李乃卿基于“土郁夺之”论治甲状腺功能亢进性腹泻经验

Professor Li Naiqing's experience in managing diarrhea in hyperthyroidism based on the theory of“when the spleen gets pent-up,expel the pathogen”

甲状腺功能亢进性腹泻(简称甲亢性腹泻),属于中医“瘿病”“泄泻”范畴。李乃卿教授认为本病病位在肠,与肝脾关系密切,核心病机为土气郁结、中焦失运,病因有虚实不同,实责之于气滞、湿、热,虚责之于脾虚。李教授临证强调从“夺之”论治,根据不同阶段采用不同治法,包括疏肝运脾,夺气之郁;清热燥湿,夺湿热郁;健脾化湿,夺湿浊郁,以恢复脾胃升降之能,取得较好疗效。结合临床病案对李教授基于“土郁夺之”治疗甲亢性腹泻的诊疗思路和用药经验进行介绍。

Hyperthyroid diarrhea falls within the categories of yingbing(goiter disease)and xiexie(diarrhea)in TCM.Professor Li Naiqing posits that the disease manifests in the intestines and is intricately linked to the liver-spleen relationship.The core pathogenesis involves the stagnation of earth qi,or spleen qi,and disruption of the middle jiao.The etiology varies between deficiency and excess,attributing the latter to stagnation of qi,dampness,and heat,and the former to spleen deficiency.Professor Li emphasizes a clinical approach rooted in the concept of"expelling".Different treatment methods are applied at various stages,including soothing the liver and promoting the spleen to alleviate qi stagnation,clearing heat and drying dampness to dispel damp-heat stagnation,and invigorating the spleen to resolve dampness,ultimately restoring the ascending and descending functions of the spleen and stomach.This comprehensive approach has yielded favorable therapeutic outcomes.This paper combines clinical cases to introduce Professor Li Naiqing's diagnostic and therapeutic approach,as well as his medication experience in managing diarrhea in hyperthyroidism based on the theory of"when the spleen gets pent-up,expel the pathogen."