《伤寒论》言懊 ，惟太阳阳明发汗吐下后有此症，则知是三阳经阳邪内陷，郁结心胸，而为
半表半里之症，非三阴症。故仲景虽立大陷胸汤、人参白虎汤、猪苓汤等，然于懊 条归重
于栀子豆豉汤。今余分各经见症施治，如太阳表邪，用羌活汤合栀子豆豉汤。阳明表症，用
葛根汤合栀子豆豉汤。少阳见症，以小柴胡汤合栀子豆豉汤。不见表症，而有热邪内结，则
以清里药合栀子豆豉汤。若食滞中焦，栀子豆豉汤加陈枳实，兼有痰凝，小陷胸汤合栀子豆
豉汤。此余推展之法也。
太阳病，脉浮动数，浮则为风，数则为热，动则为痛，数则为虚，头痛发热，微盗汗出，而
反恶寒者，表未解也。医反下之，动数变迟，膈内拒痛，胃中空虚，客气动膈，短气躁烦，
心中懊 ，阳气内陷，心内因硬，则为结胸，大陷胸汤主之。
此条因结胸症兼懊 ，故治结胸。详注结胸、头汗、发黄门。
伤寒五六日，大下之后，身热不去，心中结痛者，病欲解也，栀子豆豉汤主之。发汗若下
之，而烦热胸中窒者，栀子豆豉汤主之。发汗吐下后，虚烦不得眠，若剧者必反复颠倒，心
中懊 者；栀子豆豉汤治之。
首条言伤寒五六日，大下之，身热尚在，心中结痛，病未解也，故用栀子豆豉汤。第二条
言若发汗，又下之，胸中烦热窒塞者，允宜栀子豆豉汤。第三条言发汗又吐又下后，其人
虚烦，直至不得眠。若更剧者，必反复颠倒，心中懊 。较之前两条虽甚，然不脱栀子豆
豉汤者，以懊 惟此为正法耳。
阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒反恶热，身重。若发汗则燥，
心愦愦，反谵语。若加烧针，必怵惕烦躁不得眠。若下之，则胃中空虚，客气动膈，心中懊
，舌上白苔者，栀子豆豉汤。若渴欲饮水，口干舌燥者，人参白虎汤主之。若脉浮发热，
渴欲饮水，小便不利者，猪苓汤主之。
此章先分发汗、烧针、下之三条，误治后，立三方治法。心中懊 ，舌上白苔，故用栀子
豆豉汤；若渴欲饮水，口干舌燥，白虎加人参汤主之；若脉浮，渴欲饮水，小便不利，猪
苓汤主之。
阳明病下之，其外有热，手足温者，不结胸，心中懊 ，饥不能食，但头汗出者，栀子豆豉汤主之。
此申明表邪误下，身热仍在，阳邪未内陷，不作结胸，但成心中懊 ，饥不能食，但头汗
出，必宜以栀子豆豉汤治之。互注头汗条参看。
阳明病下之，心中懊 而烦，胃中有燥屎者，可攻之。腹微满，初头硬，后必溏，不可攻之。
阳明下后，懊 烦躁，有可攻不可攻。若果有燥屎，可攻之。若腹微满而不大满，肛门初
头之屎虽硬，后必溏薄，不可攻之。
栀子豆豉汤
栀子 豆豉
此仲景治懊 原方也。以懊 症，心下烦热致病，故以栀子豆豉汤主治。然表邪不散，亦
有烦热懊 者，家秘故有三阳表药加入之法。如羌活栀子豆豉汤，即前方加羌活，以宣发
太阳。干葛栀子豆豉汤，即前方加干葛，以宣发阳明。柴胡栀子豆豉汤，即前方加柴胡，
以宣发少阳。
栀子豆豉枳实汤
懊 热而无滞，止须原方。若有食滞，当加枳实，此开消导之法，非止用枳实一味也。
栀子豆豉陷胸汤
栀子 豆豉 半夏 川连 栝蒌霜
因结胸以致懊 ，故有大陷胸汤治法。若痛而不实，当以栀子豆豉汤合小陷胸汤。
大陷胸汤 见结胸。
人参白虎汤
人参 石膏 知母 甘草 粳米
懊 症，渴能消水，则阳明里热，故以此方清阳明。
猪苓汤 见小便不利。
懊 症，宜治上焦。今以小便不利，则利小便为急，不用五苓散者，因阳明里热耳。
The *Shanghan Lun* (Treatise on Cold Damage) mentions "Aonao" (a sensation of inner restlessness, irritability, and discomfort), which appears only after sweating, vomiting, or purging in Taiyang (Greater Yang) and Yangming (Yang Brightness) diseases. From this, it is known that this condition arises from the internal collapse of Yang pathogens from the three Yang meridians, stagnating and knotting in the chest and heart region, constituting a half-exterior, half-interior syndrome, rather than a syndrome of the three Yin meridians. Therefore, although Zhang Zhongjing established formulas such as Daxiexiong Tang (Major Chest-Knot Decoction), Renshen Baihu Tang (Ginseng White Tiger Decoction), and Zhuling Tang (Polyporus Decoction), in the clauses concerning Aonao, emphasis is placed on Zhi Zi Dou Chi Tang (Gardenia and Fermented Soybean Decoction). Now, I apply treatment based on the manifestations of each meridian: for Taiyang exterior pathogens, use Qianghuo Tang (Notopterygium Decoction) combined with Zhi Zi Dou Chi Tang; for Yangming exterior symptoms, use Gegen Tang (Kudzu Decoction) combined with Zhi Zi Dou Chi Tang; for Shaoyang (Lesser Yang) manifestations, use Xiaochaihu Tang (Minor Bupleurum Decoction) combined with Zhi Zi Dou Chi Tang; if there are no exterior symptoms but heat pathogens are internally knotted, use interior-clearing herbs combined with Zhi Zi Dou Chi Tang. If food stagnation exists in the middle jiao (middle burner), add Chen Zhishi (aged Fructus Aurantii Immaturus) to Zhi Zi Dou Chi Tang; if accompanied by phlegm coagulation, combine with Xiao Xiexiong Tang (Minor Chest-Knot Decoction). These are my extended methods of deduction.
In Taiyang disease, the pulse is floating, moving, and rapid. Floating indicates wind, rapid indicates heat, moving indicates pain, and rapid also indicates deficiency. Symptoms include headache, fever, slight night sweats, and paradoxical aversion to cold, indicating that the exterior syndrome has not yet resolved. The physician erroneously applies purging, causing the moving and rapid pulse to become slow. There is resistance and pain within the diaphragm, emptiness in the stomach, and external pathogens agitating the diaphragm. Shortness of breath, irritability, and Aonao occur. The Yang qi sinks inward, causing hardness in the heart region, resulting in Xiexiong (Chest-Knot Syndrome), which should be treated with Daxiexiong Tang.
This clause involves Aonao accompanying Xiexiong syndrome, so the treatment focuses on Xiexiong. For detailed notes, refer to the sections on Xiexiong, head sweating, and jaundice.
After five or six days of Shanghan (Cold Damage), following severe purging, if body heat persists and there is knotted pain in the heart, the disease is about to resolve; treat with Zhi Zi Dou Chi Tang. If after sweating or purging, there is irritability, heat, and a sensation of obstruction in the chest, treat with Zhi Zi Dou Chi Tang. After sweating, vomiting, and purging, if there is empty irritability preventing sleep, and in severe cases, tossing and turning with Aonao in the heart, treat with Zhi Zi Dou Chi Tang.
The first clause states that after five or six days of Shanghan and severe purging, if body heat remains and there is knotted pain in the heart, the disease has not resolved, hence Zhi Zi Dou Chi Tang is used. The second clause states that if sweating is followed by purging, resulting in irritability and obstructive heat in the chest, Zhi Zi Dou Chi Tang is appropriate. The third clause states that after sweating, vomiting, and purging, the patient suffers from empty irritability leading to insomnia. If more severe, they toss and turn with Aonao in the heart. Although worse than the previous two, it still falls under the scope of Zhi Zi Dou Chi Tang, because for Aonao, this formula is the orthodox method.
In Yangming disease, the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, aversion to neither cold nor preference for heat, and heaviness of the body. If sweating is induced, it leads to dryness, mental confusion, and paradoxically, delirious speech. If moxibustion with burning needles is added, it causes fearfulness, irritability, and inability to sleep. If purging is applied, the stomach becomes empty, external pathogens agitate the diaphragm, causing Aonao. If there is a white coating on the tongue, use Zhi Zi Dou Chi Tang. If there is thirst desire to drink water and dry mouth/tongue, use Renshen Baihu Tang. If the pulse is floating with fever, thirst desire to drink water, and dysuria, use Zhuling Tang.
This chapter first lists three erroneous treatments: sweating, burning needles, and purging, then establishes three formulas for treatment. With Aonao and a white tongue coating, Zhi Zi Dou Chi Tang is used; if thirsty with dry mouth/tongue, Baizhu Jia Renshen Tang (White Tiger plus Ginseng Decoction) is used; if floating pulse, thirst, and dysuria, Zhuling Tang is used.
After purging in Yangming disease, if there is exterior heat and warm hands/feet, without Xiexiong, but with Aonao, hunger without ability to eat, and only head sweating, treat with Zhi Zi Dou Chi Tang.
This clarifies that when exterior pathogens are erroneously purged, body heat remains, Yang pathogens have not sunk inward, and Xiexiong does not form. Instead, it results in Aonao, hunger without ability to eat, and only head sweating, necessitating treatment with Zhi Zi Dou Chi Tang. Refer to the head sweating clause for cross-reference.
After purging in Yangming disease, if there is Aonao and irritability, and dry feces exist in the stomach/intestines, purging may be applied. If the abdomen is slightly full, with hard stool at the beginning and loose stool later, purging is contraindicated.
After purging in Yangming, Aonao and irritability present both indications for and against purging. If dry feces are indeed present, purging is applicable. If the abdomen is only slightly full and not significantly distended, and although the initial stool is hard, the subsequent stool is loose, purging is contraindicated.
Zhi Zi Dou Chi Tang (Gardenia and Fermented Soybean Decoction)
Zhi Zi (Fructus Gardeniae) Dou Chi (Faba Fermentata)
This is the original formula by Zhang Zhongjing for treating Aonao. Since Aonao is caused by heat and irritability in the epigastrium, Zhi Zi Dou Chi Tang is the primary treatment. However, if exterior pathogens remain unresolved, irritability and Aonao may also occur. My family's secret method involves adding exterior-releasing herbs for the three Yang meridians. For example, Qianghuo Zhi Zi Dou Chi Tang adds Qianghuo (Rhizoma Notopterygii) to release Taiyang pathogens. Gegen Zhi Zi Dou Chi Tang adds Gegen (Radix Puerariae Lobatae) to release Yangming pathogens. Chaihu Zhi Zi Dou Chi Tang adds Chaihu (Radix Bupleuri) to release Shaoyang pathogens.
Zhi Zi Dou Chi Zhi Shi Tang (Gardenia, Fermented Soybean, and Immature Orange Fruit Decoction)
For Aonao with heat but no stagnation, the original formula suffices. If there is food stagnation, add Zhishi (Fructus Aurantii Immaturus). This is a method to open and digest stagnation, not merely using Zhishi alone.
Zhi Zi Dou Chi Xiexiong Tang (Gardenia, Fermented Soybean, and Chest-Knot Decoction)
Zhi Zi Dou Chi Banxia (Pinellia Rhizome) Chuan Lian (Coptis Rhizome) Gua Lou Shuang (Trichosanthes Peel Powder)
When Xiexiong causes Aonao, Daxiexiong Tang is indicated. If there is pain but no hardness, combine Zhi Zi Dou Chi Tang with Xiao Xiexiong Tang.
Daxiexiong Tang See Xiexiong section.
Renshen Baihu Tang (Ginseng White Tiger Decoction)
Renshen (Radix Ginseng) Shigao (Gypsum Fibrosum) Zhimu (Rhizoma Anemarrhenae) Gancao (Radix Glycyrrhizae) Jingmi (Oryza Sativa)
In Aonao syndrome, if thirst allows drinking water, it indicates Yangming interior heat, so this formula clears Yangming heat.
Zhuling Tang (Polyporus Decoction) See Dysuria section.
In Aonao syndrome, treatment should focus on the Upper Jiao. However, due to dysuria, promoting urination becomes urgent. Wuling San (Five-Ingredient Powder with Poria) is not used because of the presence of Yangming interior heat.