马云枝基于气机升降理论运用柴胡加龙骨牡蛎汤治疗不寐经验  

Professor Ma Yunzhi′s Experience in Treating Insomnia with Bupleurum Decoction plus Dragon Bones and Oyster Shell Based on the Theory of Qi Ascending and Descending

作　　者：付菊花 康超茹 马云枝[2] FU Juhua;KANG Chaoru;MA Yunzhi(Luohe Hospital of Traditional Chinese Medicine,Luohe,Henan,China,462000;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou,Henan,China,450001)

机构地区：[1]漯河市中医院,河南漯河462000 [2]河南中医药大学第一附属医院,河南郑州450001

出　　处：《河南中医》2025年第5期706-711,共6页Henan Traditional Chinese Medicine

基　　金：国家中医药管理局全国名老中医药专家传承工作室建设项目{豫中医业函〔2014〕86号};河南医学科技攻关联合共建项目(LHGJ20240766);漯河市青年拔尖人才科研课题项目(LBJZ201604)。

摘　　要：马云枝教授认为,不寐的病机较为复杂,肝胆气机升降异常是核心病机之一,肝胆枢机不利,导致阴阳失调,阳不入阴,从而引发不寐,调畅肝胆气机升降出入平衡则是不寐的主要治疗原则。柴胡加龙骨牡蛎汤具有和解少阳,疏肝和胃的功效,能够调畅肝胆气机升降平衡,透达三焦,清热安神,是治疗不寐的有效方剂。马教授临证时善用柴胡加龙骨牡蛎汤治疗不寐,并随症加减:邪热郁久伤阴而失眠心烦、目涩、视物昏花者加谷精草、青葙子、合欢花等;胆郁痰扰,见失眠、口苦口干、惊悸急躁、舌暗苔黄腻脉滑数者加黄连温胆汤;瘀血明显者加丹参、赤芍、当归等;夜梦繁多者加珍珠母、桂圆肉、何首乌藤等;口干舌燥、晨起口苦者加栀子豉汤;汗多体弱乏力者加炙黄芪、浮小麦、麻黄根;体困、不思饮食者加茯苓、白术、广藿香、木香、砂仁、神曲、麦芽;大便燥结者则加麸炒枳实、厚朴、火麻仁。诸药合用,使肝胆气机升降平衡,气血阴阳各归其位、各司其能,人体五脏平和,不寐可愈。Professor Ma Yunzhi thinks,based on the theory of qi ascending and descending,that the pathogeneses of insomnia are complex.Abnormal qi movement in the liver and gallbladder serve as one of core mechanisms.Dysregulation of the liver-gallbladder pivot disrupts the balance of yin and yang,preventing yang from entering yin,thereby leading to insomnia.The primary treatment principle lies in restoring the balance of qi movement in the liver and gallbladder.Bupleurum Decoction plus Dragon Bones and Oyster Shell,which can regulate liver-gallbladder qi movement balance,unblock the triple energizer,clear heat,and calm the mind,is an effective formula for insomnia.In clinical practice,Professor Ma skillfully applies this formula with modifications tailored to symptoms:For persistent heat damaging yin manifesting as insomnia,restlessness,dry eyes,and blurred vision,Gujingcao(Flos Eriocauli),Qingxiangzi(Semen Celosiae),and Hehuanhua(Flos Albiziae),etc.are often added.For phlegm harassing the gallbladder leading to insomnia,bitter mouth,palpitations,irritability,yellow-greasy tongue coating,and rapid-slippery pulse,Coptis Gallbladder-Warming Decoction can be combined.For excessive blood stasis,Danshen(Radix Salviae Miltiorrhizae),Chishao(Radix Paeoniae Rubra),and Danggui(Radix Angelicae Sinensis)can be added.For excessive dreaming,doses of Zhenzhumu(Concha Margaritiferae Usta),Longyanrou(Arillus Longan),and Shouwuteng(Caulis Polygoni Multiflori)can be increased.For dry mouth and morning bitterness,Gardenia and Fermented Soybean Decoction can be added.For sweating,fatigue,and weakness,Zhihuangqi(Radix Astragali Praeparata cum Melle),Fuxiaomai(Fructus Tritici Levis),and Mahuanggen(Radix et Rhizoma Ephedrae)can be added.For fatigue and poor appetite,Fuling(Poria),Baizhu(Rhizoma Atractylodis Macrocephalae),Guanghuoxiang(Herba Pogostemonis),Muxiang(Radix Aucklandiae),Sharen(Fructus Amomi),Shenqu(Massa Fermentata Medicinalis),and Maiya(Fructus Hordei Germinatus)can be added.For constipation,Zhishi(Fructus Aurantii Immaturus)fried w

关 键 词：不寐 气机升降理论 柴胡加龙骨牡蛎汤 《伤寒论》 张仲景 马云枝 

分 类 号：R256.23[医药卫生—中医内科学]