基于“一气周流”理论探讨功能性便秘伴焦虑抑郁的病机与治疗

Exploring the Pathogenesis and Treatment of Functional Constipation with Anxiety and Depression Based on the “Yiqi Circulation” Theory

摘要: 功能性便秘(functional constipation, FC)患者通常出现焦虑抑郁等情绪障碍问题，且二者相互影响。西医治疗主要目的为缓解症状，有一定效果的同时也伴随着一定的副作用。与之相比，中医在治疗FC伴焦虑抑郁方面有一定的优势。“一气周流”理论为清代医家黄元御学术思想的总结概括，其系统阐述了人体生命活动与疾病发生的基本原理。“土枢四象”为其理论核心，即脾胃为气机升降之枢纽，脾胃之气升降，引起全身气机的升降。根据该理论，FC伴焦虑抑郁的核心病机为中土升降失职、清浊不归，进而导致肝肺气郁、心肾不交等四维病变，从而导致该疾病的发生与加重。故治疗上应以培补中气为本，针对不同病机再配以疏肝降肺，和济水火等方法，以复气机升降。通过“一气周流”理论探讨FC伴焦虑抑郁的病机与治疗，是中医学重视气机升降整体观的充分体现，以期为临床诊治该疾病提供一定的思路。

Abstract: Patients with functional constipation often experience emotional disorders such as anxiety and depression, and these conditions mutually influence each other. Western medicine primarily aims to alleviate symptoms, and while it shows some efficacy, it is also accompanied by certain side effects. In contrast, traditional Chinese medicine exhibits certain advantages in treating FC accompanied by anxiety and depression. The “Yiqi circulation” is a summary of the academic philosophy of Huang Yuanyu, a Qing Dynasty physician. It systematically elaborates on the fundamental principles of human life activities and the pathogenesis of diseases. The core of this theory is “Earth Pivoting the Four Phases”, which posits that the spleen and stomach serve as the pivotal axis for the ascent and descent of Qi. The movement of spleen and stomach Qi governs the overall circulation of Qi throughout the body. According to this theory, the core pathogenesis of FC with anxiety and depression lies in the dysfunction of the central earth (spleen and stomach) in regulating Qi movement, leading to the disruption of clear and turbid Qi. This, in turn, causes stagnation of liver and lung Qi, as well as disharmony between the heart and kidney—collectively referred to as “four-dimensional disorders”—which contributes to the onset and exacerbation of the disease. Therefore, the treatment should focus on reinforcing central Qi as the foundation, supplemented by methods such as soothing the liver, descending lung Qi, and harmonizing the interaction between water (kidney) and fire (heart) to restore the normal ascent and descent of Qi. Exploring the pathogenesis and treatment of FC with anxiety and depression through the “Yiqi circulation” theory fully embodies TCM’s holistic perspective on Qi movement. This approach aims to provide clinical insights for the diagnosis and treatment of this condition.