杨进 王静 李陈渝

    [摘要] 不寐是内科常见疾病之一，中医将此病归属于“心系”疾病范畴，临床上以肝火扰心、心脾两虚、心肾不交等证常见。肝郁肾虚血瘀证并非临床常见不寐证型，患者除了不能获得正常睡眠外，还可伴随情绪烦躁、低落、兴趣减退、肢冷等症状，或合并其他躯体化障碍。尽管其症状表现复杂，但病机上仍归属不寐“阳不入阴、阴阳失交”的基本病机，故治疗上仍遵从“交通阴阳”治则。本文通过1例柴胡加龙骨牡蛎汤加减治疗肝郁肾虚血瘀型不寐的个案报道，拓展疏肝降逆法治疗不寐的临床新思路。柴胡加龙骨牡蛎汤出自《伤寒论》，具有和解少阳，通阳泄热，重镇安神之功效。本文结合病案，分析病因病机、组方用药和现代药理研究，以探讨柴胡加龙骨牡蛎汤治疗肝郁肾虚血瘀型不寐的辨证论治思路。

    [关键词] 不寐;柴胡加龙骨牡蛎汤;焦虑抑郁;肝郁肾虚血瘀;个案报道

    [中图分类号] R221? ? ? ? ? [文献标识码] C? ? ? ? ? [文章編号] 1673-9701(2022)11-0170-04

    [Abstract] Insomnia is a common disease in internal medicine and is categorized as a "heart system" disease in traditional Chinese medicine. Common clinical symptoms include liver fire disturbing the heart， heart and spleen deficiency， and heart and kidney failure. Insomnia of liver stagnation， kidney deficiency and blood stasis type is clinically rare. In addition to being unable to get normal sleep， patients also have symptoms such as irritability， depression， loss of interest， cold limbs， or other somatization disorders. Although the symptoms are complex， the pathogenesis of insomnia still belongs to the basic pathogenesis of insomnia of yang not entering yin ......