中醫治療失眠病例報告

這位41歲女性患者，有輕度憂鬱症病史，規則在精神科追蹤治療。病患失眠斷斷續續已經有5年，從去年開始症狀變得明顯，常常會入睡困難，多夢，眠淺，易醒，醒來不易再入睡，最近更出現夜尿1－2次，導致睡眠品質更差，曾服用精神科藥物（101／3月起）但是情況仍反反覆覆。中醫四診發現患者個性緊張、焦慮，自覺工作和生活壓力大，常覺得生活很忙碌、匆促。除了失眠外她容易口乾、口破，目澀、目癢；腹脹，食後腹脹加重，飯後易打嗝，大便一日一行，質乾硬，量少難排。小便頻數，自覺排不乾淨餘尿感，夜尿1－2次。婦科部份自3－4個月前開始月經提前，色暗紅，量和之前差不多，月經前腹脹較明顯。舌微瘦，舌紅，少津，少苔，舌尖瘀斑，脈沉細數。中醫診斷證屬肝鬱氣滯、相火偏亢、心陰虧損，給予疏肝解鬱、滋陰清熱、養心安神方藥治療，失眠症狀得以獲得改善，所以中醫對於失眠的治療為整體性的診治療養，並非僅鎮靜安神而已。

關鍵字

失眠；不寐；肝鬱氣滯

並列摘要

A 41-year-old female patient suffered from mild depression and has been followed-up regularly in psychiatric department. The patient also suffered from on-and-off insomnia for the past 5 years with symptoms of difficulty sleeping, dreams, light sleep, waking up easily with difficulty falling asleep, and symptoms have worsen from last year. She even started to have nocturia 1-2 times a night. She has been taking psychiatric medication started from March 2012, but the symptoms have stayed the same. From TCM diagnosis, the patient was found nervous, anxious and stressed out about life and work. She often felt dry mouth, dry eyes, distention and hiccups after meal. Her stool is dry and hard with difficult bowel movement once a day. She has frequent urination and often felt unfinished after peed. Her menstrual cycle started earlier with dark colour and pre-menstrual distention. Her tongue is slim, red, dry, scanty coating, dark spots on the tip. Her pulse is deep, thread and speedy. Based on the symptoms, the diagnosis is liver qi stagnation with deficient fire and deficient heart yin. We prescribed herbs to soothe liver stagnation, nutrient yin and clear heat, nutrient heart and calm the spirit. Her insomnia was improved. Therefore, TCM treatment on insomnia is all overall diagnosis and treatment package.