中西医结合治疗精神疾病伴发睡眠障碍述评

A Review of Integrated Traditional Chinese and Western Medicine in Treating Mental Disorders Associated with Sleep Disordera

对于精神疾病伴发失眠的中西医结合模式有辨证与辨病相结合的诊疗模式、中药与西药取长补短的联用模式、内治与外治相结合的整体治疗模式等。虽然在精神疾病伴发睡眠障碍的中西医结合治疗领域中存在很多不足,但是也对我们今后的临床及实验研究有一定提示,如:①经过文献检索发现,失眠最常用中药分别是:精神分裂症用酸枣仁,抑郁症用酸枣仁和茯苓,焦虑症用茯苓、栀子、甘草。这些中药可能既对精神疾病有效,也对伴发的睡眠障碍有效,值得进一步研究其作用机理。②针刺或电针是抑郁症伴发睡眠障碍的有效方法,常用穴位是百会穴、印堂穴和神门穴,有些报道提示效果优于中药和西药,而且不良反应较少,针药结合的研究也不少,我们应发挥针灸的独特优势,并探讨其作用机制,推广临床有效易用的针刺手法,研究治疗其他精神疾病伴发睡眠障碍的适宜技术;③目前文献报道的循证证据等级不高,可以针对性地开展双盲研究,并尽可能加大样本量;④文献报道研究抑郁症、精神分裂症、焦虑症的多,其他精神疾病伴发睡眠障碍的研究较少;研究失眠、不寐的多,很少有研究睡眠增多、多寐的。这些属于本类文献的空白区,有待广大临床医师和研究人员进一步探索。

In terms of the mode of combination of TCM and Western medicine for treating mental disorders associated with sleep disorders,there are many kinds of modes,such as the combination of diagnosis and treatment,the combination of traditional Chinese medicine and Western medicine,the combination of internal treatment and external treatment,etc.Although there are many shortcomings in the field of combination of traditional Chinese and Western medicine for mental disorders associated with sleep disorders,there are some hints for our future clinical and experimental research.They are as follows：①The literature retrieval has shown that the most commonly-used Chinese medicinal for schizophrenia of insomnia is Suanzaoren（ Semen Ziziphi Spinosae）;For depression,Suanzaoren（ Semen Ziziphi Spinosae） and Fuling（ Poria） are often used; For anxiety disorder,Fuling（ Poria）,Zhizi（ Fructus Gardeniae） and Gancao（ Radix et Rhizoma Glycyrrhizae） are often used.These Chinese herbs may be effective not only for mental disorders,but also for accompanying sleep disorders,whose mechanism is worth further studying.②Acupuncture or electroacupuncture is an effective method for depression associated with sleep disorders.The commonly-used acupoints are Baihui（ DU 20）,Yintang（ Ex-HN 3） and Shenmen（ HT 7）.Some reports suggest that the efficacy of acupuncture is better than traditional Chinese medicine and Western medicine.There are few side effects and many studies on the combination of acupuncture and medicine.We should give full play to the unique advantages of acupuncture,and discuss its mechanism of action to popularize it,and study other proper techniques to treat mental disorders associated with sleep disorders.③At present,the evidencebased evidence level reported in the literature is not high,so we can conduct a double-blind study and increase the sample size as much as possible.④There are more literature reports on depression,schizophrenia,anxiety disorders,but fewer on other psychiatric disorders associated with sleep disorders,more insomnia,fewer somnolence.These belong to the blank area of this kind of literature,which needs the majority of clinicians and researchers to further explore.