A Discussion on the Mechanisms and Research Progress of the Combined Treatment of Insomnia Due to Deficiency of Both the Heart and Spleen with Acupuncture and Gui Pi Decoction Based on the Brain-Gut Axis Theory

Abstract

Insomnia is a common clinical sleep disorder, and deficiency of both the heart and spleen is one of its primary clinical patterns. The core pathogenesis involves deficiency of qi and blood, inadequate nourishment of the heart spirit, and dysfunction of the spleen and stomach. In modern medicine, the gut-brain axis theory reveals a bidirectional signaling mechanism between the gut and the central nervous system; this pathway plays a key role in sleep regulation and aligns with the classical TCM theories that “when the stomach is not harmonious, sleep is disturbed” and “the heart and spleen are interrelated.” The combination of acupuncture and Gui Pi Decoction has demonstrated significant efficacy in the clinical treatment of insomnia caused by deficiency of both the heart and spleen. It intervenes in the gut-brain axis through multiple pathways—including the regulation of neurotransmitter secretion, gut microbiota homeostasis, hypothalamic-pituitary-adrenal (HPA) axis function, and immune-inflammatory responses—ultimately achieving the goal of improving sleep. Taking the gut-brain axis theory as a starting point, this article reviews the pathological mechanisms of heart-spleen deficiency-type insomnia from both traditional Chinese and Western medical perspectives. It elaborates on the mechanisms of action, research progress, and current challenges of the combination of acupuncture and Gui Pi Decoction, providing a theoretical basis for further mechanistic research and the optimization of clinical applications of this therapy.