基于五观辨治体系从"郁"探讨肿瘤相关性失眠诊疗策略OA

Based on the five viewpoints of diagnosis and treatment theory,this paper proposes that"constraint"constitutes the core pathomechanism throughout the entire course of cancer-related insomnia(CRI).A dynamic diag-nostic and therapeutic framework for CRI is constructed through five viewpoints,the temporal-spatial viewpoint,core viewpoint,symptom viewpoint,precision viewpoint,and preventive(pre-disease)viewpoint.The temporal-spatial viewpoint elucidates the correlations between the course of malignancy and insomnia.The core viewpoint delineates the evolution of pathomechanisms,characterized by emotional constraint before treatment,drug-and toxicity-induced constraint during treatment,and kidney deficiency with toxin-related constraint during recovery,and corresponds to therapeutic principles including soothing the liver to relieve constraint and calm the hun(魂),strengthening the spleen and tonifying the lung to stabilize the po(魄),and tonifying the kidney to resolve toxins and tranquilize the mind.The symptom viewpoint guides herbal combinations according to different insomnia symptom clusters.The pre-cision viewpoint targets regulation of the neuro-endocrine-immune network and constitutional status.The preventive viewpoint establishes a three-tier prevention strategy.By moving beyond a traditional single-symptom management model,this approach achieves holistic regulation from root pathomechanisms to clinical manifestations,forming a full-course management strategy of"identifying constraint mechanisms,alleviating constraint-related symptoms,and pre-venting constraint-prone states",and provides a traditional Chinese medicine-based framework for improving CRI diagnosis and treatment.