从“营卫之行,脏腑之变”探析睡眠障碍机制及治疗

Exploration of the Mechanism and Treatment of Sleep Disorders Based on“the Operation of Yingwei,the Disease of Viscera”

睡眠障碍(sleep disorder,SD)指睡眠-觉醒功能异常。中医上将SD分为“昼不精”“夜不暝”两种状态,而营卫和脏腑是人体寤寐变化的基础和关键。文章阐述营卫循行的常态,营卫昼夜皆行五十周,而卫气具有明显的昼夜节律性,以阴阳跷脉为枢机,以三焦膜系统为循行的物质基础,具有大小两个循行回环及“昼周于身”“夜周五脏”两种交替循行方式,在睡眠-觉醒中具有先导作用。脏腑是营卫生成的源泉,又能对营卫运行产生阻碍。提出五脏之变最终影响五神,消化系统是六腑致病的核心。治疗上不拘于针药,倡导多手段协同作用,避免一味镇静安神,关键在于恢复营卫节律性运行,平和脏腑之气,从而迅速、有效、持久地改善SD。

Sleep disorder(SD)refers to abnormal sleep-wake function.In TCM,SD is divided into two states:“daytime fatigue”and“sleeplessness at night”.Yingwei and viscera are the foundation and key of sleep-wake.Elaborating the normality of the Yingwei movement,the course of Yingwei lasted fifty weeks day and night,the defensive Qi has an obvious circadian rhythm,which is based on the Yinqiao and Yangqiao meridians as the pivot and the Sanjiao system as the material basis.Defensive Qi has two circulation loops,long and short,and two alternating circulation modes,“running on the body during the day”and“running on the five Zang organs at night”,which has a leading role in sleep-wake.Viscera are the source of Yingwei,but also hinder the operation of it.It is proposed that the changes of the five Zang organs ultimately affect the five spirits,and the digestive system is the core of the pathogenesis of six Fu organs.The treatment is not limited to acupuncture and medication,and the synergistic effect of multiple means is advocated.Attention should be paid to avoid blindly sedative and calming.The key is to restore the rhythmic operation of Yingwei and calm the Qi of viscera,thus,SD can be improved rapidly,effectively and enduringly.