【纲】仲景曰。发汗吐下后。虚烦不得眠。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。
【目】许叔微曰。虚烦者。心中郁郁而烦也。若止云烦者。为表热及邪热传里。故有胸中烦。心
中烦。虚烦之别。故凡烦皆热。以栀豉汤随症治之。所以涌去其热也。
柯琴曰。栀豉汤。本为治烦躁设。又可治虚烦。以此知阳明之虚与太阳之虚不同。阳明之烦与
太阳之烦有别矣。
【纲】仲景曰。下后更烦。按之心下濡者。为虚烦也。宜栀子豉汤。病患手足厥冷。脉乍紧者。
邪结在胸中。心下满而烦。饥不能食者。病在胸中。当吐之。宜瓜蒂散。
【目】张云岐曰。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。此二条均是烦也。药均是吐也。而有轻重之不同。汗吐下后邪气乘虚而入为烦者。谓之
虚烦。栀豉汤。是吐剂之轻者。不因汗吐下邪结胸中则为膈实。瓜蒂散。是吐剂之重者。
柯琴曰。更烦。是既烦而复烦也。要知阳明虚烦。对胃家实热而言。是空虚之虚。不是虚弱之虚。
二条。是寒结胸中之脉症。心下者。胃口也。满者。胃气逆。烦者。胃气盛也。
【纲】仲景曰。伤寒医以丸药大下之。身热不去。微烦者。栀子干姜汤主之。伤寒下后。心烦
腹满。起卧不安者。栀子浓朴汤主之。
【目】成无己曰。此二条与前发汗吐下后一条。皆是因吐下发汗而烦者。皆为内陷之烦。故俱用
取吐法。以涌去其
热。其有不经吐下发汗而烦者。则又是传经之热。不作膈实者也。如少阳症心烦喜呕。或胸中烦而
不呕。小柴胡汤。少阴病二三日。心中烦不得卧者。黄连阿胶汤。少阴病胸满心烦者。猪肤汤。是
皆用和解法而彻去其热者也。
【纲】仲景曰。伤寒二三日。心中悸而烦者。宜小建中汤。
【目】成无己曰。阳明病。不吐不下。心烦者。烦之热者也。此心中悸而烦。烦之虚者也。以
悸为虚。悸甚而烦。故亦为虚也。若少阳之邪入腑者。烦而悸。则又为热。大抵先烦而悸者是为热。
先悸而烦者是为虚也。
【总纲】张仲景说：经过发汗、催吐或泻下治疗后，出现心中空虚烦乱、无法入睡的症状。如果病情严重，必然会出现翻来覆去、坐卧不安，以及心中郁闷懊恼的感觉。此时应使用栀子豉汤进行治疗。
如果伴有气短症状的，使用栀子甘草豉汤治疗。如果伴有呕吐症状的，使用栀子生姜豉汤治疗。
【详论】许叔微说：所谓的“虚烦”，是指心中郁郁不乐且感到烦闷。如果只说“烦”，可能是因为表热或者邪热传入体内，因此有胸中烦、心中烦和虚烦的区别。所以凡是烦症都属热证，应根据具体症状用栀豉汤治疗，以此来涌吐去除体内的热邪。
柯琴说：栀豉汤原本是为治疗烦躁而设的，也可以用来治疗虚烦。由此可知，阳明病的虚与太阳病的虚是不同的，阳明病的烦与太阳病的烦也是有区别的。
【总纲】张仲景说：经过泻下治疗后，烦扰症状反而加重，按压心下部感觉柔软的，属于虚烦。适宜使用栀子豉汤。如果患者手足冰冷，脉搏突然变得紧实，这是邪气结聚在胸中，导致心下部胀满且烦扰，虽然饥饿却无法进食，病位在胸中，应当采用涌吐法治疗。适宜使用瓜蒂散。
【详论】张云岐说：虚烦的表现是，心中温热不适想要呕吐，精神昏乱无可奈何，想吐又吐不出来，内心扰乱不安，这就叫做“烦”。如果不通过涌吐的方法，症状就不能消除。这两条条文都是讲烦症，用药都属于涌吐剂，但有轻重之分。在发汗、催吐或泻下后，邪气乘虚而入导致的烦，称为虚烦。栀豉汤是涌吐剂中较轻的一类；如果不是因为发汗、催吐或泻下，而是邪气结聚在胸中形成的膈实，瓜蒂散则是涌吐剂中较重的一类。
柯琴说：“更烦”，是指已经烦过之后再次出现烦扰。要知道，阳明病的虚烦，是相对于胃家实热而言的，这里的“虚”是指空虚之虚，而不是虚弱之虚。这两条条文描述的是寒邪结聚在胸中的脉象和症状。“心下”指的是胃脘部，“满”是因为胃气上逆，“烦”是因为胃气亢盛。
【总纲】张仲景说：伤寒病两三天后，医生误用丸药猛烈泻下，导致身体发热不退，且有轻微烦扰症状的，使用栀子干姜汤治疗。伤寒经过泻下治疗后，出现心烦、腹部胀满，坐卧不安的，使用栀子厚朴汤治疗。
【详论】成无己说：这两条条文与前文提到的发汗、催吐、泻下后出现的烦症，都是因为吐下或发汗导致邪气内陷引起的烦，所以都采用涌吐法，以涌出方式去除热邪。那些没有经过吐下或发汗而出现的烦，则是传经而来的热邪，并不形成膈实。例如少阳病证见心烦喜呕，或者胸中烦而不呕，用小柴胡汤；少阴病发病两三天，心中烦乱无法躺卧的，用黄连阿胶汤；少阴病出现胸满心烦的，用猪肤汤。这些都是采用和解法来清除热邪。
【总纲】张仲景说：伤寒病两三天后，心中悸动且伴有烦扰症状的，适宜使用小建中汤。
【详论】成无己说：阳明病，如果没有经过催吐或泻下而出现心烦，这是由热引起的烦。而这里所说的“心中悸动且烦”，是由虚引起的烦。因为心悸属于虚证，心悸严重时引发烦，所以这也属于虚证。如果是少阳病的邪气传入腑脏，出现烦伴随心悸，那又是热证。大体来说，先出现烦而后出现心悸的，属于热证；先出现心悸而后出现烦的，属于虚证。
[General Principles] Zhang Zhongjing stated: After undergoing sweating, emesis, or purgation therapies, if the patient experiences empty irritability (Xu Fan) and insomnia. In severe cases, this manifests as restlessness with tossing and turning, accompanied by a sensation of depression and remorse in the chest (Xin Zhong Ao Nao). The Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) should be administered.
If shortness of breath is present, the Zhi Zi Gan Cao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) should be used. If vomiting is present, the Zhi Zi Sheng Jiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction) should be used.
[Detailed Discussion] Xu Shuwei stated: "Empty irritability" refers to a state of inner depression and irritability. If one simply says "irritability," it may result from exterior heat or pathogenic heat transmitting inward; thus, there are distinctions between irritability in the chest (Xiong Zhong Fan), irritability in the heart (Xin Zhong Fan), and empty irritability (Xu Fan). Therefore, all forms of irritability are related to heat. The Zhi Chi Tang (Gardenia and Fermented Soybean Decoction) should be prescribed according to specific symptoms to induce emesis and expel the heat.
Ke Qin stated: The Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) was originally designed to treat irritability and restlessness (Fan Zao), but it can also treat empty irritability (Xu Fan). This indicates that "deficiency" in Yangming disease differs from "deficiency" in Taiyang disease, and irritability in Yangming disease differs from that in Taiyang disease.
[General Principles] Zhang Zhongjing stated: After purgation, if irritability worsens and palpation of the epigastrium reveals softness, this constitutes empty irritability (Xu Fan). The Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate. If the patient presents with cold extremities and a pulse that suddenly becomes tight, this indicates pathogenic factors knotting in the chest. Symptoms include fullness and irritability in the epigastrium, hunger without desire to eat, indicating the disease is located in the chest. Emesis should be induced. The Gua Di San (Melon Seed Powder) is indicated.
[Detailed Discussion] Zhang Yunqi stated: The manifestation of empty irritability includes a warm discomfort in the chest with a desire to vomit, mental confusion and helplessness, a desire to vomit without actually doing so, and internal disturbance. This is termed "irritability." Without inducing emesis, the condition cannot resolve. Both preceding clauses discuss irritability and utilize emetic agents, though they differ in severity. When pathogenic factors enter due to deficiency following sweating, emesis, or purgation, resulting in irritability, it is called empty irritability (Xu Fan). The Zhi Chi Tang (Gardenia and Fermented Soybean Decoction) is a mild emetic. If pathogenic factors knot in the chest causing diaphragmatic excess (Ge Shi) not due to prior sweating, emesis, or purgation, the Gua Di San (Melon Seed Powder) is a heavy emetic.
Ke Qin stated: "More irritability" means irritability recurring after having already been present. It must be understood that Yangming empty irritability (Yangming Xu Fan) is contrasted with stomach excess heat (Wei Jia Shi Re); here, "empty" refers to emptiness rather than weakness. These two clauses describe the pulse and symptoms of cold knotting in the chest. The "epigastrium" (Xin Xia) refers to the stomach region. "Fullness" results from rebellious stomach Qi, and "irritability" results from excessive stomach Qi.
[General Principles] Zhang Zhongjing stated: In Shanghan (Cold Damage) disease lasting two to three days, if a physician mistakenly uses pill-based strong purgatives, leading to persistent body heat and slight irritability, the Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction) should be administered. If, after purgation for Shanghan, the patient presents with irritability, abdominal fullness, and inability to lie still or sit comfortably, the Zhi Zi Hou Po Tang (Gardenia and Magnolia Bark Decoction) should be administered.
[Detailed Discussion] Cheng Wuji stated: These two clauses, along with the previous clause regarding irritability after sweating, emesis, or purgation, all involve irritability caused by pathogenic factors sinking inward due to these therapies. Therefore, emetic methods are employed to expel heat via emesis. Irritability arising without prior sweating, emesis, or purgation is due to heat transmitting through meridians and does not form diaphragmatic excess. For example, Shaoyang syndrome presenting with irritability and frequent belching/vomiting, or chest irritability without vomiting, is treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). In Shaoyin disease, if after two to three days there is heart irritability and inability to sleep, Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is used. If Shaoyin disease presents with chest fullness and irritability, Zhu Fu Tang (Pig Skin Decoction) is used. All these employ harmonizing methods to eliminate heat.
[General Principles] Zhang Zhongjing stated: In Shanghan disease lasting two to three days, if the patient experiences palpitations and irritability, the Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is appropriate.
[Detailed Discussion] Cheng Wuji stated: In Yangming disease, if irritability occurs without prior emesis or purgation, it is heat-induced irritability. However, "palpitations with irritability" described here is deficiency-induced irritability. Since palpitation indicates deficiency, severe palpitation leading to irritability also indicates deficiency. If Shaoyang pathogenic factors transmit to the fu organs, causing irritability with palpitation, this is heat-induced. Generally, irritability preceding palpitation indicates heat, whereas palpitation preceding irritability indicates deficiency.