『自律神經失調之失眠』醫案一則

A Case Study of Insomnia Due to Autonomic Nervous System Dysregulation

10.6718/TJCM.202403_30(1).0009

陳俊如(Chen ,Chun-Ju)

Insomnia ； Liver yin deficiency ； modified Xiaoyao San ； Longdan Xiegan Tang ； Acupuncture for autonomic nervous system disorders

台北市中醫醫學雜誌

30卷1期（2024 / 03 / 17）

81 - 90

繁體中文;英文

47歲女性患者，近三年起睡眠狀況不穩定，時常躺很久不易入睡，有時候要躺1-2小時才入得著，但近一年症狀更加嚴重，時常在床上煎魚煎到快天亮才逐漸入睡，有時候也會半夜醒，醒來之後往往就無法再入睡了。睡不好時，會出現夜間心悸、手部汗皰疹等症狀，也時不時有胃脹氣，消化不良，便秘…等問題。患者較喜食辛辣口味食物，溫飲，平時易焦慮，性子較偏急，也是個要求完美的個性，因此，較為容易焦慮，外觀皮膚色白皙，膚質細膩，舌質淡紅，苔薄白，脈弦細。證以肝氣鬱滯，脾失運化，大腸傳導失職，治以疏肝理氣，清肝瀉火輔以通利大腸，處方以加味逍遙散、甘麥大棗湯及龍膽瀉肝湯，以及針刺調節星狀神經節後症狀逐步改善。

A 47-year-old female patient has experienced unstable sleep patterns over the past three years. She often lies awake for extended periods before falling asleep, sometimes taking 1-2 hours to do so. In the past year, her symptoms have worsened, with frequent insomnia episodes lasting until dawn, occasional nocturnal awakenings, and difficulty falling back asleep.Poor sleep quality is associated with symptoms such as nocturnal palpitations, hand sweating, and gastric discomfort, including bloating, indigestion, and constipation. The patient has a preference for spicy foods and warm beverages, and exhibits traits of anxiety, impatience, and perfectionism. Physical examination reveals fair complexion, delicate skin texture, pale tongue with thin white coating, and thin pulse. TCM diagnosis suggests liver qi stagnation, spleen deficiency leading to improper digestion, and dysfunction of the large intestine. Treatment involves regulating liver qi, clearing liver heat, promoting bowel movements, and addressing symptoms with a combination of modified Xiaoyao San, Ganmai Dazao Tang, Longdan Xiegan Tang, and acupuncture targeting the autonomic nervous system. Symptoms gradually improve with the prescribed treatment regimen.