〔《活》〕伤寒本无痞，应发汗，医反下之，遂成痞，枳实理中丸最良。审知是痞，先用桔梗枳壳汤，尤妙。
缘桔梗、枳壳行气，先用之，无不验也。
桔梗枳壳汤 治伤寒痞气，胸满欲绝。
桔梗 枳壳（麸炒，去穣。各二两）
上 咀，以水二盏，煎至一盏，去渣分二服。
发汗吐下后，虚烦不得眠，若剧者，必反复颠倒，心中懊 ，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。阳明病下之，其外有热，手足温，不结胸，心下懊 ，饥不能食，但头汗
出者，栀子豉汤主之。阳明病，脉浮紧，若下之，则胃中空虚，客气动膈，心中懊 ，舌上白胎者，宜栀子豉
汤。（论见自汗。）
下利后烦，按之心下濡者，为虚烦也，宜栀子豉汤。
肥栀子（四个，破） 香豉（半两）
上水二盏，先煎栀子一盏，纳豉同煎，取七分，去渣温服。得快吐，止后服。
栀子甘草豉汤 于栀子豉汤中加甘草半两，余根据前法，得吐止服。
栀子生姜豉汤 于栀子豉汤中加生姜一两二钱，余根据前法，得吐止后服。
伤寒医以丸药大下之，身热不去，微烦者，栀子干姜汤主之。
栀子（四两，破） 干姜（半两）
上二味，以水一盏半，煎取八分，去渣温服。得吐者，止后服。
发汗吐下后，心中懊 而烦，若无燥屎，大便 者，此条栀子豉等汤也；若有燥屎不大便者，
后条小承气汤也。
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。
阳明病下之，心下懊 而烦，胃中有燥屎者可攻。腹微满，初头硬，后必溏，不可攻之。若有燥屎者，宜
大承气汤。（方见阳明潮热。）胃实不大便，心烦，若吐下后者，此条大小承气汤也；若不吐不下者，调胃承气也。
〔许〕有人病伤寒八九日，身热无汗，时时谵语，时因下后大便不通三日矣。非躁非烦，非寒非痛，终夜
不得卧，但心中无晓会处，或时发一声如叹息之状，医者未知是何症。予诊之曰∶此懊 怫郁二症俱作也，胃
中有燥屎者，服承气汤，下燥屎二十枚，得利而解。仲景云∶阳明病下之，心中懊 ，微烦，胃中有燥屎者，
可攻。又云∶小便不利，大便乍难乍易，时有微热，怫郁不卧者，有燥屎也，承气汤主之。《素问》云∶胃不和
则卧不安，此夜所以不得眠也。仲景云∶胃中燥大便坚者，必谵语，此所以有时发谵语也。非烦非躁，非寒非
痛，所以心中懊 也。声如叹息而发一声，所谓外气怫郁也。燥屎得除，大便通利，胃中安和，故其病悉去也。
不得眠而烦。（论见不得眠。）
胸满而烦，若不经汗，兼往来寒热者，小柴胡汤。（方论见往来寒热。）兼下利咽痛者，猪肤汤。（方
论见下利。）若汗下后，往来寒热者，柴胡桂枝干姜汤。（方论见往来寒热。）兼身重不可转侧者，柴胡龙骨
牡蛎汤。（方论见惊。）
发汗若下之而烦热，胸中窒者，栀子豉汤主之。
心下硬满而烦，若满而不痛，腹中雷鸣下利者，甘草泻心汤。胁痛气冲咽，冒眩者成痿。（方论见痞。）
若满痛下利不止，水浆不下者，并病。（方论见痞。）伤寒下后，心烦腹满，卧起不安者，宜栀子浓朴汤。
栀子（去壳，四两） 浓朴（姜制，一两） 枳实（切，一枚）
以上三味，用水一盏半，煎取八分，去渣温服。得吐者，止后服。
腹满而烦，若有燥屎者，前条大承气汤也；若大便溏，胸痛欲吐，先此时极吐下者，调胃承气汤也。（论见呕。）
太阳病吐之，但太阳当恶寒，今反不恶寒，不欲近衣，此为吐之内烦也。脉之微数，不可灸，灸则烦
逆。（论见大法。）
呕时郁郁微烦，若与小柴胡汤呕不止者，大柴胡汤也；若极吐下后，胸满便溏腹痛者，调胃承气汤也。
病欲解者，必当先烦，乃有汗而解。（论见大法。）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。伤寒发热汗解，半日许复烦，脉浮数者，可更发汗，宜桂枝汤主之。
病患脉已解，而日暮微烦，以病新瘥，人强与谷，脾胃气尚弱，不能消谷，故令微热烦，损谷则愈。吐利
汗后，脉平小烦者，以胃虚不胜谷气也。（论见吐利。）
心悸而烦，若少阳汗后，谵语，胃不和烦悸者，《活人》用调胃承气汤。（论见口苦。）若二三日
心中悸而烦者，宜小建中汤。（论见悸。）心烦而渴。（方论见渴。）
少阴病，但欲寐而烦，若自利而渴，小便白者，《活人》用四逆汤。（论见欲寐。）若与白通汤后，
下利不止，厥逆无脉干呕者，白通汤加猪胆汁。若恶寒身倦，时烦欲去衣者，可治也。（论见但欲寐。）
手足厥冷而烦，若脉乍结乍紧，及心中满，饥不能食者，宜瓜蒂散吐之。若脉紧，至七八日自利，
脉紧变暴微，手足反温者，欲解也。（方论并见下利。）若下利，无脉干呕者，白通汤加猪胆汁也。（论
见下利。）
〔《活人书》〕伤寒病本来没有痞证，应当发汗治疗，医生反而使用泻下法，于是形成了痞证，枳实理中丸是最好的选择。确知是痞证后，先用桔梗枳壳汤，尤其巧妙。
因为桔梗、枳壳能行气，先使用它们，没有不灵验的。
桔梗枳壳汤 治疗伤寒引起的痞气，胸中胀满几乎要断绝的感觉。
桔梗 枳壳（麸炒，去瓤。各二两）
以上药材切碎，用水两盏，煎煮至一盏，去渣，分两次服用。
发汗、催吐或泻下之后，出现虚烦不得入睡，如果病情严重，必定会翻来覆去，心中烦闷懊恼，用栀子豉汤主治。如果伴有气短者，用栀子甘草豉汤主治。如果伴有呕吐者，用栀子生姜豉汤主治。阳明病经过泻下治疗后，体表仍有热象，手足温暖，没有形成结胸证，心下部烦闷懊恼，饥饿但不能进食，只有头部出汗的，用栀子豉汤主治。阳明病，脉象浮紧，如果误用泻下法，导致胃中空虚，客气扰动膈部，心中烦闷懊恼，舌上有白苔的，适宜用栀子豉汤。（相关论述见自汗篇。）
腹泻停止后出现心烦，按压心下部柔软无抵抗感的，属于虚烦，适宜用栀子豉汤。
肥栀子（四个，掰开） 香豉（半两）
以上用水两盏，先煎栀子至一盏，加入香豉同煎，取七分药液，去渣，温服。如果引起快速呕吐，停止后续服药。
栀子甘草豉汤 在栀子豉汤中加入甘草半两，其余按照前面的方法，引起呕吐即停止服药。
栀子生姜豉汤 在栀子豉汤中加入生姜一两二钱，其余按照前面的方法，引起呕吐即停止后续服药。
伤寒医生用丸药猛烈泻下，身体发热不退，轻微心烦的，用栀子干姜汤主治。
栀子（四两，掰开） 干姜（半两）
以上两味药，用水一盏半，煎取八分药液，去渣，温服。如果引起呕吐，停止后续服药。
发汗、催吐或泻下之后，心中烦闷懊恼，如果没有燥屎，大便通畅的，这是栀子豉汤等方的适应证；如果有燥屎且不大便的，参考后文的小承气汤方。
太阳病，如果用吐法、下法或发汗法，出现轻微心烦，小便频数，大便因此变硬的，给予小承气汤调和即可痊愈。
阳明病经过泻下治疗，心下部烦闷懊恼而心烦，胃中有燥屎的可以攻下。如果腹部微满，大便初头硬而后必溏稀的，不可攻下。如果有燥屎的，适宜用大承气汤。（方剂见阳明潮热篇。）胃实导致不大便，心烦，如果是经过吐法或下法之后的，这是大小承气汤的适应证；如果不是经过吐下的，用调胃承气汤。
〔许叔微〕有人患伤寒八九日，身体发热无汗，时常说胡话，有时因误用下法后大便不通已有三天了。既不躁动也不心烦，既不恶寒也不疼痛，整夜不能卧床休息，只是心中有一种说不清道不明的难受感，偶尔发出一声像叹息一样的声音，医生不知道这是什么病症。我诊察后说：这是懊恼和怫郁两种症状同时发作，胃中有燥屎的，服用承气汤，排出燥屎二十枚，大便通利后病愈。张仲景说：阳明病经过泻下，心中烦闷懊恼，轻微心烦，胃中有燥屎的，可以攻下。又说：小便不利，大便时而难时而易，有时有轻微发热，怫郁不安卧的，是有燥屎，用承气汤主治。《素问》说：胃不和则卧不安，这就是夜里不能睡觉的原因。张仲景说：胃中干燥大便坚硬的，必定说胡话，这就是有时说胡话的原因。不烦不躁，不寒不痛，所以心中烦闷懊恼。发出像叹息的声音，这就是所谓的外气怫郁。燥屎被清除，大便通利，胃中安和，所以疾病全部去除。
不能入睡而心烦。（相关论述见不得眠篇。）
胸中胀满而心烦，如果没有经过发汗，兼有往来寒热的，用小柴胡汤。（方论见往来寒热篇。）兼有腹泻咽痛的，用猪肤汤。（方论见下利篇。）如果经过汗法或下法后，出现往来寒热的，用柴胡桂枝干姜汤。（方论见往来寒热篇。）兼有身体沉重不可转侧的，用柴胡龙骨牡蛎汤。（方论见惊悸篇。）
发汗或泻下后出现烦热，胸中窒塞感的，用栀子豉汤主治。
心下部硬满而心烦，如果胀满但不疼痛，腹中雷鸣且有腹泻的，用甘草泻心汤。胁肋疼痛气冲咽喉，头晕目眩的，可能形成痿证。（方论见痞证篇。）
如果胀满疼痛且腹泻不止，水浆不进的是并病。（方论见痞证篇。）伤寒泻下后，心烦腹满，躺卧起坐不安的，适宜用栀子厚朴汤。
栀子（去壳，四两） 厚朴（姜制，一两） 枳实（切，一枚）
以上三味药，用水一盏半，煎取八分药液，去渣，温服。如果引起呕吐，停止后续服药。
腹部胀满而心烦，如果有燥屎的，是前条的大承气汤证；如果大便溏稀，胸痛想吐，此前刚刚经过剧烈吐下的，是调胃承气汤证。（相关论述见呕吐篇。）
太阳病用吐法，按理太阳病应当恶寒，现在反而不恶寒，不想穿衣，这是吐法导致的内烦。脉象微数，不可艾灸，艾灸会导致烦逆。（相关论述见大法篇。）
呕吐时郁郁微烦，如果给予小柴胡汤呕吐不止的，用大柴胡汤；如果剧烈吐下后，胸满便溏腹痛的，用调胃承气汤。
疾病将要解除时，必定先出现心烦，然后才有汗出而病解。（相关论述见大法篇。）太阳病，初服桂枝汤，反而心烦不解的，先针刺风池、风府穴，再给予桂枝汤即可痊愈。伤寒发热通过汗法解除，半天左右又出现心烦，脉象浮数的，可以再次发汗，适宜用桂枝汤主治。
病患脉象已平和，但傍晚时分轻微心烦，是因为病刚痊愈，人们强行喂食，脾胃之气尚弱，不能消化食物，所以导致轻微发热心烦，减少饮食即可痊愈。吐利汗出后，脉象平和但轻微心烦的，是因为胃虚不能承受谷气。（相关论述见吐利篇。）
心悸而心烦，如果是少阳病发汗后，出现谵语，胃不和导致的心烦心悸的，《活人书》用调胃承气汤。（相关论述见口苦篇。）如果发病二三日心中悸动而心烦的，适宜用小建中汤。（相关论述见悸动篇。）心烦而口渴。（方论见口渴篇。）
少阴病，只想睡觉而心烦，如果自利且口渴，小便色白的，《活人书》用四逆汤。（相关论述见嗜睡篇。）如果使用白通汤后，腹泻不止，四肢厥冷无脉干呕的，用白通汤加猪胆汁。如果恶寒身体疲倦，时常心烦想要脱衣的，是可以治疗的。（相关论述见嗜睡篇。）
手足厥冷而心烦，如果脉象乍结乍紧，以及心下部胀满，饥饿但不能进食的，适宜用瓜蒂散催吐。如果脉紧，到了七八天自行腹泻，脉紧突然变为微弱，手足反而温暖的，是欲愈之兆。（方论并见下利篇。）如果腹泻，无脉干呕的，用白通汤加猪胆汁。（相关论述见下利篇。）
[From *Huoren Shu* (Book of Vitality)] In cold damage diseases, there is originally no "Pi" (stagnation/fullness) syndrome. The correct treatment should be sweating; if the physician mistakenly uses purgation, Pi syndrome ensues. Zhishi Lizhong Wan (Aurantium Fructus and Poria Decoction) is the best choice. Once Pi syndrome is confirmed, using Jiegeng Zhike Tang (Platycodon and Bitter Orange Decoction) first is particularly effective.
This is because Jiegeng (Platycodon Root) and Zhike (Bitter Orange Fruit) regulate Qi; using them first proves invariably effective.
Jiegeng Zhike Tang treats Pi qi (Qi stagnation in the chest) caused by cold damage, characterized by chest fullness feeling as if it were about to sever.
Ingredients: Jiegeng (Platycodon Root), Zhike (Bitter Orange Fruit, bran-fried, pith removed; each 2 liang).
Preparation: Coarsely crush the herbs. Add two zhan (approx. 400ml) of water, decoct until one zhan remains. Strain and divide into two doses.
After sweating, vomiting, or purging, deficiency-heat vexation occurs with insomnia. If severe, the patient tosses and turns, experiencing internal restlessness and regret (Ao Gu), treated with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). If accompanied by shortness of breath, Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is used. If accompanied by vomiting, Zhizi Shengjiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction) is used. In Yangming disease, after purgation, if exterior heat persists, hands and feet are warm, and no Jie Xiong (chest binding) has formed, but there is internal restlessness in the epigastrium, hunger without desire to eat, and only head sweating, Zhizi Chi Tang is indicated. In Yangming disease, if the pulse is floating and tight, and purgation was mistakenly applied, leaving the stomach empty and allowing pathogenic Qi to disturb the diaphragm, resulting in internal restlessness and a white tongue coating, Zhizi Chi Tang is appropriate. (Discussion see Self-Sweating section.)
After diarrhea ceases, if vexation appears and the epigastrium is soft upon palpation, it is deficiency-vexation, treated with Zhizi Chi Tang.
Ingredients: Fei Zhizi (Large Gardenia Fruit, four pieces, broken), Xiang Chi (Fermented Soybean, half liang).
Preparation: Add two zhan of water. First decoct Zhizi until one zhan remains, then add Xiang Chi and decoct together until seven-tenths remain. Strain and take warm. If rapid vomiting occurs, stop subsequent doses.
Zhizi Gancao Chi Tang: Add half liang of Gancao (Licorice Root) to Zhizi Chi Tang. Follow previous methods; stop if vomiting occurs.
Zhizi Shengjiang Chi Tang: Add 1.2 qian of Shengjiang (Fresh Ginger) to Zhizi Chi Tang. Follow previous methods; stop subsequent doses if vomiting occurs.
In cold damage, if a physician uses pill-based strong purgatives, body heat persists, and there is slight vexation, Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) is indicated.
Ingredients: Zhizi (Gardenia Fruit, 4 liang, broken), Ganjiang (Dried Ginger, half liang).
Preparation: Add one and a half zhan of water to these two ingredients. Decoct until eight-tenths remain. Strain and take warm. Stop subsequent doses if vomiting occurs.
After sweating, vomiting, or purging, if there is internal restlessness and vexation, and there is no dry stool with normal bowel movements, this indicates the indication for Zhizi Chi Tang and similar formulas; if there is dry stool and constipation, refer to the Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) formula later.
In Taiyang disease, if emesis, purgation, or sweating leads to slight vexation, frequent urination, and consequent hard stools, Xiaochengqi Tang is given to harmonize and cure.
In Yangming disease, after purgation, if there is internal restlessness in the epigastrium and vexation, and dry stool exists in the stomach, attack may proceed. If the abdomen is slightly full, with hard stool at the beginning and loose stool later, do not attack. If dry stool exists, Dachengqi Tang (Major Order the Yellow Dragon Decoction) is appropriate. (Formula see Yangming Tidal Fever section.) For gastric excess causing constipation and vexation, if following emesis or purgation, use Dachengqi Tang or Xiaochengqi Tang; if not following emesis/purgation, use Wei Chengqi Tang (Stomach-Harmonizing Order the Yellow Dragon Decoction).
[Xu Shumi] A patient suffered from cold damage for eight or nine days, with body heat, no sweat, occasional delirium, and constipation for three days due to prior mistaken purgation. There was neither agitation nor vexation, neither aversion to cold nor pain. The patient could not lie down all night, feeling an indescribable discomfort in the heart/mind, occasionally emitting a sigh-like sound. The physician did not know the syndrome. I diagnosed it as simultaneous occurrence of Ao Gu (internal restlessness) and Fu Yu (depressed Qi). With dry stool in the stomach, administering Chengqi Tang expelled twenty pieces of dry stool, leading to recovery through bowel movement. Zhang Zhongjing stated: In Yangming disease after purgation, if there is internal restlessness and slight vexation with dry stool in the stomach, attack is possible. He also said: If there is difficulty in urination, alternating difficulty and ease in defecation, slight fever, and depressed Qi preventing sleep, there is dry stool, treated with Chengqi Tang. *Suwen* states: When the Stomach is disharmonious, sleep is uneasy; thus the inability to sleep at night. Zhang Zhongjing stated: Dryness in the Stomach with hard stools causes delirium; hence the occasional delirium. The absence of vexation/agitation/cold/pain explains the internal restlessness. The sigh-like sound represents external Qi depression. Once dry stool is removed and bowel movements normalize, Stomach harmony is restored, and the disease resolves.
Inability to sleep with vexation. (Discussion see Insomnia section.)
Chest fullness with vexation: If not preceded by sweating, accompanied by alternating chills and fever, use Xiaochaihu Tang (Minor Bupleurum Decoction). (Formula discussion see Alternating Chills and Fever section.) If accompanied by diarrhea and sore throat, use Zhufu Tang (Pig Skin Decoction). (Formula discussion see Diarrhea section.) If following sweating or purgation, with alternating chills and fever, use Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction). (Formula discussion see Alternating Chills and Fever section.) If accompanied by heavy body and inability to turn, use Chaihu Longgu Muli Tang (Bupleurum, Dragon Bone, and Oyster Shell Decoction). (Formula discussion see Palpitations/Fright section.)
After sweating or purgation, if there is vexing heat and chest obstruction, Zhizi Chi Tang is indicated.
Epigastric hardness and fullness with vexation: If full but not painful, with borborygmus and diarrhea, use Ganxiao Xiexin Tang (Licorice, Pinellia, and Scutellaria Decoction modified). Pain in the hypochondrium with Qi rushing to the throat and dizziness may lead to flaccidity syndromes. (Formula discussion see Pi Syndrome section.)
If full, painful, with incessant diarrhea and inability to swallow fluids, it is a combined disease. (Formula discussion see Pi Syndrome section.) After cold damage purgation, if there is vexation, abdominal fullness, and restlessness in lying down or sitting up, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is appropriate.
Ingredients: Zhizi (Gardenia Fruit, shelled, 4 liang), Houpo (Magnolia Bark, ginger-processed, 1 liang), Zhishi (Immature Bitter Orange, sliced, 1 piece).
Preparation: Add one and a half zhan of water to these three ingredients. Decoct until eight-tenths remain. Strain and take warm. Stop subsequent doses if vomiting occurs.
Abdominal fullness with vexation: If dry stool exists, it is the Dachengqi Tang syndrome mentioned earlier; if stools are loose, chest pain with urge to vomit, following recent violent emesis/purgation, it is Wei Chengqi Tang. (Discussion see Vomiting section.)
In Taiyang disease, after emesis, although Taiyang disease typically presents with aversion to cold, now there is no aversion to cold and a dislike for clothing; this is internal vexation caused by emesis. The pulse is slightly rapid; moxibustion is contraindicated as it will cause vexing rebellion. (Discussion see General Principles section.)
During vomiting, if there is depressed slight vexation, and Xiaochaihu Tang fails to stop vomiting, use Dachaihu Tang (Major Bupleurum Decoction); if following violent emesis/purgation, with chest fullness, loose stools, and abdominal pain, use Wei Chengqi Tang.
When a disease is about to resolve, there must first be vexation, followed by sweating and resolution. (Discussion see General Principles section.) In Taiyang disease, if initial administration of Guizhi Tang (Cinnamon Twig Decoction) results in unresolved vexation, first puncture Fengchi (GB20) and Fengfu (GV16), then administer Guizhi Tang for cure. In cold damage, if fever resolves via sweating but returns with vexation after half a day, and the pulse is floating and rapid, repeat sweating with Guizhi Tang.
If the patient's pulse has normalized but there is slight evening vexation, it is because the disease has just healed, people force feeding, and the Spleen/Stomach Qi is still weak, unable to digest food, causing slight heat and vexation; reducing food intake leads to recovery. After emesis, diarrhea, or sweating, if the pulse is calm but there is slight vexation, it is due to Stomach deficiency being unable to handle grain Qi. (Discussion see Emesis/Diarrhea section.)
Palpitations with vexation: If following Shaoyang sweating, with delirium and Stomach disharmony causing vexation and palpitations, *Huoren Shu* recommends Wei Chengqi Tang. (Discussion see Bitter Taste section.) If within two to three days there are palpitations and vexation in the heart, use Xiaojianzhong Tang (Minor Construct the Middle Decoction). (Discussion see Palpitations section.) Vexation with thirst. (Formula discussion see Thirst section.)
In Shaoyin disease, if there is desire to sleep with vexation, spontaneous diarrhea with thirst, and white urine, *Huoren Shu* uses Sini Tang (Frigid Extremities Decoction). (Discussion see Desire to Sleep section.) If after Baicong Tang (White Onion Decoction), diarrhea continues, extremities are cold, pulse is absent, and there is dry heaving, use Baicong Tang plus Pig Bile. If there is aversion to cold, fatigue, and frequent vexation with desire to remove clothes, the condition is treatable. (Discussion see Desire to Sleep section.)
Cold extremities with vexation: If the pulse is intermittently knotted or tight, with epigastric fullness, hunger but inability to eat, use Gouti San (Melon Seed Powder) to induce vomiting. If the pulse is tight, and after seven to eight days spontaneous diarrhea occurs, with the tight pulse suddenly becoming faint and extremities warming, resolution is desired. (Formulas/Discussion see Diarrhea section.) If diarrhea occurs with absent pulse and dry heaving, use Baicong Tang plus Pig Bile. (Discussion see Diarrhea section.)