（附战栗颤振）
经义
东方青色，入通于肝，其病发惊骇。○肝脉惊暴，有所惊骇。○肝气虚则恐，实则怒。○肝虚则目
KTKT 无所见，耳无所闻，善恐，如人将捕之。○阳明所谓甚则厥，恶人与火，闻木音则惕然而
惊。○诸病 肿，疼酸惊骇，皆属于火。○惊则心无所倚，神无所归，虑无所定，故气乱矣。○忧愁恐惧则伤心。
○心怵惕思虑则伤神，神伤则恐惧自失。○肾在志为恐，恐伤肾，思胜恐。○恐惧不解则伤精，精伤则骨酸痿厥，
精时自下。○忧恐忿怒则伤气。○恐则精却，却则上焦闭，闭则气还，还则下焦胀，故气下行矣。（《素问》）
哲言
惊悸者，忽若有惊，惕惕然心中不安，其动也，有时。怔忡者，心中惕惕然动摇不静，其作也，无时。（《医学正传》）
有触而心动曰惊。无惊而自动曰悸，即怔忡也。（李东垣）
恐与惊悸相似而实非也。子和云∶惊者为自不知，恐者为自知故也。盖惊者闻响即惊，恐者心中恍恍然自
知，如人将捕之状，及不能独自坐卧，须人伴侣，或夜须灯照者是也。○脏腑之恐有四∶一曰肾，《经》云∶
在脏为肾，在志为恐。又云∶精气并于肾则恐。二曰肝胆，《经》云∶肝藏血，血不足则恐。戴人曰∶胆者，
敢也，惊怕则胆伤矣。盖肝胆实则怒而勇敢，肝胆虚则善恐而不敢也。三曰胃，《经》云∶胃为恐。四曰心，
《经》云∶心怵惕思虑则伤神，神伤则恐惧自失。（《赤水玄珠》）
惊怖，即惊恐怖惧也，恐亦惧也，于义并同。凡连称其名以为提纲者，多是一阴一阳对待而言。如喜怒并
称者，喜出于心，心居于阳，怒出于肝，肝居于阴；志意并称者，志是静而不移，意是动而不定，静则阴也，
动则阳也；惊恐并称者，惊因触于外事，内动其心，心动则神摇，恐因惑于外事，内慊其志，志慊则精却。是
故《内经》谓∶惊则心无所倚，神无所归，虑无所定，故气乱矣。恐则精却，却则上焦闭，闭则气还，还则下
焦胀，故气下行矣。又谓∶尝贵后贱，尝富后贫，悲忧内结，至于脱营失精，病深无气，则洒然而惊。此类皆
是病从外事触动内之心神者也。若夫在身之阴阳盛衰而致惊恐者，惊是火热灼动其心，心动则神乱，神用无
方，故惊之变态不一，随其所之，与五神相应而动。肝藏魂，魂不安则惊骇。肺藏魄，魄不安则惊躁。脾藏意，
意不专则惊惑。肾藏志，志慊则惊恐。胃虽无神，然为五脏之海，诸热归之，则发惊狂，闻木音惕然心动也。
恐者，是热伤其肾，肾伤则精虚，精虚则志不足，志本定而不移，故恐亦无他状。《内经》于惊之病邪者，有
火热二淫司天在泉胜复之气，有各经热病所致，有三阳积并，有气并于阳，皆为惊病。故病机统而言曰∶诸病
惊骇，皆属于火也。于恐之病邪者，有积气并于肾则恐，有血不足则恐，有阴阳相搏则恐，有胃气热肾气弱则
恐，然于肝之惊恐互相作者，以其脏气属阳居阴，纳血藏魂，魂不安则神动，神动则惊；血不足则志慊，志慊
则恐。故二者肝脏兼而有之。似此之类，于火热二淫属感邪之外，余者之惊恐，皆因人气之阴阳所动而内生
者也。○惊恐二病，与内外所因，其治法同乎？异乎？曰∶惊则安其神，恐则定其志，治当分阴阳之别，何得
而同也？夫易之为卦，坎离交而后为既济。人以五脏应之，心为离火，内阴而外阳。肾为坎水，内阳而外阴。
内者是主，外者是用。又内主者五神，外用者五气。是故心以神为主，阳为用；肾以志为主，阴为用。阳则气
也火也，阴则精也水也。及乎水火既济，全在阴精上奉，以安其神；阳气下藏，以定其志。不然，则神摇于内，
阳气散于外，志惑于中，阴精走于下。既有二脏水火之分，治法安得无少异？所以惊者先安其神，然后散乱之
气可敛，气敛则阳道行矣。恐者先定其志，然后走失之精可固，精固则阴气用矣。为外事惊者，虽子和氏谓惊
者平之，平，常也，使病者时时闻之习熟，自然不惊。固是良法，不若使其平心易气以先之，而后以药平其阴
阳之盛衰，则神可安志可定矣。（《推求师意》）
怔忡之病，心胸筑筑振动，惶惶惕惕，无时得安者是也。然古无是名，其在《内经》则曰∶胃之大络，
名曰虚里，出于左乳下，其动应衣，宗气泄也。在越人、仲景则有动气在上下左右
之辨，云诸动气皆不可汗下者是也。凡此者，即皆怔忡之类，此证惟阴虚劳损之人乃有之。盖阴虚于下，则宗
气无根而气不归原，所以在上则浮撼于胸臆，在下则振动于脐旁。虚微者动亦微，虚甚者动亦甚。凡患此者，
速宜节欲节劳，切戒酒色。凡治此者，速宜养气养精，滋培根本。若或误认为痰火而妄施清利，则速其危矣。
○惊有二证∶有因病而惊者，有因惊而病者。如东方青色，入通于肝，其病发惊骇，及伤寒阳明证，闻木音则
惕然而惊之类，此则或因岁火之盛，或因岁木之衰，或因风热之相搏，或因金木之相制，是当察其客邪之轻重，
兼治其标。若因惊而病者，如惊则气乱而心无所倚，神无所归，虑无所定之类，此必于闻见夺气而得之，是宜
安养心神，滋培肝胆，当以专扶元气为主治。此固二者之辨，然总之主气强者不易惊，而易惊者必肝胆之不足
者也。故虽有客邪，亦当知先本后标之义。又如惊则气乱，恐则气下，惊恐虽同类，而不知恐之伤人尤甚于惊。
何也？盖惊出于暂，暂者可复；恐积于渐，渐者难解。甚至心怯而神伤，精却则阴痿，日消月缩，不亡不已。
此非大勇大断，必不能拔去病根，徒费药力也。予尝治暴惊者，十愈八、九，治恐惧者，十不得其一、二。（张景岳）
怔忡大概属血虚与痰。有思虑便动者属虚，时作时止者，痰因火动也。瘦人多是血虚，肥人多是痰饮。时
觉心跳者，是血少不能养心也。○病因惊而得者，惊则神出于舍，舍空得液则成痰，血气入舍，则痰拒其神不得
归焉。（朱丹溪）
怔忡，心血少也。其原起于肾水不足，不能上升，以致心火不能下降。治宜归脾汤，去木香加麦、味、枸杞，
吞都气丸。如挟包络有余之火而兼痰者，加生地、黄连、贝母之类以清之。（《己任编》）
脉候
寸口脉动而弱，动则为惊，弱则为悸。（《金匮》）
选案
一女年十余岁，病心悸，常若有人捕之，欲擗地而无所容，母抱于怀，婢护于外，犹不能安寝。医者以为
心病，用安神丸、镇心丹，不效。诊脉细弱而缓。谓曰∶此胆病，服温胆汤而安。（汪石山）
附战栗颤振
诸禁鼓栗，如丧神守，皆属于火。（《素问》）
人恐极而战栗者，由恐为肾志，其志过度则伤肾，肾水衰，则心火自盛而为战栗也。如酒性热，饮多则令
人战栗。（《原病式》）
河间曰∶战栗动摇，火之象也。或言为寒者，未明变化之道也。此由心火热甚，亢极而战，反兼水化故也。
若据此说，则凡见寒战，皆为火证，何以《经》曰∶阴胜则内寒。又曰∶阳虚则外寒。又曰∶阳虚而阴盛，外
无气，故先寒栗也。又曰∶阳明虚则寒栗鼓颔也。凡此皆属《经》言，而河间悉言为火，其然否可知也。（《景岳全书》）
颤振，有谓作诸禁鼓栗者，非也。诸禁鼓栗，乃斗牙战摇，似寒而实热也。颤振乃兼木气而言，惟手足肘
前战动，外无凛栗之状。（孙一奎）
(Attached: Trembling and Shaking)
Scriptural Principles
The color of the East is green, which communicates with the Liver. Its disease manifests as fright and horror. ○ The Liver meridian presents with sudden fright due to being startled. ○ When Liver Qi is deficient, there is fear; when excessive, there is anger. ○ When the Liver is deficient, vision is impaired, hearing is diminished, one is prone to fear, feeling as if someone were chasing them. ○ In the Yangming stage, severe cases may present with reversal (Jue), aversion to people and fire, and sudden startle upon hearing the sound of wood. ○ Various diseases involving swelling, pain, soreness, fright, and horror all belong to Fire. ○ Fright causes the Heart to have no support, the Spirit (Shen) to have no return, and thoughts to be unsettled, thus causing Qi chaos. ○ Worry and fear injure the Heart. ○ When the Heart is apprehensive and overthinking, it injures the Spirit; once the Spirit is injured, fear and loss of self-control ensue. ○ The Kidney corresponds to the emotion of fear; fear injures the Kidney, while thought overcomes fear. ○ Unresolved fear and terror injure Essence (Jing); once Essence is injured, there is bone soreness, flaccidity, cold extremities, and spontaneous emission of essence. ○ Worry, fear, and anger injure Qi. ○ Fear causes Essence to retreat; when Essence retreats, the Upper Jiao becomes closed; when closed, Qi returns; when returned, the Lower Jiao becomes distended, thus causing Qi to descend. (Suwen)
Philosophical Statements
Palpitations (Jing Ji) refer to a sudden feeling of fright, with an uneasy heart that moves intermittently. Paroxysmal palpitations (Zheng Chong) refer to a constant trembling and unrest in the heart that occurs without specific timing. (Yixue Zhengzhuan)
When the heart moves due to external stimulation, it is called Fright (Jing). When the heart moves spontaneously without external cause, it is called Palpitation (Ji), which is synonymous with Zheng Chong. (Li Dongyuan)
Fear is similar to fright and palpitations but is essentially different. Hezi said: Fright arises from not knowing what is happening, whereas fear arises from being aware of it. Generally, fright involves startling at a noise, while fear involves a vague internal awareness, feeling as if being chased, unable to sit or lie down alone, requiring companionship, or needing light at night. ○ There are four Zang organs associated with fear: First is the Kidney; the Scripture says: "In the Zang organs, it is the Kidney; in emotions, it is fear." It also says: "When Essence and Qi congregate in the Kidney, fear arises." Second is the Liver and Gallbladder; the Scripture says: "The Liver stores Blood; when Blood is insufficient, fear arises." Dairen said: "The Gallbladder represents courage; fright and fear injure the Gallbladder." When the Liver and Gallbladder are excess, there is anger and bravery; when deficient, there is timidity and fear. Third is the Stomach; the Scripture says: "The Stomach is associated with fear." Fourth is the Heart; the Scripture says: "Apprehension and overthinking injure the Spirit; once the Spirit is injured, fear and loss of self-control ensue." (Chishui Xuanzhu)
Fright and terror (Jing Bu) mean fright and fear; fear is also a form of fear, so their meanings are identical. When terms are paired as headings, they often represent Yin-Yang opposition. For example, joy and anger: Joy originates from the Heart, which resides in Yang; anger originates from the Liver, which resides in Yin. Will and intention: Will is static and unchanging (Yin); intention is dynamic and unstable (Yang). Fright and fear: Fright is triggered by external events, moving the Heart internally; when the Heart moves, the Spirit shakes. Fear is caused by confusion regarding external matters, affecting the Will internally; when the Will is compromised, Essence retreats. Thus, the Neijing states: "Fright causes the Heart to have no support, the Spirit to have no return, and thoughts to be unsettled, thus causing Qi chaos." "Fear causes Essence to retreat; when Essence retreats, the Upper Jiao becomes closed; when closed, Qi returns; when returned, the Lower Jiao becomes distended, thus causing Qi to descend." It also states: "Those who were once noble then became lowly, or once rich then poor, with sorrow and worry knotting internally, leading to depletion of Ying and loss of Jing, deep illness with no Qi, will suddenly feel frightened." These cases involve diseases triggered by external events affecting the internal Spirit and Mind. Regarding fright and fear caused by internal Yin-Yang imbalance: Fright is caused by Heat-Fire scorching the Heart; when the Heart moves, the Spirit becomes chaotic. Since the Spirit's function has no fixed pattern, the manifestations of fright vary, corresponding to the Five Spirits. The Liver stores the Hun (Ethereal Soul); if Hun is unsettled, there is fright and horror. The Lungs store the Po (Corporeal Soul); if Po is unsettled, there is agitation and restlessness. The Spleen stores Yi (Intellect); if Yi is unfocused, there is confusion and bewilderment. The Kidneys store Zhi (Willpower); if Zhi is compromised, there is fear and fright. Although the Stomach does not house a spirit, it is the Sea of the Five Zang organs; when various heats converge there, it leads to fright and mania, and sudden startle upon hearing wood sounds. Fear is caused by Heat injuring the Kidney; when the Kidney is injured, Essence becomes deficient; when Essence is deficient, Willpower is insufficient. Since Willpower is inherently stable and unchanging, fear presents with few other symptoms. Regarding the pathogenic factors for fright in the Neijing: there are winning and reversing Qi patterns of Heaven and Earth related to Fire and Heat; heat diseases of various meridians; accumulation of the Three Yang meridians; and Qi aggregating in Yang—all constitute fright diseases. Thus, the pathogenesis summary states: "All fright and horror diseases belong to Fire." Regarding pathogenic factors for fear: accumulated Qi aggregating in the Kidney causes fear; insufficient Blood causes fear; Yin-Yang conflict causes fear; Heat in Stomach Qi and weakness in Kidney Qi cause fear. However, in the Liver, fright and fear interact because its organ Qi belongs to Yang residing in Yin, storing Blood and housing the Hun. If Hun is unsettled, the Spirit moves, causing fright; if Blood is insufficient, Willpower is compromised, causing fear. Thus, both are inherent to the Liver. Apart from these external pathogens related to Fire and Heat, other instances of fright and fear arise internally due to the movement of human Qi's Yin-Yang. ○ Are the treatment methods for fright and fear, considering internal and external causes, the same or different? Answer: Fright requires calming the Spirit; fear requires stabilizing the Will. Treatment must distinguish between Yin and Yang; how can they be the same? In the I Ching, Kan and Li intersect to form Hexagram Ji Ji (After Completion). Humans correspond to the Five Zang organs: the Heart is Li Fire, Yin inside and Yang outside; the Kidney is Kan Water, Yang inside and Yin outside. The interior is the Master, the exterior is the Function. The interior Master governs the Five Spirits; the exterior Function governs the Five Qi. Therefore, the Heart takes the Spirit as Master and Yang as Function; the Kidney takes the Will as Master and Yin as Function. Yang is Qi and Fire; Yin is Essence and Water. When Water and Fire achieve mutual interaction (Ji Ji), it relies on Yin Essence ascending to calm the Spirit, and Yang Qi descending to stabilize the Will. Otherwise, the Spirit shakes internally, Yang Qi scatters externally, the Will is confused centrally, and Yin Essence flows downward. Given the distinction of Water and Fire in these two organs, how can treatments be identical? Therefore, for fright, one first calms the Spirit, then gathers scattered Qi; once Qi is gathered, the Yang pathway functions. For fear, one first stabilizes the Will, then secures lost Essence; once Essence is secured, the Yin function operates. For those frightened by external events, although Hezi stated "treat fright by making it ordinary," meaning familiarization reduces fear, this is a good method. However, it is better to first calm the mind and regulate Qi, then use medicine to balance Yin-Yang excess and deficiency, thereby calming the Spirit and stabilizing the Will. (Tuiqiu Shi Yi)
Zheng Chong (Paroxysmal Palpitations) is characterized by throbbing and vibration in the chest and heart, with constant anxiety and unrest, never finding peace. Although this name did not exist in ancient times, the Neijing refers to it as: "The great collateral of the Stomach is named Xuli, emerging below the left breast; its movement is visible through clothing, indicating leakage of Zong Qi." Yu Fan and Zhang Zhongjing discussed movements of Qi in the upper, lower, left, and right, stating that such movements should not be treated with sweating or purging. All these cases belong to Zheng Chong. This condition only occurs in individuals with Yin deficiency and consumptive disorders. Because Yin is deficient below, Zong Qi lacks a root and Qi fails to return to its origin. Thus, above, it floats and shakes in the chest; below, it vibrates near the umbilicus. Mild deficiency causes mild movement; severe deficiency causes severe movement. Those suffering from this should immediately moderate desires and labor, and strictly avoid alcohol and sexual indulgence. Treatments should quickly nourish Qi and Essence, and tonify the root. If mistakenly diagnosed as Phlegm-Heat and treated with clearing and draining agents, danger will accelerate. ○ There are two types of Fright: one where fright arises from disease, and one where disease arises from fright. For example, "The color of the East is green, communicating with the Liver, its disease manifests as fright and horror," or Yangming stage of Shanghan presenting with startle upon hearing wood sounds—these may be due to excessive annual Fire, deficient annual Wood, wind-heat conflict, or Metal-Wood constraint. One must assess the severity of exogenous pathogens and treat the branch simultaneously. If disease arises from fright, such as "Fright causes Qi chaos, Heart having no support, Spirit having no return, thoughts unsettled," this results from shock to Qi via sensory input. Treatment should calm and nourish the Heart Spirit, tonify Liver and Gallbladder, focusing primarily on supporting Yuan Qi. This distinguishes the two, but generally, those with strong primary Qi are less likely to be frightened; those easily frightened must have Liver and Gallbladder deficiency. Thus, even with exogenous pathogens, one must understand prioritizing the root before the branch. Furthermore, "Fright causes Qi chaos, Fear causes Qi descent." Although fright and fear are similar, fear harms more severely than fright. Why? Fright is temporary and recoverable; fear accumulates gradually and is difficult to resolve. It can lead to timid Heart and injured Spirit, Essence retreat causing impotence, daily wasting and monthly shrinking, continuing until death. Without great courage and decisiveness, the root cannot be removed, and medicinal effort is wasted. I have treated sudden fright with 80-90% recovery, but fear with less than 10-20%. (Zhang Jingyue)
Zheng Chong generally belongs to Blood deficiency and Phlegm. Movements triggered by thinking indicate deficiency; intermittent occurrences indicate Phlegm stirred by Fire. Thin individuals mostly suffer from Blood deficiency; obese individuals mostly suffer from Phlegm-fluids. Occasional heartbeat sensation indicates insufficient Blood failing to nourish the Heart. ○ When caused by fright, the Spirit leaves its residence; the empty residence collects fluids forming Phlegm; when Blood and Qi enter the residence, Phlegm repels the Spirit, preventing its return. (Zhu Danxi)
Zheng Chong is due to insufficient Heart Blood. Its origin lies in insufficient Kidney Water failing to ascend, causing Heart Fire to fail to descend. Treatment should use Guipi Tang, removing Xiangru, adding Maidong, Wuweizi, and Gouqi, taken with Duqi Wan. If accompanied by excess Fire in the Pericardium and Phlegm, add Shengdi, Huanglian, and Beimu to clear it. (Jiren Bian)
Pulse Diagnosis
The Cun Kou pulse is active and weak. Activity indicates Fright; weakness indicates Palpitation. (Jingui Yaolue)
Selected Cases
A girl of over ten years old suffered from palpitations, often feeling as if someone were chasing her, wanting to throw herself on the ground with nowhere to hide. Her mother held her, and maids guarded around her, yet she still could not sleep peacefully. Physicians diagnosed it as a Heart disease and used Anshen Wan and Zhenxin Dan, but with no effect. Upon diagnosis, the pulse was fine, weak, and slow. He said: "This is a Gallbladder disease; take Wendan Tang and she will be at ease." (Wang Shishan)
Attached: Trembling and Shaking
All conditions involving inhibition, drumming, and shivering, resembling a loss of spiritual control, all belong to Fire. (Suwen)
When fear reaches its extreme, trembling occurs because fear is the emotion of the Kidney; excessive fear injures the Kidney. When Kidney Water declines, Heart Fire naturally becomes excessive, causing trembling. Similarly, wine is hot in nature; excessive drinking causes trembling. (Yuanbing Shi)
He Jian said: Trembling and shaking are images of Fire. Those who say it is Cold do not understand the principles of transformation. This is due to extreme Heart Fire leading to shaking, which counteracts and mimics Water characteristics. Based on this theory, all chills would be Fire syndromes. Yet the Scripture says: "Yin excess causes internal cold." "Yang deficiency causes external cold." "Yang deficiency with Yin excess, lacking external Qi, causes initial chills." "Yangming deficiency causes cold chills and jaw quivering." All these are Scriptural statements, yet He Jian attributes them all to Fire; whether this is correct or not is evident. (Jingyue Quanshu)
Tremors (Chan Zhen) are sometimes confused with inhibited drumming and shivering, which is incorrect. Inhibited drumming and shivering involve teeth chattering and shaking, appearing cold but actually being heat. Tremors relate to Wood Qi, involving only shaking of hands, feet, and elbows, without external chilling sensations. (Sun Yikui)