基于“肝主筋脉,调畅情志”中医辨治帕金森病抑郁的思路和方法  

Theory and Methods of TCM Treatment in Depression of Parkinson’s Disease Based on "Liver Governs Tendons and Regulates emotions"

作　　者：黄瑞欧 王省[2] 盛蕾[3] 陈洁[4] Huang Ruiou;Wang Xing;Sheng Lei;Chen Jie(Children's Hospital of Nanjing Medical University,Nanjing 210008,China;The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,China;Second Chinese Medicine Hospital of Jiangsu Province,Nanjing 210013,China;The Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属儿童医院,南京210008 [2]南京中医药大学附属中西医结合医院,南京210028 [3]江苏省第二中医院,南京210013 [4]南京医科大学附属脑科医院,南京210029

出　　处：《世界科学技术-中医药现代化》2022年第3期933-938,共6页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：江苏省中医药研究院自主科研项目(BM2018024-2019013):基于前额叶m-TOR信号通路柴胡加龙骨牡蛎汤快速抗抑郁的基础及临床研究,负责人:王省;南京中医药大学自然科学基金项目(XZR2020023):柴胡加龙骨牡蛎汤“枢转少阳”快速抗抑郁的OrexinA调节机制,负责人:王省。

摘　　要：抑郁是帕金森病常见的非运动并发症,严重影响患者的生活质量。帕金森病抑郁不仅有运动迟缓、筋脉拘急等“筋脉”为病的表现,还有情绪低落,意志行为能力低下,思维迟缓等“情志”为病的特征。帕金森病抑郁属于“筋脉病”与“情志病”的“合病”。肝在体合筋,主疏泄、调畅情志,是肝藏象生理功能的主要体现;肝郁不达则情志郁结,筋脉不利。现代研究发现,肝主疏泄的功能与脑内多巴胺等单胺类神经递质相关,多巴胺分泌不足是引起帕金森病抑郁发病的重要机制之一。基于“肝主筋脉,调畅情志”的生理功能特征,我们认为“筋脉拘急,神气郁结”是帕金森病抑郁的病机;柔肝缓急,理气解郁是帕金森病抑郁的基本治则治法;提出了将理气解郁经典方越鞠丸与酸甘缓筋急的芍药甘草合用作为治疗帕金森病抑郁的基础方,为该病治疗提供新的思路。Depression in Parkinson’s disease is a common non-motor complication, affecting the quality of patient’s life seriously. Depression of Parkinson’s disease has clinical manifestations not only tendons and trepidation, head and trembling, et al, but also depressed, negative pessimism, low willpower and defect in cognitive function. From the perspective of pathogenesis of Chinese medicine, depression of Parkinson’s disease belongs to the "combination of tendons and feeling disease". According to the theory of traditional Chinese medicine in the theory of visceral manifestation of the liver, the role of the liver is to regulate mood and is closely related to the muscles of the body. This is the main content of the theory of visceral manifestation of the liver. When the liver is stagnation, the mood will be low and the tendons will be inflexible. Recent studies have found that the liver’s function of "conveyance and dispersion" is associated with monoamine neurotransmitters such as dopamine and serotonin in the brain, and the dysfunction of these neurotransmitters is one of the important causes of depression in Parkinson’s disease. Therefore, based on the physiological characteristics of the visceral manifestation of the liver, we found that "tension in the muscles and stagnation in the spirit and qi" is the basic pathogenesis of depression of Parkinson’s disease;Soothing the liver and relieving pain, and regulating qi and relieving depression is the basic principle for the treatment of the disease. It is suggested a new approach that the combination of Yueju pill and Shaoyao Gancao decoction, a classical prescription for regulating qi and resolving depression, is the basis for the treatment of depression of Parkinson’s disease.

关 键 词：帕金森病抑郁 共病 肝藏象 病证结合 思路和方法 

分 类 号：R2-031[医药卫生—中西医结合]