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失眠的发生、维持及共病演变与昼夜节律失衡密切相关。中枢—外周时钟失同步、睡眠稳态门控受扰及时钟基因网络异常，可促进神经高唤醒、免疫炎症反应和褪黑素、皮质醇时序紊乱，形成神经—免疫—内分泌交互放大。本文梳理上述机制，并结合“天人相应”“阴阳消长”“营卫失和”“心主神明”等理论，阐释“时序失调—神明失宁”病机链。中医药干预应以辨证论治为核心：现代睡眠诊断界定疾病类型与安全边界，证候辨识决定治法、方药和穴位，营卫昼夜循行与子午流注指导施治时机，形成分证、分时及方药—针刺—外治协同路径。客观睡眠与节律指标用于疗效评价和机制验证。未来需统一证候与时相记录标准，并检验辨证和择时的独立及交互效应。
Abstract：The onset， persistence， and comorbid progression of insomnia are closely associated with circadian rhythm dysregulation. Desynchronization of central and peripheral clocks， disturbed sleep-homeostatic gating， and clock-gene network abnormalities may promote neural hyperarousal， immune inflammation， and temporal disturbances in melatonin and cortisol， thereby amplifying neuro-immune-endocrine interactions. This review summarizes these mechanisms and， drawing on traditional Chinese medicine (TCM) theories of correspondence between human and nature (天人相应)， waxing and waning of yin-yang (阴阳消长)， disharmony between nutrient qi and defensive qi (营卫失和)， and the heart governs the spirit-mind (心主神明)， interprets a pathogenic chain from temporal dysregulation to disturbance of the spirit-mind (神明失宁). Syndrome differentiation should remain the core of TCM intervention. Specifically， modern sleep diagnosis defines disease categories and safety boundaries; syndrome identification determines therapeutic principles， herbal formulas， and acupoints; and the diurnal circulation of nutrient-defensive qi and midnight-noon ebb-flow (子午流注) guide treatment timing. This framework supports syndrome- and timing-based coordination of herbal medicine， acupuncture， and external therapies. Objective sleep and circadian measures serve outcome assessment and mechanism validation. Future studies should standardize syndrome definitions and phase recording and test the independent and interactive effects of syndrome differentiation and treatment timing.
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基本信息:
DOI：10.13412/j.cnki.zyyl.20260828.001
中图分类号:R256.23
引用信息:
[1]段成思,刘志勇,孔怡梦,等.昼夜节律失衡介导的神经—免疫—内分泌紊乱在失眠中的作用机制及中医药干预策略[J].中药药理与临床().DOI:10.13412/j.cnki.zyyl.20260828.001.
基金信息:
河南省自然科学基金（编号：262300420175）; 全国名老中医药专家传承工作室建设项目(国中医药人教函[2018]134号)
2026-08-28
2026-08-28
2026-08-28