先秦两汉时期对不寐病因病机的认识

Understanding of the etiology and pathogenesis of insomnia in the Pre-Qin and Han Dynasties

不寐是中医最常见的病证之一,其临床表现主要包括患者睡眠时间、深度不足,轻者入睡困难,或寐而不酣,时寐时醒,或醒后不能再寐,重则彻夜不寐。早在先秦两汉时期,各部经典就有对不寐的记载,并且对不寐的认识已经形成雏形,为后世医家更深入认识此病打下了坚实的基础。本着求本溯源的目的,笔者通过对先秦两汉时期的重要中医文献《黄帝内经》《伤寒论》《金匮要略》《中藏经》进行梳理,细致归纳出本时期对不寐病因病机的认识,认为本病通常与外邪内侵、情志过极、饮食不节、失治误治等因素相关,病机总属营卫失和、阳不入阴,病位主要在心,与肝、脾、肾等密切相关。通过梳理不寐的因机理论,以期为本病科研及临床治疗提供一定的帮助。

Insomnia is one of the most common symptoms of traditional Chinese medicine.Its clinical manifestations mainly include insufficient sleeping time and depth of the patient.For mild patient,It is difficult to fall asleep,or they may not sleep well and wake up while they are sleeping.Sometimes they can’t fall asleep again after waking up.For Severe patient,they may not fall asleep for the whole night.As early as the pre-Qin and Han Dynasties,the classics had a record of insomnia,which lay the foundation for future doctors’in-depth study of the disease.In the purpose of seeking the source of the original,the author sorts out the important TCM literatures of the Pre-Qin and Han dynasties("The Inner Canon of Huangdi",The Treatise on Febrile Diseases,“The Golden Chamber”“The Fellowship of the Chinese Buddhist Scriptures”),and sums up the understanding of etiology and pathogenesis of the disease in that period.The disease is usually related to external evil invasion,emotional extremes,Intemperate diet,no treatment or mistreatment and other factors,the pathogenesis is always the loss of the camp,Yang faiting to enter into Yin,the disease is mainly in the heart,and is closely related to the liver,spleen and kidney.I hope to provide some help for the scientific research and clinical treatment of this disease.