脉 郁脉多沉弦。或结伏。又沉涩。为血郁。沉伏为气郁。沉细为湿郁。沉数为热郁。沉滑
为痰郁。气口紧盛为食郁。又忧郁则脉涩。怒郁则脉弦。思郁则脉缓。时一止。名曰结脉。
症 丹溪云∶气血冲和。百病不生。一有拂郁。诸病生焉。又云诸病皆生于郁。治之可
开。
病作矣。大抵诸病多有兼郁者。或郁久而生病。或病久而生郁。凡治气血痰火之病。必兼郁而
治之。斯无憋矣。
治 经云∶木郁则达之。谓吐之。令其条达也。火郁则发之。谓汗之。令其疏散也。土郁则
夺之。谓下之。令无壅滞也。金郁则泄之。谓渗泄解表。利小便也。水郁则折之。谓抑之。
制其升达也。此治郁大法。惟火所属不同。随其经而治之。故曰火郁则发。当看何经。随其
经而治之也。丹溪云∶郁病有六。气血痰湿热食也。气郁则开之。其症胸胁痛。脉沉而涩者
是也。血郁则行之。或消之。其症必能食。便红。四肢无力。脉沉涩是也。痰郁则消而导之
。其症动则喘。寸口脉沉而滑是也。湿郁则燥之。利之。其症周身走痛。或关节痛。阴寒则
发。脉沉细而濡是也。热郁则清之。其症目瞀。小便赤烦咳。脉沉细而数是也。食郁则消之
。其症嗳酸。腹饱不能食。左寸脉平和。右寸脉紧盛是也。假令食在气上。气升则食自降。
余仿此。凡久恶寒。亦须解郁。郁开病亦随愈。
方 越鞠丸郁主方。解诸郁。清热。消痰。顺气。
苍术(宽中燥湿去芦一钱五分)、神
消食下气炒一钱)、川芎(和血顺气去芦一钱)、香附(开郁散结童便浸醋炒一钱五分)、山栀(
清热利痰降火炒一钱二分)
上作一服。水煎。或为末。水为丸。如绿豆大。每服八十丸。白汤送下。盖气血痰三症。多
有兼郁。而郁有六。随症加减。凡诸郁。春。宜加防风、夏。加苦参、秋。加吴茱萸、冬。
加吴茱萸、干姜炭。
气郁。加白术、陈皮(各八分)、木香、槟榔(各七分)、乌药(一钱) 虚者。兼用四君
子汤。
血郁。加当归、白芍药(各一钱)、桃仁、红花青黛、郁金(各八分)。
虚者。兼用四君子汤。
痰郁。加南星(牛胆制)、海石、栝蒌仁(各一钱)、贝母(一钱五分)、桔梗(七分)、
白芥子(八分) 痰盛者。兼用二陈汤。
湿郁。加防风、白芷、羌活、白茯苓(各八分) 倍苍术。
热郁。加黄连(吴茱萸炒八分)、青黛(八分) 甚者。加酒蒸大黄(二钱五分)。
食郁。加山楂、神曲(各一钱五分)、砂仁、陈皮、枳实(各八分)、针砂(一钱醋炒)
木郁。用梨芦、或瓜蒂散、吐之。吐后。以本方加白术、陈皮、白芍药(各一钱)、青皮(五分)。
火郁。本方加防风、羌活、柴胡、葛根(各八分)、升麻(五分) 发之。冬月。再加麻黄
根)。
土郁。用桂枝、芍药、浓朴、陈皮、枳壳(各等分)、大黄(三钱)下之。下后。以四君
子汤,加芍药、香附、陈皮、调理。
金郁。加茯苓、泽泻(各一钱),利之。
水郁。加白术(一钱五分)、陈皮、大腹皮(各一钱)、青皮(五分)、紫苏梗(六分)
怒郁。左关脉弦。加木香、槟榔、青皮、白芍药(各等分)。
思郁。右关脉结。加白术、陈皮、石菖蒲(各一钱)、木香、沉香(各五分)。
忧郁。右寸脉短涩。加贝母(一钱五分)、陈皮、枳实、乌药、苏子(各八分)、木香、槟
寒郁。加吴茱萸、干姜(各八分)、木香、沉香(各五分)、葱白(三节)。
悲哀太甚而郁。加贝母(一钱五分)、茯神、远志、石菖蒲、木香、砂仁(各七分)。
右越鞠丸。加减方法也。须量虚实新久。斟酌用之。庶无误矣。
脉象:郁证的脉象多表现为沉弦。有的呈现结伏之象,或者沉涩,这是血郁;沉伏是气郁;沉细是湿郁;沉数是热郁;沉滑是痰郁;气口脉紧盛是食郁。另外,忧郁则脉涩,怒郁则脉弦,思郁则脉缓且时有一止,这种脉象称为结脉。
症状:朱丹溪说:“气血冲和,百病不生;一旦有拂逆郁结,诸病便由此产生。”他又说:“各种疾病都生于郁,治疗时可以将其开解。”病症发作了。大抵各种疾病多有兼夹郁证的情况,或者是因郁久而生病,或者是因病久而生郁。凡是治疗气血痰火方面的疾病,必须兼顾郁证来治疗,这样就没有弊病了。
治法:《内经》说:“木郁则达之”,意思是采用吐法,使其条达舒展。“火郁则发之”,意思是采用汗法,使其疏散透发。“土郁则夺之”,意思是采用下法,使其没有壅滞。“金郁则泄之”,意思是采用渗利、解表、通利小便的方法。“水郁则折之”,意思是抑制它,制约其升发之气。这是治疗郁证的大法,只有火郁所属的经络不同,要随其所在的经络进行治疗。所以说“火郁则发之”,应当看是哪一经,随其经络而治。朱丹溪说:郁证有六种,即气、血、痰、湿、热、食。气郁则用开郁法,其症状是胸胁痛,脉沉而涩的就是气郁。血郁则用行血或消瘀法,其症状必然是能进食但大便出血,四肢无力,脉沉涩的就是血郁。痰郁则用消导化痰法,其症状是动则气喘,寸口脉沉而滑的就是痰郁。湿郁则用燥湿利湿法,其症状是周身游走性疼痛,或者关节痛,遇阴寒则发作,脉沉细而濡的就是湿郁。热郁则用清热法,其症状是目眩视物不清,小便赤红烦躁咳嗽,脉沉细而数的就是热郁。食郁则用消食法,其症状是嗳气酸腐,腹部饱胀不能进食,左寸脉平和,右寸脉紧盛的就是食郁。假如食物停滞在气分上部,气机上升则食物自然下降,其余类推。凡是久病恶寒,也必须解郁,郁结解开,病也随之痊愈。
方剂:越鞠丸是治疗郁证的主方,能解诸郁,清热,消痰,顺气。
组成:苍术(宽中燥湿,去芦头一钱五分)、神曲(消食下气,炒制一钱)、川芎(和血顺气,去芦头一钱)、香附(开郁散结,童便浸后醋炒一钱五分)、山栀(清热利痰降火,炒制一钱二分)。
用法:以上药材为一服量,加水煎煮;或者研为细末,用水泛丸,如绿豆大小。每次服用八十丸,用白开水送服。大概气血痰三种病症,多有兼夹郁证,而郁证有六种,需随症加减。凡是各种郁证,春季宜加防风,夏季加苦参,秋季加吴茱萸,冬季加吴茱萸、干姜炭。
气郁:加白术、陈皮(各八分)、木香、槟榔(各七分)、乌药(一钱)。若属虚证,兼用四君子汤。
血郁:加当归、白芍药(各一钱)、桃仁、红花、青黛、郁金(各八分)。若属虚证,兼用四君子汤。
痰郁:加南星(牛胆制)、海浮石、栝蒌仁(各一钱)、贝母(一钱五分)、桔梗(七分)、白芥子(八分)。痰盛者,兼用二陈汤。
湿郁:加防风、白芷、羌活、白茯苓(各八分),倍用苍术。
热郁:加黄连(吴茱萸炒八分)、青黛(八分)。严重者,加酒蒸大黄(二钱五分)。
食郁:加山楂、神曲(各一钱五分)、砂仁、陈皮、枳实(各八分)、针砂(一钱,醋炒)。
木郁:用梨叶芦根,或用瓜蒂散催吐。吐后,以本方加白术、陈皮、白芍药(各一钱)、青皮(五分)。
火郁:本方加防风、羌活、柴胡、葛根(各八分)、升麻(五分)以发散。冬季月,再加麻黄根。
土郁:用桂枝、芍药、厚朴、陈皮、枳壳(各等分)、大黄(三钱)以下之。泻下后,以四君子汤加芍药、香附、陈皮调理。
金郁:加茯苓、泽泻(各一钱)以利之。
水郁:加白术(一钱五分)、陈皮、大腹皮(各一钱)、青皮(五分)、紫苏梗(六分)。
怒郁:左关脉弦,加木香、槟榔、青皮、白芍药(各等分)。
思郁:右关脉结,加白术、陈皮、石菖蒲(各一钱)、木香、沉香(各五分)。
忧郁:右寸脉短涩,加贝母(一钱五分)、陈皮、枳实、乌药、苏子(各八分)、木香、槟榔。
寒郁:加吴茱萸、干姜(各八分)、木香、沉香(各五分)、葱白(三节)。
悲哀太甚而致郁:加贝母(一钱五分)、茯神、远志、石菖蒲、木香、砂仁(各七分)。
以上是越鞠丸的加减方法。必须衡量虚实和新久病程,斟酌使用,才不会出错。
Pulse: The pulse in cases of Qi Stagnation (Yu Zheng) is mostly deep and wiry. It may present as knotted and hidden, or deep and choppy, indicating Blood Stagnation; deep and hidden indicates Qi Stagnation; deep and fine indicates Dampness Stagnation; deep and rapid indicates Heat Stagnation; deep and slippery indicates Phlegm Stagnation; a tight and full pulse at the Qi Kou (radial artery point) indicates Food Stagnation. Additionally, melancholy leads to a choppy pulse, anger leads to a wiry pulse, and overthinking leads to a slow pulse that occasionally stops. This type of pulse is called a Knotted Pulse (Jie Mai).
Symptoms: Zhu Danxi stated: "When Qi and Blood are harmonious, hundred diseases do not arise; once there is frustration and stagnation, various diseases are born." He also said: "All diseases arise from stagnation, and they can be treated by opening them up." When pathological changes occur, it is generally observed that most diseases involve concurrent stagnation. Either long-standing stagnation gives rise to disease, or long-standing disease generates stagnation. In treating diseases related to Qi, Blood, Phlegm, and Fire, one must always address the stagnation concurrently, thus avoiding complications.
Treatment Principles: The *Classic of Internal Medicine* states: "For Wood stagnation, facilitate its spread," meaning induce vomiting to allow for free and smooth flow. "For Fire stagnation, disperse it," meaning induce sweating to allow for dissipation. "For Earth stagnation, seize/drain it," meaning use purgatives to eliminate obstruction. "For Metal stagnation, drain it," meaning use diaphoresis, release the exterior, and promote urination. "For Water stagnation, restrain it," meaning suppress it and control its ascending and spreading nature. These are the general principles for treating stagnation. However, Fire stagnation varies by meridian, so treatment should follow the specific meridian involved. Thus, it is said "Fire stagnation is dispersed," but one must determine which meridian is affected and treat accordingly. Zhu Danxi stated that there are six types of stagnation: Qi, Blood, Phlegm, Dampness, Heat, and Food.
- For Qi Stagnation, use methods to open stagnation. Symptoms include pain in the chest and hypochondrium, with a deep and choppy pulse.
- For Blood Stagnation, use methods to invigorate or resolve blood. Symptoms include good appetite but hematochezia (blood in stool), weakness in the four limbs, and a deep, choppy pulse.
- For Phlegm Stagnation, use methods to resolve and guide out phlegm. Symptoms include panting upon exertion, and a deep, slippery pulse at the Cun Kou (radial pulse position).
- For Dampness Stagnation, use drying and draining methods. Symptoms include wandering pain throughout the body or joint pain, worsening in cold/yin conditions, and a deep, fine, and soggy pulse.
- For Heat Stagnation, use clearing methods. Symptoms include blurred vision, red and烦 (restless/irritated) urine, cough, and a deep, fine, and rapid pulse.
- For Food Stagnation, use digestion-promoting methods. Symptoms include belching with sour taste, abdominal fullness and inability to eat, a normal pulse at the left Cun position, and a tight, full pulse at the right Cun position. If food is stagnant in the upper Qi level, raising the Qi will cause the food to descend naturally; other cases follow this analogy. For chronic aversion to cold, resolving stagnation is also necessary; once stagnation is resolved, the disease heals along with it.
Formula: Yueju Wan is the principal formula for treating stagnation. It resolves various stagnations, clears heat, eliminates phlegm, and regulates Qi.
Ingredients: Cangzhu (Atractylodis Rhizoma, broadens the middle, dries dampness, remove rhizome 1.5 qian), Shenqu (Medicated Leaven, promotes digestion and moves Qi, stir-fried 1 qian), Chuanxiong (Ligustici Chuanxiong Rhizoma, harmonizes Blood and regulates Qi, remove rhizome 1 qian), Xiangfu (Cyperi Rhizoma, opens stagnation and dissipates nodules, soaked in child's urine and stir-fried with vinegar 1.5 qian), Zhizi (Gardeniae Fructus, clears heat, benefits phlegm, descends fire, stir-fried 1.2 qian).
Usage: Combine these as one dose, decoct in water. Alternatively, grind into powder and form pills with water, size of mung beans. Take 80 pills per dose, washed down with warm water. Generally, Qi, Blood, and Phlegm disorders often involve stagnation. Since there are six types of stagnation, modify according to symptoms. For all stagnations: add Fangfeng (Saposhnikoviae Radix) in Spring; Kushen (Sophorae Flavescentis Radix) in Summer; Wuzhuyu (Evodiae Fructus) in Autumn; Wuzhuyu and Ganjiang Tan (Zingiberis Rhizoma Carbonized) in Winter.
- Qi Stagnation: Add Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium) (each 0.8 qian); Muxiang (Vladimiriae Radix), Binglang (Arecae Semen) (each 0.7 qian); Wuyao (Linderae Radix) (1 qian). For deficiency, combine with Sijunzi Tang (Four Gentlemen Decoction).
- Blood Stagnation: Add Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix Alba) (each 1 qian); Taoren (Persicae Semen), Honghua (Carthami Flos), Qingdai (Indigo Naturalis), Yujin (Curcumae Radix) (each 0.8 qian). For deficiency, combine with Sijunzi Tang.
- Phlegm Stagnation: Add Nanting (Arisaematis Cum Bile), Haishi (Calcitrum), Gualouren (Trichosanthis Semen), Beimu (Fritillariae Bulbus) (1.5 qian); Jiegeng (Platycodonis Radix) (0.7 qian); Baijiezi (Brassicae Semenis White) (0.8 qian). For severe phlegm, combine with Erchen Tang (Two Aged Decoction).
- Dampness Stagnation: Add Fangfeng, Baizhi (Angelicae Dahuricae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Baifuling (Poria) (each 0.8 qian). Double the amount of Cangzhu.
- Heat Stagnation: Add Huanglian (Coptidis Rhizoma, stir-fried with Wuzhuyu 0.8 qian), Qingdai (0.8 qian). For severe cases, add Jiuzheng Dahuang (Rhei Radix et Rhizoma steamed with wine) (2.5 qian).
- Food Stagnation: Add Shanzha (Crataegi Fructus), Shenqu (each 1.5 qian); Sharen (Amomi Fructus Rotundus), Chenpi, Zhishi (Immature Bitter Orange Fruit) (each 0.8 qian); Zhencha (Iron Filings, stir-fried with vinegar 1 qian).
- Wood Stagnation: Use Li Lu (Pear Leaf and Reed Rhizome) or Goutisan (Melon Stalk Powder) to induce vomiting. After vomiting, use the base formula plus Baizhu, Chenpi, Shaoyao (each 1 qian), Qingpi (Citri Reticulatae Pericarpium Viride) (0.5 qian).
- Fire Stagnation: Base formula plus Fangfeng, Qianghuo, Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix) (each 0.8 qian); Shengma (Cimicifugae Rhizoma) (0.5 qian) to disperse. In winter months, add Mahuanggen (Ephedrae Radix et Rhizoma).
- Earth Stagnation: Use Guizhi (Cinnamomi Ramulus), Shaoyao, Houpo (Magnoliae Officinalis Cortex), Chenpi, Zhike (Aurantii Fructus Immaturus) (equal parts); Dahuang (3 qian) to purge. After purging, regulate with Sijunzi Tang plus Shaoyao, Xiangfu, Chenpi.
- Metal Stagnation: Add Fuling (Poria), Zexie (Alismatis Rhizoma) (each 1 qian) to drain.
- Water Stagnation: Add Baizhu (1.5 qian), Chenpi, Dafupi (Arecae Pericarpium) (each 1 qian); Qingpi (0.5 qian); Zisugeng (Perillae Caulis) (0.6 qian).
- Anger-induced Stagnation: Left Guan pulse is wiry. Add Muxiang, Binglang, Qingpi, Shaoyao (equal parts).
- Overthinking-induced Stagnation: Right Guan pulse is knotted. Add Baizhu, Chenpi, Shichangpu (Acori Tatarinowii Rhizoma) (each 1 qian); Muxiang, Chenxiang (Aquilariae Lignum Resinatum) (each 0.5 qian).
- Melancholy-induced Stagnation: Right Cun pulse is short and choppy. Add Beimu (1.5 qian), Chenpi, Zhishi, Wuyao, Suzi (Perillae Fructus) (each 0.8 qian); Muxiang, Binglang.
- Cold-induced Stagnation: Add Wuzhuyu, Ganjiang (Zingiberis Rhizoma) (each 0.8 qian); Muxiang, Chenxiang (each 0.5 qian); Congbai (Scallion White) (three sections).
- Excessive Grief-induced Stagnation: Add Beimu (1.5 qian), Fushen (Poria cum Radice), Yuanzhi (Polygalae Radix), Shichangpu, Muxiang, Sharen (each 0.7 qian).
The above describes the modification methods for Yueju Wan. One must assess deficiency/excess and the duration of the condition to decide usage, thereby avoiding errors.