从郁、痰、瘀论治抑郁相关性失眠

Treating Depression-related Insomnia from the Perspective of Depression, Phlegm and Stasis

[目的]总结金杰教授从郁、痰、瘀等方面论治抑郁相关性失眠的临证经验。[方法]通过跟师临证,整理分析金师治疗抑郁相关性失眠的医案,从病因病机、治则治法及辨证论治几个层面介绍其辨治抑郁相关性失眠的临床经验,并附验案一则加以佐证。[结果]金师认为,该病病位在心肝,但首发于肝,情志不遂,初则气机郁结,肝失条达,气血失调,血脉不畅,日久导致痰浊、瘀血生于内而上扰,临床多见于实证,分为肝气郁滞型、痰热上扰型、痰瘀交阻型,治疗以疏肝开郁、清心化痰、活血祛瘀为原则,方选柴胡疏肝散、黄连温胆汤、癫狂梦醒汤等为基础方加味化裁。所举医案中,患者诊断为肝气郁结、痰热上扰型抑郁相关性失眠,金师治以化痰清热、解郁安神,明显改善了其抑郁状态及睡眠质量,疗效斐然。[结论]金师从郁、痰、瘀辨证论治抑郁相关性失眠,用药精准,效果显著,其经验具有较强的临床指导意义,值得推广应用。

[Objective] To summarize the clinical experience of Professor JIN Jie in treating depression-related insomnia from the aspects of depression, phlegm and stasis. [Methods] Through following Professor JIN’s clinical work, sorting out the clinical cases of Professor JIN in treating depression-related insomnia, Professor JIN’s clinical experience was introduced from the aspects of etiology and pathogenesis of the disease including depression, phlegm and stasis, the treatment rules and methods, and syndrome differentiation and treatment, with a medical case as evidence. [Results] According to Professor JIN, the disease is located in the heart and liver, but firstly in the liver. When the emotions are not in line with the will, the Qi becomes depressed at first, the liver loses control, the Qi and blood become unregulated and the blood vessels are blocked. Phlegm turbidity and stagnant blood are born within as the disease develops and is disturbed by upward movement, which is mostly seen in actual symptoms and is classified as syndrome of liver depression and Qi stagnation, syndrome of internal harassment of phlegm-heat, and syndrome of phlegm-stasis interlocking. The treatment is based on the principle of soothing the liver and relieving depression, clearing the heart and resolving phlegm, activating blood circulation and eliminating blood stasis, and the formula is based on the addition and reduction of Chaihu Shugan Powder, Huanglian Wendan Decoction and Diankuang Mengxing Decoction. In this medical case, the patient was diagnosed as depression-related insomnia of liver Qi stagnation and phlegm heat disturbing, and treated with the method of clearing away heat and resolving phlegm, relieving depression and calming mind, which significantly relieved his depression state and improved sleep quality, and the effect was remarkable. [Conclusion] In the treatment of depression-related insomnia, Professor JIN’s treatment is based on syndrome differentiation, from the aspect of phlegm and blood stasis,accurate application of drugs, the effect is remarkable, his medication characteristics have high clinical guiding significance, which is worthy of popularization and application.