抑郁伴失眠患者中医证素的分布与组合规律分析

Analysis of the Distribution and Combination Patterns of TCM Syndromes in Patients with Depression and Insomnia

摘要: 目的：抑郁伴失眠是临床上常见的心身共病。证素辨证方法有助于超越传统辨证中证候名称繁多、标准不一的局限，从更深层次揭示其病机特征。然而，目前尚缺乏针对抑郁伴失眠证素分布与组合规律的系统性证据整合研究。为明确抑郁伴失眠患者的中医证素分布特征及常见组合规律，研究对该类患者的证素相关数据开展系统性分析。方法：采用证据整合研究方法，检索中国知网、万方、维普数据库中建库至2024年9月12日的相关文献。纳入标准包括研究对象为抑郁或失眠患者、涉及中医证素特征分析、具有标准化辨证依据等。运用证据整合方法分析其中医病位与病性证素的分布频率及组合规律。结果：最终纳入符合标准的文献32篇，累计涵盖抑郁伴失眠患者4586例。病位证素以心(89.2%)、肝(85.6%)、肾(52.1%)和脾(47.3%)为主；病性证素以气滞(81.5%)、火热(70.8%)、阴虚(65.4%)、血虚(58.9%)及痰(42.7%)为主。证素组合中，常见的二元组合为“肝–气滞”(支持度78.3%)与“心–阴虚”(支持度62.1%)；核心三元组合包括“肝–心–气滞”(支持度65.4%)和“肝–肾–阴虚”(支持度48.7%)。关联规则分析显示，肝与心同时出现时多伴气滞(置信度92.5%)，而阴虚多伴随火热出现(置信度88.2%)，体现出显著的关联性。结论：从中医病机角度看，抑郁伴失眠的本质可总结为“情志失调、脏腑失和、神机不安”。病位主要责之于肝与心，病性以气滞、火热及阴虚为主，证素组合呈现明显规律性，为该病的中医辨证规范及治疗策略制定提供了循证依据。

Abstract: Objective: Depression with insomnia is a common comorbid psychosomatic disorder in clinical practice. The syndrome element differentiation method helps to overcome the limitations of numerous and inconsistent syndrome names in traditional differentiation, revealing the pathogenesis characteristics at a deeper level. However, there is currently a lack of systematic evidence integration studies on the distribution and combination patterns of syndrome elements in depression with insomnia. This study aims to analyze the distribution characteristics of TCM syndromes and their combination patterns in patients with depression and insomnia. Methods: Using the method of evidence integration, relevant articles published from database inception to September 12, 2024, were systematically retrieved from the China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases. Included studies met criteria such as focusing on patients with depression or insomnia, involving analysis of TCM syndrome elements, and applying standardized syndrome differentiation. The distribution frequency and combination patterns of TCM disease location and nature syndrome elements were analyzed. Results: A total of 32 eligible studies were included, covering 4586 patients with depression and insomnia. The primary disease location syndrome elements were heart (89.2%), liver (85.6%), kidney (52.1%), and spleen (47.3%). The main disease nature syndrome elements included qi stagnation (81.5%), fire-heat (70.8%), yin deficiency (65.4%), blood deficiency (58.9%), and phlegm (42.7%). Common two-element combinations were “liver-qi stagnation” (support 78.3%) and “heart-yin deficiency” (support 62.1%). Core three-element combinations included “liver–heart–qi stagnation” (support 65.4%) and “liver-kidney-yin deficiency” (support 48.7%). Association rule analysis indicated that when the liver and heart appeared together, qi stagnation was frequently present (confidence 92.5%), and yin deficiency was often accompanied by fire-heat (confidence 88.2%), revealing significant correlations. Conclusion: The core pathogenesis of depression with insomnia in TCM can be summarized as “disorder of emotions, disharmony of viscera, and restlessness of the spirit,” with the main disease locations being the liver and heart, and the main disease natures being qi stagnation, fire-heat, and yin deficiency. The syndrome element combinations show clear regularity, providing evidence-based support for the standardization of TCM differentiation and the formulation of treatment strategies for this disease.