论
《内经》曰∶木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之。张子和曰∶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，谓下之令无壅碍也。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。此治五郁之大要耳。我丹溪先生触类而长之，而又着为六郁之证，所谓气血冲和，百病不生，一有佛郁，诸
病生焉，此发前人之所未发者也。夫所谓六郁者，气、湿、热、痰、血、食六者是也。或七情之抑遏，或寒热之交侵，
故为九气怫郁之候。或雨湿之侵凌，或酒浆之积聚，故为留饮湿郁之疾。又如热郁而成痰，痰郁而成癖，血郁而成 ，
食郁而成痞满，此必然之理也。又气郁而湿滞，湿滞而成热，热郁而成痰，痰滞而血不行，血滞而食不消化，此六者皆
相因而为病者也。是以治法皆当以顺气为先，消积次之，故药中多用香附、抚芎之类，至理存焉，学人宜知此意。
脉法
脉多沉伏，气郁则必沉而涩，湿郁则脉必沉而缓，热郁脉必沉数，痰郁脉必弦滑，血郁脉必芤而结促，食郁脉必滑
而紧盛，郁在上则见于寸，郁在中则见于关，郁在下则见于尺，左右亦然。
脉或结，或促，或代。
滑氏《诊家枢要》曰∶气血食积痰饮，一有留滞于其间，脉必因之而止节矣，但当求其有神，何害之有。夫所谓有
神者，即经所谓有中气也。
方法
丹溪曰∶气血冲和，百病不生，一有怫郁，诸病生焉。其证有六∶曰气郁，曰湿郁，曰热郁，曰痰郁，曰血郁，曰
食郁。气郁（戴氏曰∶胸胁痛，脉沉）∶香附（此味而能横行胸臆间，必用童便浸，焙干用，否则燥）、苍术（米泔浸五、
七次）、抚芎（即蘼芜芎 苗头小块，气脉上行，故能散郁也）。湿郁（戴氏曰∶周身走痛，或关节痛，遇阴寒则发，脉
沉）∶苍术、白芷、川芎、茯苓。热郁（戴氏曰∶目瞀，小便赤，脉沉散）∶栀子、青黛、香附、苍术、抚芎。痰郁（戴
氏曰∶动则喘，寸口脉沉滑）∶海石、香附、南星、栝蒌子。血郁（戴氏曰∶四肢无力，大便红，脉沉）∶桃仁、红花、
青黛、川芎、香附。食郁（戴氏曰∶咽酸腹闷，不能食，左寸脉平和，右寸脉紧盛）∶香附、苍术、山楂、神曲、针砂（醋
炒）或保和丸。
诸郁药，春加防风，夏加苦参，秋、冬加吴茱萸。
凡药在中焦，以苍术、抚芎开提其气以升之。假令食在气上，气升则食降。余仿此。
越鞠丸（一名芎术丸。）
神曲（炒） 香附（童便浸一宿） 苍术 川芎 栀子（炒）
上为细末，水丸绿豆大，每服五、七十丸，温水下。
生韭饮 治食郁久则胃脘有瘀血作痛，大能开提气血。
生韭叶（一握，捣取自然汁一盏）
上先以生桃仁连皮细嚼十数个，后以韭汁送下。
六郁汤 解诸郁。
陈皮（去白，一钱） 半夏（汤泡七次） 苍术（米泔浸） 抚芎（各一钱） 赤茯苓 栀子（炒，各七分） 香
附（二钱） 甘草（炙，五分） 砂仁（研细，五分）
上细切，作一服，加生姜三片，水二盏，煎至一盏，温服。如气郁，加乌药、木香、槟榔、紫苏、干姜，倍香附、
砂仁。如湿郁，加白术，倍苍术。如热郁，加黄连，倍栀子。如痰郁，加南星、枳壳、小皂荚。如血郁，加桃仁、红花、
牡丹皮。如食郁，加山楂、神曲、麦 面。
升发二陈汤 治痰郁，火邪在下焦，大小便不利。此药能使大便润而小便长。
陈皮（去白，一钱） 半夏（一钱五分） 茯苓（一钱） 甘草（五分） 抚芎（一钱） 升麻 防风 柴胡（各
五分）
上细切，作一服，加生姜三片，水一盏半，煎至一盏，温服。
（以上丹溪方法凡七条）
升阳散火汤（东垣） 治热郁。
火郁汤（东垣，二方并见火门。）
（医案）
一男子，年二十九岁，三月间，房事后骑马渡溪，遇深渊沉没，幸得马健无事，连湿衣行十五里抵家。次日憎寒壮
热，肢节烦疼，似疟非疟之状。一医作虚证治，而用补气血药，服月余不效。又易一医，作劳瘵治，用四物汤加知母、
黄柏、地骨皮，及丹溪大补阴丸倍加紫河车服至九月，反加满闷不食。乃顾倩有乳妇人在家，止吃人乳汁四、五杯，不
吃米粒。召予诊视，六脉皆洪缓，重按若牢，右手为甚。予作湿郁处治，用平胃散，倍苍术，加半夏、茯苓、白术、川
芎、香附、木通、砂仁、防风、羌活，加姜煎服。黄昏服一帖，一更时又进一帖，至半夜，遍身发红丹如瘾疹，片时遂
没而大汗。索粥，与稀粥二碗。由是诸病皆减，能食。仍与前方，服三帖。后以茯苓渗湿汤倍加白术，服二十余帖平安。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: For Wood depression, promote its free flow; for Fire depression, disperse it; for Earth depression, purge it; for Metal depression, vent it; for Water depression, control it. Zhang Zihe stated: "Promoting the free flow of Wood" refers to using emesis to make the Qi mechanism smooth and unobstructed. "Dispersing Fire" refers to using diaphoresis to scatter the pathogenic factors. "Purging Earth" refers to using purgation to eliminate stagnation. "Venting Metal" refers to promoting urination and releasing the exterior to normalize lung qi descent. "Controlling Water" refers to suppressing its rebellious upward surge. These are the general principles for treating the five depressions. My teacher, Mr. Danxi, extended this logic and formulated the syndrome of Six Depressions. He posited that when Qi and Blood are harmonious, no diseases arise; once there is a depression (stagnation of Qi mechanism), various diseases emerge. This was an original insight not previously expounded by earlier scholars. The so-called Six Depressions refer to Qi, Dampness, Heat, Phlegm, Blood, and Food. Some cases arise from the suppression of the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) or the alternating invasion of Cold and Heat pathogens, resulting in the pattern of Nine Qi Depression. Others result from the encroachment of rain and dampness or the accumulation of alcoholic beverages, leading to retained fluids and Dampness Depression. Furthermore, Heat depression can condense into Phlegm; Phlegm depression can form masses; Blood depression leads to blood stasis; Food depression causes epigastric fullness and distension. This is the inevitable principle. Additionally, Qi depression leads to Dampness stagnation; Dampness stagnation transforms into Heat; Heat depression generates Phlegm; Phlegm stagnation impedes Blood circulation; Blood stagnation impairs food digestion. These six factors are interrelated and cause disease. Therefore, treatment methods should prioritize regulating Qi, followed by resolving accumulations. Hence, herbs such as Xiangfu (Cyperus Rhizome) and Fuxiong (Ligusticum Chuanxiong var. jeholense) are frequently used, containing profound rationale which students must understand.
Pulse Diagnosis
The pulse is often deep and hidden. In Qi depression, the pulse is necessarily deep and choppy; in Dampness depression, it is necessarily deep and slow; in Heat depression, it is deep and rapid; in Phlegm depression, it is wiry and slippery; in Blood depression, it is hollow with intermittent beats; in Food depression, it is slippery, tight, and vigorous. Depression in the Upper Jiao manifests at the Cun position; depression in the Middle Jiao manifests at the Guan position; depression in the Lower Jiao manifests at the Chi position. The same applies to both left and right hands.
The pulse may present as Knotted (Jie), Rapid-interrupted (Cu), or Intermittent (Dai).
Slao Shou, in *Zhenjia Shuyao* (Key Essentials of Pulse Diagnosis), stated: When Qi, Blood, Food retention, or Phlegm-fluids stagnate within, the pulse will inevitably exhibit pauses. However, one should seek the presence of "Spirit" (Shen) in the pulse; what harm is there? The so-called "Spirit" refers to what the classics call "Zhong Qi" (Middle Qi / Stomach Qi).
Methods
Danxi stated: When Qi and Blood are harmonious, no diseases arise; once there is depression, various diseases emerge. There are six syndromes: Qi Depression, Dampness Depression, Heat Depression, Phlegm Depression, Blood Depression, and Food Depression.
Qi Depression (Mr. Dai stated: Hypochondriac pain, deep pulse): Use Xiangfu (This herb moves freely through the chest and diaphragm; it must be soaked in child's urine and dried before use, otherwise it is too drying); Cangzhu (Soaked in rice washing water five to seven times); Fuxiong (Small pieces of Ligusticum chuanxiong seedlings; since its Qi and pulse ascend, it can disperse depression).
Dampness Depression (Mr. Dai stated: Wandering pain throughout the body or joint pain, exacerbated by cold and yin conditions, deep pulse): Use Cangzhu, Baizhi, Chuanxiong, Fuling.
Heat Depression (Mr. Dai stated: Visual blurring, red urine, deep and scattered pulse): Use Zhizi, Qingdai, Xiangfu, Cangzhu, Fuxiong.
Phlegm Depression (Mr. Dai stated: Panting upon movement, deep and slippery pulse at the Cun position): Use Haishi, Xiangfu, Nanxing, Gualouzi.
Blood Depression (Mr. Dai stated: Weakness of the four limbs, red stool, deep pulse): Use Taoren, Honghua, Qingdai, Chuanxiong, Xiangfu.
Food Depression (Mr. Dai stated: Sour regurgitation, abdominal stuffiness, inability to eat, normal pulse at left Cun, tight and vigorous pulse at right Cun): Use Xiangfu, Cangzhu, Shanzha, Shenqu, Zhensha (Stir-fried with vinegar) or Baohe Wan.
For medicines treating various depressions, add Fangfeng in Spring, Kushen in Summer, and Wuzhuyu in Autumn and Winter.
For medications acting on the Middle Jiao, use Cangzhu and Fuxiong to lift and raise the Qi. If food stagnation is located above the Qi level, raising the Qi will cause the food to descend. Other cases follow this analogy.
Yueju Wan (Also known as Xiongzhu Wan).
Shenqu (Stir-fried) Xiangfu (Soaked in child's urine overnight) Cangzhu Chuanxiong Zhizi (Stir-fried)
Grind into fine powder, form pills the size of mung beans. Take 50-70 pills each time with warm water.
Shengji Yin (Fresh Leek Decoction) Treats prolonged Food Depression causing blood stasis pain in the epigastrium; it greatly opens and lifts Qi and Blood.
Fresh leek leaves (One handful, crushed to extract one cup of natural juice)
First, chew thoroughly ten to dozen raw Tao Ren (Peach Kernel) with skin, then swallow with the leek juice.
Liuyu Tang (Six Depression Decoction) Resolves various depressions.
Chenpi (White part removed, 1 qian) Banxia (Soaked in boiling water seven times) Cangzhu (Soaked in rice washing water) Fuxiong (Each 1 qian) Chifuling Zhizi (Stir-fried, each 0.7 qian) Xiangfu (2 qian) Gancao (Honey-fried, 0.5 qian) Sharen (Ground finely, 0.5 qian)
Cut finely, prepare as one dose. Add three slices of fresh ginger, two cups of water, decoct to one cup, and take warm. If Qi Depression, add Wuyao, Muxiang, Binglang, Zisu, Ganjiang, and double the dosage of Xiangfu and Sharen. If Dampness Depression, add Baizhu and double Cangzhu. If Heat Depression, add Huanglian and double Zhizi. If Phlegm Depression, add Nanxing, Zhike, Xiao Zhaojiao. If Blood Depression, add Taoren, Honghua, Mudanpi. If Food Depression, add Shanzha, Shenqu, Maifan.
Shengfa Erchen Tang (Ascending and Issuing Erchen Decoction) Treats Phlegm Depression with Fire pathogen in the Lower Jiao causing difficulty in urination and defecation. This medicine moistens the bowels and promotes urination.
Chenpi (White part removed, 1 qian) Banxia (1.5 qian) Fuling (1 qian) Gancao (0.5 qian) Fuxiong (1 qian) Shengma Fangfeng Chaihu (Each 0.5 qian)
Cut finely, prepare as one dose. Add three slices of fresh ginger, one and a half cups of water, decoct to one cup, and take warm.
(Above are seven methods from Danxi)
Shengyang Sanhuo Tang (Li Dongyuan) Treats Heat Depression.
Huoyu Tang (Li Dongyuan, both formulas are found in the Fire Chapter.)
(Clinical Case)
A man, aged twenty-nine, in March, after sexual intercourse, rode a horse across a stream, fell into a deep abyss, and sank. Fortunately, the horse was strong and uninjured. He walked fifteen li home wearing wet clothes. The next day, he experienced aversion to cold with high fever, painful joints, resembling malaria but not quite. One physician treated it as a deficiency syndrome using Qi and Blood tonics, which yielded no effect after more than a month. Another physician changed the diagnosis to Laozai (Consumption/Tuberculosis) and prescribed Siwu Tang plus Zhimu, Huangbai, Digupi, and Danxi's Dabu Yin Wan with added large doses of Zihewu (Placenta Humanum). By September, his symptoms worsened with abdominal fullness and anorexia. He relied on a lactating woman at home, drinking only four or five cups of human breast milk and eating no grains. I was summoned to examine him. All six pulses were surging and moderate, feeling firm upon heavy pressure, especially on the right hand. I diagnosed it as Dampness Depression and treated accordingly using Pingwei San with doubled Cangzhu, plus Banxia, Fuling, Baizhu, Chuanxiong, Xiangfu, Mutong, Sharen, Fangfeng, and Qianghuo, decocted with ginger. He took one dose at dusk and another at first watch. By midnight, his entire body broke out in red rashes like urticaria, which disappeared shortly after accompanied by profuse sweating. He requested porridge; I gave him two bowls of thin porridge. Consequently, all symptoms diminished, and he could eat. He continued with the previous formula for three doses. Later, he took Fuling Shenshi Tang with doubled Baizhu for over twenty doses, achieving full recovery.