张斌霞调治慢性失眠经验

Zhang Bin-xia′s Experience of Treating Chronic Insomnia

张斌霞教授治疗慢性失眠遵循平调阴阳,补虚泻实的总治法,认为慢性失眠发病多与心、肝、脾、肾四脏密切相关,以心肾为根本,肝胆为枢机,脾胃为通路,在治疗过程中根据辨证,侧重有所不同。张教授治疗失眠强调以阴阳为纲,认为不论采用何种治疗都应遵循"平调阴阳,引阳入阴"的治疗大法,不可忽视阴阳变化,而一味安神。张教授治疗慢性失眠,以疏利肝胆为法,方用柴胡加龙骨牡蛎汤加减,尤爱甘松一药,因其性甘温,除醒脾健胃外,还可理气开郁,有肝脾同调之功。张教授治疗慢性失眠避用破气消积药物,取厚朴花而非厚朴,因厚朴花理气化湿无厚朴燥湿下气之力,花类药物质轻升散,可更好助脾胃升发清阳。张教授认为,慢性失眠病程较长,具有久病多虚、久病及肾、久病入络、久病致郁、久郁生痰特点,补虚多从肾入手,根据病邪性质,选择性配伍化瘀通络、疏肝解郁、理气化痰之品,常有良效。

In terms of chronic insomnia,Professor Zhang Bin-xia follows the general treatment method of regulating yin and yang,tonifying deficiency and reducing excess.He believes that the incidence of chronic insomnia is closely related to the heart,liver,spleen and kidney.It is based on the heart and kidney,with the liver and gallbladder as the axis and the spleen and stomach as the pathway.In the treatment process,the emphasis should be different according to syndrome differentiation.Professor Zhang stresses that yin and yang should be taken as the key points in the treatment of insomnia.She thinks that no matter what kind of treatment is adopted,we should follow the treatment principle of"regulating yin and Yang,leading yang into yin".We should not ignore the changes of yin and yang,but just calm mind.She uses the method of dispersing the stagnated liver-qi and promoting bile,adopts Modified Bupleurum Decoction Plus Os Draconis and Concha Ostreae.He prefers to use Gansong(Radix et Rhizoma Nardostachyos)with sweet and warm property to activate the spleen and strengthen the stomach,regulate stagnated qi,regulate the liver and spleen together.She tries to avoid the medicinals for dispersing qi and eliminating accumulation.For example,she uses Houpohua(Flos Magnoliae Officinalis)rather than Houpo(Cortex Magnoliae Officinalis),because Houpohua can regulate qi and resolve dampness,while Houpo can dry dampness and disperse qi.Besides,flower medicinals with light and rising and dispersing feature,can better help the spleen and stomach lift lucid yang.According to Professor Zhang,chronic insomnia has a long course of disease,with the characteristics of long illness leading to deficiency,injuring kidney,invading into the collaterals,causing depression,and phlegm.Tonifying deficiency mostly starts from the kidney,and according to the nature of disease and pathogen,it is often effective to selectively mix with the products of removing blood stasis and dredging collaterals,dispersing stagnated liver-qi and relieving depression,regulating qi and resolving phlegm.