基于“肝郁-脾虚-肾损”分期探讨“木郁达之”在原发性甲减中的应用  

Discussion on the application of the"facilitating the stagnant wood"theory in the treatment of primary hypothyroidism based on its staged pathogenesis evolution

作　　者：于汶仟 傅强[1] 任怡宣 于国竞 颜瑀彤 周泓 YU Wenqian;FU Qiang;REN Yixuan;YU Guojing;YAN Yutong;ZHOU Hong(Department of Nephrology and Endocrinology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院肾病内分泌科,北京100700

出　　处：《吉林中医药》2025年第2期135-139,共5页Jilin Journal of Chinese Medicine

基　　金：国家自然科学基金项目(8200151369);北京中医药大学新奥奖励基金项目(2019-AJLJJ-018)。

摘　　要：本文在“肝郁-脾虚-肾损”病机演变规律基础上分期探讨“木郁达之”在原发性甲减中的应用,探讨“肝郁-脾虚-肾损”与原发性甲减病机符合。该病起始于肝气郁滞,发展于脾胃亏虚,危重于邪滞伤肾,并通过梳理古代文献、临床报道及现代医学证据证实原发性甲减与木郁关系密切。在治疗上应全程贯彻“木郁达之”理论,在疾病初期应在疏肝理气基础上善用风药,疏肝解郁以达之;脾胃亏虚阶段应在补中益气基础上善用芳香药,运脾散郁以达之;邪滞伤肾阶段应在补益脾肾基础上,注意祛除实邪,活运气血,补而不滞,益肾祛邪以达之。以期为中医药治疗原发性甲减提供新思路。This paper discusses the application of the"facilitating the stagnant wood"theory in the treatment of primary hypothyroidism on the basis of its staged pathogenesis evolution law of"liver depression,spleen deficiency,and kidney damage",exploring the consistency between its pathogenesis evolution stages and the disease.The threephase evolution shows that the disease starts from liver qi stagnation,progresses to spleen and stomach deficiency,and is aggravated by pathogenic stagnation injuring the kidneys.This paper also confirms the close relationship between primary hypothyroidism and hepatic stagnation by combing ancient literature,clinical reports and modern medical evidence.In its treatment,the theory of"facilitating the stagnant wood"should be implemented throughout the whole process.In the early stage of the disease,wind medicines should be utilized on the basis of dispersing and regulating stagnated liver qi to relieve depression.In the stage of spleen and stomach deficiency,aromatic medicines should be utilized on the basis of tonifying the spleen and benefiting qi to promote the spleen transportation and disperse stagnated liver qi.In the stage of stagnated pathogens impairing the kidneys,attention should be paid to not only tonifying the spleen and kidneys,but also eliminating excessive pathogens to activate qi and blood transportation,benefiting the kidneys.This study is expected to provide new ideas for the treatment of primary hypothyroidism with traditional Chinese medicine.

关 键 词：木郁达之 原发性甲减 肝郁 脾虚 肾损 分期辨治 

分 类 号：R259[医药卫生—中西医结合]