【作者】 姬道绪；

【导师】 王天芳；

【作者基本信息】 北京中医药大学 ， 中医诊断学， 2003， 硕士

【摘要】 抑郁症属于情感性精神障碍，是一种以心境低落为主要特征的精神疾病综合征。目前中医在抑郁症的研究和治疗方面做了大量的工作，并取得了一定的成果。但目前抑郁症的中医辨证方法和辨证分型多不统一，且证候描述中患者精神症状没有统一、量化，精神症状在中医辨证中的意义没有体现出来。 本研究分析了抑郁症的一般资料特点、中医证型分布规律以及不同证型患者的精神心理学特征。全文分理论研究和临床研究两个部分： 1 理论研究 本研究介绍了抑郁症的临床表现、分类及其心理评定情况，分析了中医学对抑郁症(郁证)的认识情况以及有关抑郁症(郁证)中医辨证分型和抑郁症中医证候研究存在的问题和不足，提出了抑郁症证候学进一步研究的方向与思路。 1．1 抑郁症的临床表现及其分类 (1)抑郁症共同的临床表现是：1)心境和情感方面：主要有悲伤、动机降低，兴趣丧失，情感缺乏，空虚感，焦虑，紧张等。2)思维-认知方面：主要有注意力下降，犹豫不决，丧失自信，无价值感，悲观，自杀观念等。3)精神运动活动方面：可分为迟滞和激越两类。4)躯体表现：主要有基础功能的改变、精力的改变、身体感觉、内脏症状四类。 (2)抑郁症有类型或类别层次或因子以及一元与多元分类系统。一元法把各种抑郁状态视为一个连续谱；二分法比较混乱，主要二元分类有：原发／继发性、内源／反应性、精神病性／神经症性、单相／双相、纯粹抑郁／抑郁谱系、迟滞性／激越性抑郁、更年期抑郁／老年期抑郁；多元分类系统有ICD系统、DSM系统、CCMD系统。 1．2 心理卫生评定量表与抑郁症临床表现的量化评定 (1)心理卫生评定量表的形式有主观量表、自评量表、检核表等。按项目编排方式分类，可分为数字评定量表、描述评定量表、标准评定量表、检选量表、强迫选择评定量表5种；按评定者性质分类可以分为自评量表和他评量表。 (2)评定量表在心理卫生评估中的价值是客观、数量化、全面、经济方便。本文介绍了几种常用的抑郁及相关问题的量表，包括抑郁自评量表(SDS)、症状自评量表(SCL-90)、贝克抑郁问卷(BDI)、汉密尔顿抑郁量表(HAMD)。 1．3 中医学对抑郁症(郁证)的认识 中医学对郁证的认识起于先秦，但范围广博，包括了外邪、情志等因素所致的一切4 抑郁症证候特点及证候与精神症状的关系研究郁积不畅的病理变化。金元时代将郁证作为独立的病证来认识，在病因、病证范围等方面出现了转折；并初步确立了治法方药；明清以后始将郁证的病因界定为情志失调，治法方药渐趋完善。1．4抑郁症（郁证）证候分类及常见证型的精神症状描述情况分析 门）文献报道主要以脏腑辨证为主；病位涉及肝、脾、心、肾、胆，病理因素多为气血虚、阴虚、痰阻、血瘀、气滞等。以心脾两虚、肝气郁结、气滞血瘀、气滞痰郁、肝郁脾虚、脾肾阳虚、忧郁伤神、肝郁化火、肝肾阴虚等证较为常见。 门）文献报道中所列举的抑郁症中医证候标准中精神症状的描述存在的问题有：症状名称不规范、症状描述不统一、缺乏客观量化、缺乏特异的具有鉴别意义的症状。 门）证候研究的不足：入选病例诊断不确切；辨证标准和方法不规范；证候名称和症状表述各异；研究手段落后，缺乏大样本的临床流行病学调查。 （4）本研究提出需要从多中心、大样本入手，并借用现代医学心理学评定量表对患者精神症状进行评定，总结抑郁症的常见证型狮以及各证型患者精神心理表现特点。2临床研究 本研究在运用传统方法收集病人信息的基础上，结合国际通用的精神心理学量表对符合CCMD《亿抑郁症诊断标准的患者表现进行评定，分析了抑郁症的一般资料特点、证候规律。探讨了不同证型患者的精神心理学特征。2．且抑郁症证候特点研究2．1．1抑郁症的一般资料特点 本研究通过对抑郁症患者的一般资料分析，归纳起来主要存在如下特点：门）女性多于男性，男女比例约为1：2；（、2）已婚患者占多数，未婚患者中男性多于女性；（3）以职员、退休人员为主；（4）高中文化居多；（5）年龄以31－40岁之间最多；（6）春秋季节发病偏多，女性夏季发病也较多。2．1．2抑郁症的证候特点 门）基本证型分布特点：1）基本证型共14种，出现率排在前三位的是肝郁、脾虚、心虚；2）男性患者中较为多见的还有肝火、胃气上逆、心火、气虚；女性患者中较为多见的还有肝虚、肾虚、阴虚、血瘀。3）病程前2个月，肝郁、肝火、心火和胃气上逆等实证多见；3－4个月脾虚、心虚开始出现；7－12个月病人表现复杂，开始出现肝虚、肾虚、阴虚、气虚等虚证以及血瘀、痰郁等实证；病程进一步延长，病人的表现又简单化，以肝郁、脾虚为主，兼见痰郁、阴虚。4）肝郁和脾虚两证在各年龄段中所占比例均最大。年轻人实证多见；中年人实证减少，虚证相对增多；老年人证候表现相对简单。 门）复合证型分布特点：1）复合证型可分肝郁脾虚、肝胃不和、心脾两虚、肝肾中文摘要5阴虚、心肝火旺、肝气郁结、肝郁化火7?更多还原

【Abstract】 PrefaceDepression which belong to affective disorder is a kind of disease characterized with low mood . Up to now, TCM have done a lot of works in the study and treatment on depression , and also have gained many achievements . But till now, no unitive criterion could be followed by TCM researchers to obey . Besides, in traditional syndrome criteria, description of mental symptoms is obscure, mental symptoms have little value in identifying syndromes.This study analyzed common clinical data of depressive patients, the regularity and the features of deferent syndromes . This article includes two parts theoretical study and clinical study. 1 Theoretical Study1.1 Clinical conditions and classification of depression(1) Depression’s common symptoms : 1) Mood and Sentiment: Mainly includes sadness , low motivation , hebetude, feeling absence , anxiety , high tension , etc . 2) Thought and Cognition : Mainly contain attention descent, hesitant, self-confidence loss, self-depreciation, pessimism, suicidal idea, and so on .3) Psychomotor: Include two kinds : anergia and agitation. 4) Somatic Manifestation: Includes four categories , they are changes in basic functions and vigor of the body , feelings , visceral symptoms .(2) Classifications: Monism considers various kinds depressive states as a continuous thing. Popular dichotomy includes follow classifications: Primary Depression/Secondary Depression, Psychotic Depression/Neurotic Depression, Mono-polar Depression/Bipolar Depression, Pure Depression/ Depressive Pedigree, Anergia Depression/Agitated Depression, Climacteric Depression/Senectitude Depression, etc. Pluralism includes ICD system, DSM system and CCMD system.1.2 Psychological rating scale and evaluation of depression’s clinical situation(1) The style of rating scale includes subjective scale , self-rating scale, checking scale. According to the layout of the items they can be divide into 5 kinds, they are digital rating scales , descriptive rating scales, normal rating scales, check-lists, compulsive-selection rating scales, and generally they can also be classified as two kinds: self-rating scales and subjectivescales.(2) The values of rating scales in psychological evaluation are objective, comprehensive, convenient. This article introduced four kinds of most popular scales for depression and symptom collecting, they are SDS, SCL-90, BDI, HAMD.1.3 The opinion of Chinese Medicine in depressionThe beginning of TCM to realize depression can be retrospected to Qin-dynasty, but the range is too wide , it includes all the stagnated pathologic changes caused by exogenous factor and emotion. Till Jin-Yuan dynasty , people began to consider depression as a dependent illness, and transition appeared in the sectors of etiologh and the range of the depression. Till Ming & Qing dynasty, depression’s pathogenic factor was defined as irregular emotions.1.4 Syndrome classification and the description of mental symptoms in depression’s syndromes(1) Reports from literatures mainly used zang-fu differentiation, the popular syndromes include weakness of both the heart and spleen , stasis of the hepatic qi, stagnation of qi and blood stasis, phlegm stagnancy, the depressed liver with the insufficient spleen, asthenia of both the spleen and the kidney, you-yu-shang-shen, depression of the liver generates pathogenic fire , deficiency of liver-yin and kidney-yin deficiency of the liver-yin and kidney-yin, etc.(2) The description of mental symptoms in depression’s syndromes from reports have many problems, such as nonstandard name of the symptoms, unequal mental symptoms in same syndrome , un-quantified mental symptoms, no differential symptoms in the syndrome description, etc.(3) We consider there are many shortcomings in the present researches, for example, uncertain criteria of depression, nonstandard criteria of identification and symptom description, small sample clinical research, uncultured method, etc.(4) The paper put forward that we should make use of更多还原