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.

insomnia  /  pathogenesis  /  signaling pathways  /  neurotransmitters  /  inflammatory response  /  HPA axis  /  clock genes  /  traditional Chinese medicine