基于中医藏象整体观探讨抑郁症从心脾论治的理论和应用研究
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摘要
抑郁症(Depression)是一种常见的情感性精神障碍性疾病,以显著而持久的心境低落、忧郁不畅为主要临床表现,并伴有相应的思维和行为改变等症状。近年来,随着人们生活压力的加大和工作节奏的加快,发病呈上升趋势。抑郁症对患者的生活和工作造成的不利影响,给家庭和社会带来沉重的负担。1998年世界卫生组织(World Health Organization, WHO)公布的疾病负担表明,在中国抑郁症已跃居疾病负担的第2位,与世界上发达国家接近。目前抗抑郁治疗主要应用传统三环类和新型SSRI类抗抑郁药物。但传统抗抑郁药不良反应大,新型抗抑郁药成本却高达数十倍。而传统中医药具有“简、便、验、廉”的优势特点。为了更好的发挥中医药在抗抑郁治疗中的优势作用,本文从理论、临床及实验三个方面进行了研究。
一、理论研究：
1、经查阅大量文献资料,从中医整体观的理论角度,分析了心脾二脏在经络结构、五行关系、生理功能、病理表现等方面存在的密切联系。总结出抑郁症的发病基础为：脾失健运,神失所养。因此在治疗上以健脾益气,养心安神为主。代表方为归脾汤。结论：在对抑郁症从心脾论治的理、法、方、药进行探讨基础上,提出脾藏象在精神活动中具有重要作用。生理状态下,脾主运化,主升清功能正常,后天气血生化有源,全身脏腑功能得以正常发挥,则情志活动正常。若情志刺激,或劳倦伤脾,或脾失健运,可导致各种抑郁症(如情志之郁、气郁、湿郁、食郁、痰郁、火郁等)的发生。此理论为治疗抑郁症开辟了新的思路,具有指导临床实践的现实意义。
2、为分发挥中医药在抗抑郁治疗中的优势作用,扩大中成药的治疗范围,本文结合归脾丸治疗抑郁症探讨了药引的作用原理、功效和选用药引的基本原则。提出药引送服归脾丸的治疗方法,为推进中成药的广泛应用提供了依据。
二、临床研究：
1、目的：为进一步证实抑郁症从心脾论治理法方药的正确性和脾藏象在情志病中的重要性,探讨中成药归脾丸治疗抑郁症的适应症,更好的发挥中医药治抑郁症的优势作用,本文进行了临床研究。
2、方法步骤：确立研究方案(包括纳入标准、排除标准、诊疗标准、剔除和脱落标准等),自拟调查问卷和中医证候评分量表,并进行了预调查。在预调查结果上修订调查问卷和中医证候评分量表。收集120例心脾两虚型抑郁症病例,采用随机方法分为三组。治疗组服用中成药归脾丸,并随兼证加用中成药或药引送服；西药对照组单纯服用氟西汀；中西药对照组服用归脾丸的同时加服抗抑郁西药氟西汀。4周为1个疗程,共治疗3个疗程。在服药前、服药4周、服药8周、服药12周时,进行观测。观测指标：一般情况(血压、体重、心率),临床症状表现(汉密尔顿抑郁量表HRSD和自拟中医证候评分表进行测评),不良反应。所有数据采用Excel电子表格录入,并进行核查。对结果采用SAS 8.0统计软件进行统计分析,所有数据均采用双侧检验,P<0.05被认为所检验的差别具有统计学意义。
3、结果：三组样本经人口学资料和一般资料比较(性别、年龄)无差异；基线病情比较(病情程度、HRSD量表总分、中医症状评分量表总分)无差异。具有可比性。
症状评价：三组HRSD量表单项症状平均改善率从高到低依次为：治疗组(83.67%)>中西药对照组(78.98%)>西药对照组(77%)。三组中医证候单项症状平均改善率从高到低依次为：治疗组(81.85%)>西药对照组(79.34%)>中西药对照组(71%)。
疗效评价：从总体疗效分析,服药4周时,三组均开始有效,服药8周时,三组均有明显疗效,服药12周,三组疗效保持稳定上升态势。说明归脾丸在治疗抑郁症心脾两虚证的疗效与西药、中西药联用无明显差异性,疗效相当。从个体疗效分析,治疗4周时,三组HRSD评价有效率比较,治疗组显著优于两个对照组；中医证候评价显效率比较,治疗组显著优于对照组。说明归脾丸疗效优于两个对照组。治疗8周、12周时,HRSD评分改善率无明显差异,而中医症状评分显示三组痊愈率比较有显著差异。说明中医证候改善情况较为明显。
4、不良事件：治疗过程中共出现9例不良事件,治疗组2例胃肠道症状可能与治疗措施有关,其余2例判定与治疗措施无关。西药对照组2例胃肠道症状和1例心慌可能与治疗措施有关,继续治疗后恢复。中西药对照组服药后出现的2例胃肠道症状经判定与治疗措施无关。
5、结论：通过治脾,达到治疗情志病效果,佐证了脾藏象在情志疾病中的重要作用。归脾丸治疗抑郁症的优势在于：疗效好,在总体疗效上与西药、中西药比较无明显差异,而个体疗效在中后期的痊愈率优于其他两组；起效时间早,副反应小。因此验证了抑郁症从心脾论治思路的正确性,为进一步研究提供了依据。而随兼证合用中成药或药引送服归脾丸的治疗方法,则为中医整体观在治法中的体现,弥补中成药处方固定,不能随证加减变化的不足。通过分析120例病例症状出现的频次,提出归脾丸治疗抑郁症的适应症：主症：失眠、纳差、心悸、神疲、乏力；次症：食欲不振、多思、大便干、健忘、咽中异物感、胸闷、头晕、善太息、大便稀、脘腹胀；或有症：多梦、多汗、少气、烘热、背凉痛。除有情绪低落的精神症状外,还必须具备主症二个或以上症状；或具备一个主症+二个兼症者。
三、实验研究：为探讨服用归脾丸的抑郁症患者血清皮质醇含量对抑郁症状的影响,随机抽取临床研究中服用归脾丸治疗3个疗程者24例作为治疗1组,新纳入病例24例作为治疗2组,随机采集24例同期体检的健康人样本为正常对照组,共72例,采用化学发光免疫分析法进行血清皮质醇含量测定。治疗1组和正常对照组只测定一次,治疗2组于服药前、服药后4周分别测定血清皮质醇含量,共2次。三组间年龄、性别无差异。
结果：抑郁症患者血清皮质醇含量较正常健康者增高,且随着服药后病情的减轻而血清皮质醇含量随之降低。
结论：血清皮质醇水平与HRSD量表评分呈正相关,能反映抑郁症病情程度,临床中可用以辅助诊断,及推测抑郁症的复发率。归脾丸的抗抑郁作用机制可能是通过降低抑郁症患者血清皮质醇水平而发挥作用。
四、本文创新点：
1、提出归脾丸治疗抑郁症的适应症,及随兼证合用中成药或药引送服归脾丸之法。
2、血清皮质醇水平与抑郁症状呈正相关,能反映病情程度,临床中可用以辅助诊断,及推测抑郁症的复发率。归脾丸的抗抑郁作用机制可能是通过降低抑郁症患者血清皮质醇水平而发挥作用。
Depression is a common disease of affective disorder, featuring significant and persistent low mood and depression as the main clinical manifestations, and accompanied by changes in thinking and behaviors. In recent years, its incidence is increased by higher living pressure and faster work pace. Depression leaves adverse impact on the life and work of the patients, burdening the family and the community. In 1998 WHO announced that the disease burden of depression has leapt to No.2 in China, which was close to that of developed countries. Currently the main antidepressant approach is the application of tricyclic antidepressant and SSRI. Traditional antidepressants have more adverse reactions, while new ones, who cost as high as several dozen times. In this regard,the traditional Chinese medicine excels for its advantageous characteristics of "simple, handy, effective and heap". In order to better play its outstanding role in antidepressant treatment, in this project it is researched from a theoretical, clinical and an experiment perspective.
I. Theoretical research:
1. After an extensive reading of literature, I discuss the concept, treatment and prescription of treating depression from a heart-and-spleen-led perspective within the theoretical context of TCM holism. Through analysis, I discuss the heart-spleen connections in terms of their meridian structures, five-element system, physiological functions and pathological bases. It is summarized that depression is caused by:lack of healthy spleen operation and the support of spirit. Therefore, appropriate treatment includes nourishing spleen Qi and the heart and spirit. The representative prescription is the Guipi Soup. Conclusion:The concept, treatment and prescription of depression are discussed from a heart-and-spleen-led perspective and then the spleen is important in emotional desease is proposed. Under the physiological state, if the spleen storing spirit functions normally, and since the spleen governs transportation and transformation of substance, and rising the lighter substance, the biological Qi and blood are soundly sourced, so that body organs function into normal play. Because of the emotional stimulation, or weary spleen injury, or ineffective spleen operation, spirit can not be stored by the spleen, hence spleen dysfunction, leading to a variety of depressive illness (such as the emotional depression, Qi depression, damp depression, food stagnation, phlegm depression, heat depression, etc.) This hypothesis has opened up a new possibility for the treatment of depressive illness, and has practical significance for clinical practice.
2. The functional principle, efficacy and selection of guiding drugs are also discussed in describing the treatment of depression by Guipi Pills, invoking its application in the procedure. The discussion provides examples for the wider application of Chinese patent drugs, expanding its treatment adaptability and compensating for its inability to adjust to different degrees of disease.
II Clinical research:
1. Objective:To further evidence Chinese medicine treatment of depressive illness by a "heart-and-spleen-led" approach, to discuss the applicant range of Guipi Pills against depression, and to put into a better play of TCM against depression, we undertook the clinical research.
2.Procedure:Establishment of research programs (including the inclusion criteria, exclusion criteria, treatment standards, removal and falling standards, etc.) We intend to survey by the proposed questionnaire and TCM syndrome score scale, and have conducted pre-surveys. On the basis of the pre-survey results, we collected 120 samples of the heart-and-spleen-deficiency depression, which are randomly divided into three groups. TCM treatment group taking Guipi Pills, and providing Chinese patent drugs or guiding drugs for accompanying symtoms; in the control group both Guipi Pills and fluoxetine (an antidepressant) are taken;and the 3rd control group were taking fluoxetine alone. There are 4 weeks for a course of treatment, and a total of 3 course of treatment. At time spots of pre-medication,4 weeks,8 weeks, and 12 weeks after medication, observations were done. Observation indicators:general (blood pressure, body weight, heart rate), clinical symptoms (Hamilton Depression Scale HRSD, constructed TCM syndrome score scale), and adverse reactions. Excel spreadsheet is used for all data input and verification. The results are input SAS 8.0 statistical software for statistical analysis, all data using two-sided test (p <0.05), which means the tested difference has statistical significance.
3.Results:The three groups of samples show no difference by demographic data and more general information (gender, age); baseline comparison condition (severity, HRSD total score, TCM syndrome total score) was no different. The three groups have comparability.
Symptoms Evaluation:In terms of each symptom improvement, the three groups improved in the order of:the treatment group (83.67%)> TCM+fluoxetine group (78.98%)> Western medicine control group (77%). In terms of each symptom improvement, the three groups had improved in the order of:the treatment group (81.85%)> TCM +fluoxetine group (79.34%)> Western medicine control group (71%).
Efficacy evaluation:from the overall efficacy of medication after 4 weeks, three groups all start to effect; for 8 weeks, the three groups had significant effect; for 12 weeks, efficacy of the three groups remained stably upward;and the treatment group performs better than the control groups. It indicates that Guipi Pills, in the treatment of depressive illness caused by heart and spleen deficiency, has no significant difference of efficacy from both Western medicine treatment and Chinese and Western medicine combined treatment,and even more effective than the other two groups. Individual effects:After 4 weeks, three groups had significant efficiency difference. It indicates that Guipi Pills has better starting efficacy than the two control groups. After 8 weeks, the cure rate diverges among the three groups. As to treatment for 12 weeks, HRSD scale score showed that the efficiency of the three groups were significantly different; and clinical symptoms score showed that cure rate between the three groups were significantly different. In the treatment group, cure rate by symptom scoring was significantly higher than the control groups, while the HRSD efficiency was significantly better than the control groups. It indicates that the TCM symptoms were significantly cured.
4.Adverse events:There are 10 cases of adverse events occurred in the course of treatment:2 cases of gastrointestinal symptoms which may be relevant to the treatment measures; other 3 cases irrelevant. Control group 2 has 3 cases of gastrointestinal symptoms which may be related to treatment measures; 1 case in control group 1 and 1 case in control group 2 are irrelevant to the treatment measures.
5.Conclusion:The fact that spleen treatment results in cure of emotional depression has evidenced the importance of spleen "storing spirit". Guipi Pills' advantage in treating depression:similar or even better efficacy than fluoxetine or fluoxetine combined with TCM; earlier efficacy and less side effects. The idea of treating depression in a "heart-and-spleen-led" approach is verified as correct, providing evidence for further research. And through the treatment method of adding Chinese patent drugs or guiding drugs to Guipi Pills based on accompanying symptoms, the TCM holistic approach was put into practice. The application range of Guipi Pills include:primary symptoms:insomnia, poor appetite, palpitations, weariness, forgetfulness, light-colored tongue; accompanying symptoms:chest distress, dizziness, fatigue, poor appetite, over thinking. The pills are applicable to depressive patients who also have two or more primary symptoms or one primary and two accompanying symptoms.
III. Experimental research:
To explore the impact of the serum cortisol on the depressive symptoms of patients taking Guipi Pills,120 cases were randomly selected:24 sample of patients taking Guipi Pills as the treatment group 1,24 new patients who will taking Guipi Pills as the treatment control group 2,24 samples collected from healthy people over the same period as healthy control group, altogether 72 cases. The levels of serum cortisol are detected by luminescence immunoassay. The levels of Serum cortisol in treatment group and control group are examined for 3 times:before treatment,4 weeks and 8 weeks after treatment. The levels of serum cortisol in normal control group are detected only once. The three groups show no difference in terms of age and gender.
Results:The levels of serum cortisol in depression patients were higher than normal people. The levels of serum cortisol decreased after treatment with Guipi Pills and the disease is relieved.
Conclusion:serum cortisol level was positively correlated with HRSD score scale, which can reflect the severity of depression and can be used to aid clinical diagnosis and speculating the depression disease recurrence.
Conclusions:
1. The application range of Guipi Pills in treating depression; combination with the Chinese patent medicine or guiding-drug with Guipi Pills as symptoms indicate.
2. Serum cortisol level was positively correlated with depressive symptoms, which can reflect the severity of depression and can be used to aid clinical diagnosis and speculating the depression disease recurrence.
一、理论研究：
1、经查阅大量文献资料,从中医整体观的理论角度,分析了心脾二脏在经络结构、五行关系、生理功能、病理表现等方面存在的密切联系。总结出抑郁症的发病基础为：脾失健运,神失所养。因此在治疗上以健脾益气,养心安神为主。代表方为归脾汤。结论：在对抑郁症从心脾论治的理、法、方、药进行探讨基础上,提出脾藏象在精神活动中具有重要作用。生理状态下,脾主运化,主升清功能正常,后天气血生化有源,全身脏腑功能得以正常发挥,则情志活动正常。若情志刺激,或劳倦伤脾,或脾失健运,可导致各种抑郁症(如情志之郁、气郁、湿郁、食郁、痰郁、火郁等)的发生。此理论为治疗抑郁症开辟了新的思路,具有指导临床实践的现实意义。
2、为分发挥中医药在抗抑郁治疗中的优势作用,扩大中成药的治疗范围,本文结合归脾丸治疗抑郁症探讨了药引的作用原理、功效和选用药引的基本原则。提出药引送服归脾丸的治疗方法,为推进中成药的广泛应用提供了依据。
二、临床研究：
1、目的：为进一步证实抑郁症从心脾论治理法方药的正确性和脾藏象在情志病中的重要性,探讨中成药归脾丸治疗抑郁症的适应症,更好的发挥中医药治抑郁症的优势作用,本文进行了临床研究。
2、方法步骤：确立研究方案(包括纳入标准、排除标准、诊疗标准、剔除和脱落标准等),自拟调查问卷和中医证候评分量表,并进行了预调查。在预调查结果上修订调查问卷和中医证候评分量表。收集120例心脾两虚型抑郁症病例,采用随机方法分为三组。治疗组服用中成药归脾丸,并随兼证加用中成药或药引送服；西药对照组单纯服用氟西汀；中西药对照组服用归脾丸的同时加服抗抑郁西药氟西汀。4周为1个疗程,共治疗3个疗程。在服药前、服药4周、服药8周、服药12周时,进行观测。观测指标：一般情况(血压、体重、心率),临床症状表现(汉密尔顿抑郁量表HRSD和自拟中医证候评分表进行测评),不良反应。所有数据采用Excel电子表格录入,并进行核查。对结果采用SAS 8.0统计软件进行统计分析,所有数据均采用双侧检验,P<0.05被认为所检验的差别具有统计学意义。
3、结果：三组样本经人口学资料和一般资料比较(性别、年龄)无差异；基线病情比较(病情程度、HRSD量表总分、中医症状评分量表总分)无差异。具有可比性。
症状评价：三组HRSD量表单项症状平均改善率从高到低依次为：治疗组(83.67%)>中西药对照组(78.98%)>西药对照组(77%)。三组中医证候单项症状平均改善率从高到低依次为：治疗组(81.85%)>西药对照组(79.34%)>中西药对照组(71%)。
疗效评价：从总体疗效分析,服药4周时,三组均开始有效,服药8周时,三组均有明显疗效,服药12周,三组疗效保持稳定上升态势。说明归脾丸在治疗抑郁症心脾两虚证的疗效与西药、中西药联用无明显差异性,疗效相当。从个体疗效分析,治疗4周时,三组HRSD评价有效率比较,治疗组显著优于两个对照组；中医证候评价显效率比较,治疗组显著优于对照组。说明归脾丸疗效优于两个对照组。治疗8周、12周时,HRSD评分改善率无明显差异,而中医症状评分显示三组痊愈率比较有显著差异。说明中医证候改善情况较为明显。
4、不良事件：治疗过程中共出现9例不良事件,治疗组2例胃肠道症状可能与治疗措施有关,其余2例判定与治疗措施无关。西药对照组2例胃肠道症状和1例心慌可能与治疗措施有关,继续治疗后恢复。中西药对照组服药后出现的2例胃肠道症状经判定与治疗措施无关。
5、结论：通过治脾,达到治疗情志病效果,佐证了脾藏象在情志疾病中的重要作用。归脾丸治疗抑郁症的优势在于：疗效好,在总体疗效上与西药、中西药比较无明显差异,而个体疗效在中后期的痊愈率优于其他两组；起效时间早,副反应小。因此验证了抑郁症从心脾论治思路的正确性,为进一步研究提供了依据。而随兼证合用中成药或药引送服归脾丸的治疗方法,则为中医整体观在治法中的体现,弥补中成药处方固定,不能随证加减变化的不足。通过分析120例病例症状出现的频次,提出归脾丸治疗抑郁症的适应症：主症：失眠、纳差、心悸、神疲、乏力；次症：食欲不振、多思、大便干、健忘、咽中异物感、胸闷、头晕、善太息、大便稀、脘腹胀；或有症：多梦、多汗、少气、烘热、背凉痛。除有情绪低落的精神症状外,还必须具备主症二个或以上症状；或具备一个主症+二个兼症者。
三、实验研究：为探讨服用归脾丸的抑郁症患者血清皮质醇含量对抑郁症状的影响,随机抽取临床研究中服用归脾丸治疗3个疗程者24例作为治疗1组,新纳入病例24例作为治疗2组,随机采集24例同期体检的健康人样本为正常对照组,共72例,采用化学发光免疫分析法进行血清皮质醇含量测定。治疗1组和正常对照组只测定一次,治疗2组于服药前、服药后4周分别测定血清皮质醇含量,共2次。三组间年龄、性别无差异。
结果：抑郁症患者血清皮质醇含量较正常健康者增高,且随着服药后病情的减轻而血清皮质醇含量随之降低。
结论：血清皮质醇水平与HRSD量表评分呈正相关,能反映抑郁症病情程度,临床中可用以辅助诊断,及推测抑郁症的复发率。归脾丸的抗抑郁作用机制可能是通过降低抑郁症患者血清皮质醇水平而发挥作用。
四、本文创新点：
1、提出归脾丸治疗抑郁症的适应症,及随兼证合用中成药或药引送服归脾丸之法。
2、血清皮质醇水平与抑郁症状呈正相关,能反映病情程度,临床中可用以辅助诊断,及推测抑郁症的复发率。归脾丸的抗抑郁作用机制可能是通过降低抑郁症患者血清皮质醇水平而发挥作用。
Depression is a common disease of affective disorder, featuring significant and persistent low mood and depression as the main clinical manifestations, and accompanied by changes in thinking and behaviors. In recent years, its incidence is increased by higher living pressure and faster work pace. Depression leaves adverse impact on the life and work of the patients, burdening the family and the community. In 1998 WHO announced that the disease burden of depression has leapt to No.2 in China, which was close to that of developed countries. Currently the main antidepressant approach is the application of tricyclic antidepressant and SSRI. Traditional antidepressants have more adverse reactions, while new ones, who cost as high as several dozen times. In this regard,the traditional Chinese medicine excels for its advantageous characteristics of "simple, handy, effective and heap". In order to better play its outstanding role in antidepressant treatment, in this project it is researched from a theoretical, clinical and an experiment perspective.
I. Theoretical research:
1. After an extensive reading of literature, I discuss the concept, treatment and prescription of treating depression from a heart-and-spleen-led perspective within the theoretical context of TCM holism. Through analysis, I discuss the heart-spleen connections in terms of their meridian structures, five-element system, physiological functions and pathological bases. It is summarized that depression is caused by:lack of healthy spleen operation and the support of spirit. Therefore, appropriate treatment includes nourishing spleen Qi and the heart and spirit. The representative prescription is the Guipi Soup. Conclusion:The concept, treatment and prescription of depression are discussed from a heart-and-spleen-led perspective and then the spleen is important in emotional desease is proposed. Under the physiological state, if the spleen storing spirit functions normally, and since the spleen governs transportation and transformation of substance, and rising the lighter substance, the biological Qi and blood are soundly sourced, so that body organs function into normal play. Because of the emotional stimulation, or weary spleen injury, or ineffective spleen operation, spirit can not be stored by the spleen, hence spleen dysfunction, leading to a variety of depressive illness (such as the emotional depression, Qi depression, damp depression, food stagnation, phlegm depression, heat depression, etc.) This hypothesis has opened up a new possibility for the treatment of depressive illness, and has practical significance for clinical practice.
2. The functional principle, efficacy and selection of guiding drugs are also discussed in describing the treatment of depression by Guipi Pills, invoking its application in the procedure. The discussion provides examples for the wider application of Chinese patent drugs, expanding its treatment adaptability and compensating for its inability to adjust to different degrees of disease.
II Clinical research:
1. Objective:To further evidence Chinese medicine treatment of depressive illness by a "heart-and-spleen-led" approach, to discuss the applicant range of Guipi Pills against depression, and to put into a better play of TCM against depression, we undertook the clinical research.
2.Procedure:Establishment of research programs (including the inclusion criteria, exclusion criteria, treatment standards, removal and falling standards, etc.) We intend to survey by the proposed questionnaire and TCM syndrome score scale, and have conducted pre-surveys. On the basis of the pre-survey results, we collected 120 samples of the heart-and-spleen-deficiency depression, which are randomly divided into three groups. TCM treatment group taking Guipi Pills, and providing Chinese patent drugs or guiding drugs for accompanying symtoms; in the control group both Guipi Pills and fluoxetine (an antidepressant) are taken;and the 3rd control group were taking fluoxetine alone. There are 4 weeks for a course of treatment, and a total of 3 course of treatment. At time spots of pre-medication,4 weeks,8 weeks, and 12 weeks after medication, observations were done. Observation indicators:general (blood pressure, body weight, heart rate), clinical symptoms (Hamilton Depression Scale HRSD, constructed TCM syndrome score scale), and adverse reactions. Excel spreadsheet is used for all data input and verification. The results are input SAS 8.0 statistical software for statistical analysis, all data using two-sided test (p <0.05), which means the tested difference has statistical significance.
3.Results:The three groups of samples show no difference by demographic data and more general information (gender, age); baseline comparison condition (severity, HRSD total score, TCM syndrome total score) was no different. The three groups have comparability.
Symptoms Evaluation:In terms of each symptom improvement, the three groups improved in the order of:the treatment group (83.67%)> TCM+fluoxetine group (78.98%)> Western medicine control group (77%). In terms of each symptom improvement, the three groups had improved in the order of:the treatment group (81.85%)> TCM +fluoxetine group (79.34%)> Western medicine control group (71%).
Efficacy evaluation:from the overall efficacy of medication after 4 weeks, three groups all start to effect; for 8 weeks, the three groups had significant effect; for 12 weeks, efficacy of the three groups remained stably upward;and the treatment group performs better than the control groups. It indicates that Guipi Pills, in the treatment of depressive illness caused by heart and spleen deficiency, has no significant difference of efficacy from both Western medicine treatment and Chinese and Western medicine combined treatment,and even more effective than the other two groups. Individual effects:After 4 weeks, three groups had significant efficiency difference. It indicates that Guipi Pills has better starting efficacy than the two control groups. After 8 weeks, the cure rate diverges among the three groups. As to treatment for 12 weeks, HRSD scale score showed that the efficiency of the three groups were significantly different; and clinical symptoms score showed that cure rate between the three groups were significantly different. In the treatment group, cure rate by symptom scoring was significantly higher than the control groups, while the HRSD efficiency was significantly better than the control groups. It indicates that the TCM symptoms were significantly cured.
4.Adverse events:There are 10 cases of adverse events occurred in the course of treatment:2 cases of gastrointestinal symptoms which may be relevant to the treatment measures; other 3 cases irrelevant. Control group 2 has 3 cases of gastrointestinal symptoms which may be related to treatment measures; 1 case in control group 1 and 1 case in control group 2 are irrelevant to the treatment measures.
5.Conclusion:The fact that spleen treatment results in cure of emotional depression has evidenced the importance of spleen "storing spirit". Guipi Pills' advantage in treating depression:similar or even better efficacy than fluoxetine or fluoxetine combined with TCM; earlier efficacy and less side effects. The idea of treating depression in a "heart-and-spleen-led" approach is verified as correct, providing evidence for further research. And through the treatment method of adding Chinese patent drugs or guiding drugs to Guipi Pills based on accompanying symptoms, the TCM holistic approach was put into practice. The application range of Guipi Pills include:primary symptoms:insomnia, poor appetite, palpitations, weariness, forgetfulness, light-colored tongue; accompanying symptoms:chest distress, dizziness, fatigue, poor appetite, over thinking. The pills are applicable to depressive patients who also have two or more primary symptoms or one primary and two accompanying symptoms.
III. Experimental research:
To explore the impact of the serum cortisol on the depressive symptoms of patients taking Guipi Pills,120 cases were randomly selected:24 sample of patients taking Guipi Pills as the treatment group 1,24 new patients who will taking Guipi Pills as the treatment control group 2,24 samples collected from healthy people over the same period as healthy control group, altogether 72 cases. The levels of serum cortisol are detected by luminescence immunoassay. The levels of Serum cortisol in treatment group and control group are examined for 3 times:before treatment,4 weeks and 8 weeks after treatment. The levels of serum cortisol in normal control group are detected only once. The three groups show no difference in terms of age and gender.
Results:The levels of serum cortisol in depression patients were higher than normal people. The levels of serum cortisol decreased after treatment with Guipi Pills and the disease is relieved.
Conclusion:serum cortisol level was positively correlated with HRSD score scale, which can reflect the severity of depression and can be used to aid clinical diagnosis and speculating the depression disease recurrence.
Conclusions:
1. The application range of Guipi Pills in treating depression; combination with the Chinese patent medicine or guiding-drug with Guipi Pills as symptoms indicate.
2. Serum cortisol level was positively correlated with depressive symptoms, which can reflect the severity of depression and can be used to aid clinical diagnosis and speculating the depression disease recurrence.
引文
[1]王永炎主编.中医内科学[M].上海：上海科学技术出版社,1997.6第1版,274
[2](汉)许慎撰,(清)段玉裁注.说文解字注[M].郑州：中州古籍出版社,2006.10第1版,271
[3]黄寿祺,梅桐生译注.楚辞全译[M].贵阳：贵州人民出版社,2008.9第1版,84
[4]王云五主编,李宗侗注译.春秋左传今注今译(下册)[M].台北：台湾商务印书馆,1972.1第1版,1301-1302
[5](清)高士宗著,于天星按.黄帝素问直解[M].北京：科学技术出版社,1998.9第3版,595
[6](元)朱震亨,鲁兆麟点校.丹溪心法[M].沈阳：辽宁科学技术出版社,1997.8第1版,64
[7](金)刘元素撰,鲁兆麟点校.素问玄机原病式[M].沈阳：辽宁科学技术出版社,1997.8第1版,5
[8](明)赵献可著,陈永萍校注.医贯[M].北京：学苑出版社,2005.4第2版,61
[9](清)沈金鳌撰,李占林,李晓木校注.杂病源流犀烛[M].北京：中国中医药出版社,1994.10第1版,290
[10](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001.1第1版,43
[11](明)张介宾著,赵立勋主校.景岳全书[M].北京：人民卫生出版社,1991.6第1版,439
[12](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,298
[13](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001.1第1版,174
[14](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001.1第1版,401
[15](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,71
[16]陆渊雷编著.金匮要略今释[M].北京：学苑出版社,2008.10第1版,41
[17]陆渊雷编著.金匮要略今释[M].北京：学苑出版社,2008.10第1版,459
[18]陆渊雷编著.金匮要略今释[M].北京：学苑出版社,2008.10第1版,464
[19](隋)巢元方撰,鲁兆麟点校.诸病源候论[M].沈阳：辽宁科学技术出版社，1997.8第1版,70
[20](唐)王焘撰.外台秘要[M].北京：人民卫生出版社,1955.9第1版第1次印刷,1982.12第1版第5次印刷,456
[21](明)赵献可著,陈永萍校注.医贯[M].北京：学苑出版社,2005.4第2版,60-62
[22](明)虞抟著,郭瑞华等点校.医学正传[M].北京：中医古籍出版社,2002.2第1版,97
[23](清)张璐.张氏医通[M].上海：上海科学技术出版社,1990.12第1版第2次印刷,107
[24](明)徐春甫编集,崔仲平,王耀廷主校.古今医统大全(上册)[M].北京：人民卫生出版社,1991.8第1版,939
[25](明)张介宾著,赵立勋主校.景岳全书[M].北京：人民卫生出版社,1991.6第1版,442
[26]李志梅.抑郁障碍从肝论治[J].山东中医杂志,2007,26(10)：684-685
[27]韩毳,李晓泓.抑郁症与中医肝脏关系探讨[J].山东中医杂志,2001,20(5)：326-327
[28]孙建英.中西医结合治疗隐匿性抑郁症110例[J].四川中[J]医,1995,(9)：24
[29]张俭.李辅仁治疗老年抑郁症经验[J].中医杂志,2000。41(4)：208-209
[30]刘宝录.解郁汤治疗隐匿性抑郁症31例体会[J].天津中医,1999,8(1)：16-17
[31]卫向龙.抑郁症从脾论治[J].河北中医,2004,26(11)：832-833
[32]雷英菊,刘菊妍,梁喆盈.浅谈抑郁症从肾论治[J].四川中医,2007,25(8)：26-27
[33]陈日宙.忧郁证从脾肾论治[J].光明中医杂志,1995,(6)：7-8
[34]吕梅,王玲玲.针药结合治疗抑郁症的临床研究[J].南京中医药大学学报,2004,20(3)：149-151
[35]刘兰英,王玲玲.“脑为元神之府”理论在针灸治疗抑郁症中的指导意义[J].针灸临床杂志,2003,19(8)：6-8
[36]彭贵军,胡随瑜.抑郁症肝郁脾虚、心脾两虚证证候标准第二轮专家问卷分析[J].湖南中医学院学报,2003,23(5)：37-39
[37]王文萍,李晓斌,王天芳,等.应用临床流行病学调查方法提取抑郁症的中医证候主、次症状[J].环球中医药,2009,2(2)：110-112
[38]吴崇胜,陈家旭,胡立胜等.抑郁症中医证候诊断标准研究方法探讨[J].中医药学 刊,2006,24(6)：1015-1017
[39]唐海峰.柴胡疏肝散加减治疗抑郁症30例[J].实用中医药杂志,2009,25(4)：226-227
[40]佟凯航,赵建军.柴胡疏肝散加减治疗抑郁症38例[J].吉林中医药,2007,27(5)：23-24
[41]华刚,柴胡疏肝散加减治疗郁证46例[J].陕西中医,2003,24(6)：539
[42]杨建宏.归脾汤加味治疗心脏神经官能症78例[J].实用中医内科杂志,2007,21(9)：73-74
[43]李辉.补益心脾方治疗抑郁症40例疗效观察[J].山西中医,2006,22(增刊)：17-18
[44]赵龙现,张弛,吴华,等.归脾丸治疗神经衰弱80例[J].陕西中医,2005,26(12)：1329-1331
[45宋春联,王红伟.逍遥散治疗抑郁症疗效观察[J].临床心身疾病杂志,2007,13(5)：454
[46]章玲.逍遥散加味治疗神经衰弱56例[J].长春中医药大学学报,2009,25(1)：90
[47]王腾云,丹栀逍遥汤加减治疗抑郁症34例[J].中国中西医结合杂志,2001,21(9)：710
[48]徐文君,吴国伟,胡云英.百合地黄汤加减治疗老年抑郁症32例[J].浙江中西医结合杂志,2001,11(3)：157-158
[49]金杰.加味百合地黄汤治疗抑郁性神经症35例[J].山西中医,2001,17(2)：35
[50]张丽萍.温胆汤治疗抑郁症的辨证施治[J].中国临床康复,2005,9(16)：3
[51]解海宁.黄连温胆汤合枕中丹治疗老年情感障碍32例[J].江苏中医,1997,18(5)：19
[52]谭斌.柴芩温胆汤结合氯丙咪嗪治疗大学生抑郁症的临床观察[J].中成药,2006,28(6)：830-832
[53丁文娟,中医治疗抑郁症40例临床分析[J].江苏中医,1994,15(4)：18
[54]吴鉴明,加味甘麦大枣汤抗抑郁疗效的对照研究[J].中国临床医生,2002,30(11)：63-65
[55]李有田,洪英杰.舒肝解郁灵治疗抑郁症308例[J].吉林大学学报(医学版),2002,28(5)：546-547
[56]艾正海,钟万翠.补气芳香开窍法治疗抑郁症26例[J].北京中医药大学学报(中医临床版),2003,10(3)：47
[57]张美茹,刘文志.郁必舒冲剂治疗老年期抑郁症36例[J].中医研究,2002,15(3)：43
[58]赵志升.“抑虑康”治疗郁证(焦虑、抑郁)的疗效观察[J].上海中医药杂志,1999,2(12)：46
[59]陈珠娇.中医治疗老年性抑郁症22例[J].福建中医药,1998,29(6)：22
[60]董峰.辨证治疗抑郁症452例疗效观察[J].中医中药,2008,5(16)：87-88
[61]徐枫.中医辨证治疗郁证的临床观察[J].大连医科大学学报,1996,18(2)：123-125
[62]曾桂香,李玲.针刺治疗神经性抑郁症[J].中国针灸,1994(增刊)：49-50
[63]赵俊宏.脑卒中后抑郁的针刺治疗[J].中国康复,2002,(17)：31
[64]王学义,金圭星.电百印联合小剂量抗抑郁剂治疗老年抑郁症的研究[J].现代中西医结合杂志,2004,13(7)：856-857
[65]徐虹,孙忠人.针刺治疗抑郁症及其对患者下丘脑-垂体-肾上腺轴的影响[J].中国针灸,2004,(24)：278-280
[66]吕建明.在德国针灸治抑郁症128例疗效观察[J].针灸临床杂志,2004，20(10)：5-6
[67]宋颖.头皮针治疗脑卒中后抑郁疗效观察[J].上海针灸杂志,1999,18(1)：8-10
[68]焦素林,武连仲.武连仲临证运用“五心穴”经验[J].辽宁中医杂志,2007,34(12)：1692
[69]周正蓉.中西医结合治疗反应性抑郁症38例[J].实用中医药杂志.2001,17(10)：38-39
[70]王淑英.中西医结合治疗抑郁性神经症52例观察[J].实用中医药杂志,1997,(4)：20
[71]朱春山.文拉法辛与消遥丸联合治疗抑郁症的疗效观察[J].中国中西医结合杂志,2002,22(2)：55-59
[72]刘建平.柴胡疏肝散合并氟西汀治疗抑郁症的临床观察[J].山西中医学院学报,2001,2(4)：3-5
[73]罗和春,刘平,孟凡强等.舒血宁合并阿米替林治疗抑郁症多中心双盲对照研究[J].中国心理卫生杂志,1999,13(3)：19-21
[74]郭雅明,刘翠峰,朱晓红.电针配合万拉法新治疗抑郁症疗效观察[J].中国民政医学杂志，2002,14(3)：15-19
[75]赵丁,任雷鸣.合欢花抗抑郁作用的药理实验研究初探[J].河北医科大学学报,2003,24(4)：215-216
[76]张中启,黄世杰.巴戟天寡糖对鼠强迫性游泳和获得性无助抑郁模型的影响[J].中国药理学与毒理学杂志,2001,15(4)：262-263
[77]司银楚,孙建宁.贯叶连翘提取物对慢性应激抑郁大鼠行为及脑内5-HT、NE表达的影响[J].中国药科大学学报,2003,34(1)：70-73
[78]秦晓松,金魁和,丁宝坤.银杏叶提取物联合盐酸文拉法辛对抑郁大鼠海马n NOS蛋白表达及NO水平的影响[J].中国心理卫生杂志,2003,17(12)：828
[79]吴春福,游松,刘雯,等.银杏内酯和银杏提取物对纹状体和边缘系统多巴胺及其代谢产物含量的影响[J].中草药,1995,26(5)：253-255
[80]杨进,谢忠礼.菖欢1号对大鼠抑郁症模型脑内单胺类神经递质的影响[J].南京中医药大学学报(自然科学版),2001,17(5)：294-295
[81]张有志,聂惠民,张德昌,等.柴胡加龙骨牡蛎汤等经方治疗抑郁症的动物行为学研究[J].中国中医基础医学杂志,2001,7(7)：30-31
[82]杨士友,黄世福,孙备.解百忧口服液对抑郁模型大鼠行为及中枢神经递质的影响[J].中国中医基础医学杂志,2000,6(11)：56-58
[83]孟宏,郝晋东.抑郁-焦虑症的中医药治疗与实验研究[J].哈尔滨商业大学学报,2002,18(1)：22-24
[84]韩毳,李学武.电针对慢性应激抑郁模型大鼠海马BDNF的影响[J].中国中医基础医学杂志,2001,7(7)：55-56
[85]邱艳明,时宇静,图娅.电针印堂、百会对获得性无助大鼠不同脑区内单胺类神经递质的影响[J].北京中医药大学学报,2002,25(6)：54-56
[86]金光亮,周东丰.电针对慢性应激抑郁模型大鼠脑单胺类神经递质的影响[J].中华精神科杂志,1999,32(4)：220-222
[87]陈光.抑郁症神经内分泌功能及其对电针治疗反应的研究[J].北京医科大学学报,1992,24(5)：401-403
[1]刘玉茂主编,中医十大名方归脾汤[M].北京：中国中医药出版社,1998.3第1版,1
[2](元)危亦林,校注世医得效方[M].上海：上海科技出版社,1964年,115
[3](清)汪昂撰,鲁兆磷等点校.医方集解[M].沈阳：辽宁科学技术出版社,1997年8月第1版,46
[4](宋)严用和.济生方[M].北京：人民卫生出版社,1956.8第1版,128-129
[5]李庆业主编.方剂学[M].北京：中国医药科技出版社,1989.9第1版,146
[6](明)薛已.正体类要[M].上海：上海科学技术出版社,1959.4第1版,1963.10第1版第2次印刷,37
[7](明)薛已著.陈松育点校.内科摘要[M].南京：江苏科学技术出版社,1985.7第1版,41-42
[8](明)吴昆编著,李飞校注.医方考[M].南京：江苏科学技术出版社,1985.9第1版,150-151
[9](明)龚廷贤撰,新刊医林状元济世全书(影印本)[M].北京：中国科学技术出版社,1996.6第1版,377-378
[10](清)吴谦等原著,余瀛鳖等编选.医宗金鉴(第三分册)(卷五十六-卷五十九)痘疹心法要诀[M].沈阳：辽宁科学技术出版社,1973.4第1版,1977.10第1版第4次印刷,385
[11](清)吴谦等原著,余瀛鳖等编选.医宗金鉴(第四分册)(卷六十一-卷七十六)外科心法要诀[M].沈阳：辽宁科学技术出版社,1973.4第1版,1981.6第2版第5次印刷,(总1782)230
[12](清)沈金鳌撰.李占永,李晓林校注.杂病源流犀烛[M].北京：中国中医药出版社,1994.10第1版,118
[13](明)赵献可著；陈永萍校注.医贯[M].北京：学苑出版社,2005.4第2版,73-74
[14](清)罗美著,田代华,田丽莉,高峰点校.古今名医方论[M].天津：天津科学技术出版社,2000,7.第1版,5-6
[15](清)张秉成编著.成方便读[M].上海：科技卫生出版牡,1958.9第1版,8
[16](清)尤怡著述.医学读书记[M].南京：江苏科学技术出版社,1983.3第1版,53
[17]沈晓英,张元兴.逍遥丸联合归脾丸治疗心脏神经官能症54例[J].陕西中医,2007,28(11)：1529
[18]赵龙现,张弛,吴华,等.归脾丸治疗神经衰弱80例[J].陕西中医,2005,26(12)：1329-1331
[19]王常勇,白伟,李莉,等.归脾逍遥丸治疗神经衰弱200例临床观察[J].中医药信息,1999,(5)：38-39
[20]谢贵文,刘继强,何秀兰.归脾丸合并维思通治疗精神分裂症阴性症状65例的临床分析[J].中华现代中西医杂志,2005,3(2)：134
[21]宗大凡.六味地黄丸与归脾丸在慢性病治疗中的联合应用[J].陕西中医,1999,20(12)：567
[22]张银萍,孙静.逍遥丸合归脾丸治疗慢性疲劳综合征的临床观察[J].时珍国医国药,2006,17(12)：2559
[23]张丽梅,高学功.人参归脾丸治疗慢性疲劳综合征26例[J].时珍国医国药,2002,13(7)：423
[24]俞建良.归脾丸治疗失眠症20例[J].现代中西医结合杂志,2008,17(32)：5044-5045
[25]夏俊博,任亚仙,史历,等.归脾丸配合拔罐对大学生失眠症的影响[J].中华现代中医学杂志,2006,2(3)：195
[26]张国斌.归脾丸合逍遥散加减治疗顽固性早搏42例[J].吉林中医药,2004,24(5)：18-19
[27]高晓英.人参归脾丸治疗室性早博临床分析[J].中外医疗,2009,(14)：107
[28]钱轶华.人参归脾丸治疗胺碘酮致心动过缓6例临床观察[J].长春中医学院学报,2001,17(3)：14-15
[29]张娅珍,方红.归脾丸合六味地黄丸治疗特发性水肿31例[J].浙江中西医结合杂志,2006,16(1)：49
[30]宋兆胤.归脾丸、六味地黄丸治疗非炎证水肿11例[J].中国医学研究与临床,2004,2(9)：54-55
[31]刘莉.六味地黄丸合归脾丸治疗带状疱疹后遗神经痛8例[J].河南中医,2001,21(2)：56-57
[32]杜小正,赵彬元,秦晓光,等.针药结合治疗妇女背痛36例[J].河南中医,2005,25(7)：70
[33]滕士超.归脾丸配合小剂量甲状腺素治疗轻微甲状腺功能减退临床疗效观察[J].河北中医,2003,25(12)：895-896
[34]勇晓,李美香.归脾丸佐治内镜阴性胃食管反流病30例分析[J].中华临床新医学,2004,4(1)：86
[35]王凤岐.秦伯未医案选析[J].甘肃中医学院学报,1985,(1)：21
[36]王奎.中医药治疗崩漏的体会[J].天津中医,1996,13(2)：43
[37]吕天贵.放环后崩漏的中医论治之我见[J].四川中医,1999,17(4)：11-12
[38]肖芙姣.中西医结合治疗上环后出血225例分析[J].中国乡村医药杂志,2003,10(2)：30-31
[39]时延利,郭桂.补中益气丸与人参归脾丸合用治疗宫内节育器致子宫出血39例[J].中华中西医学杂志,2005,3(6)：92-93
[40]朱培艳.归脾六味周期分时用药治疗青春期功血129例[J].四川中医,2004,22(5)：61-62
[41]刘凤麒.传统中成药辨证治疗功血200例临床观察及机理研究[J].天津中医,2000,17(5)：20-21
[42]张卫华,刘俊保,张振英.归脾丸配阿胶口服液治疗特发性血小板减少性紫癜阴道出血30例[J].中医研究,2004,17(6)：25
[43]黄培民.止血宝合归脾丸治疗原发性血小板减少性紫癜52例[J].福建中医药,2002,33(1)：32
[44]张泽波,李学军,张冬平.归脾丸治疗肝硬化继发脾功能亢进症25例[J].中西医结合肝病杂志,2006,16(5)：298-299
[45]程静刁,易无庸,潘晓东,等.归脾丸治疗血透贫血患者的效果观察[J].护理学杂志,2005,20(1)：41
[46]刘永昌.人参归脾丸治疗白细胞减少症30例[J].实用中医内科杂志,2000,14(2)：20
[47]王世宏,孙永明.归脾丸、复方阿胶浆治疗白细胞减少症27例临床观察[J].中成药,1999,21(8)：414-415
[48]孙永明.归脾丸参芪片并用治疗白细胞减少症31例[J].实用中医内科杂志,2005,19(6)：578
[49]孙晓东.青春期经闭治验三则[J].上海预防医学杂志,1997,9(11)：510
[50]杨声,郑艳.六味地黄丸合归脾丸临证治验[J].福建中医药,2006,37(3)：39
[51]刘楚芹.中西医结合治疗流产后内分泌功能失调性不孕症30例[J].陕西中医学院学报,2003,26(5)：30
[52]李红云.宫颈糜烂治验1例[J].中国民族医药杂志,1999,5：69
[53]孙冰.知柏地黄丸、归脾丸联合行为干预治疗更年期综合征临床研究[J].山东中医药大学学报,2006,30(1)：55-56
[54]王常勇,韩金江.归脾逍遥丸治疗妇女乳腺增生症120例临床观察[J].北京中医，2001,(3)：23-25
[55]高晓钢.归脾丸治疗男性乳房发育症疗效观察[J].中国校医,2002,16(3)：236
[56]韩子英,王玉珍,朱桂枝,等.归脾丸治疗慢性荨麻疹42例[J].Chin J Derm Venereol,1997,11(5)：308
[1]Duclos M, Gatta B, Corcuff JB. Fat distribution in obese women is associated with subtle alteration of the hypothalamic-pituitary-adrenal axis activity and sensitivity to glucocorticoids. Clin Endocrnol(Oxf),2001;55(4):447-54
[2]周婕,张冬齐,孙莉莎,等.草酸-s-西酞普兰对慢性应激抑郁大鼠模型行为学及CORT和ACTH的影响[J].中国新药杂志,2006,15(14)：1160-1163
[3]胡随瑜,张春虎,曹美群,等.白松片对大鼠慢性应激抑郁模型的抗抑郁实验研究[J].中南大学学报(医学版),2006,31(5)：676-681
[4]李秋波,姜赛琳,姚迪,等.自拟舒肝解郁灵对抑郁模型小鼠行为及血清中白细胞介素2、白细胞介素6和皮质醇的影响[J].吉林大学学报(医学版),2005,31(6)：899-892
[5]李丽萍,兰敬昀,华金双.针刺百会和太冲穴对慢性应激抑郁模型大鼠下丘脑-垂体-肾上腺轴的影响[J].中医药学报.2006,34(2)：52-53
[6]韩毳,李晓泓,李学武,等.电针“百会”、“三阴交”穴对慢性应激抑郁模型大鼠HPA轴的影响[J].北京中医药大学学报.2001；24(3)：74-75
[7]张银娥,宋辉,杨惠芳,等.运动对慢性心理应激大鼠行为及血清皮质醇、IL-2、IL-8的影响[J].中国工业医学杂志,2007,20(2)：79-81
[8]吴兴曲,杨来启,李拴德,等.睡眠剥夺对大鼠血清MBP及皮质醇含量的影响[J].中国神经免疫学和神经病学杂志,2004,11(2)：102-104
[9]李琰琳,李琰珉,郭英,等.ACTH和皮质醇对抑郁症相关性研究[J].潍坊医学院学报,2009,31(3)：213-214
[10]Carrion Victor G, Weems Carl F, Ray Rebecca D, et al. Diurnal salivary cortisol in pediatric posttraumatic stress disorder[J]. Biological Psychiatry,2002;51(7):575-82
[11]Zobel AW, Nickel T, Sonntag A, et al. Cortisol response in the combined dexamethasone/CRH test as predictor of relapsein patientswith remitted depression a prospective study[J]. Jour-nal of Psychiatric Research,2001,35 (2):83-94
[12]Anisman H, Ravindran AV, Griffiths J, et al. Endocrine andcytokine correlates of major depression and dysthymia with typ-ical or atypical features[J]. Molecular Psychiatry,1999,4 (2):182-188
[13]迟松,林文娟.抑郁症神经内分泌免疫学的研究进展及心理治疗的作用[J].中国临床心理学杂志,2003,11(1)：77-80
[14]佟琳,李作孝,张标,等.脑卒中后抑郁患者血清皮质醇水平变化分析[J].中国临床医学,2007,14(3)：293-294
[15]韩冰.卒中后抑郁的生物学指标探讨[J].大连医科大学学报,2007,29(3)：236-2
[16]王振,肖泽萍,陈珏,等.焦虑症的生化病理机制探讨[J].临床精神医学杂志,2003,13(1)：1-3
[17]周涵辉,高镇松,钟湧江.创伤后应激障碍患者的焦虑抑郁与血浆皮质醇水平观察[J].精神医学杂志,2009,22(3)：201-202
[1]郭蓉娟,王嘉麟,张允岭,等.抑郁症中医证候要素相关分析[J].中医杂志,2008,49(9)：828-824
[2]张根明,宋琪,张章.抑郁障碍相关性失眠的临床特点及中医证候分布情况初步研究[J].北京中医药大学学报(中医临床版)2008年1月,15(1)：12-14
[3]蔡焯基主编.抑郁症——基础与临床[M].北京：科学出版社，1997.5第1版,6-7
[4]王永炎主编.中医内科学[M].上海：上海科学技术出版社，1997.6第1版,274
[5](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,114
[6](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001年1月第1版,86
[7](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,192
[8](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,120
[9](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001年1月第1版,50
[10](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,306
[11](明)张介宾著,赵立勋主校.景岳全书[M].北京：人民卫生出版社,1991年6月第1版,442
[12](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001年1月第1版,156
[13]刘玉茂主编,中医十大名方归脾汤[M].北京：中国中医药出版社,1998.3第1版,8
[1]李大琦主修.中医精华丛书：中医方剂学[M].成都：四川科学技术出版社,2007年4月第1版,26
[2]徐治国主编.中药学[M].成都：四川科学技术出版社,2007年第1版,24
[3](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001 年1月第1版,393
[4](魏)吴普等述,(清)孙星衍,孙冯翼辑.神农本草经[M].北京：科学技术文献出版社,1996年2月第1版,120
[5]方醉,周文泉.中药药引源流探析[J].辽宁中医杂志,1997,24(1)：41-42
[6](明)李时珍著.本草纲目(校点本)上册[M].北京：人民卫生出版社,1982年11月第1版,2002年3月第1版第11次印刷,91-92
[7]清尤怡著述,王新华点注.医学读书记[M].南京：江苏科学技术出版社,1983第1版,1985第2次印刷,52
[8]徐瑜玲,苗明三,孙艳红,等.大枣多糖对气血双虚模型小鼠造血功能的影响[J].中国临床康复,2004,8(24)：5050-5051
[9]向春,严铸云,李晓华,等.5种川产合欢花抗抑郁作用比较研究[J].时珍国医国药,2006,17(7)：1168-1169
[10]李明亚,陈红梅.石菖蒲对行为绝望动物抑郁模型的抗抑郁作用[J].中药材,2001,24(1)：40-41
[11]燕强,张其成.从中医中药角度谈特色饮食[J].吉林中医药,2009,29(9)：809-810
[12]陈屏,徐东铭,雷军.麦冬化学成分及药理作用的研究现状[J].长春中医学院学报,2004,20(1)：35-36
[1]中华人民共和国卫生部医政司.全国临床检验操作规程(第3版)[M].南京：东南大学出版社,2006,11,第3次版,第1次印刷,537
[1]郑华,马芳玲,邹效漫Centaur全自动化学发光系统测定内分密激素临床评价[J].军医进修学院学报,2005,26(1)：69-70
[2]李琰琳,李琰珉,郭英,等ACTH和皮质醇对抑郁症相关性研究[J].潍坊医学院学报,2009,31(3)：213-214
[3]Carrion Victor G, Weems Carl F, Ray Rebecca D, et al. Diurnal salivary cortisol in pediatric posttraumatic stress disorder[J]. Biological Psychiatry,2002;51(7):575-82
[4]迟松,林文娟.抑郁症神经内分泌免疫学的研究进展及心理治疗的作用[J].中国临床心理学杂志,2003,11(1)：77-80
[5]翁深宏,王高华.抑郁患者血清皮质醇与血压在应激前后的变化[J].中国行为医学科学,2004,13(5)J：524-525
[6]杨岩红,张陆云,崔中兰.抑郁症患者血浆皮质醇、血浆催乳素及地塞米松抑郁试验的研究[J].中国民康医学杂志,2005,17(9)：493-494
[7]朱晓峰.抑抑郁症人的应激激素测定及变化分析[J].医学理论与实践,2002,15(12)：1407-1408
[8]周婕,张冬齐,孙莉莎,等.草酸-S-西酞普兰对慢性应激抑郁大鼠模型行为学及CORT和ACTH的影响[J].中国新药杂志,2006,15(14)：1160-1163
[9]胡随瑜,张春虎,曹美群,等.白松片对大鼠慢性应激抑郁模型的抗抑郁实验研究[J].中 南大学学报(医学版),2006,31(5)：676-681
[10]李秋波,姜赛琳,姚迪,等.自拟舒肝解郁灵对抑郁模型小鼠行为及血清中白细胞介素2、白细胞介素6和皮质醇的影响[J].吉林大学学报(医学版),2005,31(6)：899-892
[11]李丽萍,兰敬昀,华金双.针刺百会和太冲穴对慢性应激抑郁模型大鼠下丘脑-垂体-肾上腺轴的影响[J].中医药学报,2006,34(2)：52-53
[12]韩毳,李晓泓,李学武,等.电针“百会”、“三阴交”穴对慢性应激抑郁模型大鼠HPA轴的影响[J].北京中医药大学学报,2001；24(3)：74-75
[13]张银娥,宋辉,杨惠芳,等.运动对慢性心理应激大鼠行为及血清皮质醇、IL-2、IL-8的影响[J].中国工业医学杂志,2007,20(2)：79-81
[14]吴兴曲,杨来启,李拴德,等.睡眠剥夺对大鼠血清MBP及皮质醇含量的影响[J].中国神经免疫学和神经病学杂志,2004,11(2)：102-104
[2](汉)许慎撰,(清)段玉裁注.说文解字注[M].郑州：中州古籍出版社,2006.10第1版,271
[3]黄寿祺,梅桐生译注.楚辞全译[M].贵阳：贵州人民出版社,2008.9第1版,84
[4]王云五主编,李宗侗注译.春秋左传今注今译(下册)[M].台北：台湾商务印书馆,1972.1第1版,1301-1302
[5](清)高士宗著,于天星按.黄帝素问直解[M].北京：科学技术出版社,1998.9第3版,595
[6](元)朱震亨,鲁兆麟点校.丹溪心法[M].沈阳：辽宁科学技术出版社,1997.8第1版,64
[7](金)刘元素撰,鲁兆麟点校.素问玄机原病式[M].沈阳：辽宁科学技术出版社,1997.8第1版,5
[8](明)赵献可著,陈永萍校注.医贯[M].北京：学苑出版社,2005.4第2版,61
[9](清)沈金鳌撰,李占林,李晓木校注.杂病源流犀烛[M].北京：中国中医药出版社,1994.10第1版,290
[10](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001.1第1版,43
[11](明)张介宾著,赵立勋主校.景岳全书[M].北京：人民卫生出版社,1991.6第1版,439
[12](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,298
[13](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001.1第1版,174
[14](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001.1第1版,401
[15](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,71
[16]陆渊雷编著.金匮要略今释[M].北京：学苑出版社,2008.10第1版,41
[17]陆渊雷编著.金匮要略今释[M].北京：学苑出版社,2008.10第1版,459
[18]陆渊雷编著.金匮要略今释[M].北京：学苑出版社,2008.10第1版,464
[19](隋)巢元方撰,鲁兆麟点校.诸病源候论[M].沈阳：辽宁科学技术出版社，1997.8第1版,70
[20](唐)王焘撰.外台秘要[M].北京：人民卫生出版社,1955.9第1版第1次印刷,1982.12第1版第5次印刷,456
[21](明)赵献可著,陈永萍校注.医贯[M].北京：学苑出版社,2005.4第2版,60-62
[22](明)虞抟著,郭瑞华等点校.医学正传[M].北京：中医古籍出版社,2002.2第1版,97
[23](清)张璐.张氏医通[M].上海：上海科学技术出版社,1990.12第1版第2次印刷,107
[24](明)徐春甫编集,崔仲平,王耀廷主校.古今医统大全(上册)[M].北京：人民卫生出版社,1991.8第1版,939
[25](明)张介宾著,赵立勋主校.景岳全书[M].北京：人民卫生出版社,1991.6第1版,442
[26]李志梅.抑郁障碍从肝论治[J].山东中医杂志,2007,26(10)：684-685
[27]韩毳,李晓泓.抑郁症与中医肝脏关系探讨[J].山东中医杂志,2001,20(5)：326-327
[28]孙建英.中西医结合治疗隐匿性抑郁症110例[J].四川中[J]医,1995,(9)：24
[29]张俭.李辅仁治疗老年抑郁症经验[J].中医杂志,2000。41(4)：208-209
[30]刘宝录.解郁汤治疗隐匿性抑郁症31例体会[J].天津中医,1999,8(1)：16-17
[31]卫向龙.抑郁症从脾论治[J].河北中医,2004,26(11)：832-833
[32]雷英菊,刘菊妍,梁喆盈.浅谈抑郁症从肾论治[J].四川中医,2007,25(8)：26-27
[33]陈日宙.忧郁证从脾肾论治[J].光明中医杂志,1995,(6)：7-8
[34]吕梅,王玲玲.针药结合治疗抑郁症的临床研究[J].南京中医药大学学报,2004,20(3)：149-151
[35]刘兰英,王玲玲.“脑为元神之府”理论在针灸治疗抑郁症中的指导意义[J].针灸临床杂志,2003,19(8)：6-8
[36]彭贵军,胡随瑜.抑郁症肝郁脾虚、心脾两虚证证候标准第二轮专家问卷分析[J].湖南中医学院学报,2003,23(5)：37-39
[37]王文萍,李晓斌,王天芳,等.应用临床流行病学调查方法提取抑郁症的中医证候主、次症状[J].环球中医药,2009,2(2)：110-112
[38]吴崇胜,陈家旭,胡立胜等.抑郁症中医证候诊断标准研究方法探讨[J].中医药学 刊,2006,24(6)：1015-1017
[39]唐海峰.柴胡疏肝散加减治疗抑郁症30例[J].实用中医药杂志,2009,25(4)：226-227
[40]佟凯航,赵建军.柴胡疏肝散加减治疗抑郁症38例[J].吉林中医药,2007,27(5)：23-24
[41]华刚,柴胡疏肝散加减治疗郁证46例[J].陕西中医,2003,24(6)：539
[42]杨建宏.归脾汤加味治疗心脏神经官能症78例[J].实用中医内科杂志,2007,21(9)：73-74
[43]李辉.补益心脾方治疗抑郁症40例疗效观察[J].山西中医,2006,22(增刊)：17-18
[44]赵龙现,张弛,吴华,等.归脾丸治疗神经衰弱80例[J].陕西中医,2005,26(12)：1329-1331
[45宋春联,王红伟.逍遥散治疗抑郁症疗效观察[J].临床心身疾病杂志,2007,13(5)：454
[46]章玲.逍遥散加味治疗神经衰弱56例[J].长春中医药大学学报,2009,25(1)：90
[47]王腾云,丹栀逍遥汤加减治疗抑郁症34例[J].中国中西医结合杂志,2001,21(9)：710
[48]徐文君,吴国伟,胡云英.百合地黄汤加减治疗老年抑郁症32例[J].浙江中西医结合杂志,2001,11(3)：157-158
[49]金杰.加味百合地黄汤治疗抑郁性神经症35例[J].山西中医,2001,17(2)：35
[50]张丽萍.温胆汤治疗抑郁症的辨证施治[J].中国临床康复,2005,9(16)：3
[51]解海宁.黄连温胆汤合枕中丹治疗老年情感障碍32例[J].江苏中医,1997,18(5)：19
[52]谭斌.柴芩温胆汤结合氯丙咪嗪治疗大学生抑郁症的临床观察[J].中成药,2006,28(6)：830-832
[53丁文娟,中医治疗抑郁症40例临床分析[J].江苏中医,1994,15(4)：18
[54]吴鉴明,加味甘麦大枣汤抗抑郁疗效的对照研究[J].中国临床医生,2002,30(11)：63-65
[55]李有田,洪英杰.舒肝解郁灵治疗抑郁症308例[J].吉林大学学报(医学版),2002,28(5)：546-547
[56]艾正海,钟万翠.补气芳香开窍法治疗抑郁症26例[J].北京中医药大学学报(中医临床版),2003,10(3)：47
[57]张美茹,刘文志.郁必舒冲剂治疗老年期抑郁症36例[J].中医研究,2002,15(3)：43
[58]赵志升.“抑虑康”治疗郁证(焦虑、抑郁)的疗效观察[J].上海中医药杂志,1999,2(12)：46
[59]陈珠娇.中医治疗老年性抑郁症22例[J].福建中医药,1998,29(6)：22
[60]董峰.辨证治疗抑郁症452例疗效观察[J].中医中药,2008,5(16)：87-88
[61]徐枫.中医辨证治疗郁证的临床观察[J].大连医科大学学报,1996,18(2)：123-125
[62]曾桂香,李玲.针刺治疗神经性抑郁症[J].中国针灸,1994(增刊)：49-50
[63]赵俊宏.脑卒中后抑郁的针刺治疗[J].中国康复,2002,(17)：31
[64]王学义,金圭星.电百印联合小剂量抗抑郁剂治疗老年抑郁症的研究[J].现代中西医结合杂志,2004,13(7)：856-857
[65]徐虹,孙忠人.针刺治疗抑郁症及其对患者下丘脑-垂体-肾上腺轴的影响[J].中国针灸,2004,(24)：278-280
[66]吕建明.在德国针灸治抑郁症128例疗效观察[J].针灸临床杂志,2004，20(10)：5-6
[67]宋颖.头皮针治疗脑卒中后抑郁疗效观察[J].上海针灸杂志,1999,18(1)：8-10
[68]焦素林,武连仲.武连仲临证运用“五心穴”经验[J].辽宁中医杂志,2007,34(12)：1692
[69]周正蓉.中西医结合治疗反应性抑郁症38例[J].实用中医药杂志.2001,17(10)：38-39
[70]王淑英.中西医结合治疗抑郁性神经症52例观察[J].实用中医药杂志,1997,(4)：20
[71]朱春山.文拉法辛与消遥丸联合治疗抑郁症的疗效观察[J].中国中西医结合杂志,2002,22(2)：55-59
[72]刘建平.柴胡疏肝散合并氟西汀治疗抑郁症的临床观察[J].山西中医学院学报,2001,2(4)：3-5
[73]罗和春,刘平,孟凡强等.舒血宁合并阿米替林治疗抑郁症多中心双盲对照研究[J].中国心理卫生杂志,1999,13(3)：19-21
[74]郭雅明,刘翠峰,朱晓红.电针配合万拉法新治疗抑郁症疗效观察[J].中国民政医学杂志，2002,14(3)：15-19
[75]赵丁,任雷鸣.合欢花抗抑郁作用的药理实验研究初探[J].河北医科大学学报,2003,24(4)：215-216
[76]张中启,黄世杰.巴戟天寡糖对鼠强迫性游泳和获得性无助抑郁模型的影响[J].中国药理学与毒理学杂志,2001,15(4)：262-263
[77]司银楚,孙建宁.贯叶连翘提取物对慢性应激抑郁大鼠行为及脑内5-HT、NE表达的影响[J].中国药科大学学报,2003,34(1)：70-73
[78]秦晓松,金魁和,丁宝坤.银杏叶提取物联合盐酸文拉法辛对抑郁大鼠海马n NOS蛋白表达及NO水平的影响[J].中国心理卫生杂志,2003,17(12)：828
[79]吴春福,游松,刘雯,等.银杏内酯和银杏提取物对纹状体和边缘系统多巴胺及其代谢产物含量的影响[J].中草药,1995,26(5)：253-255
[80]杨进,谢忠礼.菖欢1号对大鼠抑郁症模型脑内单胺类神经递质的影响[J].南京中医药大学学报(自然科学版),2001,17(5)：294-295
[81]张有志,聂惠民,张德昌,等.柴胡加龙骨牡蛎汤等经方治疗抑郁症的动物行为学研究[J].中国中医基础医学杂志,2001,7(7)：30-31
[82]杨士友,黄世福,孙备.解百忧口服液对抑郁模型大鼠行为及中枢神经递质的影响[J].中国中医基础医学杂志,2000,6(11)：56-58
[83]孟宏,郝晋东.抑郁-焦虑症的中医药治疗与实验研究[J].哈尔滨商业大学学报,2002,18(1)：22-24
[84]韩毳,李学武.电针对慢性应激抑郁模型大鼠海马BDNF的影响[J].中国中医基础医学杂志,2001,7(7)：55-56
[85]邱艳明,时宇静,图娅.电针印堂、百会对获得性无助大鼠不同脑区内单胺类神经递质的影响[J].北京中医药大学学报,2002,25(6)：54-56
[86]金光亮,周东丰.电针对慢性应激抑郁模型大鼠脑单胺类神经递质的影响[J].中华精神科杂志,1999,32(4)：220-222
[87]陈光.抑郁症神经内分泌功能及其对电针治疗反应的研究[J].北京医科大学学报,1992,24(5)：401-403
[1]刘玉茂主编,中医十大名方归脾汤[M].北京：中国中医药出版社,1998.3第1版,1
[2](元)危亦林,校注世医得效方[M].上海：上海科技出版社,1964年,115
[3](清)汪昂撰,鲁兆磷等点校.医方集解[M].沈阳：辽宁科学技术出版社,1997年8月第1版,46
[4](宋)严用和.济生方[M].北京：人民卫生出版社,1956.8第1版,128-129
[5]李庆业主编.方剂学[M].北京：中国医药科技出版社,1989.9第1版,146
[6](明)薛已.正体类要[M].上海：上海科学技术出版社,1959.4第1版,1963.10第1版第2次印刷,37
[7](明)薛已著.陈松育点校.内科摘要[M].南京：江苏科学技术出版社,1985.7第1版,41-42
[8](明)吴昆编著,李飞校注.医方考[M].南京：江苏科学技术出版社,1985.9第1版,150-151
[9](明)龚廷贤撰,新刊医林状元济世全书(影印本)[M].北京：中国科学技术出版社,1996.6第1版,377-378
[10](清)吴谦等原著,余瀛鳖等编选.医宗金鉴(第三分册)(卷五十六-卷五十九)痘疹心法要诀[M].沈阳：辽宁科学技术出版社,1973.4第1版,1977.10第1版第4次印刷,385
[11](清)吴谦等原著,余瀛鳖等编选.医宗金鉴(第四分册)(卷六十一-卷七十六)外科心法要诀[M].沈阳：辽宁科学技术出版社,1973.4第1版,1981.6第2版第5次印刷,(总1782)230
[12](清)沈金鳌撰.李占永,李晓林校注.杂病源流犀烛[M].北京：中国中医药出版社,1994.10第1版,118
[13](明)赵献可著；陈永萍校注.医贯[M].北京：学苑出版社,2005.4第2版,73-74
[14](清)罗美著,田代华,田丽莉,高峰点校.古今名医方论[M].天津：天津科学技术出版社,2000,7.第1版,5-6
[15](清)张秉成编著.成方便读[M].上海：科技卫生出版牡,1958.9第1版,8
[16](清)尤怡著述.医学读书记[M].南京：江苏科学技术出版社,1983.3第1版,53
[17]沈晓英,张元兴.逍遥丸联合归脾丸治疗心脏神经官能症54例[J].陕西中医,2007,28(11)：1529
[18]赵龙现,张弛,吴华,等.归脾丸治疗神经衰弱80例[J].陕西中医,2005,26(12)：1329-1331
[19]王常勇,白伟,李莉,等.归脾逍遥丸治疗神经衰弱200例临床观察[J].中医药信息,1999,(5)：38-39
[20]谢贵文,刘继强,何秀兰.归脾丸合并维思通治疗精神分裂症阴性症状65例的临床分析[J].中华现代中西医杂志,2005,3(2)：134
[21]宗大凡.六味地黄丸与归脾丸在慢性病治疗中的联合应用[J].陕西中医,1999,20(12)：567
[22]张银萍,孙静.逍遥丸合归脾丸治疗慢性疲劳综合征的临床观察[J].时珍国医国药,2006,17(12)：2559
[23]张丽梅,高学功.人参归脾丸治疗慢性疲劳综合征26例[J].时珍国医国药,2002,13(7)：423
[24]俞建良.归脾丸治疗失眠症20例[J].现代中西医结合杂志,2008,17(32)：5044-5045
[25]夏俊博,任亚仙,史历,等.归脾丸配合拔罐对大学生失眠症的影响[J].中华现代中医学杂志,2006,2(3)：195
[26]张国斌.归脾丸合逍遥散加减治疗顽固性早搏42例[J].吉林中医药,2004,24(5)：18-19
[27]高晓英.人参归脾丸治疗室性早博临床分析[J].中外医疗,2009,(14)：107
[28]钱轶华.人参归脾丸治疗胺碘酮致心动过缓6例临床观察[J].长春中医学院学报,2001,17(3)：14-15
[29]张娅珍,方红.归脾丸合六味地黄丸治疗特发性水肿31例[J].浙江中西医结合杂志,2006,16(1)：49
[30]宋兆胤.归脾丸、六味地黄丸治疗非炎证水肿11例[J].中国医学研究与临床,2004,2(9)：54-55
[31]刘莉.六味地黄丸合归脾丸治疗带状疱疹后遗神经痛8例[J].河南中医,2001,21(2)：56-57
[32]杜小正,赵彬元,秦晓光,等.针药结合治疗妇女背痛36例[J].河南中医,2005,25(7)：70
[33]滕士超.归脾丸配合小剂量甲状腺素治疗轻微甲状腺功能减退临床疗效观察[J].河北中医,2003,25(12)：895-896
[34]勇晓,李美香.归脾丸佐治内镜阴性胃食管反流病30例分析[J].中华临床新医学,2004,4(1)：86
[35]王凤岐.秦伯未医案选析[J].甘肃中医学院学报,1985,(1)：21
[36]王奎.中医药治疗崩漏的体会[J].天津中医,1996,13(2)：43
[37]吕天贵.放环后崩漏的中医论治之我见[J].四川中医,1999,17(4)：11-12
[38]肖芙姣.中西医结合治疗上环后出血225例分析[J].中国乡村医药杂志,2003,10(2)：30-31
[39]时延利,郭桂.补中益气丸与人参归脾丸合用治疗宫内节育器致子宫出血39例[J].中华中西医学杂志,2005,3(6)：92-93
[40]朱培艳.归脾六味周期分时用药治疗青春期功血129例[J].四川中医,2004,22(5)：61-62
[41]刘凤麒.传统中成药辨证治疗功血200例临床观察及机理研究[J].天津中医,2000,17(5)：20-21
[42]张卫华,刘俊保,张振英.归脾丸配阿胶口服液治疗特发性血小板减少性紫癜阴道出血30例[J].中医研究,2004,17(6)：25
[43]黄培民.止血宝合归脾丸治疗原发性血小板减少性紫癜52例[J].福建中医药,2002,33(1)：32
[44]张泽波,李学军,张冬平.归脾丸治疗肝硬化继发脾功能亢进症25例[J].中西医结合肝病杂志,2006,16(5)：298-299
[45]程静刁,易无庸,潘晓东,等.归脾丸治疗血透贫血患者的效果观察[J].护理学杂志,2005,20(1)：41
[46]刘永昌.人参归脾丸治疗白细胞减少症30例[J].实用中医内科杂志,2000,14(2)：20
[47]王世宏,孙永明.归脾丸、复方阿胶浆治疗白细胞减少症27例临床观察[J].中成药,1999,21(8)：414-415
[48]孙永明.归脾丸参芪片并用治疗白细胞减少症31例[J].实用中医内科杂志,2005,19(6)：578
[49]孙晓东.青春期经闭治验三则[J].上海预防医学杂志,1997,9(11)：510
[50]杨声,郑艳.六味地黄丸合归脾丸临证治验[J].福建中医药,2006,37(3)：39
[51]刘楚芹.中西医结合治疗流产后内分泌功能失调性不孕症30例[J].陕西中医学院学报,2003,26(5)：30
[52]李红云.宫颈糜烂治验1例[J].中国民族医药杂志,1999,5：69
[53]孙冰.知柏地黄丸、归脾丸联合行为干预治疗更年期综合征临床研究[J].山东中医药大学学报,2006,30(1)：55-56
[54]王常勇,韩金江.归脾逍遥丸治疗妇女乳腺增生症120例临床观察[J].北京中医，2001,(3)：23-25
[55]高晓钢.归脾丸治疗男性乳房发育症疗效观察[J].中国校医,2002,16(3)：236
[56]韩子英,王玉珍,朱桂枝,等.归脾丸治疗慢性荨麻疹42例[J].Chin J Derm Venereol,1997,11(5)：308
[1]Duclos M, Gatta B, Corcuff JB. Fat distribution in obese women is associated with subtle alteration of the hypothalamic-pituitary-adrenal axis activity and sensitivity to glucocorticoids. Clin Endocrnol(Oxf),2001;55(4):447-54
[2]周婕,张冬齐,孙莉莎,等.草酸-s-西酞普兰对慢性应激抑郁大鼠模型行为学及CORT和ACTH的影响[J].中国新药杂志,2006,15(14)：1160-1163
[3]胡随瑜,张春虎,曹美群,等.白松片对大鼠慢性应激抑郁模型的抗抑郁实验研究[J].中南大学学报(医学版),2006,31(5)：676-681
[4]李秋波,姜赛琳,姚迪,等.自拟舒肝解郁灵对抑郁模型小鼠行为及血清中白细胞介素2、白细胞介素6和皮质醇的影响[J].吉林大学学报(医学版),2005,31(6)：899-892
[5]李丽萍,兰敬昀,华金双.针刺百会和太冲穴对慢性应激抑郁模型大鼠下丘脑-垂体-肾上腺轴的影响[J].中医药学报.2006,34(2)：52-53
[6]韩毳,李晓泓,李学武,等.电针“百会”、“三阴交”穴对慢性应激抑郁模型大鼠HPA轴的影响[J].北京中医药大学学报.2001；24(3)：74-75
[7]张银娥,宋辉,杨惠芳,等.运动对慢性心理应激大鼠行为及血清皮质醇、IL-2、IL-8的影响[J].中国工业医学杂志,2007,20(2)：79-81
[8]吴兴曲,杨来启,李拴德,等.睡眠剥夺对大鼠血清MBP及皮质醇含量的影响[J].中国神经免疫学和神经病学杂志,2004,11(2)：102-104
[9]李琰琳,李琰珉,郭英,等.ACTH和皮质醇对抑郁症相关性研究[J].潍坊医学院学报,2009,31(3)：213-214
[10]Carrion Victor G, Weems Carl F, Ray Rebecca D, et al. Diurnal salivary cortisol in pediatric posttraumatic stress disorder[J]. Biological Psychiatry,2002;51(7):575-82
[11]Zobel AW, Nickel T, Sonntag A, et al. Cortisol response in the combined dexamethasone/CRH test as predictor of relapsein patientswith remitted depression a prospective study[J]. Jour-nal of Psychiatric Research,2001,35 (2):83-94
[12]Anisman H, Ravindran AV, Griffiths J, et al. Endocrine andcytokine correlates of major depression and dysthymia with typ-ical or atypical features[J]. Molecular Psychiatry,1999,4 (2):182-188
[13]迟松,林文娟.抑郁症神经内分泌免疫学的研究进展及心理治疗的作用[J].中国临床心理学杂志,2003,11(1)：77-80
[14]佟琳,李作孝,张标,等.脑卒中后抑郁患者血清皮质醇水平变化分析[J].中国临床医学,2007,14(3)：293-294
[15]韩冰.卒中后抑郁的生物学指标探讨[J].大连医科大学学报,2007,29(3)：236-2
[16]王振,肖泽萍,陈珏,等.焦虑症的生化病理机制探讨[J].临床精神医学杂志,2003,13(1)：1-3
[17]周涵辉,高镇松,钟湧江.创伤后应激障碍患者的焦虑抑郁与血浆皮质醇水平观察[J].精神医学杂志,2009,22(3)：201-202
[1]郭蓉娟,王嘉麟,张允岭,等.抑郁症中医证候要素相关分析[J].中医杂志,2008,49(9)：828-824
[2]张根明,宋琪,张章.抑郁障碍相关性失眠的临床特点及中医证候分布情况初步研究[J].北京中医药大学学报(中医临床版)2008年1月,15(1)：12-14
[3]蔡焯基主编.抑郁症——基础与临床[M].北京：科学出版社，1997.5第1版,6-7
[4]王永炎主编.中医内科学[M].上海：上海科学技术出版社，1997.6第1版,274
[5](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,114
[6](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001年1月第1版,86
[7](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,192
[8](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,120
[9](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001年1月第1版,50
[10](明)马莳著,孙国中,方向红点校.黄帝内经灵枢注证发微[M].北京：学苑出版社,2007.5,306
[11](明)张介宾著,赵立勋主校.景岳全书[M].北京：人民卫生出版社,1991年6月第1版,442
[12](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001年1月第1版,156
[13]刘玉茂主编,中医十大名方归脾汤[M].北京：中国中医药出版社,1998.3第1版,8
[1]李大琦主修.中医精华丛书：中医方剂学[M].成都：四川科学技术出版社,2007年4月第1版,26
[2]徐治国主编.中药学[M].成都：四川科学技术出版社,2007年第1版,24
[3](明)吴昆注,孙国中,方向红点校.黄帝内经素问吴注[M].北京：学苑出版社,2001 年1月第1版,393
[4](魏)吴普等述,(清)孙星衍,孙冯翼辑.神农本草经[M].北京：科学技术文献出版社,1996年2月第1版,120
[5]方醉,周文泉.中药药引源流探析[J].辽宁中医杂志,1997,24(1)：41-42
[6](明)李时珍著.本草纲目(校点本)上册[M].北京：人民卫生出版社,1982年11月第1版,2002年3月第1版第11次印刷,91-92
[7]清尤怡著述,王新华点注.医学读书记[M].南京：江苏科学技术出版社,1983第1版,1985第2次印刷,52
[8]徐瑜玲,苗明三,孙艳红,等.大枣多糖对气血双虚模型小鼠造血功能的影响[J].中国临床康复,2004,8(24)：5050-5051
[9]向春,严铸云,李晓华,等.5种川产合欢花抗抑郁作用比较研究[J].时珍国医国药,2006,17(7)：1168-1169
[10]李明亚,陈红梅.石菖蒲对行为绝望动物抑郁模型的抗抑郁作用[J].中药材,2001,24(1)：40-41
[11]燕强,张其成.从中医中药角度谈特色饮食[J].吉林中医药,2009,29(9)：809-810
[12]陈屏,徐东铭,雷军.麦冬化学成分及药理作用的研究现状[J].长春中医学院学报,2004,20(1)：35-36
[1]中华人民共和国卫生部医政司.全国临床检验操作规程(第3版)[M].南京：东南大学出版社,2006,11,第3次版,第1次印刷,537
[1]郑华,马芳玲,邹效漫Centaur全自动化学发光系统测定内分密激素临床评价[J].军医进修学院学报,2005,26(1)：69-70
[2]李琰琳,李琰珉,郭英,等ACTH和皮质醇对抑郁症相关性研究[J].潍坊医学院学报,2009,31(3)：213-214
[3]Carrion Victor G, Weems Carl F, Ray Rebecca D, et al. Diurnal salivary cortisol in pediatric posttraumatic stress disorder[J]. Biological Psychiatry,2002;51(7):575-82
[4]迟松,林文娟.抑郁症神经内分泌免疫学的研究进展及心理治疗的作用[J].中国临床心理学杂志,2003,11(1)：77-80
[5]翁深宏,王高华.抑郁患者血清皮质醇与血压在应激前后的变化[J].中国行为医学科学,2004,13(5)J：524-525
[6]杨岩红,张陆云,崔中兰.抑郁症患者血浆皮质醇、血浆催乳素及地塞米松抑郁试验的研究[J].中国民康医学杂志,2005,17(9)：493-494
[7]朱晓峰.抑抑郁症人的应激激素测定及变化分析[J].医学理论与实践,2002,15(12)：1407-1408
[8]周婕,张冬齐,孙莉莎,等.草酸-S-西酞普兰对慢性应激抑郁大鼠模型行为学及CORT和ACTH的影响[J].中国新药杂志,2006,15(14)：1160-1163
[9]胡随瑜,张春虎,曹美群,等.白松片对大鼠慢性应激抑郁模型的抗抑郁实验研究[J].中 南大学学报(医学版),2006,31(5)：676-681
[10]李秋波,姜赛琳,姚迪,等.自拟舒肝解郁灵对抑郁模型小鼠行为及血清中白细胞介素2、白细胞介素6和皮质醇的影响[J].吉林大学学报(医学版),2005,31(6)：899-892
[11]李丽萍,兰敬昀,华金双.针刺百会和太冲穴对慢性应激抑郁模型大鼠下丘脑-垂体-肾上腺轴的影响[J].中医药学报,2006,34(2)：52-53
[12]韩毳,李晓泓,李学武,等.电针“百会”、“三阴交”穴对慢性应激抑郁模型大鼠HPA轴的影响[J].北京中医药大学学报,2001；24(3)：74-75
[13]张银娥,宋辉,杨惠芳,等.运动对慢性心理应激大鼠行为及血清皮质醇、IL-2、IL-8的影响[J].中国工业医学杂志,2007,20(2)：79-81
[14]吴兴曲,杨来启,李拴德,等.睡眠剥夺对大鼠血清MBP及皮质醇含量的影响[J].中国神经免疫学和神经病学杂志,2004,11(2)：102-104