基于“轴枢运动”论治失眠合并焦虑症  

Treatment of insomnia combined with anxiety based on the“axial pivotal movement”theory

作　　者：吕少辉 王彦华[1] 陈昺伃 张俊[1,2] LYU Shaohui;WANG Yanhua;CHEN Bingyu;ZHANG Jun(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450003,China)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450003 [2]河南中医药大学第一临床医学院,河南郑州450046

出　　处：《陕西中医》2024年第7期938-941,共4页Shaanxi Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(82305080);河南省自然科学基金资助项目(222300420227);河南省科技攻关计划项目(212102311124);河南省中医药科学研究专项课题(2023ZY2041,20-21ZY2043)。

摘　　要：“土枢四象,一气周流”的轴枢运动理论最初由清代御医黄元御提出。中气为人体运动原动力,后天中焦脾胃斡旋,协调脏腑气机升降运动。本病病程较长,且病情错综复杂,故在临床诊疗失眠合并焦虑的患者时应注重从“轴枢运动”理论进行辨治,其基本病机为中气衰败、脏腑失调,而根本原因在于轮枢莫运、升降失职。从脾虚土壅、肝木左郁、肺金右滞三方面论述其病机特点,并提出中土衰败者,治以健运中州,使气机运化有司;其肝木左郁者,疏肝解郁,使血瘀无生成之形;其肺金右滞者,肃肺和胃,使气滞无生成之弊,故而提出临证之时应以“调和五脏之原,职在中宫”为主要治疗原则,时刻固护中焦脾胃,使得轴枢运转协调,各司其职。The axial pivotal movement theory of“earth pivot,four images,one qi circumference”was initially proposed by Huang Yuanyu,the imperial physician of the Qing Dynasty.The central Qi is the source of the body’s movement,and the spleen and stomach of Zhongjiao in the back of the body mediate and coordinate movement of Qi internal organs.This disease has a long course,and the condition is intricate and complex,so in the clinical diagnosis and treatment of insomnia combined with anxiety patients should pay attention to the theory of the“axial pivotal movement”for the identification and treatment,that basic pathology is the failure of the middle Qi and disorder of internal organs,and that the root cause lies in lack of transportation of the wheel axis and failure of lifting and lowering of duties.From the spleen deficient soil congestion,liver wood left depression,lung gold right stagnation of three aspects of characteristics in disease mechanism,and put forward the decline of middle soil,the treatment of healthy transportation in the state,so that Qi transport division.Liver wood left depression,liver relief.Blood stasis is not generated in form of right stagnation of lung gold,purging lungs and stomach,so that stagnation of Qi is not generated by the evils.Therefore,it is proposed that the main therapeutic principle should be to“harmonize the five organs and their duties in the central palace”,and to protect middle Jiao,spleen and stomach at all times,so that axes can operate in coordinated manner and each of them can perform its own duties.

关 键 词：失眠 焦虑 轴枢运动 辨证论治 脾虚土壅 肝木左郁 肺金右滞 

分 类 号：R256.23[医药卫生—中医内科学]