摘要
抑郁症是一种复杂的情感性精神障碍,中医临床治疗抑郁症多采用疏肝解郁的方法。课题组提出抑郁症存在阳气不足、气机不畅的病机,与早年创伤造成神经心理变化关系密切,治疗需温补阳气、行气解郁,并拟定了温阳解郁方。该方由温阳的二仙汤和解郁的逍遥散合方而成,通过选择母婴分离抑郁小鼠模型模拟早年创伤,并与温阳的二仙汤、解郁的逍遥散对比,发现温阳解郁方能够显著提高小鼠的活动性和环境探测能力,减少强迫游泳和悬尾实验中的不动时间,缓解趋暗和场景恐惧行为,增强社会交互和社会认知能力,改变趋向与回避决择反应的偏向,改善抑郁样行为和决择行为模式;降低小鼠血清皮质醇水平,抑制地塞米松/促肾上腺皮质激素释放激素(Dex/CRH)实验中皮质醇的高涨反应,上调海马区盐皮质激素受体(MR)和11β-羟基类固醇脱氢酶(11β-HSD2)表达,下调糖皮质激素受体(GR)和促肾上腺皮质激素释放激素受体1(CRHR1)表达,降低GR exon1甲基化程度和甲基化转移酶1(DNMT1)表达,恢复下丘脑-垂体-肾上腺(HPA)轴功能和负反馈机制;上调海马区脑源性神经营养因子(BDNF)表达,增加突触后致密蛋白95(PSD95)和突触素(Syn)蛋白的含量,降低细胞凋亡指数和B细胞淋巴瘤-2(Bcl-2)相关X蛋白(Bax)/Bcl-2,抑制胱天蛋白酶-3(Caspase-3)蛋白的表达,增强神经可塑性和抗凋亡能力。结合课题组研究成果及相关文献和临床经验,认为治疗抑郁症应以疏肝解郁药为基础,平肝药为核心,辅以健脾行气药调理气机,快速缓解抑郁症状;辅以温阳补肾药去除病源,预防复发;少佐风药通全身上下内外气机,提高解郁疗效。
Depression is a complex emotional and mental disorder.The traditional Chinese medicine(TCM)methods for treating depression mainly include soothing the liver and relieving depression.Our research team proposes that depression is caused by Yang Qi deficiency and obstructed Qi movement,which are closely related to neurological and psychological changes induced by early traumatic experiences.Therefore,we suggest that the treatment should focus on warming Yang,replenishing Qi,and promoting Qi movement and have formulated Wenyang Jieyu prescription based on Erxiantang for warming yang and Xiaoyaosan for relieving depression.The experiment with the mouse model of early trauma induced by maternal separation showed that Wenyang Jieyu prescription significantly improved the mouse activity and environmental exploration,reduced the immobility time in forced swimming and tail suspension tests,alleviated the behaviors such as aversion to darkness and fear of open space,enhanced social interaction and social cognitive abilities,altered decisionmaking biases,reduced depression-like behaviors,and improved the decision-making patterns.Additionally,the prescription lowered the serum level of cortisol,inhibited the cortisol surge in the dexamethasone/corticotropinreleasing hormone(Dex/CRH)test,up-regulated the expression of mineralocorticoid receptor(MR)and 11β-hydroxysteroid dehydrogenase 2(11β-HSD2)in the hippocampus,down-regulated the expression of glucocorticoid receptor(GR)and corticotropin-releasing hormone receptor 1(CRHR1),inhibited the methylation of GR exon 1 and the expression of DNA methyltransferase 1(DNMT1),and restored the negative feedback of the hypothalamic-pituitary-adrenal(HPA)axis.Furthermore,Wenyang Jieyu prescription upregulated the protein level of brain-derived neurotrophic factor(BDNF),elevated the levels of postsynaptic density protein 95(PSD95)and synaptophysin(Syn),decreased the cell apoptosis index and B-cell lymphoma(Bcl-2)-associated X(Bax)/Bcl-2 ratio,suppressed the expression of Caspase-3,and enhanced the neuroplasticity and anti-apoptotic capacity in the hippocampus.Considering the research results,related articles,and clinical experience,we conclude that depression should be treated with liver-soothing and depressionrelieving herbs,which can be supplemented with spleen-invigorating and Qi-regulating herbs to alleviate depressive symptoms.The Yang-warming and kidney-tonifying herbs can be used to eliminate the root cause and prevent relapse.Additionally,the wind-dispersing herbs can be supplemented to regulate the Qi movement throughout the body,thereby enhancing the efficacy of depression-relieving treatment.
作者
潘明敏
岳广欣
PAN Mingmin;YUE Guangxin(Institute of Basic Theroy for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2024年第6期58-65,共8页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金面上项目(82174251,81573846)
中国中医科学院科技创新工程项目(CI2021A00607)。
关键词
温阳解郁方
抑郁症
母婴分离
方证相应
用药规律
Wenyang Jieyu prescription
depression
maternal separation
correspondence between prescription and syndrome
medication rule
