中医杂志

基于中医学经典理论，结合现代医学对抑郁症躯体症状的认识，提出抑郁症“抑郁遏阳-五体失和-躯体表征”病机认识，认为情志抑郁首遏气机，致五脏阳气输布失常，引发筋骨失衡、筋肉拘急、经络阻滞、皮部失司，出现脊柱侧弯、疼痛、形体寒热异常等特征性躯体症状。针对病机，提出“察体定灶-疏郁通阳-五体共调”诊疗思路，通过四诊合参尤其是触诊定位病灶层次；遵循调体畅阳的治疗原则，采用柔性正骨手法以正筋骨枢纽，通阳气运行之路径；采用津沽推拿以舒筋散结，畅气血之流；采用浅刺法调脉通络，以复气机升降；采用拔罐疗法以透达皮部，启卫阳周流。通过外治法实现五体状态的整体调衡，使阳气布散正常，为抑郁症躯体症状的诊治提供理论指导。

Based on classical theories of traditional Chinese medicine(TCM) and integrated with modern medical understanding of somatic symptoms in depression, this paper proposes a pathogenesis model of "depressive constraint impeding yang-disharmony of the five body constituents-somatic manifestation". It is suggested that emotional depression first constrains the qi movement, leading to impaired distribution of yang qi among the five zang organs, which in turn causes imbalance of the bones and tendons, muscular tension, obstruction of the meridians, and dysfunction of the skin system. These processes manifest as characteristic somatic symptoms such as scoliosis, pain, and abnormal cold and heat of the body. In response to this pathogenesis, a therapeutic approach of "examining the body constituents to locate the lesion-relieving depression and unblocking yang-harmonizing the five body constituents" is proposed. The strategy emphasizes comprehensive syndrome differentiation with a focus on palpation to identify the depth and location of lesions. Following the principle of regulating the body and promoting the smooth flow of yang, flexible bone-setting manipulations are applied to realign skeletal balance and open yang pathways; tendon and bone massage is used to relax tendons, disperse nodules, and promote the circulation of qi and blood; shallow needling is employed to regulate the vessels and unblock the channels, restoring the ascending and descending of qi; and cupping therapy is performed to dredge the skin region and facilitate the circulation of defensive yang. Through these external therapies, an overall balance of the five body constituents is achieved, ensuring the proper dispersion of yang qi, and this may provide theoretical guidance for the diagnosis and treatment of somatic symptoms in depression.