金匮云。妇人咽中如有炙脔。半夏浓朴汤主之。（即四七汤。）
上焦。阳也。卫气所治。贵通利而恶闭郁。郁则津液不行而积为痰涎。胆以咽为使。胆主决
断。气属相火。遇七情至而不决。则火郁而不发。火郁则焰不达。焰不达则气如焰。与痰涎聚结
胸中。故若炙脔。千金作胸满。心下坚。咽中帖帖如有炙脔。吐之不出。吞之不下。证虽稍异。
然亦以郁而致也。用半夏等药。散郁化痰而已。
经云。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。夫所谓达者。通畅之也。当以轻扬之剂举而达之。发者。升发之也。当以升发
之剂汗而发之。夺者。攻下之也。当以咸寒之剂攻而夺之。泄者。开发之也。当以疏散之剂涌而
泄之。折者。制御之也。当以苦寒之剂伐而折之。此皆论六气之郁也。至于五志之郁。又非上法
所宜。经云。尝贵后贱。虽不中邪。病从内生。名曰脱营。尝富后贫。名曰失精。及妇人情志不
遂。悒郁不舒。而致经闭不调。发热咳嗽。师尼寡妇。种种诸患。各推其源而治之。
赵养葵云。郁者。抑而不通之义。内经五法。为因五气所乘而致郁。不必作忧郁之郁。忧乃
七情之病。但忧亦在其中。丹溪云。气血冲和。百病不生。一有怫郁。诸病生焉。又制为六郁之
论。立越鞠丸以治郁。而以香附、抚芎、苍术开郁利气为主。谓气郁而湿滞。湿滞而成热。热郁
而成痰。痰滞而血不行。血滞而食不化。此六者相因而为病者也。此说出而内经之理始晦。内经
之旨。又因释注之误而复晦。所以郁病之不明于世久矣。盖东方生木。木者生生之气。即火气附
于木中。木郁则土郁。土郁则金亦郁。金郁则水亦郁。五行相因。自然之理。惟其相因也。予以
一方治其木郁。诸郁皆因而愈。逍遥散是也。甚者。方中加佐金丸。以黄连治心火。吴茱萸气臊。
肝之气亦臊。同气相求。而佐金以制木。此佐金之所以得名也。
凡寒热往来。似疟非疟。恶寒恶热。呕吐吞酸嘈杂。胸痛 痛。小腹胀闷。头晕盗汗等证。
以逍遥散出入加减。此对证之方。无不获效。倘一服即愈。少顷即发。或半日或一日又发。发之
愈频愈甚。此必下寒上热之假证。此方不宜复投。当改用温补之剂。如阳虚。以四君子加温热药。
阴虚。以六味地黄丸作汤加温热药。甚者又须寒因热用。少以冷药
从之。用热药冷探之法。否则拒格不入。非徒无益。而反害之也。
石顽曰。郁证多缘于志虑不伸。而气先受病。故越鞠、四七始立也。郁之既久。火邪耗血。
岂苍术、香附辈能久服乎。是逍遥、归脾继而设也。然郁证多患于妇人。内经所谓二阳之病发心
脾。及思想无穷。所愿不得。皆能致病。为证不一。或发热头痛者有之。喘嗽气乏者有之。经闭
不调者有之。狂癫失志者有之。火炎失血者有之。骨蒸劳瘵者有之。 疽生虫者有之。治法总不
离乎逍遥、归脾、佐金、降气、乌沉七气等方。但当参究新久虚实选用。加减出入可也。
〔诊〕郁脉多沉伏。或结或促。或沉或涩。郁在肝肾则见于左。郁在心脾则见于右。气血食积
痰饮一有留滞于其间。脉必因之而止涩矣。但当求其有神。何害之有。所谓神者。胃气也。郁脉
虽多沉伏结促。不为患也。所虑在牢革弦强不和耳。盖沉伏结促。有气可散。气通则和。若牢革
弦强则正气先伤。无气可散。即从事调补。尚难克效。况复误行耗气之药乎。所以郁证得弦强脉
者。往往多成虚损也。
易思兰治一妇。患浑身倦怠。呵欠口干。经月不食。强之不过数粒而已。有以血虚治之者。
有以气弱治之者。有知为火而不知火之源者。用药杂乱。愈治愈病。至冬微瘥。次年夏间。诸病
复作。肌消骨露。三焦脉洪大侵上。脾肺二脉微沉。余部皆平和。此肺火病也。以栀子仁姜汁浸
一宿。炒黑研极细末。用人参、麦冬、乌梅煎汤调下。进二服。即知饥喜食。旬日肢体充实如常。
后因久病不孕。众皆以为血虚。而用参、 之品。半月胸膈饱胀。饮食顿减。至三月余而经始通。
下黑秽不堪。或行或止。不得通利。其苦万状。易复以四乌汤换生地。加陈皮、苏梗、黄芩、山
栀、青皮、枳壳十数剂。一月内即有孕。
《金匮要略》说：妇女感觉咽喉中有如烤肉块卡住的感觉，用半夏厚朴汤主治。（即四七汤。）
上焦属阳，是卫气所主管的部位，贵在通畅流利而厌恶闭结郁滞。郁滞则津液运行不畅而积聚成痰涎。胆经以咽喉为通路，胆主决断，其气属相火，遇到七情刺激而不能决断，则火气郁结而不能发散。火气郁结则炎上之势不达，炎上之势不达则气机如同火焰般壅塞，与痰涎聚结于胸中，所以感觉像有烤肉块卡住一样。《千金方》描述为胸满、心下坚硬、咽喉中贴贴然如有烤肉块感，吐之不出，吞之不下。证候虽然稍有差异，但都是由郁滞导致的。使用半夏等药物，只是为了疏散郁滞、化解痰涎罢了。
《内经》说：木郁要疏达它，火郁要发散它，土郁要攻夺它，金郁要宣泄它，水郁要制约它。然而调理气机，对于过盛的要用制约的方法，因为这是它畏惧的，这所谓的“泻”。所谓“达”，就是通畅的意思，应当用轻扬升散的药剂来举升并通达它；所谓“发”，就是升发的意思，应当用升发解表的药剂来发汗并散发它；所谓“夺”，就是攻下的意思，应当用咸寒的药剂来攻逐并夺去它；所谓“泄”，就是开发的意思，应当用疏散涌泄的药剂来涌吐并宣泄它；所谓“折”，就是制御的意思，应当用苦寒的药剂来伐灭并制约它。这些都是论述六气（风、寒、暑、湿、燥、火）之郁的治法。至于五志（喜、怒、忧、思、恐）之郁，又不适合上述方法。《内经》说：曾经尊贵后来卑贱，虽然不中邪气，病从内生，名叫脱营；曾经富有后来贫穷，名叫失精。以及妇女情志不遂，抑郁不舒，而导致经闭不调、发热咳嗽。师尼寡妇等种种病患，都要推究其根源而治疗。
赵养葵说：郁，是抑制而不通的含义。《内经》的五种治法，是因为五种外气乘袭身体而导致郁滞，不必将其理解为忧郁之郁。忧愁乃是七情致病之一，但也包含在其中。朱丹溪说：气血冲和，百病不生；一旦有怫郁，诸病便由此产生。他又制定了六郁的理论，创立越鞠丸来治疗郁证，而以香附、抚芎（川芎）、苍术作为开郁利气的主要药物。认为气郁导致湿滞，湿滞形成热郁，热郁形成痰郁，痰滞导致血行不畅，血滞导致食积不化。这六种情况相互影响而致病。这种学说出来后，《内经》的道理才开始晦暗不明，《内经》的宗旨，又因为注解的错误而更加晦暗不明，所以郁病的理论在世间长期不被阐明。大概东方生木，木代表生生之气，即火气依附于木中。木郁则土郁，土郁则金亦郁，金郁则水亦郁。五行相生相因，这是自然的道理。正因为它们相互关联，我用一方来治疗木郁，各种郁滞都会随之痊愈，这就是逍遥散。病情严重的，在方中加入佐金丸，用黄连治疗心火，吴茱萸气味臊臭，肝的气味也是臊臭，同气相求，从而借助佐金丸来制约肝木，这就是佐金丸得名的原因。
凡是出现寒热往来，似疟非疟，恶寒恶热，呕吐吞酸嘈杂，胸痛胁痛，小腹胀闷，头晕盗汗等症状，使用逍遥散进行加减出入治疗。这是对证的方剂，没有不获效的。如果服一次就痊愈，片刻后又发作，或者半天或一天后又发作，发作得越频繁越严重，这一定是下寒上热的假证，此方不宜再投。应当改用温补的药剂。如阳虚，用四君子汤加入温热药；阴虚，用六味地黄丸改为汤剂加入温热药。病情严重的，还要采用“寒因热用”的方法，少量冷药跟随热药使用，即用热药冷探的方法。否则会出现格拒不受的情况，不仅无益，反而有害。
石顽说：郁证多源于志虑不伸，而气机先受病邪侵袭，所以越鞠丸、四七汤才创立出来。郁滞既然久了，火邪耗伤血液，难道苍术、香附这类药物能久服吗？因此逍遥散、归脾汤相继设立。然而郁证多在妇人身上患病，《内经》所说的二阳之病发于心脾，以及思想无穷、所愿不得，都能导致疾病。证候表现不一，有的发热头痛，有的喘嗽气乏，有的经闭不调，有的狂癫失志，有的火炎失血，有的骨蒸劳瘵，有的生疽长虫。治疗方法总离不开逍遥散、归脾汤、佐金丸、降气汤、乌沉汤、七气汤等方剂。只是应当参究病程的新久、体质的虚实来选用，进行加减出入即可。
〔诊法〕郁证的脉象多表现为沉伏，或结或促，或沉或涩。郁滞在肝肾则脉象见于左手，郁滞在心脾则脉象见于右手。气血、食积、痰饮如果在脉道中有所留滞，脉象必然因此变得止涩。但只要脉象有神，有什么害处呢？所谓神，就是胃气。郁证的脉象虽然多表现为沉伏结促，并不构成危害。所担忧的是脉象牢革弦强而不和缓。因为沉伏结促，说明还有气可以疏散，气通则脉和。如果脉象牢革弦强，则正气先已受伤，无气可散，即使从事调补，尚且难以见效，何况误用耗气的药物呢？所以郁证出现弦强脉的，往往多演变为虚损病。
易思兰治疗一位妇女，患浑身倦怠，呵欠口干，一个月不进食，勉强喂食不过几粒而已。有人按血虚治疗，有人按气弱治疗，有人知道是火邪却不知火的源头，用药杂乱，愈治愈重。到了冬天症状轻微缓解，次年夏天，各种病症复发，肌肉消瘦骨骼显露，三焦脉洪大侵及上部，脾肺二脉微沉，其余部位脉象皆平和。这是肺火病。用栀子仁用姜汁浸泡一夜，炒黑研成极细末，用人参、麦冬、乌梅煎汤调服。服用两剂后，即知饥饿喜欢进食，十天时间肢体充实如常。后来因久病不孕，众人都认为是血虚，而使用人参、黄芪之类的药物。半个月后胸膈饱胀，饮食顿减，直到三个多月月经才来潮，排出黑色污秽不堪之物，或行或止，不通畅，痛苦万分。易思兰再用四乌汤替换生地，加入陈皮、苏梗、黄芩、山栀、青皮、枳壳十数剂，一个月内即怀孕。
The *Jingui Yaolue* states: Women may feel as if there is a piece of roasted meat stuck in their throat; this is treated with Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction). (This is also known as Siqi Tang, Four-Seven Decoction.)
The Upper Jiao (Upper Burner) belongs to Yang and is governed by Wei Qi (Defensive Qi). It values free flow and detests obstruction and stagnation. Stagnation causes Jin Ye (Body Fluids) to fail to circulate, accumulating into Tan Xie (Phlegm-Saliva). The Gallbladder meridian uses the throat as its pathway; the Gallbladder governs decision-making, and its Qi belongs to Ministerial Fire. When affected by Seven Emotions (Seven Affects), if one fails to make a clear decision, the Fire becomes stagnant and cannot be dispersed. When Fire is stagnant, its flaming nature does not reach upward; when the flaming nature does not reach upward, the Qi becomes obstructed like trapped flame, gathering with Phlegm-Saliva in the chest. Thus, the sensation is as if a piece of roasted meat is stuck. The *Qianjin Fang* describes it as chest fullness, hardness below the heart, and a feeling in the throat as if a piece of roasted meat were present, which cannot be spat out nor swallowed. Although the symptoms vary slightly, they are all caused by stagnation. Using Banxia (Pinellia Rhizome) and other herbs merely serves to disperse stagnation and resolve phlegm.
The *Neijing* states: 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, control it. However, to regulate Qi, excess should be controlled because that is what it fears; this is what is meant by "purging." To "promote free flow" means to ensure smooth passage; one should use light and ascending agents to lift and unblock it. To "vent" means to ascend and release; one should use ascending and releasing agents to induce sweating and disperse it. To "purge" means to attack downward; one should use salty and cold agents to attack and remove it. To "drain" means to open up; one should use dispersing and vomiting-inducing agents to涌 (urge) and drain it. To "control" means to restrain; one should use bitter and cold agents to subdue and restrain it. These all discuss the stagnation of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire). As for the stagnation of the Five Wills (Five Emotions), the above methods are not suitable. The *Neijing* says: One who was once noble but became lowly, though not struck by external pathogens, develops disease from within, named Tuo Ying (Depletion of Ying); one who was once rich but became poor, is named Shi Jing (Loss of Jing). Also, women whose emotions are unsatisfied, leading to depression and lack of comfort, resulting in amenorrhea or irregular menstruation, fever, and cough. Nuns, widows, and others with various ailments must have their root causes identified and treated accordingly.
Zhao Yangkui stated: "Yu" (Stagnation) implies suppression and blockage. The five methods in the *Neijing* refer to stagnation caused by the invasion of the Five External Pathogenic Factors, and should not be interpreted solely as emotional depression. Sorrow is a disease of the Seven Emotions, but it is included within the scope. Zhu Danxi stated: When Qi and Blood are harmonious, no disease arises; once there is Fu Yu (Depression/Stagnation), various diseases arise. He formulated the theory of the Six Types of Stagnation and established Yueju Wan (Yueju Pill) to treat stagnation, using Xiangfu (Cyperus Rhizome), Fuxiong (Ligusticum Chuanxiong Rhizome), and Cangzhu (Atractylodes Rhizome) as the main agents to open stagnation and benefit Qi. He believed that Qi stagnation leads to Dampness retention; Dampness retention generates Heat stagnation; Heat stagnation generates Phlegm stagnation; Phlegm stagnation impedes Blood flow; Blood stagnation leads to Food retention. These six factors interact to cause disease. Since this theory emerged, the principles of the *Neijing* began to become obscure, and the intent of the *Neijing* became even more obscured due to errors in annotations. Consequently, the understanding of stagnation diseases has remained unclear for a long time. Generally, the East generates Wood; Wood represents the vitalizing Qi, wherein Fire Qi attaches to Wood. If Wood stagnates, Earth stagnates; if Earth stagnates, Metal also stagnates; if Metal stagnates, Water also stagnates. This mutual influence among the Five Elements is the natural order. Because of this interdependence, I use one formula to treat Wood stagnation, and all other stagnations heal consequently; this is Xiaoyao San (Free and Easy Wanderer Powder). In severe cases, Zuojin Wan (Zuojin Pill) is added to the formula. Huanglian (Coptis Rhizome) treats Heart Fire; Wu Zhuyu (Evodia Fruit) has a fishy odor, and Liver Qi also has a fishy odor. Like attracts like, thereby assisting Metal to control Wood. This is why it is called Zuojin (Assisting Metal).
For symptoms such as alternating chills and fever, resembling malaria but not quite so; aversion to cold and heat; vomiting with acid regurgitation and epigastric discomfort; chest pain and hypochondriac pain; lower abdominal distension and stuffiness; dizziness and night sweats; Xiaoyao San (Free and Easy Wanderer Powder) is used with modifications. This is a formula targeted at these symptoms, and it is invariably effective. If the patient recovers after one dose but relapses shortly after, or half a day or a day later, and the relapses become more frequent and severe, this is likely a false presentation of upper Heat and lower Cold. This formula should not be administered again. Instead, warming and tonifying formulas should be used. For Yang deficiency, Sijunzi Tang (Four Gentlemen Decoction) is combined with warming herbs; for Yin deficiency, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is prepared as a decoction with warming herbs. In severe cases, the method of "treating heat with cold" (Han Yin Re Yong) is employed, where a small amount of cold medicine follows the hot medicine, using the technique of "probing with hot medicine taken cold." Otherwise, rejection may occur, causing harm rather than benefit.
Shiwan stated: Stagnation syndromes often originate from frustrated thoughts and wills, causing Qi to be diseased first; thus, Yueju Wan and Siqi Tang were established. If stagnation persists for a long time, Fire pathogenic factors consume Blood; can herbs like Cangzhu (Atractylodes Rhizome) and Xiangfu (Cyperus Rhizome) be taken for a long time? Therefore, Xiaoyao San (Free and Easy Wanderer Powder) and Guipi Tang (Restore the Spleen Decoction) were subsequently devised. However, stagnation syndromes mostly affect women. As stated in the *Neijing*, diseases of the Two Yang meridians originating from the Heart and Spleen, as well as endless thinking and unfulfilled desires, can all cause illness. The manifestations vary: some have fever and headache; some have wheezing, coughing, and Qi deficiency; some have amenorrhea or irregular menstruation; some have mania, epilepsy, and loss of mental clarity; some have hemorrhage due to flaming Fire; some have bone-steaming consumption; some develop carbuncles and parasites. Treatment methods generally revolve around Xiaoyao San (Free and Easy Wanderer Powder), Guipi Tang (Restore the Spleen Decoction), Zuojin Wan (Zuojin Pill), Jiangqi Tang (Descend Qi Decoction), Wuchen Tang (Wu Chen Decoction), and Qi Qi Tang (Seven Qi Decoction). One must investigate whether the condition is new or chronic, and whether it is excess or deficiency, to select and modify the formulas accordingly.
[Diagnosis] Pulse signs of stagnation are often deep and hidden (Chen Fu), knotted (Jie), rapid with pauses (Cu), deep (Chen), or choppy (Se). If stagnation is in the Liver and Kidney, the pulse appears on the left side; if in the Heart and Spleen, it appears on the right side. If Qi, Blood, Food Retention, or Phlegm-Fluids remain stagnant within, the pulse will inevitably become choppy and intermittent. However, as long as the pulse possesses Shen (Spirit/Vitality), there is no harm. What is meant by Shen is Wei Qi (Stomach Qi). Although stagnation pulses are often deep, hidden, knotted, or rapid, they do not constitute a major threat. The concern lies in pulses that are firm, hard, wiry, strong, and discordant. Deep, hidden, knotted, and rapid pulses indicate that Qi can still be dispersed; once Qi flows freely, harmony is restored. If the pulse is firm, hard, wiry, and strong, Zheng Qi (Upright Qi) has already been damaged, and there is no Qi left to disperse. Even with tonification, efficacy is difficult to achieve, let alone the misuse of Qi-depleting drugs. Therefore, stagnation syndromes presenting with wiry and strong pulses often evolve into deficiency consumptive diseases.
Yi Silan treated a woman suffering from general fatigue, yawning, dry mouth, and inability to eat for a month; she could barely swallow a few grains when forced. Some treated her for Blood deficiency, others for Qi weakness, and some recognized Fire but did not identify its source. Medications were mixed and chaotic, worsening her condition. Her symptoms mildly improved in winter, but in the following summer, all illnesses returned. She became emaciated with visible bones. The Three Jiao pulses were surging and large, extending upwards; the Spleen and Lung pulses were faint and deep; other parts of the pulse were peaceful. This was a Lung Fire disease. Zhi Zi Ren (Gardenia Seed) was soaked in Ginger Juice overnight, stir-fried until black, and ground into an extremely fine powder. It was taken with a decoction of Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), and Wumei (Mume Fruit). After two doses, she felt hungry and desired food. Within ten days, her body regained normal strength. Later, due to infertility from prolonged illness, everyone assumed Blood deficiency and prescribed Renshen (Ginseng Root) and Huangqi (Astragalus Root). Half a month later, she experienced chest and diaphragmatic fullness, and her appetite decreased sharply. It took over three months for her menstruation to start, passing dark, foul-smelling discharge, intermittently flowing, unable to pass smoothly, causing extreme suffering. Yi Silan then used Siwu Tang (Four Substances Decoction) replacing Shudi (Prepared Rehmannia Root), adding Chenpi (Tangerine Peel), Sugen (Perilla Stem), Huangqin (Scutellaria Root), Shanzhi (Gardenia Fruit), Qingpi (Green Tangerine Peel), and Zhike (Bitter Orange Fruit) for more than ten doses. She conceived within one month.