根据失眠症状表现不同归属五脏辨识探析

Discussion and analysis on Chinese medical syndrome classification of insomia by five zang viscera according to different symptoms

失眠病证中医证型虽十分复杂,但就其临床表现与五脏的关系可分为5类,分属五脏。失眠主症以迟寐、不寐为主者责之于心,其病机为气、血、痰、瘀、寒、热等各种原因导致的心神不入于舍;以多梦、梦呓、甚则梦魇、梦游为主者责之于肝,其病机为各种原因导致的肝魂不入于舍;以思虑纷纭而致迟寐或不寐为主者责之于脾,其病机为各种原因导致的脾意不入于舍;以易寤、频寤为主者责之于肺,其病机为各种原因导致的肺魄不入于舍;以夜寐早寤为主者责之于肾,其病机为各种原因导致的肾志不入于舍。虽然临床所见往往因五脏疾病传变不同而又有五类失眠证型相互交融,病变表现错综复杂,如既有入寐唯艰之入睡困难,又见轻浅易寤之闻声则醒等。但将失眠病证按五神归属五脏,分类清晰明确,不仅易于掌握,而且反映五脏之间的关系及其传变,与脏腑辨证融会贯通,使失眠病证证治规律清晰明了。

Although the TCM syndromes of insomnia are very complex, according to clinical manifestations and the relationship with the five viscera they can be divided into five categories： main symptoms of slow sleep and sleeplessness belong to heart, the pathogenesis is qi,blood,phlegm,stasis,cold or heat caused heart spirit not entering in the homes. Main symptoms of dreaming often, sleep talking, even nightmare and sleep walking belong to liver, the pathogenesis is a variety of reasons caused liver soul not entering in the homes. Main symptoms of diverse thoughtfulness lead to slow sleep or not sleep belong to spleen,the pathogenesis is spleen idea not entering in the homes. Main symptoms of waking up easily, waking up several times belong to lung ,the pathogenesis is a variety of reasons caused lung soul not entering in the homes. Main symptoms of slow sleep and early awakening belong to kidney, the pathogenesis is a variety of reasons caused kidney will not entering in the homes. Although the clinical symptoms are complex, we classify insomnia into five syndromes according to five spirits belong to five viscera, which is not only easy to master, but also reflect the relationships and transmissions among the five viscera ,together with differentiation of syndromes by zang-fu viscera, making the law of syndrome differentiation of insomia clear.