【作者】 齐向华；

【导师】 张洪斌；

【作者基本信息】 山东中医药大学 ， 中医内科学， 2004， 博士

【摘要】 失眠是指入睡困难、睡眠维持困难和早醒，是睡眠量的不足或质的欠佳。失眠症以其发病率之高和严重的白天功能下降，已成为许多国家广泛关注的社会公共卫生问题。目前中医对失眠的研究，存在着睡眠理论研究的停滞；临床只追求患者的“安神”疗效，忽视整体紊乱的调整；对失眠症产生的机制缺乏深入研究等不足，造成了失眠症的治疗没有突破性进展。在导师张洪斌教授指导下，本研究系统复习了古代失眠理论，统计其中与失眠相关联的中医证候，形成对失眠的整体认识。结合现代睡眠研究成果对这些证候分析，发现内在的联系：用中医病因理论分析“昼不精，夜不瞑”的原因。临床研究用Epworth困倦量表、焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹茨堡睡眠指数量表(PSQI)、中医证候量表和体质量表，对失眠组和对照组进行调查对比；并用统计学方法综合分析失眠组“昼不精，夜不瞑”相关因素的关系。通过本次研究，取得了睡眠是人体“广义之神节律性的自然体现”：失眠患者是“昼不精，夜不瞑”紊乱状态的理论认识。“昼不精”表现为白天精神萎靡、烦躁焦虑、惊悸不安、郁闷不舒和思虑过度五类证候；“夜不瞑”表现为夜晚“终夜不寐”、“忽寐忽醒”、“神魂不安”三种形式。用中医基础的五神、情志失调和体质理论，对失眠症的特定易感因素、促成因素和维持因素进行分析，奠定了失眠机制认识的新的理论基础。临床研究显示与正常的“昼精而夜瞑”相对，失眠患者处于的是“昼不精，夜不瞑”的状态；“昼不精”表现为多种中医证候的重叠，中医证候与失眠的形式相关；体质之间的失眠发病和中医证候存在差异。从而形成了中医对失眠病因病机认识的新的基本理论框架和研究方法，为今后的进一步研究和治疗打下了基础。更多还原

【Abstract】 Insomnia refers to an insufficient or low-quality sleep, which is characterized by the patients being difficult to fall asleep, difficult to maintain the sleep and easy to wake up early. It has become a public health issue, concerned in many countries extensively for high incidence and severe damage to the diurnal function. The study of the theory to direct the treatment of insomnia in TCM makes no progress these days. There are many shortcomings in the treatment of insomnia, for example, the clinicians only go after the effect of tranquilizing the mind on the patients while neglecting adjustment of the disorder in an organic whole and the researchers do less thorough investigation into insomnia, which result in no breakthrough in treating.Under the instruction of our tutor, professor Zhang Hongbin, we studied the traditional theory of insomnia, list the syndromes of TCM related to it and form a whole view about it. We tried to discover the intrinsic link among these syndromes of TCM through analyzing them combined with the results of modern research on insomnia, and to find out the cause of Zhou Bu Jing & Ye Bu Ming according to the basic pathogenesis theory of TCM. We carried out an investigating experiment in insomnia group and control group using Epworth Sleeping Scale, Self-Rating Anxiety Scale (SAS) , Self-rating Depression Scale (SDS) , Pittsburgh Sleep Quality Index (PSQI) , Scale of syndromes of TCM, Scale of constitution of TCM, and analyzed the relationship of related factors influencing Zhou Bu Jing & Ye Bu Ming using statistic method.From the study, we form a theory that sleep is the naturally rhythmical reflection of the Mind in the broad sense, and that patients with insomnia are in a disorderly condition, named Zhou Bu Jing & Ye Bu Ming. Zhou Bu Jing shows five kinds of syndromes, i.e. depression, fidgetiness, palpitation, emotional stress and anxiety. On the other hand, Ye BuMing shows restlessness all night, disturbing mind, and being asleep and awake alternately, etc. A new theoretical foundation is built by analyzing particular and susceptible factors, promoting and maintaining factors under the guidance of TCM basic theories, i.e. Five Mental Activities, imbalance between Emotions, Constitutions. The clinic study suggests patients are in a condition of Zhou Bu Jing & Ye Bu Ming in opposition to Zhou Jing & Ye Ming. Zhou Bu Jing manifests overlaps among several syndromes. Different syndromes are related to different signs of insomnia. There is a difference between constitutions and TCM symptoms, which related to insomnia. Therefore we worked out a basic theoretical framework and method in studying etiology and pathological mechanism of insomnia, which is the basement for the further theoretical and clinical research on it.更多还原