汪石山治一女。年十五。病心悸。常若有人捕之。欲避而无所。其母抱之于怀。数婢护
之于外。犹恐恐然不能安寐。医者以为病心。用安神丸、镇心丸、四物汤。不效。汪诊之。
脉皆细弱而缓。曰。此胆病也。用温胆汤。服之而安。
〔附〕许学士治四明董生。卧则魂飞扬。身虽在床而神魂离体。惊悸多魇。通宵不寐。
群皆以为心病。医之无效。许曰。以脉言之。肝经受邪。游魂为变。非心也。以肝有邪。魂
不得归于肝。是以卧则飞扬若离体也。肝主怒。必小怒则剧。用真珠母为君。龙齿佐之。因
有龙齿安魂虎睛定魄之说。
震按此二条。俱凭兼见之证。辨为肝胆之病。若汪案之脉细弱而缓。何以不认作阳气两
虚。许案不载脉象。亦难核辨。然肝胆之不寐易治。而心之不寐难瘥。盖心藏神。肾藏精与
志。寐虽由心。心赖肾之上交。精以合神。阴能包阳。水火既济。自然熟寐。内经谓阳气满
则阳跷盛。不得入于阴。阴虚。故目不瞑。又云。阴跷阳跷。阴阳相交。阳入阴。阴出阳。
交于目锐 。阳气盛则 目。阴气盛则瞑目。此是不寐要旨。非肝胆病之不寐也。如人并无
外邪侵扰。亦无心事牵挂。而常彻夜不寐者。其神与精必两伤。大病将至。殊非永年之兆。
虽投补心补肾之药。取效甚难。即内经秫米半夏汤。亦有效有不效。或初效继不效。而病者
辗转床褥。必求其寐。愈不肯寐。更生烦恼。去寐益远。慈山先生老老恒言云。寐有操纵二
法。操者如贯想头顶。默数鼻息。返观丹田之类。使心有所着。乃不纷驰。庶可获寐。纵者
任其心游思于杳渺无朕之区。亦可渐入朦胧之境。此诚慧心妙悟。可补轩岐所不逮。
汪石山治疗一名女子。年龄十五岁。患心悸病。常常感觉好像有人追捕她。想要躲避却无处可逃。她的母亲将她抱在怀里。几名婢女在外面守护。仍然惊恐不安，无法入睡。医生认为这是心病。使用安神丸、镇心丸、四物汤（补血调血方剂）。没有效果。汪石山诊察后。脉象都细弱而缓。说。这是胆病。使用温胆汤（理气化痰、清胆和胃的方剂）。服用后便安宁了。
〔附〕许学士治疗四明人董生。躺下时魂魄飞扬。身体虽然在床上，但神魂离体。惊悸多梦魇。通宵不眠。众人都认为是心病。医治无效。许学士说。从脉象来看。是肝经受邪。游魂发生变化。不是心病。因为肝有邪气。魂不能回归肝脏。所以躺下时魂魄飞扬，好像离体一样。肝主怒。一定轻微发怒就会加重病情。使用真珠母作为君药。龙齿作为佐药。因为有关于龙齿安魂、虎睛定魄的说法。
俞震按语：这两条医案。都是凭借伴随症状。辨别为肝胆的疾病。像汪石山医案中脉象细弱而缓。为什么不认定为阳气两虚？许学士医案没有记载脉象。也难以核实辨别。然而肝胆引起的不寐容易治愈。而心脏引起的心神不宁难以痊愈。大概心藏神。肾藏精与志。睡眠虽然由心主导。但心依赖肾气的上交。精来合神。阴能包阳。水火既济。自然熟睡。《内经》说阳气满则阳跷脉盛。不能进入阴分。阴虚。所以眼睛睁着睡不着。又说。阴跷脉和阳跷脉。阴阳相交。阳入阴。阴出阳。交汇于目内眦。阳气盛则睁眼。阴气盛则闭眼睡觉。这是不寐的要旨。并不是肝胆疾病导致的不寐。如果人并没有外邪侵扰。也没有心事牵挂。却经常整夜不眠。他的神与精必定两伤。大病即将发生。绝不是长寿的征兆。即使投用补心补肾的药物。取得效果很难。即使是《内经》中的秫米半夏汤。也有有效和无效的。或者起初有效后来无效。而病人辗转反侧。一定要寻求睡眠。越不肯睡。更生烦恼。离睡眠越来越远。慈山先生在《老老恒言》中说。睡眠有操纵两种方法。操的方法如贯想头顶。默数鼻息。返观丹田之类。使心有所专注。就不纷乱奔驰。或许可以获得睡眠。纵的方法任其心游思于杳渺无朕的境界。也可以渐渐进入朦胧的状态。这确实是慧心妙悟。可以弥补黄帝岐伯所不及的地方。
Wang Shishan treated a young woman. She was fifteen years old. She suffered from palpitations (Xin Ji, heart palpitations). She often felt as if someone were chasing her. She wanted to hide but had nowhere to go. Her mother held her in her arms. Several maids guarded her outside. She remained fearful and uneasy, unable to fall asleep. The physicians believed it was a Heart disease (Xin Bing). They used Anshen Wan (Calming the Spirit Pill), Zhenxin Wan (Settling the Heart Pill), and Siwu Tang (Four Substance Decoction). There was no effect. Wang examined her pulse. All pulses were fine, weak, and slow. He said, "This is a Gallbladder disease (Dan Bing)." He prescribed Wendan Tang (Warm the Gallbladder Decoction). After taking it, she became calm.
[Appendix] Academician Xu treated Dong Sheng from Siming. When lying down, his Hun (Ethereal Soul) would fly about wildly. Although his body remained in bed, his spirit seemed to leave his body. He experienced fright, palpitations, and frequent nightmares. He did not sleep all night long. Everyone considered it a Heart disease. Medical treatment was ineffective. Academician Xu said, "Judging by the pulse, the Liver Meridian (Gan Jing) has been invaded by pathogenic factors, causing changes due to the wandering Hun. It is not a Heart disease. Because there is pathogenic influence in the Liver, the Hun cannot return to the Liver. Therefore, when lying down, the Hun flies about as if leaving the body. The Liver governs anger. Any slight anger will exacerbate the condition." He used Mother of Pearl (Zhenzhumu) as the sovereign drug, with Dragon Teeth (Longchi) as an assistant drug. This was based on the theory that Dragon Teeth calm the Hun and Tiger Eyes stabilize the Po (Corporeal Soul).
Commentary by Yu Zhen: These two cases were both identified as diseases of the Liver and Gallbladder based on accompanying symptoms. In Wang's case, with pulses that were fine, weak, and slow, why was Yang Qi deficiency (Yang Qi Liang Xu) not recognized? In Academician Xu's case, the pulse characteristics were not recorded, making verification difficult. However, insomnia (Bu Mei) caused by Liver and Gallbladder disorders is easy to treat, whereas insomnia caused by Heart disorders is difficult to cure. Generally, the Heart stores the Shen (Spirit). The Kidney stores Jing (Essence) and Zhi (Willpower). Sleep is governed by the Heart, but the Heart relies on the ascending connection of the Kidney. Jing combines with Shen. Yin envelops Yang. Water and Fire interact harmoniously (Shui Huo Ji Ji), leading naturally to deep sleep. The *Neijing* states that when Yang Qi is full, the Yang Qiao Mai (Yang Heel Vessel) becomes vigorous, preventing entry into Yin. Due to Yin deficiency, one cannot close the eyes to sleep. It also says: The Yin Qiao Mai and Yang Qiao Mai intersect; Yang enters Yin, Yin exits Yang. They meet at the inner canthus of the eye. When Yang Qi is abundant, the eyes open; when Yin Qi is abundant, the eyes close for sleep. This is the essence of insomnia, distinct from insomnia caused by Liver and Gallbladder disorders. If a person has no external pathogenic invasion and no mental burdens, yet suffers from chronic all-night insomnia, their Shen and Jing must be doubly injured. A major illness is imminent; this is not a sign of longevity. Even if tonifying Heart and Kidney medicines are administered, efficacy is hard to achieve. Even the Shumi Banxia Tang (Sorghum and Pinellia Decoction) from the *Neijing* may be effective or ineffective. It might work initially but fail later. The patient tosses and turns in bed, desperately seeking sleep. The more they strive for sleep, the less they can sleep, generating further distress. This drives them further away from sleep. Mr. Cishan, in his *Laolao Hengyan*, stated that there are two methods for manipulating sleep. The 'manipulating' method includes focusing thoughts on the crown of the head, silently counting breaths, or observing the Dantian. This gives the mind something to focus on, preventing chaotic wandering, thus facilitating sleep. The 'releasing' method involves allowing the mind to wander freely in the boundless and formless realm. One can gradually enter a drowsy state. This is indeed a wise insight and profound realization, capable of supplementing what Huangdi and Qibo could not fully address.