基于“上下交损，当治其中”辨治心肾不交型失眠

Treatment of Insomnia of Disharmony Between Heart and Kidney Type Based on the Theory of "When Upper and Lower are Damaged，the Middle Should be Treated"

摘要:

基于清代医家叶天士“上下交损，当治其中”理论，深入探析从脾胃论治心肾不交型失眠的辨证思路与治疗方法。心肾水火相交不仅依赖于心肾本身的功能协调，更以脾胃为关键枢纽。脾胃通过化生气血以充养心肾、运化水湿以畅通道路、斡旋气机以交通水火三种核心机制，维持心肾相交的平衡状态。若脾胃失和，导致化源不足、痰湿内停或升降失常，则会引发或加重心肾不交，从而导致失眠。在治疗上，应重视调理中焦，如补益中焦以资化源、化痰祛湿以斡旋中焦、辛开苦降以调中交泰。通过1则病案验证“治其中”以“交心肾”理论的有效性与实用性，为临床治疗复杂病机的失眠提供了思路。

Abstract:

Abstract： Based on the theory of YE Tianshi， a physician in the Qing Dynasty， "when upper and lower are damaged，the middle should be treated，" the treatment and syndrome differentiation of insomnia of disharmony between heart and kidney type from the spleen and stomach are analyzed. The heart-kidney and water-fire intersection not only depends on the functional coordination of the heart and kidney，but also takes the spleen and stomach as the pivotal. The spleen and stomach maintain the balance of heart-kidney interaction through three core mechanisms：generating qi and blood to nourish the heart and kidney， removing dampness to unblock pathways， and mediating qi movement to restore interaction between water and fire. If there is imbalance between spleen and stomach， leading to insufficient production of vital substances，internal retention of phlegm-dampness，or disrupted ascending and descending，it may trigger or exacerbate heart-kidney disharmony，thereby causing insomnia. In treatment，regulating the middle energizer should be emphasized，such as tonifying the middle energizer to support the source of transformation，resolving phlegm and eliminating dampness to mediate the middle energizer， and employing the acrid-opening and bitter-descending method to regulate the middle energizer and promote heart-kidney interaction. A clinical case is used to validate the effectiveness and practicality of the theory of "treating the middle" to "interact the heart and kidney，" offering a clinical approach for managing insomnia with complex pathogeneses.