基于脾胃理论诊治焦虑障碍刍议

Discussion on the diagnosis and treatment of anxiety disorder based on the spleen and stomach theory

笔者基于脾胃理论认为脾胃功能失和是"焦虑障碍"的核心病机。根据病程发展规律须辨证论治。病初起者多为脾胃虚损,或见气血亏虚、心脾两虚,宜补脾胃、益气血,代表方剂有归脾汤、定志小丸、补中益气汤等。中期者常兼脾胃、心、肝之阴火,需兼泻阴火以升阳,代表方剂有补脾胃泻阴火升阳汤、丹栀逍遥散、黄连温胆汤等;或杂痰湿、瘀血者,当健脾胃、祛痰湿、化瘀血,代表方剂有加减平胃散、十枣汤、当归芍药散、苍附导痰丸合佛手散等;调畅气机也是本期常用治法,如抑木扶土、通泻胃腑、舒降胆胃,代表方剂有逍遥散、承气类方、温胆汤等。久病者多见脾肾阳虚,则需温补脾肾,代表方剂有大补元煎。

It is the dysfunction and disharmony of the spleen and stomach that is supposed to be the crucial proces of anxiety disorder.Syndrome differentiation is essential in the whole process of the disease.Spleen and stomach deficiency symptoms appear in the early disease process,likely to going with qi and blood deficiency or heart and spleen deficiency.Reinforcing the function of the spleen and stomach is appropriate.Guipi Decoction.Dingzhi Xiaoyao Powder,and Buzhong Yiqi Decoction are the main formulas.As the disease going on.qi deficiency mixed with Yin fire from the spleen,stomach,heart orliver frequently,we need to remove Yin fire along with lifting Yang qi.Bupiwei Xieyinhuo Shengyang Decoction,Danzhi Xiaoyao Powder and Huanglian Wendan Decoction are the typical ones.Sometimes,the treatment includes strengthening the Spleen.eliminating the phlegm or blood stasis.Pinwei Powder(and formulas added or subtracted based on it),Shizao Decoction,Danggui Shaoyao Powder or Cangzhu Daotan Pills are applied frequently.Regulating the qi is another useful way,such as inhibition of the liver accompanied with reinforcing the spleen,enhancing the dynamic of the stomach,and smoothing the gallbladder and stomach.There are several main formulas such as Xiaoyao Powder,Chengqi Decoction(and formulas of the same category)and Wendan Decoction.In the later period of the Anxiety Disorder,Yang deficiency of spleen and kidney arises commonly.suggesting some kinds of formula for warming the spleen and kidney.Da Buyuan Decoction is its classical formula.