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Fan (restlessness) refers to inner mental agitation; Zao (agitation) refers to physical restlessness and irritability, colloquially known as anxiety. Together, Fan-Zao constitutes a Heat syndrome. Analyzed separately, Fan belongs to Yang and represents mild Heat; Zao belongs to Yin and represents severe Heat. When Fan appears first and gradually develops into Zao, it is called "Fan-Zao"; when Zao appears first and later returns to Fan, it is called "Zao-Fan". There is also a condition where there is Zao but no Fan, which indicates Yin excess repelling Yang outward (manifesting as extreme restlessness with a desire to lie in mud or water, yet unable to drink water; in such cases, Pili San may be used).

Furthermore, there are cases of Zao-Fan due to pathogenic factors in the Exterior (e.g., Taiyang Wind-stroke with floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and restlessness, treated by Da Qing Long Tang to induce sweating); cases of Fan-Zao due to pathogenic factors in the Interior (e.g., patient has not had a bowel movement for 6-7 days, periumbilical pain, periodic episodes of restlessness, indicating dry feces accumulation); cases caused by erroneous fire therapy (e.g., Taiyang disease treated with moxibustion/fire without sweating leading to restlessness; or Taiyang disease on day 2-3 becoming restless, back steaming causing profuse sweating, allowing fire heat to enter the Stomach causing restlessness); cases due to Yang deficiency (e.g., faint pulse after sweating, restlessness and insomnia; or post-purging and re-sweating, daytime restlessness with nighttime quietness, no vomiting/thirst, no exterior signs, deep-faint pulse, no significant body heat, treated by Gan Jiang Fu Zi Tang; or persistent restlessness after sweating/purging, treated by Fu Ling Si Ni Tang); and cases due to Yin excess (e.g., Shaoyang disease with vomiting/diarrhea, cold limbs, severe restlessness, treated by Wu Zhu Yu Tang). These are common syndromes. Other untreatable conditions are detailed in the appendix and must be known.

Taiyang Wind-stroke: Floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and restlessness indicate Da Qing Long Tang to induce sweating. If sweating is incomplete and Taiyang syndrome persists, with facial redness, restlessness, and unknown pain locations, appropriate further sweating will resolve it (see Shortness of Breath). Taiyang disease: After excessive sweating, stomach dryness causes restlessness and insomnia with thirst; give small amounts of water. If floating pulse, dysuria, slight fever, and polydipsia occur, use Wu Ling San. Post-purging epigastric fullness unrelieved by Xie Xin Tang, accompanied by thirst, dry mouth/restlessness, and dysuria, also uses Wu Ling San.

Two to three days after onset: Weak pulse, no Taiyang or Shao Yang (Chai Hu) signs, restlessness, epigastric hardness. By day 4-5, if able to eat, give Xiao Cheng Qi Tang sparingly to harmonize slightly. By day 6, give one sheng of Cheng Qi Tang. If no bowel movement for 6-7 days with scanty urine, even if unable to eat, if initial stool was hard but subsequent stool is loose, do not purge prematurely lest diarrhea ensue. Wait for clear urine and confirmed hard stool before purging with Da Cheng Qi Tang. (Wang Kentang notes: No Taiyang sign means no exterior syndrome; no Chai Hu sign means no half-exterior/half-interior syndrome.) Restlessness, constipation, periumbilical pain, periodic episodes indicate dry feces. Post-purging and re-sweating, daytime restlessness/insomnia with nighttime quietness, no vomiting/thirst, no exterior signs, deep-faint pulse, no significant body heat, indicates Gan Jiang Fu Zi Tang. (No vomiting/thirst implies interior heat absence; no significant body heat implies exterior heat absence; deep-faint pulse warrants warming. Compare with Zhi Zi Chi Tang syndrome as both involve post-purging restlessness/insomnia, but drug properties differ in hot/cold nature.)

Gan Jiang Fu Zi Tang Formula:
Gan Jiang (1 liang), Fu Zi (1 piece, peeled, broken into 8 pieces, raw). Boil two ingredients in 3 sheng water to obtain 1 sheng, remove dregs, take once. (Nei Jing states: For excess cold, use pungent-hot agents to level it. For severe deficiency-cold, pungent-hot agents overcome it.)

Hai Zang suggests two methods for taking Gan Jiang Fu Zi Tang:
1. Take hot: Corresponds to Hand-Shaoyin Heart channel. Water controls Fire; hot intake connects to Heart Fire. If exterior cold is strong and internal fire weak, cold generates externally and heat dissipates internally, like freezing death where cold is external.
2. Take cold: Corresponds to Foot-Shaoyin Kidney channel. Cold pathogen enters interior; cold water intake mimics Kidney Water. If exterior has slight heat and interior water is abundant, heat generates externally and cold dissipates internally, like drinking cold liquids where cold is internal.

If disease persists after sweating or purging with restlessness, treat with Fu Ling Si Ni Tang. (Cheng Wuji notes: Sweating/purging should resolve disease; persistence implies exterior Yang deficiency from sweating and interior Yin deficiency from purging, leading to dual deficiency and lingering pathogen causing restlessness. Fu Ling Si Ni Tang restores Yin-Yang.)

Fu Ling Si Ni Tang Formula (Si Ni Tonifies Yang; adds Fu Ling/Ren Shen to Nourish Yin):
Fu Ling (6 liang), Gan Cao (roasted, 2 liang), Gan Jiang (1.5 liang), Ren Shen (1 liang), Fu Zi (1 piece, raw, peeled, broken into 8 pieces). Boil five ingredients in 5 sheng water to obtain 3 sheng, remove dregs, take 0.7 sheng warm, three times daily.

Restlessness with epigastric hardness: If not previously purged, refer to previous section (no Taiyang/Chai Hu signs, use Xiao Cheng Qi Tang sparingly). If already purged with epigastric hardness/pain, shortness of breath, and restlessness, this is Da Xian Xiong Tang syndrome. If all Jie Xiong (Chest Binding) signs are present with restlessness, prognosis is fatal (see Jie Xiong section).

Fire reversal with purging and burning needle causing restlessness: Treat with Gui Zhi Gan Cao Long Gu Mu Li Tang.

Gui Zhi Gan Cao Long Gu Mu Li Tang Formula:
Gui Zhi (bark removed, 1 liang), Gan Cao (roasted), Mu Li (calcined), Long Gu (each 2 liang). Powder form. Boil in 5 sheng water to obtain 2.5 sheng, remove dregs, take 0.8 sheng warm, three times daily. (Pungent-sweet disperses; Gui Zhi/Gan Cao disperse fire pathogen in channels. Astringency prevents collapse; Long Gu/Mu Li consolidate floating righteous Qi.)

Taiyang disease with fire smoking causing no sweat leads to restlessness. By day 6-7 unresolved, blood in stool occurs, termed Fire Pathogen. (Cheng Wuji notes: Fire pathogen forces blood downward. Taiyang fire smoking without sweat traps heat, damaging Yin and causing restlessness. Day 6 completes transmission cycle; Day 7 returns to Taiyang, heat should resolve. If not, heat forces blood downward causing hematochezia. 'Dao' implies reversal/worsening. Text specifies Taiyang disease, implying no transmission to other meridians. Context discusses days, not transmission stages. Cheng's interpretation of 'Dao' is insufficient.) Taiyang disease with back steaming causing profuse sweat allows fire heat to enter Stomach, depleting fluids, causing restlessness and delirium. After 10+ days, chills and diarrhea indicate resolution (see Delirium section).

Li Gao states: Generally, deficient Yin and excess Yang cause Heat and Fan. Thus, Taiyang Wind-stroke often presents with Fan and Zao.

Yangming Disease: Constipation for 5-6 days, periumbilical pain, periodic restlessness indicates dry feces; use Cheng Qi Tang. Generally, day 2-3 with weak pulse, no Da Chai Hu signs, restlessness, epigastric heat, clear urine, epigastric hardness: use Xiao Cheng Qi Tang sparingly. However, if disease resolves with facial redness and slight restlessness, stool is likely hard. Ask about urination frequency. If urine is scant, fluids return to Stomach; do not purge.

Shaoyang Disease: Taiyang cold for 6-7 days, no high fever, but restlessness indicates Yang pathogen entering Yin meridians.

Shao Yin Disease: Vomiting/diarrhea, cold limbs, severe restlessness: Wu Zhu Yu Tang (see Vomiting). Vomiting/diarrhea, restlessness, limb coldness: Fatal. Limb coldness, aversion to cold, curled posture, absent pulse, no Fan but Zao: Fatal. Pulse faint/deep-thin, desire to sleep, sweating, no Fan, desire to vomit; by day 5-6 spontaneous diarrhea with recurrent restlessness/insomnia: Fatal.

Jue Yin Disease: Mild heat, slight cold extremities, cold fingertips, silent anorexia, restlessness for several days, clear urine color indicates heat elimination; desire to eat indicates recovery. If cold extremities with vomiting, chest/hypochondriac fullness, likely hematochezia.

Taiyang cold with faint pulse and cold extremities, persisting 7-8 days with cold skin and constant restlessness: Zang Jie (Organ Binding), fatal. Hui Jie (Roundworm Cold) has cold/extremity restlessness but calms after vomiting roundworms, unlike Zang Jie constant restlessness. Taiyang cold 6-7 days, faint pulse, cold limbs, restlessness; if Moxibustion at Jue Yin fails to restore warmth: Fatal. Fever, diarrhea, cold extremities, restlessness/insomnia: Fatal. Onset without fever but mania/restlessness: Use Wu Ling San (2 qian) with fresh water, induce vomiting for immediate cure.

Cheng Wuji explains: Fan-Zao is gradual progression from Fan to Zao; Zao-Fan is recurrence of Fan after initial Zao. Progression from Fan to Zao indicates lingering Heat. Initial Zao followed by Fan indicates Yang repelled by Yin excess (desire to lie in mud/water but inability to drink). This is Qi attempting to escape, like a dying lamp flaring brightly. Internal Heat is Fan (mental depression); External Heat is Zao (physical agitation). Internal Heat is rooted fire (treatable if only Fan or Fan then Zao); External Heat is rootless fire (untreatable if only Zao or Zao then Fan).

Appendix:

Li Gao: Body cold, deep-thin-rapid pulse, restlessness without thirst indicates Yin excess repelling Yang. Use Pili San; restlessness stops, sleep follows, sweating cures. Huo Yan San and Dan Sha Wan also applicable (see Yin Du section).

Zhang Yuansu (Hai Zang): Yi Han Wan. Non-dispersive, Yang generated below, treats Yin syndromes. For restlessness/thirst after Si Ni decoctions, or constipation/dysuria after several days, use this pill to prevent upper restlessness and regulate bowels/bladder.
Ingredients: Rou Gui (5 qian), Fu Ling (5 qian), Liang Jiang (7 qian), Wu Tou (processed, 7 qian), Fu Zi (processed), Gan Jiang (processed), Bai Shao (1 liang), Hui Xiang (stir-fried, 1 liang). Powdered, paste pills (walnut size). Take 50-90 pills with warm wine on empty stomach. Vinegar paste also acceptable.

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

Case: Li Xin Dao suffered deep-hidden pulses, headache, warm body, restlessness, cold fingers, chest fullness, nausea. Two physicians failed, using Qi-regulating herbs. Diagnosis: Hidden Yang within Yin. Not in Shang Han Lun. Hot herbs would be blocked by Yin, failing to guide True Yang; cold herbs would extinguish hidden True Fire. Must use herbs to break Yin and guide True Fire, raising Water and lowering Fire to induce sweat. Prescribed 200 pills taken cold salt water. Soon became manic/restless/four limbs agitated. Family alarmed. Explained as "changing Yang." Patient slept, sweated from dusk till dawn, cooled down, and recovered.

Dai Yuanli: Fan-Zao occurs in both Yin and Yang meridians. Yangming Stomach dry feces cause Fan, requiring purging; Taiyang post-sweat Fan uses Wu Ling San; Shaoyang Fan uses Xiao Chai Hu Tang. Yin Fan mostly in Shao Yin, from Yang entering Yin, causing Fan with diarrhea/thirst/insomnia, treated by Chen Sha Wu Ling San. If Yin pathogen attacks Yin meridian with vomiting/diarrhea/cold limbs/Fan, per Classic: Yang deficiency with Yin invasion causes Fan; Yin excess causing Zao (desire to sit in well) uses Wu Zhu Yu Tang. Severe cases use Si Ni Tang plus Cong Bai (scallion white). Additionally, Xu Fan (Deficiency Fan) occurs post-recovery during Yin-Yang non-restoration with fever/Fan, treated by Zhu Ye Shi Gao Tang. Phlegm causing restless sleep uses Wen Dan Tang. Vomiting uses Ju Pi Tang.