李亚平结合子午流注气血学说从心肝论治失眠的经验

LI Yaping’s Experience in Treating Insomnia from Heart and Liver Combined with Meridian Flow of Qi and Blood

[目的]浅析李亚平教授结合子午流注气血学说从心肝论治失眠的临床经验。[方法]通过跟师临证,记录、分析整理李亚平导师治疗失眠的临床病案,从病因病机、用药组方及服药方法等方面总结李师的临床经验,并列举验案加以佐证。[结果]李师认为,气血是人体所有生理活动的物质基础,失眠的根本病机在于气血失和、阴阳失衡,而睡眠作为人体气血阴阳运行的生理表现之一,觉醒节律又受子午流注时辰气血运行规律的影响,而气血与心肝两脏联系又最为密切,故李师结合子午流注气血学说,提出临床治疗失眠当从心肝论治,创用"柔肝宁心"治法,柔肝理气、宁心安神,具体以"疏肝清肝,滋肝镇肝,清心养心"之法谴方用药,特拟"柔肝宁心方"治疗失眠,并主张按照气血流注规律按时服药和理疗。验案精准辨治,充分体现了李师治疗失眠的临床经验。[结论]李师治疗失眠注重整体气血阴阳的调节,强调气血与子午流注的关系,以"柔肝理气、宁心安神"为治则,按时服药调畅人体气血,自拟"柔肝宁心方"治疗失眠,临床疗效显著,故李师此治疗失眠之法值得临床医师深入学习研究。

[Objective] To analyze the clinical experience of Professor LI Yaping in treating insomnia from the heart and liver in combination with the theory of nourishing Qi and blood. [Methods]By consulting with the teacher,recording,analyzing and sorting out the clinical records of LI Yaping’s treatment of insomnia,he summarized LI’s clinical experience in terms of etiology,pathogenesis,medication prescriptions and medication methods,and enumerated test cases to support the evidence.[Result] Teacher LI believes that Qi and blood are the material basis for all physiological activities of the human body. The fundamental pathogenesis of insomnia lies in Qi and blood disharmony and Yin and Yang imbalance. Sleep is one of the physiological manifestations of Qi and blood in Yin and Yang operation. The rhythm of awakening is also influenced by the rule of Qi and blood movement during midnight-noon ebb flow,and the relationship between Qi and blood and the heart and liver are the most closely linked. Therefore, Teacher LI combines with the theory midnight-noon ebb flow, puts forward clinical treatment of insomnia from the heart and liver, creating the method of softening liver calming heart, i.e. soften liver and regulate Qi, calm heart and tranquilize mind, specifically, stretch and clear liver, tonify and suppress liver, clear and nourish heart for prescription, and advocates taking medicine and physiotherapy on time according to the law of Qi and blood flow. The accurate identification and treatment of the test cases fully reflects the clinical experience of Teacher LI ’s treatment. [Conclusion]Teacher LI’s treatment of insomnia focuses on the overall regulation of Qi and blood,Yin and Yang,and emphasizes the relationship between Qi and blood and midnight-noon ebb flow. Taking "softening the liver and regulating Qi,and calming the heart and tranguuilizing the mind" as the rule,taking medicine on time to regulate the body’s Qi and blood,and formulates "Rougan Ningxin Decoction" which has a significant clinical effect in treating insomnia. Therefore,this method of Teacher LI’s treatment of insomnia is worth in-depth study for clinicians.