经曰∶治五郁者,木郁达之,谓吐之令其调达。火郁发之,谓汗之令其疏散。土郁夺之,谓
下之令无壅碍。金郁泄之,谓渗泄解表利小便。水郁折之,谓抑之制其冲逆。六郁者;气、血、
湿、热、痰、食也。郁者,结滞而不得发越也。人之气血冲和,百病不生;一有凝聚,诸病生焉
。在妇人尤有贪、恋、慈爱、妒嫉、忧患,八者染一,则坚牢不破,无论富贵贫贱,感此最多。
气郁胸胁胀痛,脉沉而涩;湿郁周身走痛,阴雨则发,脉沉细;热郁瞀闷烦心,小便赤,脉沉数,
痰郁行动喘急,脉沉而滑;血郁四肢无力,能食便血,脉沉而芤;食郁嗳酸腹饱恶食,气口脉紧;
治宜发散鞠郁,详审其由。凡久病必开郁破滞,令气血调和始愈。
主方 香附(童便或醋炒) 抚芎 苍术 神曲 陈皮 桔梗 上加生姜水煎服。
气加木香、青皮、苏子、浓朴、枳壳;湿加羌活、白芷、泽泻;热加栀子、连翘;痰加贝母
、茯苓、半夏、海石∶血加桃仁、牡丹皮、红花;食加山楂、麦芽、浓朴、砂仁、槟榔。痰郁不
能吐咯,气郁不舒,先用稀涎散吐之(方见中风。)
越鞠丸 治诸郁。
香附(制) 苍术(制) 神曲(炒) 栀子(炒) 抚芎(等分)
上为末,水法丸绿豆大。每服百丸,白汤送下。加贝母尤效。
六郁汤 能解诸郁。
陈皮(去白) 贝母 连翘 苍术 枳壳 抚芎(各一钱) 栀子(炒) 赤茯苓(各七分)
香附子(二钱) 苏子 砂仁(研。各五分)
上水二盏,姜三片,煎一盏温服。气郁加木香、槟榔、萝卜子,倍香附、砂仁;湿郁加白术
,倍苍术;热郁加芩、连,倍栀子;痰郁加南星、半夏;血郁加桃仁、红花、赤芍;食郁加山楂、
神曲、麦芽。
木香槟榔丸 治气郁、食郁,胸膈痞满,大便结滞(方见诸气。)
生韭饮 治食郁。久则胃脘有瘀血作痛,大能开提气血。
生韭(捣自然汁一碗,温,加酒一、二杯同服。)
右先以桃仁连皮细嚼数十枚,后以韭汁送下。
简便方(治诸郁) 木香 砂仁 白豆蔻(等分)研末,每五分,不拘时,白汤下。或
木香酒磨下;或砂仁、白蔻,常嚼一粒佳。郁金,酒磨服效。
又 枇杷叶(刷去毛)、兰香叶二味煎汤,时时啜之。或贝母嚼细,白汤送下。
《黄帝内经》中说:治疗五种郁证的方法,对于木郁(肝气郁结),应当用吐法使其调达舒展;对于火郁(心火郁结),应当用汗法使其疏散;对于土郁(脾胃郁结),应当用下法使其通畅无壅滞;对于金郁(肺气郁结),应当用渗泄、解表、利小便的方法;对于水郁(肾气/水湿郁结),应当用抑制的方法以制约其冲逆之气。六种郁证是指:气郁、血郁、湿郁、热郁、痰郁、食郁。所谓“郁”,就是结滞而不能发散舒展。人的气血如果冲和顺畅,百病就不会产生;一旦有凝聚阻滞,各种疾病就会由此产生。在妇女中尤其常见贪恋、执着、慈爱过度、嫉妒、忧患等情绪,这八种情绪只要沾染一种,就会变得坚牢难破,无论富贵贫贱之人,感染此症者最多。
气郁的症状是胸胁胀痛,脉象沉而涩;湿郁的症状是周身游走性疼痛,阴雨天发作,脉象沉细;热郁的症状是头昏闷乱、心烦,小便赤黄,脉象沉数;痰郁的症状是行动时气喘急促,脉象沉而滑;血郁的症状是四肢无力,能进食但大便出血,脉象沉而芤(中空);食郁的症状是嗳气酸腐、腹部饱胀、厌恶食物,人迎/寸口脉紧。治疗应当发散鞠郁(疏通郁结),详细审察病因。凡是久病,必须开郁破滞,使气血调和才能痊愈。
主方:香附(用童便或醋炒制)、抚芎(川芎)、苍术、神曲、陈皮、桔梗。上加生姜,用水煎服。
若为气郁,加木香、青皮、苏子、厚朴、枳壳;若为湿郁,加羌活、白芷、泽泻;若为热郁,加栀子、连翘;若为痰郁,加贝母、茯苓、半夏、海浮石;若为血郁,加桃仁、牡丹皮、红花;若为食郁,加山楂、麦芽、厚朴、砂仁、槟榔。若是痰郁不能咳吐出来,气郁不舒畅,先用稀涎散催吐(方剂见中风章节)。
越鞠丸:治疗各种郁证。
香附(制)、苍术(制)、神曲(炒)、栀子(炒)、抚芎(以上五味等分)。
上药研为末,用水泛丸,如绿豆大小。每次服用一百丸,用白开水送下。加入贝母效果更佳。
六郁汤:能解除各种郁证。
陈皮(去白)、贝母、连翘、苍术、枳壳、抚芎(各一钱)、栀子(炒)、赤茯苓(各七分)、香附子(二钱)、苏子、砂仁(研碎,各五分)。
以上药物加水两盏,生姜三片,煎至一盏,温服。若为气郁,加木香、槟榔、萝卜子,加倍使用香附和砂仁;若为湿郁,加白术,加倍使用苍术;若为热郁,加黄芩、黄连,加倍使用栀子;若为痰郁,加天南星、半夏;若为血郁,加桃仁、红花、赤芍;若为食郁,加山楂、神曲、麦芽。
木香槟榔丸:治疗气郁、食郁,以及胸膈痞满、大便结滞(方剂见诸气章节)。
生韭饮:治疗食郁。日久则胃脘部有瘀血作痛,此方能大补开提气血。
生韭菜(捣取自然汁一碗,温热,加酒一至二杯同服。)
先吃数十枚带皮的桃仁,细细咀嚼后,再用韭菜汁送下。
简便方(治疗各种郁证):木香、砂仁、白豆蔻(以上等分)研为末,每次五分,不拘时候,用白开水送下。或者用酒磨木香送下;或者经常嚼一粒砂仁、白豆蔻也很好。郁金,用酒磨服有效。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: To treat the five types of Yu (Stagnation), for Mu Yu (Liver Qi Stagnation), one should use emesis to promote smooth flow and expansion; for Huo Yu (Heart Fire Stagnation), one should use diaphoresis to promote dispersion; for Tu Yu (Spleen/Stomach Stagnation), one should use purgation to remove obstruction; for Jin Yu (Lung Qi Stagnation), one should use渗泄 (draining dampness/diuresis), exterior-resolving, and promoting urination methods; for Shui Yu (Kidney/Water-Dampness Stagnation), one should use suppression to control rebellious upward movement. The six types of Yu refer to: Qi Yu (Qi Stagnation), Xue Yu (Blood Stagnation), Shi Yu (Dampness Stagnation), Re Yu (Heat Stagnation), Tan Yu (Phlegm Stagnation), and Shi Yu (Food Stagnation). "Yu" refers to knotting and stagnation that cannot be dispersed or expressed. When a person's Qi and Blood are harmonious and flowing smoothly, hundred diseases do not arise; once there is condensation and stagnation, various diseases arise from it. In women, emotions such as greed/clinging, attachment, excessive affection, jealousy, and worry are particularly prevalent. If any one of these eight emotional patterns takes root, it becomes firm and unbreakable. Regardless of wealth or poverty, many people suffer from this.
Symptoms of Qi Yu include distending pain in the chest and hypochondrium, with a deep and choppy pulse. Symptoms of Shi Yu include wandering pain throughout the body, worsening on rainy days, with a deep and fine pulse. Symptoms of Re Yu include dizziness, mental confusion, irritability, red urine, and a deep and rapid pulse. Symptoms of Tan Yu include panting and urgency during movement, with a deep and slippery pulse. Symptoms of Xue Yu include weakness in the four limbs, ability to eat but bloody stools, and a deep and hollow pulse. Symptoms of Shi Yu (Food Stagnation) include belching with sour taste, abdominal fullness, aversion to food, and a tight pulse at the Cun Kou (radial artery position). Treatment should focus on dispersing and resolving stagnation, carefully examining the cause. For chronic illnesses, one must open up stagnation and break up obstructions until Qi and Blood are harmonized before recovery can occur.
Main Formula: Xiang Fu (Cyperus Rhizome, stir-baked with child’s urine or vinegar), Fu Xiong (Chuanxiong Rhizoma), Cang Zhu (Atractylodis Rhizoma), Shen Qu (Massa Medicata Fermentata), Chen Pi (Citri Reticulatae Pericarpium), Jie Geng (Platycodonis Radix). Add fresh ginger slices, decoct with water, and take warm.
If Qi Yu, add Mu Xiang (Aucklandiae Radix), Qing Pi (Citri Reticulatae Pericarpium Viride), Su Zi (Perillae Fructus), Hou Po (Magnoliae Officinalis Cortex), Zhi Ke (Aurantii Fructus Immaturus); if Shi Yu, add Qiang Huo (Notopterygii Rhizoma et Radix), Bai Zhi (Angelicae Dahuricae Radix), Ze Xie (Alismatis Rhizoma); if Re Yu, add Zhi Zi (Gardeniae Fructus), Lian Qiao (Forsythiae Fructus); if Tan Yu, add Bei Mu (Fritillariae Bulbus), Fu Ling (Poria), Ban Xia (Pinelliae Rhizoma Preparatum), Hai Shi (Spongia); if Xue Yu, add Tao Ren (Persicae Semen), Mu Dan Pi (Moutan Cortex), Hong Hua (Carthami Flos); if Food Yu, add Shan Zha (Crataegi Fructus), Mai Ya (Hordei Fructus Germinatus), Hou Po, Sha Ren (Amomi Fructus), Bing Lang (Arecae Semen). If Tan Yu cannot be expectorated and Qi Yu feels constrained, first use Xi Yan San (Spittle-Inducing Powder) to induce vomiting (see Stroke chapter).
Yue Ju Wan (Relieving Stagnation Pill): Treats all types of Yu.
Xiang Fu (Processed), Cang Zhu (Processed), Shen Qu (Stir-fried), Zhi Zi (Stir-fried), Fu Xiong (Equal parts).
Grind into powder, make pills with water, size of mung beans. Take 100 pills each time, washed down with plain boiled water. Adding Bei Mu is especially effective.
Liu Yu Tang (Six Stagnations Decoction): Can resolve various stagnations.
Chen Pi (De-whitened), Bei Mu, Lian Qiao, Cang Zhu, Zhi Ke, Fu Xiong (each 1 qian), Zhi Zi (Stir-fried), Chi Fu Ling (Red Poria, each 7 fen), Xiang Fu Zi (2 qian), Su Zi, Sha Ren (Ground, each 5 fen).
Add two cups of water, three slices of ginger, decoct to one cup, and take warm. If Qi Yu, add Mu Xiang, Bing Lang, Luo Bo Zi (Radish Seed), double Xiang Fu and Sha Ren; if Shi Yu, add Bai Zhu (Atractylodis Macrocephalae Rhizoma), double Cang Zhu; if Re Yu, add Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), double Zhi Zi; if Tan Yu, add Nan Xing (Arisaematis Rhizoma Preparatum), Ban Xia; if Xue Yu, add Tao Ren, Hong Hua, Chi Shao (Paeoniae Radix Rubra); if Food Yu, add Shan Zha, Shen Qu, Mai Ya.
Mu Lan Bing Lang Wan (Aquilaria and Areca Pill): Treats Qi Yu and Food Yu, chest and diaphragm stuffiness/fullness, and constipation (see Qi Disorders chapter).
Sheng Jiu Yin (Raw Leek Drink): Treats Food Yu. Over time, blood stasis may form in the epigastrium causing pain; this formula greatly opens and lifts Qi and Blood.
Raw leeks (crush to obtain one bowl of natural juice, warm, mix with one or two cups of wine and take together.)
First, chew dozens of Tao Ren (Persicae Semen) with skin finely, then wash down with leek juice.
Simple Prescription (Treats all Yu): Mu Xiang, Sha Ren, Bai Dou Kou (Amomi Fructus Rotundus, equal parts) ground into powder. Take 5 fen each time, at any time, washed down with plain boiled water. Alternatively, grind Mu Xiang with wine and take; or frequently chew one grain of Sha Ren or Bai Dou Kou. Yu Jin (Curcumae Radix), ground with wine and taken, is also effective.
Another Prescription: Pa Ye (Loquat Leaf, brushed clean of hairs) and Lan Xiang Ye (Basil Leaf) decocted in water, sipped occasionally. Or, chew Bei Mu finely and wash down with plain boiled water.