中医不寐五神分型病机与辨治  

Pathogenesis and treatments of traditional Chinese medicine five spirits classificationofinsomnia

作　　者：王冠英 袁香梅 刘涛[3] 梁政亭[3] 任小娟 曲婉莹 马帅 张星平[3] 唐东昕 WANG Guanying;YUAN Xiangmei;LIU Tao;LIANG Zhengting;REN Xiaojuan;QU Wanying;MA Shuai;ZHANG Xingping;TANG Dongxin(First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550000,China;Guizhou University of Traditional Chinese Medicine,Guiyang 550000,China;Xinjiang Medical University,Urumqi 830000,China;Zhuhai Hospital of Guangdong Provincial Traditional Chinese Medicine Hospital,Zhuhai 519000,China)

机构地区：[1]贵州中医药大学第一附属医院,贵阳550000 [2]贵州中医药大学,贵阳550000 [3]新疆医科大学,乌鲁木齐830000 [4]广东省中医院珠海医院,珠海519000

出　　处：《中华中医药杂志》2025年第2期590-594,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：贵州省教育厅人文社会科学重点研究基地基金(No.23GZGXRWJD2024);贵州省中医药管理局中医药;民族医药科学技术课题(No.QZYY-2024-024);贵州省科技计划项目(No.黔科合基础-ZK[2024]一般363);贵州省卫生健康委科学技术基金项目(No.2024GZWJKJXM0507);贵州省科技厅-贵州中医药大学学术新苗项目(No.贵科合学术新苗[2023]-52);贵州中医药大学博士启动基金(No.3043-043220014);贵州省大学生创新创业训练计划项目(No.S202210662004,No.S202210662048);国家自然科学基金项目(No.82160873);国家重点研发计划“中医药现代化研究”重点专项(No.2019YFC1712500,No.2019YFC1712504)。

摘　　要：不寐与五脏藏神功能失司密切相关,其本质为五神不安于其所舍之脏。本研究结合临床发现,考校历代典籍文献,对中医不寐五神分型病因病机中蕴含的主症、主脏、主神关系及其“据主症-定主脏-分主型-安主神”辨治路径作了深入的论证阐发。迟寐早寤类不寐(肾不藏志型不寐)宜从肾分6个亚型辨治;寐中多梦类不寐(肝不藏魂型不寐)宜从肝分7个亚型辨治;寐中易寤类不寐(肺不藏魄型不寐)宜从肺分6个亚型辨治;入寐维艰类不寐(心不藏神型不寐)和思虑纷纭类不寐(脾不藏意型不寐)宜分别从心分9个亚型、从脾分7个亚型辨治,且因其定位主脏生理、病理的特殊性,而尤需重视主脏与他脏的并调。The disharmony between the organs and the spirits was closely related to insomnia whose mechanism in traditional Chinese medicine was that the five spirits can't enter and exit the five internal organs normally day and night.Based on clinical discoveries and the examinations of historical literature,this paper aimed to provide an in-depth demonstrations and explanations of the relationships between the main symptoms,main organs,and main spirits contained in the etiologies and pathogenesis of traditional Chinese medicine five spirits classifcation of insomnia,as well as the treatment paths of'determining the main organ,distinguishing the main type,and stabilizing the main spirit through the main symptom'.The typing therapies were as follows:the type of kidneys being not able to store the spirit of zhi whose typical clinical manifestations were frequently falling asleep late and waking up early should be diagnosed and treated from the kidneys based on 6 sub-types;the type of liver being not able to store the spirit of hun whose typical clinical manifestations was frequently dreaming during sleep should be diagnosed and treated from the liver based on 7 sub-types;the type of lungs being not able to store the spirit of po whose typical clinical manifestations was frequently waking up during sleep should be diagnosed and treated from the lungs based on 6 sub-types;the type of heart being not able to store the spirit of shen whose typical clinical manifestations was frequently falling asleep with difficulty should be diagnosed and treated from the heart based on 9 sub-types;and the type of spleen being not able to store the spirit of yi whose typical clinical manifestations were frequently falling asleep late or sleeplessness caused by much thoughts should be diagnosed and treated from the spleen based on 7 sub-types.Of course,it should be pointed out that the special attentions should be paid to the joint treatments of the main organ and the other four organs for the latter two types,as their physiological and patholo

关 键 词：中医不寐五神分型法 失眠症 病机 辨治 

分 类 号：R25[医药卫生—中医内科学]