大意
大率惊悸属痰与火。怔忡属血虚有火。（丹溪）
内因
人之所主者心。心之所养者血。心血一虚。神气失守。神去则舍空。舍空则郁而停痰。痰居心位。此惊悸之
所以肇端也。（汇补）
外候
惊悸者。忽然若有惊。惕惕然心中不宁。其动也有时。怔忡者。心中惕惕然。动摇不静。其作也无时。（正传）
肝胆心虚
或因怒伤肝。或因惊入胆。母令子虚。而心血为之不足。或富贵汲汲。贫贱戚戚。忧思过度。或遇事烦冗。则
心君亦为之不宁。皆致惊悸怔忡之症。其脉弦者是也。（汇补）
郁痰
或耳闻大声。目见异物。遇险临危。触事丧志。大惊大恐。心为之忤。以致心虚停痰。使人有惕惕之状。甚则
心跳欲厥。其脉滑者是也。（汇补）
停饮
有停饮水气乘心者。则胸中漉漉有声。虚气流动。水既上乘。心火恶之。故筑筑跳动。使人有怏怏之状。其
脉偏弦。（汇补）
气虚
有阳气内虚。心下空豁。状若惊悸。右脉大而无力者是也。（汇补）
血虚
有阴气内虚。虚火妄动。心悸体瘦。五心烦热。面赤唇燥。左脉微弱。或虚大无力者是也。（汇补）
痰结
有膏粱浓味。积成痰饮。口不作干。肌肤润泽如故。忽然惊惕而作悸。其脉弦滑有力者是也。（汇补）
气郁
有郁悒之人。气郁生涎。涎与气搏。心神不宁。脉必沉结或弦者是也。（汇补）
阴火
有阴火上冲。头晕眼花。耳鸣齿落。或腹中作声。怔忡不已者。宜滋阴抑火。加养心之剂。久服不愈。为无根
失守之火。脉必空豁。宜温补方愈。（汇补）
脉法
寸口脉动而弱。动为惊。弱为悸。惊者其脉止而复来。其人目睛不转。不能呼气。（必读）
治法
痰则豁痰定惊。饮则逐水蠲饮。血虚者。调养心血。气虚者。和平心气。痰结者。降下之。气郁者。舒畅之。阴火
上炎者。治其肾而心悸自已。若外物卒惊。宜行镇重。又惊者平之。所谓平者。平昔所见所闻。使之习熟。自
然不惊也。（汇补）
用药
主以安神丸。心虚甚者。加茯神、人参。神不宁者。加柏子、枣仁、远志。痰。加贝母、南星、半夏、石菖蒲。或
用吐法。
水饮。宜用小半夏茯苓汤。气虚。用参、 。血虚。用四物。肾虚。用地黄汤。阳虚。用八味丸。痰结。用温胆汤。
或滚痰丸。气郁。用四七汤
【附卑 】
有胸中痞塞。不欲饮食。心中常有所歉。爱居暗室。或倚门见人。即惊避无地。似失志状。此为卑 之病。由
心血不足者。人参养荣汤。脾胃不和者。六君子汤。加益智、远志治之。
【附失志】
有所求不遂。或过纵自悔。嘘嗟夜语。若有所失。宜温胆汤。加人参、柏子仁为丸。辰砂为衣。日进三次。
惊悸怔忡选方
朱砂安神丸 治心乱烦热。胸中气乱。兀兀欲吐。膈上伏热。
黄连（一两半） 朱砂（一两） 生地 归身（各一两） 炙甘草（五钱）
末之。汤浸蒸饼丸。如黍米大。每服十五丸。津咽下。
镇心丸 治心血不足。怔忡多梦。如堕崖谷。
枣仁（二钱半） 车前子 白茯苓 麦冬 五味 茯神
肉桂（各一两五钱） 熟地 龙齿 天冬 远志 山药（各一两五钱） 人参 朱砂（为衣各一两半）
蜜丸梧子大。每服三钱。空心米汤下。
定志丸
远志（一两） 菖蒲（二两） 茯神 茯苓（各三两） 人参（一两） 龙齿（一两）
蜜丸。辰砂为衣。米汤下三钱。
琥珀养心丹 治心跳善惊。
琥珀（二钱半） 龙齿（ 另研一两） 远志 石菖蒲 茯神 人参
枣仁（各五钱） 生地 归身（各七钱） 黄连（三钱） 柏子仁（五钱） 朱砂（三钱另研）
牛黄（一钱另研）
末之。猪心血为丸。如黍米大。金箔为衣。灯心汤下五钱。
归脾汤（方见中风） 四七汤（方见气症） 天王补心丹（方见中风）
温胆汤（千金）
半夏 枳实 竹茹 橘皮 甘草 白茯苓
每服一钱至四钱。加姜枣煎服。心虚。加人参、酸枣仁。心内烦热。加黄连、麦门冬。口燥舌干。去半
夏加麦门冬、五味子、天花粉。表热未消。加柴胡。内虚大便自利。去枳实、加白术。内热心烦。加栀子。
【大意】
大抵惊悸多由痰与火引起。怔忡多因血虚且有内火所致。（朱丹溪）
【内因】
人体由心所主宰，心所滋养的是血。心血一旦虚弱，神气就会失守。神气离去则心舍空虚，心舍空虚则气机郁滞而停聚成痰。痰邪居于心位，这就是惊悸产生的根源。（《证治汇补》）
【外候】
惊悸的表现是：忽然好像受到惊吓，心中惶恐不安，心悸发作有定时。怔忡的表现是：心中总是惶恐不安，跳动不止，心悸发作没有定时。（《医学正传》）
【肝胆心虚】
有的因为发怒损伤肝脏，有的因为受惊伤及胆腑，导致母脏（肝）令子脏（心）虚弱，从而使心血不足。或者因为富贵之人汲汲营求，贫贱之人忧愁悲伤，思虑过度；或者遇到事务繁杂冗乱，致使心神不宁。这些都会导致惊悸怔忡的症状，其脉象表现为弦脉。（《证治汇补》）
【郁痰】
有的因为耳闻大声，眼见异物，遭遇危险或面临危机，触事丧志，大惊大恐，使心气逆乱，从而导致心虚停痰，使人出现惶恐的样子，严重时心跳欲晕厥，其脉象表现为滑脉。（《证治汇补》）
【停饮】
有水饮停滞，水气上乘侵犯心脏的，则胸中漉漉有声，虚气流动。水既已上乘，心火厌恶它，所以心跳剧烈，使人感到郁郁不乐，其脉象偏于弦脉。（《证治汇补》）
【气虚】
有阳气内部虚弱，心下感觉空豁，症状类似惊悸，右脉大而无力的是这种情况。（《证治汇补》）
【血虚】
有阴气内部虚弱，虚火妄动，心悸身体消瘦，五心烦热，面红唇燥，左脉微弱，或虚大无力的，这是血虚的情况。（《证治汇补》）
【痰结】
有的因为食用膏粱厚味，积结成痰饮，口不干，肌肤润泽如常，忽然惊恐而引发心悸，其脉象弦滑有力的，这是痰结的情况。（《证治汇补》）
【气郁】
有的性格抑郁之人，气机郁滞生涎，涎与气相搏结，心神不宁，脉象必然沉结或弦。（《证治汇补》）
【阴火】
有的阴火上冲，头晕眼花，耳鸣牙齿松动脱落，或腹中作响，怔忡不已的，应当滋阴抑火，加入养心的药物。长期服用不愈的，属于无根失守之火，脉象必然空豁，应当用温补方剂才能痊愈。（《证治汇补》）
【脉法】
寸口脉搏动而弱，动脉主惊，弱脉主悸。受惊者的脉搏停止后又复来，其人目光呆滞不转，不能顺畅呼气。（《景岳全书·必读》）
【治法】
痰证则豁痰定惊，饮证则逐水蠲饮。血虚者，调养心血；气虚者，平和心气。痰结者，用降下法；气郁者，用舒畅法。阴火上炎者，治疗肾脏而心悸自止。若是外物突然惊吓，宜用镇重之法。所谓“平”，是指让患者对平日所见所闻的事物习以为熟，自然就不会惊恐了。（《证治汇补》）
【用药】
主方使用安神丸。心虚严重的，加茯神、人参。神志不宁的，加柏子仁、酸枣仁、远志。有痰的，加贝母、天南星、半夏、石菖蒲。或者使用吐法。
水饮证，宜用小半夏茯苓汤。气虚，用人参、[缺字，推测为黄芪或白术等补气药]。血虚，用四物汤。肾虚，用地黄汤。阳虚，用八味丸（金匮肾气丸）。痰结，用温胆汤，或者滚痰丸。气郁，用四七汤。
【附卑惵】
有的胸中痞塞，不想饮食，心中常常觉得歉疚不足，喜欢待在暗室，或者倚靠门口见人，就惊慌躲避无处容身，神情似丧失意志状。这是卑惵病。由心血不足引起的，用人参养荣汤；脾胃不和引起的，用六君子汤，加益智仁、远志治疗。
【附失志】
有所追求未遂，或者过分放纵后后悔，叹息夜间自语，若有所失，宜用温胆汤，加人参、柏子仁制成丸剂，辰砂为衣，每日进服三次。
惊悸怔忡选方
朱砂安神丸 治疗心乱烦热，胸中气机紊乱，恶心欲吐，膈上伏热。
黄连（一两半） 朱砂（一两） 生地 归身（各一两） 炙甘草（五钱）
研末，用水浸湿蒸饼做丸，如黍米大小。每服十五丸，津液送下。
镇心丸 治疗心血不足，怔忡多梦，感觉像从崖谷坠落一样恐惧。
枣仁（二钱半） 车前子 白茯苓 麦冬 五味子 茯神
肉桂（各一两五钱） 熟地 龙齿 天冬 远志 山药（各一两五钱） 人参 朱砂（为衣，各一两半）
蜜丸如梧桐子大。每服三钱，空腹米汤送下。
定志丸
远志（一两） 菖蒲（二两） 茯神 茯苓（各三两） 人参（一两） 龙齿（一两）
蜜丸，辰砂为衣，米汤送下三钱。
琥珀养心丹 治疗心跳善惊。
琥珀（二钱半） 龙齿（另研，一两） 远志 石菖蒲 茯神 人参
枣仁（各五钱） 生地 归身（各七钱） 黄连（三钱） 柏子仁（五钱） 朱砂（三钱，另研）
牛黄（一钱，另研）
研末，用猪心血做丸，如黍米大小，金箔为衣，灯心草汤送下五钱。
归脾汤（方见中风篇） 四七汤（方见气症篇） 天王补心丹（方见中风篇）
温胆汤（出自《千金方》）
半夏 枳实 竹茹 橘皮 甘草 白茯苓
每服一钱至四钱，加生姜、大枣煎服。心虚，加人参、酸枣仁。心内烦热，加黄连、麦门冬。口燥舌干，去半夏，加麦门冬、五味子、天花粉。表热未消，加柴胡。内虚大便自利，去枳实，加白术。内热心烦，加栀子。
**General Principles**
Generally, Jing Ji (Palpitations due to fright) is attributed to Phlegm and Fire. Zheng Chong (Constant palpitations) is attributed to Blood deficiency with internal Heat. (Zhu Danxi)
**Internal Causes**
The Heart governs the human body, and the Heart nourishes Blood. Once Heart Blood becomes deficient, Shen Qi (Spiritual Energy) loses its residence. When Shen Qi departs, the Heart mansion becomes empty; when empty, Qi stagnates and transforms into Phlegm. Phlegm residing in the position of the Heart is the origin of Jing Ji. (Zheng Zhi Hui Bu)
**External Manifestations**
Jing Ji manifests as a sudden sensation of being frightened, with a terrified and restless heart, where episodes occur at specific times. Zheng Chong manifests as a constant state of terror and restlessness within the heart, where episodes occur without specific timing. (Yi Xue Zheng Zhuan)
**Deficiency of Liver, Gallbladder, and Heart**
Some cases arise from anger injuring the Liver, or fright injuring the Gallbladder, causing the Mother organ (Liver) to weaken the Child organ (Heart), resulting in insufficient Heart Blood. Alternatively, excessive striving by the wealthy, or sorrow by the poor, overthinking, or dealing with complex affairs can disturb the Heart Sovereign, leading to Jing Ji and Zheng Chong symptoms, characterized by a Wiry pulse. (Zheng Zhi Hui Bu)
**Stagnant Phlegm**
Hearing loud noises, seeing strange objects, encountering danger or crisis, losing will upon certain events, or experiencing great fright and terror can cause Heart Qi to rebel, leading to Heart deficiency and Phlegm retention. This causes a terrified appearance, and in severe cases, palpitations leading to faintness, characterized by a Slippery pulse. (Zheng Zhi Hui Bu)
**Fluid Retention**
When retained fluids and Water Qi ascend to invade the Heart, there is a gurgling sound in the chest, and Qi moves vacuously. Since Water ascends, Heart Fire dislikes it, causing violent palpitations and a depressed mood, characterized by a predominantly Wiry pulse. (Zheng Zhi Hui Bu)
**Qi Deficiency**
Internal deficiency of Yang Qi leads to a hollow sensation below the Heart, resembling palpitations, characterized by a large but forceless Right pulse. (Zheng Zhi Hui Bu)
**Blood Deficiency**
Internal deficiency of Yin Qi leads to reckless movement of Deficient Fire, causing palpitations, emaciation, heat in the five centers (palms, soles, and chest), flushed face, and dry lips. The Left pulse is weak or vacuously large and forceless. (Zheng Zhi Hui Bu)
**Phlegm Knotting**
Consumption of rich and greasy foods accumulates into Phlegm and Fluids. The mouth is not dry, and skin remains moist. Sudden fright triggers palpitations, characterized by a Wiry, Slippery, and forceful pulse. (Zheng Zhi Hui Bu)
**Qi Stagnation**
In individuals with depressive temperaments, Qi stagnation generates Saliva. Saliva and Qi contend, disturbing the Heart Spirit. The pulse must be Deep and Knotted or Wiry. (Zheng Zhi Hui Bu)
**Yin Fire**
Rising Yin Fire causes dizziness, blurred vision, tinnitus, loose teeth, abdominal sounds, and incessant Zheng Chong. One should nourish Yin and suppress Fire, adding herbs that nourish the Heart. If long-term use fails, it indicates Rootless and Unanchored Fire, characterized by a Vacuously Hollow pulse, requiring Warm Tonification formulas for cure. (Zheng Zhi Hui Bu)
**Pulse Diagnosis**
At the Cun Kou (Radial artery), if the pulse is Agitated and Weak: Agitation indicates Fright, Weakness indicates Palpitations. In cases of Fright, the pulse stops and returns; the patient’s eyes do not move, and they cannot exhale smoothly. (Jing Yue Quan Shu - Bi Du)
**Treatment Methods**
For Phlegm, resolve Phlegm and calm fright. For Fluids, expel water and eliminate retention. For Blood deficiency, nourish and regulate Heart Blood. For Qi deficiency, harmonize Heart Qi. For Phlegm knotting, use descending methods. For Qi stagnation, use soothing methods. For rising Yin Fire, treat the Kidneys, and palpitations will cease spontaneously. If caused by sudden external fright, use heavy sedatives. The method of "Ping" (Calming) involves making the patient familiar with previously seen or heard stimuli so that they naturally no longer feel frightened. (Zheng Zhi Hui Bu)
**Medication**
The main formula is An Shen Wan. For severe Heart deficiency, add Fu Shen (Poria with Hostwood) and Ren Shen (Ginseng). For unsettled Spirit, add Bai Zi Ren (Biota Seed), Suan Zao Ren (Ziziphus Seed), and Yuan Zhi (Polygala Root). For Phlegm, add Bei Mu (Fritillaria Bulb), Nan Xing (Arisaema Rhizome), Ban Xia (Pinellia Tuber), and Shi Chang Pu (Acorus Rhizome). Alternatively, induce vomiting.
For Water-Fluid retention, use Xiao Ban Xia Fu Ling Tang (Minor Pinellia and Poria Decoction). For Qi deficiency, use Ren Shen (Ginseng) [and implied tonics]. For Blood deficiency, use Si Wu Tang (Four Substance Decoction). For Kidney deficiency, use Di Huang Tang (Rehmannia Decoction). For Yang deficiency, use Ba Wei Wan (Eight-Ingredient Pill). For Phlegm knotting, use Wen Dan Tang (Warm the Gallbladder Decoction) or Gun Tan Wan (Rolling Phlegm Pill). For Qi stagnation, use Si Qi Tang (Four-Seven Decoction).
**Appendix: Bei Die (Low Spirits/Depression)**
Symptoms include chest stuffiness, loss of appetite, a constant feeling of inadequacy in the heart, preference for dark rooms, or hiding when seeing people at the door, appearing lost in spirit. This is Bei Die disease. Caused by Heart Blood deficiency, treat with Ren Shen Yang Rong Tang (Ginseng and Longevity Decoction). Caused by Spleen-Stomach disharmony, treat with Liu Jun Zi Tang (Six Gentlemen Decoction), adding Yi Zhi Ren (Alpinia Fruit) and Yuan Zhi (Polygala Root).
**Appendix: Shi Zhi (Loss of Will)**
Caused by unfulfilled desires or regret over excessive indulgence, manifesting as sighing, night talking, and a sense of loss. Treat with Wen Dan Tang (Warm the Gallbladder Decoction), adding Ren Shen (Ginseng) and Bai Zi Ren (Biota Seed) to make pills, coated with Chen Sha (Cinnabar). Take three times daily.
**Selected Formulas for Jing Ji and Zheng Chong**
**Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill)**
Treats Heart chaos, irritability, chaotic Qi in the chest, nausea, and latent Heat above the diaphragm.
Huang Lian (Coptis Rhizome) (1.5 liang), Zhu Sha (Cinnabar) (1 liang), Sheng Di Huang (Rehmannia Root) (1 liang), Gui Shen (Angelica Sinensis Root) (1 liang), Zhi Gan Cao (Prepared Licorice Root) (0.5 liang).
Grind into powder, mix with steamed dough soaked in water, make pills the size of millet seeds. Take 15 pills per dose, swallowed with saliva.
**Zhen Xin Wan (Settling the Heart Pill)**
Treats Heart Blood deficiency, Zheng Chong, frequent dreams, and fear of falling from cliffs.
Suan Zao Ren (Ziziphus Seed) (2.5 qian), Che Qian Zi (Plantago Seed) (1.5 liang), Bai Fu Ling (Poria) (1.5 liang), Mai Dong (Ophiopogon Tuber) (1.5 liang), Wu Wei Zi (Schisandra Berry) (1.5 liang), Fu Shen (Poria with Hostwood) (1.5 liang), Rou Gui (Cinnamon Bark) (1.5 liang), Shu Di Huang (Prepared Rehmannia Root) (1.5 liang), Long Chi (Dragon Teeth/Fossilized Bones) (1.5 liang), Tian Dong (Asparagus Tuber) (1.5 liang), Yuan Zhi (Polygala Root) (1.5 liang), Shan Yao (Dioscorea Rhizome) (1.5 liang), Ren Shen (Ginseng) (1.5 liang), Zhu Sha (Cinnabar) for coating (1.5 liang).
Make honey pills the size of wutong seeds. Take 3 qian per dose on an empty stomach with rice soup.
**Ding Zhi Wan (Calming Will Pill)**
Yuan Zhi (Polygala Root) (1 liang), Chang Pu (Acorus Rhizome) (2 liang), Fu Shen (Poria with Hostwood) (3 liang), Fu Ling (Poria) (3 liang), Ren Shen (Ginseng) (1 liang), Long Chi (Dragon Teeth) (1 liang).
Make honey pills, coat with Chen Sha (Cinnabar). Take 3 qian with rice soup.
**Hu Po Yang Xin Dan (Amber Nourishing Heart Pill)**
Treats palpitations and susceptibility to fright.
Hu Po (Amber) (2.5 qian), Long Chi (Dragon Teeth) (separately ground, 1 liang), Yuan Zhi (Polygala Root) (5 qian), Shi Chang Pu (Acorus Rhizome) (5 qian), Fu Shen (Poria with Hostwood) (5 qian), Ren Shen (Ginseng) (5 qian), Suan Zao Ren (Ziziphus Seed) (5 qian), Sheng Di Huang (Rehmannia Root) (7 qian), Gui Shen (Angelica Sinensis Root) (7 qian), Huang Lian (Coptis Rhizome) (3 qian), Bai Zi Ren (Biota Seed) (5 qian), Zhu Sha (Cinnabar) (3 qian, separately ground), Niu Huang (Calculus Bovis/Bovine Calculus) (1 qian, separately ground).
Grind into powder, make pills with pig heart blood, size of millet seeds, coat with gold leaf. Take 5 qian with Deng Xin Cao (Juncus Decoction).
**Gui Pi Tang (Restore the Spleen Decoction)** (See Stroke section for formula)
**Si Qi Tang (Four-Seven Decoction)** (See Qi Disorders section for formula)
**Tian Wang Bu Xin Dan (Heavenly Emperor Heart-Nourishing Pill)** (See Stroke section for formula)
**Wen Dan Tang (Warm the Gallbladder Decoction)** (From Qian Jin Fang)
Ban Xia (Pinellia Tuber), Zhi Shi (Immature Bitter Orange), Zhu Ru (Bamboo Shavings), Ju Pi (Citrus Peel), Gan Cao (Licorice Root), Bai Fu Ling (Poria).
Take 1 to 4 qian per dose, decoct with Sheng Jiang (Fresh Ginger) and Da Zao (Jujube).
If Heart deficiency, add Ren Shen (Ginseng) and Suan Zao Ren (Ziziphus Seed).
If internal irritability and heat, add Huang Lian (Coptis Rhizome) and Mai Men Dong (Ophiopogon Tuber).
If dry mouth and tongue, remove Ban Xia, add Mai Men Dong (Ophiopogon Tuber), Wu Wei Zi (Schisandra Berry), and Tian Hua Fen (Trichosanthes Root).
If exterior heat persists, add Chai Hu (Bupleurum Root).
If internal deficiency with spontaneous diarrhea, remove Zhi Shi, add Bai Zhu (Atractylodes Macrocephala Rhizome).
If internal heat and irritability, add Zhi Zi (Gardenia Fruit).