基于国医大师夏桂成教授的“心-肾-子宫轴”理论，提出“心-肾-子宫轴”功能紊乱而致心肾不交为多囊卵巢综合 征（PCOS）的核心病机，并认为其核心病机与现代医学之下丘脑-垂体-卵巢（HPO）轴紊乱、慢性炎症及肠-脑轴失调机制高度 吻合。PCOS 的病机演变始于心神不宁，耗伤心阴，终致肾阴亏虚。“心-肾-子宫轴”失调所致之藏泻失常、心肾不交而痰 瘀化热、气血失运而痰湿内阻、肾虚痰瘀而壅阻胞宫，分别为PCOS 月经紊乱、高雄激素血症、胰岛素抵抗及卵巢多囊样改 变的发病机制。基于夏桂成教授之“心-肾-子宫轴”理论，PCOS 的治疗根本在于调养心神以复其主导之职，交通心肾以复 其既济之态，从而重建“心-肾-子宫轴”的动态平衡。临证治疗PCOS 当以“交通心肾”为总则，采用“清上实下”之法 （宁心安神以清上，滋肾填精以实下），融合周期疗法分期论治。

National Traditional Chinese Medicine（TCM）Master Xia Guicheng has developed the theory of heart kidney-uterus axis. In this article，it is proposed that the dysfunction of heart-kidney-uterus axis leading to incoordination between heart and kidney contributes to the core pathogenesis of polycystic ovary syndrome（PCOS）， which accords with the modern medical understanding of PCOS in the aspects of hypothalamic-pituitary-ovarian （HPO）axis dysregulation，chronic inflammation，and gut-brain axis imbalance. The pathological evolution of PCOS originates from the disturbance of the heart-spirit，which consumes heart yin and ultimately results in kidney yin deficiency. The disordered heart-kidney-uterus axis manifests as dysfunction of storage and discharge， incoordination between heart and kidney causing the transformation of heat from phlegm and blood stasis， unsmoothed qi and blood leading to phlegm-damp obstruction，and kidney deficiency with phlegm stasis congealing in the uterine chamber，which respectively correspond to the pathogenesis of menstrual disturbance， hyperandrogenism，insulin resistance，and polycystic ovarian morphology in PCOS. Grounded in Professor Xia’s theory of heart-kidney-uterus axis，the fundamental therapeutic approach to PCOS lies in regulating the heart spirit to restore its governing role，and coordinating between heart and kidney to recover their coordinated state， thereby restoring the dynamic equilibrium of the heart-kidney-uterus axis. Clinical management of PCOS should adopt the therapy of coordinating heart and kidney as the principle，employing the method of clearing the upper and consolidating the lower（calming the heart and quieting the spirit to clear the upper，and enriching the kidney and replenishing essence to consolidate the lower）integrated with periodic therapy according to the menstrual cycle.

R271.9

广东省中医药局科研项目（编号：20251423）；东莞市高水平医院建设专项（编号：20231800927372）