栀子（擘）十四枚 香豉（绵裹）四合
右二味，以水四升，先煮栀子，得二升半，内豉煮取一升半，去滓，分为二服，温进
一服，得吐者，止后服。
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下利后更烦，按之心下濡者，为虚烦也，宜栀子豉汤。
【注】
此承上条误下下利后，不见诸逆，惟更加烦者而言。然按之心下濡而不痞者，是虚烦
也，故亦宜栀子豉汤。若按之不濡而痞□，则又为实烦，当用大黄黄连泻心汤矣。
【集注】
方有执曰：更烦本有烦，不为利除而转甚也。
林澜曰：此利后余热之证也。曰下利后而利止者，必非虚寒之烦，乃热遗于胸中也。
按之心下濡，虽热而非实热，故用此以清其虚烦。
程应旄曰：热利则烦，若得之利后而心下不□者，此为虚烦，乃余热乘虚而客于胃中
也。
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发汗吐下后，虚烦不得眠，若剧者，必反复颠倒，心中懊□，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。
【注】
未经汗吐下之烦多属热，谓之热烦；已经汗吐下之烦多属虚，谓之虚烦。不得眠者，
烦不能卧也。若剧者，较烦尤甚，必反复颠倒，心中懊□也。烦，心烦也。躁，身躁
也。身之反复颠倒，则谓之躁无宁时，三阴死证也。心之反复颠倒，则谓之懊□，三
阳热证也。懊□者，即心中欲吐不吐，烦扰不宁之象也。因汗吐下后，邪热乘虚客于
胸中所致。既无可汗之表，又无可下之里，故用栀子豉汤，顺其势以涌其热，自可愈
也。有前证若更加少气者，是热伤其气也，加甘草以扶之；若呕者，是热迫其饮也，
加生姜以散之。
【集注】
方有执曰：虚烦不得眠者，大邪乍退，正气暴虚，余热闷乱，胃中不和也。剧，极也
。反复颠倒，心中懊□者，胸膈壅滞，不得舒快也。所以用栀子豉汤，高者因而越之
之法也。
程应旄曰：发汗若吐若下，或胸中窒，或虚烦不得眠，或反复颠倒，心中懊□，皆属
三法后，遗热壅遏在上，客于心胸，是以扰乱不宁也。并非汗不出之烦躁，大青龙无
所用，诸法亦无所用，惟宜以栀子豉汤主之。盖栀子气味轻越，合以香豉能化浊为清
，但使涌去客邪，则气升液化，而郁闷得舒矣。
汪琥曰：虚烦证奚堪再吐，不知虚者正气之虚，烦者邪气之实，邪热郁于胸中，是为
邪实，吐证仍在，理宜更用吐法。所以「虚烦」二字，不可作真虚看，作汗、吐、下
后暴虚看。
Zhi Zi (broken open) 14 seeds, Xiang Chi (wrapped in silk gauze) 4 he.
These two ingredients are boiled in four sheng of water. First, boil Zhi Zi until the liquid reduces to two and a half sheng, then add Xiang Chi and boil until one and a half sheng remains. Strain the decoction and divide it into two doses, taken warm.
If vomiting occurs after the first dose, discontinue the second dose.
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After diarrhea, if irritability worsens and palpation of the epigastrium reveals softness without hardness, it is termed Empty Irritability (Xu Fan), for which Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated.
[Annotation]
This follows the previous clause regarding cases where improper purgative treatment led to diarrhea. In the absence of adverse reactions, but with increased irritability, palpation of the epigastrium showing softness without distension indicates Empty Irritability. Therefore, Zhi Zi Chi Tang is appropriate. If palpation reveals hardness and distension, it constitutes Real Irritability, and Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Heart-Draining Decoction) should be used.
[Collected Annotations]
Fang Youzhi states: "Increased irritability" implies that irritability was already present; it did not resolve with diarrhea but rather intensified.
Lin Lan states: This is a syndrome of residual heat following diarrhea. Since the diarrhea has stopped, the irritability is certainly not due to deficiency-cold, but rather heat lingering in the chest and diaphragm. Palpation revealing softness in the epigastrium indicates heat that is not excess-heat; thus, this formula is used to clear Empty Irritability.
Cheng Yingmao states: Heat-dysentery causes irritability. If, after diarrhea, the epigastrium is not obstructed, this is Empty Irritability, caused by residual heat taking advantage of deficiency to lodge in the stomach.
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After sweating, vomiting, or purging, if Empty Irritability prevents sleep, and in severe cases, the patient tosses and turns with a feeling of stifling irritability in the heart, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment. If there is shortness of breath, Zhi Zi Gan Cao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is indicated. If there is vomiting, Zhi Zi Sheng Jiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction) is indicated.
[Annotation]
Irritability before sweating, vomiting, or purging is mostly due to heat, termed Heat Irritability. Irritability after these treatments is mostly due to deficiency, termed Empty Irritability. Inability to sleep means irritability prevents lying down. In severe cases, the condition is worse than simple irritability, manifesting as tossing and turning and stifling irritability (Ao Nao). "Fan" refers to mental irritability; "Zao" refers to physical restlessness. Physical tossing and turning without peace is called Zao, a death syndrome of the Three Yin channels. Mental tossing and turning is called Ao Nao, a heat syndrome of the Three Yang channels. Ao Nao describes the sensation of wanting to vomit but being unable to, accompanied by restless discomfort. This results from pathogenic heat lodging in the chest after sweating, vomiting, or purging. Since there is no exterior syndrome to release and no interior excess to purge, Zhi Zi Chi Tang is used to follow the pathogen's upward trend and induce emesis to expel the heat, leading to recovery. If shortness of breath accompanies these symptoms, it indicates heat damaging Qi; Gan Cao (Licorice) is added to support Qi. If vomiting occurs, it indicates heat forcing fluids upward; Sheng Jiang (Fresh Ginger) is added to disperse fluids.
[Collected Annotations]
Fang Youzhi states: Empty irritability preventing sleep occurs when major pathogens have just retreated, Zheng Qi (Upright Qi) is suddenly deficient, residual heat causes stifling confusion, and the stomach is out of harmony. "Ju" means extreme. Tossing and turning with Ao Nao indicates stagnation in the chest and diaphragm, preventing relief. Thus, Zhi Zi Chi Tang is used, employing the method of "treating high conditions by inducing emesis."
Cheng Yingmao states: After sweating, vomiting, or purging, symptoms such as chest oppression, empty irritability preventing sleep, or tossing and turning with Ao Nao all belong to residual heat obstructed above, lodging in the heart and chest, causing unrest. This is not irritability due to failure to sweat, where Da Qing Long Tang (Major Blue Green Dragon Decoction) would be used; nor does it respond to other methods. Only Zhi Zi Chi Tang is suitable. Zhi Zi has a light and ascending nature; combined with Xiang Chi, it transforms turbidity into clarity. By expelling the lodged pathogen through emesis, Qi rises, fluids transform, and depression is relieved.
Wang Hu states: How can an Empty Irritability syndrome withstand further emesis? One must understand that "Empty" refers to the deficiency of Zheng Qi, while "Irritability" refers to the excess of pathogenic factors. Pathogenic heat stagnating in the chest constitutes pathogenic excess; thus, the indication for emesis remains, and emetic therapy is theoretically appropriate. Therefore, the term "Empty Irritability" should not be interpreted as true deficiency, but rather as sudden deficiency of Zheng Qi following sweating, vomiting, or purging.