浅谈从阳虚体质论治抑郁症

抑郁症是指以显著而持久的情绪低落、活动能力减退、思维与认知功能迟缓为主要临床特征的一类心境障碍,给个人和社会带来极大负担。现代临床一线用药如盐酸舍曲林、西肽普兰、米氮平等的抗抑郁疗效肯定,然而患者依赖性大,不良反应明显。中医学于抑郁症的治疗取得了一定成效,其中中医体质学对疾病的防治有重要指导意义,但目前大多数医者治疗抑郁症等情感类疾病时,尚未考虑体质因素或仅考虑到常见的气郁体质。而笔者在临床跟诊时注意到,许多抑郁症患者明显兼夹阳虚体质,导师王琦教授将疾病与阳虚体质、证候因素综合考虑,取得了较好疗效。文章系统梳理了阳虚体质与抑郁症相关的古今文献,阐明两者的关系;并结合临床验案详细解析王琦教授诊治抑郁症"三辨诊疗模式"(辨体-辨病-辨证)和用药,希冀为临床医师治疗抑郁症及其他精神类疾病提供新的参考思路。

Discussion on the method of conditioning yang deficiency constitution in the treatment of depression

Depression refers to a type of mood disorder characterized characterized by significant and persistent depression,decreased mobility,and slow thinking and cognitive function,which imposes a great burden on individuals and society. Modern clinical first-line drugs such as sertraline hydrochloride,citalopram,and mirtazapine have a positive antidepressant effect,but patients are highly dependent and has obvious adverse reactions. Traditional Chinese medicine (TCM) has achieved certain results in the treatment of depression. Among them,TCM constitution theory has important guiding significance for the prevention and treatment of diseases. However,most medical practitioners have not considered constitution factors or only considered common qi stagnation constitution when treating emotional diseases such as depression. The author noticed in the clinical study with Professor WANG Qi that many patients with depression clearly combined yang deficiency constitution,and the instructor Professor WANG Qi comprehensively considered the disease and yang deficiency constitution and syndrome factors,and achieved good results. This paper systematically sorts out the ancient and modern literatures related to depression and yang deficiency constitution,and clarifies the relationship between them; and analyzes the "constitution differentiation-disease differentiation-syndrome differentiation model" of Professor WANG Qi''s diagnosis and treatment of depression in combination with clinical cases. This paper hopes to provide new reference ideas for clinicians to treat depression and other mental illnesses.