,中医药针灸治疗,睡眠障碍的进展,李燕梅主任医生,中医药针灸治疗,1,Treatment Development of SleepingDisorder(SD)by Traditional Chinese Herbal Medicine(TCHM)and Acupuncture(ACU),Professor Yanmei Li,MD,Dept.of TCM,Henan TCM University,Chief and Senior Attending Physician,Brain Diseases,The First Teaching Hospital of Henan TCM University,Zhengzhou,Henan,China,Treatment Development of Sleep,2,睡眠障碍SD,一、睡眠生理Physiology,二、睡眠障碍的定义及分类-顽固性Definition and,classification of SD,mainly about the chronic aspect,三、失眠的定义及分类Definition and classification of,insomnia,四、失眠的病因及发病机制 Cause and pathogenesis of,insomnia,五、失眠的临床表现Symptoms of insomnia,六、失眠的治疗Treatment of insomnia,七、临床体会Clinical Experience,睡眠障碍SD一、睡眠生理Physiology,3,睡眠Sleep,（一）形成 Formation,1、上行抑制系统Ascending inhibitory system,2、丘脑网状核、下丘脑及杏仁簇Reticular of,thalamus,hypothalamus and amygdaloid,nuclear complex,3、抑制性神经递质Inhibitory neurotransmitter,一、睡眠生理（西医）Sleep Physiology(Western Medicine),睡眠Sleep一、睡眠生理（西医）Slee,4,睡眠Sleep,（二）结构组成 Structure composition,非快速眼动睡眠(NREM)或称慢波睡眠,Slow wave sleep 80%,快速眼动睡眠(REM)或称快波睡眠,Fast wave sleep 20%,一、睡眠生理（西医）Sleep Physiology(Western Medicine),睡眠Sleep一、睡眠生理（西医）Slee,5,睡眠Sleep,（一）阴阳论Yinyang,（二）营卫论Yingwei,（三）心神论Heart Spirit/Shen,一、睡眠生理（中医）Sleep Physiology(TCM),睡眠Sleep一、睡眠生理（中医）Slee,6,二、睡眠障碍的定义及分类 Definition and classification of SD,（一）定义Definition：,睡眠量、质的异常或睡眠时发生某些临床症状如睡眠,减少或睡眠过多，睡行症等，其中以失眠症最为常见,Abnormal in both quantity&quality of sleep and includes complaints such as less sleep or too much sleep,even sleep walking.,二、睡眠障碍的定义及分类 Definition,7,请参阅:附表一、美国睡眠障碍联合会(ASDA)睡眠障碍国际分类(ICSD)2005年Please Check the Table from ASDA ICSD 2005,二、睡眠障碍的定义及分类 Definition and classification of SD,请参阅:附表一、美国睡眠障碍联合会(ASDA)睡眠障碍国际,8,定义Definition：,分类Classification：,入睡困难difficult to fall asleep,睡眠维持障碍 difficult to maintain asleep,早醒 waking up early,三、失眠的定义及分类 Definition and Classification of insomnia,定义Definition：三、失眠的定义及分类 De,9,四、失眠的病因及发病机制（西医）Cause&Pathogenesis of insomnia (Modern Western Medicine),病因Cause,（一）一过性失眠,Occasionally,（二）短期失眠,Short term,（三）长期失眠,Chronic,四、失眠的病因及发病机制（西医）Cause,10,发病机制Pathogenesis:,（一）生理抑制学说 Physiology inhibitation,（二）中枢睡眠学说 Sleeping NC,（三）中枢神经递质学说 NCN Neuron Transmitters,（四）贫血学说 Anemia,（五）体液学说 Endocrine,（六）化学学说 Chemical,四、失眠的病因及发病机制（西医）Cause&Pathogenesis of insomnia (Modern Western Medicine),发病机制Pathogenesis:四、失眠的病因及发病机,11,病因Causes：,饮食不节 Irregular Diet,情志失常 Mental,劳逸失调 Binge-purge behavior labor-wise,病后体虚 Vulnerability post healing from diseases,病机 Pathogenesis：,阳盛（虚火、实火）Excess Yang,(deficient fire,efficient fire),阴衰（血虚、阴虚）exhausted yin,(deficient blood,deficient yin),周仲瑛中医内科学.中国中医药出版社.2006.第二版,四、失眠的病因及发病机制（中医）TCM cause&Pathogenesis of insomnia,病因Causes：四、失眠的病因及发病机制（中医）,12,五、失眠的临床表现 Clinical symptoms of insomnia,（一）夜间睡眠不足deficient sleep,入睡困难difficulty in falling asleep,睡眠维持困难 difficulty in maintaining asleep,睡眠质量下降 bad quality of sleep,每天总睡眠时间少于6小时average daily sleep,time is less than 6 hours,五、失眠的临床表现 Clinical symp,13,（二）白天有缺睡症状,day time with lack of sleep symptoms,晨起后After getting up in the morning,白天Day time,（三）认知功能受损 decreased gnosia,顽固性失眠：病程长、依赖药物、身心症状 chronic,drug-dependent and somatic&mental symptoms,五、失眠的临床表现 Clinical symptoms of insomnia,（二）白天有缺睡症状 五、失眠的临床表现,14,六、失眠的治疗（西医）Treatment of insomnia by modern western Medicine,请参阅:,赵忠新.中国成人失眠诊断与治疗指南.,中国神经科杂志.第45卷第7期，2012.,534-540,Please Check:,Zhongxin Zhao.Guide of insomnias diagnosis and,treatment for Chinese adults,J.of China Neurology Vol.45 Issue 7,page 534-540,六、失眠的治疗（西医）Treatment of insomn,15,（一）辨证治疗Differentiation Treatment,肝火扰心证-龙胆泻肝汤加减,Liver fire disturbance of the heartLongdan Xiegan D.+/-,痰热扰心证-黄连温胆汤加减,Phlegm heat disturbance of the heartHuanglian Wendan D.+/-,周仲瑛.中医内科学.中国中医药出版社.2006.第二版,六、失眠的治疗（中药）Insomnia Treatment(TCHM),（一）辨证治疗Differentiation Treatm,16,六、失眠的治疗（中药）Insomnia Treatment(TCHM),（一）辨证治疗,Differentiation and Treatment,心脾两虚证归脾汤加减,Spleen-heart deficiencyGuipi D.+/-,心肾不交证六味地黄丸合交泰丸加减,Breakdown of normal heart-kidney coordinationsix flavor pill+/-,心胆气虚证安神定志丸合酸枣仁汤加减,Deficiency of heart and gallbladderAnshen Dingzhi pill+Jujube D.,周仲瑛.中医内科学.中国中医药出版社.2006.第二版,六、失眠的治疗（中药）Insomnia T,17,（二）单味中药治疗Use single herb only,酸枣仁Sour jujube seed，半夏Pinellia,夜交藤Fleeceflower vine，,龙眼肉longan,附子aconite,蝉蜕cicadae,苦参Sophora root,朴硝mirabilite,何首乌Ho-shou-wu,郁李仁bush cherry seed,灵芝lucid ganoderma,中医单药奇效（失眠）医案.2013,六、失眠的治疗（中药）Insomnia Treatment(TCHM),（二）单味中药治疗Use single herb only,18,(一)单穴治疗 Single point only,阳经:风池,百会,足窍阴.,Yang channel:GB20,Du20,GB44,阴经:三阴交,阴郄.,Yin channel:Sp6,Ht6,经外奇穴:安眠穴,十宣穴,四神聪,照海.,Extra Points:Anmian,Shixuan,Sishencong,K6,耳穴:皮质下,神门,内分泌.,Ear Points:Subcortex,Shenmen,Endocrine,陈洪沛.针灸穴位治疗失眠，中国医药科技出版社，2012年，第一版,六、失眠的治疗（针灸）Insomnia Treatment(Acupuncture),(一)单穴治疗 Single point only 陈洪沛.,19,（二）调督健脑针刺法,Regulating Du&Promoting Brain Function,针具Needles:,主穴Main Points：百会Du20、本神GB13、,神庭Du24、神道Du1、,至阳Du9、神门Ht7、三阴交穴Sp6,操作Usage：,张颖颖，刘兰英，马骋调督健脑针刺法治疗失眠症的临床研究,J 上海针灸杂志，2009，28(3)：140142,六、失眠的治疗（针灸）Insomnia Treatment(Acupuncture),（二）调督健脑针刺法六、失眠的治疗（针灸）,20,六、失眠的治疗（针灸）Insomnia Treatment(Acupuncture),(三)头穴透刺法 Points to Points,针具Needle：,穴位Points：,后神聪Hou