张兰从“郁火”论治亚急性甲状腺炎  

Zhang Lan′s Discussion on Treatment of Subacute Thyroiditis from Perspective of"Stagnation of Fire"

作　　者：孙长路 张兰[2] SUN Changlu;ZHANG Lan(Liaoning University of Traditional Chinese Medicine,Shenyang Liaoning China 110032;The Affiliated Hospital to Liaoning University of Traditional Chinese Medicine,Shenyang Liaoning China 110032)

机构地区：[1]辽宁中医药大学,辽宁沈阳110032 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《中医学报》2024年第1期149-152,共4页Acta Chinese Medicine

基　　金：全国名老中医药专家传承工作室建设项目{国中医药人教函[2022]75号};辽宁省中医药临床学(专)科能力建设项目(LNZYXZK201904)。

摘　　要：亚急性甲状腺炎多由情志不畅、肝气郁结、痰气瘀阻等病理产物化火壅结颈前所致,加之受外感六淫邪气侵袭入里,气机运行不畅郁而化火,“郁火”贯穿整个亚急性甲状腺炎的发病过程。气滞、痰凝、血瘀是产生郁火及发病关键,临床上可见多种外感内伤因素相结合导致气血瘀滞并痰、郁、火互结于颈前而发为本病。治疗当以“火郁发之”理论为指导,一方面向上、向外宣散透发郁火;另一方面顺应郁火自上向下的传变趋势,向下、向内降泻清解郁火。亦可根据郁火成因辨其火之来源,火自外来者,应从表散;火自内生者,应从内清。在治疗亚急性甲状腺炎时可在清热解毒、理气祛痰、活血通滞基础上予以辛凉之品,常运用银翘散合小柴胡汤加减,改善患者体内郁火内结的状态,从而缓解亚急性甲状腺炎因气血瘀滞并痰、郁、火互结而出现的发热、颈部疼痛等一系列临床表现。Subacute thyroiditis is often caused by pathological products such as bad mood,stagnation of Liver Qi and obstruction of Phlegm and Qi,which leads to the stagnation of Heat and obstruction of the neck.In addition,it is invaded by external factors such as the Six Yin evil factors,and the Qi movement is not smooth,leading to the transformation and the stagnation of Heat."Stagnation of Fire"runs through the entire process of subacute thyroiditis.Qi stagnation,Phlegm coagulation and blood stasis are the key factors that cause stagnation of Fire,and in clinical practice,a combination of multiple external and internal injury factors can lead to Qi and blood stasis combined with Phlegm,stagnation of Fire in the front of the neck,resulting in this disease.The treatment should be guided by the theory of"stagnation of Fire".On the one hand,the stagnation of Fire should be spread upwards and outwards;on the other hand,it is necessary to follow the upward and downward trend of the transmission of the depressed Fire,and to clear and relieve depressed fire by descending downwards and inwardly.It is also possible to identify the source of the Fire based on the cause of the depressed fire.If the fire comes from outside,it should be dispersed from the surface;Fire that originates from within should be cleared from inside.In the treatment of subacute thyroiditis,on the basis of clearing Heat and detoxifying,regulating Qi and eliminating Phlegm,promoting blood circulation and unblocking stagnation,medicines with pungent and fragrant characters can be given.Yinqiao Powder combined with Xiao Chaihu Decoction can be used with modifications to improve the state of stagnation of fire and internal stasis in patients,thereby alleviating a series of clinical manifestations such as fever and neck pain caused by the stagnation of Qi and blood and the combination of Phlegm,depression,and Fire in subacute thyroiditis.

关 键 词：亚急性甲状腺炎 郁火 辛凉宣透 清热通滞 张兰 

分 类 号：R249.27[医药卫生—中医临床基础]