六元正纪大论曰∶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。王安道曰∶木郁达之五句，治郁之法也。
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。且凡病之起也，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。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
久风入中为餐泄，及不因外风之人而清气在下为餐泄，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，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，此不能使人无疑者，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
可也，不必吐也。虽然木郁固有吐之之理，今以吐字总该达字，则是凡木郁皆当用
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
疑者，夫金之克木，五行之常道，固不待夫物伤而后能也。且为物所伤，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汨之也。
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。如东垣升阳散火汤是也。凡此之类，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，有非力轻之剂可治者，则或攻或劫，以致其平。凡此之类，皆
夺之之法也。金郁泄之，泄者、渗泄而利小便也，疏通其气也。如肺金为肾水上原，
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。凡此之类，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，此二字未当于理，今删去。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，则直治
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，伐而挫之也，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。守也、攻也、广略也，虽俱为治水之法，然不审病者之
虚实、久近浅深，杂焉而妄施治之，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，正气岂能遽平哉。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，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。虽然自调其气以下，盖经之
本旨。故予推其义如此。若扩充为应变之用，则不必尽然也。丹溪言郁有六，气、
血、湿、热、痰、食也。气郁，胸胁痛，脉沉而涩，宜香附、苍术、抚芎。湿郁，
周身走痛，或关节痛，遇阴寒则发，其脉沉细，宜苍术、川芎、白芷、茯苓。热郁，
目瞀，小便赤，其脉沉数，宜山栀、青黛、香附、苍术、抚芎。痰郁，动则喘，寸
口脉沉滑，宜海石、香附、南星、栝蒌仁。血郁，四肢无力，能食便红，其脉芤，
宜桃仁、红花、青黛、川芎、香附。食郁，嗳酸，腹满不能食，右寸脉紧盛，宜香
附、苍术、山楂、神曲、针砂。上诸郁药，春加防风，夏加苦参，秋冬加吴茱萸。
苍术、抚芎，总解诸郁。凡郁皆在中焦，以苍术、抚芎开提其气以升之，假令食在
气上，气升则食自除矣。余仿此。或问方论分门叙证，未尝有郁病之名，今出六郁
之药何也？曰∶夫人气之变，一如地六淫而分之，故郁者，燥淫为病之别称也。
燥乃阳明秋金之位化。经曰∶金木者生成之终始。又曰∶木气之下，金气乘之。盖
物之化，从于生物之成，从于杀造化之道，于生杀之气，未始相离，犹权衡之不可
轻重也。生之重杀之轻，则气殚散而不收。杀之重生之轻，则气敛涩而不通，是谓
郁矣。郁有外邪内伤，外邪者，《内经》有六气五运胜克之郁，内应乎人气而生病者
是也。用五郁而治，木郁者达之，火郁者发之，水郁者折之，土郁者夺之，金郁者
泄之。内伤者，人之天真与谷气并，分布五脏，名五阳者，金、木、水、火、土之
五气也，各司一脏，而金木则统为生杀之纪纲。以其五阳，又复相通移，五五二十
五阳，于是一脏一五气，各有生、长、化、收、藏之用。虽各自为之用，然必归于
肺。肺属金、主气，分阴阳，其化燥，其变敛涩，敛涩则伤其分布之政，不惟生气
不得升，而收气亦不得降。故经曰∶逆秋气则太阴不收，肺气焦满。又曰∶诸气怫
郁，皆属于肺，此之谓也。今观此集所云，郁病多在中焦，及六郁凡例之药，诚得
其要矣。中焦者，脾胃也，水谷之海，法天地，生万物，体干健之化，具坤静之德，
五性备而冲和之气，五脏六腑皆禀乏以为主，荣卫由谷气之精悍所化，天真亦由谷
气而充大。东垣所谓人身之清气、荣气、运气、卫气、春升之气，皆胃气之别称。
然而诸气岂尽是胃气者哉，乃因胃气以资其生故也。脾胃居中心，肺在上，肾肝在
下，凡有六淫七情劳役妄动上下，所属之脏气，致虚实胜克之变，过于中者，而中
气则常先，是故四脏一有不平，则中气不得其和而先郁矣。更有因饮食失节，停积
痰饮，寒温不适所，脾胃自受，所以中焦致郁之多也。今以其药兼升降而用之者，
盖欲升之，必先降之，而后得以升也。欲降之，必先升之，而后得以降也。老氏所
谓∶将欲取之，必先与之。其苍术足阳明药也，气味雄壮辛烈，强胃强脾，开发水
谷气，其功最大。香附阴血中快气药也，下气最速，一升一降，以散其郁。抚芎者，
足厥阴直达三焦，俾生发之气，上至头目，下抵血海，通疏阴阳气血之使者也。然
用此不专开中焦而已，其胃主行气于三阳，脾主行气于三阴，脾胃既布，水谷之气
行，纵是三阴三阳各脏腑自受其燥金之郁者，亦必因胃气可得而通矣。天真等气之
不达，亦必可得而伸矣。况苍术尤能径入诸经，疏泄阳明之湿，通行敛涩者也。观
此六郁药之凡例，其升降消导，皆因《内经》变而致，殆将于受病未深者设也。若
或气耗血衰，津液枯竭，病已入深，宁复令人守此，不从病机大要治法，以有者求
之，无者求之，盛者责之，虚者责之，必先五胜者哉。不然，如前条中风、伤寒外
邪者，尚分虚实论治，何乃郁病属内伤多者，反不分之乎。先生之意当不止是，集
书者不能备其辞也。曰子言郁乃燥淫之别称，刘河间则又以怫郁属热者何也？曰燥
之为气，有凉有热而燥者，秋风气至大凉，革候肃杀坚劲，生气不扬，草木敛容，
人物之象一也。在人身则腠理闭密，中外涩滞，气液皆不滑泽，是以《原病式》叙诸涩
枯涸，干劲皴揭者，在燥淫条下，从化何如，《内经》有之，少阴、少阳热火下临，
肺气上从，白起金用草木眚。河间又谓六气不必一气独为病，气有相兼，或风
热胜湿成燥涩者，或肺受火热、致金衰耗津而燥者，或火热亢极、兼贼鬼水化、反
闭塞而燥者，或因寒邪外闭腠理、阳气郁而成燥，其病在外，甚亦入内。或口食生
冷，阳气内郁而成燥热者，其病在肉里，甚亦在外。或兼于湿者，湿主于否，因致
怫郁成热以燥者。或兼风者，因热伤肺金不能平木，而生风胜湿而燥也。易曰∶燥
万物者，莫 乎火。燥之从化者，其此之谓欤。至于论郁之为病，外在六经九窍四
属，内在五脏六腑，大而中风、暴病、暴死、颠狂、劳痨、消渴等疾，小而百病，
莫不由是气液不能宣通之所致。治郁之法，有中外四气之异，在表者汗之，在内者
下之。兼风者散之，热微者寒以和之，热甚者泻阳救水，养液润燥，补其已衰之阴。
兼湿者，审其湿之太过不及，犹土之旱涝也。寒湿之胜，则以苦燥之，以辛温之。
不及而燥热者，则以辛润之，以寒调之。大抵须得仲景之法治之，要各守其经气而
勿违。然方论止叙风寒湿热四气之病，无燥火二淫之故。殆是从四时令气之伤人者，
于秋不言伤其燥，而乃曰伤其湿者，为相火代君火行令于暑，故止言热而不言火，夫
如是之天气合四时者尚不能明，况能推究人以一气之变，亦如天气六淫之分者乎。
且人气之燥火二淫，常通贯于风寒湿热病中，尤多于四气之相移也。何以言之？在
病之冲逆奔迫即属之火，气液不得通即属之燥，其火游行于五者之间，今不以为言，
尚不可也。抑夫燥者，正属五行金气所化，而亦舍之，此何理焉。及观其所立气门，
多是二淫之病，可见其不识人气有六化六变之道，宜乎其治气病之法，无端绪矣。
【诊】郁脉多沉伏，郁在上则见于寸，郁在中则见于关，郁在下则见于尺。郁
脉，或促、或结、或涩。滑伯仁云∶气血食积痰饮，一有留滞于其间，则脉必因之
而止涩矣。但当求其有神，所谓神者，胃气也。
《素问·六元正纪大论》说：木郁应当疏达，火郁应当发散，土郁应当攻夺，金郁应当宣泄，水郁应当制约。然而要调理其气机，对于过盛的邪气要用制约的方法，因为这是利用它所畏惧的五行属性来治疗，这就是所谓的泻法。王安道说：“木郁达之”等五句，是治疗郁证的基本法则；“调其气”一句，是治疗郁证的辅助方法；“过者折之”等三句，是调理气机的辅助方法。这五种治法，虽然经典是为五运之气郁滞所致疾病而设立的，但将其推广扩充，也是完全可行的。况且大凡疾病的产生，多由郁结引起。“郁”的意思是阻滞不通。有的因受其他病邪乘袭而形成郁结，有的不因外邪乘袭而是本脏之气自行郁滞，这些都是郁证。难道仅仅是五运的变化才能导致这种情况吗？既然郁证不仅仅局限于五运的变化，那么达、发、夺、泄、折这五种治法，自然可以推广扩充应用于各种情况了。
所谓“木郁达之”，“达”就是通畅的意思。比如肝气急躁，怒气上逆，胁肋胀满，火热时常上炎，如果用苦寒辛散的药物不能治愈，就使用升发性质的药物，并加入厥阴经的引经药进行从治（顺其性而治）。又如久风入中导致飧泄（完谷不化的腹泻），以及不因外风侵袭而是清气在下导致的飧泄，就用轻扬升散的药剂，提升并疏散它。凡是这类情况，都是“达之”的治法。王冰认为用吐法使气机条达，就是“木郁达之”。李东垣认为食物堵塞胸中，食物属坤土，胸为金位，金主杀伐，金与土都位于上部且在天时旺盛，金能克木，所以肝木生发之气潜伏于下，这难道不是木郁吗？通过吐法去除上焦阴土之物，木气得以舒畅则郁结自去，这就是木郁达之。我私下认为王冰以“吐”解释“达”，让人不能没有疑虑。如果是肺金盛而抑制肝木，那么泻肺气、举肝气就可以了，不必用吐法。如果是脾胃浊气下流，少阳清气不升，那么补益胃气、升举阳气就可以了，也不必用吐法。虽然木郁确实有可以用吐法的道理，但现在用“吐”字总括“达”字，那就意味着凡是木郁都应该用吐法，这怎么行呢？至于李东垣所说的食物堵塞肺分，认为是金与土旺于上而克制木气，也让人不能没有疑虑。金克木是五行的常理，本来就不需要等到被物所伤才发生。而且被物所伤，哪有反而旺盛的道理？如果说吐去食物以伸张木气，那是针对木郁施治，而不是针对食积施治了。食物堵塞胸中而用吐法，正是《内经》所说的“其高者因而越之”的意思罢了。恐怕不必引用木郁的说法来混淆视听。
所谓“火郁发之”，“发”就是汗法，升举之意。比如腠理闭塞，邪热怫郁在内，就解表取汗以散发它。又如龙火（相火）郁甚于内，不能用苦寒沉降的药物来治疗，就用升浮的药物，佐以甘温之品，顺从其本性而从治，使火势穷尽即止。如李东垣的升阳散火汤就是此类。凡是这类情况，都是“发之”的治法。
所谓“土郁夺之”，“夺”就是攻下，劫夺其势使其衰弱。比如邪热入胃，用咸寒的药物攻逐去除它。又如中满腹胀，湿热内盛，身体壮实正气充足的人，就攻下它；如果病势强盛不能一下子清除，就劫夺其势使其衰弱。又如湿热引起的痢疾，病情严重非轻剂可治的，就或攻或劫，以达到平复。凡是这类情况，都是“夺之”的治法。
所谓“金郁泄之”，“泄”就是渗湿泄利小便，疏通其气机。比如肺金受到肾水上源的影响，或者肺金受火灼烧，其功能不行，源头郁滞而水道闭塞。应该整肃金的气化，滋润以利导它。又如肺气壅满，胸部憋闷仰面呼吸，不用利肺气的药物，不足以疏通它。凡是这类情况，都是“泄之”的治法。王冰认为渗泄、解表、利小便是“金郁泄之”。渗泄利小便固然可以泄金郁，但“解表”二字，我不明白其意，莫非是因为人的皮毛属于肺，受邪即为金郁，解表就算作泄之吗？我认为如果这样，那么凡是筋病就是木郁，肉病就是土郁了吗？这两个字不合情理，现在删去。而且“解表”夹杂在渗泄利小便之中，使得渗泄利小便变成了两种治法。如果把渗泄理解为滋肺生水，把利小便理解为直接治疗膀胱，那么直接治疗膀胱，责任就不在肺了，为什么说是金郁呢？这也讲不通，所以我把它改为“渗泄而利小便”。
所谓“水郁折之”，“折”就是制御，讨伐挫败它，逐渐削弱其势力。比如肿胀病，水气淫溢而水道堵塞。水的所不胜者是土。现在土气衰弱不能制约水，所以反而受水之侮，治疗应当充实脾土，资助其运化功能，使其能够制水而不被侵犯，那么水道通达后病就好了。或者病势已经旺盛，上述方法不能立即控制，就用泄水的药物来讨伐挫败它，或者采用“去菀陈莝”（去除郁积的陈腐之物）、“开鬼门”（发汗）、“洁净府”（利小便）三种治法，全面运用，交替使用以逐渐平复病情。王冰所说的“抑之制其冲逆”，正是想要挫败其泛滥的势头。充实脾土是守正，泄水是攻邪，兼用三法是广略并用以求决胜。守、攻、广略，虽然都是治水的方法，但如果不审察病人的虚实、病程的久暂、病位的浅深，混杂而妄加治疗，能不跌倒失败的很少了。
况且五郁的病，虽然有固定的治法，但邪气久留体内，正气必然受损。现在邪气虽然去除，正气难道能立刻平复吗？如果不调和正气，使其各安其位恢复常态，那么在治疗郁证之余，还不足以尽治法之妙，所以说“然调其气”。如果调气之后，气机仍然过盛而未平服，就应当补益其所不胜（克制它的五行）以制约它，比如木气过盛就当补金，金能制木，木气就能平服了。所不胜者，就是所畏惧的，所以说“过者折之，以其畏也”。制约他物的，是他物所希望的；被他物制约的，是他物所不希望的。顺从其希望则喜，违背其希望则恶。现在用他所厌恶的方式来制约他，所以叫“所谓泻之”。王冰用咸味泻肾、酸味泻肝等说法来解释，没有完全领会其中的旨意。虽然从“调其气”以下，大概是经典的原本旨意，所以我推演其义如此。如果要扩充用于应对变化，则不必完全拘泥于此。
朱丹溪说郁有六种：气、血、湿、热、痰、食。气郁，表现为胸胁痛，脉沉而涩，宜用香附、苍术、抚芎。湿郁，表现为周身游走疼痛，或关节痛，遇阴寒则发作，脉沉细，宜用苍术、川芎、白芷、茯苓。热郁，表现为目眩视物不清，小便赤，脉沉数，宜用山栀、青黛、香附、苍术、抚芎。痰郁，表现为动则气喘，寸口脉沉滑，宜用海浮石、香附、南星、栝蒌仁。血郁，表现为四肢无力，能进食但大便出血，脉芤，宜用桃仁、红花、青黛、川芎、香附。食郁，表现为嗳气酸腐，腹部胀满不能进食，右寸脉紧盛，宜用香附、苍术、山楂、神曲、针砂。以上治疗诸郁的药物，春季加防风，夏季加苦参，秋冬季节加吴茱萸。苍术、抚芎，能总解诸郁。凡是郁证多在中焦，用苍术、抚芎提举气机使之上升，假如食物停滞在气之上，气升则食物自然消除。其余仿照此理。有人问：方论分类叙述证候，从未有过郁病的名称，现在列出六郁的药物是为什么呢？回答说：人气变化，如同地之六淫一样分为六类，所以郁，是燥淫致病的别称。燥属于阳明秋金之位的气化。经典说：金木是生成之终始。又说：木气之下，金气乘之。大概万物的变化，顺应生物之成，顺应杀伐造化之道，在生杀之气中，从未分离，就像秤锤不可轻重失衡一样。生重杀轻，则气耗散而不收敛；杀重生轻，则气收敛涩滞而不通，这就叫做郁。
郁证有外邪和内伤两类。外邪方面，《内经》有六气五运胜克之郁，内应乎人气而生病的，就是用五郁法治，木郁者达之，火郁者发之，水郁者折之，土郁者夺之，金郁者泄之。内伤方面，人的天真元气与谷气结合，分布于五脏，称为五阳，即金、木、水、火、土的五气，各自主管一脏，而金木则是统管生杀的大纲。因为这五阳又互相通移，五五二十五阳，于是每一脏的每一气，都有生、长、化、收、藏的作用。虽然各自发挥作用，但必然归于肺。肺属金，主气，分阴阳，其气化燥，其变敛涩，敛涩就会伤害其分布政令，不仅生气不能上升，收气也不能下降。所以经典说：逆秋气则太阴不收，肺气焦满。又说：诸气怫郁，皆属于肺，说的就是这个。现在看这部文集所说，郁病多在中焦，以及六郁凡例中的药物，确实抓住了要领。中焦就是脾胃，是水谷之海，效法天地，生化万物，体具乾健之化，具备坤静之德，五性完备而有冲和之气，五脏六腑都禀受它作为主宰，营卫由谷气中精悍的部分所化生，天真元气也由谷气而充大。李东垣所说的人身清气、荣气、运气、卫气、春升之气，都是胃气的别称。然而诸气难道全是胃气吗？是因为依赖胃气来资生它们啊。脾胃居于中心，肺在上，肾肝在下，凡是六淫七情劳役妄动上下，所属脏腑之气，导致虚实胜克的变化，过于中焦，那么中气则常常先受影响，所以四脏一旦有不平，中气就不能和谐而先郁结。更有因为饮食失节，停积痰饮，寒温不适，脾胃自受，所以中焦导致郁证很多。现在用这些药物兼有升降作用，是想升必先降，然后才能升；想降必先升，然后才能降。老子所说的：将欲取之，必先与之。苍术是足阳明胃经的药，气味雄壮辛烈，强健胃脾，开发水谷之气，功效最大。香附是阴血中的快气药，下气最快，一升一降，以疏散郁结。抚芎是足厥阴肝经直达三焦的药，使生发之气，上至头目，下抵血海，是通疏阴阳气血的使者。然而使用这些药不只是开通中焦而已，胃主行气于三阳，脾主行气于三阴，脾胃既布散，水谷之气运行，即使是三阴三阳各脏腑自受燥金之郁的，也必须凭借胃气才能通达。天真等气的不通达，也必定能得到伸展。况且苍术尤能径入诸经，疏泄阳明之湿，通行敛涩之气。看这六郁药的凡例，其升降消导，都是因《内经》变化而来，大概是为了对患病未深的人设立的。如果气耗血衰，津液枯竭，病已深入，哪里还能让人遵守此法，而不遵循病机大要治法，对有者求之，无者求之，盛者责之，虚者责之，必先辨别五胜之气呢？否则，像前面的中风、伤寒外邪，还要分虚实论治，为什么郁病属内伤多的，反而不分虚实呢？先生的意思应当不止于此，编书的人未能备述其辞罢了。
有人问：你说郁是燥淫的别称，刘河间却认为怫郁属于热，为什么呢？回答说：燥这种气，有凉有热而燥。秋风气至大凉，气候肃杀坚劲，生气不扬，草木收敛容颜，人物景象一致。在人身则腠理闭密，内外涩滞，气液都不滑泽，所以《原病式》叙述各种涩枯涸、干劲皴揭者，都在燥淫条下。随其转化如何，《内经》已有记载：少阴、少阳热火下临，肺气上从，白起金用草木眚。河间又说六气不必一气独为病，气有相兼，或风热胜湿成燥涩者，或肺受火热，致金衰耗津而燥者，或火热亢极，兼贼鬼水化，反闭塞而燥者，或因寒邪外闭腠理，阳气郁而成燥，其病在外，甚则入内。或口食生冷，阳气内郁而成燥热者，其病在肉里，甚则在外。或兼于湿者，湿主于否塞，因致怫郁成热以燥者。或兼风者，因热伤肺金不能平木，而生风胜湿而燥也。《易经》说：燥万物者，莫熯乎火。燥的从化，说的就是这个吧。至于论郁之为病，外在六经九窍四属，内在五脏六腑，大而中风、暴病、暴死、颠狂、劳痨、消渴等疾病，小而百病，无不由此气液不能宣通所致。治郁之法，有中外四气之异，在表者汗之，在内者下之。兼风者散之，热微者寒以和之，热甚者泻阳救水，养液润燥，补其已衰之阴。兼湿者，审其湿之太过不及，犹土之旱涝也。寒湿之胜，则以苦燥之，以辛温之。不及而燥热者，则以辛润之，以寒调之。大体须得张仲景的法治之，要各守其经气而不违背。然而方论只叙述风寒湿热四气之病，没有燥火二淫的缘故。大概是从四时令气伤人者，于秋不言伤其燥，而乃曰伤其湿者，为相火代君火行令于暑，故止言热而不言火，夫如是之天气合四时者尚不能明，况能推究人以一气之变，亦如天气六淫之分者乎。且人气之燥火二淫，常通贯于风寒湿热病中，尤多于四气之相移也。何以言之？在病之冲逆奔迫即属之火，气液不得通即属之燥，其火游行于五者之间，今不以为言，尚不可也。抑夫燥者，正属五行金气所化，而亦舍之，此何理焉。及观其所立气门，多是二淫之病，可见其不识人气有六化六变之道，宜乎其治气病之法，无端绪矣。
【诊】郁证的脉象多沉伏，郁在上部则见于寸口，郁在中部则见于关部，郁在下部则见于尺部。郁脉，或促、或结、或涩。滑伯仁说：气血食积痰饮，一旦留滞于其间，脉必因此而止涩。但只要寻求其有神，所谓神，就是胃气。
The *Suwen: Liuyuan Zhengji Dalun* states: For Wood depression, promote its free flow; for Fire depression, disperse it; for Earth depression, purge it; for Metal depression, drain it; for Water depression, control it. However, regulate the Qi. For excess conditions, restrain them using what they fear, which is called purging. Wang Andao said: The five sentences "Wood depression... Water depression..." are the methods for treating depression. The sentence "Regulate the Qi" is a supplementary method for treating depression. The three sentences "For excess conditions, restrain them..." are supplementary methods for regulating Qi. Although these five methods were established by the classics for diseases caused by the depression of the Five Movements (Wu Yun), they can certainly be expanded and applied more broadly. Moreover, most diseases arise from depression. "Depression" means stagnation and blockage. It may occur due to invasion by other pathogens, or without such invasion, due to the self-stagnation of the organ's own Qi. Both are forms of depression. Is it only the changes of the Five Movements that cause this? Since depression is not limited to the changes of the Five Movements, the methods of promoting, dispersing, purging, draining, and controlling can naturally be expanded and applied.
"Promote Wood depression": "Promote" means to make smooth and unobstructed. For example, if Liver Qi is irritable, anger causes Qi to rebel, ribs become distended, and Fire flares upward frequently, and bitter-cold and acrid-dispersing herbs fail to cure it, use ascending and dispersing herbs, adding guiding herbs for the Jueyin channel to treat according to its nature. Similarly, if chronic wind enters the interior causing stool with undigested food, or if clear Yang fails to ascend causing similar symptoms without external wind invasion, use light and ascending preparations to lift and scatter it. All such cases illustrate the method of "promoting". Wang Bing interpreted this as using emesis to allow free flow, calling it "promoting Wood depression". Li Dongyuan argued that food blocking the chest constitutes Earth (Kun) in the position of Metal (chest), where Metal dominates killing and controls Wood. Thus, the generating Qi of Liver Wood is suppressed underground, constituting Wood depression. Emesis removes the Yin-Earth matter from the Upper Jiao, allowing Wood Qi to flourish and depression to resolve. I have doubts about Wang Bing equating "emesis" with "promoting". If Lung Metal is excessive and suppresses Liver Wood, one should drain Lung Qi and raise Liver Qi, not necessarily use emesis. If Spleen-Stomach turbid Qi flows downward and Shaoyang clear Yang fails to ascend, one should tonify Stomach Qi and raise Yang, again, not necessarily emesis. While emesis has its place in certain Wood depressions, generalizing "emesis" to cover all "promotion" implies all Wood depressions require emesis, which is incorrect. Regarding Li Dongyuan's view on food blocking the Lungs, Metal controlling Wood is a constant principle of the Five Elements, not requiring physical obstruction. If obstructed by food, it does not imply Metal becomes excessive. Emesis for food blocking follows the *Neijing* principle of "vomiting upper pathologies," not specifically the theory of Wood depression.
"Disperse Fire depression": "Disperse" refers to sweating and lifting. If pores are closed and pathogenic heat is stifled internally, release the exterior and induce sweating to scatter it. If "Dragon Fire" (Ministerial Fire) is severely depressed internally, bitter-cold sinking agents are ineffective; instead, use floating and ascending herbs assisted by sweet-warm substances to follow its nature and treat accordingly, stopping when the pathogen is exhausted. Li Dongyuan’s *Shengyang Sanhuo Tang* is an example. These illustrate "dispersing".
"Purge Earth depression": "Purge" means catharsis and reducing excess. If pathogenic heat enters the Stomach, use salty-cold agents to purge it. For fullness and abdominal distension due to severe internal Damp-Heat in robust patients, use catharsis. If the condition is too strong to be cleared at once, reduce its momentum gradually. For dysentery caused by Damp-Heat that cannot be treated with mild agents, use purgatives or drastic measures to restore balance. These illustrate "purging".
"Drain Metal depression": "Drain" means promoting diuresis and unblocking Qi. If Lung Metal is affected by Kidney Water sources, or scorched by Fire, its function fails, the source is blocked, and water passages close. One must rectify Metal's transformation and moisten to facilitate drainage. For Lung Qi suffocation causing chest tightness and orthopnea, lung-regulating herbs are needed to unblock. These illustrate "draining". Wang Bing included "releasing the exterior" here, implying skin pathology relates to Lung depression. This logic is flawed; otherwise, tendon diseases would be Wood depression and flesh diseases Earth depression. I delete "releasing the exterior." Also, distinguishing between "moistening Lung to generate Water" and "directly treating the Bladder" is inconsistent with treating Lung depression. I revise it to "promoting diuresis."
"Control Water depression": "Control" means restraining, subduing, and gradually reducing momentum. For edema where Water overflows and blocks passages, since Earth controls Water, weak Spleen Earth allows Water to insult. Treatment should strengthen Spleen Earth to control Water. If the condition is severe, use water-draining herbs to subdue it, or employ "removing accumulation," "opening the ghost gate" (sweating), and "cleansing the residence" (diuresis) together. Wang Bing’s "suppressing rebellious Qi" aims to curb flooding. Strengthening Earth is defense; draining Water is attack; combining both is comprehensive strategy. Without assessing deficiency/excess and depth, random treatment leads to failure.
Although there are fixed methods for the Five Depressions, long-standing pathogens damage Righteous Qi. Even after pathogens are removed, Righteous Qi may not recover immediately. Therefore, "regulate the Qi" is essential to restore balance. If Qi remains excessive, tonify the element that controls it (e.g., tonify Metal to control excessive Wood). This uses what the pathogen fears, hence "purging." Wang Bing’s interpretation using salty-to-Kidney or sour-to-Liver is incomplete. From "regulating Qi" onwards reflects the classic’s intent, though practical application requires flexibility.
Zhu Danxi identified six types of depression: Qi, Blood, Dampness, Heat, Phlegm, and Food.
Qi Depression: Chest/hypochondriac pain, deep/choppy pulse. Use Xiangfu, Cangzhu, Chuanxiong.
Damp Depression: Wandering body/joint pain, worse in cold/damp, deep/fine pulse. Use Cangzhu, Chuanxiong, Baizhi, Fuling.
Heat Depression: Blurred vision, red urine, deep/rapid pulse. Use Zhizi, Qingdai, Xiangfu, Cangzhu, Chuanxiong.
Phlegm Depression: Dyspnea on exertion, deep/slippery pulse at Cun. Use Haishi, Xiangfu, Nanxing, Gualouren.
Blood Depression: Limb weakness, hematochezia, choppy pulse. Use Taoren, Honghua, Qingdai, Chuanxiong, Xiangfu.
Food Depression: Acid belching, abdominal fullness, inability to eat, tight/full pulse at Right Cun. Use Xiangfu, Cangzhu, Shanzha, Shenqu, ZhenSha.
Seasonal additions: Spring add Fangfeng; Summer add Kushen; Autumn/Winter add Wuzhuyu. Cangzhu and Chuanxiong generally resolve all depressions. Depression mostly resides in the Middle Jiao; raising Qi with these herbs resolves stagnation.
Why classify depression under Dryness? Human Qi changes mirror the Six Excesses. Dryness belongs to Autumn Metal. Metal and Wood represent the cycle of generation and destruction. Imbalance leads to stagnation (depression). External causes involve Six Qi and Five Movements (treated by the Five Methods). Internal causes involve the interaction of True Yuan and Grain Qi distributed to the Five Zang (Five Yang). Metal and Wood govern generation/destruction. Lung Metal governs Qi and dryness/constriction. Constriction hinders distribution, preventing rising and descending Qi, leading to depression ("All Qi stagnation belongs to the Lung").
The Middle Jiao (Spleen/Stomach) is the sea of Grain Qi, governing the Five Elements' harmony. Pathogens affecting the Four Zang disrupt the Middle Jiao first. Dietary irregularities also cause Middle Jiao depression. Herbs like Cangzhu (Yangming, acrid/warm) and Xiangfu (Jueyin, moving Qi) work via ascending and descending mechanisms. Chuanxiong guides Qi through the Triple Burner. This approach relies on Stomach Qi to open obstructions in all channels.
Regarding Liu Wujie’s view that depression belongs to Heat: Dryness can be cool or hot. Autumn wind brings coolness and constriction. In the body, this closes pores and dries fluids. Liu noted that Dryness can result from Wind-Heat overcoming Dampness, Lung Heat consuming fluids, Extreme Fire blocking Water transformation, Cold closing pores trapping Yang, or Cold food trapping Yang internally. Dryness can also combine with Dampness or Wind. As the *I Ching* states, Fire is the primary agent of drying.
Diagnosis of Depression: Pulse is typically deep and hidden. Upper depression shows at Cun; Middle at Guan; Lower at Chi. Pulse may be rapid (Cu), knotted (Jie), or choppy (Se). Hua Bolin stated that stagnation of Qi, Blood, Food, or Phlegm causes stoppage and choppy pulses. The key is finding "Spirit" (Shen), which is Stomach Qi.