Treatment of restless legs syndrome by acupuncture combined with medicine based on pathophysiological mechanism.

Restless legs syndrome (RLS) is a neurological disorder characterized by bilateral discomfort in the lower extremities, intense urge to move, and exacerbation of symptoms during the night. Its pathogenesis is closely associated with dysfunctions in the dopaminergic system, abnormal iron metabolism, and genetic predisposition. RLS frequently co-occurs with conditions, such as chronic kidney disease and iron deficiency anemia, significantly impairing patients' sleep quality and daytime functioning. This review systematically examines the definition, classification, epidemiological features, and diagnostic criteria of RLS, and provides an in-depth analysis of its core pathophysiological mechanisms. Furthermore, it offers a comprehensive overview of current pharmacological treatments, including dopamine receptor agonists, α2δ ligands, and iron supplementation, as well as non-pharmacological interventions, such as exercise, transcutaneous direct current spinal cord stimulation, and acupuncture. The synergistic effects of combined acupuncture and pharmacotherapy were explored, highlighting mechanisms involving neural regulation, iron metabolism modulation, and immune function enhancement, along with their clinical efficacy. Additionally, the review addresses ongoing controversies in treatment, including the stability of therapeutic outcomes and unclear mechanisms underlying interventions. Finally, it outlines prospective research directions emphasizing multidisciplinary collaboration, precision medicine approaches, and multicenter clinical trials, aiming to provide a theoretical framework and practical foundation for the individualized diagnosis and management of RLS.