凡诸郁滞,如气、血、食、痰、风、湿、寒、热,或表或里,或脏或腑,一有滞逆,皆
为之郁,当各求其属,分微甚而开之,自无不愈。气郁者,宜木香、沉香、香附、乌药、藿
香、丁香、青皮、枳壳、茴香、浓朴、抚芎、槟榔、砂仁、皂角之类。血郁者,宜桃仁、红
花、苏木、肉桂、延胡、五灵脂、牡丹皮、川芎、当归、大黄、朴硝之类。食郁者,宜山楂
、麦芽、神曲、枳实、三棱、蓬术、大蒜、萝卜,或生韭饮之类。痰郁者,宜半夏、南星、
海石、栝蒌、前胡、贝母、陈皮、白芥子、玄明粉、海藻、皂角、牛黄、天竺黄、竹沥之类
。风郁者,宜麻黄、桂枝、柴胡、升麻、干葛、紫苏、细辛、防风、荆芥、薄荷、生姜之类
。湿郁者,宜苍术、白术、茯苓、泽泻、猪苓、羌活、独活之类。寒郁者,宜干姜、肉桂、
附子、吴茱萸、荜茇、胡椒、花椒之类。热郁者,宜黄连、黄柏、黄芩、栀子、石膏、知母
、龙胆草、地骨皮、石斛、连翘、天花粉、玄参、犀角、童便、绿豆之类。以上诸郁治法,
皆所以治实邪也。若阳虚则气不能行,阴虚则血不能行,气血不行,无非郁证,若用前法
则愈虚愈郁矣,当知所辨,而参以三法如前,庶无误也。
丹溪曰∶郁病大率有六,曰∶气郁者,胸胁疼痛,脉沉而涩。湿郁者,周身走痛,或关
节疼痛,遇阴则发,脉沉而细。热郁者,瞀闷烦心,尿赤,脉沉而数。痰郁者,动则喘息,
脉沉而滑。血郁者,四肢无力,能食便血,脉沉而芤。食郁者,嗳酸腹饱,不喜饮食。或七
情之邪郁,或寒热之交侵,或九气之怫郁,或两湿之侵凌,或酒浆之积聚,故为留饮湿郁之
疾。又如热郁而成痰,痰郁而成癖,血郁而成瘕,食郁而成痞满,此必然之理也。
戴氏曰∶郁者,结聚不得发越也,当升不升,当降不降,当变化不得变化,故传化失常
而郁病作矣。大抵诸病多有兼郁者,或郁久而生病,或病久而生郁,或用药杂乱而成郁,故
凡病必参郁治。
凡是各种郁滞,如气、血、饮食、痰饮、风邪、湿邪、寒邪、热邪,无论病位在表或在里,在脏或在腑,只要出现阻滞逆乱,都会形成郁证。应当分别探究其所属的病因,辨别病情的轻重程度而予以疏通,自然没有不痊愈的。
气机郁滞的,适宜使用木香、沉香、香附、乌药、藿香、丁香、青皮、枳壳、小茴香、厚朴、抚芎(川芎的一种)、槟榔、砂仁、皂角这类药物。
血行郁滞的,适宜使用桃仁、红花、苏木、肉桂、延胡索、五灵脂、牡丹皮、川芎、当归、大黄、朴硝这类药物。
饮食积滞的,适宜使用山楂、麦芽、神曲、枳实、三棱、莪术、大蒜、萝卜,或者生韭菜汁饮这类方法。
痰浊郁滞的,适宜使用半夏、天南星、海浮石、瓜蒌、前胡、贝母、陈皮、白芥子、玄明粉、海藻、皂角、牛黄、天竺黄、竹沥这类药物。
风邪郁滞的,适宜使用麻黄、桂枝、柴胡、升麻、葛根、紫苏、细辛、防风、荆芥、薄荷、生姜这类药物。
湿邪郁滞的,适宜使用苍术、白术、茯苓、泽泻、猪苓、羌活、独活这类药物。
寒邪郁滞的,适宜使用干姜、肉桂、附子、吴茱萸、荜茇、胡椒、花椒这类药物。
热邪郁滞的,适宜使用黄连、黄柏、黄芩、栀子、石膏、知母、龙胆草、地骨皮、石斛、连翘、天花粉、玄参、犀角、童便(儿童尿液)、绿豆这类药物。以上各种郁证的治法,都是用来治疗实证邪气的。
如果阳气虚弱,则气不能运行;阴液亏虚,则血不能运行。气血不能运行,无非就是郁证的表现。如果使用上述攻伐的方法,就会使正气更虚,郁滞更甚。因此应当懂得辨别,并参考前述三种方法(指补益阴阳以助气化),这样才不会有误。
朱丹溪说:郁病大致有六种,分别是:气郁,表现为胸胁疼痛,脉象沉而涩;湿郁,表现为周身游走性疼痛,或关节疼痛,遇阴天发作,脉象沉而细;热郁,表现为头目昏闷、心烦,小便赤黄,脉象沉而数;痰郁,表现为活动后喘息,脉象沉而滑;血郁,表现为四肢无力,能进食但大便出血,脉象沉而芤;食郁,表现为嗳气酸腐、腹部饱胀,不喜欢饮食。
或者是七情(喜、怒、忧、思、悲、恐、惊)之邪气郁结,或者是寒热二气相互侵袭,或者是九气(怒、喜、悲、恐、寒、炅、惊、劳、思)怫郁,或者是两湿(外湿与内湿)相互侵凌,或者是酒浆积聚体内,所以成为留饮和湿郁的疾病。
又比如热郁而成痰,痰郁而成癖(腹中结块),血郁而成瘕(腹中结块,聚散无常),食郁而成痞满(心下痞塞胀满),这是必然的道理。
戴元礼说:郁,是指气机结聚而不能发散,该上升的不上升,该下降的不下降,该变化转化的不能变化转化,所以传导化生功能失常,郁病就产生了。
大抵各种疾病多伴有郁滞的情况,有的是因为郁久而生出其他疾病,有的是因为疾病日久而产生郁滞,有的是因为用药杂乱而导致郁滞。所以凡是有病,都必须参考郁证来治疗。
For all types of stagnation, such as Qi (vital energy), Blood, Food, Phlegm, Wind, Dampness, Cold, and Heat, whether located in the Exterior or Interior, Zang organs or Fu organs, once there is obstruction and reversal, it constitutes a Stagnation syndrome. One should seek their respective causes, differentiate between mild and severe conditions, and apply unblocking methods; thus, recovery will invariably follow.
For Qi Stagnation, aromatic and moving herbs such as *Aucklandiae Radix* (Muxiang), *Aquilariae Lignum Resinatum* (Chenxiang), *Cyperi Rhizoma* (Xiangfu), *Linderae Radix* (Wuyao), *Agastegheris Herba* (Huoxiang), *Symplocos Fructus* (Dingxiang), *Citri Reticulatae Pericarpium* (Qingpi), *Aurantii Fructus Immaturus* (Zhike), *Foeniculi Fructus* (Huixiang), *Magnoliae Officinalis Cortex* (Houpo), *Chuanxiong Rhizoma* (Fuxiong), *Arecae Semen* (Binglang), *Amomi Fructus* (Sharen), and *Gleditsiae Spina* (Zaojiao) are suitable.
For Blood Stagnation, blood-invigorating and stasis-resolving herbs such as *Persicae Semen* (Taoren), *Carthami Flos* (Honghua), *Sappan Lignum* (Sumu), *Cinnamomi Ramulus* (Rougui), *Cyperi Rhizoma* (Yanhu - referring to *Cyperus rotundus* or similar contextually), *Trogopteri Dung* (Wulingzhi), *Moutan Cortex* (Mudanpi), *Chuanxiong Rhizoma* (Chuanxiong), *Angelicae Sinensis Radix* (Danggui), *Rhei Radix et Rhizoma* (Dahuang), and *Natrii Sulfas* (Piaoxiao) are suitable.
For Food Stagnation, digestive aids such as *Crataegi Fructus* (Shanzha), *Hordei Fructus Germinatus* (Maiya), *Fabae Farmentum* (Shenqu), *Aurantii Fructus Immaturus* (Zhishi), *Sparganii Rhizoma* (Sanleng), *Curcumae Rhizoma* (Ezhu), *Allium Sativum Bulb* (Dasuan), *Raphani Semen* (Luobo), or drinking raw leek juice are suitable.
For Phlegm Stagnation, phlegm-resolving herbs such as *Pinelliae Tuber* (Banxia), *Arisaematis Rhizoma* (Nanxing), *Calcitrum* (Haishi), *Trichosanthis Fructus* (Gualou), *Peucedani Radix* (Qianhu), *Fritillariae Bulbus* (Beimu), *Citri Reticulatae Pericarpium* (Chenpi), *Sinapis Semen* (Baijiezi), *Natrii Sulfas Exsiccatus* (Xuanmingfen), *Sargassum* (Haizao), *Gleditsiae Spina* (Zaojiao), *Bovis Calculus* (Niuhuang), *Pararainieris Hirtella* (Tianzhuhuang), and *Bambusa Caulis Succus* (Zhuli) are suitable.
For Wind Stagnation, wind-dispelling herbs such as *Ephedrae Herba* (Mahuang), *Cinnamomi Ramulus* (Guizhi), *Bupleuri Radix* (Chaihu), *Bistortae Rhizoma* (Shengma), *Puerariae Lobatae Radix* (Gegen), *Perillae Folium* (Zisu), *Asari Radix et Rhizoma* (Xixin), *Saposhnikoviae Radix* (Fangfeng), *Schizonepetae Spica* (Jingjie), *Menthae Haplocalycis Herba* (Bohe), and *Zingiberis Rhizoma Recens* (Shengjiang) are suitable.
For Dampness Stagnation, damp-draining herbs such as *Atractylodis Macrocephalae Rhizoma* (Cangzhu), *Atractylodis Rhizoma* (Baizhu), *Poria* (Fuling), *Alismatis Rhizoma* (Zexie), *Polyporus* (Zhuling), *Notopterygii Rhizoma et Radix* (Qianghuo), and *Saussureae Radix* (Duhuo) are suitable.
For Cold Stagnation, warming herbs such as *Zingiberis Rhizoma* (Ganjiang), *Cinnamomi Ramulus* (Rougui), *Aconiti Lateralis Radix Praeparata* (Fuzi), *Evodiae Fructus* (Wuzhuyu), *Long Pepper Fruit* (Bibo), *Piperis Nigris Fructus* (Hujiao), and *Zanthoxyli Pericarpium* (Huajiao) are suitable.
For Heat Stagnation, heat-clearing herbs such as *Coptidis Rhizoma* (Huanglian), *Phellodendri Cortex* (Huangbai), *Scutellariae Radix* (Huangqin), *Gardeniae Fructus* (Zhizi), *Gypsum Fibrosum* (Shigao), *Anemarrhenae Rhizoma* (Zhimu), *Gentianae Radix* (Longdancao), *Bark of Ground Tree* (Digupi), *Dendrobii Caulis* (Shihu), *Forsythiae Fructus* (Lianqiao), *Trichosanthis Radix* (Tianguafen), *Scrophulariae Radix* (Xuanshen), *Rhinoceoris Cornu* (Xijiao), *Urine of Children* (Tongbian), and *Phaseoli Radiati Semen* (Lvdou) are suitable. The above treatments for various stagnations are intended to treat excess pathogens.
However, if Yang is deficient, Qi cannot move; if Yin is deficient, Blood cannot move. When Qi and Blood fail to circulate, it manifests as stagnation. Applying the aforementioned draining methods would further deplete deficiency and exacerbate stagnation. Therefore, differentiation is essential, and one should refer to the three prior methods (tonifying Yin and Yang to facilitate movement) to avoid error.
Zhu Danxi stated: Stagnation diseases generally fall into six categories:
1. Qi Stagnation presents with pain in the chest and hypochondrium, with a deep and choppy pulse.
2. Dampness Stagnation presents with wandering pain throughout the body or joint pain, worsening on cloudy days, with a deep and fine pulse.
3. Heat Stagnation presents with dizziness, mental oppression, irritability, dark urine, and a deep and rapid pulse.
4. Phlegm Stagnation presents with panting upon exertion, with a deep and slippery pulse.
5. Blood Stagnation presents with weakness in the four limbs, ability to eat but with bloody stools, and a deep and hollow pulse.
6. Food Stagnation presents with sour belching, abdominal fullness, and loss of appetite.
These may arise from the stagnation of Seven Emotions, invasion by alternating Cold and Heat, frustration of the Nine Qi, intrusion of dual Dampness, or accumulation of wine and fluids, leading to retained fluid and dampness stagnation diseases. Furthermore, Heat Stagnation can generate Phlegm; Phlegm Stagnation can form masses (Pi); Blood Stagnation can form movable masses (Jia); and Food Stagnation can lead to epigastric fullness and obstruction (Piman). This is an inevitable logical progression.
Dai Yuanli stated: Stagnation refers to the clustering of Qi that fails to disperse. When what should ascend does not ascend, what should descend does not descend, and what should transform does not transform, the transmission and transformation functions become abnormal, resulting in stagnation diseases.
Generally, many diseases involve concurrent stagnation. Some diseases arise after prolonged stagnation; some stagnation arises after prolonged disease; and some stagnation results from chaotic medication use. Therefore, in treating any disease, one must consider the aspect of stagnation.