围绝经期潮热汗出中医药治疗研究进展

Advances in Traditional Chinese Medicine for the Treatment of Hot Flashes and Sweating during Perimenopause

摘要: 围绝经期潮热汗出是女性绝经前后常见的血管舒缩症状，其反复发作、突发突止的特点严重影响患者的生活质量与心理健康。现代医学虽以激素替代疗法为主，但存在适应症限制与潜在风险。中医药基于整体观念与辨证论治原则，在缓解潮热汗出症状、调节神经–内分泌功能方面展现出独特优势。当前研究已系统梳理了该症以肾虚为本、涉及心肝脾多脏的病因病机理论，形成了肾阴虚、肾阳虚、肝郁化火等核心辨证分型体系，并积累了左归丸、知柏地黄丸、二仙汤等经典方剂的临床应用经验。此外，针灸、推拿、耳穴贴压等特色疗法通过调节下丘脑–垂体–卵巢轴及自主神经功能，亦取得确切疗效。然而，现有研究仍存在辨证标准不统一、疗效评价体系欠规范、大样本随机对照试验不足等突出问题。本文综述近年来中医药治疗围绝经期潮热汗出的病因病机、辨证分型、方剂应用及特色疗法研究进展，以期为临床实践提供系统参考，并展望该领域标准化研究与机制探索的发展方向。

Abstract: Perimenopausal hot flashes accompanied by sweating are common vasomotor symptoms occurring before and after menopause. Their recurrent, sudden, and unpredictable nature can substantially impair patients’ quality of life and psychological well-being. Although menopausal hormone therapy remains a major treatment option in modern medicine, its clinical application is limited by contraindications and potential risks. Based on the holistic concept and the principle of syndrome differentiation and treatment, traditional Chinese medicine (TCM) has demonstrated distinctive advantages in alleviating hot flashes and sweating and in regulating neuroendocrine function. Current studies have systematically elucidated the TCM etiology and pathogenesis of this condition, which is primarily attributed to kidney deficiency and may also involve dysfunction of the heart, liver, and spleen. Accordingly, a syndrome differentiation system centered on kidney yin deficiency, kidney yang deficiency, and liver constraint transforming into fire has gradually been established. Considerable clinical experience has also been accumulated in the application of classical formulas, including Zuogui Pill, Zhibai Dihuang Pill, and Erxian Decoction. In addition, characteristic TCM therapies, such as acupuncture, tuina, and auricular acupressure, have shown beneficial effects, potentially through regulation of the hypothalamic-pituitary-ovarian axis and autonomic nervous system function. Nevertheless, existing studies are still limited by inconsistent syndrome differentiation criteria, insufficiently standardized outcome assessment systems, and a lack of large-sample randomized controlled trials. This review summarizes recent advances in the TCM understanding of the etiology and pathogenesis, syndrome differentiation, herbal formula application, and characteristic external therapies for perimenopausal hot flashes and sweating. It aims to provide a systematic reference for clinical practice and to discuss future directions for standardized research and mechanistic investigation in this field.