针刺治疗抑郁伴失眠障碍的临床研究进展与 机制探讨
Clinical Progress and Mechanisms of Acupuncture for Depression Comorbid with Insomnia
DOI: 10.12677/acm.2026.1631052, PDF,   
作者: 殷 悦：山东中医药大学第一临床医学院，山东 济南；郑 艳*：青岛市中医医院心血管三科(全科医学科)，山东 青岛
关键词: 针刺；抑郁症；失眠；神经递质；HPA轴；神经可塑性；Acupuncture； Depression； Insomnia； Neurotransmitters； HPA Axis； Neural Plasticity
摘要: 抑郁症与失眠常互为因果，形成恶性循环，严重阻碍疾病康复。本文综述了针刺治疗抑郁伴失眠的临床进展与神经生物学机制。临床研究显示，针刺基于“调神”理论，能同步改善患者的客观睡眠结构与抑郁情绪，且远期疗效稳固。机制研究表明，针刺主要通过“多靶点、多层次”的整体调节发挥作用：(1) 调节神经递质，平衡5-HT、NE等水平，重塑“觉醒–睡眠”稳态；(2) 调控神经内分泌，抑制HPA轴过度激活，阻断应激反应；(3) 修复神经结构，通过抗炎并激活BDNF-TrkB通路，促进海马神经发生与可塑性恢复。针刺通过“形神同调”打破病理恶性循环，未来应进一步聚焦于精准化治疗方案与客观评价体系的研究。
Abstract: Depression and insomnia frequently coexist and interact causally, creating a vicious cycle that hinders recovery. This article reviews the clinical progress and neurobiological mechanisms of acupuncture for depression comorbid with insomnia. Clinically, based on the theory of “regulating the mind” (Tiao Shen), acupuncture synchronously improves objective sleep architecture and depressive mood with stable long-term efficacy. Mechanistically, acupuncture functions through a “multi-target, multi-level” holistic regulation: (1) Modulating neurotransmitters by balancing 5-HT and NE levels to reshape “sleep-wake” homeostasis; (2) Regulating the neuroendocrine system by inhibiting HPA axis overactivation to block stress responses; and (3) Repairing neural structure by suppressing inflammation and activating the BDNF-TrkB pathway to promote hippocampal neurogenesis and plasticity. By “treating both body and mind,” acupuncture breaks this pathological cycle. Future research should focus on precision treatment protocols and objective evaluation systems.
文章引用：殷悦, 郑艳. 针刺治疗抑郁伴失眠障碍的临床研究进展与 机制探讨[J]. 临床医学进展, 2026, 16(3): 2526-2534. https://doi.org/10.12677/acm.2026.1631052

参考文献

[1] Fang, H., Tu, S., Sheng, J. and Shao, A. (2019) Depression in Sleep Disturbance: A Review on a Bidirectional Relationship, Mechanisms and Treatment. Journal of Cellular and Molecular Medicine, 23, 2324-2332. [Google Scholar] [CrossRef] [PubMed]
[2] Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., et al. (2011) Insomnia as a Predictor of Depression: A Meta-Analytic Evaluation of Longitudinal Epidemiological Studies. Journal of Affective Disorders, 135, 10-19. [Google Scholar] [CrossRef] [PubMed]
[3] Liu, R.T., Steele, S.J., Hamilton, J.L., Do, Q.B.P., Furbish, K., Burke, T.A., et al. (2020) Sleep and Suicide: A Systematic Review and Meta-Analysis of Longitudinal Studies. Clinical Psychology Review, 81, Article 101895. [Google Scholar] [CrossRef] [PubMed]
[4] Ogawa, Y., Takeshima, N., Hayasaka, Y., Tajika, A., Watanabe, N., Streiner, D., et al. (2019) Antidepressants plus Benzodiazepines for Adults with Major Depression. Cochrane Database of Systematic Reviews, 6, CD001026. [Google Scholar] [CrossRef] [PubMed]
[5] Kwaśny, A., Włodarczyk, A., Dywel, A., Szarmach, J., Strandberg, O. and Cubała, W.J. (2023) Residual Insomnia in Major Depressive Disorder: A Systematic Review. Frontiers in Psychiatry, 14, Article 1190415. [Google Scholar] [CrossRef] [PubMed]
[6] 梁婷婷, 郑梦捷, 杨艺娇. 通督调神针法联合西药治疗抑郁症伴失眠的疗效观察及对血清SOD和BDNF水平的影响[J]. 上海针灸杂志, 2025, 44(11): 1308-1313.
[7] 李仲贤, 张潘, 姬乔玉, 等. 调神固本整合针灸治疗抑郁失眠共病24例[J]. 中国针灸, 2025, 45(11): 1559-1564.
[8] 阎路达, 李仲贤, 张瑜, 等. 疏肝调神法针刺联合西药治疗新冠疫情隔离经历致抑郁失眠共病: 多中心随机对照试验[J]. 中国针灸, 2023, 43(3): 255-260.
[9] Kuang, H.J., Yang, H.S., Feng, Y.X., et al. (2025) Efficacy and Safety of Acupuncture Therapies for Adult Patients with Mild and Moderate Major Depressive Disorder: A Systematic Review and Meta-Analysis. Journal of Integrative Medicine, 23, 471-491. [Google Scholar] [CrossRef] [PubMed]
[10] Yin, X., Li, W., Liang, T., Lu, B., Yue, H., Li, S., et al. (2022) Effect of Electroacupuncture on Insomnia in Patients with Depression: A Randomized Clinical Trial. JAMA Network Open, 5, e2220563. [Google Scholar] [CrossRef] [PubMed]
[11] Gao, Y., Li, T., Lu, Q., Wang, J., Wang, Y. and Wang, L. (2025) Electroacupuncture for Treating Depression-Related Insomnia: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry, 16, Article 1610107. [Google Scholar] [CrossRef] [PubMed]
[12] Dong, B., Chen, Z., Yin, X., Li, D., Ma, J., Yin, P., et al. (2017) The Efficacy of Acupuncture for Treating Depression-Related Insomnia Compared with a Control Group: A Systematic Review and Meta-Analysis. BioMed Research International, 2017, 1-11. [Google Scholar] [CrossRef] [PubMed]
[13] Oh, J., Petersen, C., Walsh, C.M., Bittencourt, J.C., Neylan, T.C. and Grinberg, L.T. (2018) The Role of Co-Neurotransmitters in Sleep and Wake Regulation. Molecular Psychiatry, 24, 1284-1295. [Google Scholar] [CrossRef] [PubMed]
[14] Duan, D., Tu, Y., Yang, X. and Liu, P. (2016) Electroacupuncture Restores 5-HT System Deficit in Chronic Mild Stress-Induced Depressed Rats. Evidence-Based Complementary and Alternative Medicine, 2016, Article 7950635. [Google Scholar] [CrossRef] [PubMed]
[15] Monti, J.M. (2011) Serotonin Control of Sleep-Wake Behavior. Sleep Medicine Reviews, 15, 269-281. [Google Scholar] [CrossRef] [PubMed]
[16] Zhao, D., Yu, Y., Shen, Y., Liu, Q., Zhao, Z., Sharma, R., et al. (2019) Melatonin Synthesis and Function: Evolutionary History in Animals and Plants. Frontiers in Endocrinology, 10, Article 249. [Google Scholar] [CrossRef] [PubMed]
[17] Hong, J., Chen, J., Kan, J., Liu, M. and Yang, D. (2020) Effects of Acupuncture Treatment in Reducing Sleep Disorder and Gut Microbiota Alterations in PCPA-Induced Insomnia Mice. Evidence-Based Complementary and Alternative Medicine, 2020, Article 3626120. [Google Scholar] [CrossRef] [PubMed]
[18] Wu, J. and Zhao, Z. (2024) Acupuncture in Circadian Rhythm Sleep-Wake Disorders and Its Potential Neurochemical Mechanisms. Frontiers in Neuroscience, 18, Article 1346635. [Google Scholar] [CrossRef] [PubMed]
[19] Gong, L., Shi, M., Wang, J., Xu, R., Yu, S., Liu, D., et al. (2021) The Abnormal Functional Connectivity in the Locus Coeruleus-Norepinephrine System Associated with Anxiety Symptom in Chronic Insomnia Disorder. Frontiers in Neuroscience, 15, Article 678465. [Google Scholar] [CrossRef] [PubMed]
[20] Morris, L.S., McCall, J.G., Charney, D.S. and Murrough, J.W. (2020) The Role of the Locus Coeruleus in the Generation of Pathological Anxiety. Brain and Neuroscience Advances, 4, Article 239821282093032. [Google Scholar] [CrossRef] [PubMed]
[21] Hayat, H., Regev, N., Matosevich, N., Sales, A., Paredes-Rodriguez, E., Krom, A.J., et al. (2020) Locus Coeruleus Norepinephrine Activity Mediates Sensory-Evoked Awakenings from Sleep. Science Advances, 6, eaaz4232. [Google Scholar] [CrossRef] [PubMed]
[22] Chen, Z., Jiang, T., Yin, X., Li, B., Tan, Z. and Guo, J. (2023) The Increased Functional Connectivity between the Locus Coeruleus and Supramarginal Gyrus in Insomnia Disorder with Acupuncture Modulation. Frontiers in Neuroscience, 17, Article 1131916. [Google Scholar] [CrossRef] [PubMed]
[23] Lee, G. and Kim, W. (2017) The Modulatory Effect of Acupuncture on the Activity of Locus Coeruleus Neuronal Cells: A Review. Evidence-Based Complementary and Alternative Medicine, 2017, Article 9785345. [Google Scholar] [CrossRef] [PubMed]
[24] Russo, S.J. and Nestler, E.J. (2013) The Brain Reward Circuitry in Mood Disorders. Nature Reviews Neuroscience, 14, 609-625. [Google Scholar] [CrossRef] [PubMed]
[25] Belujon, P. and Grace, A.A. (2017) Dopamine System Dysregulation in Major Depressive Disorders. International Journal of Neuropsychopharmacology, 20, 1036-1046. [Google Scholar] [CrossRef] [PubMed]
[26] Wang, X., Wang, J., Han, R., Yu, C. and Shen, F. (2024) Neural Circuit Mechanisms of Acupuncture Effect: Where Are We Now? Frontiers in Neurology, 15, Article 1399925. [Google Scholar] [CrossRef] [PubMed]
[27] Yang, Y., Wei, X., Tian, J., Zhu, Y., Jia, S. and Shu, Q. (2023) Scalp Electroacupuncture Targeting the VTADA Neurons to Relieve Negative Emotions and Promote the Alleviation of Chronic Pain. Frontiers in Neuroscience, 17, Article 1323727. [Google Scholar] [CrossRef] [PubMed]
[28] Pan, W., Wang, S., Liu, Y., Qin, S., Ge, F., Yuan, X., et al. (2025) Electroacupuncture Ameliorates Sleep Deprivation-Induced Insomnia in Mice by Regulating the Dopaminergic Projections from VTA to NAc. Experimental Neurology, 392, Article 115351. [Google Scholar] [CrossRef] [PubMed]
[29] Passos, G.S., Youngstedt, S.D., Rozales, A.A.R.C., Ferreira, W.S., De-Assis, D.E., De-Assis, B.P., et al. (2023) Insomnia Severity Is Associated with Morning Cortisol and Psychological Health. Sleep Science, 16, 92-96. [Google Scholar] [CrossRef] [PubMed]
[30] Walker, W.H., Walton, J.C., DeVries, A.C. and Nelson, R.J. (2020) Circadian Rhythm Disruption and Mental Health. Translational Psychiatry, 10, Article No. 28. [Google Scholar] [CrossRef] [PubMed]
[31] Cole, A.B., Montgomery, K., Bale, T.L. and Thompson, S.M. (2022) What the Hippocampus Tells the HPA Axis: Hippocampal Output Attenuates Acute Stress Responses via Disynaptic Inhibition of CRF+ PVN Neurons. Neurobiology of Stress, 20, Article 100473. [Google Scholar] [CrossRef] [PubMed]
[32] Li, P., Zhao, J., Wei, X., Luo, L., Chu, Y., Zhang, T., et al. (2024) Acupuncture May Play a Key Role in Anti-Depression through Various Mechanisms in Depression. Chinese Medicine, 19, Article No. 135. [Google Scholar] [CrossRef] [PubMed]
[33] Zheng, J.Y., Zhu, J., Wang, Y., et al. (2024) Effects of Acupuncture on Hypothalamic-Pituitary-Adrenal Axis: Current Status and Future Perspectives. Journal of Integrative Medicine, 22, 445-458. [Google Scholar] [CrossRef] [PubMed]
[34] Anacker, C., Zunszain, P.A., Carvalho, L.A. and Pariante, C.M. (2011) The Glucocorticoid Receptor: Pivot of Depression and of Antidepressant Treatment? Psychoneuroendocrinology, 36, 415-425. [Google Scholar] [CrossRef] [PubMed]
[35] Wang, S.J., Zhang, J.J. and Qie, L.L. (2014) Acupuncture Relieves the Excessive Excitation of Hypothalamic‐Pituitary‐Adrenal Cortex Axis Function and Correlates with the Regulatory Mechanism of GR, CRH, and ACTHR. Evidence-Based Complementary and Alternative Medicine, 2014, Article 495379. [Google Scholar] [CrossRef] [PubMed]
[36] You, W., Shi, Y.J., Han, Y.J., et al. (2010) Effect of Electroacupuncture of “Baihui” (GV 20)-“Yintang” (EX-HN 3) on the Expression of Glucocorticoid and Glucocorticoid Receptor mRNA of the Chronic Stress Model Rats. Acupuncture Research, 35, 261-266.
[37] Nadjar, A., Wigren, H.M. and Tremblay, M. (2017) Roles of Microglial Phagocytosis and Inflammatory Mediators in the Pathophysiology of Sleep Disorders. Frontiers in Cellular Neuroscience, 11, Article 250. [Google Scholar] [CrossRef] [PubMed]
[38] Himmerich, H., Patsalos, O., Lichtblau, N., Ibrahim, M.A.A. and Dalton, B. (2019) Cytokine Research in Depression: Principles, Challenges, and Open Questions. Frontiers in Psychiatry, 10, Article 30. [Google Scholar] [CrossRef] [PubMed]
[39] Wang, M., Wei, J., Yang, X., et al. (2019) The Level of IL-6 Was Associated with Sleep Disturbances in Patients with Major Depressive Disorder. Neuropsychiatric Disease and Treatment, 15, 1695-1700. [Google Scholar] [CrossRef] [PubMed]
[40] Zhang, N., Park, K., Chung, S. and Yim, Y.S. (2025) IL-1b and TNF-A-Driven Sleep Alterations: Neuroimmune Mechanisms and Behavioral Implications. Brain, Behavior, & Immunity—Health, 50, Article 101139. [Google Scholar] [CrossRef] 
[41] Pinto, M.J., Cottin, L., Dingli, F., Laigle, V., Ribeiro, L.F., Triller, A., et al. (2023) Microglial TNFα Orchestrates Protein Phosphorylation in the Cortex during the Sleep Period and Controls Homeostatic Sleep. The EMBO Journal, 42, e111485. [Google Scholar] [CrossRef] [PubMed]
[42] Ni, D., Zhang, J., Qi, R., Huang, Y., Li, M. and Duan, L. (2025) Effect of Acupuncture on Neuroinflammatory Responses in Depression Animals: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry, 16, Article 1624648. [Google Scholar] [CrossRef] 
[43] Zhang, M.M., Zhao, J.W., Li, Z.Q., Shao, J. and Gao, X.Y. (2023) Acupuncture at Back-Shu Point Improves Insomnia by Reducing Inflammation and Inhibiting the ERK/NF-κB Signaling Pathway. World Journal of Psychiatry, 13, 340-350. [Google Scholar] [CrossRef] [PubMed]
[44] Gao, T., Xiang, H., Wu, Q.N., Zhu, L.S., Pei, W.J., Fu, W.J., et al. (2025) Advances in the Research of Comorbid Insomnia and Depression: Mechanisms, Impacts, and Interventions. Frontiers in Psychiatry, 16, Article 1468212. [Google Scholar] [CrossRef] [PubMed]
[45] An, J.J., Gharami, K., Liao, G., Woo, N.H., Lau, A.G., Vanevski, F., et al. (2008) Distinct Role of Long 3’ UTR BDNF mRNA in Spine Morphology and Synaptic Plasticity in Hippocampal Neurons. Cell, 134, 175-187. [Google Scholar] [CrossRef] [PubMed]
[46] Zagrebelsky, M., Tacke, C. and Korte, M. (2020) BDNF Signaling during the Lifetime of Dendritic Spines. Cell and Tissue Research, 382, 185-199. [Google Scholar] [CrossRef] [PubMed]
[47] Lyons, L.C., Vanrobaeys, Y. and Abel, T. (2023) Sleep and Memory: The Impact of Sleep Deprivation on Transcription, Translational Control, and Protein Synthesis in the Brain. Journal of Neurochemistry, 166, 24-46. [Google Scholar] [CrossRef] [PubMed]
[48] Ditmer, M., Gabryelska, A., Turkiewicz, S. and Sochal, M. (2023) Investigating the Role of BDNF in Insomnia: Current Insights. Nature and Science of Sleep, 15, 1045-1060. [Google Scholar] [CrossRef] [PubMed]
[49] Miao, C., Li, X. and Zhang, Y. (2023) Effect of Acupuncture on BDNF Signaling Pathways in Several Nervous System Diseases. Frontiers in Neurology, 14, Article 1248348. [Google Scholar] [CrossRef] [PubMed]
[50] Yang, P., Chen, H., Wang, T., Su, H., Li, J., He, Y., et al. (2023) Electroacupuncture Promotes Synaptic Plasticity in Rats with Chronic Inflammatory Pain-Related Depression by Upregulating BDNF/TrkB/CREB Signaling Pathway. Brain and Behavior, 13, e3310. [Google Scholar] [CrossRef] [PubMed]
[51] Pei, W., Meng, F., Deng, Q., Zhang, B., Gu, Y., Jiao, B., et al. (2021) Electroacupuncture Promotes the Survival and Synaptic Plasticity of Hippocampal Neurons and Improvement of Sleep Deprivation-Induced Spatial Memory Impairment. CNS Neuroscience & Therapeutics, 27, 1472-1482. [Google Scholar] [CrossRef] [PubMed]

为你推荐