Theoretical And Applied Research From The Heart Of Governance Based On The The Zang Overall Concept To Explore Depression

Depression is a common disease of affective disorder, featuring significant and persistent low mood and depression as the main clinical manifestations, and accompanied by changes in thinking and behaviors. In recent years, its incidence is increased by higher living pressure and faster work pace. Depression leaves adverse impact on the life and work of the patients, burdening the family and the community. In 1998 WHO announced that the disease burden of depression has leapt to No.2 in China, which was close to that of developed countries. Currently the main antidepressant approach is the application of tricyclic antidepressant and SSRI. Traditional antidepressants have more adverse reactions, while new ones, who cost as high as several dozen times. In this regard,the traditional Chinese medicine excels for its advantageous characteristics of "simple, handy, effective and heap". In order to better play its outstanding role in antidepressant treatment, in this project it is researched from a theoretical, clinical and an experiment perspective.I. Theoretical research:1. After an extensive reading of literature, I discuss the concept, treatment and prescription of treating depression from a heart-and-spleen-led perspective within the theoretical context of TCM holism. Through analysis, I discuss the heart-spleen connections in terms of their meridian structures, five-element system, physiological functions and pathological bases. It is summarized that depression is caused by:lack of healthy spleen operation and the support of spirit. Therefore, appropriate treatment includes nourishing spleen Qi and the heart and spirit. The representative prescription is the Guipi Soup. Conclusion:The concept, treatment and prescription of depression are discussed from a heart-and-spleen-led perspective and then the spleen is important in emotional desease is proposed. Under the physiological state, if the spleen storing spirit functions normally, and since the spleen governs transportation and transformation of substance, and rising the lighter substance, the biological Qi and blood are soundly sourced, so that body organs function into normal play. Because of the emotional stimulation, or weary spleen injury, or ineffective spleen operation, spirit can not be stored by the spleen, hence spleen dysfunction, leading to a variety of depressive illness (such as the emotional depression, Qi depression, damp depression, food stagnation, phlegm depression, heat depression, etc.) This hypothesis has opened up a new possibility for the treatment of depressive illness, and has practical significance for clinical practice.2. The functional principle, efficacy and selection of guiding drugs are also discussed in describing the treatment of depression by Guipi Pills, invoking its application in the procedure. The discussion provides examples for the wider application of Chinese patent drugs, expanding its treatment adaptability and compensating for its inability to adjust to different degrees of disease. II Clinical research:1. Objective:To further evidence Chinese medicine treatment of depressive illness by a "heart-and-spleen-led" approach, to discuss the applicant range of Guipi Pills against depression, and to put into a better play of TCM against depression, we undertook the clinical research.2.Procedure:Establishment of research programs (including the inclusion criteria, exclusion criteria, treatment standards, removal and falling standards, etc.) We intend to survey by the proposed questionnaire and TCM syndrome score scale, and have conducted pre-surveys. On the basis of the pre-survey results, we collected 120 samples of the heart-and-spleen-deficiency depression, which are randomly divided into three groups. TCM treatment group taking Guipi Pills, and providing Chinese patent drugs or guiding drugs for accompanying symtoms; in the control group both Guipi Pills and fluoxetine (an antidepressant) are taken;and the 3rd control group were taking fluoxetine alone. There are 4 weeks for a course of treatment, and a total of 3 course of treatment. At time spots of pre-medication,4 weeks,8 weeks, and 12 weeks after medication, observations were done. Observation indicators:general (blood pressure, body weight, heart rate), clinical symptoms (Hamilton Depression Scale HRSD, constructed TCM syndrome score scale), and adverse reactions. Excel spreadsheet is used for all data input and verification. The results are input SAS 8.0 statistical software for statistical analysis, all data using two-sided test (p <0.05), which means the tested difference has statistical significance.3.Results:The three groups of samples show no difference by demographic data and more general information (gender, age); baseline comparison condition (severity, HRSD total score, TCM syndrome total score) was no different. The three groups have comparability.Symptoms Evaluation:In terms of each symptom improvement, the three groups improved in the order of:the treatment group (83.67%)> TCM+fluoxetine group (78.98%)> Western medicine control group (77%). In terms of each symptom improvement, the three groups had improved in the order of:the treatment group (81.85%)> TCM +fluoxetine group (79.34%)> Western medicine control group (71%).Efficacy evaluation:from the overall efficacy of medication after 4 weeks, three groups all start to effect; for 8 weeks, the three groups had significant effect; for 12 weeks, efficacy of the three groups remained stably upward;and the treatment group performs better than the control groups. It indicates that Guipi Pills, in the treatment of depressive illness caused by heart and spleen deficiency, has no significant difference of efficacy from both Western medicine treatment and Chinese and Western medicine combined treatment,and even more effective than the other two groups. Individual effects:After 4 weeks, three groups had significant efficiency difference. It indicates that Guipi Pills has better starting efficacy than the two control groups. After 8 weeks, the cure rate diverges among the three groups. As to treatment for 12 weeks, HRSD scale score showed that the efficiency of the three groups were significantly different; and clinical symptoms score showed that cure rate between the three groups were significantly different. In the treatment group, cure rate by symptom scoring was significantly higher than the control groups, while the HRSD efficiency was significantly better than the control groups. It indicates that the TCM symptoms were significantly cured.4.Adverse events:There are 10 cases of adverse events occurred in the course of treatment:2 cases of gastrointestinal symptoms which may be relevant to the treatment measures; other 3 cases irrelevant. Control group 2 has 3 cases of gastrointestinal symptoms which may be related to treatment measures; 1 case in control group 1 and 1 case in control group 2 are irrelevant to the treatment measures.5.Conclusion:The fact that spleen treatment results in cure of emotional depression has evidenced the importance of spleen "storing spirit". Guipi Pills' advantage in treating depression:similar or even better efficacy than fluoxetine or fluoxetine combined with TCM; earlier efficacy and less side effects. The idea of treating depression in a "heart-and-spleen-led" approach is verified as correct, providing evidence for further research. And through the treatment method of adding Chinese patent drugs or guiding drugs to Guipi Pills based on accompanying symptoms, the TCM holistic approach was put into practice. The application range of Guipi Pills include:primary symptoms:insomnia, poor appetite, palpitations, weariness, forgetfulness, light-colored tongue; accompanying symptoms:chest distress, dizziness, fatigue, poor appetite, over thinking. The pills are applicable to depressive patients who also have two or more primary symptoms or one primary and two accompanying symptoms.III. Experimental research:To explore the impact of the serum cortisol on the depressive symptoms of patients taking Guipi Pills,120 cases were randomly selected:24 sample of patients taking Guipi Pills as the treatment group 1,24 new patients who will taking Guipi Pills as the treatment control group 2,24 samples collected from healthy people over the same period as healthy control group, altogether 72 cases. The levels of serum cortisol are detected by luminescence immunoassay. The levels of Serum cortisol in treatment group and control group are examined for 3 times:before treatment,4 weeks and 8 weeks after treatment. The levels of serum cortisol in normal control group are detected only once. The three groups show no difference in terms of age and gender.Results:The levels of serum cortisol in depression patients were higher than normal people. The levels of serum cortisol decreased after treatment with Guipi Pills and the disease is relieved. Conclusion:serum cortisol level was positively correlated with HRSD score scale, which can reflect the severity of depression and can be used to aid clinical diagnosis and speculating the depression disease recurrence.Conclusions:1. The application range of Guipi Pills in treating depression; combination with the Chinese patent medicine or guiding-drug with Guipi Pills as symptoms indicate.2. Serum cortisol level was positively correlated with depressive symptoms, which can reflect the severity of depression and can be used to aid clinical diagnosis and speculating the depression disease recurrence.