（合参准绳金鉴来苏集）
金鉴云。身为热动而不安。谓之躁。心为热扰而不宁。谓之烦。烦扰于内。躁动于外也。
邵评∶躁则身体扰动。有形可见。旁人知之。烦则心中懊 。外无见象。惟病患自
知。故烦扰于内而病轻。躁动于外而病重。
独烦不躁者。属热。独躁不烦者。属寒。烦躁同见。在太阳属热。在少阴属寒。
邵评∶烦为阳而出于心。躁属阴而出于肾。
烦主心。躁主肾。烦属阳。躁属阴。
烦者心中烦乱不宁。欲起不安。欲睡不稳之状。即反复颠倒。心中懊 之证也。
邵评∶邪火内扰则烦。脘中愦愦无奈。懊恼难过。欲吐不得吐。欲眠不得眠。心烦
意乱。不能自主。病患自知其苦。外无形象可见也。
如火踞心包。上焦不清而烦者。左寸脉必躁动。舌燥尖红。当以栀子豉汤。加川连、
翘心、淡竹叶、钩藤钩之类主之。
邵评∶火热从肺卫而传心包。邪在上焦清虚之部。故烦乱不安。左寸主心包脉
位。邪盛则躁动。舌燥尖红。邪火伏于膈间。逼近心包。而津液受灼也。用栀子豉
汤以除膈间之邪。加味以清心包之火。此治邪伏膈中。火逼心包而烦之正法。
大汗后虚烦者。竹叶石膏汤主之。兼痰者。温胆汤加减。
邵评∶汗后正虚。邪火留伏。故心虚烦。用此汤养正生津。而化邪热。若兼有痰者。
涤痰化邪。此治汗后正虚。邪伏而烦之正法。
虚烦不得眠。脉虚细。宜养心。十味温胆汤及酸枣仁汤之类。
邵评∶病后心虚气弱。痰热留伏胆经。故虚烦不得眠。治以养正清心。宣泄肝胆
痰热伏邪。此方治心虚气弱。痰火留伏肝胆而烦之正法。
有表证。不得汗而烦者。取汗即愈。若不得汗。心中烦闷不安。恐有痧疹。须细察之。以上五条论烦。
邵评∶表有邪而不得汗。气郁而烦闷。汗出则气通。邪达而烦愈。如发汗而不得汗。
心中烦闷转增者。此邪伏不宣。欲发痧疹之兆。当留心细察之。
躁者。身体手足躁扰。或裸体不欲近衣。或欲坐卧水中。此阴极发躁。为外热内寒。
病属少阴。其舌不拘何色。必胖大娇嫩。其脉必细数躁动。或洪大而空。或手足厥
冷。六脉沉微。古人用四逆理中等汤冷服。不若八味饮或参附熟地浓煎冷服。
邵评∶阴火上浮则躁。其症倏起倏卧。一刻不安。扬手掷足。揭去衣被。躁扰不宁。
烦乱如狂。此等形症。旁人皆得见之。非比心烦之不外显也。此阴寒极盛。阳不
附阴而上越。阴火外浮。真元欲脱之兆。病在少阴。故躁属于肾也。此阴盛格阳。
阳浮欲散。故古人用四逆理中等方以回阳。冷服以开其拒格。令人阴亦不充。
故宜六味滋阴。桂附回阳。此治阴盛格阳。虚阳浮越而发躁之正法。
若少阴烦躁同见。口渴唇燥。舌紫而干。脉细而数。手足微厥。躁扰不宁者。又当滋
少阴之阴。左归固本之类主之。
邵评∶此水亏火旺。水不得制火而烦躁。较上条阴盛格阳阴极发躁之症似轻。
上条滋阴回阳。此是壮水制火。
凡心烦懊 不得眠。不与躁同见者。均非虚寒。当作热治。大便不秘者。只以栀子
豉汤、竹叶石膏汤、温胆汤主治。无论三法前。三法后。皆可用也。
邵评∶但烦而不躁。懊 不眠。此是阳经热邪。而非虚寒症也。若大便不秘。其邪热在于
膈间。未入胃腑。宜清上中二焦无形之热。邪清则烦自止矣。此治阳经
热邪但烦不躁之正法。
若烦躁同见。太阳有不得汗出而烦躁。大青龙症是也。少阴有吐利手足厥冷之
烦躁。四逆辈症是也。又有误下复汗之烦躁。昼不得眠。夜则安静。干姜附子汤主之是也。
邵评∶太阳风寒。表间无汗。阳热内扰而烦躁。此阳盛也。大青龙、麻桂以发汗。石
膏以清热除烦也。若少阴病。上吐下利。手足厥冷而烦躁。此阴虚阳浮。不相交恋。欲外亡也。四逆以
回阳。参苓以滋阴。下后复汗。汗出而里阳将脱。故烦躁也。昼不得眠。阳虚而邪据也。夜则安静、
阴不虚也。独任干姜、附子二味。以急回其阳。可知烦躁同见。有阳经阴经之各殊。虚实表里之不同。
若独躁不烦。而同三阴症见。便是阴寒之躁。宜四逆理中等汤主治。然烦躁见于
三阳者多生。见于三阴者多死。
邵评∶躁本属阴。独躁不烦。且同三阴症见。是纯阴无阳之候。非大剂温中扶阳
不可。若烦躁见于三阳。阳经热实。邪退自安。故多生。见于三阴。阴竭阳浮散脱之象。故多死。
（综合参考《准绳》、《医宗金鉴》、《来苏集》）
《医宗金鉴》说：身体发热躁动而不安，称为“躁”；心中受热邪干扰而不宁静，称为“烦”。烦是扰乱于内，躁是动扰于外。
邵评注：躁表现为身体扰动，有具体的形态可见，旁人能够知晓；烦则是心中懊恼不宁，外部没有明显的征象，只有患者自己知道。所以，烦扰于内病情较轻，躁动于外病情较重。
单独出现烦而没有躁的，属于热证；单独出现躁而没有烦的，属于寒证。烦和躁同时出现，在太阳病阶段属于热证，在少阴病阶段属于寒证。
烦是指心中烦乱不宁，想要起身却不安稳，想要睡觉却睡不实的样子，即反复颠倒、心中懊恼的症状。
邵评注：邪火在内干扰导致烦，胃脘部昏闷无奈，懊恼难受，想吐吐不出来，想睡睡不着，心烦意乱，不能自主控制。患者自知其痛苦，但外部没有形象可见。
如果是火热之邪占据心包，上焦不清爽而导致烦的，左寸脉必然躁动，舌燥且舌尖红，应当用栀子豉汤，加黄连、连翘心、淡竹叶、钩藤等药物为主治疗。
邵评注：火热之邪从肺卫传入心包，邪气位于上焦清虚的部位，所以烦乱不安。左寸主心包的脉位，邪气盛则脉躁动，舌燥尖红，说明邪火伏于膈间，逼近心包，灼伤津液。使用栀子豉汤以清除膈间的邪气，加味以清泄心包之火。这是治疗邪气伏于膻中，火逼心包导致烦的正治法。
大汗之后出现虚烦的，用竹叶石膏汤主治。兼有痰湿的，用温胆汤加减治疗。
邵评注：发汗后正气虚弱，邪火留伏体内，所以心虚而烦。使用此汤滋养正气、生津液，从而化解邪热。如果兼有痰湿，则涤除痰浊、化解邪气。这是治疗汗后正气虚弱、邪气留伏导致烦的正治法。
虚烦导致无法入睡，脉象虚细的，适宜养心，可用十味温胆汤及酸枣仁汤之类。
邵评注：病后心虚气弱，痰热留伏于胆经，所以虚烦不得眠。治疗以扶正清心，宣泄肝胆痰热伏邪为主。此方是治疗心虚气弱、痰火留伏肝胆导致烦的正治法。
有表证，因无法出汗而导致烦的，取汗即可痊愈。如果无法出汗，心中烦闷不安，恐怕有痧疹，必须仔细察辨。以上五条论述“烦”。
邵评注：体表有邪气而无法出汗，气机郁滞而烦闷，汗出则气机通畅，邪气外达而烦愈。如果发汗后仍无法出汗，心中烦闷反而加重，这是邪气伏留不得宣发的征兆，欲发痧疹，应当留心仔细察辨。
躁的表现是身体手足躁扰，或者裸露身体不想靠近衣物，或者想要坐在卧在水中。这是阴极发躁，表现为外热内寒，病属少阴。其舌色不拘泥于何种颜色，必定胖大娇嫩，脉象必定细数躁动，或者洪大而中空，或者手足厥冷，六脉沉微。古人用四逆汤、理中汤等方剂冷服，不如用八味丸或人参附子熟地浓煎后冷服。
邵评注：阴火上浮导致躁，症状突然发作又突然停止，一刻也不安宁，扬手掷足，掀去衣被，躁扰不宁，烦乱如狂。这些形症旁人都能看见，不像心烦那样不外显。这是阴寒极盛，阳气不依附于阴而向上浮越，阴火外浮，真元即将脱失的征兆。病在少阴，所以躁归属于肾。这是阴盛格阳，阳气浮散欲脱，所以古人用四逆汤、理中汤等方回阳，冷服以开通拒格。让人阴气也不充盈，所以宜用六味地黄丸滋阴，桂枝、附子回阳。这是治疗阴盛格阳、虚阳浮越而发躁的正治法。
如果少阴病烦躁同时出现，口渴唇燥，舌紫而干，脉细而数，手足微厥，躁扰不宁的，又应当滋补肾少阴之阴，用左归固本之类的主治。
邵评注：这是水亏火旺，水不能制约火而导致烦躁，比上一条阴盛格阳、阴极发躁的症状似乎较轻。上一条是滋阴回阳，这一条是壮水制火。
凡是心烦懊恼不得睡眠，不与躁同时出现的，均不属于虚寒，当作热证治疗。大便不秘结的，只用栀子豉汤、竹叶石膏汤、温胆汤主治。无论这三种方法之前还是之后，都可以使用。
邵评注：只烦而不躁，懊恼不眠，这是阳经的热邪，而不是虚寒症。如果大便不秘结，邪热位于膈间，未进入胃腑，适宜清泄上中二焦无形之热，邪热清除则烦自然停止。这是治疗阳经热邪、只烦不躁的正治法。
如果烦躁同时出现，太阳病有因无汗而出烦躁的，是大青龙汤证。少阴病有呕吐腹泻、手足厥冷的烦躁，是四逆汤类方证。又有误用下法后又发汗导致的烦躁，白天不能睡眠，夜间则安静，用干姜附子汤主治。
邵评注：太阳风寒，体表无汗，阳热内扰而烦躁，这是阳盛。用大青龙汤、麻黄汤、桂枝汤发汗，石膏清热除烦。若少阴病，上吐下利，手足厥冷而烦躁，这是阴虚阳浮，阴阳不相交恋，欲向外亡脱。用四逆汤回阳，人参、茯苓滋阴。下法后又发汗，汗出而里阳将脱，所以烦躁。白天不能睡眠，是阳虚而邪气占据；夜间安静，是因为阴不虚。独任干姜、附子两味药，以紧急回阳。可知烦躁同时出现，有阳经阴经的不同，虚实表里的差异。
如果单独躁而不烦，且与三阴病证同见，便是阴寒之躁，宜用四逆汤、理中汤主治。然而，烦躁见于三阳经的多能生还，见于三阴经的多死亡。
邵评注：躁本属阴，单独躁而不烦，且与三阴病证同见，是纯阴无阳的候象，非大剂量温中扶阳不可。若烦躁见于三阳经，阳经热实，邪气退去自然安宁，所以多能生还。见于三阴经，是阴竭阳浮散脱的象，所以多死亡。
(Comprehensive reference to *Zhunsheng*, *Yizong Jinjian*, and *Laosu Ji*)
*Yizong Jinjian* states: When the body is hot, restless, and uneasy, it is called "Zao" (restlessness/agitation); when the heart/mind is disturbed by heat pathogens and unsettled, it is called "Fan" (vexation/irritability). Fan refers to internal disturbance, while Zao refers to external agitation.
Shao's Commentary: Zao manifests as bodily restlessness with visible forms, which others can observe; Fan is characterized by internal vexation and unease without obvious external signs, known only to the patient. Therefore, Fan (internal disturbance) indicates a milder condition, while Zao (external agitation) indicates a more severe condition.
When Fan occurs alone without Zao, it belongs to Heat patterns; when Zao occurs alone without Fan, it belongs to Cold patterns. When Fan and Zao appear together, in Taiyang disease it belongs to Heat, whereas in Shaoyin disease it belongs to Cold.
Shao's Commentary: Fan is Yang and originates from the Heart; Zao is Yin and originates from the Kidney.
Fan primarily relates to the Heart, while Zao primarily relates to the Kidney. Fan is Yang, Zao is Yin.
Fan refers to a state of mental vexation and unrest, where one wishes to rise but feels uneasy, or wishes to sleep but cannot rest steadily. This corresponds to the syndrome of tossing and turning with internal vexation (*Ao Nao*).
Shao's Commentary: Internal disturbance by pathogenic fire causes Fan, resulting in a sense of suffocation and helplessness in the epigastrium, vexation and distress, inability to vomit despite the urge, and inability to sleep despite the desire for rest. The mind is chaotic and lacks autonomy. The patient knows their suffering, but there are no visible external manifestations.
If Fire-Heat occupies the Pericardium and fails to clear the Upper Jiao, causing Fan, the left Cun pulse will necessarily be restless and rapid, the tongue will be dry with a red tip. One should use *Zhizi Chi Tang* (Gardenia and Fermented Soybean Decoction), adding *Chuan Lian* (Coptis Rhizoma), *Qiao Xin* (Lonicerae Flos cor), *Dan Zhu Ye* (Lophatheri Herba), and *Gou Teng Gou* (Uncariae Ramulus cum Uncis), among others, as the primary treatment.
Shao's Commentary: Fire-Heat transmits from the Lung and Wei levels to the Pericardium. The pathogen resides in the clear and empty region of the Upper Jiao, causing vexation and unrest. The left Cun position governs the Pericardium pulse; when the pathogen is strong, the pulse becomes restless. Dryness of the tongue and redness of the tip indicate that pathogenic fire is latent in the diaphragm, approaching the Pericardium and scorching body fluids. Using *Zhizi Chi Tang* clears the pathogen from the diaphragm, while added herbs clear Fire from the Pericardium. This is the standard method for treating Fan caused by pathogen latent in the chest and Fire pressing on the Pericardium.
For deficiency-type Fan following profuse sweating, *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) is indicated. If accompanied by Phlegm, modify *Wendan Tang* (Warm the Gallbladder Decoction).
Shao's Commentary: After sweating, righteous Qi is deficient, and pathogenic fire remains latent, causing Heart deficiency and Fan. This decoction nourishes righteous Qi and generates fluids to transform pathogenic heat. If Phlegm is present, it eliminates Phlegm and transforms pathogens. This is the standard method for treating Fan due to post-sweat deficiency and latent pathogens.
For deficiency-type Fan preventing sleep, with a deficient and fine pulse, Heart nourishment is appropriate. Formulas such as *Shiwei Wendan Tang* (Ten-Ingredient Warm the Gallbladder Decoction) and *Suanzaoren Tang* (Ziziphus Seed Decoction) may be used.
Shao's Commentary: Post-illness Heart deficiency and Qi weakness lead to latent Phlegm-Heat in the Gallbladder channel, causing deficiency-type Fan and insomnia. Treatment focuses on supporting righteousness, clearing the Heart, and venting latent Phlegm-Heat from the Liver and Gallbladder. This formula is the standard method for treating Fan caused by Heart/Qi deficiency and latent Phlegm-Fire in the Liver/Gallbladder.
In cases with exterior syndromes where Fan arises from the inability to sweat, inducing sweating leads to recovery. If sweating does not occur and the patient experiences internal vexation and unease, one must carefully examine for potential *Sha Zhen* (scarlet fever/rash-like eruptions). The above five points discuss Fan.
Shao's Commentary: Exterior pathogens preventing sweating cause Qi stagnation and vexation. Sweating allows Qi to flow freely and pathogens to exit, resolving the Fan. If sweating fails and internal vexation worsens, this indicates latent pathogens failing to vent, a sign of impending rash eruption. Careful observation is required.
Zao manifests as restlessness of the body and limbs, nakedness with aversion to clothing, or a desire to sit or lie in water. This is "Extreme Yin generating Zao," characterized by external heat and internal cold, belonging to Shaoyin. The tongue color may vary but will typically be swollen, tender, and delicate. The pulse will be fine, rapid, and restless, or surging yet hollow. There may be cold extremities and deep, faint pulses throughout. Ancients used *Sini Tang* (Frigid Extremities Decoction) or *Lizhong Tang* (Regulate the Middle Decoction) taken cold. However, taking *Bawei Yin* (Eight-Ingredient Infusion) or a thick decoction of *Renshen* (Ginseng Radix), *Fuzi* (Aconiti Lateralis Radix Praeparata), and *Shudi Huang* (Rehmanniae Radix Preparata) taken cold is preferable.
Shao's Commentary: Floating Yin Fire causes Zao. Symptoms arise suddenly and subside, with constant unease, flailing limbs, removing blankets, and restless agitation resembling madness. These physical signs are visible to others, unlike internal Fan. This indicates extreme Yin Cold, with Yang failing to attach to Yin and floating upward, and True Yuan about to collapse. Since the disease is in Shaoyin, Zao is attributed to the Kidney. This is "Yin Excess repelling Yang," with Yang floating and scattering. Thus, ancients used *Sini* and *Lizhong* formulas to restore Yang, administered cold to overcome rejection. To prevent Yin depletion, one should use *Liujunzi* (Six-Ingredient) to nourish Yin and Gui/Zhi (Cinnamon Twig/Atractylodes) or Fu Zi to restore Yang. This is the standard method for treating Zao caused by Yin Excess repelling Yang and floating Deficient Yang.
If Shaoyin disease presents with both Fan and Zao, accompanied by thirst, dry lips, purple and dry tongue, fine and rapid pulse, and slightly cold extremities with restlessness, one should nourish the Yin of the Shaoyin Kidney. Formulas such as *Zuogui Gu Ben* (Restore the Left Solidify the Root) may be used.
Shao's Commentary: This represents Yin deficiency with Fire hyperactivity, where Yin fails to control Fire, causing Fan and Zao. It is milder than the previous case of Yin Excess repelling Yang and Extreme Yin generating Zao. The previous case involved nourishing Yin and restoring Yang; this case involves strengthening Water to control Fire.
Whenever Fan and vexation (*Ao Nao*) occur without sleep, but without accompanying Zao, it is not a deficiency-Cold pattern but should be treated as Heat. If stool is not constipated, treat primarily with *Zhizi Chi Tang*, *Zhuye Shigao Tang*, or *Wendan Tang*. These methods are applicable regardless of whether they precede or follow other treatments.
Shao's Commentary: Fan without Zao, with vexation and insomnia, indicates Heat pathogens in the Yang meridians, not deficiency-Cold. If stool is not constipated, the pathogenic heat is in the diaphragm, having not entered the Stomach fu-organ. It is appropriate to clear the formless Heat of the Upper and Middle Jiao; once the pathogen is cleared, Fan resolves. This is the standard method for treating Fan without Zao caused by Heat pathogens in the Yang meridians.
If Fan and Zao appear together: In Taiyang disease, Fan and Zao arising from anhidrosis (absence of sweating) correspond to the *Da Qing Long Tang* (Major Blue Green Dragon Decoction) syndrome. In Shaoyin disease, Fan and Zao accompanied by vomiting, diarrhea, and cold extremities correspond to *Sini Tang* category syndromes. Additionally, Fan and Zao resulting from erroneous purgation followed by sweating, where the patient cannot sleep during the day but is quiet at night, is treated with *Ganjiang Fuzi Tang* (Dried Ginger and Prepared Aconite Decoction).
Shao's Commentary: Taiwind-Cold with no sweating leads to internal disturbance by Yang Heat, causing Fan and Zao; this is Yang Excess. *Da Qing Long*, *Mahuang Tang*, and *Guizhi Tang* induce sweating, while *Shigao* (Gypsum) clears Heat and relieves Fan. In Shaoyin disease, vomiting, diarrhea, and cold extremities with Fan and Zao indicate Yin deficiency with Yang floating, failure of Yin and Yang to interact, and impending outward collapse. *Sini Tang* restores Yang, while *Renshen* and *Fuling* nourish Yin. Erroneous purgation followed by sweating depletes interior Yang, causing Fan. Daytime insomnia indicates Yang deficiency with pathogen occupancy; nighttime quietude indicates Yin is not deficient. Using only *Ganjiang* and *Fuzi urgently restores Yang. Thus, simultaneous Fan and Zao differ between Yang and Yin meridians, and in terms of deficiency/excess and interior/exterior.
If Zao occurs alone without Fan, and appears with Three-Yin syndromes, it is Zao due to Yin Cold, treated with *Sini Tang* or *Lizhong Tang*. Generally, Fan and Zao appearing in the Three-Yang meridians often result in survival, whereas those appearing in the Three-Yin meridians often result in death.
Shao's Commentary: Zao inherently belongs to Yin. Zao alone without Fan, combined with Three-Yin syndromes, indicates a pure Yin state without Yang, requiring large doses of warming the middle and supporting Yang. If Fan and Zao appear in the Three-Yang meridians, it indicates Yang meridian Heat excess; as the pathogen recedes, peace returns, hence high survival rates. Appearing in the Three-Yin meridians indicates exhaustion of Yin and floating/scattering of Yang, hence high mortality.