基于肝为五脏之贼辨治甲状腺结节  

Syndrome Differentiation Treatment of Thyroid Nodules from the Perspective of Liver Affecting Five Zang Viscera

作　　者：张兆洲 冯媛媛[2] 冯丹青[2] 刘宁宁[2] 赖优莹[2] 王炎[1,2] ZHANG Zhaozhou;FENG Yuanyuan;FENG Danqing;LIU Ningning;LAI Youying;WANG Yan(School of Integrative Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Oncology,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学中西医结合学院,上海201203 [2]上海中医药大学附属曙光医院肿瘤科,上海201203

出　　处：《光明中医》2025年第4期753-756,共4页GUANGMING JOURNAL OF CHINESE MEDICINE

基　　金：国家自然科学基金项目(No.82204893);上海市炎癌转化病证生物学前沿研究基地项目(No.2021KJ03-12);上海市教委“曙光计划”项目(No.21SG43);国家博士后派出项目(No.2020120);上海中医药大学“2022年中医药前沿创新型人才项目:杏林博士后人才跟踪培养计划”(No.2022-70)。

摘　　要：甲状腺结节和甲状腺癌的发病率持续升高且呈现年轻化趋势,现已成为中国重要的公共健康问题之一。针对高危人群进行甲状腺结节的筛查、评估、治疗和随访具有重要的现实意义。对于中、低风险且缺乏手术指征的甲状腺结节患者而言,积极采用中医药辨证论治具有较强的可行性。文章基于“肝为五脏之贼”理论,分析甲状腺结节的中医病因病机,认为气滞、痰凝、血瘀是贯穿甲状腺结节发生发展的主要病理因素,肝失疏泄是“肝为五脏之贼”的关键病理基础。治疗上,当调畅气机以顺应肝为刚脏之生理特性,调摄情志使肝变“贼”为“养”,以小柴胡汤合四逆散为基础方辨证治疗甲状腺结节可取得良好疗效。兹附医案1则,以期为临床辨治甲状腺结节提供新的治疗思路。The incidence rate of thyroid nodules and thyroid cancer continues to rise and shows a trend of youth,which has become an important public health problem in China.Therefore,screening,evaluation,treatment,and follow-up for thyroid nodules in high-risk populations have important practical significance.For thyroid nodule patients with medium and low risk and lack of surgical indications,the active use of traditional Chinese medicine(TCM)syndrome differentiation has strong feasibility.Based on the theory of“liver affecting five zang viscera”theory,this paper analyzed the etiology and pathogenesis of thyroid nodules in TCM,and proposed that qi stagnation,phlegm coagulation,and blood stasis are the main pathological factors that affect the occurrence and development of thyroid nodules,liver dysfunction is the key pathological basis for the“liver affecting five zang viscera”theory.In terms of treatment,it is important to regulate qi activity to comply with the physiological characteristics of the liver being the resolute viscera,adjust emotions to transform the liver from“discordance”to“nourishment”.Xiaochaihu decoction combined with Sini powder as the basis of syndrome differentiation treatment of thyroid nodules has achieved a good effect.One medical case was attached,aiming to provide a new treatment idea for clinical differentiation and treatment of thyroid nodules.

关 键 词：瘿病 甲状腺结节 肝为五脏之贼 辨证论治 中医药疗法 

分 类 号：R259[医药卫生—中西医结合]