北京中医药大学学报2026，Vol.49Issue(8)：1124-1129,6.DOI:10.3969/j.issn.1006-2157.2026.08.010
"土枢四象"理论视域下抑郁症的病机与辨治探析
Exploring the pathogenesis,syndrome differentiation,and treatment of depression from the theory of"earth as pivot with four elements"
摘要
Abstract
The"earth as pivot with four elements"theory posits the spleen and stomach as the pivot governing systemic qi dynamics.It emphasizes the physiological interdependence wherein the spleen elevates clear yang to facilitate the leftward ascent of water and wood,whereas the stomach descends the turbid yin to guide the rightward descent of fire and metal.This mechanism sustains the cyclical flow of qi and blood,preserves yin-yang balance,harmonizes the five zang organs,and stabilizes the spirit.Within this theoretical framework,the core pathogenesis of depression is identified as middle jiao pivot dysfunction and derangement of qi ascending-descending movement.The initial stage is characterized by the spleen failing to elevate clear yang,leading to the constraint and sinking of liver-wood,which manifests as qi stagnation and mental lassitude.This progresses to the stomach,which fails to descend turbidity,allowing phlegm-turbidity to harass the spirit and cause spiritual disorientation.In chronic refractory cases,pivot obstruction results in an intermingling of cold and heat,blocking the qi circle in round and inducing a state of profound spirit disturbance,and it becomes a difficult and intractable situation.Therapeutically,the primary objective is to restore the ascending-descending function of the middle jiao and regulate the cyclical flow of qi.In the early stage,it should warm and activate the middle jiao to awaken the spirit,using Xiangsha Liujunzi Decoction accompanied by Chaihu(Bupleuri Radix)and Baishao(Paeoniae Radix Alba)to regulate qi movement.In the progressive stage,prioritize harmonizing the stomach and guiding turbidity to calm the spirit by using modified Wendan Decoction.In the chronic stage,address the syndrome of upper heat and lower cold with heart-kidney non-interaction with modified Banxia Xiexin Decoction combined with Jiaotai Pill,to balance cold and heat and harmonize the heart and kidney.This approach highlights the restoration of spleen-stomach rotation and its ascending and descending as the key method to reposition the four elements and re-establish physiological qi circulation,offering a systematic theoretical reference for the syndrome differentiation and treatment of depression.关键词
抑郁症/土枢四象/脾胃/气机/神Key words
depression/earth as pivot with four elements/spleen and stomach/qi movement/spirit分类
医药卫生引用本文复制引用
徐文琪,王晓鸽,刘佳,许二平.."土枢四象"理论视域下抑郁症的病机与辨治探析[J].北京中医药大学学报,2026,49(8):1124-1129,6.基金项目
国家自然科学基金项目(No.82274496,No.82104776) （No.82274496,No.82104776）
河南省科技研发计划联合基金(优势学科培养类)重点项目(No.222301420021) （优势学科培养类）
河南中医药大学张仲景传承与创新专项(No.GZY-KJS-2022-044-1) National Natural Science Foundation of China(Nos.82274496 and 82104776) （No.GZY-KJS-2022-044-1）
