史载之论水气凌心。证治甚详。读医随笔。已备录之。近年历验。似于病机稍有确见。史载之叙疫痢水气凌心
者。初起寒甚。大热不退。心中凛凛。时时呕恶。治以肉桂白芷细辛茯苓诸品。此水气凌心。证治之枢要也。巢氏
病源候论。言噤黄隐黄初起。心中寒栗。口噤齿介。神识冥漠。不知东西。杀人甚速。此水气凌心之急证也。又近
见疟疾。有寒起于少腹。不复转热而死者。香港脚。有气起于少腹。上冲急喘而死者。此皆水气凌心之类。大抵此病。
病机有轻重缓急之别。而皆由于真阳不足。如前所言。噤黄香港脚者。是命门真火不足。膀胱阴邪暴涨。上攻于心也。
其证气高目努。口噤肢战。其脉尺中动摇如豆。若遇寒月。一经四肢作冷。即苦心寒凛栗。或遇感冒。一经恶寒发
热。即苦心气迫塞者。是阳明冲任血虚。血中蓄水。膻中阳微。不堪寒气侵逼也。其脉左寸动摇。或右寸鼓搏。又
有肺气与少阳经气。为风寒所袭。脉络乍闭。仆倒不省者。此肝肾阳明大气。为邪所摄也。下焦无病。上焦不虚。
大气得转。即复省矣。其脉两寸丸丸。或乍见短缩。大凡病中觉冷气侵心。如受霜雪。及心悬心悸。情绪孤危。张
惶失措者。皆阳明不足。膻中虚寒也。气喘及左寸脉或短或断者邪已逼心也。尺脉断者。邪发下焦也。不短不断而
来势郁勃不扬。如物制之者外邪内扑也。并宜开上纳下。法如菖蒲远志细辛白芷附子肉桂桃仁半夏茯苓鹿角龟版紫
石英之属选用之。
前文久成。因推求所以脉见丸丸不续之故。忽忆辨脉篇。形冷恶寒三焦伤之义。正与此合。此节是倒卷文例。
阳动则汗出。阳已透阴。所谓阳加于阴谓之汗。又脉盛而滑者。汗且出也。阴动则发热。阳欲透阴。能与阴争。而
不肯服也。至于身形作冷。心情恶寒。膻中凛凛。如受霜雪侵逼状。是阳气欲熄而不振矣。古说皆以三焦为命门。
上属于心。主三焦伤者。命门元阳之气。为寒水所犯。而其根不固。心主血脉之气。为寒水所犯。而其气不续。气
为寒伤。血为水伤。故脉来指下。丸丸动摇不能长续也。其动必应指少力。与金匮动则为惊。弱则为悸相近。弱字
承动说下。谓动而弱也。诸气冲心。皆为恶证。寒水凌犯尤恶。以其能扑灭生阳之气也。或膀胱水邪。自下上逆。
或风寒。由呼吸挟水饮而乱于膻中。其势能令命火上浮。心火下熄。任督二脉分绝而不交。史载之谓寒邪所伤。虽
治愈亦不能久。其谓此乎。西医谓凡以霍乱绞肠痧死者。剖视内膜白绉如久受水浸状。此由凉风遏暑。汗闭不得出
之故。亦水邪泛溢。三焦受伤之一征也。
又有两证。与水气凌心相似。一为火郁。一为风痰入络。总归于血虚。火郁者。内经所谓诸禁鼓栗。如丧神守。
皆属于火。是也。此证急发者。为风寒内扑。阳气乍郁。即水气凌心之类。常发者。是血虚而气不能宣。阳气久郁。
化为阴火。一经触发。即内灼于心。心孔鼻窍。如烟熏火燎刻不可堪也。风痰者。是体弱。血少。或久患脱血。血
去。水存。菀为痰涎。侵于膜络。络无血护。遂淫。淫内痒习。习应心。心气张惶。不能自持矣。此血虚。化风生
痰。肺困气滞。而膜络乏力也。其脉象。迟 。兼见洪长。而细审带弦。按之反细。其病情。触物皆畏。遇事难任。
怯弱迫塞之苦。直同心痿。远甚心悸。其病机。日落时。及天阴与乍凉为甚。其兼证。常苦筋骨胀痛。走注无定。
其始多起于暑月贪凉太过。及秋月患疟痢 疹汗出不彻之故。治法。以补血导气行水强筋为主。随四时加减。佐以
导引针灸。调其饮食起居。需以岁月。仅堪末减。罕能除根。古百合病近似之。而百合困肺。绝不可用。予身患之。
又迭见亲友患之。甚矣风痰入络之奇苦而难治也。
史载之论述水气凌心，证治非常详尽。《读医随笔》中已完整收录。近年来临床验证，发现其对病机有较为准确的见解。史载之叙述疫痢导致的水气凌心，初起时寒战严重，高热不退，心中凛冽恐惧，时常呕吐恶心。治疗使用肉桂、白芷、细辛、茯苓等药物。这是水气凌心病证治疗的枢要所在。
《巢氏病源候论》记载噤黄（一种以牙关紧闭为特征的黄疸病）和隐黄（症状隐蔽的黄疸病）初起时，心中寒冷战栗，牙关紧闭，牙齿咬合有声，神识昏蒙模糊，不知东西南北。病情发展迅速，致死极快。这是水气凌心的急重证候。
我又见过疟疾患者，寒气从小腹发起，不再转为发热而死亡；脚气病（香港脚），气从小腹发起，上冲导致急促喘息而死亡。这些都属于水气凌心的类似病症。大抵此类疾病，病机有轻重缓急的区别，但都源于真阳不足。如前所述，噤黄和脚气病患者，是命门真火不足，膀胱阴邪暴涨，向上攻伐心脏。其症状表现为气逆喘促，眼球突出，牙关紧闭，四肢颤抖。脉象尺部动摇如豆粒大小。如果在寒冷月份，一旦四肢发冷，就会痛苦地感到寒冷战栗；如果遇到感冒，一旦恶寒发热，就会痛苦地感到心气迫塞不通。这是阳明经和冲任二脉血虚，血中停聚水饮，膻中阳气微弱，不堪受寒气侵逼所致。其脉象左寸部动摇，或右寸部鼓搏有力。又有肺气与少阳经气，被风寒侵袭，脉络突然闭塞，仆倒不省人事的。这是肝肾阳明大气，被邪气所遏制。如果下焦无病，上焦不虚，大气得以运转，就能恢复清醒。其脉象两寸部圆滑流利，或乍现短缩。大凡患病中感觉冷气侵袭心脏，如同遭受霜雪，以及心脏悬空悸动，情绪孤危恐慌，张皇失措的，都是阳明不足，膻中虚寒所致。气喘且左寸脉或短或断的，是邪气已经逼迫心脏。尺脉断绝的，是邪气发自下焦。脉象不短不断而来势郁勃不畅，如同被物体制约的，是外邪向内扑击。这些都适宜采用开宣上焦、纳气归下的治法，方药可选用石菖蒲、远志、细辛、白芷、附子、肉桂、桃仁、半夏、茯苓、鹿角、龟版、紫石英等药物。
前文早已写成，因为推求脉象出现圆滑流利但不相接续的原因，忽然想起《辨脉篇》中“形冷恶寒三焦伤”的含义，正与此相合。这一节是倒叙的文例。阳脉动则汗出，阳气已经透达阴分，所谓“阳加于阴谓之汗”。又脉象盛大而滑利的，汗即将要出来。阴脉动则发热，阳气想要透达阴分，能与阴争，而不肯顺服。至于身体发冷，心情厌恶寒冷，膻中凛冽，如同遭受霜雪侵逼的样子，这是阳气想要熄灭而不能振奋。古说都认为三焦归属于命门，上属于心。主治三焦受伤者，是命门元阳之气，被寒水所侵犯，而其根基不固；心主血脉之气，被寒水所侵犯，而其气不能连续。气被寒伤，血被水伤，所以脉来指下，圆滑动摇而不能长续。这种跳动必然应指力量微弱，与《金匮要略》中“动则为惊，弱则为悸”相近。“弱”字承接“动”来说，谓动而兼弱。各种气冲犯心脏，都是恶证，寒水凌犯尤为恶劣，因为它能扑灭生发之阳气。或是膀胱水邪，自下向上逆行；或是风寒，由呼吸挟带水饮而在膻中扰乱。其势能令命门之火上浮，心火下熄，任督二脉分离隔绝而不相交。史载之说寒邪所伤，即使治愈也不能长久，说的就是这种情况。西医认为凡是因霍乱绞肠痧死亡的，剖视内膜呈白色皱缩，像久受水浸的样子。这是由于凉风遏制暑热，汗液闭结不得排出的缘故。这也是水邪泛溢，三焦受伤的一个征象。
又有两种证候，与水气凌心相似。一种是火郁，一种是风痰入络。总归于血虚。火郁者，即《内经》所说的“诸禁鼓栗，如丧神守，皆属于火”，就是这个意思。此证急发的，是风寒内扑，阳气突然郁结，即属于水气凌心的类别；常发的，是血虚而气不能宣通，阳气长期郁结，化为阴火，一经触发，就向内灼烧心脏，心窍鼻窍，如烟熏火燎，片刻难以忍受。风痰者，是体质虚弱，血液稀少，或久患失血，血去之后，水液留存，郁积成为痰涎，侵入膜络。络脉没有血液护卫，于是淫溢扩散，内部瘙痒习习，进而感应心脏，心气张皇，不能自我持守。这是血虚，化风生痰，肺困气滞，而膜络乏力所致。其脉象迟涩，兼见洪长，而仔细审视带有弦象，按之反而细。其病情，触物皆畏，遇事难当，怯弱迫塞的痛苦，简直同于心痿，远甚于心悸。其病机，在日落时分，以及天阴和突然变凉时加重。其兼证，常苦于筋骨胀痛，游走不定。其始多起于暑月贪凉太过，以及秋月患疟疾、痢疾、疹病，汗出不彻底的缘故。治法，以补血、导气、行水、强筋为主，随四季加减，佐以导引针灸，调理饮食起居，需要以年月为单位计算，仅能稍微减轻，很少能除根。这与古百合病近似，但百合病困肺，绝对不可用百合。我亲身患有此病，又多次见到亲友患此病，风痰入络的奇特痛苦和难治程度，真是厉害啊。
Shi Zaizhi discussed the pathology of Water Qi Overwhelming the Heart (Shuiqi Lingxin, water-cold pathogen overwhelming the heart), and its syndrome differentiation and treatment were very detailed. *Du Yi Suibi* (Random Notes on Reading Medicine) has fully recorded it. In recent years, clinical verification suggests that he had somewhat accurate insights into the disease mechanism. Shi Zaizhi described Water Qi Overwhelming the Heart caused by epidemic dysentery: at the onset, there is severe chills, persistent high fever, a chilling fear in the heart, and frequent nausea and vomiting. Treatment employs herbs such as Rougui (Cinnamon Bark), Baizhi (Angelicae Dahuricae Radix), Xixin (Asari Radix et Rhizoma), and Fuling (Poria). This constitutes the key principle for treating this syndrome.
*Nishi Bingyuan Houlun* (Chao Yuanfang's Treatise on the Pathogenesis and Manifestations of Various Diseases) states that for Jinhuang (Jinhuang, a type of jaundice characterized by lockjaw) and Yinhuang (Yinhuang, hidden jaundice), at the onset, there is cold shivering in the chest, lockjaw with teeth grinding, mental confusion and obscurity, disorientation regarding direction, and rapid fatality. This is an acute and critical manifestation of Water Qi Overwhelming the Heart.
I have also observed cases of malaria where cold originates from the lower abdomen, does not transition to heat, and leads to death; and cases of Jiaoxie (Hongkong Foot/Jiaoxie, a condition often associated with edema and weakness, here referring to a severe form involving qi rebellion) where qi rises from the lower abdomen, rushes upward causing急促 panting, and leads to death. These all belong to the category of Water Qi Overwhelming the Heart. Generally, this disease presents variations in severity and urgency in its mechanism, but all stem from a deficiency of True Yang (Zhenyang, the fundamental yang energy of the body). As mentioned earlier, in cases of Jinhuang and Jiaoxie, it is due to insufficiency of the True Fire of Mingmen (Mingmen, Gate of Life, located between the kidneys), leading to a surge of Yin pathogens in the Bladder attacking the Heart. Symptoms include hyperpnea, protruding eyes, lockjaw, and limb tremors. The pulse at the Chi position (Chi cun, radial pulse position at the wrist corresponding to the kidney/bladder) is trembling like a bean. If, during cold months, limbs become cold, the patient suffers from chilling shivers; if caught with a common cold, aversion to cold and fever immediately lead to a sensation of oppressive stagnation in the chest. This is due to blood deficiency in the Yangming and Chong-Ren vessels, water retention within the blood, and weak Yang Qi in the Danzhong (Danzhong, pericardium/center of chest), which cannot withstand cold invasion. The pulse may show trembling at the Left Cun position or pulsating force at the Right Cun position. Another scenario involves Lung Qi and Shaoyang channel Qi being attacked by Wind-Cold, causing sudden closure of collaterals, leading to collapse and unconsciousness. This is due to the Great Qi of Liver, Kidney, and Yangming being constrained by pathogens. If the Lower Jiao is free of disease and the Upper Jiao is not deficient, and the Great Qi can circulate, consciousness will return. The pulse at both Cun positions may be round and slippery, or occasionally short. Generally, feeling cold air invading the heart like frost or snow, along with palpitations, emotional fragility, panic, and disarray, indicates Yangming deficiency and Cold-Deficiency in the Danzhong. Panting with a short or interrupted Left Cun pulse indicates pathogens forcing upon the Heart. An interrupted Chi pulse indicates pathogens originating from the Lower Jiao. A pulse that is neither short nor interrupted but flows turbulently as if restrained indicates external pathogens attacking inward. All these should be treated by opening the Upper Jiao and guiding Qi downward. Methods include selecting herbs such as Shichangpu (Acori Tatarinowii Rhizoma), Yuanzhi (Polygalae Radix), Xixin, Baizhi, Fuzi (Aconiti Lateralis Radix Praeparata), Rougui, Taoren (Persicae Semen), Banxia (Pinelliae Rhizoma), Fuling, Lujiao (Cervi Cornus Degelatinatum), Guiban (Testudinis Carapax et Plastrum), and Zhiyingshi (Fossilis Ossis).
The previous text was completed long ago. While deducing the reason for the pulse appearing round/slippery yet discontinuous, I suddenly recalled the meaning of "Body Cold, Aversion to Cold, Injury to the Three Jiao" from the *Bian Mai Pian* (Chapter on Pulse Differentiation), which aligns perfectly with this section. This paragraph uses a flashback narrative structure. A moving Yang pulse indicates sweating, meaning Yang has penetrated Yin, as stated, "When Yang adds to Yin, it is called sweat." A pulse that is full and slippery indicates impending sweat. A moving Yin pulse indicates fever, meaning Yang desires to penetrate Yin and contends with Yin, refusing submission. When the body feels cold, the mind fears cold, and the Danzhong feels chillingly cold as if invaded by frost and snow, it signifies that Yang Qi is about to extinguish and fails to rise. Ancient theories hold that the Three Jiao belongs to the Mingmen and connects upwards to the Heart. Treating injuries to the Three Jiao involves addressing the Yuan-Yang Qi of the Mingmen being assaulted by Cold-Water, causing its root to be unstable; and the Qi of the Heart governing Blood-Vessels being assaulted by Cold-Water, causing its continuity to break. Qi is injured by Cold, Blood is injured by Water; thus, the pulse under the fingers trembles and moves roundly but cannot sustain itself. This movement must be weak against the finger, similar to the statement in *Jinkui Yaolue*: "Movement indicates fright, weakness indicates palpitation." The character "weak" follows "movement," implying movement accompanied by weakness. Any Qi rushing to the Heart is a malignant syndrome; Cold-Water overwhelming is particularly evil because it can extinguish the generating Yang Qi. It may be Bladder Water pathogens reversing upward from below, or Wind-Cold carrying fluid retention via respiration to disrupt the Danzhong. This power can cause Mingmen Fire to float upward and Heart Fire to extinguish downward, severing the Ren and Du meridians so they do not intersect. Shi Zaizhi stated that even if cured, damage from Cold pathogens cannot last long; this refers to such cases. Western medicine observes that those dying from cholera or intestinal cramping spasms show white, wrinkled mucous membranes resembling prolonged water immersion upon autopsy. This is due to cool wind suppressing summer heat, closing sweat pores and preventing excretion. This is also a sign of Water pathogens overflowing and injury to the Three Jiao.
There are two other syndromes similar to Water Qi Overwhelming the Heart: one is Fire Stagnation, the other is Wind-Phlegm entering the collaterals. Both ultimately归结 to Blood Deficiency. Fire Stagnation refers to what *Neijing* calls: "All lockjaw, drumming, and shivering, as if losing spiritual control, belong to Fire." Acute onset of this syndrome is due to internal attack by Wind-Cold and sudden stagnation of Yang Qi, belonging to the category of Water Qi Overwhelming the Heart. Chronic onset is due to Blood Deficiency preventing Qi circulation, leading to long-term Yang stagnation transforming into Yin-Fire. Once triggered, it internally burns the Heart; the heart orifices and nasal passages feel like smoke and fire burning, unbearable even for an instant. Wind-Phlegm occurs in individuals with weak constitutions and low blood, or those suffering from chronic blood loss. After blood loss, water remains, stagnating into phlegm-saliva, invading the membrane-collaterals. Without blood protection, the collaterals allow excessive spread, causing internal itching sensations that resonate with the Heart, making Heart Qi panicked and unable to maintain composure. This is Blood Deficiency generating Wind and Phlegm, Lung constraint with Qi stagnation, and weakness of the membrane-collaterals. The pulse is slow, combined with full and long qualities, but carefully examined shows a string-like quality, becoming thin upon pressure. The patient fears all stimuli, finds tasks difficult to bear, and suffers from timidity and oppression, akin to Heart Flaccidity Syndrome (Xin Wei), far worse than palpitations. The pathology worsens at sunset, cloudy days, or sudden cooling. Accompanying symptoms often include distending pain in muscles and bones, migrating without fixed location. It usually begins from excessive exposure to cold in summer, or incomplete sweating during autumn malaria, dysentery, or rashes. Treatment focuses on nourishing Blood, directing Qi, promoting Water metabolism, and strengthening sinews/bones, adjusted seasonally, assisted by Daoyin (guiding and pulling exercises) and acupuncture, regulating diet and lifestyle. Recovery takes years; only slight improvement is possible, rarely a cure. This resembles ancient Baihe Bing (Lily Disease), but since Baihe Bing constrains the Lung, Baihe (Lily Bulb) must absolutely not be used. I suffered from this personally and frequently saw relatives and friends suffer from it. The unique suffering and difficulty of treating Wind-Phlegm entering the collaterals are indeed profound.