一条 师曰。病有奔豚。有吐脓。有惊怖。有火邪。此四部病。皆从惊发得之。
病字。贯下文四部而言。豚、即猪畜。奔豚者。足少阴肾水之癸气。寄位于亥。动则上冲。如惊猪奔突。故以之为
名。然心阳照临。而胸中氤氲之气。能逼下阴静伏。惊则神散而上虚。故奔豚之气。得以乘虚而突犯之矣。吐
脓者。肺属金而主气。又心之神为火。神火因惊而出。如电光石火。则肺金受克。而败其阻滞之金液故也。惊
怖之惊。指惕然自儆。如儿童病风热。及神虚之人。睡梦惊跳之义。与下文惊发之惊不同。盖下文之惊。凡一
切奇险境遇。及耳目之所猝然见闻者。皆是。怖。合恐惧而言。盖恐属血虚。似乎内无凭根据之主。惧属气削。似
乎外有凌驾之疑。怖则阴血内空。而虚神外张。常有不遑设备之象。故曰合恐惧而言也。盖惊则神明涣散。
而其中之精汁。亦与之而从空俱耗。如气出釜甑。而湿润随之以飞越之义。及心君复辟。而内外之仓库已
虚也。火邪者。外火也。外火逼出心液而为汗。则心神已在孤危。而外火已有乘虚之势。加之以惊。则灵明出
舍。而为外火腾内入之室矣。故曰此四部病。皆从惊而发。遂致得此病也。吐脓等三症。虽不入本篇。因与
奔豚同得于惊。故类及之。然亦可借彼以明奔豚一症。有气虚血虚。并气血两虚之别也。
二条 师曰。奔豚病。从少腹起。上冲咽喉。发作欲死。复还止。皆从惊恐得之。
此叙奔豚之正病也。上下二焦。譬之天地阴阳。各相当而无所侵犯。于是上焦以天之阳气。从西肺而下降。
下焦以地之阴精。从东肝而上升。故曰左右者阴阳之道路。若上焦之心气一空。则下焦少腹之阴。不由左
右升降之道路。而于中冲直上。以犯清虚。且更至于咽喉矣。夫上焦胸分。为心肺之城郭。奔豚之气。迫肺。则
气道几阻。迫心。则神机将窜。故发作欲死。但上极必复。冲极必还。下焦之贼阴。复还于下。则上焦之神气。亦
复还于上矣。故止。凡不测之事。猝然临之于意外。则惊。凛然持之于意中。则恐。皆能销铄其阳神阳液。而招
奔脉之上突。故曰皆从惊恐得之也。张子和谓惊为自不知。恐为自知。确甚。
三条 奔豚。气上冲胸。腹痛。往来寒热。奔豚汤主之。
奔豚汤方
芎 （二两） 当归（二两） 芍药（二两） 半夏（四两） 黄芩（二两） 甘草（二两）
生姜（四两） 生葛（五两） 甘李根白皮（一升）
上九味。以水二斗。煮取五升。温服一升。日三服。夜一服。（以四服各一升计之。当作煮取四升。否则宜云
温服一升二合为是。其当日传写之讹耶。）
此平日阳明胃气。少阳膈气素壮。乍受惊恐。心阳既驰。而心血尤短。以致阳明少阳二腑之气。同上而争趋
空处。而为奔豚之变症也。夫奔豚之义。原因北方亥气。冲突上焦。故名。不知三焦臣伏之用。从上制中。从中
制下者也。上气因惊而虚。则上不能制中。于是阳明少阳之气。就近而两争之。故气上冲胸。亦如奔豚之象。
故亦曰奔豚也。阳明少阳之气素壮。则中有以制下。而少腹之气。不能假道于胃与膈。而跳冲胸中。故方意
绝不责下焦之有余。而但以黄芩清少阳之膈。生葛凉阳明之胃而已矣。其三焦滋息之源。则又从下化中。
从中化上者也。心血因惊而亏于上。则中吸旁吸胃与膈之精汁以自润。阳明液伤。故腹痛。少阳液伤。故往
来寒热。以补血之芎归芍为主。而以浮缓守中之甘草佐之。盖浮缓。则托高血药以上补心脏。守中。则持平
血药以还补胃阴。然后以辛温之生姜。并填胸分之阳。以降敛之半夏。奠定二经之逆。殿之以甘李根之白
皮者。甘李春花夏实。得少阳阳明之正气。其根皮尤为升发生阳之路。是又欲升其下焦之气。以中实阳明。
旁入少阳耳。夫气上冲胸。而见腹痛及寒热二症。故知所冲者为少阳阳明之气。以李根白皮升下焦之阳。
故知其非肾阴之上动。百世而下。当有以余言为不谬者。
四条 发汗后。烧针令其汗。针处被寒。核起而赤者。必发奔豚。气从小腹上至心。灸其核上各一壮。
与桂枝加桂汤主之。
桂枝加桂汤方
桂枝（五两） 芍药（三两） 甘草（二两炙） 生姜（三两） 大枣（十二枚）
上五味、以水七升。微火煮取三升。去滓。温服一升。
此心阳、心液两虚。而招肾阴之上冲者也。故方意单责上虚。而不责下实耳。盖以桂枝甘姜。补心中之阳神。
而以芍药、大枣。滋其心液也。余详伤寒注。本条与伤寒之文小异。且方亦少更加桂一层。而其义则一也。
五条 发汗后。脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤主之。
茯苓桂枝甘草大枣汤方 茯苓（半斤） 桂枝（四两） 甘草（二两炙） 大枣（十五枚）
上四味。以甘澜水一斗。先煮茯苓减二升。内诸药。煮取三升。去滓。温服一升。日三服。（甘澜水法 取水
二斗。置大盆内。以杓扬之。俟水上有珠子五六千颗相逐。取而用之。）
悸者。跳动之状。与心下之虚悸不同。此条着眼在发汗后脐下悸六字。故知其欲作奔豚也。盖汗为心液。发
汗后则上虚。上虚而脐下跳动。是下焦将匀其有余。以上赴空处之渐。故知之。但脐下动悸。是脐下之实者。
当责也。故君淡渗之茯苓。以肾脏不可泻。泻膀胱之腑以泻肾阴耳。桂树嫩枝。辛温而柔软。具少火生气之
妙。甘草以浮之。大枣以托之。是使桂枝生阳之性。确乎在心肺之夹空。而填其上焦。如雾之氤氲矣。夫桂甘
大枣。意在补上。而且降奔豚之上逆者。亦须凭高弹压。水性下趋。况与茯苓先煮。则尤渗泄易下。恐失上焦
之部位。故扬作甘澜。以乱其下趋之性。使少少留连。以完全其补高治上之功用而已。真穷工极巧之方也。
此篇当与惊悸门方论参看。
Article 1 The Master said: There are diseases of Ben Tun (Rushing Pig), vomiting of pus, fright and terror, and fire pathogen. These four categories of disease all arise from fright.
The term "disease" here refers to the four categories mentioned below. "Tun" refers to pigs. "Ben Tun" refers to the Gui water qi of the Foot-Shaoyin Kidney meridian, which resides in the Earthly Branch Hai. When it moves, it rushes upward like a startled pig running amok, hence the name. However, Heart Yang shines upon and oversees the chest, where the misty Qi can suppress the Yin cold of the lower Jiao, keeping it quiet. Fright scatters the Spirit, causing emptiness in the Upper Jiao. Thus, the Qi of Ben Tun takes advantage of this emptiness to invade suddenly.
Vomiting of pus occurs because the Lung belongs to Metal and governs Qi, while the Heart's Spirit belongs to Fire. Fright causes the Spirit-fire to flare out like lightning or sparks, thereby overcoming Lung Metal and destroying its obstructing Jin Ye (body fluids), leading to putrefaction into pus.
"Fright" in "Fright and Terror" refers to being startled and alert, similar to children with wind-heat illness or those with deficient Spirit jumping in their sleep. This differs from the "fright" in "arising from fright" below. The latter "fright" encompasses any sudden, dangerous situations or unexpected sights and sounds. "Terror" combines fear and dread. Generally, "fear" (kong) relates to Blood deficiency, implying an internal lack of support; "dread" (ju) relates to Qi depletion, implying external threats. "Terror" implies internal emptiness of Yin-Blood and outward张扬 (flaring) of deficient Spirit, often presenting as unpreparedness. Hence, it is described as combining fear and dread. Fright scatters the Spirit, causing essence and fluid to dissipate like steam rising from a steamer. When the Heart Monarch recovers, the internal and external stores are already empty.
"Fire Pathogen" refers to external heat. External heat forces Heart fluids out as sweat, leaving the Heart Spirit in a precarious state, allowing external heat to take advantage of the emptiness. Combined with fright, the Spirit leaves its residence, allowing external heat to enter the interior. Thus, these four diseases arise from fright. Although vomiting pus and the other two symptoms are not the main focus of this chapter, they are included because they share the etiology of fright with Ben Tun. This also illustrates that Ben Tun can be distinguished by Qi deficiency, Blood deficiency, or dual Qi and Blood deficiency.
Article 2 The Master said: In Ben Tun disease, Qi rises from the lower abdomen to the throat. During attacks, the patient feels as if dying, but then it subsides. All such cases arise from fright and terror.
This describes the typical presentation of Ben Tun. The Upper and Lower Jiao are likened to Heaven and Earth, Yin and Yang, each maintaining balance without encroachment. The Yang Qi of Heaven descends from the Lung (West), and the Yin Essence of Earth ascends from the Liver (East). Thus, left and right are the pathways of Yin and Yang. If the Heart Qi in the Upper Jiao becomes empty, the Yin Qi from the lower abdomen does not follow the normal ascending/descending pathways but rushes straight up through the Middle Jiao, invading clarity and reaching the throat. The chest is the fortress of the Heart and Lung. Ben Tun Qi compressing the Lung obstructs the airway; compressing the Heart disrupts the Spirit mechanism. Hence, the feeling of impending death. However, extreme ascent must return. When the rebellious Yin of the Lower Jiao returns downward, the Spirit of the Upper Jiao also returns upward, and the attack stops. Sudden unexpected events cause "fright"; vigilant awareness causes "terror." Both deplete Yang Spirit and Yang fluids, inviting Ben Tun Qi to surge upward. Hence, they arise from fright and terror. Zhang Zihe stated that fright is unknown to oneself, while terror is known to oneself, which is accurate.
Article 3 For Ben Tun with Qi rushing to the chest, abdominal pain, and alternating chills and fever, Ben Tun Tang is indicated.
Ben Tun Tang Formula
Xiong (Ligusticum Chuanxiong Rhizome) (2 liang)
Danggui (Angelica Sinensis Radix) (2 liang)
Shaoyao (Paeonia Lactiflora Radix) (2 liang)
Banxia (Pinellia Ternata Rhizoma Preparatum) (4 liang)
Huangqin (Scutellaria Baicalensis Radix) (2 liang)
Gancao (Glycyrrhiza Uralensis Radix) (2 liang)
Shengjiang (Zingiber Officinale Rhizoma) (4 liang)
Shengge (Pueraria Lobata Radix) (5 liang)
Ganligenbaipi (Prunus Persica Cortex Radicis) (1 sheng)
Decoct the above nine ingredients in 2 dou of water to obtain 5 sheng. Take 1 sheng warm, three times daily and once at night. (Note: Based on the dosage of 1 sheng per dose for four doses, the yield should likely be 4 sheng, suggesting a transcription error in the original text.)
This condition arises when the Stomach Qi of Yangming and the Diaphragm Qi of Shaoyang are robust, but sudden fright relaxes Heart Yang and depletes Heart Blood. Consequently, Qi from Yangming and Shaoyang rushes upward to fill the emptiness, creating the variation of Ben Tun. Originally, Ben Tun refers to Northern Hai Qi conflicting with the Upper Jiao. However, the San Jiao functions by controlling the Middle from Above and the Lower from Middle. When Upper Jiao Qi is deficient due to fright, it cannot control the Middle, leading to contention between Yangming and Shaoyang Qi. Thus, Qi rushes to the chest, resembling Ben Tun. Since Yangming and Shaoyang Qi are robust, the Middle controls the Lower, preventing Lower Abdomen Qi from jumping to the Chest. Therefore, the formula does not address excess in the Lower Jiao but uses Huangqin to clear Shaoyang diaphragm heat and Shengge to cool Yangming stomach heat. The source of San Jiao nourishment transforms from Lower to Middle, and Middle to Upper. Deficient Heart Blood absorbs fluids from the Stomach and Diaphragm. Damage to Yangming fluids causes abdominal pain; damage to Shaoyang fluids causes alternating chills and fever. The formula uses Xiong, Danggui, and Shaoyao to tonify Blood as the sovereign drugs, supported by Gancao for its floating and stabilizing properties. Gancao lifts blood-tonifying herbs to the Heart and balances them to restore Stomach Yin. Shengjiang (acrid-warm) fills the Chest Yang, and Banxia (descending) settles the rebellious Qi of the two meridians. Ganligenbaipi, derived from Prunus persica roots, obtains the righteous Qi of Shaoyang and Yangming. Its root bark promotes the ascent of Lower Jiao Qi to solidify Yangming and assist Shaoyang. Given the symptoms of Qi rushing to the chest, abdominal pain, and chills/fever, the attacking Qi is identified as Shaoyang and Yangming. Using Ganligenbaipi to ascend Lower Jiao Yang confirms this is not an uprising of Kidney Yin. Future scholars will recognize the validity of this explanation.
Article 4 After sweating therapy, if moxa needles were used to induce sweating, and the needle sites became cold, forming red nodules, Ben Tun will definitely occur, with Qi rushing from the lower abdomen to the heart. Moxibustion should be applied to each nodule (one mound), and Guizhi Jia Gui Tang is indicated.
Guizhi Jia Gui Tang Formula
Guizhi (Cinnamomi Ramulus) (5 liang)
Shaoyao (Paeonia Lactiflora Radix) (3 liang)
Gancao (Glycyrrhiza Uralensis Radix, honey-fried) (2 liang)
Shengjiang (Zingiber Officinale Rhizoma) (3 liang)
Dazao (Ziziphus Jujuba Fructus) (12 pieces)
Decoct the above five ingredients in 7 sheng of water over low heat to obtain 3 sheng. Strain and take 1 sheng warm.
This condition results from dual deficiency of Heart Yang and Heart Fluid, inviting the uprising of Kidney Yin. The formula focuses solely on treating Upper Jiao deficiency, not Lower Jiao excess. Guizhi, Gancao, and Shengjiang tonify Heart Yang Spirit; Shaoyao and Dazao nourish Heart Fluid. Details refer to the commentary on Shanghan Lun. This article differs slightly from the Shanghan Lun text, adding more Guizhi, but the principle remains the same.
Article 5 After sweating therapy, if palpitations occur below the umbilicus, indicating impending Ben Tun, Fuling Guizhi Gancao Dazao Tang is indicated.
Fuling Guizhi Gancao Dazao Tang Formula
Fuling (Poria) (8 liang)
Guizhi (Cinnamomi Ramulus) (4 liang)
Gancao (Glycyrrhiza Uralensis Radix, honey-fried) (2 liang)
Dazao (Ziziphus Jujuba Fructus) (15 pieces)
Decoct the above four ingredients in 1 dou of Ganlan Water (Gentle Wave 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. (Preparation of Ganlan Water: Take 2 dou of water, place in a large basin, and scoop/splash repeatedly until small bubbles appear on the surface.)
Palpitation (Ji) refers to a throbbing sensation, distinct from epigastric deficiency palpitations. The key phrase is "palpitation below the umbilicus after sweating." Sweat is the fluid of the Heart; sweating leads to Upper Jiao deficiency. Palpitation below the umbilicus indicates Lower Jiao excess preparing to rush upward to fill the Upper Jiao emptiness. Since the excess is below the umbilicus, it must be treated. Poria (Fuling), a diuretic, is the sovereign herb. Since the Kidney organ itself should not be purged directly, we purge the Bladder fu-organ to drain Kidney Yin. Guizhi (young twig) is acrid-warm and soft, possessing the virtue of generating Qi via mild fire. Gancao lifts, and Dazao supports, ensuring Guizhi's yang-generating nature fills the Upper Jiao between the Heart and Lung like mist. Guizhi, Gancao, and Dazao aim to tonify the Upper and descend rebellious Ben Tun Qi. To suppress water (which naturally flows downward), especially when boiled with Fuling, the water is agitated to create Ganlan Water. This disrupts its downward tendency, allowing it to linger and enhance the formula's ability to tonify the Upper Jiao. This is a masterfully crafted formula.
This chapter should be studied in conjunction with the formulas and theories in the Palpitation section.