杜辉 李桂侠 吕学玉 张锦花

摘要 不寐是最常见的临床疾病和常见疾病的伴随症状，不寐的发病人数逐年增加，不寐越来越成为影响人们身心健康的重要问题。中医药在治疗不寐方面具有疗效肯定、不良反应少等优势。不寐的辨证分虚证和实证，多与心、肝、脾、肾等有关，虚证多见心肝血虚、心脾两虚、阴虚火旺、心肾不交、心胆气虚证等;实证多见心肝火旺、瘀血内阻证、痰热内扰、食滯胃脘证等。临证以虚实夹杂证多见。现梳理不寐临床常见的方证和药证，尤其是不寐主症之入睡困难、中间醒、早醒、梦多、眠浅、日间功能障碍对应的方证和药证，抓主证，辨病与辨证相结合，使不寐的辨病与辨证论治更为精准，结合不寐的病因病机、兼症或次症、患者体质类型、现代药理研究等进行总结辑要。

关键词 不寐;方证;药证;方证对应;主症;辨证;辨病

Abstract Insomnia is the most frequent clinical disease and accompanying symptom of common diseases.The number of cases of insomnia is increasing year by year.Insomnia has become an increasingly important problem affecting people′s physical and mental health.Traditional Chinese medicine has the advantages of assuring curative effect and limited side effects in the treatment of insomnia.The syndrome differentiation of insomnia is divided into deficiency syndrome and excess syndrome，which are mostly related to the heart，liver，spleen，kidney，etc.Deficiency syndromes are more common in heart，liver and blood deficiency，heart and spleen deficiency，Yin deficiency and excess fire，heart and kidney incompatibility，heart and gall qi deficiency.Excess syndromes include syndrome of hyperactive heart and liver fire，internal obstruction of blood stasis，internal disturbance of phlegm-heat，and stomach-energy stasis due to improper diet.Clinical syndromes are more common with both deficiency and excess syndromes.This article sorts out the common prescriptions and medical syndromes of insomnia，especially the main syndromes of insomnia，such as having difficulties of falling asleep，awakening in the middle of the night，early awakening，excess dreams，shallow sleep，and daytime dysfunction.It′s important to pay attention to the main symptoms.We should combine disease differentiation and syndrome differentiation to make it more accurate.This article also summarizes the prescriptions and medicine syndromes combining the cause and pathogenesis of insomnia，comorbid or secondary symptoms，patient physique type，modern pharmacological research，etc.

Keywords Insomnia; Prescription syndrome; Medicine syndrome; Prescription and syndrome correspondence; Main symptom; Syndrome differentiation; Disease differentiation

中图分类号：R256.2;R289.1文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.24.024

不寐是最常见的临床疾病和常见疾病的伴随症状，中国睡眠研究会2016年公布的睡眠调查结果显示，中国成年人失眠发生率高达38.2%，随着人口老龄化的到来，失眠的发病人数逐年增加。随着社会生活节奏的加快，压力的增加，失眠的发病亦有年轻化的趋势。失眠越来越成为影响人们身心健康的重要问题。早在《黄帝内经》中就有半夏秫米汤治疗失眠的记载，历代医家对失眠的病因病机以及治疗方法进行发展补充。不寐的辨证总分虚实两端，多与心、肝、脾、肾等有关，虚证多见心肝血虚、心脾两虚、阴虚火旺、心肾不交、心胆气虚（痰阻）证等;实证多见心肝火旺、瘀血内阻证、痰热内扰、食滞胃脘证等。……