从“肾–天癸–冲任–胞宫”轴探析围绝经期生殖泌尿综合征的中医论治思路与研究进展

Exploring the TCM Treatment Approaches and Research Progress on Perimenopausal Genitourinary Syndrome from the Perspective of the “Kidney-Tian Gui-Chong and Ren Channels-Uterus” Axis

摘要: 围绝经期生殖泌尿综合征(Genitourinary Syndrome of Menopause, GSM)是女性围绝经期因卵巢功能衰退、雌激素水平持续下降所致的一系列外阴阴道与泌尿系统退行性症候群，主要表现为阴道干涩萎缩、灼痛不适、性交困难及反复泌尿系感染，严重影响中老年女性心身健康与生存质量。现代医学采用激素替代与对症抗感染治疗，虽短期改善明显，然存在禁忌人群广泛、长期依从性差、停药后症状反复等局限。中医学将GSM归属于“经断前后诸证”“阴燥”“带下病”“劳淋”等范畴。本文立足“肾–天癸–冲任–胞宫”女性生殖核心轴理论，认为本病以肾精亏虚、天癸竭耗、冲任血海空虚、阴器失濡为发病之本，以肝郁气滞、湿热下注、瘀血阻络为迁延之标，属本虚标实、虚实夹杂之慢性疾患文章系统梳理了GSM的中医病机演变规律，总结近年中药内服、外治、针灸及非药物调摄的研究进展，并对所引研究的证据等级、研究同一致性与矛盾进行简要评述，提出“调轴固本、内外合治”的诊疗思路，以期为GSM的中医药规范化干预与临床推广提供理论参考。

Abstract: Genitourinary Syndrome of Menopause (GSM) is a series of degenerative syndromes of the vulvovaginal and urinary systems in women during the perimenopausal period, caused by the decline of ovarian function and the continuous drop in estrogen levels. The main manifestations are vaginal dryness and atrophy, burning pain and discomfort, difficulty in sexual intercourse and repeated urinary tract infections, which seriously affect the physical and mental health and quality of life of middle-aged and elderly women. Modern medicine employs hormone replacement and symptomatic anti-infection treatment. Although there are significant short-term improvements, there are limitations such as a wide range of contraindicated populations, poor long-term compliance, and recurrence of symptoms after drug withdrawal. In traditional Chinese medicine, GSM is classified under the categories of “various syndromes before and after menopause”, “Yin dryness”, “vaginal discharge disorders”, and “strangury due to overexertion”. Drawing on the theory of the “Kidney-Tian Gui-Chong and Ren Channels-Uterus” axis as the core axis of female reproduction, this article identifies deficiency of kidney essence, depletion of Tian Gui, emptiness of the blood sea in the Chong and Ren channels, and inadequate moistening of the genitalia as the underlying basis of this disease. Liver qi stagnation, downward flow of damp-heat, and blood stasis obstructing the collaterals are considered secondary pathogenic factors contributing to its persistence. The disease is thus characterized as a chronic condition involving root deficiency and secondary excess, with coexisting deficiency and excess. This article systematically reviews the evolution of GSM pathogenesis in traditional Chinese medicine, summarizes recent research advances in oral Chinese herbal medicine, external therapies, acupuncture and moxibustion, and nonpharmacological care, and briefly appraises the levels of evidence of the cited studies and the consistency and contradictions among them. It proposes an approach to diagnosis and treatment centered on “regulating the axis and strengthening the root, with combined internal and external treatment,” aiming to provide a theoretical basis for standardized interventions using traditional Chinese medicine and their wider clinical application in GSM.