“肝藏血,血舍魂”与睡眠障碍辨治
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摘要
睡眠障碍古籍记载为失眠(不寐、不得眠、目不瞑)、失魂(离魂)等,指非疾病引起睡眠与觉醒量与质的变化;多由家庭、社会、人际关系等压力造成。神、魂、魄与生俱来,称之先天之神。《内经》记载魂由血舍、由肝藏,肝不藏血则血不舍魂,魂魄妄行,引发睡眠障碍。肝藏血,血舍魂,肝血魂正常,睡眠才能得到保障;肝血、肝阴不足及肝胆湿热,均影响肝藏魂。神有广义、狭义之别,与睡眠关系密切的主要指五神(神、魂、魄、意、志),即狭义之神。五脏对应五神,肝与魂相配,肝不藏血,血不舍魂,魂魄妄行则睡眠障碍。魂无所居则梦魇,阿胶、枣仁、枸杞、生地、熟地等养血滋阴之品,肝血得藏则不寐得治;魂失所藏易发梦遗;肝阴血不足则无以潜阳,风邪内动,肝血亏虚,魂游于外则夜惊,治以滋阴养血加镇静安神之品使肝血得养,卧则魂归而守。多卧治疗可选《赤水玄珠》"多卧醒睡汤"。多梦属肝血虚无以安魂定志,宜滋养肝阴,方选杞菊地黄汤。
Sleep disorders are recorded in ancient books as insomnia(sleepless, Budemian, Mubuming),loss of soul(soul wandering)etc, and refers to changes in the quantity and quality of sleep and awakening caused by non-disease; most of them are caused by stress from family, society, interpersonal relations, etc.Spirit, soul and Po are born to be called the innate spirit. The soul which is closely related to the liver and is one of the manifestations of the spirit. Neijing records the soul from the blood shedding and the liver storing,the liver does not store the blood, and the blood does not shed soul so that causes the sleep disorder. "Liver storing blood, blood shed soul, liver blood soul is normal, sleep can be guaranteed; liver blood, liver Yin deficiency and liver and gallbladder damp-heat, all affect liver shed soul. Spirit closes relationship with sleep mainly refers to the five spirit(spirit, soul, Po, Yi, will), that is, the narrow sense of spirit. The five viscera correspond to the five spirit, the liver is matched with the soul, so the liver does not store the blood that the blood does not shed soul, the sleep will disorder. The soul has no place to live, and the blood-nourishing and Yin-nourishing products such as colla corii asini, fructus lycii, and radix rehmanniae Preparata can be used for nourishing blood and Yin. Sleep disorder would be cure under the liver storing blood. The loss of the soul is easy to cause nocturnal emission, Liver Yin blood deficiency does not restrict Yang, wind-evil internal movement, liver blood deficiency, soul wandering will be night terror, treatment to nourish Yin and blood plus sedative and tranquil products so that the liver blood is nourished, soul will return when we sleep. Multi-lying treatment can select "Duowo Xingshui decoction" of Chishui Xuanzhu. Multi-dreams belong to the liver blood deficiency to calm down the spirit, should nourish liver Yin, and select Qiju Dihuang decoction.
Sleep disorders are recorded in ancient books as insomnia(sleepless, Budemian, Mubuming),loss of soul(soul wandering)etc, and refers to changes in the quantity and quality of sleep and awakening caused by non-disease; most of them are caused by stress from family, society, interpersonal relations, etc.Spirit, soul and Po are born to be called the innate spirit. The soul which is closely related to the liver and is one of the manifestations of the spirit. Neijing records the soul from the blood shedding and the liver storing,the liver does not store the blood, and the blood does not shed soul so that causes the sleep disorder. "Liver storing blood, blood shed soul, liver blood soul is normal, sleep can be guaranteed; liver blood, liver Yin deficiency and liver and gallbladder damp-heat, all affect liver shed soul. Spirit closes relationship with sleep mainly refers to the five spirit(spirit, soul, Po, Yi, will), that is, the narrow sense of spirit. The five viscera correspond to the five spirit, the liver is matched with the soul, so the liver does not store the blood that the blood does not shed soul, the sleep will disorder. The soul has no place to live, and the blood-nourishing and Yin-nourishing products such as colla corii asini, fructus lycii, and radix rehmanniae Preparata can be used for nourishing blood and Yin. Sleep disorder would be cure under the liver storing blood. The loss of the soul is easy to cause nocturnal emission, Liver Yin blood deficiency does not restrict Yang, wind-evil internal movement, liver blood deficiency, soul wandering will be night terror, treatment to nourish Yin and blood plus sedative and tranquil products so that the liver blood is nourished, soul will return when we sleep. Multi-lying treatment can select "Duowo Xingshui decoction" of Chishui Xuanzhu. Multi-dreams belong to the liver blood deficiency to calm down the spirit, should nourish liver Yin, and select Qiju Dihuang decoction.
引文
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[2]灵枢经[M].张秀琴,校注.北京:中国医药科技出版社,2011.
[3]素问[M].穆俊霞,王平,校注.北京:中国医药科技出版社,2011:16.
[4]郑林.张志聪医学全书[M].北京:中国中医药出版社,2015.
[5]王琦.中医藏象学[M].北京:人民卫生出版社,2004:52.
[6]欧宇芳,周德生,胡华.浅谈中医五神之“肝藏魂”理论与不寐的相关性[J].湖南中医杂志,2015,31(4):14-17.
[7]许莎莎,董路嘎,石佳,等.从季节与人生命阶段探讨“肝藏血、主疏泄”的调控机制[J].浙江中西医结合杂志,2017,27(3):249-251.
[8]贾妮.中医“魂魄”理论与现代心理学人格特质[J].中医杂志,2013,54(15):1345-1346.
[9]左丘明.左传[M].北京:线装书局,2007:512.
[10]张介宾.类经[M].北京:中国中医药出版社,1997:24.
[11]四库全书:第八五五册[M].王太岳,纂辑.上海:上海古籍出版社,1987:158
[12]谢观.中国医学大辞典[M].北京:中国中医药出版社,1994:1435.
[13]朱钰叶,张喜德,张登本.解读《内经》之神[J].陕西中医学院学报,2007,30(6):17-18.
[14]黄元御.四圣心源[M].北京:中国中医药出版社,2009:5.
[15]滕晶.中医五神辨治学:中医五神理论体系的重构与实践[M].北京:人民军医出版社,2015:79.
[16]张帅,吴佳慧,方军艳,等.李浩运用龙骨牡蛎药对经验[J].北京中医药,2018,37(1):60-61.
[17]邓雪梅,李胜涛,郭丹丹,等.从肝郁血虚浅谈不寐论治[J].中医临床研究,2015,7(5):61.
[18]田康,齐向华.从五神之“魂”治失眠[J].山东中医杂志,2014,33(11):941.
[19]张星平,刘敬标.中医梦象病机探微[J].中华中医药杂志2011,26(4):653-656.
[20]纪征瀚,王永炎.中医神志学说的构建[J].北京中医药大学学报2013,36(1):10-13.
[21]任愉嫱.刘燕池教授对《内经》“肝藏血,血舍魂”临床应用研究[J].辽宁中医药大学学报2018,20(4):91-93.
[22]王琛琛,齐文升.不寐从肝论治案例举隅[J].光明中医,2014,29(9):1958-1959.
[23]杨敏春,黄建波,张光霁.论“肝藏魂”而“肺藏魄”[J].中华中医药杂志,2016,31(10):3908-3910.
[24]何梦瑶.医碥[M].上海:上海科学技术出版社,1982:242-243.
[25]秦越人.难经[M].北京:科学技术文献出版社,1996:7.
[26]李中梓.医宗必读[M].天津:天津科学技术出版社,1999:390-391.
[27]田颖欣,时晶.田金洲从肝论治慢性失眠临床经验[J].北京中医药,2014,33(11):826-827.
[28]赵非一,许红,燕海霞.古代四部代表性本草专著对失眠临床用药的贡献[J].长春中医药大学学报,2015,31(3):631-634.
[29]袁焯.丛桂草堂医案[M].上海:科技卫生出版社,1958:6.
[30]李梴.医学入门[M].北京:中国中医药出版社,1995:60.
[31]陈士铎.辨证玉函脉诀阐微[M].北京:中国医药科技出版社,2016:41.
[32]徐大椿.徐大椿医书全集:下[M].北京:人民卫生出版社,1988:1398.
[33]李今庸.经典理论指导下的临床治验(八)--辨治泌尿生殖系疾病验案[J].中医药通报2015,14(4):10-11.
[34]孙一奎.赤水玄珠精华本[M].余瀛鳌,编选.北京:科学出版社1998:200.
[35]罗天益.卫生宝鉴[M].北京:人民卫生出版社,1963:100.
[36]宁式颖,杨玉赫.中医药治疗多梦证[J].吉林中医药2016,36(7):664-667.