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The pulse of any stagnation syndrome (Yu Zheng, 郁证) in ancient texts is described as Jie (Knotted), Cu (Rapid with intermittent pauses), Zhi (Intermittent), or Jie (Regularly irregular) pulses. If one waits for these specific pulse patterns to diagnose stagnation, stagnation syndromes would rarely be identified. Therefore, when diagnosing stagnation, if one observes disharmony of Qi and Blood with an unharmonious pulse, there is stagnation present. Specifically for emotional stagnation, pulses such as Xian (Wiry), Jin (Tight), Chen (Deep), Se (Choppy), Chi (Slow), Xi (Fine), Duan (Short), and Shu (Rapid) can all occur. Although Jie and Cu pulses are common in stagnation diseases, not all patients with stagnation exhibit them. Intermittent pulses often indicate internal deficiency of Qi and Blood. If a patient who normally does not have an intermittent pulse suddenly develops one due to illness, it signifies a lack of continuity, pointing strongly to internal deficiency. Thus, when distinguishing Jie and Cu pulses, one must assess the presence or absence of "Shen" (Spirit/Vitality) in the pulse. If the pulse comes and goes with strength, it may still be treated as a stagnation syndrome; however, if weak Jie or Cu pulses are mistaken for Qi rebellion and Phlegm stasis, and dissolving methods are wrongly applied, nine out of ten cases will be misdiagnosed.

Stagnation caused by the Five Qi (Wind, Cold, Summer-heat, Dampness, Dryness) can occur in various diseases; this is stagnation resulting from disease. In contrast, emotional stagnation originates primarily from the Heart; this is disease resulting from stagnation. Historically, discussions on stagnation have focused only on resolving stagnation and smoothing Qi, treating it uniformly as an excess pathogen, which is inaccurate. I hereby distinguish three types to avoid errors: namely, Nu Yu (Anger Stagnation), Si Yu (Pensiveness Stagnation), and You Yu (Depression/Gloom Stagnation).

Regarding Nu Yu (Anger Stagnation): During acute anger with rebellious Qi, excess pathogens reside in the Liver, manifesting as abdominal distension and fullness, requiring pacification. After the anger subsides and rebellious Qi dissipates, the Middle Qi is injured. Without symptoms of distension or pain, but with fatigue or poor appetite, this indicates Wood overacting on Earth (Liver attacking Spleen), causing damage to the Spleen. Failing to nourish at this stage and continuing to use draining methods harms the healthy Qi further. Thus, Nu Yu has early/late stages and excess/deficiency aspects that must be distinguished.

Regarding Si Yu (Pensiveness Stagnation): This occurs in unmarried women, widows, scholars facing adversity, and those burdened by suspicion and resentment. Pensiveness causes Qi to knot, affecting the Heart and damaging the Spleen. Severe cases extend upward to the Lung and Stomach, causing cough, asthma, hemoptysis, dysphagia, or vomiting; downward to the Kidney and Liver, causing leukorrhea, metrorrhagia, amenorrhea, or consumptive disease. Early-stage Qi knotting requires smoothing and opening; late-stage Middle Qi damage requires repair and tonification. Emotional illnesses require emotional resolution: for women, fulfillment of desires or using Anger to overcome Pensiveness may provide temporary relief; for men, unless they possess flexibility and philosophical detachment, recovery is difficult. Once severe damage occurs, further draining is misguided.

Regarding You Yu (Depression/Gloom Stagnation): This is purely a condition of great deficiency without excess pathogens, often caused by burdens of livelihood, concerns over profit/loss, or grief, worry, fright, and fear. Grief consumes Qi, worry sinks Qi, damaging Spleen and Lung; fright scatters Qi, fear lowers Qi, damaging Liver and Kidney. These individuals appear despondent, their Essence and Qi wasting away, spirit listless, with daily depletion of Heart and Spleen. This represents Yang decline, not excess. Failing to tonify True Yuan and instead using dispersing methods is akin to cutting flesh from an egret's legs—a futile and harmful act. Careful examination is essential to save lives.

1. Treatment of Nu Yu (Anger Stagnation): For acute liver injury with unresolved rebellious Qi causing distension or pain, use Jie Gan Decoction (Liver-Pacifying Decoction), Shen Xiang Powder (Aromatic Fragrance Powder), Liu Yu Tang (Six Stagnations Decoction), or Yue Ju Wan (Yue’s Pill for Resolving Stagnation). If anger injures the Liver, stirring Fire leading to irritability, heat, hypochondriac pain, or bleeding, use Hua Gan Decoction (Transforming Liver Decoction). If anger stagnation generates Phlegm, use Wen Dan Tang (Warming the Gallbladder Decoction). If post-anger rebellious Qi has dissipated, injuring Liver and Spleen causing fatigue and poor appetite, use Wu Wei Yi Gong San (Five-Ingredient Decoction for Enhancing Function), Wu Jun Zi Jian (Five Gentlemen Decoction), Da Ying Jian (Great Camp Decoction), or Gui Pi Tang (Restore the Spleen Decoction) for nourishment.

2. Treatment of Si Yu (Pensiveness Stagnation): For initial stagnation with obstructed Qi, use He Wei Jian (Harmonizing Stomach Decoction) with modifications, Er Chen Tang (Two Aged Ingredients Decoction), Chen Xiang Jiang Qi San (Aquilaria Descending Qi Powder), or Qi Pi Wan (Spleen-Initiating Pill). For women with unresolved pensiveness damaging Chong and Ren vessels, leading to blood/Qi deficiency and menstrual irregularities or amenorrhea, use Xiao Yao Yin (Free and Easy Wanderer Drink) or Da Ying Jian. For unfulfilled longing causing spermatorrhea or leukorrhea due to Heart-Lung failure to secure, use Mi Yuan Jian (Secretifying Origin Decoction). For excessive thinking causing spermatorrhea, slippery discharge, and menstrual chaos due to Liver-Kidney insecurity, use Gu Yin Jian (Securing Yin Decoction). For pensiveness stirring Fire causing metrorrhagia, hematuria, red leukorrhea, or menstrual chaos, use Bao Yin Jian (Protecting Yin Decoction). For pensiveness stirring Fire with Yin deficiency and Lung heat causing thirst, cough with blood, or tidal fever, use Si Yin Jian (Four Yins Decoction) or Yi Yin Jian (One Yin Decoction) as appropriate. For scholars with mental blockage, or those bearing burdens injuring Heart-Spleen causing palpitations, amnesia, fatigue, emaciation, or dysphagia/vomiting, use Shou Pi Jian (Longevity Spleen Decoction) or Qi Fu Yin (Seven Blessings Drink); for slight Qi obstruction or mild pain in the chest/diaphragm, use Gui Pi Tang or add Sha Ren, Bai Dou Kou, Ding Xiang to gently smooth Qi.

3. Treatment of Internal Injury from You Yu (Depression/Gloom Stagnation): For initial stagnation without internal injury, presenting with chest/diaphragm stuffiness, use Er Chen Tang, Ping Wei San (Peaceful Stomach Powder), He Wei Jian, Tiao Qi Ping Wei San (Regulating Qi Peaceful Stomach Powder), Shen Xiang Powder, or Liu Jun Zi Tang (Six Gentlemen Decoction) to regulate. If spleen injury causes acid regurgitation and nausea, use Wen Wei Yin (Warming Stomach Drink) or Shen Xiang Powder. If spleen-lung injury causes lassitude, palpitations, fatigue, and poor appetite, use Gui Pi Tang or Shou Pi Jian. If worry/thought injures Heart-Spleen causing progressive depletion of Qi/Blood, food intake, and muscle mass, use Wu Fu Yin (Five Blessings Drink) or Qi Fu Yin; for severe cases, use Da Bu Yuan Jian (Great Tonification of Origin Decoction).