归脾汤加减治疗老年人失眠验案报道

Clinical report of Modified Guipi decoction for treating senile insomnia

归脾汤具有益气补血、健脾养心等功效,为治疗心脾两虚证常用的中医经典方,临床在治疗老年性失眠方面取得较好之疗效。老年人大多因年老体弱,五脏渐虚,气血两亏,阴阳失调。其中心脾气血亏虚,心神失养是老年性失眠的主要病变拟制。老年性失眠病程较长,反复发作,影响老年人生活质量,甚或诱发或加重心脑血管,神经精神相关疾病。笔者在老年医学科跟随郭海英教授侍诊,观察到老师运用归脾汤加减治疗老年人失眠疗效颇佳,今报道案例一则,可窥一斑。本例患者初诊以失眠为主诉,主要表现为睡眠差易醒,醒后难以再寐,伴汗多心悸善惊,性急烦躁,大便不成形等症状。通过中医的辨证,认为该患者属于心脾两虚证导致失眠,故运用归脾汤进行加减治疗;二诊患者睡眠和其他症状有良好的缓解,但出现胃脘胀满不适感,故原方加石菖蒲、煅龙骨和煅牡蛎;三诊患者睡眠质量明显改善,取得预期疗效,每日睡眠时间达到6~8h。另外,患者的其他症状以及舌苔脉象有所好转。通过对本案的辨证分析以期为老年性失眠之临床提供可以借鉴的思路。

Guipi decoction(归脾汤)has the effect of tonifying qi and blood,fortifying the spleen and nourishing the heart.It is a classic prescription of traditional Chinese medicine in common use for treating heart and spleen deficiency and has a good curative effect in clinical practice,especially in treating senile insomnia.As a result of old age and being weak,the senile shows a decline of five viscera function,a deficiency of qi and blood and the disharmony of yin-yang(阴阳).The common factors of senile insomnia are dual deficiency of heart and spleen that leads to the heart spirit being deprived of nourishment.Senile insomnia has the relatively long duration,and it is easy to suffer from repeated attacks and influences the life quality,which may even induce or aggravate cardio-cerebrovascular diseases,mental and neurologic related diseases.The author has studied TCM with Professor Guo Haiying in department of geriatrics and has observed that Professor Guo applies modified Guipi decoction in treating senile insomnia,which has a satisfactory curative effect.Therefore the author wants to report,differentiate and analyse the example case.During the first visit,the main manifestation of the senile patient is insomnia,includes being easy to wake up,difficult to sleep after waking,sweating,palpitation,being easy to be frightened,impatient,irritability and unformed stool.After TCM syndrome differentiation,patient is diagnosed heart and spleen deficiency,therefore modified Guipi decoction(归脾汤)is applied.During the second visit,the patient has significant improvement in sleep quality,but still feels stomach fullness discomfort,so Acorus gramineus Soland,calcined os draconis and calcined concha ostreae are added.During the third visit,the patient's sleep quality is obviously improved,the expected effect is achieved,and the daily sleep time is up to 6-8 hours.In addition,the other symptoms of the patient are relieved.Through the dialectical analysis of the case,it is expected to provide useful ideas of the clinical experience in treating senile insomnia.