国医大师张琪从瘀辨治不寐  

Chinese Medicine Master Zhang Qi Treating Insomnia from Blood Stasis

作　　者：刘丹[1] 王喜凤 LIU Dan;WANG Xifeng(The First Affliated Hospital to Heilongjiang University of Chinese Medicine,Harbin Heilongjiang China 150040;Heilongjiang University of Chinese Medicine,Harbin Heilongiang China 150040)

机构地区：[1]黑龙江中医药大学附属第一医院,黑龙江哈尔滨150040 [2]黑龙江中医药大学,黑龙江哈尔滨150040

出　　处：《中医学报》2021年第1期106-109,共4页Acta Chinese Medicine

基　　金：第四批全国中医(临床、基础)优秀人才研修项目{国中医药人教发[2017]24号}。

摘　　要：张琪教授重视从瘀辨治不寐,首辨有无瘀血,次辨瘀血形成的原因,再辨瘀血的程度。情志失调可影响肝之疏泄,血行不畅,心失所养,则发为不寐,治宜疏肝活血、宁心安神,方以逍遥散或龙胆泻肝汤合血府逐瘀汤加减;痰瘀互结,或化火扰动心神,使心神不安,或阻滞脉络,导致心脉失养,则发为不寐,治宜化痰祛瘀、和中安神,方以二陈汤或黄连温胆汤合桃红四物汤加减;心脾气血两虚,无力推动血液运行以濡养心脉,则发为不寐,治宜补益心脾、养血安神,方以归脾汤合血府逐瘀汤加减;若阴虚,或阳气相对偏盛,或津亏不足以载血,血脉瘀阻化火灼津,则发为不寐,治宜滋阴降火、凉血安神,方以黄连阿胶汤合血府逐瘀汤加减;脾胃不和,或气血亏虚导致脉络不通,形成瘀血,或气机升降失常,血液运行受阻,则发为不寐,治宜调和脾胃、化瘀安神,方以保和丸或黄芪建中汤合血府逐瘀汤加减。Professor Zhang Qi pays attention to the treatment of insomnia from blood stasis.First,identify whether there is blood stasis;then,identify the causes of blood stasis;finally,identify the degree of blood stasis.Emotional disorders can affect the liver′s controlling conveyance and dispersion.If blood flow is not smooth,the heart is out of support,which can lead to insomnia.The treatment is appropriate to soothe the liver and promote blood circulation,calm the heart and tranquilize mind.The prescriptions are modified Xiaoyao Powder or Longdan Xiegan Decoction and Xuefu Zhuyu Decoction.If the phlegm and blood stasis are combined together,or the fire can disturb mind and make mind uneasy,or block the channel and cause the heart to lose nourishment,then insomnia will occur.The treatment is suitable for resolving phlegm and removing blood stasis and regulating stomach and tranquilizing mind.The prescriptions are modified Erchen Decoction or Huanglian Wendan Decoction and Taohong Siwu Decoction.If both qi and blood deficiency in heart and spleen,unable to promote blood circulation to nourish the heart and pulse,then insomnia will occur.Treatment should be tonifying the heart and spleen,nourishing blood and tranquilizing mind.The prescription are modified Guipi Decoction and Xuefu Zhuyu Decoction.If yin is deficiency,or yang qi is relatively high,or body fluid deficiency is insufficient to carry blood,blood stasis causes fire and burns body fluid,then insomnia will occur.The treatment is suitable for nourishing yin and reducing fire,cooling blood and tranquilize mind.The prescription are modified Huanglian Ejiao Decoction and Xuefu Zhuyu Decoction.If the spleen and stomach are not in harmony,or the deficiency of qi and blood leads to impaired channels and blood stasis,or abnormal qi movement,and blood circulation is blocked,then insomnia will occur.It is appropriate to treat the spleen and stomach,dissipate blood stasis and tranquilize mind.The prescription are modified Baohe pills or Huangqi Jianzhong Decoction and Xu

关 键 词：不寐 瘀血 安神 张琪 

分 类 号：R256.23[医药卫生—中医内科学]