目的：探讨上下交泰针刺联合交泰汤治疗心肾不交型失眠的临床疗效，以及对患者血清神经递质水平的影响。方法：选取心肾不交型失眠患者120例，按照随机数字表法分为汤剂组、针刺组、联合组各40例。其中汤剂组采用交泰汤治疗，针刺组采用上下交泰针刺治疗，联合组采用上下交泰针刺联合交泰汤治疗，4周为1个疗程，治疗2个疗程。比较治疗前、治疗4周后、治疗8周后中医证候积分、失眠严重程度指数（ISI）评分、客观睡眠质量[总睡眠时间（TST）、睡眠潜伏期（SL）、入睡后觉醒时长（WASO）]、焦虑自评量表（SAS）评分、匹兹堡睡眠质量指数（PSQI）评分。对治疗前、治疗4周后、治疗8周后血清神经递质[γ-氨基丁酸（GABA）、5-羟色胺（5-HT）、多巴胺（DA）]水平进行比较。并对三组临床疗效与安全性进行评估。结果：与本组治疗前比较，治疗4周后、8周后三组患者的TST、5-HT水平均升高，中医证候积分、ISI评分、SL、WASO、DA水平、SAS评分、PSQI评分均下降（均P<0.05）。联合组与针刺组治疗后比较，治疗8周后，联合组患者TST、GABA水平、5-HT水平均高于针刺组，中医证候积分、ISI评分、SL、WASO、DA水平、PSQI评分均低于针刺组（均P<0.017）。联合组与汤剂组治疗后比较，治疗8周后，联合组患者TST、GABA水平均高于汤剂组，中医证候积分、ISI评分、SL、WASO、DA水平、SAS评分、PSQI评分均低于汤剂组（均P<0.017）。联合组的治疗总有效率为90.00%，高于针刺组（65.00%）与汤剂组（70.00%）(P<0.017)；而针刺组的治疗总有效率与汤剂组比较，差异无统计学意义（P>0.017）。结论：采用上下交泰针刺联合交泰汤治疗心肾不交型失眠，临床疗效较高，可降低中医证候积分、改善睡眠质量，同时上调血清GABA、5-HT水平，下调DA水平，调节神经递质平衡，缓解焦虑，且安全性良好。

Objective:To evaluate the clinical efficacy of Upper-Lower Jiaotai Acupuncture combined with Jiaotai Decoction（交泰汤） in treating insomnia due to heart-kidney disharmony,and to investigate its effect on serum neurotransmitter levels. Method:A total of 120 patients with insomnia due to heartkidney disharmony were enrolled and randomly assigned into three groups by using random number table:the Decoction Group,the Acupuncture Group,and the Combination Group. The Decoction Group received oral Jiaotai Decoction;the Acupuncture Group received Upper-Lower Jiaotai Acupuncture;and the Combination Group received both treatments. The intervention lasted for 4 weeks per course,with a total of 2 courses. Outcomes were assessed at baseline,week 4,and week 8. These included the traditional Chinese medicine(TCM) syndrome score,the Insomnia Severity Index(ISI),objective sleep quality parameters [total sleep time(TST),sleep latency(SL),and wake after sleep onset(WASO)],the Self-Rating Anxiety Scale(SAS),and the Pittsburgh Sleep Quality Index(PSQI). Additionally,serum levels of neurotransmitters [gamma-aminobutyric acid(GABA),5-hydroxytryptamine(5-HT),and dopamine(DA)] were measured and compared across the three groups. Finally,the clinical efficacy and safety profiles were evaluated. Results:Compared with baseline within each group,TST,and 5-HT levels increased significantly,while TCM syndrome scores,ISI,SL,WASO,DA levels,SAS scores,and PSQI scores decreased significantly after 4 weeks and 8 weeks in all three groups(all P<0.05). When comparing the Combination Group with the Acupuncture Group,after 8 weeks,the Combination Group exhibited significantly higher TST,GABA,and 5-HT levels,and significantly lower TCM syndrome scores,ISI,SL,WASO,DA levels,and PSQI scores(P<0.017 for all). Compared with the Decoction Group,after 8 weeks,the Combination Group showed significantly higher TST and GABA levels,and significantly lower TCM syndrome scores,ISI,SL,WASO,DA levels,SAS scores,and PSQI scores(P<0.017 for all). The total effective rate in the Combination Group was 90.00%,which was significantly higher than that in the Acupuncture Group(65.00%) and the Decoction Group(70.00%)(P<0.017),while there was no significant difference in the treatment effective rate between the Acupuncture Group and the Decoction Group(P>0.017). Conclusions:The combination of Upper-Lower Jiaotai Acupuncture and Jiaotai Decoction demonstrates high clinical efficacy in treating insomnia due to heart-kidney disharmony. This integrated therapy significantly reduces TCM syndrome scores and improves sleep quality,up-regulates serum GABA and 5-HT levels,down-regulates DA levels,rebalances neurotransmitters,alleviates anxiety,and exhibits satisfactory safety.