张福利教授基于太阴-阳明理论治疗桥本甲状腺炎经验

Professor Zhang Fuli’s experience in treating Hashimoto thyroiditis based on taiyin-yangming theory

桥本甲状腺炎是一种临床常见的自身免疫性疾病,发病机制相对复杂,西医以手术治疗、甲状腺激素替代治疗、免疫抑制剂等手段以缓解症状,延缓病程,不良反应明显。本病属于中医“瘿病”的范畴,体质、饮食、情志等与本病发生相关,病机多为正虚邪滞,痰浊凝滞和肝失条达,病理因素多为气滞、痰凝、血瘀。张福利教授认为脾虚湿盛为基本病机,燥邪和湿邪相兼致病。燥湿互化贯穿于疾病的始终。基于太阴-阳明理论,张福利教授结合多年临证经验提出了润燥化湿、通调脾胃的基本治则,自拟基础方,临证时,根据燥邪偏亢或湿邪偏重的疾病不同阶段,增减方中诸药的润燥或祛湿之力,顺应四时之阴阳消长,随证加减,疗效颇佳。

Hashimoto thyroiditis is a clinically common autoimmune disease with a complex pathogenesis.Western medicine uses surgery,thyroid hormone replacement therapy,immunosuppressive drugs and so on to relieve symptoms and delay the course of the disease,with significant adverse effects.This disease belongs to the category of“goiter disease”in Chinese medicine.Physical,dietary,and emotional factors are related to the occurrence of this disease,and the pathogenesis of the disease is mostly due to the deficiency of vital qi and the stagnation of evil,the stagnation of phlegm and the loss of liver circulation.Pathological factors are mostly qi stagnation,phlegm coagulation,and blood stasis.Professor Zhang Fuli believes that the basic pathogenesis of the disease is dampness abundance due to spleen deficiency,with dryness and,dampness causing the disease together.Dryness and dampness interact throughout the course of the disease.Based on the taiyin-yangming theory,Professor Zhang Fuli proposes the basic treatment principle of moistening dryness,resolving dampness,and regulating the spleen and stomach,and draft the foundation plan by oneself.During the clinical treatment,according to the different stages of the disease with excessive dryness or severe dampness,the moisturizing or dispelling power of various drugs in the formula should be increased or decreased,in accordance with the growth and decline of yin and yang in the four seasons,and the therapeutic effect should be quite good with the addition and subtraction according to the symptoms.