中医药临床优势病种探讨——围绝经期综合征

Expert Consensus on Clinical Diseases Responding Specifically to Traditional Chinese Medicine： Perimenopausal Syndrome

摘要:

围绝经期综合征作为常见的内分泌系统疾病，是中医药治疗的优势病种之一。中华中医药学会组织中西医内分泌科、妇科及学科交叉领域专家，围绕西医、中医及中西医结合诊疗围绝经期综合征的优势与难点等进行讨论。与会专家讨论后认为，雌激素减退是 围绝经期综合征的始动因素，以“虚”态为主，病机本质乃肾阴阳失衡；西医绝经激素治疗可通过快速补充雌激素水平而实现迅速缓解相关症状，同时能早期发现和延缓绝经并发症，但存在一定风险，需密切监测不良反应，且绝经激素治疗存在诸多禁忌证及慎用情况，临床应用受限；中医在协同改善围绝经期综合征潮热汗出、睡眠障碍、情绪异常等多种症状方面具有突出优势，用药安全，但起效速度不及绝经激素治疗，防治绝经并发症证据尚不明确。未来对中、西医在围绝经期综合征领域的发展提出三方面建议，一是形成优势互补的围绝经期综合征中西医结合诊疗体系；二是形成中医和中西医结合干预围绝经期综合征的高质量循证证据；三是推动治疗围绝经期综合征的中药新药研发及交叉学科合作。

Abstract:

Perimenopausal syndrome （MPS）， a common endocrine system disease， is one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in endocrinology， gynecology， and interdisciplinary fields of both Western and Chinese medicine to discuss the advantages and challenges of diagnosing and treating MPS with Western medicine， TCM， and integrative medicine. Experts at the conference believe that MPS is initiated by estrogen decline and rooted in deficiency， with the pathogenesis being imbalance between Yin and Yang in the kidney. The hormone replacement therapy in Western medicine for menopause can rapidly alleviate related symptoms by quickly restoring the estrogen level and timely detect and delay complications of menopause， whereas such a therapy has certain risks， necessitating close monitoring of adverse reactions. Moreover， the various contraindications and precautions limit the clinical application of the hormone replacement therapy. TCM has advantages in synergistically alleviating symptoms such as hot flashes， sweating， sleep disorders， and emotional abnormalities of MPS without causing obvious adverse reactions. However， its efficacy is slower than the hormone replacement therapy， and the TCM evidence for preventing and treating complications of menopause remains unclear. Three suggestions were proposed for the future development of both Western and TCM for ameliorating MPS. First， an integrated diagnosis and treatment system for MPS with both Western and Chinese medicine should be established. Second， high-quality evidence-based interventions for MPS should be developed with TCM alone or in combination with Western medicine. Third， efforts should be made to promote the new TCM drug development and the interdisciplinary cooperation for treating MPS.