凡郁证之脉，在古人皆以结促止节为郁脉，使必待结促止节而后为郁，则郁证不多见矣
，故凡诊郁证，但见血气不顺而脉不和平者，其中皆有郁也。惟情志之郁，则如弦紧、沉涩、
迟细、短数之类皆能为之。至若结促之脉，虽为郁病所常有，然病郁者未必皆结促也，惟血
气内亏，则脉多间断；若平素不结而因病忽结者，此以不相接续，尤属内虚。故凡辨结促者
，又当以有神无神辨之，其或来去有力，犹可以郁证论；若以无力之结促，而悉认为气逆痰
滞，妄行消散，则十误其九矣。
凡五气之郁，则诸病皆有，此因病而郁也；至若情志之郁，则总由乎心，此因郁而病也
。第自古言郁者，但知解郁顺气，通作实邪论治，不无失矣。兹予辨其三证，庶可无误，盖
一曰怒郁，二曰思郁，三曰忧郁。如怒郁者，方其大怒气逆之时，则实邪在肝，多见气满腹
胀，所当平也。及其怒后而逆气已去，惟中气受伤矣，既无胀满疼痛等证，而或为倦怠，或
为少食，此以木邪克土，损在脾矣，是可不知培养而仍在消伐，则所伐者其谁乎？此怒郁之
有先后，亦有虚实，所当辨治者如此。又若思郁者，则惟旷女嫠妇，及灯窗困厄，积疑任怨
者皆有之。思则气结，结于心而伤于脾也。及其既甚，则上连肺胃而为咳喘，为失血，为膈
噎，为呕吐；下连肝肾，则为带浊，为崩淋，为不月，为劳损。若初病而气结为滞者，宜顺
宜开；久病而损及中气者，宜修宜补。然以情病者，非情不解，其在女子，必得愿遂而后可
释，或以怒胜思，亦可暂解；其在男子，使非有能屈能伸，达观上智者，终不易却也。若病
已既成，损伤必甚，而再行消伐，其不明也亦甚矣。又若忧郁病者，则全属大虚，本无邪实
，此多以衣食之累，利害之牵，及悲忧惊恐而致郁者，总皆受郁之类。盖悲则气消，忧则气
沉，必伤脾肺；惊则气乱，恐则气下，必伤肝肾，此其戚戚悠悠，精气但有消索，神志不振
，心脾日以耗伤。凡此之辈，皆阳消证也，尚何实邪？使不知培养真元，而再加解散，真与
鹭鸶脚上割股者何异？是不可不详加审察，以济人之危也。
一、怒郁之治∶若暴怒伤肝，逆气未解，而为胀满或疼痛者，宜解肝煎、神香散，或六
郁汤，或越鞠丸。若怒气伤肝，因而动火，以致烦热，胁痛胀满或动血者，宜化肝煎。若怒
郁不解或生痰者，宜温胆汤。若怒后逆气既散，肝脾受伤，而致倦怠食少者，宜五味异功散
，或五君子煎，或大营煎、归脾汤之类调养之。
一、思郁之治∶若初有郁结滞逆不开者，宜和胃煎加减主之，或二陈汤，或沉香降气
散，或启脾丸皆可择用。凡妇人思郁不解，致伤冲任之源，而血气日亏，渐至经脉不调，或
短少渐闭者，宜逍遥饮，或大营煎。若思忆不遂，以致遗精带浊，病在心肺不摄者，宜秘元
煎。若思虑过度，以致遗精滑泄及经脉错乱，病在肝肾不固者，宜固阴煎。若思郁动火，以
致崩淋失血，赤带内热，经脉错乱者，宜保阴煎。若思郁动火，阴虚肺热，烦渴，咳嗽见血
，或骨蒸夜热者，宜四阴煎，或一阴煎酌宜用之。若生儒蹇厄，思结枯肠，及任劳任怨，心
脾受伤，以致怔忡健忘，倦怠食少，渐至消瘦，或为膈噎呕吐者，宜寿脾煎，或七福饮；若
心膈气有不顺或微见疼痛者，宜归脾汤，或加砂仁、白豆蔻、丁香之类以微顺之。
一、忧郁内伤之治∶若初郁不开，未至内伤，而胸膈痞闷者，宜二陈汤、平胃散，或和
胃煎，或调气平胃散，或神香散、或六君子汤之类以调之。若忧郁伤脾而吞酸呕恶者，宜温
胃饮，或神香散。若忧郁伤脾肺而困倦、怔忡、倦怠、食少者，宜归脾汤，或寿脾煎。若忧
思伤心脾，以致气血日消，饮食日减，肌肉日削者，宜五福饮、七福饮，甚者大补元煎。
凡是郁证的脉象，在古人的著作中都以结脉、促脉、止脉、节脉作为郁证的脉象。如果一定要等到出现结、促、止、节的脉象才诊断为郁证，那么郁证就很少能被发现了。因此，凡是诊察郁证，只要见到气血运行不顺且脉象不平和的，其中都有郁滞存在。只有情志方面的郁证，其脉象如弦紧、沉涩、迟细、短数等类型都可以出现。至于结脉和促脉，虽然是郁病常见的脉象，但患郁病的人未必都出现结脉或促脉。只有当体内气血亏虚时，脉象才会多表现为间断；如果平时脉象不结，因病突然变得结滞，这是因为气血不相接续，尤其属于内部虚弱。所以，凡是辨别结脉和促脉的，又应当通过脉象是否有“神”来区分：如果脉象来去有力，还可以按照郁证论治；如果是无力的结脉或促脉，却全都认为是气逆痰滞，妄用消散之法，那么十次就会误九次。
凡是五气（风、寒、暑、湿、燥）引起的郁证，各种疾病中都可能出现，这是因病而导致的郁滞；至于情志引起的郁证，则总归于心，这是因郁滞而导致疾病。只是自古以来谈论郁证的人，只知道解郁顺气，一概当作实证邪气来治疗，这就不免有失偏颇了。现在我辨析这三种证候，或许可以避免错误。大概分为：一是怒郁，二是思郁，三是忧郁。
比如怒郁，在大怒气逆的时候，实邪在肝，多见气满腹胀，应当平复。等到怒气过后，逆气已去，只有中气受伤了，既然没有胀满疼痛等症状，或者出现倦怠，或者食欲减少，这是因为木邪克制土（肝木克脾土），损伤在脾。这时候如果不知道培养正气而仍在使用消伐之法，那么被消伐的是什么呢？这就是怒郁有先后、虚实之分，应当这样辨别和治疗。
又如思郁，多见于旷女寡妇，以及读书人困顿受挫、积疑任怨的人都有这种情况。思虑则气机结滞，结在心而伤及脾。等到病情严重，向上连及肺胃，导致咳嗽气喘、失血、膈噎、呕吐；向下连及肝肾，导致带下浑浊、崩漏淋沥、月经闭止、劳损。如果在初病时气结导致滞逆不开，适宜顺气开郁；久病损伤中气的，适宜修补补益。然而，因为情志致病，非情志不能解除，对于女子，必须心愿得遂才可以释怀，或者以怒胜思，也可以暂时缓解；对于男子，如果不是能够屈能伸、通达乐观的上智者，终究不容易痊愈。如果病已经形成，损伤必然很严重，如果再行消伐，这种不明智也太严重了。
又如忧郁病，则完全属于大虚，本来没有实邪，这多是因为衣食的拖累、利害的牵绊，以及悲忧惊恐而导致郁滞的，都属于受郁的一类。悲伤则气消，忧愁则气沉，必伤脾肺；惊则气乱，恐则气下，必伤肝肾。这些人神情凄惨悠长，精气只有消耗索灭，神志不振，心脾日渐耗伤。凡此之类，都是阳气消退的证候，哪里还有什么实邪？如果不知道培养真元，反而再加解散之法，这与在鹭鸶脚上割肉有什么区别呢？这是不可不详加审察，以救助人的危难啊。
一、怒郁的治疗：如果是暴怒伤肝，逆气未解，而出现胀满或疼痛的，宜用解肝煎、神香散，或者六郁汤，或者越鞠丸。如果是怒气伤肝，因而动火，导致烦热、胁痛胀满或者动血的，宜用化肝煎。如果是怒郁不解而生痰的，宜用温胆汤。如果是怒气之后逆气已散，肝脾受伤，导致倦怠食少的，宜用五味异功散，或者五君子煎，或者大营煎、归脾汤之类的调养。
二、思郁的治疗：如果初起有郁结滞逆不开的情况，宜用和胃煎加减主之，或者二陈汤，或者沉香降气散，或者启脾丸都可以择用。凡是妇人思郁不解，导致损伤冲任之源，而血气日渐亏虚，渐渐到经脉不调，或者经量短少渐渐闭止的，宜用逍遥饮，或者大营煎。如果是思忆不遂，导致遗精带浊，病在心肺不摄的，宜用秘元煎。如果是思虑过度，导致遗精滑泄及经脉错乱，病在肝肾不固的，宜用固阴煎。如果是思郁动火，导致崩淋失血、赤带内热、经脉错乱的，宜用保阴煎。如果是思郁动火，阴虚肺热，烦渴，咳嗽见血，或者骨蒸夜热的，宜用四阴煎，或者一阴煎酌情选用。如果是书生蹇厄，思结枯肠，以及任劳任怨，心脾受伤，导致怔忡健忘、倦怠食少，渐渐消瘦，或者为膈噎呕吐的，宜用寿脾煎，或者七福饮；如果心膈气有不顺或微见疼痛的，宜用归脾汤，或者加砂仁、白豆蔻、丁香之类以轻微顺气。
三、忧郁内伤的治疗：如果初郁不开，未到内伤程度，而胸膈痞闷的，宜用二陈汤、平胃散，或者和胃煎，或者调气平胃散，或者神香散、或者六君子汤之类的来调理。如果忧郁伤脾而出现吞酸呕恶的，宜用温胃饮，或者神香散。如果忧郁伤脾肺而出现困倦、怔忡、倦怠、食少的，宜用归脾汤，或者寿脾煎。如果忧思伤心脾，导致气血日渐消减，饮食日渐减少，肌肉日渐削薄的，宜用五福饮、七福饮，严重的用大补元煎。
The pulse of any stagnation syndrome (Yu Zheng, 郁证) in ancient texts is described as Jie (Knotted), Cu (Rapid with intermittent pauses), Zhi (Intermittent), or Jie (Regularly irregular) pulses. If one waits for these specific pulse patterns to diagnose stagnation, stagnation syndromes would rarely be identified. Therefore, when diagnosing stagnation, if one observes disharmony of Qi and Blood with an unharmonious pulse, there is stagnation present. Specifically for emotional stagnation, pulses such as Xian (Wiry), Jin (Tight), Chen (Deep), Se (Choppy), Chi (Slow), Xi (Fine), Duan (Short), and Shu (Rapid) can all occur. Although Jie and Cu pulses are common in stagnation diseases, not all patients with stagnation exhibit them. Intermittent pulses often indicate internal deficiency of Qi and Blood. If a patient who normally does not have an intermittent pulse suddenly develops one due to illness, it signifies a lack of continuity, pointing strongly to internal deficiency. Thus, when distinguishing Jie and Cu pulses, one must assess the presence or absence of "Shen" (Spirit/Vitality) in the pulse. If the pulse comes and goes with strength, it may still be treated as a stagnation syndrome; however, if weak Jie or Cu pulses are mistaken for Qi rebellion and Phlegm stasis, and dissolving methods are wrongly applied, nine out of ten cases will be misdiagnosed.
Stagnation caused by the Five Qi (Wind, Cold, Summer-heat, Dampness, Dryness) can occur in various diseases; this is stagnation resulting from disease. In contrast, emotional stagnation originates primarily from the Heart; this is disease resulting from stagnation. Historically, discussions on stagnation have focused only on resolving stagnation and smoothing Qi, treating it uniformly as an excess pathogen, which is inaccurate. I hereby distinguish three types to avoid errors: namely, Nu Yu (Anger Stagnation), Si Yu (Pensiveness Stagnation), and You Yu (Depression/Gloom Stagnation).
Regarding Nu Yu (Anger Stagnation): During acute anger with rebellious Qi, excess pathogens reside in the Liver, manifesting as abdominal distension and fullness, requiring pacification. After the anger subsides and rebellious Qi dissipates, the Middle Qi is injured. Without symptoms of distension or pain, but with fatigue or poor appetite, this indicates Wood overacting on Earth (Liver attacking Spleen), causing damage to the Spleen. Failing to nourish at this stage and continuing to use draining methods harms the healthy Qi further. Thus, Nu Yu has early/late stages and excess/deficiency aspects that must be distinguished.
Regarding Si Yu (Pensiveness Stagnation): This occurs in unmarried women, widows, scholars facing adversity, and those burdened by suspicion and resentment. Pensiveness causes Qi to knot, affecting the Heart and damaging the Spleen. Severe cases extend upward to the Lung and Stomach, causing cough, asthma, hemoptysis, dysphagia, or vomiting; downward to the Kidney and Liver, causing leukorrhea, metrorrhagia, amenorrhea, or consumptive disease. Early-stage Qi knotting requires smoothing and opening; late-stage Middle Qi damage requires repair and tonification. Emotional illnesses require emotional resolution: for women, fulfillment of desires or using Anger to overcome Pensiveness may provide temporary relief; for men, unless they possess flexibility and philosophical detachment, recovery is difficult. Once severe damage occurs, further draining is misguided.
Regarding You Yu (Depression/Gloom Stagnation): This is purely a condition of great deficiency without excess pathogens, often caused by burdens of livelihood, concerns over profit/loss, or grief, worry, fright, and fear. Grief consumes Qi, worry sinks Qi, damaging Spleen and Lung; fright scatters Qi, fear lowers Qi, damaging Liver and Kidney. These individuals appear despondent, their Essence and Qi wasting away, spirit listless, with daily depletion of Heart and Spleen. This represents Yang decline, not excess. Failing to tonify True Yuan and instead using dispersing methods is akin to cutting flesh from an egret's legs—a futile and harmful act. Careful examination is essential to save lives.
1. Treatment of Nu Yu (Anger Stagnation): For acute liver injury with unresolved rebellious Qi causing distension or pain, use Jie Gan Decoction (Liver-Pacifying Decoction), Shen Xiang Powder (Aromatic Fragrance Powder), Liu Yu Tang (Six Stagnations Decoction), or Yue Ju Wan (Yue’s Pill for Resolving Stagnation). If anger injures the Liver, stirring Fire leading to irritability, heat, hypochondriac pain, or bleeding, use Hua Gan Decoction (Transforming Liver Decoction). If anger stagnation generates Phlegm, use Wen Dan Tang (Warming the Gallbladder Decoction). If post-anger rebellious Qi has dissipated, injuring Liver and Spleen causing fatigue and poor appetite, use Wu Wei Yi Gong San (Five-Ingredient Decoction for Enhancing Function), Wu Jun Zi Jian (Five Gentlemen Decoction), Da Ying Jian (Great Camp Decoction), or Gui Pi Tang (Restore the Spleen Decoction) for nourishment.
2. Treatment of Si Yu (Pensiveness Stagnation): For initial stagnation with obstructed Qi, use He Wei Jian (Harmonizing Stomach Decoction) with modifications, Er Chen Tang (Two Aged Ingredients Decoction), Chen Xiang Jiang Qi San (Aquilaria Descending Qi Powder), or Qi Pi Wan (Spleen-Initiating Pill). For women with unresolved pensiveness damaging Chong and Ren vessels, leading to blood/Qi deficiency and menstrual irregularities or amenorrhea, use Xiao Yao Yin (Free and Easy Wanderer Drink) or Da Ying Jian. For unfulfilled longing causing spermatorrhea or leukorrhea due to Heart-Lung failure to secure, use Mi Yuan Jian (Secretifying Origin Decoction). For excessive thinking causing spermatorrhea, slippery discharge, and menstrual chaos due to Liver-Kidney insecurity, use Gu Yin Jian (Securing Yin Decoction). For pensiveness stirring Fire causing metrorrhagia, hematuria, red leukorrhea, or menstrual chaos, use Bao Yin Jian (Protecting Yin Decoction). For pensiveness stirring Fire with Yin deficiency and Lung heat causing thirst, cough with blood, or tidal fever, use Si Yin Jian (Four Yins Decoction) or Yi Yin Jian (One Yin Decoction) as appropriate. For scholars with mental blockage, or those bearing burdens injuring Heart-Spleen causing palpitations, amnesia, fatigue, emaciation, or dysphagia/vomiting, use Shou Pi Jian (Longevity Spleen Decoction) or Qi Fu Yin (Seven Blessings Drink); for slight Qi obstruction or mild pain in the chest/diaphragm, use Gui Pi Tang or add Sha Ren, Bai Dou Kou, Ding Xiang to gently smooth Qi.
3. Treatment of Internal Injury from You Yu (Depression/Gloom Stagnation): For initial stagnation without internal injury, presenting with chest/diaphragm stuffiness, use Er Chen Tang, Ping Wei San (Peaceful Stomach Powder), He Wei Jian, Tiao Qi Ping Wei San (Regulating Qi Peaceful Stomach Powder), Shen Xiang Powder, or Liu Jun Zi Tang (Six Gentlemen Decoction) to regulate. If spleen injury causes acid regurgitation and nausea, use Wen Wei Yin (Warming Stomach Drink) or Shen Xiang Powder. If spleen-lung injury causes lassitude, palpitations, fatigue, and poor appetite, use Gui Pi Tang or Shou Pi Jian. If worry/thought injures Heart-Spleen causing progressive depletion of Qi/Blood, food intake, and muscle mass, use Wu Fu Yin (Five Blessings Drink) or Qi Fu Yin; for severe cases, use Da Bu Yuan Jian (Great Tonification of Origin Decoction).