针刺治疗心肾不交型失眠临床研究进展

Clinical Research Progress of Acupuncture in Treating Insomnia of Heart-Kidney Disharmony Type

摘要: 心肾不交是失眠的核心证型之一，在失眠患者中占比约33%，其病机为肾水亏虚不能上济心火、心火亢盛不能下温肾水，导致阴阳失交、阳不入阴。针刺以“交通心肾”为基本法则，本文系统梳理近十年的临床研究进展。取穴包括内关、神门、太溪、肾俞等常规腧穴，以及脐针、腹针、董氏奇穴等创新思路；针法上，烧山火、透天凉、苍龟探穴等复式手法及电针参数优化成为热点；针具改良以穴位埋线、皮内针为代表；联合治疗以针药并用、针刺联合耳穴压豆最为常见。现有证据表明，针刺可有效改善匹兹堡睡眠质量指数评分、降低中医证候积分、减少催眠药物使用，且安全性良好。目前研究在生物学机制探索、针刺方案标准化及多中心大样本随机对照试验方面仍存在不足。未来应加强高质量临床证据，深入阐释“交通心肾”的神经–内分泌–免疫网络基础，推动针刺治疗的规范化与个体化。

Abstract: Heart-kidney disharmony is one of the core patterns of insomnia, accounting for approximately 33% of patients. Its pathogenesis is characterized by deficiency of kidney water failing to nourish heart fire and exuberance of heart fire failing to warm kidney water, leading to imbalance between yin and yang and failure of yang to enter yin. Acupuncture treatment adopts “restoring communication between heart and kidney” as the basic principle. This paper systematically reviews the clinical research progress over the past decade. In terms of acupoint selection, conventional points such as Neiguan (PC6), Shenmen (HT7), Taixi (KI3), and Shenshu (BL23) are used, along with innovative approaches including umbilical acupuncture, abdominal acupuncture, and Master Tung’s extraordinary points. Regarding needling techniques, compound manipulations such as “burning mountain fire” (shao shan huo), “penetrating heaven coolness” (tou tian liang), and “green turtle exploring its cave” (cang gui tan xue), as well as optimization of electroacupuncture parameters have become research hotspots. In terms of instrument modification, acupoint thread embedding and intradermal needling are representative. The most common combined therapies include acupuncture plus Chinese herbal medicine and acupuncture plus auricular point seed pressing. Current evidence shows that acupuncture can effectively improve Pittsburgh Sleep Quality Index scores, reduce traditional Chinese medicine pattern scores, decrease the use of hypnotic drugs, and has a good safety profile. Current limitations include insufficient exploration of biological mechanisms, standardization of acupuncture protocols, and accumulation of multicenter large-sample randomized controlled trials. Future efforts should focus on generating high-quality evidence, in-depth elucidation of the neuro-endocrine-immune network basis of “restoring communication between heart and kidney,” and promoting standardization and individualization of acupuncture treatment.