ISSN 1674-3865  CN 21-1569/R
主管:国家卫生健康委员会
主办:中国医师协会
   辽宁省基础医学研究所
   辽宁中医药大学附属医院

中国中西医结合儿科学 ›› 2025, Vol. 17 ›› Issue (3): 199-202.doi: 10.20274/j.cnki.issn.1674-3865.2025.03.002

• 儿童性早熟治疗专栏 • 上一篇    下一篇

从“天癸”和“相火”学说探究儿童性早熟的病机

李辉1(), 叶进1, 汪受传2   

  1. 210029 南京,南京中医药大学附属医院儿科(李辉,叶进)
    210023 南京,南京中医药大学中医儿科教研室(汪受传)
  • 收稿日期:2024-12-14 修回日期:2025-02-20 出版日期:2025-06-25 上线日期:2025-06-25
  • 通讯作者: 李辉 E-mail:13222027212@163.com
  • 作者简介:李辉(1981?),男,医学硕士,副主任医师。研究方向:中西医结合治疗儿童生长发育相关疾病
  • 基金资助:
    第七批全国老中医药专家学术经验继承工作项目(国中医药办人教函〔2021〕272号);国家中医药管理局全国名中医传承工作室建设项目(国中医药办人教函〔2018〕119号);江苏省中医院临床医学创新中心建设项目(省中科〔2023〕66号)

Exploring the pathogenesis of precocious puberty in children from the perspectives of Tiangui and Xianghuo theories

Hui LI1(), Jin YE1, Shouchuan WANG2   

  1. 1.Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029,China
    2.Nanjing University of Chinese Medicine, Nanjing 210023,China
  • Received:2024-12-14 Revised:2025-02-20 Published:2025-06-25 Online:2025-06-25
  • Contact: Hui LI E-mail:13222027212@163.com
  • Supported by:
    Project for Establishing Mentorship Studios of Renowned TCM Masters

摘要:

“天癸至”是儿童性成熟的标志和促发因素,“天癸早至”必然会导致性早熟。现代中医儿科认为“肾阴虚,相火旺”是性早熟的主要病机。汪受传教授认为,“天癸早至”和“相火偏旺”二者之间存在着一定的内在联系,分属于性早熟的不同阶段,并提出分阶段病机创新理论。早期阶段可类比不完全性中枢性性早熟,因饮食偏嗜、情志压力等致肝肾阴虚、相火偏旺,表现为第二性征初现伴烦躁、盗汗等,治以“滋肾阴、泻相火”,晚期阶段可类比完全性中枢性性早熟,相火妄动引动“君火下临肾水”,触发“天癸至”,性发育成熟加速,治需转为“泻心火、滋肾阴”,阻断君相二火交合以延缓天癸至。从“天癸”和“相火”学说探究性早熟的中医病机,整合经典理论、名医经验与现代医学成果,有助于优化性早熟中医诊疗方案。

关键词: 性早熟, 天癸, 相火, 发病机制, 老中医经验

Abstract:

The arrival of Tiangui marks and triggers sexual maturation in children, and its premature arrival inevitably leads to precocious puberty. In modern pediatric traditional Chinese medicine (TCM) it is believed that "kidney?yin deficiency with hyperactivity of Xianghuo" is the primary pathogenesis of precocious puberty. Professor Wang Shouchuan believes that there exists an intrinsic connection between "premature arrival of Tiangui" and "hyperactivity of Xianghuo", which belong to different stages of precocious puberty. He innovatively proposes a stage?differentiated pathological mechanism theory: the early stage can be referred to as incomplete central precocious puberty, which is caused by factors such as dietary imbalance and emotional stress, leading to liver?kidney?yin deficiency and hyperactivity of Xianghuo; the manifestations include initial signs of secondary sexual characteristics accompanied by irritability, night sweats, etc. the treatment focuses on "nourishing kidney yin and purging Xianghuo". Late stage can be referred to as complete central precocious puberty, in which hyperactivity of Xianghuo triggers the "Junhuo descending to mingle with kidney water", thereby activating the "arrival of Tiangui"; this accelerates sexual maturation, and the treatment must shift to "purging Junhuo and nourishing kidney yin", aiming to block the convergence of the Junhuo and Xianghuo so as to delay the arrival of Tiangui. Exploring the TCM pathogenesis of precocious puberty based on the theories of "Tiangui" and "Xianghuo", and integrating classical theories, renowned physicians' clinical experience and modern medical achievements, helps to optimize TCM diagnosis and treatment strategies for precocious puberty.

Key words: Precocious puberty, Tiangui, Xianghuo, Pathogenesis, Veteran TCM physicians' clinical experience

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