升阳法论治甲状腺功能减退症  

Discussing About the Treatment of Hypothyroidism from the Perspective of"Yang-Raising"Method

作　　者：许趁意 吕雪莲 冯志海[1] 张跃红[1] XU Chengyi;LYU Xuelian;FENG Zhihai;ZHANG Yuehong(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou,Henan,China,450001)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450001

出　　处：《河南中医》2025年第2期194-199,共6页Henan Traditional Chinese Medicine

基　　金：河南省中医药管理局项目(2019HL-089-03);2023年度河南省卫生健康委员会国家中医药传承创新中心科研专项项目(2023ZXZX1135)。

摘　　要：甲状腺功能减退症(简称甲减)病机主要为脾肾阳虚、肝郁脾虚。肝郁脾虚即土壅木郁,脾胃虚弱,少阳之气升发不利,是阳气亏损的前奏。随着病情进展,阳气日亏,久则累及脾肾之阳,进而出现脾肾阳虚,其病机演变符合中医“气损及阳”的特点。阳气本于肾、萌于肝胆、滋于脾、壮于心,治疗甲减当升阳、接阳、培阳、固阳,早期肝郁脾虚,治当升阳,方用举元煎合逍遥散加减;中期脾胃虚弱,治当接阳,方用升阳益胃汤加减;后期脾肾阳虚,治当培阳,方用金匮肾气丸合五苓散加减;阳虚凌心,治当固阳,轻者用二仙汤合真武汤,重者用破格救心汤。The pathogenesis of hypothyroidism(referred to as hypothyroidism for short)mainly involves deficiency of spleen-kidney yang and liver depression with spleen deficiency.Liver depression with spleen deficiency means that the earth element is excessive and the wood element is depressed,and the spleen and stomach are weak.The ascending of the yang qi of the lesser yang meridian is not smooth,which is a prelude to the deficiency of yang qi.As the disease progresses,the yang qi gradually declines.If it persists for a long time,it will affect the yang qi of the spleen and kidney,and then lead to deficiency of spleen and kidney yang.The evolution of its pathogenesis conforms to the characteristics of the TCM pathogenesis of"qi deficiency leading to yang deficiency".Yang qi originates from the kidney,sprouts in the liver and gallbladder,nourishes in the spleen and grows in the heart.The treatment should focus on uplifting yang,connecting yang,nourishing yang and consolidating yang.For early-stage liver depression and spleen deficiency(with the inability of the lesser yang energy to ascend),the treatment should focus on raising the yang energy,so Modified Decoction for Lifting Original Qi combined with Free Wanderer Powder can be used.For the condition of spleen and stomach weakness in the middle energizer,the treatment should focus on connecting yang,so Modified Yang-Raising and Stomach-Replenishing Decoction can be used.In the later stage,when there is deficiency of yang in the spleen and kidney,the treatment should focus on nourishing yang,so Modified Golden Cabinet′s Kidney Qi Pill combined with Five Substances Powder with Poria can be used.When yang deficiency invades the heart,the treatment should focus on consolidating yang.For mild cases,Two-elixir Decoction combined with True Warrior Decoction can be used.For severe cases,Poge Life-Saving Decoction is recommended.

关 键 词：甲状腺功能减退症 升阳法 阳气 举元煎 逍遥散 升阳益胃汤加减 金匮肾气丸 五苓散加减 二仙汤 真武汤 破格救心汤 

分 类 号：R259.582.2[医药卫生—中西医结合]