“肝气虚”理论指导亚临床甲状腺功能减退症的辨治探讨

Pathogenesis of Subclinical Hypothyroidism based on“Deficiency of Liver Qi”

“肝阴肝血多不足”的说法在现代中医院校教材的肝脏辨证体系中较为多见,历代医家临床亦多遵循肝体阴而用阳,从疏肝行气、平抑肝阳等治法来平调“有余”之肝气、肝阳,或将肝气虚笼统与胆气虚通论而混淆其临床表现,因而“肝气虚”理论并未得到广泛提及。方朝晖教授在临证治疗过程中发现,亚临床甲状腺功能减退症患者多表现为畏寒、乏力、记忆力减退、体重增加、嗜睡、性功能减退等低代谢状态及抑郁沉闷、烦躁不安、思维鲁钝呆默、寐中易惊善恐等情志障碍,是肝气亏损、升发不足的表现,故强调整体把握,选方择用黄芪、五味子为主药调补肝气,寓补于畅,可改善亚临床甲减患者整体症状。

The saying“Liver Yin and Liver Blood are too much and insufficient”is more common in the liver syndrome differentiation system of the school textbooks of modern Chinese medicine hospitals.Medical doctors of the past dynasties also followed the Yin of the liver and used Yang,treating the liver by soothing the liver and promoting Qi and suppressing the liver yang.Falai calms the liver Qi and liver yang of“surplus”,or confuses the clinical manifestations of liver Qi deficiency with the general theory of biliary Qi deficiency.Therefore,the theory of“liver Qi deficiency”has not been widely mentioned.During the course of clinical treatment,Professor Fang Zhaohui found that patients with subclinical hypothyroidism usually manifested as chills,fatigue,memory loss,weight gain,lethargy,hyposexual function and other hypometabolic states,depression,irritability,and dull thinking Emotional disorders such as being silent,easy to startle and panic during sleep sounding,are manifestations of liver Qi loss and insufficient hair growth.Therefore,the overall grasp is emphasized.The choice of astragalus and schisandrae as the main medicine to invigorate liver Qi can improve The overall symptoms of patients with subclinical hypothyroidism.