中医药针灸治疗睡眠障碍进展.ppt

中医药针灸治疗,睡眠障碍的进展,李燕梅主任医生,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,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,C,ause and pathogenesis of,insomnia,五、失眠的临床表现,S,ymptoms of insomnia,六、失眠的治疗,Treatment of insomnia,七、临床体会,Clinical Experience,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,（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）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,),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.,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,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,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,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),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,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,（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,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,（,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),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,（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),(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),（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),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,Houshencong,、前神聪,Quianshencong,、,囟会,Du22,、神庭,Du24,操作,Usage,：,周章玲，石现，李绍旦等,.,头穴透刺对失眠患者睡眠质量与睡眠结构的影响,J,中国针灸，,2010,，,9(30),：,721724,。,六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),（四）循环针法,4 Days Acupuncture,针具,Needle,：,穴位,Points,：,第,l天,Day 1:,百会,Du 20,、安眠,Anmian,、曲池,LI11,、合谷,LI4,、,足三里,ST36,、太冲穴,Liv3,第,2天,Day 2:,大椎,Du14,、大杼,UB11,、肺俞,UB13,、心俞,UB15,、,膈俞,UB17,、肝俞穴,UB18,第3天,Day 3:,命门,Du4,、肾俞,UB23,、气海俞,UB24,、,关元俞,UB26,、委中,UB40,、承山穴,UB57,第4天,Day 4:,中脘,Ren12,、天枢,ST25,、气海,Ren6,、关元,Ren4,阴陵泉,Sp9,、三阴交,Sp6,操作,Usage,：,王莉莉，任莉,.循环针法治疗单纯性失眠68例J上海针灸杂，2012,1(31)，43-44,五）眼针法,Eye Acupuncture,针具,Needle,：,主穴,Main Points,：心区,Heart Area,配穴,Supporting,：,心脾两虚证加脾区,Deficient Spleen and Heart:Sp area,心肾不交加肾区,Breakdown Heart-Kidney Nomal coordination:Kidney area,心胆气虚证加肝区、胆区，不做手法留针,20分钟,Heart and Gallbladder Deficiency:Liver and Gallbladder area,参照彭静山教授著,眼针疗法,黄兴丽，王鹏琴.眼针治疗顽固性失眠症临床观察J辽宁中医杂志，2010，37(9)：18011802,六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),（六）颞三针法,Temple,3 Needles,针具,Needles,：,主穴,main Points,:颞三针,Temple,3 Needles,配穴,supporting Points,：神门,Shenmen,，,照海,K6,，三阴交,SP6,操作,Usage,：,戴奇斌颞三针为主治疗失眠,92,例,J,江苏中医药，,2010,，,42(12),：,59,六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),(七)磁珠贴压耳穴法,Ear Seeds Embedding,主穴：神门、肾、交感、皮质下、脑、心,Main Points:Shenmen,Kidney,sympathetic,subcortex,Heart.,配穴：肝郁化火型加肝，肝阳,Supporting Points:Liver Stagnation Fire:Liver Yang,痰热内扰型加脾,Phlegm Heat:Spleen,阴虚火旺型加耳背心，耳背肾,Yin Deficient Fire:Heart and Kidney on ear back,心脾两虚型加脾,Deficient heart and Spleen:Spleen,心虚胆怯型加胆,Nervous easily:Gallbladder,操作,Usage,：,王晓琼,.,耳针治疗失眠,63,例,J,云南中医中药杂志,.2011,，,32(5),：,50,六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),(,八）灸百会法加针罐,Moxibus Du20 with Acupuncture&Cupping,穴位,points:,操作,Usage:,针刺,Acupuncture:,督脉走罐,Du Channel Cupping:魏清琳，范娥百会灸为主综合治疗失眠症,86,例,J,中医研究,2012,，,25(1),：,6061,（九）三焦针法,Sanjiao needle methods,针具,Needle,：,主穴,Main points,：膻中、中院、气海,Ren 17,12,6.,双侧血海、足三里、外关,Both sides Sp.10,St.36,SJ5.,配穴,Supporting points,：双侧风池,Both sides GB20,操作,Usage,：,杨军雄，张建平针灸治疗失眠症的临床疗效研究,J,中国全科医学,2013,，,16(4),：,466468,六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),（十）俞募配穴埋线法,Shu-mu thread embedding,主穴,main points,：,心俞,UB15,、巨阙,Ren14,配穴,Supporting points,：,心脾两虚加用脾俞,Spleen and Heart deficiency:UB20,心胆气虚加胆俞,Heart and Gallbladder Deficiency:UB19,辜锐鑫，焦杨，徐丹丹俞募配穴埋线治疗失眠症临床观察,J,上海针灸杂志,2011,，,杨军雄，张建平针灸治疗失眠症的临床疗效研究,J,中国全科医学,2013,，,16(4),：,466468,六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),（十）俞募配穴埋线法,Shu-mu thread embedding,配穴,Supporting points,：,阴虚火旺加肾俞，,Fire due to yin deficiency:UB23,肝郁化火加肝俞,Fire due to liver stagnation:UB18,痰热内扰加中脘,Phlegm heat disturbance inside:Ren12,操作,Usage,：,辜锐鑫，焦杨，徐丹丹俞募配穴埋线治疗失眠症临床观察,J,上海针灸杂志,2011,，,杨军雄，张建平针灸治疗失眠症的临床疗效研究,J,中国全科医学,2013,，,16(4),：,466468,（十一）督脉十三针,Du 13 points,针具,Needle,：,主穴,Main points,：,百会、风府、大椎、陶道、,身柱、神道、至阳、筋缩、脊中,悬枢、命门、腰阳关、长强,Du20,16,14,13,12,11,9,8,6,5,4,3,1.,操作,Usage,：,赵元展,.,督脉十三针结合中药治疗抑郁性失眠体悟,J,北京中医药出版社，,2012.8,（,31,）,.587-588,，,66468,六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),（十二）透穴配合拔罐法,point through point with cupping,主穴：百会透前顶，攒竹透印堂，曲鬓透率谷,Main points:DU20-DU21,UB2-Yintang,GB7-GB8,配穴:双侧合谷、三阴交、足三里,Supporting Points:LI 4,SP6&St.36 Both Sides,拔罐：出针后，依次双侧心腧、肝腧、脾腧、胃腧,神门、足三里、三阴交穴上进行拔罐治疗,Cupping:After acupuncture,cup all of the following points,with the same order:UB15,UB18,UB20,UB21,Ht7,St.36,SP6,和运志，李新立，王德站等透穴配合拔罐治疗失眠症,48例J 针灸临床杂志，200925(11)：659,六、失眠的治疗（针灸）,Insomnia Treatment(Acupuncture),