基于抑郁症发病机制的中药防治规律

抑郁症严重危害人类健康,防治的形势相当严峻。目前,西方医学对于抑郁症仍然未找到确切有效的治疗方法,中医心身一体的整体观和丰富的临床实践加之治疗中相对较小的副作用使其在抑郁症的防治方面可能有潜在的优势。单味中药或中药复方是中医治疗抑郁症的主要手段之一,天然药物的化学成分相当复杂,中药复方的成分更加复杂,因此该文重点探讨单味中药防治抑郁症的作用规律。不少研究者从历史文献或者不同医者的临床经验中发掘出了较多具有防治抑郁症作用的中药。目前已知的抑郁症发病机制主要有4个方面,一是单胺类神经递质及其受体表达异常引发抑郁症,二是神经细胞可塑性及相关信号通路改变导致抑郁症,三是下丘脑-垂体-肾上腺轴持续激化引发功能紊乱而出现抑郁症,四是细胞因子的异常分泌引发抑郁症。中药究竟是通过哪种机制发挥作用的;归经理论是中药临床使用中的重要指导法则,中药的不同归经与不同药理作用机制之间是否有某种关联关系?为解决这2个基本问题,该文系统梳理了所有文献库中有关中药防治抑郁症作用机制的研究,并采用卡方检验分析了中药归经与4种作用机制之间的联系。该研究可能有助于进一步的中药防治抑郁症的临床和实验研究。

Prevention and Treatment Regularity of Traditional Chinese Medicine Based on Pathogenesis of Depression

Depression is a serious threat to human health. There are grave difficulties in its prevention and treatment. At present, Western medicine has not yet found a definitive and effective therapy for depression. By virtue of its holistic view, rich clinical practice plus less side effects, traditional Chinese medicine(TCM) may have potential advantages in the prevention and treatment of depression. Single-herbal TCM or TCM compound is one of the main methods for TCM to treat depression. The chemical composition of natural medicine is quite complicated, moreover, the composition of TCM compound is more complicated. Therefore, this paper focuses on the role of single-herbal TCM in preventing and treating depression. Many researchers have discovered more TCM with the effect in preventing depression from historical literatures or clinical experience of different doctors. There are four main causes in the pathogenesis of depression:the first is the abnormal expression of monoamine neurotransmitters and their receptors, the second is the depression of nerve cells and relevant signaling pathways, the third is the hypothalamus-pituitary-adrenal axis that continuously intensifies to cause dysfunction and depression, and the fourth is the abnormal secretion of cytokines. Which mechanism does TCM work through? The meridian tropism theory is an important guiding principle in the clinical use of TCM. Is there a certain relationship between the different meridian tropisms and different pharmacological mechanisms of TCM? To solve these two basic problems, this paper systematically summarizes all the literatures on the mechanism of TCM in the prevention and treatment of depression, and uses the chi-square test to analyze the relationship between the TCM and the four mechanisms of action. This exploration may contribute to further clinical and experimental research on the prevention and treatment of depression with TCM.