顽固性失眠的辨证经验

顽固性失眠在临床较为常见,给患者带来了极大的痛苦,严重影响正常的生活工作。笔者运用中医辨证精化通过五脏辨证,从肝血不足、痰湿困脾、肾阳虚衰、心血瘀滞、肺气亏虚五个方面治疗疗效显著。     

浅析黄俊山教授运用药对治疗失眠经验

失眠为临床常见病,黄俊山教授运用阴阳寤寐学说、脏腑神志学说,结合多年失眠专科临床经验,从心、肝生理病理特点认识失眠的病因病机,将其基本病因归纳为肝郁失疏、心神不宁或肝血亏虚,心神失养。病机总属阴阳失调,脏腑、气血、情志失和而致心神不宁、魂不守舍。黄俊山教授在对本病的临证辨治方面,善于运用药对组合治疗本病,笔者现对其具体药对做一浅析,以期为临床治疗失眠提供参考依据,拓展本病的治疗思路。     

曹日隆治疗围绝经期膝骨关节炎临床经验

曹日隆教授认为围绝经期膝骨性关节炎的病因病机为肝血不足,肾阴亏虚。根据曹教授多年诊治经验,总结出中医药治疗与功能锻炼相结合的治疗方式。     

当归黄芪乌鸡汤治疗剖腹产后气血亏虚型恶漏不下8例分析

目的:观察当归黄芪乌鸡汤对剖腹产后气血亏虚型恶漏不下的临床疗效。方法:对8例剖腹产后气血亏虚型恶漏不下的患者用当归黄芪乌鸡汤治疗,加食盐少许,久煎,服汤时乌鸡肉同服,2 d内服完。服后3 d如未见恶漏可按上方再服。结果:本组均出现恶漏又下。结论:当归黄芪乌鸡汤剖腹产后引起的气血亏虚型恶漏不下有治疗作用。     

老年失眠的中医发病机制及防治探讨

失眠在老年人群的发病率要远远高于年轻人并常被人们忽视,加强老年失眠症的研究具有迫切性和重要性。中医药对于防治老年失眠具有独特的优势,文章根据老年人的生理状况特点,认为元气亏虚是老年失眠的致病基础、情志内伤是老年失眠的诱发因素、痰瘀胶结为老年失眠的病理特点,提出培元、舒郁、化痰是治疗老年失眠的重要法则。     

从肝肾同治法以李可“肾四味”加减治疗绝经后骨质疏松症

中医学上,绝经后骨质疏松症以腰脊酸痛,下肢乏力,骨痛等为主要症状,属"骨痿""骨痹"范畴。该病多因妇女衰老,肾气亏虚,日久及肝,责之"肝肾亏虚",肾虚骨髓失养,肝虚筋骨失濡。故而临证时可肝肾同治,补益肝肾,填精益髓,使肾精充盛,骨髓得养,肝血充足,筋脉得濡。作者在临床实践及跟师学习的过程中,发现运用李可"肾四味"加减,取其温、润、缓、平的特点,结合辨证论治,在绝经后骨质疏松症治疗上可取得良好的效果,现将理论依据阐述如下。     

朱建贵主任辨证论治抑郁症顽固性失眠的经验

阐述朱建贵主任治疗抑郁症顽固性失眠的辨证思路,临床常将顽固性失眠分为五型:肝淤血虚(精亏)证、心脾两虚证、心胆阳虚证、痰火上扰证、瘀血(痰瘀)内阻证,对应不同证型进行论治,临床疗效较好。     

自拟顺气潜阳汤治验2则

笔者在临床经常见到一些失眠、更年期综合征、抑郁症、疲劳综合征、高血压等患者符合中医气机失调的临床表现,如胸闷、憋气,四肢无力,脘腹胀满等.予行气活血之法不效,在参入潜阳补肾之品后效果大彰,至此方明此类疾病气机失调为标,肝肾亏虚方是根本.经反复实践形成一方,名顺气潜阳汤,比较适合这一类中医辨证属肝肾亏虚、阴不敛阳致冲气上逆、肝阳上亢、气机失调的病证.     

从肾论治老年性失眠

失眠是以经常不能获得正常睡眠为特征的一类病症。其在各个年龄层均存在,但以老年人居多。失眠主要病位在于心,与肝脾肾有着密切的关系,但根据老年人的生理特点,肾虚为老年人失眠的主要病机,包括肾精气阴阳的亏虚。临床常见心肾不交、肝肾阴虚、肾阳虚弱等型,治法上可采用滋阴补肾、交通心肾、温肾安神等法,为临床诊疗提供一定的思路与方法。     

通乳颗粒配合HBC-2000综合治疗仪治疗气血亏虚型产后乳汁不足的疗效

目的 探讨通乳颗粒配合HBC-2000综合治疗仪治疗气血亏虚型产后乳汁不足的效果.方法 选取2014年3月至2015年3月在本院分娩的308例气血亏虚型产后乳汁不足患者,随机分为单纯口服通乳颗粒治疗组(对照1组)74例;单纯HBC-2000综合治疗仪理疗组(对照2组)104例;通乳颗粒配合HBC-2000综合治疗仪组(治疗组)130例.比较三种方法的疗效.结果 产后乳汁不足患者其通乳颗粒配合HBC-2000综合治疗仪组的疗效明显优于两组对照组(P<0.05).结论 通乳颗粒配合HBC-2000综合治疗仪有利于促进产妇产后的乳汁分泌,且安全有效,值得推广.     

精细化护理对产妇心理状态、睡眠状况及产后出血量的影响

目的探讨精细化护理对产妇心理状态、睡眠状况及产后出血量的影响。方法选取2016年5月至2019年5月该院收治的79例住院分娩产妇作为研究对象,根据随机数字表法分为对照组和研究组,对照组(39例)产妇接受传统产科护理,研究组(40例)产妇在对照组的基础上接受精细化护理,比较两组产妇干预前后的心理状态及干预后的睡眠状况、产后2 h及24 h的出血量及护理满意度。结果与干预前比较,两组产妇干预后焦虑自评量表、抑郁自评量表评分均明显降低,且研究组明显低于对照组,差异均有统计学意义(P<0.05);研究组产妇匹兹堡睡眠质量指数总分明显低于对照组,差异有统计学意义(P<0.05);研究组产妇产后2 h及24 h出血量均明显少于对照组,差异均有统计学意义(P<0.05);与对照组比较,研究组产妇护理总满意度更高,差异有统计学意义(P<0.05)。结论精细化护理有助于改善产妇的心理状态及睡眠质量,预防和减少产后出血,提高护理满意度,对促进产妇产后康复、保证母婴健康有积极意义。     

养血滋阴安神法治疗老年阴虚血少型失眠的临床研究

目的:观察养血滋阴安神法治疗老年阴虚血少型失眠的临床疗效。方法:将符合诊断标准的70例患者随机分成2组,对照组35人,口服右佐匹克隆片(文飞)2 mg,每晚1次;治疗组35人,在对照组基础上服用天王补心丹(8 g/次,早晚各1次),治疗周期均为4周,观察患者治疗前后睡眠改善情况。结果:治疗组总体疗效好于对照组(P0.05),治疗组与对照组睡眠相关指标比较有显著性差异(P0.05),2组PSQI量表维度分析差异有统计学意义(P0.05)。结论:滋阴养血代表方天王补心丹联合右佐匹克隆疗效优于单纯右佐匹克隆治疗,临床上可用养血滋阴安神法治疗老年阴虚血少型失眠。     

预见性护理和常规护理在宫缩乏力性产后出血患者中的临床应用效果

目的探讨预见性护理和常规护理在宫缩乏力性产后出血患者中的临床应用效果。方法选择2016年3月至2019年3月因宫缩乏力导致产后出血的患者40例,采用随机数字法将其分为对照组和观察组,各20例。对照组接受常规护理,观察组接受预见性护理。比较两组患者产后住院天数、产后24 h出血量,护理前、后焦虑、抑郁情绪、睡眠质量及护理满意度。结果观察组产后住院天数短于对照组,产后24 h出血量少于对照组(P<0.05)。护理后,两组的SAS、SDS和PSQI评分均低于护理前,且观察组低于对照组(P<0.05)。护理后,观察组的健康教育、日常护理、心理护理、饮食护理和护理态度评分均高于对照组(P<0.05)。结论与常规护理相比,预见性护理更能减少宫缩乏力性产后出血患者的产后出血量,改善患者的焦虑、抑郁情绪和睡眠质量,提高患者的护理满意度。     

温和灸联合穴位按摩对气血虚弱型缺乳产妇泌乳启动的影响

目的探讨温和灸联合穴位按摩促进气血虚弱型缺乳产妇泌乳启动的可行性。方法2017年6月至2018年12月,便利抽样法选取在某院治疗的气血虚弱型产后缺乳产妇为研究对象,以分娩后入住母婴同室的先后顺序将其分为对照组(G1)、穴位按摩组(G2)、温和灸组(G3)、温和灸联合穴位按摩组(G4)。干预时间为3 d,比较四组产妇泌乳启动时间、产后乳汁分泌情况(12 h、24 h、72 h)及婴儿72 h体重下降幅度,评估其安全性(不良反应、血液指标及其皮肤情况)。结果G4组产妇的泌乳启动时间早于其他三组,在产后48 h和72 h的泌乳量多于其他三组,差异均有统计学意义(均P<0.05)。G4组婴儿产后72 h体质量下降幅度小于其他三组,差异均有统计学意义(均P<0.05)。所有产妇均无不适主诉及不良事件发生,干预前后血常规、肝肾功能检查及受试部位皮肤无异常变化(均P>0.05)。结论温和灸联合穴位按摩可有效促进气血虚弱型缺乳产妇泌乳启动,增加泌乳量,减少72 h婴儿体重下降幅度,操作方便、无创伤、痛苦小且能起到持续之疗效,产妇易于接受。     

“调肝安神方”治疗肝郁血瘀型失眠症的临床疗效及其对PSQI评分的影响

目的:观察调肝安神方治疗失眠症肝郁血瘀证患者的临床疗效及对匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评分的影响。方法:选取南京中医药大学第二附属医院神经内科失眠专病门诊患者96例,采用随机数字表法随机分为2组。对照组48例,给予艾司唑仑1~2 mg睡前口服;治疗组48例,在对照组基础上加用调肝安神方治疗。比较2组中医证侯疗效及PSQI分值的变化。结果:治疗组临床痊愈9例,显效16例,有效18例,无效5例,愈显率65.8%,总有效率89.6%;对照组临床痊愈3例,显效10例,有效19例,无效16例,愈显率34.2%,总有效率66.7%。治疗组临床愈显率及总有效率均明显高于对照组(均P<0.05)。治疗后,对照组睡眠质量、入睡时间、睡眠时间、睡眠效率PSQI因子积分及总积分均较治疗前明显下降(均P<0.05);治疗组睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能PSQI各因子积分及总积分均较治疗前明显下降(均P<0.01),且均显著低于对照组(均P<0.05)。结论:调肝安神方治疗失眠症肝郁血瘀证患者疗效确切,能显著延长总睡眠时间,增加睡眠深度,减轻睡眠障碍,缓解日间功能,改善睡眠质量,显著提高睡眠效率,值得临床进一步研究。     

“肝气虚”理论指导亚临床甲状腺功能减退症的辨治探讨

“肝阴肝血多不足”的说法在现代中医院校教材的肝脏辨证体系中较为多见,历代医家临床亦多遵循肝体阴而用阳,从疏肝行气、平抑肝阳等治法来平调“有余”之肝气、肝阳,或将肝气虚笼统与胆气虚通论而混淆其临床表现,因而“肝气虚”理论并未得到广泛提及。方朝晖教授在临证治疗过程中发现,亚临床甲状腺功能减退症患者多表现为畏寒、乏力、记忆力减退、体重增加、嗜睡、性功能减退等低代谢状态及抑郁沉闷、烦躁不安、思维鲁钝呆默、寐中易惊善恐等情志障碍,是肝气亏损、升发不足的表现,故强调整体把握,选方择用黄芪、五味子为主药调补肝气,寓补于畅,可改善亚临床甲减患者整体症状。     

Solving insomnia electronically: Sleep treatment for asthma (SIESTA): A study protocol for a randomized controlled trial

BackgroundChronic insomnia is associated with poor asthma control. Cognitive-behavioral treatment for insomnia (CBT-I) is an efficacious and durable treatment for comorbid insomnia in medical and psychiatric disorders. However, the efficacy and potential accompanying mechanisms of CBT-I have not been examined in asthma. The purpose of this study is to test the efficacy of a CBT-I intervention on sleep and asthma control in adults with insomnia and asthma. We will also explore airway inflammation (i.e., exhaled nitric oxide, blood eosinophils) as a potential biological mechanism linking improvements in sleep with improvements in asthma control.MethodsThe study is a single center, parallel group, randomized controlled trial. Two hundred and ten adults with insomnia and asthma that is not well-controlled will be randomized to either a 9-week Internet-based CBT-I program (Sleep Healthy Using the Internet (SHUTi)) or an enhanced usual care condition which utilizes an online educational video about insomnia. The primary sleep outcome is insomnia severity measured by the Insomnia Severity Index. Secondary sleep outcomes are sleep quality and wrist actigraph-recorded sleep parameters. Asthma control will be assessed by the Asthma Control Test, Asthma Quality of Life Questionnaire, pulmonary function testing, and self-report of asthma exacerbations and asthma-related healthcare utilization. Treatment outcomes will be measured at baseline, 9 weeks, and 6 months.DiscussionThis trial has the potential to identify a novel strategy for improving asthma control. Findings may advocate for the inclusion of treatment of comorbid insomnia into current asthma management practice guidelines.     

Insomnia Symptom Severity Modulates The Impact of Sleep Deprivation on Attentional Biases to Emotional Information

The present study evaluated the effect of experimental sleep deprivation on attentional biases to emotional information among a sample of 40 healthy, young adults. Participants were randomized into either a total sleep deprivation (i.e., 28 consecutive hours awake) or sleep control (i.e., 8-h sleep opportunity) condition. Participants also completed a modified version of the Dot Probe Task to assess attentional biases to positive and negative information and the insomnia severity index (ISI) to assess current insomnia symptom severity. While controlling for ISI scores, acute sleep deprivation was not associated with a greater bias to negative stimuli. In contrast, sleep deprivation predicted a significantly reduced bias to positive stimuli, but only among participants with relative low ISI scores. The present findings suggest that young adults with low levels of insomnia symptoms are particularly susceptible to the effects of sleep deprivation; such that acute sleep loss can reduce their natural tendencies to attend to positive information in the environment.     

协同护理模式联合穴位按摩改善高血压伴失眠患者血压峰值及负面情绪

目的 探讨协同护理模式联合穴位按摩对高血压伴失眠患者血压峰值和负面情绪的影响。方法 选取2018年1月至7月，山西中医药大学附属医院心内科住院的高血压伴失眠患者84例，按随机数字表分为对照组和试验组，采用阿森斯失眠量表评估。试验组在入睡前、血压峰值前穴位按摩进行睡眠干预。在干预后第4周进行血压峰值测量，并进行阿森斯失眠量表和汉密尔顿心理焦虑抑郁量表评分以及血压峰值相关性分析。结果 与对照组比较，试验组患者血压峰值前的睡眠护理干预使血压峰值显著降低（P<0.01）；睡眠质量较好（P<0.01），心理焦虑抑郁状态减轻（P<0.01）。相关性分析显示，焦虑抑郁、失眠状态与血压峰值存在正相关（P<0.05）。结论 失眠会影响高血压患者的血压峰值，血压峰值前通过协同护理联合穴位按摩对睡眠障碍患者进行干预，有利于改善血压峰值和焦虑抑郁状态。     

Sleep patterns and fatigue in new mothers and fathers

The purpose of this study was to describe the sleep patterns and fatigue of both mothers and fathers before and after childbirth. The authors used wrist actigraphy and questionnaires to estimate sleep and fatigue in 72 couples during their last month of pregnancy and 1st month postpartum. Both parents experienced more sleep disruption at night during the postpartum period as compared to the last month of pregnancy. Compared to fathers, with their stable 24-h sleep patterns over time, mothers had less sleep at night and more sleep during the day after the baby was born. Sleep patterns were also related to parents' work status and type of infant feeding. Both parents self-reported more sleep disturbance and fatigue during the 1st month postpartum than during pregnancy. Mothers reported more sleep disturbance than fathers, but there was no gender difference in ratings of fatigue. At both time points, fathers obtained less total sleep than mothers when sleep was objectively measured throughout the entire 24-h day. Further research is needed to determine the duration of sleep loss for both mothers and fathers, to evaluate the effect of disrupted sleep and sleep loss on psychosocial functioning and job performance, and to develop interventions for improving sleep patterns of new parents.