Sinclair-Lian Nityamo, Hollifield Michael, Menache Margaret, Warner Teddy, Viscaya Jenna, Hammerschlag Richard
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM, USA.
J Altern Complement Med. 2006 Jan-Feb;12(1):45-57. doi: 10.1089/acm.2006.12.45.
Post-traumatic stress disorder (PTSD) is a common, disabling condition with many diverse symptoms including anxiety, depression, insomnia, and body pain. These symptoms are likely to be helped by treatment with Traditional Chinese Medicine (TCM); however, PTSD is not yet a recognized disorder (bing ming) in Chinese medicine. In preparation for a phase II clinical trial comparing TCM and cognitive behavioral therapy (CBT) treatment of PTSD symptoms, a TCM diagnostic pattern framework for persons who meet the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) definition of PTSD was sought.
Three approaches were used to identify the most likely TCM pattern differentiations for PTSD: an English-language TCM textbook review on the conditions "depression," "anxiety," and "insomnia"; a survey of 20 experienced practitioners of TCM; and TCM assessments of 21 individuals affected by PTSD. Two TCM practitioners synthesized the information into a list of pattern differentiations.
The most likely pattern differentiations for PTSD were Heart Shen disturbance caused by Heat, Fire, or a constitutional deficiency; Liver Qi stagnation; and Kidney deficiency. Secondary patterns identified were outcomes of long-term Liver Qi stagnation-Liver overacting on Spleen/Stomach, Liver Fire, Phlegm Fire, Phlegm-Damp, and Heart Fire-and constitutional deficiencies in the Heart, Kidney, and Spleen organ systems.
The use of extant literature, expert knowledge, and clinical TCM diagnoses contributed to the development of a TCM diagnostic structure for PTSD. The results can inform the clinical practice of TCM. The method can be used to guide research design involving different diagnostic systems.
创伤后应激障碍（PTSD）是一种常见的致残性疾病，有多种不同症状，包括焦虑、抑郁、失眠和身体疼痛。这些症状可能通过中医（TCM）治疗得到缓解；然而，PTSD在中医中尚未被认定为一种病症。为准备一项比较中医和认知行为疗法（CBT）治疗PTSD症状的II期临床试验，我们寻求为符合美国精神病学协会《精神疾病诊断与统计手册》第四版（DSM-IV）中PTSD定义的患者建立一个中医诊断模式框架。
采用三种方法来确定PTSD最可能的中医证型鉴别：对“抑郁”“焦虑”和“失眠”病症的英文中医教科书进行回顾；对20位经验丰富的中医从业者进行调查；以及对21名受PTSD影响的个体进行中医评估。两名中医从业者将这些信息综合成一份证型鉴别清单。
PTSD最可能的证型鉴别为热、火或体质虚弱导致的心神扰动；肝郁气滞；以及肾虚。确定的次要证型是长期肝郁气滞的结果——肝乘脾/胃、肝火、痰火、痰湿和心火——以及心、肾和脾脏腑系统的体质虚弱。
运用现有文献、专家知识和中医临床诊断有助于构建PTSD的中医诊断结构。研究结果可为中医临床实践提供参考。该方法可用于指导涉及不同诊断系统的研究设计。
