广泛性焦虑障碍的发病机制及针灸治疗的研究进展

Advances in the Pathogenesis and Acupuncture Treatment of Generalized Anxiety Disorder

摘要: 广泛性焦虑障碍(GAD)是一种以持续性过度担忧和躯体症状为特征的常见精神障碍，其发病机制涉及杏仁核、前额叶皮层、前扣带皮层及海马等核心脑区的功能异常，以及5-羟色胺、γ-氨基丁酸、谷氨酸等多神经递质系统失调。中医认为广泛性焦虑障碍属“郁证”“脏躁”范畴，病机与心、肝、脾功能失调及脑神失司密切相关。针灸通过多靶点调控发挥治疗作用：一方面通过百会、内关、太冲等穴位配伍调节“神–气–脏”功能，体现“调神解郁”治则；另一方面通过调节神经递质、抑制炎症反应及修复神经环路功能改善焦虑症状。当前研究仍存在临床样本量不足、机制深度不够及治疗方案标准化程度不高等局限，未来需开展多中心大样本试验，结合神经影像与分子生物学技术，深化机制研究并推动临床应用的规范化。

Abstract: Generalized Anxiety Disorder (GAD) is a prevalent psychiatric condition characterized by persistent excessive worry and somatic symptoms. Its pathogenesis involves functional impairments in key brain regions—including the amygdala, prefrontal cortex, anterior cingulate cortex, and hippocampus—and dysregulation of multiple neurotransmitter systems such as serotonin, GABA, and glutamate. In traditional Chinese medicine (TCM), GAD is categorized under “depression syndrome” and “visceral agitation”, primarily associated with dysfunction of the heart, liver, and spleen, as well as mental dysregulation. Acupuncture exerts its therapeutic effects through multi-target mechanisms: on the one hand, it modulates “spirit-Qi-viscera” interactions via acupoint combinations (e.g., Baihui GV20, Neiguan PC6, Taichong LR3), reflecting the TCM principle of “calming the mind and relieving stagnation”; on the other hand, it alleviates anxiety symptoms by rebalancing neurotransmitters, suppressing neuroinflammation, and restoring neural circuit functionality. Current limitations include small sample sizes, insufficient mechanistic depth, and lack of standardized treatment protocols. Future directions should emphasize large-scale, multi-center trials, integrate advanced neuroimaging and molecular profiling, and establish evidence-based clinical guidelines to standardize practice.