抑郁症中医治则“疏肝解郁”与“温阳开郁”的异同点

程勋树 高明周 林文达 王海军

摘要 抑郁证属于中医郁证的范围，中医治疗抑郁证多立论于心、肝、脾、肾四脏其中“疏肝解郁”是主流治疗原则，而经验总结得来的“温阳开郁”治疗原则临床亦有较好的疗效。通过比较2种治法的异同發现2种治法的争论源于指导理论不同，温阳开郁法涵盖疏肝解郁法中调畅气机的重要内涵，并包含温补肾阳、肝阳、脾阳即“调整阴阳”的关键思想，是中医治疗郁证的关键临床经验，并有待从经典理论中进行系统的阐述。

关键词 抑郁;郁证;疏肝;温阳;相火

Exploration of the Similarities and Differences Between “Soothing Liver and Relieving Depression” and “Warming Yang and Opening Depression” in the Treatment of Depression by Traditional Chinese Medicine

CHENG Xunshu，GAO Mingzhou，LIN Wenda，WANG Haijun

（College of Traditional Chinese Medicine，Shandong University of Traditional Chinese Medicine，Jinan 250355，China）

Abstract Depression syndrome belongs to the scope of depression syndrome of traditional Chinese medicine（TCM）.TCM treats depression syndrome mainly on the heart，liver，spleen and kidney，among which “soothing liver and relieving depression” is the mainstream treatment.And the principle of “warming yang and relieving depression” summarized from experience has a better clinical effect.By comparing the similarities and differences between the 2 treatments，the author believes that the controversy between the 2 treatments is different from that of the guiding theory.The method of warming yang to relieve depression covers the important connotations of regulating qi and activating qi in the method of soothing the liver and relieving depression，and the key idea of warming kidney yang，liver yang and spleen yang is the key clinical experience of TCM in treatment of depression syndrome，and it needs to be systematically expounded from the classical theory.

Keywords Depression; Depression syndrome; Soothing liver; Warming yang; Phase fire

中图分类号：R242;R749.05文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.01.017

抑郁症（Depression）是一种常见的以抑郁情绪为主的心境障碍或情感障碍[1]，临床主要表现是出现持续且强烈的情绪低落，而且低落的程度与其客观生活工作不相符，除此之外还伴随兴趣与愉快感丧失，难以集中注意力，不明原因的持续疲劳感，活力减少，精力减退，失眠，食欲不振等，严重者会伴随幻觉，自杀倾向及行为。且抑郁症患者情绪长期低落，会增大其他疾病的患病率，如心肌梗死，高血压等疾病，严重降低影响了患者的生活工作质量。抑郁症的治疗是一个长期过程，临床治疗缓解后的患者有25%～40%的复发率[2]。世界卫生组织（WHO）认为，人们在21世纪面对的最大疾患就是精神疾病，而抑郁症是其中的重点，它已成为世界第4大疾病，大规模发生的风险为15%～20%[3]。

抑郁症属于郁证的范畴，中医以天人观和身心一体观在过去的2 000多年中对于“抑郁”这一表现有丰……