师曰。（心者。君主之官也。神明出焉。心不可病。心）病（则非轻。）有（心病。
而肾之水气凌之。则为）奔 。有（心病。而胃之燥土。从少阴之火化。而生内痈。
则为）吐脓。有（心病。而肝之风木。乘少阴之热气而煽动。则为。）惊怖。有（心病。
而肾之阴水。不交于离火而既济。则为）火邪。此四部病。皆从惊发得之。（盖以惊则
伤心。凡心伤而致病者皆是。然心既伤矣。因惊而谓之惊。可也。非惊亦谓之惊。无不
可也。）
此一节、为奔 证之开端。类及吐脓等证。四部同出一源。概以惊字括之。盖言皆
心病也。师不明言心病。而言惊发者。原为中人以上告语。后之注家。或附会其说。或
阙疑以待。恐斯道日晦。吾不得不急起而明之。
师曰。（上既以奔 合四部。而指其所从得矣。今请专言奔 之病。）奔 病。（
有物浑沦。其象如 。）从（下焦）少腹起。上冲咽喉。（从肾）发作（上乘于心。而
）欲死。（作已则气衰。）复还（于肾而）止。皆从惊（伤心。）恐（伤肾以）得之。
（推之。凡有所伤于心者。皆可作惊观也。有所伤于肾者。皆可作恐观也。盖以
心肾之气。本自交通。一受伤则无复限制矣。）
此言病发于心肾。为奔 之本证也。
（然肾处于下焦。与肝相通。所谓乙癸同源是也。然肝肾之气。并善上逆。今请言
肝邪之发为）奔 （其木）气（之逆则）。上（而）冲胸。（木邪克土。其）腹（必）痛。
（肝脏有邪。其气通于少阳。则为）往来寒热。（以）奔 汤主之。
此言奔 之由肝邪而发者。当以奔 汤畅肝气而去客邪也。第此为客邪立法。若肝
脏本病发作。以
乌梅丸为神剂。此即金匮之正面处。寻出底面也。
奔 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。日二。夜一服。
（奔 证。有肾气乘外寒而冲心者。试约其证而出其方。）发汗后。烧针令其（再
）汗。针处被寒。（寒袭腠理。火郁脉中。以致）核起而赤者。必发奔 。气从少腹上
至心。灸其核上各一壮。与桂枝加桂汤主之。
此为既成奔 ，而出其正治之方也。
尤在泾云、此肾气乘外寒而动，发为奔 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。
（奔 证。有肾侮心虚而上逆者。试约其证而出其方。）发汗后脐下悸者。（以发
汗伤其心液。心气虚而肾气亦动。）欲作奔 。（以）茯苓桂枝甘草大枣汤主之。
此为欲作奔 。而出其正治之方也。
程氏曰、汗后脐下悸者。阳气虚而肾邪上逆也。脐下为肾气发源之地。茯苓泄水以
伐肾邪。桂枝行阳以散逆气。甘草大枣。助脾土以制肾水。煎用甘澜水者。扬之无力。
全无水性。取其不助肾邪也。
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。（作甘澜水法。取水二斗。置大盆内。以勺扬之。上有珠子五六千颗相逐。
取用之也。）
老师说：“心是君主之官，神明由此产生。心脏一般不易生病，一旦生病则病情不轻。如果心脏患病，而肾脏的水气上凌于心，就会形成奔豚；如果心脏患病，而胃的燥土从少阴之火化生，导致内痈，就会吐出脓血；如果心脏患病，而肝脏的风木之气，乘着少阴的热气煽动，就会产生惊恐不安；如果心脏患病，而肾脏的阴水不能与离火相交以达成既济，就会形成火邪。这四种病证，都是从受惊引发的。（大概因为惊吓会损伤心脏，凡是因心脏受损而导致的疾病，都可以归为此类。既然心脏已经受伤，因惊吓而得名‘惊’是可以的；即使不是因惊吓，称之为‘惊’也是没有不可以的。）”
这一段是奔豚证的开端，并连带提及吐脓等证候。这四部病证同出一源，概以“惊”字概括。意思是说这些都是心病。老师没有明言是心病，而说是由惊发引起的，原本是针对中等以上资质的人而言的。后世的注释家，有的附会这种说法，有的存疑以待，恐怕中医之道日益晦暗，我不得不急切起来阐明它。
老师说：“刚才已经将奔豚与其他三部病证合论，并指出了它们的起因。现在请专门论述奔豚病。”奔豚病，感觉有一团混沌之气，其形状像小猪一样。（从下焦）从小腹发起，向上冲至咽喉。（发作时上乘于心，使人感到）快要死了。（发作过后，气机衰退），又回归（于肾而）停止。这些症状都是由于受惊（伤心）、受恐（伤肾）而获得的。（推而言之，凡是有损伤心脏的因素，都可以看作惊；凡是有损伤肾脏的因素，都可以看作恐。因为心肾之气本自交通，一旦受伤就失去了限制。）
（然而肾脏位于下焦，与肝相通，所谓乙癸同源。肝肾之气，都善于上逆。现在请论述肝邪发作形成的）奔豚（其木）气（逆乱则）。上（而）冲胸。（木邪克土，其）腹（部必）痛。（肝脏有邪，其气通于少阳，就会出现）往来寒热。（用）奔豚汤主治。
这里说的是奔豚由肝邪发作引起，应当用奔豚汤疏畅肝气、祛除客邪。这只是为客邪设立的治疗法则。如果是肝脏本病发作，乌梅丸是神效之剂。这就是《金匮要略》正面阐述之处，探寻出其底面之意。
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（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，每日两次，夜间一次。
（奔豚证中，有肾气乘外寒而上冲心的情况，试概括其证候并给出方剂。）发汗后，用烧针令其（再次）出汗，针孔处被寒气侵袭。（寒邪袭击腠理，火郁脉中，以致）局部出现红肿硬结如核状者，必定引发奔豚。气从小腹上冲至心。在红肿硬结处各灸一壮，并用桂枝加桂汤主治。
这是针对已经形成的奔豚，给出的正治方剂。
尤在泾说：这是肾气乘外寒而动，引发奔豚的情况。发汗后烧针复汗，阳气受到严重伤害，于是外寒从针孔进入并通达于肾。肾气乘外寒而上冲于心，所以需要在红肿硬结处施灸，以杜绝邪气再次侵入，并用桂枝汤在外解散寒邪，加入桂枝在内泄导肾气。
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，微火煮取三升，去渣。服一升。
（奔豚证中，有肾水侮心虚而上逆的情况，试概括其证候并给出方剂。）发汗后脐下悸动者。（因为发汗损伤了心液，心气虚弱而肾气也随之妄动。）欲作奔豚。（用）茯苓桂枝甘草大枣汤主治。
这是针对将要发生的奔豚，给出的正治方剂。
程氏说：发汗后脐下悸动，是阳气虚弱而肾邪上逆。脐下是肾气发源之地。茯苓渗泄水湿以伐除肾邪，桂枝通行阳气以散逆气，甘草和大枣辅助脾土以制约肾水。煎药使用甘澜水的原因，是因为经过扬动后无力，全无水性，取其不助长肾邪。
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，每日三次。（制作甘澜水的方法：取水二斗，放入大盆内，用勺子反复扬动，直到水面出现五六千颗珠子般的水珠相互追逐，即可取用。）
The Master said: "The Heart is the sovereign official, from which Shen Ming (Spirit and Consciousness) emerges. The Heart generally does not easily become diseased; if it does, the condition is not minor. If the Heart is diseased, and the Water Qi of the Kidney overcomes it, Ben Tun (Rushing Pig syndrome) occurs. If the Heart is diseased, and the Dry Earth of the Stomach transforms according to the Fire of Shaoyin (Lesser Yang), generating an internal abscess, pus and blood are vomited. If the Heart is diseased, and the Wind-Wood of the Liver, riding on the heat of Shaoyin, flares up, fright and terror occur. If the Heart is diseased, and the Yin Water of the Kidney fails to interact with the Li Fire (Heart Fire) to achieve Ji Ji (Mutual Completion), Huo Xie (Fire Pathogen) forms. These four categories of disease all arise from fright. (Generally speaking, fright injures the Heart. All diseases caused by Heart injury can be viewed in this light. Since the Heart has been injured, naming it 'fright' due to fright is acceptable; even if not caused by fright, calling it 'fright' is also permissible.)"
This section serves as the introduction to Ben Tun syndrome, extending to symptoms such as vomiting pus. These four categories share a common source and are broadly summarized by the character 'Jing' (Fright). It implies that these are all Heart diseases. The Master did not explicitly state 'Heart disease,' but rather 'arising from fright,' originally addressing those of medium or higher capacity. Later commentators either forced interpretations upon this statement or left doubts unresolved, fearing that this Dao would become increasingly obscure. I must urgently rise to clarify it.
The Master said: "Having previously combined Ben Tun with the other three categories and pointed out their origin, now let us speak specifically of Ben Tun disease." In Ben Tun disease, there is a sensation of a chaotic mass, resembling a piglet. (It rises from the Lower Jiao) starting from the lower abdomen, rushing upward to the throat. (During an attack, it surges up to overwhelm the Heart, causing a feeling of) impending death. (After the attack subsides, the Qi weakens), and returns (to the Kidney and) stops. These conditions are all acquired through fright (injuring the Heart) and fear (injuring the Kidney). (By extension, anything that injures the Heart can be regarded as Fright; anything that injures the Kidney can be regarded as Fear. This is because the Qi of the Heart and Kidney naturally communicate; once injured, they lose their constraints.)
This describes the disease originating in the Heart and Kidney, which constitutes the fundamental syndrome of Ben Tun.
(However, the Kidney resides in the Lower Jiao and connects with the Liver, known as 'Yi Gui Tong Yuan' (Liver and Kidney sharing the same source). The Qi of the Liver and Kidney both tend to rebel upward. Now let us discuss Ben Tun caused by the rebellion of Liver Evil. When Wood Qi rebels, it rushes upward into the chest. (Wood evil overcoming Earth causes abdominal pain.) (When the Liver harbors evil, its Qi connects with Shaoyang, resulting in alternating chills and fever.) This is treated with Ben Tun Tang.
This explains that Ben Tun arising from Liver evil should be treated with Ben Tun Tang to soothe Liver Qi and expel pathogenic factors. This establishes a prescription for exogenous pathogens. If the disease originates from the Liver organ itself, Wu Mei Wan (Mume Pill) is the miraculous formula. This represents the direct teaching of the *Jin Gui Yao Lue*, revealing its underlying meaning.
**Ben Tun Tang Formula**
Gan Cao (Licorice Root), Chuan Xiong (Sichuan Lovage Rhizome), Dang Gui (Angelica Sinensis Root), Huang Qin (Scutellaria Root), Shao Yao (White Peony Root) (each 2 liang); Ban Xia (Pinellia Tuber), Sheng Jiang (Fresh Ginger) (each 4 liang); Sheng Ge (Kudzu Root) (5 liang); Gan Li Gen Bai Pi (Bark of Prunus Spinosa Root) (1 sheng).
These nine ingredients are boiled in 2 dou of water until 5 sheng remain. Take 1 sheng warm, twice daily and once at night.
(In cases of Ben Tun where Kidney Qi rides external cold to rush toward the Heart, let us summarize the syndrome and provide a formula.) After sweating therapy, if burning needles are used to induce further sweating, and the needle sites are invaded by cold, causing nodules to rise and turn red, Ben Tun will inevitably develop. Qi rushes from the lower abdomen to the heart. Moxibustion should be applied to each nodule (one moxa cone per site), and Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon) should be administered.
This provides the primary treatment formula for established Ben Tun.
You Zaijing stated: This refers to Ben Tun triggered by Kidney Qi riding external cold. Sweating followed by burning needle-induced sweating severely damages Yang Qi. Consequently, external cold enters through the needle puncture and reaches the Kidney. Kidney Qi, aided by external cold, rushes upward to overwhelm the Heart. Therefore, moxibustion is applied to the nodules to prevent further invasion of pathogens, while Gui Zhi Tang (Cinnamon Twig Decoction) resolves exterior cold, and adding Gui Zhi (Cinnamon Twig) drains rebellious Kidney Qi internally.
**Gui Zhi Jia Gui Tang Formula**
Gui Zhi (Cinnamon Twig) (5 liang); Shao Yao (White Peony Root), Sheng Jiang (Fresh Ginger) (each 3 liang); Gan Cao (Licorice Root, honey-fried) (2 liang); Da Zao (Jujube Fruit) (12 pieces).
These five ingredients are boiled in 7 sheng of water over low heat until 3 sheng remain. Strain and take 1 sheng.
(In cases of Ben Tun where Kidney Water insults Heart Deficiency and rebels upward, let us summarize the syndrome and provide a formula.) After sweating therapy, if palpitations occur below the umbilicus, (it is because sweating damaged Heart fluids, leading to Heart Qi deficiency and subsequent movement of Kidney Qi). This indicates impending Ben Tun. Treat with Fu Ling Gui Zhi Gan Cao Da Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction).
This provides the primary treatment formula for impending Ben Tun.
Master Cheng stated: Palpitations below the umbilicus after sweating indicate Yang Qi deficiency and rebellious Kidney evil. The area below the umbilicus is the source of Kidney Qi. Fu Ling (Poria) drains dampness to subdue Kidney evil; Gui Zhi (Cinnamon Twig) promotes Yang to disperse rebellious Qi; Gan Cao (Licorice) and Da Zao (Jujube) support Spleen Earth to control Kidney Water. The decoction uses Gan Lan Shui (Agitated Water) because agitation removes its heavy nature, leaving it devoid of standard water properties, thus preventing it from aiding Kidney evil.
**Fu Ling Gui Zhi Gan Cao Da Zao Tang Formula**
Fu Ling (Poria) (8 liang); Gan Cao (Licorice Root) (2 liang); Da Zao (Jujube Fruit) (15 pieces); Gui Zhi (Cinnamon Twig) (4 liang).
These four ingredients are boiled in 1 dou of Gan Lan Shui (Agitated Water). First boil Fu Ling until reduced by 2 sheng, then add the remaining herbs. Boil until 3 sheng remain. Strain and take 1 sheng warm, three times daily. (Method for preparing Gan Lan Shui: Take 2 dou of water, place in a large basin, and agitate repeatedly with a ladle until thousands of pearl-like bubbles form and chase each other on the surface. Use this water.)