Abstract: Tian Gui, first documented in Basic Questions, is a vital, subtle substance that drives reproductive maturity during human development. Previous studies linked precocious puberty to Tian Gui, attributing it to premature activation of Tian Gui. However, this paper examines Tian Gui’s essence and argues that in precocious puberty, the timing of Tian Gui’s emergence is superficial, while its authenticity (functional integrity) is fundamental. Tian Gui relies on true yin essence as its substance and yang qi activity for its function. Suppose yang qi fails to circulate within yin essence. In that case, turbid pathological substances congest the Chong and Ren meridians and the uterus, creating a Pseudo Tian Gui that mimics the form but lacks true transformative capacity. Consequently, children exhibit premature physical maturation while their vital development is arrested. Thus, this paper proposes a therapeutic approach: activating yang qi, nourishing true yin, resolving phlegm-dampness, and transforming turbid yin, providing a theoretical and practical framework for treating precocious puberty in traditional Chinese medicine.