针灸治疗特发性耳鸣的研究进展

Research Progress on Acupuncture Treatment for Idiopathic Tinnitus

摘要: 特发性耳鸣(Idiopathic Tinnitus, IT)是指无明确器质性病变的主观性耳鸣。全球成人患病率约14.4%，严重影响患者生活质量。中医认为肾精亏虚为本，肝郁、痰瘀阻滞为标。临床采用耳周局部取穴联合远端脏腑配穴、辨证加减的针灸思路，常用毫针、电针、温针灸、耳穴贴压及穴位注射等疗法。现代机制研究表明，针灸可调控γ-氨基丁酸、5-羟色胺等神经递质水平，重塑听觉皮层可塑性，改善内耳微循环，并通过调节下丘脑–垂体–肾上腺轴功能打破耳鸣与负性情绪的恶性循环。针刺联合中药等综合疗法可进一步提高临床疗效，经皮耳迷走神经电刺激作为耳部神经调控技术亦显示出应用潜力。目前研究仍存在样本量有限、试验设计参差不齐及随访时间短等问题，今后需推进多中心大样本随机对照试验，深入挖掘针灸治疗特发性耳鸣的科学内涵。

Abstract: Idiopathic tinnitus (IT) refers to subjective tinnitus without clear organic lesions, with a global adult prevalence of approximately 14.4%, significantly impairing patients’ quality of life. Traditional Chinese Medicine (TCM) views deficiency of kidney essence as the root cause, with liver qi stagnation and phlegm-stasis obstruction as secondary manifestations. Clinically, acupuncture employs local auricular points combined with distant organ-corresponding points, adjusted according to syndrome differentiation. Commonly used therapies include filiform needle acupuncture, electroacupuncture, warm needling, auricular point application, and acupoint injection. Modern mechanistic studies indicate that acupuncture can regulate gamma-aminobutyric acid and 5-hydroxytryptamine levels, reshape auditory cortical plasticity, improve inner ear microcirculation, and break the vicious cycle between tinnitus and negative emotions by modulating hypothalamic-pituitary-adrenal axis function. Acupuncture combined with herbal medicine and other integrative approaches can further enhance clinical efficacy, and transcutaneous auricular vagus nerve stimulation also shows promise as an auricular neuromodulation technique. Current studies still face limitations including small sample sizes, inconsistent trial designs, and short follow-up periods. Future efforts should focus on advancing large-scale, multicenter randomized controlled trials to thoroughly elucidate the scientific mechanisms of acupuncture for idiopathic tinnitus.