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。
【按】篇中只有奔豚一证，而吐脓、惊怖、火邪皆简脱，必有缺文。
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。
【注】奔豚者，肾病也，以其病从少腹上冲咽喉，有如豚窜奔突之状，故名之也。发
作则肾气上乘于心而欲死，作已则气衰复还于肾而止，故其病虽有微甚不同，然必皆从
惊恐得之。盖惊伤心，恐伤肾，两脏交病也。水能胜火，肾上凌心，故治法宜泻肾而补心
也。
【集注】张从政曰∶惊者，为自不知故也；恐者，为自知也。
周扬俊曰∶少阴脉循喉咙，因其所系之经，而上冲殊便也。
发汗后，烧针令其汗，针处被寒，核起而赤者，必发奔豚，气从少腹上至心，灸其
核上各一壮，与桂枝加桂汤主之。
【注】此条与《伤寒论》同。《伤寒论》中无“发汗后”三字，而有“太阳伤寒者，加
温针必惊也”十一字，当从《伤寒论》为是。盖明所以致惊之由非一端，即寒侵针处，亦
能为是病也。夫太阳伤寒者，加温针必惊也，谓病伤寒之人，卒然加以温针，其心必惊，非
谓温针之后必生惊病也。烧针，即温针也，烧针取汗亦汗法也。针处宜当避寒，若不知谨，
外被寒袭，火郁脉中，血不流行，所以有结核肿赤之患也。夫温针取汗，其法亦为迅烈
矣，既针而营不奉行作解，必其人素寒阴盛也。故虽有温针之火，但发核赤，又被寒侵，
故不但不解，反召阴邪，而加针之时，心既惊虚，所以肾水阴邪，得上凌心阳而发奔豚
也。奔豚者，肾水阴邪之气，从少腹上冲于心，若豚之奔也。先灸核上各一壮者，外祛
其寒邪，继与桂枝加桂汤者，内伐其肾邪也。
【集注】周扬俊曰∶奔豚，北方肾邪也。烧针令汗，纵不合法，与少阴何与而作奔豚？
盖太阳相表里也，针处被寒，核起而赤，吾知前此之邪未散，而后此之邪复入，惟桂能
伐肾邪也。所以用桂加入桂枝汤中，一以外解风邪，一以内泄阴气也。先灸核上者，因
寒而肿，惟灸消之也。
桂枝加桂汤方
桂枝（五两） 芍药（三两） 甘草（炙，二两） 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。
奔豚，气上冲胸，腹痛，往来寒热，奔豚汤主之。
【注】奔豚气上冲咽喉，发作欲死，是奔豚之甚者也。气上冲胸，腹痛，往来寒热，是
奔豚之微者也。甚者以桂枝加桂汤，从肾逐阴降逆也；微者以奔豚汤，从心调血散逆也。
奔豚汤方
甘草 芎 当归（各二两） 半夏（四两）
黄芩（二两） 生葛（五两） 芍药（二两） 生姜（四两） 甘李根白皮（一升）
上九味，以水二斗，煮取五升，温服一升，日三，夜一服。
【集解】沈明宗曰∶用芎、归、白芍、甘草调养厥阴、少阳血气之正，而邪自外出；以
生葛、黄芩、半夏、生姜佐李根，解半表半里之寒热，而逆可散。盖奔豚虽属肾病，然
兼厥阴、少阳之邪而发者有之。仲景用此方，明非仅寒邪一端致然也。
发汗后，脐下悸者，欲作奔豚，茯苓桂枝甘草大枣汤主之。
【注】发汗后，心下悸者，心阳虚，本经自病也。脐下悸者，肾邪乘虚上干心病也。奔
豚者，脐下气动而上冲也。欲作奔豚者，有似奔豚之状而将作未作也。茯苓桂枝甘草大
枣汤，所以补火土而伐水邪也。上条发明外感寒邪，能病奔豚，此条更申明内有水气，亦
能病奔豚也。
【集注】徐彬曰∶仲景论证，每合数条以尽其变。言奔豚由于惊，又言其从少腹冲至
咽喉，又言其兼腹痛，而往来寒热，又言其兼核起，而无他病，又言汗后脐下悸，欲作
奔豚而未成者，其浅深了然。用和解，用伐肾，用桂不用桂，酌治微妙。奔豚一证，病
因证治，无复剩义，苟不会仲景立方之意，则峻药畏用，平剂寡效，岂古方不宜于今哉。
周扬俊曰∶汗本心之液，发汗而脐下病悸者，心气虚而肾气动也。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两） 甘草（炙，二两） 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。
作甘澜水法∶取水三升置大盆内，以杓扬之数千遍，水上有珠子五六千颗相逐，取
用之。
【集解】程林曰∶汗后脐下悸者，阳气虚而肾邪上逆也。脐下为肾气发源之地，茯苓
泄水以伐肾邪，桂枝行阳以散逆气，甘草、大枣甘温助脾土以制肾水。煎用甘澜水者，扬
之无力，全无水性，取其不助肾邪也。
老师说：疾病中有奔豚病，有吐脓血，有惊怖症，有火邪证，这四种病，都是从惊恐中引发的。
【按语】本篇中只有奔豚这一种证候，而吐脓、惊怖、火邪都简略脱漏了，必定有缺文。
老师说：奔豚病从少腹（下腹部）发起，向上冲至咽喉，发作时痛苦欲死，停止后又恢复平静，这些情况都是由于惊恐引起的。
【注释】奔豚，属于肾病，因为它的病势从少腹向上冲至咽喉，如同小猪奔跑窜突的样子，所以叫它奔豚。发作时肾气上乘于心，导致痛苦欲死；发作结束后，气衰复还于肾，于是停止。所以这种病虽然有轻重不同，但必然都是从惊恐引起的。大概是因为惊恐伤心，恐惧伤肾，心肾两脏同时受病。水能克火，肾水上凌于心，所以治疗方法应当泻肾而补心。
【集注】张从政说：惊，是因为自己不知道原因；恐，是因为自己知道原因。
周扬俊说：足少阴肾经循行经过喉咙，因为它所联系的经脉，所以气上冲非常便利。
发汗后，用烧针（温针）令其出汗，针刺部位受寒，出现红肿硬结且发红的，一定会引发奔豚，气从少腹上冲至心，应在每个红肿硬结上灸一壮，并用桂枝加桂汤主治。
【注释】这条与《伤寒论》相同。《伤寒论》中没有“发汗后”三个字，而有“太阳伤寒者，加温针必惊也”这十一个字，应当以《伤寒论》为准。这是为了说明导致惊恐的原因不止一端，即使是寒气侵袭针刺部位，也能引起这种病。所谓“太阳伤寒者，加温针必惊也”，是说患伤寒的人，突然加上温针，心里一定会惊恐，并不是说温针之后一定会生惊恐的病。烧针，就是温针，烧针取汗也是发汗法。针刺部位应当避免受寒，如果不知谨慎，外被寒气侵袭，火郁在脉中，血液运行不畅，所以会有结核肿赤的祸患。温针取汗，这种方法也很迅烈，既然针刺后营气没有奉行命令来解散病邪，一定是这个人素体阳虚阴盛。所以虽然有温针的火力，但只发出核状红肿，又被寒气侵袭，因此不仅不解，反而招引阴邪，而在施针的时候，心既已惊恐虚弱，所以肾水阴邪，能够上凌心阳而引发奔豚。奔豚，是肾水阴邪之气，从少腹上冲于心，像猪奔跑一样。先在每个红肿硬结上各灸一壮，是为了在外祛除寒邪，接着给予桂枝加桂汤，是为了在内攻伐肾邪。
【集注】周扬俊说：奔豚，是北方肾邪。烧针令汗，纵然不合法度，与少阴有什么关系而作奔豚？盖因太阳与少阴相表里。针刺部位受寒，红肿硬结且发红，我知道之前的邪气未散，之后的邪气又入内，只有桂枝能攻伐肾邪。所以用桂枝加入桂枝汤中，一方面在外解风邪，一方面在内泄阴气。先灸红肿处，是因为受寒而肿，只有艾灸能消散它。
桂枝加桂汤方
桂枝（五两） 芍药（三两） 甘草（炙，二两） 生姜（三两） 大枣（十二枚）
以上五味药，用水七升，微火煮取三升，去渣，温服一升。
【注释】奔豚气上冲咽喉，发作欲死，是奔豚病严重的情况。气上冲胸，腹痛，往来寒热，是奔豚病轻微的情况。严重的用桂枝加桂汤，从肾逐阴降逆；轻微的用奔豚汤，从心调血散逆。
奔豚汤方
甘草 川芎 当归（各二两） 半夏（四两）
黄芩（二两） 生葛根（五两） 芍药（二两） 生姜（四两） 甘李根白皮（一升）
以上九味药，用水二斗，煮取五升，温服一升，每日三次，夜间一次。
【集解】沈明宗说：用川芎、当归、白芍、甘草调养厥阴、少阳的血气之正，邪气自然外出；用生葛根、黄芩、半夏、生姜佐助李根，解除半表半里的寒热，逆气可散。大概奔豚虽然属于肾病，但也有兼夹厥阴、少阳邪气而发的。仲景用此方，明确说明不仅仅是寒邪一端导致如此。
发汗后，脐下悸动的，想要发作奔豚，用茯苓桂枝甘草大枣汤主治。
【注释】发汗后，心下悸动，是心阳虚，本经自病。脐下悸动，是肾邪乘虚上干心病。奔豚，是脐下气动而上冲。欲作奔豚，是有类似奔豚的形状将要发作但未发作。茯苓桂枝甘草大枣汤，是用来补益火土而攻伐水邪的。上一条阐明了外感寒邪能导致奔豚，这一条进一步申明内有水气，也能导致奔豚。
【集注】徐彬说：仲景论证，常常合并几条以穷尽其变化。说奔豚由于惊恐，又说它从少腹冲至咽喉，又说它兼有腹痛和往来寒热，又说它兼有核起而无其他病，又说汗后脐下悸动，想要发作奔豚而未成的，其深浅了然分明。用和解法，用攻伐肾法，用桂枝不用桂枝，斟酌治疗微妙。奔豚这一证候，病因、证候、治疗，没有剩余的意义，如果不能领会仲景立方的意思，就会畏惧使用峻药，平淡的药剂效果寡薄，难道是古方不适合今天吗？
周扬俊说：汗本是心的液汁，发汗后脐下生病悸动，是心气虚而肾气动。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（四两） 甘草（炙，二两） 大枣（十五枚）
以上四味药，用甘澜水一斗，先煮茯苓，减少二升，加入其余药物，煮取三升，去渣，温服一升，每日三次。
制作甘澜水的方法：取水三升放入大盆内，用勺子扬起几千遍，水上有珠子五六千颗相互追逐，取用这种水。
【集解】程林说：发汗后脐下悸动，是阳气虚而肾邪上逆。脐下是肾气发源之地，茯苓泄水以攻伐肾邪，桂枝行阳以散逆气，甘草、大枣甘温助脾土以制约肾水。煎药使用甘澜水，是因为扬起后无力，全无水性，取其不助长肾邪。
The Master said: There are diseases of Ben Tun (Rushing Pig), vomiting of pus, fright and terror, and fire pathogen. These four categories of diseases all arise from fright and alarm.
[Commentary] This chapter only contains the syndrome of Ben Tun, while vomiting of pus, fright/terror, and fire pathogen are abbreviated or missing; there must be lacunae in the text.
The Master said: The disease of Ben Tun starts from the lower abdomen, rushes upward to the throat, causes extreme suffering during attacks, and subsides afterward. All such cases arise from fright and alarm.
[Annotation] Ben Tun is a kidney disease. It is named so because its pathological qi rushes from the lower abdomen to the throat, resembling the running and darting of a pig. During an attack, Kidney Qi ascends to overwhelm the Heart, causing extreme suffering; after the attack, the qi weakens and returns to the Kidney, thus stopping. Therefore, although the severity varies, these diseases invariably arise from fright and alarm. Fright injures the Heart, and fear injures the Kidney; both organs are affected. Since Water overcomes Fire, and Kidney Water overwhelms the Heart, the treatment method should involve draining the Kidney and tonifying the Heart.
[Collected Annotations] Zhang Congzheng said: Fright arises from ignorance of the cause; fear arises from awareness of the cause.
Zhou Yangjun said: The Shaoyin (Kidney) meridian runs along the throat; due to its connection with this meridian, the upward rush is facilitated.
After sweating therapy, if burning needles (warm needle moxibustion) were used to induce sweat, and the puncture sites became cold, resulting in nodules rising and turning red, Ben Tun will definitely occur, with qi rushing from the lower abdomen to the heart. Moxibustion should be applied once on each nodule, followed by Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon).
[Annotation] This paragraph is identical to that in Shanghan Lun (Treatise on Cold Damage). Shanghan Lun lacks the three characters "after sweating" but includes the eleven characters "In Taiyang cold damage, adding warm needles will certainly cause fright." The Shanghan Lun version is likely correct. This clarifies that the cause of fright is not singular; even cold invading the needle site can cause this disease. "In Taiyang cold damage, adding warm needles will certainly cause fright" means that when a patient with cold damage is suddenly subjected to warm needles, their mind will be startled; it does not mean that warm needles will inevitably lead to a fright disorder. Burning needles refer to warm needles; inducing sweat via burning needles is also a sweating method. Needle sites should be protected from cold. If carelessness allows external cold invasion, fire becomes constrained within the vessels, blood circulation stagnates, leading to nodular swelling and redness. Warm needle sweating is a rapid and intense method. If the Ying (Nutritive) Qi fails to disperse the pathogen after needling, it indicates the person was originally deficient in Yang and abundant in Yin. Thus, despite the heat of the warm needles, only nodular redness appears. Combined with cold invasion, instead of resolving, it attracts Yin pathogens. At the time of needling, the Heart was already frightened and deficient, allowing Kidney Water and Yin pathogens to overwhelm Heart Yang, triggering Ben Tun. Ben Tun is the Qi of Kidney Water and Yin pathogens rushing from the lower abdomen to the Heart, like a running pig. Moxibustion on the nodules first dispels external cold; subsequently administering Guizhi Jia Gui Tang attacks internal Kidney pathogens.
[Collected Annotations] Zhou Yangjun said: Ben Tun is the pathogen of the North (Kidney). Burning needles to induce sweat, even if improper, how does it relate to Shaoyin to produce Ben Tun? Because Taiyang and Shaoyin are exterior-interior pairs. Cold at the needle site causes nodules and redness; I know the previous pathogen was not dispersed, and the new pathogen entered. Only Cinnamon can attack Kidney pathogens. Hence, Cinnamon is added to Guizhi Tang: one part to release exterior Wind pathogen externally, and one part to vent Yin internally. Moxibustion on the nodules is used because cold causes swelling, which only moxibustion can resolve.
Guizhi Jia Gui Tang (Cinnamon Twig Decoction Plus Cinnamon) Formula
Guizhi (Cinnamomi Ramulus) - 5 liang
Shaoyao (Paeoniae Radix Alba) - 3 liang
Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) - 2 liang (honey-fried)
Shengjiang (Zingiberis Rhizoma Recens) - 3 liang
Dazao (Ziziphi Jujubae Fructus) - 12 pieces
These five ingredients are boiled in 7 sheng of water, simmered until 3 sheng remain, strained, and taken warm, 1 sheng per dose.
Ben Tun with qi rushing to the chest, abdominal pain, and alternating chills and fever is treated with Bentong Tang (Rushing Pig Decoction).
[Annotation] Ben Tun with qi rushing to the throat and extreme suffering during attacks represents severe Ben Tun. Ben Tun with qi rushing to the chest, abdominal pain, and alternating chills and fever represents mild Ben Tun. Severe cases are treated with Guizhi Jia Gui Tang to drain Yin and direct rebellious Qi downward from the Kidney. Mild cases are treated with Bentong Tang to regulate Blood and dissipate rebellious Qi from the Heart.
Bentong Tang (Rushing Pig Decoction) Formula
Gancao (Glycyrrhizae Radix et Rhizoma)
Xiong (Ligustici Chuanxiong Rhizoma)
Danggui (Angelicae Sinensis Radix)
Each: 2 liang
Banxia (Pinelliae Rhizoma Praeparatum) - 4 liang
Huangqin (Scutellariae Radix) - 2 liang
Shengge (Puerariae Radix) - 5 liang
Shaoyao (Paeoniae Radix Alba) - 2 liang
Shengjiang (Zingiberis Rhizoma Recens) - 4 liang
Ganligen Baipi (Pruni Spinosae Cortex Albus) - 1 sheng
These nine ingredients are boiled in 2 dou of water until 5 sheng remain. Take 1 sheng warm, three times daily and once at night.
[Collected Exegesis] Shen Mingzong said: Xiong, Danggui, Baishao, and Gancao nourish the proper Blood and Qi of Jueyin and Shaoyang, allowing pathogens to exit outward. Shengge, Huangqin, Banxia, and Shengjiang assist Ligen to resolve half-exterior/half-interior chills and fever, dispersing rebellious Qi. Although Ben Tun belongs to Kidney disease, it sometimes occurs with concurrent Jueyin and Shaoyang pathogens. Zhongjing’s use of this formula clearly indicates that it is not caused solely by cold pathogens.
After sweating therapy, if palpitations occur below the umbilicus, indicating impending Ben Tun, Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is indicated.
[Annotation] After sweating, palpitations in the epigastrium indicate Heart Yang deficiency and disease of the primary meridian. Palpitations below the umbilicus indicate Kidney pathogens overwhelming the Heart due to deficiency. Ben Tun involves Qi moving below the umbilicus and rushing upward. Impending Ben Tun refers to symptoms resembling Ben Tun that are about to manifest but have not yet fully developed. Fuling Guizhi Gancao Dazao Tang tonifies Fire and Earth to attack Water pathogens. The previous paragraph explained that exterior cold pathogens can cause Ben Tun; this paragraph further clarifies that interior Water Qi can also cause Ben Tun.
[Collected Annotations] Xu Bin said: Zhongjing’s syndrome differentiation often combines several paragraphs to exhaust variations. He states Ben Tun arises from fright, then describes its rush from the lower abdomen to the throat, then mentions accompanying abdominal pain and alternating chills/fever, then nodules without other diseases, and finally post-sweating sub-umbilical palpitations indicating impending but unformed Ben Tun. Its depth and superficiality are clear. Using harmonizing methods, attacking Kidney methods, using Cinnamon vs. not using Cinnamon—treatment nuances are subtle. For Ben Tun, etiology, syndromes, and treatments leave no room for omission. If one does not understand Zhongjing’s intent in formulating prescriptions, one may fear potent drugs and find mild remedies ineffective. Is it that ancient formulas are unsuitable for modern times?
Zhou Yangjun said: Sweat is the fluid of the Heart. Post-sweating sub-umbilical palpitations indicate Heart Qi deficiency and Kidney Qi movement.
Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) Formula
Fuling (Polyporus Umbellatus) - 8 jin
Guizhi (Cinnamomi Ramulus) - 4 liang
Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) - 2 liang (honey-fried)
Dazao (Ziziphi Jujubae Fructus) - 15 pieces
These four ingredients are boiled in 1 dou of Ganlan Shui (Gestating Water). First boil Fuling until reduced by 2 sheng, add remaining herbs, boil until 3 sheng remain, strain, and take 1 sheng warm, three times daily.
Method for preparing Gestating Water: Take 3 sheng of water, place in a large basin, and ladle it up and down thousands of times. When small bubbles (like pearls) appear on the surface, count them; take this water for use.
[Collected Exegesis] Cheng Lin said: Post-sweating sub-umbilical palpitations indicate Yang Qi deficiency and rebellious Kidney pathogens. The area below the umbilicus is the source of Kidney Qi. Fuling drains Water to attack Kidney pathogens; Guizhi promotes Yang to scatter rebellious Qi; Gancao and Dazao, being sweet and warm, strengthen Spleen Earth to control Kidney Water. Gestating water is used because the ladling process removes its natural water properties, preventing it from aiding Kidney pathogens.