基于肝的生理功能对失眠辨证论治

Syndrome Differentiation and Treatment of Insomnia Based on Physiological Function of Liver

中医学对失眠早有记载,在《难经》中首次记载了"不寐"的病名,关于对失眠的辨证论治,历代医家持有不同的观点,但大多人认为失眠与心、肝、脾、肺、肾的气血阴阳失调密切相关。各种原因导致气血阴阳的不平衡都会引起失眠,其发病的病因病机十分复杂,因此临床上的辨证论治也不同,但各代医家的辨证核心都以调节气血阴阳的平衡为主。目前失眠已经成为临床上的常见病,多发病,其发病趋势已逐渐趋向年轻化,并影响人们的日常生活和工作,严重者会诱发抑郁等精神疾患,对于失眠的治疗已经成为了人们关注和重视的问题,当前的治疗多以苯二氮卓等镇定类药物为主,其起效快,但不良反应较大,长时间使用会让患者产生依赖性、成瘾性和其他不良反应。应用中医药对失眠进行治疗是当下的发展趋势,也是治疗失眠的根本所在,通过在跟师学习过程中对老师治疗失眠患者的信息归纳总结,从肝脏功能失调角度出发对失眠进行论述。肝藏血,主管气血的运行与疏泄,气血的平衡是保证充足睡眠的基础,气血充沛,行而不滞,心神得以濡养则人体可以保持正常的睡眠状态;肝在志为怒,大怒则气血上攻,扰乱心神,从而产生失眠;肝在五行中属木,其上可调控心肺,下可扰乱肾水,横可侵犯脾土。若肝脏生理功能失调,则会影响各个脏腑的功能而导致失眠,分别在气血阴阳脏腑等方面深入的探讨肝脏对失眠的影响,为今后临床上治疗失眠提供参考依据。

In traditional Chinese medicine,insomnia has been recorded.In the book of Nanjing,the name of"insomnia"was recorded for the first time.Medical experts of different dynasties hold different views on the treatment of insomnia,but most think insomnia and imbalance of Qi,blood and Yin-Yang of heart,liver,spleen,lung,kidney are closely related.The imbalance of Qi,blood and Yin-Yang can cause insomnia for a variety of reasons.The etiology and pathogenesis of the disease are very complex,and so the clinical treatment based on syndrome differentiation is also very different.But the syndrome differentiation core of doctors in each generation is to adjust the balance of Qi,blood and Yin-Yang.At present,insomnia has become a common and frequently-occurring disease and its incidence trend has gradually become younger.It will affect people’s daily life and work,and in serious cases,it will induce depression and other mental disorders.The treatment of insomnia has become a focuse problem.Current treatments are dominated by sedatives like benzodiazepine.Its effect is quick,but the side effect is serious.Use for a long time can let the patient produce addiction and other adverse reactions.The application of traditional Chinese medicine in the treatment of insomnia is not only the current development trend,but also the fundamental to treat insomnia.This paper intended to treat insomnia caused by liver dysfunction based on syndrome differentiation.The liver stores blood,which is responsible for the operation and drainage of Qi and blood.The balance of Qi and blood is the basis for ensuring adequate sleep.With sufficient Qi and blood,the body can maintain a normal sleep state.Liver is related with anger,and anger can attack Qi,blood and disturb the mind,resulting in insomnia.The liver belongs to wood in the five elements.It can control the heart and lung,disturb the kidney water,and invade the spleen earth.If the liver is dysfunctional,it can affect the function of the viscera and lead to insomnia.In the aspects of Qi,blood,Yin and Yang,the influence of liver on insomnia was discussed in depth,providing ideas for the future clinical treatment of insomnia.