基于“形神一体观”探讨阳虚致郁病机

Etiology of Depression Caused by Yang Deficiency Based on the Concept of "Unity of Physique and Spirit"

《中医内科学》中郁证多指情志不舒、气机郁结引起的一些病证,其病因病机和临床表现形式多样,基本表现为“形神相失”的症状。治疗上多从肝郁气滞进行辨证论治,但获效有限。根据“物成生理谓之形”“形具而神生”的思想,中医逐渐形成“形神一体”的观点。结合《黄帝内经》“阳之精气曰神”的理论,五脏阳气虚衰可导致郁证患者持久的心情低落、兴趣与乐趣丧失、精力不足与过度疲劳等“形神相失”的核心症状;而以情志变化为基础的“神伤”也会损耗人体阳气,进而导致郁证。本文从“形”“神”两方面出发,以哲学指导观念的变化为线索,探究阳虚致郁的病机学术源流。

According to Internal Medicine of Traditional Chinese Medicine,depression syndrome refers to some diseases caused by emotional discomfort and qi stagnation.The etiology,pathogenesis and clinical manifestations are various,but they are basically manifested as the symptoms of "disharmony between physique and spirit".The treatment is mainly from liver depression and qi stagnation,but the effect is limited.According to the following ideas:"The physiological formation of things is called the physique";and "Once the human body is formed,the spirit will follow",the viewpoint of "the unity of physique and spirit" has gradually formed in TCM.In combination with the theory of "the essence of yang is called spirit" in Huangdi′s Internal Classic,the deficiency of yang qi in the five zang organs can lead to the core symptoms of "disharmony between physique and spirit",such as persistent depression,loss of interest and pleasure,lack of energy and excessive fatigue;and the "spirit injury" based on emotional changes may also deplete the body yang,and then lead to the phenomenon of depression.This article starts from the two aspects of "physique" and "spirit",and explores the etiology of depression caused by yang deficiency with the change of philosophical guidance concept as the clue.