或问治气郁胁痛，有谓达之者，有谓泻之者，于达、泻二字，还有说否？生生子曰∶胁者，肝之
部分，又足少阳经所行之地，此经多有余，《经》曰∶“东方实。”丹溪曰∶“气有余，便是火。”
《内经》曰∶“肝者，将军之官，谋虑出焉。胆者，中正之官，决断出焉。”盖人于日用之间，不能恬
淡虚无，而纯合乎天和；惟不能恬淡虚无而合乎天和，是以七情一有不遂则生郁，郁久则生火，壅遏经
隧，充塞清道，而痛作矣。至于痛极而涌吐酸水者，犹洪范所谓曲直作酸，乃肝胆之咎征
也。《经》曰∶“木郁则达之。”启玄子谓吐之令其条达，此固一说也。然于“达之”之义，犹有所未尽
焉。达，是通达之达，非独止于吐也。木郁于下，以柴胡、川芎之类升而发之，以顺其挺然之性，正所谓
因曲而为之直，又谓从其性而升之，皆达之之义也。仲景小柴胡汤，治少阳胁痛，以柴胡为君，得其旨矣
。《经》曰∶“有余者泻之。”今肝实而胁痛，固宜泻之矣。本草列青皮、香附、黄连、白芍、柴胡、川
芎之类，均为泻肝之剂，苟不择而用之，吾未见得志也。何者？夫青皮、香附，泻气之冲逆者也；黄连、
白芍，泻血之沸腾者也。《经》曰∶“上者抑之”，为其当下而不下，故用此辛酸苦寒之剂，以泄其冲逆沸
腾之势，使之降下，以致于平而已，此正治法也，群皆识其为泻也。至若柴胡、川芎之所以为泻者，则异乎
是也。盖柴胡、川芎，升发肝胆之清气者也。《经》曰∶“下者举之”，为其当升而不升，故用此辛甘苦
平之味，于阴中提阳，以扶其直遂不屈之性，使之上升，以复其常，是清阳升而浊阴降也，正前所谓木郁
则达之之意，此从治法也，群皆未识其所以为泻也。《经》曰∶轻者正治，重者从治。又曰∶轻者可降，重
则从其性而升之。又曰∶“过者折之，以其畏也，所谓泻之。”过者，谓郁实而为火也。折之者，为裁之
也；畏者，如木郁之病，用辛散属金之药，而排闼其纷伙，剪伐其猖獗，以致于中和，乃拨乱反正之意也
。此皆识
阴阳升降之理，顺逆之势，有如是耳。噫！苟为医而不明阴阳升降之理，顺逆之势，则用药安能识其
正哉！且夫人与天地相流通者也，即举肝而言之，在天为雷，在方为东，在时为春，在五行为木，在
人为肝，运动之气，皆相参焉。故张子和曰∶胆与三焦寻火治，肝与包络都无异。丹溪曰∶此指龙雷
之火而言也，在人以肝胆应之。凡物不得其平则鸣，彼阳气久伏，壅遏于九地之下，则品物为之潜藏
，当其升发之际，必轰然迅烈，大发声震，惊于天关之外，然后品物咸亨，此势也，理也。今木郁之
病，亦近之，木郁于下，则春升之令不行，以故痛而猛，猛而吐，吐而愈者，亦均此势也，均此理也
。知夫此，则凡造物之所以有升降顺逆者，皆得以遂其正矣，于用药乎何有。
有人问治疗气郁引起的胁痛，有人说用“达”法，有人说用“泻”法，对于“达”和“泻”这两个字，还有什么可说的吗？生生子说：胁部是肝脏所主的部位，也是足少阳胆经循行的地方，这条经脉的病证多属于有余（实证）。《内经》说：“东方实。”朱丹溪说：“气有余，就会变成火。”《黄帝内经》说：“肝，是将军之官，谋略思虑由此产生；胆，是中正之官，决断力由此产生。”大概人在日常生活中，不能保持心境恬淡虚无，从而完全合乎自然之和；正因为不能保持恬淡虚无以合乎天和，所以七情（喜、怒、忧、思、悲、恐、惊）一旦有不顺遂就会产生郁结，郁结久了就会化火，壅塞经络隧道，充塞清阳之道，疼痛因此发作。至于疼痛剧烈到呕吐酸水的情况，就像《尚书·洪范》所说的“曲直作酸”，这是肝胆的病理征象。《内经》说：“木郁则达之。”唐代医家王冰（启玄子）解释为通过吐法使其条达，这固然是其中一种说法。然而对于“达”的含义，还有未尽之处。“达”，是通达的意思，不仅仅局限于吐法。木气郁结在下，用柴胡、川芎等药物升提发散，以顺应其挺拔向上的本性，这正是所谓“因曲而为之直”，或者说顺应其本性而升发，这都是“达”的含义。张仲景的小柴胡汤，治疗少阳经胁痛，以柴胡为君药，就抓住了这一宗旨。《内经》说：“有余者泻之。”现在肝气实证导致胁痛，固然应该用泻法。本草书中列出的青皮、香附、黄连、白芍、柴胡、川芎等药物，都被列为泻肝的药物，如果不加选择地乱用，我看不出能达到治疗目的。为什么呢？青皮、香附，是泻除气机冲逆的药物；黄连、白芍，是泻除血分沸腾的药物。《内经》说：“上部病证用抑制的方法。”因为气机本该下行却不下行，所以使用这些辛、酸、苦、寒性质的药物，来泄除其冲逆沸腾的势头，使其降下，从而达到平衡，这是正治法，大家都认识这是泻法。至于柴胡、川芎之所以被称为“泻”，则与此不同。柴胡、川芎，是升发肝胆清气的药物。《内经》说：“下部病证用举提的方法。”因为气机本该上升却不上升，所以使用这些辛、甘、苦、平性质的药物，在阴中提拔阳气，以扶持其直遂不屈的本性，使其上升，恢复常态，这就是清阳上升而浊阴下降，正是前面所说的“木郁则达之”的意思，这是从治法（反治法），大家都不认识它为什么被称为泻法。《内经》说：“病轻的用正治法，病重的用从治法。”又说：“病轻的可以降下，病重则顺应其本性而升发。”又说：“太过盛的病证要用折损的方法，利用其畏惧的药物，这就叫泻法。”所谓“过者”，是指郁结结实而化火。所谓“折之”，是指裁制它；所谓“畏”，比如木郁的病证，使用属金的辛散药物，来排除其纷乱繁杂，剪伐其猖獗之势，以达到中和，这是拨乱反正的意思。这些都是懂得阴阳升降的道理，顺逆的趋势，才有这样的见解。唉！如果做医生而不明白阴阳升降的道理，顺逆的趋势，那么用药怎么能识别其正确与否呢！况且人与天地是相互流通的，就拿肝脏来说，在天对应雷，在方位对应东，在季节对应春，在五行对应木，在人对应肝，运动的气机都是相互参验的。所以张子和说：“胆与三焦寻找火邪来治疗，肝与心包络都没有差异。”朱丹溪说：这是指龙雷之火而言，在人身上以肝胆来对应。大凡事物不得其平正就会鸣响，那些阳气久伏，壅遏在九地之下，万物就会潜藏，当它们升发之际，必然轰然迅烈，大声震动，震惊于天关之外，然后万物才能亨通，这是势，也是理。现在的木郁病证，也接近这个情况，木气郁结在下，那么春季升发的政令就不能施行，因此疼痛猛烈，猛烈则呕吐，呕吐后痊愈的，也是同样的势，同样的理。知道了这一点，那么凡是造物主之所以有升降顺逆的原因，都能得以顺应其正道了，对于用药又有什么困难呢。
A question was asked regarding the treatment of hypochondriac pain caused by Qi stagnation: some advocate "reaching" (Da, 达) methods, while others advocate "draining" (Xie, 泻) methods. Is there anything more to be said about these two terms? Shengshengzi replied: The hypochondrium is the domain governed by the Liver and the pathway traversed by the Foot-Shaoyang Gallbladder Meridian. Diseases of this meridian are often characterized by excess. The Classic states: "The East is solid." Zhu Danxi stated: "When Qi is in excess, it becomes Fire." The *Neijing* (Inner Canon) says: "The Liver is the General; strategies and deliberations originate from it. The Gallbladder is the Official of Justice; decisions and courage originate from it." Generally, in daily life, people cannot maintain a state of tranquility and emptiness (Tian Dan Xu Wu, 恬淡虚无), thereby fully harmonizing with the natural harmony. Precisely because they fail to maintain this tranquility and harmony with Heaven, when the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) encounter any obstruction, stagnation arises. Prolonged stagnation generates Fire, which obstructs the meridians and collaterals and blocks the pathways of clear Yang, resulting in pain. When the pain is extreme and leads to vomiting sour fluid, it corresponds to the principle in the *Hongfan* (Great Plan) that "Wood stagnation produces sourness," which is a pathological sign of the Liver and Gallbladder. The Classic states: "For Wood stagnation, use the method of reaching (Da)." Wang Bing (Qi Xuanzi) interpreted this as using emesis to allow for free flow, which is indeed one interpretation. However, the meaning of "reaching" is not fully exhausted by this view. "Reaching" implies unblocking and free flow, not limited solely to emesis. When Wood Qi is stagnant below, herbs such as Chai Hu (Bupleuri Radix) and Chuan Xiong (Ligustici Chuanxiong Rhizoma) are used to ascend and disperse, thereby accommodating its naturally upright and ascending nature. This is precisely what is meant by "straightening the crooked" or "ascending according to its nature," both of which embody the meaning of "reaching." Zhang Zhongjing's Xiao Chai Hu Tang (Minor Bupleurum Decoction) treats Shaoyang hypochondriac pain, using Chai Hu as the sovereign herb, thus grasping the essence of this principle. The Classic states: "Those in excess should be drained." Since the current condition involves Liver excess causing hypochondriac pain, draining is indeed appropriate. Materia Medica lists Qing Pi (Citri Reticulatae Pericarpium Viride), Xiang Fu (Cyperi Rhizoma), Huang Lian (Coptidis Rhizoma), Bai Shao (Paeoniae Radix Alba), Chai Hu, and Chuan Xiong as agents for draining the Liver. If used indiscriminately, I do not see how therapeutic goals can be achieved. Why? Qing Pi and Xiang Fu drain rebellious Qi; Huang Lian and Bai Shao drain boiling Blood. The Classic states: "For conditions above, suppress them." Because the Qi should descend but fails to do so, bitter, cold, acrid, and sour agents are used to泄 (drain/vent) the rebellious and boiling momentum, causing it to descend and reach balance. This is the orthodox treatment (Zheng Zhi, 正治), and everyone recognizes this as draining. However, the reason Chai Hu and Chuan Xiong are considered "draining" differs from this. Chai Hu and Chuan Xiong ascend and disperse the clear Yang of the Liver and Gallbladder. The Classic states: "For conditions below, lift them." Because the Qi should ascend but fails to do so, acrid, sweet, bitter, and neutral herbs are used to extract Yang from Yin, supporting its straight and unyielding nature, causing it to ascend and restore normalcy. This results in Clear Yang ascending and Turbid Yin descending, which aligns with the previously mentioned meaning of "Wood stagnation requires reaching." This is the counter-treatment (Cong Zhi, 从治), yet few recognize why it is termed "draining." The Classic states: "Light cases are treated orthodoxy; heavy cases are treated by following [the disease nature]." It also says: "Light cases can be descended; heavy cases require ascending according to their nature." Furthermore: "Excessive conditions are broken down using substances they fear; this is called draining." "Excessive" refers to stagnation turning into solid Fire. "Breaking down" means restraining it. "Fear" refers to, for example, in Wood stagnation diseases, using acrid dispersants belonging to Metal to dispel chaos and prune rampant growth, thereby achieving harmony. This represents the intent of restoring order from chaos. These insights stem from understanding the principles of Yin-Yang ascension and descent, and the trends of compliance and opposition. Alas! If a physician does not understand the principles of Yin-Yang ascension/descent and the dynamics of compliance/opposition, how can they correctly identify the appropriate medications? Moreover, humans and Heaven and Earth are mutually interconnected. Taking the Liver as an example: in Heaven it corresponds to Thunder, in direction to East, in season to Spring, in Five Elements to Wood, and in the human body to the Liver. The moving Qi is interrelated in all these aspects. Therefore, Zhang Zihe said: "The Gallbladder and San Jiao seek fire for treatment; the Liver and Pericardium are no different." Zhu Danxi explained: This refers to Dragon-Thunder Fire, which corresponds to the Liver and Gallbladder in humans. All things make noise when they are not in equilibrium. When Yang Qi has been dormant for a long time and is obstructed beneath the earth, all things remain hidden. When the moment of ascent arrives, it inevitably erupts swiftly and violently, producing loud thunderous sounds that shake the heavens, after which all things flourish. This is the trend and the principle. The current disease of Wood stagnation is similar. When Wood Qi is stagnant below, the spring-like ascending command cannot be executed, leading to severe pain, violent vomiting, and recovery after vomiting. This follows the same trend and principle. Understanding this allows one to comprehend why creation operates with ascension, descent, compliance, and opposition, enabling everything to follow its proper course. In such cases, what difficulty could there be in prescribing medication?