神经–内分泌–免疫网络视角下中医药干预围绝经期情绪障碍的研究进展

Research Progress of Traditional Chinese Medicine for Perimenopausal Emotional Disturbances from the Perspective of the Neuroendocrine-Immune Network

摘要: 围绝经期情绪障碍，是指围绝经期伴随的焦虑、抑郁等情绪症状，主要依据经验证量表或临床评估识别，并非新增的独立精神科诊断；达到焦虑障碍或抑郁障碍诊断标准者仍应按相应疾病规范诊疗。卵巢功能波动与下丘脑–垂体–卵巢轴、下丘脑–垂体–肾上腺轴、单胺类神经递质、神经可塑性及炎症免疫信号共同作用，可形成神经–内分泌–免疫(NEI)网络失衡。现有研究提示中药、针刺及其联合常规治疗可能改善部分女性的焦虑、抑郁量表评分和围绝经期伴随症状，但证据受到样本量较小、盲法不足、结局异质性及随访偏短等限制。本文围绕概念界定、NEI病理基础、中医药临床证据和可能机制进行梳理，并纳入国内外关于二仙汤、逍遥散的代表性研究，辨析动物实验、网络药理学与临床外推的边界。当前证据支持将中医药作为个体化综合管理的潜在组成部分，但不能替代规范化精神心理评估及一线治疗。未来应统一生殖分期、情绪结局和证候标准，开展多中心、注册、充分报告安全性并长期随访的随机对照试验，同时通过逍遥散等重点案例，串联复方药理、代谢组学、肠道菌群–炎症免疫及临床症状改善证据，并提出基于NEI生物标志物分层的安慰剂对照随机试验框架，以增强机制论证的深度和研究建议的可操作性。

Abstract: In this review, perimenopausal emotional disturbances refer to anxiety and depressive symptoms accompanying perimenopause, identified mainly by validated scales or clinical assessment. The term is descriptive rather than a new psychiatric diagnosis; women meeting criteria for an anxiety or depressive disorder require diagnosis-specific management. Fluctuating ovarian function interacts with the hypothalamic-pituitary-ovarian and hypothalamic-pituitary-adrenal axes, monoaminergic neurotransmission, neuroplasticity, and inflammatory signaling, producing dysregulation of the neuroendocrine-immune (NEI) network. Existing studies suggest that Chinese herbal medicine, acupuncture, and integrative treatment may improve anxiety, depressive, and co-occurring menopausal symptoms in selected women. However, certainty is limited by small samples, inadequate blinding, heterogeneous outcomes, and short follow-up. This narrative review summarizes the conceptual scope, NEI basis, clinical evidence, and plausible mechanisms, including representative studies of Erxian decoction and Xiaoyaosan published in the Journal of Ethnopharmacology. Traditional Chinese medicine may be a component of individualized comprehensive care, but it should not replace standardized psychiatric assessment or first-line treatment. Future work will unify reproductive staging, emotional outcomes, and syndrome criteria; conduct multicenter, registered, fully reportable safety, and long-term follow-up randomized controlled trials; and, through key cases such as Xiaoyao San, connect evidence from compound pharmacology, metabolomics, gut microbiota-inflammatory immunity, and clinical symptom improvement. Furthermore, a framework for placebo-controlled randomized trials based on NEI biomarker stratification will be proposed to enhance the depth of mechanistic evidence and the operability of research recommendations.