从“肝主疏泄”论治焦虑抑郁症：方药与针灸临床研究进展述评

Treatment of Anxiety and Depression Based on the Theory of “The Liver Governs Free Coursing”: A Review of Clinical Research Advances in Herbal Formulas and Acupuncture

摘要: 焦虑抑郁症是临床常见的精神障碍性疾病，二者常共病存在，严重影响患者生活质量。中医学基于“肝主疏泄”理论，从肝论治焦虑抑郁症积累了丰富的临床经验。本文系统梳理近5年相关文献，从理论内涵、方药治疗、针灸干预及机制研究等方面，综述从肝论治焦虑抑郁症的临床研究进展。方药方面，以柴胡疏肝散、逍遥散、丹栀逍遥散、解郁丸等为代表的疏肝解郁类方剂显示出确切疗效；针灸方面，头针、腹针、耳穴、揿针等疗法在改善焦虑抑郁症状方面独具优势。现代研究表明，疏肝治法可通过调节单胺类神经递质、抑制炎症反应、调节下丘脑–垂体–肾上腺轴功能、改善脑肠轴功能等多途径发挥抗焦虑抑郁作用。当前研究仍存在辨证标准不统一、高质量循证证据不足等问题，未来应加强大样本随机对照研究，建立规范化诊疗体系。

Abstract: Anxiety and depression are common psychiatric disorders in clinical practice, often co-occurring and significantly impairing patients’ quality of life. Traditional Chinese Medicine (TCM), grounded in the theory of “the liver governs free coursing”, has accumulated extensive clinical experience in treating anxiety and depression from a liver-focused perspective. This review systematically summarizes relevant literature from the past five years, covering theoretical foundations, herbal formulae, acupuncture interventions, and mechanism studies related to liver-focused treatment approaches for anxiety and depression. Regarding herbal formulas, liver-regulating and depression-relieving formulas such as Chaihu Shugan San (Bupleurum Liver-Regulating Powder), Xiaoyao San (Free and Easy Wanderer Powder), Dan Zhi Xiaoyao San (Safflower and Gardenia Free and Easy Wanderer Powder), and Jieyu Wan (Depression-Relieving Pills) have demonstrated significant therapeutic efficacy. In acupuncture, therapies including scalp acupuncture, abdominal acupuncture, auricular acupuncture, and pressure acupuncture exhibit unique advantages in alleviating anxiety and depressive symptoms. Modern research indicates that liver-regulating therapies exert anti-anxiety and anti-depressant effects through multiple pathways, including modulating monoamine neurotransmitters, suppressing inflammatory responses, regulating hypothalamic-pituitary-adrenal axis function, and enhancing brain-gut axis function. Current research still faces challenges such as inconsistent diagnostic criteria and insufficient high-quality evidence-based data. Future efforts should focus on conducting large-scale randomized controlled trials and establishing standardized diagnostic and therapeutic systems.