王忠民辨治甲状腺功能减退症合并慢性盆腔炎经验

Experience of Wang Zhongmin in Treating Hypothyroidism Combined with Chronic Pelvic Inflammatory Disease

甲状腺功能减退症（简称“甲减”）有明显的肾虚证候，而且多有胎儿期发病者，与肾虚关系极为密切。甲减常元气亏损，精血不足，神疲乏力、畏寒怯冷等，虚寒之象尤其明显，记忆力减退、毛发枯萎、性欲冷淡等，肾阳虚衰表现突出。肾为先天之本，阳气充足需要阴精支持，故在治疗时不可只顾补阳不滋其阴。再者，合并慢性盆腔炎（ chronic pelvic inflammatory disease， CPID）后，日久不愈也会伤阴，因此，尽管阳虚为主，也要注意阴中求阳，不可过补阳气而伤及阴。此外，脾主运化与气血化生，属于后天之本，对提高抗病能力尤其重要。脾气虚弱，摄食量少或不当，后天营养不足，则气血易虚，肾阳虚衰，令脾阳不振，而脾气虚弱又会加重肾虚。脾主肌肉四肢，而甲减患者肌无力者占患者多数，并伴有感觉障碍，诸如手足麻木、肌肉痛、僵硬或痉挛等尤其常见，同时，约有32%~82%患者合并贫血。这种状况的出现，使甲减合并CPID的患者更会缠绵不愈，出现气血失调、月经紊乱、盆腔积液等症状。之外，甲减患者常有心动过缓，脉沉迟等证，属于心阳不振，符合“肾命不能蒸运，心阳鼓动无能”之势，临床常见，病程较久之甲减，常在肾阳衰微之后发生心阳不振，进而加重其寒象。因此，在治疗时需要注意这一变局。甲减阳虚为重，CPID以湿邪为著，两者合并常病程拖延。久治不愈则湿浊化痰，可出现黏液性水肿，腹部囊性包块，此“乃五脏瘀血、浊气、痰滞而成”，因而治疗时要充分考虑这一病机。总之，治疗甲减合并CPID须注重在温补肾阳、助长肾气之时顾及滋补肾阴，在振奋脾阳中气、运化水湿之时考虑化瘀消浊。

Hypothyroidism has significant kidney deficiency syndrome,and many developed in the fetal period with close relations with kidney empty. Decline of kidney-Yang is outstanding. Kidney is the foundation of the innate. Hypothyroidism combined with chronic pel- vic inflammatory disease（ CPID）will hurt Yin. Although one positive syndrome,it should also pay attention to Yin and Yang,and not hurt Yin repair sun be the spirit. In addition,the spleen and the main operation and the blood metaplasia,belong to the day after tomor- row,to improve the disease resistance is particularly important. Temper weak,less food intake or inappropriate,nutritional deficiencies, the day after tomorrow is easy Qi,kidney Yang deficiency,the spleen Yang,and temper weak can worsen kidney empty again. Patients with spleen main limbs,muscle and hypothyroidism accounted for most of the patients with muscle weakness,accompanied by sensory disorder,such as hand,foot and numbness,muscle pain,stiffness or cramps are particularly common,at the same time,about 32% -82% in patients with combined anemia. The emergence of this situation,make hypothyroidism merger CPID patients more will not more lingering,appear the symptom such as disorder of Qi and blood,menstrual disorders,pelvic cavity accumulates fluid,hypothyroidism pa- tients often have bradycardia,pulse heavy card such as late,belongs to the weak heart Yang,accord with 〝kidney life canˊt evaporate, heart Yang encouraged incompetent〝,clinical common hypothyroidism of long course of disease,often happen after kidney Yang from heart Yang,to compound the cold. Therefore,when treatment it still needs to pay attention to the change. Hypothyroidism Yang deficien- cy and CPID with the origin as the combined them often delay duration. For a long time,not more is phlegm,dampness can appear in myxedema,abdominal cystic mass,this〝is completely blood stasis and turbidity Qi,phlegm stagnation and become〝. Therefore,we must give full consideration to the pathogenesis treatment. Anyhow,treatment CPID hypothyroidism merger shall pay attention to at the time of the warming Yang,fuelling kidney Qi,and nourishing kidney Yin,elevate the spleen Yang wet when considering blood gas,transport and water turbidity.