抑郁症之“调枢启神”理论构建与发微
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摘要
根据抑郁症的临床诊疗特点,将传统针灸和现代医学相结合,提出"调枢启神"治疗抑郁症。分别从"调枢"和"启神"的内涵与外延进行阐释,认为调枢是调控抑郁及其病理变化的关键环节,即包括调节神明之枢——心脑、调节开阖之枢——少阳;启神既是治疗抑郁症的目的也是治疗手段,临床针刺百会、印堂和耳穴治疗抑郁症即是调枢启神理论的具体运用。
According to the characteristics of clinical diagnosis and treatment of depression,"enlightening the spirit by regulating pivot"theory is developed by the combination of traditional acupuncture and moxibustion and modern medicine theory. The connotations and extensions of "regulating pivot theory"and "enlightening the spirit"were respectively explained in this review. "Regulating pivot theory"is considered as the crucial link of modulating depression and its pathological changes. The pivot includes the pivot of spirit-heart and brain,and the pivot of open and close-Shaoyang. "Enlightening the spirit"is both the aim and the method of depression treatment. At present,acupuncture at Baihui( DU 20),Yintang( EX-HN3) and auricular points for the treatment of depression is the application of the theory of "enlightening the spirit by modulating pivot".
According to the characteristics of clinical diagnosis and treatment of depression,"enlightening the spirit by regulating pivot"theory is developed by the combination of traditional acupuncture and moxibustion and modern medicine theory. The connotations and extensions of "regulating pivot theory"and "enlightening the spirit"were respectively explained in this review. "Regulating pivot theory"is considered as the crucial link of modulating depression and its pathological changes. The pivot includes the pivot of spirit-heart and brain,and the pivot of open and close-Shaoyang. "Enlightening the spirit"is both the aim and the method of depression treatment. At present,acupuncture at Baihui( DU 20),Yintang( EX-HN3) and auricular points for the treatment of depression is the application of the theory of "enlightening the spirit by modulating pivot".
引文
[1]刘春林,阮克锋,高君伟,等.抑郁症的多机制发病[J].生理科学进展,2013,44(4):253-258.
[2]CRISTANCHO P,CRISTANCHO MA,BALTUCH GH,et al. Effectiveness and safety of vagus nerve stimulation for severe treatment-resistant major depression in clinical practice after FDA approval:outcomes at 1 year[J]. J Clin Psychiatry,2011,72(10):1376-1382.
[3]RONG P,LIU J,WANG L,et al. Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder:a nonrandomized controlled pilot study[J]. J Affect Disord,2016,195:172-179. doi:10. 1016/j. jad.2016. 02. 031.
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[5]周仲瑛.中医内科学[M].北京:中国中医药出版社,2010:5.
[6]陈广荣.抑郁症病因病机探源[J].中国中医药现代远程教育,2014,12(11):10-11.
[7]张金茹.小柴胡汤治疗抑郁症40例[J].北京中医,2003,22(5):38-39.
[8]牟秋杰,秦萍萍,刘俊彤,等.李志刚教授“通督启神”法针刺治疗抑郁症经验[J].西部中医药,2018,31(5):25-28.
[9]魏玮,荣培晶,陈建德,等.“调枢通胃”理论的探讨与构建[J].中医杂志,2018,59(6):474-477.
[10]罗本华,于建春,成海燕,等.论三焦气化是脑神的基础[J].辽宁中医杂志,2010,37(6):1004-1007.
[11]张怀亮.从少阳论治抑郁症[J].中医杂志,2008,49(9):781-784.
[12]郝龙,韩斐.论中医心、胆、脑与神的关系[J].辽宁中医药大学学报,2014,16(11):129-130.
[13]张锡纯.医学衷中参西录[M].太原:山西出版集团山西科技出版社,2009:279-280.
[14]张晓丝,于睿.从心论治抑郁症[J].实用中医内科杂志,2015,29(1):66-68.
[15]刘从明,谢海洲.略论脑为元神之府的理论及其临床意义[J].广西中医药,1984(2):9-12.
[16]王永炎,张伯礼.中医脑病学[M].北京:人民卫生出版社,2007:4.
[17]曹奕.督脉在中医脑病治疗中的地位和作用[J].中医药临床杂志,2012,24(11):1035-1038.
[18]武峻艳,王杰,张俊龙.从督脉的循行和作用谈“脑为元神之府”[J].中医杂志,2015,56(8):636-639.
[19]冯闲野,曹姗,杨晓丽,等.中医“神”与健康状态的关系[J].中医杂志,2014,55(14):1250-1252.
[20]PEUKER ELMAR T,FILLER TIMM J. The nerve supply of the human auricle[J]. Clin Anat,2002,15(1):35-37.
[21]KONG J,FANG J,PARK J,et al. Treating depression with transcutaneous auricular vagus nerve stimulation:state of the art and future perspectives[J]. Front Psychiatry,2018,9:20. doi:10. 3389/fpsyt. 2018.00020.
[22]COOK IA,ESPINOZA R,LEUCHTER AF. Neuromodulation for depression:invasive and noninvasive(deep brain stimulation, transcranial magnetic stimulation,trigeminal nerve stimulation)[J]. Neur Clin North Amer,2014,25(1):103-116.
[23]SHIOZAWA P,DUAILIBI MS,DA SM,et al. Trigeminal nerve stimulation(TNS)protocol for treating major depression:an open-label proof-of-concept trial[J].Epilepsy Behav,2014,39:6-9. doi:10. 1016/j. yebeh.2014. 07. 021.
[24]Howland RH. Vagus Nerve Stimulation[J]. Curr Behav Neurosci Rep,2014,1(2):64-73.
[25]HANISCH UK. Microglia as a source and target of cytokines[J]. Glia,2002,40(2):140-155.
[26]王世召,张立民,张云鹤,等.血脑屏障与免疫炎症反应[J].中国临床神经外科杂志,2015,41(7):439-442.
[27]KRISHNADAS R, CAVANAGH J. Depression:an inflammatory illness?[J]. J Neurol Neurosurg Psychiatry,2012,83(5):495-502.
[28]韩毳,王磊,李晓泓,等.电针对抑郁症患者血清细胞因子的影响[J].中国行为医学科学,2002,11(3):277-279.
[2]CRISTANCHO P,CRISTANCHO MA,BALTUCH GH,et al. Effectiveness and safety of vagus nerve stimulation for severe treatment-resistant major depression in clinical practice after FDA approval:outcomes at 1 year[J]. J Clin Psychiatry,2011,72(10):1376-1382.
[3]RONG P,LIU J,WANG L,et al. Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder:a nonrandomized controlled pilot study[J]. J Affect Disord,2016,195:172-179. doi:10. 1016/j. jad.2016. 02. 031.
[4]中国针灸学会.循证针灸临床实践指南:抑郁症(修订版)[M].北京:中国中医药出版社,2014.
[5]周仲瑛.中医内科学[M].北京:中国中医药出版社,2010:5.
[6]陈广荣.抑郁症病因病机探源[J].中国中医药现代远程教育,2014,12(11):10-11.
[7]张金茹.小柴胡汤治疗抑郁症40例[J].北京中医,2003,22(5):38-39.
[8]牟秋杰,秦萍萍,刘俊彤,等.李志刚教授“通督启神”法针刺治疗抑郁症经验[J].西部中医药,2018,31(5):25-28.
[9]魏玮,荣培晶,陈建德,等.“调枢通胃”理论的探讨与构建[J].中医杂志,2018,59(6):474-477.
[10]罗本华,于建春,成海燕,等.论三焦气化是脑神的基础[J].辽宁中医杂志,2010,37(6):1004-1007.
[11]张怀亮.从少阳论治抑郁症[J].中医杂志,2008,49(9):781-784.
[12]郝龙,韩斐.论中医心、胆、脑与神的关系[J].辽宁中医药大学学报,2014,16(11):129-130.
[13]张锡纯.医学衷中参西录[M].太原:山西出版集团山西科技出版社,2009:279-280.
[14]张晓丝,于睿.从心论治抑郁症[J].实用中医内科杂志,2015,29(1):66-68.
[15]刘从明,谢海洲.略论脑为元神之府的理论及其临床意义[J].广西中医药,1984(2):9-12.
[16]王永炎,张伯礼.中医脑病学[M].北京:人民卫生出版社,2007:4.
[17]曹奕.督脉在中医脑病治疗中的地位和作用[J].中医药临床杂志,2012,24(11):1035-1038.
[18]武峻艳,王杰,张俊龙.从督脉的循行和作用谈“脑为元神之府”[J].中医杂志,2015,56(8):636-639.
[19]冯闲野,曹姗,杨晓丽,等.中医“神”与健康状态的关系[J].中医杂志,2014,55(14):1250-1252.
[20]PEUKER ELMAR T,FILLER TIMM J. The nerve supply of the human auricle[J]. Clin Anat,2002,15(1):35-37.
[21]KONG J,FANG J,PARK J,et al. Treating depression with transcutaneous auricular vagus nerve stimulation:state of the art and future perspectives[J]. Front Psychiatry,2018,9:20. doi:10. 3389/fpsyt. 2018.00020.
[22]COOK IA,ESPINOZA R,LEUCHTER AF. Neuromodulation for depression:invasive and noninvasive(deep brain stimulation, transcranial magnetic stimulation,trigeminal nerve stimulation)[J]. Neur Clin North Amer,2014,25(1):103-116.
[23]SHIOZAWA P,DUAILIBI MS,DA SM,et al. Trigeminal nerve stimulation(TNS)protocol for treating major depression:an open-label proof-of-concept trial[J].Epilepsy Behav,2014,39:6-9. doi:10. 1016/j. yebeh.2014. 07. 021.
[24]Howland RH. Vagus Nerve Stimulation[J]. Curr Behav Neurosci Rep,2014,1(2):64-73.
[25]HANISCH UK. Microglia as a source and target of cytokines[J]. Glia,2002,40(2):140-155.
[26]王世召,张立民,张云鹤,等.血脑屏障与免疫炎症反应[J].中国临床神经外科杂志,2015,41(7):439-442.
[27]KRISHNADAS R, CAVANAGH J. Depression:an inflammatory illness?[J]. J Neurol Neurosurg Psychiatry,2012,83(5):495-502.
[28]韩毳,王磊,李晓泓,等.电针对抑郁症患者血清细胞因子的影响[J].中国行为医学科学,2002,11(3):277-279.