郁证发微(十二)——郁证不寐论
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摘要
不寐有多种病因病机,但最为多见的是受思虑、悒郁、忧愁、恼怒、惊恐等情志因素影响而发生,其病机主要与心、脾、肝、胆等脏腑有关。郁证不寐的情志病因分为"外感性情志病因"与"内生性情志病因",前者是指受生活负性事件影响而发生的应激性情志变化,当内心恢复平静后,其不寐多可告愈;后者是指宿主的郁证性心理和人格特质及气郁质体质禀赋,对"外感性情志病因"的应激性更大,甚至即便无明显"外感性情志病因"刺激,亦可内生忧思悲恐惊,其不寐积年难愈。在多数情况下,寐佳则无郁,郁去则寐安。郁证不寐的治疗,可通过解郁疏泄以安神促寐,亦可通过安神促寐以舒肝怡心;解郁与促寐类药物,其药性相通。
There are various items of the etiology and pathogenesis of insomnia in TCM theory,in which over-thinking,depression,sadness,anger,panic and so on are considered as the key emotional factors to the occurrence of insomnia. As a main and common symptom of depression syndrome,dysfunctions of heart,spleen,liver and gallbladder play important role in the pathogenesis of insomnia. This paper divided the classifications of emotions into"the external emotional factors"and"the internal emotional factors". The former refers to irritable emotional changes caused by negative events. When inner peace is retrieved,insomnia is almost cured. The latter refers to psychological characteristics of depression syndrome,personality traits and Qi-stagnation constitution of the individual. The one who has"the internal emotional factors"always shows susceptibility and irritability to those external emotional stimulations,and can behaves depression,sadness,anger,panic and refractory insomnia. In most cases,good night sleep relieves depression,while the disappearance of depression syndrome promotes better sleep. So in the treatment of insomnia due to depression syndrome,soothing the liver and relieving depression could tranquilize mind and promot sleep,and vice versa. Relieving depression and promoting sleep interact on each other.
There are various items of the etiology and pathogenesis of insomnia in TCM theory,in which over-thinking,depression,sadness,anger,panic and so on are considered as the key emotional factors to the occurrence of insomnia. As a main and common symptom of depression syndrome,dysfunctions of heart,spleen,liver and gallbladder play important role in the pathogenesis of insomnia. This paper divided the classifications of emotions into"the external emotional factors"and"the internal emotional factors". The former refers to irritable emotional changes caused by negative events. When inner peace is retrieved,insomnia is almost cured. The latter refers to psychological characteristics of depression syndrome,personality traits and Qi-stagnation constitution of the individual. The one who has"the internal emotional factors"always shows susceptibility and irritability to those external emotional stimulations,and can behaves depression,sadness,anger,panic and refractory insomnia. In most cases,good night sleep relieves depression,while the disappearance of depression syndrome promotes better sleep. So in the treatment of insomnia due to depression syndrome,soothing the liver and relieving depression could tranquilize mind and promot sleep,and vice versa. Relieving depression and promoting sleep interact on each other.
引文
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[25]王俊平,许晶,胡志云,等.帕罗西汀治疗慢性失眠症的临床对照研究[J].中国心理卫生杂志,2005,19(4):291-293.
[26]潘集阳.抗抑郁药物与抗精神病药物治疗失眠临床应用[C]//中国睡眠研究会睡眠障碍专业委员会:3.21世界睡眠日暨京津冀睡眠疾病诊断及规范化治疗学术研讨会论文集,2015:68-70.
[27]蒋健.郁证发微(一)——郁证形态论[J].上海中医药杂志,2015,49(8):4-7.
[28]蒋健.郁证发微(四)——隐性郁证论[J].上海中医药杂志,2015,49(11):4-7.
[29]阿衣努尔·木合买提巴克,刘涛,胡晓灵.柴胡疏肝散化裁治疗亚健康失眠临床观察[J].湖南中医药大学学报,2012,32(9):57-59.
[30]钱超,姜亚军.逍遥散加味治疗肝郁血虚型失眠疗效观察[J].吉林中医药,2012,32(6):588-589.
[31]张勇.柴胡加龙骨牡蛎汤加减治疗不寐肝郁化火证临床观察[J].北京中医药,2010,29(7):527-528
[32]丁书申,张彦华,贺国丽,等.疏肝解郁胶囊联合小剂量氟伏沙明治疗失眠的临床体会[J].中国现代药物应用,2013,7(24):156-157.
[33]汪瑜菡,颜红,陈立伟.自拟安神解郁汤治疗亚健康人群失眠临床观察[J].中医药临床杂志,2007,19(4):367-368.
[34]王琼.酸栆仁汤治疗广泛性焦虑症[D].广州:广州中医药大学,2012.
[35]郑锦英.甘麦大枣汤合酸枣仁汤加减治疗脑卒中后抑郁疗效观察[J].北京中医药,2009,28(4):291-292.
[36]展文国.裴正学教授运用天王补心丹和生铁落饮化裁治疗抑郁症的经验[J].内蒙古中医药,2013(7):55-56.
[37]徐碧云,李艳,肖芳,等.加味逍遥散对心理应激性失眠患者单胺类神经递质的影响[J].中华中医药杂志,2009,24(6):720-723.
[38]欧碧阳,李艳,杨志敏,等.柴胡加龙骨牡蛎汤治疗失眠的机理[J].时珍国医国药,2010,21(8):1887-1888.
[39]严灿,邓中炎,王剑,等.调肝方药对束缚应激大鼠神经内分泌免疫功能的调节作用[J].中国病理生理杂志,2000,16(6):560-562.
[40]王泽剑,梁翠玲,王志铭.圣约翰草提取物的临床研究进展[J].国外医学:脑血管疾病分册,2003,11(3):212-214.
[41]尹兴斌,翟玉静,曹飒丽,等.贯叶金丝桃药理作用研究进展[J].中华中医药学刊,2013,31(8):1634-1637.
[42]朱晓旭.酸枣仁汤抗焦虑作用的实验研究[D].北京:北京中医药大学,2002.
[43]毕秀华.甘麦大枣汤对抑郁大鼠行为学及脑内单胺神经递质影响的实验研究[D].昆明:云南中医学院,2012.
[44]张家骏,陈文为.中药酸枣仁、龙齿、石菖蒲对小鼠脑组织单胺类神经递质及其代谢物的影响[J].北京中医药大学学报,1995,18(6):64-66.
[45]张峰,李发曾.合欢花对慢性应激大鼠生长和脑单胺类神经递质含量的影响[J].动物学研究,2006,27(6):621-625.
[2]Chan-Chee C,Bayon V,Bloch J,et al.Epidemiology of insomnia in France[J].Rev Epidemiol Sante Publique,2011,59(6):409-422.
[3]Soldatos CR,Allaert FA,Ohta T,et al.How do individuals sleep around the world?Results from a single-day survey in ten countries[J].Sleep Medicine,2005,6(1):5-13.
[4]徐志鹏,陈文军,黎红华,等.失眠症的研究与治疗[J].中国临床康复,2006,10(22):151-153.
[5]American Academy of Sleep Medicine.International Classification of Sleep Disorders:Diagnostic and Coding Manual[R].Westchester:AASM,2005.
[6]American Academy of Sleep Medicine.International Classification of Sleep Disorders[R].Darien:AASM,2014.
[7]American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorder[M].Arlington:American Psychiatric Association Publishing,2013.
[8]World Health Organization.The ICD-10 Classification of Mental and Behavioral Disorders:Clinical Descriptions and Diagnostic Guidelines[R].Geneva:WHO,1992.
[9]中华医学会精神科分会.CCMD-3:中国精神障碍分类与诊断标准[M].济南:山东科学技术出版社,2001.
[10]Kroese FM,Evers C,Adriaanse MA,et al.Bedtime procrastination:A self-regulation perspective on sleep insufficiency in the general population[J].J Health Psychol,2014.pii:1359105314540014.
[11]李娟,江文.睡眠分子机制研究进展[J].国际神经病学神经外科学杂志,2012,39(3):295-297.
[12]范利锋,王平仁,兰培敏.睡眠机制的研究概况[J].临床内科杂志,2005,22(10):662-664.
[13]李绍旦,杨明会,王振福,等.亚健康失眠人群脑内神经递质水平分析[J].中国全科医学,2008,11(1A):24-26.
[14]王翘楚,许红,苏泓.五脏皆有不寐及从肝论治法[J].上海中医药大学学报,2005,19(4):3-4.
[15]李融,蔡志强,候钢,等.失眠症患者的焦虑、抑郁症状的调查[J].中国行为医学科学杂志,2002,11(5):530-531.
[16]王建宁,李素霞.精神科门诊苯二氮卓类药物使用者心理健康状况调查分析[J].中国全科医学,2010,13(7A):2140-2141.
[17]柳群方,郭军,魏月玲.失眠症患者心理健康状况与相关因素的研究[J].中国行为医学科学,2004,13(3):296-297.
[18]潘集阳,赵耕源,麦慈任,等.原发性失眠症患者的主观睡眠质量及心理健康状况研究[J].中国神经精神疾病杂志,2000,26(4):240-241.
[19]尚向东,霍培金.顽固性失眠症的人格特征分析[J].中国行为医学科学,2005,14(3):267.
[20]Sanderajan P,Gaynes BN,Wisniewski SR,et al.Insomnia in patients with depression:a STAR*D report[J].CNS Spectr,2010,15(6):394-404.
[21]Nierenberg AA,Husain MM,Trivedi MH,et al.Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse:a STAR*D report[J].Psychol Med,2010,40(1):41-50.
[22]黄旭雯,黄俏庭,潘集阳.抗抑郁药治疗失眠临床应用进展[J].中国现代神经疾病杂志,2013,13(11):971-975.
[23]蒋颂,陈贵海.失眠的病理生理学改变及抗抑郁药物的治疗地位[J].中华临床医师杂志:电子版,2013,7(1):310-311.
[24]Jindal RD,Friedman ES,Berman SR,et al.Effects of sertraline on sleep architecture in patients with depression[J].J Clin Psychopharmacol,2003,23(6):540-548.
[25]王俊平,许晶,胡志云,等.帕罗西汀治疗慢性失眠症的临床对照研究[J].中国心理卫生杂志,2005,19(4):291-293.
[26]潘集阳.抗抑郁药物与抗精神病药物治疗失眠临床应用[C]//中国睡眠研究会睡眠障碍专业委员会:3.21世界睡眠日暨京津冀睡眠疾病诊断及规范化治疗学术研讨会论文集,2015:68-70.
[27]蒋健.郁证发微(一)——郁证形态论[J].上海中医药杂志,2015,49(8):4-7.
[28]蒋健.郁证发微(四)——隐性郁证论[J].上海中医药杂志,2015,49(11):4-7.
[29]阿衣努尔·木合买提巴克,刘涛,胡晓灵.柴胡疏肝散化裁治疗亚健康失眠临床观察[J].湖南中医药大学学报,2012,32(9):57-59.
[30]钱超,姜亚军.逍遥散加味治疗肝郁血虚型失眠疗效观察[J].吉林中医药,2012,32(6):588-589.
[31]张勇.柴胡加龙骨牡蛎汤加减治疗不寐肝郁化火证临床观察[J].北京中医药,2010,29(7):527-528
[32]丁书申,张彦华,贺国丽,等.疏肝解郁胶囊联合小剂量氟伏沙明治疗失眠的临床体会[J].中国现代药物应用,2013,7(24):156-157.
[33]汪瑜菡,颜红,陈立伟.自拟安神解郁汤治疗亚健康人群失眠临床观察[J].中医药临床杂志,2007,19(4):367-368.
[34]王琼.酸栆仁汤治疗广泛性焦虑症[D].广州:广州中医药大学,2012.
[35]郑锦英.甘麦大枣汤合酸枣仁汤加减治疗脑卒中后抑郁疗效观察[J].北京中医药,2009,28(4):291-292.
[36]展文国.裴正学教授运用天王补心丹和生铁落饮化裁治疗抑郁症的经验[J].内蒙古中医药,2013(7):55-56.
[37]徐碧云,李艳,肖芳,等.加味逍遥散对心理应激性失眠患者单胺类神经递质的影响[J].中华中医药杂志,2009,24(6):720-723.
[38]欧碧阳,李艳,杨志敏,等.柴胡加龙骨牡蛎汤治疗失眠的机理[J].时珍国医国药,2010,21(8):1887-1888.
[39]严灿,邓中炎,王剑,等.调肝方药对束缚应激大鼠神经内分泌免疫功能的调节作用[J].中国病理生理杂志,2000,16(6):560-562.
[40]王泽剑,梁翠玲,王志铭.圣约翰草提取物的临床研究进展[J].国外医学:脑血管疾病分册,2003,11(3):212-214.
[41]尹兴斌,翟玉静,曹飒丽,等.贯叶金丝桃药理作用研究进展[J].中华中医药学刊,2013,31(8):1634-1637.
[42]朱晓旭.酸枣仁汤抗焦虑作用的实验研究[D].北京:北京中医药大学,2002.
[43]毕秀华.甘麦大枣汤对抑郁大鼠行为学及脑内单胺神经递质影响的实验研究[D].昆明:云南中医学院,2012.
[44]张家骏,陈文为.中药酸枣仁、龙齿、石菖蒲对小鼠脑组织单胺类神经递质及其代谢物的影响[J].北京中医药大学学报,1995,18(6):64-66.
[45]张峰,李发曾.合欢花对慢性应激大鼠生长和脑单胺类神经递质含量的影响[J].动物学研究,2006,27(6):621-625.