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Cheng Wuji's commentary: Ji (palpitations) refers to a state of inner fright and unease, characterized by the heart beating vigorously (zhuzhu), trembling with fear (titit), and feeling unsettled and anxious (zhengzheng songsong), unable to find peace. There are cases of ji caused by Qi deficiency, those caused by retained fluid (Shuiyin, water retention due to impaired fluid metabolism), and those occurring after sweating or purging treatments. (Sweat is the fluid of the Heart; excessive sweating depletes Heart Qi, akin to a fish without water, thus causing palpitations.) In Taiyang cold damage disease, if palpitations accompanied by vexation occur on the second or third day, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is indicated. In Shaoyin disease, if there is cold extremities or palpitations, Si Ni San (Frigid Extremities Powder) with Guizhi (Cinnamon Twig) added is indicated; this is ji caused by Qi deficiency. (Internal weakness of Yang Qi and emptiness below the heart cause palpitations.) Drinking too much water leading to palpitations below the heart is ji caused by retained fluid. (The Heart belongs to Fire and dislikes Water; when Water stagnates internally, the Heart loses its tranquility, resulting in palpitations.) When the pathogenic factor is severe and sweating is excessive, the patient crosses their hands over the heart region, experiencing palpitations below the heart; this pertains to Taiyang disease. If purgation has been used, resulting in heaviness of the body and palpitations below the heart, sweating should not be induced again. Shaoyang disease contraindicates sweating; if sweating is forced, delirium ensues. This condition belongs to the Stomach; if Stomach Qi harmonizes, recovery occurs; if not, vexation and palpitations result. Shaoyang disease also contraindicates emesis and purgation; if these methods are mistakenly applied, palpitations and fright occur. These instances all represent ji caused by pathogens lingering after improper sweating or purging. Treatments may involve stabilizing and securing methods or resolving and dispersing methods. However, ji caused by water retention is more severe than that caused by other pathogens. Even if residual pathogens exist, one must first treat the palpitations. Why? Because water stagnating below the heart invades everywhere: invading the Lung causes wheezing and coughing; transmitting to the Stomach causes hiccups and dysphagia; overflowing into the skin causes edema; infiltrating the intestines causes diarrhea. Treatment cannot be delayed. Thus, the classics state: "In cases of cold extremities with palpitations below the heart, one should first treat the water using Fuling Gancao Gantang (Poria, Licorice, and Cinnamon Twig Decoction), and then treat the cold extremities." If the condition is severe, water treatment comes first; how much more so for mild conditions?

In Taiyang cold damage disease, if palpitations and vexation occur in the heart within two to three days, Xiao Jian Zhong Tang is used (see formula for abdominal pain). In cold damage disease, if the pulse is Jie-Dai (knotted and intermittent) and there is palpitation of the heart, Zhi Gancao Tang (Honey-Fried Licorice Decoction) is the primary treatment. (Cheng Wuji notes: The Jie-Dai pulse stops during beating; if it returns spontaneously, it is called Jie; if it does not return spontaneously, it is called Dai. This is due to deficiency and decline of Blood and Qi, preventing continuity. Palpitations indicate internal deficiency of True Qi. Zhi Gancao Tonifies deficiency, nourishes Blood and Qi, and restores the pulse.)

Formula for Zhi Gancao Tang (also known as Fu Mai Tang, Pulse-Restoring Decoction):
Zhi Gancao (Honey-fried Licoricae Radix et Rhizoma, 4 liang), Shengjiang (Fresh Zingiberis Rhizoma, sliced), Guizhi (Cinnamomi Ramulus, bark removed, each 3 liang), Renshen (Ginseng Radix et Rhizoma), Ejiao (Asini Corii Colla, each 2 liang), Sheng Dihuang (Rehmanniae Radix Praeparata, one slice), Maidong (Ophiopogonis Radix, core removed), Huoziren (Pericarpium Sesami Nigris, each half sheng), Dazao (Jujubae Fructus, 12 pieces, split). The above nine ingredients are decocted in 7 sheng of clear wine and 8 sheng of water. First boil the eight ingredients (excluding Ejiao) to obtain 3 sheng, strain, add Ejiao, melt completely, and take 1 sheng warm, three times daily. (Tonifying agents remove weakness; the sweetness of Renshen, Gancao, and Dazao tonifies deficient Qi; the pungency of Guizhi and Shengjiang augments righteous Qi. The *Shengji Jing* states: "When fluids are depleted, dryness results; when the five Zang organs are atrophied and Ying-Wei flow ceases, moistening agents are needed to lubricate." The sweet-moistening properties of Huoziren, Ejiao, Maidong, and Dihuang nourish the meridians, tonify Blood, restore the pulse, and unblock the Heart.)

In Taiyang disease, if urination is free and copious, drinking too much water will inevitably cause palpitations below the heart; if urination is scanty, there will be distress from internal urgency (abdominal tension). (Cheng Wuji notes: If water intake is high but urination is free, water does not accumulate internally; rather, excess water in the chest causes palpitations below the heart. The *Jin Gui Yao Lue* states: "If food intake is low and water intake high, water stagnates below the heart; severely, this causes palpitations. If water intake is high but urination is obstructed, water accumulates internally and fails to move, inevitably causing distress from internal urgency." For obstructed urination, use Fuling Gancao Gantang; for internal urgency, use Shizao Tang.) If the pulse is floating and rapid, sweating should normally resolve the condition. If purgation is mistakenly applied, resulting in body heaviness and palpitations, sweating is contraindicated. One must wait for spontaneous sweating to achieve resolution. This is because a faint pulse at the Chi position indicates interior deficiency. The exterior and interior must be solidified, fluids must harmonize naturally, and spontaneous sweating will lead to recovery (see section on spontaneous sweating). If sweating is excessive, and the patient crosses their hands over the heart region, experiences palpitations below the heart, and desires pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is indicated. (Cheng Wuji notes: Excessive sweating leads to loss of Yang. Qi is received in the chest; insufficiency of Yang Qi in the chest causes symptoms such as crossing hands over the heart and palpitations below the heart, which are relieved by pressure. Guizhi Gancao Tang regulates deficient Qi.)

Formula for Guizhi Gancao Tang (Guizhi's pungency enters the Lung to benefit Qi; Gancao's sweetness enters the Spleen to moderate the center):
Guizhi (Cinnamomi Ramulus, bark removed, 4 liang), Zhi Gancao (Honey-fried Licoricae Radix et Rhizoma, 2 liang). The above two ingredients are decocted in 3 sheng of water to obtain 1 sheng, strained, and taken in one dose. After sweating, if the patient experiences palpitations below the umbilicus and feels impending Ben Tun (Panicking Bull syndrome, a sensation of Qi rushing upward from the lower abdomen), Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is indicated. (Sweat is the fluid of the Heart; after sweating, palpitations below the umbilicus indicate Heart Qi deficiency triggering Kidney Qi movement. The accumulation of the Kidney is named Ben Tun; upon attack, Qi rises from the lower abdomen to below the heart, representing rebellious Kidney Qi attempting to oppress the Heart. Current palpitations below the umbilicus indicate the onset of Kidney Qi movement, hence "impending Ben Tun." Fuling Guizhi Gancao Dazao Tang is given to descend Kidney Qi.)

Formula for Fuling Guizhi Gancao Dazao Tang:
Fuling (Poria, 0.5 jin), Guizhi (Cinnamomi Ramulus, bark removed, 4 liang), Zhi Gancao (Honey-fried Licoricae Radix et Rhizoma, 2 liang), Dazao (Jujubae Fructus, 15 pieces, split). The above four ingredients are decocted in 1 dou of Ganlan Shui (Gentle Rotting Water). First boil Fuling until the volume reduces by 2 sheng, then add remaining herbs, boil to obtain 3 sheng, strain, and take 1 sheng warm, three times daily. Method for preparing Ganlan Shui: Take 2 dou of water, place in a large basin, and ladle the water repeatedly until 5,000-6,000 small bubbles form and chase each other on the surface; use this water. (Fuling attacks Kidney pathogens; Guizhi drains Ben Tun; the sweetness of Gancao and Dazao nourishes Spleen Earth to pacify Kidney Qi. Ganlan Shui is used because the vigorous ladling weakens the water's energy, ensuring it does not aid Kidney pathology.)

In Taiyang disease, if sweating fails to resolve the condition, and the patient still has fever, palpitations below the heart, dizziness, muscle twitching (shundong), and tremors threatening to collapse (zhenzhen yu pi di), Zhenwu Tang (True Warrior Decoction) is indicated.

In Shaoyang wind-strike, with deafness, red eyes, chest fullness, and vexation, emesis and purgation are contraindicated. Mistaken application leads to palpitations and fright. (Zhao's note: Shaoyang channel diseases prohibit emesis and purgation; doing so causes palpitations and fright. Also stated: If not yet emesis/purgation and pulse is deep-tight, use Xiao Chaihu Tang. Also: If delirium occurs after emesis, purgation, sweating, or moxibustion, it is a complicated disease. "Contraindicated" is a prohibitive term. "Not yet treated" implies only harmonization is needed. "Already treated" implies iatrogenic complication. The *Huo Ren Shu* states "not yet suitable for emesis/purgation"; adding the character "suitable" is potentially unstable/inaccurate.) In cold damage after five to six days, or wind-strike, with alternating chills and fever, chest/hypochondriac fullness, silent desire not to eat, vexation and frequent vomiting, or palpitations below the heart, thirstlessness, slight fever, or cough, Xiao Chaihu Tang (Minor Bupleurum Decoction) is indicated. In cold damage, if the pulse is string-taut and fine with headache and fever, it belongs to Shaoyang; sweating is contraindicated. Sweating causes delirium, belonging to the Stomach; if Stomach Qi harmonizes, recovery occurs; if not, vexation and palpitations result (Tiaowei Chengqi Tang may be used).

In Shaoyin disease, with cold extremities, and optionally cough, palpitations, difficult urination, abdominal pain, or diarrhea with rectal heaviness, Si Ni San (Frigid Extremities Powder) is indicated. (Add Guizhi 5 fen for palpitations.)

In Jueyin disease, in cold damage with cold extremities and palpitations below the heart, one should first treat the water by administering Fuling Gancao Tang, then treat the cold extremities. Otherwise, water infiltration into the Stomach will inevitably cause diarrhea. For cold extremities with palpitations, use Fuling Gancao Tang. For cold extremities that are not warm, use Si Ni San with added Guizhi. For Huoluan (cholera-like disorder) with vomiting, diarrhea, and palpitations, Lizhong Wan (Regulate the Middle Pill) with added Fuling is indicated.