吴节教授从湿论治郁证经验——基于半夏厚朴汤治疗脾虚夹湿型郁证

Professor Wu Jie’s Experience in Treating Yu Syndrome by Eliminating Dampness—Based on Banxia Houpu Decoction for Spleen-Deficiency with Dampness-Type Depression Type Yu Syndrome

摘要: 目的：总结吴节教授从湿论治脾虚夹湿型郁证的临床经验，为该证型郁证的中医辨证施治提供新思路与参考依据。方法：基于四川盆地多雨潮湿的地域特点及人群痰湿质的体质特征，梳理吴节教授提出的“湿邪困阻脾胃、气机不畅”为郁证核心病机的理论观点；以《金匮要略》半夏厚朴汤为主方，结合1例少年郁证三诊典型病案，分析其辨证思路、用药规律及临证加减技巧。结果：针对脾虚夹湿型郁证，吴节教授以半夏厚朴汤为基础，注重健脾祛湿与理气解郁并举，通过三诊辨证调方，患者症状明显改善，体现了从湿论治该证型郁证的有效性。讨论：传统郁证治疗多侧重疏肝理气、养心安神，而吴节教授从湿邪困脾、气机失调角度切入，兼顾虚实夹杂的证候特点，丰富了郁证的中医辨治体系，对临床诊治脾虚夹湿型郁证具有重要的指导价值。

Abstract: Objective: To summarize Professor WU Jie’s clinical experience in treating depression of spleen-deficiency with dampness type from the perspective of dampness elimination, and to provide new ideas and reference basis for the syndrome differentiation and treatment of this type of depression in traditional Chinese medicine (TCM). Methods: Based on the rainy and humid geographical characteristics of the Sichuan Basin and the phlegm-dampness constitution of the local population, this study sorted out the theoretical viewpoint proposed by Professor Wu Jie that “dampness pathogen obstructing the spleen and stomach, leading to unsmooth flow of qi” is the core pathogenesis of depression. Taking Banxia Houpu Decoction recorded in Synopsis of the Golden Chamber as the main prescription, combined with a typical three-visit medical case of adolescent depression, the syndrome differentiation thinking, medication rules and clinical modification skills were analyzed. Results: For depression of spleen-deficiency with dampness type, Professor WU Jie took Banxia Houpu Decoction as the foundation, focused on the combination of invigorating the spleen for eliminating dampness and regulating qi for relieving stagnation. Through syndrome differentiation and prescription adjustment in three visits, the patient’s symptoms were significantly improved, which reflected the effectiveness of treating this type of depression from the perspective of dampness elimination. Discussion: Traditional treatment of depression mostly focuses on soothing the liver to regulate qi and nourishing the heart to tranquilize the mind. However, Professor WU Jie starts from the perspective of dampness pathogen invading the spleen and qi movement disorder, taking into account the syndrome characteristics of intermingled deficiency and excess, which enriches the TCM syndrome differentiation and treatment system of depression and has important guiding value for clinical diagnosis and treatment of depression of spleen-deficiency with dampness type.