伤寒烦躁。何以明之。烦为扰扰而烦。躁为愤躁之躁。合而言之。烦躁为热也。析而
分之。烦也躁也。有阴阳之别焉。烦、阳也。躁、阴也。烦为热之轻者。躁为热之甚者。经
有烦疼、烦满、烦渴、虚烦。皆以烦为热也。有不烦而燥者。为怫怫然便作躁闷。此为
阴盛隔阳也。虽大躁欲于泥水中卧。但饮水不得入口者是矣。所谓烦躁者。谓先
烦渐至躁也。所谓躁烦者。谓先发躁而迤逦复烦者也。烦躁之由。又为不同。有邪
气在表而烦躁者。有邪气在里而烦躁者。有因火劫而烦躁者。有阳虚而烦躁者。
有阴盛而烦躁者。皆不同也。经曰。当汗不汗。其人烦躁。太阳中风。脉浮而紧。不汗
出而烦躁。大青龙汤主之者。是邪气在表而烦躁者也。病患不大便五六日。绕脐
痛。烦躁。发作有时。此有燥屎也。是邪气在里而烦躁者也。太阳病。以火熏之不得
汗。其人必躁。太阳病二日反躁。火熨其背。令人大汗出。大热入胃。躁烦者。火劫令
烦躁者也。阳微发汗。躁不得眠。与之下后复发汗。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。干姜附子汤主之者。及发汗若下之病。仍不
去烦躁者。茯苓四逆汤主之者。阳虚烦躁者也。少阴病。吐利手足冷。烦躁欲死者。
吴茱萸汤主之者。阴盛而烦躁者也。诸如此者。症之常也。非逆也。设或结胸症悉
具。烦躁者死。发热下利。厥逆。躁不得卧者死。少阴病。吐利烦躁四逆者死。少阴病。
四逆恶寒。而身蜷。脉不至。不烦而躁者死。少阴病五六日自利。复烦躁不得卧寐
者死。是数者。又皆为不治之症。呜呼。烦躁为常有之疾。复有诸不治之症。临病者
之侧。又当熟审焉。
In Taiyang disease (Taiyang Disease), how should the symptoms of Fan (restlessness/distress) and Zao (agitation/restlessness) be elucidated? "Fan" refers to a state of mental disturbance and inner turmoil, while "Zao" refers to physical agitation and irritability. Taken together, Fan and Zao indicate Heat (Re). However, when analyzed separately, there is a distinction between Yin and Yang: Fan belongs to Yang, whereas Zao belongs to Yin. Fan represents a milder manifestation of Heat, while Zao indicates a more severe degree of Heat. The Classics mention conditions such as Fan pain, Fan fullness, Fan thirst, and Empty Fan (Xu Fan), all of which identify Fan as a sign of Heat. There are cases where there is no Fan but only Zao; this presents as a feeling of stifling heat followed by agitation and discomfort, which is due to Yin Excess repelling Yang (Yin Sheng Ge Yang). Although the patient may feel extreme agitation and wish to lie in mud or water, they cannot swallow water, which characterizes this condition.
The term "Fan-Zao" refers to a progression from mental distress (Fan) gradually developing into physical agitation (Zao). Conversely, "Zao-Fan" refers to initial physical agitation (Zao) that subsequently transitions back into mental distress (Fan). The causes of Fan and Zao vary. They may arise from pathogenic factors remaining in the Exterior (Biao), from pathogenic factors in the Interior (Li), from coercive fire therapy (Huo Jie), from Yang Deficiency (Yang Xu), or from Yin Excess (Yin Sheng); these etiologies are distinct.
The Classics state: "When sweating should have been induced but was not, the patient becomes restless." For instance, in Taiyang Wind Strike (Taiyang Zhong Feng), if the pulse is floating and tight, with no sweat and accompanied by restlessness and agitation, Da Qing Long Tang (Major Blue Green Dragon Decoction) is indicated; this illustrates Fan-Zao caused by pathogenic factors in the Exterior. If a patient has not had a bowel movement for five or six days, experiences periumbilical pain, restlessness, and periodic exacerbations, this indicates Dry Stool (Zao Shi) in the interior, illustrating Fan-Zao caused by pathogenic factors in the Interior.
If Taiyang Disease is treated with fire moxibustion or steaming without inducing sweat, the patient will inevitably become agitated. If on the second day of Taiyang Disease the patient paradoxically becomes agitated, and the back is steamed causing profuse sweating, leading to intense heat entering the Stomach and resulting in agitation and distress, this is Fan-Zao caused by coercive fire therapy.
If sweating is induced in a patient with weak Yang, it may lead to agitation and insomnia. If purgation is followed by sweating, the patient may experience daytime restlessness preventing sleep, while being quiet at night, without vomiting or thirst, lacking exterior signs, with a deep and faint pulse, and no significant body heat, Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction) is indicated. Similarly, if Fan and Zao persist despite prior sweating or purgation, Fu Ling Si Ni Tang (Poria and Four Reversals Decoction) is indicated; these represent Fan-Zao due to Yang Deficiency. In Shaoyin Disease, if vomiting, diarrhea, cold extremities, and severe restlessness occur, Wu Zhu Yu Tang (Evodia Decoction) is indicated; this represents Fan-Zao due to Yin Excess. Such cases are common manifestations of disease and do not necessarily indicate a critical prognosis.
However, if all symptoms of Jie Xiong (Chest Binding) are present along with Fan and Zao, the prognosis is fatal. If fever is accompanied by diarrhea, cold extremities (Jue Ni), and agitation preventing lying down, it is fatal. In Shaoyin Disease, if vomiting, diarrhea, restlessness, and cold extremities occur together, it is fatal. In Shaoyin Disease, if there are cold extremities, aversion to cold, curling up of the body, absent pulse, no Fan but only Zao, it is fatal. If Shaoyin Disease persists for five to six days with spontaneous diarrhea, followed by restlessness and inability to sleep, it is also fatal. These several scenarios constitute untreatable conditions. Alas! While Fan and Zao are common symptoms, they can also accompany fatal conditions; therefore, clinicians must examine them with utmost care.