师曰。病有奔豚。有吐脓。有惊怖。有火邪。此四部病。皆从惊发得之。
奔豚具如下文。吐脓有咳与呕之别。其从惊得之旨未详。惊怖即惊恐。盖病从惊得。而惊气即为
病气也。火邪见后惊悸部。及伤寒太阳篇。云太阳病。以火熏之。不得汗。其人必躁。到经不解。必
圊血。名为火邪。然未尝云从惊发也。惊悸篇云。火邪者。桂枝去芍药加蜀漆牡蛎龙骨救逆汤主之。此
亦是因火邪而发惊。非因惊而发火邪也。即后奔豚证治三条。亦不必定从惊恐而得。盖是证有杂病伤
寒之异。从惊恐得者。杂病也。从发汗及烧针被寒者。伤寒也。其吐脓火邪二病。仲景必别有谓。姑
阙之以俟知者。或云。东方肝木。其病发惊骇。四部病皆以肝为主。奔豚惊怖。皆肝自病。奔豚因惊
而发病。惊怖即惊以为病也。吐脓者。肝移热于胃。胃受热而生痈脓也。火邪者。木中有火。因惊而
发。发则不特自燔。且及他脏也。亦通。
师曰。奔豚病从少腹上冲咽喉。发作欲死。复还止。皆从惊恐得之。
前云惊发。此兼言恐者。肾伤于恐。而奔豚为肾病也。豚、水畜也。肾、水脏也。肾气内动。上
冲胸喉。如豕之突。故名奔豚。亦有从肝病得者。以肾肝同处下焦。而其气并善上逆也。
奔豚。气上冲胸。腹痛。往来寒热。奔豚汤主之。
此奔豚气之发于肝邪者。往来寒热。肝脏有邪。而气通于少阳也。肝欲散。以姜、夏、生葛散之。
肝苦急。以甘草缓之。芎、归、芍药理其血。黄芩、李根下其气。桂、苓为奔豚主药。而不用者。病
不由肾发也。
奔豚汤方
甘草 芎 当归 黄芩 芍药（各二两） 半夏 生姜（各四两） 生葛（五两） 甘李根白皮（一升）
上九味。以水二斗。煮取五升。温服一升。日三夜一服。
发汗后。烧针令其汗。针处被寒。核起而赤者。必发奔豚。气从少腹上至心。灸其核上各一壮。
与桂枝加桂汤主之。
此肾气乘外寒而动。发为奔豚者。发汗后烧针复汗。阳气重伤。于是外寒从针孔而入通于肾。肾
气乘外寒而上冲于心。故须灸其核上。以杜再入之邪。而以桂枝汤外解寒邪。加桂内泄肾气也。
桂枝加桂汤方
桂枝（五两） 芍药 生姜（各三两） 甘草（二两炙） 大枣（十二枚）
上五味。以水七升。微火煮取三升。去滓。服一升。
发汗后。脐下悸者。欲作奔豚。茯苓桂枝甘草大枣汤主之。
此发汗后心气不足。而后肾气乘之。发为奔豚者。脐下先悸。此其兆也。桂枝能伐肾邪。茯苓能
泄水气。然欲治其水。必益其土。故又以甘草、大枣补其脾气。甘澜水者。扬之令轻。使不益肾邪也。
茯苓桂枝甘草大枣汤方
茯苓（半斤） 甘草（二两） 大枣（十五枚） 桂枝（四两）
上四味。以甘澜水一斗。先煮茯苓减二升。内诸药。煮取三升。去滓。温服一升。日三服。（甘
澜水法取水二斗置大盆内以杓扬之上有珠子五六千颗相逐取用之也）
老师说：疾病中有奔豚，有吐脓，有惊怖，有火邪。这四种病，都是从惊恐引发的。
奔豚的症状详见下文。吐脓有咳嗽和呕吐的区别，它从惊恐而发的机理尚不明确。惊怖就是惊恐。大概是因为疾病由惊恐引起，而惊恐之气本身就成为了致病之气。火邪见于后文的惊悸篇，以及《伤寒论》太阳篇中说：“太阳病，用火熏法治疗，未能出汗，病人必定烦躁。到了病程周期仍未解除，必然出现便血。这称为火邪。”然而这里并没有说它是从惊恐引发的。惊悸篇中说：“对于火邪证，用桂枝去芍药加蜀漆牡蛎龙骨救逆汤主治。”这也是因为火邪而引发惊恐，而不是因为惊恐而引发火邪。即后文关于奔豚证治的三条内容，也不必一定从惊恐而得。大概这种病症有杂病和伤寒的区别。从惊恐而得的，属于杂病；从发汗及烧针受寒而得的，属于伤寒。至于吐脓和火邪这两种病，张仲景必定另有深意，暂且保留疑问以等待懂的人来解答。有人说：东方属肝木，其病变表现为惊骇。这四种病都以肝为主。奔豚和惊怖，都是肝脏自身的病变。奔豚因惊恐而发病，惊怖即是因惊恐而成为疾病。吐脓，是肝将热邪转移给胃，胃受热而产生痈脓。火邪，是木中有火，因惊恐而发作，发作时不仅自身燃烧，还会波及他脏。这种说法也讲得通。
老师说：奔豚病是从少腹向上冲至咽喉，发作时感觉快要死了，随后又停止恢复。这都是从惊恐引起的。
前文说“惊发”，这里兼言“恐”。肾受到惊恐的伤害，而奔豚属于肾病。豚，是水生的动物。肾，是水脏。肾气在内扰动，向上冲击胸喉，像猪一样突进，所以名叫奔豚。也有从肝病而得的，因为肝肾同处下焦，而且它们的气都善于上逆。
这是奔豚气由肝邪引发的。忽冷忽热，说明肝脏有邪气，且气机通达于少阳。肝喜疏散，用生姜、半夏、生葛根来疏散它。肝苦急迫，用甘草来缓和它。川芎、当归、芍药调理其血液。黄芩、李根白皮降泄其气。桂枝、茯苓本是治疗奔豚的主药，但这里不用，是因为病不是由肾脏引发的。
奔豚汤方
甘草、川芎、当归、黄芩、芍药（各二两），半夏、生姜（各四两），生葛根（五两），甘李根白皮（一升）。
以上九味药，用水二斗，煮取五升。温服一升，每天三次，夜间一次。
发汗后，又用烧针令其出汗，针孔处受寒，红肿如核状，必然会引发奔豚。气从少腹上冲至心口。应在红肿处各灸一壮。并用桂枝加桂汤主治。
这是肾气乘外寒而动，引发奔豚的情况。发汗后又用烧针再次发汗，阳气严重受损，于是外寒从针孔进入并通达于肾。肾气乘外寒而上冲于心，所以需要灸红肿处以杜绝邪气再次侵入，并用桂枝汤在外部解散寒邪，加入桂枝在内部泄除肾气。
桂枝加桂汤方
桂枝（五两），芍药、生姜（各三两），甘草（二两，炙），大枣（十二枚）。
以上五味药，用水七升，用微火煮取三升，去渣。服一升。
发汗后，如果脐下跳动不安，这是将要发生奔豚的前兆，用茯苓桂枝甘草大枣汤主治。
这是发汗后心气不足，导致肾气乘虚而入，引发奔豚的情况。脐下先跳动，这是征兆。桂枝能伐除肾邪，茯苓能泄除水气。然而想要治疗水邪，必须补益脾土，所以又用甘草、大枣来补益脾气。甘澜水是取水放在大盆里，用勺子扬动，使水面出现许多小珠子互相追逐，然后取用，这样做的目的是不让水助长肾邪。
茯苓桂枝甘草大枣汤方
茯苓（半斤），甘草（二两），大枣（十五枚），桂枝（四两）。
以上四味药，用甘澜水一斗，先煮茯苓，减少二升水量，再加入其他药物，煮取三升，去渣。温服一升，每天三次。（甘澜水的制作方法：取二斗水放入大盆中，用勺子扬动，直到水面上出现五六千颗像珍珠一样的水泡互相追逐，即可取用。）
The Master said: There are conditions of Ben Tun (Rushing Pig), vomiting of pus, fright and terror, and fire pathogen. These four categories of diseases all originate from fright and alarm.
Ben Tun is described in the following text. Vomiting of pus differs in having either cough or vomiting; its origin from fright remains unclear. Fright and terror refer to frightfulness. Generally, when a disease arises from fright, the qi of fright itself becomes the pathogenic qi. Fire pathogen is discussed later in the section on palpitations and anxiety, and in the Taiyang Chapter of Shanghan Lun, which states: "In a Taiyang condition, if treated with moxibustion or heat application such that sweating does not occur, the patient will inevitably become restless. If the condition persists beyond the expected cycle, hematochezia (blood in stool) will definitely occur. This is named Fire Pathogen." However, it is not stated here that it originates from fright. The section on palpitations and anxiety states: "For Fire Pathogen conditions, Guizhi Qu Shaoyao Jia Shu Xi Mu Li Long Gu Jiuni Tang (Cinnamon Twig Decoction without Peony plus Chinese Dodder Herb, Oyster Shell, and Dragon Bone for Rescue against Adversity) should be administered." This indicates that fright was caused by the fire pathogen, rather than the fire pathogen being caused by fright. Similarly, the three subsequent clauses regarding the diagnosis and treatment of Ben Tun do not necessarily have to originate from fright and alarm. Generally, this condition has distinctions between miscellaneous diseases and cold damage. Those originating from fright and alarm belong to miscellaneous diseases; those originating from excessive sweating and cold exposure after burning needles belong to cold damage. As for vomiting of pus and fire pathogen, Zhang Zhongjing must have had specific meanings; we shall leave these questions open for future scholars to resolve. Some say: In the East, Liver Wood governs, and its pathological manifestation includes fright and shock. All four categories of diseases are primarily governed by the Liver. Ben Tun and fright/terror are both self-pathologies of the Liver. Ben Tun develops due to fright becoming the disease; fright/terror is simply fright manifesting as disease. Vomiting of pus results from Liver transferring heat to the Stomach; the Stomach,受热 (heated), generates carbuncles and pus. Fire pathogen implies fire within wood, triggered by fright; upon eruption, it not only burns itself but also affects other organs. This explanation is also plausible.
The Master said: Ben Tun disease involves qi rushing upward from the lower abdomen to the throat. During an attack, the patient feels as though death is imminent, after which it subsides and stops. All cases arise from fright and alarm.
The previous text mentioned "fright," while this one adds "alarm." Kidney injury from alarm leads to Ben Tun, which is a Kidney disease. Tun (pig) is an aquatic animal. Kidney is the Water organ. When Kidney Qi moves internally and rushes upward to the chest and throat, resembling the sudden charge of a pig, it is named Ben Tun. It can also originate from Liver pathology, as the Liver and Kidney reside together in the Lower Jiao, and their Qi both tend to rebel upward.
Ben Tun, characterized by Qi rushing upward to the chest, abdominal pain, and alternating chills and fever, is treated with Bentong Tang.
This type of Ben Tun Qi originates from Liver pathogen. Alternating chills and fever indicate Liver pathogen affecting the Shaoyang channel. The Liver desires dispersion; Ginger, Pinellia, and Pueraria are used to disperse it. The Liver suffers from tension; Licorice is used to relax it. Chuanxiong, Angelica Sinensis, and White Peony Root regulate the Blood. Scutellaria and Plum Root Bark descend the Qi. Cinnamon Twig and Poria are primary herbs for Ben Tun, but they are omitted here because the disease does not originate from the Kidney.
Bentong Tang Formula
Gancao (Licorice Root), Chuanxiong (Szechwan Lovage Rhizome), Danggui (Angelica Sinensis Root), Huangqin (Scutellaria Root), Shaoyao (White Peony Root) [each 2 liang]; Banxia (Pinellia Tuber), Shengjiang (Fresh Ginger) [each 4 liang]; Shengge (Pueraria Root) [5 liang]; Ganli Gen Bapi (Inner Bark of Sweet Plum Root) [1 sheng].
Nine ingredients. Boil in 2 dou of water until reduced to 5 sheng. Take 1 sheng warm, three times daily and once at night.
After sweating therapy, if burning needles were used to induce further sweating, and the needle sites became cold, presenting as red nodules, Ben Tun will definitely develop. Qi will rush from the lower abdomen to the heart. Apply moxibustion, one cone per nodule. Treat with Guizhi Jia Gui Tang.
This occurs when Kidney Qi moves due to external cold, triggering Ben Tun. After sweating, burning needles cause further sweating, severely damaging Yang Qi. External cold enters through the needle punctures and connects to the Kidney. Kidney Qi, aided by external cold, rushes upward to the Heart. Therefore, moxibustion is applied to the nodules to prevent further invasion, while Guizhi Tang resolves external cold, and added Cinnamon Twig drains Kidney Qi internally.
Guizhi Jia Gui Tang Formula
Guizhi (Cinnamon Twig) [5 liang]; Shaoyao (White Peony Root), Shengjiang (Fresh Ginger) [each 3 liang]; Gancao (Licorice Root, honey-fried) [2 liang]; Dazao (Jujube Fruit) [12 pieces].
Five ingredients. Boil in 7 sheng of water over low heat until reduced to 3 sheng. Strain. Take 1 sheng.
After sweating therapy, if there is palpitation below the umbilicus, indicating impending Ben Tun, treat with Fuling Guizhi Gancao Dazao Tang.
This occurs when Heart Qi is deficient after sweating, allowing Kidney Qi to invade and trigger Ben Tun. Palpitation below the umbilicus is the precursor sign. Cinnamon Twig can subdue Kidney pathogen; Poria can drain dampness/water. However, to treat water, Spleen Earth must be strengthened. Thus, Licorice and Jujube are used to tonify Spleen Qi. Ganlan Shui (Gently Rolling Water) is prepared by agitating water with a ladle to make it light, preventing it from aiding the Kidney pathogen.
Fuling Guizhi Gancao Dazao Tang Formula
Fuling (Poria) [8 liang]; Gancao (Licorice Root) [2 liang]; Dazao (Jujube Fruit) [15 pieces]; Guizhi (Cinnamon Twig) [4 liang].
Four ingredients. Boil in 1 dou of Ganlan Shui. First boil Poria until reduced by 2 sheng, then add remaining herbs. Boil until reduced to 3 sheng. Strain. Take 1 sheng warm, three times daily. (Method for Ganlan Shui: Place 2 dou of water in a large basin, agitate vigorously with a ladle until 5,000–6,000 pearl-like bubbles form and chase each other on the surface, then use.)