不寐病证的文献研究与学术源流探讨

【作者】 孙洪生；

【导师】 严季澜；

【作者基本信息】 北京中医药大学 ， 中医医史文献， 2006， 博士

【摘要】 不寐是以经常不能获得正常睡眠为特征的一类病证，主要表现为睡眠时间、深度的不足，轻者入睡困难，或寐而易醒，或醒后不能再寐，重则彻夜不寐，常影响人们正常的工作、生活、学习和健康。现代社会，人们的工作节奏明显加快，身心压力增大，身体和心理长期处于紧张、疲劳的状态，这些因素都增加了人们的患病率，而失眠的发生，又进一步加剧了人们身心疲劳的状态。因此研究该病的发生和治疗，对于促进人们的身心健康，提高人们的生活质量，具有极其重要的意义。 祖国医学对不寐病证的认识已有两千多年的历史，历代医家积累了极其丰富的认识和治疗经验，创立了不少行之有效的治法和方药，为我们治疗不寐病证，留下了极为宝贵和丰富的文献资料。本文以文献学研究方法为主，在全面系统搜集历代有关不寐病证资料的基础上，对相关材料进行了深入的分析研究，系统阐述了先秦时期到民国时期不寐病证各个历史阶段的学术发展特点。并从中医学发展史的角度，研究探索其学术发展与中医学理论发展之间的内在联系，深刻揭示了不寐证的学术发展源流，对于睡眠相关的中医学理论从其学术发展的背景下予以辨析。对现代医家诊治不寐证的经验也进行了系统的总结和整理。力图全面反映历代中医学家诊治该证的学术理论和临床治疗经验。不仅为临床辨治不寐证提供了可资借鉴的诊治经验，也必将有助于开拓不寐证的研究和治疗思路。 本文分为总论和各论两大部分。总论部分重在阐述不寐证的学术发展源流，分别论述了不寐证的病名、病因病机、辨证、治法方药、其他疗法与预防调护等的学术发展概况，并对不寐证相关的若干理论问题进行了初步探讨。 各论部分以历史发展为主线，用断代史的方法，分别对先秦至三国时期、两晋南北朝隋唐五代时期、宋辽金元时期、明代、清代至民国时期等各个历史时期的医学发展特点、不寐证相关理论的发展状况进行了概括与分析，重点研究剖析了各个历史时期与不寐证相关的重要的医学文献，内容涉及不寐证的病名、病因病机、诊断、治疗、用药特点、预防调护等。最后系统整理总结了现代医家关于不寐证辨证治疗的新经验和新方法。 在全面总结不寐证学术发展规律的基础上，初步辨析了中医学营卫睡眠学说、阴阳睡眠学说、心神睡眠学说、魂魄睡眠学说与脑髓睡眠学说的理论实质与临床应用意义。主张以营卫统摄心神、魂魄等脏腑相关理论。对于不寐证营卫调治，在兼涉五脏六腑的基础上，首次提出了当重阳明、少阴的观点，为不寐证的防治提供了新的研究思路。更多还原

【Abstract】 Insomnia is the perception or complaint of inadequate or poor-quality sleep because of one or more of the following: difficulty falling asleep, waking up frequently during the night with difficulty returning to sleep, waking up too early in the morning, sometimes even can not falling to sleep at all overnight. Insomnia often affects isomniacs’s normal work, life, study and health. In the modern society, people are under a lot of pressures and stresses because their working rhythm is getting faster and faster. This is one reason why insomnia is so common. Meanwhile, insomnia makes people more stressful physically and psychologically. So the study of insomnia is very important for improving the health and quality of life of people.Chinese traditional medicine (TCM) has more than two thousand years of knowledge about insomnia. TCM doctors over past dynasties has stored up very plentiful knowledge and clinical experiences for this syndrome. They invented many effective therapeutics and formulas. They provided us very precise and plentiful literatures about insomnia. Based on bibliographical study, I collected and analyzed insomnia -related materials from TCM literatures published over past two thousand years. I explained systematically academic characteristics about insomnia in different dynasties, from Early-Qin dynasty to the time of Republic. Also, from the aspect of TCM history, I explored internal relationship between insomnia academic progress and the development process of TCM theory, in order to reveal the origin and development of insomnia. In this article, I also analyzed and summarized famous modern TCM doctors’ academic theories and clinical experiences about insomnia, in order to provide new research and clinical ideas for insomnia.This article includes two parts, general introduction and individual chapters. In the general introduction part, I discussed the academic history of insomnia, including the syndrome’s synonyms, causes, pathogenesis, treatments based on pathogenesis, other therapies and prevention. I also discussed several theoretic issues related to insomnia.In the part of individual chapters, I discussed insomnia literatures in the order of dynastic history. I recapitulated and analyzed insomnia-related literatures from Early-Qin, Three-kingdoms, Two-jin (Western and Eastern Jin), Southern and Northern dynasties, Sui, Tang, Five-Generations, Song, Liao, Jin, Yuan, Ming, Qing, and Republics, respectively. I emphasized analyzing the issues such as insomia’s synonyms, causes, pathogenesis, treatments based on pathogenesis, other therapies and preventions from those insomnia-related literatures. I also analyzed and summarized famous modern TCM doctors’ academic theories and clinical experiences about insomnia.更多还原