In ancient times, there was no name for depression, but many descriptions of clinical manifestations similar to this disease can be found in the literature of the past generations, for example, there are many similarities between various diseases and their symptoms and depression recorded in the Treatise on Typhoid and the Essentials of the Golden Horoscope, so the related contents are scattered in the records of depression, lily disease, dirty mania, epilepsy and other diseases. Contemporary medical practitioners have elaborated their own understanding and practice on the etiology and pathogenesis of depression from different perspectives.
I. Current status of contemporary Chinese medicine treatment of depression
Therefore, the basic pathogenesis of depression is attributed to liver qi stagnation, which can lead to liver qi multiplying the spleen, liver damage and kidney damage, qi stagnation, phlegm clotting, blood stasis, and deficiency due to actuality, etc. The treatment is centered on de-liverization and depression. The treatment is centered on draining the liver and relieving depression. Chai Hu Dredging Liver San, Free and Easy San, Si Wei San, Xiao Chai Hu Tang, and Gan Mai Da Zao Tang have become commonly used formulas in clinical treatment of depression.
II. On the evidence and treatment of depression
(1) The key to the treatment of depression is to promote yang and open depression
The basic pathogenesis of depression is “Yang depression and Shen decadence”, which is the main clinical manifestation of depression. Although the clinical manifestation of depression is complex, it is not outside the scope of both the God and the form, and mainly manifests as inhibitory changes in functional activities, of which the decadence of the God is its characteristic change. The core of the pathogenesis of depression is the paralysis of Yang Qi and the abnormal growth of hair. When Yang Qi is depressed and paralyzed, the growth and development are suppressed, which is manifested by the weakening of functional activities. The weakened functional activity is characterized by the inability to concentrate during the day and to sleep at night. It is proposed that the basic treatment for depression is to unblock the Yang Qi, so as to relax the Qi, stimulate the Qi of the internal organs, invigorate the mind, and calm the mind. The heart is the sun of yang, the main blood vessel, and the reservoir of the mind, and it is also the general director of the mental and psychological activities of the human body. Therefore, the treatment of Yang can cure the heart, and the treatment of the heart can regulate the mind.
(2) Treatment of depression
Using the Yang-Qi theory of the Nei Jing as a guide, we apply sutra prescriptions to treat depression. Under the guidance of the theory of Yang Qi in the Nei Jing, and in close combination with the pathogenesis of depression, we have created the general method of treatment to promote Yang to open depression and invigorate the mind, forming the basic idea of the treatment of depression.
1. Liver qi stagnation: depression, depressed mood, distension and pain in the chest and hypochondrium, indefinite pain, sleeplessness, stuffy belching, irregular bowel movements, thin white or thin greasy moss, string pulse. Treatment: Diversifying the liver and Qi, relieving depression and calming the mind. Commonly used formula: Sichinan combined with Fu Ling Gan Cao Tang.
2. Qi depression and fire: depressed temperament, impatience and irritability, insomnia and headache, chest and hypochondriac pain, bitter and dry mouth or red eyes and tinnitus, or noisy and acid swallowing, red tongue with yellow fur and string pulse. Treatment: De-stressing the liver and relieving depression, dipping fire and calming the mind. Commonly used formula: Sifeng San combined with Gardenia Black Bean Soup plus or minus.
3. Qi stagnation and blood stasis: mental depression, anxious temperament, insomnia and headache, forgetfulness or pain in the chest and hypochondrium, or fever or numbness in a certain part of the body, with a purple tongue or petechiae, petechiae, and astringent or stringent pulse. Treatment: Regulating Qi and invigorating Blood, relieving depression and tranquilizing the mind. Commonly used formulas: Si Wei San combined with San Wu Bai San, Gui Zhi Fu Ling Wan plus or minus.
4. Liver depression and spleen deficiency: main symptoms: depressed expression, chest tightness, irritability or speechlessness, difficulty in sleeping, tiredness, loose stools, white and greasy tongue coating, slow pulse. Commonly used formula: Sichiban combined with thick park, ginger, half summer, licorice and ginseng soup, licorice and dry ginger soup plus or minus.
5.Phlegm and qi stagnation: depression, dullness and reticence, stuffiness in the chest, fullness in the ribs, indifferent expression, suspiciousness, mumbling, or obstruction in the pharynx, inability to stutter, white and greasy coating, smooth pulse. Treatment: Relieving phlegm, relieving depression and tranquilizing the mind. Commonly used formula: Gui Zhi Han Xia Tang combined with Phlegm Cleansing Tang.
6.Phlegm-heat accumulation evidence: depression, restlessness, red face, insomnia, red tongue, yellow greasy coating, slippery or smooth pulse. Treatment: Clearing heat, resolving phlegm, and relieving turbidity. Commonly used formula: Xiao Shen Che Tang with Pores and Rolling Phlegm Pill plus or minus.
7, depression and injury to the mind: mental trance, restlessness, suspicious and easily frightened, sadness and laziness, or sometimes lack of stretching, or irritable shouting and other symptoms, light tongue, string pulse. Treatment: Nourishing the heart and tranquilizing the mind, relieving depression and pleasing the will. Commonly used formula: Gan Mai Da Zao Tang with Gui Zhi plus Long Bone and Oyster Soup plus or minus.
8, Heart and kidney Yang deficiency: depression, depressed mood, sleepiness, sleeplessness, insomnia, dreaminess, whiteness, decrepitude, impotence and spermatorrhea, pale fat tongue with white coating and sunken pulse. Treatment: Warming the heart and kidney, helping Yang and pleasing the mind. Commonly used formula: Jin Kui Kidney Qi Pill with Gui Zhi Gan Cao Tang plus flavor.
9, deficiency of qi and blood: prolonged illness or postpartum, mental inactivity, lazy speech, little food and sleep, lack of color, forgetfulness and dreaminess, pale fat tongue, thin white tongue coating, sunken and thin pulse. Treatment: Benefit Qi, strengthen the spleen, nourish blood and calm the mind. Commonly used formula: Ginseng Nourishing Glory Soup with Gui Zhi Gan Cao Tang Plus.
(C) Notes on clinical evidence
The first thing to do is to unblock the Yang Qi, which can be promoted to invigorate the spirit. Of course, to emphasize that the treatment of depression should pay attention to unblocking Yang Qi and invigorating Shen Qi is not to deny the existence of other pathological mechanisms and the application of treatment methods. On the contrary, on this basis, we should also pay attention to the examination of the pathogenic mechanism of concurrently caught evidence and give appropriate treatment. Secondly, we need to pay attention to the quiet storage of yin essence, and check the surplus and deficit of yin liquid; if there is sufficient yin liquid, it is important to invigorate yang energy; if there is insufficient yin liquid, it is important to nourish yin first; if there is a deficit of yin, there is nothing to hide in the mind, so the tranquilization of the mind must be based on nourishing yin. Thirdly, there are many kinds of drugs to calm the mind, the evidence needs to be administered with the evidence, not just the pursuit of submerged town, the use of improper, but to affect the development of Yang Qi, the Shen machine is suppressed, the disease is lingering difficult to cure. Fourth, pay attention to the smoothness of the stool or not.
Constipation is one of the main clinical manifestations of depression, keeping the bowels unrestricted is an important clinical component of the treatment process of depression. The excretion of stool to Yang Qi inspiration to promote as a driving force, Yang Ming gastrointestinal conduction down is the basic organs of stool excretion, therefore, the constipation of depression to promote Yang Qi, unrestricted Qi as the first priority, not a bitter cold diarrhea, although it can seek a moment of pleasure, but later the more constipation, even a diarrhea is difficult to obtain. Fourth, adhere to the treatment, do not arbitrarily stop the drug. Depression is long, easy to rekindle, therefore, need to adhere to the medication, after a period of control of clinical symptoms, can be changed to pills, to facilitate long-term use, or soup 1 dose divided into 2 days. Fifth, pay attention to the time of taking medication. Generally speaking, if you want to promote Yang and open depression, regulate Qi and dissolve phlegm, you should take the medication in the morning and at noon; if you want to nourish and calm the mind, you should take the medication in the afternoon and evening; if you want to harmonize the stomach and dissolve turbidity, you should take the medication before meals.
The incidence of depression is increasing day by day, and its pathogenesis is still unknown; although Chinese medicine has certain efficacy in treating depression, there are still many unsatisfactory points, such as poor efficacy for moderate to severe depression, so it needs to be explored continuously.