从《内经》相关理论探讨失眠机理

【作者】 尤海玲；

【导师】 贺娟；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2007， 硕士

【摘要】 本文从《黄帝内经》中对睡眠的记载出发,阐述了失眠的相关机理及其治疗方法。《黄帝内经》所论述的睡眠正常状态与卫气的循行有密切关系。卫气的循行历经五脏六腑,五脏六腑中任何一个脏腑系统出现不调,影响到卫气正常循行都有可能导致失眠,这从《黄帝内经》中记载的五脏六腑的病症中可以找到反证。说明了失眠跟五脏六腑都有关系。基于《黄帝内经》的卫气循行理论,睡眠日节律的形成,在于卫气能够从阴蹻脉出,注于足太阳膀胱经,日间散行于六阳经。通过一系列的理论分析,本人认为卫气从阴出阳的动力来自于心阳的推动作用,正是因为卫气循行的动力来自于心阳的推动,因此任何因素引起心阳的偏盛和偏衰,都有可能导致卫气在阳经循行时间过长,延长了睡眠的日节律,导致“寤”的时间过长,“寐”的时间缩短引起失眠。这应是后世医家从调整心阳入手来治疗失眠的原因。接下来阐述了睡眠的夜节律。通过对卫气循行规律进行分析,本人认为在卫气循行路线上肾的闭藏作用对卫气夜节律的形成有重要影响,是形成睡眠夜节律的关键。肾阴肾阳的偏衰都是影响肾的闭藏作用的因素之一,二者任何一个方面失调,便可以导致卫气不能顺利入于阴,可以破坏睡眠的夜节律导致失眠,这是诸多医家治疗失眠从肾入手的理论基础。本研究对睡眠日夜节律的交替规律进行了探讨,发现“昏”时段是卫气循行从日节律进入夜节律的过渡时段,与肺的肃降有关,但这种肃降功能是在脾胃枢纽尤其是胃主降和肾主闭藏的功能下完成的;从夜节律过渡到日节律是“晨”时段所主,脾是卫气从阴出阳的关口,主要与脾主运化,主升清的功能有关,而在卫气循行的路线上,肝与脾紧密相邻,肝主升发的功能对脾的运化和升清有重要的辅助作用,是治疗失眠中一个不可忽视的脏腑系统。最后,本研究对历代医家治疗失眠常用的方剂进行了统计,进一步验证了脾胃、心、肝和肾系统是治疗失眠常涉及到的脏腑。并对脾胃、心和肝三个脏腑系统治疗失眠的机理分别作了探讨。借助于既往学者对失眠医案的研究结果,也进一步印证了,脾胃、心、肝、肾四个脏腑系统是临床治疗失眠常涉及到的,尤其是脾胃系统在治疗失眠中最值得关注。更多还原

【Abstract】 Based on Huangdi’s Internal Classic making a descriptive record of somnus, my article explains the mecharism and treatment method of insomnia. Huangdi’s Internal Classic thinks that wei-energy plays a very important role in the normal condition of somnus. And Huangdi’s Internal Classic thinks that the relationship between wei-energy and five viscera and six hollow organs is very close. As a result, it will result in insomnia if any entrails is in disorder.Huangdi’s Internal Classic thinks that hypnic day rhythmic can be shaped because of wei-energy which can pour to the urinary bladder channel of foot-taiyang from yang heel vessel and row the six kinds of yang meridians in daytime. My article thinks that wei-energy can go out to yang from yin because of the impuls affect of heart-yang. As a result, the flourishing or downward of heart-yang can lead to insomnia. It may be the reason that many doctors regulate the heart-yang to treat insomnia.When it explains the night rhythm of somnus, my article thinks that kidney plays a very important role in the forming the night rhythm of wei-energy. The downward of the kidney-YIN and kidney-YANG will hind wei-energy to put in Yin, which destroys hypnic night rhythm and result in insomnia. It may be the reason that many doctors regulate the kidney-Yin and kidney-Yang to treat insomnia.This article probes the alternation of the hypno-day rhythm and hypno-night rhythm. Dsk stage is the transition stage when wei-energy gets in night rhythm from day rhythm. During this stage, the function of the lung, the kidney and the spleen and stomach plays a very important role. Daynight stage is the transition stage when wei-energy gets in day rhythm from night rhythm. During this stage, the function of liver and spleen plays an very important role. As a result, when we treat insomnis, we can not ignore these entrails.In the last place,my article has added up the commonly used prescription about successive dynasties doctors. It thinks that when they treat insomnia, they usually in the spleen and stomach, heart, liver and kidney system, especially the spleen and stomach system. So, when we treat insomnia, we can mirror this.更多还原