从抑郁症与呕吐的理论关联探讨抑郁症中西医治疗优化方案
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摘要
抑郁症是一种以显著持久的心境低落为主要临床表现的心理疾病,据诸多资料显示,许多抑郁症患者都伴有不同程度的恶心或呕吐,可见抑郁症与呕吐之间很有可能存在着诸多联系。文章通过中医心胃相关、肝郁、脾虚、肾虚理论,以及西医学P物质、多巴胺以及5-羟色胺等物质进行探讨,阐述抑郁症与呕吐之间的理论联系,并以此得到启发,对当前抑郁症的中西医治疗方案进行优化,提出中医治疗应辨证论治,兼以调畅胃之气机为要,西医治疗应更同步和优化等观点,以弥补现有抑郁症的治疗缺陷所在。
Depression is a mental illness with a significant and persistent low mood as the main clinical manifestation.According to many data, many people with depression are accompanied by varying degrees of nausea or vomiting.It is obvious that there is a possibility between depression and vomiting. There are many connections. The article explores the theoretical connection between depression and vomiting by discussing the theory of heart and stomach, liver stagnation, spleen deficiency and kidney deficiency in Chinese medicine, as well as substances such as substance P,dopamine and serotonin in western medicine, and uses this as a breakthrough. The treatment of depression in Chinese and Western medicine is optimized, and it is proposed that TCM treatment should be treated according to syndrome differentiation,and that the treatment of Western medicine should be more synchronized and optimized to compensate for the existing treatment defects of depression.
Depression is a mental illness with a significant and persistent low mood as the main clinical manifestation.According to many data, many people with depression are accompanied by varying degrees of nausea or vomiting.It is obvious that there is a possibility between depression and vomiting. There are many connections. The article explores the theoretical connection between depression and vomiting by discussing the theory of heart and stomach, liver stagnation, spleen deficiency and kidney deficiency in Chinese medicine, as well as substances such as substance P,dopamine and serotonin in western medicine, and uses this as a breakthrough. The treatment of depression in Chinese and Western medicine is optimized, and it is proposed that TCM treatment should be treated according to syndrome differentiation,and that the treatment of Western medicine should be more synchronized and optimized to compensate for the existing treatment defects of depression.
引文
[1]邓朔,张鸿燕.抑郁症发病机制的神经免疫相关靶点研究现状[J].中国临床药理学杂志,2017,33(3):280-283.
[2]陶然,纪文博,张惠敏.青少年抑郁症研究新进展[J].武警医学,2015,26(2):109-112.
[3]李凌江,马辛.中国抑郁障碍防治指南(第二版)解读:概述[J].中华精神科杂志,2017,50(3):21.
[4]韩鑫.抑郁模型大鼠海马突触后的iTRAQ定量蛋白质组学分析[D].重庆:重庆医科大学,2015.
[5]滕金艳.不同电针对抑郁症胃肠道躯体症状的临床观察及实验研究[D].北京:北京中医药大学,2013.
[6]黄煌.张仲景50味药证[M].3版.北京:人民卫生出版社,2017:100.
[7]黄煌.经方使用手册[M].北京:中国中医药出版社,2016:1-196.
[8]何裕民.中医心理学临床研究[M].北京:人民卫生出版社,2010:247-248.
[9]罗英.消化内科患者恶心呕吐的临床分析及治疗[J].中国医药指南,2016,14(22):23-24.
[10]赵一鸣.功能性呕吐的病理生理机制和心理社会因素研究[D].北京:北京协和医学院,2009.
[11]唐启盛,曲淼,包祖晓,等.抑郁症中医证候规律及诊疗标准制定的研究[J].北京中医药大学学报,2011,34(2):77-81.
[12]张文砚,冯学功.经方治疗“胃不和”型失眠验案举隅[J].中华中医药杂志,2014,29(9):2847-2849.
[13]许蒙,王新志.“胃不和则卧不安”--其实“卧不安”则“胃也不和”[J].光明中医,2017,32(6):783-784.
[14]曲淼,孙文军,唐启盛.清利肝胆法治疗肝胆湿热型抑郁症的临床研究[J].北京中医药,2013,32(8):566-569.
[15]蒋健.郁证发微(六)--郁证畏寒论[J].上海中医药杂志,2016,50(1):11-14.
[16]陈株生,由凤鸣,肖冲,等.化疗后呕吐的肾脑胃论治探讨[J].世界中医药,2015,10(4):507-510.
[17]Diemunsch P,Grélot L.Potential of Substance P Antagonists as Antiemetics[J].Drugs,2000,60(3):533-546.
[18]张文芳,王昕光,孔秋梅,等.健脾化痰方结合托烷司琼治疗乳腺癌化疗后呕吐60例[J].环球中医药,2016,9(3):310-311.
[19]刘洋,苏东勤,张颖.高良姜醇提乙酸乙酯萃取物对异嗜高岭土模型大鼠的止呕作用[J].中国药师,2017,20(6):1020-1022.
[20]刘旭东,仲大铎,王德山,等.不同致吐物质对大鼠十二指肠组织P物质表达影响的研究[J].吉林中医药,2010,30(1):70-71.
[21]Datar P,Srivastava S,Coutinho E,et al.Substance P:structure,function,and therapeutics.[J].Current Topics in Medicinal Chemistry,2004,4(1):75-103
[22]Carcione A,Dimaago G,Cont L,et al.Metacognition Assessment Scale(MAS)V.4.0-Manual.Terzocentro,Rome,unpublished
[23]杨斌,王有德,张兰,等.抑郁症患者血浆P物质含量变化及其相关性研究[J].中华精神科杂志,2006,39(2):78-80.
[24]汪莲籽,候正华,吴明飞,等.单相抑郁症与双相障碍抑郁相患者神经肽Y、P物质水平差异及其与抑郁严重程度的相关性分析[J].国际精神病学杂志,2017(4):582-584.
[25]刘祥超,周恒,詹晓平,等.NK1受体拮抗剂的应用研究进展[J].现代生物医学进展,2015,15(10):1938-1942.
[26]Quartara L,Maggi C A.The tachykinin NK1 receptor:Part I:Ligands and mechanisms of cellular activation[J].Neuropeptides,1997,31(6):537-563
[27]Andersen H,Braestrup C,Randrup A.Apomorphine-induced stereotyped biting in the tortoise in relation to dopaminergic mechanisms.[J].Brain Behavior&Evolution,1975,11(5-6):365
[28]文眸,张伟.多巴胺受体及其与抑郁症的相关性研究进展[J].现代医药卫生,2016,32(4):549-552.
[29]彭小东,刘小辉,元建华,等.黛力新在含顺铂方案化疗后呕吐的精神抑郁患者中的应用[J].南昌大学学报(医学版),2010,50(9):30-33.
[30]王涵,王洪学,谢伟敏,等.重复使用5-HT3受体拮抗剂预防多日化疗相关性恶心呕吐的疗效和安全性分析[J].中国肿瘤临床,2017,44(13):667-672.
[31]Fink K B,Gothert M.5-H T receptor regulation of neurotransmitter release[J].Pharmacological Reviews,2007,59(4):360-417.
[32]贾琼,薛玲.5-羟色胺3受体及其应用的研究进展[J].医学综述,2012,18(10):1444-1447.
[33]Krzywkowski K,Davies P A,Feinbergzadek P L,et al.Highfrequency HTR3B variant associated with major depression dramatically augments the signaling of the human 5-HT3ABreceptor.[J].Proceedings of the National Academy of Sciences of the United States of America,2008,105(2):722-727
[34]刘春叶,张剑,尤静,等.生姜中姜黄素的高效液相色谱-质谱法检测[J].时珍国医国药,2011,22(7):1637-1639.
[35]Xu Ying,Ku Bao-shan,Yao Han-yan,et al.Antidepressant effect of curcumin in mice[J].Chinese Journal of Clinical Rehabilitation,2005,9(44):162-164
[36]马致洁,张祎,董捷鸣,等.基于代谢组学方法的姜黄素抗抑郁作用生物标志物初步筛查[J].中国中药杂志,2017,42(18):3596-3601.
[37]王业民,孔令东.半夏厚朴汤抗抑郁活性部位的筛选[J].中国中药杂志,2002,27(12):932-936.
[38]朱玉英,贾勇圣,佟仲生.奥氮平治疗化疗所致恶心和呕吐的作用及临床研究进展[J].肿瘤,2018,38(1):68-72.
[39]冯伟薇,李欣.肠道微生物对抑郁障碍影响的研究[J].世界最新医学信息文摘,2017,17(5):26.
[2]陶然,纪文博,张惠敏.青少年抑郁症研究新进展[J].武警医学,2015,26(2):109-112.
[3]李凌江,马辛.中国抑郁障碍防治指南(第二版)解读:概述[J].中华精神科杂志,2017,50(3):21.
[4]韩鑫.抑郁模型大鼠海马突触后的iTRAQ定量蛋白质组学分析[D].重庆:重庆医科大学,2015.
[5]滕金艳.不同电针对抑郁症胃肠道躯体症状的临床观察及实验研究[D].北京:北京中医药大学,2013.
[6]黄煌.张仲景50味药证[M].3版.北京:人民卫生出版社,2017:100.
[7]黄煌.经方使用手册[M].北京:中国中医药出版社,2016:1-196.
[8]何裕民.中医心理学临床研究[M].北京:人民卫生出版社,2010:247-248.
[9]罗英.消化内科患者恶心呕吐的临床分析及治疗[J].中国医药指南,2016,14(22):23-24.
[10]赵一鸣.功能性呕吐的病理生理机制和心理社会因素研究[D].北京:北京协和医学院,2009.
[11]唐启盛,曲淼,包祖晓,等.抑郁症中医证候规律及诊疗标准制定的研究[J].北京中医药大学学报,2011,34(2):77-81.
[12]张文砚,冯学功.经方治疗“胃不和”型失眠验案举隅[J].中华中医药杂志,2014,29(9):2847-2849.
[13]许蒙,王新志.“胃不和则卧不安”--其实“卧不安”则“胃也不和”[J].光明中医,2017,32(6):783-784.
[14]曲淼,孙文军,唐启盛.清利肝胆法治疗肝胆湿热型抑郁症的临床研究[J].北京中医药,2013,32(8):566-569.
[15]蒋健.郁证发微(六)--郁证畏寒论[J].上海中医药杂志,2016,50(1):11-14.
[16]陈株生,由凤鸣,肖冲,等.化疗后呕吐的肾脑胃论治探讨[J].世界中医药,2015,10(4):507-510.
[17]Diemunsch P,Grélot L.Potential of Substance P Antagonists as Antiemetics[J].Drugs,2000,60(3):533-546.
[18]张文芳,王昕光,孔秋梅,等.健脾化痰方结合托烷司琼治疗乳腺癌化疗后呕吐60例[J].环球中医药,2016,9(3):310-311.
[19]刘洋,苏东勤,张颖.高良姜醇提乙酸乙酯萃取物对异嗜高岭土模型大鼠的止呕作用[J].中国药师,2017,20(6):1020-1022.
[20]刘旭东,仲大铎,王德山,等.不同致吐物质对大鼠十二指肠组织P物质表达影响的研究[J].吉林中医药,2010,30(1):70-71.
[21]Datar P,Srivastava S,Coutinho E,et al.Substance P:structure,function,and therapeutics.[J].Current Topics in Medicinal Chemistry,2004,4(1):75-103
[22]Carcione A,Dimaago G,Cont L,et al.Metacognition Assessment Scale(MAS)V.4.0-Manual.Terzocentro,Rome,unpublished
[23]杨斌,王有德,张兰,等.抑郁症患者血浆P物质含量变化及其相关性研究[J].中华精神科杂志,2006,39(2):78-80.
[24]汪莲籽,候正华,吴明飞,等.单相抑郁症与双相障碍抑郁相患者神经肽Y、P物质水平差异及其与抑郁严重程度的相关性分析[J].国际精神病学杂志,2017(4):582-584.
[25]刘祥超,周恒,詹晓平,等.NK1受体拮抗剂的应用研究进展[J].现代生物医学进展,2015,15(10):1938-1942.
[26]Quartara L,Maggi C A.The tachykinin NK1 receptor:Part I:Ligands and mechanisms of cellular activation[J].Neuropeptides,1997,31(6):537-563
[27]Andersen H,Braestrup C,Randrup A.Apomorphine-induced stereotyped biting in the tortoise in relation to dopaminergic mechanisms.[J].Brain Behavior&Evolution,1975,11(5-6):365
[28]文眸,张伟.多巴胺受体及其与抑郁症的相关性研究进展[J].现代医药卫生,2016,32(4):549-552.
[29]彭小东,刘小辉,元建华,等.黛力新在含顺铂方案化疗后呕吐的精神抑郁患者中的应用[J].南昌大学学报(医学版),2010,50(9):30-33.
[30]王涵,王洪学,谢伟敏,等.重复使用5-HT3受体拮抗剂预防多日化疗相关性恶心呕吐的疗效和安全性分析[J].中国肿瘤临床,2017,44(13):667-672.
[31]Fink K B,Gothert M.5-H T receptor regulation of neurotransmitter release[J].Pharmacological Reviews,2007,59(4):360-417.
[32]贾琼,薛玲.5-羟色胺3受体及其应用的研究进展[J].医学综述,2012,18(10):1444-1447.
[33]Krzywkowski K,Davies P A,Feinbergzadek P L,et al.Highfrequency HTR3B variant associated with major depression dramatically augments the signaling of the human 5-HT3ABreceptor.[J].Proceedings of the National Academy of Sciences of the United States of America,2008,105(2):722-727
[34]刘春叶,张剑,尤静,等.生姜中姜黄素的高效液相色谱-质谱法检测[J].时珍国医国药,2011,22(7):1637-1639.
[35]Xu Ying,Ku Bao-shan,Yao Han-yan,et al.Antidepressant effect of curcumin in mice[J].Chinese Journal of Clinical Rehabilitation,2005,9(44):162-164
[36]马致洁,张祎,董捷鸣,等.基于代谢组学方法的姜黄素抗抑郁作用生物标志物初步筛查[J].中国中药杂志,2017,42(18):3596-3601.
[37]王业民,孔令东.半夏厚朴汤抗抑郁活性部位的筛选[J].中国中药杂志,2002,27(12):932-936.
[38]朱玉英,贾勇圣,佟仲生.奥氮平治疗化疗所致恶心和呕吐的作用及临床研究进展[J].肿瘤,2018,38(1):68-72.
[39]冯伟薇,李欣.肠道微生物对抑郁障碍影响的研究[J].世界最新医学信息文摘,2017,17(5):26.