基于“脾为吞”理论探讨桥本甲状腺炎的病机和治疗

Discussion on TCM pathogenesis and treatment of hashimoto’s thyroiditis based on the theory of“spleen for swallow”

桥本甲状腺炎(HT)可归属于中医“瘿病”“虚劳”“郁证”等范畴,其病机复杂,部分症状难以鉴别,临床治疗具有一定的难度。文章以《素问·宣明五气篇》“脾为吞”理论为指导,对桥本甲状腺炎的病因病机和治法进行全新的探讨和分析,提出“脾为病贯穿整个桥本甲状腺炎的病程”,除肝郁气滞、痰瘀互结外,脾阴亏虚,阴阳失衡也是HT的重要病机。治疗上强调“以平衡脾之阴阳为中心”,未病先防,滋养脾阴,结合化痰消瘀,补脾益肾之法,进而改善HT的预后发展。

Hashimoto’s thyroiditis can be classified into the categories of“gall disease”“melancholia”and“asthenia”in traditional Chinese medicine.Its pathogenesis is complex,some symptoms are difficult to distinguish,and clinical treatment is difficult.Guided by the theory of“spleen as swallow”,this paper discusses and analyzes the pathogenesis of hashimoto’s thyroiditis in Chinese medicine,and points out that the pathogenesis of HT is centered on the spleen and the spleen is the disease through the whole course of HT.Besides stagnation of liver qi,phlegm and blood stasis,deficiency of spleen yin and imbalance of yin and yang are important pathogenesis of HT.In the treatment,the center is to balance the yin and yang of the spleen,to prevent the disease first,to regulate the spleen and collaterals,to combine the method of removing phlegm and removing blood stasis,and to nourish the spleen and nourish the kidney,and then to improve the prognosis and development of HT.