病颤振振，乃阴气争胜，颤则阳气不复。其势之来，上冲则鼓颔，四散则肢动。至于肉
筋惕，不过来势之轻者。治此病者，平补镇心而已。惟肝不藏魂，寤寐失常，胆又内怯，惊
悸时作，加以痰火串入，用法须兼备免厥塞拟方。侯石盘竹香先生均政。
龙齿 人参 归身 远志 茯神 橘红 枣仁（川连三分拌炒） 胆星 石决明 半夏（竹沥拌）
秫米 竹茹 钩藤
颤振不发于冬至，已责阳气不复。此在冬至以前发者，尤为阳气不复，不言而喻。至于
阴气争胜似未明言，而知阴气之得争以胜者为阳气不充未经来复之故。阴气何能争胜然，
阴之争胜固明，而其所争所胜之阴究系何物邪气？曰肝属阴，痰亦属阴，痰生于脾，脾经所
生之痰，内因肝经之阴火下动，动则生风，阴痰亦随之而逆，此颤振之所来也。岂独诸风掉
眩皆属于肝而已哉？惟本有惊悸，此因颤振而更剧，无怪乎有寤多寐少等症也。
人参 冬术 茯神 炙草 半夏 陈皮 大生地 麦冬 归身 白芍 枣仁 远志 秫米 石决明 竹茹 钩藤
先服磁朱丸三钱，陈皮汤下。
阴亏之体，肾家一水本来不胜两火。此《内经》仅道其常也。此间更有变者，烦劳之
下，火从内起；炎暑之时，火自外加，内外两邪合而为一。以肾水久虚者当之，则阳络受伤，
血从外溢，溢而未清，变为咳嗽。甚至有声有痰连连不已，饮食虽可，肌肉暗削。自秋徂冬，
正属金水相生之候。是以见症尚和，自觉相安于无事，而不知仲春水旺亦反侮金。金者肺
也，肺失清肃则音不扬，咽中痛，其喉为痹，以昭一阴一阳之火气内结，金受其累矣，渐成损
症也。然脉形细数，尚未见促，阴火虽旺，阴液未竭，缓以图之，日进滋补，俾得夏至阴生，可
卜其旋元吉。现下脉虚火甚，物虽下咽，最为吃紧之时。非清不可，非补亦不可，斟酌于二
者之间，惟有钱氏阿胶散法可以加减用之，以合式。拟候政。
阿胶 马兜铃 炙甘草 牛蒡子 花粉 猪肤 川贝 秋石 凤凰衣 麦冬 粳米 珠粉 大生地 杏仁
另用水泛六味丸（三钱） 清晨淡盐汤送下。
第二次诊治：
患者出现身体颤抖、震颤的症状，这是阴气与正气相争而占上风的表现，一旦发生颤抖，阳气便无法恢复。这种病势发作时，向上冲击会导致下巴打颤，向四周扩散则引起四肢抽动。至于肌肉跳动、筋脉惕动，不过是病势较轻的情况。治疗此类疾病，只需采用平补并镇心安神的方法即可。然而，患者肝不藏魂，导致睡眠规律失常；胆气又内里怯弱，时常出现惊恐心悸的症状，再加上痰火窜扰入内，用药时必须兼顾防止厥逆和闭塞。拟方如下，请侯石盘、竹香先生指正。
龙齿 人参 当归身 远志 茯神 橘红 酸枣仁（用黄连三分拌炒） 胆南星 石决明 半夏（用竹沥拌） 秫米 竹茹 钩藤
第三次诊治：
颤抖震颤并非在冬至日发作，这就已经责在于阳气不能恢复。如果在冬至以前就发作，更是阳气不复的明显表现，这不言而喻。至于阴气争胜这一点，虽然文中没有明确说明，但知道阴气之所以能争胜，是因为阳气不充盛且未能及时恢复的缘故。阴气怎么能争胜呢？阴气的争胜固然明显，但它所争、所胜的“阴”究竞是什么邪气？回答是：肝属阴，痰也属阴。痰生于脾，脾经所产生的痰，受到肝经阴火下行的扰动，一动则生风，阴痰也随之上逆，这就是颤抖震颤产生的原因。这难道仅仅是《内经》所说的“诸风掉眩，皆属于肝”而已吗？原本就有惊悸症状，因为颤抖震颤而更加剧烈，难怪会出现醒着多、睡着少等症状。
人参 白术（冬术） 茯神 炙甘草 半夏 陈皮 大生地 麦冬 当归身 白芍 酸枣仁 远志 秫米 石决明 竹茹 钩藤
第四部分论述：
阴液亏损的体质，肾中的一水本来就无法制约两火。这是《黄帝内经》只阐述了正常情况。这里还有变化：在烦劳之下，火从内生；在炎热暑天，火从外侵，内外两种邪气合而为一。以久虚的肾水来承受这种状况，就会导致阳络受伤，血液从体外溢出，溢出后未清理干净，转变为咳嗽。甚至出现有声有痰、连绵不断的情况，饮食虽然尚可，但肌肉暗中消瘦。从秋天到冬天，正值金水相生的时节。所以见到的症状还比较平和，自觉相安无事，却不知道到了仲春时节，当水气旺盛时，也会反过来侮害金气。金对应肺，肺失去清肃的功能，声音就不响亮，咽喉疼痛，喉部痹阻，这表明一阴一阳的火气在内结聚，金气受到了牵连，逐渐形成虚损病症。然而脉象细数，尚未见到促脉，阴火虽然旺盛，但阴液尚未枯竭，可以缓慢调理，每天进补滋养，等到夏至阴气生长之时，可以预测其将恢复健康大吉。目前脉象虚弱而火气很盛，药物虽然咽下，但正处于最为关键的时刻。不清热不行，不滋补也不行，必须在两者之间斟酌，只有钱乙的阿胶散方法可以加减使用，以符合病情。拟方如下，候请指正。
阿胶 马兜铃 炙甘草 牛蒡子 天花粉 猪肤 川贝母 秋石 凤凰衣 麦冬 粳米 珍珠粉 大生地 杏仁
另外用水泛法制作六味地黄丸（三钱），清晨用淡盐汤送服。
Second Visit:
The patient presents with tremors and shaking, which indicates that Yin pathogenic factors are contending and gaining the upper hand against the healthy Qi; once tremors occur, Yang Qi fails to recover. When this pathological momentum arises, upward rushing causes the jaw to quiver, while spreading outward leads to limb movements. As for muscle twitching and sinew palpitations, these represent only milder manifestations of the disease onset. To treat this condition, one should merely employ gentle tonification combined with calming the Heart and anchoring the Spirit (Zhen Xin An Shen). However, since the Liver fails to store the Hun (Ethereal Soul), sleep-wake cycles are disrupted; additionally, the Gallbladder is internally timid, causing frequent episodes of fright and palpitations. Complicated by Phlegm-Fire wandering inward, the prescription must simultaneously prevent Jue syndrome (reversal cold/heat) and obstruction. Submitted for the correction of Mr. Hou Shipan and Mr. Zhuxiang.
Longchi (Dragon Teeth), Renshen (Ginseng Root), Guishen (Angelica Sinensis Root Body), Yuanzhi (Polygala Root), Fushen (Poria with Hostwood), Juhong (Tangerine Peel), Zaoren (Semen Ziziphus Jujubae - stir-fried with 3 fen of Chuanlian/Coptis Rhizome), Danning (Arisaema cum Bile), Shijueming (Concha Haliotidis), Banxia (Pinellia Tuber - mixed with Zhuli/Bamboo Sap), Shumi (Sorghum Grain), Zhuru (Bamboo Shavings), Gouteng (Uncaria Ramulus cum Uncis).
Third Visit:
Tremors and shaking did not occur on the Winter Solstice, which already implicates the failure of Yang Qi to recover. If it occurs before the Winter Solstice, it is even more clearly a case of Yang Qi failing to recover, which goes without saying. Although "Yin contending and winning" is not explicitly stated, it is understood that Yin gains the upper hand because Yang Qi is insufficient and has failed to recover in time. How can Yin contend? While Yin's contention is evident, what exactly is the "Yin" that is being contested and conquered? The answer is: The Liver belongs to Yin, and Phlegm also belongs to Yin. Phlegm is generated by the Spleen; the Phlegm produced by the Spleen Meridian is stirred downward by Yin-Fire from the Liver Meridian. Once stirred, Wind is generated, and Yin-Phlegm rises counter-currently. This is the origin of tremors and shaking. Is this not merely what the *Neijing* states: "All wind disorders involving tremors and dizziness belong to the Liver"? Originally, there were symptoms of fright and palpitations, which have become more severe due to the tremors. No wonder there are symptoms such as excessive wakefulness and scanty sleep.
Renshen (Ginseng Root), Dongzhu (Atractylodes Macrocephala Rhizoma harvested in winter), Fushen (Poria with Hostwood), Zhigancao (Prepared Licorice Root), Banxia (Pinellia Tuber), Chenpi (Dried Tangerine Peel), Dashengdi (Rehmannia Glutinosa Root - large size), Maidong (Ophiopogon Tuber), Guishen (Angelica Sinensis Root Body), Baishao (White Peony Root), Zaoren (Semen Ziziphus Jujubae), Yuanzhi (Polygala Root), Shumi (Sorghum Grain), Shijueming (Concha Haliotidis), Zhuru (Bamboo Shavings), Gouteng (Uncaria Ramulus cum Uncis).
First, take Sanqian (Magnetic Cinnabar Pill) 3 qian, administered with Chenpi Decoction.
Fourth Section Discussion:
In constitutions with Yin deficiency, the single water of the Kidney originally cannot control the two Fires. This is what the *Neijing* describes as the normal state. Here, however, there are variations: under conditions of mental fatigue, Fire arises from within; during hot summer weather, Fire invades from without. These internal and external evil pathogens merge into one. When borne by long-standing Kidney Water deficiency, the Yang collaterals are injured, and blood overflows externally. If the overflow is not cleared, it transforms into cough. It may even progress to continuous coughing with sound and phlegm. Although diet remains acceptable, muscles secretly waste away. From autumn to winter, it is the season where Metal and Water generate each other. Thus, the visible symptoms appear relatively harmonious, and the patient feels at peace, unaware that in mid-spring, when Water Qi is prosperous, it may reverse-insult Metal. Metal corresponds to the Lung; when the Lung loses its clear and descending function, the voice becomes hoarse, the throat hurts, and the larynx becomes obstructed (Bi syndrome). This reveals that the Fire of One Yin and One Yang is knotted internally, affecting Metal, gradually forming a chronic wasting disease (Sun syndrome). However, the pulse is fine and rapid, but not surging (Cu). Although Yin-Fire is vigorous, Yin fluids are not yet exhausted. One can plan slowly, advancing nourishment daily, so that by the Summer Solstice, when Yin grows, recovery and auspiciousness can be predicted. Currently, the pulse is deficient and Fire is severe. Although medicine is swallowed, this is the most critical moment. Clearing heat is necessary, but tonification alone is also necessary; one must weigh between the two. Only the method of Qian Yi's Ejiao San (Donkey-Hide Gelatin Powder) can be modified and used to fit the pattern. Submitted for correction.
Ejiao (Donkey-Hide Gelatin), Madouling (Aristolochia Manshuriensis Fruit), Zhigancao (Prepared Licorice Root), Niubangzi (Arctii Fructus), Huafen (Trichosanthes Radix), Zhufu (Porcine Skin), Chuanbei (Fritillaria Cirrhosa Bulb), Qiushi (Urine Sediment), Fenghuangyi (Periostracum Bombyx Batryticatus), Maidong (Ophiopogon Tuber), Jingmi (Oryza Sativa Germen), Zhufen (Pearl Powder), Dashengdi (Rehmannia Glutinosa Root - large size), Xingren (Prunus Armeniaca Seed).
Additionally, prepare Liuwang Wan (Six-Ingredient Rehmannia Pill) using water-pellet method (3 qian), taken early in the morning with light salt water.