伤寒心悸有多端。大抵三阳不一般。（仲景云。悸证有八九皆属三阳。）太阳便利多饮水。（仲景云。太阳病。小便利
者。以饮水多。心下悸。小便少者。必苦。里急也。）阳明烦呕小便难。（仲景云。伤寒五六日。中风。往来多热。心下
悸。小便不利。心烦喜呕者。小柴胡汤主之。）少阳吐下仍虚悸。（仲景云。少阳中风。两耳无所闻。目赤。胃中满而烦。
不可吐下。吐下则悸而惊。）误下烦时胃内干。（仲景云。伤寒。其脉弦细。胁痛发热。此属少阳。少阳不可发汗。发汗
则谵语。为属胃。胃和则愈。胃不和则烦而悸也。）脉来结代炙甘草。（仲景云。伤寒。脉结代。心动悸。炙甘草汤主之。
方第三十九。）小建中行三日间。（仲景云。伤寒二三日。心中悸者。小建中汤。）汗过自冒桂甘证。肉 真武定须安。（此
二证。自汗过而悸也。仲景云。发汗过多。其人叉手自冒心。心下悸。欲得按者。桂枝甘草汤。方第二十七。又云。太
阳病发汗。汗出不解。其人仍发热。心下悸。头眩身 动。振振欲擗地者。真武汤主之。方第四十二。）
二阳并病必须冒。宜刺大椎当慎表。（仲景云。太阳少阳并病。头痛或眩冒时。如结胸痞硬。当刺大椎第一间。肺俞
肝俞。慎不可发汗。）下利面赤脉沉迟。汗出中心常郁懊。（仲景云。下利脉沉迟。其人面少赤。身有微热。下利清谷者。
必郁冒汗出。）吐下汗后或动经。（伤寒吐下后。发汗虚烦。脉甚微。八九日。心下痞硬。气上冲咽喉。郁冒。经脉动惕
者。久而成痿。）汲水灌身那得好。（仲景云。荣卫中风。医为大热。解肌发汗。热不止。又汲水灌其身。栗栗振寒。则
以重被覆之。故汗出而冒烦。）汗下表里已先虚。汗出表和痊可保。（仲景云。太阳病下之而愈。先复发汗。以此表里俱
虚。其人必冒。冒家汗出自愈。所以然者。汗出表和故也。）
Palpitations in Shanghan (Cold Damage) arise from various causes. Generally, those originating from the Three Yang channels (Taiyang, Yangming, Shaoyang) differ significantly. (Zhang Zhongjing stated: There are nearly ten types of palpitation syndromes, most of which belong to the Three Yang channels.) In Taiyang disease, frequent urination and excessive water intake lead to epigastric palpitations. (Zhang Zhongjing stated: In Taiyang disease, if urination is free and water intake is excessive, palpitations occur in the epigastrium; if urination is scanty, there will be abdominal urgency.) In Yangming disease, vexation, vomiting, and difficult urination often indicate Shaoyang mechanism obstruction. (Zhang Zhongjing stated: After five or six days of Shanghan, or after wind-stroke, symptoms such as alternating fever and chills, epigastric palpitations, difficult urination, vexation, and a desire to vomit should be treated with Xiaochaihu Tang [Minor Bupleurum Decoction].) In Shaoyang disease, improper use of emetic or purgative methods leads to deficiency-induced palpitations. (Zhang Zhongjing stated: In Shaoyang wind-stroke, hearing loss, red eyes, epigastric fullness, and vexation occur. Emetic or purgative therapies are contraindicated; their misuse results in palpitations and fright.) Improper purgation causing dryness in the stomach leads to vexation and palpitations. (Zhang Zhongjing stated: In Shanghan, a wiry and thin pulse with hypochondriac pain and fever indicates Shaoyang involvement. Shaoyang disease is not suitable for diaphoresis; inducing sweat leads to delirium as the pathogen enters the Stomach. If Stomach Qi harmonizes, recovery occurs; if not, vexation and palpitations ensue.) A knotted or intermittent pulse with heart palpitations is treated with Zhigancao Tang [Honey-Fried Licorice Decoction]. (Zhang Zhongjing stated: In Shanghan, a knotted or intermittent pulse with heart palpitations should be treated with Zhigancao Tang. See Formula 39.) For palpitations occurring within three days of early-stage Shanghan, Xiao Jianzhong Tang [Minor Construct the Middle Decoction] is indicated. (Zhang Zhongjing stated: In two or three days of Shanghan, if there is heart palpitations, Xiao Jianzhong Tang is used.) Palpitations due to excessive sweating from self-sweating can be treated with Guizhi Gancao Tang [Cinnamon Twig and Licorice Decoction]; Zhenwu Tang [True Warrior Decoction] is required to stabilize and calm. (These two conditions involve palpitations due to excessive self-sweating. Zhang Zhongjing stated: Excessive sweating leading to the patient crossing hands over the heart, with epigastric palpitations relieved by pressure, is treated with Guizhi Gancao Tang. See Formula 27. Also, if after sweating in Taiyang disease the condition persists with fever, epigastric palpitations, dizziness, body tremors, and instability, Zhenwu Tang is indicated. See Formula 42.)
When Taiyang and Shaoyang diseases combine, dizziness and vertigo must be present. Acupuncture at Dazhui (GV14) is appropriate, but caution regarding exterior syndrome is needed. (Zhang Zhongjing stated: In combined Taiyang and Shaoyang disease, headache or dizziness resembling chest binding and hardness requires acupuncture at Dazhui (GV14), Feishu (BL13), and Ganshu (BL18). Diaphoresis is strictly forbidden.) Diarrhea with facial redness and a deep, slow pulse, followed by sweating, often leaves the heart feeling stifled and distressed. (Zhang Zhongjing stated: Diarrhea with a deep, slow pulse, slight facial redness, mild body heat, and undigested food in stool inevitably leads to Yu Mao [depressive dizziness] and sweating.) Post-emesis, post-purgation, or post-diaphoresis may disturb the meridians. (After Shanghan treatment involving emesis and purgation, followed by sweating, leading to deficiency vexation and an extremely weak pulse, by the eighth or ninth day, epigastric stiffness, Qi rushing to the throat, Yu Mao, and meridian twitching may occur, eventually resulting in Wei Syndrome [flaccidity syndrome].) Pouring cold water on the body does not cure the condition. (Zhang Zhongjing stated: When Ying and Wei are affected by wind, and the physician mistakenly treats it as excess heat with diaphoresis without resolving the fever, pouring cold water on the body causes shivering and aversion to cold. Covering the patient with heavy blankets to induce sweating resolves the Yu Mao and vexation.) After sweating, the interior and exterior Qi are already deficient; recovery is ensured when sweating harmonizes the exterior. (Zhang Zhongjing stated: After Shanghan is cured by purgation, subsequent sweating causes both exterior and interior deficiency, leading to dizziness. Patients with Yu Mao recover through sweating because this harmonizes the exterior Qi.)