内经曰。木郁则达之。火郁则发之。土郁则夺之。金郁则泄
之。水郁则折之。然调其气。过者折之以其畏也。所谓泻之。
注内经者。谓达之吐之也。令其条达也。发之汗之也。令其疏散也。夺之下之也。令其无壅凝也。泄
之谓渗泄解表利小便也。折之谓制其冲逆也。予谓凡病之起。多由于郁。郁者抑而不通之义。内经五法。为
因五运之气所乘而致郁。不必作忧郁之郁。忧乃七情之病。但忧亦在其中。丹溪先生云。气血冲和。百
病不生。一有怫郁。诸病生焉。又制为六郁之论。立越鞠丸以治郁。曰气曰湿曰热曰痰曰血曰食。而以香附抚
芎苍术。开郁利气为主。谓气郁而湿滞。湿滞而成热。热郁而成痰。痰滞而血不行。血滞而食不消化。此六者
相因为病者也。此说出而内经之旨始晦。内经之旨。又因释注之误而复晦。此郁病之不明于世久矣。苟能神而
明之。扩而充之。其于天下之病。思过半矣。且以注内经之误言之。其曰达之谓吐之。吐中有发散之义。盖凡
木郁乃少阳胆经半表半里之病。多呕酸吞酸证。虽吐亦有发散之益。但谓无害耳。焉可便以吐字该达字耶。达
者畅茂调达之义。王安道曰。肝性急怒气逆。 胁或胀。火时上炎。治以苦寒辛散而不愈者。则用升发之药。
加以厥阴报使而从治之。又如久风入中为飧泄。及不因外风之入而清气在下为飧泄。则以轻扬之剂举而散之。
凡此之类。皆达之之法也。此王氏推展达之之义甚好。火郁则发之。发之汗之也。东垣升阳散火汤是也。使势
穷则止。其实发与达不相远。盖火在木中。木郁则火郁相因之理。达之即所以发之。即以达之之药发之。无有
不应者。但非汗之谓也。汗固能愈。然火郁于中。未有不蒸蒸汗出。须发之得其术耳。土郁夺之。谓下夺之。
如中满腹胀。势甚而不能顿除者。非力轻之剂可愈。则用咸寒峻下之剂。以劫夺其势而使之平。此下夺之义
也。愚意谓夺不止下。如胃亦土也。食塞胃中。下部有脉。上部无脉。法当吐。不吐则死。内经所谓高者因而越之。
以吐为上夺。而衰其胃土之郁。亦无不可。东垣书引木郁于食填肺分。为金克木。何其牵强。金郁泄之。如肺
气满。胸凭仰息。非解利肺气之剂。不足以疏通之。只解表二字。足以尽泄金郁之义。不必更渗泄利小便。
而渗利自在其中。况利小便是涉水郁之治法矣。独水郁折之难解。愚意然调其气四句。非总结上文也。乃为折
之二字。恐人不明。特说此四句。以申明之耳。然犹可也。水之郁而不通者。可调其气而愈。如经曰。
膀胱者州都之官。津液藏焉。气化则能出矣。肺为肾水上源。凡水道不通者。升举肺气。使上窍通则下窍通。
若水注之法。自然之理。其过者。淫溢于四肢。四肢浮肿。如水之泛滥。须折之以其畏也。盖水之所畏者。
土也。土衰不能制之。而寡于畏。故妄行。兹惟补其脾土。俾能制水。则水道自通。不利之利。即
所谓泻之也。如此说。则折字与泻字。于上文接续。而折之之义益明矣。内经五法之注。乃出自张子和之注。
非王启玄旧文。故多误。予既改释其误。又推展其义。以一法代五法。神而明之。屡获其效。故表而书之。盖
东方先生木。木者生生之气。即火气。空中之火。附于木中。木郁则火亦郁于木中矣。不特此也。
火郁则土自郁。土郁则金亦郁。金郁则水亦郁。五行相因。自然之理。唯其相因也。予以一方治其木郁。而诸
郁皆因而愈。一方者何。逍遥散是也。方中唯柴胡薄荷二味最妙。盖人身之胆木。乃甲木少阳之气。气尚柔
嫩。象草穿地始出而未伸。此时如被寒风一郁。即萎软抑遏。而不能上伸。不上伸则下克脾土。而
金水并病矣。唯得温风一吹。郁气即畅达。盖木喜风。风摇则舒畅。寒风则畏。温风者。所谓吹面不寒杨柳风
也。木之所喜。柴胡薄荷辛而温者。辛也故能发散。温也故入少阳。古人立方之妙如此。其甚者方中加左金
丸。左金丸止黄连吴茱萸二味。黄连但治心火。加吴茱萸气燥。肝之气亦燥。同气相求。故入肝以
平木。木平则不生心火。火不刑金。而金能制木。不直伐木。而佐金以制木。此左金之所以得名也。此又法之
巧者。然犹未也。一服之后。继用六味地黄加柴胡芍药服之。以滋肾水。俾水能生木。逍遥散者。风以散
之也。地黄饮者。雨以润之也。木有不得其天者乎。此法一立。木火之郁既舒。木不下克脾土。且土亦
滋润。无燥 之病。金水自相生。予谓一法。可通五法者如此。岂惟是哉。推之大之。千之万之。其益无穷。
凡寒热往来。似疟非疟。恶寒发热呕吐吞酸嘈杂。胸痛 痛。小腹胀闷。头晕盗汗。黄胆温疫。疝气飧泄等
证。皆对证之方。推而伤风伤寒伤湿。除直中外。凡外感者。俱作郁看。以逍遥散加减出入。无不获
效。如小柴胡汤四逆散羌活汤。大同小异。然不若此方之附应也。神而明之。变而通之。存乎人耳。倘一服
即愈。少顷即发。或半日或一日又发。发之愈频愈甚。此必属下寒上热之假证。此方不宜复投。当改用温补之
剂。如阳虚以四君子汤加温热药。阴虚者。则以六味汤中加温热药。其甚者。尤须寒因热用。少以冷药从之。
用热药冷探之法。否则拒格不入。非惟无益。而反害之。病有微甚。治有逆从。玄机之士。不须予赘。
《黄帝内经》说：木气郁结，就用“达”法来疏通；火气郁结，就用“发”法来发散；土气郁结，就用“夺”法来攻逐；金气郁结，就用“泄”法来宣泄；水气郁结，就用“折”法来制约。然而调理气机时，对于邪气过盛的，要用它畏惧的方法来制约，这也就是所谓的“泻”。
注释《内经》的人认为，“达”就是吐法，使其条达通畅；“发”就是汗法，使其疏散；“夺”就是下法，使其没有壅滞凝结；“泄”就是渗利、解表、通利小便；“折”就是制约其冲逆之气。我认为，大凡疾病的产生，多由于“郁”。“郁”的意思是压抑而不通畅。《内经》的五种治法，是针对因五运之气相乘而导致的郁证，不必理解为忧郁之郁。忧是七情致病之一，但也包含在郁的范畴内。朱丹溪先生说：“气血冲和，百病不生；一旦怫郁，诸病生焉。”他又制定了六郁的理论，创立了越鞠丸来治疗郁证，分为气、湿、热、痰、血、食六种郁滞，以香附、川芎、苍术为主药，旨在开郁利气。他认为气郁导致湿滞，湿滞化热，热郁生痰，痰滞导致血行不畅，血滞导致食物不消化。这六种因素相互关联而致病。这种说法出来后，《内经》的本意才开始变得晦涩不明；而《内经》的本意，又因为注家的错误解释而再次变得晦涩。因此，郁病的理论在世间长期得不到澄清。如果能深入理解并扩充应用，那么对天下疾病的治疗就能掌握大半了。
况且从注释《内经》的错误说起。注家说“达”就是吐法，吐法中确实有发散的含义。大概木郁属于少阳胆经半表半里的病证，多有呕吐酸水、吞酸的症状，虽然使用吐法也有发散的好处，但这只是说无害罢了，怎么能直接用“吐”字来涵盖“达”字的含义呢？“达”的意思是畅茂调达。王安道说：“肝性急，易怒导致气逆，出现胁肋胀痛或胀满，火气时常上炎，如果用苦寒辛散的方法治疗无效，就使用升发药物，并加入厥阴经的引经药进行从治。”又如久风入中导致完谷不化的泄泻，以及不因外风入侵而是清气在下导致的完谷不化泄泻，就用轻扬的药物提升并疏散它。像这样的情形，都是“达”法的应用。王氏对“达”义的推展非常好。
“火郁则发之”，发之即汗之，李东垣的升阳散火汤就是例子。使火势穷尽就停止。其实“发”与“达”不相远。因为火在木中，木郁则火郁，这是相互关联的道理。“达”即是“发”，用“达”的药来“发”，没有不应验的。但这并不是指单纯的发汗。发汗固然能治愈，但火郁于中，无不蒸蒸发热的出汗，必须发汗得其方法才行。
“土郁夺之”，谓之下夺。如中满腹胀，病情严重不能立即消除的，不是轻剂可以治愈的，就用咸寒峻下的药物，以劫夺其势使之平复。这就是下夺的含义。我的意思是“夺”不仅仅指下法。胃也属土，如果食物堵塞胃中，下部有脉象而上部无脉象，治法应当用吐法，不吐就会死亡。《内经》所谓“高者因而越之”，用吐法作为上夺，从而衰减胃土的郁滞，也是可以的。李东垣的书引用木郁被食物填塞肺分，认为是金克木，何其牵强。
“金郁泄之”，如肺气胀满，胸膈憋闷需仰面呼吸，非解利肺气的药物不足以疏通。仅“解表”二字，足以尽括“泄金郁”的含义，不必再谈渗利和小便通利，而渗利自然包含在其中。况且利小便是治疗水郁的方法。
唯独“水郁折之”难以解释。我认为“然调其气”这四句，不是总结上文，而是为了说明“折”字，恐怕人们不明白，特意说这四句来申述它。然而还可以这样理解：水郁而不通，可以通过调理气机而痊愈。如经文所说：“膀胱者，州都之官，津液藏焉，气化则能出矣。”肺为肾水上源，凡是水道不通的，提升肺气，使上窍通畅则下窍自通，如同水注之法，这是自然的道理。对于邪气过盛的，如水溢于四肢，四肢浮肿，如水泛滥，须用其所畏惧的方法来制约。水所畏惧的是土。土衰不能制水，导致水气寡于畏惧而妄行。此时唯有补益脾土，使其能制水，则水道自然通畅。这种不利之利，就是所谓的“泻”。这样解释，则“折”字与“泻”字在上文中衔接，而“折”的含义更加明确了。
《内经》五种治法的注释，出自张子和的注解，并非王启玄的旧文，所以多有错误。我既然改正了其错误，又推展了其义，以一法代替五法，神而明之，屡获疗效，故记录下来。
东方属木，木代表生生之气，即火气，空中之火依附于木中。木郁则火亦郁于木中。不仅如此，火郁则土自郁，土郁则金亦郁，金郁则水亦郁。五行相生相因，是自然之理。正因为它们相互关联，我用一方治疗木郁，而其他各郁也随之痊愈。这一方是什么？就是逍遥散。方中唯柴胡、薄荷两味最妙。人身之胆木，乃甲木少阳之气，气尚柔嫩，像草穿地初出而未伸展。此时如果被寒风一郁，就会萎软抑遏，不能向上伸展。不上伸则向下克制脾土，导致金水并病。只有得到温风吹拂，郁气才能畅达。木喜风，风摇则舒畅，但畏寒风。温风，就是所谓“吹面不寒杨柳风”。木之所喜，柴胡、薄荷辛而温。辛故能发散，温故入少阳。古人立方的精妙之处就在于此。病情严重的，方中加入左金丸。左金丸仅有黄连、吴茱萸两味药。黄连只治心火，加吴茱萸因其气燥，肝之气亦燥，同气相求，故入肝以平木。木平则不生心火，火不刑金，而金能制木。不直接伐木，而是佐金以制木，这就是左金丸得名的原因。这也是方法的巧妙之处。
然而这还不够。服用一次后，继用六味地黄丸加柴胡、芍药服用，以滋补肾水，使水能生木。逍遥散，是用风来疏散它；地黄饮（此处指六味地黄丸类），是用雨来滋润它。木有不得其天时吗？此法确立后，木火之郁既已舒展，木不再向下克制脾土，且土也得到滋润，无燥热之病，金水自然相生。我认为一法可通五法，就像这样。岂止于此！推广开来，成千上万种疾病，益处无穷。
凡是寒热往来，似疟非疟，恶寒发热，呕吐吞酸，嘈杂，胸痛腹痛，小腹胀闷，头晕盗汗，黄疸，温疫，疝气，完谷不化泄泻等证候，都是对症之方。推广到伤风、伤寒、伤湿，除了直中脏腑的情况外，凡是外感病，都当作郁证来看待，用逍遥散加减出入，无不获得疗效。如小柴胡汤、四逆散、羌活汤，大同小异，但不如此方应验迅速。神而明之，变而通之，在于人自己。如果服药一次即愈，不久又发作，或半天或一天后又发作，发作得越频繁越严重，这一定是下寒上热的假证，此方不宜再投。当改用温补之剂。如阳虚者，用四君子汤加温热药；阴虚者，则在六味汤中加温热药。病情严重的，尤其须用“寒因热用”法，稍加冷药顺从病情，或用热药冷探的方法，否则会导致格拒不受。这不仅无益，反而有害。病有轻重，治有逆从，精通玄机的人士，不需要我再赘述。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When Wood Qi is stagnant, use the method of "Da" (unblocking/venting); when Fire Qi is stagnant, use the method of "Fa" (dispersing/sweating); when Earth Qi is stagnant, use the method of "Duo" (purging/draining); when Metal Qi is stagnant, use the method of "Xie" (draining/releasing); when Water Qi is stagnant, use the method of "Zhe" (restraining/checking). However, to regulate Qi, for excessive conditions, one should restrain them with what they fear; this is referred to as "Xie" (draining/purging).
Commentators on the *Neijing* interpret "Da" as emesis (吐), making it smooth and unobstructed; "Fa" as diaphoresis (汗), making it dispersed; "Duo" as purgation (下), removing stagnation and coagulation; "Xie" as promoting urination, releasing the exterior, and benefiting the bladder; and "Zhe" as restraining rebellious upward movement. I believe that the onset of most diseases stems from "Yu" (stagnation/depression). "Yu" implies suppression without free flow. The five methods in the *Neijing* address stagnation caused by the overacting of the Five Movements (Wu Yun) Qi, and should not be interpreted merely as emotional depression. Sorrow is a disease of the Seven Emotions, but it is included within the scope of Yu. Mr. Zhu Danxi stated: "When Qi and Blood are harmonious, no disease arises; once there is frustration and stagnation, various diseases emerge." He further formulated the theory of Six Types of Stagnation and established Yueju Wan (Cross-Interdicting Pill) to treat stagnation, categorizing them as Qi, Dampness, Heat, Phlegm, Blood, and Food stagnation. He used Xiangfu (Cyperus Rhizome), Chuanxiong (Ligusticum Rhizome), and Cangzhu (Atractylodis Rhizoma) as principal herbs to open stagnation and promote Qi flow. He posited that Qi stagnation leads to Dampness obstruction; Dampness obstruction generates Heat; Heat stagnation produces Phlegm; Phlegm obstruction impedes Blood circulation; and Blood stagnation causes indigestion of food. These six factors cause disease through mutual interaction. With the emergence of this theory, the original intent of the *Neijing* began to become obscure. Furthermore, the intent of the *Neijing* became even more obscured due to erroneous annotations. Thus, the understanding of Yu diseases has remained unclear in the world for a long time. If one can deeply comprehend and expand upon these principles, one would grasp more than half of the treatments for all diseases under heaven.
Let us discuss the errors in annotating the *Neijing*. The annotation claims "Da" refers to emesis. While emesis contains a meaning of dispersal, Wood stagnation typically involves the Shaoyang Gallbladder channel, presenting with symptoms like vomiting acid or acid regurgitation. Although emesis may have some dispersing benefit, claiming it is harmless does not justify equating "emesis" with the broader concept of "Da". "Da" means flourishing and smooth regulation. Wang Andao stated: "The Liver is swift and prone to anger causing Qi rebellion, leading to hypochondriac distension or pain, with Fire flaring upwards. If bitter-cold and acrid-dispersing methods fail, use ascending and dispersing herbs, combined with Yin-Yang guiding agents for counter-treatment." Similarly, for chronic wind entering the interior causing undigested stool diarrhea, or clear Yang sinking below causing similar diarrhea without external wind invasion, one should use light and uplifting agents to raise and disperse. Such cases illustrate the application of the "Da" method. Mr. Wang's expansion of the meaning of "Da" is excellent.
"Fire stagnation is treated by dispersing." Dispersing here implies sweating. Dongyuan's Shengyang Sanhuo Tang (Ascending Yang and Dispersing Fire Decoction) is an example. One stops when the pathogenic force is exhausted. In reality, "Fa" (dispersing) and "Da" (unblocking) are closely related. Since Fire resides within Wood, Wood stagnation leads to Fire stagnation. Unblocking Wood is equivalent to dispersing Fire. Using herbs that unblock Wood to disperse Fire yields effective results. This does not strictly mean inducing sweat. While sweating can cure, Fire stagnating internally inevitably causes steaming heat and sweating; one must apply the dispersing method correctly.
"Earth stagnation is treated by purging." This refers to downward purging. For severe abdominal fullness and distension that cannot be quickly resolved, mild agents are insufficient. One must use heavy, salty-cold purgatives to seize the momentum and pacify the condition. This is the meaning of downward purging. My view is that "Duo" (seizing/purging) is not limited to downward purging. The Stomach belongs to Earth. If food blocks the Stomach, with pulses present in the lower body but absent in the upper body, the treatment should be emesis; otherwise, death ensues. The *Neijing* states, "For high conditions, induce vomiting to evacuate." Using emesis as an upper purging method to alleviate Stomach Earth stagnation is also acceptable. Dongyuan’s book cites Wood stagnation blocked by food filling the Lung sector, attributing it to Metal overcoming Wood, which is far-fetched.
"Metal stagnation is treated by draining." For instance, Lung Qi fullness causing chest oppression and orthopnea requires agents that release and benefit Lung Qi to unblock it. The phrase "release the exterior" sufficiently covers the meaning of draining Metal stagnation; there is no need to additionally emphasize promoting urination, as this is inherent. Moreover, promoting urination is the treatment for Water stagnation.
Only "Water stagnation is treated by restraining" is difficult to explain. I believe the four sentences "However, regulate its Qi..." do not summarize the previous text but specifically elucidate "Zhe" (restrain), fearing people might not understand, thus explaining it further. Nevertheless, one can interpret it thus: Water stagnation and blockage can be cured by regulating Qi. As the classic says: "The Bladder is the official of the metropolitan area, storing fluids; when Qi transforms, they can be excreted." The Lung is the source of Water for the Kidney. For any blockage of water pathways, lifting Lung Qi makes the upper orifices open, thereby opening the lower orifices, following the natural logic of water flow. For excessive conditions, such as water overflowing into the limbs causing edema resembling a flood, one must restrain it with what it fears. What Water fears is Earth. If Earth is deficient and cannot control Water, Water acts recklessly due to lack of restraint. Therefore, one must tonify Spleen Earth to enable it to control Water, allowing water pathways to flow naturally. This non-draining method of draining is what is meant by "Xie" (draining). With this explanation, "Zhe" connects with "Xie" in the preceding text, clarifying the meaning of "Zhe".
The annotations for the five methods in the *Neijing* originate from Zhang Hezi’s commentary, not Wang Qixuan’s original text, hence containing many errors. Having corrected these errors and expanded their meanings, using one method to replace five, and achieving frequent success through divine comprehension, I record this.
The East corresponds to Wood. Wood represents the vital generating Qi, which is essentially Fire Qi. The Fire in the void attaches to Wood. When Wood stagnates, Fire also stagnates within Wood. Not only this: Fire stagnation leads to Earth stagnation; Earth stagnation leads to Metal stagnation; Metal stagnation leads to Water stagnation. The interdependence of the Five Elements is the law of nature. Because of this interdependence, I use one formula to treat Wood stagnation, whereby all other stagnations are subsequently cured. What is this formula? It is Xiaoyao San (Free and Easy Wanderer Powder). Among its ingredients, Chaihu (Bupleuri Radix) and Bohe (Menthae Haplocalycis Herba) are the finest. The Gallbladder Wood in the human body is the Qi of Jia Wood and Shaoyang. Its Qi is tender, resembling grass pushing through the soil, just emerging but not yet extended. If chilled by cold wind at this stage, it becomes limp and suppressed, unable to grow upward. Failure to grow upward leads to downward overacting on Spleen Earth, causing simultaneous disease in Metal and Water. Only when warmed by a gentle breeze does the stagnant Qi become smooth. Wood delights in wind; wind shaking promotes comfort, but it fears cold wind. The warm breeze, described as "the willow wind that does not chill the face," is what Wood likes. Chaihu and Bohe are acrid and warm. Acridity allows dispersion; warmth enters the Shaoyang. Such is the subtlety of ancient formula creation. For severe cases, add Zuojin Wan (Left Metal Pill) to the formula. Zuojin Wan consists only of Huanglian (Coptidis Rhizoma) and Wuzhuyu (Evodiae Fructus). Huanglian treats Heart Fire alone; adding Wuzhuyu works because both are drying. Since Liver Qi is also dry, they share similar properties and enter the Liver to pacify Wood. When Wood is pacified, it does not generate Heart Fire; Fire does not attack Metal, allowing Metal to control Wood. Instead of directly attacking Wood, it assists Metal to control Wood, which is why it is called Zuojin (Left Metal). This is another clever method.
However, this is not enough. After one dose, follow up with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Chaihu and Shaoyao (Paeoniae Radix) to nourish Kidney Water, enabling Water to generate Wood. Xiaoyao San uses wind to disperse; Dihuang Yin (Rehmannia Decoction, referring here to the nourishing action of Liuwei Dihuang Wan) uses rain to moisten. Is there any Wood that does not receive its natural season? Once this method is established, the stagnation of Wood and Fire is relieved. Wood no longer overacts on Spleen Earth downwards, and Earth is moistened, avoiding dryness. Metal and Water naturally generate each other. I assert that one method can encompass the five methods in this manner. Is it limited to this? Extend it widely, thousands and ten thousands of times, and the benefits are infinite.
For symptoms such as alternating chills and fever, malaria-like but not malaria, aversion to cold with fever, vomiting acid, acid regurgitation, epigastric discomfort, chest pain, abdominal pain, lower abdominal distension, dizziness, night sweats, jaundice, epidemic febrile diseases, hernia, and undigested stool diarrhea, this is a symptomatic formula. Extending this to wind-stroke, cold-damage, and dampness-invasion, except for direct transmission to the Zang-Fu organs, all external contractions should be viewed as stagnation. Using Xiaoyao San with modifications yields consistent efficacy. Xiao Chaihu Tang (Minor Bupleurum Decoction), Sini San (Frigid Extremities Powder), and Qianghuo Tang (Notopterygii Root Decoction) are largely similar but less responsive than this formula. Divine comprehension and flexible adaptation depend on the practitioner. If cured after one dose but relapsing shortly after, or recurring every half day or day, becoming more frequent and severe, this indicates a false syndrome of lower cold and upper heat. This formula is unsuitable; switch to warming and tonifying agents. For Yang deficiency, use Sijunzi Tang (Four Gentlemen Decoction) with warming herbs; for Yin deficiency, add warming herbs to Liuwei Tang (Six-Ingredient Decoction). For severe cases, employ "treating cold with heat" methods, slightly using cold herbs to comply with the condition, or hot herbs administered cold to probe. Otherwise, rejection may occur. This is not only ineffective but harmful. Diseases vary in severity; treatments vary in opposition or compliance. Those who understand profound mysteries need no further elaboration from me.