病机与证候并重的阴阳分治法治疗肝郁化火型失眠的临床研究
摘要
目的
本研究采用临床随机对照试验方案,探讨病机与证候并重的阴阳分治法治疗肝郁化火型失眠的临床疗效。
方法
对符合诊断标准的肝郁化火型失眠患者49例,随机分为阴阳分治法治疗的试验组26例和辨证论治的对照组23例,试验组予龙胆泻肝汤原方口服,每日一剂,水煎两次,共取汁400ml,晨起、睡前两次分服；同时晨起给予益气维血颗粒20g冲服,睡前予枣仁安神液20ml口服。对照组予龙胆泻肝汤原方口服,每日一剂,水煎两次,共取汁400ml,晨起、睡前两次分服。两组病人均在治疗前和治疗1周后进行匹兹堡睡眠质量指数(PSQI)和改良Epworth思睡量表(mESS)以及自制中医证候评分标准的评定,治疗后按照《中药新药临床研究指导原则》和匹兹堡睡眠质量指数(PSQI)评定其临床疗效。试验结束后,用SPSS 18.0统计软件建立数据库,进行统计学分析,明确试验组和对照组的最终结果。结果
本研究的入选病例来源于2009年5月至2010年10月北京中医药大学东直门医院神经内科门诊符合诊断标准的肝郁化火型失眠患者,共49例。以上完成的观察病例中,脱落病例5例,试验组男性11例,女性13例,年龄最小20岁,最大64岁,平均44.58±9.179岁,病程最短者1周,最长者为30年,平均3.75±6.102年；对照组男性9例,女性11例,年龄最小19岁,最大62岁,平均43.40±12.206岁,病程最短者4天,最长者为30年,平均3.95±6.798年。
经统计学分析,试验组与对照组在治疗前的一般资料,包括性别、年龄、受教育程度、病程、睡眠时间、入睡时间、是否服用助眠药物、PSQI各因子积分及总分、mESS评分总分及中医证候各因子积分及总分的评分均具有可比性(P>0.05)。治疗后两组PSQI、mESS及中医证候评分总分都得到明显改善,试验组与对照组的临床总有效率分别为91.67%和90%,睡眠质量的临床总有效率分别95.83%和90%,中医证候改善的临床总有效率分别为87.5%和85%,两组疗效的差别均无统计学意义(P>0.05),但试验组mESS评分总分、PSQI评分总分的改善程度优于对照组。试验组平均延长实际睡眠时间2.00小时,平均缩短入睡时间30.42分钟,平均提高睡眠效率19.49%。结论
(1)阴阳分治法的试验组与辨证论治的对照组治疗肝郁化火型失眠的临床总疗效类似,但试验组的日间觉醒状态及睡眠质量的改善程度优于对照组。
(2)病机与证候并重的阴阳分治法治疗肝郁化火型失眠的方案具有明确的临床和理论基础,临床疗效肯定,方法可行,是治疗失眠症的有效方法。
To evaluate the clinical efficacy of the treatment based on difference between the treatment of yin and yang on Liver-fire type insomnia with random clinical research method. Method
Randomly divide 49 patients with liver-fire type of insomnia into two groups which the treatment based on difference between the treatment of yin and yang group included 26 patients and the treatment based on syndrome differentiation group included 23 patients. And the first group is the treatment and the second group is the control group. The treatment group patients take the Longdan xiegan decoction one dose per day. At the same time, the treatment group takes the Qi-dimensional blood particles 20mg in the morning and Zaoren liquid sedative 20ml before going to bed. The control group patients take Longdan xiegan decoction one dose per day. The study carries out an investigation and con tradistinction to the two groups using PSQI, Epworth drowsiness scale, and syndrome scale of TCM. Evaluate the clinical efficacy with Pittsburgh Sleep Quality Index(PSQI) and Doctrine Clinical Study of Traditional Chinese New Drug Curing to Insomnia after the 1 week taking the medicine. After collecting the data, record the data, analyze with SPSS 18.0 statistic softy-ware.
These 49 cases patients of Liver-fire type insomnia come from the outpatients of Neurology in the Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine from May 2009 to October 2010. The loss account for 5 cases in all cases. The treatment group includes 11 cases of male patients and 13 patients of female patients, the youngest is 20 years old, the largest is 64 years, the mean age is 44.58±9.179 years, the shortest duration is 1 week, the longest is 30 years, the mean disease duration is3.75±6.102 years. The control group there are 9 male patients andll female patients, the youngest is 19 years old and the largest is 62 years old, the mean age is 43.40±12.206 years, the shortest duration is 4 days and the longest is 30 years, the mean disease duration was 3.95±6.798 years.
There is comparability of two group of the age, sex, duration level of education, the sleep time, the time required to fall asleep, each item and total score of PSQI and syndrome scale of TCM of the patients, total score of mESS before therapy (P> 0.05). After treatment the two groups, each item and total score of PSQI and syndrome scale of TCM of the patients, total score of mESS all improved. The total effective rate of the both groups is 91.67% and 90%. The total effective rate of sleep quality is 95.83% and 90% in the both groups. The total effective rate of TCM syndrome rates 87.5% in treatment group and 85% in control group (P>0.05). And there were no significance difference comparing with the total clinical effective. The effect of the decrease of the value of the total of PSQI and mESS in the treatment group is better than the one of the control group (P <0.05).
(1) The effect on Liver-fire type insomnia by the treatment based on difference between the treatment of yin and yang is same as the one of the treatment based on syndrome differentiation. But the wakefulness and the quality of sleep in the treatment group is better than the one of the control group.
(2) The treatment based on difference between the treatment of yin and yang has a clear clinical and theoretical basis and a positive clinical effect. SO it is an effective method for the treatment of insomnia.
本研究采用临床随机对照试验方案,探讨病机与证候并重的阴阳分治法治疗肝郁化火型失眠的临床疗效。
方法
对符合诊断标准的肝郁化火型失眠患者49例,随机分为阴阳分治法治疗的试验组26例和辨证论治的对照组23例,试验组予龙胆泻肝汤原方口服,每日一剂,水煎两次,共取汁400ml,晨起、睡前两次分服；同时晨起给予益气维血颗粒20g冲服,睡前予枣仁安神液20ml口服。对照组予龙胆泻肝汤原方口服,每日一剂,水煎两次,共取汁400ml,晨起、睡前两次分服。两组病人均在治疗前和治疗1周后进行匹兹堡睡眠质量指数(PSQI)和改良Epworth思睡量表(mESS)以及自制中医证候评分标准的评定,治疗后按照《中药新药临床研究指导原则》和匹兹堡睡眠质量指数(PSQI)评定其临床疗效。试验结束后,用SPSS 18.0统计软件建立数据库,进行统计学分析,明确试验组和对照组的最终结果。结果
本研究的入选病例来源于2009年5月至2010年10月北京中医药大学东直门医院神经内科门诊符合诊断标准的肝郁化火型失眠患者,共49例。以上完成的观察病例中,脱落病例5例,试验组男性11例,女性13例,年龄最小20岁,最大64岁,平均44.58±9.179岁,病程最短者1周,最长者为30年,平均3.75±6.102年；对照组男性9例,女性11例,年龄最小19岁,最大62岁,平均43.40±12.206岁,病程最短者4天,最长者为30年,平均3.95±6.798年。
经统计学分析,试验组与对照组在治疗前的一般资料,包括性别、年龄、受教育程度、病程、睡眠时间、入睡时间、是否服用助眠药物、PSQI各因子积分及总分、mESS评分总分及中医证候各因子积分及总分的评分均具有可比性(P>0.05)。治疗后两组PSQI、mESS及中医证候评分总分都得到明显改善,试验组与对照组的临床总有效率分别为91.67%和90%,睡眠质量的临床总有效率分别95.83%和90%,中医证候改善的临床总有效率分别为87.5%和85%,两组疗效的差别均无统计学意义(P>0.05),但试验组mESS评分总分、PSQI评分总分的改善程度优于对照组。试验组平均延长实际睡眠时间2.00小时,平均缩短入睡时间30.42分钟,平均提高睡眠效率19.49%。结论
(1)阴阳分治法的试验组与辨证论治的对照组治疗肝郁化火型失眠的临床总疗效类似,但试验组的日间觉醒状态及睡眠质量的改善程度优于对照组。
(2)病机与证候并重的阴阳分治法治疗肝郁化火型失眠的方案具有明确的临床和理论基础,临床疗效肯定,方法可行,是治疗失眠症的有效方法。
To evaluate the clinical efficacy of the treatment based on difference between the treatment of yin and yang on Liver-fire type insomnia with random clinical research method. Method
Randomly divide 49 patients with liver-fire type of insomnia into two groups which the treatment based on difference between the treatment of yin and yang group included 26 patients and the treatment based on syndrome differentiation group included 23 patients. And the first group is the treatment and the second group is the control group. The treatment group patients take the Longdan xiegan decoction one dose per day. At the same time, the treatment group takes the Qi-dimensional blood particles 20mg in the morning and Zaoren liquid sedative 20ml before going to bed. The control group patients take Longdan xiegan decoction one dose per day. The study carries out an investigation and con tradistinction to the two groups using PSQI, Epworth drowsiness scale, and syndrome scale of TCM. Evaluate the clinical efficacy with Pittsburgh Sleep Quality Index(PSQI) and Doctrine Clinical Study of Traditional Chinese New Drug Curing to Insomnia after the 1 week taking the medicine. After collecting the data, record the data, analyze with SPSS 18.0 statistic softy-ware.
These 49 cases patients of Liver-fire type insomnia come from the outpatients of Neurology in the Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine from May 2009 to October 2010. The loss account for 5 cases in all cases. The treatment group includes 11 cases of male patients and 13 patients of female patients, the youngest is 20 years old, the largest is 64 years, the mean age is 44.58±9.179 years, the shortest duration is 1 week, the longest is 30 years, the mean disease duration is3.75±6.102 years. The control group there are 9 male patients andll female patients, the youngest is 19 years old and the largest is 62 years old, the mean age is 43.40±12.206 years, the shortest duration is 4 days and the longest is 30 years, the mean disease duration was 3.95±6.798 years.
There is comparability of two group of the age, sex, duration level of education, the sleep time, the time required to fall asleep, each item and total score of PSQI and syndrome scale of TCM of the patients, total score of mESS before therapy (P> 0.05). After treatment the two groups, each item and total score of PSQI and syndrome scale of TCM of the patients, total score of mESS all improved. The total effective rate of the both groups is 91.67% and 90%. The total effective rate of sleep quality is 95.83% and 90% in the both groups. The total effective rate of TCM syndrome rates 87.5% in treatment group and 85% in control group (P>0.05). And there were no significance difference comparing with the total clinical effective. The effect of the decrease of the value of the total of PSQI and mESS in the treatment group is better than the one of the control group (P <0.05).
(1) The effect on Liver-fire type insomnia by the treatment based on difference between the treatment of yin and yang is same as the one of the treatment based on syndrome differentiation. But the wakefulness and the quality of sleep in the treatment group is better than the one of the control group.
(2) The treatment based on difference between the treatment of yin and yang has a clear clinical and theoretical basis and a positive clinical effect. SO it is an effective method for the treatment of insomnia.
引文
[1]邢秋娟,陈德火召.针灸治疗失眠症的文献研究概况[J].河南中医学院学报,2007,22(4)：80-82.
[2]刘庆义.世说新语[M].北京：北京燕山出版社,1995：187.
[3]周运峰.失眠症影响因素的研究进展[J].河南中医学院学报,2008,23(1)：82-83.
[4]师建梅,刘丽坤.失眠与营卫失调[J].山西中医,1999,15(1)：51.
[5]孙其新.走出五脏气血辨证误区与谦斋医学启示录[J].辽宁中医杂志,2003,30(9)：700.
[6]姜瑞雪,马作峰.《伤寒论》对失眠证治之析义[J].辽宁中医学院学报,2005,7(2)：112-113.
[7]黄水清,徐志伟.《伤寒论》失眠与嗜睡证治探析[J].国医论坛,2004,19(4)：5-6.
[8]崔应麟,王松龄,刘伟.失眠的中医诊疗进展[J].河南中医学院学报,2008,23(5)102-104.
[9]钱嘉熹.刘仕昌教授治疗失眠经验·新中医,1995,27(9)：12-13.
[10]徐建,施明.从肝论治失眠症—王翘楚教授学术思想初探·上海中医药杂志,1995,(7)：1-3.
[11]周乃强.失眠从脾胃论治[J].中华实用中西医杂志,2007,20(13)：1131.
[12]毛海燕.张珍玉辨治失眠经验.山东中医杂志,2002,21(6)：369-370.
[13]李建辉.顽固性不寐可从痰论治[J].甘肃中医,2000,13(2)：17-18.
[14]邢斌,韩天雄,窦丹波.颜德馨教授治疗不寐的思路与方法.江苏中医药,2006,27(4)：18.
[15]傅春梅.论肾为老年失眠病机的核心[J].北京中医药大学学报,2007,30(12)：808-809.
[16]邓红,王多让.从气血论治失眠症经验[J].实用中医药杂志,2000,16(5)：37.
[17]徐云生.邓铁涛教授治疗失眠的经验.新中医,2000,32(6)：5.
[18]黄稻,钱伟忠.从痰瘀交阻论治失眠[J].中国中医基础医学杂志,2005,11(1)：46-49.
[19]黄晓珍.谈半夏与失眠[J].辽宁中医杂志,2004,31(6)：517.
[20]王民集.对《灵枢》卫气运行与睡眠关系的探讨[J].中医中医基础医学杂志,2002,(8)：561.
[21]翟丽丽.平肝养阴潜阳法治疗失眠证50例.光明中医,2003,18(2)：52.
[22]董继香,王亚东.补脑丹择时给药治失眠200例体会[J].中国临床医药研究杂志,2005(137)：14863.
[23]刘正森.调和阴阳治疗失眠症48例[J].中国中医基础医学杂志,2002,8(1)：38-39.
[24]许凤华.分调阴阳法治疗失眠.河北中医,2006,28(6)：436-437.[32]师建梅.失眠与营养失调[J].山西中医,1999,15(1)：51.
[25]滕晶,张洪斌.调和营卫择时顺势论治失眠.山东中医药大学学报,2006,30 (1)：16-18.
[26]齐向华,张洪斌.失眠证患者“昼不精.夜不瞑”状态的相关理论及临床研究[J].山东中药大学学报,2005,29(2)：130-133.
[27]刘渊.顺时调节阴阳治疗顽固性失眠[J].中国中医基础医学杂志,1997,3(增刊)：25.
[28]马贇.从《黄帝内经》理论探讨分时调营卫治疗非器质性失眠[J].时珍国医国药,2008,19(6)：1498.
[29]肖仙祥,胡小梅.中药时间疗法治疗失眠症的疗效观察[J].现代中西医结合杂志,2000,9(15)：141.
[30]王翘楚,徐建,施明,等.落花生枝叶制剂治疗失眠症疗效观察[J].上海中医药杂志,2001,(5)：8-10.
[31]黎少尊,龚建刚.阴阳分调法治疗顽固性失眠[J].河南中医,2003,23(4)：46.
[32]林虹,李翔.施今墨先生治疗失眠经验浅析[J].天津中医,2000,17(5)：1-2.
[33]武永刚,亢连茹报.伤寒杂病论治疗失眠证七法辨析[J].中医药学报,2004,32(2)：5-6.
[34]傅澄洲,李丽克.老年性失眠的中医辨治.黑龙江中医药[J].1996,(4)：11-12.
[35]白敬华.童子玉液治疗失眠证30例疗效观察[J].甘肃中医学院学报,1996,3(1)：22-24.
[36]严石林,李正华.从心辨证治失眠.成都中医药大学学报[J],2002,25(3)：59.
[37]钱玉良,严冬.浅谈失眠从心肝论治.甘肃中医[J],2006,19(10)：3-4.
[38]苏涨.失眠从肝论治[J].中医药通报,2006,2(5)：51-53.
[39]刘翔.黄连阿胶汤加减治疗失眠35例[J].山西中医,2006,22(4)：22.
[40]吕慰秋.顽固性失眠的治疗心法[J].山东中医杂志,1999,18(3)：105-106.
[41]李晓辉,王雨波.丹栀逍遥散加味方治疗失眠120例疗效观察. 四川中医[J],2006,24 (8)：59.
[42]吴大真,刘学春,徐述,等.现代名中医精神神经疾病治疗绝技[M].北京：科学技术文献出版社,2004：171-174.
[43]姜向坤,李云,徐向青.徐明涟调肝五法治疗顽固性失眠的经验.山东中医药大学学报,2000,24：199.
[44]袁运硕.龙胆泻肝汤治疗肝火扰心型失眠56例[J].辽宁中医药大学学报,2008,10(8)：108.
[45]李运文,胡传杏子,孙彩芬.失眠证候临床辨别.中国中医基础医学杂志,2005,11(1)：11-12.
[46]苏卫东,赵兰坤,陈际苏.不寐从脾胃论治.山东中医杂志,1998,17：247-248.
[47]李景.失眠症从脾胃论治[J].中国中医基础杂志,2002,8(1)：28.
[48]赵健美,刘宗春,赵建丽.归脾汤加减治疗心脾两虚型失眠56例.陕西中医,2005,26(2)：128.
[49]孙韶华,莫中周,李新平.加味归脾汤治疗失眠50例.陕西中医,2005,26 (2)：129-130.
[50]王明蓉.调和胃气法治疗失眠临床体会.实用中医药杂志,2005,21(4)：228-229.
[51]沈小明,马云枝.温胆汤加味治疗顽固性失眠90例[J].江苏中医药,2005,25(12)：25-26.
[52]叶人,袁拯忠,何金彩,等.补肾填精法治疗老年失眠症的临床观察[J].中医药学刊,2006,24(10)：1923.
[53]周颖.补肾宁心法治疗老年性失眠65例[J].辽宁中医杂志,2001,21(8)：230.
[54]张培林.活血宁神汤治疗老年性不寐36例.河南中医,2006,26(11)：38.
[55]刘爱玲.血府逐瘀汤加减治疗失眠68例疗效观察[J].国医论坛,2004,19(3)：24.
[56]杨方尧.方以正不寐从瘀辨治的思路与方法初探[J].贵阳中医学院学报,1999,21(3)：9-10.
[57]杨丽,张荣华.痰瘀与顽固性失眠[J].陕西中医,2004,(5)：5.
[58]王锦槐.蝉蜕治疗失眠有奇效.中医杂志,1994(7)：6.
[59]范桂滨.大剂量茯苓治疗不寐24例[J].中医研究,2006,19(2)：35-36.
[60]张晓峰.合欢树叶镇静催眠作用的药理实验研究.中成药,1996,18(10)：48.
[61]刘翠玲,张颖.黄芪注射液治疗失眠62例临床观察.中国社区医师,2006,22(3)：40.
[62]曾仲意,曲敬来,冯军.刺五加注射液治疗失眠症的临床观察[J].黑龙中医药,2001,(2)10-11.
[63]冯均信.针刺百会穴治疗不寐78例.上海针灸杂志,1999,18(3)：13.
[64]杨志新.针灸临床讲座(5)失眠症.中国临床医生,2006,34(5)：22-24.
[65]刘正华.针刺头三神治疗失眠症60例.中国针灸,1995,(2)：5.
[66]马云枝,周晓卿.针药结合治疗顽固性失眠90例疗效观察[J].四川中医,2004,(6)：51-52.
[67]刘顺益.不寐的中医药研究概况[J].福建中医学院学报,2005,15(2)：63-64.
[68]肖长国,郭春莉,张洪斌.“阴阳自和”理论与失眠论治[J].光明中医,2005,20(5)：12-13.
[69]胡金凤.从五脏藏神的理论内涵探讨膀胱经五脏俞穴治疗失眠症的立法原则[J].中国针灸,2006,26(1)：69-71.
[70]Michacel Chase, Thoma Roth. Insomnia. Los Angeles:Brain Information Service[M], Brain Research Institute University of Califormia,1999,12-34.
[71]游国雄.中华医学大辞海·睡眠医学分册[M].沈阳人民出版社,2002：15.
[72]Mol ler Hj, Barbera J, Kaumov L, et al, Psychiatric Aspect of Late life Insomnia [J]. SleepMedicine (Reviews),2004,8:7-17.
[73]Liu Shi-yi.What is insomnia [J]. ASRS Newsletter,1998, (3):6-7.
[74]刘曙晨.镇静催眠药的研究进展[J].国外医学—药学分册,2000,27(4)：227.
[75]Pearson NJ, Johnson LL, Nahin RL. Insomnja, trouble sleeping, and complementary and altemative medidne:amlysis Of the 2002 national health interview survey data [J]. Arch Intem Med,2006,166 (16):1775-1782.
[76]Walsh JK. Clinical and Socioneconomic Correlates of Insomnia[J].Clinic Psychiatry,2004,65 (8):36-42.
[77]沈渔邮.精神病学[M].第4版.北京：人民卫生出版社,1994：627-64.
[78]中华医学会精神科分会中国精神障碍分类与诊断标准[M].第三版,济南：山东科学技术出社,2001,118.
[79]Rosekind M R. The epidemiology and occurrence of insomnia. J Clin Psychiatry,1992,53 (6):4.
[80]National Institutes of Health. National Institutes of Health state of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults[J]. Sleep,2005,28:1048-1057.
[81]张远惠,袁强失眠的诊断及治疗[J].国外医学：精神病学分,1996,23(3),153-155.
[82]刘贤臣.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996,29(2)：103-107.
[83]中华医学会精神科分会.中国精神障碍分类与诊断标准[M].第3版.济南：山东科学技术出版社,2001：118-9.
[84]American Sleep Disorders Association. The international classification of sleep disorders,diagnostic and coding manual. Rochester Minn esota:American Sleep Disorders Association.1990:1-3.
[85]许红.失眠症1018例相关因素调查分析[J].辽宁中医杂志,2005：32(2)：114-5.
[86]刘贤臣,唐茂芹,胡蕾,等.学生睡眠质量及其相关因素[J].中国心理卫生杂志,1995,9：148-50.
[87]张钟明,王祥.失眠症病因学本质的临床探讨.医学理论与实践,2002,15(11)：1268-1269.
[88]失眠专家组.失眠定义,诊断及药物治疗专家共识[J].中华神经科杂志,2006,39(2)：141-143.
[89]朱云贵,闫小华. 急性中毒毒物检测与治疗. 长沙：湖南科学技术出版社,2000.289-300.
[90]KRYSTAL AD. The changing perspective on chronic insomnia management[J]. J Clin Psychiatry,2004,65 Suppl 8,20-25.
[91]Gaudreauh P,Guay J,Thivierge RL,et al. Benzodiazepine poisoning. Clinical and pharmacological consideration and treamnet. Int J Legal Ned,1993,106(3):119.
[92]Lader MH. Managing dependence and withdrawal with newer hypnot ic medications in the treatment of insomnia. Primary Care Companion [J]. J Clin Psychiatry,2004,4 (1):33-37.
[93]陈磊,鲁康平,秦路平,等.药物治疗失眠[J].药学实验杂志,2003(2)：67.
[94]Drghramji PP. Treatment of insomnia with zaleplon, a novel sleep medication[J]. Int J Clin Pract,2001,55 (5):329-334.
[95]王鲁年.老年睡眠障碍的诊断与治疗[C].首届全国睡眠医学论坛文集,2005年.
[96]Bianchi M, Musch B. Zopielone discontinuation:review of 25 studies assessing withdrawal and rebound phenomena[J]. Int Clin Psychopharmacol,1990,5 (Suppl2):139.
[97]UHLENHUTH EH, BALTER MB, BAN TA, et al. Trends inrecommendations for the pharmacotherapy of anxiety disorders by an international expert panel,1992-1997 [J].Eur Neuropsycho- pharmacol,1999,9 Suppl 6:S393-5398.
[98]徐峰,李经才.褪黑素对睡眠的调节作用[J].国外医学：精神病学分册,1997,24(2)：68-72.
[99]ZLOTOS DP. Recent advances in melatonin receptor ligands[J]. Arch Pharm (Weinheim),2005,338 (5-6):229-247.
[100]潘集阳,赵耕原,张晋碚,等.原发性失眠症患者的焦虑抑郁状态研究[J].中国行为医学科学,2000,9(3)：178.
[101]Seifritz E, Gillin JC, Rapaport MH, et al. Sleep electroen cephalographic response to muscarinic with major depression and in normal controls. Biol Psychiatry,1998,44:21-23.
[1]刘世褶.睡眠研究和展望.中国第二届睡眠学术会议论文摘要汇编[C],北京：中国睡眠研究会,1996,3-6.
[2]王志铭,王红梅,曹玉媛.失眠症的药物治疗进展[J].实用心脑肺血管病杂志,2007,15(1)：6-7.
[3]张伯臾,董建华,周仲瑛.中医内科学.上海科学技术出版社,1983：113-116.
[4]崔英海.中医治疗失眠症研究[J].中国现代医生,2008,46(35)：36-37.
[5]刘顺益.不寐的中医药研究概况[J].福建中医学院学报,2005,15(2)：63-64.
[2]刘庆义.世说新语[M].北京：北京燕山出版社,1995：187.
[3]周运峰.失眠症影响因素的研究进展[J].河南中医学院学报,2008,23(1)：82-83.
[4]师建梅,刘丽坤.失眠与营卫失调[J].山西中医,1999,15(1)：51.
[5]孙其新.走出五脏气血辨证误区与谦斋医学启示录[J].辽宁中医杂志,2003,30(9)：700.
[6]姜瑞雪,马作峰.《伤寒论》对失眠证治之析义[J].辽宁中医学院学报,2005,7(2)：112-113.
[7]黄水清,徐志伟.《伤寒论》失眠与嗜睡证治探析[J].国医论坛,2004,19(4)：5-6.
[8]崔应麟,王松龄,刘伟.失眠的中医诊疗进展[J].河南中医学院学报,2008,23(5)102-104.
[9]钱嘉熹.刘仕昌教授治疗失眠经验·新中医,1995,27(9)：12-13.
[10]徐建,施明.从肝论治失眠症—王翘楚教授学术思想初探·上海中医药杂志,1995,(7)：1-3.
[11]周乃强.失眠从脾胃论治[J].中华实用中西医杂志,2007,20(13)：1131.
[12]毛海燕.张珍玉辨治失眠经验.山东中医杂志,2002,21(6)：369-370.
[13]李建辉.顽固性不寐可从痰论治[J].甘肃中医,2000,13(2)：17-18.
[14]邢斌,韩天雄,窦丹波.颜德馨教授治疗不寐的思路与方法.江苏中医药,2006,27(4)：18.
[15]傅春梅.论肾为老年失眠病机的核心[J].北京中医药大学学报,2007,30(12)：808-809.
[16]邓红,王多让.从气血论治失眠症经验[J].实用中医药杂志,2000,16(5)：37.
[17]徐云生.邓铁涛教授治疗失眠的经验.新中医,2000,32(6)：5.
[18]黄稻,钱伟忠.从痰瘀交阻论治失眠[J].中国中医基础医学杂志,2005,11(1)：46-49.
[19]黄晓珍.谈半夏与失眠[J].辽宁中医杂志,2004,31(6)：517.
[20]王民集.对《灵枢》卫气运行与睡眠关系的探讨[J].中医中医基础医学杂志,2002,(8)：561.
[21]翟丽丽.平肝养阴潜阳法治疗失眠证50例.光明中医,2003,18(2)：52.
[22]董继香,王亚东.补脑丹择时给药治失眠200例体会[J].中国临床医药研究杂志,2005(137)：14863.
[23]刘正森.调和阴阳治疗失眠症48例[J].中国中医基础医学杂志,2002,8(1)：38-39.
[24]许凤华.分调阴阳法治疗失眠.河北中医,2006,28(6)：436-437.[32]师建梅.失眠与营养失调[J].山西中医,1999,15(1)：51.
[25]滕晶,张洪斌.调和营卫择时顺势论治失眠.山东中医药大学学报,2006,30 (1)：16-18.
[26]齐向华,张洪斌.失眠证患者“昼不精.夜不瞑”状态的相关理论及临床研究[J].山东中药大学学报,2005,29(2)：130-133.
[27]刘渊.顺时调节阴阳治疗顽固性失眠[J].中国中医基础医学杂志,1997,3(增刊)：25.
[28]马贇.从《黄帝内经》理论探讨分时调营卫治疗非器质性失眠[J].时珍国医国药,2008,19(6)：1498.
[29]肖仙祥,胡小梅.中药时间疗法治疗失眠症的疗效观察[J].现代中西医结合杂志,2000,9(15)：141.
[30]王翘楚,徐建,施明,等.落花生枝叶制剂治疗失眠症疗效观察[J].上海中医药杂志,2001,(5)：8-10.
[31]黎少尊,龚建刚.阴阳分调法治疗顽固性失眠[J].河南中医,2003,23(4)：46.
[32]林虹,李翔.施今墨先生治疗失眠经验浅析[J].天津中医,2000,17(5)：1-2.
[33]武永刚,亢连茹报.伤寒杂病论治疗失眠证七法辨析[J].中医药学报,2004,32(2)：5-6.
[34]傅澄洲,李丽克.老年性失眠的中医辨治.黑龙江中医药[J].1996,(4)：11-12.
[35]白敬华.童子玉液治疗失眠证30例疗效观察[J].甘肃中医学院学报,1996,3(1)：22-24.
[36]严石林,李正华.从心辨证治失眠.成都中医药大学学报[J],2002,25(3)：59.
[37]钱玉良,严冬.浅谈失眠从心肝论治.甘肃中医[J],2006,19(10)：3-4.
[38]苏涨.失眠从肝论治[J].中医药通报,2006,2(5)：51-53.
[39]刘翔.黄连阿胶汤加减治疗失眠35例[J].山西中医,2006,22(4)：22.
[40]吕慰秋.顽固性失眠的治疗心法[J].山东中医杂志,1999,18(3)：105-106.
[41]李晓辉,王雨波.丹栀逍遥散加味方治疗失眠120例疗效观察. 四川中医[J],2006,24 (8)：59.
[42]吴大真,刘学春,徐述,等.现代名中医精神神经疾病治疗绝技[M].北京：科学技术文献出版社,2004：171-174.
[43]姜向坤,李云,徐向青.徐明涟调肝五法治疗顽固性失眠的经验.山东中医药大学学报,2000,24：199.
[44]袁运硕.龙胆泻肝汤治疗肝火扰心型失眠56例[J].辽宁中医药大学学报,2008,10(8)：108.
[45]李运文,胡传杏子,孙彩芬.失眠证候临床辨别.中国中医基础医学杂志,2005,11(1)：11-12.
[46]苏卫东,赵兰坤,陈际苏.不寐从脾胃论治.山东中医杂志,1998,17：247-248.
[47]李景.失眠症从脾胃论治[J].中国中医基础杂志,2002,8(1)：28.
[48]赵健美,刘宗春,赵建丽.归脾汤加减治疗心脾两虚型失眠56例.陕西中医,2005,26(2)：128.
[49]孙韶华,莫中周,李新平.加味归脾汤治疗失眠50例.陕西中医,2005,26 (2)：129-130.
[50]王明蓉.调和胃气法治疗失眠临床体会.实用中医药杂志,2005,21(4)：228-229.
[51]沈小明,马云枝.温胆汤加味治疗顽固性失眠90例[J].江苏中医药,2005,25(12)：25-26.
[52]叶人,袁拯忠,何金彩,等.补肾填精法治疗老年失眠症的临床观察[J].中医药学刊,2006,24(10)：1923.
[53]周颖.补肾宁心法治疗老年性失眠65例[J].辽宁中医杂志,2001,21(8)：230.
[54]张培林.活血宁神汤治疗老年性不寐36例.河南中医,2006,26(11)：38.
[55]刘爱玲.血府逐瘀汤加减治疗失眠68例疗效观察[J].国医论坛,2004,19(3)：24.
[56]杨方尧.方以正不寐从瘀辨治的思路与方法初探[J].贵阳中医学院学报,1999,21(3)：9-10.
[57]杨丽,张荣华.痰瘀与顽固性失眠[J].陕西中医,2004,(5)：5.
[58]王锦槐.蝉蜕治疗失眠有奇效.中医杂志,1994(7)：6.
[59]范桂滨.大剂量茯苓治疗不寐24例[J].中医研究,2006,19(2)：35-36.
[60]张晓峰.合欢树叶镇静催眠作用的药理实验研究.中成药,1996,18(10)：48.
[61]刘翠玲,张颖.黄芪注射液治疗失眠62例临床观察.中国社区医师,2006,22(3)：40.
[62]曾仲意,曲敬来,冯军.刺五加注射液治疗失眠症的临床观察[J].黑龙中医药,2001,(2)10-11.
[63]冯均信.针刺百会穴治疗不寐78例.上海针灸杂志,1999,18(3)：13.
[64]杨志新.针灸临床讲座(5)失眠症.中国临床医生,2006,34(5)：22-24.
[65]刘正华.针刺头三神治疗失眠症60例.中国针灸,1995,(2)：5.
[66]马云枝,周晓卿.针药结合治疗顽固性失眠90例疗效观察[J].四川中医,2004,(6)：51-52.
[67]刘顺益.不寐的中医药研究概况[J].福建中医学院学报,2005,15(2)：63-64.
[68]肖长国,郭春莉,张洪斌.“阴阳自和”理论与失眠论治[J].光明中医,2005,20(5)：12-13.
[69]胡金凤.从五脏藏神的理论内涵探讨膀胱经五脏俞穴治疗失眠症的立法原则[J].中国针灸,2006,26(1)：69-71.
[70]Michacel Chase, Thoma Roth. Insomnia. Los Angeles:Brain Information Service[M], Brain Research Institute University of Califormia,1999,12-34.
[71]游国雄.中华医学大辞海·睡眠医学分册[M].沈阳人民出版社,2002：15.
[72]Mol ler Hj, Barbera J, Kaumov L, et al, Psychiatric Aspect of Late life Insomnia [J]. SleepMedicine (Reviews),2004,8:7-17.
[73]Liu Shi-yi.What is insomnia [J]. ASRS Newsletter,1998, (3):6-7.
[74]刘曙晨.镇静催眠药的研究进展[J].国外医学—药学分册,2000,27(4)：227.
[75]Pearson NJ, Johnson LL, Nahin RL. Insomnja, trouble sleeping, and complementary and altemative medidne:amlysis Of the 2002 national health interview survey data [J]. Arch Intem Med,2006,166 (16):1775-1782.
[76]Walsh JK. Clinical and Socioneconomic Correlates of Insomnia[J].Clinic Psychiatry,2004,65 (8):36-42.
[77]沈渔邮.精神病学[M].第4版.北京：人民卫生出版社,1994：627-64.
[78]中华医学会精神科分会中国精神障碍分类与诊断标准[M].第三版,济南：山东科学技术出社,2001,118.
[79]Rosekind M R. The epidemiology and occurrence of insomnia. J Clin Psychiatry,1992,53 (6):4.
[80]National Institutes of Health. National Institutes of Health state of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults[J]. Sleep,2005,28:1048-1057.
[81]张远惠,袁强失眠的诊断及治疗[J].国外医学：精神病学分,1996,23(3),153-155.
[82]刘贤臣.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996,29(2)：103-107.
[83]中华医学会精神科分会.中国精神障碍分类与诊断标准[M].第3版.济南：山东科学技术出版社,2001：118-9.
[84]American Sleep Disorders Association. The international classification of sleep disorders,diagnostic and coding manual. Rochester Minn esota:American Sleep Disorders Association.1990:1-3.
[85]许红.失眠症1018例相关因素调查分析[J].辽宁中医杂志,2005：32(2)：114-5.
[86]刘贤臣,唐茂芹,胡蕾,等.学生睡眠质量及其相关因素[J].中国心理卫生杂志,1995,9：148-50.
[87]张钟明,王祥.失眠症病因学本质的临床探讨.医学理论与实践,2002,15(11)：1268-1269.
[88]失眠专家组.失眠定义,诊断及药物治疗专家共识[J].中华神经科杂志,2006,39(2)：141-143.
[89]朱云贵,闫小华. 急性中毒毒物检测与治疗. 长沙：湖南科学技术出版社,2000.289-300.
[90]KRYSTAL AD. The changing perspective on chronic insomnia management[J]. J Clin Psychiatry,2004,65 Suppl 8,20-25.
[91]Gaudreauh P,Guay J,Thivierge RL,et al. Benzodiazepine poisoning. Clinical and pharmacological consideration and treamnet. Int J Legal Ned,1993,106(3):119.
[92]Lader MH. Managing dependence and withdrawal with newer hypnot ic medications in the treatment of insomnia. Primary Care Companion [J]. J Clin Psychiatry,2004,4 (1):33-37.
[93]陈磊,鲁康平,秦路平,等.药物治疗失眠[J].药学实验杂志,2003(2)：67.
[94]Drghramji PP. Treatment of insomnia with zaleplon, a novel sleep medication[J]. Int J Clin Pract,2001,55 (5):329-334.
[95]王鲁年.老年睡眠障碍的诊断与治疗[C].首届全国睡眠医学论坛文集,2005年.
[96]Bianchi M, Musch B. Zopielone discontinuation:review of 25 studies assessing withdrawal and rebound phenomena[J]. Int Clin Psychopharmacol,1990,5 (Suppl2):139.
[97]UHLENHUTH EH, BALTER MB, BAN TA, et al. Trends inrecommendations for the pharmacotherapy of anxiety disorders by an international expert panel,1992-1997 [J].Eur Neuropsycho- pharmacol,1999,9 Suppl 6:S393-5398.
[98]徐峰,李经才.褪黑素对睡眠的调节作用[J].国外医学：精神病学分册,1997,24(2)：68-72.
[99]ZLOTOS DP. Recent advances in melatonin receptor ligands[J]. Arch Pharm (Weinheim),2005,338 (5-6):229-247.
[100]潘集阳,赵耕原,张晋碚,等.原发性失眠症患者的焦虑抑郁状态研究[J].中国行为医学科学,2000,9(3)：178.
[101]Seifritz E, Gillin JC, Rapaport MH, et al. Sleep electroen cephalographic response to muscarinic with major depression and in normal controls. Biol Psychiatry,1998,44:21-23.
[1]刘世褶.睡眠研究和展望.中国第二届睡眠学术会议论文摘要汇编[C],北京：中国睡眠研究会,1996,3-6.
[2]王志铭,王红梅,曹玉媛.失眠症的药物治疗进展[J].实用心脑肺血管病杂志,2007,15(1)：6-7.
[3]张伯臾,董建华,周仲瑛.中医内科学.上海科学技术出版社,1983：113-116.
[4]崔英海.中医治疗失眠症研究[J].中国现代医生,2008,46(35)：36-37.
[5]刘顺益.不寐的中医药研究概况[J].福建中医学院学报,2005,15(2)：63-64.