成痹证。总之，邪不解散即谓之郁，此外感六气而成者也。七情之郁，如思伤脾、怒伤肝之类，其原总由于心，
情志不遂，则郁而成病，其证心脾肝胆为多。治有清泄
上焦郁火，或宣畅少阳，或开降肺气，及通补肝胃、泄胆补脾、宣通脉络诸法。若热郁至阴，则用咸补苦泄。
夫郁则气滞，久必化热，热郁则津液耗而不流，升降之机失其常度，初伤气分，久延血分，而为郁劳沉 。用
药以苦辛凉润宣通，不投燥热敛涩呆补，此治疗之大法也。且郁则气滞，其滞或在形躯，或在脏腑，必有不舒
之证。盖气本无形，郁则气聚，似有形而实无质，如胸膈似阻，心下虚痞，胁胀背胀，脘闷不食，气瘕攻冲，
筋脉不舒等候。医家误认有形之滞，破气攻削，迨至愈治愈剧，转方又属呆补，此不死于病，而死于药矣。不
知情志之郁，由于隐曲不伸，故气之升降开阖，枢机不利，虽《内经》有泄、折、达、发、夺五郁之治，犹虑
难全。故《疏五过论》有尝富后贫，故贵脱势，总属难治之例。盖郁证全在病者能移情易性，医者构思灵巧，
不重在攻补，而在乎用苦泄热而不损胃，用辛理气而不破气，用滑润濡燥涩而不滋腻气机，用宣通而不揠苗助
长，庶几幸成。若必欲求十全之治，则惟道家有言，欲要长生，先学短死，此乃治郁之金丹也。（《临证指南》）
诸病久则气滞血凝而成郁结，治之各因其证，兼以解郁，郁滞一开，则气血通畅，而诸病自愈矣。今医
治久病，每用本病之药而不效者，皆郁之故也。医不悟此，妄变他方，愈变愈讹，而病剧矣。此郁之治，当熟
知也。（徐春甫）
脉候
郁火脉，极难看，大抵多弦涩凝滞，缘火不透发，则经脉俱为所遏，故多沉伏不出耳。（《己任编》）
凡沉细脉，人皆以为寒，或见其体弱，又误认为虚，不知郁脉沉细，前人已言之矣。（方星岩）
古人皆以结、促为郁脉，使必待此而后为郁，则郁证不多见矣。凡诊郁证，但见气血不顺，而脉不平和者，
皆郁也。（张景岳）
郁脉，虽多沉伏结促，不为患也，所虑在牢革弦强不和耳。
盖沉、伏、结、促，有气可散，气通则和。若牢革弦强，则正气先伤，无气可散，即从事调补，尚难克效，况
复误行耗气之药乎！所以郁证得弦强脉者，往往多成虚损也。（张路玉）
凡抑郁之病，用开郁药，而脉反洪大者，可不必虑，此病气已开也。（罗赤诚）
选案
予壮年因忧郁致疾，状如劳瘵，遍服补养诸方，其病愈重。后遇一名医，视之曰∶尔乃郁疾，非虚损也。
用越鞠丸治愈。（《东阳文集》）
一妇无子致郁，经不行者三月，病患腹痛恶心，医云有孕，安胎行气止痛，服药不效。凡未申时即发寒热，
腹中有块如弹子大者二、三十枚，翻腾作痛，行动水声漉漉，痛极呕吐酸水，吐尽则块平，而寒热除，痛亦不
作，明日依然。又作疟治转剧。予诊左弦尺涩，右濡弱，尺同左。谓曰∶此郁病也，岂有涩脉成孕之理。方以
二陈、香附、山栀、抚芎、延胡、当归、红花，药进痛止，药止痛发，调治一月，不能除根。因令就黄古潭先
生诊视，曰∶此郁火病也，其原起于肝胆，肝主谋虑，胆主决断，谋虑不决则郁生，郁生则木盛，木盛则凌脾，
脾伤则不能运化精微而生气血，故月水不来；金失母养，降令不行，木寡于畏，侮所不胜，故直犯清道而作吐，
吐后诸证皆减者，木升而火熄也。方用黄 五钱，柴胡三钱，白芍二钱，甘草一钱，陈皮、贝母、枳实各五分，
姜三片，一服而寒热除，再服而痛减吐止，水声亦绝。其夫喜曰∶何神速也？复请命于先生，曰∶寒热者，少
阳胆也；吐酸者，厥阴肝也；痛而腹块翻腾者，火盛激动其水，如锅中汤泡沸腾也。吐多则肺金愈伤，故用黄
补肺金为君，使得以制肝木；柴胡泻肝为臣，升发其胆火。《经》曰∶木郁达之。夫木性上升者也，郁则不
升，故用柴胡升发肝胆之清气，使冲开其郁结；过者折之，以其畏也，所谓泻之；补肺制肝，正谓此也。损其肝
者缓其中，甘草缓中为佐；木位之主，其泻以酸，白芍于土中泻木为佐。病久生郁，郁久生涎，贝母、陈皮、
枳实，开郁逐涎为使。然后金得其正，木得其平，土得其安，由是病去而愈速。前方用山栀降下之药，火势正
炽，岂区区寒凉所能抑哉？轻者正治，重则从其性而升之，治病要识此意。（孙一奎）
一人久抱忧郁，如痴如呆，忽笑忽哭，口中喃喃，不思饮食，家人偶持炭过，大喜夺食，后遂为常，每日
必食斤许，医用化痰清心之剂无功。予谓郁伤肝木，木火自焚，渐成焦腐，炭为木烬，同类相求。病可治者，
喜在食则胃气犹存，但补心肝之气血，而去其痰涎自愈。（程仲华）
导致痹证。总之，邪气不能解散就称为郁，这是外感六淫之气所形成的病证。七情内伤导致的郁，如思虑过度损伤脾脏、愤怒过度损伤肝脏等，其根源总在于心，情志不畅，就会因郁而致病，这类病症多涉及心、脾、肝、胆。治疗方法有清泄上焦的郁火，或宣畅少阳经气，或开降肺气，以及通补肝胃、泄胆补脾、宣通脉络等多种方法。如果热邪郁结于至阴部位，则采用咸味药以补、苦味药以泄的方法。
郁滞会导致气机阻滞，日久必然化热，热郁则津液耗损且运行不畅，升降的气机失去了正常的节度，初期损伤气分，日久延及血分，从而形成郁劳沉疴。用药应以苦、辛、凉、润、宣、通为主，不投用燥热、收敛、涩滞、呆补的药物，这是治疗的大法。况且郁滞导致气机阻滞，这种阻滞或在形体躯壳，或在脏腑内部，必定会有不适的症状。气本来是无形的，郁滞则气聚，看似有形实则无实质，如胸膈部感觉阻塞，心下虚痞满，胁肋和背部胀满，脘腹闷塞不想进食，气瘕攻冲作痛，筋脉舒展不利等情况。医生误认为是实体的积滞，使用破气攻削的药物，等到病情越来越重，再换方又使用呆补之法，这不仅是死于疾病，更是死于药物之误。不了解情志之郁，是由于隐曲之事不得伸展，所以气的升降开阖，枢机不利，虽然《内经》有泄、折、达、发、夺五种治郁的方法，但仍担心难以周全。所以《疏五过论》中提到曾经富有后来贫穷，曾经尊贵后来失势，都属于难治的例子。大概郁证全在于病人能移情易性，医生构思灵巧，不重在攻伐或补益，而在于用苦味药泄热而不损伤胃气，用辛味药理气而不破散正气，用滑润药濡养燥涩而不滋腻气机，用宣通之法而不拔苗助长，这样或许才能侥幸成功。如果一定要追求十全十美的治疗，那就只有道家所说的话：想要长生，先学短死，这才是治疗郁证的“金丹”。（摘自《临证指南》）
各种疾病日久就会导致气滞血凝而成郁结，治疗时各依据其证候，兼以解郁，郁滞一旦开通，气血通畅，各种疾病自然痊愈。现在的医生治疗久病，每用治疗本病的药物却无效，都是郁的缘故。医生不明白这个道理，胡乱变换其他方剂，越变越错，病情反而加重了。这个郁的治疗原则，应当熟练掌握。（徐春甫）
脉象候诊
郁火脉，极难诊断，大抵多为弦、涩、凝滞之象，因为火邪不透发，经脉都被其所遏制，所以多表现为沉伏不出。（摘自《己任编》）
凡是沉细脉，人们都以为是寒证，或者见到患者身体虚弱，又误认为是虚证，不知道郁证的脉象也可以是沉细的，前人已经论述过了。（方星岩）
古人都认为结脉、促脉是郁脉，如果一定要等到出现这些脉象才诊断为郁，那么郁证就不多见矣。凡诊察郁证，只要见到气血不顺，而脉象不和缓的，都是郁证。（张景岳）
郁脉，虽然多表现为沉、伏、结、促，但这并不构成危害，令人担忧的是牢脉、革脉、弦脉、强脉且不调和的情况。
因为沉、伏、结、促，还有气可以疏散，气通则脉象调和。如果是牢、革、弦、强，则正气先已受伤，没有气可散，即使从事调补，尚且难以见效，何况再误用耗气的药物呢！所以郁证出现弦强脉的，往往多转化为虚损病。（张路玉）
凡是抑郁的病，使用开郁药后，脉象反而洪大的，不必忧虑，这是因为病气已经开通。（罗赤诚）
选录医案
我壮年时因忧郁致病，症状像劳瘵（肺结核），遍服补养的各种方剂，病情反而加重。后来遇到一位名医，诊治后说：“你是郁疾，不是虚损。”用越鞠丸治愈。（摘自《东阳文集》）
有一位妇女因无子嗣而致郁，月经三个月不行，患者腹痛恶心，医生说是有孕，给予安胎行气止痛的药，服药无效。每天未时到申时（下午1点到5点）即发作寒热，腹中有如弹子大小的硬块二三十枚，翻腾作痛，行动时腹部有水声漉漉作响，痛极时呕吐酸水，吐尽后硬块平复，寒热消退，疼痛也不再发作，第二天依然如此。又按疟疾治疗反而加重。我诊察左脉弦涩，右脉濡弱，尺脉同左脉。我说：“这是郁病，哪有涩脉成孕的道理？”处方用二陈汤加香附、山栀、抚芎、延胡索、当归、红花，药进后疼痛停止，但药效过后疼痛复发，调理一个月，未能除根。于是让患者去请黄古潭先生诊治，先生说：“这是郁火病，其根源起于肝胆，肝主谋虑，胆主决断，谋虑不决则生郁，生郁则木气旺盛，木盛则克制脾土，脾受伤则不能运化精微而生生气血，所以月经不来；肺金失去母脏（脾）的滋养，肃降功能不行，木气无所畏惧，反侮其所不胜（肺金），所以直接侵犯清道而呕吐，吐后诸证皆减轻，是因为木气上升而火气熄灭。方用黄芪五钱，柴胡三钱，白芍二钱，甘草一钱，陈皮、贝母、枳实各五分，生姜三片，一服后寒热消除，再服后疼痛减轻呕吐停止，水声也绝。她的丈夫高兴地说：‘怎么这么神速？’再次请教先生，先生说：‘寒热，属于少阳胆经；吐酸，属于厥阴肝经；疼痛且腹中硬块翻腾，是火盛激动其水，如同锅中汤泡沸腾。吐得多则肺金更伤，所以用黄芪补肺金为君药，使其能够制约肝木；柴胡泻肝为臣药，升发胆火。《内经》说：木郁达之。木性本是上升的，郁滞则不升，所以用柴胡升发肝胆的清气，使冲开郁结；过盛的予以折损，因其有所畏惧，这就是所谓的泻；补肺制肝，正是说的这个意思。损伤肝者要缓其中，甘草缓中为佐药；木位之主，其泻以酸，白芍在土中泻木为佐药。病久生郁，郁久生痰涎，贝母、陈皮、枳实，开郁逐痰为使药。然后金得其正，木得其平，土得其安，因此病去而痊愈迅速。前方用山栀这样的降下药，火势正炽，岂是区区寒凉所能抑制的呢？轻症正治，重症则顺从其性质而升之，治病要认识这个意旨。（孙一奎）
一个人长期怀抱忧郁，像痴呆一样，忽笑忽哭，口中喃喃自语，不思饮食，家人偶然拿着炭经过，大喜之下抢夺食物吃，后来这就成了习惯，每天必吃一斤左右，医生用化痰清心的药剂无效。我认为这是郁伤肝木，木火自焚，逐渐变成焦腐，炭是木的灰烬，同类相求。病可治，因为喜欢吃炭说明胃气犹存，只需补心肝之气血，而去其痰涎即可自愈。（程仲华）
Leading to Bi syndrome (Painful Obstruction Syndrome). In summary, when pathogenic factors fail to disperse, it is termed Yu (Stagnation); this type arises from the external contraction of the Six Excesses (Liu Yin). Stagnation caused by the Seven Emotions, such as excessive thinking damaging the Spleen or excessive anger damaging the Liver, has its root generally in the Heart. When emotional states are unfulfilled, stagnation occurs leading to disease; these conditions most frequently involve the Heart, Spleen, Liver, and Gallbladder. Treatment methods include clearing and draining stagnant fire in the Upper Jiao, or promoting the free flow of Shaoyang (Lesser Yang), or opening and descending Lung Qi, as well as various methods such as tonifying and unblocking the Liver and Stomach, draining the Gallbladder while tonifying the Spleen, and unblocking the collaterals. If heat stagnates in the Supreme Yin, saline tonification and bitter drainage should be used.
Stagnation leads to Qi obstruction; over time, it inevitably transforms into Heat. Heat stagnation consumes Body Fluids and impedes their flow, causing the mechanism of Ascending and Descending to lose its normal rhythm. Initially, the Qi aspect is damaged; prolonged illness extends to the Blood aspect, resulting in chronic debilitating conditions due to stagnation. Medications should employ Bitter, Acrid, Cool, Moistening, Dispersing, and Unblocking properties, avoiding Dry-Heat, Astringent, Stagnant, and Tonifying drugs. This is the general principle of treatment. Furthermore, since stagnation causes Qi obstruction, this obstruction may reside in the physical body or within the Zang-Fu organs, invariably presenting with sensations of discomfort. Qi is inherently formless; upon stagnation, Qi gathers, appearing substantial but lacking true substance. Symptoms may include a sensation of blockage in the chest and diaphragm, empty fullness below the heart, distension in the hypochondrium and back, epigastric stuffiness with loss of appetite, attacking pain from Qi masses (Qi Ji), and stiffness of sinews and vessels. Physicians mistakenly identify these as tangible obstructions and use harsh Qi-breaking and purgative therapies. As the condition worsens despite treatment, subsequent prescriptions often resort to rigid tonification. In such cases, patients do not die from the disease itself, but from erroneous medication.
One must understand that emotional stagnation arises from hidden grievances that cannot be expressed, thereby impairing the pivot mechanism of Qi's ascending, descending, opening, and closing. Although the *Neijing* (*Inner Canon*) describes five treatments for Five Types of Stagnation—Draining, Breaking, Reaching, Erupting, and Seizing—it is feared that these may not be entirely sufficient. Therefore, the *Shu Wu Guo Lun* (*Treatise on Five Negligences*) notes that cases involving a transition from wealth to poverty, or from nobility to loss of power, belong to categories that are difficult to treat. Essentially, treating Stagnation disorders relies on the patient's ability to shift their emotions and alter their character, and on the physician's skillful构思 (conceptualization). The focus is not primarily on attacking or tonifying, but rather on using Bitter herbs to drain Heat without damaging the Stomach, Acrid herbs to regulate Qi without dispersing it excessively, Slippery and Moistening herbs to nourish dryness without clogging the Qi mechanism, and Dispersing methods without hastening recovery unnaturally. Only then might success be achieved. If one insists on seeking a perfect cure, one must heed the Daoist saying: "If you wish to live long, first learn to die short." This is the "Golden Pill" for treating Stagnation. (From *Lin Zheng Zhi Nan* / *Guide to Clinical Practice*)
Various diseases, if prolonged, lead to Qi stagnation and Blood coagulation, forming nodules of stagnation. Treatment should address each specific pattern while simultaneously resolving stagnation. Once the stagnation is opened, Qi and Blood flow freely, and the various diseases heal themselves. Modern physicians often treat chronic diseases using herbs specific to the primary pathology without effect; this is due to the presence of Stagnation. Physicians who fail to comprehend this point recklessly change formulas, compounding errors and exacerbating the illness. The principles of treating Stagnation must be thoroughly mastered. (Xu Chunfu)
**Pulse Diagnosis**
The pulse of Stagnant Fire is extremely difficult to diagnose; it is generally wiry (Xian), choppy (Se), and sluggish. Because the Fire pathogen fails to erupt, the meridians are all constrained by it, resulting in a deep (Chen) and concealed (Fu) pulse that is hard to detect. (From *Ji Ren Bian* / *Compilation of Personal Experience*)
Generally, a Deep and Fine pulse is interpreted as Cold, or if the patient appears weak, it is mistaken for Deficiency. However, it is unknown that Stagnation pulses can also present as Deep and Fine; this has been discussed by predecessors. (Fang Xingyan)
Ancients considered Knotted (Jie) and Intermittent (Cu) pulses as indicative of Stagnation. If one waits for these specific pulses to diagnose Stagnation, Stagnation patterns would rarely be seen. In diagnosing Stagnation, whenever there is disharmony of Qi and Blood and the pulse is not smooth and harmonious, it indicates Stagnation. (Zhang Jingyue)
Although Stagnation pulses often present as Deep, Concealed, Knotted, or Intermittent, these are not necessarily dangerous. What warrants concern is the Firm (Lao), Leathery (Ge), Wiry (Xian), and Strong pulse indicating disharmony.
Deep, Concealed, Knotted, and Intermittent pulses indicate that Qi can still be dispersed; once Qi flows, harmony is restored. However, Firm, Leathery, Wiry, and Strong pulses indicate that the Healthy Qi (Zheng Qi) has already been damaged, leaving no Qi to disperse. Even with regulatory tonification, efficacy is difficult to achieve, let alone the misuse of Qi-depleting drugs! Therefore, Stagnation cases presenting with Wiry and Strong pulses often degenerate into Deficiency consumptive diseases. (Zhang Luyu)
In cases of depressive illness, if the pulse becomes Surging and Large after administering Stagnation-resolving herbs, there is no need to worry; this indicates that the pathogenic Qi has begun to open. (Luo Chicheng)
**Selected Cases**
In my youth, I fell ill due to depression and melancholy, presenting symptoms similar to Tuberculous Consumption (Lao Fei). I took various tonic prescriptions, yet my condition worsened. Later, I encountered a renowned physician who diagnosed me, stating, "You suffer from a Stagnation disorder, not a Deficiency consumptive disease." He cured me with Yueju Wan. (From *Dongyang Wenji* / *Collected Works of Dongyang*)
A woman developed depression due to infertility. Her menstruation had ceased for three months. She suffered from abdominal pain and nausea. The physician diagnosed pregnancy and administered herbs for calming the fetus, moving Qi, and relieving pain, but they were ineffective. Every day between Wei and Shen hours (1 PM – 5 PM), she experienced alternating chills and fever. There were two or thirty hard lumps in her abdomen, about the size of quail eggs, which churned painfully. Movement produced gurgling water sounds in the abdomen. Extreme pain triggered vomiting of sour fluid; after vomiting, the lumps subsided, chills and fever ceased, and pain stopped, only to recur the next day. Treatment as Malaria exacerbated the condition. My diagnosis revealed a Wiry and Choppy pulse on the left, and a Soft and Weak pulse on the right, with the Cunchi position matching the left. I stated, "This is a Stagnation disorder. How could a Choppy pulse indicate pregnancy?" The prescription consisted of Er Chen Tang combined with Xiang Fu, Shan Zhi, Fu Xiong, Yan Hu Suo, Dang Gui, and Hong Hua. Pain ceased during medication but returned afterward. After one month of regulation, the root cause was not eliminated. I then referred her to Mr. Huang Gutan. He said, "This is a Stagnant Fire disorder originating in the Liver and Gallbladder. The Liver governs planning; the Gallbladder governs decision-making. Indecision leads to Stagnation; Stagnation causes Wood Qi to flourish. Flourishing Wood attacks Earth (Spleen). The injured Spleen fails to transform and transport essences to generate Qi and Blood, hence amenorrhea. Metal (Lung) loses nourishment from its mother (Earth), so its descending function fails. Wood, lacking restraint, insults what it cannot overcome (Metal), directly invading the clear pathways causing vomiting. The reduction of symptoms after vomiting occurs because Wood rises and Fire extinguishes. The formula uses Huang Qi (5 qian), Chai Hu (3 qian), Bai Shao (2 qian), Gan Cao (1 qian), Chen Pi, Bei Mu, and Zhi Shi (0.5 qian each), and Ginger slices (3 pieces). After one dose, chills and fever resolved; after two doses, pain decreased and vomiting stopped, and water sounds ceased. Her husband rejoiced, asking, 'How is it so swift?' Upon further inquiry, he explained: 'Chills and fever relate to Shaoyang Gallbladder; vomiting acid relates to Jueyin Liver; painful churning lumps indicate Fire stirring Water, like boiling soup in a pot. Excessive vomiting injures Lung Metal further; thus, Huang Qi tonifies Lung Metal as the Sovereign herb to control Liver Wood. Chai Hu drains Liver as the Minister herb, raising Gallbladder Fire. The Classic states: "For Wood stagnation, reach it." Wood nature tends to ascend; stagnation prevents this. Thus, Chai Hu raises the clear Qi of Liver and Gallbladder to break through the stagnation. Excess is reduced by exploiting its fear, which is the method of Draining. Tonifying Lung to control Liver exemplifies this. To soothe the Liver, one must relax the center; Gan Cao acts as the Assistant to relax the center. For the primary pathology of Wood, draining is done with Sour; Bai Shao drains Wood within Earth as an Assistant. Prolonged illness generates Stagnation; prolonged Stagnation generates Phlegm-fluids. Bei Mu, Chen Pi, and Zhi Shi open Stagnation and expel Phlegm-fluids as the Envoy. Thus, Metal regains its righteousness, Wood achieves balance, and Earth finds peace, leading to rapid recovery. The previous formula used Shan Zhi, a downward-draining herb. With raging Fire, how could mere cold herbs suppress it? Mild cases are treated orthodoxy; severe cases follow the nature of the pathogen and raise it. One must grasp this intent in treating disease.' (Sun Yikui)
A man suffered from long-term depression, appearing demented, laughing and crying intermittently, muttering to himself, and losing his appetite. Once, seeing charcoal being carried past, he became overjoyed and snatched food to eat. This became a habit; he ate approximately one jin (catty) daily. Physicians used phlegm-resolving and Heart-calming agents without success. I reasoned that Stagnation injured Liver Wood, causing Wood and Fire to self-combust, gradually turning to ash. Charcoal is wood ash; like attracts like. The disease was treatable because the desire to eat charcoal indicated that Stomach Qi remained. By tonifying the Qi and Blood of the Heart and Liver and eliminating Phlegm-fluids, he healed spontaneously. (Cheng Zhonghua)