中医药研究论丛

251.7 中医辨证施治落日症候群之失眠病例报告
TJ TCM.25(1) : 85-98, 2022
中医辨证施治落日症候群之失眠病例报告
Pattern Differentiation and Treatment of Traditional Chinese Medicine on a Sundown Syndrome Patient with Insomnia: A Case Report
吴东谦1 郑谚弭2 彭昱宪1*
中山医学大学附设医院中西整合医疗科,台中,台湾
景新中医诊所,台中,台湾
【摘要】
患者为一64 岁女性,体格肥胖,有高血压、糖尿病、高血脂病史。於103 年11 月暂时性脑缺血发作後,於104 年4 月又因缺血性脑中风送医治疗。患者自从104 年4 月中风後开始接受复健治疗,然而家属发现患者出现下午注意力不集中且容易动怒烦躁、情绪低落、食欲不佳、不易入睡、浅眠易醒、健忘情形加重等情况,西医诊断为日落症候群,服用西药之抗忧郁药物与安眠药效果有限,尤其睡眠状况一直未见起色,故於104 年7 月会诊中医。患者面色晦滞,精神不佳,表情淡漠不欲言语,口气重,腹胀,舌红瘀斑尖朱点,中根苔黄厚边齿痕,脉象左寸浮数关弦数尺细数,右寸滑关滑尺
细。中医辨证属痰热扰心,痰瘀阻络,治以清热化痰,宁心安神,活血通络之法,处方以白虎加人叁汤合葛根芩连汤与二陈汤加减,加入安神与活血凉血药物,症状渐获改善。
【关键词】日落症候群、不易入睡、浅眠易醒、痰热扰心、痰瘀阻络
Tong-Chien Wu1Yan-Mi Zheng2Yu-Hsien Peng1*
1Department of Integrated Chinese and Western Medicine, Chung Shan Medical University
Hospital, Taichung, Taiwan
2JingXin Chinese Medicine Clinic, Taichung, Taiwan
【Summary】
The 64 years old female patient who is obese figure with hypertension, diabetes,and Hyperlipidemia history, had transient ischemic attack in November 2014 and ischemic stroke in April 2015 with treatment. She had received rehabilitation therapy after the onset of the stroke since April 2015, but her family noticed she would be agitated and depressed in the afternoon with poor appetite, difficulty falling asleep, restless and light sleep, aggravated forgetfulness. Diagnosed with sundown syndrome by western medicine but the effect of the anti-depressant and sleeping pills were limited, while the sleep condition has been no better, she consulted Traditional Chinese Medicine in July, 2015. Her four examinations results included dark and gloomy complexion, lassitude, indifferent, bad breath, distended abdomen, red tongue with purple spots and teeth marks, red spots on the tip of the tongue, yellow and thick coating on the center and the root of the tongue. Pulses were left cun floating and rapid, left guan wiry and rapid, left chi thin and rapid;right cun and guan slippery, chi thin. Diagnosed as the pattern of phlegm heat disturbing
heart, and phlegm and stasis obstructing collaterals, the therapeutic principles were clearing heat and dissolving phlegm, nourishing the heart and tranquilizing the spirit, improving blood circulation and unclogging the collaterals. Prescribed with modified Bai-Hu-Jia-Shen-Tang, Er-Chen-Tang, Ge-Gen-Huang-Qin Huang-Lian-Tang, and some herbs tranquilizing the spirit and cooling blood and improving the blood circulation, her symptoms have been gradually improved.
【Keywords】Sundown Syndrome; sleeping difficulty; light sleep; phlegm heat disturbing heart; phlegm and stasis obstructing collaterals