甲状腺功能亢进症合并肝损伤的中医药治疗进展

Progress in the Treatment of Hyperthyroidism Complicated with Liver Damage by Chinese Medicine

综述了近年来中医药治疗甲状腺功能亢进症(简称甲亢)合并肝损伤的概况。甲亢合并肝损伤可归属中医“瘿病”“瘿气”“黄疸”“胁痛”等疾病范畴,病位在肝,与心、脾、肾、脑密切相关;早期多表现为肝郁气结、湿邪内蕴,治疗采用抑木扶土之法佐以祛瘀化痰之药;久病耗气伤阴,后期多见气阴两虚、痰瘀互结,后期可酌加滋阴益气药以固护正气。治疗方药可采用复方如清肝泻火方、柴芍二至散、护肝方、疏肝消瘿汤、愈瘿降酶汤、疏肝消瘿合剂等,并可根据现代药理研究,佐以保肝降酶作用的中药如柴胡、茵陈、五味子、灵芝、甘草、半枝莲、白芍、黄芪、田基黄、垂盆草等。甲亢合并肝损伤的中医药研究虽已取得一定的进展,但多仍停留在自拟方的临床试验阶段。今后可开展采用经方如茵陈蒿汤、茵陈五苓散治疗甲亢合并肝损伤的研究;拓展中医药干预甲亢合并肝损伤的疗法可基于甲亢导致的肝损伤通路着手。

The progress in the treatment of hyperthyroidism complicated with liver damage by Chinese medicine in recent years was reviewed.Hyperthyroidism complicated with liver damage can be classified into the category of“thyroid enlargement”“goiter”“jaundice”“hypochondriac pain”in the field of traditional Chinese medicine.The disease of hyperthyroidism complicated with liver damage is located in the liver,and has close relationship with the heart,spleen,kidney and brain.In the early stage,hyperthyroidism complicated with liver damage is mainly manifested as the pathogenesis of liver depression and qi stagnation,internal accumulation of dampness,and the therapy of suppressing wood(liver)and supporting earth(spleen)can be used together with the herbs of removing stasis and resolving phlegm.Lasting illness can cause the consumption of qi and injury of yin,and hyperthyroidism complicated with liver damage in the late stage usually manifests the pathogenesis of deficiency of both qi and yin,phlegm blended with blood stasis,and herbs for nourishing yin and replenishing qi can be added for consolidating and preventing healthy qi.For the treatment of hyperthyroidism complicated with liver damage,the compound prescriptions of Qinggan Xiehuo Recipe,Chao Shao Erzhi Powder,Hugan Recipe,Shugan Xiaoying Decoction,Yuying Jiangmei Decoction,and Shugan Xiaoying Mixture can be adopted,and according to the pharmacological achievement,liver-preventing and transaminase-lowering herbs of Radix Bupleuri,Herba Artemisiae Scopariae,Fructus Schisandrae Chinensis,Ganoderma Lucidum seu Japonicum,Radix Glycyrrhizae,Herba Portulacae Grandiflorae,Radix Paeoniae Alba,Radix Astragali,Herba Hyperici Japonici,Herba Sedi,etc.can be chosen.Till now,certain achievements have obtained in the clinical research of treatment of hyperthyroidism complicated with liver damage by Chinese medicine,but most of the clinical trials are about the self-prescribed recipes.In the future research,research of classical recipes such as Yinchenhao Decoction and Yinchen Wuling Powder for the treatment of hyperthyroidism complicated with liver damage will be needed,and the intervention of hyperthyroidism complicated with liver damage by Chinese medicine can be carried out through the liver injury pathways caused hyperthyroidism.