益气养心推拿法治疗慢性失眠(心脾两虚型)的临床疗效观察

Observation on the Clinical Efficacy of Qi-Tonifying and Heart-Nourishing Massage Method in the Treatment of Chronic Insomnia (Type of Deficiency of Both Heart and Spleen)

摘要: 慢性失眠表现为入睡困难、睡眠维持困难、睡眠时间不足等症状，从而严重影响白天的工作生活，其中心脾两虚型为最常见的中医证型，约占不寐患者的49%。推拿疗法作为中医非药物疗法的重要组成，具有疏通经络、调和气血、平衡阴阳的功效，在心脾两虚型失眠的治疗中展现出独特优势。益气养心推拿法是在传统推拿基础上，整合头颈、腹、背三部位操作，形成以“通督养神、益气健脾、调理脏腑、疏通经络”为核心的系统推拿方案。本文系统回顾了心脾两虚型失眠的中医病机认识、推拿治疗的理论基础、益气养心推拿法的操作体系及选穴依据，并从神经–内分泌–免疫网络、脑肠轴等角度探讨其可能的作用机制。现有研究表明，推拿疗法可显著改善心脾两虚型失眠患者的睡眠质量、日间功能及中医证候，总有效率普遍在80%~97%之间，且安全性良好。然而，当前研究仍存在样本量偏小、机制探讨不够深入、远期疗效随访不足等问题。未来应开展多中心、大样本、高质量的临床研究，并结合神经影像学、神经电生理及分子生物学技术，深入揭示推拿治疗失眠的科学内涵，为益气养心推拿法的临床推广应用提供更坚实的循证依据。

Abstract: Chronic insomnia is characterized by symptoms such as difficulty falling asleep, difficulty maintaining sleep, and insufficient sleep time, which seriously affect the work and life during the day. Among them, the type of deficiency of both heart and spleen is the most common syndrome type in traditional Chinese medicine, accounting for approximately 49% of insomnia patients. Massage therapy, as an important component of non-pharmaceutical therapies in traditional Chinese medicine, has the effects of unblocking meridians, harmonizing qi and blood, and balancing Yin and Yang. It shows unique advantages in the treatment of insomnia caused by deficiency of both heart and spleen. The Qi-tonifying and heart-nourishing massage method is based on traditional massage and integrates the operations of the head, neck, abdomen and back, forming a systematic massage plan centered on “unblocking the body and nourishing the spirit, tonifying qi and strengthening the spleen, regulating the internal organs and unblocking the meridians”. This article systematically reviews the understanding of the pathogenesis of insomnia caused by deficiency of both heart and spleen in traditional Chinese medicine, the theoretical basis of massage therapy, the operation system of qi-tonifying and heart-nourishing massage, and the basis for selecting acupoints. It also explores its possible mechanism of action from the perspectives of the neuro-endocrine-immune network and the brain-gut axis. Existing studies have shown that massage therapy can significantly improve the sleep quality, daytime function and TCM syndromes of patients with insomnia caused by deficiency of both heart and spleen. The total effective rate is generally between 80% and 97%, and it is safe. However, the current research still has problems such as a relatively small sample size, insufficient in-depth exploration of the mechanism, and inadequate follow-up of long-term efficacy. In the future, multi-center, large-sample, high-quality clinical research should be carried out, and combined with neuroimaging, neuroelectrophysiology and molecular biology techniques, the scientific connotation of massage in treating insomnia should be deeply revealed, providing a more solid evidence-based basis for the clinical promotion and application of qi-tonifying and heart-nourishing massage methods.