黄连阿胶汤治疗失眠的研究进展

Huanglian Ejiaotang in Treating Insomnia： A Review

摘要:

失眠是临床中最为常见的睡眠障碍性疾病，长期失眠会影响人们的日常生活和工作。目前，临床中治疗失眠以镇静催眠类药物为主，虽见效快，但存在诸多不良反应。中医在治疗失眠方面采取辨证论治的方法，主张治病求本，具有不良反应少，远期效果平稳、患者依从性好的优点。黄连阿胶汤首载于汉代张仲景的《伤寒杂病论》，具有滋阴降火，除烦安神之功效。有临床研究显示，黄连阿胶汤常用于治疗失眠，同时与其他经方合用或联合西药及其他疗法可起到叠加的作用，提高治疗效果。有研究表明，黄连阿胶汤治疗失眠的作用机制可能与调节下丘脑-垂体-肾上腺轴（HPA轴）、5-羟色胺（5-HT）、去甲肾上腺素（NE）、多巴胺（DA）等中枢神经递质、肠道菌群以及抑制炎性因子等相关，其治疗失眠的有效成分有小檗碱、黄芩苷、黄芩素、白芍总苷、胶原蛋白等。该文主要从理论基础、临床研究、作用机制等几个方面对黄连阿胶汤治疗失眠进行讨论，并总结了黄连阿胶汤治疗失眠的最新研究进展，以期为临床诊疗失眠提供更丰富的思路。

Abstract:

Insomnia is the most common sleep disorder in clinical practice， and prolonged insomnia can significantly impact daily life and work. Currently， the clinical treatment of insomnia primarily relies on sedative and hypnotic drugs， which， although fast-acting， come with numerous adverse reactions. Traditional Chinese medicine （TCM） approaches the treatment of insomnia by employing syndrome differentiation and focusing on addressing the root cause of the disease. This approach is characterized by fewer adverse reactions， stable long-term effects， and better patient compliance. Huanglian Ejiaotang was first recorded in Zhang Zhongjing's Treatise on Febrile and Miscellaneous Diseases（《伤寒杂病论》） during the Han dynasty. It has the effects of nourishing Yin， reducing fire， eliminating irritability， and calming the nerves. Clinical studies have shown that Huanglian Ejiaotang is frequently used to treat insomnia and， when combined with other classic prescriptions， Western medicine， or other therapies， it can have a synergistic effect， thereby enhancing therapeutic outcomes. Research indicates that the mechanism of action of Huanglian Ejiaotang in treating insomnia may be related to the regulation of the hypothalamic-pituitary-adrenal （HPA） axis， 5-hydroxytryptamine （5-HT）， norepinephrine （NE）， dopamine （DA）， central neurotransmitters， gut microbiota， and the inhibition of inflammatory factors. The active components of Huanglian Ejiaotang that are effective in treating insomnia include berberine， baicalin， baicalein， total glucosides of paeony， and collagen. This article discussed the treatment of insomnia with Huanglian Ejiaotang from several perspectives， including its theoretical foundation， clinical research， and mechanisms of action， and also summarized the latest research progress on Huanglian Ejiaotang for insomnia， with the aim of providing more comprehensive ideas for the clinical diagnosis and treatment of insomnia.