基于“恐伤肾”理论论治情志创伤后躯体化障碍

Treatment of somatization disorder after emotional trauma based on the theory of terror impairing kidney

躯体化障碍又称Briquet综合症。临床表现为多种多样、反复出现、时常变化、查无实据的躯体主诉至少两年,未发现任何恰当的躯体疾病来解释上述症状。中医临床多根据证候的不同,运用辨证施治思维,对症治疗。因其病情时常变化,患者多反复就诊,且极易误诊,因此能及时、准确识别本病极为必要,史玲教授以治病从本论治,从该病发病的根本病因入手,辨病与辨证相结合,以补肾安神为治则,针药结合治疗“惊恐伤肾”为因的情志创伤后躯体化障碍患者,达到与精神类药物同样的镇静效果,且无明显不良反应,收效甚佳。本文从肾论治躯体化障碍,“伤肾”为该病迁延难愈之因,并阐述了该病出现各类复杂多变的症状与肾及其他脏腑的关系,在恐伤肾的基础上,还会出现心神受扰、肝虚肝郁、脾胃不和等兼证,需辨清本因及不同兼夹之证再行论治。在治疗上,以肾为主的同时兼顾宁心安神、疏肝解郁、健脾和胃等治法以提高疗效。文章通过分享临床验案1例,介绍史玲教授论治躯体化障碍的经验,以期为临床提供参考。

Somatization disorder is also known as Briquet syndrome.The clinical manifestations are varied,recurrent,and frequently changing,with unsubstantiated physical complaints for at least two years,and no appropriate medical illness has been found to explain these symptoms.According to the different syndromes,TCM clinical treatment is mostly based on the use of syndrome differentiation and treatment thinking.Because its condition changes from time to time,patients often visit the hospital repeatedly,and it is easy to misdiagnose,so it is extremely necessary to be able to identify the disease in a timely and accurate manner.Professor SHI Ling treats the disease from the root,starting from the root cause of the disease,combining disease differentiation with syndrome differentiation,taking kidney tonification and soothing the nerves as the treatment principle,and acupuncture and medicine combined with the treatment of patients with emotional post-traumatic somatization disorder dueStopanic and kidney injury,so as to achieve the same sedative effect as psychotropic drugs,and there are no obvious adverse reactions,and the results are very good.This article discusses the treatment of somatization disorder from the kidney,kidney injury is the cause of the disease prolongation and difficult to heal,and expounds the relationship between the various complex and changeable symptoms of the disease and the kidney and other viscera.On the basis of fear of injuring the kidneys,there will also be concurrent symptoms such as mental disturbance,liver deficiency and liver depression,and spleen and stomach disharmony.It is necessary to identify the root cause and the evidence of different combinations before proceeding.In terms of treatment,the kidney-based treatment also takes into account the treatment methods such as calming the heart and calming the nerves,soothing the liver and relieving depression,strengthening the spleen and stomach to improve the efficacy.This article introduces Professor SHI Ling's experience in the treatment of somatization disorder by sharing a clinical case,in order to provide a reference for clinical practice.