Jian Jiang
Fatigue refers to the manifestations of fatigue, mental fatigue, fatigue, burnout, slack, fatigue, acid fatigue, etc. in past dynasties [1]. In addition to physical fatigue, ancient times have long recognized that there are mental fatigue, mental fatigue, mental drowsiness and so on. As a subjective symptom, fatigue is the decline of physical strength and/or energy when the body or psychological load is unbalanced, and it is a complex pathological state.
Fatigue is characterized by a general state. I feel tired for a while and can't be called sick. If you are often in a state of obvious fatigue and cannot recover after rest or adjustment, it is morbid. Fatigue is closely related to fatigue and deficiency syndrome, and there are differences. Fatigue refers to symptoms (or state), fatigue refers to the name of the disease, and deficiency refers to the attribute of the disease. Deficiency syndrome and deficiency syndrome often appear fatigue symptoms, but fatigue symptoms are not only deficiency syndrome and deficiency syndrome [2]. It is very important to understand this. Regrettably, for a long time, whenever patients complain of fatigue, contemporary Chinese medicine always tends to think that it belongs to deficiency or deficiency syndrome, and often uses tonic medicine to treat it, but they don't know the type of depression syndrome with deficiency [2]. Fatigue of depression syndrome generally refers to fatigue caused by internal injuries of seven emotions.
Etiology and pathogenesis of fatigue with 1 depression syndrome
1. 1 The pathogenesis of qi and blood deficiency caused by emotion seems to be fatigue, but it is actually an internal injury of seven emotions. In the Qing Dynasty, Wu Shangxian's "Li Lianwen's Tibetan Fu" said: "Blood is a worry, and qi decreases with sorrow, making people eat tasteless, tired and thin." It shows that the deficiency of qi and blood caused by sadness will make people tired and thin. Fei Xiongbo in Qing Dynasty "Medical Alcohol? "Yi Lao" contains: "Laborers, the five internal organs accumulate labor; The wounded, seven emotions are also injured. Worried about his heart, everything has its shape, and the limited qi and blood are exhausted. Thinking too much makes you tired, talking too much about your lungs, being depressed for a long time makes you tired of your liver, starving your spleen, and drinking too much makes you tired of your kidneys. From the beginning, qi and blood were still abundant. Although I worked hard every day, I didn't know it. The more tired you are, the more exhausted you are. The gas in the stomach, a natural blood, is not enough for one day. Therefore, the blood is gradually consumed, the true qi in the day is insufficient, dizziness and tinnitus, mental fatigue, dry mouth and throat, eating less and aching waist and feet. " It is pointed out that the seven emotions strain the five internal organs and eventually lead to qi and blood failure, leading to mental fatigue.
In Qing Dynasty, Yan's Theory of Fetal Birth and Steamed Bone said: "If a rich family has good food and medicine to recuperate, something will happen, but it will also cause a decrease in diet and fatigue if it gets angry and hurts its blood." It shows that deficiency of qi and blood will damage qi and blood because things are not going well. This deficiency of qi and blood has nothing to do with malnutrition, and it cannot be corrected by drugs that tonify qi and blood. Only when you are satisfied can you be lucky.
1.2 The mind dominates the mind, and the mind is exhausted. Wang Shuhe's "Three Syndrome of Pulse Meridian, Deficiency of Heart and Hand in Yin Meridian" in the Western Jin Dynasty states: "Sorrow and sadness, heart injury and bitter shock, joy and forgetfulness, anger. A heartbroken person is tired, that is, his head is red and his face is heavy, his heart is full of pain, and he is annoyed by his own heat. The umbilical cord picks up the hand and the pulse string is also caused by a heart injury. " It is pointed out that sadness and sadness will lead to fatigue, and even symptoms similar to true heartache may appear or induce true heartache.
Tao Hongjing in the Southern Dynasties wrote in the Collection of Health-keeping Secrets and Health-keeping Odes: "I am exhausted. In the battle of two skills, all the winners and losers have not lost their years. And ... Of the two skills, writing poetry and playing chess are very laborious. " It can be seen that excessive attention will cause mental fatigue.
In the Qing Dynasty, Gao Xueshan's "The 11th Syndrome of Gao Zhu Jin Gui and the Treatment of Diseases and Veins Caused by Cold Accumulation of Five Internal Organs" contained: "Tired from fatigue. Working hard outside, working hard inside. " It clearly divides fatigue into two types: fatigue and fatigue, and the latter is fatigue.
In Qing Dynasty, Chen Shiduo discussed the inevitable mechanism of mental injury and fatigue caused by thinking. "Syndrome Differentiation and Internal Injury (23 Cases)" contains: "People have palpitations and forgetfulness, pale mouth and dry tongue, sweating, weakness of limbs, fever, turbid urine, and large and rapid pulse. People think that the disease of internal injuries is also caused by excessive thinking. " "Records of Syndrome Differentiation and Treatment of Deficiency (Thirteen Items)" says: "People have too many thoughts, thinking all night, so that they are in a trance, tired of language, heavy waist and feet, weak limbs, people think they are afraid of illness, but in fact they are tired, and even hurt their minds ... Those who have hidden their thoughts in their hearts for a long time are also worried because of hard work. It takes a lot of effort to think endlessly. If the heart fails, the blood will be gradually consumed, and God is helpless, in a trance, in existence or amorphous. Besides, God should be quiet and don't move. When God moves, the heart changes; when the heart loses, the blood changes; when the blood loses, the heart changes. Although he has kidney Mizunosuke, his blood can't nourish him. Although there is liver wood, the liquid can't enter, and the weak gentleman can't stand on his own feet; Although the four bodies are not strong and have good support, the waist, feet and limbs are so heavy and tired. To cure a disease, you must first save your heart, and to save the world must be based on calming the nerves. " It emphasizes that at the beginning of infinite thinking, you will be exhausted and bleeding, and over time, you will consume liver and kidney essence and blood. Without good support, it will lead to heavy fatigue and exhaustion, and it is urgent to soothe the nerves and save the heart. Otherwise it will further develop into heart-kidney disharmony. For example, wet dream Gate (Seven Rules) also pointed out: "People who have excessive intentions and inner anxiety will suffer from wet dream. Their symptoms are dry mouth, red face and red cheekbones, and they will fall off when they close their eyes. I left it several times a night, tired and sleepy. People think that there is too much kidney deficiency, but they have a guilty conscience. My husband likes peace, but he doesn't like overwork. Overwork leads to heartburn, which in turn leads to fire inflammation and separation of water and fire. The qi of the heart cannot be handed over to the kidney, and the door of the kidney is wide open. "
Based on Chen Shiduo's theory, we can see that at the beginning of thinking about fatigue, the limbs are weak, and the degree is still light, accompanied by palpitations and forgetfulness; Secondly, the waist and feet are heavy, the limbs are weak, and the degree is getting heavier, accompanied by mental trance and language burnout; Later, it developed into fatigue and drowsiness, which was more serious, accompanied by frequent wet dream, dry mouth, blushing cheekbones, etc., which showed the pathogenesis evolution process of fatigue from fatigue to heart-kidney disharmony.
The disharmony between heart and kidney can also develop to yin deficiency and fire flourishing. For example, Zhang Lu's "Merchants of Zhang Yitong" in the Qing Dynasty said: "The seven emotions are restless, the body is tired, and the yang and fire force each other, resulting in abnormal blood circulation, hot and dry pulse and dry mouth ..."
1.3 The liver governs the drainage, which is the root of "the liver is the official of the general, and it must be thought of" (On the Secret Book of Su Wen Linglan); "The liver is the foundation of the extreme, and the soul resides in it" ("Six Sections of Hidden Images in Su Literary Theory"). The annotation of Su Wen's Dirty Elephant in Suspension, Transportation and Six Stages says: "The liver hides the soul and strengthens the tendons, so it is extremely restrained and hurts the tendons, so the liver is the foundation of extreme restraint and the place where the soul lives." The material basis of "the liver is the source of extreme depression" is that the liver governs the discharge, storing blood and strengthening tendons [3]. If the liver loses its drainage function due to intentional sadness, it will definitely affect the liver's function of storing blood and strengthening tendons, leading to extreme depression of the body. In Ming Dynasty, Huangfuzhong's "General Copy of the Ming Classics" talked about thinking extremely tired and hurting the liver: "People with six poles try their best to think, and fatigue hurts the liver, so they should be extremely tired."
The Clinical Guide to Medical Records and Liver-fire contains: "A general's official is the liver, and when he is fired, he can get real water to contain it, and he can get true qi to subdue it, so that the wood fire is alive." There is no such thing as a disease. If he is uneasy about his feelings, he will be depressed. He will be angry if he doesn't throw it away. If he thinks too much, he will be exhausted. As a result, he will become angry and attack violently. " "The Essentials of Ancient and Modern Famous Doctors and the Collection of Diseases and Energy" contains: "The liver is the ultimate source, and its people are either hard labor or internal injury, and the liver fire is dirty, so blood can not be hidden, and the yin collateral is injured by heat and blood overflows." Both Shang Ye and Luo Mei pointed out that emotional failure hurts the liver and leads to extreme truth.
The gallbladder is attached to the liver and controls the decision. Wang Kentang's Standard for Syndrome Differentiation and Treatment of Miscellaneous Diseases and Mental Disorders in the Ming Dynasty pointed out: "Weak heart and gallbladder, timidity, easy to be shocked by touching things, or having ominous dreams, causing fright and fear, stagnation of qi leads to salivation, and palpitation leads to various syndromes, or shortness of breath, palpitation and fatigue, or spontaneous sweating ..." It shows that emotional reasons affect the decision-making function of gallbladder, and can also cause shortness of breath, palpitation and fatigue, thus causing qi.
1.4 spleen governs muscle, * * * lung governs qi, spleen and stomach transport essence of Shui Gu, and lung inhales and clears qi, which are combined into main qi. Qi deficiency of spleen and lung is a common mechanism of fatigue, but it can still be hurt by emotion. Thinking about fatigue can also hurt the spleen. Emotional factors, like diet fatigue, can cause spleen deficiency and fatigue symptoms. The Jin Dynasty pointed out in the Secret Collection of the Blue Room, the Door of Diet and Labor Injury: "The husband's qi is not enough, and from time to time, it is harmful to his qi. When qi fails, the fire is flourishing, and the spleen occupies its spleen, so it is sleepy and hot, so it is lifeless, lazy, panting, sweating and upset. In the Qing Dynasty, Wu Cheng's book "No Collection, Volume II, Spleen Meridian Should Be Divided into Yin and Yang" pointed out: "People with spleen and stomach deficiency and cold are mostly injured by thinking or fatigue. Spleen deficiency, weak stomach, uncomfortable middle uterus, drowsiness of limbs, decreased diet, emaciation of muscles, nausea of epigastrium, diarrhea due to spleen deficiency, aversion to heat and cold, restless sleep, and weak and slow six-pulse. "All of the above points out that worrying about hurting the spleen will lead to fatigue.
Anger and impatience can lead to lung qi deficiency and fatigue. In Tang Dynasty, Sun Simiao's "Prescription for Preparing a Thousand Valleys: Lung Prescription" said: "Lung-qi injury, when people are tired, they cough and vomit blood, and the pulse is thin and tight, all of them vomit blood, which is mostly caused by irritability and lung-qi injury." Worry and harm to the heart, lungs and health can lead to fatigue. Ye Cough, the essence of Ye Medical Records in Qing Dynasty said: "Anyone who worries about internal injuries is bound to damage his heart and lungs first. Heart is the main business, lung is the main health care. Both qi are weak, and impatience is prone to evil. "
Depression leads to qi deficiency of spleen and lung, laziness and fatigue. Yang Yunfeng's "Clinical Outline of Tongue Diagnosis" in Qing Dynasty states: "Overwork, thinking too much when you are hungry, and stagnation will lead to deficiency of spleen and lung, deficiency of qi and blood, aversion to cold and fever, tasteless food, weakness of limbs, lethargy, thin hunger, shortness of breath and palpitations, forgetfulness and insomnia ..." In Qing Dynasty, Lin Pei. This loss of spleen and lung is caused by anxiety and disharmony between camp and health ... "
1.5 Phlegm and blood stasis can also lead to burnout. Emotional causes can produce phlegm and blood stasis and secondary depression syndrome [4.5], and fatigue with depression syndrome is no exception. The so-called deficiency of both heart and gallbladder, qi stagnation and fluid production, shortness of breath and palpitation in the standard of syndrome treatment are all examples of fatigue caused by drinking phlegm. In the Ming Dynasty, Li Zhongzi's "Phlegm Drink Required for Medical Cases" contained: "Xu Lingru, who was in charge of the punishment department, was tired and sweaty, and his language was disordered, so he was in danger, so he welcomed the treatment. The pulse is large and soft, and this qi deficiency has phlegm. " This case is mostly caused by fatigue and exhaustion, and the pathogenesis is qi deficiency and phlegm production.
The famous medical case of Jiangzhou in Ming Dynasty "Yu" contains: "The young woman is nineteen years old. Because of a great disappointment, her diaphragm is full of food, and she is exhausted, so she can't sit up. I have a fever (spleen) in the afternoon, my face is red, my kidney (pericardium) is receding, and I have a little urine at night. This qi is depressed in appetite and has blood stasis deficiency, but the middle palace is food accumulation. " The patient in this case can't sit up because of fatigue, which is caused by something unsatisfactory, and the pathogenesis is phlegm and blood stasis.
"Yilin Gaicuo Tongqiao Huoxue Decoction" written by Wang Qingren in the Qing Dynasty records: "Men are overworked, weak in limbs at the beginning, gradually emaciated in muscles, reduced in diet, pale complexion, coughing and spitting, upset and irritable, hot flashes in the afternoon, and sweating heavily in the morning. Delaying medical treatment, nourishing yin first, then replenishing yang; If it doesn't work, there's nothing we can do. Funny writers do not make themselves weak because of weakness, but because of typhoid fever, plague, weakness of qi and blood and illness because of weakness, so they have to make up for it and recover. If you are not weak, you will get sick. If you are weak due to illness for a long time, you should go to the hospital to recuperate. There is no exterior syndrome or interior syndrome, and the symptoms I see are blood stasis. " In this case, the patient's limbs are weak and weak, but he is upset and impatient. The pathogenesis is blood stasis. To sum up, qi and blood deficiency, mental fatigue, liver depression and timidity, spleen and lung qi deficiency, phlegm and blood stasis are all caused by internal injuries of seven emotions, forming mental fatigue and physical laziness.