郁证发微(二十七)——郁证痞满论

探讨郁证性痞满的病脉证治。郁证性痞满主要是指由情志因素触发或加重的胃痞与腹胀；其病机是“无邪无滞无形”之气郁,也可以是气机郁滞继发引起的食滞、痰阻、瘀血及气血亏虚；其临床表现除脾胃病症状外,也可以伴其他广泛多样的症状；其形态既可以是单纯郁证,也可以是病郁同存；其治疗既可以从郁论治,也可以病郁同治。从郁论治的原则主要包括疏肝理气消痞、运脾祛湿、化痰导滞等。鉴别痞满是否属于郁证,当参考实验室检查。郁证性痞满相当于由精神心理因素参与引起的功能性消化不良、功能性腹胀、吞气症、肠易激综合征、功能性便秘等功能性胃肠病,以及部分抑郁症、焦虑症、躯体化障碍等精神障碍性疾病。郁证性痞满的诊治理论与实践已得到现代医学越来越多的支持。

Distention and fullness due to depression syndrome

This paper discusses the syndrome and treatment of distention and fullness due to depression syndrome.Distention and fullness due to depression syndrome mainly refers to gastric stuffiness and abdominal fullness triggered or aggravated by emotional factors.Its pathogenesis involve qi depression without pathogen,stagnation and visibility,and also can be food retention,phlegm stagnation,blood stasis or deficiency of qi and blood caused by stagnant qi movement. Apart from the spleen-stomach disorder,its clinical manifestations also can be accompanied by various symptoms. Its patterns include single depression syndrome and the coexistence of diseases and depression syndrome. It can be treated based on relieving depression or both on depression and diseases. The principles of treatment based on relieving depression include dispersing stagnated liver qi and regulating qi-flowing for eliminating stuffiness,activating spleen for eliminating dampness,dissipating phlegm and removing food stagnation. Identifying whether distention and fullness is induced by depression syndrome should refer to laboratory test.Distention and fullness due to depression syndrome is similar to functional dyspepsia,functional abdominal distention,aerophagia,irritable bowel syndrome,functional constipation or other functional gastrointestinal disorders correlated with psychological factors,or depression,anxiety,somatization disorder or other mental disorders.The theory and practice of distention and fullness due to depression syndrome in the diagnosis and treatment have got more and more support by modern medicine.