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。
想要了解这种气病，切脉时指下感觉沉。沉脉到了极点就会变成伏脉，涩脉和弱脉则表明病邪深入日久。
所谓气，指的是七情之气。七情作为内因致病，所以脉象表现为沉。沉脉的极致状态是，即使按压至骨，脉搏依然不显露，这就是伏脉。如果再见到往来不利的涩脉，或者无力衰微的弱脉，如果不是七情内伤日久，是不会出现这种情况的。
六郁证的脉象多呈沉象，滑脉主痰，紧脉主食积，涩脉主气滞，芤脉主血虚，数脉主火郁，细脉主湿郁。
郁证有六种，也属于内因致病。郁结导致气血不再浮畅，所以脉象多为沉。说“多沉”，并非全是沉脉。脉沉而滑，说明体内有水湿和有形之物，这是痰停造成的郁结。脉沉而紧，说明寒邪实且有形之物，这是食积造成的郁结。脉沉而涩，说明气血往来滞涩不畅，这是气虚导致的郁结。脉沉而芤，说明脉位沉且中空，这是血虚不能濡养导致的郁结。脉沉而数，说明阳气不能炎上，这是火邪潜伏造成的郁结。脉沉而细，说明湿气附着于骨间流衍，这是湿邪留着造成的郁结。（大抵以越鞠丸为主方最为巧妙。如果想要分别治疗，痰郁适宜用济生导痰汤，重症用滚痰丸；食郁适宜用丹溪保和丸；气郁适宜用准绳气郁汤；血郁适宜用血郁汤；火郁适宜用热郁汤；湿郁适宜用湿郁汤等。）
越鞠丸（朱丹溪创制） 治疗六郁引起的胸膈痞闷胀满，或者吞酸呕吐，饮食不消化。这是治疗郁证的圣药。
苍术（用米泔水浸泡一夜后炒制） 神曲（炒制） 抚芎 山栀（炒制） 香附（炒制） 山楂（取净肉） 麦芽（炒制，各等分）
以上药物研成末。用水调和神曲、麦芽制成糊状来制作丸药，大小如梧桐子。每次服用七八十丸，用白开水送服。
济生导痰汤 治疗痰涎壅盛，胸膈间留有饮邪，痞塞不通。
半夏（用热水洗七次，四两） 南星（炮制、去皮） 枳实（去瓤、麸皮炒） 赤茯苓（去皮） 橘红（各一两） 甘草（炙制，半两）
以上药物切碎，每服四钱。用水一盏，生姜十片，煎至八分，饭后稍远时间温服。
准绳气郁汤 治疗因为谋求不成，或者遭受横逆对待，或者被贫穷窘迫所逼，或者被暴怒所伤，或者被悲哀所致，或者思念过度，都称为气郁。其症状表现为胸满胁痛，脉象沉而涩的就是气郁。
香附（用童子尿浸泡一夜，焙干，捣去毛，研为粗末三钱） 苍术（炒制） 橘红 制半夏（各一钱半） 贝母（去心） 白茯苓（去皮） 抚芎 紫苏叶（自汗者用苏子） 山栀仁（炒制，共一钱） 甘草 木香槟榔（各五分） 生姜（五片）
加水煎服。如果胸胁作痛，这是有血瘀阻滞，适宜参看血郁汤进行治疗。
血郁汤 凡是七情郁结，盛怒叫呼，或者起居失常，或者挫闪导致瘀血，一切饥饱劳役，都能导致血郁。其脉象沉涩而芤，身体胸胁常有针刺样疼痛的就是血郁。
香附（用童子尿炮制，二钱） 牡丹皮 赤曲（炒制） 川通草 穿山甲（炒制） 降真香 苏木 山楂肉 大麦芽（炒制、研碎，各一钱） 红花（七分）
用水、酒各一半煎煮。滤去药渣，加入桃仁（去皮、捣泥七分），韭菜汁半盏，混合均匀，一次性口服。
热郁汤 有因阴虚而得的，有因胃虚食用冷物，遏制阳气于脾土中而得的。其治疗方法都在发热条文中记载。这里治疗的是既非阴虚，也非阳陷，也不发热，但常常自觉蒸蒸发热的情况。
连翘（四钱） 薄荷叶 黄芩（各一钱五分） 山栀仁（炒制，二钱） 麦门冬（去心，三钱） 甘草（五分） 郁金（一钱） 栝蒌皮穣（二钱）
加竹叶七片煎服。问为什么不用苍术、香附、抚芎？回答说：火性就燥，燥性的药物都能助长火势，所以不使用。
湿郁汤 治疗因为雨露侵袭，或者山岚瘴气侵犯，或者坐卧湿地，或者出汗后衣衫未干，都称为湿郁。其症状表现为身体沉重而痛，倦怠嗜睡，遇到阴寒天气则发作，脉象沉而细缓的就是湿郁。
苍术（三钱） 白术（炒制） 香附（炒制） 橘红 浓朴（姜汁炒制） 半夏（炮制） 白茯苓（去皮） 抚芎 羌活 独活（各一钱） 甘草（五分）
加生姜五片，用水煎煮。
虞抟说：有一个男子，年龄二十九岁。三月间，房事后骑马渡溪，遭遇深渊落水，幸好马健壮无事。穿着湿衣服走了十五里路到家。第二天憎寒壮热，肢节烦疼，症状像疟疾又不是疟疾。一位医生当作虚证治疗，使用补气血的药物，服用一个多月无效。又换了一位医生，当作劳瘵治疗，使用四物汤加知母、黄柏、地骨皮之类，以及丹溪的大补阴丸，加倍使用紫河车。服用到九月，反而增加了满闷不食的症状。于是请我去诊治，发现患者家中有一位哺乳妇女，只喝人乳汁四五杯，不吃米粒。我诊视患者，六脉皆洪缓，重按若牢，右手更为明显。我将其诊断为湿郁，采用平胃散，加倍使用苍术，加入半夏、茯苓、白术、川芎、香附、木通、砂仁、防风、羌活，加生姜煎服。黄昏时服下一帖，一更时又进服一帖。到了半夜，全身发红如瘾疹，片刻之后随大汗而出。索要粥喝。给予稀粥两碗，从此之前的病症减轻消除，能够进食。仍然给前方再服三帖。后来用茯苓渗湿汤，加倍使用白术，服用二十帖后平安无事。
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.