基于阴阳体用关系试述针灸治疗围绝经期失眠的临床思路

来源:用户上传      作者:粟胜勇 张熙 覃美相 林媛媛 蔡慧倩 王甜

　　摘要 以阴阳体用关系为理论指导，从调整阴阳使其回归本位的角度出发，分析围绝经期失眠阳不入阴的关键影响因素，论述基于阴阳体用关系指导下针灸治疗围绝经期失眠的临床思路。围绝经期阴虚、阳虚或阴阳两虚均可导致阳气浮越于外上，不能顺利潜藏于内下本位，阳不入阴而发为失眠，是围绝经期失眠的主要病因病机，就此提出协调阳气下潜，使其回归本位，恢复“内阳外阴”本体结构的治疗原则，在临床上结合三焦的生理功能，形成清上焦以泻浮阳、运中焦助阳下潜、补下焦以纳阳归阴的针灸治疗方案，通过使浮越于外、上的阳气顺利潜藏于内、下本位，恢复“内阳外阴”的本体结构，阳得以入阴而治疗本病。
　　关键词 阴阳体用关系;内阳外阴;外阳内阴;针灸;三焦;围绝经期失眠;临床思路
　　Clinical Thinking of Acupuncture and Moxibustion in the Treatment of Perimenopausal Insomnia Based on Essence-function Relationship between Yin and Yang
　　SU Shengyong1，ZHANG Xi1，QIN Meixiang1，LIN Yuanyuan2，CAI Huiqian1，WANG Tian2
　　（1 The Affiliated Hospital of Guangxi University of Chinese Medicine，Nanning 530023，China; 2 Guangxi University of Chinese Medicine，Nanning 530001，China）
　　Abstract Under the theoretical guidance of the essence-function relationship between yin and yang and from the point of view of adjusting yin and yang to return to the standard，the present study analyzed the key influencing factors of perimenopausal insomnia that yang fails in promoting yin，and discussed the clinical thinking of acupuncture and moxibustion in the treatment of perimenopausal insomnia.Yin deficiency，yang deficiency，or deficiency of both yin and yang in the perimenopausal period can cause yang qi to float upward，deviating from the inner site downward.Insomnia occurs when yang fails in promoting yin，which is the main etiology and pathogenesis of perimenopausal insomnia.Therefore，this study put forward the treatment principle of coordinating the descending of yang and restoring the original structure of “internal yang and external yin”.Additionally，based on the physiological functions of triple energizers，this study proposed the treatment protocol of acupuncture and moxibustion，i.e.，purging floating yang by clearing upper energizer，descending yang by activating middle energizer，and improving yang and returning yin by tonifying lower energizer，and expounded treatment thinking of this disease by descending the external floating yang to the inner site to restore the structure of “internal yang and external yin”.
　　Keywords Essence-function relationship between yin and yang; Internal yang and external yin; External yang and internal yin; Acupuncture and moxibustion; Triple energizers; Perimenopausal insomnia; Clinical thinking
　　中D分类号：R246;R256.23文献标识码：Adoi：10.3969/j.issn.1673-7202.2022.10.011
　　现代医学认为，围绝经期失眠是指女性在围绝经期受体内雌激素水平下降、神经递质失衡、血管舒缩变化等因素影响而形成的一种睡眠障碍，属于中医学“不寐”“目不瞑”“不得眠”等范畴[1]。围绝经期阴虚、阳虚或阴阳两虚均可导致阳气浮越于外上，不能顺利潜藏于内下本位，阳不入阴而发为失眠，这是围绝经期失眠的主要病因病机。在阴阳体用关系中，“内阳外阴”的阴阳相对位置是“体”，即阳的本位在内、在下，阴的本位在外、在上，这是维持生命状态平衡稳定的基本形式、基本架构;而阴阳的“用”则指阳外向、上升，阴内守、下降的基本运动属性，阴阳通过“用”以推动脏腑气血的功能活动[2]。常态下，无论阴阳如何升降运动，均须在“内阳外阴”的本体范围内进行。阴阳在运动后须各归其本位，若阴阳在运动后不能顺利回归各自本位，则将导致疾病的产生[3]。如《素问・六微旨大论》所云：“当其位则正，非其位则邪。”基于此，我们认为，围绝经期失眠阳不入阴的关键是由于阳气浮越于外上，不能顺利下降潜藏于内下本位所致，故在治疗上主张协调阳气下降、潜藏，使其回归本位，阳得入阴则失眠自愈。

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