大意
气血冲和。百病不生。一有怫郁。百病生焉。（丹溪）郁者。结聚而不得发越也。当升不升。当降不降。当变化不
得变化。（医鉴）故有病久而生郁者。亦有郁久而生病者。或服药杂乱而成者。
内因
郁乃滞而不通之义。或七情之抑遏。或寒暑之交侵。而为九气怫郁之候。或雨雪之浸淫。或酒食之积聚。
而为留饮湿郁之候。（汇补）其因有六。气血湿热痰食是也。然气郁则生湿。湿郁则成热。热郁则成痰。痰郁
而血不行。血郁而食不化。六者。又相因也。（丹溪）
外症
气郁胸满胁痛。噫气腹胀。痰郁胸满喘促。起卧倦怠。血郁能食肢倦。溺淋便赤。食郁嗳酸作胀。恶食痞硬。
湿郁关节重痛。首如物蒙。遇阴则甚。热郁目蒙溺涩。口干烦躁。遇暖便发。（戴氏）
五脏郁症
有本气自郁而生病者。心郁昏昧健忘。肝郁胁胀嗳气。脾郁中满不食。肺郁干咳无痰。肾郁腰胀淋浊。不
能久立。胆郁口苦晡热。怔忡不宁。（汇补）
七情郁症
七情不快。郁久成病。或为虚怯。或为噎膈。或为痞满。或为腹胀。或为胁痛。女子则经闭堕胎。带下崩中。可
见百病兼郁如此。（何氏）
脉法
郁脉多沉。在上见于寸。在中见于关。在下见于尺。又郁脉或结或促或代。盖血气食积痰饮。一有留滞于
其间。脉必因之而止矣。（脉经）
总治
郁病虽多。皆因气不周流。法当顺气为先。开提为次。至于降火化痰消积。犹当分多少治之。（汇补）
郁宜调中
治郁之法。多以调中为要者。无他。盖脾胃居中。心肺在上。肾肝处下。四脏所受之邪。过于中者。中气常先
受之。况乎饮食不节。寒暑不调。停痰积饮。而脾胃亦先受伤。所以中焦致郁恒多也。治宜开发运动。鼓舞
中州。则三阴三阳之郁。不攻自解矣。（汇补）
郁分五行
五行之理。木性条达。火性发扬。土性冲和。金性清肃。水性流通。一有怫郁。失其性矣。（滑氏）故木郁达之。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。（内经）
木郁治法
胁胀满。目赤暴痛。此木郁也。治宜达之。达者。通畅之义。如怒动肝气。火因上炎。治以苦寒辛散而不愈
者。则用升发之品。加厥阴报使之药以从治之。又如久风入中为飧泄。及清气在下为飧泄者。则用轻扬
之剂举而升之。又如木实为病。脉弦而急。用降气苦寒不愈者。则吐以提之。使木气舒畅。则痛自止。此皆
达之之法也。
火郁治法
咳嗽痰喘。风疹潮热。此火郁也。治宜发之。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。又如生冷抑遏。火郁于内。非苦寒降沉之剂可治。则用升浮之品。佐以甘温。顺其性而从治之。势穷
则止。此皆发之之义也。
土郁治法
食滞中焦。痰凝脾藏。热壅肠胃。皆土郁也。治宜夺之。夺者。攻下也。劫而衰之也。如邪热入胃。用咸寒以攻
下之。如中满腹胀。湿热内甚。其人壮实者。则亦攻下之。其或势甚而不能顿除者。则劫夺其势而使之衰。
又如湿热为痢。非轻剂可已。或行或通。以致其平。皆夺之之义也。
金郁治法
癃闭气喘。胀满不眠。皆金郁也。治宜泄之。泄者。渗泄而利小便。疏通其气也。如肺受火烁。化令不行。致水
源郁而渗道闭者。宜清肃金化。滋以利之。又如肺气 郁。胸满仰息不得卧下。非利肺气不足以疏通之。
此皆泄之之法也。
水郁治法
水肿胀满。二便阻隔。皆水郁也。治宜折之。折者。制御之也。伐而挫之也。渐杀其势也。如胀满之病。水气浸
淫而渗道以塞。乃土弱不能制水。当实脾土。资运化。使能制水而不敢泛滥。则渗道自通。或病势方锐。非
上法所能遽制。则用泄水之药。伐而挫之。或动大便。或利小水。或发表汗。三法酌举迭用。以渐平之。此皆
折之之义也。
调气总法
五郁之治。各有其法。然邪气之客。正气必损。故必调平正气。以复其常于治郁之后。苟调其气而尚未平
复。则当益其所不胜以制之。如木郁不已。当清肺金。火郁不已。当滋肾水。水郁不已。当补脾土。金郁不已。
当引火归源。土郁不已。当养肝调气。此皆以其所畏而治之。即过者折之之理也。（汇补）
用药
主以二陈汤。加香附、抚芎。如湿郁。加苍术、白芷。热郁。加黄芩、山栀。痰郁。加枳实、贝母。血郁。加桃仁、
红花。食郁。加山楂、麦芽。气郁。加枳、朴、乌药、木香。盖气血痰食之病。多有兼郁者。故必以开郁药佐之。古方
越鞠丸。是得治法之要也。（汇补）若夫思虑成郁。用归脾汤。恚怒成郁。用逍遥散。俱加山栀。盖郁则气涩血耗。故用
当归随参补血。白芍随术解郁。复用炒黑山栀。取其味清气浮。能升能降。以解五脏热。益少阴血。若不早
治。劳瘵之由也。（入门）
【附失精脱营】
饮食居处。暴乐暴苦。始乐后苦。皆伤精气。病从内生。其先富后贫而病。曰失精。先贵后贱而病。曰脱营。外
症身渐瘦。无精神。（钱氏）又有郁结在脾。不思饮食。午后发热。酉戌时退。或烦闷渴呕。或坐卧如痴。喜向暗
处。妇人经少。男子溺涩。皆郁病也。更有失名利之士。有志恢图。过于劳倦。形气衰少。谷气不盛。上焦不行。
下脘不通。胃气热。热气熏胸中。因而内热。亦郁病也。宜归脾汤随症调之。（入门）
郁症选方
越鞠丸（丹溪） 一名芎术丸。统治诸郁。
香附 苍术 抚芎（各二两） 山栀 神曲（各一两半）
为末。水泛成丸。如绿豆大。白汤下百粒。
气郁汤 治郁怒。气滞胸膈不行。胀满嗳气作酸。
香附 苍术 橘红 半夏（各一钱半） 贝母 茯苓 抚芎 山栀 苏子 甘草 木香 槟榔（各五分）
水煎。加姜五片。如胁膈痛。此血滞也。参血郁汤。
湿郁汤 治湿气熏蒸。身重倦卧疼痛。天阴则发。
苍术（三钱） 白术 香附 橘红 羌活 独活 抚芎 半夏 浓朴 茯苓（各一钱） 生姜（三片） 甘草（五
分）
水煎服。
血郁汤 治挫闷跌仆。身有痛处。胸膈不宽。大便黑色。
香附（二钱） 丹皮 苏木 山楂 桃仁 赤曲 穿山甲 降香 通草 麦芽（各一钱） 红花（七分）
水酒煎。入姜汁半盏。和匀服。
火郁汤 治火郁于中。四肢发热。五心烦闷。皮肤尽赤。
连翘 薄荷 黄芩 山栀 干葛 柴胡 升麻 芍药
水煎服。
保和丸 治食郁吞酸。腹满噫臭。身热便硬。（方见伤食）
润下丸 治痰郁肠胃。脉滑而沉。变生百病。
南星（一两） 半夏（三两） 黄芩 黄连（各一两） 橘红（五钱） 白矾（三两）
姜汁竹沥和丸。
逍遥散（方见火症） 归脾汤（方见中风） 二陈汤（方见痰症）
General Principles
When Qi and Blood are harmonious, a hundred diseases do not arise. Once there is stagnation (Qi mechanism obstruction and lack of free flow), a hundred diseases arise. (Zhu Danxi) "Yu" refers to the condensation and inability to disperse. What should ascend does not ascend; what should descend does not descend; what should transform does not transform. (Yi Jian) Therefore, there are cases where long-standing illness leads to Yu, cases where long-standing Yu leads to illness, and cases caused by chaotic medication.
Internal Causes
"Yu" implies stagnation and blockage. It may result from the suppression of the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), or the alternating invasion of Cold and Summer-heat pathogens, leading to the syndrome of Nine Qi stagnation. It may also result from the infiltration of rain and snow dampness, or the accumulation of alcohol and food, leading to the syndrome of retained fluid and dampness Yu. (Zhengzhi Huibu) The causes are sixfold: Qi, Blood, Dampness, Heat, Phlegm, and Food. However, Qi Yu generates Dampness; Dampness Yu transforms into Heat; Heat Yu forms Phlegm; Phlegm Yu impedes Blood flow; Blood Yu prevents food digestion. These six factors are interdependent. (Zhu Danxi)
External Manifestations
Qi Yu manifests as chest fullness and hypochondriac pain, belching, and abdominal distension. Phlegm Yu manifests as chest fullness, panting, and fatigue in both rising and lying down. Blood Yu manifests as ability to eat but limb fatigue, dysuria with red urine, and dark stools. Food Yu manifests as acid belching, abdominal distension, aversion to food, and hard epigastric masses. Dampness Yu manifests as heavy and painful joints, a sensation of the head being covered, worsening on cloudy days. Heat Yu manifests as blurred vision, scanty and painful urination, dry mouth, irritability, and exacerbation in warm environments. (Dai Yuanli)
Five Zang Organs Yu Syndromes
There are cases where the organ's own Qi becomes stagnant and causes disease. Heart Yu manifests as mental confusion and forgetfulness. Liver Yu manifests as hypochondriac distension and belching. Spleen Yu manifests as abdominal fullness and anorexia. Lung Yu manifests as dry cough without phlegm. Kidney Yu manifests as lumbar distension, turbid and dribbling urination, and inability to stand for long periods. Gallbladder Yu manifests as bitter taste, evening fever, palpitations, and restlessness. (Zhengzhi Huibu)
Seven Emotions Yu Syndromes
Unhappiness of the Seven Emotions, when prolonged, becomes disease. It may become deficiency and timidity, dysphagia (difficulty swallowing), epigastric fullness, abdominal distension, or hypochondriac pain. In women, it may cause amenorrhea, miscarriage, leukorrhea, or metrorrhagia. Thus, it can be seen that a hundred diseases often involve Yu. (He Shi)
Pulse Diagnosis
Yu pulses are mostly deep. Upper Yu is seen at the Cun position, Middle Yu at the Guan position, and Lower Yu at the Chi position. Additionally, Yu pulses may be Knotted (slow with irregular pauses), Rapid with interruptions (fast with irregular pauses), or Intermitting (regular pauses). This is because Blood, Qi, Food retention, or Phlegm-fluids, if滞留 (retained) within, will cause the pulse to stop intermittently. (Mai Jing)
General Treatment
Although Yu syndromes are numerous, they all stem from the failure of Qi to circulate freely. The treatment principle should prioritize regulating Qi, followed by lifting and opening. Methods such as purging Fire, resolving Phlegm, and eliminating accumulation should be applied according to their severity and quantity. (Zhengzhi Huibu)
Yu Should Be Regulated via the Middle Jiao
The method of treating Yu prioritizes regulating the Middle Jiao (Spleen and Stomach) for no other reason than that the Spleen and Stomach reside in the center, while the Heart and Lungs are above, and the Kidneys and Liver are below. When pathogens affect the four organs and reach the center, the Middle Qi is often affected first. Moreover, irregular diet, improper regulation of cold and heat, retained Phlegm, and accumulated fluids injure the Spleen and Stomach first. Hence, Middle Jiao Yu is common. Treatment should involve stimulating movement and encouraging the Qi of the Central State (Middle Jiao), so that the Yu of the Three Yin and Three Yang channels resolves spontaneously without forceful attack. (Zhengzhi Huibu)
Yu Divided by Five Elements
The principle of the Five Elements is: Wood nature is flexible and spreading; Fire nature is uplifting and radiant; Earth nature is balanced and harmonious; Metal nature is clear and肃 (purifying/restricting); Water nature is flowing. Once there is stagnation, these natures are lost. (Hua Shi) Therefore, Wood Yu should be reached (dispersed); Fire Yu should be emitted (released); Earth Yu should be seized (attacked/purged); Metal Yu should be drained (vented); Water Yu should be checked (controlled). However, one must regulate the Qi. For excess, use control methods based on what the element fears. This is called purging. (Huangdi Neijing)
Treatment of Wood Yu
Hypochondriac fullness and sudden red, painful eyes indicate Wood Yu. Treatment should be to "reach" (disperse). "Reaching" means ensuring smooth flow. For example, if anger stirs Liver Qi and Fire flares upward, and bitter-cold acrid-dispersing herbs fail, use ascending herbs combined with channel-guiding drugs for the Jueyin Liver to treat according to its nature. If chronic wind enters the interior causing undigested stool diarrhea, or clear Yang sinks causing diarrhea, use light and ascending formulas to raise the Qi. If Wood excess causes disease with wiry and rapid pulses, and descending bitter-cold herbs fail, use emesis to lift the Qi, allowing Wood Qi to flow smoothly, stopping pain. These are methods of "reaching."
Treatment of Fire Yu
Cough, phlegm, wheezing, wind rashes, and tidal fever indicate Fire Yu. Treatment should be to "emit" (release). "Emitting" means sweating and uplifting. If pores are closed and pathogenic heat is stagnant, resolve the exterior and induce sweat to disperse it. If cold/raw foods suppress Fire internally, bitter-cold sinking herbs cannot treat it; instead, use floating/ascending herbs assisted by sweet-warm herbs to follow its nature. Stop when the condition subsides. These are meanings of "emitting."
Treatment of Earth Yu
Food stagnation in the Middle Jiao, Phlegm coagulation in the Spleen, and Heat congestion in the intestines/stomach are Earth Yu. Treatment should be to "seize" (attack/purge). "Seizing" means purgation and reducing the pathogen. If pathogenic heat enters the stomach, use salty-cold herbs to purge. If there is abdominal fullness with severe internal damp-heat in a robust patient, use purgation. If the condition is severe and cannot be cleared instantly, reduce its momentum gradually. If damp-heat causes dysentery, light herbs are insufficient; use moving or unblocking methods to restore balance. These are meanings of "seizing."
Treatment of Metal Yu
Urinary retention, asthma, distension, and insomnia are Metal Yu. Treatment should be to "drain" (vent). "Draining" means渗泄 (percolating/drainage) and promoting urination to unblock Qi. If the Lung is scorched by Fire, failing to distribute fluids, causing water source stagnation and blocked drainage channels, clear and purify the Lung transformation and nourish to promote flow. If Lung Qi is stagnant, causing chest fullness, orthopnea (inability to lie flat), unblocking Lung Qi is essential. These are methods of "draining."
Treatment of Water Yu
Edema, distension, and blockage of urination and defecation are Water Yu. Treatment should be to "check" (control). "Checking" means restraining, defeating, and gradually reducing the momentum. If distension is caused by water infiltration blocking drainage channels due to weak Earth failing to control Water, strengthen the Spleen Earth to aid transformation, enabling it to control Water and prevent flooding, thus opening drainage channels. If the condition is acute and cannot be controlled by the above, use diuretic herbs to defeat it. Use methods to move bowels, promote urination, or induce sweating, applying them alternately to gradually calm the condition. These are meanings of "checking."
General Method for Regulating Qi
The five Yu syndromes have specific treatments. However, when pathogens invade, righteous Qi is damaged. Therefore, after treating Yu, one must regulate and level the righteous Qi to restore normalcy. If regulating Qi does not restore balance, tonify the element that overcomes the diseased element to control it. For example, if Wood Yu persists, clear Lung Metal; if Fire Yu persists, nourish Kidney Water; if Water Yu persists, tonify Spleen Earth; if Metal Yu persists, guide Fire back to its source; if Earth Yu persists, nourish Liver and regulate Qi. This treats based on what the element fears, following the principle of "controlling excess." (Zhengzhi Huibu)
Medication
The main formula is Er Chen Tang, added with Xiang Fu (Cyperus Rhizome) and Fu Xiong (Ligusticum Chuanxiong Rhizome). For Dampness Yu, add Cang Zhu (Atractylodes Rhizome) and Bai Zhi (Angelica Dahurica Root); for Heat Yu, add Huang Qin (Scutellaria Root) and Shan Zhi (Gardenia Fruit); for Phlegm Yu, add Zhi Shi (Immature Bitter Orange) and Bei Mu (Fritillaria Bulb); for Blood Yu, add Tao Ren (Peach Seed) and Hong Hua (Carthamus Flower); for Food Yu, add Shan Zha (Hawthorn Fruit) and Mai Ya (Barley Sprout); for Qi Yu, add Zhi Ke (Bitter Orange Peel), Hou Po (Magnolia Bark), Wu Yao (Lindera Root), and Mu Xiang (Aucklandia Root). Diseases of Qi, Blood, Phlegm, and Food often involve Yu, so opening-Yu herbs must be used as assistants. The ancient formula Yue Ju Wan grasps the essence of treatment. (Zhengzhi Huibu) For Yu caused by overthinking, use Gui Pi Tang; for Yu caused by resentment, use Xiao Yao San, both added with Shan Zhi. Since Yu causes Qi stagnation and Blood consumption, Dang Gui (Angelica Sinensis Root) assists Ren Shen (Ginseng Root) to tonify Blood, and Bai Shao (White Peony Root) assists Bai Zhu (Atractylodes Macrocephala Rhizome) to resolve Yu. Use charred Shan Zhi for its light, floating nature, capable of ascending and descending, to clear Five Zang Heat and benefit Shaoyin Blood. If not treated early, it leads to Lao Zhai (consumption). (Yixue Rumen)
[Appendix: Loss of Essence and Depletion of Ying]
Irregular diet and lifestyle, sudden extreme joy or sorrow, starting with joy and ending with sorrow, all damage Essence and Qi, causing internal disease. Illness arising from prior wealth followed by poverty is called "Loss of Essence"; illness arising from prior nobility followed by low status is called "Depletion of Ying." External symptoms include gradual emaciation and lack of spirit. (Qian Yi) There is also Yu knotting in the Spleen, causing anorexia, afternoon fever subsiding at You/Xu hours (5-9 PM), or irritability, thirst, vomiting, sitting/lying like a fool, preferring dark places, scanty menstruation in women, and difficult urination in men; these are all Yu diseases. Furthermore, scholars who lose fame and fortune but strive for grand plans, suffering excessive fatigue, leading to decline of form and Qi, insufficiency of Grain Qi, blockage of Upper Jiao, and obstruction of Lower Wan (stomach/intestines), resulting in Stomach Heat steaming the chest, causing internal heat, is also a Yu disease. Treat with Gui Pi Tang adjusted to symptoms. (Yixue Rumen)
Selected Formulas for Yu Syndromes
Yue Ju Wan (Zhu Danxi) Also known as Xiong Zhu Wan. Governs all types of Yu.
Xiang Fu (Cyperus Rhizome), Cang Zhu (Atractylodes Rhizome), Fu Xiong (Ligusticum Chuanxiong Rhizome) (2 liang each), Shan Zhi (Gardenia Fruit), Shen Qu (Massa Medicata Fermentata) (1.5 liang each).
Grind into powder, make pills with water, size of mung beans. Take 100 pills with warm water.
Qi Yu Tang
Treats Yu anger, Qi stagnation in chest/diaphragm, distension, belching, and acid regurgitation.
Xiang Fu, Cang Zhu, Ju Hong (Citrus Reticulata Peel), Ban Xia (Pinellia Tuber) (1.5 qian each), Bei Mu (Fritillaria Bulb), Fu Ling (Poria), Fu Xiong, Shan Zhi, Su Zi (Perilla Fruit), Gan Cao (Licorice Root), Mu Xiang, Bing Lang (Areca Seed) (0.5 qian each).
Decoct in water, add 5 slices of ginger. If hypochondriac/chest pain occurs, this is Blood stagnation; refer to Blood Yu Tang.
Shi Yu Tang
Treats dampness steaming, heaviness, fatigue, pain, worsening on cloudy days.
Cang Zhu (3 qian), Bai Zhu (Atractylodes Macrocephala Rhizome), Xiang Fu, Ju Hong, Qiang Huo (Notopterygium Rhizome), Du Huo (Angelica Pubescens Root), Fu Xiong, Ban Xia, Hou Po, Fu Ling (1 qian each), Sheng Jiang (Fresh Ginger) (3 slices), Gan Cao (0.5 qian).
Decoct in water and take.
Xue Yu Tang
Treats frustration/falls, body pain, chest tightness, black stools.
Xiang Fu (2 qian), Dan Pi (Moutan Cortex), Su Mu (Sappan Wood), Shan Zha, Tao Ren, Chi Qu (Red Fermented Rice), Chuan Shan Jia (Pangolin Scale), Jiang Xiang (Dalbergia Odorifera Lignum), Tong Cao (Tetrapanax Pith), Mai Ya (Barley Sprout) (1 qian each), Hong Hua (Carthamus Flower) (0.7 qian).
Decoct with water and wine, add half cup of ginger juice, mix well, and take.
Huo Yu Tang
Treats Fire Yu in the middle, hot limbs, five-palm heat, full skin redness.
Lian Qiao (Forsythia Fruit), Bo He (Mentha Haplocalyx), Huang Qin, Shan Zhi, Gan Ge (Pueraria Lobata Root), Chai Hu (Bupleurum Root), Sheng Ma (Cimicifuga Rhizome), Shao Yao (Peony Root).
Decoct in water and take.
Bao He Wan
Treats Food Yu with acid regurgitation, abdominal fullness, foul belching, fever, and hard stools. (See Shang Shi chapter)
Run Xia Wan
Treats Phlegm Yu in intestines/stomach, slippery and deep pulse, generating various diseases.
Nan Xing (Arisaema Cum Bile) (1 liang), Ban Xia (3 liang), Huang Qin, Huang Lian (Coptis Rhizome) (1 liang each), Ju Hong (0.5 liang), Bai Fan (Alumen) (3 liang).
Make pills with ginger juice and bamboo sap.
Xiao Yao San (See Huo Zheng chapter), Gui Pi Tang (See Zhong Feng chapter), Er Chen Tang (See Tan Zheng chapter).