甘麦大枣汤及其合方治疗抑郁症研究新进展  

Ganmai Dazaotang Alone and Combined with Medication for Depression:A Review

作　　者：杨雪静 许二平[1,2] 尚立芝 YANG Xue-jing;XU Er-ping;SHANG Li-zhi(Academy of Chinese Medical Sciences,Henan University of Henan University of Chinese Medicine,Zhengzhou 450046,China;Henan Key Laboratory for Modern Research of Zhongjing Compound Traditional Chinese Medicine,Zhengzhou 450046,China)

机构地区：[1]河南中医药大学中医药科学院,郑州450046 [2]河南省仲景方药现代研究重点实验室,郑州450046

出　　处：《中国实验方剂学杂志》2021年第24期55-60,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(81973739);河南省高等学校重点科研项目(20B360011,21A630020);河南省教育科学“十三五”规划一般课题([2019]-JKGHYB-0101,[2019]-JKGHYB-0114);国家级大学生创新创业训练计划项目(202010471016,202010471003)。

摘　　要：抑郁症是一类情感障碍和心境障碍性疾病,多表现为显著持久的情绪低落,兴趣减退或快感缺失,常伴有疲乏、头痛、背痛、失眠等躯体症状。其发病机制不清,目前认为抑郁症与下丘脑-垂体-肾上腺(HPA)轴,神经元损伤与神经营养因子(BDNF),单胺类神经递质和细胞因子等有关。中医认为抑郁症属于"郁证"范畴,其发病多与情志失调,气机郁滞导致的五脏六腑气机失和有关。甘麦大枣汤为安神剂,出自张仲景的《金匮要略》,具有养心安神、和中缓急的作用,临床上常用于治疗抑郁症。目前应用甘麦大枣汤治疗抑郁症的临床类型主要有产后抑郁症、更年期抑郁症、乳腺癌合并抑郁症和中风后抑郁症等,这些病的中医发病病机大多与肝脾郁结、心脾两虚、肾气不足、情志郁滞有关。该方治疗抑郁症的作用机制主要与其能够增加抑郁症患者单胺类神经递质含量、调节单胺系统功能;降低中枢及外周促炎因子,调节中枢和外周炎症;降低血清促肾上腺皮质激素(ACTH)和皮质类固醇(CORT),抑制HPA轴亢进;增加脑源性神经营养因子(BDNF)mRNA及蛋白表达等有关。本文结合抑郁症的发病机制,对甘麦大枣汤的临床应用、实验研究等方面的最新进展进行综述,总结其抗抑郁的作用机制,为临床治疗抑郁症提供新思路和新依据。Depression is an affective or mood disorder mainly manifested as significant and persistent low mood,loss of interest or anhedonia,often accompanied by fatigue,headache,back pain,insomnia and other physical symptoms.The pathogenesis of depression is still not clear.At present,depression is believed related to hypothalamus-pituitary-adrenal(HPA)axis,neuron damage and brain-derived neurotrophic factor(BDNF),monoamine neurotransmitters,cytokines,and so on.It falls into the category of ’depression syndrome’ in traditional Chinese medicine(TCM),and its pathogenesis mostly lies in Qi movement disorder in five-zang and six-fu organs caused by emotional disorder and qi stagnation.Ganmai Dazaotang is a tranquilizer first recorded in Synopsis of the Golden Chamber(《金 匮 要 略》) by Zhang Zhong-jing.It has the effects of nourishing heart,tranquilizing mind,harmonizing the middle,and relaxing tension,making it commonly used for the treatment of depression,especially the postpartum depression,menopausal depression,breast cancer with depression,and post-stroke depression.All of these diseases mostly result from liver-spleen stagnation,heart-spleen deficiency,kidney qi deficiency,and emotional upset.Ganmai Dazaotang exerts the anti-depression effect mainly by increasing the content of monoamine neurotransmitters,regulating the function of monoamine system,reducing the central and peripheral proinflammatory factors,ameliorating central and peripheral inflammation,lowering serum adrenocorticotropic hormone(ACTH)and corticosteroid(CORT),inhibiting HPA axis hyperthyroidism,and up-regulating mRNA and protein expression of BDNF.Based on the pathogenesis of depression,the paper reviewed the clinical applications and experimental findings of Ganmai Dazaotang and summarized its antidepressant mechanism,so as to provide new ideas for clinical treatment of depression.

关 键 词：甘麦大枣汤 抑郁症 单胺类神经递质 作用机制 

分 类 号：R2-0[医药卫生—中医学] R289