从“胃不和则卧不安”认识胃食管反流病伴失眠

Understanding Gastroesophageal Reflux Disease with Insomnia from the Perspective of“Gastric Disorder Causing Restless Sleep”

“胃不和则卧不安”是胃肠疾病影响睡眠的总体病机概括,亦是胃食管反流病(GERD)伴失眠症状发生的中医理论依据,其内涵与胃食管反流病致失眠的西医学机制亦高度契合。本文通过对“胃不和则卧不安”的理解,重新认识GERD及其相关失眠的发生机制,即脾胃失常的“胃不和”状态可发生GERD,GERD又可通过多途径直接或间接影响睡眠。根据其理论联系临床实际,在治疗此类GERD伴失眠时,当以调和脾胃为根本,包括补益脾胃使机体正气充足,能量有源,运行有序;消除壅滞胃腑之实邪,使邪散神自不扰;同时需配合疏肝和胃及心理疏导之法,使患者心情舒畅胃和卧安。当GERD致患者夜间喘息、咳嗽等不能平卧间接影响睡眠时,需顺肺降逆,和胃化痰,标本兼顾方能使人夜能安卧。此外,临床实际中仍需根据失眠症状灵活运用安神类药物,从多维度综合治疗,方能显出最好的疗效。

“Gastric disorder causing restless sleep”is a generalization of the overall pathogenesis of gastrointestinal diseases affecting sleep,and it is also the TCM theoretical basis for the occurrence of gastroesophageal reflux disease(GERD)with insomnia symptoms.Its connotation is also highly consistent with the modern medical mechanism of insomnia caused by GERD.In this paper,we re-understand the mechanism of GERD and its related insomnia through the understanding of“gastric disorder causing restless sleep”,i.e.,stomach disorders caused by abnormality of spleen and stomach can lead to GERD,and GERD can directly or indirectly affect sleep through multiple pathways.According to the theory and clinical practice,in the treatment of such GERD accompanied by insomnia,the basic principle should be harmonizing the spleen and stomach,including tonifying the spleen and stomach to make the body healthy,making energy resourceful,and getting the work in order.Excess pathogenic factors that is congested in the stomach should be eliminated,so that no pathogenic factors disturb the spirit,and the spirit gets quiet.At the same time,the therapy of soothing the liver,harmonizing the stomach and psychological counseling should be combined to make the patients feel relaxed and stomach feel at ease.When GERD causes patients to feel short of breath and cough at night and cannot lie down,thus indirectly affecting sleep,the lung should be conformed and the counterflow qi should be directed downward,and the stomach should be harmonized and the phlegm should be resolved.Only by taking both root and tip into consideration can patients lie quiet at night.In addition,it is still necessary to flexibly use tranquilizing drugs according to the symptoms of insomnia in clinical practice,and comprehensive treatment from multiple dimensions is required to obtain the best efficacy.