甲状腺机能亢进症中医辨治述略与李赛美临床经验探讨
|
摘要
这个研究分为两个部份,第一个部份是研究从1949年迄今,中医辨治甲状腺机能亢进症的经验。第二个部份是探讨导师李赛美教授对辨治甲状腺机能亢进症的个人经验,一为宏观,一为微观,宏微相合,以祈得全。
目的：
中国自从1994年开始,全民强制在食盐中加碘,成为国策,执行18年,最近调查显示,全民补碘过度,以致甲状腺功能亢进、甲状腺肿瘤,发病率飚升,碘在人体,大部份被甲状腺吸收,碘盐摄取太多,反而对健康构成威胁,不单会造成甲状腺疾病,还可引发高血压、心脏病、肾病。湖北中医学院,甲状腺病专科医师左新河教授指出,过犹不及,缺碘者不缺,不缺者变成增多,成高碘民众,形成甲状腺病,天津十年来发病率上升三倍。国内推行在食盐中加碘,但患甲状腺病群众却有所增加,说明其导致甲状腺发病的因素,逐渐形成,这是值得关注的。近年经济趋向蓬勃,由农业社会型转向经济型,讲求效率、速迅,工作压力大增,情绪出问题而导致发病,这是值得我们深思。个人也曾经是甲亢的受害者,深深体会到甲亢患者无助与无奈,可能要面对终身服药的窘局,在服药的同时,西药有机会损害肝功能及减低白细胞数量,需要定期监测。甲亢进则可成危象如心力衰竭,退则甲减。服用放射性碘,可能终身不孕、不育,手术治疗,有声带受伤,终身声音嘶哑的危险,用碘与手术治疗,同样会面对由甲亢转成甲减的情况,结果都是终身服药。面对如此总总,究竟中药有没有方法,帮上一把?
经过初步的文献检索,发现中医中药治理甲亢,大有苗头。但却又发觉医者治疗甲亢经验,零星散落,毫无系统,检用困难,所以尝试从恒河沙数的文献中,淘沙铄金,作一次系统的梳理,冀求检索的方便。
李赛美教授是经方名家,亦为《伤寒论讲义》最新版教材主编,长于治疗内分泌疾患,尤于甲状腺机能亢进症与糖尿病,别具心得,疗效肯定。尝言六经铃百病,倡导六经辨证,辨治百病,临床用六经辨证辨治甲亢、糖尿病等疑难病,知行合一,取得满意疗效。根据吴彦麟的论文报导,李赛美教授对甲亢治疗总有效率为91.67%。究竟她如何用六经辨治甲亢,用药思路,对临床有何指导意义?我们的知识是由「知之」和「不知」构成,但「不知」远比「知之」多,只要有「不知」,我们就要去猜,本论文希望搜集更多「知之」,不用再去「猜之」,期望透过李赛美教授对甲亢的「知之」,引领我们对治理甲亢,作为借镜,是这次研究另一目的。
方法：
从中国期刊网、香港大学图书馆及私人三千多本藏书中,仔细翻阅,将有关治理甲亢理、法、方、药的条文抽出,分成四类,按目条述。计有将古人、今人与现代医学对甲亢的认识,分成三类,归入“说理”篇；将甲亢相关的治法,分成内治法、外治法、针灸法、食疗法,归入“议法”篇；将方剂分成经方、经典方、经验方三类,归入“阐方”篇；将医者相关用治甲亢药物经验,汇集归入“述药”篇。
从2012年8月2日至2012年11月15日期间,搜集李赛美教授门诊病案,将被确诊为甲亢的病例,观察甲亢在六经证型的分布情况,进行分析。并按雷载权编着《中药学》教材内订定的药物功效,进行分类,从而分析用药与药量情况。
成果：
将医者从1949年对甲亢的论述,分为理、法、方、药四个方法,作出梳理,方便检查医者在这四个范畴的经验,以备临床借镜。
从1233个病案中,经李赛美教授诊断为甲亢的病人,共308个人次。其中女性人数132人,男性38人。研究发现,李赛美教授是使用三个辨证方法去辨治甲亢,分别是六经辨证、脏腑辨证、病因辨证,在308例中,六经辨证法有203例占66%、脏腑辨证法有72例占23%、病因辨证法有33例占11%。
在203例六经辨证法中,三阳经有197例占97%,三阴经有6例占3%。而在三阳经197例当中,太阳经证有33例占17%,阳明经有29例占15%,少阳经有135例估68%。
在太阳证用药中,其使用频次依次为补气药、发散风寒药、清热药、利水渗湿药、补血药、化痰药、发散风热药、补阳药、平息肝风药、化湿药、活血化瘀药、补阴药、温里药、止咳平喘药、安神药、理气药、收涩药、祛风湿药、止血药、消食药,涉及药物共20类,使用总频次为493次,删除使用频次低于3%者,余下为依次为补气药、发散风寒药、清热药、利水渗湿药、补血药、化痰药、发散风热药、补阳药、平息肝风药、化湿药、活血化瘀药。
在阳明证用药中,其使用频次依次为清热药、补气药、化痰药、发散风寒药、活血化瘀药、平息肝风药、发散风热药、补血药、补阴药、利水渗湿药、化湿药、补阳药、止咳平喘药、理气药、安神药、温里药、止血药、收涩药,涉及药物共18类,使用总频次为441次,删除使用频次低于3%者,余下为依次为清热药、补气药、化痰药、发散风寒药、活血化瘀药、平息肝风药、发散风热药、补血药、补阴药。
在少阳证用药中,其使用频次依次为补气药、清热药、发散风寒药、化痰药、发散风热药、利水渗湿药、补血药、补阴药、平息肝风药、活血化瘀药、化湿药、补阳药、祛风湿药、温里药、理气药、止咳平喘药、止血药、安神药、消食药、收涩药、泻下药,涉及药物共21类,使用总频次为2073次,删除使用频次低于3%者,余下为依次为补气药、清热药、发散风寒药、化痰药、发散风热药、利水渗湿药、补血药、补阴药、平息肝风药、活血化瘀药。
结论：
从1949年迄今,医者用中医中药去治理甲亢,取得丰硕的成果,唯在海藻、昆布等含碘量丰富的药物去治疗甲亢,存在着不同的声音,这需留待我们进一步的考证与思考。
六经是为百病而立法,而非单纯为伤寒而设,李赛美教授用诸临床辨治甲亢,可体现《伤寒论》并不是单纯治理外感伤寒的专着,而是全方位服务于各科,她亦用六经辨治糖尿病,是有力的明证。名不正,言不顺,《伤寒论》这个书名,给历代初学者带来无穷的困扰与误导,随着现代医者包括李赛美教授等努力下,赋与《伤寒论》一个明确定位,说明它是一本辨治百病的专着,是传承经典一次重要胜利。
甲亢患者临床表现绝大多数属于三阳证,而非三阴证,这从李赛美教授医案中,三阳证占97%之强,三阴证仅占3%,得到证实,对治疗甲亢用药,给了明确的指引,临床可用补气药、清热药、发散风寒、化痰药、发散风热药、利水渗湿药、补血药、补阴药、平息肝风药、活血化瘀药等,随证加减。
药量方面,根据少阳证2073次用药频次中可见,李赛美教授恪守一般常规用量,绝大部药量不超过30g,极少超常规药量,体现稳中求变,既不浪费药源,又能取得疗效,这是值得借镜学习之处。
This research is divided into two parts. The first part analyses the experience of CMP's Chinese medical treatment on hyperthyroidism from1949till now. The second part is to discuss the personal experience in dealing with hyperthyroidism of Professor Li Saimei's clinical treatment. In order to be comprehensive, I would like to discuss the topic in both macroscopically, the first part, and microscopically, the second part.
Objective
Since1994, China compulsory adds iodine into edible salt. This becomes a national policy which has been carried out for18years. From a recent research, people absorb too much iodine, which leads to hyperthyroidism and thyroid tumors. Iodine, which stays in human body, will be mostly absorbed by thyroid. Absorbing too much iodine salt will actually affect health. It will cause thyroid disease, high blood pressure, heart disease and kidney disease. A thyroid disease specialist, Professor Zuo Xinhe of Hubei University of Chinese Medicine indicates that its going too far is as bad as not going far enough. People, lack of iodine, become normal but people who are not lack of iodine, absorbs too much will lead to the formation of thyroid disease. Recently, there is three times of thyroid disease patients in Tianjin than before. In China, our country promotes adding iodine in salt, but the number of thyroid patients increases instead. The cause of thyroid disease is becoming visible. We should pay attention on it. Recently, economy blooms, the society is shifting from agricultural to economical. Efficiency is becoming more and more important, and working pressure is gradually increasing too. Emotional problem will also cause illness. I was one of the hyperthyroidism patients. I understand the helpless feeling of being one of them. There is a possibility that patients have to take medicine for lifetime long. By taking western medicine, it may hurt liver function and reduce the number of white blood cells. Therefore, patients need to be monitored regularly. Hyperthyroidism may lead to the crisis of heart failure. Taking radioactive iodine may have side effect like infertility. With operation, there may have a risk of hurting vocal cord and lifelong hoarseness. Taking radioactive iodine or operation will also facing a problem of lifelong medication. With problems mentioned above, can Chinese medicine help?
After an initial research, I found that CMP's hyperthyroidism treatment have great success. However, lack of systematically arrangement and sort out, it is difficult to put it on practice. Therefore, I tried to organize the information systematically. Hopefully the information can be used conveniently after that.
Professor Li Saimei is an expert of classic prescription, at the same time, the editor of the newest version of "Shanghanlun Lecture". She specializes in endocrine disorders, especially hyperthyroidism and diabetes. Her contribution on those fields is confirmative. As saying, Six Meridian cure all kinds of diseases. Professor Li Saimei advocates six-meridian pattern identification. She follows the rules of Six Meridian for hyperthyroidism and diabetes treatment. The result is satisfactory. According to Ng Yinlun's dissertation, Professor Li Saimei's efficacy rate is91.67%. How she puts forward the Six Meridian for hyperthyroidism treatment? What is her rule of using herbs? How she affects clinical diagnosis? Our knowledge is combined by "known" and "unknown"."unknown" is much more than "known". With "unknown", we are forced to guess. One of my aims of this research is to collect, re-arrange and analysis of the "known" information to give a clear picture for practice. Also, with the study of Professor Li Saimei's theory and practice of Six-Meridian Pattern Identification, I hope we will have a clear guideline for hyperthyroidism treatment in the near future.
Methods
Thorough study and analysis the writings from CNKI, books from library of the University of Hong Kong and my personal collection of over3,000books, we take out all clauses about the Theory, Methodology, Prescription, Meditation of hyperthyroidism treatment. We can divide our study into4chapters. The "Theory" chapter divides the previous and modern knowledge of hyperthyroidism into3categories. The "Method" chapter divides our methods of hyperthyroidism treatment into internal therapy, external therapy, acupuncture and food therapy. The "Prescription" chapter divides prescriptions into three categories:Shanghanlun's prescription, classic prescription and experience prescription. The "Medicine Analysis" chapter studies the herbs adopted by CMP for hyperthyroidism treatment.
Results
By analyzing CMP s'study of hyperthyroidism from1949onwards, we can divide it into four fields:Theory, Methodology, Prescription, Meditation. My arrangement and data collection in each field, give a clear picture to check each efficiency for clinical treatment.
In Professor Li Saimei's1233cases,308cases (170patients) are hyperthyroidism. Amongst,132patients are female and38patients are male. Discovering by the case study, she has three methods of pattern identification: Six-Meridian Pattern Identification, Visceral Pattern Identification and Diseases Cause Pattern Identification. Within these308cases,203cases (66%) are Six-Meridian Pattern Identification.72cases (23%) are Visceral Pattern Identification.33cases (11%) are Diseases Cause Pattern Identification.
Within203cases of Six-Meridian Pattern Identification,197cases (97%) are three yang meridians pattern and6cases (3%) are three yin meridians pattern. For those197cases of three yang meridians pattern,33cases (17%) are greater yang meridian pattern.29cases (15%) are yang brightness meridian pattern and135cases (68%) are lesser yang meridian pattern.
For the cases of greater yang meridian pattern, the frequency of herb adopted, from high to low:tonics for invigorating qi herbs, pungent-warm herbs relieving superficies herbs, heat clearing herbs, promoting diuresis herbs, tonics for nourishing blood herbs, phlegm resolving herbs, pungent-cool herbs relieving superficies, tonics for reinforcing yang herbs, pacify the wind of liver herbs, dampness removing herbs, invigorating the blood and removing blood stasis herbs, tonics for nourishing yin, interior warming herbs, suppress cough and to calm panting herbs, tranquilize herbs, qi regulating herbs, astringent herbs, dispel wind and dampness herbs, hemostatic herbs and food retention relieving herbs. It totally involves20categories of herbs and493frequency of use. Excluding the frequency rate under3%, the sequence is:tonics for invigorating qi herbs, pungent-warm herbs relieving superficies herbs, heat clearing herbs, promoting diuresis herbs, tonics for nourishing blood herbs, phlegm resolving herbs, pungent-cool herbs relieving superficies, tonics for reinforcing yang herbs, pacify the wind of liver herbs, dampness removing herbs and invigorating the blood and removing blood stasis herbs.
For the cases of yang brightness meridian pattern, the frequency of herb adopted, from high to low:heat clearing herbs, tonics for invigorating qi herbs, phlegm resolving herbs, pungent-warm herbs relieving superficies, invigorating the blood and removing blood stasis herbs, pacify the wind of liver herbs, pungent-cool herbs relieving superficies, tonics for nourishing blood herbs, tonics for nourishing yin herbs, promoting diuresis herbs, dampness removing herbs, tonics for reinforcing yang herbs, suppress cough and to calm panting herbs, qi regulating herbs, tranquilizer herbs, interior warming herbs, hemostatic herbs and astringent herbs. It totally involves18categories of herbs and441frequency of use. Excluding the frequency rate under3%, the sequence is:heat clearing herbs, tonics for invigorating qi herbs, phlegm resolving herbs, pungent-warm herbs relieving superficies, invigorating the blood and removing blood stasis herbs, pacify the wind of liver herbs, pungent-cool herbs relieving superficies, tonics for nourishing blood herbs and tonics for nourishing yin herbs.
For the cases of lesser yang meridian pattern, the frequency of herb adopted, from high to low:
tonics for invigorating qi herbs, heat clearing herbs, pungent-warm herbs relieving superficies, phlegm resolving herbs, pungent-cool herbs relieving superficies, promoting diuresis herbs, tonics for nourishing blood herbs, tonics for nourishing yin herbs, pacify the wind of liver herbs, invigorating the blood and removing blood stasis herbs, dampness removing herbs, tonics for reinforcing yang herbs, dispel wind and dampness herbs, interior warming herbs, qi regulating herbs, suppress cough and to calm panting herbs, hemostatic herbs, tranquilizer herbs, food retention relieving herbs, astringent herbs and cathartics herbs. It totally involves21categories of herbs and2,073frequency of use. Excluding the frequency rate under3%, the sequence is:tonics for invigorating qi herbs, heat clearing herbs, pungent-warm herbs relieving superficies, phlegm resolving herbs, pungent-cool herbs relieving superficies, promoting diuresis herbs, tonics for nourishing blood herbs, tonics for nourishing yin herbs, pacify the wind of liver herbs and invigorating the blood and removing blood stasis herbs.
Conclusions
From1949up to now, CMP use traditional Chinese medicine to cure hyperthyroidism with fruitful achievements. However, the use of seaweed and kelp, which are rich with iodine, for hyperthyroidism treatment, have different argument. We need to have further study and research.
Six Meridain is a valuable code for curing thousands of sickness. It is not only a book for curing cold. By studying Professor Li Saimei's clinical hyperthyroidism treatment, we find that Shanghanlun is not a monograph only for curing cold. It should be a giant code for all kinds of diagnosis and treatment. Professor Li Saimei curing diabetes with six-meridian pattern identification, is a powerful proof. Misleading by its name "Shanghanlun", previous beginners misinterpreted that it is a book for curing cold only. By the great effort of our modern CMPs, including Professor Li Saimei, give a clear status for Shanghanlun. It is a great book for all kinds of diagnosis and treatment. It is also a victory for studying classic book.
Most hyperthyroidism patients, with clinical manifestation, are three yang meridians pattern, rather than three yin meridians pattern. It can be proved by Professor Li Saimei's medical cases,97%are three yang meridians pattern and only3%are three yin meridians pattern. Thus, we have a good guideline for hyperthyroidism treatment. For clinical diagnosis, we can use tonics for invigorating qi herbs, heat clearing herbs, pungent-warm herbs relieving superficies, phlegm resolving herbs, pungent-cool herbs relieving superficies, promoting diuresis herbs, tonics for nourishing blood herbs, tonics for nourishing yin herbs, pacify the wind of liver herbs and invigorating the blood and removing blood stasis herbs. We should adjust the quantity of each herb with different diagnosis.
Referring to Professor Li Saimei's three yin meridians pattern,2073medicine taking frequency, she had a standard rule for the quantity of each herb. She seldom exceeds the standard. It is a golden rule for us to follow as it is safe but efficiency.
目的：
中国自从1994年开始,全民强制在食盐中加碘,成为国策,执行18年,最近调查显示,全民补碘过度,以致甲状腺功能亢进、甲状腺肿瘤,发病率飚升,碘在人体,大部份被甲状腺吸收,碘盐摄取太多,反而对健康构成威胁,不单会造成甲状腺疾病,还可引发高血压、心脏病、肾病。湖北中医学院,甲状腺病专科医师左新河教授指出,过犹不及,缺碘者不缺,不缺者变成增多,成高碘民众,形成甲状腺病,天津十年来发病率上升三倍。国内推行在食盐中加碘,但患甲状腺病群众却有所增加,说明其导致甲状腺发病的因素,逐渐形成,这是值得关注的。近年经济趋向蓬勃,由农业社会型转向经济型,讲求效率、速迅,工作压力大增,情绪出问题而导致发病,这是值得我们深思。个人也曾经是甲亢的受害者,深深体会到甲亢患者无助与无奈,可能要面对终身服药的窘局,在服药的同时,西药有机会损害肝功能及减低白细胞数量,需要定期监测。甲亢进则可成危象如心力衰竭,退则甲减。服用放射性碘,可能终身不孕、不育,手术治疗,有声带受伤,终身声音嘶哑的危险,用碘与手术治疗,同样会面对由甲亢转成甲减的情况,结果都是终身服药。面对如此总总,究竟中药有没有方法,帮上一把?
经过初步的文献检索,发现中医中药治理甲亢,大有苗头。但却又发觉医者治疗甲亢经验,零星散落,毫无系统,检用困难,所以尝试从恒河沙数的文献中,淘沙铄金,作一次系统的梳理,冀求检索的方便。
李赛美教授是经方名家,亦为《伤寒论讲义》最新版教材主编,长于治疗内分泌疾患,尤于甲状腺机能亢进症与糖尿病,别具心得,疗效肯定。尝言六经铃百病,倡导六经辨证,辨治百病,临床用六经辨证辨治甲亢、糖尿病等疑难病,知行合一,取得满意疗效。根据吴彦麟的论文报导,李赛美教授对甲亢治疗总有效率为91.67%。究竟她如何用六经辨治甲亢,用药思路,对临床有何指导意义?我们的知识是由「知之」和「不知」构成,但「不知」远比「知之」多,只要有「不知」,我们就要去猜,本论文希望搜集更多「知之」,不用再去「猜之」,期望透过李赛美教授对甲亢的「知之」,引领我们对治理甲亢,作为借镜,是这次研究另一目的。
方法：
从中国期刊网、香港大学图书馆及私人三千多本藏书中,仔细翻阅,将有关治理甲亢理、法、方、药的条文抽出,分成四类,按目条述。计有将古人、今人与现代医学对甲亢的认识,分成三类,归入“说理”篇；将甲亢相关的治法,分成内治法、外治法、针灸法、食疗法,归入“议法”篇；将方剂分成经方、经典方、经验方三类,归入“阐方”篇；将医者相关用治甲亢药物经验,汇集归入“述药”篇。
从2012年8月2日至2012年11月15日期间,搜集李赛美教授门诊病案,将被确诊为甲亢的病例,观察甲亢在六经证型的分布情况,进行分析。并按雷载权编着《中药学》教材内订定的药物功效,进行分类,从而分析用药与药量情况。
成果：
将医者从1949年对甲亢的论述,分为理、法、方、药四个方法,作出梳理,方便检查医者在这四个范畴的经验,以备临床借镜。
从1233个病案中,经李赛美教授诊断为甲亢的病人,共308个人次。其中女性人数132人,男性38人。研究发现,李赛美教授是使用三个辨证方法去辨治甲亢,分别是六经辨证、脏腑辨证、病因辨证,在308例中,六经辨证法有203例占66%、脏腑辨证法有72例占23%、病因辨证法有33例占11%。
在203例六经辨证法中,三阳经有197例占97%,三阴经有6例占3%。而在三阳经197例当中,太阳经证有33例占17%,阳明经有29例占15%,少阳经有135例估68%。
在太阳证用药中,其使用频次依次为补气药、发散风寒药、清热药、利水渗湿药、补血药、化痰药、发散风热药、补阳药、平息肝风药、化湿药、活血化瘀药、补阴药、温里药、止咳平喘药、安神药、理气药、收涩药、祛风湿药、止血药、消食药,涉及药物共20类,使用总频次为493次,删除使用频次低于3%者,余下为依次为补气药、发散风寒药、清热药、利水渗湿药、补血药、化痰药、发散风热药、补阳药、平息肝风药、化湿药、活血化瘀药。
在阳明证用药中,其使用频次依次为清热药、补气药、化痰药、发散风寒药、活血化瘀药、平息肝风药、发散风热药、补血药、补阴药、利水渗湿药、化湿药、补阳药、止咳平喘药、理气药、安神药、温里药、止血药、收涩药,涉及药物共18类,使用总频次为441次,删除使用频次低于3%者,余下为依次为清热药、补气药、化痰药、发散风寒药、活血化瘀药、平息肝风药、发散风热药、补血药、补阴药。
在少阳证用药中,其使用频次依次为补气药、清热药、发散风寒药、化痰药、发散风热药、利水渗湿药、补血药、补阴药、平息肝风药、活血化瘀药、化湿药、补阳药、祛风湿药、温里药、理气药、止咳平喘药、止血药、安神药、消食药、收涩药、泻下药,涉及药物共21类,使用总频次为2073次,删除使用频次低于3%者,余下为依次为补气药、清热药、发散风寒药、化痰药、发散风热药、利水渗湿药、补血药、补阴药、平息肝风药、活血化瘀药。
结论：
从1949年迄今,医者用中医中药去治理甲亢,取得丰硕的成果,唯在海藻、昆布等含碘量丰富的药物去治疗甲亢,存在着不同的声音,这需留待我们进一步的考证与思考。
六经是为百病而立法,而非单纯为伤寒而设,李赛美教授用诸临床辨治甲亢,可体现《伤寒论》并不是单纯治理外感伤寒的专着,而是全方位服务于各科,她亦用六经辨治糖尿病,是有力的明证。名不正,言不顺,《伤寒论》这个书名,给历代初学者带来无穷的困扰与误导,随着现代医者包括李赛美教授等努力下,赋与《伤寒论》一个明确定位,说明它是一本辨治百病的专着,是传承经典一次重要胜利。
甲亢患者临床表现绝大多数属于三阳证,而非三阴证,这从李赛美教授医案中,三阳证占97%之强,三阴证仅占3%,得到证实,对治疗甲亢用药,给了明确的指引,临床可用补气药、清热药、发散风寒、化痰药、发散风热药、利水渗湿药、补血药、补阴药、平息肝风药、活血化瘀药等,随证加减。
药量方面,根据少阳证2073次用药频次中可见,李赛美教授恪守一般常规用量,绝大部药量不超过30g,极少超常规药量,体现稳中求变,既不浪费药源,又能取得疗效,这是值得借镜学习之处。
This research is divided into two parts. The first part analyses the experience of CMP's Chinese medical treatment on hyperthyroidism from1949till now. The second part is to discuss the personal experience in dealing with hyperthyroidism of Professor Li Saimei's clinical treatment. In order to be comprehensive, I would like to discuss the topic in both macroscopically, the first part, and microscopically, the second part.
Objective
Since1994, China compulsory adds iodine into edible salt. This becomes a national policy which has been carried out for18years. From a recent research, people absorb too much iodine, which leads to hyperthyroidism and thyroid tumors. Iodine, which stays in human body, will be mostly absorbed by thyroid. Absorbing too much iodine salt will actually affect health. It will cause thyroid disease, high blood pressure, heart disease and kidney disease. A thyroid disease specialist, Professor Zuo Xinhe of Hubei University of Chinese Medicine indicates that its going too far is as bad as not going far enough. People, lack of iodine, become normal but people who are not lack of iodine, absorbs too much will lead to the formation of thyroid disease. Recently, there is three times of thyroid disease patients in Tianjin than before. In China, our country promotes adding iodine in salt, but the number of thyroid patients increases instead. The cause of thyroid disease is becoming visible. We should pay attention on it. Recently, economy blooms, the society is shifting from agricultural to economical. Efficiency is becoming more and more important, and working pressure is gradually increasing too. Emotional problem will also cause illness. I was one of the hyperthyroidism patients. I understand the helpless feeling of being one of them. There is a possibility that patients have to take medicine for lifetime long. By taking western medicine, it may hurt liver function and reduce the number of white blood cells. Therefore, patients need to be monitored regularly. Hyperthyroidism may lead to the crisis of heart failure. Taking radioactive iodine may have side effect like infertility. With operation, there may have a risk of hurting vocal cord and lifelong hoarseness. Taking radioactive iodine or operation will also facing a problem of lifelong medication. With problems mentioned above, can Chinese medicine help?
After an initial research, I found that CMP's hyperthyroidism treatment have great success. However, lack of systematically arrangement and sort out, it is difficult to put it on practice. Therefore, I tried to organize the information systematically. Hopefully the information can be used conveniently after that.
Professor Li Saimei is an expert of classic prescription, at the same time, the editor of the newest version of "Shanghanlun Lecture". She specializes in endocrine disorders, especially hyperthyroidism and diabetes. Her contribution on those fields is confirmative. As saying, Six Meridian cure all kinds of diseases. Professor Li Saimei advocates six-meridian pattern identification. She follows the rules of Six Meridian for hyperthyroidism and diabetes treatment. The result is satisfactory. According to Ng Yinlun's dissertation, Professor Li Saimei's efficacy rate is91.67%. How she puts forward the Six Meridian for hyperthyroidism treatment? What is her rule of using herbs? How she affects clinical diagnosis? Our knowledge is combined by "known" and "unknown"."unknown" is much more than "known". With "unknown", we are forced to guess. One of my aims of this research is to collect, re-arrange and analysis of the "known" information to give a clear picture for practice. Also, with the study of Professor Li Saimei's theory and practice of Six-Meridian Pattern Identification, I hope we will have a clear guideline for hyperthyroidism treatment in the near future.
Methods
Thorough study and analysis the writings from CNKI, books from library of the University of Hong Kong and my personal collection of over3,000books, we take out all clauses about the Theory, Methodology, Prescription, Meditation of hyperthyroidism treatment. We can divide our study into4chapters. The "Theory" chapter divides the previous and modern knowledge of hyperthyroidism into3categories. The "Method" chapter divides our methods of hyperthyroidism treatment into internal therapy, external therapy, acupuncture and food therapy. The "Prescription" chapter divides prescriptions into three categories:Shanghanlun's prescription, classic prescription and experience prescription. The "Medicine Analysis" chapter studies the herbs adopted by CMP for hyperthyroidism treatment.
Results
By analyzing CMP s'study of hyperthyroidism from1949onwards, we can divide it into four fields:Theory, Methodology, Prescription, Meditation. My arrangement and data collection in each field, give a clear picture to check each efficiency for clinical treatment.
In Professor Li Saimei's1233cases,308cases (170patients) are hyperthyroidism. Amongst,132patients are female and38patients are male. Discovering by the case study, she has three methods of pattern identification: Six-Meridian Pattern Identification, Visceral Pattern Identification and Diseases Cause Pattern Identification. Within these308cases,203cases (66%) are Six-Meridian Pattern Identification.72cases (23%) are Visceral Pattern Identification.33cases (11%) are Diseases Cause Pattern Identification.
Within203cases of Six-Meridian Pattern Identification,197cases (97%) are three yang meridians pattern and6cases (3%) are three yin meridians pattern. For those197cases of three yang meridians pattern,33cases (17%) are greater yang meridian pattern.29cases (15%) are yang brightness meridian pattern and135cases (68%) are lesser yang meridian pattern.
For the cases of greater yang meridian pattern, the frequency of herb adopted, from high to low:tonics for invigorating qi herbs, pungent-warm herbs relieving superficies herbs, heat clearing herbs, promoting diuresis herbs, tonics for nourishing blood herbs, phlegm resolving herbs, pungent-cool herbs relieving superficies, tonics for reinforcing yang herbs, pacify the wind of liver herbs, dampness removing herbs, invigorating the blood and removing blood stasis herbs, tonics for nourishing yin, interior warming herbs, suppress cough and to calm panting herbs, tranquilize herbs, qi regulating herbs, astringent herbs, dispel wind and dampness herbs, hemostatic herbs and food retention relieving herbs. It totally involves20categories of herbs and493frequency of use. Excluding the frequency rate under3%, the sequence is:tonics for invigorating qi herbs, pungent-warm herbs relieving superficies herbs, heat clearing herbs, promoting diuresis herbs, tonics for nourishing blood herbs, phlegm resolving herbs, pungent-cool herbs relieving superficies, tonics for reinforcing yang herbs, pacify the wind of liver herbs, dampness removing herbs and invigorating the blood and removing blood stasis herbs.
For the cases of yang brightness meridian pattern, the frequency of herb adopted, from high to low:heat clearing herbs, tonics for invigorating qi herbs, phlegm resolving herbs, pungent-warm herbs relieving superficies, invigorating the blood and removing blood stasis herbs, pacify the wind of liver herbs, pungent-cool herbs relieving superficies, tonics for nourishing blood herbs, tonics for nourishing yin herbs, promoting diuresis herbs, dampness removing herbs, tonics for reinforcing yang herbs, suppress cough and to calm panting herbs, qi regulating herbs, tranquilizer herbs, interior warming herbs, hemostatic herbs and astringent herbs. It totally involves18categories of herbs and441frequency of use. Excluding the frequency rate under3%, the sequence is:heat clearing herbs, tonics for invigorating qi herbs, phlegm resolving herbs, pungent-warm herbs relieving superficies, invigorating the blood and removing blood stasis herbs, pacify the wind of liver herbs, pungent-cool herbs relieving superficies, tonics for nourishing blood herbs and tonics for nourishing yin herbs.
For the cases of lesser yang meridian pattern, the frequency of herb adopted, from high to low:
tonics for invigorating qi herbs, heat clearing herbs, pungent-warm herbs relieving superficies, phlegm resolving herbs, pungent-cool herbs relieving superficies, promoting diuresis herbs, tonics for nourishing blood herbs, tonics for nourishing yin herbs, pacify the wind of liver herbs, invigorating the blood and removing blood stasis herbs, dampness removing herbs, tonics for reinforcing yang herbs, dispel wind and dampness herbs, interior warming herbs, qi regulating herbs, suppress cough and to calm panting herbs, hemostatic herbs, tranquilizer herbs, food retention relieving herbs, astringent herbs and cathartics herbs. It totally involves21categories of herbs and2,073frequency of use. Excluding the frequency rate under3%, the sequence is:tonics for invigorating qi herbs, heat clearing herbs, pungent-warm herbs relieving superficies, phlegm resolving herbs, pungent-cool herbs relieving superficies, promoting diuresis herbs, tonics for nourishing blood herbs, tonics for nourishing yin herbs, pacify the wind of liver herbs and invigorating the blood and removing blood stasis herbs.
Conclusions
From1949up to now, CMP use traditional Chinese medicine to cure hyperthyroidism with fruitful achievements. However, the use of seaweed and kelp, which are rich with iodine, for hyperthyroidism treatment, have different argument. We need to have further study and research.
Six Meridain is a valuable code for curing thousands of sickness. It is not only a book for curing cold. By studying Professor Li Saimei's clinical hyperthyroidism treatment, we find that Shanghanlun is not a monograph only for curing cold. It should be a giant code for all kinds of diagnosis and treatment. Professor Li Saimei curing diabetes with six-meridian pattern identification, is a powerful proof. Misleading by its name "Shanghanlun", previous beginners misinterpreted that it is a book for curing cold only. By the great effort of our modern CMPs, including Professor Li Saimei, give a clear status for Shanghanlun. It is a great book for all kinds of diagnosis and treatment. It is also a victory for studying classic book.
Most hyperthyroidism patients, with clinical manifestation, are three yang meridians pattern, rather than three yin meridians pattern. It can be proved by Professor Li Saimei's medical cases,97%are three yang meridians pattern and only3%are three yin meridians pattern. Thus, we have a good guideline for hyperthyroidism treatment. For clinical diagnosis, we can use tonics for invigorating qi herbs, heat clearing herbs, pungent-warm herbs relieving superficies, phlegm resolving herbs, pungent-cool herbs relieving superficies, promoting diuresis herbs, tonics for nourishing blood herbs, tonics for nourishing yin herbs, pacify the wind of liver herbs and invigorating the blood and removing blood stasis herbs. We should adjust the quantity of each herb with different diagnosis.
Referring to Professor Li Saimei's three yin meridians pattern,2073medicine taking frequency, she had a standard rule for the quantity of each herb. She seldom exceeds the standard. It is a golden rule for us to follow as it is safe but efficiency.
引文
[1]左新河.复方甲亢片的使用剂量和疗程对亚临床甲亢疗效的影响分析[J].湖北中医杂志,2010,(5)：25-26
[2]陈四清.周仲瑛医案从肝论治单纯性甲状腺肿大[J].江苏中医药,2005,(11)：34-35
[3]伊藤公一.甲状腺病症[M].1版.台湾：枫叶社文化事业有限公司,2011,16-20；28-29
[4]李赛美.名师临床带教与四大经典汇通[M].1版.北京：中国中医药出版社,2012：1-2
[5]黄仕沛,何莉娜.梦回伤寒四大金刚[M].1版.北京：中国中医药出版社,2012：1-2
[6]李培生,李家庚.李培生医论医案[M].1版.北京：科学出版社,2012：1-2
[7]仝小林.重剂起沉疴[M].1版.北京：人民卫生出版社,2010：13-16；105-106
[8]杨则民.潜厂医话[M].1版.北京：人民卫生出版社,2010：70-71
[9]李梃.医学入门[M].1版.上海：上海科学技术文献出版社,1997：973-974
[10]裘沛然.裘沛然医案百例[M].1版.台北：知音出版社,2000：221-223
[11]马永华,叶加南,叶庭兰等.叶橘泉[M].1版.北京：中国中医药出版社,2004：37-40
[12]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[13]韩学杰,李成卫.沈绍功验案精选[M].1版.北京：学苑出版社,2006：178-179；304-307
[14]凌耀星.中医治疗疑难病130例纪实[M].1版.上海：上海三联书店,2002：285-289
[15]郭文友.中医临证精华录[M].1版.成都：四川科学技术出版社,1999：158-162
[16]张步桃,赖国徽.张步桃医方思维[M].2版.台湾：台湾中国临床医学会,2007：66-70
[17]朱进忠.中医临证五十年心得录[M].1版.北京：人民卫生出版社,2006：515-518
[18]陈湘君.中医内科常见病证辨证思路与方法[M].1版.北京：人民卫生出版社,2003：268-274
[19]陈可冀.中医药学临床验案范例[M].1版.北京：新世界出版社,1994：226-230
[20]颜德馨.颜德馨临床经验辑要[M].1版.北京：中国医药科技出版社,2000：197-198
[21]陈四清.周仲瑛医案赏析[M].1版.北京：人民军医出版社,2008：148-149
[22]赵玉屏,刘艳萍,刘润芝,.从《伤寒论》厥阴病论治甲状腺功能亢进症[J].中医杂志,2012,(3)：262-263
[23]戚沁园,彭万年,.彭万年教授治疗内分泌疾病验案3则[J].新中医,2008,(2)：15-116
[24]刘丽娟,黄仰模,.黄仰模教授中医治疗甲亢的经验[J].中国中医药现代远程教育,2008,(10)：158-1159
[25]邝秀英.廖世煌辨治甲亢性甲状腺肿大的经验[J].辽宁中医杂志,2001,(7)：398
[26]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[27]雷磊.李慧芳主编.内分泌与代谢病名家医案.妙方解析[M](第1版).北京：人民军医出版社,2007,211-273
[28]吴德广,霍青,周秀芬.临证思辨精要[M].1版.济南：山东科学技术出版社,2008：288-290
[29]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[30]孟景春.孟景春选评疑难病案[M].1版.北京：人民军医出版社,2012：48-49
[31]张渊,张鹏,张雪丽.张渊崧医案医话集[M].1版.北京：中医古籍出版社,2009：61-64
[32]邹燕勤,王钢.中国百年百名中医临床家邹云翔[M].1版.北京：中国中医药出版社,2003：208-211
[33]朱文锋.中医内科疾病诊疗常规[M](第1版).湖南：湖南科学技术出版社,1999,480-487
[34]张渊,张鹏,张雪丽.张渊崧医案医话集[M].1版.北京：中医古籍出版社,2009：61-64
[35]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[36]贾召.中国百年百名中医临床家贾堃[M].1版.北京：中国中医药出版社,2002：171-177
[37]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[38]陈金山.刘培新.高琦涵译.最新解剖生理学[M](第1版).台湾：华腾文化股份有限公司,1999,224-226
[39]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[40]郭芫沅,郭宏涛.郭宗正医案[M].1版.郑州：河南科学技术出版社,2009：2009：152-178
[41]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[42]岳美中.岳美中医学文集[M].1版.北京：中国中医药出版社,2000：16-23；735-737
[43]郑翔,章汉明,韩乐兵等.中国百年百名中医临床家章真如[M].1版.北京：中国中医药出版社,2001：32-34；98-99
[44]卢祥之.名中医治病绝招[M].1版.北京：中国医药科技出版社,1999：499-502
[45]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[46]万友生.中国百年百名中医临床家万友生[M].1版.北京：中国中医药出版社,2003：223-228；270-272
[47]耿呈祥.耿呈祥老中医经验方实录[M].1版.太原：山西科学技术出版社,2013：104-105
[48]董建华.中国现代名中医医案精华五[M].1版.北京：北京出版社,2002：675-676
[49]郑翔,刘惠武.章真如医论精选[M].1版.北京：中国中医药出版社,2011：185-186
[50]邹燕勤,王钢.邹云翔[M].1版.北京：中国中医药出版社,2003：208-211
[51]张佩青,朱永志,迟继铭等.张琪[M].1版.北京：中国中医药出版社,2003：268-269
[52]何任.何任临床经验辑要[M].1版.北京：中国医药科技出版社,1998：478-479
[53]曾德环,程方,黎国昌等.中国秘方验方精选[M].1版.广州：广东科技出版社,1998：34-37
[54]马风彬.中国百年百名中医临床家何炎燊[M].1版.北京：中国中医药出版社,2001：211-214
[55]万友生.中国百年百名中医临床家万友生[M].1版.北京：中国中医药出版社,2003：223-228；270-272
[56]龙治平.龙治平疑难病验案与方论[M].1版.北京：人民卫生出版社,2009：55-57
[57]顾润环,周兴武,顾维超.杏林耕耘录[M].1版.北京：人民军医出版社,2013：344-348
[58]陈国源,柯联才,盛云鹤.盛国荣临证经验集[M].1版.湖南：湖南科学技术出版社,2007：359-361
[59]孙希圣.孙希圣临证心得实录[M].1版.北京：中国医药科技出版社,2012：109-110
[60]顾润环,周兴武,顾维超.杏林耕耘录[M].1版.北京：人民军医出版社,2013：344-348
[61]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[62]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[63]沈惠风.秦亮甫临床经验集萃[M].1版.上海：上海中医药大学出版社,2002：99-100；339-340
[64]董建华.中国现代名中医医案精华二[M].1版.北京：北京出版社,2002：1354-1355
[65]沈惠风.秦亮甫临床经验集萃[M].1版.上海：上海中医药大学出版社,2002：99-100；339-340
[66]沈惠风.秦亮甫临床经验集萃[M].1版.上海：上海中医药大学出版社,2002：99-100；339-340
[67]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[68]钟洪.中医内科常见病证诊治精粹[M].1版.北京：人民军医出版社,2006：228-232
[69]钟洪.中医内科常见病证诊治精粹[M].1版.北京：人民军医出版社,2006：228-232
[70]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[71]曾培杰,陈创涛.任之堂跟诊日记2[M].1版.北京：人民军医出版社,2013：228-231
[72]刘方柏.刘方柏重急奇顽证治实[M].1版.北京：人民军医出版社,2010：25-29
[73]黄学宽.郭子光临床经验集[M].1版.北京：人民卫生出版社,2009：183-185
[74]张步桃,赖国徽.张步桃医方思维[M].2版.台湾：台湾中医临床医学会,2007：66-70
[75]何国梁,.炙甘草汤新用3则[J].中医杂志,1998,(12)：724-725
[76]尤昭玲,何清湖.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：106-156
[77]王付.经方学用基本功[M].1版.北京：人民军医出版社,2012：83-84
[78]马玉红,.《金匮要略》温经汤治疗甲亢体会[J].山东中医杂志,2007,(3)：169-170
[79]金克勤.真武汤治疗老年性甲亢持久性心房纤颤体会[J].实用中西医结合临床,2002,(6)：35
[80]阳怀来.桂枝甘草龙骨牡蛎汤治疗甲状腺机能亢进症38例[J].实用中医药杂志,1996,(3)：3-4
[81]冯志海,魏桂梅,.甘麦大枣汤合酸枣仁汤加味治疗甲状腺功能亢进症60例[J].河南中医,2009,(1)：11-12
[82]张静,刘美莲,.四逆散病机源流探讨及治疗瘿气病的体会[J].辽宁中医杂志,2008,(9)：1324-1325
[83]马永华,叶加南,叶庭兰等.中国百年百名中医临床家叶橘泉[M].1版.北京：中国中医药出版社,2004：37-40
[84]卢祥之.国医大师何任经验良方赏析[M].1版.北京：人民军医出版社,2012：55-59
[85]杨成春.半夏泻心汤临床应用举隅[J].安徽中医临床杂志,1999,(4)：276-2777
[85]董振华,季元,范爱平.祝谌予经验集[M].1版.北京：人民卫生出版社,2000：108-109
[86]裘沛然.裘沛然医案百例[M].1版.台北：知音出版社,2000：221-223
[87]刘剑波.临症指南[M].1版.广州：羊城晚报出版社,2003：20-21
[88]尤昭玲,何清湖.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：106-156
[89]刘兰芳,刘典功.古今名医中药汤剂临床活用[M].1版.北京：人民军医出版社,2003：18-19
[90]林寿宁.中国百年百名中医临床家林沛湘[M].1版.北京：中国中医药出版社,2001：255-256
[91]尤昭玲,何清湖.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：106-156
[92]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[93]大冢敬节.汉方诊疗三十年[M].1版.北京：华夏出版社,2011：293-294
[94]孔劲平,孔令谦.孔少华临证经验纂要[M].1版.北京：人民卫生出版社,2009：193-194
[95]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[96]程学生.常见病症主证效方应用[M].1版.北京：学苑出版社,2012：175-176
[97]顾润环,周兴武,顾维超.杏林耕耘录[M].1版.北京：人民军医出版社,2013：344-348
[98]韩学杰,李成卫.沈绍功验案精选[M].1版.北京：学苑出版社,2006：178-179；304-307
[99]何晓.陈友芝医案(续集)[M].1版.杭州：浙江人民出版社,2005：155-164；231-236
[100]王咪咪.名医治验汇编[M].1版.北京：学苑出版社,2012：513-515
[101]刘石坚.岭南中医药名家何炎燊[M].1版.广州：广东科技出版社,2009：132-139
[102]万友生.中国百年百名中医临床家万友生[M].1版.北京：中国中医药出版社,2003：223-228；270-272
[103]韩仲成.随印会河侍诊记[M].1版.北京：中国中医药出版社,2012：192-193
[104]李玉奇.中国百年百名中医临床家李玉奇[M].1版.北京：中国中医药出版社,2001：91-92
[105]胡天雄.中国百年百名中医临床家胡天雄[M].1版.北京：中国中医药出版社,2001：130
[106]张栋.名老中医屡试屡效方[M].1版.北京：人民军医出版社,2009：190-192
[107]章真如.章真如临床经验辑要[M].1版.北京：中国医药科技出版社,2000：112
[108]陈可冀.中医药学临床验案范例[M].1版.北京：新世界出版社,1994：226-230
[109]张琪.张琪临床经验辑要[M].1版.北京：中国医药科技出版社,1998：203-204
[110]张文选.叶天士用经方[M].1版.北京：人民卫生出版社,2011：6-7
[111]鲍艳举.花宝金.经方时方「六经辨证J应用案解[M](第1版).北京：中国中医药出版社,2011,1-5
[112]温成平.现代疑难病经方验案评析[M].1版.北京：人民军医出版社,2007：98-103
[113]凌耀星.中医治疗疑难病130例纪实[M].1版.上海：上海三联书店,2002：285-289
[114]张佩青,朱永志,迟继铭等.中国百年百名中医临床家张琪[M].1版.北京：中国中医药出版社,2003：268-269
[115]张琪.张琪临床经验辑要[M].1版.北京：中国医药科技出版社,1998：203-204
[116]孙希圣.孙希圣临证心得实录[M].1版.北京：中国医药科技出版社,2012：109-110
[117]张步桃,赖国徽.张步桃医方思维[M].2版.台湾：台湾中医临床医学会,2007：66-70
[118]周信有.周信有临床经验辑要[M].1版.北京：中国医药科技出版社,2000：199
[119]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[120]张栋.名老中医屡试屡效方[M].1版.北京：人民军医出版社,2009：190-192
[121]马风彬.中国百年百名中医临床家何炎燊[M].1版.北京：中国中医药出版社,2001：211-214
[122]王旭.略论含碘中药治疗在治疗“甲亢”中药的运用[J].江苏中医,2000,21(4)35-36
[123]王咪咪.名医治验汇编[M].1版.北京：学苑出版社,2012：513-515
[124]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[125]周信有.周信有临床经验辑要[M].1版.北京：中国医药科技出版社,2000：199
[126]颜德馨.颜德馨临床经验辑要[M].1版.北京：中国医药科技出版社,2000：197-198
[127]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[128]凌耀星.中医治疗疑难病130例纪实[M].1版.上海：上海三联书店,2002：285-289
[129]韩学杰,李成卫.沈绍功验案精选[M].1版.北京：学苑出版社,2006：178-179；304-307
[130]凌耀星.中医治疗疑难病130例纪实[M].1版.上海：上海三联书店,2002：285-289
[131]朱良春.朱良春医集[M].1版.长沙：中南大学出版社,2007：387-388
[132]刘石坚.岭南中医药名家何炎燊[M].1版.广州：广东科技出版社,2009：132-139
[133]何晓.陈友芝医案(续集)[M].1版.杭州：浙江人民出版社,2005：155-164；231-236
[134]刘石坚.岭南中医药名家何炎燊[M].1版.广州：广东科技出版社,2009：132-139
[135]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[136]仝小林.重剂起沉疴[M].1版.北京：人民卫生出版社,2010：13-16；105-106
[137]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[138]何任.何任临床经验辑要[M].1版.北京：中国医药科技出版社,1998：478-479
[139]仝小林.重剂起沉疴[M].1版.北京：人民卫生出版社,2010：13-16；105-106
[140]刘石坚.岭南中医药名家何炎燊[M].1版.广州：广东科技出版社,2009：132-139
[141]雷磊、李慧芳.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：132-133；155-157
[142]翁维良,于英奇.郭士魁临床经验选集一杂病证治[M].1版.北京：人民卫生出版社,2006；143-147
[143]谷言芳,张天文,牛煜等.谷铭三治疗肿瘤经验集[M].1版.上海：上海科学技术出版社,2002：220-224
[144]岳美中.岳美中医学文集[M].1版.北京：中国中医药出版社,2000：214-215
[145]董建华.中国现代名中医医案精华二[M].1版.北京：北京出版社,2002：1354-1355
[146]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[147]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[148]吕景山.施今墨医案解读[M].1版.北京：人民军医出版社,2007：366-368
[149]张渊,张鹏,张雪丽.张渊崧医案医话集[M].1版.北京：中医古籍出版社,2009：61-64
[150]万友生.万友生[M].1版.北京：中国中医药出版社,2003：223-228；270-272
[151]朱良春.朱良春医集[M].1版.长沙：中南大学出版社,2007：387-388
[152]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[153]张栋.名老中医屡试屡效方[M].1版.北京：人民军医出版社,2009：190-192
[154]凌云鹏.临诊一得录[M].1版.北京：人民卫生出版社,2006：117-122
[155]张谷才.济民医案[M].1版.上海：上海中医药大学出版社,2010：230-231
[156]尤昭玲,何清湖.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：106-156
[157]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[158]翁维良,于英奇.中国百年百名中医临床家郭士魁[M].1版.北京：中国中医药出版社,2001：261-265
[159]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[160]李赛美,李宇航.伤寒论讲义[M].2版.北8京：人民卫生出版社,2013：8
[161]雷载权、陈松育、高学敏.中药学[M].1版.上海：上海科学技术出版社,1998：1-8
[162]岳美中.岳美中医学文集[M].1版.北京：中国中医药出版社,2000：16-23；214-215；735-737
[163]李赛美.浅谈糖尿病及其并发症六经辨治思路[J].中华中医药杂志,2007,(12)：857-859
[164]李赛美,李宇航.伤寒论讲义[M].2版.北京：人民卫生出版社,2013：8
[165]章浩军.伤寒心悟[M].1版.北京：人民军医出版社,2012：61-71
[166]张学林.六经论治慢性荨麻疹验案6则[J].安徽中医临床杂志,2000,(3).221-222
[167]郝小波,张彩霞,.《中医眼科六经法要》与《伤寒论》学术渊源探讨[J].四川中医,2007,(9).35-36
[168]李赛美.名师临床带教与四大经典汇通[M].1版.北京：中国中医药出版社,2012：1-2
[169]岳美中.岳美中医学文集[M].1版.北京：中国中医药出版社,2000：214-215
[2]陈四清.周仲瑛医案从肝论治单纯性甲状腺肿大[J].江苏中医药,2005,(11)：34-35
[3]伊藤公一.甲状腺病症[M].1版.台湾：枫叶社文化事业有限公司,2011,16-20；28-29
[4]李赛美.名师临床带教与四大经典汇通[M].1版.北京：中国中医药出版社,2012：1-2
[5]黄仕沛,何莉娜.梦回伤寒四大金刚[M].1版.北京：中国中医药出版社,2012：1-2
[6]李培生,李家庚.李培生医论医案[M].1版.北京：科学出版社,2012：1-2
[7]仝小林.重剂起沉疴[M].1版.北京：人民卫生出版社,2010：13-16；105-106
[8]杨则民.潜厂医话[M].1版.北京：人民卫生出版社,2010：70-71
[9]李梃.医学入门[M].1版.上海：上海科学技术文献出版社,1997：973-974
[10]裘沛然.裘沛然医案百例[M].1版.台北：知音出版社,2000：221-223
[11]马永华,叶加南,叶庭兰等.叶橘泉[M].1版.北京：中国中医药出版社,2004：37-40
[12]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[13]韩学杰,李成卫.沈绍功验案精选[M].1版.北京：学苑出版社,2006：178-179；304-307
[14]凌耀星.中医治疗疑难病130例纪实[M].1版.上海：上海三联书店,2002：285-289
[15]郭文友.中医临证精华录[M].1版.成都：四川科学技术出版社,1999：158-162
[16]张步桃,赖国徽.张步桃医方思维[M].2版.台湾：台湾中国临床医学会,2007：66-70
[17]朱进忠.中医临证五十年心得录[M].1版.北京：人民卫生出版社,2006：515-518
[18]陈湘君.中医内科常见病证辨证思路与方法[M].1版.北京：人民卫生出版社,2003：268-274
[19]陈可冀.中医药学临床验案范例[M].1版.北京：新世界出版社,1994：226-230
[20]颜德馨.颜德馨临床经验辑要[M].1版.北京：中国医药科技出版社,2000：197-198
[21]陈四清.周仲瑛医案赏析[M].1版.北京：人民军医出版社,2008：148-149
[22]赵玉屏,刘艳萍,刘润芝,.从《伤寒论》厥阴病论治甲状腺功能亢进症[J].中医杂志,2012,(3)：262-263
[23]戚沁园,彭万年,.彭万年教授治疗内分泌疾病验案3则[J].新中医,2008,(2)：15-116
[24]刘丽娟,黄仰模,.黄仰模教授中医治疗甲亢的经验[J].中国中医药现代远程教育,2008,(10)：158-1159
[25]邝秀英.廖世煌辨治甲亢性甲状腺肿大的经验[J].辽宁中医杂志,2001,(7)：398
[26]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[27]雷磊.李慧芳主编.内分泌与代谢病名家医案.妙方解析[M](第1版).北京：人民军医出版社,2007,211-273
[28]吴德广,霍青,周秀芬.临证思辨精要[M].1版.济南：山东科学技术出版社,2008：288-290
[29]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[30]孟景春.孟景春选评疑难病案[M].1版.北京：人民军医出版社,2012：48-49
[31]张渊,张鹏,张雪丽.张渊崧医案医话集[M].1版.北京：中医古籍出版社,2009：61-64
[32]邹燕勤,王钢.中国百年百名中医临床家邹云翔[M].1版.北京：中国中医药出版社,2003：208-211
[33]朱文锋.中医内科疾病诊疗常规[M](第1版).湖南：湖南科学技术出版社,1999,480-487
[34]张渊,张鹏,张雪丽.张渊崧医案医话集[M].1版.北京：中医古籍出版社,2009：61-64
[35]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[36]贾召.中国百年百名中医临床家贾堃[M].1版.北京：中国中医药出版社,2002：171-177
[37]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[38]陈金山.刘培新.高琦涵译.最新解剖生理学[M](第1版).台湾：华腾文化股份有限公司,1999,224-226
[39]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[40]郭芫沅,郭宏涛.郭宗正医案[M].1版.郑州：河南科学技术出版社,2009：2009：152-178
[41]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[42]岳美中.岳美中医学文集[M].1版.北京：中国中医药出版社,2000：16-23；735-737
[43]郑翔,章汉明,韩乐兵等.中国百年百名中医临床家章真如[M].1版.北京：中国中医药出版社,2001：32-34；98-99
[44]卢祥之.名中医治病绝招[M].1版.北京：中国医药科技出版社,1999：499-502
[45]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[46]万友生.中国百年百名中医临床家万友生[M].1版.北京：中国中医药出版社,2003：223-228；270-272
[47]耿呈祥.耿呈祥老中医经验方实录[M].1版.太原：山西科学技术出版社,2013：104-105
[48]董建华.中国现代名中医医案精华五[M].1版.北京：北京出版社,2002：675-676
[49]郑翔,刘惠武.章真如医论精选[M].1版.北京：中国中医药出版社,2011：185-186
[50]邹燕勤,王钢.邹云翔[M].1版.北京：中国中医药出版社,2003：208-211
[51]张佩青,朱永志,迟继铭等.张琪[M].1版.北京：中国中医药出版社,2003：268-269
[52]何任.何任临床经验辑要[M].1版.北京：中国医药科技出版社,1998：478-479
[53]曾德环,程方,黎国昌等.中国秘方验方精选[M].1版.广州：广东科技出版社,1998：34-37
[54]马风彬.中国百年百名中医临床家何炎燊[M].1版.北京：中国中医药出版社,2001：211-214
[55]万友生.中国百年百名中医临床家万友生[M].1版.北京：中国中医药出版社,2003：223-228；270-272
[56]龙治平.龙治平疑难病验案与方论[M].1版.北京：人民卫生出版社,2009：55-57
[57]顾润环,周兴武,顾维超.杏林耕耘录[M].1版.北京：人民军医出版社,2013：344-348
[58]陈国源,柯联才,盛云鹤.盛国荣临证经验集[M].1版.湖南：湖南科学技术出版社,2007：359-361
[59]孙希圣.孙希圣临证心得实录[M].1版.北京：中国医药科技出版社,2012：109-110
[60]顾润环,周兴武,顾维超.杏林耕耘录[M].1版.北京：人民军医出版社,2013：344-348
[61]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[62]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[63]沈惠风.秦亮甫临床经验集萃[M].1版.上海：上海中医药大学出版社,2002：99-100；339-340
[64]董建华.中国现代名中医医案精华二[M].1版.北京：北京出版社,2002：1354-1355
[65]沈惠风.秦亮甫临床经验集萃[M].1版.上海：上海中医药大学出版社,2002：99-100；339-340
[66]沈惠风.秦亮甫临床经验集萃[M].1版.上海：上海中医药大学出版社,2002：99-100；339-340
[67]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[68]钟洪.中医内科常见病证诊治精粹[M].1版.北京：人民军医出版社,2006：228-232
[69]钟洪.中医内科常见病证诊治精粹[M].1版.北京：人民军医出版社,2006：228-232
[70]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[71]曾培杰,陈创涛.任之堂跟诊日记2[M].1版.北京：人民军医出版社,2013：228-231
[72]刘方柏.刘方柏重急奇顽证治实[M].1版.北京：人民军医出版社,2010：25-29
[73]黄学宽.郭子光临床经验集[M].1版.北京：人民卫生出版社,2009：183-185
[74]张步桃,赖国徽.张步桃医方思维[M].2版.台湾：台湾中医临床医学会,2007：66-70
[75]何国梁,.炙甘草汤新用3则[J].中医杂志,1998,(12)：724-725
[76]尤昭玲,何清湖.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：106-156
[77]王付.经方学用基本功[M].1版.北京：人民军医出版社,2012：83-84
[78]马玉红,.《金匮要略》温经汤治疗甲亢体会[J].山东中医杂志,2007,(3)：169-170
[79]金克勤.真武汤治疗老年性甲亢持久性心房纤颤体会[J].实用中西医结合临床,2002,(6)：35
[80]阳怀来.桂枝甘草龙骨牡蛎汤治疗甲状腺机能亢进症38例[J].实用中医药杂志,1996,(3)：3-4
[81]冯志海,魏桂梅,.甘麦大枣汤合酸枣仁汤加味治疗甲状腺功能亢进症60例[J].河南中医,2009,(1)：11-12
[82]张静,刘美莲,.四逆散病机源流探讨及治疗瘿气病的体会[J].辽宁中医杂志,2008,(9)：1324-1325
[83]马永华,叶加南,叶庭兰等.中国百年百名中医临床家叶橘泉[M].1版.北京：中国中医药出版社,2004：37-40
[84]卢祥之.国医大师何任经验良方赏析[M].1版.北京：人民军医出版社,2012：55-59
[85]杨成春.半夏泻心汤临床应用举隅[J].安徽中医临床杂志,1999,(4)：276-2777
[85]董振华,季元,范爱平.祝谌予经验集[M].1版.北京：人民卫生出版社,2000：108-109
[86]裘沛然.裘沛然医案百例[M].1版.台北：知音出版社,2000：221-223
[87]刘剑波.临症指南[M].1版.广州：羊城晚报出版社,2003：20-21
[88]尤昭玲,何清湖.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：106-156
[89]刘兰芳,刘典功.古今名医中药汤剂临床活用[M].1版.北京：人民军医出版社,2003：18-19
[90]林寿宁.中国百年百名中医临床家林沛湘[M].1版.北京：中国中医药出版社,2001：255-256
[91]尤昭玲,何清湖.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：106-156
[92]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[93]大冢敬节.汉方诊疗三十年[M].1版.北京：华夏出版社,2011：293-294
[94]孔劲平,孔令谦.孔少华临证经验纂要[M].1版.北京：人民卫生出版社,2009：193-194
[95]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[96]程学生.常见病症主证效方应用[M].1版.北京：学苑出版社,2012：175-176
[97]顾润环,周兴武,顾维超.杏林耕耘录[M].1版.北京：人民军医出版社,2013：344-348
[98]韩学杰,李成卫.沈绍功验案精选[M].1版.北京：学苑出版社,2006：178-179；304-307
[99]何晓.陈友芝医案(续集)[M].1版.杭州：浙江人民出版社,2005：155-164；231-236
[100]王咪咪.名医治验汇编[M].1版.北京：学苑出版社,2012：513-515
[101]刘石坚.岭南中医药名家何炎燊[M].1版.广州：广东科技出版社,2009：132-139
[102]万友生.中国百年百名中医临床家万友生[M].1版.北京：中国中医药出版社,2003：223-228；270-272
[103]韩仲成.随印会河侍诊记[M].1版.北京：中国中医药出版社,2012：192-193
[104]李玉奇.中国百年百名中医临床家李玉奇[M].1版.北京：中国中医药出版社,2001：91-92
[105]胡天雄.中国百年百名中医临床家胡天雄[M].1版.北京：中国中医药出版社,2001：130
[106]张栋.名老中医屡试屡效方[M].1版.北京：人民军医出版社,2009：190-192
[107]章真如.章真如临床经验辑要[M].1版.北京：中国医药科技出版社,2000：112
[108]陈可冀.中医药学临床验案范例[M].1版.北京：新世界出版社,1994：226-230
[109]张琪.张琪临床经验辑要[M].1版.北京：中国医药科技出版社,1998：203-204
[110]张文选.叶天士用经方[M].1版.北京：人民卫生出版社,2011：6-7
[111]鲍艳举.花宝金.经方时方「六经辨证J应用案解[M](第1版).北京：中国中医药出版社,2011,1-5
[112]温成平.现代疑难病经方验案评析[M].1版.北京：人民军医出版社,2007：98-103
[113]凌耀星.中医治疗疑难病130例纪实[M].1版.上海：上海三联书店,2002：285-289
[114]张佩青,朱永志,迟继铭等.中国百年百名中医临床家张琪[M].1版.北京：中国中医药出版社,2003：268-269
[115]张琪.张琪临床经验辑要[M].1版.北京：中国医药科技出版社,1998：203-204
[116]孙希圣.孙希圣临证心得实录[M].1版.北京：中国医药科技出版社,2012：109-110
[117]张步桃,赖国徽.张步桃医方思维[M].2版.台湾：台湾中医临床医学会,2007：66-70
[118]周信有.周信有临床经验辑要[M].1版.北京：中国医药科技出版社,2000：199
[119]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[120]张栋.名老中医屡试屡效方[M].1版.北京：人民军医出版社,2009：190-192
[121]马风彬.中国百年百名中医临床家何炎燊[M].1版.北京：中国中医药出版社,2001：211-214
[122]王旭.略论含碘中药治疗在治疗“甲亢”中药的运用[J].江苏中医,2000,21(4)35-36
[123]王咪咪.名医治验汇编[M].1版.北京：学苑出版社,2012：513-515
[124]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[125]周信有.周信有临床经验辑要[M].1版.北京：中国医药科技出版社,2000：199
[126]颜德馨.颜德馨临床经验辑要[M].1版.北京：中国医药科技出版社,2000：197-198
[127]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[128]凌耀星.中医治疗疑难病130例纪实[M].1版.上海：上海三联书店,2002：285-289
[129]韩学杰,李成卫.沈绍功验案精选[M].1版.北京：学苑出版社,2006：178-179；304-307
[130]凌耀星.中医治疗疑难病130例纪实[M].1版.上海：上海三联书店,2002：285-289
[131]朱良春.朱良春医集[M].1版.长沙：中南大学出版社,2007：387-388
[132]刘石坚.岭南中医药名家何炎燊[M].1版.广州：广东科技出版社,2009：132-139
[133]何晓.陈友芝医案(续集)[M].1版.杭州：浙江人民出版社,2005：155-164；231-236
[134]刘石坚.岭南中医药名家何炎燊[M].1版.广州：广东科技出版社,2009：132-139
[135]邓铁涛.邓铁涛临床经验辑要[M].1版.北京：中国医药科技出版社,1998：63-66；212-213
[136]仝小林.重剂起沉疴[M].1版.北京：人民卫生出版社,2010：13-16；105-106
[137]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[138]何任.何任临床经验辑要[M].1版.北京：中国医药科技出版社,1998：478-479
[139]仝小林.重剂起沉疴[M].1版.北京：人民卫生出版社,2010：13-16；105-106
[140]刘石坚.岭南中医药名家何炎燊[M].1版.广州：广东科技出版社,2009：132-139
[141]雷磊、李慧芳.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：132-133；155-157
[142]翁维良,于英奇.郭士魁临床经验选集一杂病证治[M].1版.北京：人民卫生出版社,2006；143-147
[143]谷言芳,张天文,牛煜等.谷铭三治疗肿瘤经验集[M].1版.上海：上海科学技术出版社,2002：220-224
[144]岳美中.岳美中医学文集[M].1版.北京：中国中医药出版社,2000：214-215
[145]董建华.中国现代名中医医案精华二[M].1版.北京：北京出版社,2002：1354-1355
[146]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[147]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[148]吕景山.施今墨医案解读[M].1版.北京：人民军医出版社,2007：366-368
[149]张渊,张鹏,张雪丽.张渊崧医案医话集[M].1版.北京：中医古籍出版社,2009：61-64
[150]万友生.万友生[M].1版.北京：中国中医药出版社,2003：223-228；270-272
[151]朱良春.朱良春医集[M].1版.长沙：中南大学出版社,2007：387-388
[152]汪庆安.用药杂谈[M].1版.北京：中国中医药出版社,2010：55-57
[153]张栋.名老中医屡试屡效方[M].1版.北京：人民军医出版社,2009：190-192
[154]凌云鹏.临诊一得录[M].1版.北京：人民卫生出版社,2006：117-122
[155]张谷才.济民医案[M].1版.上海：上海中医药大学出版社,2010：230-231
[156]尤昭玲,何清湖.内分泌与代谢病[M].1版.北京：人民军医出版社,2007：106-156
[157]王智贤.王智贤老中医六十年杂病治验实录[M].1版.太原：山西科学技术出版社,2006：232-239
[158]翁维良,于英奇.中国百年百名中医临床家郭士魁[M].1版.北京：中国中医药出版社,2001：261-265
[159]魏子孝.学用中医体会录[M].1版.北京：人民卫生出版社,2010：151-161
[160]李赛美,李宇航.伤寒论讲义[M].2版.北8京：人民卫生出版社,2013：8
[161]雷载权、陈松育、高学敏.中药学[M].1版.上海：上海科学技术出版社,1998：1-8
[162]岳美中.岳美中医学文集[M].1版.北京：中国中医药出版社,2000：16-23；214-215；735-737
[163]李赛美.浅谈糖尿病及其并发症六经辨治思路[J].中华中医药杂志,2007,(12)：857-859
[164]李赛美,李宇航.伤寒论讲义[M].2版.北京：人民卫生出版社,2013：8
[165]章浩军.伤寒心悟[M].1版.北京：人民军医出版社,2012：61-71
[166]张学林.六经论治慢性荨麻疹验案6则[J].安徽中医临床杂志,2000,(3).221-222
[167]郝小波,张彩霞,.《中医眼科六经法要》与《伤寒论》学术渊源探讨[J].四川中医,2007,(9).35-36
[168]李赛美.名师临床带教与四大经典汇通[M].1版.北京：中国中医药出版社,2012：1-2
[169]岳美中.岳美中医学文集[M].1版.北京：中国中医药出版社,2000：214-215
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |