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基于"肝肾同源"理论探讨失眠的病机及论治OA

Exploring the Pathogenesis and Treatment of Insomnia Based on the Theory of Homology of Liver and Kidney

中文摘要英文摘要

失眠是以入睡困难、睡眠维持困难或早醒为核心症状,并导致日间功能损害的睡眠障碍.其发病率逐年攀升,呈现慢性化、年轻化趋势,严重影响患者生活质量.中医药基于"肝肾同源"理论治疗失眠,具有形神共调、标本兼顾的优势:从生理关联而言,肝肾"魂安志定"是调控睡眠的重要机制,"精血互生"构建维持睡眠的物质基础,"藏泄互用、共司相火"为实现昼精夜瞑的功能关键;现代研究证实其作用机制涉及神经-内分泌-免疫网络调控,并可通过睡眠进程与结构参数得到客观验证.总之,肝肾精血亏虚导致魂志失守,相火妄动扰乱心神为其主要病机;肝失疏泄、肾不封藏则阴阳失衡,营卫失和,导致失眠.基于"肝肾同源"理论,结合现代人群熬夜耗精、情志郁结易耗损肝肾的致病特点,提出失眠"肝肾阴虚、肾虚肝郁、肾虚肝逆"三大辨治分型.治疗上则分别以滋补肝肾、滋肾疏肝、益肾平肝法为主,辅以安神.通过调燮肝肾实现形气神合一以改善睡眠,以冀为中医药治疗失眠提供新思路.

Insomnia is a sleep disorder characterized by core symptoms of difficulty initiating sleep,maintaining sleep,or early morning awakening,accompanied by daytime functional impairment.With rising incidence rates and emerging trends of chronicity and younger onset,it significantly compromises patients'quality of life.Traditional Chinese Medicine(TCM)addres-ses insomnia through the theoretical framework of "Homology of Liver and Kidney",demonstrating unique advantages in holistic regulation of physical and mental states while managing both symptoms and root causes.Physiologically,the coordinated func-tions of the liver and kidney ensure sleep regulation through hun-zhi homeostasis as the regulatory mechanism,essence-blood mutual generation forming the material basis for sleep maintenance,and storage-discharge synergy and co-governance of min-isterial fire function maintaining circadian rhythm.Contemporary research confirms that its therapeutic mechanisms involve neuro-endocrine-immune network regulation,objectively verified through sleep architecture parameters.Pathologically,deficiency of liver-kidney essence-blood leads to instability of hun-zhi and ministerial fire hyperactivity disturbing the heart-mind(shen),while impaired liver qi dispersion and deficient kidney storage cause yin-yang imbalance and disharmony of ying-nu-trient and wei-defense systems.Given modern lifestyle patterns characterized by nocturnal essence depletion due to late-night routines and emotional stagnation,this study proposes three syndrome differentiation patterns under the liver-kidney homology framework:Liver-Kidney Yin Deficiency Pattern,Kidney Deficiency with Liver Qi Stagnation Pattern and Kidney Deficiency with Liver Qi Rebellion Pattern.Corresponding therapeutic strategies emphasize liver-kidney nourishing,kidney-tonifying with liver-soothing,and kidney-fortifying with liver-pacifying approaches,complemented by mind-calming therapy.The integration of physical form,vital energy,and mental spirit through the harmonization of liver and kidney systems demonstrates potential for sleep improvement,offering a novel therapeutic paradigm for Traditional Chinese Medicine in insomnia management.

赵孟婷;杨凛然;廖菁;邓奕辉

湖南中医药大学第一中医临床学院,湖南 长沙 410007湖南中医药大学第一中医临床学院,湖南 长沙 410007湖南中医药大学,湖南 长沙 410208湖南中医药大学,湖南 长沙 410208

医药卫生

失眠不寐肝肾同源:乙癸同源

InsomniaInsomnia(Bumei)Homology of Liver and KidneyYi-Gui Homology

《实用中医内科杂志》 2026 (4)

20-23,4

国家级大学生创新创业训练计划项目(202110541091)湖南省自然科学基金创新研究群体项目(2024JJ1007)湖南省科技创新计划资助项目(2020RC4050)

10.13729/j.issn.1671-7813.Z25050812

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