Exterior/Half-Interior, symptoms include alternating chills and fever, and hypochondriac pain.
If pathogen is above the chest/diaphragm, symptoms include chest fullness and Ao Nao (Oppressive Discomfort), treatable by vomiting.
If due to Yin-Cold, symptoms include aversion to cold, curling up, diarrhea, cold reversal, faint pulse, or vomiting roundworms.
When Severe Agitation precedes resolution, the pulse must be harmonious; if the pulse does not match, it is difficult to treat. If feet are cold with a deep, fine, and faint pulse, this is Yin-pattern agitation, requiring urgent warming with Ren Shen Fu Zi (Ginseng and Aconite) hot decoctions.
If due to internal injury from overwork, Yin deficiency with fire hyperactivity, presenting with fatigue, spontaneous sweating, and floating/deficient radial pulse, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with fried Huang Lian (Coptis), Sheng Di Huang (Rehmannia), Mai Men Dong (Ophiopogon), Huang Bo (Phellodendron), and Zhi Mu (Anemarrhena) is suitable.
For insomnia with mental agitation, Zhu Sha An Shen Wan (Cinnabar Calm-the-Spirit Pill) can be taken adjunctively to anchor floating fire and calm the spirit. This is a general overview. Practitioners should cross-reference various syndromes.
Xu Fan (Deficiency Agitation), Xiong Zhong Fan (Chest Agitation), and Xin Zhong Fan (Heart Agitation) that arise without prior sweating, vomiting, or purging indicate transmitted pathogenic factors, not diaphragmatic excess. They are treated with harmonizing methods, e.g., Xiao Chaihu Tang, Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction), or Zhu Fu Tang (Pig Skin Decoction).
If agitation arises after sweating, vomiting, or purging, it indicates pathogenic heat sinking inward to become Xu Fan, characterized by Ao Nao and helpless urge to vomit. These are treated by inducing vomiting, e.g., Zhi Zi Chi Tang, Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction), or Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction).
Generally, if pathogen binds in the chest without prior sweating/vomiting/purging, it becomes Diaphragmatic Excess, treated with Gua Di San (Melon Seed Powder). Yangming mental agitation is treated with Tiao Wei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction); these are Excess patterns of agitation.
In Shanghan, palpitations with agitation after 2-3 days indicate Deficiency, treated with Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). Shaoyang pathogen entering the Fu organs causing agitation with palpitations indicates Heat. Generally, agitation followed by palpitations is Heat; palpitations followed by agitation is Deficiency. Treating disease requires addressing the root.
In Taiyang Disease (Taiyang Channel Disease) Shanghan, if after sweating resolves, agitation returns after half a day with a floating, rapid pulse, another sweating method is appropriate using Guizhi Tang (Cinnamon Twig Decoction). (Sweating leads to coolness/resolution; return of heat after half a day indicates incomplete pathogen expulsion, necessitating further sweating.)
In Taiyang Disease, if initial administration of Guizhi Tang causes increased agitation without resolution, needle Fengchi (GB20) and Fengfu (GV16) first, then administer Guizhi Tang for cure. (Fengchi is the intersection of Shaoyang and Yang Linking Vessel. Needling Fengchi instead of Tianzhu is because Yang Linking Vessel links all Yang vessels, and Greater Yang governs Yang qi.)
After sweating, if pulse is floating/rapid with agitation and thirst, use Wu Ling San (Five-Ingredient Powder with Poria).
For Wind Strike fever unresolved after 6-7 days with agitation, exterior/interior signs, thirst for water, and vomiting upon drinking (Water Reversal), use Wu Ling San.
If Yang-pattern disease is incorrectly treated with cold water washing instead of sweating, heat cannot escape, worsening agitation, causing gooseflesh, desire to drink but no actual thirst. Use Wen Ge San (Clam Shell Powder); if ineffective, use Wu Ling San. (Formula see Thirst chapter).
After vomiting/purging in Shanghan, if 7-8 days pass with unresolved heat binding in interior, exterior/interior heat, occasional aversion to wind, severe thirst, dry tongue, and agitation, use Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng).
After heavy sweating from Guizhi Tang, if severe agitation/thirst persists with a flooding pulse, Bai Hu Jia Ren Shen Tang is indicated.
Yuan treated Yin-deficiency fever with agitation, thirst, hunger-heat, and night exacerbation. Pulse is flooding but empty on pressure, indicating Blood deficiency causing restlessness. Treat with Dang Gui Bu Xue Tang (Angelica Sinensis Decoction to Tonify Blood). Using Bai Hu Tang would be an error. If pulse is floating/large lightly but empty deeply (Scattered Pulse), it indicates extreme deficiency and impending Yuan Qi collapse. Do not use exterior-releasing or heat-clearing methods; use large doses of Ren Shen Sheng Mai Tang (Ginseng Generate the Pulse Decoction) to save life. (Dang Gui Bu Xue Tang formula see Miscellaneous Diseases Fever chapter).
In Taiyang Disease, after sweating or purging, if heat-agitation and chest oppression occur, use Zhi Zi Chi Tang.
After severe purging in Shanghan (5-6 days), if body heat persists with painful chest constriction, disease is unresolved; use Zhi Zi Chi Tang.
After sweating/vomiting/purging, if patient has mental agitation and insomnia, or severe restlessness with Ao Nao, use Zhi Zi Chi Tang.
If short of qi, use Zhi Zi Gan Cao Chi Tang (Gardenia, Licorice and Fermented Soybean Decoction).
If vomiting, use Zhi Zi Sheng Jiang Chi Tang (Gardenia, Ginger and Fermented Soybean Decoction).
Zhi Zi Chi Tang Formula: Zhi Zi (14 pods, broken), Xiang Chi (4 he, wrapped in silk). Boil Zhi Zi in 4 sheng water to 2.5 sheng, add Chi, boil to 1.5 sheng, strain. Divide into two warm doses. Stop subsequent dose if vomiting occurs.
The Classics state: High pathogen, induce vomiting; Low pathogen, drain thoroughly; Middle fullness, purge internally; Pathogen in form, soak to sweat; Pathogen in skin, release via sweating. Shanghan treatment varies but adheres to these principles. Pathogen moving from exterior to interior, lodging in chest (high area), can be vomited.
If pathogen condenses in diaphragm without prior sweating/vomiting/purging, it is Excess; use Gua Di San to purge chest excess.
If pathogen lodges in chest due to deficiency after sweating/vomiting/purging, it is Xu Fan; use Zhi Zi Chi Tang to purge chest Xu Fan.
Zhi Zi is bitter and cold. *Neijing* states: "Sour and bitter induce vomiting and drainage (Yin)." Vomiting Xu Fan requires bitter taste; thus Zhi Zi is Sovereign. Fan is due to heat excess; bitter clears heat, cold cools. Xiang Chi is bitter/cold, assisting Zhi Zi, thus Minister. *Neijing*: Qi has high/low, disease has far/near, syndrome has exterior/interior, treatment has light/heavy. Apply appropriately.
Zhi Zi Gan Cao Chi Tang: Add 1 liang Gan Cao to Zhi Zi Chi Tang. Follow previous method. Stop if vomiting.
Zhi Zi Sheng Jiang Chi Tang: Add 2 liang Sheng Jiang to Zhi Zi Chi Tang. Follow previous method. Stop if vomiting.
After purging in Shanghan, if agitation, abdominal fullness, and restlessness (lying down/sitting up) occur, use Zhi Zi Hou Po Tang. (Cheng Wuji: Post-purgation abdominal fullness without agitation is Interior Excess. Agitation without fullness is Chest Xu Fan. Both indicate pathogen stagnating between heart and abdomen. Fullness prevents sitting, agitation prevents lying. Zhi Zi Hou Po Tang purges agitation and relieves fullness.)
Zhi Zi Hou Po Tang Formula: Zhi Zi (14 pods, broken), Hou Po (4 liang, ginger-fried), Zhi Shi (4 pieces, soaked, de-rinded, fried). Boil in 3.5 sheng water to 1.5 sheng, strain. Divide into two warm doses. Stop if vomiting.
If doctor uses pill-based strong purgatives in Shanghan, resulting in persistent mild heat and slight agitation, use Zhi Zi Gan Jiang Tang. (Cheng Wuji: Pills do not clear heat but damage righteous qi. Pathogen lodges in chest without deep invasion, causing mild heat and slight agitation. Zhi Zi Gan Jiang Tang purges agitation. Pills referred to as Shen Dan Gan Sui or sometimes Ba Dou/Ephedrae Herba contextually misattributed here as purgative pills).
Zhi Zi Gan Jiang Tang Formula: Zhi Zi (14 pods, broken), Gan Jiang (2 liang). Boil in 3.5 sheng water to 1.5 sheng, strain. Divide into two warm doses. Stop if vomiting.
Contraindication: Do not use Zhi Zi Tang in patients with chronic loose stools (Interior Deficiency-Cold). Even if agitated, it is not heat accumulation. *Neijing*: If diarrhea precedes other diseases, treat the root (diarrhea) first.
In Taiyang Disease, if vomiting/purging/sweating leads to mild agitation, frequent urination, and consequent hard stool, give Xiao Chengqi Tang (Minor Order the Qi Decoction) to harmonize.
Post-sweating/vomiting/purging, if Ao Nao and agitation occur:
- No dry stool, soft stool: Zhi Zi category formulas.
- Dry stool, constipation: Xiao Chengqi Tang.
Pi (Stagnation), Jie Xiong, Xin Fan (See Chapter 2); Xin Fan with Thirst (See Thirst chapter).
In Shanghan, if 2-3 days bring palpitations and agitation, use Xiao Jian Zhong Tang. (Cheng Wuji: Pathogen is still in exterior. Palpitations indicate Qi deficiency; agitation indicates Blood deficiency. Internal deficiency of Qi/Blood requires Xiao Jian Zhong Tang to build the Interior first.)
In Taiyang Disease, if pulse is floating/tight, no sweat, fever, body pain for 8-9 days, exterior signs persist, sweating is indicated. After medication, if symptoms slightly improve but agitation and eye closure occur, severe cases will resolve via nasal hemorrhage (Ni Xue). Resolution requires agitation followed by sweating.
If Taiyang disease exceeds meridian cycle (>10 days), with epigastric hardness, urge to vomit, chest pain, loose stool, slight fullness, and slight depression/agitation (See Chest Disease).
Shanghan with floating pulse, spontaneous sweat, frequent urination, agitation, slight aversion to cold, and leg cramps. Incorrectly giving Guizhi Tang to attack exterior causes error: leading to cold limbs, dry throat, irritability, vomiting. Treat with Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) (See Cold Reversal).
If Taiyang disease is treated with vomiting, aversion to cold should cease but clothing rejection occurs due to internal agitation from vomiting. With slight rapid pulse, avoid moxibustion; fire pathogen causes agitation/reversal, chasing deficiency, pursuing excess, scattering blood, damaging bones/tendons.
After vomiting/diarrhea/sweating, if pulse is平和 (peaceful) with mild agitation, it is due to Stomach deficiency unable to process grain qi.
In Yangming Disease, after purging, if exterior heat exists, hands/feet are warm, no Jie Xiong, Ao Nao in chest, hunger but inability to eat, and only head sweats, use Zhi Zi Chi Tang.
If Yangming pulse is floating/tight and purged, stomach becomes empty, guest qi moves diaphragm, Ao Nao in chest, white tongue coating, use Zhi Zi Chi Tang. (See Spontaneous Sweat chapter).
After diarrhea, if agitation occurs and epigastrium is soft on pressure, it is Xu Fan; use Zhi Zi Chi Tang.
Yangming pulse slow, difficulty eating to fullness, slight agitation/head dizziness upon fullness, difficult urination, indicates impending Gu Dan (Grain Jaundice) (See Dizziness).
Yangming post-purging, Ao Nao/agitation, dry stool in stomach allows purging; slight fullness with hard start/loose end prohibits purging. If dry stool exists, use Da Chengqi Tang.
After major purging, if 6-7 days pass without stool, unresolved agitation, abdominal fullness/pain, due to old food retention, use Da Chengqi Tang.
Yangming without vomiting/purging but with agitation, use Tiao Wei Chengqi Tang. (Cheng Wuji: Post-vomit agitation is Internal Agitation; post-purge is Xu Fan. Here, no vomit/purge but agitation indicates Stomach stagnant heat; Tiao Wei Chengqi Tang purges stagnant heat.)
Yangming with spontaneous sweat, aggravated sweating, residual mild agitation, due to fluid loss and dry stomach causing hard stool. If urine is low, fluids return to stomach, stool will resolve soon.
Patient with heat-agitation resolving with sweat, or malarial-like afternoon fever belongs to Yangming.
Regarding Stomach Excess constipation with agitation:
- Post-vomit/purge: Da/Xiao Chengqi Tang.
- Pre-vomit/purge: Tiao Wei Chengqi Tang.
Xu treated a Shanghan case of 8-9 days: fever, no sweat, delirium, constipation for 3 days post-purge. Not dry, not agitated, not cold, not painful, but sleepless all night with indescribable discomfort and sighing sounds. Diagnosed as combined Ao Nao and Fu Yu (Depression). Stomach had dry stool. Given Chengqi Tang, passed >20 dry stools, resolved.
Jing Fang said: Yangming post-purge, Ao Nao/mild agitation, dry stool allows purging. Also: No urine difficulty, irregular stool, slight heat, Fu Yu insomnia indicates dry stool, treat with Chengqi Tang. *Suwen*: "Stomach disharmony leads to restless sleep." Jing Fang: "Dry stomach/hard stool causes delirium." Hence delirium and sighing (external Qi Fu Yu). Removing dry stool harmonizes stomach, curing disease.
Shaoyang Shanghan with wiry/fine pulse, headache, fever belongs to Shaoyang. Do not sweat; sweating causes delirium (Stomach issue). Stomach harmony cures; disharmony causes agitation/palpitations (*Huoren* uses Tiao Wei Chengqi Tang).
Chest fullness/agitation without mild sweating/purging or alternating chills/fever: Xiao Chaihu Tang.
Post-sweating/purging alternating chills/fever: Chaihu Guizhi Gan Jiang Tang.
With fright, difficult urination, delirium, heavy body: Chaihu Guizhi Longgu Muli Tang.
Vomiting with slight depression/agitation: If Xiao Chaihu Tang fails to stop vomiting, use Da Chaihu Tang (Major Bupleurum Decoction).
Post-extreme vomiting/purging, chest fullness, loose stool, abdominal pain: Tiao Wei Chengqi Tang.
Taiyin Shanghan with floating/slow pulse, warm hands/feet belongs to Taiyin, likely jaundice unless urine is free. By day 7-8, sudden agitation with >10 diarrheal episodes will self-resolve because Pi Jia Shi (Spleen Righteousness) expels foul rot. (Cheng Wuji: Day 7-8 hard stool is Taiyin transmitting to Yangming. Here, sudden agitation/diarrhea is Spleen expelling pathogens. Diarrhea with restlessness is fatal; here, Spleen harmony expels pathogen, so diarrhea stops. Use Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) or Ping Wei San (Peaceful Stomach Powder) + Shan Jian Jia (Pangolin Scale)).
Shaoyin Disease with somnolence and agitation. If diarrhea/thirst with white urine, *Huoren* uses Si Ni Tang (Counterflow Decoction). (See Somnolence).
If post-Bai Tong Tang (Bai Tong Decoction), diarrhea persists, cold reversal, no pulse, dry heaves/agitation, use Bai Tong Tang plus Pig Bile. (Known Yin pattern warmed by Aconite; dry heaves/agitation indicate rejection; adding human urine/pig bile facilitates entry, "Heat treating with Cold").
Shaoyin 2-3 days, agitation/insomnia: Huang Lian E Jiao Tang.
Diarrhea 6-7 days, cough/vomit, agitation/insomnia: Zhu Ling Tang (Polyporus Decoction).
Diarrhea, sore throat, chest fullness, agitation: Zhu Fu Tang.
Aversion to cold, curling up, spontaneous agitation, wanting to remove clothes: Treatable.
Tight pulse, day 7-8 spontaneous diarrhea, pulse suddenly faint, hands/feet warm, tight pulse gone: Resolving. Agitation/diarrhea will self-resolve.
Jueyin cold limbs with agitation. Pulse knotted/tight, chest full, hunger/no desire to eat: Use Gua Di San to vomit.
Hui Jue (Roundworm Cold Reversal) quiet then periodic agitation (See Vomiting Roundworms).
Day 6-7, pulses present in three positions, severe agitation/jaw lock, restlessness: Resolving.
Pulse harmonious, severe agitation, yellow inner canthus: Resolving.