病
夫虚烦者，心胸烦扰而不宁也。多是体虚之人，摄养有乖，荣卫不调，使阴阳二气有所偏胜也。又或
阴虚而阳盛，或阴盛而阳虚。《内经》曰∶阳虚则外寒，阴虚则内热；阳盛则外热，阴盛则内
寒。令之虚烦，多是阴虚生内热所致。虚劳之人，肾水有亏，心内火蒸，其烦必躁；吐泻之后，津液枯竭，
烦而有渴。惟伤寒大病之后，虚烦之证，却无霍乱，临病宜审之。
巢氏《病源》曰∶心烦不得眠，心热也，但虚烦不得眠者，胆冷也。
方
温胆汤 治病后虚烦不得卧，及心胆虚怯，触事易惊，短气悸乏，或复自汗，并治。
半夏（七钱） 竹茹 枳实（各三钱） 陈皮（四钱半） 白茯苓（去皮） 甘草（炙，二钱二分半）
上锉作一剂，姜、枣煎服。
一方加酸枣仁、炒远志肉、五味子、熟地黄、人参。
竹叶石膏汤（方见伤寒） 治大病后，表里俱虚，内无津液，烦渴心
躁，热与伤寒相似，但不恶寒，身不疼痛，不可汗下，宜服之。
病
不寐有二种∶有病后虚弱，及高年人阳衰不寐者；有痰在胆经，神不归舍，亦令不寐。
治
虚者，用六君子汤加炒酸枣仁、黄 ；痰者，用温胆汤减竹茹
一半，加南星、炒酸枣仁；伤寒不寐者，当求之本门。
酸枣仁炒熟，便补胆虚寒不眠；生用，便泻胆实热而多睡。
惊悸、健忘、怔忡、失志不寐、心风，皆是胆涎沃心，以致
心气不足。若用凉剂太过，则心火愈微，痰涎愈盛，而病益深，宜理痰气。
方
高枕无忧散（云林制） 治心胆虚怯，昼夜不睡，百方无效，服此一剂如神。
人参（五钱） 软石膏（三钱） 陈皮 半夏（姜汁浸炒） 白茯苓 枳实 竹
茹麦门冬 龙眼肉 甘草（各钱半） 酸枣仁（炒，一钱）
上锉，水煎服。
温胆汤（方见虚烦） 治大病虚烦不得眠，此胆寒也，根据本方，加人参、茯神、远志尤良。
酸枣仁丸 治胆气实热，痰迷不睡。
酸枣仁（炒，二两） 柏子仁（炒，另研，三两） 远志（去心，三两） 生地黄（酒
洗，五钱） 防风（三两，去芦） 枳实（五钱） 青竹茹（二钱半）
上为末，炼蜜为丸，如梧子大。每服七十丸，不拘时，热水下。
治劳心胆冷，夜卧不睡。
定志丸加炒酸枣仁、炒柏子仁，共为末，蜜丸如梧子大，朱砂、乳香为衣。每服五十丸，枣汤送下。
[Pathogenesis Discussion]
The so-called "Xu Fan" (Deficiency Heat Agitation) refers to a sensation of restlessness and disturbance in the chest and heart region. This condition mostly occurs in individuals with weak constitutions due to improper nursing, leading to disharmony between Ying (Nutritive Qi) and Wei (Defensive Qi), causing an imbalance where Yin or Yang Qi becomes excessive. It may manifest as Yin deficiency with Yang hyperactivity, or Yin excess with Yang deficiency. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Yang deficiency leads to external cold; Yin deficiency leads to internal heat; Yang excess leads to external heat; Yin excess leads to internal cold." Current cases of Xu Fan are mostly caused by internal heat generated from Yin deficiency. Patients suffering from Xu Lao (Deficiency Consumption) have depleted Kidney Water, causing Heart Fire to steam internally, resulting in agitation accompanied by restlessness. After vomiting and diarrhea, when body fluids are exhausted, one experiences agitation accompanied by thirst. However, in cases of Xu Fan following severe Shang Han (Cold Damage) disease, there is no Huoluan (Cholera-like syndrome); clinical judgment must be careful.
Chao Yuanfang stated in *Zhubing Yuanhou Lun* (Source Book of Diseases and Syndromes): "Heart agitation causing inability to sleep indicates Heart Heat; but if it is purely Xu Fan causing inability to sleep, it indicates Gallbladder Cold."
[Formulas]
Wendan Tang (Gardenia and Tangerine Peel Decoction): Treats Xu Fan after major illness causing inability to lie down, as well as Heart and Gallbladder deficiency and timidity, easily startled by events, shortness of breath, palpitations, fatigue, or spontaneous sweating. All these conditions can be treated with this formula.
Ingredients: Banxia (Pinelliae Rhizoma, 7 qian), Zhuru (Bambusae Caulis in Taeniam, 3 qian), Zhishi (Aurantii Fructus Immaturus, 3 qian), Chenpi (Citri Reticulatae Pericarpium, 4.5 qian), Baifuling (Poria, peeled), Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 2.25 qian).
Grind into powder for one dose, decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), and take orally.
Another prescription adds Suanzaoren (Ziziphi Spinosae Semen), Chao Yuanzhi (Polygalae Radix, fried), Wuweizi (Schisandrae Fructus), Shudihuang (Rehmanniae Radix Praeparata), and Renshen (Ginseng Radix et Rhizoma).
Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) (See Shang Han chapter for formula): Treats post-major illness where both exterior and interior are deficient, internal body fluids are lacking, causing agitation, thirst, and mental restlessness. The heat resembles Shang Han, but without aversion to cold or body pain. Sweating and purging methods are contraindicated; this formula is appropriate.
[Pathogenesis Discussion]
Bu Mei (Insomnia) has two types: one type occurs after major illness due to weakness, or in elderly people due to declining Yang Qi; the other type is caused by Phlegm obstructing the Gallbladder Meridian, preventing the Shen (Spirit) from returning to its residence, also leading to insomnia.
[Treatment Methods]
For deficiency patterns, use Liujunzi Tang (Six Gentlemen Decoction) added with Chao Suanzaoren (Ziziphi Spinosae Semen, fried) and Huangqi (Astragali Radix). For phlegm patterns, use Wendan Tang reducing Zhuru by half, adding Nanting (Arisaematis Rhizoma Preparatum) and Chao Suanzaoren. For insomnia caused by Shang Han, refer to the relevant section within this treatise.
When Suanzaoren is fried, it tonifies Gallbladder deficiency and cold causing insomnia; when used raw, it drains Gallbladder excess heat and promotes sleep.
Jing Ji (Palpitations due to fright), Jian Wang (Amnesia), Zheng Chong (Violent Palpitations), Shi Zhi Bu Mei (Insomnia due to loss of will), and Xin Feng (Wind affecting the Heart) are all caused by Gallbladder fluid moistening/infiltrating the Heart, leading to insufficiency of Heart Qi. If cold-natured medicines are overused, Heart Fire becomes weaker, Phlegm-Fluid increases, and the disease deepens. Therefore, regulating Phlegm-Qi is appropriate.
[Formulas]
Gaozhi Wuyou San (High Pillow Without Worry Powder) (Prescription from Yunlin): Treats Heart and Gallbladder deficiency and timidity, inability to sleep day or night, ineffective against various other methods. One dose acts miraculously.
Ingredients: Renshen (Ginseng Radix et Rhizoma, 5 qian), Ruangao (Gypsum Fibrosum, 3 qian), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma, soaked in Shengjiang juice and fried), Baifuling (Poria), Zhishi (Aurantii Fructus Immaturus), Zhuru (Bambusae Caulis in Taeniam), Maidong (Ophiopogonis Radix), Longyanrou (Longan Aril), Gancao (Glycyrrhizae Radix et Rhizoma, 1.5 qian each), Suanzaoren (Ziziphi Spinosae Semen, fried, 1 qian).
Grind into powder, decoct with water, and take orally.
Wendan Tang (Gardenia and Tangerine Peel Decoction) (See Xu Fan chapter for formula): Treats Xu Fan after major illness causing inability to sleep, which is due to Gallbladder Cold. Based on the original formula, adding Renshen (Ginseng Radix et Rhizoma), Fushen (Poria with Hostwood), and Yuanzhi (Polygalae Radix) yields better results.
Suanzaoren Wan (Sour Jujube Seed Pill): Treats Gallbladder Excess Heat and Phlegm confusing the mind causing insomnia.
Ingredients: Suanzaoren (Ziziphi Spinosae Semen, fried, 2 liang), Baiziren (Platycladi Semen, fried, separately ground, 3 liang), Yuanzhi (Polygalae Radix, heart removed, 3 liang), Shengdihuang (Rehmanniae Radix, washed with wine, 5 qian), Fangfeng (Saposhnikoviae Radix, 3 liang, radix removed), Zhishi (Aurantii Fructus Immaturus, 5 qian), Qingzhuru (Bambusae Caulis in Taeniam, 2.5 qian).
Grind into powder, mix with refined honey to make pills the size of wu zi (Chinese parasol tree seeds). Take 70 pills per dose at any time, swallowed with hot water.
Treats insomnia due to mental exertion causing Gallbladder Cold and restless sleep at night.
Dingzhi Wan (Dingzhi Pill) added with Chao Suanzaoren (Ziziphi Spinosae Semen, fried) and Chao Baiziren (Platycladi Semen, fried), ground into powder, made into pills the size of wu zi with honey, coated with Zhusha (Cinnabar) and Xuxiang (Olibanum). Take 50 pills per dose, swallowed with Jiu Tang (Date Decoction).