情志病“痰热”隐性证候之辨析

An analysis of “phlegm-heat” recessive syndrome of emotional diseases

情志病指发病与情志刺激有关,具有情志异常表现的病症,涵盖了中医学郁证、不寐、脏躁、梅核气、百合病、健忘、癫狂等,现代医学常见于抑郁症、焦虑症、失眠、躁狂症等。因现代社会高效率、快节奏、竞争激烈导致负面情绪增加而使此类疾病发病率不断升高,逐渐受到社会各界的重视。情志病虽临床表现各异,但均以情志刺激、肝郁失疏为始动因素,并因体质及内生邪气不同而产生各种病理因素,形成相应的病理变化。其中,现代人情绪易郁结化火、不良饮食及生活习惯的产生及体质因素等的影响,导致痰热在情志病发病发展中具有重要作用,采用清化痰热安神法治疗典型的痰热型情志病取效显著。而非典型痰热型情志病由于证候隐匿,辨析不详易致错漏,因此根据痰热致病特点,全面重点地搜集四诊素材,从病程、体质、心神不宁主症、呼吸症状、肠胃症状、头面肢体症状等方面辨析痰热隐性证候,为准确辨治该病提供依据。虽然痰热扰神是痰热型情志病的共同病机,但不同情志病仍有其病机证候的特异性。如抑郁症痰热必兼肝郁,焦虑症痰热常伴胆虚,失眠痰热使阳过于盛而不得入阴,癫狂有痰浊与痰火之别却又可交互转化。文章重在探讨情志病痰热的形成机制及其隐性证候辨析要点,并分析不同情志病痰热证机特点,为临床从痰热精准论治情志病提供思路。

Emotional disorder refers to a condition that is related to emotional stimulation and exhibits abnormal emotional manifestations.It covers depression,insomnia,visceral restlessness,globus hystericus,lily disease,forgetfulness,and mania in traditional Chinese medicine.It is commonly seen as depression,anxiety,insomnia,and mania in modern medicine.The incidence rate of this kind of disease is rising due to the increase of negative emotions caused by high efficiency,fast pace and fierce competition in modern society,and it has gradually attracted the attention of all sectors of society.Although the clinical manifestations of emotional disorders are vary,they are all initiated by emotional stimulation,liver depression and stagnation,and various pathological factors arise due to differences in constitution and endogenous evil,resulting in corresponding pathological changes.Phlegm-heat plays an important role in the onset and the development of emotional diseases because of modern people's easily depressed emotions,irritability,unhealthy diet and lifestyle habits,as well as physical factors.Qinghua Tanre Anshen Therapy(清化痰热安神法) has remarkable effects in the treatment of typical phlegm-heat emotional diseases.However,non-typical phlegm-heat emotional disease is prone to be missed and misdiagnosed due to the hidden syndromes and unclear discrimination.Therefore,according to the pathogenic characteristics of phlegm-heat,four diagnostic materials are collected comprehensively and emphatically,and the recessive syndromes of phlegm-heat are analyzed from the aspects of disease course,constitution,main symptoms of restfulness,respiratory symptoms,gastrointestinal symptoms,and head,face and limb symptoms,so as to provide a basis for accurate differentiation and treatment.Although phlegm-heat disturbance is the common pathogenesis of phlegm-heat emotional diseases,different emotional diseases still have their specific pathogenesis,For example,depression phlegm-heat must be accompanied by the syndrome of liver depression;anxiety phlegm-heat is often accompanied by gallbladder deficiency syndrome;insomnia phlegm-heat makes Yang(阳) too abundant to enter Yin(阴);there is a difference between turbid phlegm and phlegm-fire,but the two can be transformed mutually.This article focuses on exploring the formation mechanism and recessive syndrome differentiation of phlegm-heat in emotional diseases,and analyzing the characteristics of phlegm-heat syndrome in different emotional diseases,providing ideas for the precise treatment of emotional diseases from the perspective of phlegm-heat in clinical practice.