邴雅珺主任医师治疗老年性失眠的经验

The experience of Chief Physician BING Yajun in treating senile insomnia

随着社会竞争及工作压力的不断增加,失眠的患病率逐年增长,近年来呈现出年轻化趋势。其主要表现为入睡困难,或睡而不酣,或时睡时醒,或醒后不能再睡,甚或彻夜不眠等,严重影响患者的身心健康及生活质量,也由此增加了心脑血管疾病及精神疾病的患病风险。现代医学对于失眠的治疗以口服镇静催眠药为主,长时间服用易产生药物依赖及停药回弹现象。中医药治疗失眠具有用药灵活、易于化裁、疗效显著、不良反应小、药物依赖小及无回弹等优势。笔者有幸跟随邴雅珺教授学习,收获甚多,文章是对邴雅珺教授治疗失眠的临床经验进行总结。邴雅珺教授从事老年病研究30余年,坚持西医诊病,中医辨证,中药为主,西药为辅,内调外治,扬长避短,提高疗效的中西医治疗原则,临床上疗效显著。邴教授认为治疗失眠应补虚泻实,以清热化痰、和中安神为基本原则,处方以黄连温胆汤为主,方中无峻补攻伐之品,选用平和中正之剂,调理人身阴阳、气血、脏腑,恢复胆中正温和之性,具有清肃胆气,和顺胃腑,理气化痰,升清降浊的功能。再根据患者不同的临床症状进行灵活加减,并嘱患者在服用中药汤剂的同时增加饮食、情绪调护及主适当的功能锻炼,从而达到精神平和,睡眠安稳的效果。

With competition and the increasing work pressure of the society,the prevalence of insomnia is also increased year by year,which presents a trend of getting younger in recent years.It is mainly manifested as difficulty in falling asleep,or sleep without deep sleep,or waking up from sleep,or not falling sleep after waking up,or even sleepless through the night,which seriously affects the patients’physical and mental health and quality of life,and thus increases the risk of cardiovascular and cerebrovascular diseases and mental diseases.Modern medicine mainly uses oral sedative and hypnotic drugs in the treatment of insomnia,which is easy to produce drug dependence and drug withdrawal rebound phenomenon after long-term use.Traditional Chinese medicine has advantages in the treatment of insomnia,such as flexible medication,appropriate modification,significant curative effect,small adverse reactions,less drug dependence and no rebound.Professor BING Yajun has been engaged in the research of geriatric diseases for more than 30 years and has insisted on adhering to the principle of Western medicine diagnosis and syndrome differentiation of traditional Chinese medicine for more than 30 years.Traditional Chinese medicine is used as the main treatment and Western medicine is used as the auxiliary,internal and external treatment are combined to enhance the strengths and avoid the weaknesses,which in turns improves the curative effect of tradi­tional Chinese medicine and Western medicine treatment,of which the clinical effect is significant.Professor BING believes that the treat­ment of insomnia should be reinforcing deficiency and reducing excess,and taking clearing heat and phlegm and harmonizing mind as the basic principle.The major prescription is Huanglian Wendan decoction(黄连温胆汤),which uses mild medicinals to regulate Yin(阴)and Yang(阳),Qi(气)and blood,Zang-fu organs(脏腑),restore the gallbladder,and it has the function of clearing bile,and harmoniz­ing the stomach,regulating Qi and phlegm,clearing and reducing turbidity.Then,according to different clinical symptoms of patients,flex­ible addition and subtraction are carried out,and patients are instructed to increase diet,emotional care and appropriate functional exercise while taking traditional Chinese medicine decoction,so as to obtain mental peace and restful sleep.