172例失眠症的体质辨析与调理（中英文对照）

1、 172例失眠症的 体质辨析和调理 Analyses and Treatments of 172 Cases of Insomnia 山东中医药大学Shandong University of TCM孙广仁 Sun Guangren刘瀚阳 Liu Hanyang张 喆 Zhang Zhe 摘要：收集了临床治疗的172例失眠病例，参照中华中医药学会标准“中医体质分类与判定，进行了体质类型辨析，并按其体质类型分析调体治疗用药规律，发现失眠者的体质类型以气郁质、湿热质和阴虚质为最多见，分别给予疏肝解郁方、清热利湿方和滋阴清热方调理，收到明显的治疗效果。对于兼杂体质多以调整阴阳、交通上心下肾之法治之，

2、疗效亦佳。关键词：失眠；体质分类Abstract:172 cases of insomnia were analyzed according to The Standard for Classification and Identification of Body Constitution in TCM by China Association of Chinese Medicine, to find out patients constitution types, and were treated according to constitution types. Based on this

3、therapy for 172 cases, principles for treating insomnia according to constitution type were summarized. The most common constitution types for patient with insomnia are the type of qi stagnation, damp-heat, and yin-deficiency, and are respectively treated with the formula of regulating liver and rel

4、ieving depression, clearing heat and removing dampness, nourishing yin-qi and clearing heat, usually with obvious therapeutic effect. For patients of multiple-type of body constitution, treatments of regulating yin and yang, communicating the upper (heart) and the lower (kidneys) are usually applied

5、, also with favorable outcome. Keywords: insomnia；classification of body constitution 失眠是一种常见疾病，中医称之为“不寐、“不得眠、“不得卧等。与现代医学相比，中医对失眠的治疗具有一定优势。本文试从体质的角度出发，通过对失眠证病例进行分析，探讨失眠治疗的一般规律。Insomnia is a common disease, known as “anhypnia, “loosing sleep, or “pervigilium in TCM. Compared with modern medicine, TCM

6、 shows its advantage in treating insomnia. In this thesis, from the perspective of body constitution, the insomniac cases were analyzed, so as to find out the principle of treating insomnia. 1 病例选取 Eligibility of Patients1.1入选标准 Criteria 病例的入选诊断标准参照了失眠定义、诊断及药物治疗共识专家组对于常见失眠形式的诊断共识：The criteria for el

7、igibility of patients refer to diagnostic consensus of insomnia from The Consensus of Experts on the Definition, Diagnosis and Pharmaceutical Therapy of Insomnia. 1睡眠潜伏期延长：入睡时间超过30min； Prolongation of sleep latency: Time for falling asleep is more than 30 minutes;2睡眠维持障碍：夜间觉醒次数大于2次； Disorder of slee

8、p maintenance: waking up more than 2 times during sleep; 3睡眠质量下降：睡眠浅、多梦； Poor quality of sleep: superficial sleep, dreaminess;4总睡眠时间缩短：少于6h； Decrease of total sleep time: less than 6 hours;5日间残留效应：次晨感觉头昏、精神不振、嗜睡、乏力等。 Diurnal Residual Effects: dizziness, dispiritedness, drowsiness, fatigue on next da

9、y morning. 1.2一般情况 General Information参照以上标准采集了2007年9月至2021年4月的门诊失眠病例共172例。Based on the above criteria, from September 2007 to April 2021, 172 cases of insomnia were selected. 性别：男69例，女103例。Gender: male 69 cases; female 103 cases年龄：年龄18岁77岁。其中1830岁29例，3140岁31例，4150岁59例，5160岁33例，61岁以上20例。Age: Ranging

10、 from 18 -77 years old. 29 cases (18-30), 31 cases (31-40), 59 cases (41-50), 33 cases (51-60), 20 case ( 61)疗程：病程小于4周65例，大于4周小于6个月75例，大于6个月32例。Course of Treatment: 65 cases less than 4 weeks; 75 cases ranging from 4 weeks to 6 months; 32 cases more than 6 months.2 调理效果 Outcome2.1 疗效标准 Evaluation St

11、andard for Therapeutic Effect疗效标准参照国家中医药管理局制定的?中医病症诊断疗效标准?结合临床拟定：The evaluation standard for therapeutic effect is drawn based on The Diagnostic and Therapeutic Standard for TCM Disease formulated by State Administration of TCM of Peoples Republic of China: 治愈：睡眠恢复正常。Cured: Sleeping becomes normal .

12、好转：失眠病症减轻，睡眠增加2小时以上。Improved: Symptoms were improved with 2 hours increase of sleeping.无效：失眠没有改善。Non-effect: No improvement of sleeping.2.2 体质分类标准 The Standard for Classification of Body Constitution体质分类采用中华中医药学会标准“中医体质分类与判定ZYYXH/T157-2021。The Standard for Classification and Identification of Body C

13、onstitution in TCM by China Association of Chinese Medicine. (ZYYXH/T157-2021)参照标准对病例进行分析,发现失眠者体质类型以气郁质、湿热质和阴虚质为最多见。It is found that the most common types of body constitutions are qi stagnation, damp-heat, and yin-deficiency after analyzing the cases according to the criteria.具体情况见表1。Please see tab

14、le-1 for details.表1 172例病例中体质类型分布情况 例%Table-1 Classification of Body Constitution in 172 Cases of Insomnia Cases (%) 平和质气虚质阳虚质阴虚质痰湿质湿热质瘀血质气郁质兼杂质3（1.74）17（9.88）4（2.33）42（24.42）7（4.07）31（18.02）6（3.49）41（23.84）21（12.21）2.3 疗效观察 Observation on Therapeutic Effect172例病例中治愈75例，好转86例，无效11例。疗程最短为1周，最长为7周。Of

15、172 cases, 75 cases were cured, 86 cases were improved, and 11 cases shows non-effect. The course of trearment ranges from 1 week to 7 weeks. 具体治疗效果见表2。For detailed patients outcome, please look at table-2.体质分类 治愈 好转 有效（治愈+好转） 无效平和质 1（33.33） 1（33.33） 2（66.67） 1（33.33）气虚质 6（35.29）11（64.71） 17（100.00）

16、 0阳虚质 2（50.00） 2（50.00） 4 (100.00) 0阴虚质19 (45.24)22 (52.38) 41 (97.62) 1 (2.38)痰湿质 3 (42.86) 3 (42.86) 6 (85.71) 1 (14.29)湿热质12 (38.71)18 (58.06) 30 (96.77) 1 (3.23)瘀血质 3 (50.00) 1 (16.67) 4 (66.67) 2 (33.33)气郁质16 (39.02)22 (53.66) 38 (92.68) 3 (7.32)兼杂体质13 (61.90) 6 (28.57) 19 (90.48) 2 (9.52)所有病例7

17、5 (43.60)86（50.00）161（93.60）11（6.40）表2 各体质类型调理效果 例%Table-2 Outcome of Each Body Constitution Cases (%)2.4 调理规律 Laws of Treatment172例失眠者的体质类型以气郁质、湿热质和阴虚质为多见。Of 172 cases, Qi-stagnation, damp-heat and yin-deficiency are common。.依据其体质类型的疏肝解郁方、清热利湿方和滋阴清热方具有明显的治疗效果。According to body constitution, formula

18、s of regulating liver and relieving depression, clearing heat and removing dampness, nourishing yin-qi and clearing heat usually shows obvious therapeutic effects.对于气郁质的失眠，假设是因心情不畅而致的肝气郁滞，当用四逆散或柴胡疏肝散为主组方以复肝气之升发之性。Insomnia due to qi stagnation or insomnia due to liver qi stagnation caused by emotiona

19、l depression, should be treated with formulas, such as Sini Powder or Chaihu Shugan Powder to rehabilitate liver qis dispersing and lifting. 假设是因肝气郁滞而化火，当用丹栀逍遥散并重用白芍、当归。Liver qi stagnation transforming into fire should be treated with Danzhi Xiaoyao Powder plus large dosage of Bai Shao and Dang Gui.

20、假设是因肝气虚而升发无力，当用人参、黄芪合四逆散。Liver qi deficiency leading to failing to disperse and lift should be treated with Ren Shen and Huang Qi plus Sini Powder. 对于湿热体质的失眠者，用龙胆泻肝汤为主组方调理之。Patients of insomnia with damp-heat body constitution, should be treated with Longdan Xiegan Decoction or its modification. 对于阴

21、虚体质的失眠者，用生脉散合黄连阿胶汤，或知柏地黄汤。心火旺者加淡竹叶以利尿。Insomnia due to yin deficiency body constitution, should be treated with Shengmai Powder plus Huanglian Erjiao Decoction, or Zhibai Dihuang Decoction. If with strong heart fire, Dan Zhu Ye should be added to promote urination. 并非所有处方都符合此规律。每一体质类型中均有与其不相合者，此种病例共计

22、16例。通过对这些病例处方进行分析，发现这局部病例处方用药中还有一定的规律：But not all the prescription conform to the mentioned principles. There are totally 16 cases which does not conform to the principles according to classification of body constitution. Based on the analyses of cases, some principles can be summarized. 处方多以调和阴阳、交通

23、上下立意；多以桂枝类方及柴胡类方为主，如交泰丸、桂枝汤、桂枝加龙骨牡蛎汤、小柴胡及柴桂龙牡汤等。Such formulas are prescribed aiming at harmonizing yin and yang, communicating the upper and the lower; they usually are the Gui Zhi-class decoction and Chai Hu-class decoction, such as Jiaotai Bolus, Guizhi Decoction, Guizhi Jia Longgu Muli Decoction,

24、 Xiaochaihu Decoction and Chaigui Longmu Decoction. 3 讨论 Discussion失眠属中医不寐范畴，临床治疗多以辨证论治。Insomnia usually means failing to fall asleep in TCM, and is treated based on syndrome differentiation. 失眠病因多种多样，临床病症众多且易于变化，各家辨证分型也多不一致。Causes of insomnia are various, with verified clinical symptoms, so doctors

25、 of different schools classify this disease into different types.体质的九种分类相对简单，稳定性也比证候强。The 9 types of body constitution is simple and stable compared with syndromes.依据体质的不同类型调理失眠，并探索出一定的处方用药规律，对失眠的治疗具有重要的临床意义。It is full of clinical importance to find out the principle of prescription for insomnia tre

26、atment according to the classification of body constitution. 从我的调理结果来看，依据体质类型调理失眠，确能找到一定的处方用药规律。According to patients outcome, definitely there is the principle of prescription for insomnia treatment based on body constitution. 对单一体质类型的失眠者，分别针对体质类型调理即可如前所言。As for Insomnia patient with simple body co

27、nstitution, it is approvable just to give treatment aiming at body constitution (Mentioned in the previous part). 对于兼杂体质类型的失眠者，应作整体调理。Insomnia patients of multiple-type of body constitution, should be treated based on the wholism. 下面就简要介绍我对兼杂体质的失眠者的整体调理经验。The following is the brief introduction of m

28、y experience on treating insomniac patients of multiple-type of body constitution. 局部失眠者无法判定为某一类型的体质，而是兼有2型以上体质特征，且各种体质特征之间主次关系并不明显，称为兼杂体质。如气郁质与阴虚质相兼，阴虚质与湿热质相兼等。Sometimes it is impossible to judge the type of body constitution of insomniac patients, who usually show 2 or more types of body constitut

29、ion, which cannot be distinguished to find out the primary and the secondary, so such type is known as multiple-type of body constitution, such as qi stagnation with yin deficiency, and yin deficiency with damp-heat. 还有局部失眠者，虽可判定为某一类型的体质，尚还兼有其他一种或几种体质特征的，我们称其为以某体质类型为主而具有兼杂其他体质类型的倾向。如阴虚质兼有气郁倾向等。Some

30、patients body constitution can be judged, but usually accompanied with features of 1 or more body constitutions, which is called the primary body constitution accompanied with the trend of other body constitution, for example, yin deficiency accompanied with the trend of qi stagnation. 以上两种情况，多采用整体调

31、理的思路和方法。临床上我是用“河图五行模式来组方调理的。The above two conditions usually are treated with the thought and method of wholism. Clinically, based on the The Five-Element Pattern of River Table, I prescribe formulas to treat patients. 河图与太极河图River Table and Taiji River Table 土5,10脾胃至阴中木3,8肝少阳东春火2,7心太阳南夏水1,6肾太阴北冬金4,

32、9肺少阴西秋 把上图翻译过来，配上太少阴阳、四时、方位、五脏，即是此图。阴气虚而心肝火旺不得降者，当调太阳少阴心肺二象为主，用大小阴旦汤，或用生脉散合黄连阿胶汤，配百合地黄汤、桑叶、淡竹叶。Yin qi deficiency with strong heart and liver fire failing to descend, should be treated with Da Yindan Decoction and Xiao Yindan Decoction by harmonizing Tai Yang and Shao Yin (heart and longs), or with S

33、hengmai Powder plus Huanglian Ejiao Decoction, usually accompanied with Baihe Dihuang Decoction, Sang Ye and Dan Zhu Ye. 小阴旦汤：黄芩，芍药，生姜，大枣，甘草大阴旦汤：人参，柴胡，黄芩，芍药，生姜，大枣，甘草阳气虚而不升，或不能煽动阴气上承者，调太阴少阳肾肝二象，可用大小阳旦汤。Yang qi deficiency failing to lift or failing to stimulating yin qi to ascend, should be treated wi

34、th Da Yangdan Decoction and Xiao Yangdan Decoction by harmonizing Tai Yin and Shao Yang (kidneys and liver).小阳旦汤 ：桂枝，芍药，生姜，大枣，甘草大阳旦汤：人参，黄芪，桂枝，芍药，生姜，大枣，甘草上下失于交感者，调太阳与太阴心与肾，用交泰丸黄连，肉桂。The upper and the lower failing to communicate should be treated with Jiaotai Bolous (Huang Lian, Rou Gui) to harmonize

35、 Tai Yang and Tai Yin (heart and kidneys).人体之太少阴阳四脏四象赖于脾胃的长养，所谓“中央土以灌四傍。且土为中气，为脏气升降之枢，故调理失眠也要时时顾护脾胃，务使脾胃健旺，脾气升而胃气降，升降和调。Tai Yang, Tai Yin, Shao Yang, Shao Yin of the human body (four manifestations) depend on the nourishment from the spleen and stomach, i.e., the central earth irrigates the four per

36、ipherals. Earth is the middle qi and the pivot for the ascending and descending of visceral qi. Therefore, treating insomnia should be with protecting the spleen and stomach, to invigorate the spleen and stomach, which can lead to the harmonization of spleen qis ascending and stomach qis descending. 加减用药 Formula Modif