基层中医药

围绝经期失眠属中医学“不寐”范畴。叶志英主任医师在二十余年的临证中发现，其证候以心肾不交型最为多见。三才思想与中医学整体观念不谋而合，基于三才理论中“天-人-地”层级结构与人体“脑-心-肾”的功能映射关系，结合女性围绝经期这一特殊阶段，叶师提出“脑-心-肾三才失衡”的病机新诠。治疗上突破单纯交通心肾思路，强调脑神调控的核心地位，运用三才配穴法选取岭南特色针灸疗法“靳三针”中的四神针（天部通督调神）、手智针（人部清心宁神）、足智针（地部滋肾潜阳），实现脑、心、肾同治，形成“调神-安脏-固本”的三才治疗理念。本文总结叶师的诊治思路及经验，旨在为临床治疗该病提供参考。

Perimenopausal insomnia falls under the category of "sleeplessness" in traditional Chinese medicine(TCM).Through over two decades of clinical practice,Chief Physician Ye Zhiying has identified heart-kidney disharmony as the most prevalent pattern associated with this condition.Drawing on the Sancai Thought,which coincides with the holistic perspective of TCM,a functional correspondence was established between its hierarchical structure of "Heaven-Earth-Man" and the human "Brain-Heart-Kidney" axis.Considering the specific physiological stage of perimenopause,Dr.Ye proposed a novel pathogenic interpretation termed "the Imbalance of Brain-Heart-Kidney Sancai".In terms of treatment strategy,this approach transcended the conventional method of merely restoring heart-kidney communication,emphasizing the core regulatory role of brain-spirit.By utilizing the Sancai acupoint combination method,specific points from the Lingnan-characteristic acupuncture technique "Jin' s Three-Needle Therapy" were selected:Sishenzhen(Heaven division,for governing the governor vessel and regulating spirit),Shouzhizhen(Man division,for clearing the heart and calming the spirit),and Zuzhizhen(Earth division,for enriching kidney yin and subduing yang).This methodology achieves simultaneous regulation of the brain,heart,and kidneys,thereby establishing a Sancai therapeutic principle of " regulating spirit-harmonizing viscera-consolidating foundation." This study summarized Dr.Ye' s diagnostic and therapeutic insights and experience,aiming to provide a reference for the clinical treatment of this disease.