态靶结合辨治青少年抑郁症思路探讨

Exploration on Treatment of Adolescent Depression Based on State-Target Syndrome Differentiation

基于态靶辨证理论,分析青少年抑郁症之“态”与“靶”及其“调态打靶”的可能思路。认为青少年抑郁症之病机主要为气机郁滞,郁积日久而致情志异常,是为“郁”态;久之郁火易上逆上亢,并累及他脏,可产生“逆”态与“虚”态。中枢五羟色胺能系统改变及中缝背核-中脑奖赏系统神经环路可作为青少期抑郁症调控的核心靶点与通路。临证时,“调态”应首先调心理之态,再调病证之态;“打靶”可打中枢五羟色胺能系统及其神经环路之靶。基于态靶辨证构建青少年抑郁症辨治新体系,将有助于阐明青少年抑郁症的宏观与微观防治机制。

This paper analyzed the“state”and“target”of adolescent depression and explored the possible ways to adjust the state and hit the target based on the theory of state-target syndrome differentiation.It is believed that the pathogenesis of adolescent depression is mainly due to the stagnation of qi,and qi stagnation over time leads to emotional disorders,which results into“depressed”state.Fire developed from persistent qi stagnation tends to flow upward and being hyperactive upward,and then affects other organs,which develops into a“rebellious”state and a“deficient”state.Alterations in central serotonergic system and the neural circuit for reward system in the dorsal raphe nucleus(DRN)-midbrain may serve as the central targets and pathways for the regulation of adolescent depression.In clinical practice,“adjusting the state”should firstly focus on mental adjustment,and then on the adjustment of the disease and syndromes;“hitting the target”aims to hit the target of the central serotonergic system and its corresponding neural circuit.The construction of a new system of syndrome differentiation and treatment for adolescent depression based on state-target syndrome differentiation will help to elucidate the macroscopic and microscopic mechanisms for the prevention and treatment of adolescent depression.