基于“土壅木郁”理论辨治功能性便秘伴 焦虑、抑郁状态

Treatment of Functional Constipation Complicated with Anxiety and Depression Based on the Theory of “Earth-Obstructing and Wood-Stagnation”

摘要: 功能性便秘(FC)患者常伴随精神心理异常，其中焦虑、抑郁障碍的发生率显著高于健康人群。目前，该病发病机制尚未完全阐明，临床治疗多存在副作用显著、远期疗效不理想等问题。“土壅木郁”理论源于中医经典五行学说，核心旨在阐明脾土运化失健、中焦气机壅遏，进而反侮肝木，导致肝失疏泄、条达不畅的病理演变过程。这一理论与FC患者焦虑、抑郁的形成过程相契合：脾虚不运、土气壅滞是病程发展的始动因素，枢机不通、木郁不达而情志失调为其演变结局。临床上可依据“木郁”的阶段变化特点将功能性便秘合并焦虑抑郁状态划分为三个不同时期，由此总结出健脾理气通腑、疏肝泻火导滞、养血润肠的对应治法，以期为临床同道提供参考。

Abstract: Patients with functional constipation (FC) are frequently accompanied by mental and psychological abnormalities, among which the incidence rates of anxiety and depressive disorders are significantly higher than those in healthy individuals. At present, the pathogenesis of this disease has not been fully elucidated, and clinical treatments are mostly associated with problems such as significant side effects and unsatisfactory long-term efficacy. The theory of “Earth-obstructing and wood-stagnation” is derived from the classic Five Elements Theory in traditional Chinese medicine, whose core is to clarify the pathological evolution process in which the dysfunction of the spleen (corresponding to Earth) in transportation and transformation leads to the stagnation of qi in the middle energizer, which in turn counteracts the liver (corresponding to Wood), resulting in the failure of the liver to disperse and regulate qi smoothly. This theory is consistent with the development process of anxiety and depression in FC patients: spleen deficiency with impaired transportation and stagnation of Earth qi serve as the initiating factors in the progression of the disease, while blocked qi movement and constrained Wood qi lead to emotional disorders as the ultimate outcomes of its evolution. Clinically, FC complicated with anxiety and depression can be divided into three distinct stages according to the characteristics of qi constraint in the liver during different phases, and corresponding therapeutic methods including invigorating the spleen, regulating qi and unblocking the fu organs, soothing the liver, purging fire and relieving stagnation, as well as nourishing yin, calming the blood and moistening the intestines are summarized accordingly, so as to provide a reference for clinical practitioners.