治五郁之法。尝闻之王太仆矣。其释内经曰。木郁达之。谓吐之令其条达也。火郁发之。谓
汗之令其疏散也。土郁夺之。谓下之令无壅碍也。金郁泄之。谓渗泄解表利小便也。水郁折
之。谓抑之制其冲逆也。太仆此说之后。靡不宗之。然愚则未能快然于中焉。尝细观之似犹
有可言。且折之一句。较之上四句。尢为难晓。因有反复经文以求其至。按内经。帝曰。郁
之甚者。治之奈何。岐伯曰。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。所谓泄之总十三句通为一章。当分三节。自帝曰。止木郁折
之九句为一节。治郁法之问答也。然调其气一句。为一节治郁之余法也。过者折之。以其畏
也。所谓泄之。三句为一节。调气之余法也。夫五法者。经虽为病由五运之郁所致而立。然
扩而充之。则未常不可也。且凡病之起也。多由乎郁。郁者。滞而不通之义。或因所乘而为
郁。或不因所乘而本气自郁皆郁也。岂惟五运之变能使然哉。郁既非五运之变可拘。则达之
。发之。夺之。泄之。折之之法。固可扩焉而充之矣。可扩而充。其应变不穷之理也欤。
姑
陈于左。木郁达之。达者。通畅之也。如肝性急怒气逆 胁或胀火时上炎。治以苦寒辛散而不
愈者。则用升发之药。加以厥阴报使而从治之。又如久风入中为飧泄。及不因外风之入。而清
气在下为飧泄。则以轻扬之剂举而散之。凡此之类。皆达之之法也。王氏谓吐之。令其条达
。为木郁达之。东垣谓食塞胸中。食为坤土。胸为金位。金主杀伐。与坤土俱在于上。而旺于
天。金能克木。故肝木生发之气。伏于地下。非木郁而何。吐去上焦阴土之物。木得舒畅。则
郁结去矣。此木郁达之也。窃意王氏。以吐训达。此不能使人无疑者。以为肺金盛而抑制肝
木欤。则泻肺气。举肝气。可矣。不必吐也。以为脾胃浊气下流。而少阳清气不升欤。则益
胃
升阳。可矣。不必吐也。虽然。木郁固有吐之之理。今以吐字。总该达字。则是凡木郁。
皆当用吐矣。其可乎哉。至于东垣所谓食塞
肺分。为金与土旺于上。而克木。又不能使人无疑者。夫金之克木。五行之常道。固不待夫
物伤而后能也。且为物所伤。岂有反旺之理。若曰吐去其物。以伸木气。乃是反为木郁而施
治。非为食伤而施治矣。夫食塞
胸中而用吐。正内经所谓。其高者因而越之之义
耳。恐不劳引木郁之说。以汨之也。火郁发之。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。又如龙火郁甚于内。非苦寒降沉之剂可治。则用升浮之药。佐
以甘温。顺其性而从治之。使势穷则止。如东垣升阳散火汤是也。凡此之类。皆发之之法也
。
土郁夺之。夺者。攻下也。劫而衰之也。如邪热入胃。用咸寒之剂以攻去之。又如中满腹胀
。
湿热内甚。其人壮气实者。则攻下之。其或势盛。而不能顿除者。则劫夺其势。而使之衰。
又如湿热为痢。有非力轻之剂可治者。则或攻或劫以致其平。凡此之类。皆夺之之法也。金
郁
泄之。泄者。渗泄而利小便也。疏通其气也。如肺金为肾水上原。金受火铄。其令不行。
原郁而渗道闭矣。宜整肃金化滋以利之。又如肺气 满。胸凭仰息。非利肺气之剂。不
足以疏通之。凡此之类。
皆泄之之法也。王氏谓渗泄解表
利小便。为金郁泄之。夫渗泄利小便。固为泄金郁矣。其解表二字。
莫晓其意。得非以人之
皮毛属肺。其受邪为金郁。而解表为泄之乎。窃谓如此则凡筋病便是木郁。肉病便是土郁耶
。此二字未当于理。今删去。且解表间于渗泄利小便之中。是渗泄利小便为二治矣。若以渗
泄为滋肺生水。以利
小便为直治膀胱。则直治膀胱。既责不在肺。何为金郁乎。是亦不通。故余易之曰。渗泄而
利小便也。水郁折之。折者。制御也。伐而挫之也。渐杀其势也。如肿胀之病。水气淫溢。
而渗道以塞。夫水之所不胜者。土也。今土气衰弱。不能制之。故反受其侮。治当实其脾土
。资其运化。俾可以制水而不敢犯。则渗道达而后愈。或病势既旺。非上法所能遽制。则用
泄
水之药以伐而挫之。或去菀陈 开鬼门洁净府。三治备举。迭用以渐平之。王氏所谓抑之制
其冲逆。正欲折挫其泛滥之势也。夫实土者守也。泄水者攻也。兼三治者。广略而决胜也。
守也。攻也。广略也。虽俱为治水之法。然不审病者之虚实。久近。浅深。杂焉而妄施治之
。其不倾踣者寡矣。且夫五郁之病。固有法以治之矣。然邪气久客。正气必损。今邪气虽去
。正气岂能遽平哉。苟不平调正气。使各安其位。复其常于治郁之余。则犹未足以尽治法之
妙。故又曰。然调其气。苟调之。而其气犹或过而未服。则当益其所不胜以制之。如木过者
当益金。金能制木。则木斯服矣。所不胜者所畏者也。故曰。过者折之以其畏也。夫制物者
。物之所欲也。制于物者。物之所不欲也。顺其欲则喜。逆其欲则恶。今逆之以所恶。故曰
。所谓泻之。王氏以咸泻肾。酸泻肝之类为说。未尽厥旨。虽然。自调其气以下。盖经之
本旨。故余推其义如此。若扩充为应变之用。则不必尽然也。
治疗五郁的方法，我曾听王太仆（王冰）说过。他注释《内经》说：木郁达之，意思是使用吐法使其条达；火郁发之，意思是使用汗法使其疏散；土郁夺之，意思是使用下法使其没有壅滞阻碍；金郁泄之，意思是使用渗利、解表、通利小便的方法；水郁折之，意思是抑制它以控制其冲逆之势。王太仆这种说法之后，人们无不尊奉。然而我内心却未能完全信服。曾经仔细研读，似乎还有可以探讨的地方。特别是“折之”这一句，比起前四句，尤其难以理解。因此反复研读经文以求探求其真谛。
按照《内经》，黄帝问：郁证严重的，该怎么治疗？岐伯回答：木郁达之，火郁发之，土郁夺之，金郁泄之，水郁折之。然后调节气机。对于过盛的病邪，用其所畏惧的方法加以制约，这就是所谓的“泄之”。总共十三句话通为一章，应当分为三节。从“帝曰”开始到“水郁折之”共九句为第一节，这是关于治疗郁证的问答。而“然调其气”一句为第二节，这是治疗郁证的辅助方法。“过者折之，以其畏也，所谓泄之”这三句为第三节，也是调气的辅助方法。这五种治法，虽然经文是因为疾病由五运之郁所致而设立，但推广开来充实其意，也未尝不可。而且大凡疾病的产生，多由于郁。郁，是停滞不通的意思。有的因为受克制而产生郁，有的不因受克制而本气自郁，这都是郁。难道只是五运的变化才能导致这样吗？郁既然不是仅由五运变化所拘限，那么达之、发之、夺之、泄之、折之的方法，自然可以推广并充实其意了。可以推广充实，这是应对变化无穷的道理吧。姑且陈述如下：
木郁达之，“达”就是通畅的意思。比如肝性急，怒气上逆，胁肋胀满，火热时常上炎，如果用苦寒辛散的药物不能治愈，就用升发的药物，配合厥阴经的引经药进行从治。又如久风入中导致完谷不化的泄泻，以及不因外风入侵，而是清气在下导致的完谷不化泄泻，就用轻扬的药物提升并发散它。凡此类情况，都是达之法。王氏认为吐法令其条达，即为木郁达之。东垣认为食物堵塞胸中，食物属坤土，胸为金位，金主杀伐，与坤土俱在于上，且旺于天，金能克木，所以肝木生发之气伏于地下，这不是木郁是什么？通过吐去上焦阴土之物，木得舒畅，则郁结去除，这就是木郁达之。我私下认为，王氏以吐来解释达，这不能不让人怀疑。如果是肺金盛而抑制肝木，那么泻肺气、举肝气就可以了，不必用吐法。如果是脾胃浊气下流，而少阳清气不升，那么补益胃气、升举阳气就可以了，也不必用吐法。虽然木郁固有使用吐法的道理，但现在用“吐”字总括“达”字，那就是凡是木郁都应当用吐法了，这可以吗？至于东垣所说的食物堵塞肺分，说是金与土旺于上而克木，也不能不让人怀疑。金克木是五行常道，固然是不需要等到被物伤后才能发生。况且被物所伤，哪有反而旺盛的道理？如果说吐去其物，以伸展木气，那反而是针对木郁施治，而不是针对食伤施治了。食物堵塞胸中使用吐法，正是《内经》所说的“其高者因而越之”的意思罢了。恐怕不必引用木郁的说法来混淆它。
火郁发之，“发”就是汗法，升举之意。比如腠理闭塞，邪热怫郁，就解表取汗以散发它。又如龙火郁甚于内，不能用苦寒沉降的药物来治疗，就用升浮的药物，佐以甘温，顺从其本性而从治，使火势穷尽就停止，如东垣的升阳散火汤就是这类。凡此类情况，都是发之法。
土郁夺之，“夺”就是攻下，劫夺使其衰败。比如邪热入胃，用咸寒的药物攻去它。又如中满腹胀，湿热内盛，其人正气壮实，就攻下它。如果病势强盛，不能立刻清除，就劫夺其势使其衰败。又如湿热导致的痢疾，有非力量轻微的药剂可治疗的，就或攻或劫以达到平衡。凡此类情况，都是夺之法。
金郁泄之，“泄”就是渗利通小便，疏通气机。比如肺金受到肾水上源的影响，金受火灼，其功能不行，原气郁滞而水道闭塞。应当整肃金化，滋生水液以利之。又如肺气胀满，胸部憋闷仰面呼吸，不用利肺气的药剂，不足以疏通它。凡此类情况，都是泄之法。王氏说渗泄、解表、利小便是金郁泄之。渗泄利小便固然可以泄金郁，但那“解表”二字，我不明白其意。莫非是因为人的皮毛属于肺，受邪即为金郁，而解表即为泄之吗？我认为如果这样，那么凡是筋病就是木郁，肉病就是土郁了吗？这两个字不合情理，现在删去。而且“解表”夹杂在渗泄利小便之中，使得渗泄利小便变成了两种治法。如果把渗泄理解为滋肺生水，把利小便理解为直接治疗膀胱，那么直接治疗膀胱既责任不在肺，为什么说是金郁呢？这也是讲不通的。所以我改为：渗利而通利小便。
水郁折之，“折”就是制御，讨伐并挫败它，逐渐削弱其势。比如肿胀病，水气淫溢，而水道堵塞。水的所不胜者是土。现在土气衰弱，不能制约水，所以反而受其侮慢。治疗应当充实脾土，资助其运化，使之能够制水而不敢侵犯，则水道通达而后痊愈。或者病势已经旺盛，上述方法不能立即制约，就用泄水的药物来讨伐挫败它。或者采用去菀陈莝、开鬼门、洁净府三种治法齐备，交替使用以逐渐平复。王氏所说的抑制以控制其冲逆之势，正是想要折挫其泛滥之势。充实土气是守，泄水是攻，兼用三种治法是广略而决胜。守、攻、广略，虽然都是治水的方法，但如果不明辨病人的虚实、病程长短、病位浅深，混杂而妄加治疗，能不跌倒失败的很少了。
况且五郁的病，虽然有法可以治疗。但是邪气久留，正气必然受损。现在邪气虽去，正气岂能立刻平复？如果不调和正气，使其各安其位，恢复常态于治疗郁证之余，那就还不足以尽治法的妙处。所以说“然调其气”。如果调气了，而其气仍然过盛而不顺服，那么就补益其所不胜以制约它。比如木过盛就当益金，金能制木，那么木就顺服了。所不胜者就是所畏惧的，所以说“过者折之以其畏也”。制服事物的，是事物所希望的；被事物制服的，是事物所不希望发生的。顺从它的欲望则喜悦，违背它的欲望则厌恶。现在用它所厌恶的方法来逆制它，所以说“所谓泻之”。王氏以咸味泻肾、酸味泻肝等说法来解释，未尽其旨意。虽然如此，从“调其气”以下，大概是经文的本来旨意，所以我推究其义如此。若扩充用于应变，则不必完全如此。
The methods for treating the Five Stagnations (Wu Yu) were once heard from Wang Taipu (Wang Bing). In his commentary on the *Neijing* (Inner Canon), he stated: "For Wood stagnation, promote its free flow (Da zhi)," meaning to use emesis to allow it to become smooth and unobstructed; "For Fire stagnation, vent it (Fa zhi)," meaning to use diaphoresis to allow it to disperse; "For Earth stagnation, purge it (Duo zhi)," meaning to use purgation to remove obstruction and blockage; "For Metal stagnation, drain it (Xie zhi)," meaning to use diuresis, release the exterior, and promote urination; "For Water stagnation, restrain it (Zhe zhi)," meaning to suppress it to control its rebellious upward surge. After Wang Taipu's explanation, everyone has followed it as a standard. However, I have not been entirely convinced in my heart. Upon careful examination, there seems to be room for discussion. Particularly, the phrase "restrain it" is especially difficult to understand compared to the preceding four phrases. Therefore, I repeatedly studied the classic text to seek its ultimate meaning.
According to the *Neijing*, the Yellow Emperor asked: "How should severe stagnation be treated?" Qibo replied: "For Wood stagnation, promote its free flow; for Fire stagnation, vent it; for Earth stagnation, purge it; for Metal stagnation, drain it; for Water stagnation, restrain it." Then, regulate the Qi. For excess conditions, restrain them using what they fear; this is referred to as "draining." The total of thirteen sentences form one chapter and should be divided into three sections. From "The Yellow Emperor said" up to "Water stagnation, restrain it," comprising nine sentences, constitutes the first section, which is the dialogue regarding the treatment of stagnation. The sentence "Then, regulate the Qi" forms the second section, representing the auxiliary method for treating stagnation. The three sentences "For excess conditions, restrain them using what they fear; this is referred to as 'draining'" form the third section, also an auxiliary method for regulating Qi. Although these five methods were established by the classic because diseases arise from the stagnation of the Five Movements (Wu Yun), expanding and enriching their meaning is certainly permissible. Moreover, the onset of most diseases is due to stagnation. Stagnation implies a state of obstruction and lack of free flow. It may arise from being overcome by other factors, or it may occur spontaneously due to the inherent Qi becoming stagnant without external overcoming. Is it only the changes of the Five Movements that can cause this? Since stagnation is not limited to the changes of the Five Movements, the methods of promoting free flow, venting, purging, draining, and restraining can naturally be expanded and enriched. This expansion and enrichment reflect the principle of endless adaptability. I shall briefly state them below.
"Wood stagnation, promote its free flow": "Promote" means to ensure smooth flow. For example, if the Liver nature is urgent, with angry Qi rebelling upwards, causing hypochondriac distension and frequent upward flare-up of fire, and bitter-cold and acrid-dispersing herbs fail to cure it, then use ascending and dispersing herbs, combined with guiding herbs of the Jueyin channel for counter-treatment. Similarly, if long-standing Wind enters the interior causing undigested food diarrhea, or if clear Yang fails to ascend causing undigested food diarrhea without external Wind invasion, use light and ascending agents to lift and disperse it. All such cases are methods of "promoting free flow." Mr. Wang interpreted "emesis allowing smooth flow" as "Wood stagnation, promote its free flow." Dongyuan interpreted "food blocking the chest" as follows: Food belongs to Kun Earth, the chest belongs to the Metal position. Metal governs killing and cutting, residing above with Kun Earth and flourishing in Heaven. Metal overcomes Wood, so the generating Qi of Liver Wood is buried underground—is this not Wood stagnation? By vomiting out the Yin Earth matter from the Upper Jiao, Wood becomes comfortable, and the stagnation resolves; this is "Wood stagnation, promote its free flow." I privately doubt Mr. Wang's interpretation of "Da" (promote) as "emesis." If it is Lung Metal flourishing and suppressing Liver Wood, then draining Lung Qi and raising Liver Qi would suffice; emesis is unnecessary. If it is Turbid Qi of Spleen and Stomach flowing downward while Shaoyang Clear Yang fails to ascend, then tonifying Stomach Qi and raising Yang would suffice; emesis is unnecessary. Although there is a rationale for using emesis in certain Wood stagnations, using the character "emesis" to generalize "promote" implies that all Wood stagnations require emesis, which is unacceptable. As for Dongyuan's view that food blocking the Lung sector causes Metal and Earth to flourish above and overcome Wood, I also have doubts. Metal overcoming Wood is the normal order of the Five Elements, occurring regardless of physical injury. Furthermore, if injured by an object, how could it flourish? If vomiting the object extends Wood Qi, this treats Wood stagnation rather than food injury. Using emesis for food blocking the chest aligns with the *Neijing* principle: "Where the pathogen is high, induce vomiting." It is unnecessary to invoke the theory of Wood stagnation to confuse the issue.
"Fire stagnation, vent it": "Vent" means diaphoresis and lifting. For instance, when pores are closed and pathogenic heat is constrained, resolve the exterior and induce sweating to disperse it. Similarly, if Dragon Fire is deeply constrained within, bitter-cold sinking agents are ineffective; instead, use floating and ascending herbs assisted by sweet-warm ones, following its nature for counter-treatment, stopping when the pathogenic force is exhausted, such as in Dongyuan's Shengyang Sanhuo Tang. All such cases are methods of "venting."
"Earth stagnation, purge it": "Purge" means attacking downwards and劫夺 (intercepting/overpowering) to reduce its strength. For example, if pathogenic heat enters the Stomach, use salty-cold agents to attack and remove it. If there is abdominal fullness and distension with severe internal Damp-Heat, and the patient has strong Qi, use purgation. If the pathogenic force is strong and cannot be cleared instantly, intercept its momentum to weaken it. For Dysentery caused by Damp-Heat, where mild agents are insufficient, use attacking or intercepting methods to restore balance. All such cases are methods of "purging."
"Metal stagnation, drain it": "Drain" means diuresis and promoting urination, and unblocking Qi. For example, if Lung Metal is affected by the source of Kidney Water, and Metal is scorched by Fire, its functions cease, leading to stagnation of the source and closure of the water passages. One should regulate Metal transformation and nourish Water to promote drainage. If there is Lung Qi fullness, chest oppression, and orthopnea, only agents that benefit Lung Qi can unblock it. All such cases are methods of "draining." Mr. Wang included "release the exterior" in "Metal stagnation, drain it." While diuresis drains Metal stagnation, the meaning of "release the exterior" is unclear. Does it imply that since skin and hair belong to the Lung, exterior pathogens constitute Metal stagnation, and releasing the exterior constitutes draining? If so, does any tendon disease constitute Wood stagnation and any flesh disease constitute Earth stagnation? These two words are illogical and are deleted here. Placing "release the exterior" among diuresis and urination makes them two separate treatments. If diuresis is interpreted as nourishing Lung to generate Water, and urination as directly treating the Bladder, then direct Bladder treatment is not the Lung's responsibility, so why call it Metal stagnation? This is also inconsistent. Therefore, I change it to: "Diuresis and promoting urination."
"Water stagnation, restrain it": "Restrain" means controlling, attacking, and frustrating, gradually reducing its momentum. For edema where Water Qi overflows and water passages are blocked: Earth is the element that controls Water. Now, Earth Qi is weak and cannot control Water, resulting in Water insulting Earth. Treatment should strengthen Spleen Earth and aid its transportation and transformation, enabling it to control Water and prevent invasion, thus opening water passages for recovery. If the disease is too advanced for this method, use water-draining herbs to attack and frustrate it. Or employ the three methods: removing accumulation (Qu Wan Chen Cuo), opening the ghost gate (Kai Gui Men - sweating), and cleansing the palace (Jie Jing Fu - diuresis), using them alternately to gradually calm the condition. Mr. Wang's "suppress to control rebellious surge" aims to restrain the flooding momentum. Strengthening Earth is defense; draining Water is attack; combining three methods is comprehensive strategy. Although all are water-treatment methods, failing to assess the patient's deficiency/excess, duration, and depth, and applying treatments indiscriminately, will likely lead to failure.
Although there are methods for treating the Five Stagnations, prolonged pathogenic presence inevitably damages Righteous Qi. Even after pathogens are removed, Righteous Qi cannot immediately recover. Without regulating Righteous Qi to restore its proper position and normal function after treating stagnation, the subtleties of treatment are not fully realized. Hence, "Then, regulate the Qi." If Qi remains excessive and unruly after regulation, tonify the element that overcomes it to control it. For example, if Wood is excessive, tonify Metal, as Metal controls Wood, making Wood submissive. The element that overcomes is the one feared; hence, "For excess, restrain using what it fears." What controls an element is desired by that element; what controls it against its will is unwanted. Following its desire brings joy; opposing it brings aversion. Here, we oppose it with what it fears, hence "referred to as 'draining'." Mr. Wang's explanation using salty-draining-Kidney and sour-draining-Liver theories does not fully capture the essence. Nevertheless, from "regulate the Qi" onwards reflects the original intent of the classic, so I deduce its meaning as such. However, when expanding for adaptive application, it need not be rigidly applied.