Theoretical study of 1
1. 1 Emotion and the connotation of emotional diseases and syndromes
The word "emotion" comes from the discussion of emotion and five records in Neijing, which is the collective name of seven emotions and five records by later physicians. Modern scholars have different academic opinions on the meaning of emotion: The Basic Theory of Traditional Chinese Medicine says that emotion is the mental state of the body, and it is seven different emotional reactions of the human body to objective external things and phenomena. Jin [1] thinks that emotion is an inner experience, which is an attitude expression with a certain tendency through the induction of the mind under the influence of external stimulus factors. WU GANG [2] thinks that emotion is the mental state of the body. Under the guidance and adjustment of the mind, the body takes the essence of the five internal organs as the material condition, and under the stimulation and influence of the external environment, it produces a special form of reflection on objective things through internal and external comprehensive effects, which is the experience of people on whether objective things can satisfy their own desires. Joe et al. [3] pointed out that emotion is a unique title of emotion in modern sense in traditional Chinese medicine, and its meaning itself includes emotional experience and emotional expression. After the application and development of contemporary doctors, the concept of emotion has included the main connotation of emotion in the modern sense; The mental state of the body does not belong to the mind and cannot be confused with it. This is a complex reaction involving psychological and physiological systems. Experience, expression and the accompanying physiological and behavioral changes are the main connotations of emotions. Li Huiji [4] and Song et al. [5] believe that emotion refers to seven emotions and five aspirations, and also involves the content of five gods. It includes psychological processes such as emotion, emotion and passionate will in modern psychology, and is also related to individual psychological characteristics. It is a summary of various psychological factors in modern psychology.
In the understanding of traditional Chinese medicine, many diseases are related to the seven emotions, so the scope of emotional illness is very wide. Li Kai [6] pointed out that among nearly 50 kinds of diseases in traditional Chinese medicine, palpitation, insomnia, syncope, depression, madness, epilepsy, headache, dizziness, stroke and other diseases can be directly caused by abnormal emotions, such as cough, asthma, chest pain, stomachache, epilepsy and so on. Li Huiji and others [4] think that emotional diseases refer to a kind of diseases in which emotional factors play a major role in the occurrence, development and outcome of diseases, including mental diseases, psychosomatic diseases, psychological diseases, nervous system diseases and all functional diseases. Xu Zhiwei [7] thinks that emotional illness syndrome is caused by internal injuries of seven emotions, which is characterized by emotional activity disorder, including mental symptoms, such as depression syndrome, impatience, insomnia and madness. A kind of diseases with physical symptoms, similar to psychosomatic diseases in modern medicine, involves many diseases in internal medicine, surgery, gynecology and pediatrics, such as asthma, choking cough, diarrhea, impotence, dysmenorrhea, etc., that is, emotional diseases in traditional Chinese medicine, including psychosomatic diseases, neurosis and mental diseases in modern medicine.
1.2 emotional etiology, pathogenesis and pathogenic characteristics
1.2. 1 emotional etiology and pathogenesis For emotional etiology, the accepted theory is that sudden, intense or persistent emotional stimulation exceeds the normal physiological activities of the human body, leading to the imbalance of qi, yin and yang, and qi and blood, thus leading to the occurrence of diseases; Jin [1] thinks that since emotion is the expression of the functional activities of the five internal organs, and its generation depends on the activities of the viscera essence and external stimuli, the cause of emotional diseases should not be emotion itself, but only bad external stimuli. Tang Xianyu [8] pointed out that external stimuli and individual physical differences are two important aspects that affect emotional diseases. The pathological mechanism of emotional diseases is qi disorder, viscera dysfunction, and the balance of yin and yang being destroyed, which leads to the weakness of healthy qi and the invasion of evil spirits. Jin et al. [9] think that qi disorder is the key pathogenesis of emotional diseases. There are many reasons leading to qi disorder, and its pathogenesis changes are complicated, but the basic pathogenesis law has three characteristics: qi disorder and deficiency, viscera disorder and adverse meridians, and qi disease first involves body fluid and blood. Sun Lijun [10] pointed out that there is a whole regulation system in the human body to undertake emotional activities, which is recognized by the Institute of Integrated Traditional Chinese and Western Medicine. The emotional regulation system of traditional Chinese medicine takes the five zang-organs as the center, essence, qi, blood and body fluid as the material basis, so the intermediary mechanism of emotional diseases is the imbalance of qi and blood in viscera, especially qi and blood in five zang-organs; The emotional regulation system of modern medicine is neuroendocrine immune network, and its material basis is neurotransmitters, hormones and immunocompetent substances. Emotional diseases reduce the immune ability of the body by stimulating the neuroendocrine system closely related to internal organs. Therefore, the theory of emotional diseases in traditional Chinese medicine has its important immunological basis.
1.2.2 emotional pathogenic characteristics emotional pathogenic factors directly hurt viscera, causing qi disorder and qi-blood imbalance, which has been recognized by scholars. However, there are different opinions on the characteristics of emotional illness and the bias of visceral injury. Most people think that emotional illness is easy to hurt the liver. Lu Mingyuan [1 1] thinks that emotional diseases can be urgent or slow, which are mostly caused by two or more emotions, and the onset of various emotional diseases has the same intermediary pathogenesis; Emotional pathological changes can present different pathological stages, such as qi disorder, fire damaging yin, loss of shape and quality, phlegm failure, blood coagulation and so on. At the initial stage of the disease, that is, loss of qi, loss of spirit and disorder of five internal organs, the further development of the disease will lead to secondary symptoms such as phlegm-fire, blood stasis, qi, blood and body fluid loss. Xu Zhiwei [7] found that the spleen and stomach, liver and gallbladder, heart and brain play the most close role in emotional diseases. Cheng [12] and others believe that excessive emotion will not only affect Qi, but also damage the five internal organs. Qi will lead to blood circulation, and qi stagnation will lead to blood stasis, which will lead to cardiovascular diseases. Joe and others [13] think that the model of "five emotions hurting five internal organs" is not in line with clinical practice, and the probability of liver injury caused by multiple emotions intertwined with the same disease is greater, and "social events" are the initial factors of emotional stimulation. Therefore, this paper puts forward the hypothesis that "deep affection interweaves * * * and causes the same disease to damage the liver first" and makes a logical argument. Li Feng and others [14] believe that the core of human body's stress response is the liver, emphasizing that the liver plays a decisive role in regulating various changes caused by emotional factors (psychological stress). Guo Lei [15] thinks that emotional activities are closely related to the liver, and the liver is particularly closely related to gynecological diseases, so the liver should be adjusted first in treatment. Tang et al. [16] believe that "thinking about injury" in traditional Chinese medicine is in a central position and plays a leading role in the process of seven emotions, so we should pay full attention to it when studying and treating emotional diseases. Bai et al. [17] discussed the correlation between spleen and emotion, and pointed out that the spleen dominates the qi axis, and the middle-earth spleen plays a balancing role in emotional activities. Zhang Zongfang [18] pointed out that kidney deficiency is the root cause of mental and emotional abnormalities in menopause.
1.2.3 emotional differentiation Xu Zhiwei [7] believes that "emotional differentiation" includes four elements: pathogenic factors-"happiness, anger, worry, thinking, fear, sadness and shock"; The main idea of "emotional syndrome differentiation" is a dialectical thinking process with the five internal organs as the center, the emotional changes of the body as the representation, and the emotional activities related to the relationship between the human body and the viscera as the content; Pathological features-The pathogenic factors of "seven emotions" are mostly internal injuries of spirit and emotion, which mainly lead to the disorder of qi movement, the dysfunction of viscera, and the imbalance of qi, blood and yin. The pathological characteristics of "emotional syndrome differentiation" should be discussed in combination with the syndrome differentiation of eight categories, qi, blood, body fluid, viscera, defending qi, nourishing blood and triple energizer. Therefore, the main content of "emotional syndrome differentiation" is closely related to mental emotional activities, and the main point of syndrome differentiation can be mainly mental symptoms, rather than blaming an independent emotional change on a certain viscera. The law of transmission and change-although emotional diseases hurt the internal organs, the first disease is in the liver, and the disease spreads to the heart and gradually becomes dirty.
2 experimental research
In recent years, the academic circles of traditional Chinese medicine, based on the theory of viscera-state and seven emotions of traditional Chinese medicine, combined with the theory of modern psychology, have carried out experimental research on the pathogenic mechanism of emotions and the prevention and treatment of traditional Chinese medicine: Qiao et al. [13] perfected the concept of "stagnation of liver-qi and stagnation of liver-qi", established the syndrome differentiation standard and rat model, and pioneered the stagnation of liver-qi in premenstrual syndrome. Yan Can et al. [19-20] discussed the pathogenesis of NEI network of psychological stress and the intervention effect of tiaogan prescription from many aspects by using the restraint braking model. It is suggested that Tiaogan recipe has a multi-level, multi-target and multi-link regulation effect on various central nervous information factors. Ma Yuan et al. [2 1] observed the effect of Liuwei Dihuang decoction on the functional changes of hypothalamus-pituitary-ovary axis in mice under suspension stress, and found that taking Liuwei Dihuang decoction orally could significantly increase the levels of GnRH and LH in hypothalamus of mice and reduce the concentration of serum estradiol. Han Juan [22] from the heart, through the methods of rotation, restriction, crowding and so on, simulated the syndrome of qi disorder caused by emotional stimulation. Giving Shuxin 1 can increase the contents of norepinephrine, 5- hydroxytryptamine and acetylcholine in hypothalamus of stress rats; Liang et al. [23] used electrical stimulation model to study, suggesting that the traditional Chinese medicine compound of invigorating spleen and benefiting qi and resolving phlegm and warming has different degrees of regulation on HPA axis abnormality in chronic stress rats. Li Jie et al. [24] demonstrated that the disorder of qi movement caused by bad stimulation was related to the disorder of HPA regulation by restraining rats from soaking in water to simulate the cause of "seven emotions failure". In view of the wide application of Wendan decoction in the treatment of mental and physical diseases, He Youshun et al. [25] proposed that Ningshen Wendan decoction (Jiawei Wendan decoction) may play a role in treating mental and nervous system diseases by changing the contents of monoamine and amino acid neurotransmitters in brain tissue. Wang Mi Qu and others [26] pushed the stress research of "fear of hurting the kidney" to the forefront of emotional psychology, psychosomatic medicine, genetic psychology and traditional Chinese medicine psychology by studying and accumulating the whole behavior, physiology and pathology, immunity, biochemistry and molecular biology of fear.
3 existing problems and thinking
To sum up, in recent years, Chinese medicine scholars have carried out some research work on emotional diseases and achieved certain results: in theoretical research, new hypotheses have questioned and challenged the original basic theories; In the experimental study, the single emotional stimulus mainly focuses on two aspects: "anger hurts the liver" and "fear hurts the kidney". The research work goes deep into the regulation of the liver governing the release of qi on the nervous, endocrine and immune networks, as well as the emotional inheritance of fear. The successful establishment of PMS model of liver-qi inversion and liver-qi stagnation in rhesus monkeys and the listing of new drugs have laid a good foundation for further research. However, from the analysis of the overall research status, there are still problems worthy of consideration.
As far as theoretical research is concerned, the concept of emotion and the connotation of emotional disease are still not unified, which is the first problem that must be clarified in the study of emotional disease. Otherwise, the systematic research on syndrome differentiation, standardization and quantification of emotional diseases cannot be carried out scientifically and orderly. From the experimental research, there are three shortcomings: first, the acute and chronic stress models used in the current emotional pathogenicity research are mostly single stressor stimulation models, which have a certain gap with the reality of human multi-factor stress response; Second, due to inconsistent model selection, some drug-based studies are difficult to compare, which is not conducive to scientific evaluation and survival of the fittest; Thirdly, emotional illness is closely related to the time, nature, intensity and individual differences of multi-factor stimuli, but there are few quantitative studies on emotional illness at present. In addition, is it scientific to study the pathogenic mechanism of emotion based on the theory that single emotion hurts specific viscera in traditional Chinese medicine? Does a single emotional stimulus hurt his filth at the same time? No experimental evidence has been seen yet; When the physiology and pathology of Tibetan images are not clear when stimulated by single or compound stressors, it is inevitable that there is blindness in studying the deep mechanism of traditional Chinese medicine, and it is difficult to clarify the systematic and overall regulation mechanism; The related research of traditional Chinese medicine mostly focuses on the liver, while the related research of other zang-fu organs is obviously insufficient, which is also worth thinking about.
Based on the above problems, it is considered that the following work needs to be discussed: in theoretical research, it is urgent for Chinese medicine scholars to make clear the concept of emotion and the connotation of emotional diseases and syndromes through expert discussion; After scientific argumentation, the original questioned theory was abandoned, and innovative scientific hypothesis was put forward, which was tested, sublimated and established in clinical and experimental research. In experimental research, animal models can be compared with the existing recognized single stressor model and chronic compound stress model, and the most ideal model can be selected to simulate human emotional diseases (single emotion and passion intertwined). You can also combine disease and syndrome to prepare a model and establish a quantitative evaluation standard. Through the overall research combining macro and micro, the physiological and pathological characteristics and laws of each model are discussed respectively, new problems are found, new laws are explored, and the theory of emotional diseases is realized. On the basis of model research, we should integrate traditional Chinese medicine, modern medicine, psychology and other multidisciplinary methods. , and from the behavioral characteristics, Tibetan image structure, overall function and metabolism, tissue, cells, molecules and other aspects of a comprehensive discussion. The study of effective prescriptions should focus on curative effect, and then the mechanism discussion and new drug development research should be carried out after screening. In a word, there is still a lot of arduous work to be done to make the research on the prevention and treatment of emotional diseases in traditional Chinese medicine truly enter the scientific track and finally form an emotional medical system integrating diagnosis, treatment and prevention, and it is necessary to integrate multidisciplinary knowledge and technology in an organized and planned way.