运用“脾胃论”思想治疗焦虑障碍的思考与探讨(1)
[摘要] 本文运用“脾胃论”思想，结合临床实践，对焦虑障碍的病因病机进行分析，指出该病主要病机为“脾胃受损，升降失调”。并根据广东省中医院李艳教授多年治疗焦虑障碍的临床经验，总结焦虑障碍患者呈现出的不同证候特征，包括：“脾胃虚热”“脾虚火乘”“阳郁脾土”“脾虚津耗”“脾胃不和”;治疗上，以“调脾胃，益元气，泻阴火，和气血”为原则，分别选用补中益气汤、补脾胃泻阴火升阳汤、升阳散火汤、黄芪人参汤、加减平胃散等有效方剂。
[关键词] 焦虑障碍;脾胃论;健脾;补中益气汤
[中图分类号] R277.7 [文献标识码] A [文章编号] 1673-7210(2020)09(c)-0135-04
Thinking and discussion on the treatment of anxiety disorder with the theory of “Piwei Lun”
ZHAO Chunyi1 XIAO Rong1 ZHENG Zhuanfang1 ZHENG Liming2 LI Yan2
1.The Second Clinical Medical College， Guangzhou University of Chinese Medicine， Guangdong Province， Guangzhou 510405， China; 2.Department of Psychology and Sleeping， Guangdong Provincial Hospital of Traditional Chinese Medicine， Guangdong Province， Guangzhou 510120， China
[Abstract] By combining the theory of “Piwei Lun” with clinical practices， this paper analyzes the etiology and pathogenesis of anxiety disorder， and points out that the main pathogenesis of such disorder lies in “spleen and stomach damage with imbalanced rising and falling of vital energy”. According to Professor Li Yan′s clinical experience in treating anxiety disorder for many years in Guangdong Provincial Hospital of Traditional Chinese Medicine， this paper summarizes different syndrome characteristics of anxiety disorder patients as followed： “deficiency heat in spleen and stomach”， “spleen deficiency and flaring-up of liver-fire”， “stagnation of liver qi and spleen deficiency”， “spleen deficiency and body-fluid consumption”， and “spleen and stomach disharmony”. In terms of treatment， effective prescriptions， such as Buzhong Yiqi Decoction， Bupiwei Xieyinhuo Shengyang Decoction， Shengyang Sanhuo Decoction， Huangqi Renshen Decoction and Modified Pingwei Powder are respectively selected based on the principle of “regulating spleen and stomach， benefiting primordial qi， purging yin fire and harmonizing qi and blood”.
[Key words] Anxiety disorder; Piwei Lun; Invigorating spleen; Buzhong Yiqi Decoction
焦虑障碍是精神科最为常见的情绪障碍，以广泛而持续的焦虑紧张、过分担心或反复发作惊恐为主要特征，常伴有植物神经系统症状[1-2]。焦虑障碍属中医“情志病”范畴，并无准確对应病名，多涉及中医古籍中的“郁证”“惊悸”“怔忡”“奔豚”“惊悸”“不寐”“脏躁”“百合病”等病症。临床观察中，患者常以周身躯体不适为主诉就诊，西医治疗往往效果欠佳，专科治疗多使用抗焦虑药物及镇静安眠药，起效快，但存在一定的药物局限性、依赖性及副作用[3]。此时，中医治疗在改善患者整体症状及西药不良反应上凸显优势。
中医认为，五脏主五志，脾胃位于中焦，为一身气血生化之源，灌溉四旁，滋养五脏，因此脾胃功能正常，则五脏安定、情志安宁。另外，岭南人群长期处于湿热环境，脾胃最易受损，情志疾病往往伴有诸多脾胃症状，临床运用调和脾胃法治疗情志疾病效果颇佳。因此，笔者以“脾胃”为核心探讨焦虑障碍的病因病机及治法，期望为今后情志类疾病的中医临床工作提供诊疗新思路。, http://www.100md.com(赵春 肖荣 郑转芳 郑莉明 李艳)
[关键词] 焦虑障碍;脾胃论;健脾;补中益气汤
[中图分类号] R277.7 [文献标识码] A [文章编号] 1673-7210(2020)09(c)-0135-04
Thinking and discussion on the treatment of anxiety disorder with the theory of “Piwei Lun”
ZHAO Chunyi1 XIAO Rong1 ZHENG Zhuanfang1 ZHENG Liming2 LI Yan2
1.The Second Clinical Medical College， Guangzhou University of Chinese Medicine， Guangdong Province， Guangzhou 510405， China; 2.Department of Psychology and Sleeping， Guangdong Provincial Hospital of Traditional Chinese Medicine， Guangdong Province， Guangzhou 510120， China
[Abstract] By combining the theory of “Piwei Lun” with clinical practices， this paper analyzes the etiology and pathogenesis of anxiety disorder， and points out that the main pathogenesis of such disorder lies in “spleen and stomach damage with imbalanced rising and falling of vital energy”. According to Professor Li Yan′s clinical experience in treating anxiety disorder for many years in Guangdong Provincial Hospital of Traditional Chinese Medicine， this paper summarizes different syndrome characteristics of anxiety disorder patients as followed： “deficiency heat in spleen and stomach”， “spleen deficiency and flaring-up of liver-fire”， “stagnation of liver qi and spleen deficiency”， “spleen deficiency and body-fluid consumption”， and “spleen and stomach disharmony”. In terms of treatment， effective prescriptions， such as Buzhong Yiqi Decoction， Bupiwei Xieyinhuo Shengyang Decoction， Shengyang Sanhuo Decoction， Huangqi Renshen Decoction and Modified Pingwei Powder are respectively selected based on the principle of “regulating spleen and stomach， benefiting primordial qi， purging yin fire and harmonizing qi and blood”.
[Key words] Anxiety disorder; Piwei Lun; Invigorating spleen; Buzhong Yiqi Decoction
焦虑障碍是精神科最为常见的情绪障碍，以广泛而持续的焦虑紧张、过分担心或反复发作惊恐为主要特征，常伴有植物神经系统症状[1-2]。焦虑障碍属中医“情志病”范畴，并无准確对应病名，多涉及中医古籍中的“郁证”“惊悸”“怔忡”“奔豚”“惊悸”“不寐”“脏躁”“百合病”等病症。临床观察中，患者常以周身躯体不适为主诉就诊，西医治疗往往效果欠佳，专科治疗多使用抗焦虑药物及镇静安眠药，起效快，但存在一定的药物局限性、依赖性及副作用[3]。此时，中医治疗在改善患者整体症状及西药不良反应上凸显优势。
中医认为，五脏主五志，脾胃位于中焦，为一身气血生化之源，灌溉四旁，滋养五脏，因此脾胃功能正常，则五脏安定、情志安宁。另外，岭南人群长期处于湿热环境，脾胃最易受损，情志疾病往往伴有诸多脾胃症状，临床运用调和脾胃法治疗情志疾病效果颇佳。因此，笔者以“脾胃”为核心探讨焦虑障碍的病因病机及治法，期望为今后情志类疾病的中医临床工作提供诊疗新思路。, http://www.100md.com(赵春 肖荣 郑转芳 郑莉明 李艳)