The Theoretic And Clinical Research On The Therapy Of Chaihulonggumulitang To Cure Depression

ObjectiveScience and Civilization have brought prosperity and material comfort, but the ensuing tension and stress, resulting in complex mental disorders. Among these disorders, depression is the most harmful and troubled problem. Depression is a common affective disorder, with persistent low mood as the main feature. The main clinical manifestations are as follows:loss of interest in daily life, lenovo difficulties or ability decreased to think significantly; low self-evaluation, or remorse, or guilt; energy decreased significantly, no reason for the continuing sense of fatigue, recurrent thoughts of death or suicidal behavior; loss of appetite, or loss of weight significantly; awakening early or insomnia or hypersomnia; sexuality decreased significantly and so on. In the Chinese ancient literature, there is no record of the name of depression disease, but a variety of related terms are found such as "depression syndrome", "lily disease " and so on.Depression is vividly known as "cold heart". It means that depression like the common cold, is a common mood disorders.It has become the world's fourth largest disabling disease. The World Health Organization (WHO) predicted that by 2020, depression would be the second disabling disease only to ischemic heart disease. In 1998,for anxiety disorders, mood disorder, impulse-control disorders and drug dependence, the world mental health survey consortium (WMH) investigated prevalence, disease severity, functional damage and treatment conditions, etc. In 2004,14 countries had completed the survey, and 15 surveys were reported. The result showed the prevalence of mood disorders was between 0.8%～9.6%in these countries. Among these country, the United States was the highest, and Nigeria the lowest; It was 2.5% in China's Beijing and 1.7% in Shanghai.Depression is a major burden on the family, society, and the overall economy. Most outpatient with depression is in mild condition, to explore the fast and reliable therapy with fewer side effects is a core concern of the medical community. From the perspective of Chinese and Western medicine, This paper analysed the etiology, pathology, symptoms and the treatment of depression. Based on integration of the classical origins and modern clinical medicine, the paper systematically discussed the depression. This is the subject of theoretical support and a basis for clinical practice. Application of traditional Chinese medicine treatment and psychological therapy to improve immune function in mind are expected to be a breakthrough on the effect of the treatment of depression. To observe the effect of Chaihulonggumuli soup on patients with depression, and to explore the possible mechanism of the treatment of syndrome of Bupleurum Liver of the depression. By summarying the patient's clinical symptoms and syndromes, and analyzing the clinical data of the psychosomatic effects, we can detect and treat the patients with mild depression as early as possible, and overcome Two-way syndrome in disease due to Yu or Yu-induced illness. This can make effective reduction of the dependence on anti-anxiety drugs and its side effects, and achieve innovation objectives.MethodFrom September 2009 to February 2011, we selected 90 cases of patients diagnosed with depression, who received treatment in guangde Chinese medicine clinics in Taiwan. All of these patients were the liver depression syndrome, and were randomly divided into treatment group and control group, each 45 patients. Other drugs which affect the effect were prohibited to use on the patients, and natural therapy was given to make it through the atmosphere to ease emotional adjustment.The treatment group combination with Chaihulonggumuli soup (Bupleurum 12g, Scutellaria 10g, Pinellia 6g, Codonopsis 15g, Suanzaoren 30g, Cassia twig 10g, White peony root 12g, Licorice 6g, Acanthopanax 12g, keel 20g, Poria 12g, Cyperus-rotundus 10g, Salvia 10g, Morinda 12g, Oysters 20g. Addition and Subtraction:heavier depression plus Turmeric 20g, Albizia 30g, Polygala 10g; insomnia plus Caulis 30g, Albizia 30g; more than a dream plus Mother-of-pearl 30g, Floating wheat 30g, Lily 15g; stomach pain plus Villosum 6g, White-Syndromeamom 6g; poor appetite or low appetite plus Fried-Malt 30g, Coke-Hawthorn 10g; Flank pain plus Chuan-Dong-Son 15g, Corydalis 10g; dizziness or headache plus Tianma 15g, Chuanxiong 15g. Make the prescription into powder, and take one powder a time and 3 times a day, morning, noon and night each time).The control group combination with Xiaoyaosan (Angelica 10g,White peony root 20g,Bupleurum 15g, Poria 30g, Atractylodes 20g, Licorice 6g, Ginger 3slices, Mint 10g. Addition and Subtraction:heavier depression plus Turmeric 20g, Albizia 30g, Polygala 10g; insomnia plus Caulis 30g, Albizia 30g; more than a dream plus Mother-of-pearl 30g, Floating-wheat 30g, Lily 15g; stomach pain plus Villosum 6g, White-Syndromeamom 6g; poor appetite or low appetite plus Fried-Malt 30g, Coke-Hawthorn 10g; Flank pain plus Chuan-Dong-Son 15g, Corydalis 10g; dizziness or headache plus Tianma 15g, Chuanxiong 15g. Make the prescription into powder, take one powder a time and 3 times a day, morning, noon and night each time).After the treatment, the scores of HAMD scale and related factors, self symptom rating scale are recorded at lday,1 week,2weeks,3weeks,4weeks,8 weeks, and 12 weeks, adverse reactions are observed. Record patients'morbidity season, sex, occupation and other basic conditions and compare the effect between the treatment group and the control group. Observe the effect of Chaihulonggumuli soup and natural therapy on depression, and explore the possible mechanism of the treatment of TCM combination with emotional therapy.Results1. The syndrome of 90 cases were distributed as follows:26 cases of liver qi depression syndrome(27.8%),39 cases of syndrome of liver depression and spleen deficiency (44.4%),15 cases of syndrome of liver depression transforming into fire(16.7%),7 cases of syndrome of liver depression and phlegm obstruction(7.8%),3 cases of syndrome of liver depression and kidney deficiency(3.3%). Syndrome of liver depression and spleen deficiencygroup and liver qi depression syndromen group were the mian groups, the total number of the two groups was 65 cases(72.2%).2. The gender of the syndrome were distributed as follows:liver qi depression syndromen syndrome,male 10, female 16;Syndrome of liver depression and spleen deficiency,male 11, female 28;Syndrome of liver depression transforming into fire, male 5, female 10; Syndrome of liver depression and phlegm obstruction,male 4, female 3; Syndrome of liver depression and kidney deficiency,male 1, female 2. 3. The total number of incidence was 20 cases in spring, and 14 cases in summer,31 cases in fall,25 cases in winter. Autumn and winter were the high seasonal incidence of depression.4. The symptoms frequency of two groups of patients, in descending order as follows:depression appeared 90 times(100%); chest tightness (breathing difficultly) appeared 90 times(100%); Languid appeared 90 times (100%); insomnia (falling asleep difficultly) appeared 83 times (92%); more than a dream appeared 77 times (85%); waking up early or easy appeared 77 times (85%); gastrointestinal disorders (including bloating, abdominal distension, diarrhea, less appetite) appeared 73 times(81%); Anxiety and irritability appeared 61 times(68%); loss of interest appeared 56 times(62%); dizziness and body pain appeared 56 times (62%); Low attention (thinking slowly) appeared 51 times (57%); flank pain appeared 45 times (50%); sentimentality appeared 38 times (42%); sigh appeared 34 times (38%); spirit atrophy extravagant appeared 34 times (38%); memory decline appeared 31 times(34%).5. According to HAMD scale, the number of patients in descending order as follows:90 cases of depression,90 cases of somatic anxiety (hyperventilation, chest tightness),90 cases of languid,88 cases of ability decreased,89 cases of insight decreased,86 cases of hypochondria,83 cases of falling asleep difficultly(insomnia in early stage),77 cases of sleeping not deeply(insomnia in middle stage),77 cases of awakening early(insomnia in last stage),73 cases of gastrointestinal disease,61 cases of anxiety,89 cases of suspicion,50 cases of despair,42 cases of weight loss.6. The HAMD total score decreased in both groups(P<0.05), and the total score of treatment group decreased significantly than the control group's (P <0.05). After the treatment, the score of symptoms and signs decreased significantly in both groups(P<0.01). comparing with the control group, the score of treatment group decreased significantly(P<0.01). There were no side effects in both groups.7. In the treatment group of Chaihulonggumuli soup,2 cases were off, and 2 cases recovered,19 cases were effective markedly,17 cases were effective, 5 cases were ineffective, the total effective rate was 88.6%. In the control group of Xiaoyaosan,2cases were off(1 case got no further treatment due to the initial poor effect, and the other cases were off because of gastric ulcer), 1 case recovered,16cases were effective markedly,14 cases were effective,12 cases were ineffective, the total effective rate was 73.3%.Conclusion1. The effect of Chaihulonggumuli soup is better than Xiaoyaosan on the treatment of depression.2. The effect of Chaihulonggumuli soup is markedly on patients with mild depression, while poor on patients with Moderate to severe depression.3. Chaihulonggumuli soup on the treatment of depression combination with gastric ulcer, together with damp-heat syndrome or real evil gains poor effect. It is thought that the result has something to do with the keel and oysters which prevent gastrointestinal function.4. Improving gastrointestinal function and sleep quality is critical on the treatment of depression.5. Depression is more common in Women, and the incidence is mainly in fall and winter season.6. In the pathogenesis of the depression, it appears excess syndrome mostly in early stage, and its mainly syndrome is liver qi depression syndromen; It becomes deficiency-excess in complexity mostly in the mid stage, and its mainly syndrome is syndrome of liver depression and spleen deficiency; It appears deficiency-excess in complexity or deficiency mostly in the late stage, its mainly syndrome is liver depression kidney deficiency.The syndrome and symptoms of the patients included with depression were summarized as follows:(1)liver qi depression syndromeMain symptoms:depression, restless mood, oppression, loss of interest and pleasure, slow speech and action, flank pain, pale red tongue, thin white moss, taut pulse.Secondary symptoms:chest tightness, sigh, stuffiness of stomach and belch, abdominal distension, insomnia and more than a dream, dizziness, shoulder tightness, less appetite, loss of weight, poor bowel, lacteal gland expanding pain, dysmenorrhea disorders.(2) syndrome of liver depression and spleen deficiencyMain symptoms:low emotion, depression and thoughtfulness, fatigue, listlessness, loss of interest, not thinking of eating, loss of weight, lack of concentration, forgetfulness, waking up easily and falling asleep difficultly again, fat tongue with teeth marks, white moss, soggy pulse of spleen, taut pulse of liver.Secondary symptoms:deep sigh, chest tightness, flank pain, abdominal distension, loose stools, self-blame, suicidal thought, yellow face.(3)syndrome of liver depression transforming into fireMain symptoms:irritability, insomnia and more than a dream, lack of concentration, chest tightness, flank pain, red tongue, yellow moss, taut and rapid pulse.Secondary symptoms:dizziness, headache, dry throat with a bitter taste, dry throat, noisy feeling and acid regurgitation, constipation.(4)syndrome of liver depression and phlegm obstructionMain symptoms:depression, thinking slowly, chest tightness and asphyxia, foreign body sensation in the throat, pale red tongue, greasy moss, taut and slippery pulse.Secondary symptoms:dizziness, heavy head as if wrapped, listlessness and liking to lay in bed, to sigh, stuffiness of stomach and abdominal distension, poor appetite, nausea and vomiting.(5)syndrome of liver depression and kidney deficiencyMain symptoms:irritability, flank pain, dizziness, forgetfulness, red tongue, less moss, taut and thin pulse.Secondary symptoms depression, pessimism, loss of interest, fatigue, hypobulia, virtual vexation and less sleep, waist and knee pain, sweating, frequent urination, loss of sexuality, lack of energy.7. The correspondence between syndromes and symptoms:of all the depressive syndromes, depression is a central symptom. Chest tightness and sleep disorders are found in all of the syndromes. Gastrointestinal disorders symptom is more common in the syndrome of liver qi depression.syndrome of liver depression and spleen deficiency and syndrome of liver depression and phlegm obstruction. Loss of weight is mainly seen in the syndrome of liver depression and spleen deficiency, and self-blame and inferiority are also seen in liver depression and spleen deficiency. The coexistence of anxiety and depression are more common in the syndrome of liver qi depression and liver depression transforming into fire, and the uneasy agitation too.