基于肾损肝郁理论的创伤后应激障碍的病机的探讨

Discussion about the Pathogenesis of PTSD from the Perspective of "Kidney Damage and Liver Depression"

创伤后应激障碍临床病因病机,众说纷纭。笔者结合临床情况,从中医基础理论、诊断、临床治疗,多角度、多维度分析了肝、肾与PTSD关系,总结PTSD发病关键病机为:"惊则气乱-气乱生痰-痰气胶结"+"恐则气下-恐伤精却-肾虚易恐",由两者结合共同发病,表现为一系列严重的心理反应如强烈恐惧感、无助感、抑郁或厌恶等。PTSD整个过程是动态变化的,亦不能忽视"胆""脾"等在PTSD中发挥的"肝胆相济,勇敢乃成""脾思胜恐"等作用。综上可知,"肾损肝郁"乃PTSD发病的关键点,亦是指导临床治疗的重要病机。

There are different opinions on the etiology and pathogenesis of post-traumatic stress disorder.The author combined with clinical cases, from the basic theory of TCM, diagnosis, clinical treatment, multi-angle, multi-dimensional analysis of the relationship between the liver and kidney and PTSD, summarizes key pathogenesis of PTSD onset: "surprised the gas disorderly and chaotic, produce phlegm-nitrogen cementation" + "under the fear of the gas-fear of injury but pure-kidney empty easy could", by a combination of common disease, characterized by a series of serious psychological reactions such as intense fear, helplessness, depression, or disgust, etc.The whole process of PTSD is dynamic, and the role of "gallbladder" and "spleen" in the development of PTSD, such as "liver and gallbladder help each other, courage becomes" and "spleen thinking wins fear", cannot be ignored.In conclusion, "kidney damage and liver depression" is the key point of the onset of PTSD, and also an important pathogenesis guiding clinical treatment.