基于“五运六气”与“肝肺气机”理论探讨论治女性更年期抑郁症

Discussion on the Treatment of Female Menopausal Depression Based on the Theories of “Five Circuits and Six Qi” as Well as “Liver-Lung Qi Movement”

摘要: 近年来女性更年期抑郁症发病率显著上升，其病机阐释多从肾虚肝郁立论，鲜有从“肺”脏及五运六气气化节律角度加以审视。本文提出以“肝肺气机”为核心轴枢，将五运六气的时间节律理论引入更年期抑郁症的辨证体系，探讨“金木交互失序”在情志病发病中的深层机理。文章从运气气化视角重审女性“七七”天癸竭之生理转折与岁运岁气之间的同构共振关系，揭示肝肺升降逆乱为更年期郁证的关键病机，并据此构建“辨天–辨病–辨体”三辨合参的临床思维模型，提出疏肝降肺、调畅气机之治法及相应方药思路，以期为更年期抑郁症的中医诊疗提供新的理论视角与实践路径。

Abstract: In recent years, the incidence of menopausal depression among women has risen markedly. Its pathogenesis is mostly interpreted from the perspective of kidney deficiency and liver stagnation, while few studies examine it from the lung viscera and the qi transformation rhythms of the five circuits and six qi. Centering on the “liver-lung qi movement” as the core pivot, this paper introduces the temporal rhythm theory of the five circuits and six qi into the syndrome differentiation system of menopausal depression, and explores the underlying mechanism of “disordered interaction between metal and wood” in the onset of emotional disorders. From the perspective of transport qi transformation, this article re-examines the isomorphic resonance relationship between women’s physiological transition of exhausted heavenly gui at the age of seven sevens and annual movements and annual qi, reveals that disordered ascent and descent of liver and lung qi serves as the key pathogenesis of menopausal depression, and accordingly constructs a clinical thinking model integrating three differentiations: differentiation of celestial qi, differentiation of disease, and differentiation of physical constitution. It also proposes the therapeutic method of soothing the liver and descending lung qi to regulate and unblock qi movement together with corresponding medicinal formula strategies, aiming to provide a novel theoretical perspective and practical approach for the traditional Chinese medical diagnosis and treatment of menopausal depression.