34.筑筑惕惕心动悸, 怔怔忡忡不自安, 饮多尿少为停水, 厥冷汗后
是虚寒.
【注】心下筑筑惕惕、 怔怔忡忡, 谓悸病之状也. 饮水多而小便少,
水停心下之悸也, 宜茯苓甘草汤, 或五苓散. 厥冷为寒, 宜真武汤.
汗后为虚, 宜小建中汤. 或不因汗后, 是虚之甚也, 宜炙甘草汤.
35.战身耸动栗心??, 振虽耸动比战轻, 故振责虚因无力, 栗战相交
邪正争, 此证若生三法后, 虚其中外逆而成, 不逆因和而作解, 正胜
邪却战汗平.
【注】战, 谓身抖耸动也. 栗, 谓心内发?? 也. 振, 亦耸动, 比之
于战则无力也. 所以论中曰: 振振者, 皆责其虚也. 栗, 邪气为之也
.战, 正气为之也. 邪正相交故争也. 此证若生于汗, 吐,下之后,是
虚其中外而致逆也. 若不致逆, 邪因以衰, 正因以和而作解, 则为正
胜邪却, 战栗汗出而平也.
36. 呃逆今名?? 古名, 不似哕哕胃里声,?? 声格格连声作, 原夫脐
下气来冲, 颇类嗳噫情自异, 均属气逆治能同. 虚热橘皮竹茹治, 二
便不利利之宁, 气不归原宜都气, 寒虚丁萸附理中, 痞硬下痢生姜泻
,痞硬噫气代赭功.
【注】今之名曰呃逆, 即古之名曰?? 也.?? 者, 气噎结有声也. 世
有以哕呃逆者, 盖不知哕哕之声, 声从胃里出口, 不似?? 之格格连
声,气从脐下来自冲脉, 出口作声也. 呃逆颇类嗳气噫气. 嗳气者,
因饱食太急, 比时作嗳, 转食气也. 噫气者, 因过食伤食, 越时作噫
,食臭气也, 故曰情自异也. 但均属气逆为病, 故曰治能同也. 呃逆
之病, 胃气虚竭也. 兼热者, 以橘皮竹茹汤加柿蒂主之. 兼大便不利
,以三承气汤主之. 兼小便不利, 以二苓散汤主之. 兼肾虚不能摄冲
脉之气归原, 以都气汤加牛膝主之. 兼寒虚, 太阴手足温, 以丁萸理
中汤主之, 少阴手足厥, 更加附子. 兼痞硬下痢, 以生姜泻心汤主之
.兼痞硬噫气, 以旋覆代赭石汤主之.
34. 心中悸动不安,如筑物跳动般惕惕然,怔忡不宁,自觉心神无法安定。饮水多而小便少,这是水饮停聚所致;四肢厥冷、冷汗出或发汗后出现此症,属于虚寒证。
【注】心下感到筑筑跳动、惕惕不安,以及怔怔忡忡、心神不宁,这就是心悸病的症状表现。饮水多而小便少,是水饮停聚在心下引起的心悸,适宜用茯苓甘草汤,或者五苓散。四肢厥冷属于寒证,适宜用真武汤。发汗后出现此症属于虚证,适宜用小建中汤。如果不是因为发汗后出现,而是极度虚弱所致,适宜用炙甘草汤。
35. 身体战栗耸动,心中恐惧发抖。振(zhèn)虽然也是耸动,但比战(zhàn)轻微,所以振责之于正气虚弱导致无力;栗(lì)与战相互交织,是邪气与正气相争的表现。如果这种症状出现在发汗、催吐、攻下三种治法之后,是因为体内正气亏虚,内外失调而导致的逆乱;如果不发生逆乱,说明邪气已经衰退,正气调和从而病愈,这是正气战胜邪气,通过战栗出汗而病情平复。
【注】“战”,是指身体抖动耸动。“栗”,是指内心发出恐惧颤抖的感觉。“振”,也是耸动,但比起“战”来显得无力。所以医经中说:凡是出现振振动摇的,都责之于正气虚弱。“栗”,是由邪气引起的。“战”,是由正气引起的。邪气与正气相交争,所以称为“争”。如果这种症状产生于发汗、催吐、攻下之后,是因为正气在内部和外部都虚弱而导致气机逆乱。如果不能导致逆乱,邪气因此衰弱,正气因此调和而病解,那就是正气战胜邪气,通过战栗出汗而痊愈。
36. 呃逆现在称为呃逆,古代称为哕(yuě)。它不像哕哕那样声音从胃里传出,呃逆的声音格格连声不断响起。原本是由于脐下之气上冲,这与嗳气、噫气的情况自然不同,但都属于气机上逆,治疗方法能够相同。对于虚热型的呃逆,用橘皮竹茹汤治疗;二便不通利的,用通利的方法使其安宁;气不归元(肾不纳气)的,宜用都气丸;寒虚型的,用丁香、吴茱萸、附子配合理中汤;伴有痞硬和下痢的,用生姜泻心汤;伴有痞硬和噫气的,用旋覆代赭石汤功效显著。
【注】现在的名称叫呃逆,就是古代的名称叫哕。哕,是指气机噎结而有声音。世上有人把呃逆叫做哕,大概是不了解哕哕的声音,是从胃里出来经过口发出的,不像呃逆那样格格连声,呃逆的气是从脐下冲脉上来,经过口发出声音。呃逆颇类似嗳气和噫气。嗳气,是因为饱食太急,当时就打嗝,是转达食气的声音。噫气,是因为过食伤食,隔一段时间打嗝,是散发食物臭味的声音,所以说它们的情状自然不同。但都属于气逆为病,所以说治疗方法能够相同。呃逆这个病,是胃气虚竭造成的。兼有热的,用橘皮竹茹汤加柿蒂为主方。兼有大便不通利的,用三承气汤为主方。兼有小便不通利的,用二苓散汤(即五苓散之误或变方,此处依原文译)为主方。兼有肾虚不能摄纳冲脉之气归原的,用都气汤加牛膝为主方。兼有寒虚,太阴病手足温的,用丁萸理中汤为主方,少阴病手足厥冷的,再加附子。兼有痞硬和下痢的,用生姜泻心汤为主方。兼有痞硬和噫气的,用旋覆代赭石汤为主方。
34. Palpitations with a thumping sensation in the heart, restlessness and anxiety, feeling that the mind cannot find peace. Excessive drinking of water with scanty urination indicates fluid retention; cold extremities, cold sweating, or palpitations occurring after sweating are signs of deficiency-cold.
[Note] The sensations of thumping and restlessness in the chest, along with palpitations and mental unease, describe the manifestations of Heart Palpitations (Xin Ji). When water intake is high but urine output is low, it indicates palpitations caused by fluid retention in the chest area; this is suitable for treatment with Fuling Gancao Tang (Poria and Licorice Decoction) or Wuling San (Five-Ingredient Powder with Poria). Cold extremities indicate a cold syndrome, suitable for Zhenwu Tang (True Warrior Decoction). Palpitations occurring after sweating indicate a deficiency syndrome, suitable for Xiaojianzhong Tang (Minor Construct the Middle Decoction). If not caused by sweating but due to extreme deficiency, Zhigancao Tang (Honey-Fried Licorice Decoction) is suitable.
35. Shivering and trembling of the body, with inner fear and trembling. "Zhen" (trembling/shaking) involves bodily movement but is milder than "Zhan" (shivering/rigors); thus, Zhen is attributed to deficiency and lack of strength. "Li" (fearful trembling) combined with Zhan represents the struggle between pathogenic factors and healthy Qi. If this condition arises after diaphoresis (sweating), emesis, or purgation, it results from internal and external deficiency leading to rebellious Qi. If it does not lead to rebellion, the pathogen declines, healthy Qi harmonizes, and recovery ensues; this signifies healthy Qi overcoming the pathogen, with resolution through shivering and sweating.
[Note] "Zhan" refers to the shaking and trembling of the body. "Li" refers to the inner feeling of fearful trembling. "Zhen" also involves trembling but is weaker than "Zhan." Hence, the classics state: All cases of Zhenzhen (trembling) are attributed to deficiency. "Li" is caused by pathogenic factors. "Zhan" is caused by healthy Qi. The interaction between pathogen and healthy Qi constitutes the struggle. If this condition occurs after sweating, vomiting, or purging, it is due to deficiency in both interior and exterior causing Qi rebellion. If no rebellion occurs, the pathogen weakens, healthy Qi becomes harmonious, and the disease resolves; this means healthy Qi overcomes the pathogen, and the patient recovers through shivering and sweating.
36. Hiccups (E Ni) are currently called E Ni, while in ancient times they were referred to as Yue. Unlike the sound of Yue which originates from within the stomach, the sound of E Ni is continuous and grating. It originally stems from Qi rushing up from below the navel. Although it resembles belching (Ai Qi) and eructation (Yi Qi), their characteristics differ naturally; however, since all belong to rebellious Qi, their treatments can be similar. For deficiency-heat type hiccups, Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is used. If there is obstruction in both bowel movements and urination, unblocking methods are employed to restore balance. For Qi failing to return to its origin (Kidney failing to grasp Qi), Duqi Wan (Duqi Pill) is indicated. For cold-deficiency types, Dingyu Lizhong Tang (Evodia and Cinnamon Twig Regulate the Middle Decoction) combined with Fuzi (Aconite Root) is used. For cases accompanied by epigastric fullness/stiffness and diarrhea, Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction) is used. For cases accompanied by epigastric fullness/stiffness and eructation, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is effective.
[Note] The current name is E Ni (Hiccups), which corresponds to the ancient name Yue. Yue refers to Qi stagnation with audible sounds. Some people mistakenly equate E Ni with Yue, likely unaware that the sound of Yue comes from the stomach out through the mouth, whereas E Ni produces a continuous grating sound, with Qi rising from the Chong Mai (Penetrating Vessel) below the navel and exiting through the mouth. E Ni is somewhat similar to Ai Qi (belching) and Yi Qi (eructation). Ai Qi occurs due to eating too quickly when full, resulting in immediate belching to release food Qi. Yi Qi occurs due to overeating or indigestion, resulting in belching later to release the odor of food; hence, their characteristics differ. However, since all involve rebellious Qi, their treatments share similarities. The pathology of E Ni is rooted in the exhaustion of Stomach Qi. If accompanied by heat, Jupi Zhuru Tang added with Diospyros Leaf (Shi Di) is the primary formula. If accompanied by constipation, one of the Three Chengqi Decoctions (San Chengqi Tang) is used. If accompanied by dysuria, Erling San (Two-Poria Powder, likely referring to a variation of Wuling San) is used. If accompanied by Kidney deficiency failing to control the Qi of the Chong Mai returning to its origin, Duqi Tang added with Achyranthes Root (Niuxi) is used. For cold-deficiency patterns, if it is Taiyin pattern with warm extremities, Dingyu Lizhong Tang is used; if it is Shaoyin pattern with cold extremities, Fuzi (Prepared Aconite Root) is added. For patterns with epigastric fullness/stiffness and diarrhea, Shengjiang Xiexin Tang is used. For patterns with epigaustic fullness/stiffness and eructation, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is used.