1.Introduction Psychiatric and somatic treatment (hereinafter collectively referred to as dual diagnosis and treatment) is the result of the joint research of Chinese and Western medicine and various humanities in neurological disorders, which has generally satisfactory efficacy and prognosis for neurological disorders. At present, the common form of superior treatment for neurological disorders is still recognized as some kind of psychotherapy + antidepressants and anxiolytics. Few controlled studies of dual diagnosis and treatment of neurological disorders have been reported. As one of a series of controlled studies on dual diagnosis and treatment of neurological disorders, this paper is the first to report the efficacy of dual diagnosis and treatment of depressive neurological disorders in an open psychiatric ward of a general hospital. 2. Subjects and methods Design: Diagnosis-based, case-control study. INCLUSION CRITERIA: (1) Compliant with both the Chinese classification scheme and diagnostic criteria for mental disorders and the rational diagnostic model for depressive neurosis; (2) Free of the following co-morbidities: severe somatic diseases, organic brain diseases, menopausal syndrome and other psychiatric disorders. (3) Voluntary participation. (4) Total score of self-rated depression scale (SDS) ≥ 53. There were 33 cases in the study group, 19 males and 14 females; age 18-40 years, average (24±7) years; duration of illness 2-18 years, average (6±4) years; education level: 13 cases in university and 20 cases in secondary school. In the control group, there were 33 cases, 16 males and 17 females; age ranged from 16 to 43 years, mean (24±10) years; duration of disease ranged from 2 to 14 years, mean (6±3) years; education level: 11 cases in university and 22 cases in secondary school. The differences in age and disease duration between the two groups were not significant, respectively (t= 0.100, p>0.5; t= 0.147, p>0.5). Methods: Preparation for the study period: Patients in the study group who had not used before enrollment or had stopped using anxiolytics antidepressants antipsychotics for half a month could enter the formal study period directly; otherwise, they had to stop cleansing for half a month first to pass the period of drug dependence and withdrawal reaction. Patients in the control group could enter the formal study period directly. Formal study period: 5 months in total, divided into two phases. The first 2 months were active treatment period and the last 3 months were free treatment period. The study group was treated with dual discriminative therapy, which included: discriminative psychotherapy, neurological gong, martial arts training, life coaching and training, diet and herbal therapy. In addition, as a curative measure, 400 mg/d of intestinal worm cleaner was used for 3 d at the beginning and 3 d after half a month. detailed specific operations were carried out according to the relevant requirements, which are not repeated here. During the active treatment period, the above plan was followed exactly. During the free treatment period, patients stayed away from the open psychological ward of the general hospital, stopped relying on the psychotherapy of the doctor himself, and adapted to life mainly by the psychological instincts learned during the active treatment period, and occasionally practiced neurological gong or martial arts by themselves. The control group was treated with cognitive therapy + fluoxetine, alprazolam, etc., often combined with the Chinese medicine Xin Shen Ning, etc., and nutritional drugs. The dosage of fluoxetine was 20 mg/d, 1 time/d. The dosage of alprazolam was 0.8-2.8 mg/d, divided into 2-3 times; the initial daily dosage was 0.8 mg, and later adjusted according to the condition. Self-regulation of diet. During the active treatment period, the above plan is followed exactly. During the free treatment period, the patient is away from the open psychiatric ward of the general hospital and stops relying on the doctor’s personal psychotherapy, so that on the one hand he or she can adapt to life with the help of medication, based on the psychological skills learned during the active treatment period. The continued use of medication was self-determined, and 26 patients were still taking fluoxetine (and) or alprazolam until the end of the free treatment period. Clinical efficacy assessment criteria: (1) Cured: complete or nearly complete disappearance of symptoms and complete or nearly complete recovery of function. (2) Significant progress: most of the symptoms disappear, the degree is significantly reduced, and most of the functions are restored. (3) Improvement: partial reduction of symptoms or slight reduction in degree, and some recovery of function. (4) Ineffective: no change in symptoms or worsening of symptoms, and failure to restore function or worsening of functional impairment. The efficacy assessment was performed at the end of the active treatment period and the end of the free treatment period, respectively. Self-rated depression scale (SDS): 4 levels were selected from 1 to 4, before the start of treatment, at the end of active treatment and at the end of free treatment. Main outcome indicators: The following indicators were used in both groups: (1) The degree of symptom control. (2) The degree of functional recovery. (3) Self-rated depression scale (SDS) scores and subtractive scores. In addition, the dichotomous treatment group was also able to use a unique, more covert and centrally useful observation (which was not conditionally implemented in the control group): the ability to automatically control persistent evil thoughts in the absence of antidepressant-anxiolytic and other drugs. Statistical analysis: clinical efficacy was compared with Yates continuity corrected x2 value test. Scales, age and duration of illness were compared with t-test. 3. Results 2.1 Comparison of clinical efficacy between two groups Clinical efficacy at the end of active treatment period: 33 cases in the study group, all healed, healing rate of 100%; 33 cases in the control group, 25 cases healed, 5 cases significantly improved, 3 cases improved, healing rate of 76%, efficiency rate of 100%. The difference in the healing rate between the two groups was significant (x2=6.97 , P < 0.01). 2.2. Comparison of the clinical efficacy of the two groups at the end of the free treatment period The 33 cases in the study group were all cured, with a cure rate of 100%; the 33 cases in the control group were cured, 20 cases, 3 cases with significant improvement, 5 cases with improvement, 5 cases with invalidation, with a cure rate of 61% and an effective rate of 85%. The difference of healing rate between the two groups was extremely significant ( x2=13.79, P < 0.005 ). 3.3 Comparison of SDS assessment between the two groups Self-rated depression scale (SDS) 3 times total score assessment is shown in Table 1. the difference between the total score of the two groups before treatment was not significant (t=0.272, p>0.5); at the end of active treatment period, the total score of both groups decreased significantly, and the score of the study group was lower than that of the control group, and the difference between the two groups was significant (t=10.596, p<0.001); at the end of free treatment period At the end of the free treatment period, the total score of the study group continued to decrease, and the total score of the control group rebounded, and the difference between the two groups was extremely significant (t=11.116,p<0.001). 4, Discussion Depressive neurosis is a common type of neurosis. The pathological mechanism is the pathological change of the God essence qi; there are a series of dependence and waxing and waning relationships between the etiology and symptoms of the disease available for treatment; the key and trick of treatment is to eliminate the etiology of persistent evil thoughts and cultivate the God essence qi, thus eliminating the depressive symptoms in conjunction. The effect of dual diagnosis and treatment on depressive neurosis is as follows: in the mental aspect, eliminating the cause of the disease and persistent evil thoughts in order to calm the spirit, tranquility and emptiness in order to nourish the spirit, calm and relaxed in order to protect the spirit, and at the same time, cultivating good qualities such as perseverance, hard work, self-improvement, open-mindedness, ruggedness, boldness, roundness and harmony in order to adapt to the internal and external environment; in the physical aspect, nourishing the essence, blood and fluid internally in order to reduce consumption, and restoring and strengthening the functions of the internal organs in order to reduce depression. In the body, the internal nourishment of essence, blood and fluids to reduce consumption, restore and strengthen the internal organs to promote regeneration, and the external strengthening of the body and bones to adapt to life. All of the above roles are synergistic and complementary, with the overall situation in mind for long term peace. Attacking the evil and supporting the righteous, treating the disease and building the foundation together, the present and the long term should be taken care of, not only can precisely focus on eliminating the cause of the disease and lasting evil thoughts and then disintegrate other symptoms, but also can widely improve the mental and physical qualities to ensure sustainable progress. The combination of attack and defense, treatment and defense promote each other, killing two birds with one stone. Under the leadership and guidance of the doctor, the patient is cured through his or her own painstaking practice and has a thorough understanding of the principles, methods and processes of dual diagnosis and treatment. After curing depressive neurosis, it is the patient's own ability and will be implicitly transferred to many aspects of life, and can play a long-term role in improving, consolidating, preventing relapse and even curing. The way to heal and consolidate or even cure is to prevent the re-formation of the cause of the disease lasting evil thoughts, usually to be calm and void, to strengthen the body, to improve the mind and body tolerance, when there are evil thoughts to eliminate it in the bud. The control group was treated with cognitive therapy + fluoxetine, alprazolam, etc., which was set up based on the still recognized superior form of treatment. Cognitive therapy is based on rational analysis and preaching to change the patient's cognitive style and perception, thus improving their emotional, behavioral and somatic symptoms; fluoxetine and alprazolam can directly improve the symptoms of depression and anxiety; if combined with herbal medicine, they can calm the mind and calm the mind, and nutritional drugs can improve the physical condition. However, their own inherent defects are also obvious. Cognitive therapy for patients with pathological cognitive patterns of persistence, complexity and involuntary lack of understanding and methods to deal with, so it is not easy to terminate the patient's cause of persistent evil thoughts, the result is often just to get the right cognition will soon be persistent evil interference or denial and the former work is lost or even lost. In addition, cognitive therapy is far inferior to dual diagnosis and treatment in reshaping good personality and rebuilding physical constitution, as a result, the defective personality base and inferior physical constitution base prevent the comprehension, acceptance, implementation and improvement of cognitive therapy. Fluoxetine, despite its antidepressant effect, is ultimately a passive therapy. The more alprazolam is used, the more resistant and massive it becomes, with certain toxic side effects, and addictive, eventually becoming an obstacle to further treatment. Although nutritional injections can temporarily improve physical fitness, but often rely on unconventional ways, seems very passive and difficult to last. Depressive neurosis was treated with cognitive therapy + amitriptyline or concurrent benzodiazepines in an outpatient clinic for 8 weeks as a course of treatment. RESULTS: Of the 28 study participants, 26 completed treatment and 2 fell off. Among the 26 completed treatment cases, the recovery rate was 38.46% and the efficiency rate was 100%. Depressive neurosis was treated in an inpatient setting with a combination of cognitive therapy + one of the medications of choice (doxepin, amitriptyline, chlorpromazine, or meperidine) with an active treatment period of 12 weeks. RESULTS: Of the 21 study participants, 20 completed treatment and 1 dropped out. Of the 20 treatment completers, the recovery rate was 25% and the efficiency rate was 95%. Higher cure rate (76%) and 100% effective rate were achieved in the treatment of depressive neurosis using cognitive therapy + fluoxetine and alprazolam in the open psychological ward of our general hospital. This indicates that open psychiatric wards in general hospitals provide more convenient conditions for depressive neurosis. However, dichotomous discriminative treatment was superior to cognitive therapy + fluoxetine and alprazolam for depressive neurosis in the open psychiatric ward of the general hospital. The clinical efficacy of the two groups was compared as described above. Although the control group had a high recovery rate at the end of the active treatment period, the disadvantages were obvious when compared with the study group: (a) cognitive therapy is not yet able to take the lead in depressive neurosis and has to rely on medication; (b) long-term reliance on medication hinders the further effect of cognitive therapy; (c) based on symptom control, it is difficult to maintain the efficacy in the long term, and to consolidate the efficacy at the cost of long-term treatment, if (d) if we stop using drugs, the disease will rebound or even be complicated by withdrawal or dependence symptoms; (e) the external conditions of dependence are higher and the medical costs are greater, which makes it difficult to implement long-term follow-up treatment because of the economic pressure on patients and society in the long run. Unlike the study group, where the relevant herbal treatments were used or could be dispensed with only in their first 5 d, what was involved was the essential nature of the etiology of the disease such as enduring evil thoughts, pathological changes in the disease mechanism of the gods and essence and all kinds of internal relationships, while the realm reached was already the overall treatment goal. It can be seen that the level of the disease and the treatment goal pursued by the two groups are no longer at the same level, and the research group is superior. Conclusion: Dual discriminative treatment has generally superior healing efficacy and healing consolidation efficacy for depressive neurosis and should be actively promoted. The open psychological ward of a general hospital can be used as a medical platform for dual diagnosis and treatment of depressive neurosis. Case example Chen XX, male, 19 years old. He was admitted to the hospital on 2002-3-16 due to pessimism, disappointment, uninteresting life and pain for 3 years. 4 years ago, he was suffering from pain in the right quadrant of the rib cage and was found to have hepatitis B "small third". He was very worried about cirrhosis and liver cancer due to the influence of propaganda advertisements, so he put all his hopes on the basis of turning negative for hepatitis B. According to the guidance of the advertisements, he searched for medicine and insisted on taking medicine every day in order to get what he wanted. After a year of unsuccessful treatment, the course of treatment has exceeded the initial plan of many "famous doctors" several times; still continue to search for doctors and take medicine, but also gradually feel the disease stubborn and pessimistic disappointment. The interest in study and life has diminished, the energy is not concentrated, and the performance has dropped. She was in pain, had chest pain, panic attacks, fatigue and dizziness. He had already taken a year off from school in order to recuperate from liver disease, but just resumed school and could not continue to study and sought medical help. He was worried about his illness and was afraid of approaching others; he suspected that all six organs of his body were sick when he was slightly unwell. It is almost desperate, thinking that the disease cannot be cured in this life, and there is no hope for other things. The person has no interest and does not want to do anything. He hates taking medicine, but he has to take it reluctantly for fear that stopping it will aggravate his illness. Easy to get angry, and regret afterwards. Lack of patience, giving up when things don't go well. Headaches, panic attacks and palpitations. Insomnia, sleep for about 4-5 hours a day. Dry mouth, poor appetite, streaky or rotten stools, slightly yellow urine. Physical examination: thin body, light red tongue with thin white and slightly yellow coating, slow and stringent pulse. Mental examination: excessive thinking, worrying more about liver disease and pessimism about the future; more concern about the body. Sadness and pain, reduced interest, irritability and regret. Suicidal thoughts, but does not want to die. Good self-awareness. Aversion to seeking medical treatment, but willing to cooperate with treatment if it can be cured. No delusions or hallucinations. Secondary investigations: cranial CT, ECG, chest X-ray, FT3FT4TSH, blood, urine and stool routine were normal. Liver function was basically normal. Two-to-one half: HBsAg(+), HBeAb(+), HBcAb(+). Diagnosis: 1. Depressive neurosis 2. HBsAg carrier. Mental identification: evidence of suspiciousness and pessimism and depression evidence of attention bias. Somatic evaluation: heart and spleen deficiency evidence and liver qi stagnation evidence. Depressive neurosis, treated by twofold diagnosis, cured in one month, no recurrence in nearly 2 years of follow-up; HBsAg carrier, not treated.