基于"病郁结合"理论探讨乳腺癌与抑郁症的共病机制和治疗策略OA

Based on the disease-depression integration theory—the mutual causal relationship between depression induced by disease and disease induced by depression—this paper explores the comorbidity mechanism and therapeutic strategies of breast cancer and depression.In traditional Chinese medicine(TCM),stagnation is divided into broad and narrow categories.The broad sense refers to various stagnant states caused by external pathogens,internal injuries,and disharmony of Qi(气)and blood,while the narrow sense specifically denotes emotional stagnation resulting from emotional discomfort and Qi disturbance.Both conditions share stagnation as their pathological basis for comorbidity.Regarding the comorbidity mechanism,depression induced by disease is manifested as deficiency of vital Qi leading to stagnation of pathogenic factors,in which phlegm,blood stasis and toxin obstruct the mammary collaterals to form a vicious cycle.Meanwhile,physical and mental trauma caused by breast cancer and its treatments lead to liver disorder in coursing and discharging as well as Qi stagnation,further inducing secondary emotional depression.Disease induced by depression is characterized by stagnant fire from emotional depression which exacerbates the proliferation of pathogenic toxins:prolonged liver depression transforms into fire,which flares up to the mammary collaterals and binds with latent pathogens and toxins,thereby aggravating tumor infiltration,ulceration and the syndrome of deficiency-fire hyperactivity.In addition,obstruction of the mammary collaterals impairs the function and causes obstruction of the triple energizer,allowing pathogenic toxins to spread to the upper,middle and lower triple energizer along with disordered Qi movement due to the viscous and stagnant nature of phlegm and blood stasis,resulting in metastases to the lung,lymph nodes,bones and other sites.The treatment follows the general principle of regulating both physical body and mental state.For physical regulation,the priority is to reinforce vital Qi,eliminate pathogenic factors,unblock collaterals and resolve stagnation,which can be achieved with modified Butian Dazao Wan(补天大造丸)to ameliorate the state of vital Qi deficiency and pathogenic stagnation,thus resolving the pathological basis of depression induced by disease.For mental regulation,the focus is to soothe the liver,relieve depression,promote Qi movement and dispel stagnation,which can be implemented with modified prescriptions such as Xiaoyao San(逍遥散)or Chaihu Shugan San(柴 胡 疏 肝 散),flexibly applied according to different syndromes including liver depression transforming into fire syndrome,turbid phlegm syndrome and triple energizer obstruction syndrome,so as to block the deterioration pathway of disease induced by depression.Meanwhile,integrated interventions including psychological counseling,five-element music therapy,and traditional exercises such as Baduanjin(八段锦)and Taijiquan(太极拳)are actively adopted to restore the balance of Yin(阴)and Yang(阳)and achieve simultaneous treatment of body and mind.A clinical and practical case is included for verification,aiming to provide a theoretical reference for the TCM treatment of the comorbidity of breast cancer and depression.