欲知是气，下手脉沉。沉极则伏，涩弱久深。
气者，七气也。七气为内因，故脉沉。沉之极，虽按之至骨，犹不显露，是为
伏脉。再或见涩之往来不利，弱之无力衰微，非七气内伤之久，不如是也。
六郁多沉，滑痰紧食，气涩血芤，数火细湿。
郁有六种，亦为内因。郁则不复浮畅，故脉多沉。多沉者，不尽沉也。沉而滑，
则有水有物，痰停之郁也。沉而紧，则寒实有物，食积之郁也。沉而涩，则往来滞
涩，气虚不 之郁也。沉而芤，则沉下中空，血虚不濡之郁也。沉而数，则不能炎
上，火伏之郁也。沉而细，则附骨流衍，湿着之郁也。（大抵以越鞠丸为主最妙。如欲分治，痰宜
济生导痰汤，重则滚痰丸。食宜丹溪保和丸。气宜准绳气郁汤。血宜血郁汤。火宜热郁汤。
湿宜湿郁汤之类。）
越鞠丸（丹溪） 治六郁胸膈痞满，或吞酸呕吐，饮食不化。此治郁之圣药也。
苍术（米泔浸一宿炒） 神曲（炒） 抚芎 山栀（炒） 香附（炒） 山楂（净肉） 麦芽
（炒，各等分）
上末。水调神曲、麦芽作糊丸，如梧子大。每七八十丸，白汤下。
济生导痰汤 治痰涎壅盛，胸膈留饮，痞塞不通。
半夏（汤洗七次，四两） 南星（炮、去皮） 枳实（去瓤、麸炒） 赤茯苓（去皮） 橘红（
各一两） 甘草（炙，半两）
上 咀，每服四钱。水一盏，姜十片，煎八分，食远温服。
滚痰丸（见第十七）
丹溪保和丸（见第十七）
准绳气郁汤 治因求谋不遂，或横逆之来，或贫窘所迫，或暴怒所伤，或悲哀所致，
或思念太过，皆为气郁。其状胸满胁痛，脉沉而涩者是也。
香附（童便浸一宿，焙干，杵去毛，为粗末三钱） 苍术（炒） 橘红 制半夏（各一钱半）
贝母（去心） 白茯苓（去皮） 抚芎 紫苏叶（自汗则用子） 山栀仁（炒，共一钱） 甘草 木
香槟榔（各五分） 生姜（五片）
煎服。如胸胁作痛，此有血滞也，宜参血郁汤治之。
血郁汤 凡七情郁结，盛怒叫呼，或起居失宜，或挫闪致瘀，一应饥饱劳役，皆能
致血郁。其脉沉涩而芤，其体胸胁常有痛如针刺者是也。
香附（童便制，二钱） 牡丹皮 赤曲（炒） 川通草 穿山甲（炒） 降真香 苏木 山楂
肉大麦芽（炒、研，各一钱） 红花（七分）
水、酒各一半煎。去滓，入桃仁，去皮、泥七分，韭汁半盏，和匀，通口服。
热郁汤 有阴虚而得之者，有胃虚食冷物，抑遏阳气于脾土中而得之者。其治法皆
见发热条中。此则治夫非阴虚，非阳陷，亦不发热，而常自蒸蒸不解者也。
连翘（四钱） 薄荷叶 黄芩（各一钱五分） 山栀仁（炒，二钱） 麦门冬（去心，三钱）
甘草（五分） 郁金（一钱） 栝蒌皮穣（二钱）
竹叶七片煎服。问何不用苍术、香附、抚芎？曰∶火就燥，燥药皆能助火，故不用也。
湿郁汤 治因雨露所袭，或岚气所侵，或坐卧湿地，或汗出衣衫，皆为湿郁。其状
身重而痛，倦怠嗜卧，遇阴寒则发，脉沉而细缓者是也。
苍术（三钱） 白术（炒） 香附（炒） 橘红 浓朴（姜汁炒） 半夏（制） 白茯苓（去皮
）抚芎 羌活 独活（各一钱） 甘草（五分）
生姜五片，水煎。
虞抟云∶一男子，年二十九。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，服之月余不效。又易一医，作劳瘵治，用四物汤加知柏
地骨皮之类，及丹溪大补阴丸，倍加紫河车。服至九月，反加满闷不食。乃顾请
有乳妇人在家，只吃人乳汁四、五杯，不吃米粒。召余诊视，六脉皆洪缓，重按
若牢，右手为甚。余作湿郁处治，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，片时随没而大汗。索粥。与稀粥二碗，由是前病除
减，能食。仍与前方服三帖。后以茯苓渗湿汤，倍加白术，服二十帖平安。
To understand this Qi disorder, the pulse feels deep (Chen) upon palpation. When the deepness reaches its extreme, it becomes a Hidden pulse (Fu); if accompanied by a Choppy (Se) or Weak (Ruo) quality, it indicates that the pathogenic factor has been deeply entrenched for a long time.
The term "Qi" here refers to the Seven Emotions (Qi). As internal causes, they manifest as a Deep pulse. At the extreme of depth, even when pressing down to the bone, the pulse is not revealed; this is called the Hidden pulse (Fu Mai). If one additionally observes a Choppy pulse (Se), indicating obstructed flow, or a Weak pulse (Ruo), indicating feebleness and decline, it implies that unless there has been long-term internal injury from the Seven Emotions, such a presentation would not occur.
In Six Stagnations (Liu Yu), the pulse is mostly Deep (Chen). A Slippery (Hua) pulse indicates Phlegm, a Tight (Jin) pulse indicates Food retention, a Choppy (Se) pulse indicates Qi stagnation, a Scallion-stalk (Kou) pulse indicates Blood deficiency, a Rapid (Shu) pulse indicates Fire stagnation, and a Fine (Xi) pulse indicates Dampness stagnation.
There are six types of stagnation, which also act as internal causes. Stagnation prevents the pulse from being floating and free-flowing, so the pulse is mostly Deep. However, "mostly Deep" does not mean exclusively Deep. A Deep and Slippery pulse suggests the presence of water and tangible matter, indicating stagnation due to Phlegm accumulation. A Deep and Tight pulse suggests cold excess with tangible matter, indicating stagnation due to Food retention. A Deep and Choppy pulse suggests obstructed and sluggish flow, indicating stagnation due to Qi deficiency. A Deep and Scallion-stalk pulse suggests hollowness in the center at the deep level, indicating stagnation due to Blood deficiency failing to nourish. A Deep and Rapid pulse suggests an inability to flare upwards, indicating stagnation due to latent Fire. A Deep and Fine pulse suggests moisture spreading along the bones, indicating stagnation due to lingering Dampness. (Generally, Yueju Wan is the primary formula and is most effective. For differentiated treatment: Phlegm stagnation is treated with Jisheng Daotan Tang, or Guntan Wan for severe cases; Food stagnation is treated with Danxi Baohe Wan; Qi stagnation is treated with Zhunsheng Qi Yu Tang; Blood stagnation is treated with Xue Yu Tang; Fire stagnation is treated with Re Yu Tang; Dampness stagnation is treated with Shi Yu Tang.)
Yueju Wan (by Zhu Danxi) treats chest and diaphragm stuffiness and fullness caused by the Six Stagnations, or acid regurgitation and vomiting, and indigestion. It is considered the sacred medicine for treating stagnation.
Cangzhu (Atractylodis Rhizoma, soaked overnight in rice wash water and stir-fried) Shenqu (Medicated Leaven, stir-fried) Fuxiong (Ligustici Chuanxiong Hort. Radix) Shanzhi (Gardeniae Fructus, stir-fried) Xiangfu (Cyperi Rhizoma, stir-fried) Shanzha (Crataegi Fructus, cleaned flesh) Maiya (Hordei Fructus Germinatus, stir-fried, equal parts).
Grind into powder. Use water to mix Shenqu and Maiya to make a paste for forming pills, sized like wu zi (seeds of Cerasus pseudocerasus). Take 70-80 pills each time, washed down with warm water.
Jisheng Daotan Tang treats excessive phlegm-saliva, retained fluid in the chest and diaphragm, and obstruction/blockage.
Banxia (Pinelliae Rhizoma, washed seven times in hot water, 4 liang) Nanxing (Arisaematis Rhizoma, processed, peeled) Zhishi (Aurantii Fructus Immaturus, pulp removed, bran-fried) Chi Fuling (Poria cum Radio mycelium, peeled) Juhong (Citri Reticulatae Pericarpium Rubrum, 1 liang each) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 0.5 liang).
Cut into pieces. Take 4 qian per dose. Add one sheng (approx. 200ml) of water and 10 slices of fresh ginger, decoct until reduced to 0.8 sheng, and take warm after meals.
Guntan Wan (See Chapter 17)
Danxi Baohe Wan (See Chapter 17)
Zhunsheng Qi Yu Tang treats Qi stagnation caused by unfulfilled desires, sudden adversity, poverty and distress, violent anger, sorrow, or excessive thinking. The symptoms include chest fullness and hypochondriac pain, with a Deep and Choppy pulse.
Xiangfu (Cyperi Rhizoma, soaked overnight in urine of a young boy, dried, pounded to remove hairs, ground to coarse powder, 3 qian) Cangzhu (Atractylodis Rhizoma, stir-fried) Juhong (Citri Reticulatae Pericarpium Rubrum) Zhi Banxia (Prepared Pinelliae Rhizoma, 1.5 qian each) Beimu (Fritillariae Bulbus, heart removed) Bai Fuling (Poria cum Radio mycelium, peeled) Fuxiong (Ligustici Chuanxiong Hort. Radix) Zisu Ye (Perillae Folium, use Zisu Zi/Perillae Fructus if spontaneous sweating occurs) Shanzhi Ren (Gardeniae Fructus seed, stir-fried, total 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma) Muxiang (Aucklandiae Radix) Binglang (Arecae Semen, 0.5 qian each) Shengjiang (Zingiberis Rhizoma Recens, 5 slices).
Decoct and take orally. If there is pain in the chest and hypochondrium, this indicates Blood stasis, and one should refer to Xue Yu Tang for treatment.
Xue Yu Tang treats Blood stagnation caused by any of the following: emotional stagnation, furious shouting, improper daily routine, trauma causing blood stasis, or irregular diet and overwork. The pulse is Deep, Choppy, and Scallion-stalk-like, and the body experiences needle-like pain in the chest and hypochondrium.
Xiangfu (Cyperi Rhizoma, prepared with urine of a young boy, 2 qian) Mudanpi (Moutan Cortex) Chi Qu (Red Medicated Leaven, stir-fried) Chuantongcao (Tetrapanacis Pith) Chuanshanjia (Manis Squama, stir-fried) Jiangzhengxiang (Daemonorops Spica) Sumu (Sappan Lignum) Shanzha Rou (Crataegi Fructus flesh) Dayamai (Hordei Fructus Germinatus, stir-fried and ground, 1 qian each) Honghua (Carthami Flos, 0.7 qian).
Decoct with half water and half wine. Strain the dregs, add Taoren (Persicae Semen, peeled and pounded to paste, 0.7 qian) and half a zhan of Jiuzhi (Allium tuberosum juice), mix evenly, and take orally in one go.
Re Yu Tang (Heat Stagnation Decoction) can be contracted due to Yin deficiency, or due to Spleen/Stomach deficiency from consuming cold food, which suppresses Yang Qi within the Spleen Earth. Its treatment methods are detailed in the section on Fever. This formula treats cases that are neither Yin deficiency nor Yang collapse, and do not present with fever, but rather a constant sensation of steaming heat.
Lianqiao (Forsythiae Fructus, 4 qian) Bohe Ye (Menthae Haplocalycis Folium) Huangqin (Scutellariae Radix, 1.5 qian each) Shanzhi Ren (Gardeniae Fructus seed, stir-fried, 2 qian) Maidong (Ophiopogonis Radix, heart removed, 3 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 qian) Yujin (Curcumae Radix, 1 qian) Gualou Pi Rang (Trichosanthis Pericarpium and pulp, 2 qian).
Add 7 slices of Zhuye (Bambusae Folium) and decoct. Why are Cangzhu, Xiangfu, and Fuxiong not used? Because Fire tends towards dryness, and drying herbs can assist Fire, hence they are excluded.
Shi Yu Tang (Dampness Stagnation Decoction) treats Dampness stagnation caused by rain/dew exposure, mountain miasma invasion, sitting/lying on damp ground, or sweat-soaked clothes remaining on the body. Symptoms include heavy and painful body, fatigue, desire to sleep, exacerbation in yin-cold weather, and a Deep, Fine, and Slow pulse.
Cangzhu (Atractylodis Rhizoma, 3 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried) Xiangfu (Cyperi Rhizoma, stir-fried) Juhong (Citri Reticulatae Pericarpium Rubrum) Houpo (Magnoliae Officinalis Cortex, fried with ginger juice) Banxia (Pinelliae Rhizoma, prepared) Bai Fuling (Poria cum Radio mycelium, peeled) Fuxiong (Ligustici Chuanxiong Hort. Radix) Qianghuo (Notopterygii Rhizoma et Radix) Duhuo (Angelicae Pubescentis Radix, 1 qian each) Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 qian).
Add 5 slices of Shengjiang (Zingiberis Rhizoma Recens) and decoct with water.
Yu Tun stated: A man, aged twenty-nine, rode a horse across a stream in March after sexual intercourse, fell into a deep abyss, and was submerged, though fortunately the horse remained safe. He walked fifteen li home wearing wet clothes. The next day, he experienced aversion to cold with high fever, vexatious pain in limbs and joints, resembling malaria but not quite. One physician treated it as a Deficiency syndrome using Qi and Blood tonics, but after more than a month of intake, there was no effect. Another physician treated it as Lao Zhai (consumptive disease) using Siwu Tang plus Zimu, Huangbai, Digupi, and Danxi's Dabu Yin Wan, with added large doses of Zihewei (Placenta Humana). By September, his condition worsened with abdominal fullness and loss of appetite. I was consulted. The patient was only drinking human milk (from a wet nurse in the house), four or five cups, without eating rice grains. Upon examination, all six pulses were Surging and Slow (Hong Huan), firm upon heavy pressure, especially on the right hand. I diagnosed it as Dampness Stagnation and prescribed Pingwei San, doubling the dosage of Cangzhu, adding Banxia, Fuling, Baizhu, Chuanxiong, Xiangfu, Mutong, Sharen, Fangfeng, and Qianghuo, with fresh ginger. He took one dose at dusk and another at first watch. By midnight, his whole body turned red like urticaria, which disappeared shortly followed by profuse sweating. He asked for porridge. I gave him two bowls of thin porridge, after which his previous symptoms subsided, and he could eat. He continued the same prescription for three more doses. Later, he took Fuling Shenshi Tang with doubled Baizhu for twenty doses, resulting in complete recovery.