从少阳枢机探析柴胡加龙骨牡蛎汤治疗儿童睡眠障碍辨治思路

Exploring the thoughts of treatment for pediatric sleep disorders with Chaihu Longgu Muli decoction from the perspective of Shaoyang pivot-mechanism

摘要

儿童睡眠障碍作为儿科常见神经系统与行为相关性疾病，近年来发病率逐年上升，已成为危害儿童身心健康的重要公共卫生问题。该病不仅直接干扰儿童正常睡眠节律，更会严重影响生长激素分泌、骨骼发育、认知功能与情绪调节，对患儿生长发育、心理健康及远期生活质量均造成多重不良影响。中医在本病诊疗上体系完整、疗效确切，具备独特优势与临床价值。本文立足于中医“少阳枢机”核心理论，深入阐释小儿生理病理特点与少阳功能的密切关联，明确儿童睡眠障碍的核心病机为少阳枢机不利，进而引发气机升降失常、三焦气化失司、少阳胆气怯弱，最终导致阳不入阴、痰热扰神、魂不守舍而发病。柴胡龙骨牡蛎汤为中医调和少阳、安神定志的经典名方，兼具疏肝解郁、镇惊安神、调和阴阳、和解枢机之效。临床应用中，可依据肝郁化火、阴阳失和、痰热扰神、胆气虚、胆腑郁热五大常见证型灵活化裁，精准施治，充分彰显中医辨证论治、治病求本的诊疗理念，为儿童睡眠障碍的中医药防治提供新思路与理论依据。

Abstract

Pediatric sleep disorders(PSD) are common neurological and behavioral disorders in pediatrics. In recent years, the incidence has been increasing year by year, and they have become an important public health issue that poses a threat to children's physical and mental health. This disease not only directly interferes with children's normal sleep rhythm, but also significantly affects the secretion of growth hormone, bone development, cognitive function, and emotional regulation, causing multiple adverse effects on the growth and development, mental health, and long-term quality of life of the children. Traditional Chinese medicine(TCM) has a complete system and proven efficacy in the diagnosis and treatment of this disease, and it has unique advantages and clinical value. Based on the core theory of "Shaoyang pivot-mechanism" in traditional Chinese medicine, this article deeply explains the close relationship between the physiological and pathological characteristics of children and the functions of Shaoyang, clarifying that the core pathogenesis of pediatric sleep disorders is the dysfunction of the Shaoyang pivot-mechanism, which further leads to the abnormal ascending and descending of qi, the disorder of qi transformation in the tri-jiao, and the weakness of the Shaoyang gallbladder qi. Eventually, it results in the failure of yang to enter yin, the disturbance of the spirit by phlegm-heat, and the failure of Hun to stay in its abode. Chaihu Longgu Muli decoction is a classic formula in traditional Chinese medicine for harmonizing Shaoyang and calming the mind. It has the effects of regulating liver and resolving depression, calming the spirit and the mind, harmonizing yin and yang, and resolving the pivot-mechanism. In clinical application, it can be flexibly formulated based on the five common syndromes of liver depression to generate fire, imbalance of yin and yang, disturbance of the spirit by phlegm-heat, weakness of the gallbladder qi, and heat in the gallbladder and liver, in order to provide precise treatment. This fully demonstrates the diagnostic and therapeutic concepts of traditional Chinese medicine, which are syndrome differentiation and treatment based on the overall condition and the principle of managing the root cause of the disease. The paper provides new ideas and theoretical basis for the prevention and treatment of pediatric sleep disorders with traditional Chinese medicine.

关键词

儿童睡眠障碍 / 少阳枢机 / 柴胡龙骨牡蛎汤 / 病因病机 / 辨证论治

Key words

Pediatric sleep disorders / Shaoyang pivot-mechanism / Chaihu Longgu Muli decoction / Etiology and pathogenesis / Treatment based on syndrome differentiation

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基金资助

国家自然科学基金面上项目(82274580)