摘要
针对目前中医精神病学存在的指导理论不统一、疾病命名有局限、内科躯体症状辨证论治模式在精神科不适用及临床疗效待提高 4 个学科瓶颈问题,本文以"针对以核心症状为代表的核心病机确定核心方药"这一辨证论治的基本思想为指导原则,以西医精神病学的精神症状为辨治的核心症状,用整理加工提高的五神藏理论对精神症状定性、定位,确立常见精神疾病的核心病机和治法.其中,精神分裂症的核心病机为"肾虚肝妄",治以益肾平肝;抑郁症的核心病机为"阳气郁遏",治以升阳开郁;双相情感障碍的核心病机为"金旺火伏",治以益阴调阳;焦虑症的核心病机为"肾虚志亢",治以益肾平虑;抽动障碍的核心病机为"肾虚肝风",治以益肾平肝息风;注意缺陷多动障碍的核心病机为"肾志亏虚、心神浮越",治以补肾益志藏神;孤独症的核心病机为"肾虚神弱",治以补肾养心益神.最后针对核心病机,以临床实证经验确立常见精神疾病治疗的核心方药,构建精神症状五神藏辨治体系.
Abstract
To date,there are four critical challenges currently present in traditional Chinese medicine psychiatry:inconsistency in guiding theory,limitations in disease nomenclature,inapplicability of the syndrome differentiation and treatment model of internal medicine somatic symptoms to psychiatry,and need for improved clinical treatment efficacy.This study follows the guiding principle of syndrome differentiation and treatment that focuses on"identifying core prescriptions based on core symptoms and pathogenesis",by using psychiatric symptoms from Western psychiatry as the core symptoms for differentiation and treatment,and by applying the refined five spiritual zang viscera theory to qualitatively and locationally assess psychiatric symptoms,this approach establishes the core pathogenesis and corresponding treatment methods for common psychiatric disorders.Specifically,the core pathogenesis of schizophrenia is identified as"kidney deficiency with liver hyperactivity",treated by tonifying kidney and tranquilizing liver;for depression,the core pathogenesis is"yang qi stagnation",treated by ascending yang and relieving stagnation;for bipolar affective disorder,the core pathogenesis is"excess metal with latent fire",treated by nourishing yin and regulating yang;for anxiety disorder,the core pathogenesis is"kidney deficiency with hyperactivity of the will",treated by tonifying kidney and calming anxiety;for tic disorder,the core pathogenesis is"kidney deficiency with liver wind",treated by tonifying kidney and suppressing hyperactive liver for calming endogenous wind;for attention deficit hyperactivity disorder,the core pathogenesis is"kidney will deficiency with heart spirit imbalance",treated by nourishing kidney and enhancing will for storing the spirit;and for autism,the core pathogenesis is"kidney deficiency with weak spirit",treated by nourishing kidney and strengthening heart for benefiting spirit.Based on clinical evidence and the identified core pathogenesis,core herbal prescriptions for treating common psychiatric disorders are established,thereby constructing a syndrome differentiation and treatment system for psychiatric symptoms based on the five spiritual zang viscera theory.
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