彭建 欧阳伟

[摘要]老年抑郁症发生率较高，加强对其的研究和防治势在必行。笔者在临床实践中发现，老年抑郁症以情绪低落、思维迟缓、主动性下降等表现为主，呈现一派阳气不足（阳虚）之候，辨证属于阴证、柔证。经过探析认为阳气不足是老年抑郁症发病的重要因素，结合临床症状、四逆散的应用、抗抑郁西药的不良反应3个方面，提出温补肾阳心阳治疗老年抑郁症的思路，并采取内外治结合方法进行临床治疗验证，尝试为治疗老年抑郁症提供新的思路与方法。

[关键词]抑郁症；中医药治疗；温补肾阳心阳；老年

[中图分类号] R249 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0154-03

[Abstract] The incidence rate of geriatric depression is high， and it is imperative to strengthen its research， prevention and treatment. In the author′s clinical practice， it has been found that geriatric depression is mainly characterized by depressed mood， slow thinking， and decreased initiative， and the symptom of a lack of yang （yang deficiency） is shown. The dialectical syndrome belongs to the negative and soft syndromes. After analysis， it is believed that the lack of yang is an important factor in the onset of geriatric depression. Combined with clinical symptoms， application of Sini Powder， and adverse reactions of anti-depression Western medicine， the concept of warming kidney-yang and heart-yang in the treatment of geriatric depression has been put forward. Also， the combined internal and external treatment is applied in clinical treatment verification， trying to provide new ideas and methods for the treatment of geriatric depression.

[Key words] Depression； Treatment with traditional Chinese medicine； Warming kidney-yang and heart-yang； Geriatric

老年抑郁症，是发生于老年人群（≥60岁），以显著而持久的心境低落为主要特点的一组特殊的抑郁相关症状群。我国老年性抑郁症发生率较高，作为老年期常见精神疾病之一，加强对其的研究和防治势在必行[1]。祖国医学虽未记载“抑郁”病名，但与之相关的病证有郁证、脏躁、梅核气、怔忡、不寐等，今人多按“郁证”诊治。该病以情绪抑郁为主要临床表现，临床治疗多责之于肝，无不以疏肝解郁为要。王玲等[2]认为肝主疏泄、调达情志，若气机调畅，则心情舒畅、五脏协调，反之则五脏失调。笔者在临床实践中发现，老年抑郁症以情绪低落、思维迟缓、主动性下降等表现为主，呈现一派阳气不足（阳虚）之候，临床采用温阳补阳的方法治疗有效，故尝试开展相关探析。

1老年人生理病理特点

中医学很早就非常重视人体的阳气，认为阳气是人体之根本，阳气是一切生命活动的原始动力，“阳主动，为一身动力之源”（《素问·宝命全形论》）。……