| Objective: To explore the syndromes and treatment of depression based on rousing Qi and relieving stagnation,supporting Yang and harmonizing Yin,in oder to uplift spirit and observe the clinical efficacy of modified Mahuang Shengma Decoction(MSD)based on Qi stagnation and fire exuberance,Yin damage and Yang depletion,spirit inactivity.Methods: 1.With the help of the CNKI,VIP,Wanfang,Chinese medical dictionary software,and the traditional medical literatures,we analyzed the difference and connection of depression between traditional Chinese medicine(TCM)and modern medicine.Then,we established criteria for case selection and used the Chinese Medical Dictionary V5.0software to search ancient medical cases of depression.The Excel software was used to collect information on bibliographic sources,publication date,authorship and drug composition.SPSS 25.0 and SPSS Modeler 18.0 were used to perform frequency analysis,cluster analysis,and association rule analysis on the included cases.2.Based on a summary of tutor’s experience of treating depression,theoretical research was conducted to explore the feasibility of analyzing the syndromes and treatment of depression based on Yang Qi stagnation and spirit inactivity.Firstly,we sorted out the ancient theories of "valuing Yang Qi" with the help of CNKI,VIP,Wan Fang and traditional medical texts.Then,we analyzed the function of Yang Qi unobstruction in spirit inspiration and the mechanism of Yang Qi stagnation in spirit inactivity.We further analyzed the complex pathological aspects of Yang Qi as the basis of pathology,and explored the rationality of treating depression from the perspective of rousing Qi and relieving stagnation,supporting Yang and harmonizing Yin,in oder to uplift spirit.3.Clinical cases were collected by establishing criteria.Block randomization was used.The treatment group(50 cases)was applied with MSD and the control group(50 cases)was applied with fluoxetine.Patients in both groups were treated continuously for 6weeks.The Hamilton Depression Scale(HAMD)scores,HAMD factor scores,and TCM syndrome scores were recorded.Then,we evaluated the clinical efficacy of MSD,which was established according to the treatment method of rousing Qi and relieving stagnation,supporting Yang and harmonizing Yin,and in oder to uplift spirit in the treatment of depression with the characteristics of Qi stagnation and fire generation,Yin injury and Yang depletion,and spirit inactivity.Results: 1.literature study:(1)The 362 medical cases of depression involved 308 herbs.(2)The four natures involved in high frequency drugs were cold(39.44%)and warm(36.62%),suggesting that depression was characterized with severe hot symptoms and mild cold symptoms;the five tastes were bitter(36.28%),sweet(30.09%),and pungent(24.78%),suggesting that clearing fire,tonifying and dispersing were significant for depression;the meridians were lung(18.37%),spleen(15.31%),liver(14.29%),and heart(13.78%),suggesting that the treatment of depression from the lung had been practised since ancient times;the herbs was for resolving phlegm and relieving cough(15.49%),regulating Qi(14.09%),tonifying Qi(9.86%),suggesting that Qi stagnation was the main pathogenesis of depression and regulating Qi was a significant method.(3)In the cluster analysis,the drug group associated with regulating Qi was the most numerous(75.00%),followed by the drug group associated with clearing heat(50.00%),suggesting that Qi stagnation was the primary pathogenesis of depression,followed by fire disturbance,so treatment should focus on regulating Qi and clearing heat.(4)In the association rule analysis,various herbs were often used in combination,suggesting that the pathogenesis of depression was complex.Qi stagnation,heat disturbance,phlegm blockage,cold condensation,blood stasis were often combined,suggesting that a combination of Qi management,Qi tonification,heat removal,cold dispersion,and phlegm elimination should be used to treat depression.2.Theoretical exploration: Based on the tutor’s clinical experience and the theory of "Yang Qi is essential to nourish the mind and the tendons " in Huangdi Neijing,it was concluded that Yang Qi has the physiological functions of generating,nourishing,regulating and solidifying the mind.The unobstruction of Yang Qi can promote the harmonization of Yin and Yang and make the mind inspire.Yang Qi stagnation led to a malfunction of generating,nourishing,regulating and solidifying the mind.As the pathogenesis and pathological basis,Yang Qi stagnation can trigger many complex pathological links,such as Yang Qi stagnation and heat exuberance,fire prosperity and Yin deficiency,and Yin damage and Yang depletion,which eventually led to the disharmony of yin and yang,and the inactivity of spirit.This study pointed out that Qi stagnation and fire prosperity,Yin injury and Yang depletion,and spirit inactivity was an important pathogenic mechanism and established the treatment principle of rousing Yang and relieving stagnation,supporting Yang and harmonizing Yin,in oder to uplift spirit based on this.3.Clinical study:(1)Before treatment,there was no significant difference in the general information and baseline disease between the treatment group and the control group(P>0.05).(2)The intergroup comparison of HAMD scores suggested that there was no difference in the improvement of HAMD scores between MSD and fluoxetine(P>0.05).(3)The intragroup comparison of HAMD scores suggested that both MSD and fluoxetine could improve HAMD scores(P < 0.01),but MSD had an earlier onset of action than fluoxetine(P < 0.01).(4)The intergroup comparison of HAMD factor scores suggested that there was no difference in the improvement of HAMD factor scores between MSD and fluoxetine(P > 0.05).(5)The intragroup comparison of HAMD factor scores suggested that both MSD and fluoxetine could improve anxiety/somatization factor scores and retardation factor scores(P < 0.01),but the onset of action of MSD was earlier than that of fluoxetine(P < 0.01);MSD improved sleep disorder factor scores(P < 0.01),while fluoxetine had no significant effect on sleep disorder factor scores(P > 0.05);the improvement of weight factor scores was not significant for both MSD and fluoxetine(P>0.05).(6)The intergroup comparison of TCM syndrome scores suggested that MSD was better than fluoxetine in improving TCM syndrome(P<0.01).(7)The intragroup comparison of the TCM syndrome scores suggested that both MSD and fluoxetine could improve the TCM syndrome scores(P < 0.01).(8)The intergroup comparison of the HAMD score response rate and reduction rate suggested that the efficacy of MSD and fluoxetine in improving depressive symptoms was comparable(P > 0.05),and both could meet the effective criteria,but the effect of MSD was earlier than that of Fluoxetine(P <0.01).(9)The intergroup comparison of the TCM syndrome score response rate and reduction rate suggested that MSD was better than fluoxetine in improving TCM syndrome(P < 0.01),and MSD was effective in improving TCM syndrome,but fluoxetine did not reach the effective standard.Conclusion: 1.The results of the excavation of ancient medical cases suggest that the primary pathogenesis of depression is Qi stagnation,with the important link of heat disturbance,and often accompaning by phlegm,dampness,cold and blood stasis.Treatment of depression should firstly focus on regulating Qi,followed by clearing internal heat,while taking into account the use of methods such as resolving dampness,eliminating phlegm,warming the interior and invigorating the blood.2.This study is based on a summary of the supervisor’s clinical experience in treating depression.Through theoretical exploration,it is concluded that Yang Qi stagnation is the origin of the pathogenesis,and Qi stagnation and fire prosperity,Yin injury and Yang depletion,and spirit inactivity is the important pathogenesis of depression.It is reasonable to treat depression by means of rousing Yang and relieving stagnation,supporting Yang and harmonizing Yin,in oder to uplift spirit.3.The formula based on the treatment principle of rousing Yang and relieving stagnation,supporting Yang and harmonizing Yin,in oder to uplift spirit —— MSD,is effective for depression caused by Qi stagnation and fire generation,Yin injury and Yang depletion,and spirit inactivity,providing new ideas for the treatment of depression. |
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