（脾为胃行津液热则枯）
脾中有热胃干枯。口燥咽干津液无。宜用白虎加参治。少阳口苦小柴胡。咽干慎不可发
汗。发汗无津气愈虚。少阴火威水欲涸。口苦却宜承气需。
伤寒吐下仍不解。大便不利寒热在。循衣摸床殊不安。独语犹如见鬼怪。微喘直视不识
人。谵语狂言不可骇。大承服后脉强生。忽若清兮死难待。
伤寒烦躁症如何。阳明经与少阴科。阳明脉长大便秘。伤寒之候太阳多。阴盛阳虚亦烦
躁。
少阴之症勿会讹。汗之而烦医者误。病解而烦气不和。更有虚烦宜竹叶。根据方调治莫蹉跎。
卫气循环不暂停。昼则行阳夜在阴。卫独留阳阳跷盛。阳盛阴虚夜不宁。卫若留阴阴跷
满。
阴满阳虚昼却宁。暮谵昼了阴虚症。昼燥阳虚夜气清。须要调胃各归分。二气和谐可渐平。
多眠思症病形殊。风温狐惑及柴胡。更有少阴当慎别。须知四者病何如。风温身热当自
汗。小柴胁满项强拘。少阴自利但欲寐。狐惑多眠非一途。
伤寒何事不得眠。汗过胃中干燥烦。或因吐下虚烦致。或因大热语言颠。小便不利
正发
渴。心烦少气苦忧煎。若其水停心下满。但与猪苓可保痊。伤寒瘥后热还在。阴来复时阳使
然。
胃中干则无小便。慎勿利之强使然。下焦有热不通泄。量病时须泄与宣。咳而有水青龙
候。
项强无汗桂枝痊。大抵中遇发黄者。先利小盒饭使快。阳明汗多津液无。却以小便利为戒。
阳若凑之阴分虚。小便难出热邪拘。伤风不止桂加附。阳明风中小柴胡。
(Spleen transports fluids to the Stomach; heat in the Spleen leads to dryness)
Heat within the Spleen causes dryness and withering of the Stomach. There is dryness in the mouth and throat, and a lack of body fluids (Jinye). It is appropriate to use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) for treatment. If Shaoyang disease presents with a bitter taste in the mouth, Xiaochaihu Tang (Minor Bupleurum Decoction) is applicable. For symptoms of dry throat, sweating methods must be used with caution. Sweating consumes fluids and further weakens Qi. In Shaoyin disease, if Fire pathogen is vigorous and Kidney Water is about to dry up, presenting with bitter taste, Chengqi Tang formulas (Gut-Draining Decoctions) are appropriate to purge heat through the bowels.
After vomiting or purging treatments for Shanghan (Cold Damage), the condition remains unresolved. There is difficulty in bowel movement, accompanied by alternating chills and fever. The patient exhibits "circular clothing and bed-grabbing" (unconscious grasping movements), showing extreme restlessness. They speak alone, as if seeing ghosts. There is slight panting, fixed gaze, and inability to recognize people. Delirious speech and wild talk should not cause alarm. After administering Dachengqi Tang (Major Gut-Draining Decoction), if the pulse becomes strong, it indicates remaining righteous Qi and potential recovery; however, if the pulse suddenly becomes faint and cold, it is a fatal sign that is difficult to save.
How to differentiate irritability and restlessness in Shanghan? It mainly involves the Yangming Meridian and Shaoyin Meridian. Yangming disease is characterized by a large and long pulse and constipation, which is a typical sign of Shanghan, though Taiyang disease also frequently presents this. Irritability caused by Yin excess and Yang deficiency belongs to Shaoyin syndrome and must not be misdiagnosed. Misusing sweating methods will worsen irritability, which is a medical error. If irritability persists after the pathogen has resolved, it is due to disharmony of Qi. Additionally, for deficiency irritability, Zhuyeqi Tang (Bamboo Leaf Decoction) or similar formulas are appropriate. Treatment should be adjusted according to the specific situation without delay.
Wei Qi (Defensive Qi) circulates continuously without pause. During the day, it moves through the Yang aspects; at night, it resides in the Yin aspects. If Wei Qi stays exclusively in the Yang aspect, causing the Yang Qiao vessel to become full, Yang excess and Yin deficiency occur, leading to insomnia at night. If Wei Qi stays in the Yin aspect, causing the Yin Qiao vessel to become full, Yin excess and Yang deficiency occur, leading to calmness during the day. Delirium at dusk and clarity during the day indicate Yin deficiency; irritability during the day and calmness at night indicate Yang deficiency. One must regulate the Stomach Qi so that Yin and Yang return to their respective places. When the two Qi harmonize, the condition can gradually subside.
The manifestations of hypersomnia vary significantly. Fengwen (Wind-Warmth), Huhuo (Huhuo Disease), and Chaihu syndromes may all present this. Shaoyin disease must also be carefully distinguished. One must understand the differences among these four conditions. Fengwen presents with fever and spontaneous sweating. Shaoyang disease presents with hypochondriac fullness and neck stiffness/contracture. Shaoyin disease presents with spontaneous diarrhea and a desire to sleep. Hypersomnia in Huhuo disease follows different pathways.
Why does insomnia occur in Shanghan? Excessive sweating leads to dryness in the Stomach and irritability. It may also result from deficiency irritability caused by vomiting or purging. Or it may result from high fever causing confused speech. Difficulty in urination accompanied by thirst, irritability, shortness of Qi, and distressful anxiety. If water retention causes fullness under the heart, Zhu Ling Tang (Polyporus Decoction) alone can ensure recovery. After Shanghan resolves, lingering heat occurs when Yin returns and Yang struggles.
Dryness in the Stomach leads to absence of urine. Do not forcibly induce diuresis, as this is incorrect. If heat in the Lower Jiao causes obstruction of excretion, one must judge based on the duration of the illness whether to purge heat or promote circulation. Cough with water retention indicates Xiao Qinglong Tang (Minor Green Dragon Decoction). Neck stiffness with no sweat indicates Guizhi Tang (Cinnamon Twig Decoction). Generally, for patients with jaundice, first promote urination to facilitate the smooth discharge of damp-heat. In Yangming disease, excessive sweating depletes fluids; thus, promoting urination is contraindicated. If Yang gathers in the Yin aspect causing Yin deficiency, difficulty in urination results from heat pathogen constraint. For persistent wind-strike, Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) is used. For Yangming wind-strike, Xiaochaihu Tang is used.