经义
诸气 郁，皆属于肺。○木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之。然调其气，过者折之，
以其畏也，所谓泻之。（《素问》）
哲言
流水不腐，户枢不蝼，动也。形气亦然，形不动，则精不流，精不流，则气郁矣。（《吕氏》）
郁者，结聚而不得发越，当升者不得升，当降者不得降，当变化者不得变化，所以传化失常，而病作矣。（滑伯仁）
气血冲和，百病不生，一有怫郁，百病生焉。其因有六∶曰气，曰湿，曰热，曰痰，曰血，曰食。气郁
则生湿，湿郁则成热，热郁则成痰，痰郁则血不行，血郁则食不化，六者相因为病也。○气郁者，胸胁疼痛，
其脉沉涩。湿郁者，关节疼痛，天阴则发，其脉沉细。热郁者，瞀闷烦心，小便赤涩，其脉沉数。痰郁者，动
则喘急，脉沉而滑。血郁者，四肢无力，能食便血，脉沉而芤。
食郁者，嗳酸腹满，不能饮食，右脉紧盛。或七情之抑郁，或寒热之交侵，或雨湿之浸淫，或酒浆之积聚，而
成郁疾；又如热郁而成痰，痰郁而成癖，血郁而成瘕，食郁而成痞满，此必然之理也。（朱丹溪）
有本气自郁而生病者∶心郁则昏昧健忘；肝郁则胁胀嗳气；脾郁则中满不食；肺郁则干咳无痰；肾郁则腰
胀淋浊，不能久立，胆郁则口苦晡热，怔忡不定。（《证治汇补》）
七情不快，郁久成病∶或为虚怯，或为噎隔，或为痞满，或为腹胀，或为胁痛；女子则经闭堕胎，带下崩
中。可见百病兼郁如此。（何伯斋）
补编
木郁达之，谓吐之令其条达也。火郁发之，谓汗之令其疏散也。土郁夺之，谓下之令无壅滞也。金郁泄之，
谓渗泄解表，利小便也。水郁折之，谓抑之制其冲逆也。（王太仆）
郁者，郁塞不通也。一有所郁，通之而已。《经》有五法，皆所以通之，特其所以通之之法不一也。如
条达者，木之性也。木性受郁，则不能条达矣。枝叶过密，而虫转生，因而枯瘁，非芟之、剔之，不顺其性也，
故《经》言达之。达之者，伐肝即所以补肝也。炎上者，火之性也，火性受郁，则不能炎上矣。如呜灰堆然，
则火气不升而将熄矣，非拨之、吹之，不顺其性也，故《经》言发之。发之者，升散无取乎逆折也。至于
土郁，如径之塞，如山之崩，而碍往来，非畚插除之不可也，故《经》言夺之。若夫金郁，如铸钟及鸣钲然，
失于过浓者，则无声，必须刮磨，然后应律，故《经》言泄之。或开肺窍，或通汗孔，或利水道，皆所以泄之
也。水性流行，本当无郁，或堤防阻焉，污秽塞焉，虑其横决，多其曲折以缓之，言分消也。汗、下、利酌而
用之，不拘一法也。（《医参》）
《内经》“木郁达之”五句，治郁之法也；“然调其气”一句，治郁
之余法也；“过者折之”三句，调气之余法也。夫五法者，《经》虽为病由五运之郁所致而立，然扩而充之，
则未尝不可也。且凡病之起，多由乎郁；郁者，滞而不通之义。或因所乘而为郁，或不因所乘，而本气自郁，
皆郁也，岂惟五运之变，能使然哉！木郁达之；达者，通畅之也。如肝性急，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
清气在下为飧泄者，则以轻扬之剂，举而散之。此皆达之之法也。王氏谓吐之令其条达，为木郁达之。东垣谓
食塞胸中，食为坤土，胸为金位，金主杀伐，与坤土俱在于上而旺于天，金能克木，故肝木生发之气，伏于地
下，非木郁而何？吐去上焦阴土之物，木得舒畅，则郁结去矣，此木郁达之也。窃意王氏以吐训达，不能使人
无疑。以为肺金盛而抑制肝木欤？则泻肺气举肝气可矣，不必吐也。以为脾胃浊气下流，而少阳清气不升欤？
则益胃升阳可矣，不必吐也。虽然木郁固有吐之之理，今以“吐”字总该“达”字，则凡木郁皆当用吐矣，其
可乎哉？至于东垣所谓食塞肺分，为金与土旺于上而克木，又不能使人无疑。夫金之克木，五行之常道，固不待
夫物伤而后能也。且既为物所伤，岂有反旺之理？若曰吐去其物，以伸木气，乃是反为木郁而施治，非为食伤
而施治矣。夫食塞胸中而用吐，正《内经》所谓其高者因而越之之义耳，恐不劳引木郁之说以 之也。火郁发
之；发者，汗之也，升举之也。如腠理外闭，邪热怫郁，则解表取汗以散之。又如龙火郁甚于内，非苦寒沉降
可治，则用升浮之药，佐以甘温，顺其性而从治之，如升阳散火汤是也。此皆发之之法也。土郁夺之；夺者，
攻下也，劫而衰之也。如邪热入胃，用咸寒之剂，以攻去之。又如中满腹胀，湿热内甚，其人壮气实者，则攻
下之。其或势盛而不能顿除者，则劫夺其势而使之衰。又如湿热为痢，有非轻剂可治者，则或攻或劫，以致其
平。此皆夺之之法也。金郁泄之；泄者，渗泄
而利小便也，疏通其气也。如肺金为肾水上源，金受火烁，其令不行，源郁而渗道闭矣，宜整肃金化滋以利之。
又如肺气 郁，胸满仰息，非利肺气不足以疏通之。此皆泄之之法也。王氏谓渗泄解表利小便，为金郁泄之。
夫渗泄利小便，固为泄金郁矣，其“解表”二字，莫晓其意，得非以人之皮毛属肺，其受邪为金郁，而解表为
泄之乎？窃谓如此，则凡筋病便是木郁，肉病便是土郁耶？且解表间于渗泄、利小便之中，是渗泄、利小便为
二治矣。若以渗泄为滋肺生水，以利小便为直治膀胱，既责不在肺，何为金郁乎？是亦不通。故予易之曰∶渗
泄而利小便也。水郁折之；折者，制御也，伐而挫之，渐杀其势也。如肿胀之病，水气淫溢，而渗道以塞。夫
水之所不胜者土也，今土气衰弱，不能制之，故反受其侮，治当实其脾土，资其运化。俾土可以制水而不敢犯，
则渗道达而后愈也。或病势既旺，非上法所能遽制，则用渗水之药，以伐而挫之；或去菀陈 、开鬼门、洁净
府，三治备举迭用，以渐平之。王氏所谓抑之，制其冲逆，正欲折挫其泛滥之势也。夫实土者守也，泄水者攻
也，兼三治者，广略而决胜也，虽俱为治水之法，然不审病之虚实、久近、浅深，杂焉而妄施之，其不倾踣者
寡矣。且夫五郁之病，固有法以治之矣，然邪气久客，正气必损；今邪气虽去，正气岂能遽平？苟不平调正气，
使各安其位，复其常于治郁之余，则犹未足以尽其妙。故又曰∶然调其气，苟调之而其气犹或过而未服，则当
益其所不胜以制之。如木过者，当益金，金能制木，则木斯服矣。所不胜者，所畏者也。故曰∶过者折之，以
其畏也。夫制物者，物之所欲也；制于物者，物之所不欲也；顺其欲则喜，逆其欲则恶。今逆之以所恶，故曰，
所谓泻之。王氏以咸泻肾、酸泻肝之类为说，未尽厥旨。（王安道）
《经》云∶木郁达之。释者以达为宣吐；又云，用柴胡、川芎条达之。愚谓此不过随文训释，而于达之
之意，犹有未尽。夫木郁即肝郁也。《素问》云∶治病必求其本。郁证之起，必有所
因，求其所因而治之，则郁自解；郁解，而达自在其中矣。矧木郁之证，妇人居多，其情性偏执；肝病变幻多
端，总宜从其性，适其宜，而致中和，即为达也。彼若吐若升，止可以言实，未可以言虚。今人柔脆者恒多，
岂可概施升吐哉？若火土金水四郁，古人注释，虽于经义未悖，然亦止可以言实、言外因，未可以言虚、言内
因也。盖因郁致疾，不特外感六淫，而于情志为更多，治当求其所因，则郁自解；郁解，则发、夺、泄、折，
俱在其中矣。因者，病之本；本之为言，根也，源也。（《吴医汇讲》）
木郁宜达。若气陷不举者，发即达也；气壅不开者，夺即达也；气秘不行者，泄亦达也；气乱不调者，
折亦达也。火郁当发。若元阳被抑，则达非发乎？脏腑留结，则夺非发乎？肤窍闭塞，则泄非发乎？津液不化，
则折非发乎？且夺者，挽回之谓，大实，非大攻不足以荡邪；大虚，非大补不足以夺命，是皆所谓夺也。折者，
折中之谓，火实则阳亢阴虚，火虚则气不化水，制作随宜，是皆所谓折也。○凡五气之郁，则诸病皆有，此因
病而郁也。至若情志之郁，则总由乎心，此因郁而病也。第自古言郁者，但知解郁顺气，通作实邪论治，兹予
辨其三证，庶可无误。盖一曰怒郁，二曰思郁，三曰忧郁。如怒郁者，方其大怒气逆之时，则实邪在肝，多见
气满腹胀，所当平也。及其怒后而逆气已去，惟中气受伤矣，既无胀满疼痛等证，而或为倦怠，或为少食，此
以木邪克土，损在脾矣。是可不知培养而仍加消伐，则所伐者其谁乎？此怒郁之有先后，亦有虚实，所当辨治
者如此。○又若思郁者，则惟旷女嫠妇，及灯窗困厄，积疑任怨者皆有之。思则气结，结于心而伤于脾也。及其
既甚，则上连肺胃，而为咳喘，为失血，为隔噎，为呕吐；下连肝肾，则为带浊，为崩淋，为不月，为劳损。
若初病而气结为滞者，宜顺宜开；久病而损及中气者，宜修宜补。然以情病者，非情不解，其在女子，必得顺
遂而后可释；或以怒胜思，亦可暂解。其在男子，使非有能屈能伸，达观上智
者，终不易却也。○又若忧郁者，多以衣食之累，利害之牵，及悲忧惊恐而致者。盖悲则气消，忧则气沉，必
伤脾肺；惊则气乱，恐则气下，必伤肝肾。此其戚戚悠悠，精气但有消索，神志不振，心脾日以耗伤，凡此皆
阳消之证，尚何实邪？而再加解散，其与鹭鸶脚上割股者，何异也！（张景岳）
东方生木，木者生生之气，木郁则火亦郁矣。火郁则土郁，土郁则金郁，金郁则水郁，此五行相因，自然
之理。予以一方治其木郁，而诸郁皆愈。一方者何？逍遥散是也。方中柴胡、薄荷二味最妙，盖木喜风，风摇
则舒畅。甚者加黄连以治心火；吴萸气臊，肝之气亦臊，同气相求，而佐金以制木，此左金之所以得名也。然
犹未也。一服之后，继用六味地黄汤，加柴胡、芍药以滋肾水，俾水能生木。逍遥散，风以散之也；地黄汤，
雨以润之也。木火之郁既舒，木不克土，土亦滋润，无燥 之病，金水自相生矣。予谓一法可通五法者如此，
岂惟是哉！推之大之，其益无穷。凡寒热往来，似疟非疟，吐酸嘈杂，胸 胁痛，小腹胀闷，黄胆瘟疫，疝气
飧泄等证，皆对证之方也。推而至于伤风、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！（《赵氏医贯》）
《内经》论“木郁达之”五句，治郁之法最详。所谓郁者，清气不升，浊气不降也。然清浊升降，皆出
于肺，使太阴失治节之令，不惟生气不升，收气亦不降，上下不交，而郁成矣。故《经》云∶太阴不收，肺气
焦满。又云∶诸气 郁，皆属于肺。然肺气之布必由胃气之输，胃气之运必本三焦之化，甚至为痛、为呕、为
胀、为利，莫非胃气不宣，三焦失职所致。故五郁之中，金木尤甚。前人用逍遥散调肝之郁，兼清火滋阴；用
泻白散清肺之郁，兼润燥降逆。要以木郁上冲即为火，金郁敛涩即为燥也。（季楚重）
郁之为病，非止一端∶有郁久而生病者，有病久而生郁者，有误药而成郁者。故凡病属郁，古人立越鞠丸
以治之。王节斋云∶气虚者，兼用四君；血虚者，兼用四物；挟痰者，兼用二陈，得其要矣。（罗赤诚）
郁证，多缘于志虑不伸，气先受病，故越鞠、四七，始而立也。郁之既久，火邪耗血，岂苍术、香附辈能
久服乎？是逍遥、归脾继而设也。然郁证多患于妇人，《经》谓二阳之病发心脾，及思想无穷，所愿不得，皆
能致病。为证不一∶或发热头痛者有之，喘嗽气乏者有之，经闭不调者有之，狂癫失志者有之，火炎失血者有
之，骨蒸劳瘵者有之， 疽生虫者有之。治法总不离乎逍遥、归脾、左金、越鞠、四七等方，参究新久虚实选
用。（张路玉）
归脾汤，治脾而开郁；逍遥散，治肝而疏郁，二方为治郁妙剂，他药恐消耗元气，宜慎用之。（《折肱漫录》）
郁证主于开郁，开郁不过行气，行气则用香燥。然有香燥过多，因而窍不润泽，气终不行，郁终不开者，
宜用养血药以润其窍，利其经，香附、川芎不足恃也。（吴篁池）
治郁之法，多以调中为要者，盖脾胃居中，心肺在上，肾肝处下，四脏所受之邪过于中者，中先受之。况
饮食不节，寒暑不调，停痰积饮，而脾胃亦先受伤，所以中焦致郁恒多也。治宜开发运动，鼓舞中州，则三阴、
三阳之郁，不攻自解矣。（《证治汇补》）
《经》言五郁之发，乃因五运之气太过不及，遂有胜复之变。由此观之，天地且有郁，况于人乎！故六
气着人，皆能郁而致病。如伤寒之邪郁于营卫，暑湿之蕴于三焦，疫邪之客于膜原，风、寒、湿三气，杂感而
【经典理论】
各种气机郁滞的病证，都归属于肺。○对于木郁（肝气郁结），应当用疏达的方法治疗；对于火郁（心火郁结），应当用发散的方法治疗；对于土郁（脾胃郁结），应当用攻夺的方法治疗；对于金郁（肺气郁结），应当用宣泄的方法治疗；对于水郁（肾与膀胱水湿郁结），应当用制约的方法治疗。然而要调理气机，对于过盛的病邪要用制约的方法，因为这是顺应脏腑的畏性，这就是所谓的泻法。（出自《素问》）
【哲人言论】
流动的水不会腐臭，转动的门轴不会被虫蛀，这是因为它们在运动。人的形体和气机也是如此，形体不运动，精气就不能流通，精气不流通，就会导致气机郁滞。（出自《吕氏春秋》）
郁，是指气机结聚而不能发越，该升发的不能升发，该下降的不能下降，该变化的不能变化，所以导致传化功能失常，从而疾病发生。（滑伯仁）
气血冲和调顺，百病就不会产生；一旦有怫郁（气机不畅），百病就会由此而生。其病因有六种：即气、湿、热、痰、血、食。气郁则生湿，湿郁则成热，热郁则成痰，痰郁则血行不畅，血郁则食物不消化，这六者互为因果而导致疾病。○气郁的症状是胸胁疼痛，脉象沉涩。湿郁的症状是关节疼痛，阴天发作，脉象沉细。热郁的症状是头昏闷乱、心烦，小便赤红涩痛，脉象沉数。痰郁的症状是活动后喘急，脉象沉而滑。血郁的症状是四肢无力，能进食但大便出血，脉象沉而芤（中空）。
食郁的症状是嗳气酸腐、腹部胀满，不能饮食，右脉紧盛。或者是七情（喜、怒、忧、思、悲、恐、惊）抑郁，或者是寒热交替侵袭，或者是雨湿浸淫，或者是酒浆积聚，从而形成郁疾；又比如热郁而成痰，痰郁而成癖积，血郁而成瘕块，食郁而成痞满，这是必然的道理。（朱丹溪）
有因本脏之气自郁而生病的：心郁则神志昏昧健忘；肝郁则胁肋胀满嗳气；脾郁则中焦胀满不思饮食；肺郁则干咳无痰；肾郁则腰部胀满、淋浊，不能久立；胆郁则口苦、傍晚发热，心悸不安。（《证治汇补》）
七情不畅，郁久成病：有的成为虚怯证，有的成为噎隔证，有的成为痞满证，有的成为腹胀证，有的成为胁痛证；女子则出现经闭、堕胎、带下、崩漏。可见百病兼夹郁证的如此普遍。（何伯斋）
【补编】
木郁达之，意思是使用吐法使其条达舒畅。火郁发之，意思是使用汗法使其疏散。土郁夺之，意思是使用下法使其没有壅滞。金郁泄之，意思是使用渗利小便和解表的方法。水郁折之，意思是抑制它以控制其冲逆之势。（王太仆）
郁，就是郁塞不通。一旦有所郁滞，疏通它就罢了。《内经》有五法，都是用来疏通的，只是疏通的方法不同罢了。比如条达，是木的特性。木性受到郁滞，就不能条达了。就像枝叶过密，虫子滋生，因而枯死，如果不修剪剔除，不顺从它的本性，所以《内经》说“达之”。达之，就是伐肝即是补肝。炎上，是火的特性。火性受到郁滞，就不能炎上了。就像捂着灰烬的火堆，火气不升就要熄灭了，如果不拨开、吹气，不顺从它的本性，所以《内经》说“发之”。发之，升散不需要逆势折挫。至于土郁，像道路堵塞、山崩地裂阻碍往来，不用畚箕铁锹清除是不行的，所以《内经》说“夺之”。至于金郁，像铸造钟和敲击钲一样，如果铸得太厚，就没有声音，必须刮磨，然后才能应律发声，所以《内经》说“泄之”。或者开通肺窍，或者通开汗孔，或者利水道，都是用来泄之的方法。水性流行，本来没有郁滞，或者堤防阻挡，污秽堵塞，担心它横决泛滥，多设曲折来减缓它，这叫分消。汗法、下法、利小便法酌情使用，不拘泥于一种方法。（《医参》）
《内经》“木郁达之”等五句，是治疗郁证的方法；“然调其气”一句，是治疗郁证后的余法；“过者折之”三句，是调气的余法。这五种方法，《内经》虽然是为五运之郁所致而立论，但推广开来，也是可以的。而且凡是疾病的起，多由郁引起；郁，是滞而不通的意思。或者因所乘侮而为郁，或者不因所乘侮，而是本气自郁，都是郁，难道只有五运的变化才能使这样吗！木郁达之；达，就是通畅。比如肝性急，怒气逆乱，胁肋或胀，火时常上炎，用苦寒辛散药治疗无效时，就用升发药，加上厥阴引经药而从治。又比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，就用轻扬之剂，举而散之。这些都是达之的方法。王氏认为吐法令其条达，是木郁达之。东垣认为食塞胸中，食属坤土，胸为金位，金主杀伐，与坤土俱在于上而旺于天，金能克木，所以肝木生发之气伏于地下，这不是木郁是什么？吐去上焦阴土之物，木得舒畅，则郁结去矣，这就是木郁达之。我私下认为王氏以吐解释达，不能使人没有疑问。认为是肺金盛而抑制肝木吗？那么泻肺气举肝气就可以了，不必用吐法。认为是脾胃浊气下流，而少阳清气不升吗？那么益胃升阳就可以了，不必用吐法。虽然木郁固有吐之的道理，现在用“吐”字总括“达”字，那么凡木郁都当用吐法了，这可以吗？至于东垣所说的食塞肺分，为金与土旺于上而克木，也不能使人没有疑问。金克木，是五行的常道，确实不需要等到物伤之后才能发生。况且既然被物所伤，哪有反而旺盛的道理？如果说吐去其物，以伸张木气，那是针对木郁施治，而不是针对食伤施治了。食塞胸中而用吐法，正是《内经》所谓“其高者因而越之”的意思罢了，恐怕不必引用木郁的说法来附会它。火郁发之；发，就是汗法，升举之法。比如腠理外闭，邪热怫郁，就解表取汗以散之。又比如龙火郁甚于内，不能用苦寒沉降药治疗，就用升浮药，佐以甘温，顺其性而从治，比如升阳散火汤就是这类。这些都是发之的方法。土郁夺之；夺，就是攻下，劫夺使其衰败。比如邪热入胃，用咸寒之剂，以攻去之。又比如中满腹胀，湿热内甚，其人壮气实者，就攻下之。或者势盛而不能顿除者，就劫夺其势使之衰。又比如湿热为痢，有非轻剂可治者，就或攻或劫，以达到平衡。这些都是夺之的方法。金郁泄之；泄，就是渗泄利小便，疏通其气。比如肺金为肾水上源，金受火烁，其令不行，源郁而渗道闭矣，宜整肃金化滋以利之。又比如肺气郁，胸满仰息，不利肺气不足以疏通之。这些都是泄之的方法。王氏说渗泄解表利小便，是金郁泄之。渗泄利小便，固然是泄金郁，那“解表”二字，不懂其意，莫非是因为人的皮毛属肺，其受邪为金郁，而解表为泄之吗？我认为如此，那么凡筋病便是木郁，肉病便是土郁吗？且解表间于渗泄、利小便之中，是渗泄、利小便是两种治法了。若以渗泄为滋肺生水，以利小便为直治膀胱，既责不在肺，何为金郁乎？这也是不通的。所以我改为：渗泄而利小便也。水郁折之；折，就是制御，伐而挫之，渐杀其势。比如肿胀之病，水气淫溢，而渗道以塞。水的所不胜者是土，现在土气衰弱，不能制水，故反受其侮，治当实其脾土，资其运化。使土可以制水而不敢犯，则渗道达而后愈也。或者病势既旺，非上法所能遽制，就用渗水之药，以伐而挫之；或者去菀陈莝、开鬼门、洁净府，三治备举迭用，以渐平之。王氏所谓抑之，制其冲逆，正欲折挫其泛滥之势也。实土者是守，泄水者是攻，兼三治者是广略而决胜也，虽俱为治水之法，然不审病之虚实、久近、浅深，杂焉而妄施之，其不倾踣者寡矣。且夫五郁之病，固有法以治之矣，然邪气久客，正气必损；今邪气虽去，正气岂能遽平？苟不平调正气，使各安其位，复其常于治郁之余，则犹未足以尽其妙。故又曰∶然调其气，苟调之而其气犹或过而未服，则当益其所不胜以制之。如木过者，当益金，金能制木，则木斯服矣。所不胜者，所畏者也。故曰∶过者折之，以其畏也。夫制物者，物之所欲也；制于物者，物之所不欲也；顺其欲则喜，逆其欲则恶。今逆之以所恶，故曰，所谓泻之。王氏以咸泻肾、酸泻肝之类为说，未尽厥旨。（王安道）
《内经》说∶木郁达之。解释的人认为达是宣吐；又说，用柴胡、川芎条达之。我认为这不过是随文训释，而对于达之意，还有未尽之处。夫木郁即肝郁也。《素问》说∶治病必求其本。郁证之起，必有所因，求其所因而治之，则郁自解；郁解，而达自在其中矣。何况木郁之证，妇人居多，其情性偏执；肝病变幻多端，总宜从其性，适其宜，而致中和，即为达也。彼若吐若升，止可以言实，未可以言虚。今人柔脆者恒多，岂可概施升吐哉？若火土金水四郁，古人注释，虽于经义未悖，然亦止可以言实、言外因，未可以言虚、言内因也。盖因郁致疾，不特外感六淫，而于情志为更多，治当求其所因，则郁自解；郁解，则发、夺、泄、折，俱在其中矣。因者，病之本；本之为言，根也，源也。（《吴医汇讲》）
木郁宜达。若气陷不举者，发即达也；气壅不开者，夺即达也；气秘不行者，泄亦达也；气乱不调者，折亦达也。火郁当发。若元阳被抑，则达非发乎？脏腑留结，则夺非发乎？肤窍闭塞，则泄非发乎？津液不化，则折非发乎？且夺者，挽回之谓，大实，非大攻不足以荡邪；大虚，非大补不足以夺命，是皆所谓夺也。折者，折中之谓，火实则阳亢阴虚，火虚则气不化水，制作随宜，是皆所谓折也。○凡五气之郁，则诸病皆有，此因病而郁也。至若情志之郁，则总由乎心，此因郁而病也。第自古言郁者，但知解郁顺气，通作实邪论治，兹予辨其三证，庶可无误。盖一曰怒郁，二曰思郁，三曰忧郁。如怒郁者，方其大怒气逆之时，则实邪在肝，多见气满腹胀，所当平也。及其怒后而逆气已去，惟中气受伤矣，既无胀满疼痛等证，而或为倦怠，或为少食，此以木邪克土，损在脾矣。是可不知培养而仍加消伐，则所伐者其谁乎？此怒郁之有先后，亦有虚实，所当辨治者如此。○又若思郁者，则惟旷女嫠妇，及灯窗困厄，积疑任怨者皆有之。思则气结，结于心而伤于脾也。及其既甚，则上连肺胃，而为咳喘，为失血，为隔噎，为呕吐；下连肝肾，则为带浊，为崩淋，为不月，为劳损。若初病而气结为滞者，宜顺宜开；久病而损及中气者，宜修宜补。然以情病者，非情不解，其在女子，必得顺遂而后可释；或以怒胜思，亦可暂解。其在男子，使非有能屈能伸，达观上智者，终不易却也。○又若忧郁者，多以衣食之累，利害之牵，及悲忧惊恐而致者。盖悲则气消，忧则气沉，必伤脾肺；惊则气乱，恐则气下，必伤肝肾。此其戚戚悠悠，精气但有消索，神志不振，心脾日以耗伤，凡此皆阳消之证，尚何实邪？而再加解散，其与鹭鸶脚上割股者，何异也！（张景岳）
东方生木，木者生生之气，木郁则火亦郁矣。火郁则土郁，土郁则金郁，金郁则水郁，此五行相因，自然之理。予以一方治其木郁，而诸郁皆愈。一方者何？逍遥散是也。方中柴胡、薄荷二味最妙，盖木喜风，风摇则舒畅。甚者加黄连以治心火；吴萸气臊，肝之气亦臊，同气相求，而佐金以制木，此左金之所以得名也。然犹未也。一服之后，继用六味地黄汤，加柴胡、芍药以滋肾水，俾水能生木。逍遥散，风以散之也；地黄汤，雨以润之也。木火之郁既舒，木不克土，土亦滋润，无燥之病，金水自相生矣。予谓一法可通五法者如此，岂惟是哉！推之大之，其益无穷。凡寒热往来，似疟非疟，吐酸嘈杂，胸胁痛，小腹胀闷，黄胆瘟疫，疝气飧泄等证，皆对证之方也。推而至于伤风、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！（《赵氏医贯》）
《内经》论“木郁达之”五句，治郁之法最详。所谓郁者，清气不升，浊气不降也。然清浊升降，皆出于肺，使太阴失治节之令，不惟生气不升，收气亦不降，上下不交，而郁成矣。故《经》云∶太阴不收，肺气焦满。又云∶诸气郁，皆属于肺。然肺气之布必由胃气之输，胃气之运必本三焦之化，甚至为痛、为呕、为胀、为利，莫非胃气不宣，三焦失职所致。故五郁之中，金木尤甚。前人用逍遥散调肝之郁，兼清火滋阴；用泻白散清肺之郁，兼润燥降逆。要以木郁上冲即为火，金郁敛涩即为燥也。（季楚重）
郁之为病，非止一端∶有郁久而生病者，有病久而生郁者，有误药而成郁者。故凡病属郁，古人立越鞠丸以治之。王节斋云∶气虚者，兼用四君；血虚者，兼用四物；挟痰者，兼用二陈，得其要矣。（罗赤诚）
郁证，多缘于志虑不伸，气先受病，故越鞠、四七，始而立也。郁之既久，火邪耗血，岂苍术、香附辈能久服乎？是逍遥、归脾继而设也。然郁证多患于妇人，《经》谓二阳之病发心脾，及思想无穷，所愿不得，皆能致病。为证不一∶或发热头痛者有之，喘嗽气乏者有之，经闭不调者有之，狂癫失志者有之，火炎失血者有之，骨蒸劳瘵者有之，疽生虫者有之。治法总不离乎逍遥、归脾、左金、越鞠、四七等方，参究新久虚实选用。（张路玉）
归脾汤，治脾而开郁；逍遥散，治肝而疏郁，二方为治郁妙剂，他药恐消耗元气，宜慎用之。（《折肱漫录》）
郁证主于开郁，开郁不过行气，行气则用香燥。然有香燥过多，因而窍不润泽，气终不行，郁终不开者，宜用养血药以润其窍，利其经，香附、川芎不足恃也。（吴篁池）
治郁之法，多以调中为要者，盖脾胃居中，心肺在上，肾肝处下，四脏所受之邪过于中者，中先受之。况饮食不节，寒暑不调，停痰积饮，而脾胃亦先受伤，所以中焦致郁恒多也。治宜开发运动，鼓舞中州，则三阴、三阳之郁，不攻自解矣。（《证治汇补》）
《经》言五郁之发，乃因五运之气太过不及，遂有胜复之变。由此观之，天地且有郁，况于人乎！故六气着人，皆能郁而致病。如伤寒之邪郁于营卫，暑湿之蕴于三焦，疫邪之客于膜原，风、寒、湿三气，杂感而
[Classic Theory]
All disorders of Qi stagnation belong to the Lung. ○ For Wood stagnation (Liver Qi stagnation), one should employ the method of dispersing and smoothing; for Fire stagnation (Heart Fire stagnation), one should employ the method of venting and releasing; for Earth stagnation (Spleen-Stomach stagnation), one should employ the method of purging and reducing; for Metal stagnation (Lung Qi stagnation), one should employ the method of draining and unblocking; for Water stagnation (Kidney and Bladder water-dampness stagnation), one should employ the method of restraining and checking. However, to regulate Qi, for excessive pathogens, the method of restraining should be used, because this conforms to the nature that the Zang-Fu organs fear, which is what is meant by "draining" (Xie). (From *Su Wen*)
[Philosophical Remarks]
Flowing water does not rot, and a door pivot does not get eaten by worms, because they are in motion. The human form and Qi are the same; if the form does not move, Essence (Jing) will not circulate, and if Essence does not circulate, Qi stagnation will occur. (From *Lüshi Chunqiu*)
Stagnation (Yu) refers to the accumulation and inability to vent forth; what should ascend cannot ascend, what should descend cannot descend, what should transform cannot transform, thus leading to dysfunction in transmission and transformation, resulting in disease. (Hua Borén)
When Qi and Blood are harmonious and smooth, hundred diseases do not arise; once there is obstruction (Fu Yu) [Qi mechanism dysfunction], hundred diseases arise from it. Its causes are six: namely Qi, Dampness, Heat, Phlegm, Blood, and Food. Qi stagnation generates Dampness; Dampness stagnation becomes Heat; Heat stagnation becomes Phlegm; Phlegm stagnation impedes Blood flow; Blood stagnation impedes food digestion. These six factors cause disease mutually and causally. ○ Symptoms of Qi stagnation include pain in the chest and hypochondrium, with a deep and choppy pulse. Symptoms of Dampness stagnation include joint pain, occurring on cloudy days, with a deep and fine pulse. Symptoms of Heat stagnation include dizziness, mental stuffiness, irritability, red and scanty urine, with a deep and rapid pulse. Symptoms of Phlegm stagnation include panting and urgency upon movement, with a deep and slippery pulse. Symptoms of Blood stagnation include weakness in the four limbs, ability to eat but bloody stools, with a deep and hollow (Kou) pulse.
Symptoms of Food stagnation include belching with sour taste, abdominal fullness, and inability to eat, with a tight and vigorous right pulse. It may also result from depression of the Seven Emotions (Joy, Anger, Worry, Pondering, Sorrow, Fear, Fright), alternating invasion of Cold and Heat, soaking of rain and dampness, or accumulation of wine and fluids, thereby forming stagnation diseases; furthermore, Heat stagnation forms Phlegm, Phlegm stagnation forms masses (Pi), Blood stagnation forms fixed masses (Jia), and Food stagnation forms fullness and blockage (Pi Man). This is an inevitable principle. (Zhu Danxi)
There are cases where disease arises from the self-stagnation of the primary Qi: Heart stagnation leads to mental confusion and forgetfulness; Liver stagnation leads to distension in the hypochondrium and belching; Spleen stagnation leads to middle-jiao fullness and loss of appetite; Lung stagnation leads to dry cough without phlegm; Kidney stagnation leads to waist distension, strangury, and inability to stand for long periods; Gallbladder stagnation leads to bitter taste in the mouth, afternoon fever, and palpitations. (*Zhengzhi Huibu*)
Unhappiness of the Seven Emotions, when stagnant for a long time, becomes disease: it may become deficiency and timidity, dysphagia, fullness and blockage, abdominal distension, or hypochondriac pain; in women, it may lead to amenorrhea, miscarriage, leukorrhea, and metrorrhagia. Thus, it can be seen how common hundred diseases are accompanied by stagnation. (He Bozhai)
[Supplement]
"Wood stagnation, disperse it" means using emesis to make it smooth and spreading. "Fire stagnation, vent it" means using diaphoresis to make it dispersed. "Earth stagnation, purge it" means using purgation to eliminate obstruction. "Metal stagnation, drain it" means using diuresis and resolving the exterior. "Water stagnation, restrain it" means suppressing it to control its rebellious upward surge. (Wang Taipu)
Stagnation is obstruction and blockage. Once there is any stagnation, simply unblock it. The *Classic* has five methods, all used to unblock, only the methods of unblocking differ. For example, smoothing and spreading is the nature of Wood. If the nature of Wood is stagnant, it cannot spread smoothly. Like dense branches and leaves where insects breed, causing withering, if one does not prune and remove them, failing to follow their nature, then the *Classic* says "disperse it". Dispersing it means tonifying the Liver by clearing it. Flaming upward is the nature of Fire. If the nature of Fire is stagnant, it cannot flame upward. Like covering ash piles, if the Fire Qi does not rise, it will extinguish; if one does not stir and blow, failing to follow its nature, then the *Classic* says "vent it". Venting it means ascending and dispersing without needing to counteract and check. As for Earth stagnation, like blocked roads or landslides hindering passage, it cannot be cleared without baskets and spades, so the *Classic* says "purge it". As for Metal stagnation, like casting bells or striking gongs, if cast too thickly, there is no sound; it must be scraped and ground before it resonates with the pitch pipes, so the *Classic* says "drain it". Opening lung orifices, opening sweat pores, or promoting urination are all methods of draining. Water flows naturally and should have no stagnation; if dams block it or filth clogs it, fearing overflow, one creates detours to slow it down, called distributing and eliminating. Diaphoresis, purgation, and diuresis are used as appropriate, not limited to one method. (*Yican*)
The five sentences "Wood stagnation, disperse it..." in the *Nei Jing* are methods for treating stagnation; "However, regulate its Qi" is a residual method for treating post-stagnation conditions; "Excess should be restrained" are residual methods for regulating Qi. Although these five methods were established by the *Classic* for diseases caused by the stagnation of the Five Movements (Wu Yun), they can be expanded and applied broadly. Moreover, most diseases originate from stagnation; stagnation means obstruction and lack of free flow. It may arise from being overcome (Cheng) or from the primary Qi stagnating on its own; both are stagnation. Is it only the changes of the Five Movements that cause this? Wood stagnation, disperse it; Disperse means to make smooth and unobstructed. For instance, if the Liver nature is urgent, anger causes Qi rebellion, hypochondriac distension occurs, and Fire flares up frequently, and bitter-cold and acrid-dispersing medicines fail to cure, then use ascending and dispersing herbs, combined with Jueyin guiding herbs, to treat according to the nature. Similarly, if prolonged Wind enters the interior causing undigested stool diarrhea, or if clear Qi sinks below causing undigested stool diarrhea without external Wind invasion, use light and揚 (yang/rising) formulas to lift and disperse. These are all methods of dispersing. Master Wang considers emesis to make things smooth as Wood stagnation dispersion. Dongyuan considers food blocking the chest; food belongs to Kun Earth, the chest is the Metal position, Metal governs killing and cutting, and both Metal and Kun Earth are upper and prosperous in Heaven, Metal overcomes Wood, so the generating Qi of Liver Wood is buried underground, is this not Wood stagnation? Emesis removes Yin-Earth substances from the Upper Jiao, Wood becomes comfortable, and stagnation resolves; this is Wood stagnation dispersion. I privately believe Master Wang's explanation of emesis as dispersion raises doubts. Does he mean Lung Metal is excessive and suppresses Liver Wood? Then draining Lung Qi and raising Liver Qi would suffice, no need for emesis. Does he mean Spleen-Stomach turbid Qi flows downward, and Shaoyang clear Qi fails to ascend? Then benefiting Stomach Qi and raising Yang would suffice, no need for emesis. Although there is logic for emesis in Wood stagnation, now using "emesis" to generalize "dispersion" implies all Wood stagnation requires emesis, which is unacceptable. As for Dongyuan's claim that food blocks the Lung sector, with Metal and Earth prosperous above overcoming Wood, this also raises doubts. Metal overcoming Wood is the normal way of the Five Elements, indeed not requiring injury to occur first. Furthermore, if injured by objects, how could it be prosperous? If saying emesis removes the object to extend Wood Qi, that is treating Wood stagnation, not food injury. Using emesis for food blocking the chest is exactly the meaning of "those high up should be made to vomit" in the *Nei Jing*; it is unnecessary to invoke the theory of Wood stagnation. Fire stagnation, vent it; Vent means diaphoresis and lifting. For example, if pores are closed externally and pathogenic heat is obstructed, resolve the exterior and induce sweating to disperse it. Again, if Dragon Fire is severely stagnant internally, bitter-cold and sinking medicines cannot treat it; use floating and rising herbs assisted by sweet-warm ones, following its nature and treating accordingly, such as Shengyang Sanhuo Tang. These are all methods of venting. Earth stagnation, purge it; Purge means attacking and purging to reduce it. For example, if pathogenic heat enters the Stomach, use salty-cold agents to attack and remove it. Again, if there is middle-fullness and abdominal distension with severe internal damp-heat, and the person has strong Qi and substance, then purge it. Or if the condition is intense and cannot be removed instantly,劫夺 (rob and reduce) its momentum to weaken it. Again, if damp-heat causes dysentery, which cannot be treated with mild agents, then either attack or rob to achieve balance. These are all methods of purging. Metal stagnation, drain it; Drain means渗泄 (percolate and drain) and promoting urination, unblocking its Qi. For example, Lung Metal is the source of Kidney Water; if Metal is scorched by Fire, its commands fail, the source is stagnant, and the percolation channels close; one should regulate Metal transformation and nourish to promote drainage. Again, if Lung Qi is stagnant, causing chest fullness and orthopnea, draining Lung Qi is insufficient to unblock it. These are all methods of draining. Master Wang says percolating, resolving the exterior, and promoting urination is Metal stagnation draining. Percolating and promoting urination certainly drains Metal stagnation, but the meaning of "resolving the exterior" is unclear. Does he mean human skin and hair belong to the Lung, so when invaded by pathogens it is Metal stagnation, and resolving the exterior is draining? I think if so, then all tendon diseases are Wood stagnation, and all flesh diseases are Earth stagnation? Also, resolving the exterior is placed between percolating and promoting urination, making them two treatments. If percolating is nourishing Lung to generate Water, and promoting urination is directly treating the Bladder, since the responsibility is not on the Lung, why is it Metal stagnation? This is also illogical. Therefore, I change it to: percolating and promoting urination. Water stagnation, restrain it; Restrain means controlling, attacking and crushing, gradually killing its momentum. For example, in edema diseases, Water Qi overflows, and percolation channels are blocked. What Water cannot overcome is Earth; now Earth Qi is weak and cannot control Water, so it suffers humiliation instead. Treatment should solidify Spleen Earth and assist transportation and transformation. Let Earth control Water so it dares not offend, then percolation channels open and recovery follows. Or if the disease momentum is already strong and cannot be quickly controlled by the above methods, use water-draining herbs to attack and crush it; or combine Quwen Chen Cuo (removing accumulated decay), Kaiguimen (opening ghost gates/sweating), and Jingjifu (cleaning the residence/diuresis), using all three treatments alternately to gradually calm it. Master Wang's "suppressing it to control rebellious surge" aims precisely to crush its overflowing momentum. Solidifying Earth is defense; draining Water is attack; combining three treatments is broad strategy for decisive victory. Although all are methods of treating Water, if one does not examine the deficiency/excess, duration, and depth of the disease, and mixes them arbitrarily, few will avoid collapse. Furthermore, although there are methods for the five stagnations, if pathogenic Qi stays long, Righteous Qi must be damaged; even if pathogenic Qi is gone, can Righteous Qi recover immediately? If one does not harmonize Righteous Qi, letting each return to its place and restore normalcy after treating stagnation, then one has not exhausted the subtleties. Hence it says: "However, regulate its Qi." If after regulation the Qi is still excessive and unyielding, then benefit its unconquered element to control it. For example, if Wood is excessive, benefit Metal, as Metal controls Wood, then Wood will submit. The unconquered element is the feared element. Hence it says: "Excess should be restrained, because it fears [the controlling element]." That which controls things is desired by things; that which is controlled by things is unwanted by things; following desires brings joy, opposing desires brings aversion. Now opposing with what is disliked, hence it says, "what is called draining." Master Wang's explanation using salty-draining-Kidney and sour-draining-Liver does not fully capture the essence. (Wang Andao)
The *Nei Jing* states: "Wood stagnation, disperse it." Interpreters say dispersion is vomiting; also say, use Chaihu and Chuanxiong to smooth it. I believe this is merely interpreting the text, and the meaning of "dispersion" is not fully exhausted. Wood stagnation is Liver stagnation. The *Su Wen* states: "In treating disease, one must seek the root." The onset of stagnation syndromes must have a cause; seeking the cause and treating it, the stagnation resolves itself; once resolved, dispersion is inherent within it. Moreover, Wood stagnation syndromes are more common in women, whose temperaments are often stubborn; Liver pathology is变幻多端 (variable and complex), one should always follow its nature, adapt to appropriateness, and achieve harmony, which is dispersion. Methods like emesis or lifting apply only to excess, not deficiency. Nowadays, people are often delicate and fragile, how can lifting and emesis be applied generally? For Fire, Earth, Metal, and Water stagnations, ancient commentaries, while not contradicting the classic meaning, apply only to excess and external causes, not to deficiency and internal causes. Generally, diseases caused by stagnation are not only due to external Six Evils, but more so due to emotional factors. Treatment should seek the cause, then stagnation resolves; once resolved, venting, purging, draining, and restraining are all included. The cause is the root of the disease; "root" means source and origin. (*Wu Yi Hui Jiang*)
Wood stagnation should be dispersed. If Qi sinks and fails to rise, venting is dispersion; if Qi is congested and fails to open, purging is dispersion; if Qi is constipated and fails to move, draining is dispersion; if Qi is chaotic and fails to regulate, restraining is dispersion. Fire stagnation should be vented. If Yuan Yang is suppressed, is dispersion not venting? If organs and bowels have retained knots, is purging not venting? If skin pores are closed, is draining not venting? If body fluids fail to transform, is restraining not venting? Moreover, "Purge" means rescuing; for great excess, only great attacking can sweep away evil; for great deficiency, only great tonification can save life; these are all called "purge". "Restrain" means moderation; for Fire excess, Yang is hyperactive and Yin is deficient; for Fire deficiency, Qi fails to transform Water; applications vary appropriately; these are all called "restrain". ○ For stagnation of the Five Qi, various diseases exist; this is stagnation caused by disease. Regarding emotional stagnation, it originates from the Heart; this is disease caused by stagnation. Since ancient times, those speaking of stagnation only know to resolve stagnation and smooth Qi, generally treating it as excess pathogen. Here I distinguish three syndromes to avoid error. First is Anger Stagnation (Nu Yu); during sudden anger and Qi rebellion, excess pathogen is in the Liver, manifesting as Qi fullness and abdominal distension, which should be pacified. After anger subsides and rebellious Qi is gone, only Middle Qi is injured; without distension or pain, but perhaps fatigue or poor appetite, this is Wood evil overcoming Earth, damaging the Spleen. If one does not nourish but continues to attack, whom is one attacking? Thus, Anger Stagnation has sequence and deficiency/excess aspects that must be distinguished. ○ Second is Pondering Stagnation (Si Yu); it occurs in unmarried women, widows, scholars trapped in poverty, and those accumulating suspicion and bearing resentment. Pondering knots Qi, knotting in the Heart and damaging the Spleen. When severe, it connects upward to Lung and Stomach, causing cough/asthma, bleeding, dysphagia, vomiting; downward to Liver and Kidney, causing leukorrhea/turbidity, metrorrhagia/menstrual issues, amenorrhea, and consumptive disease. In early stages with Qi knotting and stagnation, one should smooth and open; in chronic stages damaging Middle Qi, one should repair and tonify. However, diseases caused by emotions cannot be resolved without emotional resolution. In women, relief comes only when wishes are fulfilled; or anger overcoming pondering can provide temporary relief. In men, unless one is flexible and optimistic, it is difficult to resolve. ○ Third is Depression Stagnation (You Yu); often caused by burdens of food and clothing, concerns of profit and loss, and sorrow, worry, fright, and fear. Sorrow dissipates Qi, worry sinks Qi, inevitably damaging Spleen and Lung; Fright scatters Qi, Fear sinks Qi, inevitably damaging Liver and Kidney. Their anxious and lingering state causes Essence and Qi to waste away, spirit lacks vigor, and Heart and Spleen are consumed daily. All these are Yang-consumption syndromes, where is the excess pathogen? Adding dispersing and resolving treatments here, what is the difference from cutting flesh off a heron's legs! (Zhang Jingyue)
The East generates Wood; Wood is the Qi of generation. Wood stagnation leads to Fire stagnation. Fire stagnation leads to Earth stagnation; Earth stagnation leads to Metal stagnation; Metal stagnation leads to Water stagnation. This is the natural principle of the interdependence of the Five Elements. I use one formula to treat Wood stagnation, and all stagnations heal. What is this one formula? Xiaoyao San (Free and Easy Wanderer Powder). The two herbs Chaihu and Bohe in the formula are excellent, for Wood likes wind, and wind shaking makes it comfortable. For severe cases, add Huanglian to treat Heart Fire; Wu Zhu Yu has a fishy odor, and Liver Qi also has a fishy odor; similar energies seek each other, assisting Metal to control Wood, hence the name Zuojin Wan (Left Metal Pill). But this is not enough. After one dose, continue with Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia), adding Chaihu and Shaoyao to nourish Kidney Water, enabling Water to generate Wood. Xiaoyao San uses wind to disperse; Dihuang Tang uses rain to moisten. Once Wood and Fire stagnation are relaxed, Wood does not overcome Earth, Earth becomes moistened, avoiding dryness diseases, and Metal and Water generate each other naturally. I say one method can pass through five methods like this, isn't this beneficial infinitely? Pushing it further, it applies to chills and fever alternating, malaria-like but not malaria, acid regurgitation and stomach discomfort, chest and hypochondriac pain, lower abdominal fullness, jaundice and plague, hernia, and undigested stool diarrhea. It is a specific formula for these syndromes. Extending it to wind-cold, cold damage, and dampness injury, except for direct invasion, all external infections can be viewed as stagnation, and with modifications of Xiaoyao San, efficacy is invariably achieved. Such as Xiao Chaihu Tang, Sini San, Qianghuo Tang, are largely similar with minor differences, yet none match the responsiveness of this formula. Spiritual illumination and flexible application depend on the practitioner! (*Zhao Shi Yi Guan*)
The *Nei Jing* discusses the five sentences "Wood stagnation, disperse it...", detailing methods for treating stagnation most thoroughly. What is meant by stagnation is clear Qi failing to ascend and turbid Qi failing to descend. However, the ascent and descent of clear and turbid Qi all originate from the Lung; if the Taiyin fails to issue commands of governance, not only will generating Qi fail to ascend, but receiving Qi will also fail to descend, upper and lower fail to interact, and stagnation forms. Hence the *Classic* states: "Taiyin does not receive, Lung Qi becomes scorched and full." And again: "All Qi stagnation belongs to the Lung." However, the distribution of Lung Qi must rely on the transport of Stomach Qi, and the operation of Stomach Qi must be based on the transformation of the Sanjiao. Even pain, vomiting, distension, and diarrhea are all caused by Stomach Qi failing to disseminate and Sanjiao failing in its duties. Thus, among the five stagnations, Metal and Wood are particularly severe. Predecessors used Xiaoyao San to regulate Liver stagnation, simultaneously clearing Fire and nourishing Yin; used Xiebai San to clear Lung stagnation, simultaneously moistening dryness and descending rebellion. Essentially, Wood stagnation rushing upward becomes Fire, and Metal stagnation contracting and astringing becomes Dryness. (Ji Chuzhong)
Diseases of stagnation are not limited to one aspect: there are those who develop disease after long-term stagnation, those who develop stagnation after long-term disease, and those who form stagnation due to erroneous medication. Therefore, for all diseases belonging to stagnation, the ancients established Yueju Wan to treat it. Wang Jiezhai said: For Qi deficiency, combine Si Jun Zi Tang; for Blood deficiency, combine Si Wu Tang; for Phlegm attachment, combine Er Chen Tang; this grasps the essentials. (Luo Chicheng)
Stagnation syndromes often arise from unexpressed thoughts and intentions, with Qi suffering first, hence Yueju and Siqi formulas were established. If stagnation persists, Fire evil consumes Blood, how can Cangzhu and Xiangfu be taken for long? Thus Xiaoyao and Guipi Tang were subsequently designed. However, stagnation syndromes are mostly suffered by women; the *Classic* states: "Diseases of the Two Yang originate in the Heart and Spleen," and endless thinking with unfulfilled desires can all cause disease. Syndromes vary: some have fever and headache, some have asthma/cough and Qi deficiency, some have irregular menstruation/amenorrhea, some have mania/depression and loss of will, some have Fire flaming and bleeding, some have bone-steaming consumption, some have ulcers with parasites. Treatment methods generally do not depart from Xiaoyao, Guipi, Zuojin, Yueju, Siqi, etc., selecting based on new/chronic and deficiency/excess. (Zhang Luyu)
Guipi Tang treats the Spleen and opens stagnation; Xiaoyao San treats the Liver and disperses stagnation. These two formulas are excellent agents for treating stagnation; other drugs may consume Yuan Qi and should be used cautiously. (*Zhe Gong Man Lu*)
Treating stagnation focuses on opening stagnation; opening stagnation is merely moving Qi; moving Qi uses aromatic-dry herbs. However, if aromatic-dry herbs are used excessively, orifices become unmoistened, Qi ultimately fails to move, and stagnation remains unopened; in such cases, use Blood-nourishing herbs to moisten orifices and benefit meridians, relying solely on Xiangfu and Chuanxiong is insufficient. (Wu Huangchi)
Methods for treating stagnation often emphasize regulating the Middle, for the Spleen and Stomach are central, Heart and Lung are upper, Liver and Kidney are lower. Pathogens affecting the Four Zang organs that exceed the Middle are first received by the Middle. Moreover, irregular diet and mismatched cold/heat cause retained Phlegm and accumulated fluids, injuring the Spleen and Stomach first, so Middle Jiao stagnation is common. Treatment should involve developing and moving, encouraging the Central State, so that stagnation of the Three Yin and Three Yang resolves without direct attack. (*Zhengzhi Huibu*)
The *Classic* states the emergence of the five stagnations is due to the excess or deficiency of the Qi of the Five Movements, leading to winning and repelling changes. From this, we see that Heaven and Earth have stagnation, let alone humans! Thus, the Six Qi attaching to humans can all cause stagnation and disease. For example, Cold Damage pathogens stagnate in Ying and Wei; Summerheat and Dampness accumulate in the Sanjiao; Epidemic pathogens lodge in the Membrane Source; Wind, Cold, and Dampness, mixed and contracted...