烦躁有阴阳表里四条，按烦与躁，同一烦闷不宁也。身大热，脉浮大，有表症，无汗而烦，
名曰烦热，宜发汗。身不大热，脉沉数，无表症，汗多而烦，名曰烦躁，宜清里。另有不发
热，脉沉迟，口不消水而烦者，名曰阴躁，用温里。夫烦热，表症；烦躁，里症；阴躁，阴
症。是以烦躁，宜分表里阴阳。若太阳中风，汗出而烦躁，脉反浮紧，发热恶寒，身疼痛，
此太阳经营卫两伤之烦躁，大青龙汤主之。若身痛无汗，脉浮紧，身大热而烦，此太阳经寒
伤营之烦躁也，冬月北方，用麻黄汤，三时南方，用羌活汤。若发热有汗而烦，脉浮缓，此
太阳经风伤卫之烦躁也，冬月北方，用桂枝汤，三时用防风汤。若汗出不解而烦，渴欲饮
水，小便不利，此太阳经热结膀胱之烦躁也，北方用五苓散，南方羌活木通汤。若发热无汗而
烦，目痛鼻干，脉长浮洪，此阳明表症烦躁也，冬月葛根汤，三时升麻干葛汤。若有汗而烦，
脉洪而数，口渴消水，此阳明里症烦躁也，白虎汤。若表邪尽散，脉沉而数，有下症而烦者，
承气汤。若寒热呕而口苦，脉弦而烦者，此少阳半表半里烦躁也，小柴胡汤合栀子豆豉汤。
若腹胀便闭，有汗而烦躁，此少阳有下症烦躁也，大柴胡汤下之。又有积热内结，外不大
热，手足反冷，脉沉而数，口渴饮水，时有汗出而烦者，宜用清里。又有表邪伏于经络，中
焦凝滞，表热不能外发，遍身反冷，脉反沉伏而烦热，宜用升散。总之，有汗之烦躁，里症
也，宜清热；无汗之烦躁，表症也，宜散表；脉浮之烦躁，表症也，宜散表；脉伏之烦躁，
伏邪也，宜升提；沉数之烦躁，里热也，宜清热；沉迟之烦躁，里寒也，宜温经；杂症烦躁，
另具大方条内。
太阳篇曰∶伤寒欲自解者，必先烦，乃有汗而解，何以知之？脉浮，故知汗出解。
此首揭伤寒表症，若欲作汗，必先见烦热躁闷，呻吟不宁之候。何以知之？以浮脉见烦，
故知汗出而解。
太阳病，初服桂枝汤，反烦不解者，先刺风池，风府，却与桂枝汤则愈。
太阳中风，当用桂枝解肌。今服后反烦者，太阳之邪充塞肌窍，刺风池、风府，泄其所郁
之热，再与桂枝，则愈矣。
中风发热，六七日不解而烦，有表里症，渴欲饮水，水入即吐者，名曰水逆。五苓散主之。
多服暖水，汗出愈。
此条即太阳热结膀胱之烦。详注发热。
太阳脉浮动数，头痛发热，微盗汗出，反恶寒者，表未解也。医反下之，动数变迟，膈内拒
痛，短气躁烦，心中懊 ，阳气内陷，心下因硬，则为结胸。大陷胸汤主之。
此条言表邪未解，误下变结胸，当用结胸法。
结胸症具烦躁者，即死。
结胸症见烦躁，则内水将竭矣，下之则死，不下亦死。
伤寒发汗，解半日许复烦，脉浮数者，可更发汗，宜桂枝汤。
发汗后，只解得半日许，又复烦，脉又浮数，不可更行麻黄，用桂枝汤解肌发汗。伤寒下
后，心烦腹满，卧起不安者，栀子浓朴汤主之。
烦而腹不满，表症也；腹满不烦，里症也。既烦且满，虽经下后，邪在半表半里，故以栀
子去烦，浓朴泄满。
伤寒医以丸药大下之，身热不去，微烦者，栀子干姜汤主之。
大下，过下也，肠胃因寒，用栀子去烦，加干姜以暖中。
下之后，复发汗，昼日烦躁不得眠，夜而安静，不呕不渴，无表症，脉沉微，身无大热者，
干姜附子汤主之。
昼夜烦躁，乃是阳症。今以汗下后，夜则安静，且不呕不渴，外无表症，脉又沉微，身无
大热，此本是阳症，因汗下太过，故用温中之药。
太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁者，大青龙汤主之。
太阳中风症，又见浮紧伤寒脉，发热恶寒，身疼痛，不汗出烦躁之伤寒症，故用大青龙
汤，双解营卫之邪。
太阳病脉浮紧，无汗发热，身疼痛，八九日不解，表症仍在，此当发其汗。服药已微除，其
人发烦热，目瞑，剧者必衄，衄乃解。所以然者，阳气重故也。麻黄汤主之。
麻黄汤主之一句，在当发其汗下看，从前诸注，皆误也。详注衄血条内。
服桂枝汤，大汗出后，大烦渴不解，脉洪大者，白虎汤主之。
伤寒无大热，口燥渴，心烦，背恶寒者，白虎加人参汤主之。
二条详注口渴。重在烦，故用白虎。
太阳病，若吐若下，若发汗微烦，小便数，大便因硬者，与小承气汤和之愈。
此条详注大便硬。
病患不大便六七日，绕脐痛，烦躁发作有时者，此有燥屎，故使不大便也。
一派下症，不立下法，而大承气汤在矣。
得病二三日，脉弱无太阳柴胡症，烦躁心下硬至四五日，虽能食，以小承气汤少少微和之，
令小安，与承气汤一升。若不大便六七日，小便少者，虽不能食，但初头硬，后必溏，未定
成硬，攻之必溏。须小便利，屎定硬，乃可攻之，宜大承气汤。
脉不浮紧，非表脉，无太阳少阳表症，见烦躁心下硬，明表解而为里热烦躁矣。详注大便结内。
阳明病，不吐不下心烦者，可与调胃承气汤。
言阳明病，无太阳少阳表症，不吐不下，未曾伤其肠胃。若有心烦，是里热，调胃承气汤可与。
伤寒六七日，无大热，其人烦躁者，此为阳去入阴故也。
六七日传里之时，身无大热，表邪已解，其人反烦躁，则阳邪传入于里，宜用清里之法。
栀子干姜汤
栀子 干姜
阳症烦躁用栀子，阴症发躁用干姜。今因本是阳症，宜清不宜下，反误下之，身热不去而
微烦，故以二味合用。仲景常以一味解表药，一味清里药，和解表里之邪。今以化出一味
寒药，一味热药，和解冷热不调误下后之身热心烦，极开化方用药之妙悟。
栀子浓朴汤 即清气汤。
栀子 浓朴 枳实 小便不利，加木通，大便结，有下症，加大黄。
栀子豆豉汤，治心烦懊 ，腹不满，重在懊 ，此方去豆豉，加浓朴、枳实，治心烦、腹
满，不懊 ，重在腹满。观此二方加减治烦，全在懊 腹满二症上分别，因此悟得仲景治
寒伤营，无汗烦躁，用麻黄汤，风伤卫，有汗烦躁，用桂枝汤，营卫两伤之烦躁，用大青
龙汤；热结膀胱，小便不利之烦躁，用五苓散；膈内拒痛，结胸烦躁，用大陷胸汤；大汗
出烦渴，背恶寒，用白虎汤；无表症烦躁，心下硬，用大承气；阳症误下变阴，身热不去
之微烦，用冷热各半之栀子干姜汤；下后复发汗，昼日烦躁，夜则安静，身无热之亡阳
症，用干姜附子汤。要知表症烦躁，当汗之；里症烦躁，当清之；邪在半表半里，当和解
之，有表复有里当双解之；阴躁致烦，温之灸之。推而广之，凡治病当如是也。
大青龙汤
麻黄 桂枝 甘草 杏仁 生姜 石膏 大枣
桂枝汤，治风伤卫之轻症，仲景之轻方也。麻黄汤，治寒伤营之重症，仲景之重方。其大
青龙汤，恐麻黄汤太峻，故加大枣、生姜，补养胃气；加石膏，制麻、桂辛温。以烦躁
之症，忌用温热，此变麻黄汤重方，而为稍轻之剂，后代皆注此方太峻，似乎反重于麻黄
汤，千古差谬。
桂枝汤 见恶寒。
羌活汤 见发热。
防风汤 见身痛。
五苓散 见小便不利。
羌独木通汤 见发热。
葛根汤 见似疟。
升麻干葛汤
升麻 干葛 白芍药 甘草
阳明表邪烦躁，难用原方葛根汤辛温，以此方治之。若无汗恶寒，加羌活、防风，去白
芍；胸前饱闷，加枳壳、桔梗；烦渴消水，加知母、石膏。
白虎汤 见潮热。
承气汤 见潮热。
烦躁有属于阴、阳、表、里四种情况，按烦与躁来看，都是同一类烦闷不宁的症状。身体大热，脉象浮大，有表证，无汗而烦，名叫烦热，适宜用发汗法。身体不大热，脉象沉数，没有表证，出汗多而烦，名叫烦躁，适宜清里热。另有不发热的，脉象沉迟，口不渴水而烦的，名叫阴躁，用温里法。所谓烦热，是表证；烦躁，是里证；阴躁，是阴证。因此对于烦躁，应当区分表里阴阳。如果是太阳中风证，出汗而烦躁，脉象反而浮紧，发热恶寒，身体疼痛，这是太阳经营卫两伤的烦躁，用大青龙汤主治。如果身体疼痛无汗，脉象浮紧，身体大热而烦，这是太阳经寒伤营的烦躁，冬季北方，用麻黄汤，其他三个季节南方，用羌活汤。如果发热有汗而烦，脉象浮缓，这是太阳经风伤卫的烦躁，冬季北方，用桂枝汤，其他三个季节用防风汤。如果出汗后病不解而烦，口渴想喝水，小便不利，这是太阳经热结膀胱的烦躁，北方用五苓散，南方用羌活木通汤。如果发热无汗而烦，眼睛痛鼻子干，脉象长浮洪，这是阳明表证烦躁，冬季用葛根汤，其他三个季节用升麻干葛汤。如果有汗而烦，脉象洪大而数，口渴喝水，这是阳明里证烦躁，用白虎汤。如果表邪完全消散，脉象沉而数，有下证而烦的，用承气汤。如果寒热呕吐且口苦，脉弦而烦的，这是少阳半表半里烦躁，用小柴胡汤合栀子豆豉汤。如果腹胀便秘，有汗而烦躁，这是少阳有下证烦躁，用大柴胡汤攻下。又有积热内结，外表不大热，手脚反而冷，脉象沉而数，口渴饮水，偶尔出汗而烦的，适宜用清里法。又有表邪伏在经络，中焦凝滞，表热不能向外发散，全身反而冷，脉象反而沉伏而烦热的，适宜用升散法。总之，有汗的烦躁，是里证，适宜清热；无汗的烦躁，是表证，适宜解表；脉浮的烦躁，是表证，适宜解表；脉伏的烦躁，是伏邪，适宜升提；沉数的烦躁，是里热，适宜清热；沉迟的烦躁，是里寒，适宜温经；杂症烦躁，另在大方条内叙述。
太阳篇说：伤寒想要自行解除的，必定先出现烦，然后才有汗出而解，怎么知道呢？因为脉浮，所以知道汗出而解。这是首先揭示伤寒表证，如果想要作汗，必定先见到烦热躁闷、呻吟不宁的征候。怎么知道呢？因为见浮脉而有烦，所以知道汗出而解。
太阳病，初服桂枝汤，反而烦闷不解的，先针刺风池穴、风府穴，然后再给予桂枝汤就会痊愈。
太阳中风，应当用桂枝汤解肌。现在服药后反而烦的，是太阳之邪充塞肌窍，针刺风池、风府，泄去所郁积的热，再给予桂枝汤，就会痊愈。
中风发热，六七天不愈而烦，有表里证，口渴想喝水，水喝进去就吐的，名叫水逆。用五苓散主治。多喝暖水，出汗就好了。
太阳脉浮动数，头痛发热，微微盗汗，反而恶寒的，是表证未解。医生反而用下法，脉动数变为迟，膈内拒痛，短气躁烦，心中懊恼，阳气内陷，心下因而硬，就成为结胸。用大陷胸汤主治。
结胸证见到烦躁，则体内津液将枯竭了，用下法会死，不下也会死。
伤寒发汗，过了半天左右又烦，脉象浮数的，可以再发汗，适宜用桂枝汤。
发汗后，只解了一半天左右，又复烦，脉又浮数，不可再用麻黄汤，应用桂枝汤解肌发汗。伤寒下之后，心烦腹满，卧起不安的，用栀子厚朴汤主治。
烦而腹部不满，是表证；腹满而不烦，是里证。既烦且满，虽然经过下法，邪气在半表半里，所以用栀子去除烦，厚朴泄除满。
伤寒医生用丸药大力攻下，身热不去，微烦的，用栀子干姜汤主治。
下之后，又发汗，白天烦躁不得眠，夜间安静，不呕不渴，无表证，脉沉微，身体没有大热的，用干姜附子汤主治。
昼夜烦躁，本是阳证。现在因为汗下之后，夜间则安静，且不呕不渴，外无表证，脉又沉微，身体无大热，这本来是阳证，因为汗下太过，所以用温中的药。
太阳中风，脉浮紧，发热恶寒，身体疼痛，不出汗而烦躁的，用大青龙汤主治。
太阳中风证，又见浮紧的伤寒脉，发热恶寒，身体疼痛，不出汗烦躁的伤寒证，所以用大青龙汤，双解营卫之邪。
太阳病脉浮紧，无汗发热，身体疼痛，八九天不愈，表证仍在，这应当发其汗。服药后症状轻微减轻，其人发烦热，闭目，严重的必定鼻衄，衄血后才解。之所以这样，是因为阳气重的缘故。用麻黄汤主治。
“麻黄汤主之”一句，应放在“当发其汗”之下看，从前的各种注释，都错了。详细注解在衄血条内。
太阳病，如果用吐法或用下法，或者发汗微烦，小便频数，大便因此变硬的，给小承气汤调和即可痊愈。
这一条详细注解在大便硬条下。
病人不大便六七天，绕脐痛，烦躁发作有定时的，这是有燥屎，所以导致不大便。
一派下证，不立下法，但大承气汤已在其中了。
得病二三天，脉弱无太阳、柴胡证，烦躁心下硬直到四五天，虽然能吃饭，用小承气汤少量微微调和它，让它稍微安宁，给承气汤一升。如果不大便六七天，小便少的，虽然不能吃饭，但初头硬，后必溏，未定成硬，攻之必溏。必须小便利，屎定硬，才可以攻之，宜用大承气汤。
脉不浮紧，不是表脉，无太阳、少阳表证，见烦躁心下硬，明显示表解而为里热烦躁了。详细注解在大便结内。
说阳明病，无太阳、少阳表证，不吐不下，未曾损伤其肠胃。若有心烦，是里热，调胃承气汤可给予。
六七天传里的时期，身无大热，表邪已解，其人反烦躁，则阳邪传入于里，适宜用清里法。
栀子干姜汤
栀子 干姜
阳证烦躁用栀子，阴证发躁用干姜。现在因为本是阳证，宜清不宜下，反而误下，身热不去而微烦，所以用这两味合用。仲景常用一味解表药，一味清里药，和解表里之邪。现在化出一味寒药，一味热药，和解冷热不调误下后的身热心烦，极开化方用药之妙悟。
栀子厚朴汤 即清气汤。
栀子 厚朴 枳实 小便不利，加木通，大便结，有下证，加大黄。
栀子豉汤，治心烦懊憹，腹不满，重在懊憹，此方去掉豆豉，加厚朴、枳实，治心烦、腹满，不懊憹，重在腹满。观此二方加减治烦，全在懊憹、腹满二症上分别，因此悟得仲景治寒伤营，无汗烦躁，用麻黄汤，风伤卫，有汗烦躁，用桂枝汤，营卫两伤的烦躁，用大青龙汤；热结膀胱，小便不利的烦躁，用五苓散；膈内拒痛，结胸烦躁，用大陷胸汤；大汗出烦渴，背恶寒，用白虎汤；无表证烦躁，心下硬，用大承气；阳证误下变阴，身热不去的微烦，用冷热各半的栀子干姜汤；下后复发汗，昼日烦躁，夜则安静，身无热的亡阳症，用干姜附子汤。要知道表证烦躁，当汗之；里证烦躁，当清之；邪在半表半里，当和解之，有表复有里当双解之；阴躁致烦，温之灸之。推而广之，凡治病当如是也。
大青龙汤
麻黄 桂枝 甘草 杏仁 生姜 石膏 大枣
桂枝汤，治风伤卫的轻症，是仲景的轻方。麻黄汤，治寒伤营的重症，是仲景的重方。那大青龙汤，恐怕麻黄汤太峻烈，所以加大枣、生姜，补养胃气；加石膏，制约麻黄、桂枝的辛温。因为烦躁之症，忌用温热，这是变麻黄汤重方，而为稍轻的剂，后代都注解说此方太峻烈，似乎反而重于麻黄汤，千古差谬。
桂枝汤 见恶寒条。
羌活汤 见发热条。
防风汤 见身痛条。
五苓散 见小便不利条。
羌独木通汤 见发热条。
葛根汤 见似疟条。
升麻干葛汤
升麻 干葛 白芍药 甘草
阳明表邪烦躁，难用原方葛根汤辛温，以此方治之。若无汗恶寒，加羌活、防风，去白芍；胸前饱闷，加枳壳、桔梗；烦渴消水，加知母、石膏。
Irritability and restlessness fall into four categories: Yin, Yang, Exterior, and Interior. Analyzing "Fan" (irritability) and "Zao" (restlessness), they are essentially the same state of mental agitation and discomfort. If the body is very hot, the pulse is floating and large, there are exterior symptoms, no sweating, and irritability, it is called "Fan Re" (Heat with Irritability), and diaphoresis (sweating method) is indicated. If the body is not very hot, the pulse is deep and rapid, there are no exterior symptoms, excessive sweating occurs with irritability, it is called "Fan Zao" (Irritability and Restlessness), and clearing the interior is indicated. In cases without fever, with a deep and slow pulse, thirst for water absent but irritability present, it is called "Yin Zao" (Yin Restlessness), and warming the interior is indicated. Thus, Fan Re is an exterior syndrome; Fan Zao is an interior syndrome; Yin Zao is a Yin syndrome. Therefore, Fan Zao must be differentiated by Exterior/Interior and Yin/Yang.
If it is Taiyang Wind Strike syndrome, with sweating and irritability, but the pulse is surprisingly floating and tight, accompanied by fever, aversion to cold, and body pain, this is irritability due to injury of both Ying (Nutrient) and Wei (Defensive) in the Taiyang channel, treated with Da Qing Long Tang (Major Blue Dragon Decoction). If there is body pain, no sweating, a floating and tight pulse, high fever, and irritability, this is irritability due to Cold injuring Ying in the Taiyang channel. In winter or northern regions, Ma Huang Tang (Ephedra Decoction) is used; in other seasons or southern regions, Qiang Huo Tang (Notopterygium Decoction) is used. If there is fever, sweating, and irritability with a floating and moderate pulse, this is irritability due to Wind injuring Wei in the Taiyang channel. In winter or northern regions, Gui Zhi Tang (Cinnamon Twig Decoction) is used; in other seasons, Fang Feng Tang (Saposhnikovia Decoction) is used. If sweating does not resolve the condition, leading to irritability, thirst for water, and difficult urination, this is irritability due to Heat binding in the Bladder in the Taiyang channel. In northern regions, Wu Ling San (Five-Ingredient Powder with Poria) is used; in southern regions, Qiang Huo Mu Tong Tang (Notopterygium and Akebia Decoction) is used. If there is fever, no sweating, irritability, eye pain, dry nose, and a long, floating, and surging pulse, this is Yangming exterior syndrome irritability. In winter, Ge Gen Tang (Kudzu Decoction) is used; in other seasons, Sheng Ma Gan Ge Tang (Cimicifuga and Kudzu Decoction) is used. If there is sweating, irritability, a surging and rapid pulse, and thirst for water, this is Yangming interior syndrome irritability, treated with Bai Hu Tang (White Tiger Decoction). If exterior pathogens have completely dispersed, the pulse is deep and rapid, there are purgative indications with irritability, Cheng Qi Tang (Order the Qi Decoction) is used. If there is alternating chills and fever, vomiting, bitter taste in the mouth, a wiry pulse, and irritability, this is Shaoyang half-exterior/half-interior irritability, treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). If there is abdominal distension and constipation, sweating, and irritability, this is Shaoyang irritability with interior excess, treated with Da Chai Hu Tang (Major Bupleurum Decoction) via purgation.
In cases of accumulated heat binding internally, with little external heat, cold hands and feet, a deep and rapid pulse, thirst for water, occasional sweating, and irritability, clearing the interior is indicated. In cases where exterior pathogens lie latent in the collaterals, causing stagnation in the Middle Jiao, preventing exterior heat from venting, resulting in whole-body coldness, a surprisingly deep and hidden pulse, and heat with irritability, lifting and dispersing methods are indicated. In summary: Irritability with sweating indicates an interior syndrome, requiring heat-clearing; irritability without sweating indicates an exterior syndrome, requiring exterior-dispersing; a floating pulse with irritability indicates an exterior syndrome, requiring exterior-dispersing; a hidden pulse with irritability indicates latent pathogens, requiring lifting; a deep and rapid pulse with irritability indicates interior heat, requiring heat-clearing; a deep and slow pulse with irritability indicates interior cold, requiring meridian-warming; irritability in miscellaneous diseases is detailed elsewhere.
The Taiyang Chapter states: When Shaoyang disease resolves spontaneously, it must first manifest irritability, followed by sweating and resolution. How do we know this? Because the pulse is floating, we know sweating will lead to resolution. This initially reveals Taiyang exterior syndromes; if sweat is about to form, one must first see signs of heat with irritability, restlessness, groaning, and agitation. How do we know? Seeing a floating pulse with irritability indicates resolution through sweating.
In Taiyang disease, if after taking Gui Zhi Tang (Cinnamon Twig Decoction) irritability worsens or persists, first puncture Feng Chi (GB20) and Feng Fu (GV16), then administer Gui Zhi Tang again for cure.
Taiyang Wind Strike should be treated with Gui Zhi Tang to release the muscle layer. If irritability arises after administration, it is because Taiyang pathogens obstruct the skin pores. Puncturing Feng Chi and Feng Fu vents the stagnant heat; subsequently administering Gui Zhi Tang leads to recovery.
Wind strike with fever persisting for six or seven days without resolution, accompanied by irritability, exterior and interior symptoms, thirst for water, and vomiting immediately after drinking, is named Shui Ni (Water Rebellion). It is treated with Wu Ling San (Five-Ingredient Powder with Poria). Drinking warm water promotes sweating and cure.
This clause refers to irritability from Taiyang Heat binding in the Bladder. See detailed notes under Fever.
If the Taiyang pulse is floating, moving, and rapid, with headache, fever, slight night sweats, and paradoxical aversion to cold, the exterior is unresolved. If a physician erroneously applies purgation, the moving/rapid pulse becomes slow, epigastric pain resisting pressure occurs, shortness of breath, irritability, and inner vexation (Ao Nao) arise. Yang Qi sinks inward, the epigastrium becomes hard, resulting in Jie Xiong (Chest Binding). Da Xian Xiong Tang (Major Sinking Chest Decoction) is indicated.
This clause explains that when exterior pathogens are unresolved, erroneous purgation transforms the condition into Jie Xiong; thus, Jie Xiong treatment methods apply.
If Jie Xiong symptoms are accompanied by irritability and restlessness, death ensues.
If Jie Xiong presents with irritability, internal fluids are nearly exhausted. Purging causes death; not purging also causes death.
After Shaoyang diaphoresis, if irritability returns after half a day with a floating and rapid pulse, diaphoresis may be repeated, preferably with Gui Zhi Tang (Cinnamon Twig Decoction).
After diaphoresis, if symptoms resolve only partially for half a day and irritability returns with a floating and rapid pulse, Ma Huang Tang (Ephedra Decoction) should not be used again; instead, Gui Zhi Tang should be used to release the muscle layer and induce sweating. After purgation in Shaoyang, if there is irritability, abdominal fullness, and restlessness (lying down and getting up uncomfortably), Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction) is indicated.
Irritability without abdominal fullness indicates an exterior syndrome; abdominal fullness without irritability indicates an interior syndrome. With both irritability and fullness, even after purgation, the pathogen remains at the half-exterior/half-interior level. Therefore, Zhi Zi clears irritability, and Hou Po drains fullness.
If a physician uses pill-based strong purgatives in Shaoyang, leaving residual body heat and mild irritability, Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction) is indicated.
"Strong purgation" implies over-purgation, causing cold in the intestines and stomach. Zhi Zi clears irritability, while Gan Jiang warms the middle.
After purgation followed by diaphoresis, if there is daytime irritability preventing sleep, nighttime quietness, no vomiting or thirst, no exterior symptoms, a deep and faint pulse, and no significant body heat, Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction) is indicated.
Day-and-night irritability is typically a Yang syndrome. However, post-diaphoresis/purgation, with nighttime quietness, no vomiting/thirst, no exterior symptoms, a deep/faint pulse, and no significant heat, this was originally a Yang syndrome but became so due to excessive sweating and purging. Thus, warming middle herbs are used.
In Taiyang Wind Strike, if the pulse is floating and tight, with fever, aversion to cold, body pain, no sweating, and irritability, Da Qing Long Tang (Major Blue Dragon Decoction) is indicated.
When Taiyang Wind Strike symptoms coincide with a floating/tight Shaoyang pulse, fever, aversion to cold, body pain, no sweating, and irritability, Da Qing Long Tang is used to simultaneously resolve Ying and Wei pathogens.
In Taiyang disease, if the pulse is floating and tight, with no sweating, fever, and body pain persisting for eight to nine days without resolution, and exterior symptoms remain, diaphoresis is indicated. After medication, symptoms may slightly improve, but the patient develops irritability, heat, and closed eyes. Severe cases may experience nasal bleeding (Nu), which leads to resolution. This occurs because Yang Qi is heavy. Ma Huang Tang (Ephedra Decoction) is indicated.
The phrase "Ma Huang Tang is indicated" should be read under "should induce sweating." Previous commentaries are mistaken. See detailed notes under Nasal Bleeding.
After taking Gui Zhi Tang, if massive sweating occurs leading to severe irritability, unquenchable thirst, and a surging pulse, Bai Hu Tang (White Tiger Decoction) is indicated.
In Shaoyang with no significant body heat, dry mouth/throat, irritability, and aversion to cold on the back, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is indicated.
These two clauses are detailed under Thirst. The focus is on irritability, hence the use of Bai Hu Tang.
In Taiyang disease, if emesis, purgation, or mild diaphoresis leads to irritability, frequent urination, and consequent hard stool, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is given to harmonize and cure.
See detailed notes under Hard Stool.
If a patient has not had a bowel movement for six to seven days, experiences periumbilical pain, and has periodic episodes of irritability, this indicates Dry Stool (Zao Shi) causing the constipation.
Although all signs point to purgation, the text does not explicitly state the method, yet Da Cheng Qi Tang (Major Order the Qi Decoction) is implied.
Two to three days after onset, if the pulse is weak, lacking Taiyang or Chai Hu symptoms, and progressing to irritability and epigastric hardness by day four or five, even if the patient can eat, Xiao Cheng Qi Tang should be given in small amounts to mildly harmonize and provide slight relief, administering one sheng of Cheng Qi Tang. If there is no bowel movement for six to seven days and urine output is low, even if the patient cannot eat, if the stool is hard at the beginning but loose later, it is not yet definitively hard; purging will cause looseness. Only when urine is clear and stool is definitively hard should purgation be applied, using Da Cheng Qi Tang.
A pulse that is not floating/tight is not an exterior pulse. Lacking Taiyang/ShaoYang exterior symptoms, the presence of irritability and epigastric hardness clearly indicates resolved exterior and interior heat irritability. See detailed notes under Hard Bowel Movement.
In Yangming disease, if there is irritability without prior emesis or purgation, Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) may be given.
This states that in Yangming disease, lacking Taiyang/ShaoYang exterior symptoms and having undergone no emesis/purgation (thus gastrointestinal integrity is intact), if irritability arises, it indicates interior heat, warranting Tiao Wei Cheng Qi Tang.
In Shaoyang, after six or seven days, with no significant body heat but patient irritability, this indicates the transition from Yang to Yin.
During the six-to-seven-day period of transmission to the interior, absence of significant body heat indicates resolved exterior pathogens. Recurrent irritability suggests Yang pathogens have entered the interior, requiring interior-clearing methods.
Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction)
Ingredients: Zhi Zi (Gardeniae Fructus), Gan Jiang (Zingiberis Rhizoma).
For Yang syndrome irritability, Zhi Zi is used; for Yin syndrome restlessness, Gan Jiang is used. Here, originally a Yang syndrome requiring clearing rather than purging, erroneous purgation caused persistent heat and mild irritability. Hence, these two are combined. Zhang Zhongjing often paired one exterior-releasing herb with one interior-clearing herb to harmonize exterior and interior. Here, a cold herb and a hot herb are paired to harmonize the heat/cold imbalance and residual heat/irritability following erroneous purgation, demonstrating profound insight into formula modification.
Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction), also known as Qing Qi Tang.
Ingredients: Zhi Zi, Hou Po (Magnoliae Officinalis Cortex), Zhi Shi (Aurantii Fructus). Add Mu Tong (Akebiae Caulis) for difficult urination; add Da Huang (Rhei Radix et Rhizoma) for hard bowels with purgative indications.
Zhi Zi Chi Tang treats irritability and Ao Nao (inner vexation) without abdominal fullness, focusing on Ao Nao. Removing Chi (Fermented Soybeans) and adding Hou Po and Zhi Shi treats irritability and abdominal fullness without Ao Nao, focusing on fullness. Observing the modifications of these two formulas for treating irritability reveals differentiation based on Ao Nao versus abdominal fullness. From this, we understand Zhang Zhongjing’s approach: Cold injuring Ying with no sweating/irritability uses Ma Huang Tang; Wind injuring Wei with sweating/irritability uses Gui Zhi Tang; Ying/Wei dual injury with irritability uses Da Qing Long Tang; Heat binding in Bladder with difficult urination/irritability uses Wu Ling San; Epigastric pain resisting pressure/Jie Xiong with irritability uses Da Xian Xiong Tang; Massive sweating/irritability/thirst/back aversion to cold uses Bai Hu Tang; No exterior symptoms/irritability/epigastric hardness uses Da Cheng Qi Tang; Yang syndrome erroneously purged transforming to Yin with persistent heat/mild irritability uses Zhi Zi Gan Jiang Tang (half cold/half hot); Post-purgation/diaphoresis/daytime irritability/nighttime quietness/no heat/Yang collapse uses Gan Jiang Fu Zi Tang. One must know: Exterior irritability requires diaphoresis; Interior irritability requires clearing; Half-exterior/half-interior pathogens require harmonizing; Exterior with concurrent Interior requires simultaneous resolution; Yin restlessness causing irritability requires warming and moxibustion. Extending this principle, all treatments should follow such logic.
Da Qing Long Tang (Major Blue Dragon Decoction)
Ingredients: Ma Huang (Ephedrae Herba), Gui Zhi (Cinnamomi Ramulus), Gan Cao (Glycyrrhizae Radix et Rhizoma), Xing Ren (Armeniacae Semen Amarum), Sheng Jiang (Zingiberis Rhizoma Recens), Shi Gao (Gypsi Fibrosus), Da Zao (Jujubae Fructus).
Gui Zhi Tang treats mild Wind injuring Wei, a light formula of Zhang Zhongjing. Ma Huang Tang treats severe Cold injuring Ying, a heavy formula. Da Qing Long Tang, fearing Ma Huang Tang is too harsh, adds Da Zao and Sheng Jiang to nourish Stomach Qi, and Shi Gao to restrain the acrid-warm nature of Ma Huang and Gui Zhi. Since irritability contraindicates warm-hot herbs, this modifies the heavy Ma Huang Tang into a milder preparation. Later commentators mistakenly claimed this formula is too harsh, heavier than Ma Huang Tang, a千古 (eternal) error.
Gui Zhi Tang (Cinnamon Twig Decoction) - See Aversion to Cold.
Qiang Huo Tang (Notopterygium Decoction) - See Fever.
Fang Feng Tang (Saposhnikovia Decoction) - See Body Pain.
Wu Ling San (Five-Ingredient Powder with Poria) - See Difficult Urination.
Qiang Du Mu Tong Tang - See Fever.
Ge Gen Tang (Kudzu Decoction) - See Malaria-like Symptoms.
Sheng Ma Gan Ge Tang (Cimicifuga and Kudzu Decoction)
Ingredients: Sheng Ma (Cimicifugae Rhizoma), Gan Ge (Puerariae Radix), Bai Shao Yao (Paeoniae Radix Alba), Gan Cao (Glycyrrhizae Radix et Rhizoma).
For Yangming exterior irritability, the original acrid-warm Ge Gen Tang is unsuitable; this formula is used instead. If no sweating/aversion to cold, add Qiang Huo and Fang Feng, remove Bai Shao Yao; if chest/stomach fullness, add Zhi Ke (Aurantii Fructus) and Jie Geng (Platycodonis Radix); if irritability/thirst for water, add Zhi Mu (Anemarrhenae Rhizoma) and Shi Gao.
Bai Hu Tang (White Tiger Decoction) - See Tidal Fever.
Cheng Qi Tang (Order the Qi Decoction) - See Tidal Fever.