张正基于气机升降运动采用针药结合治疗失眠的经验

Summary of ZHANG Zheng’s Experience in Treating Insomnia Based on the Lifting and Lowering Movement of Qi

中医学将失眠归属于“不寐”,认为其病机主要为阴阳不交、营卫不调、气血不和、脏腑功能失调。张正教授从人体气机升降失和探索失眠的针药结合治疗方法,提出失眠的病机与针药结合治疗如下:(1)脾胃不运致中焦升降不利而致失眠:中药治疗当以运脾化湿为法,方选半夏秫米汤加减;针刺可选用扶正套穴(双侧合谷、曲池、足三里、三阴交、太冲、中脘、天枢、气海)。(2)肝失疏泄、胆火不降之左右升降失司而致失眠:中药治疗当以疏肝利胆为法,方选柴胡加龙骨牡蛎汤;针刺可选用降压套穴(双侧风池、合谷、曲池、足三里、阳陵泉、三阴交、照海、太冲)。(3)心火上炎、肾水沉寒、水火不济之上下升降失交而致失眠:中药治疗当以交通心肾为法,热象明显者可用黄连阿胶汤加减,寒象明显者则用附子汤、四逆汤加减;针刺可选用补肾套穴(双侧肾俞、气海俞、大肠俞、中空),并配合心俞放血。张正教授基于气机升降运动从调理中焦、疏通左右、交通上下论治失眠,采用运脾化湿、疏肝利胆、交通心肾三法,针药结合以运轴行轮,使人体气机运动调和,取得较好的临床效果。

In the field of traditional Chinese medicine(TCM),insomnia is also called sleeplessness,and thepathogenesis of insomnia is due to the non-interlocking of yin and yang,disharmony between nutritive qi anddefensive qi,incoordination between qi and blood,and dysfunction of zang-fu organs.Professor ZHANG Zhengexplored the combined therapy of acupuncture and Chinese medicine for insomnia based on the disorder of liftingand lowering movement of qi,and made the treatment by further differentiating insomnia into three syndrometypes.(1)For the treatment of insomnia due to the disorder of lifting and lowering movement of middle-energizer qi caused by spleen-stomach disharmony,Chinese medicine therapy should be focused on invigorating spleen toeliminate dampness,and modified Banxia Shumi Decoction is the first choice,and set acupoints for supportinghealthy qi including the points of bilateral Hegu(LI4),Quchi(LI11),Zusanli(ST36),Sanyinjiao(SP6),Taichong(LR3),Zhongwan(CV12),Tianshu(ST25)and Qiha(iCV6)are selected for acupuncture.(2)For thetreatment of insomnia due to the disorder of lifting and lowering movement of left and right qi caused by liver failingin conveying and dispersing and gallbladder fire flaming upward,Chinese medicine therapy should be focused onsoothing liver and normalizing gallbladder function,and Chaihu Decoction Plus Longgu Muli is widely used.Theacupuncture therapy can be performed on the set acupoints for lowering blood pressure including the points of bilateral Fengchi(GB20),Hegu(LI4),Quchi(LI11),Zusanli(ST36),Yanglingquan(GB20),Sanyinjiao(SP6),Zhaohai(KI6)and Taichong(LR3).(3)For the treatment of insomnia due to the disorder of lifting andlowering movement of upward and downward qi caused by upward flaming of heart fire,sinking downward ofkidney water,and incoordination of water and fire,Chinese medicine therapy should be focused on coordinatingbetween heart and kidney,and modified Huanglian Ejiao Decoction can be used for the patients with predominantheat-syndrome symptoms,while Fuzi Decoction and Sini Decoction can be used for those with predominant cold-syndrome symptoms.The acupuncture therapy can be performed on the set acupoints for tonifying kidney includingthe points of bilateral Shenshu(BL23),Qihaishu(BL24),Dachangshu(BL25)and Zhongkong(an extra point),and bloodletting on Xinshu(BL15)can be used together.Based on the regulation of qi movement of middleenergizer,left liver and right gallbladder,upward heart and downward kidney,professor ZHANG Zheng adoptsthe combined therapy of acupuncture and Chinese medicine and uses the methods of invigorating spleen toeliminate dampness,soothing liver and normalizing gallbladder function,and coordinating between heart andkidney for the treatment of insomnia,so as to move the shaft and the wheel of qi movement and harmonize qi movement and then to achieve satisfactory clinical efficacy.