中医治疗失眠的现状

Present status of traditional Chinese medicine in treating insomnia

目的:中医治疗失眠有独特的思路与方法,是治疗失眠的重要手段,综述目前中医治疗失眠的思路与方法,在继承的基础上进行发扬。资料来源:应用计算机检索中文生物医学期刊文献数据库(CMCC)1998-01/2003-12中与治疗失眠相关的文献,检索词“失眠,治疗”,并限定文献语种为中文。资料选择:从资料中选取中医、中药、针灸、推拿按摩治疗失眠的文献。纳入标准:①有固定方药的临床研究。②名医的经验总结。③针灸、推拿按摩治疗失眠的代表性文献。排除标准:排除综述类文献、护理类文献、西医类文献、方法介绍类文献、临床体会类文献、调查研究类文献。资料提炼:共收集关于中医、中药、针灸、推拿按摩治疗失眠的文献163篇,选取有代表性文献30篇;余133篇按上述标准排除。资料综合:①失眠的中医辨证论治主要有4种观点,其一为血虚,阴虚,气虚,阳虚,食积及肝郁6型;其二为血郁肝旺,痰火扰心,心脾两虚,气郁血郁4型;其三为肝郁化火、痰热内扰、阴虚火旺、心脾两虚4型;其四为筋肉疲劳、脾胃失调、肾阴虚3型;另外尚有从肝论治、从脾胃论治、从火热论治等。②失眠的中药专方专药主要为酸枣仁类,温胆汤类,逍遥散类。③有些医家以失眠为独立的疾病,有自身的规律、特点,一病一方,在一方的基础上辨证加减用药,病证结合论治失眠。④名老中医经验,观点一认为失眠的病机关键是心神不宁和阴不入阳,治疗上注重调治胆胃;观点二认为失眠病理变化总属阳盛阴衰,阴阳失交,治疗上常加用滋补肝肾而养心安神之药,并从虚实论治;观点三认为失眠的基本病机是阳不入阴,认为神魂不安是失眠的主要表现,对顽固性失眠则多用血府逐瘀汤加减治疗;观点四治疗顽固失眠总结,半夏枯草治失眠,慢肝不寐多灵验;温补镇摄治失眠,甘麦芪仙磁石蝉;达胆和胃治失眠,温胆汤加龙牡敛。⑤针灸,推拿作为一种传统疗法能调节神经系统兴奋和抑制的相对平衡,而灸百会有调整阴阳、醒脑开窍、宁心安神之功。结论:中医治疗失眠疗效肯定,方法多样,副作用少,是失眠治疗中必不可少的方法。但在临床研究中,仍存在很多问题有待解决,如缺少设计严格的随机双盲对照试验,论证强度不够;对照组设计不理想,基本上无安慰剂对照;针药治疗机理研究不足,难以在国内外大范围推广等。

OBJECTIVE： Traditional Chinese medicine （TCM） is an important means to treat insomnia by special idea and means. This paper reviewed the idea and means about insomnia treated by TCM, in order to carry forward the treatment method. DATA SOURCES： A eamputer-based search of Chinese medical current contents （CMCC） database was undertaken to identify articles about the treatment of insomnia published in Chinese from January 1998 to December 2003 by using the keywords of ＂treatment, insomnia＂. STUDY SELECTION： The articles about insomnia treated by TCM, Chinese herbs, acupuncture, moxibustion and massage were selected. Inclusive criteria： ① clinical researches of fixed prescription of herb; ②experience summarization from famous TCM doctors; ③representative papers about acupuncture, moxibustion and massage in treating insomnia. Exclusive criteria： review, nursing papers, western medicine papers, introduced methods papers, experience of clinical application papers, survey research papers. DATA EXTRACTION： Totally 163 papers about TCM, Chinese herbs, acupuncture, moxibustion and massage in treating insomnia were collected, and 31 representative ones were selected, others were deleted according to the above-mentioned exclusive standard. DATA SYNTHESIS： ①There are four main viewpoints in the treatment of insomnia based on TCM eategorical identification： The first is deficiency of blood, deficiency of yin, deficiency of qi, deficiency of yang, retention of food and liver stasis. The second is stagnancy of blood and exuberance of liver yang, mental disturbance due to phlegmatic fire, deficiency of functional activities and blood of the heart and the spleen, stagnancy of qi and theblood. The third is stagnancy of qi of the liver with manifestations of fire, inside phlegmatic heat; deficiency of y/n leads to flaming up of evil fire; deficiency of functional activities and blood of the heart and the spleen. The fourth is tiredness of tendon and muscle, imbalance of the stomach and the spleen, deficiency of yin of the kidney. In addition, someone advocated that to treat insomnia we should think highly of the liver, the stomach and the spleen, the heat and fire and other aspect. ②The special herds and prescriptions for treating insomnia are classified three, spine date seed, Wendan tang and Xiaoyao san. ③ Some doctors think that, as an independent disease, insomnia has its own characteristic and regularity, it should be treated by an underlying prescription, and adjust the prescription to the disease and the symptom. ④ The experience of the old famous doctors： someone think that the key change of insomnia is the disorder of heart in charge of mental activities and the breakdown of the normal physiological coordination between yin and yang, think highly of the stomach and the gallbladder;, someone think that the key change of insomnia is the deficiency of yin essence brings on pathological hyperactivity of yang, yin does not cooperate with yang, so herds for reinforcing vital essence of the liver by way of replenishing the vital essence of the kidney and nourishing the heart and relieving mental strain are usually applied, excessiveness and deficiency should be distinguished clearly; someone think that the basic change of insomnia is y/n does not cooperate with yang, the mainly phenotype is that the heart is uneasy, Xuefu Zhuyu Tang is applied to treat the refractory insomnia, someone advocates that Pinellia ternate, Spica Prunellae, Radix Glycyrrhizae, Radix Ophiopogonis, Radix Astrgali seu Hedysari, Rhizoma Cureuliginis, Magnetitum, Periostracum Cicadae should be used to treat refractory insomnia, and Wendan tang with Os Draconis and Concha Ostreae is a good prescription. ⑤ As a traditional therapy, acupuncture and massage can redress the balance of excitation and inhibition of nervous system. Moxibustion of Baihui acupoint has the function of rectifying derangement of yin and yang, opening the aperture of the heart blocked and bring back to consciousness from coma, relieving anxiety or mental uneasiness. CONCLUSION： The curative effect of TCM in treating insomnia is obvious by many means and with fewer side effects, so TCM is essential in the treatment of insomnia. But there are lots of problems to resolve in clinical research, such as deficiency of randomized control trials, bad design of control group, unclear reason of the curative effect.