韩祖成从痰、瘀、虚论治顽固性失眠经验

Han Zucheng’s experience in treating intractable insomnia from the perspectives of phlegm,blood stasis and deficiency

顽固性失眠是各种原因导致长期不能获得正常睡眠并影响日常生活质量的主观体验性疾病,为临床常见疾病。陕西省名中医韩祖成认为其病机可分为虚证、实证和虚实夹杂,主要以本虚标实、虚实夹杂为主,临床中以心脾两虚、心神失养为本,以痰瘀互结、心神受扰为标,其病变过程特点概括为“痰、瘀、虚”;治疗上以祛实补虚为原则,实证辅以重镇安神,虚证兼以养心安神。具体治疗可分为化痰祛湿安神、活血化瘀安神和健脾养心安神;以痰为主方选加减二陈汤,以瘀为主则以血府逐瘀汤加减,以虚为主方选归脾汤加减,并辨证论治,急则治标,缓则治本,临床疗效显著。

Intractable insomnia,a common disease in clinic,is a subjective experiential disease that can cause a long-term failure to get normal sleep for various reasons and affect the quality of daily life.Han Zucheng,a wellknown Chinese medicine doctor in Shaanxi Province,maintains that its pathogenesis can be divided into deficiency syndrome,excess syndrome and syndrome of intermingled deficiency and excess,among which it mainly features the syndrome of root deficiency and manifestation excess,and the syndrome of intermingled deficiency and excess.Clinically,its root causes lie in the deficiency of both the heart and spleen,malnutrition of the heart spirit,while its manifestations involve the syndrome of intermingled phlegm and blood stasis,and the syndrome of disturbed heart spirit,with its pathological process characterized by"phlegm,blood stasis,and deficiency".Accordingly,he proposes that intractable insomnia should be treated under the principle of eliminating excess and tonifying deficiency,with the excess syndrome supplemented with the method for tranquillization with a heavy prescription,while with the deficiency combined with the method for tranquillization by nourishing the heart.Its treatment methods can be specified as tranquillization by dissipating phlegm and eliminating dampness,tranquillization by promoting blood circulation for removing blood stasis,and tranquillization by invigorating the spleen and nourishing the heart.For mainly dealing with phlegm,the modified Erchen Decoction should be opted for,and for mainly dealing with blood stasis,the modified Xuefu Zhuyu Decoction can be selected,while mainly for deficiency,the modified Guipi Decoction can be applied.In addition,each method should be adopted based on syndrome differentiation,administering a symptomatic treatment in an acute condition while a radical treatment in a chronic case.Professor Han Zucheng's clinical effect in the treatment of intractable insomnia proves remarkable.A medical case is attached to the paper as evidence.