俗名心跳。心为火脏。无血以养之。则火气冲动。是以心跳。安神丸清之。归脾汤加麦冬五味子以补之。凡
思虑过度。及失血家去血过多者。乃有此虚证。否则多挟痰瘀。宜细辨之。
心中有痰者。痰入心中。阻其心气。是以心跳动不安。宜指迷茯苓丸。加远志菖蒲黄连川贝母枣仁当归
治之。朱砂安神丸。加龙骨远志金箔牛黄麝香治之。
又有胃火强梁。上攻于心。而跳跃者。其心下如筑墙然。听之有声。以手按其心下。复有气来抵拒。此为心
下有动气。治宜大泻心胃之火。火平则气平也。泻心汤主之。或玉女煎加枳壳浓朴代赭石旋复花以降
之。再加郁金莪术以攻之。使血气火三者皆平。自不强梁矣。
悸者。惧怯之谓。心为君火。君火宣明。则不忧不惧。何悸之有。心火不足。则气虚而悸。血不养心。则神浮而
悸。仲景建中汤。治心气虚悸。炙甘草汤。治心血不足而悸。今则以养荣汤代建中。以归脾汤代炙甘草。一
治气虚。一治血虚。又有饮邪上干。水气凌心。火畏水克而悸者。苓桂术甘汤治之。失血家多是气血虚悸。
水气凌心者绝少。又曰正虚者。邪必凑之。凡是怔忡惊悸健忘恍惚。一切多是痰火沃心。扰其神明所致。
统用金箔镇心丸主之。
惊者。猝然恐惕之谓。肝与胆连。司相火。君火虚则悸。相火虚则惊。盖人之胆壮则不惊。胆气不壮。故发惊
惕。桂枝龙骨牡蛎甘草汤治之。恐畏不敢独卧者。虚之甚也。仁熟散治之。又凡胆经有痰。则胆火上越。此
胆气不得内守。所以惊也。温胆汤。加龙骨牛黄枣仁琥珀柴胡白芍治之。复有阳明火盛。恶闻人声。闻木
音则惊者。此内经所谓气并于阳。故发惊狂者也。乃肝胆木火脾土。法宜大泻阳明之火。大柴胡汤治之。
当归芦荟丸亦治之。血家病惊。多是阳明火盛。病虚惊者。亦复不少。用以上诸方。须兼顾血证。以尽其化
裁。勿执桂甘龙牡等汤。而不知宜忌也。
俗名心跳。心为火脏。无血以养之。则火气冲动。是以心跳。安神丸清之。归脾汤加麦冬五味子以补之。凡思虑过度。及失血家去血过多者。乃有此虚证。否则多挟痰瘀。宜细辨之。
俗称为心跳。心脏是属火的脏器。如果没有血液来滋养它，那么火气就会冲动，因此出现心跳。用安神丸来清热。用归脾汤加入麦冬、五味子来滋补。凡是思虑过度的人，以及失血患者因失血过多导致的，才是这种虚证。否则大多夹杂痰湿和瘀血，应当仔细辨别。
心中有痰者。痰入心中。阻其心气。是以心跳动不安。宜指迷茯苓丸。加远志菖蒲黄连川贝母枣仁当归治之。朱砂安神丸。加龙骨远志金箔牛黄麝香治之。
心脏中有痰湿的情况。痰湿进入心中，阻碍了心气的运行，因此出现心跳动且不安稳。适宜使用指迷茯苓丸。加入远志、石菖蒲、黄连、川贝母、酸枣仁、当归进行治疗。或者使用朱砂安神丸。加入龙骨、远志、金箔、牛黄、麝香进行治疗。
又有胃火强梁。上攻于心。而跳跃者。其心下如筑墙然。听之有声。以手按其心下。复有气来抵拒。此为心下有动气。治宜大泻心胃之火。火平则气平也。泻心汤主之。或玉女煎加枳壳浓朴代赭石旋复花以降之。再加郁金莪术以攻之。使血气火三者皆平。自不强梁矣。
又有胃火亢盛猛烈。向上攻冲心脏，导致心脏跳动剧烈如跳跃状。感觉心下部像砌墙一样坚硬，倾听时有声音，用手按压心下部，又有气体来抵抗。这是心下有动气。治疗应当大力清泻心和胃的火邪。火邪平息了，气机也就平和了。以泻心汤为主方。或者使用玉女煎加入枳壳、厚朴、代赭石、旋覆花以降逆。再加入郁金、莪术以攻逐。使得血、气、火三者都平和，自然就不会再亢盛猛烈了。
悸者。惧怯之谓。心为君火。君火宣明。则不忧不惧。何悸之有。心火不足。则气虚而悸。血不养心。则神浮而悸。仲景建中汤。治心气虚悸。炙甘草汤。治心血不足而悸。今则以养荣汤代建中。以归脾汤代炙甘草。一治气虚。一治血虚。又有饮邪上干。水气凌心。火畏水克而悸者。苓桂术甘汤治之。失血家多是气血虚悸。水气凌心者绝少。又曰正虚者。邪必凑之。凡是怔忡惊悸健忘恍惚。一切多是痰火沃心。扰其神明所致。统用金箔镇心丸主之。
“悸”是指恐惧胆怯的意思。心脏是君主之火（君火）。如果君火光明通达，就不会忧虑恐惧，哪里会有心悸呢？如果心火不足，就会导致气虚而心悸。如果血液不能滋养心脏，就会导致神志浮越而心悸。张仲景的建中汤，治疗心气虚引起的心悸。炙甘草汤，治疗心血不足引起的心悸。现在则用养荣汤代替建中汤，用归脾汤代替炙甘草汤。一个治疗气虚，一个治疗血虚。又有饮邪向上干扰，水气凌犯心脏，火畏惧水的克制而导致心悸的，用苓桂术甘汤治疗。失血患者大多是气血虚弱导致的心悸，水气凌心的情况极少。又说正气虚弱的人，邪气必定会侵袭。凡是怔忡、惊悸、健忘、恍惚，大多是因为痰火壅塞心脏，扰乱了神明所致。统一使用金箔镇心丸作为主方。
惊者。猝然恐惕之谓。肝与胆连。司相火。君火虚则悸。相火虚则惊。盖人之胆壮则不惊。胆气不壮。故发惊惕。桂枝龙骨牡蛎甘草汤治之。恐畏不敢独卧者。虚之甚也。仁熟散治之。又凡胆经有痰。则胆火上越。此胆气不得内守。所以惊也。温胆汤。加龙骨牛黄枣仁琥珀柴胡白芍治之。复有阳明火盛。恶闻人声。闻木音则惊者。此内经所谓气并于阳。故发惊狂者也。乃肝胆木火脾土。法宜大泻阳明之火。大柴胡汤治之。当归芦荟丸亦治之。血家病惊。多是阳明火盛。病虚惊者。亦复不少。用以上诸方。须兼顾血证。以尽其化裁。勿执桂甘龙牡等汤。而不知宜忌也。
“惊”是指突然的恐惧警惕。肝脏与胆相连，主管相火。君火虚弱会导致心悸，相火虚弱会导致惊恐。大概人的胆气壮实就不会惊恐。如果胆气不壮实，所以会发生惊恐警惕。用桂枝龙骨牡蛎甘草汤治疗。如果恐惧害怕到不敢独自睡觉，这是虚损非常严重的表现。用仁熟散治疗。另外，凡是胆经有痰湿，就会导致胆火上炎。这是因为胆气不能内守，所以发生惊恐。用温胆汤。加入龙骨、牛黄、酸枣仁、琥珀、柴胡、白芍治疗。又有阳明火邪旺盛，厌恶听到人声，听到木头敲击的声音就惊恐的，这是《内经》所说的阳气并聚，所以发生惊恐狂乱的症状。这涉及肝胆木火和脾土的关系，治疗方法应当大力清泻阳明之火。用大柴胡汤治疗。当归芦荟丸也可以治疗。失血患者患惊恐病，大多是阳明火邪旺盛。患虚性惊恐病的，也不在少数。使用以上各种方剂时，必须兼顾血证的特点，以充分发挥方剂的加减变化作用。不要固执于桂枝甘草龙骨牡蛎汤等方剂，而不知道适宜的禁忌。
Commonly known as palpitations. The Heart is the organ of Fire. Without blood to nourish it, the Fire Qi will surge impulsively, thus causing palpitations. Anshen Wan (Calming the Spirit Pill) is used to clear [the heat]. Guipi Tang (Restore the Spleen Decoction) with added Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) is used to tonify [deficiency]. Whenever excessive mental exertion occurs, or in patients who have lost blood excessively, this deficiency syndrome arises. Otherwise, phlegm and blood stasis are often involved, requiring careful differentiation.
When phlegm resides within the Heart, phlegm enters the Heart, obstructing the Heart Qi, thereby causing restless palpitations. Zhimi Fuling Wan (Pill to Eliminate Phlegm with Poria) is indicated. It should be treated by adding Yuanzhi (Polygalae Radix), Shichangpu (Acori Tatarinowii Rhizoma), Huanglian (Coptidis Rhizoma), Chuanbeimu (Fritillariae Cirrhosae Bulbus), Suanzaoren (Ziziphi Spinosomi Semen), and Danggui (Angelicae Sinensis Radix). Alternatively, Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) can be used, treating it by adding Longgu (Fossilia Ossis Mastodi), Yuanzhi (Polygalae Radix), Jinbo (Gold Leaf), Niuhuang (Bovis Calculus), and Shexiang (Moschus).
There are also cases where Stomach Fire is vigorous and aggressive, attacking upward into the Heart, causing jumping palpitations. The area below the heart feels like a wall being built; listening reveals sounds, and pressing the area below the heart with the hand meets resistance from Qi. This is termed "moving Qi" below the Heart. Treatment should focus on vigorously purging the Fire of the Heart and Stomach. Once the Fire is pacified, the Qi becomes peaceful. Xiexin Tang (Decoction to Drain the Heart) is the primary formula. Or, Yunu Jian (Jade Woman Decoction) with added Zhike (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), Daizheshi (Haematitum), and Xuanfuhua (Inulae Flos) is used to direct downward. Additionally, Yujin (Curcumae Radix) and Ezhu (Curcumae Rhizoma) are added to attack [the pathogen]. This ensures that Blood, Qi, and Fire all become balanced, and the aggression ceases naturally.
Palpitation (Ji) refers to fear and timidity. The Heart governs Ministerial Fire (Jun Huo). When Ministerial Fire is bright and clear, there is no worry or fear, so how could there be palpitation? If Heart Fire is insufficient, Qi deficiency leads to palpitation. If Blood fails to nourish the Heart, the Spirit floats, leading to palpitation. Zhang Zhongjing’s Jianzhong Tang (Establish the Middle Decoction) treats palpitation due to Heart Qi deficiency. Zhigancao Tang (Honey-fried Licorice Decoction) treats palpitation due to Heart Blood insufficiency. Currently, Yangrong Tang (Nourish the Prosperity Decoction) replaces Jianzhong Tang, and Guipi Tang (Restore the Spleen Decoction) replaces Zhigancao Tang. One treats Qi deficiency, the other treats Blood deficiency. There are also cases where fluid retention pathogens interfere upward, and Water Qi overwhelms the Heart; fearing the control of Water over Fire, palpitation occurs. Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Glycyrrhiza Decoction) treats this. Patients who have lost blood mostly suffer from Qi and Blood deficiency palpitations; cases of Water Qi overwhelming the Heart are extremely rare. It is said that when Righteous Qi is deficient, Pathogenic factors must invade. All conditions such as constant palpitations (Zhengchong), startled palpitations (Jingji), forgetfulness, and confusion are mostly caused by Phlegm-Fire flooding the Heart and disturbing the Spirit. Jinpiao Zhenxin Wan (Gold Foil Calming the Heart Pill) is uniformly used as the main formula.
Startle (Jing) refers to sudden terror and alertness. The Liver connects with the Gallbladder, which governs Ministerial Fire (Xiang Huo). Deficiency of Ministerial Fire (Jun Huo) causes palpitation; deficiency of Ministerial Fire (Xiang Huo) causes startle. Generally, if a person’s Gallbladder Qi is strong, they do not startle. If Gallbladder Qi is not strong, startle and alertness occur. Guizhi Longgu Muli Gancao Tang (Cinnamon Twig, Dragon Bone, Oyster Shell, and Licorice Decoction) treats this. Fear so severe that one dares not sleep alone indicates extreme deficiency. Renshu San (Renshu Powder) treats this. Furthermore, whenever there is phlegm in the Gallbladder Meridian, Gallbladder Fire flares upward. Because Gallbladder Qi cannot remain internally secure, startle occurs. Wendan Tang (Warm the Gallbladder Decoction) with added Longgu (Fossilia Ossis Mastodi), Niuhuang (Bovis Calculus), Suanzaoren (Ziziphi Spinosomi Semen), Hupo (Succinum), Chaihu (Bupleuri Radix), and Baishao (Paeoniae Radix Alba) treats this. There are also cases where Yangming Fire is excessive, causing aversion to human voices and startle upon hearing wooden sounds. This corresponds to what the *Neijing* describes as Qi merging with Yang, thus causing startle and mania. Involving the Wood and Fire of the Liver and Gallbladder, and the Earth of the Spleen, the method should be to vigorously purge Yangming Fire. Dachaihu Tang (Major Bupleurum Decoction) treats this. Danggui Luehua Wan (Angelica and Aloe Pill) also treats this. For blood-deficient patients suffering from startle, it is mostly due to Yangming Fire excess. Cases of deficiency-type startle are also numerous. When using the aforementioned formulas, one must take into account the blood syndrome to fully utilize modifications. Do not rigidly adhere to formulas like Guizhi Gancao Longgu Muli Tang without knowing indications and contraindications.