国医大师王庆国应用柴胡桂枝汤合甘麦大枣汤治疗围绝经期失眠经验

WANG Qingguo’s experience in treating perimenopausal insomnia with Bupleurum and Cinnamon Twig Decoction plus Licorice,Wheat and Jujube Decoction

围绝经期失眠归属于中医“不寐”“绝经前后诸症”等范畴,王庆国教授认为围绝经期失眠以枢机不利、气血不和为核心病机,并伴有脏腑功能失调,需综合考虑围绝经期这一特殊阶段的生理特点,紧抓核心病机,善用经方化裁。他认为柴胡桂枝汤可调气血、调营卫、调三焦、调少阳之枢的出入和脾胃之枢的升降,是“和”法的重要体现。擅用柴胡桂枝汤合甘麦大枣汤化裁调和枢机、调畅气血、调平脏腑关系,配合单药或对药燮理阴阳、安神增效,同时重视疏导患者情绪,临床收效颇佳。结合临床医案对围绝经期失眠的诊治经验进行总结。

Perimenopausal insomnia belongs to the categories of “bú mèi(sleeplessness)” and “jué jīnɡ qián hòu zhū zhènɡ(menopausal symptoms)” in Traditional Chinese Medicine. According to Prof. Wang, the core pathogenesis of perimenopausal insomnia lies in dysfunction of shaoyang acting as a pivot, disharmony of qi and blood, accompanied by disorders of the zangfu organs. It is necessary to comprehensively consider the physiological characteristics of this special stage, grasp the core pathogenesis, and make good use of classical TCM prescriptions. He believes that Bupleurum and Cinnamon Twig Decoction is an important tool of the “harmonizing” methods which regulates qi and blood, ying qi and wei qi, and the three jiao, and restores the entering and exiting at the pivot of shaoyang and the ascending and descending at the pivot of the spleen and stomach. Prof. Wang has developed his unique insights into using Bupleurum and Cinnamon Twig Decoction plus Licorice, Wheat and Jujube Decoction with necessary additions or reductions to adjust the pivot, invigorate the flow of qi and blood, balance the zangfu organs. He may also add single herb or herb pairs to the formula, which creates a synergy to harmonize yin and yang and calm the mind. Furthermore, he attaches great importance to patients’ emotions, and has achieved satisfactory clinical result. His experience of diagnosis and treatment of perimenopausal insomnia was summarized in this study in combination with clinical cases.