王安道曰∶《内经》帝曰∶郁之甚，治之奈何？岐伯曰∶
木郁达之，土郁夺之，金郁泄之。总十三句，通为一章，当分三节。火郁以上九句为一节，治郁之问答也。
然调其气为一节，治郁之余法也。过者抑之，以其畏也，所谓泻之三句为一节，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，且凡病之起也，多由乎郁，郁者滞而不通之义。
或所乘而为郁，或不因所乘而本气自郁，皆郁也。郁既非五运之变可拘，则达之、发之、夺之、泄之、折之之
法，固可扩焉而充之矣。
木郁达之，达之者，通畅之也。如肝性急，怒气逆，HT 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，而清风在下为飧泄，则以
轻扬之剂举而散之。凡此之类，皆达之之法也。王氏谓吐之令其条达，以吐训达，则是凡为木郁皆当吐矣，
可乎？至于东垣所谓食塞太阴，金旺克木，夫为物所伤；岂有反旺之理？若吐伸木气，则是反为木郁而施治，
非为食伤而施治矣。且食塞胸中而用吐，正《内经》所谓其高者因而越之之义耳，恐不烦木郁之说以 之也。
火郁发之，发者汗之也，升举之也。如腠里外闭，邪热怫郁，则解表取汗以散之。又如龙火郁甚于内，
非苦寒降沉之剂可治。则用升浮之药，佐以甘温，顺其性而从治之，使势穷则止，如东垣升阳散火是也。
凡此皆发之之法也。
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，温热内甚，
其人壮气实者，则攻下之。甚有势盛而不能顿除者，则劫夺其势而使之衰。又如湿热为痢者，有非力轻之
剂可治者，则或攻或劫，以致其平。凡此皆夺之之法也。
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，原郁而渗道闭矣，宜整肃金化，滋以利之。又如肺气满
，胸凭仰息，非利肺气之剂，不足以疏通之。
凡此皆泄之之法也。王氏谓渗泄、解表、利小便，使解表二字，间于渗泄、利小便之中，是渗泄、利
小便为二治矣。未当于理，宜删去。
水郁折之，折者制御也，伐而挫之也，渐杀其势也。如肿胀之病，水气淫溢，而渗道以塞。夫水之不胜
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，俾可以制水而不敢犯，则渗道达而
后愈。或病势既旺，非上法所能遽制，则用泄水之药以伐而挫之，或去菀陈 、开鬼门、洁净腑，三治备举，
选用以渐平之。王氏谓抑之制其冲逆，虽俱为治水之法，乃不审病者之虚实、久近、浅深，妄施治之，其
不踣者寡矣。
然邪久客，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，
优未足以尽治法之妙，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，则木斯服矣。所不胜者，所畏者也，故曰过者抑之以所畏也。物顺其欲则喜，逆其欲则恶。今逆之
以所恶，故曰所谓泻之。王氏未尽厥旨，余故推明之。若应变之用，则又未必尽然矣。
朱丹溪曰∶郁者积聚而不能发越也，当升者不得升，当降者不得降，当变化者不得变化也。其郁有六，
气、湿、痰、热、血、食。气郁者，胸胁痛，脉沉涩。湿郁者，周身走痛，或关节痛，遇阴寒则发，脉沉细。
痰郁者，动则喘，寸口脉沉滑。热郁者，督闷，小便赤，脉沉数。血郁者，四肢无力，能食便红，脉沉。食
郁者，暖酸腹饱，不能食，人迎脉平和，气口紧盛。苍术、抚芎总解诸郁，随症加入药。凡郁在中焦
以苍术、抚芎开提其气以升之，假如食在气上，提其气则食自降矣。又方，气郁香附、苍术、抚芎，湿郁
白芷、苍术、抚芎、茯苓，痰郁海石、香附、南星、栝蒌，热郁山栀、青黛、香附、苍术、抚芎，血郁桃仁、
红花、青黛、香附、川芎，食郁苍术、香附、山楂、神曲、针砂醋炒七次，并越鞠丸解诸郁。
王节斋曰∶丹溪先生治病不出乎血、气、痰三者，故用药之要有三∶气用四君，血用四物，痰用二陈。
又云久病属郁，立治郁之方，曰越鞠丸。盖气、血、痰三病，多有兼郁者，或郁久而生病，或病久而生郁，
或误药杂乱而成郁，故予每用此三方治病时，以郁法参之。故四法治病，用药之大要也。
王安道说：《黄帝内经》中黄帝问道：郁证严重的情况，该如何治疗？岐伯回答说：木郁应当疏达，土郁应当攻夺，金郁应当宣泄。总共十三句话，通篇作为一章，应当分为三节。从“火郁发之”到前面的九句为一节，这是关于治疗郁证的问答。然而，“调其气”这一句为一节，这是治疗郁证之后的辅助方法。“过者抑之，以其畏也，所谓泻之”这三句为一节，这是调理气机之后的辅助方法。这五种治法，虽然经典是为五运之气郁滞所致疾病而设立，但将其推广扩充，也是可以的。况且大凡疾病的产生，多由郁滞引起，“郁”就是停滞不通的意思。有的是因为被其他邪气乘虚而入而导致郁滞，有的不是因外邪乘袭而是本脏之气自行郁滞，这些都是郁证。既然郁证不仅仅局限于五运的变化，那么疏达、发散、攻夺、宣泄、折挫这几种治法，自然可以推广并扩充应用了。
木郁应当疏达，“达”就是通畅的意思。比如肝性急，怒气上逆，导致胁肋胀满，火热时常上炎，如果用苦寒辛散的药物治疗无效，就使用升发性质的药物，配合厥阴经的引经药，顺从其本性而从治。又如久风侵入体内导致完谷不化的泄泻，或者不是因为外风侵入，而是由于风气在下导致完谷不化的泄泻，就用轻扬升散的药物来举散它。凡是这类情况，都是“达”的治疗方法。王履认为用吐法使其条达，把“吐”解释为“达”，这意味着凡是木郁都应当用吐法，这可以吗？至于李东垣所说的食物堵塞太阴脾土，导致金气旺盛克制木气，这是被物所伤；哪有反而使金气旺盛的道理呢？如果通过吐法来舒展木气，那就是针对木郁进行治疗，而不是针对食积损伤进行治疗了。而且食物堵塞胸中而使用吐法，正是《黄帝内经》所说的“其高者，因而越之”的意思罢了，恐怕不需要借用木郁的说法来解释它。
火郁应当发散，“发”就是发汗的意思，也就是升举阳气。比如腠理闭塞，邪热怫郁在内，就解表取汗以疏散它。又比如龙雷之火郁结于内，不能用苦寒沉降的药物来治疗。就使用升浮性质的药物，佐以甘温药物，顺从其本性而从治，使火势穷尽就停止，就像李东垣的升阳散火汤那样。凡是这些，都是“发”的治疗方法。
土郁应当攻夺，“夺”就是攻下的意思，强行削弱它的势头。比如邪热进入胃腑，用咸寒性质的药物来攻逐去除它。又比如中焦胀满腹胀，温热邪气在体内很盛，病人正气壮实，就用攻下法。甚至有病势强盛不能一下子清除的，就强行削弱其势头使其衰退。又比如湿热导致的痢疾，有非轻剂所能治疗的，就或攻或劫，以达到平衡。凡是这些，都是“夺”的治疗方法。
金郁应当宣泄，“泄”就是渗湿利小便的意思，疏通其气机。比如肺金是肾水的源头，肺金受火热灼烧，其功能不行，原气郁滞且水道闭塞，应当整肃肺金的气化功能，滋润以利导它。又比如肺气壅满，胸部憋闷需要仰面呼吸，不用利肺气的药物，不足以疏通它。凡是这些，都是“泄”的治疗方法。王履认为渗泄、解表、利小便，如果把“解表”二字夹杂在渗泄和利小便之间，就把渗泄和利小便分成了两种治法，这不合理，应该删去。
水郁应当折制，“折”就是控制的意思，讨伐并挫败它，逐渐削弱其势头。比如肿胀的病，水气淫溢，导致水道闭塞。水之所以不能被制约，是因为土；现在脾气衰弱不能制约水，所以反而受到水的反侮，治疗应当充实脾土，资助其运化功能，使其能够制约水而不被侵犯，这样水道通达后才能痊愈。或者病势已经旺盛，上述方法不能立即控制，就使用泄水的药物来讨伐挫败它，或者采用“去菀陈莝”、“开鬼门”、“洁净腑”三种治法，全面运用，选择使用以逐渐平复病情。王履认为抑制它来控制冲逆，虽然都是治水的方法，但不审察病人的虚实、病程长短、病位浅深，妄加治疗，不跌倒死亡的很少了。
然而邪气长久停留，正气必然受损，现在邪气虽然去除，正气难道能立刻平复吗？如果不平和地调理正气，使各安其位，恢复常态，在治疗郁证之后，还不足以穷尽治法的妙处，所以说“调其气”。如果调理后气机仍然有余而未服，就应当补益其所不胜（即克己者）以制约它。比如木气过旺就应当补益金气，那么木气就能平息了。所不胜者，就是所畏惧的，所以说“过者抑之以所畏也”。事物顺从其欲望则喜悦，违背其欲望则厌恶。现在用其所厌恶的方式来逆制它，所以说“所谓泻之”。王履没有完全领会其中的旨意，所以我推演阐明它。若应变的使用，则未必完全如此了。
朱丹溪说：郁证是积聚而不能发散，该升的不能升，该降的不能降，该变化的不能变化。郁证有六种，即气、湿、痰、热、血、食。气郁证，表现为胸胁痛，脉沉涩。湿郁证，表现为周身游走疼痛，或关节痛，遇阴寒则发作，脉沉细。痰郁证，表现为动则气喘，寸口脉沉滑。热郁证，表现为心中烦闷，小便赤红，脉沉数。血郁证，表现为四肢无力，能进食但大便带血，脉沉。食郁证，表现为嗳气酸腐，腹部饱胀，不能进食，人迎脉平和，气口脉紧盛。苍术、抚芎（川芎）总解诸郁，随症状加入药物。凡是郁证在中焦，用苍术、抚芎开提气机以升之，假如食积在气之上，提起气机则食积自然下降。又有方子：气郁用香附、苍术、抚芎；湿郁用白芷、苍术、抚芎、茯苓；痰郁用海浮石、香附、南星、瓜蒌；热郁用山栀、青黛、香附、苍术、抚芎；血郁用桃仁、红花、青黛、香附、川芎；食郁用苍术、香附、山楂、神曲、针砂醋炒七次，都用越鞠丸来解诸郁。
王节斋说：丹溪先生治病不出乎血、气、痰三者，所以用药的要领有三条：气病用四君子汤，血病用四物汤，痰病用二陈汤。又说久病属于郁证，创立治疗郁证的方子，叫越鞠丸。大概气、血、痰三种病，多有兼夹郁证的，或者因郁久而生病，或者因病久而生郁，或者因误药杂乱而成郁，所以我每次用这三个方子治病时，参酌郁证的方法。所以这四法治病，是用药的大要。
Wang Andao stated: In the *Huangdi Neijing* (Yellow Emperor's Inner Canon), the Yellow Emperor asked: How should severe cases of Yu syndrome (Stagnation) be treated? Qibo replied: For Wood Yu, promote its flow; for Earth Yu, attack and drain it; for Metal Yu, vent and release it. The total thirteen sentences form one chapter, which should be divided into three sections. From "Fire Yu" to the preceding nine sentences constitute one section, representing the dialogue on treating Yu. However, "Regulate its Qi" constitutes one section, which is a supplementary method after treating Yu. The three sentences "Excess should be suppressed, using that which it fears, as mentioned in 'draining'" constitute one section, which is a supplementary method after regulating Qi. Although these five methods were established by the classic for diseases caused by stagnation of the Five Movements (Wu Yun), they can certainly be expanded and applied broadly. Moreover, most diseases arise from stagnation; "Yu" implies stagnation and obstruction. Some stagnations occur due to pathogenic factors taking advantage of weakness, while others result from the intrinsic Qi of an organ stagnating without external invasion; both are considered Yu. Since Yu is not strictly confined to changes in the Five Movements, the methods of promoting flow, dispersing, attacking/draining, venting, and suppressing can naturally be expanded and applied.
For Wood Yu, "promoting flow" means ensuring smoothness and unobstructed movement. For instance, if the Liver nature is urgent, anger causes Qi rebellion, leading to distension or fullness in the hypochondrium, with fire flaring up frequently, and bitter-cold and acrid-dispersing herbs fail to cure it, then use ascending and dispersing herbs, combined with guiding herbs for the Jueyin channel, to treat it by following its nature. Similarly, if long-standing wind enters the interior causing undigested food diarrhea, or if clear wind resides below causing such diarrhea without external wind invasion, use light and ascending agents to raise and disperse it. All such cases illustrate the method of "promoting flow." Wang Lu interpreted "promoting flow" as inducing vomiting to achieve smoothness, equating "vomiting" with "flow," implying that all Wood Yu should be treated with emesis. Is this acceptable? Regarding Li Dongyuan's statement that food blockage in the Taiyin Spleen causes Metal Qi to flourish and overcome Wood, this is injury by foreign matter; how could it cause Metal to flourish? If vomiting is used to extend Wood Qi, it treats Wood Yu rather than food injury. Furthermore, using emesis for food blockage in the chest aligns with the *Neijing* principle "where it is high, induce vomiting." It is unnecessary to invoke the theory of Wood Yu to explain this.
For Fire Yu, "dispersing" means sweating and raising Yang. For example, when pores are closed and pathogenic heat is constrained internally, resolve the exterior and induce sweating to disperse it. Or, when Dragon Fire (mineral fire) is severely constrained within, bitter-cold sinking agents cannot treat it. Instead, use ascending and floating herbs assisted by sweet-warm herbs, following its nature to treat it, stopping when the pathogenic force is exhausted, such as in Li Dongyuan's *Shengyang Sanhuo Tang* (Ascending Yang and Dispersing Fire Decoction). These all exemplify the method of "dispersing."
For Earth Yu, "attacking/draining" means purgation and forcibly reducing its strength. For instance, if pathogenic heat enters the Stomach, use salty-cold agents to purge and eliminate it. If there is abdominal fullness and distension with intense internal heat, and the patient has robust Qi and excess condition, apply purgation. If the pathogenic force is too strong to be cleared at once, forcibly reduce its momentum to weaken it. For dysentery caused by damp-heat, where mild agents are ineffective, use purgation or forcible reduction to restore balance. These all exemplify the method of "attacking/draining."
For Metal Yu, "venting/releasing" means promoting diuresis and unblocking Qi. For example, Lung Metal is the source of Kidney Water. If Lung Metal is scorched by fire, its functions fail, original Qi stagnates, and the water passages close. One should regulate Lung transformation and moisten to facilitate flow. If Lung Qi is excessive, causing chest oppression and orthopnea (difficulty breathing while lying flat), only Lung-Qi-regulating agents can effectively unblock it. These all exemplify the method of "venting." Wang Lu argued that including "resolving the exterior" between "promoting diuresis" and "benefiting urination" splits them into two treatments, which is illogical and should be deleted.
For Water Yu, "suppressing" means controlling, attacking, and gradually weakening its momentum. For edema diseases where Water Qi overflows and blocks the water passages, since Earth controls Water, but now Spleen Earth Qi is weak and fails to control Water, resulting in Water insulting Earth, treatment should tonify Spleen Earth and support its transportation and transformation, enabling it to control Water so it dares not invade, allowing water passages to open before recovery. If the disease is too advanced for these methods to quickly control, use water-draining drugs to attack and suppress, or employ the three methods of "removing accumulation," "opening the ghost gate" (sweating), and "purifying the hollow organs" (urination), selecting appropriate ones to gradually calm the condition. Wang Lu criticized suppressing rebellious Qi as a water-treatment method, stating that failing to assess deficiency/excess, duration, and depth leads to reckless treatment and frequent death.
However, prolonged pathogenic presence damages righteous Qi. Even after pathogens are removed, can righteous Qi recover immediately? Without harmoniously regulating righteous Qi to restore its position and normal state, the subtleties of treatment are incomplete. Hence, "regulate its Qi." If regulation leaves Qi still excessive and unruly, tonify what it fears (its controller) to suppress it. For example, if Wood is excessive, tonify Metal to subdue Wood. What is feared is the controller; thus, "excess is suppressed by what it fears." Things are pleased when their desires are met and displeased when thwarted. By thwarting with what it dislikes, it is called "draining." Wang Lu did not fully grasp this intent, so I elucidate it. Practical application may vary.
Zhu Danxi said: Yu syndrome is accumulation without dispersion; what should ascend does not, what should descend does not, what should transform does not. There are six types of Yu: Qi, Dampness, Phlegm, Heat, Blood, and Food. Qi Yu presents with chest and hypochondriac pain, deep-choppy pulse. Dampness Yu presents with wandering body pain or joint pain, worsening in cold-damp weather, deep-thin pulse. Phlegm Yu presents with panting upon exertion, deep-slippery pulse at Cun Kou. Heat Yu presents with stifling sensation, red urine, deep-rapid pulse. Blood Yu presents with limb weakness, ability to eat but bloody stools, deep pulse. Food Yu presents with belching sourness, abdominal fullness, inability to eat, peaceful Ren Ying pulse, tight-full Qi Kou pulse. Cangzhu (Atractylodis Rhizoma) and Fuxiong (Chuanxiong Rhizoma) generally resolve various Yus, with additions based on symptoms. For Yu in the Middle Jiao, use Cangzhu and Fuxiong to lift Qi; if food stagnation is above Qi, lifting Qi will cause food to descend. Another formula: Qi Yu uses Xiangfu (Cyperus Rhizome), Cangzhu, Fuxiong; Dampness Yu uses Baizhi (Angelicae Dahuricae Radix), Cangzhu, Fuxiong, Fuling (Poria); Phlegm Yu uses Haishi (Fossilia Arthropodi), Xiangfu, Nanting (Arisaematis Cum Bile), Gualou (Trichosanthis Fructus); Heat Yu uses Shanzhi (Gardeniae Fructus), Qingdai (Indigo Naturalis), Xiangfu, Cangzhu, Fuxiong; Blood Yu uses Taoren (Persicae Semen), Honghua (Carthami Flos), Qingdai, Xiangfu, Chuanxiong; Food Yu uses Cangzhu, Xiangfu, Shanzha (Crataegi Fructus), Shenqu (Massa Medicata Fermentata), Zhensha (Magnetitum) stir-fried seven times in vinegar. All utilize Yueju Wan (Yueju Pill) to resolve various Yus.
Wang Jiezhai said: Mr. Danxi’s treatment focuses on Blood, Qi, and Phlegm, so the key medication principles are three: Qi disorders use Sizijunzi Tang (Four Gentlemen Decoction), Blood disorders use Siwu Tang (Four Substances Decoction), Phlegm disorders use Erchen Tang (Two Aged Decoction). He also stated that chronic diseases belong to Yu, establishing Yueju Wan for treating Yu. Since Qi, Blood, and Phlegm disorders often involve Yu, or Yu leads to disease, or disease leads to Yu, or mismedication causes Yu, I always incorporate Yu-methods when using these three formulas. Thus, these four methods represent the major principles of medication.