2026 年第 9 期 第 21 卷

基于“亢害承制”理论探讨乳腺癌相关性失眠的中医病机及治疗进展

Traditional Chinese medicine pathogenesis and treatment progress of breast cancer-related insomnia based on the theory of "excess impairment and restraint control"

作者：杨梦蕾冯鸣洪珂姚昶

英文作者：Yang Menglei Feng Ming Hong Ke Yao Chang

单位：南京中医药大学附属医院乳腺病科，南京210029

英文单位：Department of Breast Diseases the Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing 210029 China

关键词：乳腺癌；失眠；中医药疗法；病因病机；研究进展；亢害承制

英文关键词：Breastcancer;Insomnia;Chinesemedicinetherapy;Etiologyandpathogenesis;Researchprogress;Excessimpairmentandrestraintcontrol

• 摘要：

• 乳腺癌作为全球发病率首位的女性恶性肿瘤，其相关性失眠的发生率高达40%~70%，严重削弱机体免疫功能并影响预后。中医“亢害承制”理论强调脏腑间的动态平衡与自我调节，为乳腺癌相关性失眠（BCRI）的辨证施治提供了系统框架。在BCRI病理过程中，手术、化疗及内分泌治疗常致“肝阳亢盛”或“药毒为亢”，进而损及“承制”之脏，引发心肾不交、脾虚痰扰等阴阳失调状态，这与现代医学“炎症-神经-激素”轴功能紊乱高度契合。本文基于“亢害承制”理论，系统综述中医药内服与外治法在平调脏腑之亢、恢复承制功能方面的研究进展，分析其在改善睡眠结构及调节免疫微环境中的临床优势，旨在为BCRI的个体化精准治疗提供理论依据与创新思路。

• As the most common female malignant tumor worldwide with the highest incidence, breast cancer is accompanied by a 40%-70% incidence rate of breast cancer-related insomnia (BCRI), which severely impairs immune function and affects prognosis. The traditional Chinese medicine (TCM) theory of "excess impairment and restraint control" emphasizes the dynamic balance and self-regulation among Zang-fu organs, providing a systematic framework for syndrome differentiation and treatment of BCRI. In the pathological process of BCRI, surgery, chemotherapy and endocrine therapy often induce "hyperactivity of liver Yang" or "hyperactivity due to medicinal toxicity", which further damages the organs responsible for counterregulation, leading to Yin-yang imbalance such as disharmony between heart and kidney, and spleen deficiency with phlegm disturbance. This is highly consistent with the dysfunction of the "inflammation-neuroendocrine-hormone" axis in modern medicine. Based on the theory of "excess impairment and restraint control", this paper systematically reviews the research progress of internal and external TCM therapies in calming hyperactivity of Zang-fu organs and restoring the function of restraint and control, and analyzes their clinical advantages in improving sleep structure and regulating immune microenvironment, aiming to provide theoretical basis and innovative ideas for individualized and precise treatment of BCRI.