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Leading to Bi syndrome (Painful Obstruction Syndrome). In summary, when pathogenic factors fail to disperse, it is termed Yu (Stagnation); this type arises from the external contraction of the Six Excesses (Liu Yin). Stagnation caused by the Seven Emotions, such as excessive thinking damaging the Spleen or excessive anger damaging the Liver, has its root generally in the Heart. When emotional states are unfulfilled, stagnation occurs leading to disease; these conditions most frequently involve the Heart, Spleen, Liver, and Gallbladder. Treatment methods include clearing and draining stagnant fire in the Upper Jiao, or promoting the free flow of Shaoyang (Lesser Yang), or opening and descending Lung Qi, as well as various methods such as tonifying and unblocking the Liver and Stomach, draining the Gallbladder while tonifying the Spleen, and unblocking the collaterals. If heat stagnates in the Supreme Yin, saline tonification and bitter drainage should be used.

Stagnation leads to Qi obstruction; over time, it inevitably transforms into Heat. Heat stagnation consumes Body Fluids and impedes their flow, causing the mechanism of Ascending and Descending to lose its normal rhythm. Initially, the Qi aspect is damaged; prolonged illness extends to the Blood aspect, resulting in chronic debilitating conditions due to stagnation. Medications should employ Bitter, Acrid, Cool, Moistening, Dispersing, and Unblocking properties, avoiding Dry-Heat, Astringent, Stagnant, and Tonifying drugs. This is the general principle of treatment. Furthermore, since stagnation causes Qi obstruction, this obstruction may reside in the physical body or within the Zang-Fu organs, invariably presenting with sensations of discomfort. Qi is inherently formless; upon stagnation, Qi gathers, appearing substantial but lacking true substance. Symptoms may include a sensation of blockage in the chest and diaphragm, empty fullness below the heart, distension in the hypochondrium and back, epigastric stuffiness with loss of appetite, attacking pain from Qi masses (Qi Ji), and stiffness of sinews and vessels. Physicians mistakenly identify these as tangible obstructions and use harsh Qi-breaking and purgative therapies. As the condition worsens despite treatment, subsequent prescriptions often resort to rigid tonification. In such cases, patients do not die from the disease itself, but from erroneous medication.

One must understand that emotional stagnation arises from hidden grievances that cannot be expressed, thereby impairing the pivot mechanism of Qi's ascending, descending, opening, and closing. Although the *Neijing* (*Inner Canon*) describes five treatments for Five Types of Stagnation—Draining, Breaking, Reaching, Erupting, and Seizing—it is feared that these may not be entirely sufficient. Therefore, the *Shu Wu Guo Lun* (*Treatise on Five Negligences*) notes that cases involving a transition from wealth to poverty, or from nobility to loss of power, belong to categories that are difficult to treat. Essentially, treating Stagnation disorders relies on the patient's ability to shift their emotions and alter their character, and on the physician's skillful构思 (conceptualization). The focus is not primarily on attacking or tonifying, but rather on using Bitter herbs to drain Heat without damaging the Stomach, Acrid herbs to regulate Qi without dispersing it excessively, Slippery and Moistening herbs to nourish dryness without clogging the Qi mechanism, and Dispersing methods without hastening recovery unnaturally. Only then might success be achieved. If one insists on seeking a perfect cure, one must heed the Daoist saying: "If you wish to live long, first learn to die short." This is the "Golden Pill" for treating Stagnation. (From *Lin Zheng Zhi Nan* / *Guide to Clinical Practice*)

Various diseases, if prolonged, lead to Qi stagnation and Blood coagulation, forming nodules of stagnation. Treatment should address each specific pattern while simultaneously resolving stagnation. Once the stagnation is opened, Qi and Blood flow freely, and the various diseases heal themselves. Modern physicians often treat chronic diseases using herbs specific to the primary pathology without effect; this is due to the presence of Stagnation. Physicians who fail to comprehend this point recklessly change formulas, compounding errors and exacerbating the illness. The principles of treating Stagnation must be thoroughly mastered. (Xu Chunfu)

**Pulse Diagnosis**

The pulse of Stagnant Fire is extremely difficult to diagnose; it is generally wiry (Xian), choppy (Se), and sluggish. Because the Fire pathogen fails to erupt, the meridians are all constrained by it, resulting in a deep (Chen) and concealed (Fu) pulse that is hard to detect. (From *Ji Ren Bian* / *Compilation of Personal Experience*)

Generally, a Deep and Fine pulse is interpreted as Cold, or if the patient appears weak, it is mistaken for Deficiency. However, it is unknown that Stagnation pulses can also present as Deep and Fine; this has been discussed by predecessors. (Fang Xingyan)

Ancients considered Knotted (Jie) and Intermittent (Cu) pulses as indicative of Stagnation. If one waits for these specific pulses to diagnose Stagnation, Stagnation patterns would rarely be seen. In diagnosing Stagnation, whenever there is disharmony of Qi and Blood and the pulse is not smooth and harmonious, it indicates Stagnation. (Zhang Jingyue)

Although Stagnation pulses often present as Deep, Concealed, Knotted, or Intermittent, these are not necessarily dangerous. What warrants concern is the Firm (Lao), Leathery (Ge), Wiry (Xian), and Strong pulse indicating disharmony.

Deep, Concealed, Knotted, and Intermittent pulses indicate that Qi can still be dispersed; once Qi flows, harmony is restored. However, Firm, Leathery, Wiry, and Strong pulses indicate that the Healthy Qi (Zheng Qi) has already been damaged, leaving no Qi to disperse. Even with regulatory tonification, efficacy is difficult to achieve, let alone the misuse of Qi-depleting drugs! Therefore, Stagnation cases presenting with Wiry and Strong pulses often degenerate into Deficiency consumptive diseases. (Zhang Luyu)

In cases of depressive illness, if the pulse becomes Surging and Large after administering Stagnation-resolving herbs, there is no need to worry; this indicates that the pathogenic Qi has begun to open. (Luo Chicheng)

**Selected Cases**

In my youth, I fell ill due to depression and melancholy, presenting symptoms similar to Tuberculous Consumption (Lao Fei). I took various tonic prescriptions, yet my condition worsened. Later, I encountered a renowned physician who diagnosed me, stating, "You suffer from a Stagnation disorder, not a Deficiency consumptive disease." He cured me with Yueju Wan. (From *Dongyang Wenji* / *Collected Works of Dongyang*)

A woman developed depression due to infertility. Her menstruation had ceased for three months. She suffered from abdominal pain and nausea. The physician diagnosed pregnancy and administered herbs for calming the fetus, moving Qi, and relieving pain, but they were ineffective. Every day between Wei and Shen hours (1 PM – 5 PM), she experienced alternating chills and fever. There were two or thirty hard lumps in her abdomen, about the size of quail eggs, which churned painfully. Movement produced gurgling water sounds in the abdomen. Extreme pain triggered vomiting of sour fluid; after vomiting, the lumps subsided, chills and fever ceased, and pain stopped, only to recur the next day. Treatment as Malaria exacerbated the condition. My diagnosis revealed a Wiry and Choppy pulse on the left, and a Soft and Weak pulse on the right, with the Cunchi position matching the left. I stated, "This is a Stagnation disorder. How could a Choppy pulse indicate pregnancy?" The prescription consisted of Er Chen Tang combined with Xiang Fu, Shan Zhi, Fu Xiong, Yan Hu Suo, Dang Gui, and Hong Hua. Pain ceased during medication but returned afterward. After one month of regulation, the root cause was not eliminated. I then referred her to Mr. Huang Gutan. He said, "This is a Stagnant Fire disorder originating in the Liver and Gallbladder. The Liver governs planning; the Gallbladder governs decision-making. Indecision leads to Stagnation; Stagnation causes Wood Qi to flourish. Flourishing Wood attacks Earth (Spleen). The injured Spleen fails to transform and transport essences to generate Qi and Blood, hence amenorrhea. Metal (Lung) loses nourishment from its mother (Earth), so its descending function fails. Wood, lacking restraint, insults what it cannot overcome (Metal), directly invading the clear pathways causing vomiting. The reduction of symptoms after vomiting occurs because Wood rises and Fire extinguishes. The formula uses Huang Qi (5 qian), Chai Hu (3 qian), Bai Shao (2 qian), Gan Cao (1 qian), Chen Pi, Bei Mu, and Zhi Shi (0.5 qian each), and Ginger slices (3 pieces). After one dose, chills and fever resolved; after two doses, pain decreased and vomiting stopped, and water sounds ceased. Her husband rejoiced, asking, 'How is it so swift?' Upon further inquiry, he explained: 'Chills and fever relate to Shaoyang Gallbladder; vomiting acid relates to Jueyin Liver; painful churning lumps indicate Fire stirring Water, like boiling soup in a pot. Excessive vomiting injures Lung Metal further; thus, Huang Qi tonifies Lung Metal as the Sovereign herb to control Liver Wood. Chai Hu drains Liver as the Minister herb, raising Gallbladder Fire. The Classic states: "For Wood stagnation, reach it." Wood nature tends to ascend; stagnation prevents this. Thus, Chai Hu raises the clear Qi of Liver and Gallbladder to break through the stagnation. Excess is reduced by exploiting its fear, which is the method of Draining. Tonifying Lung to control Liver exemplifies this. To soothe the Liver, one must relax the center; Gan Cao acts as the Assistant to relax the center. For the primary pathology of Wood, draining is done with Sour; Bai Shao drains Wood within Earth as an Assistant. Prolonged illness generates Stagnation; prolonged Stagnation generates Phlegm-fluids. Bei Mu, Chen Pi, and Zhi Shi open Stagnation and expel Phlegm-fluids as the Envoy. Thus, Metal regains its righteousness, Wood achieves balance, and Earth finds peace, leading to rapid recovery. The previous formula used Shan Zhi, a downward-draining herb. With raging Fire, how could mere cold herbs suppress it? Mild cases are treated orthodoxy; severe cases follow the nature of the pathogen and raise it. One must grasp this intent in treating disease.' (Sun Yikui)

A man suffered from long-term depression, appearing demented, laughing and crying intermittently, muttering to himself, and losing his appetite. Once, seeing charcoal being carried past, he became overjoyed and snatched food to eat. This became a habit; he ate approximately one jin (catty) daily. Physicians used phlegm-resolving and Heart-calming agents without success. I reasoned that Stagnation injured Liver Wood, causing Wood and Fire to self-combust, gradually turning to ash. Charcoal is wood ash; like attracts like. The disease was treatable because the desire to eat charcoal indicated that Stomach Qi remained. By tonifying the Qi and Blood of the Heart and Liver and eliminating Phlegm-fluids, he healed spontaneously. (Cheng Zhonghua)