子宫内膜异位症与抑郁、焦虑关系探讨

Discussion on the relationship between endometriosis and depression and anxiety

子宫内膜异位症(Endometriosis, EMs)是慢性、高复发性、终身性疾病,属中医"癥瘕"范畴,"血瘀"是EMs的基本病机,"气滞"是EMs形成的关键环节,妇人"气滞"责之于"气郁"。EMs病程长、症状重、易复发、治疗效果的不可预期性,给患者身心带来极大折磨,EMs患者常伴有抑郁、焦虑症状。抑郁、焦虑则通过放大躯体症状、降低诊疗效果、启动免疫抑制等途径促进EMs的发生和发展。这与中医"因郁致瘀""瘀阻气机"理论一脉相承。基于此,我们提出EMs与抑郁、焦虑存在交互作用,两者互为因果、循环往复;"气郁"致"血瘀"是EMs的主要病机,"解郁活血"为基本治则。通过深入探讨EMs与抑郁、焦虑的关系,强调抑郁、焦虑在EMs治疗和预后中所起的重要作用,弥补临床医生和科研工作者对EMs患者心理健康问题重视的不足,为EMs中医诊疗策略提供新思路;推动"移精变气"理论在EMs慢病管理中的应用,以期形成具有生物-心理-社会医学模式特点的EMs中医管理方案。

Endometriosis, a chronic, highly recurrent and life-long disease, falls into the category of abdominal mass in traditional Chinese medicine. Blood stasis is the basic pathogenesis of EMs and qi stagnation is a key process in EMs formation. Qi stagnation of women is attributable to qi constraint. EMs brings great physical and mental sufferings to patients because of its long disease course, severe symptoms, easy recurrence and unpredictable curative effects. EMs is often accompanied with depression and anxiety symptoms, which can in turn promote the occurrence and development of EMs by amplifying somatic symptoms, reducing therapeutic effects and activating immunosuppression. This is in line with the traditional Chinese medicine understanding of "depression leads to stasis" and "stasis obstructs qi movement". Based on this, we argue that there is interaction and mutual causality between EMs and depression and anxiety. That qi constraint leads to blood stasis is the main pathogenesis of EMs. Resolving constraint and invigorating blood is the basic treatment. We explore the relationship between EMs and depression and anxiety to emphasize the important role of depression and anxiety in EMs treatment and prognosis, draw clinicians’ and researchers’ attention to mental health problems of EMs patients, and provide new ideas for TCM diagnosis and treatment strategies of EMs. In this way, the idea of "shifting the essence and changing qi" can be applied to chronic disease management to form TCM management plans of EMs with biopsychosocial characteristics.