毛德西治疗郁证经验

Mao Dexi's Experience of Treating Depression Syndrome

毛德西教授认为,郁证首当辨清虚实。实证多见于发病之初,以气机郁结为主,可兼见血瘀、痰湿、火郁,分为气滞证、血瘀证、痰湿证、火郁证。气滞证治以疏肝解郁,理气畅中,多选柴胡疏肝散为主方治疗,脾胃病兼郁证者,从调理脾胃着手,疏肝解郁,和胃畅中,自拟三三九气汤加减;血瘀证者方用《医林改错》之癫狂梦醒汤加减,血瘀证好转后,改用疏肝解郁、宁心安神之法。火郁证者方选柴胡疏肝散合栀子豉汤加减;气滞痰郁证,治以行气开郁,降逆化痰,选用半夏厚朴汤加减。病程日久则多为虚证或虚实夹杂证,可分为心神失养、心脾两虚证、心肾阴虚证。心神失养、心脾两虚证治以健脾养心,补益气血,常选归脾汤合甘麦大枣汤加减;心病及肾,心肾阴虚证采用香蜜膏养心安神,补肾健脑,解郁润燥。

Professor Mao Dexi believes that the first thing to treat depression syndrome is to distinguish deficiency and excess.Excess syndrome is mostly seen at the beginning of the disease,mainly marked by stagnation of qi movement,combined with blood stasis,phlegm dampness,fire stagnation,which can be divided into qi stagnation syndrome,blood stasis syndrome,phlegm dampness syndrome,and fire stagnation syndrome.For qi stagnation syndrome,the treatment should focus on soothing the liver and relieving depression,regulating the qi in the middle energizer,so Bupleurum Liver-Soothing Powder can be used as the main formula for treatment.For patients with spleen and stomach disease combined with depression,the treatment can start from regulating the spleen and stomach to sooth the liver and relieve depression,and harmonize the stomach,so self-made Modified Three-Three-Nine Qi Decoction can be used.For blood stasis syndrome,Modified Depressive-Manic Psychosis and Dream-Awakening Decoction in Correction of Errors in Medical Works can be used.After blood stasis syndrome is improved,the methods of soothing liver depression,calming the heart,etc.can be adopted.For fire stagnation syndrome,Modified Bupleurum Liver-Soothing Powder combined with Gardenia and Fermented Soybean Decoction can be used.For syndrome of qi stagnation and phlegm depression,the treatment focuses on driving qi and removing depression,suppressing upward perversion of qi and resolving phlegm,so Modified Pinellia and Officinal Magnolia Bark Decoction can be adopted.The course of disease for a long time mostly means deficiency syndrome or intermingled deficiency and excess syndromes,mainly marked by the heart,spleen and kidney deficiency,which can be divided into syndrome of impaired preservation of the mind,deficiency syndrome of both the heart and spleen,and heart-kidney yin deficiency syndrome;For syndrome of impaired preservation of the mind,the treatment focuses on activating the spleen and nourishing the heart,tonifying qi and blood,so Modified Spleen-Restoring Decoction combined with Licorice and Wheat and Jujube Decoction can be adopted.For heart disease affecting the kidney,leading to heart-kidney yin deficiency syndrome,Fragrant Honey Cream can be used to nourish the heart and calm the mind,tonify the kidney and strengthen the brain,relieve depression and moisten dryness.