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34. Palpitations with a thumping sensation in the heart, restlessness and anxiety, feeling that the mind cannot find peace. Excessive drinking of water with scanty urination indicates fluid retention; cold extremities, cold sweating, or palpitations occurring after sweating are signs of deficiency-cold.
[Note] The sensations of thumping and restlessness in the chest, along with palpitations and mental unease, describe the manifestations of Heart Palpitations (Xin Ji). When water intake is high but urine output is low, it indicates palpitations caused by fluid retention in the chest area; this is suitable for treatment with Fuling Gancao Tang (Poria and Licorice Decoction) or Wuling San (Five-Ingredient Powder with Poria). Cold extremities indicate a cold syndrome, suitable for Zhenwu Tang (True Warrior Decoction). Palpitations occurring after sweating indicate a deficiency syndrome, suitable for Xiaojianzhong Tang (Minor Construct the Middle Decoction). If not caused by sweating but due to extreme deficiency, Zhigancao Tang (Honey-Fried Licorice Decoction) is suitable.

35. Shivering and trembling of the body, with inner fear and trembling. "Zhen" (trembling/shaking) involves bodily movement but is milder than "Zhan" (shivering/rigors); thus, Zhen is attributed to deficiency and lack of strength. "Li" (fearful trembling) combined with Zhan represents the struggle between pathogenic factors and healthy Qi. If this condition arises after diaphoresis (sweating), emesis, or purgation, it results from internal and external deficiency leading to rebellious Qi. If it does not lead to rebellion, the pathogen declines, healthy Qi harmonizes, and recovery ensues; this signifies healthy Qi overcoming the pathogen, with resolution through shivering and sweating.
[Note] "Zhan" refers to the shaking and trembling of the body. "Li" refers to the inner feeling of fearful trembling. "Zhen" also involves trembling but is weaker than "Zhan." Hence, the classics state: All cases of Zhenzhen (trembling) are attributed to deficiency. "Li" is caused by pathogenic factors. "Zhan" is caused by healthy Qi. The interaction between pathogen and healthy Qi constitutes the struggle. If this condition occurs after sweating, vomiting, or purging, it is due to deficiency in both interior and exterior causing Qi rebellion. If no rebellion occurs, the pathogen weakens, healthy Qi becomes harmonious, and the disease resolves; this means healthy Qi overcomes the pathogen, and the patient recovers through shivering and sweating.

36. Hiccups (E Ni) are currently called E Ni, while in ancient times they were referred to as Yue. Unlike the sound of Yue which originates from within the stomach, the sound of E Ni is continuous and grating. It originally stems from Qi rushing up from below the navel. Although it resembles belching (Ai Qi) and eructation (Yi Qi), their characteristics differ naturally; however, since all belong to rebellious Qi, their treatments can be similar. For deficiency-heat type hiccups, Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is used. If there is obstruction in both bowel movements and urination, unblocking methods are employed to restore balance. For Qi failing to return to its origin (Kidney failing to grasp Qi), Duqi Wan (Duqi Pill) is indicated. For cold-deficiency types, Dingyu Lizhong Tang (Evodia and Cinnamon Twig Regulate the Middle Decoction) combined with Fuzi (Aconite Root) is used. For cases accompanied by epigastric fullness/stiffness and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction) is used. For cases accompanied by epigastric fullness/stiffness and eructation, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is effective.
[Note] The current name is E Ni (Hiccups), which corresponds to the ancient name Yue. Yue refers to Qi stagnation with audible sounds. Some people mistakenly equate E Ni with Yue, likely unaware that the sound of Yue comes from the stomach out through the mouth, whereas E Ni produces a continuous grating sound, with Qi rising from the Chong Mai (Penetrating Vessel) below the navel and exiting through the mouth. E Ni is somewhat similar to Ai Qi (belching) and Yi Qi (eructation). Ai Qi occurs due to eating too quickly when full, resulting in immediate belching to release food Qi. Yi Qi occurs due to overeating or indigestion, resulting in belching later to release the odor of food; hence, their characteristics differ. However, since all involve rebellious Qi, their treatments share similarities. The pathology of E Ni is rooted in the exhaustion of Stomach Qi. If accompanied by heat, Jupi Zhuru Tang added with Diospyros Leaf (Shi Di) is the primary formula. If accompanied by constipation, one of the Three Chengqi Decoctions (San Chengqi Tang) is used. If accompanied by dysuria, Erling San (Two-Poria Powder, likely referring to a variation of Wuling San) is used. If accompanied by Kidney deficiency failing to control the Qi of the Chong Mai returning to its origin, Duqi Tang added with Achyranthes Root (Niuxi) is used. For cold-deficiency patterns, if it is Taiyin pattern with warm extremities, Dingyu Lizhong Tang is used; if it is Shaoyin pattern with cold extremities, Fuzi (Prepared Aconite Root) is added. For patterns with epigastric fullness/stiffness and diarrhea, Shengjiang Xiexin Tang is used. For patterns with epigaustic fullness/stiffness and eructation, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is used.