大黄及其有效成分治疗躁狂症的研究进展

Research Progress on Rhubarb and Its Active Ingredients in the Treatment of Mania

摘要: 躁狂症是双相情感障碍的主要临床表现，属中医“狂证”范畴，其核心病机为“痰火扰心、肝火上炎”。大黄作为一味具有泻下攻积、清热泻火、逐瘀通经功效的传统中药，在治疗狂证方面历史悠久且疗效确切。现代研究表明，大黄中的蒽醌类成分(如大黄素、大黄酸等)是其发挥药理活性的核心物质，可通过调节神经递质、抑制神经炎症、保护神经细胞及调节肠道菌群等多途径发挥作用。动物实验和临床研究显示，单味大黄、含大黄的经典复方(如承气汤类方)以及中西医结合方案，在改善躁狂症状(降低BRMS/Y-MRS评分)方面展现出良好效果，且安全性较高。文中系统综述了大黄治疗躁狂症的理论基础、有效成分、实验研究与临床进展，并指出当前研究在作用机制、临床循证及制剂开发方面的不足，展望未来应深化机制探索、开展高质量临床研究、创新药物研发，以推动其临床应用与发展。

Abstract: Mania, a core manifestation of bipolar disorder, belongs to the category of “mania syndrome” in Traditional Chinese Medicine (TCM), with its key pathogenesis being “phlegm-fire harassing the heart and liver fire flaming upward”. Rhubarb, a traditional Chinese herb with the effects of purging accumulation, clearing heat, and removing blood stasis, has a long history and proven efficacy in treating mania. Modern research indicates that anthraquinones (such as emodin, rhein, etc.) are the core active components of rhubarb, exerting pharmacological effects through multiple pathways including regulating neurotransmitters, inhibiting neuroinflammation, protecting nerve cells, and modulating gut microbiota. Animal experiments and clinical studies have shown that single rhubarb, classic formulations containing rhubarb (such as Chengqi Decoction types), and integrated Chinese-Western medicine regimens demonstrate good effects in improving manic symptoms (reducing BRMS/Y-MRS scores) with high safety. This article systematically reviews the theoretical basis, active ingredients, experimental research, and clinical progress of rhubarb in treating mania, points out the current shortcomings in the mechanism of action, clinical evidence-based medicine, and preparation development, and proposes future research directions to deepen mechanistic exploration, conduct high-quality clinical research, and innovate drug development to promote its clinical application and development.