基于“阴火”学说探讨广泛性焦虑障碍的临床诊疗思路  

Exploring the diagnosis and treatment of general anxiety disorder based on the theory of “yin fire”

作　　者：李旌菀 孟得心 周光玮 贾志华 邢佳[2] LI Jingwan;MENG Dexin;ZHOU Guangwei;JIA Zhihua;XING Jia(Beijing University of Chinese Medicine,Beijing 100029;Department of Psychosomatic Medicine,Dongfang Hospital,Beijing University of Chinese Medicine)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]北京中医药大学东方医院心身医学科

出　　处：《现代中医临床》2025年第2期19-23,共5页Modern Chinese Clinical Medicine

基　　金：北京中医药大学基本科研业务费项目(No.2023-JYB-JBQN-032);中华中医药学会雏鹰计划中医临床青年人才研修项目(No.CYJH2024047)。

摘　　要：广泛性焦虑障碍(generalized anxiety disorder, GAD)以过度担忧及广泛的躯体症状为主要临床特征,病程常持续半年以上。GAD多系统的躯体症状与阴火流行全身各处所致的周身症状相吻合。李东垣的著作中多次提及“阴火”,具有心火、脾胃火、肾火等多种内涵。本团队认为“阴火”为脾胃气虚、元气不足而产生的火热内扰之病理状态,是因饮食失和、五志七情太过或过劳后内伤脾胃最终形成的虚火。GAD与阴火为病的关系主要为:脾胃内伤,元气不足;阴火乘阳,灼烧津血;阴火合邪,损伤五脏。临证以“补脾胃、升清阳、泻阴火”为治疗大法,选方补脾胃泻阴火升阳汤。并结合临床验案阐述基于“阴火”学说诊疗GAD的经验。Generalized anxiety disorder(GAD) is defined by persistent, excessive worry and a spectrum of somatic symptoms, typically enduring beyond six months. These somatic manifestations align with the peripheral symptoms attributed to the concept of yin fire, prevalent in Traditional Chinese Medicine, which encompasses various conditions such as heart fire, spleen fire, stomach fire, and kidney fire. In the works of Li Dongyuan, yin fire is frequently referenced, suggesting it as a prevalent term in the context of GAD. This concept is interpreted as a pathological state of fire and heat resulting from deficiencies in spleen and stomach qi, as well as vital energy, stemming from internal injuries to the spleen and stomach due to improper diet, emotional strain, or overexertion. The association between GAD and yin fire can be delineated by the following aspects: internal spleen and stomach injuries and vital energy deficiency;the proliferation of yin fire intensifying yang, which consumes body fluids and blood;and the interaction of yin fire with pathogenic factors, thereby damaging the five viscera. The therapeutic approach to GAD is grounded in the principle of strengthening the spleen and stomach, elevating yang, and purging yin fire. The formula chosen for this purpose is the Bupiwei Shengqingyang Xieyinhuo Decoction(Spleen-Stomach-Strengthening, Yang-Elevating, and Yin-Fire-Purging Decoction). This paper also discusses clinical experiences in diagnosing and treating GAD based on the theory of “yin fire, ” incorporating real case examples.

关 键 词：广泛性焦虑障碍 阴火学说 补脾胃升清阳泻阴火 补脾胃泻阴火升阳汤 

分 类 号：R277.7[医药卫生—中医学]