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Palpitating and startled (Xin Dong Ji), the heart beats restlessly; trembling and anxious (Zheng Zheng Zhong Zhong), the mind is unsettled and cannot find peace. Drinking much water but urinating little indicates retained fluid (Ting Shui); cold extremities, cold sweat, or palpitations after sweating indicate deficiency-cold (Xu Han).

[Note] The sensations of "palpitating and startled" and "trembling and anxious" beneath the heart describe the manifestations of Heart Palpitation (Ji Bing). When one drinks much water but urinates little, it is palpitation caused by fluid retention in the epigastrium (Shui Ting Xin Xia), for which Lingzhi Gancao Tang (Poria and Licorice Decoction) or Wuling San (Five-Ingredient Powder with Poria) is indicated. Cold extremities indicate cold, for which Zhenwu Tang (True Warrior Decoction) is indicated; palpitations after sweating indicate deficiency, for which Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is indicated. If not occurring after sweating, it signifies severe deficiency, for which Zhigancao Tang (Honey-Fried Licorice Decoction) is indicated.

Shivering with body shaking (Zhan Shen Song Dong) and inner fear (Li Xin), although both involve shaking, shivering (Zhen) is milder than shuddering (Zhan). Therefore, Zhen is attributed to deficiency due to lack of strength, while Li and Zhan intermingling represents the struggle between pathogenic factors (Xie Qi) and healthy qi (Zheng Qi). If this syndrome arises after the three methods of sweating, vomiting, or purging, it is due to internal and external deficiency leading to rebellion. If it does not lead to rebellion, the pathogenic factor declines, healthy qi harmonizes, and resolution occurs; this means healthy qi overcomes the pathogen, and the condition calms through shivering and sweating.

[Note] "Zhan" refers to the shaking and耸动 (upright movement) of the body. "Li" refers to inner fear and trembling. "Zhen" also involves耸动, but compared to "Zhan," it lacks strength. Thus, the Treatise states: All cases of "Zhenzhen" (trembling/shaking) are attributed to deficiency. "Li" is caused by pathogenic factors; "Zhan" is caused by healthy qi. The interaction between pathogenic factors and healthy qi constitutes the "struggle." If this syndrome arises after sweating, vomiting, or purging, it is because the middle and exterior were damaged, causing qi rebellion. If it does not cause rebellion, the pathogen declines, healthy qi harmonizes, and the disease resolves, meaning healthy qi overcomes the pathogen, and the condition calms through shivering, shuddering, and sweating.

E'ni (Hiccups/Inverted Stomach Qi), now named so, differs from Yue (belching/gurgling sound) as the latter's sound originates from within the stomach. E'ni produces a continuous 'ge-ge' sound, originally arising from qi rushing up from below the navel. It resembles Aqi (burping) and Yi Qi (sighing/belching), yet their conditions differ; however, all belong to rebellious qi, so treatments can be similar. For deficiency-heat type, Chuanpi Zhuru Tang (Citrus Peel and Bamboo Shavings Decoction) is used. For obstruction of both bowels and bladder, unblocking them brings peace. For qi failing to return to its origin, Duqi Wan (Duqi Pill) is suitable. For cold-deficiency, Dingyu Fuli Zhong Tang (Clove, Evodia, Aconite, and Ginger-Building-Middle Decoction) is used. For fullness-hardness with diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Draining Epigastrium Decoction) is used. For fullness-hardness with belching, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is effective.

[Note] The current name is E'ni, which corresponds to the ancient name Yue. "Yue" refers to qi stagnation with sound. Some mistakenly equate Yue with E'ni, likely unaware that the sound of Yue emerges from the stomach towards the anus, unlike E'ni's continuous 'ge-ge' sound, where qi rises from the Chong Mai (Penetrating Vessel) below the navel and sounds at the throat. E'ni resembles Aqi and Yi Qi. Aqi occurs when eating too quickly, resulting in immediate burping to expel food qi. Yi Qi occurs after overeating and damaging the spleen/stomach, resulting in belching with a sour odor later, hence the different conditions. However, all are diseases of rebellious qi, so treatments can be similar. E'ni results from exhaustion of Stomach Qi. If accompanied by heat, Chuanpi Zhuru Tang added with Persimmon Calyx (Shidi) is the main formula. If accompanied by constipation, San Chengqi Tang (Three Bowel-Unblocking Decoctions) is the main formula. If accompanied by dysuria, Er Ling San (Two Poria Powders) is the main formula. If accompanied by Kidney deficiency failing to control the Chong Mai qi returning to its origin, Duqi Tang added with Achyranthes Root (Niuxi) is the main formula. If accompanied by cold-deficiency, with Taiyin pattern presenting warm hands and feet, Dingyu Lizhong Tang (Clove, Evodia, and Ginger-Building-Middle Decoction) is the main formula; for Shaoyin pattern with cold extremities, add Aconite (Fuzi). If accompanied by fullness-hardness and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Draining Epigastrium Decoction) is the main formula. If accompanied by fullness-hardness and belching, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is the main formula.