健忘之健,与健啖、健步之健同义,犹言善忘。或以为健者建也,如创建其事,随即遗忘也,谬矣。
病由心虚 多忘者,心虚也。心主血脉而藏于神,若风邪乘于血气,使阴阳不和,时相并隔,乍虚乍实,
血气相乱,致心神虚损而多忘。(《病源论》)
健忘之病,本于心虚,血气衰少,精神昏愦,故志动乱而多忘也。盖心者,君主之官,神明出焉。苟为怵惕
思虑所伤,或愁忧过损,惊惧失志,皆致是疾。故曰愁忧思虑则伤心,心伤则喜忘。(《圣济》)
病由心脾受伤 脾主意与思,意者记所往事,思则兼心之所为也。故论云∶言心未必是思,言思则必是
心。破外人议思心同时,理甚明也。今脾受病,则意舍不清,心神不宁,使人健忘,尽心力思量不来者是也。
或曰常常喜忘,故谓之健忘。二者通治。(《三因》)
夫健忘者,常常喜忘是也。盖脾主意与思,心亦主思。思虑过度,意舍不清,神官不职,使人健忘。治之之
法,当理心脾,使神意宁静,思则得之矣。(《济生》)
健忘者,陡然而忘其返也。虽曰此证皆由忧思过度,损其心胞,以致神舍不清,遇事多忘;然过思伤脾,
亦能令人健忘。治之须兼理心脾,神凝意定,其证自除。(《大成》)
健忘者,陡然而忘其事也。皆主于心脾二经,盖心之官则思,脾之官亦主思。此由思虑过多,伤于心,则
血耗散,神不守舍,伤于脾,则胃气衰惫而虑愈深,二者皆令人遇事则卒然而遂忘也。盖心主血,因血少不能养其
真藏,或停饮
而气郁以生痰,气既滞,脾不得舒,是病皆由此作,然治之之法,必须养其心血,理其脾土,凝神定志之剂以
调理之。亦当以幽闲之处,安乐之中,使其绝于忧虑,远其六淫七情,如此日渐安矣。(《奇效》)
病由心肾不交《内经》之原健忘,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,
精气伏而不用。火居上则因而为痰,水居下则因而生躁,扰扰纭纭,昏而不宁。故补肾而使之时上,养心而使
之善下,则神气清明,志意常治,而何健忘之有。(《必读》)
病由痰由热由怒由血气并 健忘,精神短少者多,亦有因痰者。(《丹溪》)
痰之健忘者,乃一时之病。然病忘之邪,非独痰也。凡是心有所寄,与诸火热伤乱其心者,皆得健忘。如
《灵枢》谓盛怒伤志,志伤善忘。《内经》谓血并于下,气并于上,乱而善忘。夫如是,岂可不各从所由而为
治耶。(《准绳》)
老少之别 少壮之人,营卫足而心肾充,多无是证;惟衰老之人,多见此候也。治疗是证,惟中衰者
可愈,老迈者难复。其有少壮之人,多昏睡健忘者,乃内有火痰之候。(《医级》)
治例 健忘属气血两虚,忌升、燥热,复忌苦寒、辛散,宜益脾阴兼补气、酸敛、甘温、甘寒、辛平
以通窍。(《本草经疏》)
心火不降,肾水不升,神志不定,事多健忘,宜朱雀丸。(《准绳》)
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。(《医
通》)
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。(同上)
补心诸方 孔子大圣智枕中方。
龟甲 龙骨 远志 菖蒲
上四味等分,治下筛,酒服方寸匕,日三,常服令人大聪。(《翼》云∶食后水服。)(《千金》)(按∶
此出好忘门。又《肘后》曰∶孔子大圣智枕中方,已出第九卷,姚同。然其方缺佚,无可考。)《圣惠》补心
虚健忘,助神。
治健忘方。
天门冬 远志 茯苓 干地黄(等分)
上四味末之,蜜丸,酒服二十丸,如梧子,日三服,加至三十丸,常服之勿绝。(《千金》)《圣惠》补
心虚,治健忘,茯神散,于本方加人参、龙骨、菖蒲,粗罗为散,入枣三枚,水煎。
治心气不定,惊悸多忘,养神丸方。
远志(去心) 麦门冬(去心焙) 菖蒲 熟干地黄(焙) 山芋 人参 茯神(去木各一两) 甘草
(炙半两) 白术(三分)
上九味捣罗为末,炼蜜和,再捣下三二百杵,丸如梧桐子大,每服三十丸,食后米饮下。(《圣济》)
归脾汤,治思虑过度,劳伤心脾,健忘怔忡。
白术 茯神(去木) 黄 (去芦) 龙眼肉 酸枣仁(炒去壳各一两) 人参 木香(不见火各半两)
甘草(炙二钱半)
上 咀,每服四钱,水一盏半,生姜五片,枣子一枚,煎至七分,去滓温服,不拘时候。(《济生》)
《内科摘要》治思虑伤脾,不能摄血,致血妄行,或健忘怔忡,惊悸盗汗,于本方加当归、远志。又加味归脾
汤,于前方加柴胡、山栀。
“健忘”的“健”,与“健啖”(食欲旺盛)、“健步”(步履矫健)中的“健”意思相同,都意为“善于”。有人误以为“健”通“建”,意思是像建立事物一样,随即就遗忘,这是错误的。
病由心虚引起:容易忘记事情的人,是因为心气虚弱。心主管血脉并藏神,如果风邪侵袭血气,导致阴阳不和,时而相互阻隔,忽虚忽实,血气紊乱,致使心神虚损而多忘。(《诸病源候论》)
健忘之病,根本在于心虚,血气衰少,精神昏沉混乱,所以意志动摇而多忘。大概心是君主之官,神明由此产生。如果被惊恐思虑所伤,或者忧愁过度损伤身体,惊惧导致志气丧失,都会导致这种疾病。所以说忧愁思虑会伤心,心受伤就会喜欢遗忘。(《圣济总录》)
病由心脾受伤引起:脾主管意念和思虑,“意”是指记忆过去的事情,“思”则是兼用心力的活动。所以论述说:说心不一定是在思虑,但说思虑则必定涉及心。这清楚地驳斥了外人认为思和心同时发生的议论。现在脾受病,则意舍不清,心神不宁,使人健忘,即尽心竭力也想不起来的情况。或者说常常喜欢遗忘,所以称为健忘。这两种情况可以通用治疗。(《三因极一病证方论》)
所谓健忘,就是常常容易遗忘。大概脾主管意念和思虑,心也主管思虑。思虑过度,意舍不清,神官失职,使人健忘。治疗的方法,应当调理心脾,使神意宁静,思虑得当即可。(《济生方》)
健忘,就是突然忘记原本要做的事或记得的事。虽然都说此证都是由忧思过度,损伤心包,以致神舍不清,遇事多忘;然而过度思虑伤脾,也能令人健忘。治疗必须兼顾调理心脾,神凝意定,病症自然消除。(《医学正传》)
健忘,就是突然忘记事情。此证主要归属于心和脾两经,大概心的功能主思,脾的功能也主思。这是由于思虑过多,伤及心,则血液耗散,神不守舍;伤及脾,则胃气衰败而思虑更深,两者都让人遇事突然遗忘。大概心主血,因为血少不能滋养真脏,或者停聚水饮导致气郁而生痰,气既阻滞,脾不得舒展,这些病都由此产生。然而治疗的方法,必须滋养心血,调理脾土,使用凝神定志的药物来调理。也应当在幽静闲适的地方,安乐的环境中,使其断绝忧虑,远离六淫七情,这样日渐就能安好。(《奇效良方》)
病由心肾不交引起:《黄帝内经》探究健忘的根源,都归责于心肾不交。心火不下交于肾,浊火扰乱神明;肾水不上交于心,精气潜伏而不发挥作用。火居上则因而生痰,水居下则因而生躁动,纷乱嘈杂,昏沉而不安宁。所以补肾使其时而上行,养心使其善于下行,则神气清明,志意常治,哪里还会有健忘呢?(《医宗必读》)
病由痰、热、怒、血气并引起:健忘,大多是因为精神短少,也有因痰引起的。(《丹溪心法》)
因痰导致的健忘,是一时的病症。然而导致遗忘的病邪,不仅仅是痰。凡是心中有所寄托,以及各种火热邪气扰乱心脏的,都能导致健忘。如《灵枢》所说盛怒伤志,志受伤则善忘。《内经》说血并于下,气并于上,混乱而善忘。像这样,怎么能不分别根据病因进行治疗呢?(《医学纲目》)
老年与少年的区别:年轻力壮的人,营卫充足且心肾充盈,大多没有这种证候;只有衰老的人,多见这种症状。治疗此证,只有中年衰退者可愈,年老迈者难恢复。那些年轻力壮的人,如果多昏睡且健忘,那是内有火痰的症状。(《医级》)
治疗原则:健忘属于气血两虚,忌用升提、燥热的药物,又忌用苦寒、辛散的药物,宜用益脾阴兼补气、酸敛、甘温、甘寒、辛平的药物以通窍。(《本草经疏》)
心火不降,肾水不升,神志不定,做事多健忘,宜用朱雀丸。(《医学纲目》)
心气不足,精神恍惚,睡眠少,夜间多盗汗,怔忡健忘,用辰砂妙香散。瘀积于内而善忘如狂,用代抵当丸。(《医宗金鉴》)
因病而导致的健忘,是精血亏少,或是痰饮瘀血所致,可以用药物治疗。如果是生平就健忘,那是心窍疏松的缘故,难道药物能治疗吗?所以凡是开凿混沌的方剂,全部予以淘汰。(同上)
补心各类方剂:孔子大圣智枕方。
龟甲 龙骨 远志 石菖蒲
以上四味药等分,研成细筛,用酒送服一方寸匕,每日三次,常服使人聪明。(《翼元》说:饭后用水送服。)(出自《千金方》)(按:此方出自好忘门。另外《肘后备急方》也说:孔子大圣智枕中方,已在第九卷出现,姚氏观点相同。然而该方缺失,无法考证。)《太平圣惠方》补心虚健忘,助神。
治疗健忘方。
天门冬 远志 茯苓 干地黄(等分)
以上四味药研末,蜜丸,酒送服二十丸,如梧桐子大,每日三次服用,加至三十丸,常服不停。(《千金方》)《太平圣惠方》补心虚,治健忘,茯神散,在本方基础上加人参、龙骨、石菖蒲,粗罗为散,入枣三枚,水煎。
治疗心气不定,惊悸多忘,养神丸方。
远志(去心) 麦门冬(去心焙) 石菖蒲 熟干地黄(焙) 山芋 人参 茯神(去木各一两) 甘草(炙半两) 白术(三分)
以上九味药捣罗为末,炼蜜调和,再捣三二百杵,丸如梧桐子大,每次服三十丸,饭后米饮送下。(《圣济总录》)
归脾汤,治疗思虑过度,劳伤心脾,健忘怔忡。
白术 茯神(去木) 黄芪(去芦) 龙眼肉 酸枣仁(炒去壳各一两) 人参 木香(不见火各半两) 甘草(炙二钱半)
以上药切碎,每服四钱,水一盏半,生姜五片,枣子一枚,煎至七分,去渣温服,不拘时候。(《济生方》)
《内科摘要》治疗思虑伤脾,不能摄血,致血妄行,或健忘怔忡,惊悸盗汗,在本方基础上加当归、远志。又加味归脾汤,在前方基础上加柴胡、山栀。
The "jian" (vigorous/active) in "Jianwang" (forgetfulness) has the same meaning as the "jian" in "Jiandan" (good appetite) and "Jianbu" (brisk walking), implying "being prone to" or "skilled at." Some mistakenly believe that "jian" is a homophone for "jian" (to establish/build), suggesting that one establishes something and then immediately forgets it; this is incorrect.
Etiology: Deficiency of the Heart
Those who are prone to forgetting are suffering from Heart deficiency. The Heart governs the blood vessels and houses the Shen (Spirit). If Wind pathogens invade the blood and Qi, causing Yin and Yang disharmony, where they occasionally block each other, fluctuating between deficiency and excess, and blood and Qi become chaotic, it leads to damage of the Heart Shen and frequent forgetting. (*Zhubing Yuanhou Lun*)
The disease of forgetfulness originates fundamentally from Heart deficiency, with decline in blood and Qi, leading to mental confusion and agitation of will, thus causing forgetfulness. The Heart is the official of the sovereign, from which the Shen emerges. If injured by fright and overthinking, or damaged by excessive sorrow and grief, or if fright causes loss of Zhi (Will), all these can lead to this disease. Thus it is said: sorrow and overthinking injure the Heart; when the Heart is injured, one becomes prone to forgetting. (*Shengji Zonglu*)
Etiology: Injury to the Heart and Spleen
The Spleen governs Yi (Intent) and Si (Deliberation). Yi refers to remembering past events, while Si involves the mental activity of the Heart. Therefore, discussions state: speaking of the Heart does not necessarily imply deliberation, but speaking of deliberation must involve the Heart. This clearly refutes the external argument that Yi and Si occur simultaneously. Now, if the Spleen is diseased, the residence of Yi becomes unclear, and the Heart Shen becomes restless, causing forgetfulness—specifically, the inability to recall despite utmost effort. Or, it is called "Jianwang" because one is constantly prone to forgetting. Both aspects can be treated together. (*Sanyin Fanglun*)
Forgetfulness is defined as being constantly prone to forgetting. The Spleen governs Yi and Si, and the Heart also governs Si. Excessive deliberation makes the residence of Yi unclear and the official of Shen fail in its duties, causing forgetfulness. The treatment method should regulate the Heart and Spleen, calming the Shen and Yi, so that proper thought yields results. (*Jisheng Fang*)
Forgetfulness is the sudden forgetting of things. Although it is said that this syndrome is caused by excessive worry and thinking, damaging the Pericardium, leading to an unclear residence of Shen and frequent forgetting upon encountering events; however, excessive thinking also damages the Spleen, which can cause forgetfulness. Treatment must address both the Heart and Spleen; with Shen condensed and Yi stabilized, the syndrome will naturally disappear. (*Yixue Zhengchuan*)
Forgetfulness is the sudden forgetting of matters. It primarily concerns the Heart and Spleen meridians. The function of the Heart is deliberation, and the function of the Spleen also governs deliberation. This arises from excessive thinking: injuring the Heart causes blood consumption and dispersion, with Shen not guarding its residence; injuring the Spleen causes Stomach Qi to decay and deepens deliberation. Both cause sudden forgetting upon encountering events. The Heart governs blood; due to blood deficiency, it cannot nourish the True Zang organs. Alternatively, retained fluids cause Qi stagnation and phlegm generation. Once Qi is stagnant, the Spleen cannot relax. These diseases arise from this. However, the treatment method must nourish Heart blood and regulate Spleen earth, using agents that condense Shen and stabilize Yi for regulation. One should also reside in quiet and leisurely places, amidst peace and joy, cutting off worries and distancing oneself from the Six Evils and Seven Emotions, so that gradually health will return. (*Qixiao Liangfang*)
Etiology: Failure of Communication between Heart and Kidney
The *Neijing* traces the origin of forgetfulness to the failure of communication between the Heart and Kidney. When Heart Fire does not descend to communicate with the Kidney, turbid fire disturbs the Shen; when Kidney Water does not ascend to communicate with the Heart, Essence and Qi remain latent and unused. Fire residing above generates phlegm; water residing below generates restlessness. In chaos and turmoil, one is confused and unrestful. Therefore, tonifying the Kidney to allow it to ascend timely, and nourishing the Heart to allow it to descend well, results in clear Shen Qi and stable Zhi Yi, eliminating forgetfulness. (*Yizong Bidu*)
Etiology: Phlegm, Heat, Anger, and Confluence of Blood and Qi
Forgetfulness is mostly due to insufficiency of Jing Shen (Spirit), but there are also cases caused by Phlegm. (*Danxi Xinfa*)
Forgetfulness caused by Phlegm is a temporary condition. However, the pathogen causing forgetfulness is not solely Phlegm. Any situation where the mind is attached to something, or various heat-fire pathogens disturb the Heart, can lead to forgetfulness. As stated in the *Lingshu*, excessive anger injures Zhi (Will); when Zhi is injured, one is prone to forgetting. The *Neijing* states that when Blood congregates below and Qi congregates above, chaos ensues and one is prone to forgetting. In such cases, how can one not treat according to the specific cause? (*Yixue Gangmu*)
Distinction between Young/Old and Old/Aged
Young and vigorous individuals have sufficient Ying and Wei (Defensive and Nutritive Qi) and full Heart and Kidney, so they rarely suffer from this syndrome; only aged individuals commonly show this manifestation. Treating this syndrome, only those in mid-life decline may recover, while the very old are difficult to restore. Those young and vigorous individuals who suffer from excessive drowsiness and forgetfulness have internal Fire-Phlegm syndromes. (*Yiji*)
Treatment Principles
Forgetfulness belongs to dual deficiency of Qi and Blood. Avoid ascending and drying-hot herbs; also avoid bitter-cold and acrid-dispersing herbs. It is suitable to use herbs that benefit Spleen Yin, supplement Qi, astringe sourly, are sweet-warm, sweet-cool, or acrid-neutral to open orifices. (*Bencao Jingshu*)
When Heart Fire does not descend and Kidney Water does not ascend, with unstable Shen Zhi and frequent forgetfulness in tasks, Zhuque Wan is indicated. (*Yixue Gangmu*)
For insufficient Heart Qi,恍惚 (spiritual trance), insomnia, night sweats, palpitations, and forgetfulness, Chen Sha Miaoxiang San is used. For internal stasis causing forgetfulness resembling madness, Daidi Dang Wan is used. (*Yizong Jinjian*)
Forgetfulness caused by illness, 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 looseness of the Heart orifice; can medicine cure this? Therefore, all formulas claiming to "open chaos" should be discarded. (Ibid.)
Formulas for Tonifying the Heart
Kongzi Dasheng Zhenzhong Fang (Confucius the Great Sage Pillow Formula):
Guijia (Testudinis Carapax et Plastrum), Longgu (Fossilia Ostreae), Yuanzhi (Polygalae Radix), Changpu (Acori Tatarinowii Rhizoma).
These four ingredients in equal parts are ground into powder and sieved. Take one cun bi (measure) with wine, three times daily. Regular use makes one intelligent. (*Yiyuan* says: take with water after meals.) (*Qianjin Fang*) (Note: This appears in the chapter on Forgetfulness. Also, *Zhouhou* states: Kongzi Dasheng Zhenzhong Fang appeared in Volume 9, agreeing with Yao. However, the formula is missing and unverifiable.) *Taiping Shenghui Fang* tonifies Heart deficiency and forgetfulness, aiding Shen.
Formula for treating forgetfulness:
Tianmendong (Asparagi Radix), Yuanzhi (Polygalae Radix), Fuling (Poria), Dihuang (Rehmanniae Radix) in equal parts.
These four ingredients are powdered, made into honey pills, taken with wine, twenty pills per dose (size of Sophora seeds), three times daily, increasing to thirty pills. Continue regular use without interruption. (*Qianjin Fang*) *Taiping Shenghui Fang* tonifies Heart deficiency, treats forgetfulness: Fushen San. Add Renshen (Ginseng Radix), Longgu (Fossilia Ostreae), Changpu (Acori Tatarinowii Rhizoma) to the base formula. Grind coarsely into powder, add three dates, decoct with water.
Formula for calming Shen, treating unstable Heart Qi, palpitations, and forgetfulness:
Yuanzhi (Polygalae Radix, remove heart), Maidong (Ophiopogonis Radix, remove heart and roast), Changpu (Acori Tatarinowii Rhizoma), Shudihuang (Prepared Rehmanniae Radix, roast), Shanyao (Dioscoreae Rhizoma), Renshen (Ginseng Radix), Fushen (Poria with Hostwood, remove wood, 1 liang each), Gancao (Licorice Root, roasted, 0.5 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 3 qian).
Nine ingredients are ground into powder, mixed with refined honey, pounded 200-300 times, formed into pills size of Sophora seeds. Take 30 pills per dose, with rice water after meals. (*Shengji Zonglu*)
Guipi Tang (Restore the Spleen Decoction), treats excessive thinking, exhausting Heart and Spleen, forgetfulness, and palpitations.
Baizhu (Atractylodis Macrocephalae Rhizoma), Fushen (Poria with Hostwood, remove wood), Huangqi (Astragali Radix, remove rhizome), Longyanrou (Longan Aril), Suanzaoren (Ziziphi Spinosae Semen, stir-fry and remove shell, 1 liang each), Renshen (Ginseng Radix), Muxiang (Aucklandiae Radix, do not expose to fire, 0.5 liang each), Gancao (Licorice Root, roasted, 2.5 qian).
Cut the herbs. Take 4 qian per dose, with 1.5 cups of water, 5 slices of fresh ginger, and one date. Decoct until 0.7 cup remains, strain, and take warm. No restriction on time. (*Jisheng Fang*)
*Neike Yaosuo* treats spleen injury from thinking, failing to control blood, causing erratic bleeding, or forgetfulness, palpitations, and night sweats. Add Danggui (Angelicae Sinensis Radix) and Yuanzhi (Polygalae Radix) to this formula. Additionally, Jiawei Guipi Tang (Modified Restore the Spleen Decoction) adds Chaihu (Bupleuri Radix) and Zhizi (Gardeniae Fructus) to the previous formula.