张三锡曰∶《内经》云∶心者君主之官，神明出焉。夫怔忡惊悸之病，或因怒气伤肝，或因惊入胆气，
母令子虚，因而心血为之不足；又或遇事烦冗，思想无穷。则心君亦为之不宁，故神不安，而怔忡惊悸之
所由生也。
夫所谓怔忡者，心神惕惕然，动摇而不得安静，无时而作者是也。惊悸者，蓦然跳动有欲厥之状，有
时而作者是也。然症之由，亦有停痰积饮，留结于心胸胃口而病者，又不可执以为心虚而治。健忘者，陡
然而忘其事也，为事有始无终，言谈不知首尾。此因遇事烦冗，思想无穷，精神斫丧之所致也。然过思伤脾，
亦能令人健忘。治之当兼理心脾，神宁志定，其证自除。大抵怔忡、惊悸、健忘三者，名虽不同，未有不由心
血不足，脾气虚弱，积饮停痰而成此症。其治惟在补养心血，调和脾气，宁神化痰，使神完气充，则无此
三者之患矣。
又有一种虚烦，心中扰乱，郁郁不宁，良由津液去多，五内枯燥；或营血不足，阳胜阴微；或肾水下
竭，心火上炎，故虚热而烦生焉，甚则至于躁也。
又有大病后，血气未复而烦者。陈氏曰∶内热曰烦，外热曰躁；心热则烦，肾热则躁。宜八珍汤加竹
叶、枣仁、麦冬，或四物加人参、茯神。
又有不寐一种，老年人及病后虚弱人，阳衰而不寐；有痰在胆经，神不归舍而不寐。虚者四君子加枣
仁、黄 、痰者温胆汤加天南星。亦有心血不足而然者，宜益营汤。
《原病式》曰∶因水衰火旺，其心胸躁动，谓之怔忡。然悸之为病，是心脏之气不得其正，
动而为火邪者也。盖心为君火，包络为相火，火之为阳，阳主动。君火之下，阴精承之；相火之下，水气
承之。夫如是而动，则得其正，而清净光明，为生之气也。若乏所乘，则君火过而不正，变而为烦热，相
火妄动，既热且动，岂不见心悸之证哉？况心者神明居之，经曰两精相搏，谓之神。又曰∶血气者，人之
神。则是阴阳气血在心脏，未始相离也。今失其阴，偏倾于阳，阳亦失其所承而散乱，故精神怔怔忡忡不能
自安矣。如是者，当自心脏中补其不足之心血，以安其神气。不已，则求其属以衰之，壮水之主以制阳光
也。又包络之火，非惟辅心，而且游行于五脏。故五脏之气妄动者，皆火也。是以各脏有痰，皆能于包络
之火合动而作悸。如是者，当自各脏补泻其火起之由，而后从包络调之平之，随其攸利而治。若各脏移热于
心，而致包络之火动者，治亦如之。若心气不足，肾水凌之，逆上而停心者，心折其逆气，泻其水，补
其阳。若左肾之真水不足，而右肾之火上逆，与包络合动者，必峻补左肾之阴以制之。若内外诸邪郁其二
火，不得发越，隔绝营卫，不得充养其正气者，则皆以治邪解郁为主，若痰饮停于中焦，碍其经络，不得舒
通，而郁火与痰相击于心下，以为怔忡者，必导去其痰，经脉行则病自已。
朱丹溪曰∶怔忡，大概属血虚与痰。有虑使动属虚。时作时止者，痰因火动，瘦人多是血虚。肥人多是
痰饮。食直觉心跳者是血少。多劳则心跳，属虚兼气。
东垣曰∶六脉大而空虚，病面赤心跳，乃火虚炎上也，补以降之，有不因惊而心动者，谓之 动，属
痰火。王宇泰曰∶一阴一阳，多对待而言。如喜怒并称者，喜出于心，为
阳；怒出于肝，为阴。志意并称者，志是静而不移，意是动而不定；静则阴也，动则阳也。惊恐并称者，
惊因触于外事，内动其心，心动则神摇；恐因惑于外事，内歉其志，志歉则精却。是故《内经》所谓∶惊则
心无所根据，神无所归，虑无所定，故气乱矣；恐则精却，却则上焦闭，闭则无气还，无气还则下焦胀，
故气不行矣。又谓尝贵后贱，尝富后贫，悲忧内结，至于脱营失精，病深无气，则洒然而惊。此类皆是
病从外事而动内之心神者也。
若夫在人身之阴阳盛衰而致惊恐者，惊是火热，躁动其心，心动则神乱，神用无方，故惊之。变态亦不一
状，与五神相应而动。肝藏魂，魂不安则为惊骇为惊妄；肺藏魄，魄不安则惊躁；脾藏意，意不专则为惊惑；
肾藏志，志不慊则为惊恐，心惕惕然；胃虽无神，然五脏之海，诸热归之，则发惊狂，若闻木音，亦惕惕然
心欲动也。惊则安其神而散乱之气可敛，恐则定其志而走失之精可固。
张三锡说：《内经》记载：心是君主之官，精神意识由此产生。所谓怔忡、惊悸这类疾病，有的因为怒气损伤肝脏，有的因为受惊导致胆气紊乱，母脏（肝）虚弱不能滋养子脏（心），从而导致心血不足；又或者是遇到繁杂事务，思虑无穷无尽。这样心君也会因此不安宁，所以神志不守舍，这就是怔忡、惊悸产生的原因。
所谓怔忡，是指心神惊恐不安，动摇而不能安静，没有特定时间发作的情况。惊悸，是指突然心跳剧烈，有快要昏厥的样子，有时发作的情况。然而病症的成因，也有因停痰积饮，留结在心胸胃口部位而致病者，又不能固执地认为是心虚来治疗。健忘，是指突然忘记事情，做事有始无终，说话不知首尾。这是因为遇到繁杂事务，思虑无穷，导致精神耗损所致。然而过度思虑会伤脾，也能让人健忘。治疗时应当兼顾调理心脾，使神志安宁、意志坚定，病症自然消除。大抵怔忡、惊悸、健忘这三种病，名称虽然不同，但没有不是由心血不足、脾气虚弱、积饮停痰而形成这些症状的。治疗关键在于补养心血，调和脾气，宁神化痰，使神气完备充盛，就没有这三种病的祸患了。
还有一种虚烦，心中扰乱，郁郁寡欢不得安宁，大多是因为津液流失过多，五脏内部枯燥；或者营血不足，阳气偏胜阴气微弱；或者肾水下竭，心火上炎，所以产生虚热而烦躁，严重时甚至出现躁动。
又有大病之后，气血尚未恢复而产生的烦躁。陈氏说：体内发热称为烦，体表发热称为躁；心热则烦，肾热则躁。适宜用八珍汤加竹叶、酸枣仁、麦冬，或者四物汤加人参、茯神。
还有不寐（失眠）这一种情况，老年人及大病后体虚的人，因阳气衰弱而不寐；有痰在胆经，神志不能回归本位而不寐。属虚的用四君子汤加酸枣仁、黄柏；属痰的用温胆汤加天南星。也有因心血不足而导致的，适宜用益营汤。
《原病式》说：因为水衰火旺，心胸躁动，称为怔忡。然而悸这种病，是心脏之气失去正常状态，变动而产生火邪的缘故。盖因心为君火，心包络为相火，火属于阳，阳主动。在君火之下，有阴精来承托；在相火之下，有水气来承托。像这样而动，就符合正道，呈现清净光明的状态，这是生发之气。如果缺乏所承托的力量，那么君火过盛而不正，变化为烦热，相火妄动，既热又动，难道看不出心悸的症状吗？况且心是神明居住的地方，《内经》说两精相搏，谓之神。又说：血气，就是人的神。那么阴阳气血在心脏中，从未分离过。现在失去了阴，偏倾于阳，阳也失去了承托而散乱，所以精神怔忡不安，不能自我安定。像这种情况，应当从心脏中补充不足的心血，以安顿神气。如果无效，则寻求其所属脏腑来衰退亢盛的阳气，即壮水之主以制阳光（补肾阴以制约心火）。另外包络之火，不仅辅助心脏，而且游行于五脏。所以五脏之气妄动的，都是火邪。因此各脏有痰，都能与包络之火合动而引发悸症。像这种情况，应当从各脏补泻引起火动的根源，然后从包络进行调理平复，根据其有利之处进行治疗。如果是各脏移热于心，导致包络之火动者，治疗也是如此。如果心气不足，肾水凌犯其上，逆上而停留于心者，需折服其逆气，泻其水邪，补其阳气。如果左肾真水不足，而右肾之火上逆，与包络合动者，必须峻补左肾之阴以制约它。如果内外各种邪气郁闭二火，不得发散，隔绝营卫，不能充养正气者，则以治邪解郁为主。若痰饮停于中焦，阻碍经络，不得舒通，而郁火与痰击撞于心下，形成怔忡者，必须导去其痰，经脉通畅则病自然痊愈。
朱丹溪说：怔忡，大概属于血虚和痰。因忧虑而动的属虚。时作时止的，是痰因火动，瘦人多是血虚，肥人多是痰饮。吃饭时直接感觉心跳的是血少。多劳累则心跳，属虚兼气虚。
李东垣说：六脉大而空虚，面色红赤心跳，这是火虚炎上，需补益以降火。有不因惊吓而心动者，称为悸动，属痰火。王宇泰说：一阴一阳，多是对待而言。如喜怒并称，喜出于心，为阳；怒出于肝，为阴。志意并称，志是静而不移，意是动而不定；静则阴，动则阳。惊恐并称，惊因触于外事，内动其心，心动则神摇；恐因惑于外事，内歉其志，志歉则精却。所以《内经》所说：惊则心无所根据，神无所归，虑无所定，所以气乱了；恐则精却，却则上焦闭塞，闭塞则无气归还，无气归还则下焦胀满，所以气不行。又说曾经尊贵后来卑贱，曾经富有后来贫穷，悲忧内结，至于脱营失精，病深无气，则洒然而惊。此类都是病从外事触动内心神明的情况。
如果在人身上的阴阳盛衰而导致惊恐的，惊是火热，躁动其心，心动则神乱，神用无方，所以惊。变态也不一状，与五神相应而动。肝藏魂，魂不安则为惊骇为惊妄；肺藏魄，魄不安则惊躁；脾藏意，意不专则为惊惑；肾藏志，志不慊则为惊恐，心惕惕然；胃虽无神，但为五脏之海，诸热归之，则发惊狂，若闻木音，亦惕惕然心欲动也。惊则安其神而散乱之气可敛，恐则定其志而走失之精可固。
Zhang Sanxi stated: The *Neijing* (Classic of Internal Medicine) records: "The Heart is the sovereign official, from which spirit and consciousness emerge." Diseases such as palpitations (Zhenchong, persistent palpitation) and fright palpitations (Jingji, sudden palpitation due to fright) may arise because anger injures the Liver, or because fright disrupts Gallbladder Qi. When the mother organ (Liver) is deficient and fails to nourish the son organ (Heart), Heart Blood becomes insufficient. Alternatively, encountering complex matters with endless thinking causes the Heart Sovereign to become unsettled, leading to restless spirit, which gives rise to Zhenchong and Jingji.
Zhenchong refers to a state where the heart spirit is terrified, trembling and unable to remain quiet, occurring at any time. Jingji refers to sudden violent heartbeat with a sensation of impending fainting, occurring intermittently. However, the etiology of these symptoms may also involve retained phlegm and accumulated fluid stagnating in the chest, diaphragm, stomach, and throat; thus, one must not rigidly treat them solely as Heart deficiency. Amnesia (Jianwang) refers to suddenly forgetting events, undertaking tasks without finishing them, and speaking without knowing beginning or end. This results from complex affairs and endless thinking, which deplete spirit and essence. However, excessive thinking injures the Spleen, which can also cause amnesia. Treatment should simultaneously regulate the Heart and Spleen; once the spirit is calm and will is settled, the symptoms will naturally resolve. Generally, Zhenchong, Jingji, and Jianwang, though named differently, all stem from insufficient Heart Blood, weak Spleen Qi, and accumulation of fluids and phlegm. Treatment focuses on nourishing Heart Blood, harmonizing Spleen Qi, calming the spirit, and resolving phlegm. When spirit and Qi are complete and abundant, these three ailments will be prevented.
There is also a type of deficiency-related vexation (Xufan), characterized by internal disturbance and depression. This is largely due to excessive loss of body fluids causing dryness in the five zang organs; or insufficient Ying (Nutritive) Blood with excess Yang and deficient Yin; or exhaustion of Kidney Water allowing Heart Fire to flare upward, generating deficiency heat and vexation, which may progress to restlessness (Zao).
Another type occurs after severe illness when Qi and Blood have not yet recovered. Chen stated: Internal heat is called vexation (Fan); external heat is called restlessness (Zao). Heart heat causes Fan; Kidney heat causes Zao. One should use Bazhen Tang (Eight Treasures Decoction) plus Zhuye (Bamboo Leaf), Zaoren (Sour Jujube Seed), and Maidong (Ophiopogon Root), or Siwu Tang (Four Substances Decoction) plus Renshen (Ginseng) and Fushen (Poria with Hostwood).
Regarding insomnia (Bumei), elderly individuals and those debilitated after illness suffer from insomnia due to declining Yang. Insomnia caused by phlegm in the Gallbladder channel, preventing the spirit from returning to its residence, is another type. For deficiency, use Sijunzi Tang (Four Gentlemen Decoction) plus Zaoren and Huangbo (Phellodendron Bark); for phlegm, use Wendan Tang (Warm the Gallbladder Decoction) plus Tiannanxing (Arisaema Rhizome). It may also result from insufficient Heart Blood, in which case Yying Tang (Nourish Ying Decoction) is suitable.
The *Yuanbing Shi* states: Due to water deficiency and fire prosperity, causing agitation in the chest and heart, it is called Zhenchong. Palpitation (Ji) arises when Heart Qi deviates from normality, transforming into fire pathogen. The Heart is Ministerial Fire (Junhuo), and the Pericardium is Assistant Fire (Xianghuo). Fire belongs to Yang, and Yang is active. Beneath Junhuo, Yin Essence supports it; beneath Xianghuo, Water Qi supports it. When moving under this support, it adheres to the correct way, presenting clarity and brightness, constituting the vital energy. If lacking support, Junhuo becomes excessive and abnormal, transforming into vexation and heat; Xianghuo moves recklessly, creating both heat and movement, manifesting as palpitations. Since the Heart houses spirit, the classics say: "When two essences interact, spirit is formed," and "Qi and Blood constitute human spirit." Thus, Yin-Yang and Qi-Blood in the Heart never separate. Now, losing Yin leads to bias toward Yang; Yang loses its support and scatters, causing spiritual instability and inability to self-regulate. In such cases, one must supplement the deficient Heart Blood within the Heart to calm the spirit. If ineffective, seek the related organ to reduce excess Yang, i.e., strengthen the source of Water to control Solar Fire (nourish Kidney Yin to restrain Heart Fire). Furthermore, Pericardium Fire not only assists the Heart but also circulates through the five zang organs. Therefore, reckless movement of Qi in any zang is due to fire. Phlegm in any zang can combine with Pericardium Fire to induce palpitation. Treatment requires addressing the root of fire in each zang via supplementation or purgation, then regulating the Pericardium according to favorable conditions. If heat from other zangs transfers to the Heart, activating Pericardium Fire, treatment follows similarly. If Heart Qi is deficient and Kidney Water invades upward, stopping in the Heart, one must curb the rebellious Qi, drain the water, and tonify Yang. If Left Kidney True Water is insufficient while Right Kidney Fire rebels upward, combining with Pericardium Fire, one must vigorously tonify Left Kidney Yin to restrain it. If various internal and external pathogens depress the two fires, preventing their release, isolating Ying and Wei, and failing to nourish righteous Qi, treatment primarily targets expelling pathogens and resolving depression. If phlegm-fluids stagnate in the Middle Jiao, obstructing meridians, and depressed fire clashes with phlegm below the heart causing Zhenchong, one must guide out the phlegm; once meridians flow freely, the disease resolves spontaneously.
Zhu Danxi stated: Zhenchong generally belongs to Blood deficiency and phlegm. Movement caused by worry indicates deficiency. Intermittent episodes suggest phlegm stirred by fire; thin individuals are mostly Blood deficient, while obese individuals are mostly affected by phlegm-fluids. Feeling heartbeat immediately after eating indicates low Blood. Heartbeat after overwork indicates deficiency combined with Qi deficiency.
Li Dongyuan stated: A large and empty pulse in all six positions, with a red face and heartbeat, indicates deficient fire flaring upward; tonification is needed to descend it. Heartbeat not caused by fright is called Ji Dong, belonging to phlegm-fire. Wang Yutai stated: Yin and Yang are often discussed in opposition. Joy and anger together: Joy originates from the Heart (Yang); anger from the Liver (Yin). Will (Zhi) and intention (Yi) together: Will is static and unchanging; Yi is dynamic and unstable. Static is Yin; dynamic is Yang. Fright (Jing) and fear (Kong) together: Fright arises from external stimuli agitating the Heart internally, causing spirit to waver; fear arises from confusion regarding external matters, causing the Will to feel inadequate, leading to essence retreat. Thus, the *Neijing* states: "Fright leaves the Heart without foundation, spirit without refuge, thoughts without direction, so Qi becomes chaotic." "Fear causes essence to retreat; retreat blocks the Upper Jiao; blockage prevents Qi return; lack of Qi return causes Lower Jiao distension, so Qi does not move." Also, "Once noble, now base; once rich, now poor; sorrow and grief knot internally, leading to depletion of Ying and loss of Jing, deep disease with no Qi, resulting in shivering fright." These are all cases where external events disturb internal spirit.
If fright and fear arise from Yin-Yang imbalance within the body, fright involves fire-heat agitating the Heart, disturbing spirit unpredictably, manifesting in various forms corresponding to the five spirits. The Liver stores Hun (Ethereal Soul); if Hun is unsettled, there is fright and delusion. The Lungs store Po (Corporeal Soul); if Po is unsettled, there is fearful restlessness. The Spleen stores Yi (Intellect); if Yi is unfocused, there is bewildered fright. The Kidneys store Zhi (Willpower); if Zhi is unsatisfied, there is fear and fright, with the Heart trembling. Although the Stomach has no specific spirit, it is the sea of the five zang organs; when various heats converge, it triggers fright mania. Hearing wooden sounds may also cause the Heart to tremble. Fright calms the spirit and gathers scattered Qi; fear stabilizes the will and secures escaping essence.