《临证指南医案·不寐》辨治经验与应用

Experience and application of Linzheng Zhinan Yian · Insomnia

通过学习《临证指南医案·虚劳》所载12案,可体会到叶天士以虚实为纲辨治不寐。叶天士以"阳不交阴"为不寐病机,不寐实证病位以心、胆为主,治当清火降阳,虚证病位则有阳跷脉虚、脾营虚、肝胆虚等不同情况,分以半夏秫米汤、归脾汤、酸枣仁汤等治疗;对于肝肾亏极的情况,叶天士创咸苦酸收甘缓之法。叶天士辨治不寐经验既承经方之用,又有独创之法,值得我们学习应用。

By studying the 12 cases contained in Linzheng Zhinan Yian · Insomnia,it is realized that YE Tian-shi treats insomnia based on the principle of deficiency and excess.YE takes ‘yang does not cross yin’ as the pathogenesis of insomnia,with heart and gallbladder as the main evidences for insomnia,and he treats yang deficiency with clearing fire and lowering yang.The deficiency syndrome has different conditions such as yang deficiency,spleen deficiency and liver and gallbladder deficiency,and is treated with Banxia Shumi Decoction,Guipi Decoction and Suanzaoren Decoction,etc.For the cases of liver and kidney deficiency,YE Tian-shi uses salty,bitter and sour for astringent,and sweet for remission.The experience of YE Tian-shi in treating insomnia not only inherits the classics but also has original methods,which is worthy of our study and application.