运用调周法结合应时方组治疗心肾不交型失眠  

Applying Circadian Rhythm Adjustment with Timely Herbal Formula to Ttreat Heart-Kidney Disharmony Insomnia

作　　者：胡梦云 徐厚平 张林 高立 杨静 戴文斌 冯文战 Hu Mengyun;Xu Houping;Zhang Lin;Gao Li;Yang Jing;Dai Wenbin;Feng Wenzhan(College of Integrated Traditional and Western Medicine,Southwest Medical University,Luzhou,646000,China;General Medicine of the Affiliated Traditional Chinese Medicine Hospital,Southwest Medical University,Luzhou,646000,China;Preventive Treatment Center,Affiliated Hospital of Traditional Chinese Medicine,Southwest Medical University,Luzhou,646000,China)

机构地区：[1]西南医科大学中西医结合学院,四川泸州646000 [2]西南医科大学附属中医医院全科医学科,四川泸州646000 [3]西南医科大学附属中医医院治未病中心,四川泸州646000

出　　处：《成都中医药大学学报》2024年第4期31-36,共6页Journal of Chengdu University of Traditional Chinese Medicine

基　　金：四川省中医药管理局项目(2021MS546)。

摘　　要：目的:观察使用应时方组调节机体阴阳周期对于心肾不交型失眠的疗效。方法:将60例患者随机分为试验组和对照组,各30例。试验组辰时(早8点)服用补中益气汤加减,酉时(晚6点)和亥时(晚10时)服用天王补心丹加减治疗;对照组每日服用天王补心丹加减,早、中、晚分3次服。比较两组治疗前后以及随访2周的匹兹堡睡眠质量指数(PSQI)、疲劳量表(FS-14)、中医证候积分和血清皮质醇(cortisol,CORT)水平。结果:治疗后,试验组有效率为90.00%,对照组为72.41%(P<0.05)。治疗后,试验组在入睡时间、睡眠时间、睡眠效率、日间功能方面的改善情况优于于对照组(P<0.05);随访时,试验组在睡眠时间、日间功能方面改善优于对照组(P<0.05)。治疗后及随访时试验组FS-14评分、中医证候积分评分均优于对照组(P<0.05)。治疗后,两组血清CORT水平均明显下降,且试验组在治疗后血清CORT水平更低。结论:从调节机体阴阳角度,结合方组天王补心丹加补中益气汤的形式用药对心肾不交型失眠患者的临床疗效优于单纯使用天王补心丹治疗,其机制可能与调节下丘脑-垂体-肾上腺轴的负反馈机制,降低血清CORT水平,从而抑制下丘脑-垂体-肾上腺轴过度活化有关。Objective:To observe the efficacy of using timely herbal formula to regulate the Yin-Yang cycle of the body in the treatment of Heart-Kidney disharmony type insomnia.Methods:Sixty patients were randomly divided into an experimental group and a control group,with 30 patients in each group.The experimental group took Buzhong YiQi Decoction in the Chenshi(8 am),and Tianwang Buxin Dan in the Youshi(6 pm)and Haishi(10 pm)for treatment.The control group took Tianwang Buxin Dan three times a day(morning,noon,and evening).Pittsburgh Sleep Quality Index(PSQI),Fatigue Scale(FS-14),The traditional Chinese medicine syndrome scores,and serum cortisol levels were compared before and after treatment,as well as during a 2-week follow-up.Results:After treatment,the effective rate was 90.00%in the experimental group and 72.41%in the control group,with a statistically significant difference(P<0.05).After treatment,the improvement of time to fall asleep,sleep time,sleep efficiency,and daytime function in the experimental group were better than those in the control group(P<0.05);at follow-up,the improvement of sleep time and daytime function in the experimental group were better than those in the control group(P<0.05).After treatment and at follow-up,the scores of FS-14 score and TCM syndrome score to the experimental group were better than those of the control group(P<0.05).Aafter treatment,the serum cortisol levels of the two groups were significantly lower,and the serum cortisol level of the experimental group was lower after treatment.Conclusion:From the perspective of regulating Yin and Yang,the clinical efficacy of combined treatment with Tianwang Buxin Dan and Buzhong YiQi Decoction for insomnia patients with Heart-Kidney non-junction is better than that of Tianwang Buxin Dan alone.The mechanism may be related to regulating the negative feedback mechanism of hypothalamic-pituitary-adrenal axis,reducing serum cortisol level,and inhibiting the excessive activation of hypothalamic-pituitary-adrenal axis.

关 键 词：失眠 调周法 方组 心肾不交 择时服药 皮质醇 

分 类 号：R256.23[医药卫生—中医内科学] R741[医药卫生—中医学]