阳虚不寐证治思路

The syndrome differentiation and treatment thought of Yang deficiency type insomnia

不寐是一种很常见的疾病,西医学称之为失眠。中医认为,该病病因病机以火盛、阴虚及气血虚等多见,阳虚引起的不寐较少见。近几年来,由于人们生活饮食习惯改变,如生冷饮食、寒性药物及抗生素滥用、熬夜和运动减少等,机体阳气不断损耗,出现较多的阳虚体质人群,阳虚不寐患者也逐渐增多。文章基于文献资料结合临床实践,从阳虚不寐的理论起源、理论形成、病因病机、鉴别诊断、临床治疗及案例分析等多方面进行论述,较全面地阐述了阳虚不寐,以解决临床顾虑。阳虚不寐可分为阳性不寐及阴性不寐,阳性不寐病机为阳气亏虚,龙雷之火外浮,扰动心神;阴性不寐病机为阳气亏虚,虚寒内生,心神失于温煦。分析病机的同时,应对二者加以区别。文章将阳虚不寐与心火炽盛、肝火扰心、肝郁脾虚、痰热扰神、气血亏虚、肝血亏虚及阴虚火旺之不寐进行鉴别,同时结合当今社会出现较多的阳虚不寐患者,根据病机自拟潜阳安神汤(炙附子、干姜、炙甘草、砂仁、黄柏、肉桂、磁石)。该方有温补脾肾、恢复阳气、收纳虚火之效,临床辨证辅以附子理中丸或金匮肾气丸加减,在临床实践中取得较好疗效,解除了阳虚不寐患者的困扰。

Insomnia is a very common disease,which is called insomnia in Western medicine.TCM believes that the etiology and pathogenesis of this disease are mainly fire hyperactivity,Yin(阴)deficiency and Qi(气)and blood deficiency,while Yang(阳)deficiency caused by insomnia is rare.In recent years,due to the changes of living and eating habits of people,such as raw and cold diet,cold drugs and antibiotics abuse,staying up late and reducing exercise,Yang QiI in the body is constantly losing,there are more and more people with Yang deficiency physique,and Yang deficiency type insomnia patients are also gradually increasing.Therefore,the author consulted data and combined with clinical practice,comprehensively expounded Yang deficiency type insomnia from the perspectives of the theoretical origin,theoretical formation,etiology and pathogenesis,differential diagnosis,clinical treatment and case analysis,so as to solve clinical concerns.The author believes that Yang deficiency type insomnia can be divided into positive insomnia and negative insomnia.The pathogenesis of positive insomnia is Yang deficiency,resulting in unquiet state of mind due to hyperactive fire floating outside.The pathogenesis of negative insomnia is the deficiency of Yang Qi,resulting in restlessness after endogenous deficiency.In the analysis of pathogenesis,the two should be distinguished.The author differentiates Yang deficiency type insomnia and other insomnia types such as heart fire burning type,liver fire disturbing the heart type,liver stagnation and spleen deficiency type,phlegm-heat disturbing mind type,Qi and blood deficiency type,liver blood deficiency type,Yin deficiency and fire hyperactivity type.At the same time,according to the pathogenesis of many Yang deficiency type insomnia patients in today’s society,the Qianyang Anshen decoction(潜阳安神汤)was prescribed clinically.This prescription has the effects of warming and tonifying spleen and kidney,restoring Yang Qi,and absorbing deficiency fire.It is supplemented with Fuzi Lizhong Wan(附子理中丸)or Jingui Shenqi Wan(金匮肾气丸)in clinic based on syndrome differentiation.This method has achieved good curative effects in clinical practice,and relieves the troubles of patients with Yang deficiency type insomnia.