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Article(id=1322923465312969386, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923268038078806, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.04.037, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339132859, onlineDateStr=2026-10-30, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339132859, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339132859, creator=13701087609, updateTime=1793339132859, updator=13701087609, issue=Issue{id=1322923268038078806, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='4', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1744214400000', pubDateStr='2025-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339085826, creator='13701087609', updateTime=1793340586453, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929562572686061, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923268038078806, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929562572686062, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923268038078806, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=217, endPage=220, ext={EN=ArticleExt(id=1322923465644319403, articleId=1322923465312969386, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Clinical Study of Five-Element Acupuncture Reusing Source Acupoints Method Combined with Ningshen Wendan Decoction（宁神温胆汤）in Treatment of Schizophrenia Auditory Hallucinations, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To observe the clinical effect of five-element acupuncture and moxibustion reusing the source acupoints combined with Ningshen Wendan Decoction（宁神温胆汤）on schizophrenic auditory hallucinations.

Methods

A total of 82 patients with phlegm-fire disturbance type of schizophrenia who were treated in the hospital from June 2021 to January 2023 were selected and divided into conventional group（41 cases）and traditional Chinese medicine（TCM）group（41 cases）by random number table method. The conventional group was given risperidone oral treatment，and the TCM group was given five-element acupuncture reusing the source acupoints combined with Ningshen Wendan Decoction on this basis. TCM syndrome scores，Positive and Negative Symptom Scale（PANSS）and Auditory Hallucinations Rating Scale（AHRS）scores，brain neurotransmitter levels，clinical efficacy and adverse reactions were observed in two groups.

Results

After treatment，TCM syndrome scores，PANSS and AHRSscores and dopamine（DA）level in TCM group were lower than those in the conventional group（P<0.05），and 5-hydroxytryptamine（5-HT）level was higher than that in the conventional group（P<0.05）. The total effective rate of the TCM group was higher than that of the conventional group（P<0.05）. There was no significant difference in the total incidence of adverse reactions between the two groups（P>0.05）.

Conclusion

The five-element acupuncture reusing the source acupoints method combined with Ningshen Wendan Decoction can effectively improve the clinical symptoms such as auditory hallucinations，the levels of brain neurotransmitters，the treatment efficiency and safety.

, authors=Wei WANG, Xinxin JIANG, Zhengping CHEN, authorsList=Wei WANG, Xinxin JIANG, Zhengping CHEN, authorCompany=null, correspAuthors=Zhengping CHEN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923466910999220, articleId=1322923465312969386, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症幻听临床研究, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

观察五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症幻听的临床疗效。

方法

选择2021年6月—2023年1月于医院就诊的痰火上扰型精神分裂症患者82例，采用随机数字表法分成常规组（41例）与中医组（41例）。常规组给予利培酮口服治疗，中医组在此基础上给予五行针灸重用原穴法联合宁神温胆汤治疗。观察两组患者中医证候积分、阳性和阴性症状量表（Positive and Negative Symptoms Scale，PANSS）与幻听评定量表（Auditory Hallucination Rating Scale，AHRS）评分、脑神经递质水平、临床疗效与不良反应。

结果

治疗后，中医组中医证候积分、PANSS与AHRS评分、多巴胺（dopamine，DA）水平均低于常规组（P<0.05），5-羟色胺（5-hydroxytryptamine，5-HT）水平高于常规组（P<0.05）；中医组患者治疗总有效率高于常规组（P<0.05）；两组不良反应总发生率差异无统计学意义（P>0.05）。

结论

五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症可有效改善幻听等临床症状，改善脑神经递质水平，提高治疗有效率，安全性较高。

, authors=王威, 蒋新新, 陈正平, authorsList=王威, 蒋新新, 陈正平, authorCompany=null, correspAuthors=陈正平, authorNote=

王威（1975-），男，浙江绍兴人，主治医师，学士，研究方向：针灸中医精神心理。

, correspAuthorsNote=
陈正平（1968-），男，湖南桂东人，主任医师，学士，研究方向：精神疾病社区康复与治疗、司法鉴定。E-mail：。
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王威（1975-），男，浙江绍兴人，主治医师，学士，研究方向：针灸中医精神心理。

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王威（1975-），男，浙江绍兴人，主治医师，学士，研究方向：针灸中医精神心理。

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tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, doi=null, pmid=null, pmcid=null, year=2004, volume=10, issue=5, pageStart=68, pageEnd=70, url=null, language=null, rfNumber=[22], rfOrder=21, authorNames=谢辉, 贺又舜, journalName=湖南中医药导报, refType=null, unstructuredReference=谢辉，贺又舜．温胆汤及其配伍对大鼠纹状体DA代谢的影响［J］．湖南中医药导报，2004，10（5）：68-70., articleTitle=温胆汤及其配伍对大鼠纹状体DA代谢的影响, refAbstract=null), Reference(id=1322923479821066993, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, doi=null, pmid=null, pmcid=null, year=2017, volume=26, issue=7, pageStart=502, pageEnd=506, url=null, language=null, rfNumber=[23], rfOrder=22, authorNames=占建华, 蒋新新, 严伟良, journalName=药物流行病学杂志, refType=null, unstructuredReference=占建华，蒋新新，严伟良，等．宁神温胆汤治疗以阴性症状为主精神分裂症患者的研究概述［J］．药物流行病学杂志，2017，26（7）：502-506., articleTitle=宁神温胆汤治疗以阴性症状为主精神分裂症患者的研究概述, refAbstract=null), Reference(id=1322923479900758770, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, doi=null, pmid=null, pmcid=null, year=2022, volume=42, issue=7, pageStart=817, pageEnd=821, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=崔界峰, 王绍礼, 赵霞, journalName=中国中西医结合杂志, refType=null, unstructuredReference=崔界峰，王绍礼，赵霞，等．中医针刺疗法治疗伴有顽固性幻听慢性精神分裂症患者功能康复多中心随机对照研究［J］．中国中西医结合杂志，2022，42（7）：817-821., articleTitle=中医针刺疗法治疗伴有顽固性幻听慢性精神分裂症患者功能康复多中心随机对照研究, refAbstract=null), Reference(id=1322923480001422067, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, doi=null, pmid=null, pmcid=null, year=2022, volume=42, issue=1, pageStart=109, pageEnd=114, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=韩雨欣, 杨必安, journalName=河南中医, refType=null, unstructuredReference=韩雨欣，杨必安．结合出土文献研究秦汉时期古典针灸理论体系［J］．河南中医，2022，42（1）：109-114., articleTitle=结合出土文献研究秦汉时期古典针灸理论体系, refAbstract=null), Reference(id=1322923480076919540, tenantId=1146029695717560320, journalId=1255847919539208197, 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of Shaoxing, Shaoxing 312000, Zhejiang, China), AuthorCompanyExt(id=1322923467288486583, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, companyId=1322923467271709365, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=绍兴市第七人民医院，浙江　绍兴　312000)])], figs=[ArticleFig(id=1322923474460746448, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主症积分次症积分
治疗前治疗后治疗前治疗后
常规组4125.15±3.6615.82±2.59*21.14±3.1212.34±2.05*
中医组4124.87±3.5212.13±2.03*21.36±3.089.11±1.84*
t值0.3537.1800.3217.508
P值0.725<0.0010.749<0.001
), ArticleFig(id=1322923474779513553, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, language=CN, label=表1, caption=

两组精神分裂病患者中医证候积分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主症积分次症积分
治疗前治疗后治疗前治疗后
常规组4125.15±3.6615.82±2.59*21.14±3.1212.34±2.05*
中医组4124.87±3.5212.13±2.03*21.36±3.089.11±1.84*
t值0.3537.1800.3217.508
P值0.725<0.0010.749<0.001
), ArticleFig(id=1322923474846622418, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数PANSSAHRS
治疗前治疗后治疗前治疗后
常规组4174.01±6.4561.14±7.46*23.64±3.1215.23±2.94*
中医组4172.81±5.7454.27±7.92*23.32±3.0711.48±2.63*
t值0.8904.0430.4686.087
P值0.376<0.0010.641<0.001
), ArticleFig(id=1322923474926314195, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, language=CN, label=表2, caption=

两组精神分裂病患者PANSS与AHRS评分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数PANSSAHRS
治疗前治疗后治疗前治疗后
常规组4174.01±6.4561.14±7.46*23.64±3.1215.23±2.94*
中医组4172.81±5.7454.27±7.92*23.32±3.0711.48±2.63*
t值0.8904.0430.4686.087
P值0.376<0.0010.641<0.001
), ArticleFig(id=1322923474997617364, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数DA/（ng/mL）5-HT/（ng/L）
治疗前治疗后治疗前治疗后
常规组41216.28±15.96169.34±11.17*41.96±7.0955.34±9.68*
中医组41218.59±16.13135.58±9.47*42.11±7.3267.82±10.25*
t值0.65214.7620.0945.668
P值0.516<0.0010.925<0.001
), ArticleFig(id=1322923475257664213, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, language=CN, label=表3, caption=

两组精神分裂病患者DA与5-HT水平比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数DA/（ng/mL）5-HT/（ng/L）
治疗前治疗后治疗前治疗后
常规组41216.28±15.96169.34±11.17*41.96±7.0955.34±9.68*
中医组41218.59±16.13135.58±9.47*42.11±7.3267.82±10.25*
t值0.65214.7620.0945.668
P值0.516<0.0010.925<0.001
), ArticleFig(id=1322923475324773078, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数痊愈显效有效无效总有效
常规组415（12.20）12（29.27）13（31.71）11（26.83）30（73.17）
中医组419（21.95）18（43.90）10（24.39）4（9.76）37（90.24）
χ2值3.998
P值0.046
), ArticleFig(id=1322923475417047767, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, language=CN, label=表4, caption=

两组精神分裂病患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数痊愈显效有效无效总有效
常规组415（12.20）12（29.27）13（31.71）11（26.83）30（73.17）
中医组419（21.95）18（43.90）10（24.39）4（9.76）37（90.24）
χ2值3.998
P值0.046
), ArticleFig(id=1322923475681288920, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923465312969386, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数椎体外系反应代谢综合征胃肠道反应头晕头痛总发生
常规组412（4.88）2（4.88）01（2.44）5（12.2）
中医组411（2.44）2（4.88）2（4.88）2（4.88）7（17.7）
χ2值0.390
P值0.532
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两组精神分裂病患者不良反应发生率比较

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组别例数椎体外系反应代谢综合征胃肠道反应头晕头痛总发生
常规组412（4.88）2（4.88）01（2.44）5（12.2）
中医组411（2.44）2（4.88）2（4.88）2（4.88）7（17.7）
χ2值0.390
P值0.532
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五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症幻听临床研究
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王威 , 蒋新新 , 陈正平
中华中医药学刊 | 省级项目平台 2025,43(4): 217-220
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中华中医药学刊 |省级项目平台 2025 , 43 (4) : 217 -220
五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症幻听临床研究
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王威, 蒋新新, 陈正平
作者信息
  • 绍兴市第七人民医院，浙江　绍兴　312000
通讯作者:
陈正平（1968-），男，湖南桂东人，主任医师，学士，研究方向：精神疾病社区康复与治疗、司法鉴定。E-mail：。
作者简介:

王威（1975-），男，浙江绍兴人，主治医师，学士，研究方向：针灸中医精神心理。

Clinical Study of Five-Element Acupuncture Reusing Source Acupoints Method Combined with Ningshen Wendan Decoction（宁神温胆汤）in Treatment of Schizophrenia Auditory Hallucinations
Wei WANG, Xinxin JIANG, Zhengping CHEN
Affiliations
  • The Seventh People＇s Hospital of Shaoxing, Shaoxing 312000, Zhejiang, China
出版时间: 2025-04-10 doi: 10.13193/j.issn.1673-7717.2025.04.037
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摘要
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目的

观察五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症幻听的临床疗效。

方法

选择2021年6月—2023年1月于医院就诊的痰火上扰型精神分裂症患者82例，采用随机数字表法分成常规组（41例）与中医组（41例）。常规组给予利培酮口服治疗，中医组在此基础上给予五行针灸重用原穴法联合宁神温胆汤治疗。观察两组患者中医证候积分、阳性和阴性症状量表（Positive and Negative Symptoms Scale，PANSS）与幻听评定量表（Auditory Hallucination Rating Scale，AHRS）评分、脑神经递质水平、临床疗效与不良反应。

结果

治疗后，中医组中医证候积分、PANSS与AHRS评分、多巴胺（dopamine，DA）水平均低于常规组（P<0.05），5-羟色胺（5-hydroxytryptamine，5-HT）水平高于常规组（P<0.05）；中医组患者治疗总有效率高于常规组（P<0.05）；两组不良反应总发生率差异无统计学意义（P>0.05）。

结论

五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症可有效改善幻听等临床症状，改善脑神经递质水平，提高治疗有效率，安全性较高。

五行针灸  /  宁神温胆汤  /  精神分裂症  /  幻听
Objective

To observe the clinical effect of five-element acupuncture and moxibustion reusing the source acupoints combined with Ningshen Wendan Decoction（宁神温胆汤）on schizophrenic auditory hallucinations.

Methods

A total of 82 patients with phlegm-fire disturbance type of schizophrenia who were treated in the hospital from June 2021 to January 2023 were selected and divided into conventional group（41 cases）and traditional Chinese medicine（TCM）group（41 cases）by random number table method. The conventional group was given risperidone oral treatment，and the TCM group was given five-element acupuncture reusing the source acupoints combined with Ningshen Wendan Decoction on this basis. TCM syndrome scores，Positive and Negative Symptom Scale（PANSS）and Auditory Hallucinations Rating Scale（AHRS）scores，brain neurotransmitter levels，clinical efficacy and adverse reactions were observed in two groups.

Results

After treatment，TCM syndrome scores，PANSS and AHRSscores and dopamine（DA）level in TCM group were lower than those in the conventional group（P<0.05），and 5-hydroxytryptamine（5-HT）level was higher than that in the conventional group（P<0.05）. The total effective rate of the TCM group was higher than that of the conventional group（P<0.05）. There was no significant difference in the total incidence of adverse reactions between the two groups（P>0.05）.

Conclusion

The five-element acupuncture reusing the source acupoints method combined with Ningshen Wendan Decoction can effectively improve the clinical symptoms such as auditory hallucinations，the levels of brain neurotransmitters，the treatment efficiency and safety.

five-element acupuncture  /  Ningshen Wendan Decoction（宁神温胆汤）  /  schizophrenia  /  auditory hallucination
王威, 蒋新新, 陈正平. 五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症幻听临床研究. 中华中医药学刊, 2025 , 43 (4) : 217 -220 . DOI: 10.13193/j.issn.1673-7717.2025.04.037
Wei WANG, Xinxin JIANG, Zhengping CHEN. Clinical Study of Five-Element Acupuncture Reusing Source Acupoints Method Combined with Ningshen Wendan Decoction（宁神温胆汤）in Treatment of Schizophrenia Auditory Hallucinations[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (4) : 217 -220 . DOI: 10.13193/j.issn.1673-7717.2025.04.037
正文
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精神分裂症是一种相对罕见的严重慢性精神疾病，其特征为情绪、思维和行为的紊乱。症状包括幻觉、妄想、思维紊乱、情感减退、社交退缩、认知障碍等[1-2]。其具体发病机制尚不完全清楚，但认为遗传、环境和神经生物学因素可能共同作用[3]。精神分裂症的治疗主要包括药物治疗和心理社会干预，抗精神病药物可以减轻症状，但可能引起运动障碍、代谢紊乱、心血管问题等不良反应[4-5]。随着中医学的不断发展，中医药手段治疗精神分裂症因其独特优势逐渐受到重视[6]。中医理论中，精神分裂症属于“癫病”范畴，痰火上扰证是其常见证型之一，治疗应以涤痰泻火为主要原则[7]，宁神温胆汤可清热化痰、宁心安神，在精神疾病治疗中有较好的疗效；五行针灸结合了五行学说和经络理论，以及针灸疗法来调整人体的阴阳平衡，促进健康。目前尚未有二者集合用于精神分裂症幻听治疗的相关报道，本研究使用五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症幻听，观察其疗效及对幻听的影响，以期为精神分裂症的临床治疗提供更多用药参考，现报道如下。
1　资料与方法
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1.1　一般资料
选择2021年6月—2023年1月于我院就诊的痰火上扰型精神分裂症患者82例，采用随机数字表法分成常规组（41例）与中医组（41例）。常规组中男22例，女19例；年龄21～55岁，平均（36.84±7.17）岁；体质量指数18～25 kg/m2，平均（21.65±1.38）kg/m2；精神分裂症病程0.5～9年，平均（3.76±1.61）年；幻听病程3～14个月，平均（7.94±2.18）个月。中医组中男24例，女17例；年龄20～58岁，平均（35.37±6.92）岁；体质量指数18～26 kg/m2，平均（21.33±1.45）kg/m2；精神分裂症病程0.4～10年，平均（4.02±1.72）d；幻听病程3～15个月，平均（8.23±2.42）个月。两组基线资料具有可比性（P>0.05）。本研究经本院医学伦理委员会批准（批件号：2022-001-01）。
1.2　诊断标准
1.2.1　西医诊断标准
符合《中国精神障碍诊断与分类标准（第3版）》[8]中精神分裂症的诊断标准，且均存在幻听症状。
1.2.2　中医辨证标准
符合《中医病证诊断疗效标准》[9]中痰火上扰证的辨证标准。主症：烦躁易怒、精神亢奋、打人毁物、骂詈躁扰、善思多疑、妄见妄闻；次症：面唇红赤、烦渴多饮、口苦口干、失眠多梦、小便黄赤、大便秘结。舌质红，苔黄腻，脉滑数，或脉实。
1.3　纳入标准
①符合精神分裂症的西医诊断标准及痰火上扰证中医辨证标准；②年龄18～60岁；③阳性和阴性症状量表（Positive and Negative Symptoms Scale，PANSS）[10]总分≥60分；④幻听症状持续3个月及以上；⑤依从性强，能配合完成各项相关检查与治疗者；⑥患者及家属自愿签署知情同意书。
1.4　排除标准
①继发性精神分裂症、难治性精神分裂症患者或合并其他精神疾病者；②存在自杀风险者；③对本研究药物过敏或穴位处皮肤溃破或感染者；④合并恶性肿瘤、免疫缺陷及其他系统功能严重障碍者；⑤妊娠及哺乳期妇女；⑥入组前1个月内服用过相关精神类药物者；⑦不能配合完成量表者。
1.5　治疗方法
常规组给予利培酮口服治疗。给予利培酮片（常州四药制药有限公司，国药准字H20050410，1 mg）口服，起始剂量为每天1 mg，依据患者病情于治疗开始后1周内调整为每天2～3 mg，2周内调整药量范围至4～6 mg为治疗剂量后不再变化。连续治疗8周。
中医组在常规组的基础上给予五行针灸重用原穴法联合宁神温胆汤治疗。①给予宁神温胆汤口服治疗。方药组成为：茯苓30 g，酸枣仁10 g，石菖蒲10 g，半夏10 g，竹茹10 g，枳实10 g，陈皮10 g，甘草6 g，生姜6 g，大枣6 g。将药物浸泡30 min后，每次加水500～700 mL，共加水6次，煮沸后煎煮至200 mL，煎煮2次后混合为1剂，每剂400 mL，每日1剂，分早晚2次服用。连续治疗8周。②给予五行针灸重用原穴法治疗。通过声音、颜色、气味、感情判断患者主导行，依据五行判断选取患者主导一行的原穴：木行为主导的患者取太冲穴、丘墟穴；火行为主导者，君火取神门穴、腕骨穴，相火取大陵穴、阳池穴；土行取太白穴、冲阳穴；金行取太渊穴、合谷穴；水行取太溪穴、京骨穴。均为双侧取穴。按照先阳经后阴经、先左后右的顺序以先泻后补法针刺，各留针15 min。1次/3 d，连续治疗8周。
1.6　观察指标
1.6.1　中医证候积分
分别记录两组患者治疗前、治疗后主证与次证情况，按照等级症状积分法分为无（0分）、轻（2分）、中（4分）、重（6分），记录各证候积分；舌质、舌苔、脉象不计分。
1.6.2　PANSS与幻听评定量表（Auditory Hallucination Rating Scale，AHRS）[11]评分
使用PANSS与AHRS分别于治疗前、治疗后对两组患者阳性与阴性症状及幻听情况进行评估。PANSS主要包含30个项目，分为阳性症状、阴性症状和总体心理病理学3个维度，满分为100分，评分越高症状越严重；AHRS量表从内容、响度、频率、患者痛苦程度方面评估幻听症状，满分为30分，评分越高症状越严重。
1.6.3　脑神经递质水平
使用脑涨落图仪（上海涵飞医疗器械有限公司，SP03）分别于治疗前、治疗后检测两组患者多巴胺（dopamine，DA）与5-羟色胺（5-hydroxytryptamine，5-HT）水平。
1.6.4　临床疗效
①临床控制：幻听症状消失，PANSS评分下降≥75%；②显效：幻听症状较前显著改善，50%≤PANSS评分下降<75%；③有效：幻听有所改善，25%≤PANSS评分下降<50%；④无效：幻听症状无明显改善或加重，PANSS评分减少<25%。
1.6.5　不良反应
观察治疗中两组患者出现的如椎体外系反应、代谢综合征、胃肠道反应、头晕头痛等不良反应。
1.7　统计学方法
使用SPSS 23.0统计学软件。例（%）表示计数资料，应用χ2检验；表示计量资料，应用t检验。P<0.05为差异有统计学意义。
2　结果
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2.1　中医证候积分
治疗后，两组中医证候积分均降低，中医组低于常规组（P<0.05）。见表1。
2.2　PANSS与AHRS评分
治疗后，两组PANSS、AHRS评分均降低，中医组低于常规组（P<0.05）。见表2。
2.3　脑神经递质水平
治疗后，两组DA水平降低，5-HT水平升高，中医组改善幅度优于常规组（P<0.05）。见表3。
2.4　临床疗效
中医组治疗总有效率高于常规组（P<0.05）。见表4。
2.5　不良反应
两组不良反应总发生率差异无统计学意义（P>0.05）。见表5。
3　讨论
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精神分裂症的核心特征是持续存在的精神病理，包括视听幻觉、妄想等阳性症状和情感减退、社交退缩等负性症状，以及注意力不集中、工作记忆受损等认知功能障碍，具有较高的致残、致死率[12-13]。幻听是其最常见阳性症状之一[14]，目前西医药物治疗具有一定的缓解效果，但部分患者难以完全治愈，复发率较高，且不良反应较大，加重了患者心理与生活负担[15-17]。因此，探究更为安全、有效的治疗手段具有重要意义。精神分裂症在中医理论中被归属于“癫证”“邪祟”等范畴，其发病与“痰”“火”“气”“瘀”之邪关系密切，患者由于长期情志不畅等原因而肝气郁结、脾胃功能失调，导致气血津液运行不畅，化生痰浊，瘀而生热，上扰神明、蒙蔽清窍，从而发病，治疗应当以涤痰泻火为主要治疗原则[18-19]。
本研究中，中医组患者治疗后PANSS、AHRS评分与中医证候积分均降低，脑神经递质DA与5-HT水平均有改善，且改善幅度优于常规组。表明五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症可有效缓解幻听及其他临床症状，改善患者脑神经递质水平，提高治疗总有效率。
宁神温胆汤是由温胆汤化裁而来，方中茯苓健脾利湿、宁心安神；酸枣仁安五脏、养肝肾，养心安神；石菖蒲开窍豁痰、醒神益智、化湿开胃，善治痰湿秽浊蒙蔽神窍之证；半夏燥湿化痰、降逆止呕；竹茹清热涤痰、除烦开郁；枳实微寒，可泻痰消积、破气散痞，陈皮性温，可健脾理气、燥湿化痰，二药合用，温凉相辅，增益化痰之功；甘草补脾和胃、益气复脉，可调和药性；生姜温中化痰，可制半夏之毒；大枣补中益气、养血安神。诸药合用共奏涤痰泻火、宁心安神之功[20]。幻听与其他阳性症状的发生与患者脑神经递质表达异常具有密切联系，DA功能亢进5-HT功能减弱可引起精神分裂症患者出现阳性症状[21]，有研究表明，温胆汤可加速DA代谢，恢复5-HT含量，从而改善精神分裂症幻听等阳性症状[22-23]。
五行针灸是中医针灸学的一个重要分支，属中医特色外治法。针刺疗法通过刺激经络穴位可以改善幻听慢性精神分裂症患者认知功能[24]，而五行针灸则将人体与自然界的木、火、土、金、水五行相联系，认为人禀五气而生，五行属性与人一同诞生并主导着人体的生长、发育、精神状态和行为等方面，其中一种属性被称为“主导一行”，扮演着引领其他四行的角色，决定了人的整体平衡状态，如果“主导一行”失去平衡，就无法有效地调节其他四行，进而影响到各个器官和脏腑的功能，导致疾病的出现[25]。五行针灸理论强调个体化的治疗，将患者的五行属性、疾病症状和身体状况纳入考虑，通过调整五行之间的相互关系，影响人体的气血运行、脏腑功能、精神状态，选穴重用每一行对应的经脉原穴，从而辅助此行，恢复五行平衡，达到治疗疾病、促进健康的效果[26]。有研究表明，五行针灸可有效缓解精神疾病患者抑郁、焦虑等负面情绪，改善患者认知功能，恢复受损的神经功能，提高睡眠质量[27-28]。
两组患者在治疗中均出现了不良反应，但差异不具有统计学意义，且均为轻症，表明五行针灸重用原穴法联合宁神温胆汤治疗精神分裂症并不会增加不良反应发生风险，安全性较高。
综上所述，五行针灸重用原穴法联合宁神温胆汤在精神分裂症的治疗中可有效改善患者脑神经递质水平，缓解幻听等临床症状，提高治疗有效率，且安全性较高，值得临床推广。
基金
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  • 浙江省中医药科技计划项目(2022ZA176)
文献
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2025年第43卷第4期
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doi: 10.13193/j.issn.1673-7717.2025.04.037
  • 首发时间：2026-10-30
  • 出版时间：2025-04-10
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浙江省中医药科技计划项目(2022ZA176)
作者信息
    绍兴市第七人民医院，浙江　绍兴　312000

通讯作者:

陈正平（1968-），男，湖南桂东人，主任医师，学士，研究方向：精神疾病社区康复与治疗、司法鉴定。E-mail：。
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https://castjournals.cast.org.cn/joweb/zhzyyxk/CN/10.13193/j.issn.1673-7717.2025.04.037
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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