基于肾分期论治帕金森病失眠的思路探讨

Discussion on the approach of treating insomnia in Parkinson′s disease based on kidney staging

帕金森病睡眠障碍作为帕金森病(Parkinson′s disease,PD)最常见的非运动症状之一,对患者的生活质量影响颇深,主要包括失眠、快速眼球运动睡眠期行为障碍、不宁腿综合征、日间过度嗜睡以及睡眠呼吸紊乱,而失眠是其中最常见的一种类型。肾脏虚损是PD失眠的病理基础:肾阴虚则阴阳失交,肾阳亏则神失温养,肾脏衰则诸邪丛生,皆可致不寐。治宜将补肾贯穿全程,具体可结合PD失眠分期以标本兼顾。早期宜滋补肝肾,兼以息风、清热、和血;中期可益气养阴,兼顾息风、化痰、活血;晚期当阴阳气血并补,兼以息风、破血、涤痰、减毒。

Parkinson′s disease sleep disorder(PDSD),one of the most common non-motor symptoms of Parkinson′s disease(PD),has a profound impact on patients′quality of life.PDSD primarily includes insomnia,rapid eye movement(REM)sleep behavior disorder,restless legs syndrome,excessive daytime sleepiness,and sleep-related breathing disorders,with insomnia being the most prevalent type.Deficiency and impairment of the kidney serves as the pathological basis for PD insomnia:Yin deficiency of the kidney disrupts the balance between Yin and Yang,Yang deficiency of the kidney leads to insufficient nourishment of the spirit,and kidney decline allows various pathogenic factors to arise,all of which can result in insomnia.Treatment should involve replenishing the kidney throughout the course of the disease,while considering the specific stage of PDSD to address both the root cause and the symptoms.In the early stage,nourishing the liver and kidney should be prioritized,combined with methods to calm endogenous wind,clear heat,and harmonize blood.During the middle stage,Qi-invigorating and Yin-nourishing strategies should be employed,along with calming endogenous wind,resolving phlegm,and promoting blood circulation.In the late stage,both Yin and Yang,as well as Qi and blood,should be replenished,complemented by methods to calm endogenous wind,break blood stasis,resolve phlegm,and detoxify.