基于“木曰敷和”理论探讨柔肝法治疗耳鸣合并失眠

Discussion on the Treatment of Tinnitus Complicated with Insomnia by Liver‑Softening Therapy Based on the Theory of “Wood Governs Diffusion and Harmony”

摘要: 肝主疏泄、藏血，在畅气机、统气血、安神魂方面发挥关键作用。“木曰敷和”是对肝体阴用阳、升敛协调、气血敷布、阴阳平和生理功能的高度概括。耳鸣与失眠常互为因果、合并出现，严重影响患者生活质量。本文基于《素问·五常政大论》“木曰敷和”理论，从肝的生理特性出发，探讨耳鸣合并失眠的病因病机及柔肝法的治疗思路。认为肝“木失敷和”是耳鸣合并失眠的核心病机，表现为气血怫郁、阴阳失衡、清窍失养。治疗上主张“柔肝胜于疏肝”，从养血柔肝、酸甘合阴、咸寒潜阳、辛润通络等方面论治，以恢复肝木敷和之性，达到耳鸣缓解、睡眠改善的治疗目标。

Abstract: The liver governs free flow of qi and stores blood, playing a vital role in smoothing qi‑movement, regulating qi‑blood, and calming the spirit. “Wood governs diffusion and harmony” is a high‑level generalization of the liver’s physiological functions: yin in substance yet yang in function, coordinated ascent and restraint, proper distribution of qi and blood, and balanced yin‑yang. Tinnitus and insomnia often cause each other and occur concurrently, severely impairing patients’ quality of life. Based on the theory that “wood governs diffusion and harmony” in the chapter “Treatise on the Great Regulations of the Five Constants” of Suwen, this paper explores the etiology and pathogenesis of comorbid tinnitus and insomnia as well as the therapeutic approach of liver‑softening therapy from the physiological properties of the liver. It holds that “loss of dispersion‑harmony of the liver‑wood” constitutes the core pathogenesis of comorbid tinnitus and insomnia, manifested as stagnated qi‑blood, disturbed yin‑yang, and malnourished orifices of sense. Therapeutically, it advocates that “softening the liver is superior to soothing the liver”. Treatments are implemented via nourishing blood to soften the liver, combining sour‑sweet medicinals to nourish yin, using salty‑cold medicinals to subdue yang, and employing pungent‑moist medicinals to unblock collaterals, so as to restore the dispersion‑harmony property of liver‑wood and achieve the therapeutic goals of relieving tinnitus and improving sleep.