Li Zhenhua, a master of traditional Chinese medicine, was inspired by Zhang Zhongjing's record of the disease of impudence in synopsis of the golden chamber, such as "women are dirty and anxious, and love to cry, as if they were made by God". This classic book focuses on the main symptoms of depression. According to Li Zhenhua's clinical experience, some patients are upset and impatient, insomnia and dreaminess, memory loss, crying and trance, which is very similar to dirty and impatient. Most of the causes are long-term mental depression and depression. Appear upset and impatient, anger hurts the liver, liver qi stagnates, and stagnation turns into fire, which leads to heart fire. Liver-fire not only consumes kidney yin, but also is not conducive to spleen and stomach, resulting in spleen failing to transport and transform normally. When the water is wet, it stops inside, and when it is hot, it becomes phlegm. Phlegm dampness goes up with liver qi, which blinds the mind and leads to confusion. It can be seen that the liver qi loses its function of circulating qi and turns into heat, which can lead to visceral mania and insomnia, and can develop into depression, resulting in the above symptoms.
Li Zhenhua has cured a large number of such cases clinically, and a few patients with serious illness will have anger, suspicious fantasies and even suicidal behaviors. So Li Zhenhua thinks that the pathogenesis of depression lies in the liver. The cause is that the spirit is affected by * * *, and anger hurts the liver, which is depressed and insoluble, and the liver loses its qi and turns into fire. Excessive liver fire consumes kidney yin, and insufficient kidney yin cannot control heart fire normally, and water and fire are incompatible. Anger of liver and heart will not only lead to insomnia, dreaminess, anxiety and impatience, but also lead to nervous disorder and confusion. When the liver loses the function of dispersing qi, the liver qi can damage the spleen and stomach, and the water and dampness are transported abnormally, and when it meets fire, it becomes phlegm; When phlegm and blood stasis are in the throat, it is plum-nucleated gas, spleen deficiency, dishonorable qi and blood, and lack of wood; Liver blood deficiency forgetfulness insomnia; Phlegm goes up with liver-qi, turbid and clear-headed, and thinking is more chaotic and can't be independent. Therefore, the heart, liver, spleen and kidney are out of balance with each other. For this complicated pathogenesis, Li Zhenhua thinks that it is appropriate to relieve liver qi and restore the function of soothing the liver and relieving depression, but to remove dampness, strengthen the spleen and resolve phlegm, clear the heart and resolve phlegm, and eliminate phlegm and dampness, so that heat becomes a fire without roots, and phlegm fire will disappear by itself. At the same time, both drug therapy and psychotherapy are paid equal attention to in treatment, so that liver qi is no longer stagnant and other viscera functions can be restored.
Development of "Qingxin Huatan Decoction"
Li Zhenhua thinks that liver depression and spleen deficiency are the root of visceral mania and belong to depression. After decades of clinical practice and long-term clinical thinking, Li Zhenhua put forward his own views. Most of the causes are spleen injury caused by diet or thinking, spleen loss of health, endogenous dampness, depressed soil and liver disorder; Or depressed anger hurts the liver, the liver is depressed and qi is stagnant, and the wood is covered with soil. The pathogenesis is liver-spleen imbalance, liver depression and spleen deficiency, and liver-heart heat. Therefore, Li Zhenhua preferred Ganmai Jujube Decoction, and created Qingxin Huatan Decoction by soothing the liver and regulating qi, invigorating spleen and resolving phlegm, and clearing heart and resolving phlegm. Over the years, through clinical observation, this prescription not only has a significant effect on visceral mania, but also has a satisfactory effect on depression which is more serious than visceral mania. Because this disease is a mental disorder caused by stagnation of liver qi, it is particularly important to give repeated psychological counseling and comfort. Clinically, it is necessary to find a psychological breakthrough in combination with the specific situation of patients, which is convincing.
Li Zhenhua drew up "Qingxin Huatan Decoction" (also known as "Qingxin Mania Decoction"). The basic drugs are Atractylodis Rhizoma, Poria, Orange, Pinellia ternata, Rhizoma Cyperi, Radix Curcumae, Rhizoma Acori Graminei, Fructus Gardeniae preparata, plumula Nelumbinis, Fructus Foeniculi, Radix Linderae, Sanguis Draxonis, Caulis Polygoni Multiflori, Cortex Albizziae, Rhizoma Anemarrhenae, amber, and Radix Glycyrrhizae. In the prescription, dampness and phlegm are mainly eliminated, and Atractylodes macrocephala, Poria, Fructus Aurantii and Pinellia ternata are used to strengthen the spleen and regulate the stomach. Yujin and Acorus calamus wake up; Stir-fried Gardenia, Lotus plumule and Anemarrhena rhizome; Foeniculum vulgare, Cyperus rotundus and Lindera root soothe the liver and regulate qi, and promote qi to relieve depression; Dragon's teeth, Polygonum Multiflori Radix and Cortex Albizziae are used for tranquilizing; Glycyrrhiza uralensis Fisch blends various drugs; Use amber in ore to calm nerves. The compatibility of the whole prescription makes the spleen healthy, the liver and wood can not be used, the liver and qi are relaxed, the phlegm is clear, the mind is clear, and it is cured.
Clinical application, with the addition and subtraction of the syndrome, has a significant effect. Li Zhenhua pointed out: Generally, 30 days is a course of treatment, and there are about 2 courses of treatment. Liver depression and spleen deficiency are the main pathogenesis. However, Li Zhenhua thinks that liver depression and spleen deficiency are not the same, which is biased. For patients with liver depression and hyperactivity of liver fire, Qingxin Huotan Decoction is used to soothe the liver and strengthen the spleen, regulate qi and regulate the stomach. Spleen deficiency, Xiangsha Liujunzi Decoction, Bupleurum, Rhizoma Cyperi, Yujin, etc. Used for invigorating spleen and qi, soothing the liver and relieving depression. Li Zhenhua emphasized that the treatment in recovery period should be properly controlled, and premature use of Xiaoyaosan would aggravate the condition, which was related to early use of Gui and Shao and other yin-nourishing drugs to nourish yin and astringe dampness. Drug therapy should be used to soothe the liver and regulate qi, not just sedatives and inhibitors.
Because this disease is a mental disorder caused by stagnation of liver-qi, Li Zhenhua attached great importance to the treatment of "heart disease requiring heart medicine" recorded in classic medical books. Emphasize the importance of emotional regulation and establish confidence in overcoming diseases. If psychological problems are not solved by persuasion, although drugs can have short-term effects, they can still recur, which is why the disease is difficult to cure.
Examples of medical records
Case 1 Dirty mania (spleen deficiency and liver depression)
Wang, female, 50 years old. The first visit in February was 20 1 1+0 1.
The patient complained of insomnia and hyperhidrosis for more than 5 years. In recent five years, patients often suffer from insomnia, sweating and other symptoms, especially at night, accompanied by anxiety and impatience, dizziness and headache, easy to lose temper, occasional bilateral pain, occasional general malaise, and even suicidal thoughts and menstrual disorders. I went to the psychological department of the local hospital for treatment and gave Deanxit and other anti-anxiety and anti-depression drugs. The symptoms were mild during taking the medicine and recurred after stopping taking the medicine. Later, gynecology was treated with estrogen, and the menstruation was basically normal, and the symptoms were relieved, but the effect was not good. Or recurrent attacks, sometimes light and sometimes heavy, gradually appear stomach discomfort, bitter taste, bad breath, poor appetite, bloating after eating a little, and sticky stool for two days. In order to seek systematic Chinese medicine treatment, he came to Li Zhenhua clinic for treatment. The symptoms are insomnia, hyperhidrosis, obvious night sweat, dizziness, impatience, irritability, bilateral pain, uncertain pain, abdominal distension, anorexia, abnormal taste, dry and sticky stool, 1~2 days, pale tongue, red edge, slightly fat body, thin white and greasy fur, and thready pulse.
Diagnosis: visceral mania (spleen deficiency and liver depression).
Treatment: strengthen the spleen and soothe the liver, clear the heart and soothe the nerves, strengthen the exterior and stop sweating.
Prescription: Xiangsha Liujunzi Decoction. Atractylodis Rhizoma 10g, Poria cocos 10g, Pericarpium Citri Reticulatae 10g, Rhizoma Pinelliae 10g, Rhizoma Cyperi 10g, Fructus Amomi 10g, Radix Bupleuri 6g, Radix Curcumae 10g, and Radix Curcumae. 10 dose, decocted in water, daily 1 dose.
Doctor's advice: avoid eating hard and sour food, live a regular life, avoid tension and emotional excitement, and relax.
Secondary diagnosis (2011February 2 1): After taking the medicine, sweating was reduced, sleep was improved, and there was basically no dizziness, thin tongue coating, abdominal distension and belching. Remove Pinellia ternata, Gastrodia elata, and Lophatherum gracile, and add Pericarpium Citri Reticulatae10g, Persimmon15g, Raphani Seed15g, Dragon Tooth15g, and Anemarrhena asphodeloides10g to enhance the function of soothing the liver and regulating qi. At the same time, Anemarrhena asphodeloides has the function of preventing yin deficiency injury caused by qi-regulating drugs. After taking the dose of 10, decoct it, daily 1 dose.
Doctor's advice: same as above.
The third diagnosis (20165438+March 2, 0): After taking the medicine, the symptoms of bitter mouth, abdominal distension, hypochondriac pain and hyperhidrosis basically disappeared, and the spirit improved obviously, with normal appetite and poor sleep, but better than before. Therefore, removing Rhizoma Anemarrhenae and adding 30 grams of Polygonum Multiflori Radix can help improve sleep, and then taking 15 dose with water, and taking 1 dose daily to consolidate the treatment.
After nearly two months of treatment, the patient's mental state recovered as before, his life was normal, and his symptoms did not recur.
Press: The patient in this case is 50 years old, suitable for menopause, stagnation of liver-qi, deficiency of liver-yin, stagnation of qi to turn into heat, heat disturbing the mind, clearing the orifices and losing nutrition. Symptoms include insomnia, excessive sweating, dizziness, irritability, hypochondriac pain, abdominal distension, anorexia, dry and sticky stool, red tongue, thin and greasy fur, and thready pulse, which are manifested as liver-spleen imbalance and liver-heart heat. The treatment of Xiangsha Liujunzi Decoction aims at strengthening the spleen and soothing the liver, clearing away the heart and calming the nerves, and strengthening the exterior and stopping sweating. In this case, people with spleen deficiency tend to use Xiangsha Liujunzi decoction, such as Bupleurum, Cyperus rotundus and Yujin. To strengthen the spleen, soothe the liver and relieve depression. Li Zhenhua emphasized that the treatment in recovery period should be properly controlled, and premature use of Xiaoyao Powder will aggravate the condition, which is related to early use of Gui and Shao and other negative drugs to nourish yin and astringe dampness. In addition, Li Zhenhua emphasized the importance of emotional regulation.
Case 2 Depression (Liver Depression and Phlegm Obstruction)
Cui, female, 32 years old. 20 13 First visit in September.
In the past year, due to marital problems, patients were often in a state of anger and depression for a long time, with less menstrual flow, dysmenorrhea, dark blood clots, premenstrual pain and so on. Then there is anxiety and irritability, insomnia and dreaminess, dizziness and memory decline gradually, bitter mouth and dry mouth, and then it develops into fear, world-weariness and unaccustomed to anything. Parents keep telling the truth, but they shouldn't accept it, which leads to quarrels. Even emotional impatience, can no longer work with peace of mind. Especially in recent months, from being world-weary to wanting to commit suicide and dying on earth, western medicine has been treating depression in mental hospitals, and it has not been fully effective. After leaving the hospital, he committed suicide by taking a lot of sleeping pills. After being discovered, he was sent to the hospital for gastric lavage and recovered. But the idea of suicide is still endless. I tried to cut my wrist with a knife for the second time, but fortunately I was found to have taken it out, and it didn't work. The idea of suicide still haunts me. I feel that there is no point in living, and I am afraid that the disease can't be cured. Repeatedly advised by parents and relatives to seek medical treatment. In addition to the above symptoms, we can also see that the patient's face is yellow and thin, his mood is depressed, his eyes are dull, he doesn't think about diet, and he is sleepy and weak. The tongue coating is thin, greasy and yellowish, the tongue body is fat, the tongue quality is slightly light, and the pulse string is thin.
Diagnosis: Depression (stagnation of the liver and phlegm).
Treatment: soothing the liver and regulating qi, clearing away heart fire and resolving phlegm.
Prescription: Self-made Qingxin Huatan Decoction. Atractylodes macrocephala 10g, Poria cocos 10g, Fructus Aurantii 10g, Rhizoma Pinelliae 10g, Rhizoma Cyperi 10g, Radix Curcumae 10g, Rhizoma Acori Graminei 10g, and fried Fructus Gardeniae. Polygonum multiflorum Thunb. 30g, Cortex Albizziae18g, Fructus Amomi10g, Jiao Sanxian each10g, Rhizoma Anemarrhenae12g and Radix Glycyrrhizae 3g. 3 grams of amber, 0.5 grams of cinnabar/kloc-,and * * * is fine powder for oral administration. 20 doses, decoction, daily 1 dose.
During another diagnosis and treatment, Li Zhenhua patiently enlightened the patient, and must not entertain foolish ideas.
Second diagnosis (20 13 10): after persuasion, the patient gradually became cheerful, talked with others, was able to smile, stopped contradicting his parents, and said that he would repent. Symptoms such as sleep, irritability and dizziness have also been significantly reduced, appetite has increased, and mental outlook has been greatly improved. Remove cinnabar and Jiao Sanxian from above, add peach kernel 10g, safflower 10g and salvia miltiorrhiza 15g, and then take 20 doses. In the suggestion, he praised the patient for his quick thinking, broad mind and rapid progress. The patient began to cry in words and turned to joy.
Third visit (20 13 1 1 month): After taking the medicine for nearly a month, the patient was no longer irritable and could talk harmoniously with his family and colleagues and work normally. Insomnia, dreaminess, diet and menstruation are basically normal. Remove peach kernel and safflower, and add polygala tenuifolia 10g and jujube kernel 10g to help restore memory. After conditioning for more than a month, my condition has greatly improved.
According to Li Zhenhua's understanding of this disease, it is believed that its pathogenesis is not only related to spleen-qi deficiency, but also related to long-term mental discomfort, stagnation of liver qi, which turns into heat, so that the heart and liver are full of fire, and the liver loses the function of dispersing qi, which leads to phlegm-dampness stagnation, blinding the mind, leading to mental disorder and inability to make decisions. At the same time, if psychological problems are not solved, taking medicine can have short-term effects, but it is still possible to relapse. Therefore, Li Zhenhua believes that in the treatment of this disease, the correct medication and psychotherapy should be paid equal attention, and one of them should not be underestimated.
The patient in this case failed to solve the problem correctly because of marriage and other problems, and suffered from * * * syndrome for a long time, with anxiety, impatience, depression and anger, insomnia and dreaminess, dizziness and memory gradually declining, bitter taste and dry mouth, and then developed into paranoid fantasy, fear, world-weariness, suicidal behavior and other mental symptoms. Its pathogenesis is that patients worry and think too much, thinking hurts the spleen, spleen loses health, dampness and turbidity are endogenous, soil is depressed, liver is out of order, cremation is phlegm, phlegm fire overflows, disturbing the mind, uneasy mind and uneasy soul. Irregular menstruation and loss of appetite are all syndromes of spleen deficiency and liver depression, and phlegm-fire disturbs the mind. The treatment was modified by Li Zhenhua's self-made Qingxin Huatan Decoction. Yujin and Acorus calamus wake up; Stir-fried Gardenia, Lotus plumule and Anemarrhena rhizome; Foeniculum vulgare, Cyperus rotundus and Lindera root soothe the liver and regulate qi, and promote qi to relieve depression; Dragon's teeth, Polygonum Multiflori Radix and Cortex Albizziae are used for tranquilizing; Amomum cardamom and Jiao Sanxian regulate dampness and stomach, promote digestion and eliminate accumulation; Glycyrrhiza uralensis Fisch blends various drugs; Also use amber and cinnabar in the ore to soothe the nerves. The compatibility of the whole prescription makes the spleen healthy, the liver and wood can not be used, the liver and qi are relaxed, the phlegm is clear, the mind is clear, and it is cured.