吳茱萸湯治療憂鬱症患者失眠之病例報告

A Case Study of Using Wu Zhu Yu Tang for Treating the Depression Patients with Insomnia

本文報告一例47歲男性患者，有重度憂鬱症病史，此次主訴為失眠加重5個月，難以入睡且睡眠片斷，伴有焦慮煩躁、全身無力感，因服西藥效果不顯而轉求中醫診治。辨證為肝寒犯胃擾神，治以暖肝和胃，安神定志，以吳茱萸湯為主方加減，服藥三週後，病人症狀明顯好轉，焦慮煩躁感消失，不須使用西藥即可入眠，生活品質大有改善。經由辨證治療，中藥治療失眠的效果顯著，且較少產生如中樞神經鎮定劑等西藥的耐藥或反跳現象，為使用西藥、行為治療、心理治療等方式外的另一選擇治療。此外，雖然歷來少用吳茱萸湯以治療失眠、憂鬱症等精神症狀，但臨床應用上只要符合病機脈證，皆可使用，方劑的使用範圍才能擴大。

The object of this study was a forty-seven years old male patient with major depressive disorder. His main complaint was his severe insomnia characterized by persistent difficulty falling asleep and difficulty maintaining sleep for five months. In addition, he also created anxiety irritability and had no energy. He tried to seek traditional Chinese treatment since taking western medicine seeded to be not helpful. With TCM syndrome differentiation, it was caused by liver cold invading stomach and disturbing heart-mind. The treatment was focused on warming liver for regulating stomach and transquillization (quieting the spirit). Wu Zhu Yu Tang was used as the main prescription. After three-week treatment, the patient's condition was obviously improving. His anxiety and irritability disappeared and he could fall asleep without taking any western medicine. With the help of syndrome differentiation, TCM treatment on insomnia has good efficiency and can avoid the related drug-resistance and rebound effects from west medicine such as central nervous system depressants. In addition to western medical drugs, behavior therapy and psychology therapy, TCM treatment can be another choice. Although Wu Zhu Yu Tang was seldom used to treat insomnia or depressive disorder in the past, it can be clinically applied under the proper mechanism and pulse syndrome. Based on this, the application range of prescription can be extended.