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Fan (restlessness) refers to inner disturbance, while Zao (agitation) refers to outer irritability and restlessness; colloquially known as anxiety. Combined, Fan-Zao belongs to Heat syndromes. Analytically, Fan is Yang and represents mild heat; Zao is Yin and represents severe heat. When Fan appears first and gradually progresses to Zao, it is called "Fan-Zao"; when Zao appears first and later reverts to Fan, it is called "Zao-Fan". There are cases of Zao without Fan, which indicates Yin excess repelling Yang outward (manifesting as extreme agitation desiring to lie in mud or water, yet unable to drink water; in such cases, Pili San from *Ren Jian Shu* may be used). There are also cases where pathogenic factors are in the Exterior causing Zao-Fan (such as Taiyang Wind Strike syndrome with floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and restlessness, treated by inducing sweating with Da Qing Long Tang); cases where pathogenic factors are in the Interior causing Fan-Zao (such as a patient not having bowel movements for six or seven days, with periumbilical pain, and periodic episodes of restlessness, indicating dry fecal matter accumulation); cases caused by erroneous fire therapy leading to restlessness (such as Taiyang disease treated with moxibustion/fire fumigation without sweating, inevitably causing agitation; or Taiyang disease on the second or third day presenting with sudden agitation, treated by ironing the back causing profuse sweating, allowing fire-heat to enter the Stomach and cause agitation); cases caused by Yang deficiency leading to restlessness (such as faint pulse followed by sweating causing agitation and insomnia; or after purgation and subsequent sweating, daytime agitation with nighttime quietness, no vomiting, no thirst, no exterior syndrome, deep-faint pulse, and no significant body heat, treated with Gan Jiang Fu Zi Tang; or persistent agitation after sweating and purgation, treated with Fu Ling Si Ni Tang); and cases caused by Yin excess leading to restlessness (such as Shaoyang disease with vomiting, diarrhea, cold extremities, and severe restlessness, treated with Wu Zhu Yu Tang). These are all common syndromes. Other untreatable syndromes are detailed in the appendix and must be known.

Taiyang Wind Strike Syndrome: If the pulse is floating-tight, with fever, aversion to cold, body pain, anhidrosis, and restlessness, use Da Qing Long Tang to induce sweating. If sweating is incomplete and Taiyang syndrome persists, with facial redness, agitation, and unknown pain locations, resuming sweating will cure it (see Shortness of Breath section).

Taiyang Disease: After excessive sweating, if the Stomach is dry causing restlessness and insomnia with desire for water, give small amounts of water. If there is a floating pulse, difficulty urinating, slight fever, and polydipsia, use Wu Ling San. If epigastric fullness persists after treating with Xie Xin Tang following erroneous purgation, accompanied by thirst, dry mouth, restlessness, and difficulty urinating, use Wu Ling San.

Two to three days after illness onset, if the pulse is weak, without Taiyang exterior or Shaoyang half-exterior/half-interior symptoms, but with restlessness and epigastric hardness, wait until the fourth or fifth day. Even if the patient can eat, give Xiao Cheng Qi Tang in small amounts to gently harmonize and provide slight relief. By the sixth day, administer one sheng of Cheng Qi Tang. If there is no bowel movement for six or seven days and urine output is low, even if the patient cannot eat, if the initial stool was hard but subsequent stools are loose, do not purge prematurely as it will cause loose stools. Only purge when urine is clear and stool is confirmed hard, using Da Cheng Qi Tang. (Wang Ken-tang notes: No Taiyang syndrome means no exterior syndrome; no Chai Hu syndrome means no half-exterior/half-interior syndrome.)

Restlessness, constipation, periumbilical pain, and periodic episodes indicate dry fecal matter. After purgation, if sweating is induced again, causing daytime agitation with nighttime quietness, no vomiting, no thirst, no exterior syndrome, deep-faint pulse, and no significant body heat, use Gan Jiang Fu Zi Tang. (No vomiting/thirst indicates no interior heat; no significant body heat indicates no exterior heat; deep-faint pulse warrants warming. Compare this with Zhi Zi Chi Tang syndrome, as both involve post-purgation insomnia, but differ in herbal properties.)

Gan Jiang Fu Zi Tang Formula:
Gan Jiang (Rhizoma Zingiberis, 1 liang), Fu Zi (Radix Aconiti Lateralis Preparata, 1 piece, peeled, broken into eight pieces, raw). Boil these two ingredients in 3 sheng of water to obtain 1 sheng, remove dregs, and take in one dose. (*Nei Jing* states: For excess cold, use pungent-hot herbs to neutralize. For severe deficiency-cold, pungent-hot agents overcome it.)

Hai Zang suggests two methods for taking Jiang Fu Tang: One method is hot administration, corresponding to the Hand-Shaoyin Heart meridian. Water envelops fire; hot administration connects to Heart fire. With severe exterior cold and weak external fire, cold generates externally and heat dissipates internally, like freezing to death with cold outside. The other method is cold administration, corresponding to the Foot-Shaoyin Kidney meridian. Cold pathogen enters cold water; cold administration mimics Kidney water. With slight exterior heat and abundant internal water, heat generates externally and cold dissipates internally, like ingesting cold with internal cold.

If illness persists after sweating or purgation with restlessness, treat primarily with Fu Ling Si Ni Tang. (Cheng Wu-ji notes: Illness should resolve after sweating/purgation. Persistence implies exterior Yang deficiency from sweating and interior Yin deficiency from purgation, leaving pathogenic factors unresolved, causing restlessness. Fu Ling Si Ni Tang restores Yin and Yang.)

Fu Ling Si Ni Tang Formula: (Si Ni Tonifies Yang; adding Fu Ling and Ren Shen tonifies Yin)
Fu Ling (Poria, 6 liang), Gan Cao (Radix Glycyrrhizae Preparata, 2 liang), Gan Jiang (Rhizoma Zingiberis, 1.5 liang), Ren Shen (Radix Ginseng, 1 liang), Fu Zi (Radix Aconiti Lateralis Preparata, 1 piece, raw, peeled, broken into eight pieces). Boil these five ingredients in 5 sheng of water to obtain 3 sheng, remove dregs, and take 7 ge warm, three times daily.

Restlessness with epigastric hardness: If not previously purged, referring to the previous case without Taiyang/Chai Hu symptoms, use small amounts of Xiao Cheng Qi Tang to gently harmonize. If already purged and epigastric hardness/pain with shortness of breath and restlessness occur, it is Da Xian Xiong Tang syndrome. If all Jie Xiong (Chest Binding) symptoms are present with restlessness, it is fatal (see Chest Binding section).

For Fire Reversal syndrome caused by burning needles leading to restlessness, use Gui Zhi Gan Cao Long Gu Mu Li Tang.

Gui Zhi Gan Cao Long Gu Mu Li Tang Formula:
Gui Zhi (Ramulus Cinnamomi, 1 liang, bark removed), Gan Cao (Radix Glycyrrhizae Preparata), Mu Li (Concha Ostreae, roasted), Long Gu (Os Draconis, each 2 liang). Grind to powder, boil in 5 sheng of water to obtain 2.5 sheng, remove dregs, and take 8 he warm, three times daily. (Pungent-sweet disperses; Gui Zhi and Gan Cao disperse fire-pathogens in meridians. Astringent prevents collapse; Long Gu and Mu Li consolidate floating Yang.)

Taiyang disease treated with fire fumigation without sweating causes inevitable agitation. If unresolved, hematochezia occurs, termed Fire Pathogen. (Cheng Wu-ji notes: Fire pathogen forces blood downward. Taiyang disease with fire fumigation prevents sweat release, trapping heat; Yin deficiency with fire causes agitation. On the sixth day, transmission completes; on the seventh day, returning to Taiyang, heat should resolve. If not, heat forces blood downward causing hematochezia. 'Dao' is synonymous with 'Dao' (reverse); 'Dao bu jie' means worsening. The text specifies Taiyang disease, implying no transmission to other meridians. Cheng's interpretation of 'Dao' is insufficient.)

Taiyang disease with back ironing causing profuse sweating allows fire-heat to enter the Stomach, depleting fluids, causing agitation, delirium. After ten-plus days, chills and diarrhea indicate resolution (see Delirium section).

*Ren Jian Shu* states: Generally, less Yin and more Yang causes heat and Fan, so Taiyang Wind Strike often presents with Fan and Zao.

Yangming Disease: Patients with no bowel movements for five-six days, periumbilical pain, and periodic restlessness have dry fecal matter; use Cheng Qi Tang. Generally, two-three days after onset, weak pulse, no Da Chai Hu syndrome, restlessness, epigastric heat, free urination, and epigastric hardness are treated with small amounts of Xiao Cheng Qi Tang to gently harmonize. However, if illness has resolved with facial redness and slight Fan, constipation is likely. Ask about urine frequency. If urine is scant, fluids return to the Stomach; do not purge.

Shaoyang Disease: Six-seven days after Shang Han, with no significant heat but restlessness, indicates Yang moving into Yin.

Shaoyin Disease: Vomiting, diarrhea, cold extremities, and severe restlessness are treated with Wu Zhu Yu Tang (see Vomiting section). Shaoyin disease with vomiting, diarrhea, restlessness, and cold extremities is fatal. Shaoyin disease with cold extremities, aversion to cold, curled posture, absent pulse, no Fan but Zao is fatal. Shaoyin disease with faint-deep-thin pulse, desire to sleep, sweating, no Fan, spontaneous vomiting, progressing to self-diarrhea and restlessness with inability to sleep by the fifth-sixth day is fatal.

Jueyin Disease: Shang Han with slight heat and mild cold extremities (cold fingertips), silent demeanor, anorexia, and restlessness for several days, with free urination and white urine, indicates heat elimination and recovery if appetite returns. If cold extremities with vomiting and chest/hypochondriac fullness occur, hematochezia is likely.

Shang Han with faint pulse and cold extremities persisting seven-eight days, with cold skin and constant agitation without rest, indicates Zang Jie (Organ Binding) and is fatal. Hui Jue (Roundworm Revulsion) involves cold extremities and Fan, but calms after vomiting roundworms, unlike Zang Jue's constant agitation. Shang Han with faint pulse, cold extremities, and restlessness unrelieved by moxibustion at Jueyin points is fatal. Shang Han with fever, diarrhea, cold extremities, and agitation preventing lying down is fatal. Shang Han presenting with no fever but mania and restlessness is treated with Wu Ling San (2 qian) taken with fresh well water, inducing vomiting for immediate cure.

Cheng Wu-ji notes: Fan-Zao is Fan progressing to Zao; Zao-Fan is Zao reverting to Fan. Progression from Fan to Zao indicates Heat, always starting with Fan. Preceding Zao with Fan indicates Fu Fu Ran agitation due to Yin excess repelling Yang. Extreme agitation desiring mud/water but unable to drink indicates Qi exhaustion and struggle, like a dying lamp flaring up. Inner heat is Fan (mental distress); outer heat is Zao (physical agitation). Inner heat is rooted fire, treatable if only Fan or Fan precedes Zao. Outer heat is rootless fire, untreatable if only Zao or Zao precedes Fan.

Appendix:

*Ren Jian Shu* states: Patients with cold body, deep-thin-rapid pulse, restlessness, and no desire for water have Yin excess repelling Yang; use Pili San. Agitation stops, sleep ensues, sweating occurs, and recovery follows. Huo Yan San and Dan Sha Wan are also indicated.

Pili San, Huo Yan San (see Yin Du section), Dan Sha Wan (see *Ren Jian Shu*).

Hai Zang: Yi Han Wan. This pill does not ascend excessively; Yang generates from below, treating Yin syndromes. After Si Ni class herbs, if chest agitation and thirst occur, or constipation/difficult urination for days, take this pill to stop upper agitation and normalize bowels/bladder.
Rou Gui (Cortex Cinnamomi), Fu Ling (Poria, each 5 qian), Liang Jiang (Rhizoma Alpiniae Officinarum), Wu Tou (Radix Aconiti Carmichaelii, prepared, each 7 qian), Fu Zi (Radix Aconiti Lateralis Preparata), Gan Jiang (Rhizoma Zingiberis, prepared), Shao Yao (Radix Paeoniae Alba), Hui Xiang (Fructus Foeniculi, stir-fried, each 1 liang). Grind to fine powder, make pills with paste size of Sophora seeds. Take 50-70 pills with warm wine on an empty stomach; 80-90 is acceptable. Wine or vinegar paste is suitable.

Ben Cao: Po Yin Dan. Treats hidden Yang within Yin, restlessness, deep-hidden six pulses (see Yin Du section).

Recently, a villager named Li Xin Dao suffered from deep-hidden six pulses, strong force upon deep pressure, headache, warm body, restlessness, cold fingertips, chest fullness, and nausea. Two physicians failed to diagnose, prescribing only Qi-regulating herbs. I diagnosed: Hidden Yang within Yin. This syndrome is absent in Zhang Zhongjing's texts but common. Hot herbs would be blocked by Yin, failing to guide True Yang and generating false pathogens; cold herbs would extinguish hidden True Fire. Treatment requires breaking Yin and guiding True Fire to allow water-fire balance and sweating resolution. Prescribed 200 pills of this medicine in one dose with cold salt water. Soon, intense agitation, fever, and limb restlessness occurred, alarming the family. I explained: This is colloquially "changing Yang." Shortly after, calmness returned, slight sleep ensued, sweating began from dusk till dawn, body cooled, and illness resolved.

Dai Yuanli: Restlessness occurs in both Yin and Yang meridians. Yangming Meridian Stomach dry fecal matter causes Fan, requiring purgation. Taiyang Meridian restlessness after sweating is treated with Wu Ling San. Shaoyang may have Fan, treated with Xiao Chai Hu Tang. Yin Fan is mostly Shaoyin, caused by Yang transmitting to Yin, Yin receiving Yang causing Fan, with diarrhea, thirst, insomnia, treated with Chen Sha Wu Ling San. If not Yang transmitting to Yin, but Yin invading Yin meridians with vomiting, diarrhea, cold extremities, and Fan, classics state "Yang deficiency, Yin invasion causes Fan" and "Yin excess causes agitation, desiring to sit in wells," treated with Wu Zhu Yu Tang. Severe cases use Si Ni Tang plus Cong Bai (Scallion Stem). Additionally, Xu Fan (Deficiency Fan) occurs during recovery when Yin-Yang are unbalanced, with fever and Fan, treated with Zhu Ye Shi Gao Tang. Phlegm causing restless sleep is treated with Wen Dan Tang. Vomiting is treated with Ju Pi Tang.