程丑夫从肝论治甲状腺结节经验

Cheng Choufu′s Experience in Treating Thyroid Nodules from the Perspective of Liver

程丑夫教授认为,甲状腺结节的病因病机为情志失调、气郁痰凝、气滞血瘀、痰瘀毒蕴,从肝论治甲状腺结节治疗要旨在于“疏肝调气”。程教授认为,情志失调,疏肝为先,常选用柴胡疏肝散、逍遥散、小柴胡汤等,多选用柴胡、白芍、佛手、枳壳等性味平和的疏肝药治疗体质平和者;选用乌药、木香、香附、小茴香等性味温燥的疏肝药治疗体质偏寒者;选用橘核、荔枝核等质沉重味浑厚的疏肝药治疗肝气郁结证日久者。气郁痰凝,应调气化痰,程教授用海藻玉壶汤合《医学心悟》中消瘰丸,或自拟方昆藻消瘰丸(由昆布、海藻、生牡蛎、玄参、浙贝母组成)加减调气化痰散结,若郁久化热见烦热、舌红苔黄、脉数者,加夏枯草、栀子、黄连等清热泻火;若结块较大者,加白芥子、猫爪草、天葵子等以增化痰散结之功。气滞血瘀,当行气活血,瘀血初凝者多加用王不留行、丹参、赤芍等作用平和的活血化瘀药;气滞血瘀者多加用川楝子、川芎、延胡索等活血行气之品;久病入血入络者加用化瘀善走络的全蝎、蜈蚣等药。痰瘀毒蕴,当解毒散结,程教授喜用自拟方二七散(由三七、重楼组成)解毒活血散结,对结块较硬者,会酌情加用三棱、莪术、黄药子、露蜂房、僵蚕等增强活血软坚、解毒消肿之功;对结块坚硬且不可移者,会酌情加用山慈菇、天葵子、半枝莲等增强散瘀通络、解毒散结之功。

Professor Cheng Choufu believes that the etiology and pathogenesis of thyroid nodules involve emotional disturbances,qi depression,phlegm condensation,qi stagnation with blood stasis,and phlegm-stasis toxin accumulation.His approach to treating thyroid nodules from the liver perspective emphasizes"soothing the liver and regulating qi."According to Professor Cheng,emotional disturbances require liver soothing as a priority,often using formulas such as Bupleurum Liver-Soothing Powder,Free Wanderer Powder,Minor Bupleurum Decoction,etc.For individuals with the balanced constitution,Chaihu(Radix Bupleuri),Baishao(Radix Paeoniae Alba),Foshou(Fructus Citri Sarcodactylis),Zhiqiao(Fructus Aurantii),etc.with mild nature and flavor are often used.For those with the cold constitution,warming liver-soothing drugs such as Wuyao(Radix Linderae),Muxiang(Radix Aucklandiae),Xiangfu(Rhizoma Cyperi),and Xiaohuixiang(Fructus Foeniculi),etc.are used.For long-standing liver qi depression,heavier and more substantial drugs such as Juhe(Semen Citri Reticulatae)and Lizhihe(Semen Litchi),etc.are selected.For qi stagnation and phlegm condensation,he uses Sargassum Yuhu Decoction combined with Scrofula-Dispersing Pills from Medical Revelations,or his own self-made Thallus Laminariae and Sargassum Scrofula-Dispersing Pills composed of Kunbu(Laminariae and Sargassum),Haizao(Sargassum),Shengmuli(Concha Ostreae),Xuanshen(Radix Scrophulariae),and Zhebeimu(Bulbus Fritillariae Thunbergii)to regulate qi,resolve phlegm,and disperse nodules.If stagnation has transformed into heat,causing irritability,red tongue with yellow coating,and rapid pulse,he adds drugs such as Xiakucao(Spica Prunellae),Zhizi(Fructus Gardeniae),and Huanglian(Rhizoma Coptidis),etc.to clear heat and purge fire.For larger nodules,Baijiezi(Semen Sinapis),Maozhuacao(Radix Ranunculi Ternati),and Tiankuizi(Radix Semiaquilegiae)are used to enhance the phlegm-resolving and nodule-dispersing effects.For qi stagnation and blood stasis,it is necessary to promote qi and invigorate blood.For early-stage blood stasis,mild blood-activating drugs such as Wangbuliuxing(Semen Vaccariae),Danshen(Radix Salviae Miltiorrhizae),and Chishao(Radix Paeoniae Rubra)are used.For qi stagnation with blood stasis,Chuanlianzi(Fructus Toosendan),Chuanxiong(Rhizoma Chuanxiong),and Yanhusuo(Rhizoma Corydalis)are added.For long-standing illness involving blood stasis in the collaterals,potent stasis-removing drugs such as Quanxie(Scorpio)and Wugong(Scolopendra),etc.are used.For phlegm-stasis toxin accumulation,he focuses on detoxifying and resolving nodules,often using his own self-made formula Two-Seven Powder which is composed of Sanqi(Radix et Rhizoma Notoginseng)and Chonglou(Rhizoma Paridis)to detoxify,activate blood,and disperse nodules.For harder nodules,he considers adding drugs such as Sanleng(Rhizoma Sparganii),Ezhu(Rhizoma Curcumae),Huangyaozi(Rhizoma Dioscoreae Bulbiferae),Lufengfang(Nidus Vespae),and Baijiangcan(Bombyx Batryticatus)to enhance the effects of invigorating blood,softening hardness,detoxifying,and reducing swelling.For nodules that are hard and immovable,he adds drugs such as Shancigu(Pseudobulbus Cremastrae seu Pleiones),Tiankuizi(Radix Semiaquilegiae),and Banzhilian(Herba Scutellariae Barbatae),etc.to strengthen the effects of removing stasis,unblocking collaterals,detoxifying,and resolving nodules.