从“天癸竭”探析围绝经期综合征的理论源流与现代机制

Exploring the Theoretical Origins and Modern Mechanisms of Perimenopausal Syndrome from the Perspective of “Exhaustion of Tian-Gui”

摘要: 围绝经期综合征(perimenopausal syndrome, PMS)是指女性在绝经前后因卵巢功能衰退出现的生理、心理症候群，全球患病群体庞大。西医激素替代疗法因其安全风险应用而在临床使用上受限。中医学将其归属于“经断前后诸证”“脏躁”等范畴，并以《黄帝内经》“天癸竭”理论为核心构建了较为完整的诊疗体系。本文系统梳理“天癸竭”理论的思想源流与内涵，深入探析该理论指导下围绝经期综合征的病机演变规律，并结合现代研究阐释其生物学基础，认为天癸竭为发病根本，阴阳失衡为核心病机，具体表现为肾精亏虚、冲任失调、脏腑失和，其现代机制与下丘脑–垂体–卵巢轴功能紊乱、神经内分泌失衡密切相关。本文旨在从理论源流与现代机制双重维度，为临床防治围绝经期综合征提供思路，以飨同道。

Abstract: Objective: Perimenopausal syndrome (PMS) refers to a constellation of physiological and psychological symptoms that occur in women due to declining ovarian function before and after menopause, affecting a large population worldwide. Hormone replacement therapy (HRT) in Western medicine has limited clinical application due to its associated safety risks. In traditional Chinese medicine (TCM), PMS falls under the categories of “various disorders before and after menstrual cessation” and “visceral agitation,” and a relatively comprehensive diagnostic and therapeutic framework has been developed based on the theory of “exhaustion of Tian-Gui” as articulated in the Huangdi Neijing (Yellow Emperor’s Inner Classic). This paper systematically reviews the intellectual origins and connotations of the “exhaustion of Tian-Gui” theory, explores the pathogenesis evolution of perimenopausal syndrome under this theoretical framework, and elucidates its biological basis through the lens of modern research. It posits that the exhaustion of Tian-Gui constitutes the root cause of the disorder, with yin-yang imbalance serving as the core pathogenesis, clinically manifested as depletion of kidney essence, dysregulation of the Chong and Ren meridians, and disharmony among the viscera. The underlying modern mechanisms are closely linked to dysfunction of the hypothalamic-pituitary-ovarian (HPO) axis and neuroendocrine imbalance. By integrating theoretical origins with contemporary mechanistic insights, this paper aims to provide strategic guidance for the clinical prevention and treatment of perimenopausal syndrome for the benefit of fellow practitioners.