主治胸膈烦躁、不能眠也。
考 证
酸枣仁汤证曰∶虚烦，不得眠。
（为则按∶虚烦当作烦躁。）
以上一方，酸枣仁二升。
辨 误
时珍曰∶熟用不得眠，生用好眠，误矣！眠与不眠，非生熟之所为也。乃胸膈烦躁，或
眠或不眠者，服酸枣仁，则皆复常矣。然则酸枣仁之所主，非主眠与不眠也。而历代诸医，
以此立论误也，以不知人道也。夫人道者，人之所能为也。非人之所能为者，非人道也。学
圣人之道，然后始知之。盖眠者寤者，造化之主也，而非人之为也。而烦躁者，毒之为而人
之造也，酸枣能治之。故胸膈烦躁、或寤而少寐、或寐而少寤，予不问酸枣之生熟，用而治
之，则烦躁罢而寤寐复故。呜呼悲哉！圣人之世远人亡。历代之学人，其解圣经，往往以天
事混之于人事，故其论可闻，而行不可知也。人而不人，医而不医，吾党小子慎之！勿混造
化与人事矣。
品 考
酸枣仁 和、汉共有焉。汉产为良也。
主治悸及肉 、筋惕也。旁治小便不利、头眩烦躁。
考 证
苓桂甘枣汤证曰∶脐下悸。
茯苓戎盐汤，证不具也。（说在互考中）
茯苓泽泻汤，证不具也。（说在互考中）
以上三方，茯苓皆半斤。
防己茯苓汤证曰∶四肢聂聂动。
茯苓四逆汤证曰∶烦躁。
以上二方，茯苓皆六两。
茯苓杏仁甘草汤，证不具也。（说在互考中）
以上一方，茯苓三两，而亦六两之例。
苓桂术甘汤证曰∶身为振振摇。又云∶头眩。
苓桂五味甘草汤证曰∶小便难。
苓姜术甘汤，证不具也。（说在互考中）
木防己去石膏加茯苓芒硝汤，证不具也。（说同上）
小半夏加茯苓汤证曰∶眩悸。
半夏浓朴汤，证不具也。（说在互考中）
以上六方，茯苓皆四两，此外苓桂剂颇多，今不枚举焉。
茯苓甘草汤证曰∶心下悸。
以上一方，茯苓二两，而亦四两之例。
茯苓饮，证不具也。（说在互考中）
栝蒌瞿麻丸证曰∶小便不利。
葵子茯苓散证曰∶头眩。
真武汤证曰∶心下悸、头眩、身 动。
附子汤，证不具也。（说在互考中）
桂枝去桂加茯术汤证曰∶小便不利。
以上方六，茯苓皆三两。
五苓散证曰∶脐下有悸、吐涎沫而癫眩。
以上一方，茯苓十八铢。
猪苓汤证曰∶小便不利、心烦。
桂枝茯苓丸证曰∶胎动。（说在互考中）
以上二方，茯苓诸药等分。
上历观此诸方。曰心下悸、曰脐下悸、曰四肢聂聂动、曰身 动、曰头眩、曰烦躁，一
是皆悸之类也。小便不利而悸者，用茯苓则治。其无悸证者而用之，则未见其效。然则悸者，
茯
互 考
茯苓戎盐汤、茯苓泽泻汤，各用茯苓半斤，以为主药，而不举茯苓之证。苓桂甘枣汤，
亦用茯苓半斤，而有脐下悸之证。其他用茯苓为主药者，各有悸眩 动之证。况于二方多用
茯苓，而可无若证乎？其证脱也必矣。
茯苓杏仁甘草汤方，是苓桂术甘汤去桂术加杏仁者也，然则其脱茯苓之证也明矣。
茯姜术甘汤，有身为振振摇证，此非桂之主证，而苓之所能治也，然则苓姜术甘汤条，
脱此证也明矣。
木防己去石膏加茯苓芒硝汤方，是防己茯苓汤，以黄 、甘草代人参、芒硝者。而防己
茯苓汤，有四肢聂聂动之证，是非黄 、甘草之主证，而茯苓之所主治也。由是观之，此汤
脱四肢 动之证也明矣。
半夏浓朴汤，是小半夏加茯苓汤，更加浓朴、苏叶者也。然则其脱眩悸之证也明矣。
茯苓甘草汤方，是苓桂术甘汤，去术加姜者也。可以前例而推之。
茯苓饮，以苓为主，而不举其证，以他例推之。心悸下而痞硬、小便不利、自吐宿水者，
此
附子汤方，是真武汤去姜加参者也；真武汤条，有心下悸、头眩、身 动之证，然则此
汤之条，脱若证也明矣。
桂枝茯苓丸证曰∶胎动在脐上。为则按∶盖所谓奔豚也，而不可臆测焉。以旁例推之，
上冲
人参茯苓黄连，其功大同而小异，说在人参部中。
品 考
茯苓 和、汉无异也。陶弘景曰∶仙方止云茯苓，而无茯神。为疗既同，用之应无嫌。
斯言得之，赤白补泻之说，此臆之所断也，不可从矣。
主治胸膈部位烦躁不安、无法入睡的症状。
考证
酸枣仁汤证表现为：虚烦，无法入睡。
（为则按：这里的“虚烦”应当理解为“烦躁”。）
以上一方中，使用酸枣仁二升。
辨误
李时珍说：熟用的酸枣仁会导致失眠，生用的酸枣仁有助于安眠，这是错误的！能否入睡，并不取决于酸枣仁的生熟。而是因为胸膈烦躁，导致有的人能睡有的人睡不着；服用酸枣仁后，这些症状都会恢复正常。既然如此，酸枣仁所主治的，并不是针对“能睡”或“不能睡”本身。历代众多医生因此立论是错误的，因为他们不了解人道。所谓人道，是指人能够主动掌控的事情。不是人所能掌控的，就不是人道。学习圣人的道理，然后才能明白这一点。大概睡眠与觉醒，是由造化（自然规律）主宰的，而不是由人主观决定的。而烦躁，是邪毒所致且与人造作有关，酸枣仁能够治疗它。所以无论是胸膈烦躁，还是醒着时间多睡着时间少，或者睡着时间多醒着时间少，我不问酸枣仁是生是熟，只要用它来治疗，那么烦躁就会停止，睡眠和觉醒也会恢复常态。唉，可悲啊！圣人的时代久远，圣人已逝。历代的学者，在解释经典时，往往将天事（自然造化）混同于人事（人为因素），所以他们的理论听起来似乎有理，但在实践中却无法验证。做人不像人，做医不像医，我们这一辈的年轻人要谨慎啊！不要把造化和人事混淆了。
品考
酸枣仁：中国和日本都有出产。汉朝产地的品质较好。
主治心悸以及肌肉跳动、筋脉抽搐的症状。旁治小便不利、头晕、烦躁。
考证
苓桂甘枣汤证表现为：脐下悸动。
茯苓戎盐汤证，原文证据不全。（说明见互考部分）
茯苓泽泻汤证，原文证据不全。（说明见互考部分）
以上三方中，茯苓均使用半斤。
防己茯苓汤证表现为：四肢轻微颤动。
茯苓四逆汤证表现为：烦躁。
以上两方中，茯苓均使用六两。
茯苓杏仁甘草汤证，原文证据不全。（说明见互考部分）
以上一方中，茯苓使用三两，这也是六两用量的一个先例。
苓桂术甘汤证表现为：身体震颤摇晃。又说：头晕。
苓桂五味甘草汤证表现为：小便困难。
苓姜术甘汤证，原文证据不全。（说明见互考部分）
木防己去石膏加茯苓芒硝汤证，原文证据不全。（说明同上）
小半夏加茯苓汤证表现为：眩晕、心悸。
半夏厚朴汤证，原文证据不全。（说明见互考部分）
以上六方中，茯苓均使用四两，此外含有茯苓的桂枝类方剂还有很多，此处不再一一列举。
茯苓甘草汤证表现为：心下悸动。
以上一方中，茯苓使用二两，这也是四两用量的一个先例。
茯苓饮证，原文证据不全。（说明见互考部分）
栝蒌瞿麦丸证表现为：小便不利。
葵子茯苓散证表现为：头晕。
真武汤证表现为：心下悸动、头晕、身体颤动。
附子汤证，原文证据不全。（说明见互考部分）
桂枝去桂加茯术汤证表现为：小便不利。
以上六方中，茯苓均使用三两。
五苓散证表现为：脐下有悸动感、吐涎沫且癫痫样眩晕。
以上一方中，茯苓使用十八铢。
猪苓汤证表现为：小便不利、心烦。
桂枝茯苓丸证表现为：胎动。（说明见互考部分）
以上两方中，茯苓与其他药物等量分配。
纵观上述各方，提到的症状有心下悸、脐下悸、四肢轻微颤动、身体颤动、头晕、烦躁，这些都属于悸动类的症状。如果有小便不利并伴有悸动的情况，使用茯苓就能治愈。如果没有悸动症状却使用茯苓，则未见其疗效。由此可见，悸动才是茯苓的主治证候。
互考
茯苓戎盐汤、茯苓泽泻汤，各使用茯苓半斤作为主药，却没有列出茯苓的主治证候。苓桂甘枣汤，也使用茯苓半斤，却有脐下悸动的证候。其他以茯苓为主药的方剂，各有悸动、眩晕、颤动的证候。何况有两方大量使用茯苓，怎么可能没有相应的证候呢？那些证候肯定是脱漏了。
茯苓杏仁甘草汤方，是在苓桂术甘汤中去掉桂枝、白术加入杏仁而成的，那么它脱漏茯苓证候的情况就很明显了。
苓姜术甘汤，有身体震颤摇晃的证候，这不是桂枝的主治证候，而是茯苓所能治疗的，那么苓姜术甘汤条文中脱漏此证候的情况就很明显了。
木防己去石膏加茯苓芒硝汤方，是防己茯苓汤，用黄芪、甘草代替人参、芒硝而成。而防己茯苓汤，有四肢轻微颤动的证候，这不是黄芪、甘草的主治证候，而是茯苓所主治的。由此看来，此汤方脱漏了四肢颤动的证候是很明显的。
半夏厚朴汤，是小半夏加茯苓汤，再加厚朴、紫苏叶而成。那么它脱漏眩晕、心悸证候的情况就很明显了。
茯苓甘草汤方，是苓桂术甘汤，去掉白术加入生姜而成。可以参照前面的例子进行推断。
茯苓饮，以茯苓为主药，但没有列出其证候，参照其他例子推断，应该是心下悸动而痞硬、小便不利、自行呕吐出隔宿水的症状。
附子汤方，是真武汤去掉生姜加入人参而成；真武汤条文，有心下悸动、头晕、身体颤动的证候，那么此汤方条文中脱漏这些证候的情况就很明显了。
桂枝茯苓丸证表现为：胎动发生在脐上。为则按：这大概是所谓的奔豚病，但不能凭空猜测。参照旁例推断，应该是气上冲……
人参、茯苓、黄连，它们的作用大体相同而略有差异，说明见人参部中。
品考
茯苓：中国和日本没有区别。陶弘景说：仙方只提到茯苓，而没有提到茯神。既然治疗作用相同，使用它们应该没有忌讳。这话是对的，关于赤茯苓和白茯苓补泻之说的观点，这是臆断的，不可采纳。
Indicated for irritability in the chest and diaphragm, and insomnia.
Textual Research
The syndrome of Suanzaoren Tang is characterized by: deficiency vexation (Xu Fan), inability to sleep.
(Wei Ze notes: "Deficiency vexation" should be understood as "irritability".)
In the above-mentioned formula, 2 sheng of Suanzaoren (Semen Ziziphi Spinosae) is used.
Correction of Errors
Li Shizhen stated: Cooked Semen Ziziphi Spinosae causes insomnia, while raw Semen Ziziphi Spinosae promotes sleep; this is erroneous! Whether one sleeps or not does not depend on whether the herb is raw or cooked. It is due to irritability in the chest and diaphragm that some can sleep and others cannot; after taking Semen Ziziphi Spinosae, these conditions return to normal. Therefore, what Semen Ziziphi Spinosae primarily treats is not simply "sleeping" or "not sleeping." The physicians of past dynasties erred in their theories because they did not understand human agency. Human agency refers to what humans can control. What is beyond human control is not human agency. Only by studying the Way of the Sages can one know this. Sleep and wakefulness are governed by natural creation (Zao Hua), not by human will. Irritability, however, is caused by pathogenic toxins and involves human factors; Semen Ziziphi Spinosae can treat it. Thus, whether one is awake more than asleep, or asleep more than awake, due to chest and diaphragmatic irritability, I do not distinguish between raw or cooked Semen Ziziphi Spinosae; when used for treatment, the irritability ceases, and sleep-wake cycles return to normal. Alas, how tragic! The era of the Sages is long gone, and the Sages have passed away. Scholars of successive dynasties often confused natural phenomena with human affairs when interpreting classics; thus, their theories may sound plausible but cannot be verified in practice. To be less than human in conduct, and less than a physician in practice—let us, the younger generation, be cautious! Do not confuse natural creation with human affairs.
Product Examination
Semen Ziziphi Spinosae (Suanzaoren): Available in both China and Japan. The variety produced in Han region is of superior quality.
Indications
Primarily indicated for palpitations (Ji) and muscle twitching (Rou Tiao), tendon tremors (Jin Ti). Secondarily indicated for difficulty in urination (Xiao Bian Bu Li), dizziness (Tou Xuan), and irritability (Fan Zao).
Textual Research
The syndrome of Linggui Gan Zao Tang is characterized by: palpitations below the umbilicus (Qi Xia Ji).
The syndrome of Fuling Rongyan Tang is incomplete in the text. (See Mutual Verification)
The syndrome of Fuling Zexie Tang is incomplete in the text. (See Mutual Verification)
In the above three formulas, Fuling (Poria) is used in the amount of half a jin.
The syndrome of Fangji Fuling Tang is characterized by: slight trembling of the four limbs (Si Zhi Nie Nie Dong).
The syndrome of Fuling Sini Tang is characterized by: irritability (Fan Zao).
In the above two formulas, Fuling (Poria) is used in the amount of six liang.
The syndrome of Fuling Xingren Gancao Tang is incomplete in the text. (See Mutual Verification)
In the above-mentioned formula, Fuling (Poria) is used in the amount of three liang, which also serves as an example for the six-liang dosage.
The syndrome of Linggui Zhugan Tang is characterized by: body trembling and swaying (Shen Wei Zhen Zhen Yao). It also states: dizziness (Tou Xuan).
The syndrome of Linggui Wuwei Gancao Tang is characterized by: difficulty in urination (Xiao Bian Nan).
The syndrome of Lingjiang Zhugan Tang is incomplete in the text. (See Mutual Verification)
The syndrome of Mufangji Qushigao Jia Fuling Mangxiao Tang is incomplete in the text. (See above)
The syndrome of Xiao Banxia Jia Fuling Tang is characterized by: dizziness (Xuan) and palpitations (Ji).
The syndrome of Banxia Houpo Tang is incomplete in the text. (See Mutual Verification)
In the above six formulas, Fuling (Poria) is used in the amount of four liang. There are many other Guiji (Cinnamon Twig) formulas containing Fuling, which are not enumerated here.
The syndrome of Fuling Gancao Tang is characterized by: palpitations in the epigastrium (Xin Xia Ji).
In the above-mentioned formula, Fuling (Poria) is used in the amount of two liang, which also serves as an example for the four-liang dosage.
The syndrome of Fuling Yin is incomplete in the text. (See Mutual Verification)
The syndrome of Gulou Qu Ma Wan is characterized by: difficulty in urination (Xiao Bian Bu Li).
The syndrome of Kuizi Fuling San is characterized by: dizziness (Tou Xuan).
The syndrome of Zhenwu Tang is characterized by: palpitations in the epigastrium (Xin Xia Ji), dizziness (Tou Xuan), and body tremors (Shen Dong).
The syndrome of Fuzi Tang is incomplete in the text. (See Mutual Verification)
The syndrome of Guizhi Qu Gui Jia Fu Zhu Tang is characterized by: difficulty in urination (Xiao Bian Bu Li).
In the above six formulas, Fuling (Poria) is used in the amount of three liang.
The syndrome of Wuling San is characterized by: palpitations below the umbilicus (Qi Xia You Ji), spitting of saliva (Tu Xian Mo), and epileptic-like dizziness (Dian Xuan).
In the above-mentioned formula, Fuling (Poria) is used in the amount of eighteen zhu.
The syndrome of Zhuling Tang is characterized by: difficulty in urination (Xiao Bian Bu Li) and heart vexation (Xin Fan).
The syndrome of Guizhi Fuling Wan is characterized by: fetal movement (Tai Dong). (See Mutual Verification)
In the above two formulas, Fuling (Poria) and other herbs are used in equal proportions.
Having reviewed all these formulas, the symptoms mentioned include palpitations in the epigastrium, palpitations below the umbilicus, slight trembling of the four limbs, body tremors, dizziness, and irritability. All of these belong to the category of palpitations (Ji). When difficulty in urination is accompanied by palpitations, using Fuling (Poria) yields effective results. However, if used without palpitation symptoms, efficacy has not been observed. Therefore, palpitations are the primary indication for Fuling (Poria).
Mutual Verification
Fuling Rongyan Tang and Fuling Zexie Tang each use half a jin of Fuling (Poria) as the principal herb but do not list the indications for Fuling. Linggui Gan Zao Tang also uses half a jin of Fuling and presents the symptom of palpitations below the umbilicus. Other formulas where Fuling is the principal herb present symptoms of palpitations, dizziness, and tremors. How could there be no corresponding symptoms when two formulas use large amounts of Fuling? The absence of such symptoms in the text must be due to omission.
Fuling Xingren Gancao Tang is derived from Linggui Zhugan Tang by removing Guizhi (Cinnamon Twig) and Baizhu (Atractylodes Macrocephala Rhizome) and adding Xingren (Apricot Seed); thus, the omission of Fuling's indications is clear.
Lingjiang Zhugan Tang presents the symptom of body trembling and swaying. This is not the primary indication for Guizhi (Cinnamon Twig) but is treatable by Fuling (Poria); therefore, the omission of this symptom in the Lingjiang Zhugan Tang section is clear.
Mufangji Qushigao Jia Fuling Mangxiao Tang is Fangji Fuling Tang with Huangqi (Astragali Radix) and Gancao (Licorice Root) replacing Renshen (Ginseng Radix) and Mangxiao (Natrii Sulfas). Fangji Fuling Tang presents the symptom of slight trembling of the four limbs. This is not the primary indication for Huangqi (Astragali Radix) and Gancao (Licorice Root) but is treated by Fuling (Poria). Thus, the omission of the symptom of limb trembling in this formula is clear.
Banxia Houpo Tang is Xiao Banxia Jia Fuling Tang with additional Houpo (Magnolia Bark) and Ziye (Perilla Leaf). Thus, the omission of dizziness and palpitations is clear.
Fuling Gancao Tang is Linggui Zhugan Tang with Zhuru (Atractylodes Rhizome) removed and Shengjiang (Fresh Ginger) added. This can be inferred by analogy with previous examples.
Fuling Yin uses Fuling (Poria) as the principal herb but does not list its indications. By analogy with other cases, the indications should be palpitations in the epigastrium with fullness and hardness, difficulty in urination, and spontaneous vomiting of retained water.
Fuzi Tang is Zhenwu Tang with Shengjiang (Fresh Ginger) removed and Renshen (Ginseng Radix) added. The Zhenwu Tang section lists symptoms of palpitations in the epigastrium, dizziness, and body tremors; therefore, the omission of these symptoms in the Fuzi Tang section is clear.
Guizhi Fuling Wan indicates fetal movement occurring above the umbilicus. Wei Ze notes: This is likely what is referred to as Ben Tun (Running Piglet Qi), but one should not speculate arbitrarily. By analogy with other cases, it involves upward rushing...
Renshen (Ginseng Radix), Fuling (Poria), and Huanglian (Coptidis Rhizome) have similar major effects but minor differences. See the section on Renshen.
Product Examination
Fuling (Poria): No difference between Chinese and Japanese varieties. Tao Hongjing stated: Immortal prescriptions mention only Fuling (Poria), not Fushen (Poria with Hostwood). Since their therapeutic effects are the same, there should be no objection to using them interchangeably. This statement is correct. The theory that red Fuling (Poria) drains and white Fuling (Poria) tonifies is merely subjective speculation and should not be followed.