失眠症作为一种全球高发且易慢性化的睡眠障碍性疾病，发病率持续攀升，常合并焦虑、抑郁等多种并发症，严重影响患者身心健康与社会功能。目前，失眠症的治疗以认知行为疗法等非药物干预为基础，存在明显睡眠功能障碍及伴随症状时需联合药物干预，但现有药物存在成瘾性、停药反跳等局限性，尚无针对失眠症的特异性根治药物。现代医学认为失眠的发病机制涉及神经递质失衡、炎症反应、氧化应激、下丘脑-垂体-肾上腺轴功能障碍、激素紊乱、生物钟基因表达异常等多因素交互作用。中医药凭借其多机制、多通路、多靶点的优势，在改善失眠核心症状、延缓病程慢性化、降低复发风险及协同改善共病状态方面显示出独特潜力。然而，当前研究仍缺乏对失眠发病机制及其相互作用关系的直观梳理，更少有将各机制与中药调控作用及信号通路进行系统对应与整合的研究。通过系统检索分析数据库文献，对失眠症的发病机制及中医药防治研究进行梳理总结，旨在为中医药治疗失眠症的临床应用提供科学依据和理论支撑。

Insomnia disorder, a highly prevalent and often chronic sleep disorder globally, exhibits a continuously rising incidence rate. It is frequently comorbid with various complications such as anxiety and depression, severely impacting patients’ physical and mental health as well as social functioning. Current treatment strategies for insomnia are primarily based on non-pharmacological interventions like cognitive behavioral therapy, while pharmacological interventions are required when significant sleep dysfunction and accompanying symptoms are present. However, existing medications are associated with limitations including addiction potential and rebound insomnia upon discontinuation, and no specific curative drugs targeting the root cause of insomnia is currently available. Modern medical research suggests that the pathogenesis of insomnia involves multifactorial interactions, including neurotransmitter imbalances, inflammatory responses, oxidative stress, hypothalamic-pituitary-adrenal axis dysfunction, hormonal disturbances, and abnormal expression of circadian clock genes. Traditional Chinese medicine (TCM), leveraging its multi-mechanism, multi-pathway, and multi-target advantages, demonstrates unique potential in improving core symptoms of insomnia, delaying disease progression, reducing relapse risk, and synergistically ameliorating comorbid conditions. Nevertheless, existing studies still lack intuitive elucidation of the pathogenesis of insomnia and its interactive relationships, and there is particularly limited research systematically correlating and integrating these mechanisms with TCM regulatory effects and signaling pathways. Therefore, this paper systematically reviews and analyzes database literature to summarize the pathogenesis of insomnia and TCM prevention and treatment research, aiming to provide scientific evidence and theoretical support for the clinical application of TCM in treating insomnia disorder.

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国家现代农业产业技术体系资助(CARS-21)