论曰伤寒心下悸者，谓悸动不定也。伤寒饮水过多，水停心下，肾气乘心，则心气虚弱，
故为之悸动也，此皆由发汗以后又下之，津液燥少，若内生虚热，热则饮水，水气停积，故
必振寒而心下悸也。
治伤寒厥心下悸，宜先治水，当服茯苓甘草汤，却治其厥，不尔水渍入胃，必作利也。
茯苓甘草汤方
赤茯苓（去黑皮） 桂（去粗皮各二两） 甘草（炙锉一两）
上三味，粗捣筛，每服五钱匕，水一盏半，入生姜一枣大拍碎，煎取七分，去滓温服。
治伤寒发汗不解，发热心忪惊悸，头眩目 。真武汤方
赤茯苓（去黑皮一两） 芍药（一两） 附子（炮裂去皮脐半两） 白术（一两） 甘
草（炙半两）
上五味，锉如麻豆大，每服五钱匕，用水一盏半。入生姜半分切，同煎至七分，去滓温
服。
治伤寒发汗过多，其人叉手自冒沁，心下悸欲得按者。桂枝甘草汤方
桂枝（去粗皮四两） 甘草（炙三两）
上二味，锉如麻豆大，每服五钱匕，水一盏半，煎取七分，去滓温服。
治伤寒脉结心悸动。炙甘草汤方
甘草（炙一两） 人参（半两） 桂（去粗皮三分） 麦门冬（去心焙一两） 麻仁（一
合） 生地黄（四两）
上六味， 咀如麻豆大，每服五钱匕，水一盏半，酒半盏，入生姜半分切，大枣二枚劈
破，
治伤寒水在心下，心悸动，欲得人按。桂枝汤方
桂（去粗皮二两） 赤茯苓（去黑皮一两半） 白术（一两） 甘草（炙锉三分） 陈
橘皮（汤浸去白焙半两）
上五味，粗捣筛，每服五钱匕，水一盏半，煎取七分，去滓温服，不拘时候。
治伤寒饮水过多，心下悸动不定。赤茯苓汤方
赤茯苓（去黑皮二两） 陈橘皮（汤浸去白焙二两） 半夏（汤洗七遍切焙二两） 枳
壳（麸炒去瓤半两） 人参（一两） 白术（三分）
上六味，粗捣筛，每服五钱匕，水一盏半，入生姜半分拍碎，同煎取八分，去滓温服，
不拘时候。
治伤寒呕哕，心下悸动，胸膈有滞水，往往头眩。茯苓半夏汤方
赤茯苓（去黑皮二两） 半夏（汤洗七遍炒干三两） 陈橘皮（汤浸去白焙一两）
上三味，粗捣筛，每服五钱匕，水一盏半，入生姜一分拍碎，同煎至七分，去滓温服，
晚再服。
治伤寒吐后，心下逆满，忪悸不定，起即头眩。茯苓白术汤方
赤茯苓（去黑皮一两） 白术（三分） 桂（去粗皮三分） 甘草（炙锉半两） 芎
（一两）
上五味，粗捣筛，每服三钱匕，水一盏，煎至六分，去滓温服。
治伤寒发汗后，引饮过多，心下悸动。茯苓桂枝汤方
赤茯苓（去黑皮） 桂（去粗皮） 半夏（汤洗七遍炒干各一两） 甘草（炙锉半两）
上四味，粗捣筛，每服三钱匕，水一盏，入生姜半分拍碎，同煎至七分，去滓温服。
治伤寒心下有饮，悸动不定。桂心汤方
桂（去粗皮一两） 槟榔（锉） 半夏（汤洗七遍炒各半两）
上三味， 咀，如麻豆大，每服四钱匕，水一盏半，入生姜五片，同煎至七分，去滓食
前温服，如人行三五里再服。
Commentary states: Palpitations in the epigastrium (heart region) during Shanghan (Cold Damage disease) refer to a sensation of unsettled, irregular heartbeat. When a patient with Shanghan drinks excessive water, fluid retention occurs in the epigastrium. The Qi of the Kidney attacks the Heart, causing deficiency of Heart Qi, thus resulting in palpitations. This is often due to purgation following sweating, which dries up body fluids; if deficient heat arises internally, it induces thirst and water intake. Consequently, water qi stagnates and accumulates, inevitably leading to chills and palpitations in the epigastrium.
For treating Shanghan with cold extremities and palpitations in the epigastrium, one should first treat the water retention by administering Fuling Gancao Tang (Poria and Licorice Decoction), and subsequently treat the cold extremities. If this order is not followed, water dampness will infiltrate the Stomach, inevitably causing diarrhea.
Fuling Gancao Tang Formula
Chifuling (Red Poria, removed black skin) [Guizhi] (Cinnamon Twig, removed coarse bark, each 2 liang) Gancao (Licorice Root, roasted and chopped, 1 liang)
The above three herbs are coarsely crushed and sieved. Each dose consists of 5 qianbi (approx. 15-20g depending on era/measure), boiled in 1.5 sheng (approx. 300ml) of water with one date-sized piece of fresh ginger (Shengjiang, sliced). Simmer until reduced to 70%, strain, and take warm.
For treating Shanghan where sweating fails to resolve the condition, accompanied by fever, palpitations (Xin Song),惊悸 (startle palpitations), dizziness (Tou Xuan), and blurred vision, use Zhenwu Tang (True Warrior Decoction).
Chifuling (Red Poria, removed black skin, 1 liang) Shaoyao (Peony Root, 1 liang) Fuzi (Prepared Aconite Root, cracked, skin and umbilicus removed, 0.5 liang) Baizhu (Atractylodes Macrocephala Rhizome, 1 liang) Gancao (Licorice Root, roasted, 0.5 liang)
The above five herbs are chopped like hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with half a qian of sliced fresh ginger. Simmer until reduced to 70%, strain, and take warm.
For treating Shanghan where excessive sweating leads to the patient crossing hands over the chest, experiencing palpitations in the epigastrium that desire pressure, use Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction).
Guizhi (Cinnamon Twig, removed coarse bark, 4 liang) Gancao (Licorice Root, roasted, 3 liang)
The above two herbs are chopped like hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water. Simmer until reduced to 70%, strain, and take warm.
For treating Shanghan with knotted pulse (Jie Mai) and palpitations, use Zhigancao Tang (Roasted Licorice Decoction).
Gancao (Licorice Root, roasted, 1 liang) Renshen (Ginseng Root, 0.5 liang) Guizhi (Cinnamon Twig, removed coarse bark, 3 fen) Maimendong (Ophiopogon Tuber, heart removed, roasted, 1 liang) Mahren (Hemp Seed, 1 he) Shengdihuang (Rehmannia Root, fresh, 4 liang)
The above six herbs are chopped like hemp seeds. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water and half a zhan of wine, with half a qian of sliced fresh ginger and two broken Jujube fruits. (Cooking instructions incomplete in source text).
For treating Shanghan with water retention in the epigastrium, palpitations desiring pressure, use Guizhi Tang (Cinnamon Twig Decoction - *Note: Formula ingredients listed correspond to a variation involving Poria and Atractylodes*).
Guizhi (Cinnamon Twig, removed coarse bark, 2 liang) Chifuling (Red Poria, removed black skin, 1.5 liang) Baizhu (Atractylodes Macrocephala Rhizome, 1 liang) Gancao (Licorice Root, roasted and chopped, 3 fen) Chenpi (Dried Tangerine Peel, soaked in water, white pith removed, roasted, 0.5 liang)
The above five herbs are coarsely crushed and sieved. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water. Simmer until reduced to 70%, strain, and take warm at any time.
For treating Shanghan caused by excessive water drinking, resulting in unsettled palpitations in the epigastrium, use Chifuling Tang (Red Poria Decoction).
Chifuling (Red Poria, removed black skin, 2 liang) Chenpi (Dried Tangerine Peel, soaked in water, white pith removed, roasted, 2 liang) Banxia (Pinellia Tuber, washed seven times in water, chopped and roasted, 2 liang) Zhike (Bitter Orange Fruit, bran-fried, placenta removed, 0.5 liang) Renshen (Ginseng Root, 1 liang) Baizhu (Atractylodes Macrocephala Rhizome, 3 fen)
The above six herbs are coarsely crushed and sieved. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with half a qian of smashed fresh ginger. Simmer until reduced to 80%, strain, and take warm at any time.
For treating Shanghan with vomiting or hiccups, palpitations in the epigastrium, stagnant water in the chest and diaphragm, often accompanied by dizziness, use Fuling Banxia Tang (Poria and Pinellia Decoction).
Chifuling (Red Poria, removed black skin, 2 liang) Banxia (Pinellia Tuber, washed seven times in water, fried dry, 3 liang) Chenpi (Dried Tangerine Peel, soaked in water, white pith removed, roasted, 1 liang)
The above three herbs are coarsely crushed and sieved. Each dose consists of 5 qianbi, boiled in 1.5 sheng of water with one qian of smashed fresh ginger. Simmer until reduced to 70%, strain, and take warm. Take again in the evening.
For treating Shanghan after vomiting, presenting with fullness and rebellious Qi in the epigastrium, unsettled palpitations, and dizziness upon rising, use Fuling Baizhu Tang (Poria and Atractylodes Decoction).
Chifuling (Red Poria, removed black skin, 1 liang) Baizhu (Atractylodes Macrocephala Rhizome, 3 fen) Guizhi (Cinnamon Twig, removed coarse bark, 3 fen) Gancao (Licorice Root, roasted and chopped, 0.5 liang) Xiong (Ligusticum Chuanxiong Rhizome, 1 liang)
The above five herbs are coarsely crushed and sieved. Each dose consists of 3 qianbi, boiled in 1 sheng of water. Simmer until reduced to 60%, strain, and take warm.
For treating Shanghan after excessive sweating and drinking, resulting in palpitations in the epigastrium, use Fuling Guizhi Tang (Poria and Cinnamon Twig Decoction).
Chifuling (Red Poria, removed black skin) Guizhi (Cinnamon Twig, removed coarse bark) Banxia (Pinellia Tuber, washed seven times in water, fried dry, each 1 liang) Gancao (Licorice Root, roasted and chopped, 0.5 liang)
The above four herbs are coarsely crushed and sieved. Each dose consists of 3 qianbi, boiled in 1 sheng of water with half a qian of smashed fresh ginger. Simmer until reduced to 70%, strain, and take warm.
For treating Shanghan with fluid retention in the epigastrium and unsettled palpitations, use Guixin Tang (Cinnamon Heart Decoction).
Guixin (Cinnamon Heart, removed coarse bark, 1 liang) Binglang (Areca Seed, chopped) Banxia (Pinellia Tuber, washed seven times in water, fried, each 0.5 liang)
The above three herbs are chopped like hemp seeds. Each dose consists of 4 qianbi, boiled in 1.5 sheng of water with five slices of fresh ginger. Simmer until reduced to 70%, strain, and take warm before meals. Re-administer after walking for three to five li.