针灸治疗失眠的中医理论与现代神经定位机制综述

A Review of the Traditional Chinese Medicine Theory and Modern Neuro-Localization Mechanisms of Acupuncture in Treating Insomnia

摘要: 失眠作为临床最常见睡眠障碍，全球患病率持续攀升，给个体健康与社会医疗带来沉重负担。针灸凭借其整体调节、安全性高、无依赖性等优势，在失眠治疗中展现出独特价值。本文系统梳理针灸治疗失眠的中医理论渊源与辨证体系，基于“神主睡眠”的核心观念，从脏腑失调、阴阳失衡、经络阻滞三个维度阐释失眠的病机。在治疗层面，归纳以神门、百会、三阴交为核心的高频选穴规律，总结毫针、电针、艾灸、耳穴及近年来兴起的激光针灸等多样化的治疗手段。进一步结合现代神经影像学与神经生物学研究成果，从脑功能网络重塑(如下丘脑–皮层连接调节、默认模式网络调制)、神经递质调控(5-羟色胺、γ-氨基丁酸、orexin系统)、神经炎症通路干预及微生物–肠–脑轴调节等角度，探讨针灸治疗失眠的现代科学内涵。文献研究表明，针灸可通过多靶点、多通路整合调节睡眠–觉醒环路，其疗效机制正从宏观临床表现向微观分子网络层面不断深入。未来研究需开展更多高质量随机对照试验，并借助多模态技术进一步揭示针灸效应的跨尺度整合机制。

Abstract: Insomnia, as the most prevalent clinical sleep disorder, has a rising global prevalence, imposing substantial burdens on individual health and healthcare systems. Acupuncture, characterized by its holistic regulation, high safety profile, and non-addictive nature, demonstrates unique therapeutic value in insomnia management. This paper systematically reviews the theoretical foundations and syndrome differentiation system of acupuncture for insomnia within traditional Chinese medicine. Grounded in the core concept that “the mind governs sleep”, it elucidates the pathogenesis from three dimensions: visceral dysfunction, yin-yang imbalance, and meridian obstruction. At the therapeutic level, it summarizes the acupoint selection patterns centered around Shenmen (HT7), Baihui (DU20), and Sanyinjiao (SP6), and outlines diversified intervention methods including manual acupuncture, electroacupuncture, moxibustion, auricular therapy, and the emerging laser acupuncture. Furthermore, integrating contemporary neuroimaging and neurobiological findings, this review explores the modern scientific underpinnings of acupuncture’s effects on insomnia from perspectives such as cerebral functional network remodeling (e.g., hypothalamic-cortical connectivity regulation, default mode network modulation), neurotransmitter regulation (serotonin, γ-aminobutyric acid, orexin system), intervention in neuroinflammatory pathways, and modulation of the microbiota-gut-brain axis. Current literature indicates that acupuncture can integratively regulate the sleep-wake circuitry through multi-target and multi-pathway mechanisms. The understanding of its therapeutic mechanisms is advancing from macroscopic clinical manifestations toward microscopic molecular networks. Future research necessitates more high-quality randomized controlled trials and the application of multimodal technologies to further elucidate the cross-scale integrative mechanisms underlying acupuncture’s effects.