调肝四法治疗围绝经期失眠的理论依据

Theoretical basis for treating perimenopausal women’s insomnia with four methods of regulating liver

围绝经期综合征又称更年期综合征,是指妇女绝经前后出现性激素波动或减少而导致的一系列以自主神经系统功能紊乱为主,且伴有神经心理症状的一组综合征。失眠作为围绝经期综合征的常见症状之一,严重降低了围绝经期女性的生活质量,给患者的身体和心理健康带来了较大危害。目前对于围绝经期失眠的治疗,现代医学以口服镇静药物为主要治疗手段,但其远期效果不乐观且不良反应较大,并且停药后易产生戒断反应,而中医治疗具有疗效明确且不良反应小的优势,有较大的临床研究价值。对于围绝经期失眠的病因病机,从古至今历代医家有着不同的看法,但大多数医家认为围绝经期失眠以肾水亏虚为本。随着时代的发展及生活压力的增加,心理及情绪因素成为影响失眠最重要的因素之一。魂居于肝,肝气不畅、肝火扰乱、肝血不养则魂居不宁,夜寐不安,围绝经期女性因其特殊的生理变化常加剧情志的病变,因此从肝论治围绝经期失眠往往能取得较为满意的疗效。张恒教授从事中医内科杂病的临床研究二十余年,其临证经验丰富,尤其擅长用中医中药治疗围绝经期综合征及各种内科杂病。张教授在大量的临床实践中发现,围绝经期女性失眠单见肾虚者少,兼有肝病者多,由此总结出了调肝四法治疗围绝经期失眠,即疏肝活血法、清肝豁痰法、养血安魂法、滋补肝肾法,并取得了较好的疗效,值得进一步探讨。

Perimenopausal syndrome,also known as climacteric syndrome,refers to a series of symptoms characterized by dysfunction of autonomic nervous system and neuropsychological symptoms caused by fluctuations or decreases of sex hormones before and after menopause.As one of the common symptoms of perimenopausal syndrome,insomnia seriously reduces the overall quality of life of perimenopausal women,and brings great harm to the physical and mental health of patients.At present,for the treatmentP of perimenopausal insomnia,modern medicine mainly uses oral sedatives as the main treatment method,but its long-term effect is not optimistic,and it has the disadvantages of large side effects and easy withdrawal reaction after drug withdrawal,while TCM medicine treatment has the advantages of clear efficacy and small adverse reactions,which has greater clinical research value.Doctors of all ages have different views on the etiology and pathogenesis of perimenopausal insomnia,but most believe that perimenopausal insomnia is based on deficiency of kidney essence.With the development of the times and the increase of life pressure,psychological and emotional factors have become one of the most important factors affecting insomnia.The soul resides in the liver.If the liver Qi(气)is not smooth,or the liver fire is disturbed,or the liver blood is insufficient,the soul cannot be quiet,which will lead to insomnia.Perimenopausal women often have pathological changes due to their special physiological changes.Therefore,treating perimenopausal insomnia from the perspective of liver can often achieve satisfactory results.Professor ZHANG Heng has been engaged in the clinical research of miscellaneous diseases in TCM medicine for more than 20 years.He has rich clinical experience,especially in the treatment of perimenopausal syndrome and various miscellaneous diseases in internal medicine with TCM medicine.In a large number of clinical practices,he found that there were few perimenopausal women who suffered from insomnia only due to kidney deficiency,and many women suffered from liver disease.Therefore,he summarized the four methods for regulating the liver to treat perimenopausal insomnia,namely,the method of soothing the liver and activating blood circulation,the method of clearing the liver and removing phlegm,the method of nourishing blood and tranquilizing soul,and the method of nourishing the liver and kidney,and achieved good effects,which is of great value for further discussion.