郁者，滞而不通之义。百病皆生于郁，人若气血流通，病安从作？一有拂郁，
当升不升，当降不降，当化不化，或郁于气，或郁于血，病斯作矣。凡脉见沉、伏、
结、促、弦、涩，气色青滞，意思不舒，胸胁胀痛，呕吐酸苦者是也。治法，《经》
言∶木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之。解者以吐训达，以汗
训发，以下训夺，以解表、利小便训泄，以制其冲逆训折，大概如此，不必泥定。
何则？木郁者，肝气不舒也。达取通畅之义，但可以致其通畅，不特升提以上达之。
发汗以外达之，甚而泻夺以下达之，无非达也，安在其泥于吐哉？余仿此。（尝见有病
热发汗不出者，以承气汤下之，里气一通，余邪自化汗以出，岂非火郁以夺为发之义哉？）丹溪分六郁，气、
血、湿、火、食、痰也。故制越鞠丸，以香附理气，抚芎行血，苍术开湿，栀子治
火，神曲消食，痰郁加贝母。而大要以理气为主，盖气滞则血亦滞，而饮食不行，
痰湿停积，郁而成火。气行则数者皆行，故所重在气，不易之理也。赵献可则以加
味逍遥为主，（逍遥之归、芍即越鞠之川芎，逍遥之白术即越鞠之苍术，逍遥之陈皮即越鞠之神曲，逍遥之柴胡
即越鞠之香附，逍遥之加味即越鞠之栀子也。）谓肝胆少阳木气，象草穿地而出，此时被寒风一
郁，即萎软遏抑而不能上伸。惟温风一吹即畅达，盖木喜风，风摇即舒畅，寒风则
畏，温风则喜。柴胡、薄荷辛而温者，辛故能发散，温故入少阳。其郁甚而热者加
左金丸，（见发热。）热非寒品不除，故用黄连治火，实则泻其子也。郁非辛热不开，吴
萸辛热且气臊，肝之气亦臊，同气相求，故用为反佐，引以入肝。服后木郁已舒，
继用六味地黄汤（见虚损）加柴胡、芍药以滋肾水。逍遥，风以散之也；六味，雨以润之
也。木有不得其天者乎？按赵氏此论甚精，但谓此方可以通治诸郁，则主张太过，
举一废百，乌乎可也？六淫七情，皆足以致郁。如外伤于风寒湿三气，皆足以闭遏
阳气，郁而成热固也。暑热燥三气，亦足令气郁。《准绳》谓∶燥金收涩，收涩则伤
其分布之政，不惟生气不得升，即收气亦不得降。（不升属肝郁，不降属肺郁。）
《经》曰∶逆
秋气则太阴不收，肺气焦满。又谓∶诸气怫郁，皆属于肺。是燥气之致郁也。
又燥为火化，《易》曰∶燥万物者，莫 于火。是燥之致郁，无非火热之气所为
也。至于七情，除喜则气舒畅外，其忧思悲怒，皆能令气郁结。而痰食之遏闭，水
湿之停阻，又可知矣。《准绳》谓郁多在中焦，盖不论何脏腑郁结，皆关中土也。
又谓用药兼升降，盖欲升必先降之而后得升也；欲降之，必先升之而后得降也。
越HT 之苍术，足阳明药也，气味雄壮辛烈，开发水谷气，上升之力多；香附阴血中
快气药也，下气之功多。一升一降，互用也。按上升下降，则中焦之郁开矣。气郁，
胸胁痛，脉沉而涩，宜香附、苍术、抚芎。湿郁，周身走痛，或关节痛，遇阴寒则
发，其脉沉细，宜苍术、川芎、白芷、茯苓。热郁，目瞀，小便赤，其脉沉数；宜
山栀、青黛、香附、苍术、抚芎。痰郁，动则喘，寸口脉沉滑，宜海石、香附、南
星、栝蒌仁。血郁，四肢无力，能食便红，其脉芤涩，宜桃仁、红花、青黛、川芎、
香附。食郁，嗳酸，腹满不能食，右寸脉紧盛，宜香附、苍术、山楂、神曲、针砂。
上诸郁药，春加防风，夏加苦参，秋冬加吴茱萸。苍术、抚芎，总治诸郁。
按百病皆生于郁，与凡病皆属火，及风为百病之长，三句总只一理。盖郁未有
不为火者也，火未有不由郁者也，（浓酒浓味，房劳损阴，以致火炎，似无关于郁，
然亦必由不能运散乃然耳。）而郁而不舒则皆肝木之病矣。故曰知其要者，一言而终。
郁，是指气机阻滞而不通畅的含义。各种疾病都产生于郁滞，如果人体气血流通顺畅，疾病又从何发生呢？一旦有拂逆郁结，该升的不能升，该降的不能降，该转化的不能转化，或者郁结在气分，或者郁结在血分，疾病就产生了。凡是脉象出现沉、伏、结、促、弦、涩，面色青暗滞涩，神情抑郁不舒，胸胁胀痛，呕吐酸苦水气的，就是这种情况。治疗方法，《黄帝内经》说：木郁应当疏达，火郁应当发散，土郁应当攻夺，金郁应当宣泄，水郁应当制约。解释者把“吐法”训释为“达”，把“汗法”训释为“发”，把“下法”训释为“夺”，把“解表、利小便”训释为“泄”，把“制约冲逆之气”训释为“折”，大体上就是这样，不必拘泥死板。为什么呢？木郁，就是肝气不舒展。达取通畅的意思，只要能使气机通畅即可，不仅仅是指升提以上行通达。通过发汗使之外达，甚至通过泻下使之下达，无非都是“达”的作用，怎么能拘泥于用吐法呢？其余类推。（我曾经见到患热病发不出汗的人，用承气汤（Chengqi Decoction）攻下，里气一通，余邪自然化汗而出，这难道不是火郁用攻夺法作为发散的意义吗？）朱丹溪将郁分为六种：气、血、湿、火、食、痰。因此他制作了越鞠丸（Yueju Wan），用香附调理气机，抚芎（川芎）行血，苍术燥湿，栀子清火，神曲消食，痰郁加贝母。其大要以调理气机为主，因为气滞则血也滞，饮食不运化，痰湿停积，郁而化火。气行则这些病理产物都能随之运行，所以重在治气，这是不可改变的道理。赵献可则以加味逍遥散（Jiawei Xiaoyao San）为主方。（逍遥散中的当归、白芍即相当于越鞠丸中的川芎，逍遥散中的白术即相当于越鞠丸中的苍术，逍遥散中的陈皮即相当于越鞠丸中的神曲，逍遥散中的柴胡即相当于越鞠丸中的香附，逍遥散的加味即相当于越鞠丸中的栀子。）他认为肝胆少阳木气，像草穿地而出，此时被寒风一郁结，就会萎软遏抑而不能向上伸展。只有温风一吹就能舒畅通达，因为木喜风，风摇动就舒畅，畏寒风，喜温风。柴胡、薄荷性辛温，辛故能发散，温故入少阳经。郁结严重而有热象的加左金丸（Zuojin Pill）。（见发热条）热非寒凉药不能清除，所以用黄连治疗火邪，实际上是泻其子脏（心）。郁结非辛热药不能开通，吴茱萸辛热且气味臊，肝脏之气亦臊，同气相求，所以用作反佐，引导药物入肝。服用后木郁已舒，继用六味地黄汤（Liujun Dihuang Decoction）加柴胡、白芍以滋补肾水。逍遥散，是用风来疏散它；六味地黄汤，是用雨来滋润它。木还有不得其天性吗？按赵氏的这个论述非常精妙，但说这个方子可以通治各种郁证，则主张太过，举一废百，怎么可以呢？六淫（风、寒、暑、湿、燥、火六种外感病邪）七情（喜、怒、忧、思、悲、恐、惊七种情志变化），都足以导致郁证。如外伤于风寒湿三气，都足以闭遏阳气，郁而化热，这是肯定的。暑热燥三气，也足以令气机郁结。《医宗必读》说：燥金收涩，收涩则损伤其分布政令，不仅生气不能上升，就连收气也不能下降。（不升属于肝郁，不降属于肺郁。）《黄帝内经》说：违背秋气则太阴不收，肺气焦满。又说：诸气怫郁，皆属于肺。这是燥气导致的郁证。另外燥由火化，《易经》说：燥万物者，莫熯乎火。这是燥致郁，无非是火热之气所为。至于七情，除了喜则气机舒畅外，忧思悲怒，都能令气机郁结。而痰食之闭塞，水湿之停阻，也就可想而知了。《医宗必读》说郁多在中焦，大概不论哪个脏腑郁结，都关乎中土脾胃。又说用药兼用升降，想要升必先降之后才能升；想要降必先升之后才能降。越鞠丸中的苍术，是足阳明胃经的药，气味雄壮辛烈，开发水谷之气，上升的力量多；香附是阴血中的快气药，下气的作用多。一升一降，互相配合。按上升下降，则中焦的郁结就打开了。气郁，表现为胸胁痛，脉沉而涩，宜用香附、苍术、抚芎。湿郁，表现为周身游走疼痛，或关节痛，遇阴寒则发作，其脉沉细，宜用苍术、川芎、白芷、茯苓。热郁，表现为目视模糊，小便赤黄，其脉沉数；宜用山栀、青黛、香附、苍术、抚芎。痰郁，表现为动则气喘，寸口脉沉滑，宜用海浮石、香附、南星、栝蒌仁。血郁，表现为四肢无力，能进食但大便出血，其脉芤涩，宜用桃仁、红花、青黛、川芎、香附。食郁，表现为嗳气酸腐，腹部胀满不能进食，右寸脉紧盛，宜用香附、苍术、山楂、神曲、针砂。上述治疗各郁证的药物，春季加防风，夏季加苦参，秋冬季节加吴茱萸。苍术、抚芎，总治各种郁证。
按：百病皆生于郁，与凡病皆属火，以及风为百病之长，这三句话总的道理只有一条。因为郁结没有不化为火的，火邪没有不由郁结产生的，（浓酒厚味，房劳损阴，以致火炎上，似乎与郁无关，但也必然是由于不能运散才这样的），而郁结不舒则都是肝木的病证。所以说知道要领的人，一句话就能终结（掌握全部道理）。
Yu (Stagnation) refers to the meaning of obstruction and lack of free flow. All diseases arise from Yu; if Qi and Blood flow smoothly, how could disease arise? Once there is frustration and stagnation, what should ascend does not ascend, what should descend does not descend, what should transform does not transform; whether it stagnates in Qi or in Blood, disease then arises. Whenever the pulse presents as Chen (Deep), Fu (Hidden), Jie (Intermittent), Cu (Rapid with irregularity), Xian (Wiry), or Se (Choppy); the complexion is cyanotic and stagnant; the mental state is depressed and uncomfortable; there is distending pain in the chest and hypochondrium; vomiting of sour and bitter fluids occurs—this is Yu syndrome. Regarding treatment methods, the *Classic* states: For Wood Yu, achieve Da (free flow); for Fire Yu, achieve Fa (dispersal); for Earth Yu, achieve Duo (purging/draining); for Metal Yu, achieve Xie (draining/venting); for Water Yu, achieve Zhe (restraining). Interpreters explain "Da" as emesis, "Fa" as sweating, "Duo" as purgation, "Xie" as releasing the exterior and promoting urination, and "Zhe" as restraining rebellious Qi. This is roughly the case, but one need not adhere rigidly to these definitions. Why? Wood Yu is Liver Qi failing to disperse. "Da" implies achieving smoothness; it simply means facilitating free flow, not merely lifting and ascending. Whether dispersing via sweating to reach the exterior, or even purging to reach the interior, all are forms of "Da"; how can one be bound to emesis alone? The rest follows this analogy. (I have seen cases of heat illness where sweating failed to occur; administering Chengqi Tang (Cinnamon Twig and Rhubarb Decoction) to purge the interior allowed the interior Qi to unblock, after which residual pathogens transformed into sweat and exited. Is this not the principle that Fire Yu can be treated by purging as a form of dispersal?) Zhu Danxi divided Yu into six types: Qi Yu, Blood Yu, Dampness Yu, Fire Yu, Food Yu, and Phlegm Yu. Therefore, he formulated Yueju Wan (Yueju Pill), using Xiangfu (Cyperi Rhizoma) to regulate Qi, Fuxiong (Ligusticum Chuanxiong Rhizoma) to move Blood, Cangzhu (Atractylodis Rhizoma) to dry Dampness, Zhizi (Gardeniae Fructus) to treat Fire, Shenqu (Massa Medicata Fermentata) to digest food, and adding Beimu (Fritillariae Bulbus) for Phlegm Yu. The general principle focuses on regulating Qi, because when Qi stagnates, Blood also stagnates, and food/drink fail to move, leading to accumulation of Phlegm and Dampness, which eventually transforms into Fire. When Qi moves, these several factors all move; thus, emphasis is placed on Qi, which is an immutable principle. Zhao Xianke prioritized Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). (The Danggui and Shaoyao in Xiaoyao San correspond to Chuanxiong in Yueju Wan; Baizhu in Xiaoyao San corresponds to Cangzhu in Yueju Wan; Chenpi in Xiaoyao San corresponds to Shenqu in Yueju Wan; Chaihu in Xiaoyao San corresponds to Xiangfu in Yueju Wan; the added ingredients in Xiaoyao San correspond to Zhizi in Yueju Wan.) He stated that the Wood Qi of the Gallbladder and Shaoyang resembles grass piercing through the earth; at this time, if constrained by cold wind, it becomes withered, suppressed, and unable to extend upward. Only when warm wind blows does it become smooth and accessible, for Wood delights in wind; wind shaking makes it comfortable, while cold wind is feared and warm wind is liked. Chaihu and Bohe are acrid and warm; acrid allows dispersion, and warmth enters the Shaoyang channel. If stagnation is severe and accompanied by heat, Zuojin Pill (Left Metal Pill) is added. Heat cannot be eliminated without cold herbs, so Huanglian (Coptidis Rhizoma) is used to treat Fire, which is actually applying the method of "tonifying the mother and draining the child" (here referring to draining Fire via its child element, Earth, though clinically Huanglian clears Heart Fire). Stagnation cannot be opened without acrid-hot herbs; Wuzhuyu (Evodiae Fructus) is acrid-hot and has a fishy odor; the Qi of the Liver also has a fishy odor; like attracts like, so Wuzhuyu is used as a reverse assistant to guide the medicine into the Liver. After服用, once Wood Yu is relieved, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) with added Chaihu and Shaoyao is subsequently used to nourish Kidney Water. Xiaoyao San uses Wind to disperse it; Liuwei Dihuang Tang uses Rain to moisten it. Does Wood ever fail to receive its natural conditions? Although Zhao's theory is very refined, claiming this formula can treat all types of Yu is too absolute, sacrificing the many for the one, which is unacceptable. The Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Thought, Grief, Fear, Fright) are all sufficient to cause Yu. For example, external injury by Wind, Cold, and Dampness can close off Yang Qi, leading to stagnation transforming into Heat, which is certain. Summerheat, Heat, and Dryness are also sufficient to cause Qi stagnation. *Zhunsheng* states: Dryness-Metal restricts and astringes; restriction and astringency damage its distributing function, so not only can Sheng (ascending/generating) Qi not rise, but also Shou (descending/receiving) Qi cannot descend. (Failure to ascend belongs to Liver Yu; failure to descend belongs to Lung Yu.) The *Classic* says: Violating Autumn Qi causes Taiyin to fail to receive, resulting in scorched and full Lung Qi. It also states: All Qi obstruction and stagnation belong to the Lung. This is Yu caused by Dryness Qi. Furthermore, Dryness transforms into Fire; the *I Ching* says: Nothing dries things more than Fire. Thus, Yu caused by Dryness is nothing but the work of Hot-Fire Qi. As for the Seven Emotions, except for Joy which makes Qi smooth and flowing, Worry, Thought, Grief, and Anger all cause Qi to knot and stagnate. The blockage by Phlegm and Food, and the retention/blockage by Water-Dampness, can be inferred. *Zhunsheng* states that Yu mostly resides in the Middle Jiao, implying that regardless of which Zang-Fu organ is stagnant, it involves the Central Earth (Spleen/Stomach). It also states that medication should combine ascending and descending actions: to ascend, one must first descend to achieve ascent; to descend, one must first ascend to achieve descent. In Yueju Wan, Cangzhu is a herb of the Foot-Yangming Stomach channel; its aroma is robust and acrid-pungent, developing Grain-Qi, with much ascending power; Xiangfu is a Qi-moving herb within Yin-Blood, with much descending power. One ascends, one descends, used mutually. By ascending and descending, the Middle Jiao Yu is opened. Qi Yu manifests as chest/hypochondriac pain, with a Deep and Choppy pulse; suitable herbs are Xiangfu, Cangzhu, and Fuxiong. Dampness Yu manifests as wandering body pain or joint pain, worsening in cold/yin conditions, with a Deep and Fine pulse; suitable herbs are Cangzhu, Chuanxiong, Baizhu, and Fuling. Heat Yu manifests as blurred vision and red urine, with a Deep and Rapid pulse; suitable herbs are Zhizi, Qingdai, Xiangfu, Cangzhu, and Fuxiong. Phlegm Yu manifests as panting upon movement, with a Deep and Slippery pulse at Cun Kou; suitable herbs are Haishi, Xiangfu, Nanting, and Gualouren. Blood Yu manifests as limb weakness, ability to eat but bloody stools, with a Kou (Hollow) and Choppy pulse; suitable herbs are Taoren, Honghua, Qingdai, Chuanxiong, and Xiangfu. Food Yu manifests as belching with sour taste, abdominal fullness and inability to eat, with a Tight and Exuberant pulse at Right Cun; suitable herbs are Xiangfu, Cangzhu, Shanzha, Shenqu, and Zhensha. For the above herbs treating various Yus, add Fangfeng in Spring, Kushen in Summer, and Wuzhuyu in Autumn/Winter. Cangzhu and Fuxiong generally treat all Yus.
Note: "All diseases arise from Yu," "All diseases belong to Fire," and "Wind is the chief of a hundred diseases"—these three statements share a single underlying principle. For Yu never exists without becoming Fire, and Fire never arises without Yu. (Thick wine and rich foods, sexual exhaustion damaging Yin, leading to flaming Fire, may seem unrelated to Yu, but it necessarily occurs because the Qi fails to circulate and disperse.) And stagnation that is not smoothed out constitutes a disease of Liver Wood. Therefore, it is said: He who knows the essentials, concludes with one word.