柴胡加龙骨牡蛎汤治疗甲亢引起失眠理论探讨

Theoretical Study on Chaihu Longgu Muli Decoction(柴胡加龙骨牡蛎汤)in Treating Insomnia Caused by Hyperthyroidism

失眠,中医称之为不寐,是临床上甲亢患者常见的并发症之一。西医常给予巴比妥盐类、苯二氮类等药物来治疗失眠,通过刺激GABA受体来减少神经元兴奋,从而起到镇静和抑制的效果。西药治疗失眠具有一定的成瘾性且不良反应较大;近年来,运用中药治疗失眠优势显著,越来越被患者接受;临床上常用仲景《伤寒论》中柴胡加龙骨牡蛎汤一方来治疗甲亢引起的失眠证;通过对柴胡加龙骨牡蛎汤的方证组成、功效配伍、作用机制及现代医家对此方治疗失眠的研究应用入手,结合甲亢引起失眠的病因病机等特点,探讨本方的证治机制,发现该方能有效治疗伴有焦虑症状的失眠和抑郁症,其机制是通过调节下丘脑-垂体-甲状腺轴/肾上腺轴激素水平及5-羟色胺(5-HT)、多巴胺(NA)、去甲肾上腺素(NE)等多种神经递质的作用来调节失眠。方中柴胡、黄芩、龙骨、牡蛎等药物的有效成分具有明显的镇静、消炎、抗抑郁作用。该文从以上多个角度出发,探索柴胡加龙骨牡蛎汤治疗甲亢引起失眠的理论机制,旨在为中医药治疗不寐提供理论基础,亦为临床运用经方治疗甲亢提供思路。

Insomnia,which is called“Bumei”in traditional Chinese medicine,is one of the common complications in patients with hyperthyroidism. Western medicine often give barbiturates,benzodiazepines and other drugs to treat insomnia,by stimulating GABA receptors to reduce neuronal excitability,so as to play a sedative and inhibitory effect. Western medicine treatment of insomnia has certain addiction and side effects;in recent years,the use of traditional Chinese medicine in the treatment of insomnia has obvious advantages and is increasingly accepted by patients;commonly used in clinical Zhongjing Treatise on Febrile Diseases Chaihu Longgu Muli Decoction to treat patients with hyperthyroidism caused by insomnia;based on the prescription composition,efficacy compatibility,mechanism of action of Chaihu Longgu Muli Decoction and the research and application of modern physicians in the treatment of insomnia,combined with the etiology and pathogenesis of insomnia caused by hyperthyroidism,this paper discusses the syndrome and treatment mechanism of Chaihu Longgu Muli Decoction,and finds that Chaihu Longgu Muli Decoction can effectively treat insomnia and depression with anxiety symptoms. The mechanism is to regulate insomnia by regulating the levels of hypothalamic-pituitary-thyroid axis/adrenal axis hormones and 5-hydroxytryptamine(5-HT),dopamine(NA),norepinephrine(NE)and other neurotransmitters. The effective components of Chaihu(Bupleuri Radix),Huangqin(Scutellariae Radix),Longgu(Fossilizid)and Muli(Ostreae Concha)have obvious sedative,anti-inflammatory and antidepressant effects. This paper explores the theoretical mechanism of Chaihu Longgu Muli Decoction in the treatment of insomnia caused by hyperthyroidism from the above perspectives,aiming to provide theoretical basis for the treatment of insomnia by traditional Chinese medicine and ideas for the clinical application of classical prescriptions in the treatment of hyperthyroidism.