基于“胃不和则卧不安”的中医理论溯源与临床应用研究

Research on TCM Theoretical Origin and Clinical Application Based on the Theory of “Stomach Disharmony Causes Restless Sleep”

摘要: “胃不和则卧不安”出自《黄帝内经》，是阐释脏腑相关、整体辨证的经典中医理论，揭示脾胃运化失常与睡眠失调之间固有的病理关联。当代人群饮食失宜、情志失调、作息失序等不良生活习惯普遍存在，胃肠功能紊乱合并失眠共病发病率逐年攀升，两类病症互为因果、形成恶性循环，严重损害民众身心健康。西医多采用镇静催眠药物对症干预失眠，存在药物依赖、日间后遗不适、远期复发率高等短板。中医秉持整体观念与辨证论治，确立“从脾胃调治失眠”核心治法，通过调和中焦气机、恢复脾胃纳运、安定心脑元神，同步干预胃肠疾患与睡眠障碍，实现标本兼治，具备独特临床优势。本文系统梳理该理论源流沿革，阐释核心病机与学术内涵，归纳食积胃脘、痰湿困脾、肝胃不和、脾胃虚弱四大核心证型的辨证要点、治则与代表方药，结合两例规范临床病案、循证医学证据佐证临床疗效；依托脑肠轴、肠道菌群、神经内分泌、HPA轴等现代机制解析理论科学内涵，完善该理论现代临床诊疗体系。本文同时批判性剖析现有研究体系的固有局限，对比梳理国内外同类研究分歧与共识，提出可落地、可验证的后续科研思路，为基于脾胃论治失眠提供完整理论依据与标准化临床实践参考。

Abstract: The theory of “stomach disharmony causes restless sleep” originates from Huangdi Neijing, a classic traditional Chinese medicine theory that interprets visceral correlation and holistic syndrome differentiation, revealing the inherent pathological connection between spleen-stomach dysfunction and sleep disorders. Unhealthy lifestyles including irregular diet, emotional disorder and disturbed daily routine are prevalent among modern people, leading to a year-by-year rising comorbidity rate of gastrointestinal dysfunction and insomnia. The two diseases interact as cause and effect and form a vicious cycle, which seriously impairs people’s physical and mental health. Western medicine mostly applies sedative-hypnotics for symptomatic treatment of insomnia, accompanied by drawbacks such as drug dependence, daytime adverse reactions and high long-term recurrence rate. Guided by holistic concept and syndrome differentiation and treatment, TCM establishes the core therapeutic principle of “treating insomnia by regulating spleen and stomach”. By harmonizing middle-jiao qi movement, recovering the transportation and transformation function of spleen and stomach, and calming the spirit of heart and brain, TCM simultaneously treats gastrointestinal diseases and sleep disorders to achieve simultaneous treatment of root causes and symptoms, with unique clinical advantages. This paper systematically sorts out the origin and evolution of the theory, explains its core pathogenesis and academic connotation, summarizes the syndrome differentiation essentials, therapeutic principles and representative prescriptions of four core syndromes including food stagnation in stomach cavity, phlegm-dampness trapping spleen, disharmony between liver and stomach, and spleen-stomach deficiency. Combined with two standardized clinical medical records and evidence-based medical data, the clinical efficacy is verified. The scientific connotation of the theory is interpreted based on modern mechanisms such as gut-brain axis, intestinal flora, neuroendocrine and HPA axis, so as to improve the modern clinical diagnosis and treatment system of this theory. Meanwhile, this paper critically analyzes the inherent limitations of existing research systems, compares and sorts out the consensus and differences of similar domestic and foreign studies, and puts forward operable and verifiable follow-up research ideas, so as to provide complete theoretical basis and standardized clinical practice reference for treating insomnia by regulating spleen and stomach.