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经前期综合征（PMS）及其严重类型经前烦躁障碍症（PMDD）是育龄期女性常见疾病，严重困扰女性正常生活，日益受到人们重视。中医认为PMS/PMDD核心病机为肝失疏泄，同时与冲任二脉失调密切相关。文章基于冲任二脉的循行及脏腑关系，以及中医肾-天癸-冲任-胞宫生殖轴与西医学下丘脑-垂体-卵巢（HPO）轴的功能对应关系，揭示冲任失调与HPO轴激素节律紊乱、负反馈异常等机制在PMS/PMDD发病中的作用。冲任气血的周期性骤变可导致肝、脾、肾功能失调，进而引发经前情绪及躯体症状；而HPO轴性激素波动通过影响神经递质及中枢反应性，加剧经前相关症状。中医药通过多靶点调节冲任和HPO轴功能，可改善黄体功能及内分泌状态，可为临床治疗提供新思路。通过整合中西医理论，深化中医肝藏象理论的现代科学内涵，为PMS/PMDD的机制研究与诊疗实践架设桥梁。
Abstract：Premenstrual syndrome(PMS) and its severe type,premenstrual dysphoric disorder(PMDD),are common diseases among women of childbearing age,seriously disturbing their normal lives and receiving increasing attention. According to traditional Chinese medicine,the core pathogenesis of PMS and PMDD is the liver's failure in governing conveyance and dispersion,and it is closely related to the imbalance of the Chong and Ren meridians. Based on the circulation and visceral relationship of the Chongren meridians,and the functional correspondence between the “ kidney-Tiangui-Chong and Ren-uterine cavity ” reproductive axis of traditional Chinese medicine and the hypothalamic-pituitary-ovarian(HPO) axis of western medicine,this article reveals the role of Chongren meridians incompatibility and the mechanisms of hormonal rhythm disorder and negative feedback abnormality,etc. in the pathogenesis of PMS/PMDD. The periodic abrupt changes of qi and blood in the Chong and Ren meridians can lead to disorders of liver,spleen and kidney functions,which subsequently triggers premenstrual emotional and physical symptoms;whereas HPO-axis sex hormone fluctuations exacerbate premenstrual-related symptoms by affecting neurotransmitters and central responsiveness. Through multi-targeted regulation of Chongren meridians and HPO axis functions,TCM can improve luteal function and endocrine status,providing new ideas for the clinical treatment. By integrating the theories of traditional Chinese and western medicine and deepening the modern scientific connotation of the theory of liver storage in traditional Chinese medicine,a bridge is built for the mechanism research and diagnosis and treatment practice of PMS/PMDD.
[1] HARTLAGE S A,BREAUX C A,YONKERS K A. Addressing concerns about the inclusion of premenstrual dysphoric disorder in DSM-5[J]. J Clin Psychiatry,2014,75(1):70-76.
[2] FRANKLIN C L,RAINES A M,CHAMBLISS J L,et al.Examining various subthreshold definitions of PTSD using the Clinician Administered PTSD Scale for DSM-5[J].J Affect Disord,2018,234:256-260.
[3]孙文君，乔明琦，王海军．关于经前烦躁障碍症亚型的理论探讨[J].辽宁中医杂志，2017,44(10):2071-2073.
[4]马雪，闫津豪，王浩田，等．中医学冲任理论的建立及其意义[J].中医药学报，2020,48(3):5-7.
[5]商婷婷，周俊兵，任青玲.陈自明辨治月经病经验采撷[J].中国中医药图书情报杂志，2024,48(1):201-203.
[6]宋玮，帅垠琦，张雪珥，等.调摄冲任法论治经前皮肤黏膜疾病[J].中华中医药杂志，2023,38(10):4753-4757.
[7]龚思琦，王翠霞.从“实则阳明，虚则太阴”论治卵巢储备功能减退[J].中医药临床杂志，2024,36(3):395-399.
[8]李晓燕.从痰论治经行乳房胀痛胃虚痰滞证38例[J].浙江中医杂志，2019,54(4):273.
[9]范浩浩，董宏利.从脏腑及奇经八脉探讨经行头痛的病因病机[J].中国民间疗法，2024,32(5):103-106.
[10]庄美佳，储继军．储继军治疗经行头痛经验浅析[J].中国民间疗法，2021,29(10):27-29.
[11]韩秀林．辨证施治经前期综合征经验[J]．河北中医，2014,36(7):1018-1019.
[12]任璐露，于志强.于志强治疗经行泄泻临床经验[J]．内蒙古中医药，2019,38(9):86-87.
[13]张艳佶，黄伟，王佳捷，等.阴阳调理灸联合耳穴贴压治疗肝郁脾虚型经前期综合征34例[J].中国针灸，2023,43(7):818-820.
[14]高明周，乔明琦，张长龙，等.基于PMS/PMDD研究探讨肝主疏泄与GABAA受体机制相关性[J]．时珍国医国药，2022,33(3):673-676.
[15]薛晓丽.柴胡疏肝散加减治疗肝郁气滞型经前期综合征的临床观察[D].哈尔滨：黑龙江中医药大学，2017.
[16] WYATT K M,DIMMOCK P W,ISMAIL K M K,et al.The effectiveness of GnRHa with and without’addback’therapy in treating premenstrual syndrome:a meta analysis[J]. BJOG Int J Obstet Gynaecol,2004,111(6):585-593.
[17] SCHMIDT P J ,MARTINEZ P E ,NIEMAN L K ,et al. Premenstrual dysphoric disorder symptoms following ovarian suppression:triggered by change in ovarian steroid levels but not continuous stable levels[J].Am J Psychiatry,2017,174(10):980-989.
[18] STIERNMAN L,DUBOL M,COMASCO E,et al.Emotioninduced brain activation across the menstrual cycle in individuals with premenstrual dysphoric disorder and associations to serum levels of progesterone-derived neurosteroids[J]. Transl Psychiatry,2023,13(1):124.
[19] SCHMIDT P J,NIEMAN L K,DANACEAU M A,et al.Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome[J]. N Engl J Med,1998,338(4):209-216.
[20]李学智.雌性激素受体ER与PGR基因在经前期综合征模型动物下丘脑中的表达研究[D].济南：山东大学，2007.
[21] KALTSOUNI E,FISHER P M,DUBOL M,et al. Brain reactivity during aggressive response in women with premenstrual dysphoric disorder treated with a selective progesterone receptor modulator[J]. Neuropsychopharmacology,2021,46(8):1460-1467.
[22] TIRANINI L,NAPPI R E. Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome[J]. Fac Rev,2022,11:11.
[23] B?CKSTR?M T,ANDREEN L,BIRZNIECE V,et al.The role of hormones and hormonal treatments in premenstrual syndrome[J]. CNS Drugs,2003,17(5):325-342.
[24]乔明琦，张惠云，于艳红，等.经前期综合征肝气逆证患者月经周期血清雌二醇、孕酮含量的动态变化[J].中医杂志，2006,47(4):295-297.
[25] KIMBALL A,DICHTEL L E,NYER M B,et al. The Allopregnanolone to progesterone ratio across the menstrual cycle and in menopause[J]. Psychoneuroendocrinology,2020,112:104512.
[26]陈可点，高双荣，刘雪婷，等.黄体酮撤退加情志刺激诱导型经前期综合征大鼠模型的建立与评价[J].中国中药杂志，2024,49(13):3608-3618.
[27]罗颂平，曹蕾.黄体功能不全的中医治疗[J].中国实用妇科与产科杂志，2021,37(4):440-443.
[28]柯欣吟.基于数据挖掘探讨肖承悰教授治疗黄体功能不全性不孕的用药规律[D].北京：北京中医药大学，2022.
[29]杨丽洁，吴节，苗润青，等.调冲任、固肾元针灸法改善黄体功能不全患者子宫内膜容受性的临床研究[J].中华中医药杂志，2019,34(7):3320-3323.
[30]闫菲，史云，赵琦，等.中西医女性生殖轴互参探讨继发性闭经的辨治思路[J].环球中医药，2020,13(7):1178-1181.
[31]夏天，高慧，柴淑娟，等.韩冰教授运用冲任学说治疗卵巢功能失调性疾病的研究总结[J].天津中医药，2011,28(4):271-273.
[32]张莉莉，曾纪红，马玲.冲任学说与卵巢功能失调性疾病的治疗[J].中国中医药现代远程教育，2019,17(14):28-30.
基本信息:
DOI：10.16295/j.cnki.0257-358x.2025.11.003
中图分类号:R271.115
引用信息:
[1]刘桦沅,王玉芳,孟庆岩,等.从冲任和HPO轴失调探究PMS/PMDD发病机制[J].山东中医杂志,2025,44(11):1187-1191.DOI:10.16295/j.cnki.0257-358x.2025.11.003.
基金信息:
国家自然科学基金项目（编号：82074293）; 山东省研究生教育教学改革研究项目（编号：SDYJSJGC2024063）; 山东省研究生精品和优质专业学位教学案例库项目（编号：SDYAL2024147）; 山东中医药大学科学研究基金项目（编号：KYZK2024M08）
2025-11-05
2025-11-05