脉
脉多沉伏，或涩或芤。
证
《内经》曰∶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。此治五郁
之大要。盖郁者，结聚而不得发越也。当升者不得升，当降者不得降，当变化者不得变化也。此为传化失
常。六郁者，气、湿、热、痰、血、食是也。丹溪曰∶气血冲和，百病不生，一有怫郁，诸病生焉。
治
气郁，胸胁痛，脉沉涩，用香附（童便浸炒）、苍术、抚芎。
湿郁，周身走痛，或关节病，遇阴寒则发，脉沉缓，用苍术、川芎、白芷、茯苓、羌活、防风、柴胡。
热郁，目瞀，小便赤，脉沉数，用栀子、青黛、香附、苍术、抚芎、黄芩、天花粉。
痰郁，动则喘，寸口脉沉滑，用海石、南星、香附、栝蒌仁、贝母、竹沥、姜汁。
血郁，四肢无力，能食，便红或黑，脉沉而涩，用桃仁泥、红花、牡丹皮、延胡索、川芎、香附。
食郁，嗳酸，饱闷，畏闻食气，人迎脉平和，气口脉紧盛，用苍术、香附、山楂、神曲、枳实。
方
六郁汤 开诸郁之总司也。
香附（童便浸炒） 苍术（米泔浸炒） 神曲（炒） 山栀仁（炒黑） 连翘 陈皮
抚芎 贝母（去心） 枳壳（炒） 白茯苓 苏梗（各一钱） 甘草（五分）
上锉一剂，水煎服。有痰，加南星、半夏。有热，加柴胡、黄芩。血郁，加桃仁泥、红花。湿郁，加白
术、羌活。气郁，加木香，槟榔。食郁，加山楂、砂仁。
加味越鞠丸 解诸郁火痰气，开胸膈，进饮食。
苍术（米泔浸，姜汁炒，四两） 抚芎（四两） 香附（童便浸炒，四两） 神曲（炒，
四两） 栀子（炒黑，四两） 橘红（一两五钱） 白术（炒，一两半） 黄芩（炒，一两半）
山楂（去核，蒸熟，一两半）
上为末，稀糊丸如桐子大。每服百丸，白汤下。
越鞠保和丸〔批〕（按此方治诸郁之妙剂也） 扶脾开郁，行气消食，清热化痰。
苍术（米泔浸三宿，炒，一两） 抚芎（酒洗，一两） 神曲（炒，一两） 香附（童便
浸炒，一两） 栀子（炒，五钱） 陈皮（一两） 半夏（炮，一两） 白茯苓（一两） 连翘
（五钱） 莱菔子（炒，五钱） 枳实（麸炒，一两） 白术（三两） 黄连（酒炒，一两） 山
楂（去核，二两） 木香（五钱） 当归（酒洗，一两）
上为末，姜汁泡，蒸饼为丸，如桐子大。每服五十丸，淡姜汤下，或酒下亦可。
脉象
脉象多表现为沉伏，或者涩脉、芤脉。
证候
《黄帝内经》说：木郁应当疏达。意思是采用吐法，使其气机条达舒畅。火郁应当发散。意思是采用汗法，使其邪气疏散。土郁应当攻夺。意思是采用下法，使其没有壅滞阻塞。金郁应当宣泄。意思是采用渗利泄热的方法，解除表邪并通利小便。水郁应当制约。意思是抑制它，控制其冲逆之气。这是治疗五种郁证的总纲要。所谓郁，是指气机结聚而不能发越舒展。该升的不能升，该降的不能降，该变化的不能变化。这属于传化功能失常。六郁，指的是气郁、湿郁、热郁、痰郁、血郁、食郁。朱丹溪说：气血冲和调畅，百病不生；一旦有怫郁（气机不畅），各种疾病就会产生。
治法
气郁，症状为胸胁疼痛，脉象沉涩，使用香附（用童便浸泡后炒制）、苍术、抚芎。
湿郁，症状为周身游走性疼痛，或关节疼痛，遇阴寒天气则发作，脉象沉缓，使用苍术、川芎、白芷、茯苓、羌活、防风、柴胡。
热郁，症状为视物昏花，小便色赤，脉象沉数，使用栀子、青黛、香附、苍术、抚芎、黄芩、天花粉。
痰郁，症状为活动后气喘，寸口脉象沉滑，使用海浮石、天南星、香附、瓜蒌仁、贝母、竹沥、姜汁。
血郁，症状为四肢无力，能进食，大便带血或呈黑色，脉象沉而涩，使用桃仁泥、红花、牡丹皮、延胡索、川芎、香附。
食郁，症状为嗳气酸腐，脘腹胀闷，厌恶闻见食物气味，人迎脉象平和，气口脉象紧盛，使用苍术、香附、山楂、神曲、枳实。
方剂
六郁汤 是开通各种郁证的总司方。
香附（用童便浸泡后炒制） 苍术（用米泔水浸泡后炒制） 神曲（炒制） 山栀仁（炒黑） 连翘 陈皮
抚芎 贝母（去心） 枳壳（炒制） 白茯苓 苏梗（各一钱） 甘草（五分）
以上药物锉碎为一剂，加水煎服。若有痰，加天南星、半夏。若有热，加柴胡、黄芩。若是血郁，加桃仁泥、红花。若是湿郁，加白术、羌活。若是气郁，加木香、槟榔。若是食郁，加山楂、砂仁。
加味越鞠丸 解除各种郁火、痰浊、气滞，开通胸膈，增进饮食。
苍术（用米泔水浸泡，姜汁炒制，四两） 抚芎（四两） 香附（用童便浸泡后炒制，四两） 神曲（炒制，四两） 栀子（炒黑，四两） 橘红（一两五钱） 白术（炒制，一两半） 黄芩（炒制，一两半）
山楂（去核，蒸熟，一两半）
以上药物研为细末，用稀糊制作成如梧桐子大小的丸药。每次服用一百丸，用白开水送服。
越鞠保和丸〔批注〕（按：此方是治疗各种郁证的妙方） 扶持脾气，开通郁结，行气消食，清热化痰。
苍术（用米泔水浸泡三夜，炒制，一两） 抚芎（酒洗，一两） 神曲（炒制，一两） 香附（用童便浸泡后炒制，一两） 栀子（炒制，五钱） 陈皮（一两） 半夏（炮制，一两） 白茯苓（一两） 连翘（五钱） 莱菔子（炒制，五钱） 枳实（麸皮炒制，一两） 白术（三两） 黄连（酒炒制，一两） 山楂（去核，二两） 木香（五钱） 当归（酒洗，一两）
以上药物研为细末，用姜汁浸泡，以蒸饼为粘合剂制成如梧桐子大小的丸药。每次服用五十丸，用淡姜汤送服，或用酒送服也可以。
Pulse
The pulse is mostly deep and hidden (Chen Fu), or choppy (Se) or hollow (Kou).
Syndrome
The *Neijing* (Classic of Internal Medicine) states: "Wood depression should be reached/dispersed." This means using emesis to make its qi mechanism smooth and unobstructed. "Fire depression should be emitted/dispersed." This means using diaphoresis to scatter the pathogenic factors. "Earth depression should be seized/attacked." This means using purgation to eliminate stagnation and obstruction. "Metal depression should be drained/released." This means using渗利 (percolating and draining) methods, releasing the exterior, and promoting urination. "Water depression should be restrained." This means suppressing it and controlling its rebellious upward rush. These are the general principles for treating the five depressions (Wu Yu). Depression refers to the accumulation and knotting of qi that cannot be released and spread. What should ascend fails to ascend; what should descend fails to descend; what should transform fails to transform. This constitutes a dysfunction in transmission and transformation. The Six Depressions (Liu Yu) are Qi depression, Dampness depression, Heat depression, Phlegm depression, Blood depression, and Food depression. Zhu Danxi said: When Qi and Blood are harmonious and flowing smoothly, no disease arises; once there is frustration and depression (Fu Yu), various diseases emerge.
Treatment
Qi Depression: Symptoms include pain in the chest and hypochondrium, with a deep and choppy pulse. Use Xiangfu (Cyperi Rhizoma, soaked in child's urine and stir-fried), Cangzhu (Atractylodis Rhizoma), and Fuxiong (Chuanxiong Rhizoma).
Dampness Depression: Symptoms include wandering pain throughout the body or joint pain, which worsens in cold and damp weather, with a deep and slow pulse. Use Cangzhu (Atractylodis Rhizoma), Chuanxiong (Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Fuling (Poria), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Chaihu (Bupleuri Radix).
Heat Depression: Symptoms include blurred vision and dark red urine, with a deep and rapid pulse. Use Zhizi (Gardeniae Fructus), Qingdai (Indigo Naturalis), Xiangfu (Cyperi Rhizoma), Cangzhu (Atractylodis Rhizoma), Fuxiong (Chuanxiong Rhizoma), Huangqin (Scutellariae Radix), and Tianhuafen (Trichosanthis Radix).
Phlegm Depression: Symptoms include panting upon exertion, with a deep and slippery pulse at the Cun position. Use Haishi (Fossilia Arthropodi), Nanxing (Arisomatis Tuber), Xiangfu (Cyperi Rhizoma), Gualouren (Trichosanthis Semen), Beimu (Fritillariae Bulbus), Zhuli (Bambusa Textilis Caulis Juice), and Jiangzhi (Zingiberis Recensis Juice).
Blood Depression: Symptoms include weakness in the four limbs, ability to eat, blood in stool or black stool, with a deep and choppy pulse. Use Taoren (Persicae Semen paste), Honghua (Carthami Flos), Mudanpi (Moutan Cortex), Yanshusuo (Corydalis Rhizoma), Chuanxiong (Chuanxiong Rhizoma), and Xiangfu (Cyperi Rhizoma).
Food Depression: Symptoms include sour belching, fullness and stuffiness, aversion to the smell of food. The Renying pulse is peaceful, while the Qikou pulse is tight and vigorous. Use Cangzhu (Atractylodis Rhizoma), Xiangfu (Cyperi Rhizoma), Shanzha (Crataegi Fructus), Shenqu (Massa Medicata Fermentata), and Zhishi (Aurantii Fructus Immaturus).
Formulas
Liuyu Tang (Six-Depression Decoction): It is the master formula for opening all types of depressions.
Xiangfu (Cyperi Rhizoma, soaked in child's urine and stir-fried), Cangzhu (Atractylodis Rhizoma, soaked in rice wash water and stir-fried), Shenqu (Massa Medicata Fermentata, stir-fried), Shanzhiren (Gardeniae Fructus, stir-fried until black), Lianqiao (Forsythiae Fructus), Chenpi (Citri Reticulatae Pericarpium), Fuxiong (Chuanxiong Rhizoma), Beimu (Fritillariae Bulbus, heart removed), Zhiqiao (Aurantii Fructus Immaturus, stir-fried), Bai Fuling (Poria, stir-fried), Sugeng (Perillae Caulis) (each 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (0.5 qian).
Grind these into pieces for one dose, decoct with water, and take orally. If there is phlegm, add Nanxing (Arisomatis Tuber) and Banxia (Pinelliae Rhizoma). If there is heat, add Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix). For Blood Depression, add Taoren (Persicae Semen paste) and Honghua (Carthami Flos). For Dampness Depression, add Baizhu (Atractylodis Macrocephalae Rhizoma) and Qianghuo (Notopterygii Rhizoma et Radix). For Qi Depression, add Muxiang (Aucklandiae Radix) and Binglang (Arecae Semen). For Food Depression, add Shanzha (Crataegi Fructus) and Sharen (Amomi Fructus Rotundus).
Jiawei Yueju Wan (Modified Yueju Pill): Resolves various depressions of fire, phlegm, and qi, opens the chest and diaphragm, and promotes appetite.
Cangzhu (Atractylodis Rhizoma, soaked in rice wash water, stir-fried with ginger juice, 4 liang), Fuxiong (Chuanxiong Rhizoma, 4 liang), Xiangfu (Cyperi Rhizoma, soaked in child's urine and stir-fried, 4 liang), Shenqu (Massa Medicata Fermentata, stir-fried, 4 liang), Zhizi (Gardeniae Fructus, stir-fried until black, 4 liang), Juhong (Citri Reticulatae Pericarpium Rubrum, 1.5 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 1.5 liang), Huangqin (Scutellariae Radix, stir-fried, 1.5 liang), Shanzha (Crataegi Fructus, pitted, steamed, 1.5 liang).
Grind into powder, mix with thin paste to form pills the size of paulownia seeds. Take 100 pills per dose, washed down with plain warm water.
Yueju Baohe Wan [Commentary] (Note: This formula is an excellent remedy for treating various depressions): Supports the Spleen, opens depression, moves Qi, resolves food stagnation, clears heat, and transforms phlegm.
Cangzhu (Atractylodis Rhizoma, soaked in rice wash water for three nights, stir-fried, 1 liang), Fuxiong (Chuanxiong Rhizoma, wine-rinsed, 1 liang), Shenqu (Massa Medicata Fermentata, stir-fried, 1 liang), Xiangfu (Cyperi Rhizoma, soaked in child's urine and stir-fried, 1 liang), Zhizi (Gardeniae Fructus, stir-fried, 0.5 liang), Chenpi (Citri Reticulatae Pericarpium, 1 liang), Banxia (Pinelliae Rhizoma, processed, 1 liang), Bai Fuling (Poria, 1 liang), Lianqiao (Forsythiae Fructus, 0.5 liang), Laifuzi (Raphani Semen, stir-fried, 0.5 liang), Zhishi (Aurantii Fructus Immaturus, bran-stir-fried, 1 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 3 liang), Huanglian (Coptidis Rhizoma, wine-stir-fried, 1 liang), Shanzha (Crataengi Fructus, pitted, 2 liang), Muxiang (Aucklandiae Radix, 0.5 liang), Danggui (Angelicae Sinensis Radix, wine-rinsed, 1 liang).
Grind into powder, soak in ginger juice, use steamed leavened bread as binder to form pills the size of paulownia seeds. Take 50 pills per dose, washed down with light ginger soup, or taken with wine.