基于“气之余便是火”理论探讨升降散治疗亚急性甲状腺炎的机制与思路

Mechanism of Shengjiangsan in Treatment of Subacute Thyroiditis Based on Theory of Excessive Qi Causing Fire

亚急性甲状腺炎是常见的甲状腺炎症性疾病。患者常常因发热、疼痛等症状需要药物治疗。糖皮质激素及非甾体类抗炎药(NSAIDs)是目前主要治疗药物,但不良反应大,病情易复发。中医药治疗亚急性甲状腺炎疗效明确,在改善症状、缩短病情有一定的优势。“气有余便是火”理论认为六淫之气、七情之气或脏腑阳亢之气超过正常,化火、化热,从而产生病理变化。该文根据“气有余便是火”理论,提出从“气”与“火”的角度探讨亚急性甲状腺炎的发病机制及治疗思路,认为亚急性甲状腺炎病机乃因起居生活不节,素体情志内伤、阳气偏胜或虚火上炎,不慎感受六淫邪毒,内外合病,气机郁闭,升降失常,壅滞成火,久则成痰、成瘀,蕴结颈前,发为本病。从亚急性甲状腺炎临床特征及发病特点分析,亚急性甲状腺炎的发生均与“气”与“火”相关。治疗思路上,泻火解毒、调节气机及活血化痰散结是亚急性甲状腺炎的主要治法。升降散具有清热解毒,化痰通络散结之效,对于亚急性甲状腺炎有明确疗效。该文详细阐述升降散通过治火调气方法治疗亚急性甲状腺炎的中医疗效机制,并结合现代研究分析,初步探讨及其可能通过抗病毒、调节免疫、消炎止痛等方面发挥作用,以期为亚急性甲状腺炎从“气“与“火”角度进行辨证论治提供新的思路,也为升降散治疗亚急性甲状腺炎的临床及基础研究提供基础伦理支撑。

Subacute thyroiditis,a common inflammatory disease of the thyroid gland,needs drug therapies due to fever,pain and other symptoms.Glucocorticoids and non-steroidal anti-inflammatory drugs(NSAIDs)are mainly used to treat this disease,while they may lead to severe side effects and high recurrence.Traditional Chinese medicine(TCM)demonstrates definite efficacy in alleviating the symptoms and shortening the disease course.The theory of excessive Qi causing fire holds that the excessive Qi of six excesses,seven emotions,or Yang hyperactivity in the Zangfu organs turns into fire and heat,resulting in pathological changes.According to this theory,this paper proposes the research on the pathogenesis and therapies of subacute thyroiditis can be started from the perspectives of Qi and fire.The disordered daily life causes internal injury of body and mind,predominant Yang Qi,or deficiency fire flaming upward,which leads to the invasion of six excesses and pathogenic toxins.Both the internal and external disorders induce the stagnation and the abnormal ascending and descending of Qi.The excessive Qi generates fire,the accumulation of which causes phlegm and stasis in front of the neck,eventually leading to the occurrence of subacute thyroiditis.The clinical and pathogenic characteristics of subacute thyroiditis indicate that the occurrence of this disease is associated with Qi and fire.Therefore,the treatment should focus on purging fire and detoxifying,regulating Qi movement,activating blood,resolving phlegm,and dissipating mass.Shengjiangsan has the effect of clearing heat and toxin,resolving phlegm,dredging collaterals,and dissipating mass,demonstrating definite therapeutic effect on subacute thyroiditis.This paper expounds the mechanism of Shengjiangsan in treating subacute thyroiditis from purging fire and regulating Qi.Furthermore,we preliminarily elaborate on the anti-viral,immunomodulatory,anti-inflammatory,and pain-relieving effects of Shengjiangsan from modern medicine.This paper provides new ideas for the syndrome differentiation and treatment of subacute thyroiditis from the perspectives of Qi and fire and basic ethical support for the clinical and basic research on the treatment of subacute thyroiditis by Shengjiangsan.