营卫不和是失眠的核心病机，营卫的正常输布离合是实现营卫交合的重要条件，如营卫之输布离合异常，可导致营 卫不和，发为失眠。营卫之输异常所致之失眠，可用桂枝汤类方健运中焦、益卫养营；营卫之布异常所致之失眠缘于邪气 外客者可用麻黄汤类方解表祛邪，缘于三焦不利者可用小柴胡汤类方疏利三焦；营卫之离异常所致之失眠缘于里热炽盛者 可采用苦寒之大黄类方清泻里热，缘于里热兼表者可采用辛寒之石膏类方解肌清热，缘于里热兼燥者可采用咸寒之芒硝类 方清热润燥散结，缘于里热兼水、兼虚、兼表者可采用酸寒之品清热而除水、补虚、解表，缘于营阴耗散者宜用麦冬类方、 百合类方清热养营；营卫之合异常所致之失眠缘于水饮为主者可用茯苓、桂枝配伍以温阳化饮，缘于瘀血为主者可用桃红 四物汤类方以活血化瘀，缘于水血共病者可用茯苓、白芍配伍以水血同治。以营卫输布离合为切入点辨治营卫不和之失眠， 能紧扣失眠的核心病机，执简驭繁，可为临证辨治失眠提供参考。

Disharmony between nutritive qi（ying）and defensive qi（wei）is the core pathogenesis of insomnia. The normal function of ying-wei in the generation，dispersion，divergence and aggregation is the precondition for the realization of the coordination between ying and wei. The disordered function of ying-wei in the generation， dispersion，divergence and aggregation will cause the disharmony between ying and wei，and then the insomnia occurs. For the treatment of insomnia caused by the disordered function of ying-wei in the generation， Guizhi Decoction associated prescriptions are used for strengthening middle energizer and nourishing ying and wei. For the treatment of insomnia caused by the disordered function of ying-wei in the dispersion， Mahuang Decoction associated prescriptions are used to relieve the exterior and eliminate the pathogen for insomnia patients with the manifestations of the attack of exopathogens， and Xiao Chaihu Decoction associated prescriptions are used to dredge the triple energizer for insomnia patients with the dysfunction of the triple energizer. For the treatment of insomnia caused by the disordered function of ying-wei in the divergence， Rhei Radix et Rhizoma associated bitter-cold prescriptions are used to purge the interior heat for insomnia patients with abundant interior heat syndrome，Gypsum Fibrosum associated pungent-cold prescriptions are used to release muscles and clear heat for insomnia patients with the interior heat complicated by exterior syndrome， Natrii Sulfas Exsiccatus associated salty-cold prescriptions are used to clear heat，moisten dryness and dissipate the masses for insomnia patients with interior heat complicated by dryness syndrome， sour-cold medicines are used to clear heat and remove retained water，supplement deficiency and relieve exterior for insomnia patients with interior heat complicated by waterretention syndrome， deficiency syndrome and exterior syndrome， and Ophiopogonis Radix associated prescriptions and Lillli Bulbus associated prescriptions are used to clear heat and nourish ying for insomnia patients with the consumption of ying and yin. For the treatment of insomnia caused by the disordered function of ying-wei in the aggregation，the compatibility of Poria and Cinnamomi Ramulus is used for warming yang and resolving fluid retention in patients with fluid retention，Taohong Siwu Decoction associated prescriptions are used to activate blood and remove stasis in patients with predominance of blood stasis syndrome，the compatibility of Poria and Paeoniae Radix Alba are used to treat retained water and blood stasis in patients with water-blood co-morbidity. Treating insomnia caused by disharmony between ying and wei from the perspective of the function of ying-wei in the generation， dispersion，divergence and aggregation is aimed at the core pathogenesis of insomnia，which makes the treatment easy to be carried out，and can provide reference for clinical differentiation and treatment of insomnia.

R256.23

国家中医药管理局中医药古籍文献和特色技术传承专项（编号：GZY-KJS-2020-071）；广东省中医药局中医药科研项目（编号： 20202003）；广东省中医院治未病专项（编号：YN2019ZWB03，YN2020ZWB04）