活血化瘀法治疗顽固性失眠的研究进展

Research Progress on the Treatment of Refractory Insomnia with Blood-Activating and Stasis-Resolving Therapy

摘要: 顽固性失眠是临床常见难治性疾病，现代医学治疗存在药物依赖、不良反应等局限。中医学基于“久病入络”“瘀血致不寐”理论，提出活血化瘀法可作为重要干预策略。文章系统梳理该疗法的理论基础、临床研究进展及作用机制：理论层面，瘀血阻滞导致气血失调、阴阳失交是核心病机；临床研究表明，中药及针灸能显著改善PSQI评分、调节5-HT等神经递质，疗效优于西药对照组；机制研究揭示其通过抗炎、改善脑血流、调节神经递质等多靶点途径起效。当前研究存在样本量小、随访不足等问题，未来需开展多中心大样本RCT并深化机制探索。活血化瘀法为顽固性失眠提供了安全有效的治疗新方向，具有重要临床推广价值。

Abstract: Refractory insomnia is a common, difficult-to-treat condition in clinical practice. Modern medical treatments face limitations such as drug dependence and adverse effects. Based on the traditional Chinese medicine (TCM) theories of “chronic illness entering the collaterals” and “blood stasis causing insomnia”, the blood-activating and stasis-resolving method has been proposed as a significant intervention strategy. This article systematically reviews the theoretical basis, clinical research progress, and mechanisms of action of this therapeutic approach. At the theoretical level, the core pathogenesis involves blood stasis obstructing the flow, leading to disharmony of qi and blood, and disrupted interaction of yin and yang. Clinical studies demonstrate that both Chinese herbal medicine and acupuncture can significantly improve PSQI scores, regulate neurotransmitters like 5-HT, and exhibit superior efficacy compared to Western medication control groups. Mechanistic research reveals its multi-target effects, functioning through pathways such as anti-inflammation, improvement of cerebral blood flow, and modulation of neurotransmitters. Current research faces limitations, including small sample sizes and insufficient follow-up. Future studies require multicenter, large-sample randomized controlled trials (RCTs) and deeper exploration of mechanisms. The blood-activating and stasis-resolving method provides a safe and effective novel therapeutic direction for refractory insomnia, holding significant value for clinical promotion.