基于络病理论探讨桥本甲状腺炎并发抑郁症的病因病机与治疗

The etiology,pathogenesis and treatment of Hashimoto’s thyroiditis plus depression based on the collateral disease theory

甲状腺功能异常与抑郁症的发生关系密切,桥本甲状腺炎所导致的甲状腺功能异常可以增加抑郁症的发病率。桥本甲状腺炎和抑郁症在中医学中分别属于“瘿病”和“郁证”的范畴,情志不舒,气机郁滞,气、血、津液代谢失常导致络脉不通是二者共同的病理基础。络病理论以中医经络、脏腑、阴阳、气血理论为基础,已在诸如糖尿病、心脑血管疾病等多种疾病的辨证诊疗过程中发挥了独特的优势。络脉为病,易虚易瘀,以气郁、痰浊、血瘀、瘀毒阻滞络脉,气血运行不畅,脏腑机体失荣进而影响脏腑机能为病理特征。文章以络病理论为基础,结合桥本甲状腺炎并发抑郁症气机不畅、络脉瘀滞的发病机制,将桥本甲状腺炎并发抑郁症分为“肝气郁结,络气不通”“痰结血瘀,气阴两虚”“络脉久瘀,阳气亏损”三个病理损伤阶段,并且针对不同阶段的病理特征分别提出“益气通络,疏肝健脾”“化瘀通络,益气养阴”“温阳益气,祛瘀通络”的治疗原则。同时,基于络脉的生理结构与功能特点,文章关注形病与神病的关系,通络脉以行气血,使气机畅达,气血调和,阴平阳秘,化神有源,并强调形神共治的治疗策略,以期为桥本甲状腺炎并发抑郁症的诊断与治疗提供新的思路和方法。

Thyroid dysfunction is closely related to the occurrence of depression,and thyroid dysfunction caused by Hashimoto’s thyroiditis can increase the incidence of depression.Hashimoto’s thyroiditis and depression belong to the categories of gall disease and depression syndrome respectively in traditional Chinese medicine.The common pathological basis of the two diseases is emotional depression,stagnation of Qi(气)circulation,and abnormal metabolism of Qi,blood and body fluid.The theory of collateral diseases is based on the theories of TCM meridians,Zang-Fu organs(脏腑),Yin(阴)and Yang(阳),and Qi and blood,and has played a unique advantage in the diagnosis and treatment of many diseases such as diabetes,cardiovascular and cerebrovascular diseases.The pathological features are Qi stagnation,phlegm turidity,blood stasis and stasis toxin blocking collateral vessel,resulting in the movement of Qi and blood is not smooth,and Zang-Fu organs are not nourished,which affects the function of the body.Based on the theory of collateral disease,combined with the pathogenesis of Hashimoto’s thyroiditis plus depression,such as Qi dysfunction,collaterals stasis,Hashimoto’s thyroiditis plus depression is divided into three pathological damage stages in this article,namely,stagnation of liver Qi,obstruction of collateral Qi,phlegm accumulation and blood stasis,deficiency of both Qi and Yin,stagnation of collateral vessels,and deficiency of Yangqi(阳气).According to the pathological characteristics of different stages,the therapeutic principles of soothing liver and invigorating spleen,removing blood stasis and invigorating Yin,and warming Yang and removing blood stasis were proposed respectively,so as to supplement Qi and dredge collateral.Meanwhile,based on the physiological structure and functional characteristics of the collateral vessel,the paper focuses on the relationship between the form disease and the spirit disease,and promoting Qi and blood movement by dredging collateral vessel,so that Qi and blood movement is smooth,and Yin and Yang are in equilibrium,in order to provide new ideas and methods for the diagnosis and treatment of Hashimoto’s thyroiditis plus depression.