调经通衢，引卫入阴——罗玲从头部营卫转输失常辨治失眠经验

Regulating Channels and Unblocking the Pathway, Guiding Defensive Qi into Yin—Associate Professor Luo Ling’s Experience in Treating Insomnia Based on Abnormal Ying-Wei Transition in the Head

摘要: 失眠属中医“不寐”范畴，现有中医辨治体系多以脏腑气血阴阳失调为核心，虽体系成熟，但对头部作为诸阳之会在营卫由阳入阴过程中的转输枢纽作用关注不足。临床中伴头部局部压痛、结节、肤温异常的失眠患者，单纯从脏腑论治疗效欠佳。罗玲副教授从事针灸临床、教学及科研工作二十余年。基于《灵枢》营卫循行理论，她提出“头部为六阳经营卫下行入阴的关键转输枢纽”这一原创病机观点，指出头部营卫转输失常可致卫气浮于阳分而不得入阴：实证系营卫郁阻络脉、卫气无路入阴，虚证系营弱卫强、卫气无力入阴，病久则内传脏腑形成双向恶性循环。临床创立“望–按–触”三步头部诊察法，以头部压痛、结节、肤温异常等阳性体征为客观辨证依据；确立“调经通衢，引卫入阴”总治则，以大艾条重灸为核心手段，遵循“寻结而灸、以痛为腧”原则，针对单纯头部经络营卫失调与经络–脏腑同病两类情况动态施治，临床疗效显著。基于此，文章系统总结罗玲副教授的学术经验与标准化操作规范，并附典型验案佐证，以期为失眠的针灸辨治提供新的局部病机视角与可推广的临床方案。

Abstract: Insomnia falls into the category of “Bu Mei” in traditional Chinese medicine (TCM). The existing TCM syndrome differentiation and treatment system is mainly centered on the disharmony of zang-fu organs, qi, blood, yin, and yang. Despite the maturity of this system, insufficient attention has been paid to the role of the head—the confluence of all yang meridians—as the transport pivot for ying-wei during its transition from yang to yin. Clinically, for insomnia patients presenting with local head signs, including tenderness, subcutaneous nodules, and abnormal skin temperature, treatment based solely on zang-fu syndrome differentiation often produces unsatisfactory curative effects. Associate Professor Luo Ling has been engaged in acupuncture clinical practice, teaching, and scientific research for more than 20 years. Based on the ying-wei circulation theory recorded in Lingshu, she proposes the original pathogenesis view that “the head serves as the critical transport pivot for ying-wei of the six yang meridians to descend into the yin aspect”. Abnormal ying-wei transport in the head leads to defensive qi floating in the yang aspect and failing to enter yin: the excess pattern manifests as ying-wei stagnation obstructing the collaterals, leaving defensive qi no pathway to enter yin; the deficiency pattern presents as insufficient nutrient qi and hyperactive defensive qi, depriving defensive qi of the driving force to enter yin. Long-standing disease can transmit inward to the zang-fu organs, forming a two-way vicious cycle. Clinically, she developed the three-step head diagnostic approach of “observation-palpation-touch”, taking positive signs such as head tenderness, nodules, and abnormal skin temperature as objective evidence for syndrome differentiation. She established the general therapeutic principle of “regulating meridians to unblock the thoroughfare, guiding defensive qi into yin”, with intensive moxibustion using large-diameter moxa sticks as the core intervention. Following the principle of “moxibustion targeting palpable nodules and taking tender points as acupoints”, treatment is dynamically tailored to two patterns: simple ying-wei disorder of head meridians, and concurrent meridian-zang-fu disease, achieving significant clinical efficacy. This paper systematically summarizes her academic experience and standardized operation procedures, supported by typical proven cases, to provide a novel local pathogenesis perspective and a replicable clinical protocol for acupuncture treatment of insomnia.