五、抑郁症 Depression

某，女，60，

2014.4.5 因是老主顾，我曾与2014年春节治好其重症哮喘，这次其女代叙：母亲节后回老家后因老人院分配房间不适，心情忧郁，又犯了忧郁症。15年间症状严重，自杀4次，一直就医精神病院，服西药控制。9号今天从老家接回青。忧郁症状严重，不吃饭、面部无表情、独处、呆坐、恐惧、难寐、烦躁、心悸、小便浓茶色，2天无大便。

刻诊：面色晦涩、面目呆滞，冷漠，见了我不打招呼，可能不认识了。舌红无苔水滑、喜冷饮、

诊断：痰证、上热下寒证

病机：气虚甚，体寒，气不化水成痰饮，阳气完全不能通达巅顶，则病抑郁。西药似可一时控制抑郁，但伤阴更甚，中焦火郁，则喜冷饮，阴火耗炼真阴，则见难寐、小便色深。

治则：先清内热，旋温下寒，豁痰开窍

药后当夜睡了5个多小时，至14号，小便量大，饭量大增，仍唠叨、情绪低。15号解下柏油便，开始说笑如常人。4.29号，因有粘痰难以咳出，用吐涌法，突出粘痰甚多，精神立刻好转。孩子说咱妈今天好了。2014/5/29各方面都不错：能吃、能睡、大便稍难，精神也不错。跟孙子玩得很开心。临床治愈。

此案前后近2个月。其母是养母，孝敬若生母，我敬其美德，鉴于家境一般，自始至终没收一分钱。所以其女改称我叫叔叔。呵呵， 意外收了个侄女。这个医案的特点是夸时较长，各种治法都用上了：下法、吐涌法、温法，除了第一次面诊外，其余都是网诊。古训：脉证不符，舍脉从证。所以，仅凭口述，仍取得较好疗效。另外，辩证尚对，因水滑舌一般为寒证，气不化水，但又喜冷饮，说明有内热，诊为上热下寒，先清内热，旋即大剂参附汤托底，上下交泰，当晚睡好。最后，其女非常明睿，始终遵医嘱，不再服西药，使得病证较为单纯。医患配合默契，取得较好疗效。



60-year-old female Apr 9, 2014

April 5, 2014, daughter called and said her mom developed gloomy mood at senior house for room assignment and depression hit her again. In the last fifteen years, she tried to kill herself four times by taking great amount of sleeping pills. Each time she was saved at emergency room. stayed in mental hospital before symptoms improved, relying on drugs.

Today the patient was back at Qingdao home. motionless, didn't greet me, would not talk, eat, stay alone, fears, sleepless, palpitation, fidget, dark color pee. didn't poo for two days.

Diagnosis: Qi deficiency, too weak to circulate through the body. therefore, stagnated heat lingering on the top of head, would not go down.

Treatment principle:  clear inner heat and warm the kidney, expel phlegm and opening aperture.

Slept five hours the same day and four days later appetite increased greatly. still murmuring and low mood. on the 15th, after tar-like stool, began to talk and laugh like a normal person.

Except the first home visit, all the next were Internet communications for diagnosis and formula prescription.

According to TCM masters, when the pulse shows different pattern coordinating with the verbal symptoms, forget the pulse, administrate therapy based on main symptoms.

One more thing in this case, the daughter was smart enough to listen to the doctor strictly: never use drug anymore, that made the treatment much easier.

Drugs are of chemicals, strong enough to resist herbs. Most CM doctors would suggest mental illness patients not to take drugs when the symptoms are controlled and rely on herbs, the only stuff can nourish human body, including neurosis. The drug can only make the treatment more difficult, such as sleeplessness.