中西医结合疗法对抑郁症患者辨证施治的效果

Effect of integrated therapy of Chinese and western medicine on differentiation of symptoms and signs of patients with depression

目的:观察中医药方剂加针刺疗法,配合西医抗抑郁药物对抑郁症患者辨证施治的治疗效果。方法:①选取2004-01/2005-05河北医科大学第一医院精神卫生中心收治的100例抑郁症住院患者,随机数字表法分为中西医结合治疗组、抗抑郁剂对照组,各50例。两组患者均签署知情同意书,符合CCMD-3抑郁症的诊断标准,性别、年龄、病程等基线资料基本相似(P>0.05)。②抗抑郁剂对照组单纯给予常规抗抑郁药物帕罗西汀片剂(中美史克天津药业公司生产,批号0401351,商品名赛乐特)进行治疗,20mg/片,20～40mg/d。中西医结合治疗组除给予等量帕罗西汀片剂进行治疗外,同时根据患者不同的临床表现辨证施治,每天口服中药方剂1剂+针刺1次(针刺留针30min/次),15d为1个疗程,两个疗程期间休息5d,以3个疗程为宜。③中西医结合辨证分型包括肝郁痰结型(方药以柴胡疏肝散为主,针刺合谷、太冲、中脘、丰隆、内关穴)、气郁化火型(方药以丹栀逍遥丸为主,针刺合谷、太冲、期门、神门穴)、气滞血瘀型(方药以血府逐瘀汤为主,针刺肝腧、膈腧、血海、三阴交穴)、肝肾亏虚型(方药以滋水清肝饮为主,针刺太溪、照海、三阴交、百会、肝俞、肾俞穴)、肝郁脾虚型(方药以越鞠丸为主,针刺太冲、太白、中脘、足三里、神门穴)。④两组治疗时间均为8周。分别于治疗前、治疗后2,4,8周由经过培训的统一人员采用汉密顿抑郁量表(包括焦虑/躯体化、体质量、认识障碍、日夜变化、阻滞、睡眠障碍、绝望感7类因子,5级评分法:0分为无症状,1分为轻度,2分为中度,3分为重度,4分为极重度)、汉密顿焦虑量表(分为躯体性和精神性焦虑两大类因子,分级与评分标准同抑郁量表)对患者进行抑郁、焦虑疗效评定,同时观察两组治疗后副反应。结果:100例抑郁症住院患者均进入结果分析。①两组患者治疗前后抑郁与焦虑情况的比较:治疗前,两组汉密顿抑郁、焦虑量表评分基本相似[(37.75±5.51),(36.71±5.59)分,t=0.937,P>0.05;(31.74±3.78),(32.96±4.75)分,t=1.421,P>0.05];治疗8周后,中西医结合治疗组汉密顿抑郁、焦虑量表评分均显著低于抗抑郁剂对照组[(13.12±2.14),(16.33±4.37)分,t=4.665,P<0.01;(13.46±4.75),(16.33±5.21)分,t=3.139,P<0.01]。②两组患者治疗8周后临床效果观察:中西医结合治疗组患者低落情绪明显改善,活动增加,睡眠良好。抗抑郁剂对照组患者低落情绪有改善,在督促下参加活动,有时出现睡眠不踏实现象。③不良事件和副反应:中西医结合治疗组出现口干、恶心各3例,排尿困难2例,食欲减退、便秘各1例。抗抑郁剂对照组出现失眠5例,口干、恶心各4例,排尿困难2例,食欲减退、便秘2例。结论:根据活血化郁、宁心安神、舒经活络等辨证施治原则,中医药方剂和针刺疗法联合抗抑郁药物治疗抑郁症有利于症状缓解,提高患者依从性,减少药物的副作用,提高治疗效果。

To observe the curative effect of Chinese medicine prescription and acupuncture combined with western antidepressant drugs on differentiation of symptoms and signs of patients with depression, METHODS： ① 100 inpatients with depression admitted to the Mental Health Center, First Hospital of Hebei Medical University between January 2004 and May 2005 were selected and randomly divided into integrated treatment group and antidepressant drug group with 50 cases in each group. All the patients signed the agreement, and they were accordance with the diagnosis criteria of CCMD-3 depression, No significant difference was found in the baseline data such as sex, age and course of disease （P 〉 0,05）, ②The patients in the antidepressant drug group were only given routine antidepressant drug Paroxetine 20 mg per pallet, 20-40 mg daily （produced by the Tianjin Sino-America Squibb Pharmaceutics Co., Ltd. No. 0401351）. Additional to Seroxat, the patients in the integrated treatment group orally took one dose of Chinese prescription and acupuncture （retaining the needle for 30 minutes every time） once daily with 15 days as one course of treatment, and 5 days relaxed between two courses for 3 courses, ③The differentiation of symptoms and signs included liver stagnated phlegm （the prescription was composed of Caihu Sugan San, and acupunctured Hegu, Taichong, Zhongwan. Fenglongand Neiguan）, firetransmission due to stagnation of qi （the prescription was composed of Dan Zhi Xiaoyao Wan, and acupunctured Hegu, Taichong, Qimen and Shenmen）, stagnancy of qi and blood stasis （the prescription was composed of Xuefu Zhuyu Tang, and acupunctured Ganshu, Keshu, Xuehai and Sanyinjiao）, deficiency of liver-yin and kidney-yin （the prescription was composed of Zishui Qinggai Yin, and acupunctured Taixi, Zhaohai, Sanyinjiao, Baihui, Ganshu and Shenshu）, stagnation of the liver-qi and deficiency of the spleen （the prescription was composed of Yueju Wan, and acupunctured Taichong, Taibai, Zhongwan, Zusanli and Shenmen）. ④The two groups were treatment for 8 weeks. The curative effect on depression and anxiety was evaluated by the same person after trained with Hamilton Depression Scale （HAMD included anxiety, somatization, body mass, cognitive disorder, change of day and night, blockage, sleeping disorder, feeling of despair with 5-grade system： 0 meant no symptoms, 1 meant mild, 2 meant moderate, 3 meant serious and 4 meant very serious）, Hamilton Anxiety Scale （HAMA, composed of somoand psycho-anxiety, the grade and criteria was the same to HAMD） before and 2, 4, 8 weeks after treatment. Meanwhile, the adverse reaction in the two groups was observed after treatment. RESULTS： 100 patients were involved in the result analysis. ①Comparison of depression and anxiety between the two groups before and after treatment： Before treatment, the scores of HAMD and HAMA of the two groups were similar [（37.75±5.51）, （36.71±5.59） scores, t=0.937, P 〉 0.05; （31.74±3.78）, （32.96±4.75） scores, t=1.421, P 〉 0.05]; 8 weeks later, the scores of the integrated treatment group Were lower than the Control group [（13.12±2.14）, （16.33±4.37） scores, t=4.665, P 〈 0.01; （13.46±4.75）, （16.33±5.21） scores, t=3A39, P 〈 0.01]. ②Clinical observation after 8 weeks treatment： The low emotion of patients in the integrated treatment group was significantly improved, their activities were increased and sleeping condition was better. The low emotion of patients in the control group was improved, they did activities under supervision and sometimes sleeping condition was unstable. ③Bad events and adverse reaction： In the integrated treatment group, there were 3 cases with dry mouth, 3 with nauseated, 2 with dysuria, 1 with decreased food appetite and 1 with constipation; in the control group, there were 5 insomnia, 4 with dry mouth, 4 with nauseated, 2 with dysuria, 2 with decreased food appetite and 2 with constipation. CONCLUSION： According to the rules of promoting blood circulation by removing stagnation, tranquilization, relieving rigidity of muscles and acti- vating collaterals, the therapy with Chinese prescription and acupuncture combined with antidepressant drugs can relieve symptoms, improve the dependence of patients, decrease the adverse reaction of drugs and improve the curative effect.