心惊本是上症而余分上下者有故心与肾相通心气不下交于肾则能成惊而不寐肾气不能上
交于
心亦能不寐而成惊也故症须分别而治法亦宜各异也但二症何以别其在上在下乎大约心不交肾
者终日不寐而肾不交心者终夜难眠耳以此分别最得病情若人有心惊不寐于日者用止惊补心汤
一剂即寐二剂而心惊少安矣四剂全愈此方补心而
不补肾惟引其心肾之合而不必治肾经之虚也盖肾气原未常大虚补其心而肾不必上之于心则
肾气有养又何至心肾之不交哉心惊而夜不寐此肾水之竭急用定惊补肾汤此方妙在大补肾水而
不去
补心肾足原能上通于心也方中用肉桂黄连相济成功盖二物同用原能交心肾于顷刻况又有肾经
之味大壮其真水之气则水火既济亦何至惊悸而不寐哉
止惊补心汤
人参（五钱） 白术（五钱） 茯苓（五钱） 炒枣仁（五钱） 丹砂（二钱） 竹茹（一丸） 远志（一
钱） 甘草（一钱） 麦冬（五钱） 黄连（三分） 肉桂（三分） 半夏（八分） 北五味（一钱）水煎服
定惊补肾汤
熟地（一两） 山茱萸（五钱） 山药（五钱） 北五味（二钱） 牛膝（三钱） 葳蕤（五钱） 当归（
五钱）
丹皮（三钱） 沙参（一两） 薏仁（五钱） 芡实（五钱） 白芥子（三钱） 肉桂（一钱） 黄连（二分）
巴戟天（五钱） 白术（三钱）水煎服
心惊（因受惊而心神不宁）本属于上焦病症，但根据病情表现的不同，又分为上、下两种情况。这是因为心与肾在生理上相互通联：若心气不能下行交于肾，就会导致惊恐且失眠；若肾气不能上行交于心，也会导致失眠并引发惊恐。因此，这两种症状需要分别辨证，治疗方法也应当有所不同。
那么，如何区分病位是在上还是在下的呢？大致而言，心气不交于肾者，表现为整天无法入睡；而肾气不交于心者，表现为整夜难以安眠。以此作为鉴别标准，最能符合病情实际。
如果患者出现白天心惊不寐的症状，使用止惊补心汤，服用一剂即可入睡，两剂后心悸惊恐稍安，四剂即可痊愈。此方重在补心而非补肾，其妙处在于引导心肾相交，而不必专门治疗肾经的虚损。因为肾气原本并未严重亏虚，只要补益心气，使肾气自然上承于心，肾气得到滋养，又怎会出现心肾不交的情况呢？
如果是夜间心惊不寐，这是肾水枯竭所致，需急用定惊补肾汤。此方的精妙之处在于大补肾水而不直接补心，因为肾水充足自然能上通于心。方中配伍肉桂与黄连，二者同用能迅速交通心肾；再加上具有收敛固涩作用的五味子等药物，大力壮旺真阴之气，使得水火既济，又怎会出现惊悸和不寐呢？
止惊补心汤
人参（五钱） 白术（五钱） 茯苓（五钱） 炒枣仁（五钱） 丹砂（二钱） 竹茹（一丸） 远志（一钱） 甘草（一钱） 麦冬（五钱） 黄连（三分） 肉桂（三分） 半夏（八分） 北五味（一钱） 水煎服
定惊补肾汤
熟地（一两） 山茱萸（五钱） 山药（五钱） 北五味（二钱） 牛膝（三钱） 葳蕤（五钱） 当归（五钱） 丹皮（三钱） 沙参（一两） 薏仁（五钱） 芡实（五钱） 白芥子（三钱） 肉桂（一钱） 黄连（二分） 巴戟天（五钱） 白术（三钱） 水煎服
Palpitations due to fright (disquietude of the mind caused by sudden fright) originally belong to disorders of the Upper Jiao, but they are further differentiated into upper and lower patterns based on specific manifestations. This is because the Heart and Kidney are physiologically interconnected: if Heart Qi fails to descend and interact with the Kidney, it results in fright and insomnia; conversely, if Kidney Qi fails to ascend and interact with the Heart, it also leads to insomnia and the manifestation of fright. Therefore, these two presentations require distinct differentiation, and their therapeutic methods should differ accordingly.
How then can one distinguish whether the pathology lies in the upper or the lower? Generally speaking, when Heart Qi does not interact with the Kidney, the patient experiences inability to sleep throughout the day; whereas when Kidney Qi does not interact with the Heart, the patient suffers from difficulty sleeping throughout the night. Using this criterion for differentiation best aligns with the clinical reality.
If a patient presents with daytime palpitations and insomnia, Zhi Jing Bu Xin Tang (Calm Fright and Tonify Heart Decoction) should be administered. One dose allows for sleep, two doses alleviate the palpitations and fright slightly, and four doses result in complete recovery. This formula focuses on tonifying the Heart rather than the Kidney. Its efficacy lies in guiding the interaction between the Heart and Kidney, without the need to specifically treat deficiency in the Kidney Meridian. Since Kidney Qi is not severely deficient initially, by tonifying the Heart, Kidney Qi will naturally ascend to interact with the Heart. Once the Kidney Qi is nourished, how could Heart-Kidney non-interaction occur?
In cases of nighttime palpitations and insomnia, this indicates exhaustion of Kidney Water. Ding Jing Bu Shen Tang (Stabilize Fright and Tonify Kidney Decoction) should be used urgently. The brilliance of this formula lies in vigorously tonifying Kidney Water without directly tonifying the Heart, as sufficient Kidney Water naturally communicates upward to the Heart. The combination of Rou Gui (Cinnamon Bark) and Huang Lian (Coptis Rhizome) within the formula facilitates the rapid interaction between the Heart and Kidney. Furthermore, combined with herbs possessing astringent properties such as Bei Wu Wei (Schisandra Berry) to strongly strengthen the Qi of True Yin, Fire and Water achieve mutual balance (Water-Fire Mutual Interaction), thereby preventing palpitations and insomnia.
Zhi Jing Bu Xin Tang (Calm Fright and Tonify Heart Decoction)
Ren Shen (Ginseng Radix et Rhizoma) (5 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma) (5 qian)
Fu Ling (Poria) (5 qian)
Chao Zao Ren (Ziziphus Seed, Stir-fried) (5 qian)
Dan Sha (Cinnabar) (2 qian)
Zhu Ru (Bamboo Shavings) (1 pill)
Yuan Zhi (Polygalae Radix) (1 qian)
Gan Cao (Licorice Root) (1 qian)
Mai Dong (Ophiopogonis Tuber) (5 qian)
Huang Lian (Coptidis Rhizoma) (3 fen)
Rou Gui (Cinnamon Bark) (3 fen)
Ban Xia (Pinelliae Tuber) (8 fen)
Bei Wu Wei (Schisandrae Chinensis Fructus) (1 qian)
Decoct with water and take orally.
Ding Jing Bu Shen Tang (Stabilize Fright and Tonify Kidney Decoction)
Shu Di (Rehmanniae Radix Praeparata) (1 liang)
Shan Zhu Yu (Corni Fructus) (5 qian)
Shan Yao (Dioscoreae Rhizoma) (5 qian)
Bei Wu Wei (Schisandrae Chinensis Fructus) (2 qian)
Niu Xi (Achyranthis Bidentatae Radix) (3 qian)
Wei Rui (Polygonati Odorati Rhizoma) (5 qian)
Dang Gui (Angelicae Sinensis Radix) (5 qian)
Dan Pi (Moutan Cortex) (3 qian)
Sha Shen (Glehniae Radix or Adenophorae Radix) (1 liang)
Yi Yi Ren (Coicis Semen) (5 qian)
Qian Shi (Euryales Semen) (5 qian)
Bai Jie Zi (Sinapis Semen) (3 qian)
Rou Gui (Cinnamon Bark) (1 qian)
Huang Lian (Coptidis Rhizoma) (2 fen)
Ba Ji Tian (Morindae Officinalis Radix) (5 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma) (3 qian)
Decoct with water and take orally.