目的 观察四逆散合桂枝甘草龙骨牡蛎方治疗多囊卵巢综合征（PCOS）合并昼夜节律失调的临床效果。 方法 将2023年3月至2025年3月期间在山西白求恩医院就诊的102例PCOS合并昼夜节律失调患者采用随机数字表法分为观察组和对照组各51例，对照组给予达英-35及生活方式干预，观察组在对照组基础上予以四逆散合桂枝甘草龙骨牡蛎方加减，均连续治疗3个月经周期。比较两组临床疗效，治疗前后中医证候积分、内分泌激素、糖脂代谢指标、睡眠质量与节律指标变化，并记录不良反应。 结果 观察组总有效率（96.08%）高于对照组（80.39%）（P < 0.05）；观察组治疗后中医证候积分、LH、LH/FSH比值、T、AMH、FBG、FINS、HOMA-IR、TG、TC、COR水平及PSQI评分均低于对照组（P < 0.05），FSH及褪黑素（MT）水平均高于对照组（P < 0.05）；治疗期间，观察组与对照组不良反应发生率（3.92% vs. 5.88%）比较差异无统计学意义（P > 0.05）。 结论 四逆散合桂枝甘草龙骨牡蛎方可有效调节性激素紊乱，改善胰岛素抵抗与脂质代谢异常，重建正常的睡眠觉醒节律。

Objective To observe the clinical efficacy of Sini powder combined with Guizhi Gancao Longgu Muli decoction in the treatment of polycystic ovary syndrome （PCOS） accompanied by circadian rhythm disorder. Methods A total of 102 patients diagnosed with PCOS and comorbid circadian rhythm disorder， who received treatment at Shanxi Bethune Hospital from March 2023 to March 2025， were randomly assigned to either an observation group or a control group using a random number table， with 51 cases in each group. The control group received Diane-35 along with lifestyle intervention， whereas the observation group was additionally treated with modified Sini powder combined with Guizhi Gancao Longgu Muli decoction. Both groups underwent treatment for three consecutive menstrual cycles. The clinical efficacy was compared between the two groups. Moreover， changes in traditional Chinese medicine syndrome scores， endocrine hormones， glucose and lipid metabolism indices， sleep quality， and circadian rhythm indicators were evaluated both before and after the treatment. Adverse reactions were also documented. Results The total effective rate in the observation group （96.08%） was significantly higher than that in the control group （80.39%） （P < 0.05）. After treatment， the observation group showed lower scores of Traditional Chinese Medicine （TCM） syndromes， luteinizing hormone （LH）， LH/follicle-stimulating hormone （FSH） ratio， testosterone （T）， anti-Müllerian hormone （AMH）， fasting blood glucose （FBG）， fasting insulin （FINS）， homeostasis model assessment of insulin resistance （HOMA-IR）， triglyceride （TG）， total cholesterol （TC）， cortisol （COR）， and Pittsburgh Sleep Quality Index （PSQI） scores compared to the control group （P < 0.05）. In contrast， the levels of follicle-stimulating hormone （FSH） and melatonin （MT） were higher in the observation group than in the control group （P < 0.05）. There was no statistically significant difference in the incidence of adverse reactions between the observation group （3.92%） and the control group （5.88%） （P > 0.05）. Conclusion Sini powder combined with Guizhi Gancao Longgu Muli decoction can effectively regulate sex hormone disorders， improve insulin resistance and abnormal lipid metabolism， and restore the normal sleep-wake rhythm.