惊悸之别杂病中辨之甚明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耳聋目赤胸满而烦
者不可吐下吐下则悸而惊一条而已
海 茯苓丸 治伤寒后或用心劳倦四肢羸弱心忪惊悸吸吸短气
茯神 麦门冬(去心) 熟地(各一两) 牡丹皮 人参 黄 (各七钱) 桂枝 甘草(炙) 牛膝 泽泻(各
半两)上为细末炼蜜和捣三五百杵丸如梧桐子大每服二十丸食前温酒下
犀角汤 治伤寒后伏热在心怔忡惊悸不得眠睡
犀角屑(半两镑) 茵陈蒿(七钱半) 茯苓(二两) 芍药(二两) 生地黄(焙二两) 麦门冬(去心一两半)
山栀(半两)上 咀每服五钱水一盏生姜二片竹叶三七片同煎至七分食后服
麦门冬茯苓饮子 治伤寒后心神恍惚不得卧
麦门冬(去心) 赤茯苓(去皮) 知母(焙) 芎 炙甘草 酸枣仁(微炒) 陈皮(去白炒) 槟榔(各一
两)上 咀每服五钱水一盏半生姜五片煎温服日三
夫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
伤寒八九日下之胸满烦惊小便不利谵语一身尽重不可转侧者柴胡加龙骨牡蛎汤主之(成 伤寒八九日邪气已成热而
复传阳经之时下之虚其里而热不除胸满而烦者阳热客于胸中也惊者心恶热而神不守也小便不利者里虚津液不行也谵语
者胃热也一身尽重不可转侧者阳气内行于里不营于表也与柴胡汤以除胸满而烦加龙骨牡蛎铅丹收敛神气而镇惊加茯苓
以行津液利小便加大黄以逐胃热止谵语加桂枝以行阳气而解身重杂错之邪斯悉愈矣)
柴胡加牡蛎龙骨汤方
半夏(汤洗二合) 柴胡(四两) 大黄(二两) 人参 桂枝(去粗皮) 茯苓 龙骨 铅丹 牡蛎(熬) 生
姜(各一两半) 大枣(六枚)上十一味以水八升煮取四升纳大黄切如棋子更煮一二沸去滓温服一升
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牡蛎龙骨救逆汤主之(成 伤寒脉浮责邪在表医以
火劫发汗汗大出者亡其阳汗者心之液亡阳则心气虚心恶热火邪内迫则心神浮越故惊狂起卧不安与桂枝汤解未尽表邪去
芍药以芍药益阳非亡阴所宜也火邪错逆加热漆之辛以散之阳气亡脱加龙骨牡蛎之涩以固之本草云涩可去脱龙骨牡蛎之
属是也)
桂枝去芍药加蜀漆龙骨牡蛎救逆汤方
桂枝(去粗皮) 生姜(切) 蜀漆(洗去腥各三两) 牡蛎(熬五两) 龙骨(四两) 甘草(炙二两) 大枣
(十二枚劈)上为末以水一斗二升先煎蜀漆减二升纳诸药煎取三升去滓温服一升
太阳伤寒者加温针必惊也(心属火火先入心心主血而藏神血如水也神如鱼也两阳相熏灼水热汤沸则鱼惊跃不能安
矣)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 (论见风温)
吴 大抵伤寒汗吐下之后虚极之人或因事未决遂生惊悸者宜养血安神镇心之剂或朱砂安神丸之类
If excessive sweating leads to the patient crossing their hands over the heart area, experiencing palpitations (Xin Ji, palpitations of the heart) that are relieved by pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) should be used (see entry on Palpitations).
The distinction between Jing (Jing, sudden fright/shock) and Ji (Ji, palpitations/heart flutters) is clearly analyzed in miscellaneous diseases. In Shanghan (Cold Damage), there are cases mentioning only "Jing" and cases mentioning only "Ji"; since the principles differ, they are separated into two discussions. The only case where both "Jing" and "Ji" are mentioned together is in Shaoyang disease characterized by deafness, red eyes, chest fullness, and irritability; vomiting and purging methods must not be used. If mistakenly applied, vomiting or purging will result in Ji and Jing.
Haizang Fuling Wan (Sea Store Poria Pill): Treats post-Shanghan conditions or those caused by mental labor and fatigue, presenting with emaciated limbs, empty-hearted palpitations (Xin Song), and shortness of breath.
Ingredients: Fushen (Poria with Hostwood), Maidong (Ophiopogon Tuber, heart removed), Shudi (Prepared Rehmannia Root) (each 1 liang); Mudanpi (Tree Peony Bark), Renshen (Ginseng Root), Huangqi (Astragalus Root); Guizhi (Cinnamon Twig), Zhigancao (Honey-fried Licorice Root); Niuxi (Achyranthes Root), Zexie (Alisma Rhizome) (each 0.5 liang). Grind all ingredients into a fine powder, mix with refined honey, and pound/beaten 300-500 times. Form pills the size of paulownia seeds. Take 20 pills before meals, washed down with warm wine.
Xijiao Tang (Rhinoceros Horn Decoction): Treats lingering heat lurking in the Heart after Shanghan, presenting as Zhengchong (palpitations with anxiety), Jingji (startle palpitations), and insomnia.
Ingredients: Xijiao xie (Rhino Horn Shavings, half liang, shaved); Yinchenshao (Artemisia Capillaris Herb, 7.5 qian); Fuling (Poria, 2 liang); Shaoyao (Peony Root, 2 liang); Shengdihuang (Fresh Rehmannia Root, baked, 2 liang); Maidong (Ophiopogon Tuber, heart removed, 1.5 liang); Shanzhi (Gardenia Fruit, half liang). Coarsely crush the ingredients. Take 5 qian per dose, add 1 zhang of water, 2 slices of Shengjiang (Fresh Ginger), and 30 Zhu Ye (Bamboo Leaves). Decoct until 70% remains. Take after meals.
Maidong Fuling Yinzi (Ophiopogon and Poria Infusion): Treats post-Shanghan conditions with vague spirit (Shen Hunhuang) and inability to lie down.
Ingredients: Maidong (Ophiopogon Tuber, heart removed); Chifuling (Red Poria, peel removed); Zhimu (Anemarrhena Rhizome, baked); Xiong (Ligusticum Rhizome); Zhigancao (Honey-fried Licorice Root); Suanzaoren (Ziziphus Seed, lightly stir-fried); Chenpi (Tangerine Peel, white pith removed and stir-fried); Binglang (Areca Seed) (each 1 liang). Coarsely crush the ingredients. Take 5 qian per dose, add 1.5 zhang of water and 5 slices of Shengjiang (Fresh Ginger). Decoct, take warm. Three times daily.
The term "Jing Huai Bing" (Fright-induced complicated disease) refers to conditions caused by mistaken purging, fire therapy counter-indications, or warm needle treatment. Zhang Zhongjing’s method is simply to regulate according to the deviation of the pathogen.
In Shanghan, if after eight or nine days, purging is performed leading to chest fullness, irritability, startle/palpitations, difficulty urinating, delirium, and whole-body heaviness making turning difficult, Chaihu Jia Longgu Muli Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction) is the primary treatment. (Cheng Wuji commentary: When Shanghan reaches eight or nine days, the pathogenic factor has transformed into heat and transmitted to the Yang meridians. Purging at this time damages the interior while heat persists. Chest fullness and irritability indicate Yang-heat lodging in the chest. Startle occurs because the Heart dislikes heat and the Spirit does not remain anchored. Difficulty urinating indicates interior deficiency and impaired fluid circulation. Delirium indicates Stomach heat. Whole-body heaviness and immobility indicate Yang Qi moving inward and failing to nourish the exterior. This formula uses Chaihu Tang to resolve chest fullness and irritability; adds Longgu (Dragon Bone), Muli (Oyster Shell), and Qiandan (Lead Monoxide) to anchor the Spirit and calm startle; adds Fuling (Poria) to promote fluid circulation and diuresis; adds Dahuang (Rhubarb Root) to purge Stomach heat and stop delirium; adds Guizhi (Cinnamon Twig) to circulate Yang Qi and resolve body heaviness and mixed pathogens. Thus, all symptoms are resolved.)
Chaihu Jia Longgu Muli Tang Formula:
Banxia (Pinellia Tuber, washed in hot water, 2 he); Chaihu (Bupleurum Root, 4 liang); Dahuang (Rhubarb Root, 2 liang); Renshen (Ginseng Root); Guizhi (Cinnamon Twig, coarse bark removed); Fuling (Poria); Longgu (Dragon Bone); Qiandan (Lead Monoxide); Muli (Oyster Shell, calcined); Shengjiang (Fresh Ginger) (each 1.5 liang); Dazao (Jujube Fruit, 6 pieces). Eleven ingredients. Add 8 sheng of water, decoct to obtain 4 sheng. Add chopped Dahuang, boil for one or two more boils. Strain. Take 1 sheng warm.
If Shanghan presents with a floating pulse, and the physician uses fire methods to force sweating, causing Yang collapse, it inevitably leads to Jingkuang (frightened madness), restlessness, and inability to lie still. Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang (Cinnamon Twig Decoction without Peony plus Kochia Herb, Dragon Bone, and Oyster Shell to Rescue Deviation) is the primary treatment. (Cheng Wuji commentary: A floating pulse in Shanghan indicates the pathogen is in the exterior. Using fire methods to劫 (rob/coerce) sweat causes excessive sweating, leading to Yang collapse. Sweat is the fluid of the Heart; Yang collapse implies Heart Qi deficiency. The Heart dislikes heat; internal forcing by fire pathogen causes the Spirit to float outward, resulting in frightened madness, restlessness, and inability to lie still. Use Guizhi Tang to resolve residual exterior pathogens. Remove Shaoyao (Peony Root) because Shaoyao benefits Yin, which is unsuitable for Yang collapse. For chaotic fire pathogen, add Shuqi (Kochia Herb) for its acridity to disperse. For collapsing Yang, add Longgu (Dragon Bone) and Muli (Oyster Shell) for their astringency to secure leakage. Materia Medica states: "Astringents can treat collapse." Longgu and Muli belong to this category.)
Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang Formula:
Guizhi (Cinnamon Twig, coarse bark removed); Shengjiang (Fresh Ginger, sliced); Shuqi (Kochia Herb, washed to remove fishy smell) (each 3 liang); Muli (Oyster Shell, calcined, 5 liang); Longgu (Dragon Bone, 4 liang); Zhigancao (Honey-fried Licorice Root, 2 liang); Dazao (Jujube Fruit, 12 pieces, split). Grind into powder. Add 12 sheng of water, first decoct Shuqi until reduced by 2 sheng, then add other herbs. Decoct to obtain 3 sheng. Strain. Take 1 sheng warm.
Taiyang Shanghan (Sun-Yang Cold Damage) treated with warm needles will inevitably cause Jing (startle/fright). (The Heart belongs to Fire; Fire enters the Heart first. The Heart governs Blood and houses the Spirit. Blood is like water; Spirit is like a fish. When two Yangs [pathogenic heat and needle heat] scorch each other, it is like boiling water; the fish [Spirit] becomes startled and jumps, unable to remain tranquil.) Fengwen (Wind-Warmth) presents with a floating pulse, spontaneous sweating, body heaviness, and somnolence. If treated with fire therapy, mild cases result in jaundice; severe cases resemble convulsive epilepsy with spasms. (This discussion appears in the Wind-Warmth chapter.)
Wu Kun stated: Generally, after Shanghan has been treated with sweating, vomiting, or purging, patients who are extremely deficient, or whose minds are unsettled due to unresolved matters, often develop Jingji (startle palpitations). They should be treated with formulas that nourish Blood, calm the Spirit, and anchor the Heart, such as Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill).