龚旭初“消、托、补”三法分期论治桥本甲状腺炎经验  

GONG Xuchu's experience in staged treatment of Hashimoto thyroiditis with three methods of"resolving,supporting,and tonifying"

作　　者：陈海东[1] 龚旭初 CHEN Haidong;GONG Xuchu(Nantong Hospital Affiliated to Nanjing University of Chinese Medicine,Nantong,Jiangsu 226001,China)

机构地区：[1]南京中医药大学南通附属医院,江苏南通226001

出　　处：《湖南中医药大学学报》2025年第3期553-557,共5页Journal of Hunan University of Chinese Medicine

基　　金：第七批全国名老中医师承项目(国中医药人教函[2022]76号);国家中医药管理局重点专科项目(国中医药办医政函[2019]210号);南通市“十四五”科教强卫工程临床医学中心及青年医学重点人才项目(通卫科教[2021]15号)。

摘　　要：桥本甲状腺炎(Hashimoto thyroiditis,HT)是一种慢性自身免疫性的甲状腺疾病,病理特征是淋巴细胞浸润,导致甲状腺逐渐萎缩和纤维化,早期因甲状腺滤泡性细胞过度破坏,可出现甲状腺功能亢进,最终可因耗竭导致甲状腺功能减退。该病发病较隐蔽,发病率高,难以根治,西医缺乏有效的治疗方案,长期服用甲状腺激素补充治疗容易出现心慌、骨质疏松等不良反应。龚旭初教授认为,本病发病机制多为脾肾阳虚、肝脾失衡,病理因素为气滞、痰凝、血瘀,病性为本虚标实。治疗上承袭陈实功“外科正宗”学术思想,结合HT的病机特点,将疮疡病“消、托、补”三法用于该病的不同阶段,强调根据患者的症状、体征、甲状腺激素及抗体水平分期辨证论治,酌情配合西医治疗,可缩短疾病治疗周期,降低复发,临床疗效好,值得推广。Hashimoto thyroiditis(HT)is a chronic autoimmune thyroid disease characterized pathologically by lymphocyte infiltration,leading to gradual atrophy and fibrosis of the thyroid gland.In the early stages,due to excessive destruction of thyroid follicular cells,hyperthyroidism may occur,ultimately progressing to hypothyroidism as a result of thyroid depletion.The onset of the disease is insidious,with a high incidence rate,and it is difficult to cure completely.Western medicine lacks effective treatment options,and long-term thyroid hormone replacement therapy is associated with adverse reactions such as palpitations and osteoporosis.Professor GONG Xuchu believes that the pathogenesis of this disease is mostly attributed to deficiency of spleen and kidney yang,as well as imbalance between the liver and spleen.The pathological factors include qi stagnation,phlegm coagulation,and blood stasis,with the disease nature being deficiency in root and excess in manifestation.In treatment,Professor GONG has adopted the academic thought of Wai Ke Zheng ZONG(Orthodox Lineage of External Medicine)by CHEN Shigong,and has combined it with the pathogenic characteristics of HT,applying the three methods of“resolving,supporting,and tonifying”,which are used in treating sores and ulcers,to different stages of HT.He has emphasized the importance of staged treatment based on pattern identification according to patients'symptoms,signs,thyroid hormone levels,and antibody levels.By appropriately combining this method with Western medicine,the treatment cycle can be shortened,recurrences can be reduced,and good clinical efficacy can be achieved,making it worthy of promotion.

关 键 词：消法 托法 补法 桥本甲状腺炎 《外科正宗》 学术经验 龚旭初 

分 类 号：R249[医药卫生—中医临床基础]