郁证的理论溯源及国医大师徐经世治郁思路  

Theoretical origin of depression syndrome and TCM master XU Jingshi's thought of treating depression syndrome

作　　者：李艳[1] 赵进东[1] 张国梁[1] 徐经世[1] LI Yan;ZHAO Jindong;ZHANG Guoliang;XU Jingshi(The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei 230031,China)

机构地区：[1]安徽中医药大学第一附属医院,合肥230031

出　　处：《中华中医药杂志》2023年第11期5284-5289,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：中国中医科学院科技创新工程学部委员学术传承与传播专项(No.CI2022E037XB);国家中医药管理局徐经世国医大师传承工作室,安徽高校自然科学研究项目(No.KJ2019A0442,No.KJ2020A0401);安徽省高等学校省级质量工程项目(No.2021jyxm0834)。

摘　　要：《黄帝内经》首现五气之郁的论述,《伤寒论》有“郁郁”“郁冒”“怫郁”等记载。《丹溪心法》阐发了“六郁”论,《医学正传》首以“郁病”作为病证名称。张景岳认为郁证有虚实之分,初期多实,日久演变到虚实夹杂或虚证阶段。《临证指南医案》提出郁证初期病在气分,中期延及血分,后期病情危重。张锡纯注重开肝气之郁结,使气化流通,虽有所虚,自能渐渐复原。国医大师徐经世认为郁证的致病因素是气机郁滞,病位在中焦,治以“安中”之法,一则“理脾和胃,和煦肝木”,喜用归芍六君汤、芍药甘草汤等方;一则“疏肝理气,条达木郁”,方选逍遥散、四逆散、温胆汤之类,灵活化裁,使气机升降平衡,而达到治郁。The first discussion on the depression of the wu qi'is in Huangdi Neijing.Shanghan Lun has records of Yu Yu'Yu Mao'and‘Fu Yu'.The theory of‘Liu Yu'was expounded in Danxi Xinfa.‘Depression'was the first name of the disease in Yixue Zhengzhuan.ZHANG Jingyue believed that depression syndrome could be divided into deficiency and sufficiency,which was more than sufficiency in the initial stage,and had evolved into the stage of deficiency and sufficiency or deficiency syndrome over time.According to the Lingzheng Zhinan Yian,the disease of depression syndrome is in the qifen at the initial stage,the Xuefen at the middle stage,and the disease is critical at the later stage.ZHANG Xichun paid attention to opening the stagnation of liver qi and making it circulate.Although it is deficiency syndrome,it can gradually recover.TCM master XU Jingshi believes that the pathogenic factor of depression syndrome is the stagnation of qi,and the disease is located in the middle energizer.With the method of'calming the middle',one is'regulating the spleen and stomach,warming the Ganmu',the representative prescription is Guishao Liujun Decoction and Shaoyao Gancao Decoction.Other one is to'dredge the liver and regulate the qi,regulating up Ganmu',and select Xiaoyao Powder,Sini Powder,and Wendan Decoction,which can be flexibly adjusted to balance the rise and fall of qi and achieve the treatment of depression syndrome.

关 键 词：郁证 抑郁症 六郁 健运脾胃 疏调肝胆 

分 类 号：R249[医药卫生—中医临床基础]