【纲】仲景曰。太阳病。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。
脉但浮者。与麻黄汤。
【目】朱肱曰。多眠有四症。有风温症。有小柴胡症。有少阴症。有狐惑症。
黄仲理曰。脉浮头项强痛而恶寒者。太阳症也。此必兼有诸症。
虞抟曰。少阴有脉微细但欲寐之症。今无少阴症。而脉浮细而嗜卧者。虽十日后。尚属太阳。
此即表解而不了了之谓也。设见胸满嗜卧。亦太阳之余邪未散。兼胁痛。则太少二阳合病矣。故和
之以柴胡汤。倘若脉浮不细。是浮而有力也。无胸胁痛。则不属少阳。但浮不大。则不属阳明。仍
在太阳。太阳为开。开病反合。故嗜卧。故开之以麻黄。
【纲】仲景曰。太阳病。二三日。不得卧。但欲起。心下必结。脉微弱者。此本有寒分也。
【目】朱肱曰。其伤寒瘥后不得眠者。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。
王肯堂曰。本条宜桂枝加浓朴杏仁汤。
陈士铎曰。不得卧但欲起。在二三日似乎与阳明并病。必其人心下结。故作此状。然结而不硬。
脉微弱而不浮大。此其人素有久寒宿饮。结于心下。非亡津液而胃家实。
【纲】仲景曰。伤寒脉浮。医以火迫劫之。亡阳。必惊狂。起卧不安者。桂枝去芍药加蜀漆龙骨牡
蛎救逆汤主之。
【目】柯琴曰。伤寒者。寒伤君主之阳也。以火劫汗。并亡离中之阴。此为火逆矣。妄汗亡阴而
曰亡阳者。心为阳中之太阳。故心之液。为阳之汗也。惊狂者。神明扰乱也。阴不藏精。惊发于内。
阳不能固。狂发于外。起卧不安者。起则惊。卧则狂也。
【纲】仲景曰。衄家不可发汗。汗出必额上陷。脉紧急。目直视不能 。不得眠。
【目】鳌按。太阳脉起目内 。上额。故此条脉症。皆从目上见得。盖荣行脉中。衄家则荣血
已脱。脉无所养。而又汗之。是重竭其液。故脉见紧急之象。脉无所养。则脉所自起之目 。亦必
枯涩而不能转运。故直视而不能 不得眠也。盖 必其目之能转而动。眠必其目之能运而合也。
【纲】仲景曰。太阳病。发汗后。大汗出。胃中干。烦躁不得眠。欲得饮水者。少少与饮之。令
胃气和。则愈。
【目】许叔微曰。大汗之后。精气不能游溢以上输于脾。脾不能为胃行其精液。胃不和。故不得
眠也。内水不足。思外水以相济。故欲得水饮之。此便是转属阳明症。
陶华曰。多眠者。以人之卫气。昼则行阳。夜则行阴。行阳则寤。行阴则寐。阳气虚。阴气盛。
则目瞑。故多眠。乃邪气传于阴而不在阳也。昏昏闭合者。阴自阖也。默默不言者。阴主静也。
不得卧者。阳气盛。阴气虚。则昼夜不得眠。盖夜以阴为主。阴气盛。则目闭而安卧。若阴为阳所
胜。故终夜烦扰而不得眠。所谓阴虚则夜争者是也。汗出鼻干不得卧。则邪在表也。葛根解肌汤。
若胃有燥屎。与大热错语。反大汗。胃中汁干而不得卧。则为邪在里也。大承气汤。胃不和。则卧
不安。故宜散热和胃也。若汗下后虚烦不得眠者。栀子豉汤以涌之。下后复热。昼日烦躁。夜则安
静。无大热。干姜附子汤。吐下后。心中懊 不眠。栀子豉汤。阳胜阴。狂言不眠。乱梦心烦乏气。
酸枣仁汤。阴胜阳。惊悸昏沉。大热干呕错语。呻吟不眠。犀角地黄汤。三阳合病。欲眠。目合
则汗。谵语者。有热也。小柴胡汤。其胃热者。亦卧也。犀角解毒汤。风温狐惑。亦有此症。
[Outline] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), after ten days, if the pulse is floating and fine, and the patient prefers to lie down, it indicates that the exterior pathogens have been resolved. If chest fullness and hypochondriac pain occur, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be administered.
If the pulse is merely floating, Ma Huang Tang (Ephedra Decoction) should be administered.
[Commentary] Zhu Gong stated: There are four types of hypersomnia: Feng Wen syndrome (Wind-Warmth syndrome), Xiao Chai Hu syndrome, Shaoyin syndrome, and Hu Huo syndrome (Fox-Confusion syndrome).
Huang Zhongli stated: A floating pulse, stiffness and pain in the head and neck, and aversion to cold constitute a Taiyang syndrome. This condition must be accompanied by other symptoms.
Yu Tun stated: Shaoyin disease presents with a faint and fine pulse and a desire to sleep. Currently, there are no Shaoyin symptoms, but rather a floating and fine pulse with hypersomnia. Although ten days have passed, it still belongs to Taiyang disease.
This is referred to as the exterior being resolved but the body feeling unwell. If chest fullness and hypersomnia are observed, it indicates residual pathogens of Taiyang have not dispersed; combined with hypochondriac pain, it signifies a concurrent disease of Taiyang and Shaoyang. Therefore, Chai Hu Tang (Bupleurum Decoction) is used to harmonize. If the pulse is floating but not fine, indicating strength, and without chest or hypochondriac pain, it does not belong to Shaoyang. If the pulse is floating but not large, it does not belong to Yangming. The disease remains in Taiyang. Taiyang governs opening; when opening pathology reverses to closing, hypersomnia occurs. Thus, Ma Huang Tang is used to open and disperse.
[Outline] Zhang Zhongjing stated: In Taiyang disease, after two or three days, if the patient cannot lie down comfortably and only wishes to rise, there will necessarily be obstruction in the epigastrium (Xin Xia). If the pulse is weak and faint, this is due to pre-existing cold-fluid retention in the body.
[Commentary] Zhu Gong stated: Insomnia following the recovery from Shang Han (Cold Damage) occurs because heat qi merges with the various Yang qi, while Yin qi has not yet recovered, causing continued inability to sleep after illness. Zhi Zi Wu Mei Tang (Gardenia and Sour Plum Decoction) is the primary treatment.
Wang Kentang stated: This clause is suitable for Gui Zhi Jia Nong Po Xing Ren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel).
Chen Shiduo stated: Inability to lie down and a desire to rise, appearing within two or three days, seems similar to a concurrent Yangming disease. It is certain that there is epigastric obstruction causing this state. However, the obstruction is not hard, and the pulse is weak/faint rather than floating/large. This indicates the person has long-standing cold and retained fluid accumulating in the epigastrium, not a Stomach excess syndrome caused by fluid depletion.
[Outline] Zhang Zhongjing stated: Individuals prone to nasal bleeding (Nu Jia) should not undergo sweating therapy. If sweating is induced, it will lead to loss of Yang Qi (Wang Yang), inevitably resulting in fright, mania, restlessness, and inability to sit or lie still. Gui Zhi Qu Shao Yao Jia Shu Ji Long Gu Mu Li Jiu Ni Tang (Cinnamon Twig Decoction minus Peony plus Chinese Dodder Herb, Dragon Bone, and Oyster Shell to Rescue the Perished Yang) is the primary treatment.
[Commentary] Ke Qin stated: Shang Han refers to cold damaging the Yang Qi of the Sovereign Heart. Using fire methods to force sweating simultaneously depletes the Yin within the Li trigram, constituting Fire Reversal. While mistaken sweating causes Yin loss, it is termed Yang loss because the Heart is the Supreme Yang among Yang organs; thus, the Heart's fluids are considered Yang sweat. Fright and mania represent disturbance of the Spirit. When Yin fails to store essence, fright arises internally; when Yang fails to consolidate, mania manifests externally. Restlessness implies fright upon rising and mania upon lying down.
[Outline] Zhang Zhongjing stated: Individuals prone to nasal bleeding should not undergo sweating therapy. If sweating induces perspiration, it will cause depression of the arteries at the forehead, an urgent/tight pulse, fixed staring gaze unable to move, and insomnia.
[Commentary] Shen Jin'ao noted: The Taiyang meridian originates from the inner canthus and ascends to the forehead. Therefore, the pulse and symptoms in this clause manifest through the eyes and head. Ying Qi (Nutritive Qi) circulates within the vessels. In individuals prone to nasal bleeding, Ying Blood has already been lost, leaving the vessels un-nourished. Further sweating further exhausts fluids, resulting in an urgent pulse. Without nourishment, the vessels originating at the eyes become dry and unable to rotate, leading to fixed staring, inability to blink, and insomnia. Blinking requires eye movement, and sleep requires eye closure and movement.
[Outline] Zhang Zhongjing stated: After treating Taiyang disease with sweating, excessive perspiration leads to dryness in the Stomach, irritability, and insomnia. If the patient desires water, provide small amounts frequently to harmonize the Stomach Qi, and the condition will resolve.
[Commentary] Xu Shuwei stated: After excessive sweating, Jing Qi (Essence Qi) cannot overflow upward to the Spleen, and the Spleen cannot transport fluids to the Stomach. Stomach disharmony causes insomnia. Due to internal fluid deficiency, there is a craving for external water to compensate, hence the desire to drink. This constitutes a transition to Yangming syndrome.
Tao Hua stated: Hypersomnia occurs because Wei Qi (Defensive Qi) travels through Yang during the day and Yin at night. Traveling through Yang results in wakefulness; traveling through Yin results in sleep. When Yang Qi is deficient and Yin Qi is abundant, the eyes close, causing hypersomnia. This indicates pathogens have entered Yin and are not in Yang. Drowsiness and closed eyes reflect Yin's closing nature. Silence reflects Yin's quiet nature. Insomnia occurs when Yang Qi is abundant and Yin Qi is deficient, preventing sleep day and night. Night is governed by Yin; abundant Yin allows closed eyes and peaceful sleep. If Yin is overcome by Yang, restlessness persists all night, known as Yin deficiency leading to nightly contention. Sweating, dry nose, and insomnia indicate pathogens in the Exterior; Ge Gen Jie Ji Tang (Pueraria Decoction to Release the Muscle Layer) is indicated. Dry stool in the Stomach, high fever, delirium, and excessive sweating leading to dry stomach fluids and insomnia indicate pathogens in the Interior; Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. Disharmony of the Stomach leads to restless sleep, so clearing heat and harmonizing the Stomach is appropriate. Irritability and insomnia after sweating/purging are treated with Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) to induce vomiting of trapped heat. Fever returning after purging, daytime irritability, nighttime calmness, and absence of high fever are treated with Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction). Regret and insomnia after vomiting/purging are treated with Zhi Zi Chi Tang. Yang overcoming Yin, causing delirious speech and insomnia, along with chaotic dreams, irritability, and fatigue, are treated with Suan Zao Ren Tang (Ziziphus Seed Decoction). Yin overcoming Yang, causing palpitations, dizziness, high fever, dry retching, delirium, groaning, and insomnia, are treated with Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction). Concurrent disease of the Three Yang channels, desire to sleep, sweating upon eye closure, and delirium indicate heat; Xiao Chai Hu Tang is used. Stomach heat also causes hypersomnia, treated with Xi Jiao Jie Du Tang (Rhinoceros Horn Detoxification Decoction). Feng Wen and Hu Huo syndromes also present with these symptoms.