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Yuhang Qi Gong Ping
Clinical depression is recognized as a pervasive mood disorder characterized by persistent low mood and loss of interest, with severe cases posing a risk of self-harm or suicide. It is one of the most serious and pervasive mental illnesses and has become a leading cause of disability worldwide. The World Health Organization predicts that by 2030, depression could become the leading cause of global disease burden［1］. Current mainstream treatments for depression are largely based on the monoamine deficiency hypothesis, which suggests that the onset of depression is related to the deficiency or reduced activity of one or several neurotransmitters in the brain, such as serotonin, norepinephrine, and dopamine［2］. However, considering the brain’s complexity with over a hundred neurotransmitters and billions of neuronal connections, this hypothesis seems overly simplistic. Therefore, traditional antidepressants targeting single molecules have limited effects and are insufficient to fully address the complexity of depression.
In Traditional Chinese Medicine (TCM), depression is referred to as “Yu Syndrome.” TCM has a long history of treating depression with unique advantages. Due to its significant clinical efficacy, lower side effects, and higher compliance, it is widely used in clinical settings. Although TCM does not have a specific term for depression, many records related to it exist, with different names given based on clinical manifestations, such as “Bai He Bing,” (Lily Disease) “Dian Bing,” (Mania Disease) “Zang Zao,” (Restless Organ) “Mei He Qi,”(Plum Pit Qi) and “Ben Tun,” (Running Piglet) all falling within the scope of depression［3,4］. Huang Di Nei Jing describes “Five Stagnations” caused by imbalances in the five elements. Su Wen · Liu Yuan Zhi Ji Da Lun chapter records: “［If there is］ wood stagnation send it, fire stagnation emit it, earth stagnation remove it, metal stagnation drain it, water stagnation break it; then regulate its Qi, if it is excessive break it with ［the phase］ that it fears, that is called draining it［５］.” Zhu Danxi of the Yuan dynasty first proposed the concept of “Six Stagnations,” suggesting in Dan Xi Xin Fa on Six Stagnations that harmony within qi and blood prevents all diseases, and any stagnation leads to various illnesses, thus, many diseases arise from stagnation［６］. Yi Xue Zheng Zhuan states, “The so-called Six Stagnations are qi, dampness, heat, phlegm, blood, and food［７］.” Additionally, Zhang Jingyue of the Ming dynasty introduced “Three Stagnations” in his Jing Yue Quan Shu· Yin Shi Men, namely anger stagnation, pondering stagnation, and sorrow stagnation, which clinically resemble the main manifestations of depression closely［８］. Zhang further detailed how anger damages the liver, leading to failure in spreading and draining, causing liver wood to oppress the spleen earth, resulting in spleen deficiency and consequently affecting the heart, kidneys, and other organs.
The clinical manifestations of depression involve both mental and physical symptoms. Mental symptoms include unrest, depressed mood, disappointment, loss of interest, sighing, easy sadness, sleep disorders, anxiety, sluggish thinking, lethargy, emotional instability, and loss of work and social abilities, sometimes leading to suicidal thoughts. Physical symptoms include frequent headaches, dizziness, chest tightness, palpitations, shortness of breath, loss of appetite, nausea, plum pit qi, and more. In women, more gynecologic issues are often observed. The high incidence and severity of depression in modern society, leading to a high suicide rate, are closely related to the stress and pressure of daily work and life. Stress and pressure are the primary causes of liver qi stagnation, which is a common initial stage of depression. In summary, depression has become a serious disease affecting human health in modern society, causing significant harm to patients and their families.
In recent years, due to the continuous development of TCM, the treatment of depression with acupuncture and herbal medicine has gained widespread recognition for its efficacy, safety, and acceptability to patients. In the clinical practice of TCM treatment for depression, a comprehensive plan is formulated through individualized diagnosis to adjust the patient’s organ functions and restore internal balance. Here is an analysis of three typical clinical cases:
Case 1:
A 37-year-old unmarried white female presented with difficulty falling asleep, low mood, unprovoked anger, loss of interest in things, and a feeling of extreme loneliness, with occasional suicidal thoughts, 8 months after a breakup due to occupational stress. Diagnosed with severe depressive disorder by Western medicine, she was prescribed fluoxetine, which provided temporary relief but was discontinued due to side effects, leading to a recurrence of symptoms. Therefore, the patient explored natural medicine. No family history of depression was reported. Symptoms at consultation included lack of energy, slow actions, difficulty communicating, low mood, insomnia, chest pain, irritability, dry mouth, constipation, menstrual issues, breast tenderness, dark red tongue with a yellow coating, and a slippery rapid pulse.
TCM diagnosis was liver qi stagnation transforming into fire, and the treatment applied was clearing heat and moving the liver qi. Acupuncture was performed on LR-3 (Tai Chong), SP-6 (San Yin Jiao), LR-14 (Qi Men), HT-7 (Shen Men), LI-4 (He Gu), PC-6 (Nei Guan), N-HN-54 (Anmian), and M-HN-3 (Yintang) points using 0.25mm x 40mm needles. After local disinfection, the needles were quickly inserted using the tapping method and manipulated until the patient felt the de qi sensation. An electroacupuncture device connected LR-3 with SP-6 and LI-4 with HT-7, setting the frequency to 2Hz and adjusting the electric current intensity based on the patient’s tolerance. Each treatment lasted 25 minutes, twice a week.
Herbal treatment used concentrated herbal powder based on modified Dan Zhi Xiao Yao Tang and Zhi Zi Chi Tang composed of Chai Hu 12g, Zhi Zi 9g, Mu Dan Pi 9g, Dou Chi 9g, Bai Shao 15g, Yu Jin 9g, Xiang Fu 9g, Qing Pi 9g, Huang Bai 9g, Huang Lian 9g, Ge Gen 9g, Chao Zao Ren 15g, Zhen Zhu Mu 15g. The patient took 8g twice daily, morning and evening. Additionally, 15 minutes of mindfulness meditation daily［9］and supplementation with essential fatty acids (Omega-3) and creatine were recommended［10,11］.
After three treatments, the patient reported being able to fall asleep quickly at night, with significant improvement in the mentioned symptoms and almost normal sleep patterns, a more pleasant mood, and significantly reduced irritability. After six treatments, the symptoms were essentially gone. Nine consolidation treatments were conducted, and the patient remained in good condition without discomfort.
This case illustrates the effectiveness of combining acupuncture and herbal medicine in treating depression with almost no adverse reactions. TCM theory considers emotional injury as one of the main causes of depression. Prolonged worry and mental tension can disrupt the liver’s ability to regulate qi, leading to stagnation and, ultimately, depression and liver fire harming the heart and kidneys. Therefore, acupuncture primarily targets points along the heart, liver, and kidney meridians. Herbal treatments focus on clearing heat and cooling the liver. Combined with modern research, numerous articles published in authoritative journals indicate that mindfulness meditation, essential fatty acid, and creatine supplementation can effectively improve symptoms of depression.
Case 2:
A 36-year-old Eurasian male, single, with a family history of mental illness and family upheavals since childhood, suffered from depression and anxiety starting in high school, which worsened with work stress, leading to several panic attacks characterized by a sensation of burning, palpitations, sweating, chest tightness, and difficulty breathing, necessitating emergency room visits. The patient typically felt low, avoided social interactions, was irritable, had fluctuating sleep quality with nightmares, felt sad upon waking, and was reluctant to go to work, with reasonable appetite but post-meal discomfort and slow digestion, sometimes experiencing nausea and general muscle tension. The patient looked downcast, had lackluster eyes, and hesitated in conversation, darkish tongue with a yellow coating and a wiry thin pulse. Despite years of antidepressant medication and regular sessions with a psychologist, along with extensive physical exercise to alleviate anxiety, the results were unstable. TCM diagnosed him with liver qi stagnation transforming into heat and heart blood deficiency. As the patient feared acupuncture, the treatment focused on herbal medicine and Tuina therapy.
The herbal formula consisted of concentrated herbal powder with Chai Hu 9g, Bai Shao 12g, Dang Gui 12g, Zhi Ke 9g, Sheng Di Huang 12g, Zhi Zi 9g, Suan Zao Ren 12g, Yuan Zhi 12g, Fu Shen 12g, Dai Zhe Shi 12g, Fu Xiao Mai 15g, Gan Cao 9g., taken twice daily, 8g each time. After one week, re-evaluation showed improvement, with notably better sleep. However, slight nausea occurred after taking the medicine. Continued with the previous formula, doubled the dosage, added Ban Xia 9g, Sheng Jiang 6g, and followed the same method for two more weeks. At the third visit, the patient reported significant improvement, relaxed and stable mood, no panic or anxiety, better sleep duration and quality, and a willingness to interact and socialize. Requested to continue the treatment. In the second formula, Dai Zhe Shi was removed, He Huan Pi 15g was added, and the dosage was increased to a month’s supply. By the fourth visit, the patient felt very good and wished to continue with the third formula, totaling six months of medication.
Herbal formula analysis: Chai Hu, Bai Shao, Dang Gui, and Zhi Ke primarily softened the liver, dredged the liver, and regulated qi, aiming to relax the patient mentally; Sheng Di Huang, Zhi Zi, and Dai Zhe Shi cleared the liver heat, cooled the liver, aiming to eliminate irritability and calm the mind; Suan Zao Ren, Yuan Zhi, Fu Shen, and Fu Xiao Mai nourished the heart and spirit, aiding in sleep, to ensure the patient got adequate rest. The second consultation added Ban Xia and Sheng Jiang to harmonize the stomach and stop nausea; the fourth consultation removed Dai Zhe Shi, a mineral medicine that is heavy and can harm the spleen and stomach yang qi, replacing it with He Huan Pi to relieve liver stagnation and calm the spirit.
During taking Chinese herbs, continued with antidepressant medication and weekly Tuina therapy. The Tuina focused on the head, chest, and back, mainly pressing GV-20 (Bai Hui), GB-8 (Shang Xing), GV-24 (Shen Ting), GB-9 (Tai Yang), CV-17 (Shan Zhong), CV-15 (Jiu Wei), CV-17 (Dan Zhong), BL-15 (Xin Shu), LR-14 (Qi Men), GB-24 (Ri Yue), SP-21 (Da Bao) and other points. These acupoints helped relieve depression and anxiety.
Case 3:
A 54-year-old Asian male patient presented with a primary complaint of insomnia lasting more than five years, accompanied by a decline in mood and weight loss. Five years prior, conflicts at work led to anger and difficulties falling asleep at night, frequent awakenings, and reliance on non-prescription sleep aids for rest, which resulted in reduced sleep quality and frequent dreaming. The recurring episodes of insomnia worsened after a year, not only persisting but also accompanied by depressive moods, mental distress, excessive worry, and occasional disorientation, prompting consultation with Western medicine and a diagnosis of “depression”. The patient began treatment with two types of antidepressants, which slightly alleviated symptoms but caused side effects such as fatigue, particularly weakness in the lower limbs, dry mouth, loss of appetite, postprandial bloating, and significant weight loss, leading to seeking acupuncture and herbal medicine treatment. At the initial consultation, the patient appeared mentally exhausted, depressed, seemingly sorrowful, overly contemplative, doubting his health, leading to restless sleep and difficulty falling back asleep after waking, with a maximum of 3～4 hours of sleep per night, daytime lethargy, inability to concentrate, irritability, aversion to cold with cold limbs, poor appetite, bloating, loose stools, and frequent urination at night, up to 3～4 times. The tongue was pale red with a slightly greasy white coating, and the pulse was deep and slippery. TCM diagnosis identified Yu Zheng, with patterns of spleen and kidney yang deficiency and the heart/shen not being nourished. The treatment principle focused on warming and supplementing the spleen and kidneys, nourishing the heart, and calming the spirit. The treatment is as follows:
Acupuncture points: the nape line, GV-20 (Bai Hui), M-HN-1 (Si Shen Cong), M-HN-3 (Yin Tang), HT-7 (Shen Men), PC-6 (Nei Guan), CV-6 (Qi Hai), CV-12 (Zhong Wan), CV-10 (Xia Wan), ST-25 (Tian Shu), GB-24 (Ri Yue), LR-14 (Qi Men), SP-9 (Yin Ling Quan), ST-36 (Zu San Li), Feng Long, SP-6 (SanYin Jiao), KI-3 (Tai Xi). The procedure began with needling along the nape line, inserting the needles 0.5 cun deep, twisting and reinforcing for one minute before removal; next, bilateral PC-6 (Nei Guan) points were needled 0.5–0.8 cun deep, applying a twisting and reinforcing method for 30 seconds; then needling M-HN-3 (Yin Tang) obliquely towards the nasal root at 0.5 inches; M-HN-1 (Si Shen Cong) needles were directed towards GV-20 (Bai Hui), inserting 0.3 inches deep, until the patient felt a sensation of soreness and swollen. Other points used standard techniques, applying even reinforcing-reducing methods, with GB-24 (Ri Yue) and LR-14 (Qi Men), needled obliquely at 0.3–0.5 inches, retaining all needles for 20 minutes, including using electroacupuncture on SP-6 (SanYin Jiao) and KI-3 (Tai Xi) for the same duration. Additionally, the patient was advised to perform ginger moxibustion at the CV-8 (Shen Que, navel) three cones per session, once daily. Concurrently, herbal medicine combined Si Ni Tang and Gui Pi Tang with modifications, taken once in the morning and evening. After six treatments, the patient’s sleep improved, extending to 6–7 hours, with reduced nocturnal urination, a more pleasant mood, less anxiety, increased appetite, and significant alleviation of bloating. After 15 treatments, the patient felt significantly better overall, leading to a reduction in antidepressant medication without rebound symptoms. After 30 treatments, the patient gained 4 kilograms and discontinued treatment. The patient continued practicing Tai Chi and walking daily after treatment cessation. At a six-month follow-up, he reported good sleep quality, a pleasant mood, and no discomfort.
Case analysis: The patient’s distress led to liver qi stagnation and liver overacting on the spleen, damaging spleen qi, subsequently affecting the heart and kidneys, manifesting as insomnia, anxiety, and restlessness. According to the theory of the Five Elements, damage to one organ affects all, making the condition more complex due to years of illness. Spleen deficiency resulted in impaired transformation and transportation functions, poor appetite, bloating, loose stools, and weight loss, while liver stagnation consumed blood, and spleen deficiency failed to generate sufficient qi and blood, causing the spirit to be unnourished, leading to insomnia, excessive pondering, lack of concentration, and disorientation; long-term spleen deficiency caused spleen and kidney yang deficiency, weakening life gate fire, manifesting as the aversion to cold with cold limbs, and frequent nocturnal urination, among others. Acupuncture, moxibustion, and herbal treatments are all aimed to warm and supplement the spleen and kidney yang, enhancing the spleen’s functions, generating blood to nourish the spirit, and warming kidney yang to reduce nocturnal urination. The combination of acupuncture and herbal medicine addressed the root causes and achieved significant results, illustrating the effectiveness of integrating TCM principles in treating complex conditions like this patient’s insomnia and associated depressive symptoms.
Author information:
Qi Yuhang, L.Ac., LMT Qi Yuhang is an emerging star in the field of Traditional Chinese Medicine (TCM) in the US, currently serving as a researcher and instructor at the New York College of Health Professions. His research and teaching focus on utilizing TCM practices, such as acupuncture, to treat depression and drug addiction.
Ping Gong, L.Ac. Ping Gong is an emerging star in the field of Traditional Chinese Medicine (TCM) in the US, currently serving as a researcher and instructor at the New York College of Health Professions. His research and teaching focus on utilizing TCM practices, such as acupuncture, to treat depression and drug addiction.
參考文獻
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中醫治療憂鬱症的臨床經驗
戚宇航 龔萍
憂鬱症，作為一種廣泛見諸於臨床的情緒障礙疾病，主要表現為持續的情緒低落和興趣喪失，嚴重時甚至會有自傷或自殺的風險。憂鬱症被認定為是最嚴重的精神疾病之一，已成為全球致殘的首要原因。根據世界衛生組織的預測，到2030年，憂鬱症有可能成為引起全球疾病負擔最重的疾病［1］。目前，憂鬱症的主流治療方案基本上建立在單胺缺乏假說之上，該假說認為憂鬱症的發生與大腦中的某一種或多種神經傳導物質（如5-羥色胺、去甲腎上腺素和多巴胺）的缺乏或活動減弱有關［2］。然而，考慮到大腦中存在超過一百種神經傳導物質以及數十億個神經元之間的複雜聯繫，此種假設顯然過於簡單。因此，傳統上針對單一標靶的抗憂鬱藥物治療效果有限，遠不足以全面應對憂鬱症的複雜性。
憂鬱症，在中醫稱為“憂鬱症”。中醫在治療憂鬱症方面歷史悠久，具有獨特的優勢。由於其顯著的臨床療效、較低的副作用和較高的依從性，而被廣泛的用之於臨床。中醫雖然沒有憂鬱症的病名，但與其相關的記載卻有很多，依臨床表現不同而得不同的病名，如“百合病”，“癲病”，“臟躁”，“梅核氣”，“奔豚”等都屬於現今憂鬱症的範疇［3,4］。早在《黃帝內經》中就描述了因五行相生相剋不平衡導致的“五鬱”，《素問·六元正紀大論篇》中記載：“木鬱達之，火鬱發之，土鬱奪之，金鬱洩之，水鬱折之；然調其氣，過者折之，以其畏也，所謂瀉之［5］。”元代朱丹溪首倡導“六鬱”之說，在《丹溪心法·六鬱》中提出“氣血沖和，萬病不生，一有怫鬱，諸病生焉，故人身諸病，多生於鬱”的論點［6］。《醫學正傳》則指出：“夫所謂六鬱者，氣、濕、熱、痰、血、食六者是也［7］。”另外，明代張景岳在其《景岳全書·飲食門》中提出的“三鬱”，即怒鬱、思鬱、憂鬱，縱觀“三鬱”的臨床表現均與抑鬱症的主要臨床表現有較高的相似性［8］。張景岳進一步詳細指出怒氣傷肝之致肝失疏洩，肝木抑鬱之氣橫克脾土，導致脾虛，從而發展影響到心臟、腎等臟腑。
憂鬱症的臨床表現涉及精神和軀體，精神症狀包括：情緒不寧、精神抑鬱、失望沮喪、喪失興趣、長嘆息、易悲傷、睡眠障礙、焦慮煩躁、神思遲鈍、嗜臥少動，甚至情緒失控，喪失工作和社交能力，欲尋短見。軀體症狀則包括：常頭痛眩暈、胸脅脹悶、心慌氣短，食慾不振，噁心欲嘔、咽喉有阻塞感等等，女性患者會有更多生理功能的失調。結合現代社會之所以憂鬱症發生率高，症狀嚴重，導致自殺率高的現實情況，明顯與現代社會人們日常工作生活緊張，壓力大有密切關係。緊張和壓力是導致肝氣鬱結的主要原因，肝氣鬱結是憂鬱症最常見的初始。總之，憂鬱症已成為現代社會嚴重影響人類健康的疾病，會對患者及其家人造成巨大的傷害。
近年來由於中醫藥的不斷發展，針灸中藥治療抑鬱症，無論是從療效、安全性和可接受度方面都獲得了普遍的認可。在中醫治療憂鬱症的臨床實務中，透過個人化的診斷和綜合性的治療方案來全面調整患者的髒腑功能，恢復內在的平衡狀態。以下是三個較為典型的臨床病例分析：
病例1：
患者女性，白人，37歲，未婚。自述8個月前因職業壓力與伴侶分手後，出現入睡難、情緒低落、無故發怒、對事物興趣喪失伴隨極度孤獨感等問題，偶有自殺的念頭。西醫診斷為重度憂鬱症，服用氟西汀加以控制。 藥物初期帶來暫緩，但副作用導致間斷用藥，病情反覆。因此，患者探索自然療法。患者家族無憂鬱史。
就診時症狀：精神不振、行動緩慢、溝通困難、情緒低沉、失眠、胸痛、急躁、口乾舌燥、便秘及月經不調，乳房脹痛，舌質暗紅苔黃，脈滑數。
中醫為肝鬱化火，治以清熱疏肝。採用0.25mm×40mm的針灸針刺太沖、三陰交、期門、神門、合谷、內關、安眠、印堂等穴。穴位局部消毒後，使用彈針法快速刺入，並提插至得氣。使用電針儀，將太衝與三陰交，合谷與神門連接，設定頻率為2Hz，根據患者耐受度調節電流強度，每次治療持續25分鐘，每週兩次。
中藥治療採用濃縮中藥粉，以丹梔逍遙湯和梔子豉湯加減，具體藥材包括柴胡12克、梔子9克、牡丹皮9克、豆豉9克、白芍15克、鬱金9克 、香附9克、青皮9克、黃柏9克、黃連9克、葛根9克、炒棗仁15克和珍珠母15克。每日早晚服用兩次，每次服用8克。此外，建議患者在治療期間每天進行15分鐘的正念冥想［9］，並建議補充必需脂肪酸（Omega-3）和肌酸［10,11］。
經過3次治療後，患者表示夜間能快速入睡，上述症狀有明顯好轉，睡眠基本上恢復正常，情緒變得更加舒暢，易怒情緒明顯減輕。經過6次治療，上述症狀基本消失。之後進行了9次的鞏固治療，患者狀態良好，沒有不適。
解析：對該患者而言，針灸和中藥結合治療憂鬱顯效，幾乎沒有不良反應。中醫理論認為，情誌內傷是導致憂鬱症的主要原因之一。長期的憂愁思慮和精神緊張會使肝氣失去調達，導致氣機鬱滯，進而形成氣鬱，氣鬱轉火，損及心腎。因此，針灸治療主要選取心經、肝經、腎經的穴位。中藥治療則以清熱涼肝為主。同時，結合現代研究，多項發表在權威性期刊的文章表明，正念冥想以及補充必需脂肪酸和肌酸能有效改善憂鬱症症狀。
病例2：
患者男性，歐亞混血，36歲，單身。主訴：憂鬱，焦慮。患者有家族史，加之家庭變故，自幼跟隨單親母親。高中時起患有憂鬱，焦慮，工作後因壓力大，病情逐漸加重，出現過幾次恐慌發作。發作時全身灼熱，心慌，出汗，感覺胸悶，吸氣困難，為此幾次進急診室。患者平時情緒低落，不喜社交，煩躁易怒，睡眠時好時壞，時做噩夢，早上起床常覺悲傷，不願去上班，食慾尚可，但餐後不適，消化慢，有時噁心，全身肌肉緊張。患者看起來情緒不佳，兩眼無神，對話猶豫，舌質暗淡伴隨黃苔，脈象弦細。患者服用抗憂鬱藥物多年，定時看心理醫生，花費大量時間鍛鍊身體，試圖透過運動緩解焦慮，如此種種收效不穩。中醫辨證屬典型的肝鬱氣滯化熱，心血不足。因患者恐懼針灸，選擇中藥及推拿治療。
中藥治療如下：採用濃縮中藥粉：柴胡9克，白芍12克，當歸12克，枳殼9克，生地黃12克，梔子9克，酸棗仁12克，遠志12克，茯神12克，代赭石12克，浮小麥15克，甘草9克。每日早晚服用兩次，每次服用8克。一週後復診，自覺似有改善，睡眠較前明顯改善。但服藥後略有噁心，續用前方，量加倍，新增半夏9克，生薑6克，服藥同前服用二週。三診，患者報告明顯好轉，情緒放鬆穩定，未出現恐慌焦慮，睡眠時間和品質較好，有意願與人交流，社交。要求繼續服用。二診方去代赭石，加合歡皮15公克，增加劑量至一個月。四診，患者感覺非常好，希望繼續服用三診方，總共服藥六個月。
藥效分析：用柴胡，白芍，當歸，枳殼主要柔肝，疏肝，理氣，目的是讓患者從精神上放鬆；生地黃，梔子，代赭石清肝熱，涼肝平肝，目的是消除病人的煩躁易怒情緒，使其心境平和；酸棗仁，遠志，茯神，浮小麥可以養心神，助睡眠，目的是讓病人得到充分睡眠休息。二診增加半夏，生薑是和胃止噁心；四診去代赭石，因其為礦物藥，性質較重，易傷脾胃陽氣，換合歡皮亦能解肝鬱，寧心神。
服用中藥期間同時繼續服用抗憂鬱藥，堅持每週一次推拿治療。推拿集中頭部，前胸，後背，主要指壓百會，上星，神庭，太陽，神藏，彧中，膻中，心俞，厥陰俞，肝俞，膽俞，脾俞等。這些穴位均有助於緩解憂鬱，焦慮。
病例3：
患者男性，54歲，亞裔。主因失眠5年餘，加重伴隨情緒低落，體重減輕。5年前患者因工作與人發生矛盾，生氣出現夜間難以入睡，睡後易醒，自行服用非處方安眠藥後方可入睡，但睡眠品質大不如前，時常做夢。因失眠反覆發作，一年後病情明顯加重，除失眠外，出現情緒低落，精神煩悶，多思多慮，有時甚至精神恍惚，遂就診西醫，診斷為“抑鬱症”，開始服用兩種抗抑鬱藥。抗憂鬱藥物治療使症狀略有緩解，但副作用使其出現疲倦，尤其雙下肢乏力、口乾舌燥，食慾不振，食後腹脹，體重嚴重減少，遂尋求針灸中藥治療。初診：精神差，情緒低落，看似悲傷，思慮過度，懷疑自身健康出現嚴重問題，故而寢食不安，寐後易醒，醒後難以入睡，每晚最多睡3～4小時，白天精神不振，無法集中精力，煩躁，畏寒肢冷，納呆，胃脹，大便稀，夜尿頻，每晚3～4次排尿，舌質淡紅，舌苔白略膩，脈象沉滑。中醫辯證診斷為鬱病，證屬脾腎陽虛，心神失於榮養。治療原則：溫補脾腎，養心安神。治療如下：
針刺取穴：項枕線、百會、四神聰、印堂、神門、內關、氣海、中脘、下脘、天樞、日月、期門、陰陵泉、足三里、豐 隆、三陰交、太谿。操作過程：先針刺項枕線，進針0.5寸，捻轉補法1分鐘後起針；再針刺雙側內關穴，進針0.5～0.8寸，施捻轉提插補法30秒；繼針印堂，向鼻根方向斜刺0.5寸；四神聰，針尖向百會方向斜刺，進針0.3寸，患者自覺酸脹即可；其他穴採常規刺法，均施平補平瀉，日月、期門淺斜刺0.3～0.5，所有穴位留針20分鐘，其中三陰交、太谿使用電針連續緩波每次同留針時間。另囑患者自行神闕穴（即肚臍）隔姜灸，每次3壯，每日1次。同時佐以中藥四逆湯合歸脾湯加減，早晚各服1次。如此治療6次後，患者睡眠好轉，睡眠時間延長，可達6～7小時，夜尿次數減少，心情較舒暢，不再特別焦慮，食慾增加，胃脹明顯緩解。治療15次後，患者自覺各方面較前明顯改善，尊囑抗憂鬱藥物減量，減藥後患者無症狀反彈。治療30次後，患者體重增加4公斤，隨停止治療。停止治療後，患者堅持每日晨間練太極、散步。半年後隨訪，其睡眠良好，心情舒暢，未訴不適。
病例分析：此患者因精神不愉快，至肝氣鬱，肝克脾土，損及脾氣，進而傷及心腎，出現失眠，焦慮等心神不寧之症。根據五行生剋理論，五臟一損俱損，一榮俱榮，因遭遇多年病痛，致使病情變得較為複雜。因為脾虛水穀運化功能低下，病人納呆，胃脹，大便稀，體重減輕，同時肝鬱血耗，脾虛又不能生成足夠氣血，致心神失於榮養，所以出現失眠，思慮過度，注意力不集中，精神恍惚；長期脾虛導致脾腎陽虛，命門火衰，出現畏寒肢冷，夜尿頻繁，等等。針，灸，藥均溫補脾腎陽氣，加強脾的生化功能，脾生血，血養神；溫補腎陽，腎可固攝，夜尿減少。透過針灸和中藥結合從根本上的治療，收到明顯效果，顯示了中醫在治療這位患者的失眠及其相關憂鬱症狀複雜情況的有效性。
作者簡介:
戚宇航，紐約州執照針灸師，按摩師。戚宇航是美國中醫領域的後起之秀，目前在紐約健康學院擔任研究員和講師。他的研究和教學重點是利用中醫療法，如針灸，治療憂鬱症和藥物成癮。
龔萍，紐約州執照針灸師，龔萍是美國中醫領域的後起之秀，目前在紐約健康學院擔任研究員和講師。她的研究和教學重點是利用中醫療法，如針灸，治療憂鬱症和藥物成癮。
