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[General Principle] Zhang Zhongjing stated: After the treatment of sweating for a Taiyang disease, if the patient experiences palpitations below the umbilicus, this indicates an impending onset of Ben Tun (Rushing Pig Syndrome). It should be primarily treated with Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction).

If burning needle therapy is used to induce sweating, and the puncture site becomes cold, resulting in nodular swelling and redness, Ben Tun will inevitably occur. If there is a sensation of Qi rushing from the lower abdomen up to the heart, moxibustion should be applied once on each nodule, followed by the administration of Guizhi Jia Gui Tang (Cinnamon Twig Decoction with Additional Cinnamon Twig), which involves adding two liang of Guizhi (Cinnamon Twig) to the original formula.

[Commentary] Wei Litong stated: The use of burning needles to induce sweating implies that the patient's Yin is inherently deficient, making it susceptible to Fire Evil invasion; their Yang is also inherently deficient, leading to easy sweating. Now, after sweating, Yang is further depleted. Since Yang nature is light and floating, tending to rise upward, Yin is thus agitated below. Taking advantage of the wind-cold entering through the needle pores, nodules form and turn red, while Kidney Yin-Cold evil rushes from the lower abdomen up to the heart. The momentum of Cold Water directly assaults the Heart Mind (Heart), resembling a pig suddenly charging. Is this not dangerous? He Shi from Chongming stated: Ben Tun syndrome occurs when Cold Evil enters through the needle pore, Wind Evil cannot exit, directly invading the Taiyang organ system, stirring up pre-existing Yin-Cold in the Kidneys, causing it to flare up and rush upward. This explanation also seems reasonable.

Yang Shiyin stated: Ben Tun resembles the sudden charge of a wild boar, with Qi rushing from the lower abdomen to the heart causing pain. In cases of Ben Tun, the Qi is located below the umbilicus, throbbing intensely. One should use Fuling Dazao Tang (Poria and Jujube Decoction), or Lizhong Tang (Regulate the Middle Decoction) with Baizhu (Atractylodes Macrocephala Rhizome) removed and Guizhi added. If pain is severe, adding Wuyu (Evodia Fruit) is also good. Regarding the burning needle clause, Guizhi Jia Gui Tang is used. If pain is severe accompanied by cold limbs, Danggui Sini Tang (Angelica Sinensis Decoction to Nourish the Extremities) with added Guizhi and Wuyu should be used. Only Guizhi can effectively relieve Ben Tun; it must not be omitted from any prescription.

[General Principle] Zhang Zhongjing stated: On the first day of Shanghan (Cold Damage), the pathogen affects the Taiyang channel. If the pulse is calm, it indicates no transmission. If the patient desires to vomit, or exhibits restlessness and irritability with a rapid and urgent pulse, it indicates transmission of the disease.

[Commentary] Zhu Gong stated: Restlessness and irritability caused by Shanghan are most common in the Taiyang and Shaoyin channels because Taiyang and Shaoyin are exterior-interior pairs.

Zhao Sizhen stated: "Fan" refers to internal mental agitation, while "Zao" refers to physical restlessness. Together, Fan-Zao indicates Heat. Separately, Fan and Zao have Yin-Yang distinctions: Fan is Yang, and Zao is Yin. Fan represents mild Heat, while Zao represents severe Heat. There are also Fan Teng (painful agitation), Fan Men (oppressive agitation), Fan Ke (thirsty agitation), and Xu Fan (deficiency agitation), all indicating Heat. However, there are cases of Zao without Fan, characterized by a sense of stifling restlessness, caused by Yin Excess repelling Yang. Although the patient may feel extreme restlessness wanting to lie in mud, yet unable to swallow water, this is the case. "Fan-Zao" means starting with Fan and progressing to Zao. "Zao-Fan" means starting with Zao and gradually returning to Fan.

Ke Qin stated: Taiyang governs the exterior, so when Cold Evil attacks, it first affects Taiyang. The Taiyang pulse should be Floating. If only a Floating pulse is seen without the Tight pulse typical of Cold Damage, it is considered "calm." Desire to vomit is a precursor to retching; irritability indicates heavy Yang; a rapid and urgent pulse is a rhetorical variation of both Yin and Yang being Tight. "Transmission" refers to the concept in Neijing: "When humans are injured by Cold, it transmits as Heat." This is Taiyang Qi generating Heat and transmitting to the exterior, referring to the seven-day transmission of "manifesting in Yang," not necessarily transmission between Taiyang, Yangming, and Shaoyang meridians.

[General Principle] Zhang Zhongjing stated: After six or seven days of Shanghan, if there is no significant high fever but the patient exhibits irritability, this is because Yang Evil has left the exterior and entered the interior.

[Commentary] Zhang Yunqi stated: When Yin is scant and Yang prevails, heat and irritability occur; thus, Taiyang Shanghan often presents with Fan and Zao. Yang deficiency with Yin excess also causes irritability. When Yang Qi is weak and overwhelmed by Yin, restlessness occurs; hence, Shaoyin disease also presents with irritability. Students should distinguish these based on external symptoms and pulses. Irritability can occur after sweating, after purgation, or after recovery when slight irritability returns due to the stomach's inability to handle food immediately; reducing food intake leads to recovery.

Mr. Ke stated: This discusses symptoms where Yang Evil moves from exterior to interior. Irritability appearing on the first day of Shanghan indicates Yang Evil emerging outward. By day six or seven, when Yin and Yang should naturally harmonize, the appearance of irritability signals the inward sinking of Yang Evil. "Yin" here refers to the interior, not specifically the Three Yin channels.

[General Principle] Zhang Zhongjing stated: In Taiyang disease, if joint pain is accompanied by irritability, and the pulse is Deep and Thin, this is named Shi Bi (Dampness Bi Syndrome).

[Commentary] Shen Jin'ao noted: Irritability typically belongs to excessive Yang. Dampness diseases usually do not present with irritability. Here, "irritability" occurs because Taiyang Qi is constrained by Dampness and cannot circulate freely.

[General Principle] Zhang Zhongjing stated: When a disease is about to resolve spontaneously, it must first present with irritability, followed by sweating and resolution. How do we know this? Because the pulse is Floating, indicating resolution through sweating. After treating Shanghan with sweating, if irritability recurs after half a day and the pulse is Floating and Rapid, another sweating treatment may be administered using Guizhi Tang (Cinnamon Twig Decoction).

[Commentary] Wang Kentang stated: "Fan" refers to Heat, specifically Fan Re (Heat Agitation). It differs from Fa Re (Fever). Fan Re is persistent distress caused by heat, whereas Fa Re comes and goes. The classics mention various forms of Fan such as slight Fan, Fan Re, recurrent Fan, reverse Fan, fullness Fan, thirst Fan, chest Fan, heart Fan, internal Fan, deficiency Fan, and great Fan desiring resolution, all indicating Heat. However, Fan caused by Yin-Cold is also common. If Fan is at the exterior, symptoms include Floating pulse, aversion to wind-cold, and body stiffness/pain. If Fan is at the interior, symptoms include tidal fever, delirium, abdominal fullness with constipation, and dark/scanty urination. If Fan is at half-exterior/half-interior, symptoms include alternating chills and fever, and chest/hypochondriac pain. If pathogen is above the chest/diaphragm causing Fan, symptoms include chest fullness and oppression, suitable for emesis. If Fan is due to Yin-Cold, symptoms include aversion to cold with curling up, diarrhea, cold limbs, faint pulse, and vomiting of roundworms. For Great Fan desiring resolution, the pulse must be Harmonious; if the pulse does not match, prognosis is poor. Cold feet with Deep/Thin/Faint pulse indicate Yin Syndrome, requiring immediate warming with Renshen (Ginseng) and Fuzi (Aconite Root). If Fan is due to internal injury, overwork, Yin deficiency with fire hyperactivity, symptoms include fatigue, spontaneous sweating, and Floating/Empty Chi pulse; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with fried Huanglian (Coptis Rhizome), Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Shengdi (Rehmannia Root), and Maidong (Ophiopogon Tuber) is appropriate. For insomnia with heart Fan, Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) helps settle floating fire and calm the spirit. Generally, Xu Fan, Chest Fan, and Heart Fan not caused by sweating, emesis, or purgation indicate transmitted pathogenic factors without forming Diaphragm Solidity, treated with harmonizing methods like Xiaochaihu Tang (Minor Bupleurum Decoction), Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction), or Zhufu Tang (Pig Skin Decoction). If Fan occurs after sweating/emesis/purgation, it indicates Heat Evil sinking inward becoming Xu Fan, with a sensation of nausea and helplessness; emetic methods like Zhizi Chi Tang (Gardenia and Soybean Decoction), Zhizi Jiang Tang (Gardenia and Ginger Decoction), or Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) are used. If pathogen knots in the chest without prior treatment, forming Diaphragm Solidity, Gengti San (Melon Spume Powder) is used. Yangming heart Fan is treated with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction); these are Excess Fan cases. Palpitations and Fan after two or three days of Shanghan indicate Deficiency, treated with Jianzhong Tang (Establish the Middle Decoction). Shaoyang pathogen entering the Fu organs causing Fan and palpitations indicates Heat. Generally, Fan then palpitations is Heat; palpitations then Fan is Deficiency. Heart Fan with constipation depends on prior treatment: if after emesis/purgation, consider Da/Xiao Chengqi Tang; if not, consider Tiaowei Chengqi Tang.

Min Ziqing stated: All channels can have Fan, but Taiyang is most severe. Fan is internal disturbance; sweating is Yang Qi emitting outward; Floating is a pulse of Yang abundance. A Floating pulse indicates Yang emitting from within, guaranteeing prior Fan. Upon seeing Fan, one must wait for sweating and avoid rashly administering decoctions.

Shen Jin'ao noted: These two clauses discuss residual heat after Shanghan, where Wei (Defensive) level is resolved but Ying (Nutritive) level is not. Floating-Rapid pulse is typical of Mahuang Tang syndrome, but Zhongjing prescribed Guizhi Tang because the Mahuang Tang syndrome had passed after sweating. The Floating-Rapid pulse here results from internal Fan, not Mahuang pulse. Moreover, Mahuang is purely Yang and cannot treat Fan; Guizhi Tang contains Shaoyao (Peony Root) to soothe the Ying level, specifically treating Fan. Guizhi treats Fan; after taking it, exterior heat resolves via sweat, but interior heat flares again, hence "recurrent Fan."

[General Principle] Zhang Zhongjing stated: After one dose induces sweating (taking Mahuang Tang), stop subsequent doses. Excessive sweating leads to Yang collapse, resulting in deficiency, aversion to wind, irritability, and insomnia. For excessive sweating, apply warm powder to the body.

In Shanghan with Floating-Slow pulse, fever, aversion to cold, no sweating, irritability, body ache absent but heaviness present (occasionally alleviated), and absence of Shaoyin symptoms, Da Qinglong Tang (Major Blue Dragon Decoction) should be used to disperse.

[Commentary] Ke Qin stated: The first clause is a contraindication for Mahuang Tang. Mahuang is a potent diaphoretic, requiring caution. The second clause shares fever/aversion to cold with Guizhi Tang and body ache/no-sweat with Mahuang Tang, but irritability is unique to this syndrome, hence this formula was created to treat Wind-Heat conflict.

[General Principle] Zhang Zhongjing stated: In Taiyang Wind Strike, with Floating-Tight pulse, fever, aversion to cold, body pain, no sweating, and irritability, Da Qinglong Tang is the primary treatment.

[Commentary] Cheng Wuji stated: Causes of Fan-Zao vary: pathogen at exterior, pathogen at interior, fire coercion, Yang deficiency, or Yin excess. As stated in the classics: Failure to sweat when indicated causes irritability, as in Taiyang Wind Strike with Floating-Tight pulse, no sweat, and irritability—pathogen at exterior. Constipation for 5-6 days, periumbilical pain, intermittent irritability—dry stool, pathogen at interior. Fire fumigation failing to induce sweat causes restlessness. Taiyang disease on day 2 showing reverse restlessness, back fanning causing profuse sweat, heat entering stomach causing irritability—fire coercion. Mild Yang causing restlessness requires avoiding purgation. Post-purgation sweating causing daytime irritability and nighttime quietness, or persistent irritability post-sweating/purgation—Yang deficiency. Shaoyin disease with vomiting/diarrhea, cold limbs, extreme irritability—Yin excess. These are normal pathological states, not terminal signs. However, if all Jie Xiong (Knotting Chest) symptoms are present with irritability, it is fatal. Fever with diarrhea, cold limbs, and inability to lie down due to restlessness is fatal. Shaoyin vomiting/diarrhea with irritability and cold limbs is fatal. Shaoyin cold limbs, aversion to cold, curling up, absent pulse, restlessness without Fan is fatal. Shaoyin day 5-6 spontaneous diarrhea with irritability and insomnia is fatal. These are untreatable conditions.

[General Principle] Zhang Zhongjing stated: After Taiyang disease sweating treatment, profuse sweating dries the Stomach, causing irritability and insomnia. If the patient desires water, give small amounts frequently to harmonize Stomach Qi and restore health. If the pulse is Floating, urination is difficult, there is slight fever and polydipsia, Wuling San (Five-Ingredient Powder with Poria) is indicated.

[Commentary] Wei Yilin stated: Sweat is the fluid of the Heart. Profuse sweating depletes Heart Yin, failing to control Heart Fire, causing Fan. Kidney Water decline fails to control Fire, causing Zao.

[General Principle] Zhang Zhongjing stated: In Taiyang disease, if fire fumigation fails to induce sweat, the patient will inevitably become restless. If the disease persists beyond its stage, rectal bleeding will occur, termed Huo Xie (Fire Evil).

[Commentary] Fang Zhongxing stated: Fire fumigation failing to induce sweat but causing rectal bleeding indicates Yang Evil sinking into Yin levels. During the prolonged unresolved stage, failure to sweat and subsequent bleeding show that coercing sweat yields rapid complications, while failure to sweat yields delayed complications. Named "Fire Evil," treatment focuses solely on the fire, ignoring previous wind-cold. Coercing sweat yielding rapid complications refers to Shanghan with Floating pulse treated by fire coercion, causing Yang collapse,惊狂 (fright/manic behavior), and tossing/restlessness.

[General Principle] Zhang Zhongjing stated: Following erroneous fire treatment, purgation, and burning needle therapy, if irritability occurs, Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is indicated. If the pulse is Deep, Ying Qi is weak. In cases of weak Ying Qi, adding burning needle therapy causes blood coagulation and stagnation, leading to fever and irritability.

[Commentary] Dai Yuanli stated: Fan-Zao occurs in both Yin and Yang channels. Yangming channel Stomach dry stool causes Fan, requiring purgation. Taiyang channel Fan after sweating uses Wuling San. Shaoyang channel may have Fan, treated with Xiaochaihu Tang. Yin Fan is common in Shaoyin. Yang transmitting to Yin causes Yin to become Fan with self-diarrhea, thirst, and insomnia; Chen Sha Wuling San (Cinnabar Five-Ingredient Powder) is used. If Yin Qi invades Yin channels causing vomiting/diarrhea, cold limbs, and Fan due to Yang deficiency allowing Yin invasion, Wuzhuyu Tang (Evodia Decoction) is used. Severe cases use Sini Tang (Frigid Extremities Decoction) with Scallion White. Additionally, Xu Fan (Deficiency Fan) occurs post-recovery during Yin-Yang non-restoration, presenting as intermittent heat; Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is used. Phlegm causing sleeplessness uses Wendan Tang (Warm Gallbladder Decoction). Vomiting uses Chupi Tang (Tangerine Peel Decoction).

Li Gao stated: Treating Yin deficiency fever, thirst, muscle heat, worse at night, with Large pulse empty upon pressure indicates Blood deficiency causing restlessness; Danggui Buxue Tang (Angelica Tonifying Blood Decoction) is used. Baihu Tang (White Tiger Decoction) would be a mistake. Floating-Large pulse empty upon pressure indicates scattered pulse, extreme deficiency with impending Yuan Qi collapse; do not use diaphoresis or heat-clearing. Use large doses of Rensheng Maishan San (Ginseng Pulse-Nourishing Powder).

Ke Qin stated: Erroneous fire treatment exhausts Yin and Yang. Irritability is a precursor to mania and tossing/restlessness. This decoction must be urgently used to calm the spirit and rescue from reversal.

[General Principle] Zhang Zhongjing stated: On the second day of Taiyang disease, irritability occurs. Instead of sweating, the back was fanned, causing profuse sweat. Intense heat enters the Stomach, exhausting Stomach fluids, causing restlessness and delirium. After ten-plus days, shaking chills and spontaneous diarrhea indicate impending resolution. Sweat stops below the waist; desire to urinate but inability; reverse vomiting; desire for incontinence; fear of wind on feet; hard stool; frequent but not urgent urination; increased frequency. After defecation, sudden head pain occurs; sole warmth indicates Grain Qi flowing downward.

[Commentary] Ke Qin stated: This is a mild case of Fire Reversal. Taiyang disease on day 2 with no sweat and irritability is originally Da Qinglong Tang syndrome. Fanning instead of sweating drives Fire Evil into the Stomach, exhausting fluids and causing persistent restlessness. Tiaowei Chengqi Tang should be used immediately to prevent Stomach Qi exhaustion.

[General Principle] Zhang Zhongjing stated: If all Jie Xiong (Knotting Chest) symptoms are present and irritability occurs, it is a fatal sign.

[Commentary] Wei Litong stated: With complete Jie Xiong symptoms and severe irritability, internal fluids are dried. Driving to the exterior causes sweating and total Yang loss; purging removes disease but causes Yin collapse and Yang death. Thus, neither action saves the patient. This clause follows the previous mention of Floating-Large pulse. Complete Jie Xiong with Floating-Large pulse and irritability differs from initial Jie Xiong irritability. Only combining these signs predicts death; otherwise, irritability is just one symptom. Floating-Large pulse must be rootless to be fatal; if rooted, treat from exterior, and irritability may not be fatal. Given complete Jie Xiong, pulse should be Slow; a sudden Floating-Large pulse indicates either Yang Evil trying to exit or True Yang rising.

Shen Jin'ao noted: The character "Yi" (also) connects to the previous clause regarding Jie Xiong with Floating-Large pulse, stating that purging leads to death, hence "also."