基于“相火动静观”探讨失眠伴焦虑障碍辨治思路  

Discussion on Differentiation and Treatment of Insomnia with Anxiety Disorders based on “Concept of Ministerial Fire Stirring and Stillness”

作　　者：王雪[1] 张明雪 WANG Xue;ZHANG Mingxue(Graduate School of Liaoning University of Traditional Chinese Medicine,Shenyang,110032;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine)

机构地区：[1]辽宁中医药大学研究生学院,辽宁省沈阳市110032 [2]辽宁中医药大学附属医院

出　　处：《中医杂志》2023年第5期452-456,共5页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81273698);辽宁省教育厅特聘教授滚动支持项目(辽教函[2018]35号)。

摘　　要：相火理论是中医学体系中的重要组成部分,朱震亨将相火论与理学紧密结合,提出相火动静观。以“相火动静观”为基础,探讨失眠伴焦虑障碍的病机及治则治法,认为五志过极、脏腑失调、各有火起是本病发生的基础;相火离位、妄动扰神为核心病机;病位在心、肝,与脾、肾密切相关。在失眠伴焦虑障碍的发生发展过程中,五脏阴阳失调均会引起相火妄动,上扰神明,故治疗当安脏腑之相火,以求静而守位;提出动中求静的治疗总则,与心相关则收心、养心、清心,与肝相关则清肝、疏肝、补肝,与脾相关则益气、健脾、升清,与肾相关则补肾、滋阴、降火。The theory of ministerial fire is an important part of the system of traditional Chinese medicine.By closely combining the theory of ministerial fire with neo-confucianism,ZHU Zhenheng put forward the concept of stirring and stillness of ministerial fire.Based on this concept,the paper discussed the pathogenesis and treatment principle ofinsomnia with anxiety disorder(AD).Itis believed that overacting ofthefiveemotions,disordered zang-fu organs(脏腑),and the generated fire are the basis of the disease,while out-of-place ministerial fire and frenetic stirring of ministerial fire harassing the spirit are the core pathogenesis.The disease is located at the heart and liver,closely related to the spleen and the kidney.During the occurrence and development of insomnia with AD,the imbalance of yin and yang of the five zang organs will cause the frenetic stirring of ministerial fire,thereby harassing the spirit.Therefore,the treatment should be calming the ministerial fire of the zang-fu organs,to seek stllness and keep the spirit.The general treatment principle is seeking for stllness from stirring;that is,calming,nourishing and clearing the heart if it is related;when the liver is involved,it is suggested to clear,soothe,and supplement it;if the spleen is related,the method of boosting qi,fortifying the spleen and ascending the clear should be used;for the kidney,it is suggested to supplement kidney,enrich yin and reduce fire.

关 键 词：失眠 焦虑障碍 相火 朱震亨 

分 类 号：R256.23[医药卫生—中医内科学] R277.7[医药卫生—中医学]