成 悸心忪也筑筑惕惕然动怔怔忪忪不能自安也有气虚而悸有停饮而悸有汗下后而悸者（汗为心液汗去心虚如
鱼无
水故悸）伤寒二三日心悸而烦者小建中汤少阴病四逆或悸者四逆散加桂是气虚而悸也（阳气内弱心下空虚故悸）饮水多
心下悸是停饮而悸也（心为火而恶水水既内停心不自安则为悸矣）太过病发汗过多叉手自冒心心下悸者太阳病若下之身
重心下悸者不可发汗少阳病不可发汗汗则谵语此属胃胃和则愈胃不和则烦而悸少阳病不可吐下吐下则悸而惊是数者皆
汗下后挟邪而悸者也其治或镇固之或化散之惟饮之为悸甚于他邪虽有余邪必先治悸何者以水停心下无所不入侵于肺为
喘嗽传于胃为哕噎溢于皮肤为肿渍于肠者为利治不可缓也故经曰厥而心下悸宜先治水与茯苓甘草汤后治其厥病甚重犹
先治水况病之浅者乎
太阳伤寒二三日心中悸而烦者小建中汤（方见腹痛）伤寒脉结代心动悸炙甘草汤主之（成 结代之脉动而中止能自
还者名曰结不能自还者名曰代由血气虚衰不能相续也心中悸动知真气内虚也与炙甘草汤益虚补血气而脉复）
炙甘草汤方（一名复脉汤）
甘草（炙四两） 生姜（切） 桂枝（去粗皮各三两） 人参 阿胶（各二两） 生地黄（一片） 麦门冬（去心）
麻子仁（各半升） 大枣（十二枚擘）上九味以清酒七升水八升先煮八味取三升去滓纳胶烊消尽温服一升日三服（补可
以去弱人参甘草大枣之甘以补不足之气桂枝生姜之辛以益正气圣济经曰津耗散为枯五脏痿弱荣卫涸流湿剂所以润之麻
仁胶阿麦门冬地黄之甘润经益血复脉通心也）
太阳病小便利者以饮水多必心下悸小便少者必苦里急也（成 饮水多而小便利者则水不内蓄但胸中水多令心下悸金
匮要略曰食少饮多水停心下甚者则悸饮水多而小便不利则水蓄于内而不行必苦里急也小便不利茯苓甘草汤里急十枣
汤）脉浮数者法当汗出而愈若下之身重心悸者不可发汗当自汗出乃解所以然者尺中脉微此里虚须表里实津液自和便自汗
出愈（详自汗）发汗过多其人叉手自冒心心下悸欲得按者桂枝甘草汤主之（成 发汗过多亡阳也阳受气于胸中胸中阳气
不足故病叉手自冒心心下悸欲得按者与桂枝甘草汤以调不足之气）
桂枝甘草汤方（桂枝之辛走肺而益气甘草之甘入脾而缓中）
桂枝（去粗皮四两） 甘草（炙二两）上二味以水三升煮取一升去滓顿服发汗后其人脐下悸者欲作奔豚茯苓桂枝甘
草大枣汤主之（汗者心之液发汗后脐下悸者心气虚而肾气发动也肾之积名曰奔豚发则从少腹上至心下为肾气逆欲上凌心
今脐下悸为肾气发动故云欲作奔豚与茯苓桂枝甘草大枣汤以降肾气）
茯苓桂枝甘草大枣汤方
茯苓（半斤） 桂枝（去粗皮四两） 甘草（二两炙） 大枣（十五枚掰）上四味以甘烂水一斗先煮茯苓减二升纳
诸药煮取三升去滓温服一升日三服作甘烂水法取水二斗置大盆内以杓扬之水上有珠子五六千颗相逐取用之（茯苓以伐肾
邪桂枝能泄奔豚甘草大枣之甘滋助脾土以平肾气煎用甘烂水者扬之无力取不助肾气也）
太阳病汗出不解其人仍发热心下悸头眩身 动振振欲擗地真武汤
少阳 中风两耳无所闻目赤胸中满而烦者不可吐下吐下则悸而惊（救逆小柴胡去黄芩加茯苓赵 少阳经病证为不可
吐下吐下则悸而惊又云尚未吐下脉沉紧者小柴胡汤又云已吐下发汗温针后谵语为坏病盖不可吐下者禁止之辞也未吐下
者未经误治但可和解而已已汗下者失于误治成坏病也活人于少阳经病证中云尚未可吐下今添一可字恐未稳）伤寒五六日
中风往来寒热胸胁满默默不欲饮食心烦喜呕或心下悸或不渴身有微热或咳者小柴胡汤伤寒脉弦细头痛发热者属少阳不
可汗汗则谵语此属胃胃和则愈胃不和则烦而悸（调胃承气汤）
少阴 病四逆其人或咳或悸或小便不利或腹中痛或泄利下重者四逆散主之（悸者加桂五分）
厥阴 伤寒厥而心下悸者宜先治水当服茯苓甘草汤却治其厥不尔水渍入胃必作利也手足厥冷而悸者茯苓甘草汤手
足逆而不温者四逆散加桂枝霍乱吐利心悸者理中丸加茯苓
成无己注：悸，即心中惊慌不安，感觉心脏怦怦跳动，惊恐不安，怔忡不宁，无法自我安定。有的因气虚而悸，有的因停饮（水饮内停）而悸，有的因发汗、攻下之后而悸。（汗为心之液，汗出过多则心气虚弱，如同鱼无水，故发生心悸。）伤寒病二三日，出现心悸且心烦的，用小建中汤；少阴病出现四肢厥逆或心悸的，用四逆散加桂枝，这是气虚所致的心悸。（阳气内部虚弱，心下空虚，所以心悸。）饮水过多导致心下悸动的，是停饮所致的心悸。（心属火而厌恶水，水既在内停聚，心不能自安，因此产生心悸。）病情过重时，发汗过多，患者双手交叉按护心胸，心下悸动的，属于太阳病；若经过攻下后身体沉重且心下悸动的，不可再发汗；少阳病不可发汗，若发汗则会出现谵语，这归属于胃，胃气和顺则痊愈，胃气不和则心烦且心悸；少阳病不可吐下，若误用吐下法则会导致心悸且惊骇。这些情况都是发汗、攻下后挟带邪气所致的心悸。其治疗方法，有的采用镇固之法，有的采用化散之法。唯独水饮所致的心悸，比其它邪气更为严重，即使有余邪，也必须先治疗心悸。为什么呢？因为水停于心下，无处不入：侵入肺脏则变为喘嗽，传于胃腑则变为呃逆噎膈，溢于皮肤则变为浮肿，浸渍肠道则变为泄利。治疗不可迟缓。所以经典说：“四肢厥冷且心下悸动的，应当先治水，给予茯苓甘草汤，之后再治疗厥逆。”病情严重时尚且要先治水，何况病情较轻的呢？
太阳伤寒病二三日，心中悸动且心烦的，用小建中汤。（方剂见腹痛篇）伤寒脉象结代（脉搏跳动中有间歇），心动悸（心跳剧烈慌乱）的，以炙甘草汤为主治。（成无己注：结脉与代脉，脉搏跳动中止，能自行恢复的称为结脉，不能自行恢复的称为代脉。这是由于气血虚衰，不能相互接续所致。心中悸动，可知真气内部虚弱。给予炙甘草汤以补益虚损、补血气，从而使脉象恢复。）
炙甘草汤方（又名复脉汤）
甘草（炙制四两）、生姜（切片）、桂枝（去除粗皮，各三两）、人参、阿胶（各二两）、生地黄（一片）、麦门冬（去心）、麻子仁（各半升）、大枣（十二枚，掰开）。以上九味药，用清酒七升、水八升，先煮前八味药，取汁三升，去渣，加入阿胶烊化消尽，温服一升，每日三次服用。（《圣济经》曰：津液耗散则为枯槁，五脏痿弱，营卫涸流，湿剂用来滋润它。麻仁、阿胶、麦门冬、地黄的甘润之性，能滋养经脉，补益血液，恢复脉象，通达心神。）
太阳病，小便利者，如果饮水过多，必然心下悸动；小便少者，必然苦于里急（腹部拘急不适）。（成无己注：饮水多而小便利的，则水不内蓄，只是胸中水多令心下悸动。《金匮要略》说：食少饮多，水停心下，严重的则悸动；饮水多而小便不利，则水蓄积于内而不行，必然苦于里急。小便不利用茯苓甘草汤，里急用十枣汤。）脉浮数的，依法应当汗出而愈；若误用攻下法，导致身体沉重、心悸的，不可发汗，应当等待自然汗出才能解除。之所以这样，是因为尺中脉微，这是里虚，需要表里充实，津液自和，便会自然汗出而愈。（详见自汗条）发汗过多，其人双手交叉按护心胸，心下悸动，喜欢被按压的，用桂枝甘草汤主治。（成无己注：发汗过多导致亡阳。阳气受气于胸中，胸中阳气不足，所以发病表现为双手交叉按护心胸，心下悸动，喜欢被按压。给予桂枝甘草汤以调补不足之气。）
桂枝甘草汤方（桂枝的辛味走肺而益气，甘草的甘味入脾而缓中）
桂枝（去除粗皮四两）、甘草（炙制二两）。以上两味药，用水三升，煮取一升，去渣，一次性服下。发汗后，其人脐下悸动，想要发作奔豚（一种自觉有气从少腹上冲心胸的病证）的，用茯苓桂枝甘草大枣汤主治。（成无己注：汗为心之液，发汗后脐下悸动的，是心气虚而肾气发动。肾的积病名为奔豚，发作时从少腹上至心下，为肾气上逆，想要上凌犯心。现在脐下悸动，是肾气发动，所以说“欲作奔豚”。给予茯苓桂枝甘草大枣汤以降敛肾气。）
茯苓桂枝甘草大枣汤方
茯苓（半斤）、桂枝（去除粗皮四两）、甘草（二两，炙制）、大枣（十五枚，掰开）。以上四味药，用甘烂水一斗，先煮茯苓，减少二升水量，再加入其他药物，煮取三升，去渣，温服一升，每日三次。制作甘烂水的方法：取水二斗，放入大盆内，用勺扬水，水面上有珠子五六千颗互相追逐，取此水使用。（茯苓用以伐除肾邪，桂枝能泄除奔豚，甘草、大枣的甘味滋助脾土以平抑肾气。煎煮使用甘烂水，是因为经过扬动后无力，取其不助肾气之意。）
太阳病，发汗后病不解，其人仍然发热，心下悸动，头眩，身体肌肉瞤动（跳动），振振然欲倒地（站立不稳，颤抖欲倒）的，用真武汤。
少阳中风，两耳无所闻，目赤，胸中满而心烦的，不可用吐下法。若误用吐下法，则会导致心悸且惊骇。（赵嗣真注：少阳经病证禁止吐下，若吐下则悸而惊。又云：尚未吐下，脉沉紧的，用小柴胡汤。又云：已吐下发汗温针后出现谵语的，为坏病。大概“不可吐下”是禁止之辞。“未吐下”是指未经误治，只需和解即可。“已汗下”是指失于误治，已成坏病。《活人书》在少阳经病证中说“尚未可吐下”，如今添一个“可”字，恐怕不妥稳。）伤寒五六日，中风，往来寒热，胸胁满闷，默默不欲饮食，心烦喜呕，或者心下悸动，或者不渴，身体有微热，或者咳嗽的，用小柴胡汤。伤寒脉弦细，头痛发热的，属于少阳病，不可发汗，若发汗则谵语，这归属于胃，胃和则愈，胃不和则烦而悸。（可用调胃承气汤调理）
少阴病，四肢厥逆，其人或者咳嗽，或者心悸，或者小便不利，或者腹中痛，或者泄利下重（腹泻伴有肛门重坠感）的，用四逆散主治。（心悸者加桂枝五分）
厥阴病，伤寒四肢厥冷且心下悸动的，应当先治水，当服用茯苓甘草汤，然后再治疗厥逆。否则，水气浸渍入胃，必然导致泄利。手足厥冷且心悸的，用茯苓甘草汤。手足逆冷且不温的，用四逆散加桂枝。霍乱吐利伴有心悸的，用理中丸加茯苓。
Cheng Wuji's commentary: Ji (palpitation) refers to a state of inner panic and unease, where the heart beats palpably and fearfully, with restlessness and inability to feel at ease. It may arise from Qi deficiency, fluid retention (accumulation of pathological fluids), or excessive sweating/purging. (Sweat is the fluid of the Heart; excessive loss depletes Heart Qi, akin to a fish without water, thus causing palpitations.) In Cold Damage disease, if palpitations accompanied by vexation occur on the second or third day, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is indicated. In Sha Yin (Lesser Yin) disease, if there are cold extremities or palpitations, Si Ni San (Frigid Extremities Powder) with Gui Zhi (Cinnamon Twig) is indicated; this is palpitation due to Qi deficiency. (Internal weakness of Yang Qi and emptiness below the Heart cause palpitations.) Drinking too much water leading to palpitations below the Heart is due to fluid retention. (The Heart belongs to Fire and dislikes Water; when Water stagnates internally, the Heart cannot remain at peace, resulting in palpitations.) When the pathogenic factor is severe, excessive sweating may cause the patient to cross their hands over the chest/heart area, experiencing palpitations below the Heart; this pertains to Tai Yang (Greater Yang) disease. If purging was performed previously, resulting in heaviness of the body and palpitations below the Heart, sweating should not be induced again. For Shao Yang (Lesser Yang) disease, sweating is contraindicated; inducing sweating leads to delirious speech, which indicates involvement of the Stomach. If Stomach Qi harmonizes, recovery ensues; if not, vexation and palpitations occur. For Shao Yang disease, vomiting and purging are contraindicated; doing so causes palpitations and fright. These cases all involve palpitations caused by residual pathogens following improper sweating or purging. Treatments may involve stabilizing/astringing methods or resolving/dispersing methods. However, palpitation caused by water/fluid retention is more severe than that caused by other pathogens. Even if residual pathogens exist, the palpitation must be treated first. Why? Because water stagnating below the Heart invades everywhere: invading the Lung causes wheezing and coughing; transmitting to the Stomach causes hiccups and dysphagia; overflowing into the skin causes edema; infiltrating the intestines causes diarrhea. Treatment must not be delayed. Thus, the classics state: "When there are cold extremities and palpitations below the Heart, treat the water first with Fu Ling Gan Cao Tang (Poria, Licorice, and Cinnamon Twig Decoction), then treat the cold extremities." If the condition is severe, water treatment comes first; how much more so for mild conditions?
In Tai Yang Cold Damage, if palpitations and vexation occur in the heart/mind within two to three days, Xiao Jian Zhong Tang is used. (Formula see Abdominal Pain section.) In Cold Damage, if the pulse is Jie Dai (knotted and intermittent) and there is Xin Dong Ji (violent palpitation), Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) is the primary treatment. (Cheng Wuji notes: The Jie and Dai pulses have interruptions during beating. If they resume spontaneously, it is called Jie; if not, it is called Dai. This results from deficiency and decline of Blood and Qi, unable to continue sequentially. Palpitations indicate internal deficiency of True Qi. Zhi Gan Cao Tonifies deficiency and nourishes Blood/Qi to restore the pulse.)
Zhi Gan Cao Tang Formula (also known as Mai Mai Huan Jing Tang / Pulse-Restoring Decoction):
Gan Cao (Honey-fried, 4 liang), Sheng Jiang (Fresh Ginger, sliced), Gui Zhi (Cinnamon Twig, bark removed, each 3 liang), Ren Shen (Ginseng Root), E Jiao (Donkey-Hide Gelatin, each 2 liang), Sheng Di Huang (Rehmannia Root, one piece), Mai Men Dong (Ophiopogon Tuber, core removed), Huo Ma Ren (Hemp Seed, each half sheng), Da Zao (Jujube Fruit, 12 pieces, split). The above nine ingredients are boiled in 7 sheng of clear wine and 8 sheng of water. First boil the eight ingredients to obtain 3 sheng, strain, add E Jiao and melt completely. Take 1 sheng warm, three times daily. (Sheng Ji Jing states: Consumption of fluids leads to withering; weakness of the Five Zang organs and stagnation of Ying and Wei require moistening agents. The sweet-moistening nature of Huo Ma Ren, E Jiao, Mai Men Dong, and Sheng Di Huang nourishes meridians, tonifies Blood, restores the pulse, and unblocks the Heart.)
In Tai Yang disease, if urination is free and copious, drinking too much will inevitably cause palpitations below the Heart; if urination is scanty, there will be distressing sensation of fullness/tightness in the interior. (Cheng Wuji notes: If drinking is high but urination is free, water does not retain internally; rather, excess water in the chest causes palpitations below the Heart. *Jin Gui Yao Lue* states: Eating little and drinking much leads to water stagnation below the Heart; severe cases cause palpitations. If drinking is high but urination is obstructed, water accumulates internally and cannot move, causing distressing tightness. Scanty urination is treated with Fu Ling Gan Cao Tang; distressing tightness is treated with Shi Zao Tang.) If the pulse is floating and rapid, recovery should normally come through sweating. If purging is mistakenly applied, causing body heaviness and palpitations, sweating is contraindicated. Recovery occurs only when spontaneous sweating happens. This is because the pulse at the Chi position (cun-kou) is faint, indicating interior deficiency. The exterior and interior must become solid, fluids must harmonize, and spontaneous sweating will lead to recovery. (See Spontaneous Sweating section.) If excessive sweating causes the patient to cross hands over the chest, experience palpitations below the Heart, and desire pressure, Gui Zhi Gan Cao Tang (Cinnamon Twig and Licorice Decoction) is indicated. (Cheng Wuji notes: Excessive sweating leads to loss of Yang. Yang Qi originates in the chest; insufficiency here causes crossing hands over the chest and palpitations desiring pressure. Gui Zhi Gan Cao Tang regulates insufficient Qi.)
Gui Zhi Gan Cao Tang Formula:
Gui Zhi (Cinnamon Twig, bark removed, 4 liang), Gan Cao (Licorice Root, honey-fried, 2 liang). The above two ingredients are boiled in 3 sheng of water to obtain 1 sheng, strained, and taken in one dose. (Gui Zhi's pungency enters the Lung to benefit Qi; Gan Cao's sweetness enters the Spleen to moderate the center.) After sweating, if the patient experiences palpitations below the umbilicus and desires an attack of Ben Tun (Rushing Pig - a sensation of Qi rushing upward), Fu Ling Gui Zhi Gan Cao Da Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is indicated. (Cheng Wuji notes: Sweat is the fluid of the Heart. Post-sweating palpitations below the umbilicus indicate Heart Qi deficiency triggering Kidney Qi movement. The Kidney accumulation named Ben Tun rises from the lower abdomen to the epigastrium due to rebellious Kidney Qi attempting to oppress the Heart. Current palpitations below the umbilicus signal Kidney Qi activation, hence "desiring to become Ben Tun." Fu Ling Gui Zhi Gan Cao Da Zao Tang subdues Kidney Qi.)
Fu Ling Gui Zhi Gan Cao Da Zao Tang Formula:
Fu Ling (Poria, 8 liang), Gui Zhi (Cinnamon Twig, bark removed, 4 liang), Gan Cao (Licorice Root, honey-fried, 2 liang), Da Zao (Jujube Fruit, 15 pieces, split). The above four ingredients are boiled in 1 dou of "Gan Lan Shui" (Gentle Rotting Water). First boil Fu Ling until reduced by 2 sheng, then add remaining herbs, boil to obtain 3 sheng, strain, and take 1 sheng warm, three times daily. Method for making Gan Lan Shui: Take 2 dou of water, place in a large basin, ladle and splash the water until thousands of small bubbles chase each other on the surface; use this water. (Fu Ling attacks Kidney pathogenic factors; Gui Zhi drains Ben Tun; the sweetness of Gan Cao and Da Zao nourishes Spleen Earth to calm Kidney Qi. Using Gan Lan Shui, which has been agitated and lost its heavy/yin nature, avoids assisting Kidney Water.)
In Tai Yang disease, if sweating fails to resolve the condition, and the patient still has fever, palpitations below the Heart, dizziness, muscle twitching, and trembling instability (wanting to fall to the ground), Zhen Wu Tang (True Warrior Decoction) is indicated.
In Shao Yang Wind Strike, with deafness, red eyes, chest fullness, and vexation, vomiting and purging are contraindicated. Mistaken vomiting or purging causes palpitations and fright. (Zhao Sizhen notes: Shao Yang channel diseases prohibit vomiting and purging; doing so causes palpitations and fright. Also, if not yet vomited/purged and pulse is deep and tight, use Xiao Chai Hu Tang. Also, if delirium occurs after vomiting, purging, sweating, or moxibustion, it is a damaged disease. "Contraindicated" is a prohibition. "Not yet" means no error occurred, only harmonization is needed. "Already" means error led to damaged disease. *Huo Ren Shu* says "not yet suitable for vomiting/purging"; adding "suitable" is unstable.) In Cold Damage or Wind Strike lasting five to six days, with alternating chills and fever, chest/hypochondriac fullness, silence, poor appetite, vexation, frequent vomiting, or palpitations below the Heart, thirstlessness, slight body heat, or cough, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated. In Cold Damage, if the pulse is string-taut and fine with headache and fever, it belongs to Shao Yang. Sweating is contraindicated; inducing sweating causes delirium, indicating Stomach involvement. If Stomach Qi harmonizes, recovery ensues; if not, vexation and palpitations occur. (Tiao Wei Cheng Qi Tang may regulate the Stomach.)
In Shao Yin disease, with cold extremities, and optionally cough, palpitations, difficult urination, abdominal pain, or diarrhea with rectal heaviness, Si Ni San (Frigid Extremities Powder) is indicated. (Add Gui Zhi 5 fen if palpitations are present.)
In Jue Yin disease, in Cold Damage with cold extremities and palpitations below the Heart, treat the water first with Fu Ling Gan Cao Tang, then treat the cold extremities. Otherwise, water infiltration into the Stomach will cause diarrhea. For cold extremities with palpitations, use Fu Ling Gan Cao Tang. For cold extremities that are not warm, use Si Ni San with added Gui Zhi. For Huo Luan (Cold-Heat Complex Disorder) with vomiting, diarrhea, and palpitations, use Li Zhong Wan with added Fu Ling.