摘要
甲状腺功能减退症可归属"虚劳""虚损""水肿""劳瘿"等范畴,多与情志不遂、先天禀赋不足、饮食劳倦内伤、病久不愈等有关,肾阳虚为本,气滞、痰凝、血瘀为标。甲状腺与足厥阴肝经、足少阴肾经、足太阴脾经循行部位重合,能调节人体生殖、生长代谢,与中医肝、脾、肾功能相似:"助肝疏泄,助脾运化,助肾生阳"。现代医学以补充左甲状腺素为主,终身服药,易发生不良反应;患者依从性差,需长期监测指标及药物不良反应。中医药治疗可较好改善临床症状,但中、重度甲减难以立即见效。倡导中西医并举、缩短病程,缓解痛苦,有显著优势,也能减轻长期服用西药不良反应。根据心、脾、肾阳气亏损偏重以及亏损程度,温阳散寒、温补脾肾、温补心肾、温肾回阳等补益法,常用附子理中丸、金匮肾气丸、右归丸、真武汤、温脾汤等加减化裁,酌加行气解郁、利湿化痰、活血祛瘀药物;遣方用药并非一味补阳,尤要重视阴阳协调、阴阳并补或阴中求阳,如六味地黄汤加温阳药物。气机郁滞宜行气解郁,药用柴胡、郁金、枳实、厚朴、佛手等;颈部肿大、周身浮肿,脘腹胀满不适,舌质淡,脉滑或弦滑等痰湿内阻可利湿化痰,药用茯苓、白术、浙贝母、半夏、瓜蒌等;病情迁延,见肢体麻木,刺痛固定不移,舌有瘀斑,脉细涩或细弦,可活血祛瘀,加丹参、三七、延胡索等。临证需四诊合参,辨证论治,灵活用药;记忆力减退,可加益智仁、远志、龙眼肉等养心安神益智;便秘,可加肉苁蓉、决明子等以温阳润肠通便;月经不调者,可加当归、王不留行、益母草等活血利水调经。
Hypothyroidism can be classified as "virtuous labor","virtual damage","edema" and "stimulated goiter". It is relevant to emotional factors, lack of congenital endowment, eating and sluggish internal injuries and choronic diseases. Analysis of its pathogenesis is based on kidney yang deficiency, with Qi stagnation, phlegm, blood stasis as the standard. deficiency of kidney-yang is the basis, and Qi stagnation,phlegm, blood stasis are inferior factor. Thyroid and Zujueyin liver meridian, Zushaoyin kidney meridian and Zutaiyin spleen meridian coincide. It can regulate human reproduction, growth and metabolism, which is similar to the functions of liver, spleen and kidney of traditional Chinese medicine:"help liver to control dispersion, help spleen to transport, help kidney to generate Yang". Modern medicine advocate supplements of levothyroxine and takes medication for life. Traditional Chinese medicine treatment is more beneficial to alleveliate clinical symptoms, but less immediately effective to sever hypothyroidism. Based on syndrome differentiation, both Chinese and western medicine treat this disease. According to the excessive deficit of heart spleen and kidney,use the methods of warming Yang and dispelling cold, warming and tonifying spleen and kidney, warming and tonifying heart and kidney, warming kidney and returning Yang, as Fuzi Lizhong pill, Jingui Shenqi pill, Yougui pill, Zhenwu decoction, Wenpi decoction and so on;drugs for dispelling depression, dampness and phlegm, promoting blood circulation and removing blood stasis should be added at discretion. If there is depression in Qi, it is better to promote Qi circulation and relieve depression by using bupleurum, radix curcumae, fructus aurantii, magnolia officinalis, buddhist hand,etc. If one has neck swelling, body edema, abdominal distension, to relieve dampness and phlegm by using Poria cocos,Atractylodes macrocephala, fritillaria thunbergii, pinellia ternata, trichosanthes trichosanthis, etc. If a person has a prolonged illness, with numbness of limbs, stabbing pain, tongue with ecchymosis, to promote blood circulation and remove blood stasis by using salvia miltiorrhiza, panax notoginseng, Yanhusuo, etc. If a person’s memory is impaired, he can be given to nourish one’s mind and improve one’s intelligence by using Yi Zhiren, Yuanzhi and Longan meat. If constipation occurs, cistanche deserticola and cassia seed can be added to warm the Yang and moisten the intestine to relieve constipation. If irregular menstruation occurs,angelica sinensis, Wangbuliuxing and leonurus heterophyllus can be added to promote blood circulation and diversify menstruation.
作者
刘静
LIU Jing(Feicheng in Shandong Province Chinese Medicine Hospital,Feicheng 271600,Shandong,China)
出处
《实用中医内科杂志》
2019年第5期4-6,共3页
Journal of Practical Traditional Chinese Internal Medicine
