[1]陈 喆,胡锦晗,蔡超产,等.基于“气-水-血”理论探讨顽固性失眠的病机与辨治[J].陕西中医,2024,(6):803-807.[doi:DOI:10.3969/j.issn.1000-7369.2024.06.017]
　CHEN Zhe,HU Jinhan,CAI Chaochan,et al.Pathogenesis and the differentiation and treatment of intractable refractory insomnia based on the theory of “qi-water-blood”[J].,2024,(6):803-807.[doi:DOI:10.3969/j.issn.1000-7369.2024.06.017]
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基于“气-水-血”理论探讨顽固性失眠的病机与辨治
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《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2024年6期
页码:
803-807
栏目:
学术探讨
出版日期:
2024-06-05

文章信息/Info

Title:
Pathogenesis and the differentiation and treatment of intractable refractory insomnia based on the theory of “qi-water-blood”
作者:
陈 喆1; 2; 胡锦晗2; 蔡超产1; 2; 罗艳超1; 2; 徐 峰1
(1.北京中医药大学第三附属医院,北京 100029; 2.北京中医药大学,北京 100105)
Author(s):
CHEN Zhe; HU Jinhan; CAI Chaochan; LUO Yanchao; XU Feng
(The Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China)
关键词:
顽固性失眠;  气-水-血;  阴阳失交;  痰瘀;  病机;  辨治
Keywords:
Refractory insomnia;  Qi-water-blood;  Losing interactions between yin and yang;  Phlegm and blood stasis;  Pathogenesis;  Differentiation and treatment
分类号:
R 256.23
DOI:
DOI:10.3969/j.issn.1000-7369.2024.06.017
文献标志码:
A
摘要:
“气”为阳,“水-血”为阴,“气-水-血”生理中相互关联,病理中相互影响,三者失衡则共同致病。顽固性失眠是临床常见的一种多系统复杂疾病,其基础病机是“阴阳失交”。基于“气-水-血”理论,结合顽固性失眠的病程发展特点,将其分为前、中、末三个阶段,前期阳气鼓动致水血壅盛于脉道,责之于心、肝,治疗以清心疏肝,疏散水血,安定神魂为法; 中期机体形成痰瘀胶结之势,阻碍气机,导致肝疏泄功能异常,脾气运化无能,责之于肝、脾,治疗以祛痰化瘀,生化水血,导阳入阴为法; 末期痰瘀互结日久,耗散水血精微,阳气衰弱,新生津液、气血能力下降,痰瘀互结变为次要病机,主要病机成为阴阳俱衰竭,心肾失交,治疗以温阳化气、调补水血、交通心肾为法。临证当辨其阶段,定其关键病机,再遵各期治法以遣方选药。
Abstract:
“Qi” is yang,while “water and blood” are yin.“Qi,water,and blood” are related to each other in physiology and influence each other in pathology.An imbalance among the three will cause disease together.Refractory insomnia is a common multi-system complex disease in clinical practice,and its underlying pathogenesis is “losing interactions between yin and yang”. Based on the “qi-water-blood” theory and combined with the characteristics of the development of intractable insomnia course,it is divided into three stages which are the early,the middle,and the last.In the early stage,the heart and the liver make yang qi agitational,causing water and blood to accumulate in the channels,so the therapeutic methods should be clearing heart and soothing liver,dispersing water and blood,and tranquilizing mind.In the middle stage,the body forms a tendency to condense phlegm and blood stasis,stagnating the qi movement.It results in the liver not being able to govern the free flow of qi,and the spleen can't govern transportation and transformation,so the therapeutic methods should be dispelling phlegm and resolving stasis,generating and transforming water and blood,and guiding yang into yin.In the last stage,the main pathogenesis becomes the deficiency of both yin and yang and non-interaction between heart and kidney.It is because of the long-time phlegm and blood stasis,consumption of water and blood essentials,weakness of yang qi,and disability of generating and transforming qi blood and fluid.The therapeutic methods should be warming yang and transforming qi,tonifying and nourishing water and blood,and restoring coordination between heart and kidney.When practicing,the stages of the clinical syndrome should be differentiated,the key pathogenesis should be determined,and then the formula and medicine should be elected according to the therapeutic methods of each stage.

参考文献/References:

[1] MORIN C M,JARRIN D C.Epidemiology of insomnia:Prevalence,course,risk factors,and public health burden[J].Sleep Medicine Clinics,2022,17(2):173-191.
[2] 梁昆,常会敏,岳波,等.银杏叶提取物片联合百乐眠胶囊治疗特发性耳鸣伴失眠疗效研究[J].陕西医学杂志,2018,47(8):1053-1055.
[3] 刘琼,关双,陈亚飞,等.中西医治疗顽固性失眠的研究进展[J].中国中医基础医学杂志,2021,27(10):1670-1674.
[4] 颜鸿,张蕊.佐匹克隆治疗失眠60例疗效观察[J].陕西医学杂志,2012,41(9):1259-1260.
[5] SHI Y,CUI M,OCHS K,et al.Long-term diazepam treatment enhances microglial spine engulfment and impairs cognitive performance via the mitochondrial 18 kDa translocator protein(TSPO)[J].Nature Neuroscience,2022,25(3):317-329.
[6] 卢芳,匡海学,刘树民.诠释“中医之水”——水、湿、痰、饮的内涵及治疗理论[J].世界中医药,2015,10(12):1813-1818.
[7] 马铭泽,孟静岩.试论唐荣川《血证论》痰瘀相关思想[J].西部中医药,2022,35(3):61-63.
[8] 聂天义.论水血相关[J].安徽中医学院学报,1991,10(1):10-13.
[9] 王诗恒,刘剑锋,秦培洁,等.刘剑锋教授治疗失眠临床经验[J].陕西中医,2020,41(1):95-98.
[10] 聂天义.《内经》水血相关论探讨[J].四川中医,1992,17(6):3-4.
[11] 张思奇,赵菁,王欣彤,等.方祝元基于神、气、血一体同调理论治疗冠心病合并失眠之经验[J].江苏中医药,2023,55(3):6-9.
[12] 潘军伟,曾怡龙,李亚平.浅谈柔肝解毒法在顽固性失眠中的运用[J].新中医,2020,52(1):175-177.
[13] 黄玫玫.李德新教授治疗顽固性失眠经验举偶[J].辽宁中医药大学学报,2009,11(4):111-112.
[14] 马洪明,高兴慧,田金洲.田金洲教授从瘀、虚辨治慢性失眠[J].长春中医药大学学报,2015,31(4):710-712.
[15] 李铎,李佳,刘悦,等.基于中医基础理论探讨痰证现代生物学基础[J].辽宁中医杂志,2020,47(2):93-95.
[16] 杨丽,张荣华,蔡宇,等.痰瘀与顽固性失眠[J].陕西中医,2004,25(5):431-434.
[17] 惠波波,张晓乐,王翠,等.韩祖成从痰、瘀、虚论治顽固性失眠经验[J].吉林中医药,2022,42(10):1144-1148.
[18] 古金晓,于海青,李伟荣,等.基于“虚气留滞”病机探讨心脑同治理论[J].环球中医药,2022,15(5):792-796.
[19] 王淞,朱俊楠,宋修道,等.国医大师张志远运用黄连阿胶汤加减治疗心肾不交型失眠的经验[J].中华中医药杂志,2020,35(7):3424-3426.
[20] 王华楠.对《血证论》“阴阳水火气血论”的气化阐释[J].中国中医药信息杂志,2012,19(7):90-92.
[21] 张海航,薛丹,张冰月,等.基于“少阳为枢、少阴为枢”探讨顽固性失眠的诊疗思路[J].中医杂志,2022,63(4):323-326.
[22] 张彤,李非洲,夏婧,等.王平从心肝论治不寐的经验[J].中华中医药杂志,2019,34(7):3063-3065.
[23] 杨盼盼,王华伟,马勇,等.王宝亮教授从心肝辨治失眠[J].中医临床研究,2015,35(7):55-56.
[24] 依秋霞,张泽.李敬林学术思想传承——重视情志,从肝论治消渴[J].辽宁中医杂志,2017,44(4):699-701.
[25] 杨泽祺,许妙婵,张世雄,等.王彦刚“一体三翼”从脾胃论治失眠经验探析[J].江苏中医药,2020,52(7):23-25.
[26] 王姜,王道成,薛刚,等.王道成从痰瘀论治顽固性失眠经验[J].中医药导报,2023,29(8):205-208.
[27] 张瑶,梅俊,徐凤芹,等.运用引火汤治疗不寐的辨治思路探讨[J].现代中医临床,2023,30(2):109-112.
[28] 赵斌,李亮,张金铃,等.耳甲电针对原发性失眠患者脑默认网络的即刻调节作用[J].针刺研究,2019,44(12):884-887.

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备注/Memo

备注/Memo:
基金项目:国家中医药管理局科研课题(GZY-KJS-2021-039); 北京中医药大学第三附属医院院级孵化项目(BZYSY-2022-XYYF-23)
更新日期/Last Update: 2024-06-11