基于营卫循行规律探析肿瘤相关性失眠的病机及治疗  

Exploring the Pathomechanism and Treatment of Cancer-related Insomnia based on the Law of Ying-wei(营卫) Circulation

作　　者：曹璐畅 王新苗 朱潇雨 许博文 李杰[1] CAO Luchang;WANG Xinmiao;ZHU Xiaoyu;XU Bowen;LI je(Guang anmen Hospital,China Academy of Chinese Medical Sciences,Bejing,100053;Graduate School of Bejjing University of Chinese Medicine)

机构地区：[1]中国中医科学院广安门医院,北京市100053 [2]北京中医药大学研究生院

出　　处：《中医杂志》2023年第1期27-31,共5页Journal of Traditional Chinese Medicine

基　　金：中国中医科学院科技创新工程(CI2021A01802)。

摘　　要：肿瘤相关性失眠是与肿瘤发生发展及治疗相关的常见症状,且失眠对肿瘤演变具有负向推进作用。基于《黄帝内经》中营卫循行规律,提出以营卫昼夜“肌表-募原”循环阐释睡眠机理;并根据肿瘤相关性失眠不同表现将其分为寐质、寐时、寐期异常分别施以不同治法。其中入睡困难型寐时异常,核心病机为肝郁而失枢转之职,治以柔肝体、疏肝阴;早醒型寐时异常,核心病机为脾虚失摄,治以健脾疏肝并辅以分时施治;寐浅易醒型寐质异常,核心病机为肺魄不安,治以养血降肺;多梦型寐质异常,核心病机为痰瘀扰心,治以通达募原;主要表现为昼不精、夜不瞑的寐期异常,核心病机为肾阳内损,治以少火生阳。从营卫运行规律探讨肿瘤相关性失眠的病机及辨治,可进一步拓展该病的病机理论内涵与临证治疗思路。Cancer related insomnia(CRI)often occurs in cancer patients,and is related to onset,development and treatment of cancer.CRI has a negative promoting effect on cancer evolution and may become one of the risk factors for cancer development.Based on the law of ying-wei(营卫)circulation recorded in Inner Canon of Yellow Emperor(《黄帝内经》),this paper puts forward the diurnal cycle of“fleshy exterior-muscle surface(pleurodiaphragmatic interspace)”in ying-wei to explore the mechanism of sleep,and divide the cancer-related insomnia into sleep qua-lity,sleep time,and sleep period abnormalities based on manifestations.The core pathomechanism of difficulty in falling asleep(sleep time abnormality)is loss of the governing in qi flow due to liver constraint,which could be treated by softening the liver form and soothing the liver yin.Early awakening(sleep time abnormality)is mainly due to deficiency of spleen-qi failing to constrain,and can be treated by fortifying the spleen and soothing the liver with appropriate therapy at different time.In terms of sleep quality abnormalities,shallow sleep and easy awakening is mainly due to restless corporeal soul of lung,and the method of nourishing blood and directing lung qi downward is suggested;insomnia and dreaminess is mainly caused by phlegm and blood stasis disturbing the heart,and can be treated by unblocking and venting the membrane-source.Sleep stage abnormality is mainly manifested as lack of spirit during the day and sleeplessness at night,with the pathomechanism of kidney-yang deficiency,for which the method of lesser fire generating yang is advised.By discussing the pathomechanism,differentiation and treatment of cancerrelated insomnia from the law of ying-wei circulation,this paper can enrich the theoretical connotation and the clinical treatment ideas of cancer-related insomnia by TCM.

关 键 词：肿瘤相关性失眠 营卫理论 肌表 募原 

分 类 号：R273[医药卫生—中西医结合] R256.23[医药卫生—中医肿瘤科]