【纲】仲景曰。伤寒八九日。下之。胸满烦惊。小便不利。谵语。一身尽重。不可侧转者。柴
胡加龙骨牡蛎汤主之。伤寒脉浮。医以火迫劫之。亡阳。必惊狂。起卧不安者。桂枝去芍药加蜀漆
龙骨牡蛎救逆汤主之。风温。脉浮。自汗。身重。多眠。若被火者。微则发黄。剧则如惊痫。时螈
。
【目】成无己曰。伤寒中。有单言惊者。有单言悸者。理不得淆。故两分之。其兼言惊悸者。
则少阳中风。两耳无所闻。目赤。胸中满而烦者。不可吐下。吐下则悸而惊一条而已。惊。坏病也。由误下火逆温针所
致。仲景之法。不过随其逆而调之。
【纲】仲景曰。发汗过多。其人叉手自冒心。心下悸。欲得按者。桂枝甘草汤主之。
发汗后。其人脐下悸。欲作奔豚。茯苓桂枝甘草大枣汤主之。
【目】黄仲理曰。心下悸。欲按者。心气虚。脐下悸者。肾水乘火而上克。以发汗多而心液虚。
心气馁。故悸。豚为水畜。奔则昂首疾驰。酷有水势上干之象。然水势尚在下焦。欲作云者。尚
未发也。
【纲】仲景曰。伤寒二三日。心下悸而烦者。小建中汤主之。少阴病。四逆。泄利下重。其人
或咳。或悸。或小便不利。或腹中痛者。四逆散主之。
【目】成无己曰。此二条都是气虚而悸。其气虚者。由阳气内弱。心下空虚。正气内动而为悸
也。
柯琴曰。心悸而烦者。是少阳中枢受寒。而木邪挟相火为患。则君火虚。离中真火不藏故悸。
离中真火不足故烦。
【纲】仲景曰。太阳病。饮水多。小便利者。必心下悸。小便少者。必苦里急也。
【目】韩祗和曰。此是停饮为悸者也。其停饮者。由水停心下。心为火而恶水。水故内停。心
亦不安而为悸也。
【纲】仲景曰。太阳病。若下之。身重。心下悸者。不可发汗。少阳病。不可发汗。发汗则谵
语。此属胃。胃和则愈。胃不和则烦而悸。
【目】赵嗣真曰。此汗下后正气内虚。邪气交击而令悸。与他条气虚而悸者不同。且更甚焉。
或镇固。或化散。皆须定其浮气也。
【纲】仲景曰。伤寒厥而心下悸者。宜先治水。当用茯苓甘草汤。却治其厥。不尔。水渍入胃。
必作利也。
【目】刘完素曰。厥为邪之深者。犹先治水。况其邪气之浅焉者乎。金匮云。食少饮多。水停
心下。甚者则悸。饮之为悸。甚于他邪。虽有余邪。必先治悸。何也。以水停心下。若水气散。则
无所不至。侵于肺则为喘为咳。传于胃则为哕为噎。溢于皮肤则为肿。渍于肠胃则为利。下之不可
缓也。
[General Principle] Zhang Zhongjing stated: In Taiyang disease (Exterior Syndrome of the Bladder Channel) lasting for eight or nine days, if purgation is applied inappropriately, symptoms such as chest fullness, irritability, fright, difficulty in urination, delirium, heaviness of the entire body, and inability to turn over occur. This should be treated with Chaihu Jia Longgu Muli Tang (Bupleurum Decoction with Dragon Bone and Oyster Shell). If Taiyang disease presents with a floating pulse, and the physician uses fire therapy to force sweating, leading to Yang collapse, symptoms of fright, mania, restlessness, and inability to sit or lie still will inevitably appear. This should be treated with Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang (Cinnamon Twig Decoction without Paeonia, plus Chinese Asarum, Dragon Bone, and Oyster Shell, for Rescue from Peril). In Fengwen (Wind-Warmth Disease), presenting with a floating pulse, spontaneous sweating, heaviness of the body, and somnolence, if fire therapy is additionally applied, mild cases may result in jaundice, while severe cases may resemble convulsive epilepsy with intermittent clonic spasms.
[Detailed Commentary] Cheng Wuji stated: In Taiyang disease, there are instances where "fright" (Jing) is mentioned alone, and where "palpitation" (Ji) is mentioned alone. The principles must not be confused; thus, they are separated into two categories. The only instance mentioning both "fright and palpitation" together is the case of Shaoyang Wind-Strike, characterized by deafness, red eyes, chest fullness, and irritability. In this condition, emesis and purgation are contraindicated; applying them would lead to palpitation and fright. "Fright" is considered a complication (Huabing) resulting from erroneous treatments such as inappropriate purgation, fire reversal, or moxibustion. Zhang Zhongjing's method involves merely regulating the pathology according to its deviation.
[General Principle] Zhang Zhongjing stated: If sweating is excessive, and the patient crosses their hands over the heart region, experiencing palpitations in the epigastrium that are relieved by pressure, this should be treated with Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction). After sweating, if the patient experiences palpitations below the umbilicus, indicating an impending Ben Tun (Rushing Pig/Running Piglet syndrome), this should be treated with Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction).
[Detailed Commentary] Huang Zhongli stated: Palpitations in the epigastrium that are relieved by pressure indicate Heart Qi deficiency. Palpitations below the umbilicus indicate Kidney Water overcoming Heart Fire and attacking upwards. This occurs because excessive sweating depletes Heart fluids, causing Heart Qi to become weak and deficient, resulting in palpitations. "Tun" refers to water animals, symbolizing water pathogens. "Ben" implies rushing forward with head high, vividly describing the upward surge of water energy. However, since the water energy remains in the Lower Jiao, "yu zuo" (about to arise) means it has not yet fully manifested.
[General Principle] Zhang Zhongjing stated: In Taiyang disease lasting two or three days, if there are palpitations and irritability in the epigastrium, this should be treated with Xiao Jianzhong Tang (Minor Construct the Middle Decoction). In Shaoyin disease, presenting with cold extremities, diarrhea with a sensation of heaviness in the rectum, and optionally cough, palpitations, difficulty in urination, or abdominal pain, this should be treated with Sini San (Counterflow Powder).
[Detailed Commentary] Cheng Wuji stated: Both these cases involve palpitations due to Qi deficiency. The Qi deficiency arises from internal weakness of Yang Qi, leaving the epigastrium empty, causing righteous Qi to move internally and generate palpitations.
Ke Qin stated: Palpitations accompanied by irritability indicate that the Shaoyang pivot is affected by Cold, with Wood pathogen carrying Ministerial Fire to cause harm. This leads to a deficiency of Sovereign Fire, and the True Fire within the Li Trigram fails to store properly, causing palpitations. The insufficiency of True Fire in the Li Trigram causes irritability.
[General Principle] Zhang Zhongjing stated: In Taiyang disease, if fluid intake is excessive and urination is free, palpitations in the epigastrium will inevitably occur. If urination is scanty, distressing lower abdominal urgency will inevitably occur.
[Detailed Commentary] Han Zhihe stated: This is palpitation caused by retained fluid (Ting Yin). Retained fluid occurs because water stagnates in the epigastrium. Since the Heart belongs to Fire and dislikes Water, the water stagnates internally, causing the Heart Spirit to be unsettled and generating palpitations.
[General Principle] Zhang Zhongjing stated: In Taiyang disease, if purgation is erroneously applied, resulting in body heaviness and epigastric palpitations, sweating is contraindicated. In Shaoyang disease, sweating is also contraindicated; if sweating is forced, delirium will occur. This belongs to the Stomach (Yangming); if the Stomach harmonizes, recovery ensues. If the Stomach does not harmonize, irritability and palpitations will follow.
[Detailed Commentary] Zhao Sizhen stated: This palpitation occurs after sweating and purgation when righteous Qi is internally deficient and pathogens clash violently. It differs from other cases of Qi-deficiency palpitation and is more severe. Treatment requires either stabilizing/astringing methods or resolving/dispersing methods, all aiming to calm the floating Qi.
[General Principle] Zhang Zhongjing stated: In Taiyang disease, if cold extremities are accompanied by epigastric palpitations, one should first treat the water retention using Fuling Gancao Tang (Poria and Licorice Decoction), and subsequently treat the cold extremities. Otherwise, water moisture will infiltrate the Stomach, inevitably leading to diarrhea.
[Detailed Commentary] Liu Wansu stated: "Jue" (cold extremities) indicates deep-seated pathogens; even so, water must be treated first, let alone shallow pathogens. The Jingui Yaolue states: Eating little but drinking much causes water to stagnate in the epigastrium; severe cases result in palpitations. Palpitation caused by water retention is more serious than that caused by other pathogens. Even if other residual pathogens exist, palpitation must be treated first. Why? Because water stagnating in the epigastrium, if allowed to scatter, can reach anywhere. Invading the Lung, it causes asthma and cough; transmitting to the Stomach, it causes hiccups and dysphagia; overflowing into the skin, it causes edema; infiltrating the intestines and stomach, it causes diarrhea. This situation cannot be delayed.