张永华从“气、火”辨治女性孕产期抑郁性失眠症

ZHANG Yonghua Treats Female Depressive Insomnia During Pregnancy and Parturition with“Qi and Fire”

[目的]总结张永华教授从“气、火”理论辨治女性孕产期抑郁性失眠症的经验,提高对女性孕产期抑郁性失眠症特点的认识。[方法]通过跟诊学习、收集整理张教授的医案、查阅相关文献,总结张教授基于“气、火”理论阐释女性孕产期抑郁性失眠症的病因病机,以及治疗的临床经验,并举验案两例加以佐证。[结果]张教授认为,女性的体质基础加上孕产期特殊的生理变化是孕产期抑郁性失眠症的主要原因,其发病以气郁与火郁为主导,治疗上以理气、清火为要,辅以滋阴养血,同时应注重情绪的调节。所举验案其一为肝郁脾虚之证,治予柴胡疏肝散加减疏肝泄热、养血安神;另一验案为阴虚火旺之证,治予酸枣仁汤化裁滋阴清热、镇心安神,两案虽看似截然不同,但实则皆从“气、火”入手治疗,疗效显著,可为证验。[结论]张教授针对女性孕产期抑郁性失眠症中“气、火”致病的特点,从理气、清火、滋阴等方面着手进行治疗,临床疗效显著,具有一定的指导意义,值得推广学习。

[Objective]To summarize Professor ZHANG Yonghua’s experience in treatment of female depressive insomnia during pregnancy and parturition with the theory of“Qi and fire”,and improve the understanding of the characteristics of female depressive insomnia during pregnancy and parturition.[Methods]Through the consultation,collecting and sorting out Professor ZHANG’s medical records and consulting related literatures,this paper summarizes Professor ZHANG’s clinical experience in explaining the etiology,pathogenesis and treatment of female depressive insomnia during pregnancy and parturition from the two pathological factors of“Qi and fire”,and presents two cases to prove.[Results]Professor ZHANG believes that female’s physical foundation and special physiological changes during pregnancy and parturition are the main causes of insomnia.Its onset is dominated by Qi depression and fire depression,and the treatment is based on regulating Qi and clearing fire,supplemented by nourishing Yin and blood,and paying attention to emotional regulation.One of the cases cited was the syndrome of liver depression and spleen deficiency,which was treated with Chaihu Shugan Powder to soothe the liver and relieve heat,nourish blood and tranquilize the nerves.Another case was the syndrome of Yin deficiency and excessive fire,which was treated with Suanzaoren Decoction to nourish Yin and clear heat,calm the heart and the nerves.Although the two cases seemed completely different,they were both treated with the theory of“Qi and fire”,which had remarkable curative effect and could be used as evidence.[Conclusion]According to the pathogenic characteristics of“Qi and fire”in female depressive insomnia during pregnancy and parturition,Professor ZHANG starts to treat it from the aspects of regulating Qi,clearing fire and nourishing Yin,which has remarkable clinical curative effect and certain guiding significance,and is worth popularizing and learning.