逍遥散加味方治疗肝郁脾虚型抑郁症的临床效果

Clinical effect of Jiawei Xiaoyao Powder in the treatment of depression with liver stagnation and spleen deficiency

目的观察逍遥散加味方治疗肝郁脾虚型抑郁症的临床效果。方法选取2020年8月至2021年6月北京中医药大学第三附属医院收治的肝郁脾虚型轻中度抑郁患者72例,根据随机数字表法将其分为试验组与对照组,每组36例。试验组给予口服逍遥散加味方联合氟西汀治疗,对照组给予西药氟西汀口服,均连续治疗4周。比较两组抗抑郁治疗效果及汉密顿抑郁量表(HAMD)评分、中医证候评分、HAMD各因子变化,记录治疗过程中的不良事件。结果治疗后,试验组抗抑郁治疗效果优于对照组(P<0.05)。整体分析发现,HAMD评分总分、中医证候评分总分在时间点比较及交互作用差异方面均有统计学意义(P<0.05);治疗2、4周后,两组HAMD评分总分、中医症候评分均低于治疗前(P<0.05)。治疗后,试验组各因子评分均优于治疗前,对照组焦虑/躯体化、认知障碍、日夜变化、迟缓/阻滞、睡眠障碍、绝望感评分优于治疗前,且试验组焦虑/躯体化、睡眠障碍评分均优于对照组(P<0.05)。试验组治疗过程中无明显不适;对照组出现便秘1例,口干1例,嘱患者增加膳食纤维摄入和增加日间饮水量后改善,未予停药或特殊处理。结论逍遥散加味方联合氟西汀治疗肝郁脾虚型抑郁症效果优于单用氟西汀,在改善焦虑抑郁情绪、躯体化不适及睡眠质量方面有一定优势,且安全性高,值得临床推广。

Objective To observe the clinical effect of Jiawei Xiaoyao Powder in the treatment of depression with liver stagnation and spleen deficiency.Methods A total of 72 patients with mild to moderate depression of liver stagnation and spleen deficiency type admitted to the Third School of Clinical Medicine of Beijing University of Chinese Medicine from August 2020 to June 2021 were selected,according to the random number table method,they were divided into experimental group and control group,with 36 cases in each group.The experimental group was given internal application of Jiawei Xiaoyao Powder combined with Fluoxetine,and the control group was given internal application of the western medicine Fluoxetine,both of which were treated for four consecutive weeks.The antidepressant treatment effect,Hamilton depression scale(HAMD)score,traditional Chinese medicine syndrome score,and HAMD factor scores were compared between the two groups,and adverse events during the treatment were recorded.Results After treatment,the antidepressant treatment effect of the experimental group was better than that of the control group(P<0.05).Overall analysis showed that the total score of HAMD and the total score of traditional Chinese medicine syndrome had statistical significance in the comparison of time points and the difference of interaction(P<0.05).After 2 and 4 weeks of treatment,the total HAMD score and traditional Chinese medicine syndrome score of the two groups were lower than those before treatment(P<0.05).After treatment,the scores of all factors in the experimental group were better than those before treatment,while the scores of anxiety/somatization,cognitive impairment,day/night variation,delay/block,sleep disorder and hopelessness in the control group were better than those before treatment,and the scores of anxiety/somatization and sleep disorder in the experimental group were better than those in the control group(P<0.05).There was no obvious discomfort during treatment in the experimental group.One case of constipation and one case of dry mouth occurred in the control group,which were improved after patients were advised to increase dietary fiber intake and daily water intake,without drug withdrawal or special treatment.Conclusion Jiawei Xiaoyao Powder combined with Fluoxetine in the treatment of depression with liver stagnation and spleen deficiency is more effective than Fluoxetine alone,and has certain advantages in improving anxiety and depression,somatization discomfort and sleep quality,has high safety and is worthy of clinical promotion.