黄丽娟辨证治疗桥本氏甲状腺炎经验

HUANG LIjuna′s Experience in Treatment of Hashimoto′s Thyroiditis Based on Syndrome Differentiation

桥本氏甲状腺炎是一种以自身甲状腺组织为抗原的免疫性疾病,目前发病机制尚未完全阐明,有研究表明与免疫因素、遗传因素、环境因素等有关,近年来发病率呈显著增加趋势。西医治疗桥本氏甲状腺炎主要是采用甲状腺素代替疗法、免疫疗法、手术等缓解局部症状,即对症治疗为主,尚无有效的预防及根治手段。黄丽娟教授认为桥本氏甲状腺炎属于中医"瘿病"的范畴,基本病机为:情志不遂、恼怒忧郁或饮食不调、水土失宜及先天禀赋,体质差异等,引起脏腑功能失调,导致气滞、痰凝、血瘀壅结颈前发为本病。桥本氏甲状腺炎病性以实证居多,久病可见由实致虚,或虚实夹杂。辨证分型包括气滞痰凝、肝郁化火、心肝阴虚、血瘀痰结、脾肾阳虚五种,早期多为气滞痰凝型,进展期多为肝郁化火、心肝阴虚型,后期多为血瘀痰结、脾肾阳虚型。本病以理气化痰,消瘿散结为主要治则,可依据不同证型辅以清肝泄火、滋阴降火、活血化瘀、温补脾肾等治法,在临床实践中取得良好疗效。

Hashimoto′s thyroiditis is an immune disease with thyroid tissue as antigen,and the pathogenesis has not been fully elucidated.Studies show that it is related to immune factors,genetic factors,environmental factors and so on.In recent years,the incidence of Hashimoto′s thyroiditis has been increasing significantly.The western medicine mainly uses the thyroxine replacement therapy,immunotherapy and operation to relieve local symptoms,namely symptomatic treatment.Until now,there is no effective means of prevention and cure.Professor HUANG Lijuna thinks Hashimoto′s thyroiditis belongs to the category of simple goiter in traditional Chinese medicine and the basic pathogenesis includes emotional failure,anger,depression or disordered diet,inappropriate climate and diet,congenital and physical differences,resulting in dysfunction of Zang-Fu organs,leading to Qi stagnation,phlegm coagulation and blood stasis blocking the neck.Most of the diseases are excess types.Long-term illness could induce the excess to the deficiency,or excess complicated with deficiency.The syndrome differentiation includes Qi stagnation and phlegm coagulation,liver depression forming fire,deficiency of Yin of heart and liver,blood stasis and phlegm stagnation and spleen-kidney Yang deficiency.In the early stage,Qi stagnation and phlegm coagulation is more common;in the progressive stage,liver depression forming fire and deficiency of Yin of heart and liver are more common;in the later stage,blood stasis and phlegm stagnation and spleen-kidney Yang deficiency are more common.Regulating Qi-flowing for eliminating phlegm,eliminating goiter and stagnation are the main treatment principles,and adding clearing liver-fire,nourishing Yin and reducing fire,promoting blood circulation for removing blood stasis and tonifying spleen and kidney according to the syndrome differentiation,and good curative effect had been achieved in clinical practice.