基于亢害承制理论从血舍神角度论治焦虑症

张达 赵燕 李青 杨亚伟 于泽楷 扈新刚

摘要 焦虑症是临床上较常见的一种精神障碍性疾病，对人体的身心健康具有重大影响。中医根据其症状描述可归属于情志类范畴。肝藏血，在志为魂，心主血，在志为神，心肝二脏相互协调，血液充足，神魂安定，人的情志才能正常表达。心肝邪热亢盛，血不养神，神魂被扰，导致焦虑症的发生，本病责之心肝，所以治疗当以清肝热泻心火、调血安神为主。五脏制化维持机体的动态平衡，心肝两脏邪热亢盛必然会受到所不胜脏腑的制约，出现“本化”之象即临床表现与病机一致，制约不及则出现“鬼贼之化”的现象即临床表现与病机相反。比如肝阳亢盛出现焦虑、口苦、急躁易怒等“本化”之外，还可能兼有喘憋、咳血等肺气不宣，此为“鬼贼之化”即木极似金，所以在治疗焦虑症的时候，除治疗本化之外，还应该兼顾鬼贼之化。

关键词 焦虑症;亢害承制;本化;鬼贼之化;血舍神;动态平衡;脏象学说;五行生克

Abstract Anxiety disorder is a common mental disorder in clinical practice，which has a significant impact on physical and mental health.According to the description of its symptoms in TCM，anxiety disorder belongs to the category of emotions.The liver stores blood.connected with soul.The heart governs the blood，connected with the spirit.When they are coordinated with each other，the blood is sufficient and the spirit is stable，thus the human emotions can be expressed normally.When the heart and liver have excessive heat，the blood is not nourishing，and the soul is disturbed，which leads to the occurrence of anxiety.This disease roots in the heart and liver，so the treatment should mainly focus on clearing the heat，regulating the blood and calming the nerves.The five internal organs maintain the dynamic balance of the body.Excessive heat in the heart and liver will be restricted by the overwhelming internal organs.The emergence of “intrinsic ization” means that the clinical manifestations are consistent with the pathogenesis.If the restriction is not enough，“the transformation of ghosts and thieves”，means clinical manifestations are opposite to the pathogenesis，will occur.For example，anxiety，bitter mouth，irritability and other “intrinsic ization” of hyperactive liver yang may also be accompanied by wheezing，coughing up blood and other lung-qi obstruction symptoms.This is “the transformation of ghosts and thieves”，which is because that the wood is extremely similar to the gold.Therefore，in the treatment of anxiety，in addition to the treatment of the intrinsic ization，the transformation of ghosts and thieves should also be taken into consideration.

Keywords Anxiety disorder; Unrestrained excess causing disorders; Intrinsic ization; Transformation of ghosts and thieves; Blood house god; Dynamic balance; Viscera-state theory; Inter-generation and inter-restraint among the five elements

中圖分类号：R277.7文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.22.016

焦虑症是精神科最常见的疾病之一，与遗传、疾病、社会心理环境等多种因素有关[1]，既可以单独发病，往往是在情绪刺激或者应激性事件之后，也可以继发于其他疾病，常见的主要有中风、糖尿病、心肌梗死等。中医并没有焦虑症这一疾病名称，主要归属于情志病范畴，与烦躁、不寐、脏躁、卑惵、百合病等疾病密切相关。笔者基于亢害承制理论从五脏制化的角度出发，以血舍神为切入点，尝试对焦虑症发生机制及其论治进行分析，希望为焦虑症的治疗提供新思路和新方法。……