老年失眠特点与证治

Characteristics and Treatment of Senile Insomnia

老年失眠的生理特点为脏腑渐衰、阴阳渐虚;易感外邪,易生积滞;性情不定、情志抑郁。老年失眠的病理特点为虚中夹实、多痰多瘀、易传易变。治疗老年失眠应辨证论治。情志不遂、气郁化火者,应清肝泻火、镇心安神,方用龙胆泻肝汤;酿生痰热、胃气失和者,应清热化痰、和中安神,方用黄连温胆汤;气滞血瘀、扰及心神者,应疏肝活血、通窍安神,方用血府逐瘀汤;营血亏虚、心神不安者,应补益心脾、养血安神,方用归脾汤;阳热亢盛、心神不宁者,应润养心肺、安神定魄,方用百合地黄汤合生脉散;肾精亏虚、心阳独亢者,应滋阴降火、清心安神,方用黄连阿胶汤;心虚胆怯、神魂不安者,应益气镇惊、安神定志,方用安神定志丸;肝阴亏虚、心神失荣者,应补养肝血、宁心安神,方用酸枣仁汤;元阳亏损、心神不养者,应温肾壮阳、填精安神,方用右归丸。

The physiological characteristics of senile insomnia are the declining Zang-fu organs and the declining of Yin and Yang levels,susceptibility to external Evil factprs,prone to blood and Qi stagnation,with unstable temperament or emotional depression.The pathological features are deficiency complicated with excessiveness,with Phlegm and Blood stasis,and easy transmission.The treatment should be based on syndrome differentiation.For those with mental disorders and Qi depression transforming into fire should clearing Liver-fire,calm the Heart,and soothe the nerves by using Longdan Xiegan Decoction.For those with phlegm-heat accumulation and Stomach-Qi disorders should removing heat-phlegm,harmonize middle Qi,and soothe the nerves by using Huanglian Wendan Decoction.For those with Qi stagnation and blood stasis that disturbing the Heart spirit,should soothe the Liver and invigorate the Blood,unblocking stuffy orifice and calm the nerves,by using Xuefu Zhuyu Decoction.Those with nutrient-blood deficiency and uneasy mind should replenish the Heart and Spleen,nourish blood and soothe the nerves,by using Guipi Decoction.Those with the exuberance of Yang-heat and unrestingly Heart-mind should moisturize the Heart and Lungs,tranquilizing and soothe the spirit by using Baihe Dihuang Decoction and Shengmai powder.For those with deficiency of kidney essence and hyperactivity of Heart-yang,Yin should be nourished and evil Fire be lowered,by clearing the Heart Fire and soothe nerves by using Huanglian Ejiao Decoction.Those who are timidity due to deficiency of heart Qi and restless spirit should replenish Qi and calm the nerves,soothe the nerves and calm the mind by using Dingzhi pills.Those who suffer from Liver-Yin deficiency and malnutrition of heart spirit,should replenish Liver Blood and calm the Heart spirit by using Suanzaoren Decoction.And for those who have a loss of Kidney-Yang and malnutrition of Heart spirit should warm the Kidneys and strengthen the Yang,reinforce essence and soothe the nerves,by using Yougui pills.