阿片类药物戒断综合征继发顽固性失眠六经辨证特色探讨

Approach to Syndrome-differentiation Characteristics of Intractable Insomnia Secondary to Opioid Withdrawal Syndrome with Syndrome-differentiation of the Six Meridians

目的:从六经辨证角度出发,探讨阿片类药物戒断综合征继发顽固性失眠(IISS)的辨治特色。方法:运用仲景六经辨证方法,结合营卫学说、胃气学说、神明学说加以探讨。结果:"营卫不和,阴阳失调"与"胃气不和,枢机不利"是IISS的主要病机;和法、通法是IISS六经论治的主要方法:"大建中州,顾护后天"、"益阴扶阳,三阴并治"是IISS六经辨治的关键和根本。结论:从六经辨治IISS,发病初期,辨在三阳经;发病后期,辨在三阴经。治疗上以和法、通法为主,重视枢机,三阴并重,对于改善睡眠,增强正气,缓解阿片类药物戒断综合征症状,提高临床效果有重要的指导意义,体现了仲景学说全程性、多维度的辨治特色。

Objective： To investigate the differentiation-treatment characteristics of intractable insomnia（IISS） secondary to opioid withdrawal syndrome in the view of syndrome-differentiation of the six meridians. Methods： Such methods were applied to as Zhong-jing＇s Six-meridian syndrome differentiation method combined with the theory of Ying and Wei, gastric-qi theory and theory of mind. Results ： The main pathogenesis of IISS was＇ disharmony of nutrient qi with defensive qi, imbalance of yin and yang＇ and＇ disorder of stomach-qi, dysfunction of acting as a pivot＇. The main treatment of IISS was regulating therapy and catharis therapy. The key and basic treatment was＇ building up Zhong-zhou and protecting the postnatal＇ , and＇ assisting yang and supporting yin, and treating three yins at the same time＇. Conclusion： Syndrome-differentiation and treatment of IISS from the six meridians lies in the three yang meridians in early onset;and in the three yin meridians in late onset. The regulating therapy and catharis therapy were the main treatment methods. The function of Shao-yang was paid attention to, and the three yins were laid equal stress on at the same time. Those have an important significance on improving sleep, enhancing healthy energy and alleviating opioid withdrawal syndrome to improve the clinical effect and embody the characteristics of Zhongjing＇s theory about the whole range and multi-dimension during syndrome-differentiation.