徐凤芹从“心主神明”辨治失眠经验  

Experience by XU Fengqin in Diagnosis and Treatment of Insomnia Based on Theory of“Heart Governing Mental Activities”

作　　者：翁家俊 环璐瑶 李的徽 张诗雨 张艳虹[1] 徐凤芹(指导)[1] WENG Jiajun;HUAN Luyao;LI Dehui;ZHANG Shiyu;ZHANG Yanhong;XU Fengqin(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;The Second Department of Geriatrics,Traditional Chinese Medicine Clinical Medical School(Xiyuan),Peking University,Beijing 100091,China;Department of Integrated Traditional and Western Medicine,Peking University,Beijing 100091,China;Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China;Shanxi University of Chinese Medicine,Jinzhong 030619,China)

机构地区：[1]中国中医科学院西苑医院,北京100091 [2]北京大学中医药临床医学院(西苑)老年病二科,北京100091 [3]北京大学医学部中西医结合系,北京100191 [4]北京中医药大学研究生院,北京100029 [5]山西中医药大学,山西晋中030619

出　　处：《山东中医杂志》2024年第7期739-744,共6页Shandong Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:82204923);中医药传承与创新“百千万”人才工程(岐黄工程)项目(编号:02045006);中国中医科学院科技创新工程项目(编号:CI2021A01406);国家中医药管理局全国名老中医药专家传承工作室建设项目、第七批全国老中医药专家学术经验继承项目(批文号:国中医药人教函[2022]75号);西苑医院“提升高水平中医医院临床研究和成果转化能力十点建设”资助项目(XYZX0101-45)。

摘　　要：失眠病位主要在心,涉及肝、脾、肾。心神失养或实邪内扰、心神不宁皆可导致失眠。临证宜分清脏腑病位、标本虚实。肝郁血虚、心神失养者,常以柴胡加龙骨牡蛎汤或解郁合欢汤加减;痰热内盛,扰动心神者,常以半夏秫米汤或十味温胆汤加减;心脉瘀阻、心神不宁者,常以血府逐瘀汤加减。老年人作为特殊的群体,失眠病位多在心肾,常合并脾胃虚弱,可选用交泰丸或合用归脾汤加减,并强调对于原发病的治疗和药物因素。失眠患者也需适当使用安神药物。在安神药物配伍上,多基于辨证论治角度,结合现代药理研究精妙施用安神药物。The insomnia mainly occurs in the heart,involving the liver,spleen,and kidneys.Either malnu-trition of heart spirit,disturbance of excess evil,or disquieted heart spirit can lead to insomnia.It is advisable to distinguish disease locations in viscera,branch and root,and deficiency and excess in clinical practice.For syndrome of liver stagnation and blood deficiency,and malnutrition of heart spirit,Chaihu Jia Longgu Muli Decoction(柴胡加龙骨牡蛎汤)or Jieyu Hehuan Decoction(解郁合欢汤)should be applied with modification;for syndrome of internal exuberance of phlegm heat,and disturbance of heart spirit,Banxia Shumi Decoction(半夏秫米汤)or Shiwei Wendan Decoction(十味温胆汤)should be applied with modification;for syndrome of stasis and blockage in heart vessels,and disquieted heart spirit,Xuefu Zhuyu decoction(血府逐瘀汤)should be applied with modification.In the elderly,as a special group,insomnia is mostly located in the heart and kidneys,often accompanied by the weakness of spleen and stomach,and therefore Jiaotai Pill(交泰丸)or Guipi Decoction(归脾汤)can be applied with modification,and the treatment and medication factors for the primary disease should emphasized.In addition,patients with insomnia should be further treated with tranquilizing medicinals correspondingly.The compatibility of tranquilizing medicinals should be based on pattern differentiation and modern pharmacological research.

关 键 词：徐凤芹 失眠 心主神明 心神失养 实邪内扰 安神 

分 类 号：R249[医药卫生—中医临床基础] R256.23[医药卫生—中医学]