烦躁有表证,发热恶寒,体痛脉浮紧者,大青龙汤也。(方论见发热条。)
若发汗不彻,太阳证不罢,其人面赤,躁烦短气者,更发汗则愈。(论见短气。)
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,以小承气汤少少与微和之,令小
安。至六日,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。(王注云∶无太阳证为无表证也,无柴胡症为无半表半里
证也。)烦躁不大便,续脐痛,发作有时者,有燥屎也。下之后复发汗,日夜烦躁不得安,眠时安静,不呕不
渴,无表证,脉沉微,身无大热者,宜干姜附子汤。
干姜(一两) 附子(生用,一枚)
上二味,以水三升,煮取一升,去渣顿服。
〔海〕服姜附汤有二法∶一法当热服,手少阴心也,水包火,热服以接心火,身表寒盛,外火少也,寒从
外生,热从内消,譬如冻死,寒在外也;一法当寒服,足少阴肾也,寒邪入水,冷服以类肾水,身表微热,内
水多也,热从外生,寒从内消,譬如饮冷,寒在内也。
发汗若下之,病仍不解,烦躁者,宜茯苓四逆汤。
茯苓(一两) 人参(六钱) 附子(一枚,生用,去皮脐,作八片,只用二片) 甘草 干姜(各二钱)
上锉,如麻豆大。作一服,水一盏半,煎至八分,去渣温服。
烦躁心下硬,若未曾下者,即前条无太阳、柴胡症,以小承气少少微和之也。若已曾下,心下硬痛,
短气躁烦者,大陷胸也。若结胸证悉具,烦躁者死也。(方论见结胸。)
火逆下之,因烧针烦躁者,宜桂枝甘草龙骨牡蛎汤。
桂枝(去皮,半两) 甘草(炙) 牡蛎(熬) 龙骨(各一两)
上锉,如麻豆大。每服五钱,水一盏半,煎至八分,去渣温服。
太阳病,以火熏之不得汗,其人必躁。如不解必清血,名为火邪。
太阳病,火熨其背,大汗出,火热入胃,胃中水竭,躁烦,必发谵语,十余日振栗下利者,欲解也。
(论见谵语。)
烦躁厥逆,若吐利者,吴茱萸汤也。(论见吐利。)
若不烦而躁,四逆,脉不至,死也。(论见厥。)不得卧者,死也。(论见下利。)
〔成〕所谓烦躁者,谓先烦渐至躁也。所谓躁烦者,谓先发躁而迤逦复烦者也。从烦至躁为热,未有不渐
烦而躁者也。先躁后烦,谓怫怫然更作躁闷,此为阴盛隔阳也,虽大躁欲于泥水中卧,但饮水不得入口是也,
此气欲脱而争,譬如灯将灭而暴明也。盖内热曰烦,谓心中郁烦也;外热曰躁,谓气外热躁也。内热为有根之
火,故但烦不躁,及先烦后躁者,皆可治;外热为无根之火,故但躁不烦,及先躁后烦者,皆不可治也。脏厥
蛔厥烦躁。(方论见厥。)躁无暂定而厥者,为脏厥。静而复烦,吐虫而厥者,为蛔厥,乌梅丸主之。
(方论见厥。)热少厥微,不欲食,烦躁数日,小便白者,热除也,若欲食者愈,若厥而呕,胸胁烦满者,
便血。(论见厥。)少阴病,但欲寐不烦,至五六日变自利,烦躁不得卧者死。(论见欲寐。)
烦躁伴有表证,出现发热、恶寒、身体疼痛、脉象浮紧的,适用大青龙汤。(方剂论述见“发热”条目。)
如果发汗不彻底,太阳病证候未解除,患者面部发红、躁动不安、呼吸短促的,再次发汗即可痊愈。(论述见“短气”条目。)
患病二三日,脉象虚弱,没有太阳病和少阳病的症状,出现烦躁、胃脘部硬满,到了四五日虽然能进食,应少量给予小承气汤以轻微调和肠胃,使病情稍安。到了第六日,给予一升承气汤,如果大便不通,六七日小便少的,即使不能进食,但大便初头干硬,后必稀溏,尚未完全形成干硬粪便,攻下必然导致腹泻,必须等到小便通利、大便确定干硬后,才可以攻下,适宜使用大承气汤。(王冰注解说:没有太阳病证就是没有表证,没有少阳病证就是没有半表半里证。)烦躁且不大便,持续脐腹部疼痛,发作有定时的,是有燥屎内结。攻下之后又发汗,日夜烦躁不得安宁,睡眠时安静,不呕吐、不口渴、无表证、脉象沉微、身体没有大热的,适宜使用干姜附子汤。
以上两味药,用水三升,煮取一升,去渣一次性服用。
〔海藏〕服用姜附汤有两种方法:一种方法是热服,对应手少阴心经,水包火,热服可以接续心火,体表寒气盛,外火不足,寒气从外而生,热气从内消亡,就像冻死的人,寒气在体外;另一种方法是冷服,对应足少阴肾经,寒邪侵入水中,冷服可以类比肾水,体表微热,体内水气多,热气从外而生,寒气从内消亡,就像喝冷饮,寒气在体内。
茯苓(一两) 人参(六钱) 附子(一枚,生用,去皮脐,切成八片,只用其中两片) 甘草 干姜(各二钱)
以上药物切碎,如麻豆大小。作为一服药,用水一盏半,煎至八分,去渣温服。
烦躁且胃脘部硬满,如果未曾攻下的,就是前条所述无太阳、少阳病证,用小承气汤少量轻微调和肠胃。如果已经攻下过,胃脘部硬痛、呼吸短促、烦躁的,是大陷胸汤证。如果结胸证的诸症全部具备,出现烦躁的,预后不良,属死证。(方剂论述见“结胸”条目。)
因火法误治而攻下,又因烧针导致烦躁的,适宜使用桂枝甘草龙骨牡蛎汤。
以上药物切碎,如麻豆大小。每次服用五钱,用水一盏半,煎至八分,去渣温服。
太阳病,用火熏法治疗却未能出汗,患者必定躁动。如果病不解,必然出现便血,这称为火邪。
太阳病,用火熨背部,大汗出,火热之邪入胃,胃中津液枯竭,出现躁烦,必然发生谵语,十余日后出现战栗并下利的,是病情欲解的表现。(论述见“谵语”条目。)
烦躁伴四肢厥冷,如果有呕吐下利的,适用吴茱萸汤。(论述见“吐利”条目。)
如果不烦躁只是躁动,四肢厥冷,脉搏摸不到,属死证。(论述见“厥”条目。)不能卧睡的,属死证。(论述见“下利”条目。)
〔成无己〕所谓烦躁,是指先烦逐渐发展到躁。所谓躁烦,是指先发躁随后又转为烦。从烦到躁属于热证,没有不先烦而后躁的。先躁后烦,是指怫郁不舒、反复躁闷,这是阴盛格阳所致,虽然极度躁动想要躺在泥水中,但饮水却无法入口,这是正气欲脱而抗争,就像灯将灭时突然变亮一样。一般来说,体内的热称为烦,指心中郁结烦乱;体表的躁动称为躁,指气息外越而躁动。体内的热是有根之火,所以仅烦不躁,以及先烦后躁的,都可以治疗;体表的躁是无根之火,所以仅躁不烦,以及先躁后烦的,都不可治疗。脏厥和蛔厥都会出现烦躁。(方剂论述见“厥”条目。)躁动没有暂时缓解且伴有四肢厥冷的,称为脏厥。安静后又出现烦躁,吐出蛔虫且伴有四肢厥冷的,称为蛔厥,主方为乌梅丸。(方剂论述见“厥”条目。)热势轻浅、厥冷轻微、不想进食、烦躁数日、小便色白的,说明热已除,如果想进食则病愈,如果厥冷且呕吐、胸胁烦满的,会出现便血。(论述见“厥”条目。)少阴病,只想睡觉且不烦躁,到了五六天变为自利,烦躁不能卧睡的,属死证。(论述见“欲寐”条目。)
Fan Zao (Restlessness and Irritability) accompanied by exterior syndrome, presenting with fever, aversion to cold, body pain, and a floating-tight pulse, is treated with Da Qing Long Tang (Major Blue Green Dragon Decoction). (The discussion on the formula can be found under the entry "Fever".)
If sweating therapy was incomplete and the Tai Yang syndrome (Tai Yang disease) has not resolved, and the patient presents with a red face, restlessness, irritability, and shortness of breath, further sweating therapy will lead to recovery. (The discussion can be found under the entry "Shortness of Breath".)
After two or three days of illness, if the pulse is weak, and there are no signs of Tai Yang syndrome or Shao Yang syndrome (Shao Yang disease), but there is irritability and hardness in the epigastrium, even if the patient can eat by the fourth or fifth day, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be given in small amounts to gently harmonize the interior, allowing for slight relief. By the sixth day, one sheng of Cheng Qi Tang (Order the Qi Decoction) is administered. If there is still no bowel movement, and after six or seven days the urine output is scanty, even if the patient cannot eat, if the stool is hard at the beginning but loose at the end, it indicates that the stool has not yet definitively hardened. Purging would inevitably cause diarrhea. One must wait until urination is free and the stool is confirmed to be hard before purging; in such cases, Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate. (Wang Bing's commentary states: No Tai Yang syndrome means no exterior syndrome; no Shao Yang syndrome means no half-exterior, half-interior syndrome.) For irritability with constipation, continuous periumbilical pain, and periodic exacerbations, this indicates the presence of dry feces (Zao Shi). After purging followed by sweating, if the patient experiences day-and-night irritability without peace, but is quiet during sleep, without vomiting or thirst, with no exterior syndrome, a deep-micro pulse, and no significant body heat, Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction) is indicated.
Gan Jiang (Dried Ginger, 1 liang) Fu Zi (Raw, 1 piece)
These two ingredients are boiled in 3 sheng of water to obtain 1 sheng of decoction. Strain and take in one dose.
[Hai Zang] There are two methods for taking Jiang Fu Tang (Ginger and Aconite Decoction): One method is to take it hot, corresponding to the Hand-Shaoyin Heart channel. Water envelops fire; taking it hot helps to connect with Heart Fire. When exterior cold is excessive and exterior fire is deficient, cold generates from outside and heat dissipates from inside, similar to freezing to death where cold is external. The other method is to take it cold, corresponding to the Foot-Shaoyin Kidney channel. Cold pathogenic factors enter the water element; taking it cold mimics Kidney Water. When there is slight heat on the body surface and abundant internal water, heat generates from outside and cold dissipates from inside, similar to drinking cold liquids where cold is internal.
If sweating or purging fails to resolve the disease, and irritability persists, Fu Ling Si Ni Tang (Poria and Four Reversals Decoction) is indicated.
Fu Ling (Poria, 1 liang) Ren Shen (Ginseng Root, 6 qian) Fu Zi (Aconite Root, 1 piece, raw, peeled and umbilicus removed, sliced into eight pieces, using only two slices) Gan Cao (Licorice Root) Gan Jiang (Dried Ginger) (each 2 qian)
Crush the herbs to the size of hemp seeds. Prepare as one dose, boil in 1.5 zhan of water until reduced to 0.8 zhan. Strain and take warm.
For irritability with epigastric hardness, if purging has not been performed previously, it refers to the earlier case of no Tai Yang or Shao Yang syndrome, treated with small amounts of Xiao Cheng Qi Tang to gently harmonize. If purging has already been performed, and there is epigastric hardness and pain, shortness of breath, and irritability, this is Da Xian Xiong Tang (Major Trap the Chest Decoction) syndrome. If all symptoms of Jian Xiong (Trap the Chest) syndrome are present and irritability occurs, the prognosis is fatal. (The discussion on the formula can be found under the entry "Trap the Chest".)
If fire therapy was misused followed by purging, and burning needle therapy caused irritability, Gui Zhi Gan Cao Long Gu Mu Li Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) is indicated.
Gui Zhi (Cinnamon Twig, peeled, 0.5 liang) Gan Cao (Licorice Root, honey-fried) Mu Li (Oyster Shell, calcined) Long Gu (Dragon Bone) (each 1 liang)
Crush the herbs to the size of hemp seeds. Take 5 qian per dose, boil in 1.5 zhan of water until reduced to 0.8 zhan. Strain and take warm.
In Tai Yang disease, if fire fumigation is used but sweat does not occur, the patient will certainly become agitated. If the condition does not resolve, hematochezia (blood in stool) will inevitably occur, which is called Huo Xie (Fire Pathogen).
In Tai Yang disease, if the back is ironed with fire causing profuse sweating, the fire-heat enters the Stomach, depleting fluids in the Stomach, leading to irritability and inevitable delirious speech (Chan Yu). If after ten-plus days the patient experiences chills and diarrhea, this indicates the disease is about to resolve. (The discussion can be found under the entry "Delirious Speech".)
For Fan Zuo (Irritability) with Jue Ni (Cold Extremities), if accompanied by vomiting and diarrhea, Wu Zhu Yu Tang (Evodia Decoction) is indicated. (The discussion can be found under the entry "Vomiting and Diarrhea".)
If there is no Fan (Irritability) but only Zao (Restlessness), with cold extremities and an imperceptible pulse, the prognosis is fatal. (The discussion can be found under the entry "Jue".) Inability to lie down indicates a fatal prognosis. (The discussion can be found under the entry "Diarrhea".)
[Cheng Wuji] What is referred to as Fan Zao (Irritability and Restlessness) is when Fan (mental agitation) gradually progresses to Zao (physical restlessness). What is referred to as Zao Fan (Restlessness and Irritability) is when Zao (physical restlessness) occurs first and then transitions back to Fan (mental agitation). Progression from Fan to Zao belongs to Heat syndromes; there is no case of progressing to Zao without prior Fan. First Zao then Fan refers to a state of stifling discomfort and repeated physical restlessness, which is Yin Excess repelling Yang. Although the patient may be extremely restless and wish to lie in mud or water, they cannot swallow water. This represents Qi attempting to escape and struggle, like a lamp about to extinguish suddenly flaring up. Generally, internal heat is called Fan, referring to mental depression and agitation in the heart; external heat/agitation is called Zao, referring to Qi escaping outward with physical restlessness. Internal heat is fire with roots; thus, cases with only Fan or Fan preceding Zao are treatable. External heat/agitation is fire without roots; thus, cases with only Zao or Zao preceding Fan are untreatable. Zang Jue (Visceral Cold Extremities) and Hui Jue (Roundworm Cold Extremities) both involve Fan Zao. (The discussion on the formula can be found under the entry "Jue".) Physical restlessness without temporary relief accompanied by cold extremities is Zang Jue. Quietness followed by irritability, vomiting roundworms, and cold extremities is Hui Jue, primarily treated with Wu Mei Wan (Mume Pill). (The discussion on the formula can be found under the entry "Jue".) With mild heat and mild cold extremities, loss of appetite, irritability for several days, and white urine, the heat has dissipated. If the desire to eat returns, the disease will resolve. If cold extremities are accompanied by vomiting and fullness/irritability in the chest and hypochondrium, hematochezia will occur. (The discussion can be found under the entry "Jue".) In Shao Yin disease, if the patient only desires sleep without irritability, but by the fifth or sixth day develops spontaneous diarrhea, irritability, and inability to lie down, the prognosis is fatal. (The discussion can be found under the entry "Desire to Sleep".)