象思维指导下的应用“一气周流”理论辨治失眠

Insomnia treatment based on the yiqi zhouliu theory guided by xiang (image) thinking

摘要

象思维是中医学的核心思维方式，在象思维指导下的“一气周流”理论出自清代医家黄元御所著《四圣心源》，强调以“中气”为“一”，用气的流转变化阐释五脏功能的相互联系。本文从象思维指导下的“一气周流”理论出发，认为脾胃失调、四象失序为失眠的核心病机，治以健脾和胃之法佐以交通心肾，兼以疏肝降肺，结合中药法象，在黄元御顾护脾胃的核心处方黄芽汤基础上加味创制调气安眠方，使气机调和、升降有序，人体气机良性循环，从根本上治疗失眠。并结合临床验案阐明象思维指导下的“一气周流”理论辨治失眠。

Abstract

Xiang (image) thinking constitutes the core cognitive modality of Traditional Chinese Medicine (TCM). Guided by xiang thinking, the theory of yiqi zhouliu, formulated by Qing physician Huang Yuanyu in Sisheng Xinyuan (The Spiritual Source of the Four Sages), emphasizes taking central qi as the unifying core and employs the dynamic circulation and transformation of qi to elucidate the functional interrelationships among the five zang organs. Guided by this theory, we propose that the fundamental pathogenesis of insomnia resides in spleen-stomach disharmony and the resultant derangement of the four xiang. Therapeutic strategy therefore focuses on fortifying the spleen and harmonizing the stomach, supplemented by coordinating heart-kidney interaction, soothing the liver, and descending lung qi. Integrating the doctrine of medicinal images, we augmented Huang’s archetypal Huangya Decoction designed to safeguard the spleen and stomach-to create the Tiaoqi Anmian Formula (Qi-Regulating and Sleep-Improving Formula). By re-establishing the physiological ascent-descent dynamics of qi, this regimen restores orderly qi circulation and initiates a virtuous cycle of bodily qi movement, thereby eradicating insomnia at its root.

关键词

失眠 / 一气周流 / 象思维 / 中药法象

Key words

insomnia / yiqi zhouliu / xiang thinking / xiang-based classification of Chinese herbal medicine

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基金资助

国家自然科学基金项目(81904120)

北京市自然科学基金-首都临床医学创新联合基金项目(L2510129)