基于“肝体阴而用阳”理论自拟枣仁地黄汤 治疗抑郁症医案一则

Treatment of Depression with Self-Modified Zao Ren Di Huang Tang Based on the Theory of “Liver Storing Yin in Substance and Displaying Yang in Function”: A Case Report

摘要: 抑郁症临床常见虚实证候并存，单纯疏肝解郁法治疗部分虚证患者难以奏效。本文基于“肝体阴而用阳”理论，提出慢性抑郁症中存在“肝阴阳两虚”的重要病机类型，即肝体阴血不足与肝阳升发无力并存。据此自拟枣仁地黄汤，方中以酸枣仁、熟地黄为君药，酸枣仁养肝血、安神魂，熟地黄滋肾水、补肝体；臣以山萸肉、枸杞子助君药滋补肝阴，肉桂、川芎温助肝阳；佐以浮小麦、柏子仁、五味子养心安神，茯苓、山药顾护中焦。通过一则典型医案验证，服药7剂后睡眠改善，14剂后情绪平稳，1个月后HAMD由20分降至6分，随访3个月未复发。提示从肝阴阳两虚辨治抑郁症，以补为通、阴阳互济，可为临床提供新思路。

Abstract: Depression often presents with concurrent deficiency and excess patterns. Simple liver-qi stagnation relief methods are often ineffective in patients with deficiency patterns. Based on the theory of “liver storing yin in substance and displaying yang in function”, this paper proposes that chronic depression involves an important pattern of “liver yin and yang deficiency”, i.e., concurrent deficiency of liver yin-blood and failure of liver yang to ascend and disperse. Accordingly, the self-modified Zao Ren Di Huang Tang was formulated, with Suanzaoren (Ziziphi Spinosae Semen) and Shudihuang (Rehmanniae Radix Praeparata) as sovereign herbs: the former nourishes liver blood and calms the spirit, the latter enriches kidney water and supplements liver substance. Shanyurou (Corni Fructus) and Gouqizi (Lycii Fructus) serve as ministerial herbs to assist in nourishing liver yin, while Rougui (Cinnamomi Cortex) and Chuanxiong (Chuanxiong Rhizoma) warm and assist liver yang. Fuxiaomai (Tritici Levis Fructus), Baiziren (Platycladi Semen) and Wuweizi (Schisandrae Chinensis Fructus) are adjuvant herbs to nourish the heart and calm the mind, and Fuling (Poria) and Shanyao (Dioscoreae Rhizoma) protect the middle jiao. A typical case report showed that after 7 doses, sleep improved; after 14 doses, mood stabilized; and after one month, the HAMD score decreased from 20 to 6, with no recurrence during a 3‑month follow‑up. This approach suggests that treating depression from the perspective of liver yin and yang deficiency, supplementing to promote free flow and harmonizing yin and yang, may provide a new clinical strategy.