定，言动急速，妄辨妄笑，甚则登高而歌，弃衣而走，逾垣上屋，不饥不卧。皆因汗下失宜，阳
气亢极，阴气暴虚，非大吐下不止。伤寒四五日，身热烦躁，不得汗发狂者，表里俱热，三黄
石膏汤、双解散。伤寒六七日，壮热胸满便闭，脉实数发狂者，大承气汤加黄连。阳毒暴盛发
狂，多干呕，面赤，发斑咽痛，下利黄赤，壮热而不得汗者，葶苈苦酒汤。咽痛吐脓血者，阳
毒升麻汤。潮热甚者，栀子仁汤。潮热大便闭者，升麻葛根汤加大黄，或三黄汤。发斑不可
下者，草龙胆一味，水煎服。狂走者，瓜蒂散吐痰。时行热毒发狂者，黑奴丸。通用水渍法、火
劫法、王氏玄明粉。凡发狂见阳证阳脉者顺，见阴证阴脉及舌卷囊缩者即死。
多眠阴盛，而昼寝不厌；
伤寒邪传阴则多眠，昏昏闭目者，阴主阖也；默默不欲言者，阴主静也。有太阳证外已
解而神将复者，设若胸满胁痛鼻干，得汗者，小柴胡汤；脉浮，羌活冲和汤；冬月，麻黄汤。有
阳明热伏于里而嗜卧者，小柴胡汤。少阴脉沉细，自利欲吐而渴多眠者，四逆汤加人参、茯
苓以益阴回阳。或热病得汗后，脉沉细，身冷，初觉安静，渐次昏沉，喜卧不省，亦急与四逆
汤，令四肢温，不尔，有熟睡而死者。合病目合则汗出，风温常不了了，狐惑精神恍惚，治见
各条。惟汗下后酣睡者，为正气已复，不必药也。
不眠阳盛，而夜卧不遑。
或终夜烦扰，或昼夜惺惺不眠。未经汗下而不眠，属阳明初证者，葛根解肌汤；在里属
心神不清者，大承气汤。已经汗下不眠，津液干，热盛阴虚，胃不和也。太阳发汗过多，躁不
得眠，欲饮水者即愈。若脉浮而渴，小便难者，五苓散。汗吐下后，懊 不眠者，栀豉汤。昼夜不眠者，酸枣
仁汤。错语干呕不眠者，解毒汤。谵语，小便淋涩，烦躁少睡者，白虎汤加山栀。挟瘀血者，犀角地黄汤。
少阴下利而渴，或因下后不得眠者，猪苓汤。少阴二三日，心烦不眠者，黄连鸡子汤。下后阳虚，脉沉无表证，
夜静昼烦不得眠者，宜古姜附汤，或四逆汤加茯苓。汗多者，小建中汤。伤寒瘥后不眠者，阴气未复也，栀子
乌梅汤，或温胆汤加竹茹；虚者，十味温胆汤。精神恍惚者，朱雀丸，古法不眠者，单熟酸枣散；多眠者，单生
酸枣散亦好。
常病常法易知，变病变法难详。
上一段论伤寒杂证，从面至足及眠，逐一详审，以便问证云。
Stable spirit, rapid speech and movement, delirious talk and laughter, in severe cases climbing high to sing, discarding clothes and running, scaling walls and roofs, without hunger or desire to lie down. All these result from improper sweating or purging therapies, leading to extreme hyperactivity of Yang Qi (Yang Energy) and sudden deficiency of Yin Qi (Yin Energy); only drastic emesis or purging can stop it. In Shanghan (Cold Damage) disease on the fourth or fifth day, with body heat, irritability, inability to sweat, and mania, this indicates heat in both exterior and interior; Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) or Shuangjie San (Double-Release Powder) may be used. On the sixth or seventh day, with high fever, chest fullness, constipation, excess-rapid pulse, and mania, Da Chengqi Tang (Major Order the Qi Decoction) added with Huanglian (Coptidis Rhizoma) is indicated. For acute Yang Toxin (Yang Du) causing mania, often accompanied by dry heaving, red face, macules, sore throat, yellow-red diarrhea, high fever, and anhidrosis, Tingli Kujiu Tang (Descurainia Vinegar Decoction) is used. For sore throat with pus and blood expectoration, Yangdu Shengma Tang (Yang Toxin Cimicifugae Decoction) is prescribed. For severe tidal fever, Zhizi Ren Tang (Gardenia Seed Decoction) is used. For tidal fever with constipation, Shengma Gegen Tang (Cimicifugae and Puerariae Decoction) added with Dahuang (Rhei Radix et Rhizoma), or Sanhuang Tang (Three-Yellow Decoction), may be used. For macules where purging is contraindicated, Caolongdan (Dragon's Beard Gentian) alone, decocted in water, is taken. For manic running, Gouti San (Melon Pedicle Powder) is used to induce vomiting of phlegm. For epidemic heat-toxin causing mania, Heinu Wan (Black Slave Pill) is administered. General methods include water immersion therapy, fire coercion therapy, and Wangshi Xuanmingfen (Wang's Purified Mirabilite). Generally, mania presenting with Yang syndrome and Yang pulse is favorable; presenting with Yin syndrome and Yin pulse, or with tongue retraction and testicular retraction, indicates immediate death.
Excessive sleepiness is due to Yin excess, with no aversion to sleeping during the day;
When Shanghan pathogen transmits to the Yin meridians, there is excessive sleepiness; drowsy with eyes closed indicates Yin governs closure; silent and unwilling to speak indicates Yin governs stillness. If Taiyang (Greater Yang) exterior symptoms have resolved and spirit is recovering, but chest fullness, hypochondriac pain, and dry nose persist, if sweating occurs, Xiaochaihu Tang (Minor Bupleurum Decoction) is used; if the pulse is floating, Qianghuo Chonghe Tang (Notopterygii Harmonizing Decoction) is used; in winter, Mahuang Tang (Ephedra Decoction) is used. If Yangming (Bright Yang) heat is latent internally causing drowsiness, Xiaochaihu Tang is used. If Shaoyin (Lesser Yin) presents with deep-thready pulse, spontaneous diarrhea, desire to vomit, thirst, and sleepiness, Sini Tang (Frigid Extremities Decoction) added with Renshen (Ginseng Radix et Rhizoma) and Fuling (Poria) is used to nourish Yin and restore Yang. Or after a febrile disease sweats, if the pulse is deep-thready, body cold, initially feeling calm but gradually becoming comatose and preferring to lie down unconscious, Sini Tang should be urgently administered to warm the limbs; otherwise, death in deep sleep may occur. In combined diseases where closing eyes causes sweating, Fengwen (Wind-Warmth) often lingers unresolved; Huhuo (Huoxue Disease) involves mental恍惚 (fluctuation/unsteadiness); treatments are found in respective sections. Only deep sleep after sweating or purging indicates recovery of Zheng Qi (Upright Qi), requiring no medication.
Insomnia is due to Yang excess, with restlessness at night.
Or tossing all night, or remaining awake day and night without sleep. Insomnia without prior sweating or purging belongs to initial Yangming stage; Gegen Jiexi Tang (Pueraria Muscle-Releasing Decoction) is used. If internal and belonging to unclear Shen (Spirit/Mind), Da Chengqi Tang is used. Insomnia after sweating or purging results from dry Jin Ye (Body Fluids), excess heat, Yin deficiency, and disharmony of Stomach. Excessive sweating in Taiyang disease causes restlessness and insomnia; if thirsty, recovery follows. If pulse is floating with thirst and difficult urination, Wuling San (Five-Ingredient Powder with Poria) is used. After sweating, vomiting, or purging, if Ao'ao (oppressive discomfort) prevents sleep, Zhichi Tang (Gardenia and Soybean Decoction) is used. Day-and-night insomnia is treated with Suanzaoren Tang (Ziziphus Seed Decoction). Erratic speech, dry heaving, and insomnia are treated with Jiedu Tang (Detoxification Decoction). Delirium, dysuria, irritability, and little sleep are treated with Baihu Tang (White Tiger Decoction) added with Shanzhi (Gardeniae Fructus). With blood stasis, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is used.
Shaoyin diarrhea with thirst, or insomnia after purging, is treated with Zhuling Tang (Polyporus Decoction). Shaoyin disease for two to three days with heart vexation and insomnia is treated with Huanglian Jizi Tang (Coptis and Egg Yolk Decoction). After purging, Yang deficiency with deep pulse and no exterior signs, quiet at night but vexed during day preventing sleep, requires Gu Jiangfu Tang (Ancient Ginger and Aconite Decoction) or Sini Tang added with Fuling. With profuse sweating, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is used. Post-Shanghan insomnia indicates incomplete recovery of Yin Qi; Zhizi Wumei Tang (Gardenia and Mume Fruit Decoction) or Wendan Tang (Warm Gallbladder Decoction) added with Zhuru (Bambusa Caulis in Taenia) is used; for deficiency, Shiwei Wendan Tang (Ten-Ingredient Warm Gallbladder Decoction) is used. For mental fluctuation, Zhuque Wan (Vermilion Bird Pill) is used. Ancient methods for insomnia use Dan Shu Suan Zao San (Single-Roasted Ziziphus Seed Powder); for hypersomnia, Dan Sheng Suan Zao San (Single-Fresh Ziziphus Seed Powder) is also good.
Common diseases and common methods are easy to know; changed diseases and changed methods are hard to detail.
The previous section discussed Shanghan miscellaneous syndromes, examining from face to feet and sleep patterns in detail, to facilitate inquiry into symptoms.