中医心身医学视角下焦虑相关性不孕的诊疗现状与思考

Current Status and Reflections on the Diagnosis and Treatment of Anxiety-Related Infertility from the Perspective of Traditional Chinese Medicine Psychosomatic Medicine

摘要: 焦虑相关性不孕是当今生殖医学领域日益突出的临床难题。在中医心身医学视角下心因性不孕的关键病机在于“心肾失交、胞宫失养”，强调胞宫受心、肾之养而具胎孕之能，情志之患伤心、累肾，构成不孕之机。临证重视肝与心、肾的关系，设“肝为心肾相交之媒”，立“疏肝养血、滋肾清心”“温肾通脉，疏肝升阳”“温肾化浊，调肝和枢”之法。本文系统梳理了焦虑与不孕的双向关联机制，阐述了“心–肾–胞宫”轴的理论内涵，并结合临床实践重点讨论了夫妻同房时紧张焦虑状态对受孕的影响——当排卵期性生活异化为“生育任务”时，焦虑不仅通过神经内分泌途径干扰生殖功能，还直接导致排卵期性功能障碍等临床问题。丛慧芳教授主张妇科疾病应归为心身疾病，临床中应重视“心身合治”，以心理疏导结合中药调理，构建“筛查–评估–干预–随访”一体化的诊疗模式。

Abstract: Anxiety-related infertility has become an increasingly prominent clinical challenge in the field of reproductive medicine. From the perspective of traditional Chinese medicine psychosomatics, the key pathogenesis of psychogenic infertility lies in “loss of coordination between the heart and kidney, and malnutrition of the uterus”, emphasizing that the uterus relies on the nourishment of the heart and kidney to fulfill its reproductive function, while emotional disorders impair the heart and consume the kidney, thereby constituting the mechanism of infertility. In clinical practice, emphasizes the relationship among the liver, heart, and kidney, proposing that “the liver serves as the mediator for heart-kidney interaction”, and establishes three therapeutic approaches: “soothing the liver and nourishing blood, nourishing the kidney and clearing the heart”, “warming the kidney and unblocking the vessels, soothing the liver and elevating yang”, and “warming the kidney and resolving turbidity, regulating the liver and harmonizing the pivot”. This article systematically reviews the bidirectional association mechanism between anxiety and infertility, elucidates the theoretical connotation of the “heart-kidney-uterus” axis, and, in combination with clinical practice, focuses on the impact of tension and anxiety during sexual intercourse on conception—when ovulatory sexual activity is alienated into a “reproductive task”, anxiety not only interferes with reproductive function through the neuroendocrine pathway but also directly leads to clinical problems such as ovulation-induced erectile dysfunction. Professor Cong Huifang advocates that gynecological diseases should be classified as psychosomatic disorders, and emphasizes “psychosomatic co-treatment” in clinical practice, integrating psychological counseling with traditional Chinese medicine regulation and constructing an integrated “screening, assessment, intervention, follow-up” diagnostic and therapeutic model.