从肝主疏泄论治围绝经期女性高血压合并甲状腺结节

Treatment of Perimenopausal Hypertension with Thyroid Nodules Based on Theory of Liver Governing Free Flow of Qi

原发性高血压与甲状腺结节均是临床常见疾病,处于绝经期前后的女性由于体内激素水平发生变化,易引起植物神经功能失调,表现出一系列具有多变性的症状,如血压升高、月经周期紊乱,易烦躁大怒、烘热汗出、焦虑失眠等;甲状腺结节属于众多甲状腺疾病的一个重要特征,主要表现为颈部肿块及颈部压迫性憋闷感,常伴有甲状腺功能异常。两种疾病均受情志因素影响大,从中医角度分析,其发病与肝关系密切,肝郁气滞不仅是甲状腺结节形成的重要病因,肝气不舒也会导致围绝经期女性血压升高,引起一系列围绝经期综合征症候群。该文细析导师朱琳主任心得,着重从疏肝理气、调整气机兼顾补益脾肾的角度介绍辨证治疗围绝经期高血压合并甲状腺结节的经验,并附医案一则,与同道分享。

Both essential hypertension and thyroid nodules are common clinical diseases.Due to changes in hormone levels in the body,women who are in the perimenopausal period are easy to cause autonomic nerve dysfunction and show a series of symptoms with variability,such as elevation of blood pressure,menstrual cycle disorder,anxiety and irritability,sweating,and insomnia.Thyroid nodules are important features of various thyroid diseases,and they mainly manifest as neck lump and compressive tightness in the neck,often accompanied by thyroid dysfunction.Both diseases are closely related to emotions.From the perspective of traditional Chinese medicine(TCM),the incidence is closely related to liver.The syndrome of liver depression and qi stagnation is an important cause of thyroid nodules,and it also causes the elevation of blood pressure in perimenopausal women,thereby causing a series of perimenopausal syndromes.This article analyzed the experience of Supervisor ZHU Lin in detail,focusing on the experience of syndrome differentiation in the treatment of perimenopausal hypertension with thyroid nodules from the perspective of soothing liver and regulating qi,adjusting qi movement,and tonifying spleen and kidney,and attached a medical record to share with colleagues.