张景岳“邪正”理论在不寐中的运用与局限

The Application and Limitation of Zhang Jingyue's“Evil and upright”Theory in Insomnia

张景岳以“邪正”理论将不寐的病因病机简化,分为无邪和有邪致不寐,用虚实二字概括。无邪时多因思劳过度致病,当补其虚,注重心脾;有邪时当祛邪气。在补虚祛邪的过程中,也当注意标本缓急。然而,张景岳的理论有其局限,其一是脏腑辨证时对肝、肾两脏致病描述不足,肾水不足、肝主谋虑太过会导致不寐,应分别予以黄连阿胶汤、丹栀逍遥散加味等进行治疗;其二是邪气理论中未涉及瘀血致病,瘀血阻滞气血运转,治疗宜用血府逐瘀汤一类;另外,张景岳局限了半夏汤中半夏的作用,忽视了从调和阴阳角度论治不寐的方法,这亦为其局限之一。

Zhang Jingyue simplifies the etiology and pathogenesis of insomnia with the theory of“evil and righteousness”,which is divided into innocence and insomnia caused by evil,which is summarized by the words“deficiency and reality”.When innocent,it is often caused by excessive thought,so we should replenish its deficiency and pay attention to the heart and spleen;when there is evil,we should dispel evil qi.In the process of tonifying deficiency and dispelling evil,we should also pay attention to the priority of specimens.However,Zhang Jingyue's theory has its limitations:one is that insufficient description of the pathogenesis of liver and kidney in syndrome differentiation of Zang-fu organs,insufficient kidney water and too much concern for the liver will lead to insomnia,which should be treated with Huanglian Ejiao decoction and Danzhi Xiaoyao Powder respectively;second,blood stasis is not involved in evil qi theory,and blood stasis blocks the movement of qi and blood,and Xuefu Zhuyu decoction should be used for treatment.In addition,Zhang Jingyue limited the role of Pinellia ternata in Pinellia decoction and ignored the method of treating insomnia from the perspective of reconciling yin and yang,which is also one of its limitations.