吳宇琛

SUM WU

Sum Wu

Registered Chinese Medicine Practitioner

Bachelor of Health Science in Traditional Chinese Medicine (UTS)

Bachelor of Science Majoring in Psychology (UOW)

Specialising in pain management and mental wellbeing through Tradition Chinese medicine in combination with modern science in mental health, dieting and nutrition.

吳宇琛，澳洲政府註冊中醫師、針灸師，五龍崗大學心理學學士、悉尼科技大學中醫系學士，擅長用傳統針灸理傷手法和中藥治療各種新舊損傷痛症，特別採用中醫中藥和現代心理學、營養學相結合調理治療各種慢性病和亞健康。

Mental Health – Spleen and Anxiety 2

心理健康-脾臟和焦慮（二）

In TCM the Spleen has slightly different functions than in Western medicine as mentioned previous. It governs transportation and transformation of energy and Qi, it controls the muscles and four limbs, the Spleen house the Yi or “thoughts”, it manages the blood and controls Upright Qi but from our previous episode I also covered on how through modern research, some of these functions that was only from TCM theory may have some connection to Western understanding of the Spleens role in other previously non-related functions.

中醫中的脾與西醫中的功能略有不同，就像前面提到過的，脾主運化氣血，主肌肉和四肢，脾主意或“意念”，主統血，但在我們上一部分裏，我們還介紹了如何通過現代研究，一些僅來自中醫理論的功能可能與西方對脾臟在其他先前不相關功能中的理解有一定聯系。

The Spleen is responsible for transforming food and drinks into sources the body needs, Qi and Blood, and transporting them to where they need to be in the body. Qi and Blood are vital to all the functions the body needs to carry out; when the transformation and transportation function is working properly, the Qi is strong, digestion is smooth and the muscles and limbs of the body get the nutrients they need transported to them. When the Spleen Qi is weak, the muscles and four limbs will not receive adequate nourishment and they will become weak, tired and not function as effectively.

脾負責將食物和飲料轉化為人體所需的氣和血，並將它們輸送到體內需要的地方。氣和血對於身體的所有功能都至關重要。當運化功能正常時，則氣盛，消化順暢，全身肌肉、四肢可以得到所需的營養輸送。脾氣虛弱，肌肉四肢得不到充分的滋養，就會出現無力、疲倦、功能不全的情況。

The Spleen is directly linked to our capacity for thinking and concentration. The ability we have to concentrate well, think clearly, have mental clarity, form intentions and decisions is very dependent on the strength of the Spleen Qi. All organs in Chinese Medicine have an emotion attached to them and the emotion of the Spleen is worry. This is twofold; excessive worrying damages the Spleen, however a deficient Spleen can also weaken the mind and make us more susceptible to emotions such as worry. Many people often see a link in their own bodies between digestion and bowel movements and their state of mind, in particular when worrying or having anxious thoughts.

脾臟與我們的思考和集中能力直接相關。我們能否集中注意力、思維清晰、頭腦清晰、形成意圖和決策，很大程度上取決於脾氣的強弱。中醫認為五臟六腑都有情，脾的情就是憂。這是雙重的；過度憂慮傷脾，但脾虛也會削弱心志，使我們更容易受到憂慮等情緒的影響。許多人經常看到自己身體的消化和排泄與他們的精神狀態之間存在聯系，特別是在擔心或有焦慮想法時。

The Spleen is responsible for making and manufacturing the blood and the Spleen Qi keeps the blood within the vessels (veins and arteries). When Spleen Qi is weak a person will usually bruise easily and may have problems with bleeding.

脾負責生成和製造血液，脾氣將血液保持在血管（靜脈和動脈）內。當脾氣虛弱時，人通常會容易瘀傷，並可能出現出血問題。

Spleens Qi also helps to hold the organs upright and in place. When the Spleen is weak we see prolapse of organs often including the Uterus, Bladder, Stomach or Vagina as well as things such as haemorrhoids.

脾氣還有助於保持器官的直立且在正確的位置。當脾虛時，我們會看到器官脫垂，包括子宮、膀胱、胃或陰道，以及痔瘡等疾病。

In summary, when the Spleen Qi is weak it will results in lethargy and lassitude; the appetite may also be poor, digestion sluggish and stools may be loose and watery and anxiety symptoms.

總結來講就是，脾氣虛弱，就會出現嗜睡、倦怠；食欲也可能不佳、消化遲緩、大便松軟、水樣和焦慮症狀。

Both Spleen and anxiety belong to the Earth, giving rise to a TCM theory stating that “Anxiety impairs Spleen”. According to TCM, over-focusing or over-thinking on one subject will lead to anxiety, with resultant dysfunction in the transport of water and nutrients around the body and the stagnation of Qi, indicative of a poorly functioning of the Spleen. Prolonged anxiety can worsen the functions of other Zang, which is consistent with the inter-functional relationship among various Zang. Interestingly, anger can be used to alleviate anxiety. Anger belongs to Wood, which restricts the Earth according to the Five Element theory. Thus, by inducing a state of rage, the effects of anger can effectively alleviate a state of anxiety. Although such psychotherapy is theoretically sound, little is currently known about the scientific basis of such treatment.

脾與憂同屬土，故中醫有“憂傷脾”的理論。中醫認為，過度專註或過度思考某一件事會導致焦慮，從而導致全身水和營養的輸送功能障礙以及氣滯，這表明脾的功能不佳。長期的焦慮會使其他臟的功能惡化，這與各臟腑之間的功能關系是一致的。而有趣的是，憤怒可以用來緩解焦慮。憤怒屬於木，根據五行理論，木剋制土。因此，通過誘發憤怒狀態，憤怒的影響可以有效緩解焦慮狀態。盡管這種心理治療在理論上是合理的，但目前人們對這種治療的科學基礎知之甚少。

It is worth noting the difference between stress and anxiety. Stress can be defined as a short-term psychological pressure when only limited resources are available to finish a task, whereas anxiety can be defined as a long-term worry about something uncertain in the future. Yet, a prolonged state of stress can also lead to anxiety. Studies have shown that General Anxiety Disorder (GAD) can be characterized by an asymmetrical expression of the Sympathetic Nervous System (SNS) and the Hypothalamic-Pituitary-Adrenal (HPA) axis. Based on this observation, it can be deduced that the influence of anxiety on Spleen function is likely mediated by both nervous and endocrine factors. The SNS, a component of the autonomic nervous system, serves to inhibit digestive functions (including peristalsis) and the enteric nervous system, an intrinsic nervous system in the digestive process. The HPA axis regulates a series of endocrine glands, wherein the hypothalamus secretes Corticotropin Releasing Hormone (CRH) that stimulates the pituitary gland to secrete adrenocorticotropic hormone (ACTH), and ACTH in turn stimulates the secretion of cortisol from the adrenal cortex.

值得注意的是壓力和焦慮之間的區別。壓力可以定義為只有有限的資源可以完成任務時的短期心理壓力，而焦慮可以定義為對未來不確定事物的長期擔憂。然而，長期的壓力狀態也會導致焦慮。研究表明，廣泛性焦慮症（GAD）的特徵是交感神經系統（SNS）和下丘腦-垂體-腎上腺（HPA）軸的不對稱表達。根據這一觀察，可以推斷焦慮對脾功能的影響可能是由神經和內分泌因素共同介導的。 交感神經系統是自主神經系統的組成部分，用於抑制消化功能（包括蠕動）和腸神經系統（消化過程中的內在神經系統）。下丘腦-垂體-腎上腺軸調節一系列內分泌腺，其中下丘腦分泌促腎上腺皮質激素釋放激素（CRH），刺激垂體分泌促腎上腺皮質激素（ACTH），促腎上腺皮質激素又刺激腎上腺皮質分泌皮質醇。

Cortisol primarily activates gluconeogenesis and the metabolism of fat, protein and carbohydrate in cells. However, cortisol sometimes referred to as a stress hormone, has been found to be strongly associated with anxiety. The overproduction of cortisol under conditions of anxiety leads to immunosuppression, a symptom of Spleen dysfunction in TCM.

皮質醇主要激活細胞中的糖異生和脂肪、蛋白質和碳水化合物的代謝。然而，皮質醇有時被稱為應激激素，已被發現與焦慮密切相關。焦慮狀態下皮質醇的過度產生會導致免疫抑制，這是中醫脾功能障礙的症狀。

Another example that can tie the theory of Spleen dysfunction in TCM closely with stress and anxiety and digestive issues is Irritable Bowel Syndrome. It common knowledge that Irritable Bowel Syndrome (IBS) was closely associated with anxiety and it is one of the number one triggers.

另一個將中醫脾功能失調理論與壓力、焦慮和消化問題緊密聯系起來的例子是腸易激綜合症。眾所周知，腸易激綜合症（IBS）與焦慮密切相關，是第一大誘因之一。

This may be explained by the over-stimulation or under-stimulation of the digestive system by the SNS, leading to contradicting IBS symptoms such as constipation and diarrhoea. A study also shows that stressors can disrupt the function of GI microbiota by inducing a neural response, which increases the risk of mucosal infection and inflammation. Stress on the GI mucosal immune system can lead to the translocation of pathogenic microbes from the GI tract to the interior of the body, with the resultant infection and the associated inflammatory response. Severe and sustained anxiety can induce peptic ulceration. Symptoms of peptic ulcer, including digestive discomfort and bleeding along the digestive tract, can be related with Spleen dysfunction, in which the Spleen fails to sustain the function of the digestive system and regulate the circulation of blood.

這可能是由於交感神經系統對消化系統的過度刺激或刺激不足，導致便秘和腹瀉等矛盾的腸易激綜合症症狀。一項研究還表明，壓力源可以通過誘導神經反應來破壞胃腸道微生物群的功能，從而增加粘膜感染和炎症的風險。胃腸道粘膜免疫系統的壓力可能導致病原微生物從胃腸道轉移到身體內部，從而導致感染和相關的炎症反應。嚴重且持續的焦慮可誘發消化性潰瘍。消化性潰瘍的症狀，包括消化道不適和消化道出血，可能與脾臟功能失調有關，脾臟不能維持消化系統的功能和調節血液循環。

In TCM, it is believed that anxiety arises from an imbalance of Zang functions, wherein different combinations of functional imbalances among Zang result in various symptoms. Yet, as the Five Element theory goes, Earth, which is considered as the center of the five elements, will eventually be hindered by the imbalance of other elements. Thus, the treatment of different types of anxiety is primarily focused on invigorating the function of the Spleen. Gui Pi Tang, which is a commonly used formulation in treating anxiety, not only ameliorates the symptoms of Spleen dysfunction caused by anxiety, but also directly alleviates anxiety. From the perspective of TCM theory, Gui Pi Tang mobilizes the stagnant Qi and nourishes shen in the Heart, which is thought to be the master of emotion. As anxiety is pathologically- related to the stagnation of Qi, a smooth flow of Qi will ease anxiety.

中醫認為，焦慮是由於臟腑功能失衡而產生的，臟腑功能失衡的不同組合會導致不同的症狀。然而，正如五行理論所說，土作為五行的中心，最終會受到其他元素不平衡的阻礙。因此，治療不同類型的焦慮症，主要以健脾為主。歸脾湯是治療焦慮症的常用方劑，不僅能改善焦慮症引起的脾虛症狀，還能直接緩解焦慮症。從中醫理論來看，歸脾湯調動鬱氣，養神於心，被認為是情志之主。由於焦慮在病理上與氣滯有關，氣暢則可以緩解焦慮。

如有疑問想咨詢吳宇琛中醫師，可以在微信或whatsapp搜索0404836368，加吳宇琛中醫師微信或whatsapp，也可以發短信或致電0404836368作語音留言，吳宇琛中醫師有空就會回復。

（吳宇琛中醫師，澳洲政府註冊中醫師、針灸師，五龍崗大學心理學學士、悉尼科技大學中醫系學士，悉尼好思维松轩药行主治中医师，本文僅供參考，具體診療應諮詢專業人士。）