〔海〕茯苓丸 治伤寒后或用心劳倦,四肢羸弱,心忪惊悸,吸吸短气。
茯神 麦门冬(去心) 熟地(各一两) 牡丹皮 人参 黄 (各七钱) 桂枝 甘草(炙)
牛膝 泽泻(各半两)
上为细末,炼蜜和捣三五百杵,丸如桐子大。食前温酒下二十丸。
犀角汤 治伤寒后伏热在心,怔忪惊悸,不得眠睡。
犀角屑(半两) 茵陈蒿(七钱半) 茯苓(二两) 芍药 生地(焙,二两) 麦门冬(去心,两半)
山栀(半两)
上 咀,每服五钱,水一盏半,姜二片,竹叶三七片,同煎,食后服。
麦门冬茯苓饮子 治伤寒后心神恍惚,不得卧。
麦门冬(去心) 赤茯苓(去皮) 知母(焙) 芎 甘草(炙) 酸枣仁(微炒) 陈皮(去
白,炒) 槟榔(各一两)
上 咀,每服五钱,水一盏半,生姜五片煎,温服,日三服。
少阴心悸者,四逆不可与也。心悸者,火惧水也,惟肾欺心,故为心悸者,是足经上手经也。若与四逆汤,
变无形中恶候生矣。故先以甘草茯苓汤导其湿,次以四逆汤温之者,为心悸全无,手经火令入足水也。心悸在
湿未去,终至于毙,故不敢温之,温之则坏矣。
汗后心下悸,若头眩身 动,振振欲擗地者,真武汤也。(论见战振。)若叉手自冒心者,后条桂枝甘
草汤也。若谵语胃不和烦悸者,《活人》用调胃承气汤也。(论见口苦。)若脐下悸者,后条茯苓桂枝甘草
大枣汤也。发汗过多,其人叉手自冒心,心下悸欲得按者,宜桂枝甘草汤。
桂枝(四钱) 甘草(二钱)
上二味,以水一盏半,煎八分,去渣温服。
发汗后,其人脐下悸者,欲作奔豚,宜茯苓桂枝甘草大枣汤。
茯苓(八钱) 甘草(炙,二钱) 桂枝(四钱) 大枣(二枚)
上作二服,以甘澜水二钟,先煮茯苓,减二分,纳诸药,煮取一盏,去渣温服,日三。作甘澜水法∶取水
斗许,置大盆中,以杓扬之,水上有珠子五六千颗相逐,取用之。
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。少阳病,耳聋胸满,不可吐下,吐下则悸而惊者。注云∶气血虚,往来寒
热,胸胁满,心下悸而小便不利者,小柴胡去黄芩加茯苓汤。(方论见往来寒热。)
太阳病,小便利者,以饮水多,必心下悸,小便少者,必苦里急也。伤寒二三日,心中悸而烦者,小建
中汤主之。伤寒脉结代,心动悸,宜炙甘草汤。
甘草(炙,一两) 生姜(三片) 人参(半两) 生地(一两) 桂枝(去皮) 麦门冬(去心。各一两)
麻仁(一合) 阿胶(半两)
上 咀,每服五钱,水一盏半,入酒半钟,煎至八分,去渣纳阿胶,溶尽温服,日三。
霍乱吐利心悸者,理中丸加茯苓。
手足厥冷而悸者,茯苓甘草汤。手足逆而不温悸者,四逆散加桂枝。
【海】茯苓丸:治疗伤寒病后,或因用心劳倦,导致四肢瘦弱无力,心中悸动不安、惊悸,呼吸短促。
药物组成:茯神、麦门冬(去心)、熟地黄(各一两);牡丹皮、人参、黄芪(各七钱);桂枝、炙甘草、牛膝、泽泻(各半两)。
制法与用法:将上述药材研为细末,用炼蜜调和并捣杵三五百下,制成如梧桐子大小的丸剂。饭前用温酒送服二十丸。
犀角汤:治疗伤寒病后,余热伏留于心,出现怔忡惊悸,无法入睡。
药物组成:犀角屑(半两)、茵陈蒿(七钱半)、茯苓(二两)、芍药、生地黄(焙干,各二两)、麦门冬(去心,一两半)、山栀子(半两)。
制法与用法:将药材切碎,每次服用五钱,加水一盏半,生姜两片,竹叶三十片,共同煎煮,饭后服用。
麦门冬茯苓饮子:治疗伤寒病后,心神恍惚不定,无法安卧。
药物组成:麦门冬(去心)、赤茯苓(去皮)、知母(焙干)、川芎、炙甘草、酸枣仁(微炒)、陈皮(去白,炒)、槟榔(各一两)。
制法与用法:将药材切碎,每次服用五钱,加水一盏半,生姜五片,共同煎煮,温服,每日三次。
少阴经心悸者,不可使用四逆汤。所谓心悸,是火(心)畏惧水(肾),只有当肾水欺侮心火时,才会发生心悸,这是足少阴肾经与手少阴心经之间的病变。如果误用四逆汤,会导致无形的恶候产生。因此,应当先用甘草茯苓汤引导湿气排出,然后再用四逆汤温补,这样才能使心悸完全消除,使手经的火令回归足经的水位。如果心悸发生在湿气未去除之时,最终会导致死亡,所以不敢直接温补,一旦温补就会造成坏证。
发汗后出现心下部悸动,如果伴有头晕目眩、身体震颤动摇,想要倒地者,适用真武汤。(相关论述见“战振”条。)如果患者双手交叉护住心胸部者,适用后文提到的桂枝甘草汤。如果出现胡言乱语、胃气不和、烦躁且心悸者,《活人书》主张使用调胃承气汤。(相关论述见“口苦”条。)如果脐下悸动者,适用后文提到的茯苓桂枝甘草大枣汤。发汗过多,导致患者双手交叉护住心胸部,心下部悸动且喜欢按压者,适宜使用桂枝甘草汤。
药物组成:桂枝(四钱)、甘草(二钱)。
制法与用法:以上两味药,加水一盏半,煎至八分,去渣滓,温服。
发汗后,患者脐下悸动,有发作奔豚病的趋势,适宜使用茯苓桂枝甘草大枣汤。
药物组成:茯苓(八钱)、炙甘草(二钱)、桂枝(四钱)、大枣(两枚)。
制法与用法:分为两次服用,用甘澜水两钟,先煎煮茯苓,减少二分之一的体积,再加入其他药物,煎取一盏,去渣滓,温服,每日三次。制作甘澜水的方法:取水约一斗,放入大盆中,用勺子反复扬水,直到水面上出现五六千颗相互追逐的小水泡,取此水使用。
脉象浮数者,按照法则应当通过出汗而痊愈。如果误用攻下法,导致身体沉重、心悸者,不可再发汗,应当等待其自汗出才能解除。之所以这样,是因为尺中脉微弱,这表示里虚,需要表里之气充实,津液自然调和,便会自汗出而痊愈。少阳病,出现耳聋、胸满,不可使用吐法和下法,如果误用吐下法,会导致心悸和惊骇。注解说:气血虚弱,往来寒热,胸胁胀满,心下悸动且小便不利者,使用小柴胡汤去掉黄芩加上茯苓的方剂。(方论见“往来寒热”条。)
太阳病,如果小便通畅,是因为饮水过多,必然导致心下部悸动;如果小便量少,必然感到腹部急迫难受。伤寒发病二三日,心中悸动且烦躁者,以小建中汤主治。伤寒脉象结代,心动悸动者,适宜使用炙甘草汤。
药物组成:炙甘草(一两)、生姜(三片)、人参(半两)、生地黄(一两)、桂枝(去皮)、麦门冬(去心,各一两)、麻仁(一合)、阿胶(半两)。
制法与用法:将药材切碎,每次服用五钱,加水一盏半,加入酒半钟,煎至八分,去渣滓,加入阿胶,溶化尽后温服,每日三次。
霍乱伴有呕吐、腹泻及心悸者,使用理中丸加茯苓。
手足厥冷且心悸者,使用茯苓甘草汤。手足逆冷且不温暖且心悸者,使用四逆散加桂枝。
[Ha] Fuling Wan (Poria Pill): Treats post-typhoid fever or mental overexertion, resulting in emaciation and weakness of the four limbs, palpitations with fright, and shortness of breath.
Ingredients: Fushen (Poria with Hostwood), Maidong (Ophiopogonis Radix, heart removed), Shudi (Prepared Rehmanniae Radix) (each 1 liang); Mudanpi (Moutan Cortex), Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix) (each 7 qian); Guizhi (Cinnamomi Ramulus), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Niuxi (Achyranthis Bidentatae Radix), Zexie (Alismatis Rhizoma) (each 0.5 liang).
Preparation and Administration: Grind the above herbs into a fine powder, mix with refined honey, and pound for three to five hundred strokes. Form pills the size of tung tree seeds. Take 20 pills before meals with warm wine.
Xijiao Tang (Rhinoceros Horn Decoction): Treats latent heat lingering in the Heart after typhoid fever, causing severe palpitations and insomnia.
Ingredients: Xijiaoxie (Hornis Rhinocerotis Cutis, note: substitute with water buffalo horn in modern practice), Yinchenhao (Artemisiae Scopariae Herba), Fuling (Poria), Shaoyao (Paeoniae Radix), Shengdi (Rehmanniae Radix, baked) (each 2 liang), Maidong (Ophiopogonis Radix, heart removed, 1.5 liang), Shanzhi (Gardeniae Fructus) (0.5 liang).
Preparation and Administration: Coarsely crush the herbs. For each dose, take 5 qian, add 1.5 zhan of water, 2 slices of Shengjiang (Zingiberis Rhizoma Recens), and 30 leaves of Zhuye (Bambusae Folium). Decoct together and take after meals.
Maidong Fuling Yinzi (Ophiopogon and Poria Infusion): Treats post-typhoid fever characterized by vague spirit and inability to lie down.
Ingredients: Maidong (Ophiopogonis Radix, heart removed), Chifuling (Red Poria, peel removed), Zhimu (Anemarrhenae Rhizoma, baked), Xiong (Chuanxiong Rhizoma), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Suanzaoren (Ziziphi Spinosae Semen, lightly fried), Chenpi (Citri Reticulatae Pericarpium, white pith removed, fried), Binglang (Arecae Semen) (each 1 liang).
Preparation and Administration: Coarsely crush the herbs. For each dose, take 5 qian, add 1.5 zhan of water and 5 slices of Shengjiang (Zingiberis Rhizoma Recens). Decoct and take warm, three times daily.
In cases of Heart palpitations associated with the Shaoyin (Lesser Yin) channel, SiNi Tang (Frigid Extremities Decoction) must not be administered. Palpitations arise from Fire (Heart) fearing Water (Kidney); specifically, when Kidney Water bullies Heart Fire, palpitations occur, involving both the Foot Shaoyin Kidney channel and the Hand Shaoyin Heart channel. If SiNi Tang is mistakenly used, formless malignant conditions will arise. Therefore, one should first use Gancao Fuling Tang (Licorice and Poria Decoction) to guide out dampness, and subsequently use SiNi Tang (Frigid Extremities Decoction) to warm; this ensures the complete resolution of palpitations, allowing the Fire command of the Hand channel to return to the Water position of the Foot channel. If palpitations occur while dampness remains, it may ultimately lead to death; thus, warming is contraindicated initially, as it would cause adverse transformations.
After sweating, if there is palpitation in the epigastrium, accompanied by dizziness, body tremors, and a desire to fall to the ground, Zhenwu Tang (True Warrior Decoction) is indicated. (See discussion on "Tremors".) If the patient crosses their hands over the heart region, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is indicated. If there is delirious speech, disharmony of the Stomach, irritability, and palpitations, the *Ren Shu* (Book that Saves Lives) recommends Tiaowei Chengqi Tang (Regulate and Nourish the Stomach Major Purge Decoction). (See discussion on "Bitter Taste in Mouth".) If there is palpitation below the umbilicus, Linggui Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is indicated. After excessive sweating, if the patient crosses their hands over the heart region, experiences palpitation in the epigastrium that desires pressure, Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) is appropriate.
Ingredients: Guizhi (Cinnamomi Ramulus, 4 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian).
Preparation and Administration: Boil these two ingredients in 1.5 zhan of water until reduced to 0.8 zhan. Strain and take warm.
After sweating, if the patient experiences palpitation below the umbilicus and has a tendency toward Ben Tun (Running Piglet syndrome), Linggui Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is appropriate.
Ingredients: Fuling (Poria, 8 qian), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma, 2 qian), Guizhi (Cinnamomi Ramulus, 4 qian), Dazao (Jujubae Fructus, 2 pieces).
Preparation and Administration: Divide into two doses. Use 2 zhong of Ganlan Shui (Gentle Wave Water). First decoct Fuling (Poria) until reduced by two parts. Add the remaining herbs and decoct until 1 zhan remains. Strain and take warm, three times daily. Method for making Ganlan Shui (Gentle Wave Water): Take about one dou of water, place it in a large basin, and scoop/splash it repeatedly with a ladle until 5,000–6,000 pearl-like bubbles chase each other on the surface. Use this water.
If the pulse is floating and rapid, recovery should normally come through sweating. If purgation is incorrectly applied, resulting in heavy body and palpitations, sweating should not be induced again. Recovery will occur spontaneously through natural sweating. This is because a faint pulse at the Chi position indicates interior deficiency. When both exterior and interior become solid and fluids harmonize, spontaneous sweating will occur, leading to recovery. In Shaoyang (Lesser Yang) disease, with deafness and chest fullness, vomiting and purging are contraindicated. If vomiting or purging is mistakenly used, it leads to palpitations and fright. The annotation states: For Qi and Blood deficiency with alternating cold and heat, chest and hypochondriac fullness, epigastric palpitations, and difficulty urinating, Xiao Chaihu Tang (Minor Bupleurum Decoction) without Huangqin (Scutellariae Radix) plus Fuling (Poria) is used. (See discussion on "Alternating Cold and Heat".)
In Taiyang (Greater Yang) disease, if urination is free, it is due to excessive fluid intake, which inevitably causes epigastric palpitations; if urination is scanty, there will be distressing abdominal urgency. In typhoid fever lasting two to three days, with palpitations and irritability in the heart, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment. In typhoid fever with knotted or intermittent pulse and violent heart palpitations, Zhi Gancao Tang (Honey-Fried Licorice Decoction) is appropriate.
Ingredients: Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 1 liang), Shengjiang (Zingiberis Rhizoma Recens, 3 slices), Renshen (Ginseng Radix et Rhizoma, 0.5 liang), Shengdi (Rehmanniae Radix, 1 liang), Guizhi (Cinnamomi Ramulus, peeled), Maidong (Ophiopogonis Radix, heart removed, each 1 liang), Huren (Semen Cannabis), Ejiao (Asini Corii Colla, 0.5 liang).
Preparation and Administration: Coarsely crush the herbs. For each dose, take 5 qian, add 1.5 zhan of water and half a zhong of wine. Decoct until 0.8 zhan remains. Strain, add Ejiao (Donkey-hide Gelatin), melt completely, and take warm, three times daily.
For Huoluan (Shock/Colera) with vomiting, diarrhea, and palpitations, Lizhong Wan (Middle Regulator Pill) plus Fuling (Poria) is used.
For cold extremities with palpitations, Fuling Gancao Tang (Poria and Licorice Decoction) is used. For cold extremities that are not warm with palpitations, Sini San (Frigid Extremities Powder) plus Guizhi (Cinnamomi Ramulus) is used.