经曰。心怵惕思虑则伤神。神伤则恐惧自失。(神伤则心怯。火伤则畏水。)胆病者惊惕。
心下 。恐人将捕之。肝病者如人将捕之。肾病善怒。心惕惕如人将捕之。心胞络是动。心中
大动。精气并于肾则恐。胃为恐。(土邪伤水故也。)恐则精却。却则上焦闭。闭则气还。
还则下焦胀。故气不行矣。(恐则热伤其肾。故精虚志不足也。)
恐者。似惊悸而实非。忽然心中恐惧。如人将捕之状。属肾本脏。而傍及于他脏。治法则有
别焉。治肾伤者。宜补精髓。六味丸加枸杞、远志。治肝虚者。宜养阴血。六味丸加枣仁、龙齿。
治阳明者。壮其气。四君子加木香。治心包者。镇其神。远志丸加朱砂、琥珀、犀角。头眩而恐。
脉弦无力。属胆虚。六君子加柴胡、防风、当归。兼进加减八味丸。胆虚目暗。喉痛
数唾。眩冒五色所障。梦见争讼。恐惧面色变者。补胆防风汤。劳心思虑伤魂者。羸瘦善恐。梦
寐不宁。一味鹿角胶。酒溶多服效。肾脏阳虚善恐。八味丸。
经云。上气不足。下气有余。肠胃实而心肺虚。虚则营卫留于下。久之不以时上。故善忘也。
按内经之原健忘者。俱责之心肾不交。心不下交于肾。浊火乱其神明。肾不上交于心。精气
伏而不灵。火居上。则因而为痰。水居下。则因而生躁。躁扰不宁。是以健忘也。治法。心气不
足。妄有见闻。心悸跳动。恍惚不定。千金茯神汤。思虑过度。病在心脾者。归脾汤。挟虚痰者。
加姜汁、竹沥。精神短少。人参养荣汤送远志丸。痰迷心窍者。导痰汤加木香。上虚下热。天王
补心丹。心火不降。肾水不升。神明不定而健忘。六味丸加五味、远志。心气不定。恍惚多忘。
四君子去白术加菖蒲、远志、朱砂。等分。蜜丸服。心气不足。精神恍惚。少睡。夜多盗汗。怔
忡健忘。辰砂妙香散。瘀积于内而善忘如狂。代抵当丸。
石顽曰。因病而健忘者。精血亏少。或为痰饮瘀血所致。是可以药治之。若生平健忘。乃心
大窍疏之故。岂药石所能疗乎。故凡开凿混沌之方。悉行裁汰。
《黄帝内经》说:心中惊惧、思虑过度会损伤心神。心神受损就会出现恐惧、丧失自主控制能力的症状。(所谓神伤,就是心气怯弱;火邪受伤,就会畏惧水。)胆有病的人,容易受惊害怕,感到胃脘部不适,恐惧别人将要抓捕自己。肝有病的人,感觉像有人要抓捕自己。肾有病的人容易发怒,心中惕惕不安,感觉像有人要抓捕自己。手厥阴心包络发生病变时,心中剧烈跳动。精气并入肾脏就会导致恐惧。胃的功能失调也会产生恐惧(这是因为土邪损伤了肾水)。恐惧会导致肾精下陷退缩,精气退缩则上焦闭塞,上焦闭塞则气机返还,气机返还则下焦胀满,所以气机运行不畅了。(恐惧会热伤肾脏,导致肾精虚亏、意志不足。)
恐惧症,看起来像惊悸,但实际上并非惊悸。它是突然心中产生恐惧感,好像有人要抓捕自己一样的状态。这主要属于肾脏本脏的病变,但也会波及到其他脏腑,因此治疗方法各有不同。治疗肾损伤的,应当补益精髓,用六味丸加枸杞子、远志。治疗肝虚的,应当滋养阴血,用六味丸加酸枣仁、龙齿。治疗阳明胃经病变的,应当壮其正气,用四君子汤加木香。治疗心包络病变的,应当镇摄心神,用远志丸加朱砂、琥珀、犀角。如果伴有头晕目眩且恐惧,脉象弦而无力,属于胆虚,用六君子汤加柴胡、防风、当归,同时兼服加减八味丸。如果是胆虚导致视力昏暗、咽喉疼痛、频繁吐唾沫、眩晕冒昧、眼前出现五色遮蔽、梦见争讼诉讼、因恐惧而面色改变的情况,使用补胆防风汤。如果是劳伤心神、思虑过度损伤肝魂,导致身体消瘦、容易恐惧、睡眠中梦境不宁,单用鹿角胶一味药,用酒溶化后多服用,效果很好。如果是肾脏阳虚导致的容易恐惧,使用八味丸。
经文说:上部之气不足,下部之气有余,肠胃充实而心肺虚弱。虚弱则营卫之气滞留于下部,时间久了不能按时上行,所以容易健忘。按照《内经》的原意,健忘的原因,都归结于心肾不交。心气不下交于肾,浊火扰乱神明;肾气不上交于心,精气潜伏而不灵验。火居在上,因而生痰;水居在下,因而生躁。躁动扰攘不得安宁,这就是健忘的原因。治疗方法:心气不足,出现幻觉妄见,心悸跳动,恍惚不定,用千金茯神汤。思虑过度,病在心脾的,用归脾汤。兼有虚痰的,加入姜汁、竹沥。精神短少不足的,用人参养荣汤送服远志丸。痰迷心窍的,用导痰汤加木香。上虚下热的,用天王补心丹。心火不降,肾水不升,神明不定而健忘的,用六味丸加五味子、远志。心气不定,恍惚多忘的,用四君子汤去掉白术,加入石菖蒲、远志、朱砂,等分制成蜜丸服用。心气不足,精神恍惚,睡眠少,夜间多盗汗,怔忡健忘的,用辰砂妙香散。瘀血积滞于体内而导致容易遗忘甚至如狂乱的,用代抵当丸。
张璐(号石顽)说:因病而导致的健忘,是由于精血亏少,或者是痰饮、瘀血所致,这是可以用药物治疗的。如果是生平以来就健忘,那是心窍疏漏的缘故,难道药物所能治愈的吗?所以凡是那些强行开窍混沌的方剂,全部予以淘汰。
The *Classic of Medicine* (Huangdi Neijing) states: "If the heart is startled and anxious, or if there is excessive thinking and worrying, the Shen (Spirit) will be injured. When the Shen is injured, fear arises spontaneously, and self-control is lost." (When the Shen is injured, the Heart Qi becomes timid; when Fire is damaged, one fears water.) Diseases of the Gallbladder manifest as startling and apprehension, discomfort in the epigastrium, and a fear that others are about to arrest them. Diseases of the Liver present as a sensation that someone is about to arrest them. Diseases of the Kidney manifest as irritability and anger, with the Heart feeling restless and apprehensive, as if someone were about to arrest them. When the Pericardium Meridian (Shou Jue Yin Xin Bao Luo) is affected, there is severe palpitation within the Heart. When Essence (Jing) merges into the Kidney, fear results. Dysfunction of the Stomach also generates fear (this is because Earth pathogen damages Water). Fear causes Jing to retreat downward; when Jing retreats, the Upper Jiao becomes obstructed; when obstructed, Qi returns; when Qi returns, the Lower Jiao becomes distended. Thus, Qi movement ceases. (Fear causes heat to damage the Kidney, leading to deficiency of Jing and insufficiency of Zhi [Will].)
Fear differs from palpitations due to fright, though it resembles it. It is characterized by a sudden onset of fear within the Heart, resembling the state of being hunted. This primarily belongs to the pathology of the Kidney organ itself but can extend to other organs; therefore, treatment methods vary. For injury to the Kidney, it is appropriate to tonify Essence and Marrow using Liuwei Wan (Six-Ingredient Rehmannia Pill) added with Gouqi Zi (Lycium Fruit) and Yuanzhi (Polygala Root). For Liver deficiency, it is appropriate to nourish Yin and Blood using Liuwei Wan added with Zaoren (Sour Jujube Seed) and Longchi (Dragon Bone). For Yangming (Stomach) involvement, it is appropriate to strengthen Qi using Sijunzi Tang (Four Gentlemen Decoction) added with Muxiang (Aucklandia Root). For Pericardium involvement, it is appropriate to calm the Spirit using Yuanzhi Wan (Polygala Pill) added with Zhusha (Cinnabar), Hupo (Amber), and Xijiao (Rhinoceros Horn). If accompanied by dizziness and fear, with a wiry and forceless pulse, this belongs to Gallbladder deficiency; use Liujunzi Tang (Six Gentlemen Decoction) added with Chaihu (Bupleurum Root), Fangfeng (Saposhnikovia Root), and Danggui (Angelica Sinensis), taken concurrently with Jiajian Bawei Wan (Modified Eight-Ingredient Pill). For Gallbladder deficiency manifesting as dim vision, sore throat, frequent spitting, vertigo, visual obscurations of five colors, dreams of litigation, and facial color changes due to fear, use Budan Fangfeng Tang (Gallbladder-Tonifying Saposhnikovia Decoction). For those whose Hun (Ethereal Soul) is damaged by mental labor and excessive thinking, resulting in emaciation, easy fear, and restless sleep, taking single-ingredient Lujiaojiao (Deer Antler Glue) dissolved in wine and consumed in large amounts is effective. For Kidney Yang deficiency causing easy fear, use Bawei Wan (Eight-Ingredient Rehmannia Pill).
The Canon states: "Upper Qi is insufficient, while Lower Qi is excessive; the Intestines and Stomach are full, while the Heart and Lungs are deficient. Due to deficiency, Ying (Nutritive) and Wei (Defensive) Qi remain in the lower part, and over time fail to ascend when they should. Therefore, one suffers from forgetfulness." According to the original meaning of the *Neijing*, the root of forgetfulness lies in the failure of communication between the Heart and Kidney. When Heart Qi fails to descend to the Kidney, turbid Fire disturbs the Shen (Spirit); when Kidney Qi fails to ascend to the Heart, Jing (Essence) remains latent and unresponsive. Fire residing above generates Phlegm; Water residing below generates restlessness. This agitation prevents tranquility, resulting in forgetfulness. Treatment methods: For Heart Qi deficiency manifesting as hallucinations, palpitations, and mental instability, use Qianjin Fushen Tang (Thousand-Gold Poria Spirit Decoction). For excessive thinking damaging the Heart and Spleen, use Guipi Tang (Restore the Spleen Decoction). For cases complicated by deficiency-phlegm, add Jiangzhi (Ginger Juice) and Zhuli (Bamboo Juice). For insufficiency of Spirit and Qi, administer Renshen Yangrong Tang (Ginseng Nourishing Harmony Decoction) to deliver Yuanzhi Wan. For Phlegm confusing the Heart Orifice, use Daotan Tang (Resolve Phlegm Decoction) added with Muxiang. For upper deficiency and lower heat, use Tianwang Buxin Dan (Heavenly Emperor Heart-Nourishing Pill). For Heart Fire failing to descend and Kidney Water failing to ascend, leading to unstable Shen and forgetfulness, use Liuwei Wan added with Wuweizi (Schisandra Berry) and Yuanzhi. For unstable Heart Qi manifesting as恍惚 (mental confusion) and frequent forgetting, use Sijunzi Tang removing Baizhu (Atractylodes Macrocephala Rhizome), adding Shichangpu (Acorus Tatarinowii Rhizome), Yuanzhi, and Zhusha, processed into honey pills for equal parts. For Heart Qi deficiency manifesting as mental confusion, insomnia, night sweats, palpitations, and forgetfulness, use Chensha Miaoxiang San (Cinnabar Wonderful Fragrance Powder). For internal blood stasis causing forgetfulness resembling mania, use Daididang Wan (Substitute Collateral-Attacking Pill).
Zhang Lu (styled Shiwen) stated: Forgetfulness caused by disease, resulting from deficiency of Essence and Blood, or due to Phlegm-Fluids and Blood Stasis, can be treated with medicine. However, lifelong forgetfulness is due to the laxity of the Heart's orifices; how could medicinal therapy cure this? Therefore, all formulas intended to forcibly open the chaotic mind should be discarded.