从五脏虚损、神失敛藏探讨快速眼动睡眠期行为障碍中医证治OA

Rapid eye movement sleep behavior disorder(RBD)is a sleep disorder characterized by the acting out of dreams during sleep and plays a significant role in neuroprotective research for neurodegenerative diseases.The holistic perspective and the treatment principle of addressing the root cause in Traditional Chinese Medicine(TCM)hold potential value in guiding the diagnosis and treatment of RBD.By reviewing records on the relationship between the five Zang organs and sleep in traditional Chinese medicine classics from the time of the Huangdi Neijing onward,and integrating the disease characteristics of RBD,it can be concluded that"deficiency and impairment of the five Zang organs leading to unrestrained spirit"is the core traditional Chinese medicine pathogenesis of RBD.The five Zang organs are closely related to sleep and dreaming.When the five Zang organs are harmonious,the source for nutrient and defense qi is sufficient,their circulation follows a proper daily rhythm,and the transition between wakefulness and sleep occurs normally.When the five Zang organs store essence,replenish the marrow of the brain,and nourish the spirit,ethereal soul(hun),and corporeal soul(po),then sleep and dreams are peaceful.The abnormal dream enactment in RBD patients,the characteristic multi-system involvement throughout the disease course,the widely distributed pathological α-synuclein deposits,and the dysregulation of brain networks all suggest that RBD represents a psychosomatic disorder state characterized by deficiency and impairment of the five Zang organs,unrestrained spirit,and instability of the ethereal and corporeal souls.This article further proposes the treatment principle of"regulating and tonifying the five Zang organs,nourishing essence,and calming the spirit"for RBD.Regarding herbal medicine,the focus should be on tonifying the five Zang organs and warming/nourishing supplementation.Formulas such as Shi Quan Da Bu Tang(Ten Complete Great Tonification Decoction)or Shuang He San(Double Harmony Powder)may be selected,combined with heavy sedative substances to calm the spirit,such as Margaritifera Concha(zhen zhu mu)and Dens Draconis(long chi).For acupuncture treatment,the aim is to harmonize the five Zang organs and calm the spirit to stabilize the mind.The selection can include the"Back-Shu points of the five Zang organs plus Geshu(BL17)",combined with specific points for nightmares,such as Yinbai(SP1),Lidui(ST45),Qiaoyin(GB44),and Shangqiu(SP5).