吕玉娥从肝脾论治失眠经验  

Lyu Yu′e′s Experience of Treating Insomnia from the Perspective of Liver and Spleen

作　　者：贺美洁 吕玉娥 张斌 李蕾 武春慧 李圣云 HE Meijie;LYU Yu′e;ZHANG Bin;LI Lei;WU Chunhui;LI Shengyun(Shanxi University of Chinese Medicine,Jinzhong,Shanxi,China,030600;Shanxi Acupuncture Hospital,Taiyuan,Shanxi,China,030006)

机构地区：[1]山西中医药大学,山西晋中030600 [2]山西省针灸医院,山西太原030006

出　　处：《河南中医》2024年第12期1866-1870,共5页Henan Traditional Chinese Medicine

基　　金：中国中医科学院科技创新工程项目(CI2022E010XB);山西省科技人才创新团队建设项目(202204051002011);山西省中医药管理局中医药创新团队建设计划项目(zyytd2024013);山西省中医药管理局科研课题项目(2020ZYYC040,2022ZYYZ063);山西中医药大学创新团队项目(2022TD1006,2019TD-003)。

摘　　要：吕玉娥主任医师认为情志因素、肝脾不调、气血阴阳失衡为失眠的主要原因,治疗应肝脾同治、气血阴阳并调,提出疏肝健脾、安神助眠的治疗原则。吕主任从肝脾论治失眠,用药以疏肝行气、解郁安神,疏肝泻火、化痰安神,疏肝健脾、养心安神为主,通过调和肝脾,平衡气血阴阳以安心神、助睡眠,常用方剂为柴胡疏肝散加减、丹栀逍遥散合温胆汤加减、归脾汤加减等。胁痛乳胀甚者,可加用郁金、延胡索增加其行气活血之效;顽固性失眠者,加活血化瘀药如赤芍、川芎、丹参等。失眠日久的患者,可加酸枣仁以加强宁心安神之功。心慌心悸者,加煅龙骨、煅牡蛎;心神不宁、多梦者,加紫石英、紫贝齿;肝肾阴虚者,症见口苦咽干、头晕目眩、失眠多梦者,与女贞子、墨旱莲合用;记忆力减退者,与甘松、鹿角霜配伍服用。Chief Physician Lyu Yu′e believes that emotional factors,disharmony between the liver and spleen,and imbalances in qi,blood,yin,and yang are the main causes of insomnia.Treatment should aim to harmonize the liver and spleen,regulate qi,blood,yin,and yang.The principle of treatment is to soothe the liver and invigorate the spleen,calm the mind,and assist sleep.Lv′s treatment for insomnia from the liver-spleen perspective involves soothing the liver to move qi,resolving stagnation,calming the mind,soothing liver fire,resolving phlegm,and nourishing the heart to calm the mind.This is achieved through balancing the liver and spleen,regulating qi,blood,yin,and yang to calm the mind and promote sleep.Common formulas include Modified Bupleurum Liver-Soothing Powder,Modified Cortex Moutan and Fructus Gardeniae Free Wanderer Powder combined with Gallbladder-Warming Decoction,Modified Spleen-Restoring Decoction,etc.For patients with severe rib-side pain and breast distention,Yujin(Radix Curcumae)and Yanhusuo(Rhizoma Corydalis)can be added to enhance qi-moving and blood-activating effects.For persistent insomnia,blood-activating herbs such as Chishao(Radix Paeoniae Rubra),Chuanxiong(Rhizoma Chuanxiong),and Danshen(Radix Salviae Miltiorrhizae),etc.are added.In cases of long-term insomnia,Suanzaoren(Semen Ziziphi Spinosae)is used to strengthen the calming and mind-soothing effect.For patients with palpitations and anxiety,Duanlonggu(Calcined Os Draconis)and Duanmuli(Calcined Concha Ostreae)are added.If the patient is restless with vivid dreams,Zishiying(Fluoritum)and Zibeichi(Concha Mauritiae)are added.For liver and kidney yin deficiency,with symptoms of bitter taste in the mouth,dry throat,dizziness,and excessive dreaming,Nvzhenzi(Fructus Ligustri Lucidi)and Mohanlian(Herba Ecliptae)are used.For those with memory loss,Gansong(Radix et Rhizoma Nardostachyos)and Lujiaoshuang(Cornu Cervi Degelatinatum)can be combined.

关 键 词：失眠 从肝脾论治 柴胡疏肝散 丹栀逍遥散 温胆汤 归脾汤 吕玉娥 

分 类 号：R256.23[医药卫生—中医内科学]