The Comparative Study And Pathological Analysis On Depressive Disorder Combining Anxiety Based On TCM Hypothesis "Defensive Qi, Nourishing Qi And Vital Activity"

Objective: To explore the clinical characteristics and syndrome distributions of depressive disorder combining anxiety.To explain the pathology of depressive disorder combining anxiety in Chinese medicine theory.To provide the theoretical basis for intervening the disorder.Methods: Collect demographic characteristics,clinical information,Chinese medicine syndrome,the assessment of Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)of depressive disorder patients from Jan.2015 to Dec.2016 in prof.Yuanqing Ding's clinic(348 in total).Divide all these patients into the depressive disorder combining anxiety group(“co-morbidity group” for short)and single depressive disorder group(“depression group” for short),according the diagnostic criteria of depressive disorder and anxiety disorder,referring to the score of HAMD and HAMA.Describe and compare these data using statistical methods.Use chi-square test for enumeration data,t test for measurement data in normal distribution and rank sum test for measurement data in skewed distribution in order to find the difference and similarity between two groups.Setting the demographic data and symptoms as independent variance and whether combining anxiety as dependent variance,carry out unconditional logistic regression to find out the relevant factors of combining anxiety.Match 140 pairs of cases to unify the baseline information,and then carry out Bonferroni multiple comparison to find out the difference in TCM syndrome distribution.Study the conception and description of defensive qi and nutritious qi from the Internal Canon of Medicine,then create the theoretical model explaining the relation between vital activities and defensive qi,as well as nutritious qi.Propose the pathological mechanism of depressive disorder based on its clinical symptoms.Then explain the results of this comparative study using the model and relevant traditional Chinese medicine theory,and explore the pathology of depressive disorder combining anxiety.Results: In the 348 collected cases,there are 191 depression patients combining with anxiety and 157 patients with single depressive disorder,the co-morbidity rate is 54.89%.According to HAMD,the patients from co-morbidity group are mainly in moderate depression(26~34),while the patients from depression group are mainly in mild depression(20~25).Compared to single depressive disorder patients,the patients with anxiety have more complicated symptoms mentally and somatically.The logistic regression show that the age,gender,occupation,and personal history of patients in two groups have no significant difference,but combining anxiety is quite related to high HAMD score and mental symptoms like compulsive thinking and behavior,nervousness,irritability,worry,and somatic symptom like smothery sensation and hot feeling.The two groups have similar frequency in phlegm-heat syndrome,blood-heat combining stasis syndrome and yin-deficiency combining blood stasis syndrome,while the stagnant-heat syndrome and Qi yin-deficiency syndrome in co-morbidity group are significantly more than the depression group,while the yang qi stasis syndrome are obviously less.Conclusion: The general pathogenesis of depressive disorder is the stasis of defensive qi which causes the inhibition of vital activity.The congested defensive qi then cause the accumulation of heat,disturbing the vital activity,which is the main cause of the co-morbidity of anxiety.The disturbing heat causes numerous mental symptoms and complex somatic symptoms.The stasis of defensive qi and accumulation of heat both cause the congestion of phlegm and blood.The phlegm heat and blood stasis heat consume yin and qi,which causes the deficiency of defensive qi and nutrient qi.The vital activity is then lack of defense and nutrition.This is the pathological course of the depressive disorder combining anxiety.