Literally: inside – grieve – outside – affliction
Alternately: Troubles both within and from without (a country). Internal and external problems. For example, alienating both your populace and your neighbors. By extension, can refer to the combination of intra- and inter-entity problems for households, corporations, and so on.
Notes: Some versions replace 憂 with 患 and the second 患 with 禍 (ka, “misfortune”).
This compound comes to us from the Commentary of Zuo (『春秋左氏伝』, in Japanese Shunjuu sashiden), which we’ve seen before.