运用引火汤治疗不寐的辨治思路探讨

Thoughts on the pattern identification and treatment of insomnia with Yinhuo Tang

不寐是由多种原因引起的心神失养、心神不宁而导致不能获得正常睡眠的病症。引火汤源自陈士铎《辨证录》一书,原为治疗“阴蛾”所创,全方由熟地黄、巴戟天、茯苓、麦冬、五味子组成。引火汤所治证候的病机为肾水亏虚、相火妄动,中焦脾胃升降失司,三焦气化失常。后世医家经过临床实践与探索,拓展了引火汤的应用范围,发现引火汤治疗不寐心肾不交证效果颇佳。心肾不交是不寐常见的证候,引火汤可滋阴潜阳、引火下行、交通心肾、阴阳同治,与不寐心肾不交证的病机相契合。临床治疗不寐时,常根据病情对引火汤进行适当加减以增强疗效。结合临床病例对运用引火汤治疗不寐的辨治思路、用药特点进行介绍。

Insomnia is characterized by an inability to obtain enough sleep,which is caused by heart spirit with inadequate nourishment and disquieted mind.Yinhuo Tang(YHT)has its origin in Record of Pattern Identification written by Chen Shiduo.It was originally used as a prescription for the treatment of“Yin E”,composed of Shudihuang(Radix Rehmanniae Praeparata),Bajitian(Morindae Officinalis Radix),Fuling(Poria),Maidong(Ophiopogons Radix),Wuweizi(Schisandrae Chinensis Fructus).The pathogenesis of the syndrome treated by YHT is the kidney water deficiency,the frenetic stirring of the ministerial fire,the spleen-stomach disharmony,and the abnormal vaporizing of the triple energizer.After clinical practice and exploration,doctors of later generations expanded the application scope of YHT.It is found that YHT has good effects on insomnia with disharmony of the heart and kidney.The disharmony of the heart and kidney is a common syndrome of insomnia.YHT could nourish Yin for suppressing hyperactive Yang,return fire to the origin,coordinate the heart and the kidney.It is consistent with the pathogenesis of insomnia with the disharmony of the heart and kidney.According to the condition,doctors often modify YHT to strengthen the curative effect,in the treatment of insomnia.Combined with clinical cases,this article introduces thoughts on pattern identification and treatment and medication characteristics of treating insomnia with YHT.