治力小任重，努力太过，以致血瘀膈上，常觉短气。若吐血未愈者，多服补药或凉药，或多用诸药炭，强
止其血，亦可有此病，皆宜服此药化之。
三七（二钱，捣细） 鸭蛋子（四十粒，去皮）
上药二味，开水送服，日两次。凡服鸭蛋子，不可嚼破，若嚼破即味苦不能下咽，强下咽亦多呕出。
一童子，年十四，夏日牧牛野间。众牧童嬉戏，强屈其项背，纳头 中，倒缚其手，置而弗顾，戏名为看
瓜。后经人救出，气息已断。俾盘膝坐，捶其腰背，多时方苏。惟觉有物填塞胸膈，压其胸中大气，妨碍呼吸。
剧时气息仍断，两目上翻，身躯后挺。此必因在 中闷极之时努挣不出，热血随努挣之气力上溢，而停于膈上
也。俾单用三七三钱捣细，开水送服，两次全愈。
一人，年四十七，素患吐血。医者谓其虚弱，俾服补药，连服十余剂，觉胸中发紧，而血益不止。后有人
语以治吐血便方，大黄、肉桂各五分轧细，开水送服，一剂血止。然因从前误服补药，胸中常觉不舒，饮食减
少，四肢酸懒无力。愚诊之，脉似沉牢，知其膈上瘀血为患也。俾用鸭蛋子五十粒去皮，糖水送服，日两次，
数日而愈。
治心虚怔忡。
龙眼肉（一两） 酸枣仁（五钱，炒捣） 萸肉（五钱，去净核） 柏子仁（四钱，炒捣） 生龙骨
（四钱，捣细） 生牡蛎（四钱，捣细） 生明乳香（一钱） 生明没药（一钱）
心因热怔忡者，酌加生地数钱，若脉沉迟无力者，其怔忡多因胸中大气下陷，详观拙拟升陷汤后跋语及诸
案自明治法。
《内经》谓“心藏神”，神既以心为舍字，即以心中之气血为保护，有时心中气血亏损，失其保护之职，
心中神明遂觉不能自主而怔忡之疾作焉。故方中用龙眼肉以补心血，枣仁、柏仁以补心气，更用龙骨入肝以安
魂，牡蛎入肺以定魄。魂魄者心神之左辅右弼也，且二药与萸肉并用，大能收敛心气之耗散，并三焦之气化亦
可因之团聚。特是心以行血为用，心体常有舒缩之力，心房常有启闭之机，若用药一于补敛，实恐于舒缩启闭
之运动有所妨碍，故又少加乳香、没药之流通气血者以调和之。其心中兼热用生地者，因生地既能生血以补虚，
尤善凉血而清热，故又宜视热之轻重而斟酌加之也。
西人曰∶人身心肺关系尤重，与脑相等。凡关系重者、护持
之尤谨，故脑则有头额等八骨以保护之，而心肺亦有胸胁诸骨以保护之。心肺体质相连，功用亦相倚赖，心之
功用关系全体，心病则全体皆受害，心之重如此。然论其体质，不过赤肉所为，其能力专主舒缩，以行血脉。
有左右上下四房；左上房主接肺经赤血；右上房主接周身回血；左下房主发赤血，营运周身；右下房主接上房
回血过肺，更换赤血而回左上房；左上房赤血，落左下房入总脉管，以养全体；右上房回血，落右下房上注于
肺，以出炭气而接养气。故人一身之血，皆经过于心肺。心能运血周流一身，无一息之停，实时接入，实时发
出，其跳跃即其逼发也，以时辰表验试，一 （即一分钟）跳七十五次，每半时跳四千五百次，一昼夜计跳
十万八千次。然平人跳不自觉，若觉心跳即是心经改易常度。心房之内左浓于右，左下房浓于右下房几一倍，
盖左房主接发赤血，功用尤劳，故亦加浓也。心位在胸中居左，当肋骨第四至第七节，尖当肋骨第五第六之间，
下于乳头约一寸至半寸，横向胸骨。病则自觉周遭皆跳，凡心经本体之病，或因心房变薄变浓，或心房之门有
病，或夹膜有病，或总管有病。亦如眼目之病，或在明角罩，或在瞳人，或在睛珠，非必处处皆病也。大概心
病左多于右因左房功用尤劳故耳。心病约有数端∶一者，心体变大，有时略大，或大过一半。因心房之户，有
病拦阻，血出入不便，心舒缩之劳过常度。劳多则变大，亦与手足过劳则肿大之理相同。大甚，则逼血舒缩之
用因之不灵矣。一者，心房门户变小、或变大、或变窄、或变阔，俱为非宜。盖心血自上房落下房之门，开张
容纳血入后，门即翕闭，不令血得回旋上出。其自下房入总管处亦有门，血至则开张使之上出，血出后门即翕
闭，不令血得下返。若此处太窄太小，则血不易出。太大太阔，则血逼发不尽，或已出复返，营运不如常度矣。
再者心跳∶凡无病之人心跳每不自觉。若因病而跳时时自觉，抚之或觉动。然此
证有真有假∶真者心自病而跳也，或心未必有病，但因身虚而致心跳，亦以真论；若偶然心跳，其人惊惧，防
有心病，其实心本无病，即心跳亦临时之事，是为假心跳证，医者均须细辨。凡心匀跳无止息，侧身而卧，可
左可右，呼吸如常，大概心自不病。所虑跳跃不定，或三四次一停，停后复跳不能睡卧，左半身着床愈觉不安，
当虑其门户有病，血不回运如常。有停滞妄流而为膨胀者，有累肺而咳嗽、难呼吸或喘者，有累脑而昏蒙头疼，
中风慌怯者，有累肝而血聚积满溢者，有累胃不易消化，食后不安，心更跳者，皆心病之关系也。若胸胁骨之
下有时动悸，人或疑为心跳，其实因胃不消化、内有风气，与心跳病无涉，虚弱人及妇女患者最多，略服补胃
及微利药可也。
按∶西人论心跳证有真假，真者手扪之实觉其跳，假者手扪之不觉其跳。其真跳者又分两种∶一为心体
自病，若心房门户变大小窄阔之类，可用定心汤，将方中乳香、没药皆改用三钱，更加当归、丹参各三钱；一
为心自不病，因身弱而累心致跳，当用治劳瘵诸方治之。至假心跳即怔忡证也，其收发血脉之动力，非大于常
率，故以手扪之不觉其跳。特因气血虚而神明亦虚，即心之寻常舒缩，徐徐跳动，神明当之，亦若有冲激之势，
多生惊恐，此等证治以定心汤时，磨取铁锈水煎药更佳。至于用铁锈之说，不但如西人之说，取其能补血分，
实借其镇重之力以安心神也。载有一味铁养汤，细观方后治验诸案，自知铁锈之妙用。惟怔忡由于大气下陷者，
断不宜用。
治疗因体力负荷过重、用力过度，导致膈上血瘀，常感觉气短。如果是吐血病未愈，多服补药或凉药，或者多用各种炭类药材强行止血，也可能出现这种病症，都适宜服用此药来化解瘀血。
三七（二钱，捣碎成细粉） 鸭蛋子（四十粒，去皮）
以上两味药，用开水送服，每日两次。凡是服用鸭蛋子，不可嚼破，如果嚼破了味道极苦无法咽下，强行咽下也大多会呕吐出来。
有一个童子，十四岁，夏天在野外放牛。其他牧童嬉戏打闹，强行弯曲他的脖子和背部，将头塞入其中，倒绑双手，放置不顾，戏称为“看瓜”。后来被人救出时，气息已经断绝。让他盘腿坐好，捶打他的腰背，过了很久才苏醒。只感觉有东西堵塞胸膈，压迫胸中的大气，妨碍呼吸。严重时气息再次断绝，两眼上翻，身体向后挺立。这一定是因为在被闷住极度挣扎却出不来时，热血随着挣扎的气力上溢，而停滞在膈上的缘故。让他单用三七三钱捣碎成细粉，用开水送服，两次后完全痊愈。
另有一人，四十七岁，素来患有吐血病。医生认为他虚弱，让他服用补药，连续服用了十多剂，感觉胸中发紧，而出血更加不止。后来有人告诉他一个治吐血的便方：大黄、肉桂各五分，轧碎成细粉，用开水送服，一剂后血止住了。但是因为之前误服了补药，胸中常觉得不舒服，饮食减少，四肢酸软无力。我诊察他的脉象，脉象似沉牢脉，知道这是膈上瘀血为患。于是让他用鸭蛋子五十粒去皮，用糖水送服，每日两次，几天后就痊愈了。
龙眼肉（一两） 酸枣仁（五钱，炒后捣碎） 山茱萸（五钱，去净果核） 柏子仁（四钱，炒后捣碎） 生龙骨（四钱，捣碎成细粉） 生牡蛎（四钱，捣碎成细粉） 生明乳香（一钱） 生明没药（一钱）
如果是因热引起的心慌悸动，酌情加入生地数钱；如果脉象沉迟无力，这种怔忡多是因为胸中大气下陷，详细观察我拟定的升陷汤后的跋语及各个医案，自然明白治疗方法。
《内经》说“心藏神”，既然神以心为居所，就以心中气血作为保护。有时心中气血亏损，失去了保护的职能，心中的神明遂觉不能自主，于是怔忡之病发作。所以方中使用龙眼肉来补心血，枣仁、柏仁来补心气，更用龙骨入肝以安魂，牡蛎入肺以定魄。魂魄是心神左右的辅佐，而且这两味药与山茱萸并用，大能收敛耗散的心气，并且三焦的气化功能也可因此团聚。只是心以行血为功用，心体常有舒缩之力，心房常有启闭之机，如果用药一味地补敛，实在担心会妨碍舒缩启闭的运动，所以又少量加入乳香、没药这类流通气血的药物来调和。心中兼有热的情况使用生地，是因为生地既能生血以补虚，尤其善于凉血清热，所以应根据热的轻重斟酌加入。
西方人说：人身中心肺关系尤为重要，与脑相等。凡是关系重要的器官，保护得尤其谨慎，所以脑有头额等八块骨头来保护它，而心肺也有胸胁诸骨来保护它们。心肺体质相连，功用也相互依赖，心的功用关系到全身，心病则全身都受害，心的重要性如此。然而论其体质，不过是赤肉构成，其能力专门主管舒缩，以运行血脉。心脏有左右上下四个房室；左上房主要接收来自肺经的含氧血；右上房主要接收全身回流的静脉血；左下房主要发出含氧血，营运至全身；右下房主要接收来自上房的回流血液经过肺部，更换为含氧血后回到左上房；左上房的含氧血，落入左下房进入总脉管，以滋养全身；右上房的回流血，落入右下房上注于肺，以排出二氧化碳并摄取氧气。所以人身所有的血液，都经过心肺。心能运血周流全身，没有一刻停止，实时接入，实时发出，其跳跃就是逼迫发出的动力，用计时表验证，一分钟跳七十五次，每半小时跳四千五百次，一昼夜计跳十万八千次。然而正常人跳动自己感觉不到，如果感觉到心跳，就是心经改变了常态。心房之内左侧比右侧浓密，左下房比右下房几乎浓密一倍，大概因为左房主接发含氧血，功用特别劳累，所以也加浓了。心位于胸中偏左，对应肋骨第四至第七节，尖端对应肋骨第五第六之间，低于乳头约一寸至半寸，横向对着胸骨。生病时自觉周围都在跳动，凡是心经本体的病，或因心房变薄变厚，或心房之门有病，或夹膜有病，或总管有病。也像眼睛的病，有的在角膜，有的在瞳孔，有的在晶状体，不一定处处都病。大概心病左边多于右边，是因为左房功用特别劳累的缘故。心病大约有几种情况：一是，心体变大，有时略大，或大过一半。因为心房之门有病阻拦，血出入不便，心舒缩的劳作超过常态。劳作多则变大，也与手足过劳则肿大的道理相同。变得很大，则逼迫血舒缩的功能因此不灵敏了。二是，心房门户变小、或变大、或变窄、或变宽，都不适宜。盖心血从上房落下房之门，开张容纳血入后，门即闭合，不让血回旋流出。从下房入总管处也有门，血至则开张使其上出，血出后门即闭合，不让血下返。如果此处太窄太小，则血不易出。太大太阔，则血逼迫发出不尽，或已出又返回，营运不如常态了。再者心跳：凡无病的人心跳往往不自觉。如果因病而跳时时自觉，抚摸可能感觉到跳动。然而此证有真有假：真者是自己心脏有病而跳，或者心脏未必有病，但因为身体虚弱而导致心跳，也以真证论处；如果偶然心跳，其人惊惧，担心有心病，其实心脏本来无病，即心跳也是临时的事，这是假心跳证，医者都必须仔细辨别。凡是心跳均匀无停歇，侧身而卧，可左可右，呼吸如常，大概心脏本身没病。所担心的是跳跃不定，或三四次一停，停后复跳不能睡卧，左半身着床更觉得不安，应当考虑其门户有病，血不回运如常。有停滞妄流而导致膨胀的，有累及肺而咳嗽、难呼吸或喘息的，有累及脑而昏蒙头疼、中风慌怯的，有累及肝而血聚积满溢的，有累及胃不易消化，食后不安，心跳更厉害的，都是心病的关系所致。如果胸胁骨之下有时动悸，有人怀疑是心跳，其实是因为胃不消化、内有风气，与心跳病无关，虚弱人及妇女患者最多，稍微服用补胃及微利药即可。
按语：西方人论述心跳证有真假，真者手摸确实感觉到跳动，假者手摸感觉不到跳动。其真跳者又分两种：一是心体自病，若心房门户变大小窄阔之类，可用定心汤，将方中乳香、没药都改用三钱，再加当归、丹参各三钱；一是心脏本身没病，因为身体虚弱累及心脏导致跳动，应当用治劳瘵的各种方子治疗。至于假心跳即怔忡证，其收发血脉的动力，并不大于常态，所以用手摸感觉不到跳动。只是因为气血虚而神明也虚，即使是心脏寻常的舒缩，徐徐跳动，神明承受，也好像有冲激之势，多产生惊恐，此类证候治疗用定心汤时，磨取铁锈水煎药更佳。至于用铁锈的说法，不但像西方人说的那样，取其能补血分，实际上是借其镇重之力来安心神。书中记载有一味铁养汤，细观方后治疗验案，自然知道铁锈的妙用。只是怔忡由于大气下陷者，绝对不宜使用。
Treats conditions caused by excessive effort and overexertion, leading to blood stasis above the diaphragm (upper thoracic region), often accompanied by a sensation of shortness of breath. If hematemesis (vomiting blood) has not healed, taking too many tonifying or cooling medicines, or using various carbonized herbs to forcibly stop bleeding, can also cause this condition; all such cases are suitable for taking this medicine to resolve the stasis.
Sanqi (Radix Notoginseng, 2 qian, finely ground) Yadanzi (Semen Cocculus, 40 grains, peeled)
The above two herbs are taken with boiled water, twice daily. When taking Yadanzi, it must not be chewed broken; if chewed, it becomes extremely bitter and difficult to swallow, and even if forced down, it is often vomited out.
A boy, aged fourteen, was herding cattle in the wild during summer. Other herd children were playing, forcing his neck and back into a bent position, stuffing his head inside, binding his hands upside down, and leaving him there, jokingly calling it "watching melons." He was later rescued by others, but his breathing had ceased. He was made to sit cross-legged, and his lower back and waist were beaten for a long time before he regained consciousness. He only felt something blocking his chest and diaphragm, pressing on the "Great Qi" (vital energy) in the chest, hindering respiration. At its worst, his breathing stopped again, eyes rolled upward, and his body arched backward. This was certainly because when he was suffocated and struggled desperately without success, hot blood surged upward with the force of his struggle and stagnated above the diaphragm. He was treated with Sanqi (3 qian, finely ground) alone, taken with boiled water, and was completely cured after two doses.
Another person, aged forty-seven, had suffered from chronic hematemesis. The physician considered him weak and prescribed tonifying medicines. After taking more than ten doses, he felt tightness in the chest, and the bleeding worsened. Later, someone told him of a simple prescription for stopping hematemesis: Dahuang (Radix et Rhizoma Rhei) and Rougui (Cortex Cinnamomi), each 5 fen, finely ground, taken with boiled water. One dose stopped the bleeding. However, due to the previous misuse of tonifying medicines, he often felt uncomfortable in the chest, had reduced appetite, and experienced soreness, lassitude, and weakness in the four limbs. I palpated his pulse, which appeared deep and firm (chen lao), knowing that blood stasis above the diaphragm was the cause. I prescribed fifty peeled Yadanzi grains, taken with sugar water, twice daily, and he recovered in a few days.
Treats palpitations (zheng tong) caused by Heart deficiency.
Longyanrou (Arillus Longan, 1 liang) Suanzaoren (Semen Ziziphi Spinosae, 5 qian, stir-fried and crushed) Yurou (Fructus Corni, 5 qian, pits removed) Baiziren (Semen Platycladi, 4 qian, stir-fried and crushed) Sheng Longgu (Os Draconis, 4 qian, finely ground) Sheng Muli (Concha Ostreae, 4 qian, finely ground) Sheng Ming Rushiang (Resina Incensi, 1 qian) Sheng Ming Moyao (Resina Olibani, 1 qian)
For palpitations caused by heat, add Shengdi (Radix Rehmanniae) in varying amounts (several qian). If the pulse is deep, slow, and powerless, the palpitations are mostly due to the sinking of Great Qi in the chest; refer to my postscript on Shengxi Tang and other case records for treatment methods.
The *Neijing* states, "The Heart stores the Spirit (Shen)." Since the Spirit resides in the Heart, it relies on the Qi and Blood of the Heart for protection. Sometimes, when Qi and Blood in the Heart are deficient and lose their protective function, the Spirit within loses autonomy, resulting in the onset of palpitations. Therefore, the formula uses Longyanrou to nourish Heart Blood, Suanzaoren and Baiziren to tonify Heart Qi, Longgu to enter the Liver and calm the Hun (Ethereal Soul), and Muli to enter the Lung and stabilize the Po (Corporeal Soul). The Hun and Po are the left and right assistants of the Heart Spirit. Moreover, these two herbs combined with Yurou strongly converge scattered Heart Qi and help gather the Qi transformation of the Triple Burner. However, the Heart's function is to move Blood; the Heart organ constantly possesses expanding and contracting forces, and the heart chambers have opening and closing mechanisms. If medicines are used solely for tonification and convergence, there is a fear that they may hinder these movements. Thus, small amounts of Rushiang and Moyao, which promote the circulation of Qi and Blood, are added to harmonize. For cases where Heat accompanies the Heart condition, Shengdi is used because it not only generates Blood to tonify deficiency but is also excellent at cooling Blood and clearing Heat; therefore, its addition should be adjusted according to the severity of the Heat.
Western medicine states: In the human body, the relationship between the Heart and Lungs is particularly important, comparable to that of the Brain. Organs of great importance are protected most carefully; thus, the Brain is protected by eight bones of the skull, while the Heart and Lungs are protected by the ribs and sternum. The Heart and Lungs are physically connected and functionally interdependent. The Heart's function affects the whole body; Heart disease harms the entire body, highlighting the Heart's significance. However, structurally, the Heart is merely composed of red muscle, its capability primarily governing expansion and contraction to circulate blood vessels. It has four chambers: left and right upper, and left and right lower. The left upper chamber mainly receives oxygenated blood from the lungs; the right upper chamber mainly receives deoxygenated blood returning from the body; the left lower chamber mainly pumps oxygenated blood to circulate throughout the body; the right lower chamber mainly receives returning blood from the upper chamber to pass through the lungs, exchange gases, and return as oxygenated blood to the left upper chamber. Oxygenated blood from the left upper chamber falls into the left lower chamber, enters the main vessel, and nourishes the whole body. Deoxygenated blood from the right upper chamber falls into the right lower chamber, ascends to the lungs to expel carbon dioxide and absorb oxygen. Thus, all blood in the body passes through the Heart and Lungs. The Heart circulates blood throughout the body without pause, receiving and emitting blood in real-time; its beating is the force of expulsion. Verified by a stopwatch, the heart beats 75 times per minute, 4,500 times per half-hour, and 108,000 times per day. Normally, people do not perceive their heartbeat; feeling one's heartbeat indicates an abnormality in the Heart meridian. The left atrium is denser than the right, and the left ventricle is nearly twice as dense as the right ventricle, likely because the left chambers handle oxygenated blood and work harder, hence becoming denser. The Heart is located in the chest, slightly to the left, corresponding to the fourth to seventh ribs, with its apex between the fifth and sixth ribs, about one to half an inch below the nipple, facing the sternum horizontally. When diseased, one feels pulsations all around. Diseases of the Heart organ itself include thinning or thickening of the heart walls, pathology of the heart valves, pathology of the pericardium, or pathology of the major vessels. Similar to eye diseases affecting the cornea, pupil, or lens, heart disease does not necessarily affect every part. Generally, Heart disease manifests more on the left side due to the greater workload of the left chambers. Heart diseases include several types: First, enlargement of the Heart organ, sometimes slightly larger or more than half again in size. This occurs because pathology in the heart valves obstructs blood flow, causing excessive labor in expansion and contraction. Increased labor leads to enlargement, similar to swelling in limbs due to overuse. Severe enlargement renders the pumping function inefficient. Second, abnormalities in the size or width of the heart valves (too small, too large, too narrow, or too wide) are unfavorable. Blood flows from the upper to the lower chambers; after entering, the valve closes to prevent reflux. Similarly, the valve leading to the main vessel opens to allow ejection and closes afterward. If too narrow/small, blood exits poorly; if too wide/large, ejection is incomplete, or blood returns, disrupting normal circulation. Third, regarding heartbeat: Healthy individuals do not perceive their heartbeat. Pathological palpitations are consciously perceived and may be palpable. However, this symptom has true and false forms. True palpitations result from intrinsic Heart disease or general bodily weakness affecting the Heart. False palpitations occur occasionally due to fear or anxiety, despite no organic Heart disease; these are temporary. Physicians must distinguish carefully. Regular, uninterrupted heartbeat, comfortable in any sleeping position, and normal respiration generally indicate a healthy Heart. Concern arises with irregular, intermittent beating, inability to sleep, discomfort lying on the left side, suggesting valve pathology and stagnant blood flow. This can lead to distension, pulmonary involvement (cough, dyspnea, asthma), cerebral involvement (dizziness, headache, stroke-like symptoms), hepatic involvement (blood accumulation), or gastric involvement (indigestion, postprandial discomfort, exacerbated palpitation). Palpitations under the rib cage are often mistaken for Heart issues but are usually due to indigestion and internal wind, common in weak individuals and women; mild stomach-tonifying and purgative herbs suffice.
Note: Western medicine distinguishes true and false palpitations. True palpitations are palpable; false ones are not. True palpitations are divided into two: intrinsic Heart disease (e.g., valve abnormalities), treatable with Dingxin Tang (modifying Rushiang and Moyao to 3 qian each, adding Danggui and Danshen 3 qian each); or non-Heart disease caused by systemic weakness affecting the Heart, treated with formulas for consumption (lao zhai). False palpitations correspond to Zhengtong (palpitations). The driving force of blood circulation is not abnormally strong, so they are not palpable. Due to Qi and Blood deficiency, the Spirit is also deficient; even normal, gentle Heart contractions feel like impacts to the Spirit, causing fear and panic. For such cases, Dingxin Tang is effective, preferably decocted with rust water. The use of rust aligns with Western views on blood tonification but primarily utilizes its heavy, sedating nature to calm the Spirit. A single-herb formula, Tieyang Tang, is recorded; reviewing its clinical cases reveals the efficacy of rust. However, for palpitations caused by sinking of Great Qi, this formula is strictly contraindicated.