基于“君火以明,相火以位”理论探析不寐的辨治思路  

The differentiation and treatment thoughts of insomnia based on the theory of “Junhuo Yi Ming, Xianghuo Yi Wei”

作　　者：李嘉茜 许多 LI Jiaqian

机构地区：[1]山西中医药大学,山西晋中030619

出　　处：《中医临床研究》2024年第23期96-100,共5页Clinical Journal Of Chinese Medicine

基　　金：2023年山西省研究生实践创新项目(2023SJ268)。

摘　　要：不寐是临床常见病,现代医学称之为失眠症,主要表现为入睡困难、时寐时醒、醒后睡不着甚则彻夜难眠等症状。本病可引发日间功能障碍,是多种慢性疾病发生发展的重要危险因素之一。随着社会竞争压力增大,失眠发病率呈现不断上升趋势,严重影响患者身心健康。目前,西医治疗失眠以服用镇静、安眠类药物为主,但存在一定的药物依赖及不良反应。与西医相比,中医治疗不寐具有疗效佳、个体化、安全性高、无明显不良反应、价格低廉等优势。中医认为,不寐的关键病机在于阳不入阴,阴阳失交,神明受扰。心为君主之官,主神明,内寄君火;相火禀命于君,寄于肝肾。君相安位,则阴阳和调,寤寐有常;若君火亢盛,相火失位,君相不交,可致君相不守其职,神明受扰而发为不寐。治疗当据病机辨证选用“清心降火,宁心安眠”“滋补肝肾,养心安神”“交通心肾,和调阴阳”之法,以恢复“君火以明,相火以位”的状态。文章从“君火以明,相火以位”探索不寐,以期拓宽临床诊疗思路。Insomnia is a common clinical disease in modern medicine. It is mainly characterized by difficulties in falling asleep, waking up from time to time, being unable to sleep after waking up, and even having trouble falling asleep all night. Insomnia can cause daytime dysfunction, and is also one of the important risk factors for the occurrence and development of a variety of chronic diseases. With the increasing pressure of social competition, the incidence rate of insomnia is on the rise, seriously affecting the physical and mental health of patients. At present, Western medicine mainly treats insomnia with sedatives and sleepers, but their long-term use carries a certain risk of drug dependence and adverse reactions. Compared with Western medicine, traditional Chinese medicine has the advantages of better curative effects, individualization, high safety, no obvious adverse reactions, and low price. Traditional Chinese medicine believes that the key pathogenesis of insomnia lies in the inability of Yang(阳) to enter Yin(阴), the lack of coordination between Yin and Yang, and disturbance of the mental activity. The heart has the responsibility of a sovereign and is responsible for managing the mental activity, which is where the Junhuo(君火) is. The liver and kidney are responsible for assisting the sovereign, which is where the Xianghuo(相火) is. When the sovereign and the minister are in their own positions, Yin and Yang will be harmonious, and sleep will be normal. When the Junhuo is hyperactive and the Xianghuo is out of position, it can cause the mental activity to be disturbed and then cause insomnia. In terms of treatment, the methods of clearing the heart and reducing fire to calm the heart, nourishing the liver and kidney to nourish the heart and calm the mind, and communicating the heart and kidney to regulate Yin and Yang should be selected according to the pathogenesis, so as to restore the state of “Junhuo Yi Ming, Xianghuo Yi Wei”(君火以明, 相火以位). This article introduces and explo

关 键 词：君火 相火 不寐 六气 《黄帝内经》 

分 类 号：R256.23[医药卫生—中医内科学]