基于圆运动理论探讨慢性肝病失眠辨治

Discussion About Syndrome Differentiation and Treatment of Insomnia in Chronic Liver Disease Based on Circular Motion

慢性肝病失眠病机为胃土不降、肝木不升、肺金不敛、火不归原,导致机体圆运动失衡,相火不降,阳不入阴。己土湿寒,戊土不降者,应燥土祛湿,升清降浊,可用炒白术、茯苓、干姜、炒薏苡仁等健脾升清祛湿,半夏、黄连、干姜、吴茱萸、紫苏叶等降胃气,蛰相火。乙木不升,甲木不降者,应养肝荣木,升肝降胆,可用小剂量柴胡、桂枝、川芎、麦芽等升达乙木,以助胆降,佐用炒白芍寒热并调,降胆经,敛相火。癸水浅寒,火不归原属肾阴虚者,应调中降逆,滋阴潜阳,可用杏仁、百合、沙参、陈皮、山药、炒白芍、紫苏叶等降肺金、胆木、胃土,龟板、鳖甲大补真阴兼软坚散结;属肾阳虚者,应温肾水,升肝木,燥脾土,用菟丝子、盐补骨脂、淫羊藿、巴戟天等温肾阳,茯苓、白术、干姜等补益中气,厚土敛火。黄芪、桂枝、川芎等升达木气,水温土燥木升则圆运动自复,肾水得温,相火得潜于肾水,失眠自愈。

The pathogenesis of insomnia in chronic liver disease is that the stomach earth does not descend,the liver wood does not ascend,the lung mental does not converge,and the fire does not return to the origin,resulting in the imbalance of body circular motion,the ministerial fire failing to descend,and yang failing to enter yin.If Ji earth is damp and cold,and Wu earth fails to descend,the treatment should focus on drying earth and removing dampness,ascending lucidity and descending turbidity,so stir-baked Baizhu(Rhizoma Atractylodis Macrocephalae),Fuling(Poria),Ganjiang(Rhizoma Zingiberis),stir-baked Yiren(Semen Coicis),etc.can be used to invigorate spleen,ascend lucidity and remove dampness;Banxia(Rhizoma Pinelliae),Huanglian(Rhizoma Coptidis),Ganjiang(Rhizoma Zingiberis),Wuzhuyu(Fructus Evodiae),Suye(Folium Perillae)can be used to descend stomach qi and hide ministerial fire.If Yi wood does not ascend and Jia wood does not descend,the treatment should focus on nourishing the liver wood,ascending the liver and lowering the gall.So small doses of Chaihu(Radix Bupleuri),Guizhi(Ramulus Cinnamomi),Chuanxiong(Rhizoma Chuanxiong),Maiya(Fructus Hordei Germinatus),etc.can be used,and stir-baked Baishao(Radix Paeoniae Alba)can be combined to regulate cold and heat together,to reduce the gall meridian,and condense the ministerial fire.If menstruation is shallow and cold,and fire fails to return to the origin,it belongs to kidney yin deficiency.The treatment should focus on regulating the middle and descending the adverse qi,nourishing yin and suppressing yang,so Xingren(Semen Armeniacae Amarum),Baihe(Bulbus Lilii),Shashen(Radix Adenophorae seu Glehniae),Chenpi(Pericarpium Citri Reticulatae),Shanyao(Rhizoma Dioscoreae),stir-baked Baishao(Radix Paeoniae Alba),Suye(Folium Perillae)can be used to descend lung mental and gall wood and stomach earth.Guiban(Plastrum Testudinis),and Biejia(Carapax Trionycis)can be used to greatly supplement genuine yin,soften hardness and dissipate mass.For those with kidney yang deficiency,the treatment should focus on warming kidney water,ascending liver wood,drying spleen earth,so Tusizi(Semen Cuscutae),Buguzhi(Fructus Psoraleae)prepared with salt,Yinyanghuo(Herba Epimedii),Bajitian(Radix Morindae Officinalis),etc.can be used to warm kidney yang cold water.Fuling(Poria),Baizhu(Rhizoma Atractylodis Macrocephalae),Ganjiang(Rhizoma Zingiberis),etc.can be used to replenish middle qi,thicken earth and converge fire.Huangqi(Radix Scutellariae),Guizhi(Ramulus Cinnamomi),Chuanxiong(Rhizoma Chuanxiong),etc.can be used to ascend wood qi.When water becomes warm,earth becomes dry,and wood ascends,circular motion with recover itself,kidney water will get warm,ministerial fire will hide in kidney water,and insomnia will heal itself.