【摘 要】 张景岳以“邪正”理论将不寐的病因病机简化，分为无邪和有邪致不寐，用虚实二字概括。无邪时多因思劳过度致病，当补其虚，注重心脾;有邪时当祛邪气。在补虚祛邪的过程中，也当注意标本缓急。然而，张景岳的理论有其局限，其一是脏腑辨证时对肝、肾两脏致病描述不足，肾水不足、肝主谋虑太过会导致不寐，应分别予以黄连阿胶汤、丹栀逍遥散加味等进行治疗;其二是邪气理论中未涉及瘀血致病，瘀血阻滞气血运转，治疗宜用血府逐瘀汤一类;另外，张景岳局限了半夏汤中半夏的作用，忽视了从调和阴阳角度论治不寐的方法，这亦为其局限之一。

【关键词】 张景岳;不寐;邪正;局限

【中图分类号】R259   【文献标志码】 A    【文章编号】1007-8517（2021）22-0008-03

The Application and Limitation of Zhang Jingyue’s “Evil and upright” Theory in Insomnia

WEI Jingwen

Hospital of Chengdu university of traditional Chinese medicine， Chengdu 610075，China

Abstract：Zhang Jingyue simplifies the etiology and pathogenesis of insomnia with the theory of “evil and righteousness”， which is divided into innocence and insomnia caused by evil， which is summarized by the words “deficiency and reality”. When innocent， it is often caused by excessive thought， so we should replenish its deficiency and pay attention to the heart and spleen; when there is evil， we should dispel evil qi. In the process of tonifying deficiency and dispelling evil， we should also pay attention to the priority of specimens. However， Zhang Jingyue’s theory has its limitations： one is that insufficient description of the pathogenesis of liver and kidney in syndrome differentiation of Zang-fu organs， insufficient kidney water and too much concern for the liver will lead to insomnia， which should be treated with Huanglian Ejiao decoction and Danzhi Xiaoyao Powder respectively; second， blood stasis is not involved in evil qi theory， and blood stasis blocks the movement of qi and blood， and Xuefu Zhuyu decoction should be used for treatment. In addition， Zhang Jingyue limited the role of Pinellia ternata in Pinellia decoction and ignored the method of treating insomnia from the perspective of reconciling yin and yang， which is also one of its limitations.

Keywords：Zhang Jingyu;Insomnia;Evil and Righteous;Limitation

不寐，現又称失眠，临床上主要以难以入睡，或眠而复醒，或寐而不酣，或彻夜不眠等为表现。不寐的原因有很多，从古至今，许多医家多从情志失调、心虚胆怯、阴虚火旺、痰湿壅遏、饮食积滞等角度施以方药。在众多医家中，张景岳独出心裁，以有邪无邪作为不寐的辨证纲领，化繁为简，为后世医家治疗不寐提供了新的思路，但限于种种原因，张景岳的理论也有其局限。

1 张景岳对不寐的认识

张景岳对“不寐”的认识主要集中在《景岳全书》、《类经》两书中，以《景岳全书》为主。其中，张景岳的“邪正”思想在《类经》中已可管窥一二，在《类经·不卧多卧》篇中，他提到：“凡不寐之证，有邪实者属外因，有营虚者多属内因”。这一思想在《景岳全书》中得到了充分地论述与运用，他在该书中强调，不寐虽然病因病机各异，然而总体而言可用“邪正”二字概括，有邪者多属实，无邪者多属虚[1]，因此，在不寐的治疗上，他主要遵从补虚、驱邪两大方针。……