Startled and watchful · chu ti

Also rendered: Startled and watchful (This site) · Frightened and restless (Clinical) · Trembling fear (Loose)

Reviewed · 2026-10-31

At a glance

Pinyin: chù tì
Simplified: 怵惕
Literal: 怵 chù is the flinch — 《說文》 gives 恐, fear; 惕 tì is the wary, awake fear that keeps a man watchful, glossed in the same book as 敬, reverence. Together they name not panic but a frightened alertness: the patient starts at nothing, cannot settle, and cannot sleep. It is fear with the eyes open.
Shuowen: **《說文》：「怵，恐也。」「惕，敬也。」** 敬者警惕之意，故惕爲心動而不安。**六至十篇一見**，在第八篇行543，與「煩燥不得眠」連文。**與「懊憹」對舉**：怵惕因燒鍼，屬火逆；懊憹因誤下，屬客氣動隔。同一段而兩誤兩候，可觀誤治之跡。

In brief

A frightened, wakeful unrest: the patient flinches at nothing, is startled by what is not there, and cannot lie still or sleep. The chapter produces it by a particular error — a cautery needle applied to a yang brightness patient already dry and hot. Fire added to fire drives the heat inward and upward, and what follows is this startled watchfulness with restlessness and insomnia. It is set in the same paragraph beside 懊憹, which a mistaken purge produces: one comes of fire, the other of a usurping qi stirred up by purgation, and the pair shows how precisely the text reads the marks of a treatment gone wrong.

Senses in the classical corpus

燒鍼致怵惕必怵惕煩燥不得眠

陽明裏熱未除，加燒鍼則火熱相合，心神被擾，故怵惕不安、煩燥而不得眠

The heat within was never cleared; add a cautery needle and fire joins fire. The heart spirit is harassed, and the patient is startled, restless, dry-hot and unable to sleep.

若發汗，則燥，心憒憒，反讝語，若加燒鍼，必怵惕煩燥不得眠。 — 辨陽明病脉證并治第八

Occurrences in the classics

Passages where the term does real work, with the original, pinyin and English on the same line.

Display

1 passages

辨陽明病脉證并治第八·辨陽明病脉證并治第八 Read in context →

陽明病，脉浮而緊，咽燥口苦，腹滿而喘，發熱汗出，不惡寒，反惡熱，身重。若發汗，則燥，心憒憒，反讝語，若加燒鍼，必怵惕煩燥不得眠。若下之，則胃中空虚，客氣動隔，心中懊憹，舌上胎者，梔子豉湯主之。阳明病，脉浮而紧，咽燥口苦，腹满而喘，发热汗出，不恶寒，反恶热，身重。若发汗，则燥，心愦愦，反讝语，若加烧针，必怵惕烦燥不得眠。若下之，则胃中空虚，客气动隔，心中懊𢙐，舌上胎者，栀子豉汤主之。

yáng míng bìng mài fú ér jǐn yàn zào kǒu kǔ fù mǎn ér chuǎn fā rè hàn chū bù wù hán fǎn wù rè shēn zhòng ruò fā hàn zé zào xīn kuì kuì fǎn zhān yǔ ruò jiā shāo zhēn bì chù tì fán zào bù dé mián ruò xià zhī zé wèi zhōng kōng xū kè qì dòng gé xīn zhōng ào náo shé shàng tāi zhě zhī zǐ shì tāng zhǔ zhī

In yangming disease with a floating, tense pulse, dry throat, bitter mouth, full abdomen, panting, fever, sweat, no aversion to cold but aversion to heat, and a heavy body: sweating brings dryness and a confused heart with delirium; adding burning needles brings fearful restlessness, irritation, and sleeplessness. Purging empties the stomach, and guest qi stirs the diaphragm, with a troubled heart; if the tongue has a coating, Gardenia and Fermented Soy Decoction governs it.

燒鍼火逆，一針而怵惕煩燥不得眠；與誤下之懊憹並列，兩誤兩候，界然可分。

Compounds built on this term

怵惕

chù tì

startled and watchful

辨陽明病脉證并治第八

煩燥不得眠

fán zào bù dé mián

restless and unable to sleep

辨陽明病脉證并治第八

燒鍼

shāo zhēn

cautery needle

辨陽明病脉證并治第八

懊憹

ào náo

restless and annoyed

辨陽明病脉證并治第八

How it has been translated

Every rendering below is a decision about which reader is being addressed. There is no neutral option.

This site	startled and watchful	keeps both graphs and the sleeplessness
Literal	fear and reverence	exact etymology, wrong sense
Clinical	frightened, cannot settle	plain, loses 惕's alertness

Entry status

Review pending — who reviews this?

2026-10-31

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