成 振者耸动也战者战摇也栗者心战也振轻而战重也战外而栗内也振者责其虚寒虚则不至于争故止于振耸耳战者
为正与邪争争则股栗而战矣战虽重于振而栗重于战也战者正气胜栗者邪气胜也皆邪正之相争也
太阳 伤寒若吐若下后心下逆满气上冲胸起则头眩脉沉紧发汗则动经身为振振摇者茯苓桂枝白术甘草汤主之（成
吐下后里虚气上逆者心下逆满气上冲胸表虚阳不足起则头眩脉浮紧为邪在表当发汗脉沉紧为邪在里则不可发汗则外动
经络损伤阳气阳气外虚则不能主持诸脉身为振振摇也与此汤以发汗和经益阳）
茯苓桂枝白术甘草汤方
桂枝（去皮三两） 茯苓（四两） 白术 甘草（各二两炙）上四味以水六升煮取三升去滓分温三服（阳不足者补
之以甘茯苓白术生津液而益阳也里气逆者散之以辛桂枝甘草行阳散气）
太阳病发汗汗出不解其人仍发热心下悸头眩身 动振振欲擗地真武汤主之（方见下利）
孙 太乙宫道士周德真患伤寒发汗出多惊悸目眩身战掉欲倒地众医有欲发汗者有作风治者有用冷药解者病皆不除
召孙至曰太阳经病得汗早欲解不解者因太阳经欲解复作汗肾气不足汗不来所以心悸目眩身转遂作真武汤服之三服微汗
自出遂解盖真武汤附子白术和其肾气肾气得行故汗得来也若但责太阳者惟能干涸血液尔仲景云尺脉不足荣气不足不可
以汗以此知肾气怯则难得汗也明矣许学士云乡里有一姓高者子年三十初得病身微汗脉弱恶风医以麻黄药与之汗遂不止
发热心多惊悸夜不得眠谵语不识人筋惕肉 振振动摇医又进镇心药予曰强汗之过也仲景曰脉微汗出恶风不可服青龙汤
服之则筋惕肉 此为逆也惟真武汤可救进此三服佐以清心竹叶汤数日遂愈（清心竹叶汤方未考）
下后复发汗必振寒脉细微所以然者以内外俱虚故也亡血家不可发汗发汗则寒栗而振太阳病火熨其背大汗出火热入
胃发谵语十余日振栗自下利者此为解也（详谵语）
脉沉紧按之芤当战而汗出解脉芤为虚是以发战脉浮为在表故当汗出解也（论见首卷）太阳病脉阴阳俱停等证必战栗
汗出而解（论见发热）凡柴胡证下之苟下之而仍不罢者复与柴胡汤必蒸蒸而振发热汗出而解（论见往来寒热）脉浮而迟
面热赤而战惕者当汗出解也反发热者脉迟不能作汗其身必痒（论见面赤）诸乘寒者则为厥郁冒不仁口急不能言战而栗也
阴中于邪必内栗也表气微虚里气不守故邪中于阴也
韩 汗下后战者与救逆汤微减与羊肉汤再投而战解若阴气内盛正气大虚心栗鼓颔身不战者遂成寒逆宜灸之或用大
建中汤仲景治尸厥战而栗者刺期门巨阙
吴 凡振者大抵气血俱气不能荣养筋骨故为之振摇而不能主持也须大补气血则可予曾用人参养荣汤得效又一人身
摇不得眠者以十味温胆汤倍加人参遂愈内经曰寒之伤人使人毫毛毕直鼓颔战栗而无汗按此表寒而战栗也经言病有战而
汗出因得解其脉浮而紧按之反芤此为本虚故当战而汗出也又曰脉阴阳俱停以三部浮沉迟数脉同等必先振栗汗出而解若
脉浮数按之不芤其人本不虚者则汗出而解不发战也若不发战而心栗者此阴中于邪必内栗也凡正气怯弱寒邪在内必为栗
也学人宜详究焉
加味人参养荣汤 治发汗过多气血俱虚而筋惕肉 或身振摇者
人参（二钱半） 茯苓 甘草 川芎（各一钱） 白术 麦门冬（去心） 当归身（各一钱半） 五味子（十五粒）
肉桂（一钱有热者减半） 生地黄（一钱半有热者用此无汗用熟地黄） 黄 （二钱半有自汗者用二钱） 生姜（三片）
枣子（二枚擘）水二钟煎至一钟去滓温服如阴虚相火动者加知母黄柏各一钱酒炒用若阳虚下寒脉微者加熟附子一钱肉桂
倍之不得眠加远志酸枣仁各一钱
加味温胆汤 治虚烦身振不得眠
人参（二钱半） 橘红 茯苓 黄连（酒炒） 软苗柴胡 当归身 川芎 白芍药 生地黄 酸枣仁（以上各一钱）
半夏（七分） 甘草（五分） 竹茹（一团） 生姜（三片）上煎服法前同
成无己：振，是身体耸动；战，是身体战摇；栗，是内心恐惧颤抖。振的程度较轻，而战的程度较重；振表现于外，而栗表现于内。振多责之于虚寒，因为虚证不足以引起剧烈的抗争，所以仅表现为身体的耸动。战则是正气与邪气相争，抗争剧烈导致大腿颤抖和身体战摇。虽然战比振重，但栗比战更重。战代表正气占优势，栗代表邪气占优势，这都是邪正相互斗争的表现。
太阳病伤寒，如果经过催吐或泻下治疗后，出现心下逆满（胃脘部胀满且有气上逆感），气向上冲至胸部，起身时头晕目眩，脉象沉紧。此时若再发汗，就会扰动经络，导致全身震颤摇晃。应当用茯苓桂枝白术甘草汤主治。（成无己注：吐下之后里气虚弱，气机上逆，故见心下逆满、气上冲胸；表虚阳气不足，起身时头眩，脉浮紧为邪在表，当发汗；脉沉紧为邪在里，则不可发汗。若误发汗，则外动经络，损伤阳气。阳气外虚，不能主持诸脉，故身体震颤摇晃。给予此汤以调和经络、益助阳气。）
茯苓桂枝白术甘草汤方
桂枝（去皮三两） 茯苓（四两） 白术 甘草（各二两，炙） 以上四味药，用水六升，煮取三升，去渣，分三次温服。（注：阳气不足者，用甘味药补之，如茯苓、白术生津液而益阳；里气上逆者，用辛味药散之，如桂枝、甘草行阳散气。）
太阳病发汗后，汗出而病不解，其人仍然发热，心下悸动，头晕目眩，身体筋肉跳动，震颤欲倒在地上。应当用真武汤主治。（方剂见下文“下利”条）
孙一奎：太乙宫道士周德真患伤寒，发汗过多，出现惊悸、目眩、身体战抖欲倒地。众医有的想再次发汗，有的按风证治疗，有的用冷药解热，病皆不愈。召请孙一奎诊治，他说：“这是太阳经病，得汗后本应解除而未解除，是因为太阳经欲解之时又欲作汗，但肾气不足，汗不得出，所以心悸、目眩、身体转动。遂服用真武汤，服三剂后微汗自出，病遂痊愈。盖真武汤中的附子、白术能调和肾气，肾气得行，故汗能得出。若只责治太阳经，只会干涸血液罢了。张仲景说：尺脉不足，营气不足，不可以发汗。由此可知肾气怯弱则难以出汗，这是很明显的道理。许学士说：乡里有一姓高的人，其子三十岁，初得病时身体微汗，脉弱恶风，医生用麻黄药给他发汗，汗遂不止，发热，心中多惊悸，夜间不能安眠，胡言乱语不识人，筋惕肉瞤，振动摇晃。医生又进镇心安神药。我说：这是强发汗造成的过错。张仲景说：脉微、汗出、恶风，不可服青龙汤。服之则筋惕肉瞤，此为逆证。只有真武汤可救。进服此方三剂，佐以清心竹叶汤，数日后痊愈。（清心竹叶汤方未能考证）”
攻下后又复发汗，必然出现怕冷战栗，脉象细微。之所以这样，是因为内外俱虚的缘故。亡血家（失血患者）不可发汗，发汗则会出现寒栗而振。太阳病用火熨背部，大汗出，火热入胃，发谵语。十余日后，若出现振栗并自下利，这是病将解除的表现。（详见“谵语”条）
脉沉紧，按之芤（中空），应当战栗而后汗出才能解除。脉芤为虚，所以表现为发战；脉浮为邪在表，故应当汗出而解。（此论见首卷）太阳病脉阴阳俱停等证，必战栗汗出而解。（此论见“发热”条）凡是柴胡证，经过攻下后，如果攻下后病仍不罢，再给予柴胡汤，必然会出现蒸蒸而振（寒战高热），随后发热汗出而解。（此论见“往来寒热”条）脉浮而迟，面部红赤而战栗恐惧的，应当汗出而解。若反而发热，脉迟不能作汗，其身必痒。（此论见“面赤”条）凡受寒邪侵袭者，则为厥逆、郁冒、麻木不仁、口急不能言语、战栗。阴分中邪，必定内部战栗。这是因为表气微弱虚损，里气不固守，所以邪气侵入阴分。
韩祗和：汗下后出现战栗的，用救逆汤，症状稍减后再投羊肉汤，战栗即解。若阴气内盛，正气大虚，心中恐惧、鼓颔（下巴打颤）、身体不战，遂成寒逆，宜灸之或用大建中汤。张仲景治疗尸厥战栗者，刺期门、巨阙穴。
吴崑：凡是振，大抵是气血俱虚，气不能荣养筋骨，所以为之振摇而不能主持身体。须大补气血才可治愈。我曾用人参养荣汤获效。又有一人身摇不得眠者，用十味温胆汤倍加人参遂愈。《内经》说：寒邪伤人，使人毫毛毕直，鼓颔战栗而无汗。按此属表寒而战栗。经文说：病有战栗汗出因得解的，其脉浮而紧，按之反芤，此为本虚，故当战而汗出也。又说：脉阴阳俱停，以三部浮沉迟数脉同等，必先振栗汗出而解。若脉浮数，按之不芤，其人本不虚者，则汗出而解不发战也。若不发战而心栗者，此阴中于邪，必内栗也。凡正气怯弱，寒邪在内，必为栗也。学人宜详究焉。
加味人参养荣汤：治发汗过多，气血俱虚而筋惕肉瞤或身振摇者。
人参（二钱半） 茯苓 甘草 川芎（各一钱） 白术 麦门冬（去心） 当归身（各一钱半） 五味子（十五粒） 肉桂（一钱，有热者减半） 生地黄（一钱半，有热者用此，无汗用熟地黄） 黄芪（二钱半，有自汗者用二钱） 生姜（三片） 枣子（二枚，擘开） 水二钟，煎至一钟，去渣，温服。如阴虚相火动者，加知母、黄柏各一钱，酒炒用。若阳虚下寒脉微者，加熟附子一钱，肉桂倍之。不得眠者，加远志、酸枣仁各一钱。
加味温胆汤：治虚烦身振不得眠。
人参（二钱半） 橘红 茯苓 黄连（酒炒） 软苗柴胡 当归身 川芎 白芍药 生地黄 酸枣仁（以上各一钱） 半夏（七分） 甘草（五分） 竹茹（一团） 生姜（三片） 上煎服法与前同。
Cheng Wuji: "Zhen" (trembling/shivering) refers to the body shaking; "Zhan" (rigid shivering) refers to violent trembling; "Li" (inner fear/trepidation) refers to inner mental dread. Zhen is mild, while Zhan is severe; Zhen manifests externally, whereas Li manifests internally. Zhen is attributed to deficiency and cold; because deficiency is insufficient to cause intense struggle, it only results in bodily shaking. Zhan occurs when righteous Qi (Zheng Qi) struggles with pathogenic factors (Xie Qi); the intensity of the struggle causes thigh tremors and body rigidity. Although Zhan is heavier than Zhen, Li is heavier than Zhan. Zhan indicates that righteous Qi prevails, while Li indicates that pathogenic factors prevail; both are manifestations of the struggle between righteous Qi and pathogens.
In Taiyang disease (Taiyang syndrome) caused by Cold damage (Shanghan), if purgation or emesis has been performed, symptoms such as fullness and rebellious Qi sensation below the heart (epigastric distension with upward rushing of Qi), Qi rushing up to the chest, dizziness upon rising, and a deep, tight pulse may occur. If sweating therapy is applied at this stage, it will disturb the meridians, causing the whole body to tremble and sway. The formula Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction) should be administered. (Cheng Wuji's commentary: After emesis or purgation, the interior is deficient, leading to rebellious Qi and epigastric fullness/rushing Qi; exterior deficiency and Yang insufficiency lead to dizziness upon rising. A floating, tight pulse indicates exterior pathogens requiring sweating; a deep, tight pulse indicates interior pathogens where sweating is contraindicated. Incorrect sweating disturbs the meridians and damages Yang. Exterior Yang deficiency fails to govern the vessels, causing body tremors. This formula harmonizes the meridians and benefits Yang.)
Formula for Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction):
Guizhi (Cinnamomi Ramulus, peeled, 3 liang), Fuling (Poria, 4 liang), Baizhu (Atractodis Macrocephalae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, each 2 liang, honey-fried). These four ingredients are boiled in 6 sheng of water to obtain 3 sheng. Strain and divide into three warm doses. (Commentary: For Yang insufficiency, sweet herbs like Fuling and Baizhu generate fluids and benefit Yang; for interior rebellious Qi, acrid herbs like Guizhi and Gancao promote Yang and dissipate Qi.)
In Taiyang disease, after sweating therapy, if the condition does not resolve despite sweating, and the patient still has fever, palpitations, dizziness, twitching muscles, and feels as though they are about to fall to the ground due to severe trembling, the formula Zhenwu Tang (True Warrior Decoction) should be administered. (See formula under "Diarrhea".)
Sun Yikui: Daoist Zhou Dezhen from Taiyi Palace suffered from Shanghan. Excessive sweating led to palpitations, dizziness, and violent trembling as if falling. Physicians suggested further sweating, treating it as wind-stroke, or using cold herbs to clear heat, but none were effective. I was summoned and said: "This is a Taiyang meridian disease. Sweating should have resolved it, but it did not because, although the Taiyang meridian desired to resolve via sweating, Kidney Qi was insufficient to produce sweat, resulting in palpitations, dizziness, and body turning. I prescribed Zhenwu Tang. After three doses, slight sweating occurred naturally, and the disease resolved. Zhenwu Tang contains Fuzi (Aconiti Lateralis Radix Praeparata) and Baizhu to harmonize Kidney Qi; once Kidney Qi moves, sweat can be produced. If one only treats the Taiyang meridian, it will only dry up the blood. Zhang Zhongjing stated: 'If the Chi pulse is deficient and Ying Qi (Nutritive Qi) is insufficient, sweating is contraindicated.' Thus, it is clear that weak Kidney Qi makes sweating difficult. Xu Xueshi said: 'A villager’s son, aged thirty, initially had slight sweating, weak pulse, and aversion to wind. The physician gave him Mahuang (Ephedrae Herba) to induce sweating. Sweating continued excessively, accompanied by fever, frequent palpitations, insomnia, delirium, inability to recognize people, twitching muscles, and violent trembling. The physician then administered heart-calming herbs. I said: This is an error caused by forced sweating. Zhang Zhongjing stated: 'With a faint pulse, sweating, and aversion to wind, Qinglong Tang (Green Dragon Decoction) is contraindicated. Administering it leads to twitching muscles, which is a adverse reaction. Only Zhenwu Tang can save this case.' He took three doses of this, supplemented with Qingxin Zhuye Tang (Clear Heart Bamboo Leaf Decoction), and recovered in a few days. (The formula for Qingxin Zhuye Tang could not be verified)."
After purgation followed by re-sweating, chills and trembling inevitably occur, with a fine pulse. This is because both the interior and exterior are deficient. Patients who have lost blood (Wangxue Jia) must not undergo sweating therapy; doing so will result in chills and trembling. In Taiyang disease, if the back is scorched with hot iron, causing excessive sweating, and the fire-heat enters the Stomach causing delirium, if after ten-plus days the patient experiences trembling and spontaneous diarrhea, this indicates the disease is resolving. (See "Delirium".)
A deep, tight pulse that feels hollow (Kou) upon pressure indicates that trembling followed by sweating will resolve the disease. A Kou pulse signifies deficiency, hence trembling; a floating pulse indicates exterior pathogens, so sweating will resolve it. (See discussion in Volume 1.) In Taiyang disease, when pulses at Yin and Yang positions are equally stopped/silent, trembling and sweating will resolve the disease. (See discussion on "Fever".) In all Chaihu syndromes (Bupleurum syndromes), if purgation fails to resolve the condition, administering Chaihu Tang again will cause vigorous trembling (Zhengzheng er Zhen) followed by fever, sweating, and resolution. (See discussion on "Alternating Chills and Fever".) A floating and slow pulse with a red-hot face and trembling/fear indicates resolution via sweating. If there is contrary fever, a slow pulse prevents sweating, and the body will itch. (See discussion on "Red Face".) All conditions caused by Cold invasion result in Jue Ni (cold extremities), Yu Mao (depression/dizziness), numbness, oral stiffness/inability to speak, and trembling. Pathogens invading the Yin aspect cause internal trembling. This is because exterior Qi is slightly deficient and interior Qi is unguarded, allowing pathogens to enter the Yin.
Han Zhihe: For trembling after sweating and purgation, use Jiuni Tang (Rescue Adverse Reaction Decoction); if symptoms decrease slightly, administer Moutang (Mutton Soup) again to resolve trembling. If interior Yin is abundant, Righteous Qi is greatly deficient, with inner fear, jaw quivering, but no body trembling, leading to Cold reversal, moxibustion should be used, or Dajianzhong Tang (Great Construct the Middle Decoction) administered. Zhang Zhongjing treated Shi Jue (Corpse-like Coma) with trembling by needling Qimen (LR14) and Jueque (CV14).
Wu Kun: Generally, trembling is due to deficiency of both Qi and Blood, where Qi fails to nourish sinews and bones, causing shaking and loss of motor control. Greatly tonifying Qi and Blood is required. I once used Renshen Yangrong Tang (Ginseng Nourishing Qi and Blood Decoction) with success. Another patient with body shaking and insomnia recovered using Shimei Wendan Tang (Ten-Ingredient Gallbladder-Warming Decoction) with doubled Renshen. The *Neijing* states: "Cold invading the body causes hair to stand erect, jaw quivering, and trembling without sweating." This belongs to exterior Cold causing trembling. The classics state: Disease resolves via trembling and sweating when the pulse is floating and tight but feels hollow upon pressure, indicating root deficiency necessitating trembling before sweating. It also states: When pulses at Yin and Yang positions are equal, trembling and sweating precede resolution. If the pulse is floating and rapid but not hollow, and the patient is not inherently deficient, sweating resolves the disease without trembling. If there is no trembling but inner fear (Li), this indicates pathogens invading the Yin, causing internal trembling. Whenever Righteous Qi is weak and Cold pathogens are inside, trembling occurs. Students should investigate this carefully.
Jiawei Renshen Yangrong Tang (Modified Ginseng Nourishing Qi and Blood Decoction): Treats excessive sweating leading to Qi and Blood deficiency, with twitching muscles or body trembling.
Renshen (Panacis Ginseng Radix, 2.5 qian), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma, each 1 qian), Baizhu (Atractodis Macrocephalae Rhizoma), Maidong (Ophiopogonis Radix, heart removed), Danggui (Angelicae Sinensis Radix, body part, each 1.5 qian), Wuweizi (Schisandrae Fructus, 15 grains), Rougui (Cinnamomi Cortex, 1 qian, halve if heat is present), Shengdihuang (Rehmanniae Radix, 1.5 qian; use this if heat is present, use Shudihuang if no sweating), Huangqi (Astragali Membranacei Radix, 2.5 qian, use 2 qian if spontaneous sweating), Shengjiang (Zingiberis Rhizoma Recens, 3 slices), Zaozi (Jujubae Fructus, 2 pieces, split). Boil in 2 zhong of water to 1 zhong, strain, and take warm. If Yin deficiency with ministerial fire movement, add Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) each 1 qian, wine-fried. If Yang deficiency with lower Cold and faint pulse, add Shufuzi (Aconiti Lateralis Radix Praeparata) 1 qian and double Rougui. For insomnia, add Yuanzhi (Polygalae Radix) and Suanzaoren (Ziziphi Spinosae Semen) each 1 qian.
Jiawei Wendan Tang (Modified Gallbladder-Warming Decoction): Treats deficiency-heat irritability, body trembling, and insomnia.
Renshen (Panacis Ginseng Radix, 2.5 qian), Juhong (Citri Reticulatae Pericarpium Rubrum), Fuling (Poria), Huanglian (Coptidis Rhizoma, wine-fried), Chaihu (Bupleuri Radix), Danggui (Angelicae Sinensis Radix, body part), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba), Shengdihuang (Rehmanniae Radix), Suanzaoren (Ziziphi Spinosae Semen, each 1 qian), Banxia (Pinelliae Rhizoma, 0.7 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 qian), Zhuru (Bambusae Caulis in Taenia, one ball), Shengjiang (Zingiberis Rhizoma Recens, 3 slices). Decoct and take as described above.