马淑然辨治肾阳虚型不寐经验  

Experience of MA Shuran in Treating Insomnia of Kidney Yang Deficiency Type

作　　者：陈伯成 邓娴 蓝毓营[1] 覃骊兰[1] 马淑然(指导) CHEN Bocheng;DENG Xian;LAN Yuying;QIN Lilan;MA Shuran(Mentor)(Guangxi University of Chinese Medicine,Nanning 530200,China;不详)

机构地区：[1]广西中医药大学,广西南宁530200 [2]不详

出　　处：《山东中医杂志》2025年第2期213-217,共5页Shandong Journal of Traditional Chinese Medicine

基　　金：科技部重大专项“民族医药发掘整理与学术传承研究”项目(编号:2017YFC1703903);国家中医药管理局“刘燕池名医工作室”项目(编号:201401);北京中医药薪火传承“3+3”工程“刘燕池名家研究室”项目(编号:202301);北京市东城中医院“马淑然教授名医工作室”项目(编号:2023JJ451632);山东省德州市中医院“马淑然教授名医工作站”项目(编号:2023C714);广西中医药大学桂派杏林拔尖人才资助项目(批文号:桂中医大党〔2022〕23号,编号:2022C006);国家重点研发计划项目(编号:2018YFC1707204)。

摘　　要：总结马淑然教授辨治肾阳虚型不寐的临证经验。马淑然教授提出嗜食生冷、不避寒湿等不良生活习惯为肾阳虚型不寐发病之因,临证基于肾阳虚型不寐肾阳虚、肾中阴阳不和、血脉经络不畅的核心病机辨治,以四逆汤为温肾散寒基础方。基于整体观念,随证加减药物:虚阳上浮者佐以潜降;夹杂实火者兼以清透;阴阳并补平调肾中阴阳;水湿内盛者合苓术汤分消水湿;巧用苦味药清降心火坚肾,顾护生命本源,温升肝木、敛降肺金以流通气血;重用安神以治标。附验案1则。Experience of MA Shuran in treating insomnia of kidney yang deficiency type was summarized.According to MA,poor living habits such as consuming cold and failing to avoid cold foods and failing to avoid exposure to cold and dampness are the causes of insomnia of kidney yang deficiency type.In clinic,syndrome differentiation should be based on the core disease mechanism of insomnia of kidney yang deficiency type,that is,kidney yang deficiency leads to disharmony of yin and yang in kidney,and obstruction of blood vessels and meridians.Sini Decoction(四逆汤)is employed as the fundamental prescription for warming kidneys and dispersing cold.Guided by the wholistic concept,the prescriptions is modified based on syndrome differentiation:for patients with floating deficiency yang,descending herbs are added;for those with mixed excessive fire,clearing and dispersing herbs are added;in case both yin and yang are deficient,supplementing,balancing and regulating yin and yang in the kidney is applied;and when internal water-dampness is excessive,Lingzhu Decoction(苓术汤)is added to eliminate water and dampness separately.In clinical practice,bitter herbs could clear and lower heart fire to consolidate kidney so as to pro-tect the source of life,and warming liver wood could consolidate and lower lung metal qi to facilitate the circulation of qi and blood,and tranquilizing herbs of large dosage is applied to treat the branch syndrome.One verified case is provided for reference.

关 键 词：肾阳虚 四逆汤 不寐 温肾散寒 马淑然 辨证加减 

分 类 号：R249[医药卫生—中医临床基础]