张志玲运用“十纲辨证”治疗失眠经验

Experience of Zhang Zhiling in Treating Insomnia by“Ten-principle Syndrome Differentiation”

张志玲教授认为,失眠的总病机为阴阳失调、阳不入阴,其直接病机为营卫交会失和,虚实寒热为其表象,脏腑气血失衡为其根本。当从阴阳、营卫、表里、虚实、寒热“十纲”入手以辨证论治。其中,阴阳为总纲,营卫、表里、虚实、寒热为八变。以卫阳不入营阴而致失眠,其病位在心,与肝、脾胃、肺、肾相关,现代失眠患者尤以肝、脾最为密切,寒热虚实夹杂多见。临证之时需四诊合参,观其脉证,知其逆从,测知病机,对证施治。首以调和营卫、安神助眠为法;若有邪气者,兼以驱邪,或清热化痰,或行气活血;继而培补气血、调和阴阳,使人身阴平而阳秘,以防失眠复发。

Professer Zhang Zhiling believes that the overall pathogenesis of insomnia is the imbalance of yinyang,and yang failing to enter yin,and the direct pathogenesis is the disharmony between the nutritive and defensive levels.The superficial symptoms of insomnia are deficiency-excess and cold-heat,but the root is the imbalance of qi and blood of viscera.Syndrome ddifferentiation and treatment should be based on“ten-principle”,which is the combination of yin-yang,the nutritive and defensive levels,exterior-interior,deficiency-excess,cold-heat.Yin-yang is the general principle,and the nutritive and defensive levels,exterior-interior,deficiency-excess,cold-heat are eight changes.Insomnia is caused by the absence of defensive yang into nutritive yin.The disease is located in the heart and is related to the liver,spleen,stomach,lung and kidney.The liver and spleen are the most closely related to modern insomnia patients,and cold,heat,deficiency,excess are common.When the doctor is in clinical,it is necessary to combine four methods of diagnosis,observe pulse condition,understand the development of the disease,detect the pathogenesis,and apply treatment to the symptoms.The first method of treatment is to reconcile the nutritive and defensive levels,calm the nerves and help sleep.If there are pathogens,at the same time,it should expel pathogenic factors,such as clearing heat and phlegm,promoting qi and blood circulation,and then replenish qi and blood,and reconcile yin-yang,so that people can reach a harmonious state with yin-yang balance,to prevent insomnia recurrence.