【纲】仲景曰。发汗吐下后。虚烦不得眠。若剧者。必反复颠倒。心中懊 者。栀子豉汤主之。
若少气者。栀子甘草豉汤主之。若呕者。栀子生姜豉汤主之。
【目】许叔微曰。虚烦者。心中郁郁而烦也。若止云烦者。为表热及邪热传里。故有胸中烦。心
中烦。虚烦之别。故凡烦皆热。以栀豉汤随症治之。所以涌去其热也。
柯琴曰。栀豉汤。本为治烦躁设。又可治虚烦。以此知阳明之虚与太阳之虚不同。阳明之烦与
太阳之烦有别矣。
【纲】仲景曰。下后更烦。按之心下濡者。为虚烦也。宜栀子豉汤。病患手足厥冷。脉乍紧者。
邪结在胸中。心下满而烦。饥不能食者。病在胸中。当吐之。宜瓜蒂散。
【目】张云岐曰。虚烦之状。心中温温然欲吐。愦愦然无奈。欲呕不呕。扰扰乱乱。是名烦也。非
吐则不能已。此二条均是烦也。药均是吐也。而有轻重之不同。汗吐下后邪气乘虚而入为烦者。谓之
虚烦。栀豉汤。是吐剂之轻者。不因汗吐下邪结胸中则为膈实。瓜蒂散。是吐剂之重者。
柯琴曰。更烦。是既烦而复烦也。要知阳明虚烦。对胃家实热而言。是空虚之虚。不是虚弱之虚。
二条。是寒结胸中之脉症。心下者。胃口也。满者。胃气逆。烦者。胃气盛也。
【纲】仲景曰。伤寒医以丸药大下之。身热不去。微烦者。栀子干姜汤主之。伤寒下后。心烦
腹满。起卧不安者。栀子浓朴汤主之。
【目】成无己曰。此二条与前发汗吐下后一条。皆是因吐下发汗而烦者。皆为内陷之烦。故俱用
取吐法。以涌去其
热。其有不经吐下发汗而烦者。则又是传经之热。不作膈实者也。如少阳症心烦喜呕。或胸中烦而
不呕。小柴胡汤。少阴病二三日。心中烦不得卧者。黄连阿胶汤。少阴病胸满心烦者。猪肤汤。是
皆用和解法而彻去其热者也。
【纲】仲景曰。伤寒二三日。心中悸而烦者。宜小建中汤。
【目】成无己曰。阳明病。不吐不下。心烦者。烦之热者也。此心中悸而烦。烦之虚者也。以
悸为虚。悸甚而烦。故亦为虚也。若少阳之邪入腑者。烦而悸。则又为热。大抵先烦而悸者是为热。
先悸而烦者是为虚也。
[General Principles] Zhang Zhongjing stated: After undergoing sweating, emesis, or purgation therapies, if the patient experiences empty irritability (Xu Fan) and insomnia. In severe cases, this manifests as restlessness with tossing and turning, accompanied by a sensation of depression and remorse in the chest (Xin Zhong Ao Nao). The Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) should be administered.
If shortness of breath is present, the Zhi Zi Gan Cao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) should be used. If vomiting is present, the Zhi Zi Sheng Jiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction) should be used.
[Detailed Discussion] Xu Shuwei stated: "Empty irritability" refers to a state of inner depression and irritability. If one simply says "irritability," it may result from exterior heat or pathogenic heat transmitting inward; thus, there are distinctions between irritability in the chest (Xiong Zhong Fan), irritability in the heart (Xin Zhong Fan), and empty irritability (Xu Fan). Therefore, all forms of irritability are related to heat. The Zhi Chi Tang (Gardenia and Fermented Soybean Decoction) should be prescribed according to specific symptoms to induce emesis and expel the heat.
Ke Qin stated: The Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) was originally designed to treat irritability and restlessness (Fan Zao), but it can also treat empty irritability (Xu Fan). This indicates that "deficiency" in Yangming disease differs from "deficiency" in Taiyang disease, and irritability in Yangming disease differs from that in Taiyang disease.
[General Principles] Zhang Zhongjing stated: After purgation, if irritability worsens and palpation of the epigastrium reveals softness, this constitutes empty irritability (Xu Fan). The Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate. If the patient presents with cold extremities and a pulse that suddenly becomes tight, this indicates pathogenic factors knotting in the chest. Symptoms include fullness and irritability in the epigastrium, hunger without desire to eat, indicating the disease is located in the chest. Emesis should be induced. The Gua Di San (Melon Seed Powder) is indicated.
[Detailed Discussion] Zhang Yunqi stated: The manifestation of empty irritability includes a warm discomfort in the chest with a desire to vomit, mental confusion and helplessness, a desire to vomit without actually doing so, and internal disturbance. This is termed "irritability." Without inducing emesis, the condition cannot resolve. Both preceding clauses discuss irritability and utilize emetic agents, though they differ in severity. When pathogenic factors enter due to deficiency following sweating, emesis, or purgation, resulting in irritability, it is called empty irritability (Xu Fan). The Zhi Chi Tang (Gardenia and Fermented Soybean Decoction) is a mild emetic. If pathogenic factors knot in the chest causing diaphragmatic excess (Ge Shi) not due to prior sweating, emesis, or purgation, the Gua Di San (Melon Seed Powder) is a heavy emetic.
Ke Qin stated: "More irritability" means irritability recurring after having already been present. It must be understood that Yangming empty irritability (Yangming Xu Fan) is contrasted with stomach excess heat (Wei Jia Shi Re); here, "empty" refers to emptiness rather than weakness. These two clauses describe the pulse and symptoms of cold knotting in the chest. The "epigastrium" (Xin Xia) refers to the stomach region. "Fullness" results from rebellious stomach Qi, and "irritability" results from excessive stomach Qi.
[General Principles] Zhang Zhongjing stated: In Shanghan (Cold Damage) disease lasting two to three days, if a physician mistakenly uses pill-based strong purgatives, leading to persistent body heat and slight irritability, the Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction) should be administered. If, after purgation for Shanghan, the patient presents with irritability, abdominal fullness, and inability to lie still or sit comfortably, the Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction) should be administered.
[Detailed Discussion] Cheng Wuji stated: These two clauses, along with the previous clause regarding irritability after sweating, emesis, or purgation, all involve irritability caused by pathogenic factors sinking inward due to these therapies. Therefore, emetic methods are employed to expel heat via emesis. Irritability arising without prior sweating, emesis, or purgation is due to heat transmitting through meridians and does not form diaphragmatic excess. For example, Shaoyang syndrome presenting with irritability and frequent belching/vomiting, or chest irritability without vomiting, is treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). In Shaoyin disease, if after two to three days there is heart irritability and inability to sleep, Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is used. If Shaoyin disease presents with chest fullness and irritability, Zhu Fu Tang (Pig Skin Decoction) is used. All these employ harmonizing methods to eliminate heat.
[General Principles] Zhang Zhongjing stated: In Shanghan disease lasting two to three days, if the patient experiences palpitations and irritability, the Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is appropriate.
[Detailed Discussion] Cheng Wuji stated: In Yangming disease, if irritability occurs without prior emesis or purgation, it is heat-induced irritability. However, "palpitations with irritability" described here is deficiency-induced irritability. Since palpitation indicates deficiency, severe palpitation leading to irritability also indicates deficiency. If Shaoyang pathogenic factors transmit to the fu organs, causing irritability with palpitation, this is heat-induced. Generally, irritability preceding palpitation indicates heat, whereas palpitation preceding irritability indicates deficiency.