柴胡疏肝散在抗抑郁治疗中的药效物质与作用机制研究进展

Pharmacodynamic Substances and Action Mechanisms of Chaihu Shugansan in Antidepressant Treatment:A Review

抑郁症是一种复杂的神经精神疾病,目前主要采取西药治疗的方式,但由于抗抑郁西药存在不良反应与患者个体化差异的综合影响导致疗效欠佳。抑郁症属中医的“郁证”,其治疗原则为疏肝解郁。中医经典名方柴胡疏肝散治疗抑郁症历史悠久、疗效确切。临床上,柴胡疏肝散加减方灵活,但有效成分性质性能模糊、机制作用不清。为阐明柴胡疏肝散药效基础、抗抑郁机制作用机制,该文综述了柴胡疏肝散药效物质基础、抗抑郁的临床研究与机制研究进展。临床上柴胡疏肝散可以治疗原发性抑郁、卒中后抑郁、产后抑郁等多种抑郁。汇总了柴胡疏肝散的32种主要成分,其中芍药苷内酯、阿魏酸、柚皮苷、橙皮苷、柴胡皂苷A、甘草次酸、桔皮素、橙皮内酯水合物、川陈皮素、甘草酸是柴胡疏肝散发挥抗抑郁作用的中药质量标志物(Q-Marker)。柴胡疏肝散抗抑郁作用机制复杂,包括调控单胺类神经递质、下丘脑-垂体-肾上腺轴(HPA轴)、神经营养因子、炎症反应、细胞损伤相关通路、氧化应激等。该文有助于深入理解柴胡疏肝散治疗抑郁的药效基础与作用机制,为柴胡疏肝散抗抑郁的临床应用与抗抑郁药物研发提供了理论依据。

Depression is a kind of complex mental illness,which is mainly treated by western medicine at present,but the effect of western antidepressant drugs is not good due to the combined influence of side effects and individual differences of patients.Depression is a"stagnation syndrome"in traditional Chinese medicine,and its treatment principle is to disperse stagnated liver Qi for relieving Qi stagnation.The classic traditional Chinese medicine formula Chaihu Shugansan(CHSGS)has a long history of treating depression and demonstrates significant therapeutic efficacy.Clinically,the addition and subtraction of CHSGS is flexible,but the properties of the active ingredients are vague,and the mechanism and function are unclear.In order to elucidate the pharmacodynamic basis and antidepressant mechanism of CHSGS,this article reviews the pharmacodynamic material basis of CHSGS,clinical research and antidepressant mechanism research progress.Clinically,CHSGS can treat various types of depression such as primary depression,post-stroke depression,and postpartum depression.This article summarizes 32 main ingredients of CHSGS,among which albiflorin,ferulic acid,naringin,hesperidin,saikosaponin a,glycyrrhetinic acid,tangeretin,meranzin hydrate,nobiletin and glycyrrhizic acid are the quality markers(Q-markers)for the antidepressant effect of CHSGS.The antidepressant mechanism of CHSGS is complex,including regulating monoamine neurotransmitters,hypothalamic-pituitary-adrenal(HPA)axis,neurotrophic factors,inflammatory response,cell damage-related pathways,oxidative stress,etc.This article helps to deeply understand the pharmacodynamic basis and mechanism of CHSGS in treating depression,and provides a theoretical basis for the clinical application of CHSGS in treating depression and the development of antidepressant drugs.