基于“阳气升降圆运动”探讨失眠的四时病机及治法

Discussion on the Four-Season Pathogenesis and Treatment of Insomnia Based on the “Circular Movement of Yang Qi Ascending and Descending”

在“阳气升降圆运动”理论的视域下,基于人体脏腑阳气盛衰的季节变化特点探讨失眠的四时病机及治法,认为失眠的病机以脾胃亏虚,湿邪内生为核心,四时病机各有侧重。春季阳气升发异常,肝火上炎或肝气郁滞;夏季阳气偏盛于上,心胆火旺;秋季肺降失司,阳气下降异常,阳热化燥或营卫失和;冬季阳气潜藏失常,虚阳浮越或阴阳两虚。倡导在时间的动态变化中灵活把握失眠的病机,提出构建以化湿健脾为核心,疏肝健脾、清降心胆、肃降肺气、潜阳益肾为四时侧重的“复阳升降”辨治框架,从而丰富以年节律时间特点辨治失眠的中医时间医学研究,以期更好地服务临床,为临床诊治失眠提供思路。

In the perspective of the theory of “circular movement of yang qi ascending and descending”,the author explores the four-season pathogenesis and treatment of insomnia based on the seasonal changes of the body's yin-yang balance.It is believed that the core pathogenesis of insomnia lies in the spleen and stomach deficiency and the internal buildup of dampness.The four-season pathogenesis of insomnia focuses can be categorized into four aspects:abnormal ascending of yang qi in the spring,leading to the liver fire inflammation or the liver qi stagnation;Predominance of yang qi in the upper side of the heart and gallbladder fire in the summer;Lung disorder and abnormal descent of yang qi,resulting in yang-heat conversion into dryness or disharmony between nutrient qi and defensive qi;Abnormal hiding of yang qi,manifesting as floating yang or deficiency in both yin and yang in the winter.It is advocated to dynamically grasp the pathogenesis of insomnia in accordance with the changes in time.A treatment framework called “restoring ascending and descending of yang qi” is proposed,with the core focus on resolving dampness and strengthening the spleen,while also addressing the liver and strengthen the spleen,clearing and descending the heart and gallbladder,purifing and descending the lung qi,and suppressing hyperactive the yang and invigorating the kidneys in different seasons.This enrichment of the traditional Chinese medicine time medicine research in insomnia treatment,based on the characteristics of seasonal rhythmic time,aims to better serve clinical practice and provide ideas for the clinical diagnosis and treatment of insomnia.