伤寒烦热。何以明之。烦者热也。与发热若同而异也。发热者。怫怫然发于肌表。有
时而已者是也。烦者为烦而热。无时而歇者是也。二者均是表热。而烦热为热所
烦。非若发热而时发时止也。故谓之烦热。经曰病患烦热。汗出则解。又曰。发汗已
解。半日许复烦。脉浮数者。再与桂枝汤。又曰。服桂枝汤。反烦不解者。先刺风池风
府。却与桂枝汤则愈。即此观之。烦为表热明矣。故又有烦疼。即是热疼。又有烦渴。
即是热渴也。以烦为热。又何疑焉。至于胸中烦。心中烦。内虚烦。须皆以烦为热。设
伤寒至六七日。手足三部脉皆至。大烦而口噤不能言。其人躁扰者。与脉和大烦。
目重睑内际黄者。又皆为欲解。所以言大烦者。以肌表大热。则是邪热欲去。泄达
于外也。故为欲解。内经曰。谨熟阴阳。以意调之。
伤寒虚烦。何以明之。虚烦者。心中郁郁而烦也。有胸中烦。有心中烦。有虚烦。诸如
此者。皆热也。若止云烦者。表热也。及其邪热传里。故有胸中烦。心中烦。虚烦之别。
三者要在观其热所从来。审其虚实而治。为不同也。如不经发汗吐下而烦者。则
是传经之热。不作膈实者。但多和解而已。故经曰。心烦喜呕。或胸中烦而不呕者。
小柴胡汤主之。少阴病二三日。心中烦不得卧者。黄连阿胶汤主之。少阴病。胸满
心烦者。猪肤汤主之。是皆利解而彻热者也。若因吐下发汗后而烦者。则是内陷
之烦。但多涌吐而已。发汗吐下后。虚剧不得眠。若剧者必反复颠倒。心中懊 者。
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。心烦
腹满。卧起不安者。栀子浓朴汤主之。丸药大下后。身热不去。微烦者。栀子干姜汤
主之。是皆取其吐而涌其热者也。虚烦之状。心中温温然欲吐。愦愦然无奈。欲呕
不呕。扰扰乱乱。是名烦也。非吐则不能已。经曰。下利后更烦。按之心下濡者。为虚
烦也。宜栀子豉汤。脉乍结。心中满而烦。饥不能食者。病在胸中。瓜蒂散。二者症均
是烦也。药均是吐也。而又轻重之不同。吐下发汗后。邪气乘虚而入为烦者。则谓
之虚烦。与栀子豉汤。则是吐剂之轻者。不因吐下发汗后。邪气结于胸中。则为膈
实。与瓜蒂散。则是吐剂之重者。又阳明病。不吐不下心烦者。则是烦之实者也。与
调胃承气汤下之。伤寒二三日。心中悸而烦者。则是烦之虚者也。与小建中汤补
之。烦为热也。悸而复烦为虚者。以悸为虚。悸甚而烦。故为虚也。少阳之邪入腑者。
烦而悸。则为热也。大抵先烦而悸者。是为热也。先悸而烦者。是为虚也。内经曰。治
病必先求其本。诚哉是言也。
伤寒烦热。如何阐明？烦，就是热。它与发热看似相同实则不同。发热，是热气怫郁发于肌表，有时发作有时停止的病症。烦热，则是既烦闷又发热，没有间歇时刻都在持续的病症。两者都属于表热，但烦热是被热邪所困扰，不像发热那样时发时止。所以称之为烦热。医经说：病人出现烦热，出汗后就会缓解。又说：发汗后病证似乎解除了，过了半天左右又出现烦热，脉象浮数的，再给予桂枝汤治疗。又说：服用桂枝汤后，反而烦热不解的，先针刺风池穴和风府穴，然后再给予桂枝汤就能痊愈。由此看来，烦属于表热是明确的了。所以又有“烦疼”，就是热痛；又有“烦渴”，就是热渴。把烦归结为热，又有什么可疑的呢？至于胸中烦、心中烦、内虚烦，都需要以烦为热来理解。假设伤寒到了六七天，手三阴三阳、足三阴三阳三部脉象都显现出来，出现大烦闷且口噤不能说话，其人躁动不安的，如果脉象和缓而大烦，以及眼睑内侧发黄者，也都属于将要解除病证的征兆。之所以说大烦，是因为肌表大热，这是邪热想要离去，向外宣泄达出的表现。所以说是将要解除。《内经》说：仔细熟习阴阳理论，凭心意去调治它。
伤寒虚烦。如何阐明？虚烦，是指心中郁郁不乐而感到烦闷。有胸中烦，有心中烦，有虚烦，像这样的情况，都是热证。如果只是说“烦”，那是表热。等到邪热传入里部，所以有胸中烦、心中烦、虚烦的区别。这三者的关键在于观察热邪从哪里来，审察其虚实性质然后进行治疗，因此治疗方法各不相同。比如没有经过发汗、催吐、泻下而出现的烦，那就是传经的热邪，并没有形成膈实（胸膈间痰食结聚），大多只需要和解即可。所以医经说：心烦且喜欢呕吐，或者胸中烦但不呕吐的，用小柴胡汤主治。少阴病两三天，心中烦闷不能安卧的，用黄连阿胶汤主治。少阴病，胸满心烦的，用猪肤汤主治。这些都是通过利湿清热而彻除热邪的方法。如果是因催吐、泻下、发汗之后出现的烦，那就是内陷之烦，大多需要用涌吐法治疗。发汗、催吐、泻下之后，虚损严重导致无法入睡，如果严重的必定翻来覆去，心中懊恼郁闷的，用栀子豉汤主治。如果气短的，用栀子甘草豉汤主治。如果呕吐的，用栀子生姜豉汤主治。心烦且腹部胀满，躺下坐起都不安稳的，用栀子厚朴汤主治。误用丸药猛烈泻下后，身热不退，轻微烦闷的，用栀子干姜汤主治。这些都是取其涌吐作用以涌出热邪的方法。虚烦的症状，心中温温然想吐，昏沉无奈，想吐又吐不出来，扰扰乱乱，这就叫作烦。不是用吐法就不能停止。医经说：下利之后更加烦闷，按压心下部柔软的，这就是虚烦。适宜用栀子豉汤。脉象突然结滞，心中胀满且烦闷，饥饿但不能进食的，病位在胸中，用瓜蒂散。这两种症状虽然都是烦，用药虽然都是吐剂，但又有轻重的不同。在催吐、泻下、发汗之后，邪气乘虚而入导致的烦，就称为虚烦，给予栀子豉汤，这是吐剂中较轻的。不因催吐、泻下、发汗之后，邪气结聚在胸中，就成为膈实，给予瓜蒂散，这是吐剂中较重的。另外阳明病，没有经过催吐、泻下却心烦的，这是烦的实证，用调胃承气汤攻下它。伤寒二三天，心中悸动且烦闷的，这是烦的虚证，用小建中汤补益它。烦属于热证。悸动后又出现烦闷且属于虚证的，是因为悸动属于虚，悸动严重进而导致烦闷，所以属于虚证。少阳的邪气传入腑，烦闷且悸动，这属于热证。大抵先出现烦闷而后悸动的，是为热证；先出现悸动而后烦闷的，是为虚证。《内经》说：治病必须先探求根本。这话真是正确啊。
Shanghan Fanre (Vexation-Heat in Cold Damage). How shall this be elucidated? "Fan" (vexation) refers to heat. It appears similar to "Fare" (fever) but differs essentially. "Fare" (fever) is characterized by heat stagnating and erupting at the muscle-surface, occurring intermittently. "Fanre" (vexation-heat) involves both vexation and heat, persisting without cessation. Both are exterior heat syndromes, yet "Fanre" implies being troubled by heat, unlike fever which comes and goes. Hence it is termed "Fanre". The Classics state: "When patients suffer from vexation-heat, sweating leads to resolution." It also states: "After sweating, if symptoms seem resolved, but half a day later vexation recurs with a floating and rapid pulse, administer Guizhi Tang (Cinnamon Twig Decoction) again." Furthermore: "If after taking Guizhi Tang, vexation persists and does not resolve, first puncture Fengchi (GB20) and Fengfu (GV16), then administer Guizhi Tang (Cinnamon Twig Decoction) for recovery." From this, it is clear that vexation indicates exterior heat. Thus, there is also "Fan Teng" (vexatious pain), which is heat-pain; and "Fan Ke" (vexatious thirst), which is heat-thirst. Regarding vexation as heat, what doubt remains? As for vexation in the chest, vexation in the heart, and internal empty vexation, all must be understood as heat. Suppose cold damage progresses to the sixth or seventh day, and pulses in the three positions of hand and foot are all palpable, presenting with severe vexation, locked jaw, inability to speak, and restlessness; if the pulse is harmonious and large, along with yellow discoloration at the inner canthus of the eyelids, these are signs of impending resolution. The reason for severe vexation here is excessive heat at the muscle-surface, indicating that pathogenic heat is attempting to exit and vent outward. Hence, it signifies resolution. The *Neijing* states: "Mastery of Yin and Yang allows one to regulate through intent."
Shanghan Xufan (Empty Vexation in Cold Damage). How shall this be elucidated? "Xufan" (empty vexation) refers to a feeling of depression and vexation in the heart. There is vexation in the chest, vexation in the heart, and empty vexation; such cases all involve heat. If merely stated as "vexation," it is exterior heat. When pathogenic heat transmits inward, distinctions arise between chest vexation, heart vexation, and empty vexation. The key lies in observing the origin of the heat and assessing deficiency or excess to determine treatment, hence methods differ. For instance, vexation arising without prior sweating, vomiting, or purging indicates heat transmitted via meridians, without forming "Ge Shi" (diaphragmatic excess/stagnation); such cases generally require harmonizing treatments. The Classics state: "For heart vexation with frequent vomiting, or chest vexation without vomiting, Xiao Chaihu Tang (Minor Bupleurum Decoction) is indicated." For Shaoyin disease lasting two to three days, with heart vexation and insomnia, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is indicated. For Shaoyin disease with chest fullness and heart vexation, Zhufu Tang (Pig Skin Decoction) is indicated. These all employ methods to benefit fluid metabolism and thoroughly clear heat. Conversely, vexation arising after vomiting, purging, or sweating indicates internalized vexation, typically treated with emetic methods. After sweating, vomiting, or purging, if deficiency is severe leading to insomnia, or if severe cases involve tossing and turning with profound mental discomfort ("Ao Nao"), Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. If Qi is deficient, Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is used. If vomiting occurs, Zhizi Shengjiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction) is used. For heart vexation with abdominal fullness and restlessness in lying or sitting, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is used. After mistaken aggressive purging with pill medicines, if body heat persists with mild vexation, Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) is used. These all utilize emetic properties to vent heat. The manifestation of empty vexation includes a warm sensation in the heart prompting nausea, a sense of helplessness, desire to vomit without success, and chaotic disturbance; this is called vexation. Only emesis can resolve it. The Classics state: "After diarrhea, if vexation worsens and the epigastrium is soft upon palpation, it is empty vexation, suitable for Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction)." If the pulse suddenly knotted, with chest fullness, vexation, hunger but inability to eat, the pathology is in the chest, treated with Gouti San (Melon Trichosanthes Powder). Although both conditions present with vexation and use emetics, they differ in severity. Vexation caused by pathogenic qi entering due to deficiency after vomiting, purging, or sweating is termed "Xufan" (empty vexation); Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is given, representing a mild emetic. If not following vomiting/purging/sweating, but pathogenic qi stagnates in the chest forming "Ge Shi" (diaphragmatic excess), Gouti San (Melon Trichosanthes Powder) is given, representing a strong emetic. Additionally, in Yangming disease, if vexation occurs without vomiting or purging, it is an excess type of vexation, treated with Tiaowei Chengqi Tang (Regulating the Stomach and Harmonizing the Bowel Decoction) via purgation. In cold damage, if within two to three days there is heart palpitation with vexation, it is a deficiency type of vexation, treated with Xiaojianzhong Tang (Minor Construct the Middle Decoction) via tonification. Vexation belongs to heat. Palpitation followed by vexation indicating deficiency arises because palpitation itself denotes deficiency; severe palpitation leading to vexation thus indicates deficiency. When Shaoyang pathogenic factors enter the Fu organs, causing vexation and palpitation, it is heat. Generally, vexation preceding palpitation indicates heat; palpitation preceding vexation indicates deficiency. The *Neijing* states: "In treating disease, one must first seek the root." This statement is indeed true.