倪青主任医师温阳健脾利水法治疗甲状腺疾病经验
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摘要
甲状腺疾病属于中医“瘿病”的范畴。西医学认为甲状腺疾病多与自身的免疫功能有关,临床以甲状腺功能亢进症(以下简称“甲亢”)、甲状腺功能减退症(以下简称“甲减”)、桥本氏甲状腺炎、亚急性甲状腺炎最为常见甲状腺疾病发病率呈逐年上升趋势,本类疾病具有病程长,检查指标易波动和反复的特点,患者常有疲倦乏力、手抖、急躁易怒、消瘦、多食易饥、大便溏薄或乏力困倦、形体臃肿、怕冷、反应迟钝、便秘、月经不调、肢体浮肿等临床表现。不少患者需长期服用药物,有较大的毒副作用,且单纯服用西药并不能完全改善所有症状,最大程度恢复患者的生活质量,另外,在甲状腺疾病患者中不少有颈部肿大、目睛突出的症状,如病情控制不佳,还会影响生育,严重影响了患者的身心健康。中医在治疗甲状腺方面具有显著优势,在改善症状、稳定病情、降低西药毒副作用、减少西药用量等诸多方面取得良好效果。
     本文结合古今治疗甲状腺疾病的资料,对甲状腺疾病治疗法则进行了和归纳,并重点对导师倪青主任医师运用温阳健脾利水法治疗本类疾病的适用范围和临床经验进行了探讨和总结。导师经过多年潜心研究古今文献,结合自己临床经验认为,甲状腺疾病的发生与先天禀赋不足和后天失养、情志失调相关。病之根本在肾,可涉及脾、心,三脏互损。在甲亢后期、甲减、甲状腺炎后期多脾肾阳气亏虚,水湿不运,停滞体内,形成“阳虚水停”的共同病机,以脾肾阳虚最为常见,气滞、痰凝、瘀血相互影响,共为标实,病性以虚为本,虚实错杂。在治疗上,导师常病证结合,“异病同治”。导师常用的温阳健脾利水法,正中该病病机,在运用上灵活多变,温阳以脾肾为先勿忘滋阴、益气,利水不宜峻利,宜甘平淡渗,并协调好气、水、血之间的关系。常“谨守病机,各司其主”,抓住核心病机,结合患者的体质、各自的症状和疾病发展阶段等诸多方面因素,知常达变,灵活遣方用药。导师运用温阳健脾利水法治疗不同甲状腺疾病在临床上能快速改善症状,显著缩短疾病疗程、稳定指标,受到广大患者的好评。总结导师治疗经验也可丰富甲状腺疾病中医治疗理论,启迪临床诊疗思路。
Thyroid diseases is the category of simple goiter in Traditional Chinese Medicine(TCM).In west medicine,thyroid diseases is related to autoimmune hypothyoidism hashimoto's thyroiditis and subacute thyroiditis was most com mon in clinic study.the incidence of thyroid diseases is rising year by year. This kinddisease has a longer course and a Fluctuated and repeated examin ation indexes.The clinical manifestations ofpatients include lassitude hands q uake irascibility hyperphagia with easy starvation.diarrhea hypodynamia with sleepless,shape overstaffed,afraid of cool,bad-response,constipation,menoxenia,li mb edema A couple of patients need have medicine in a long term with str ong side effect,especially,only using west medicine can not deal with the sy mptoms or recovery the quality of life in maximal degree in patients.in add ition there are many patients with symptoms of deroncus and eyeball hernia tion.If the severity of disease was not in control, it can have a influence o n the physical and psychological health. TCM has a significant advantage in the treatment of thyroid, which has achieved good results in improving sym ptoms, stabilizeing the disease, reducing the side effects of western medicin e and reducing dosage of western medicine so as to the many aspects.
     This article combined the Literature of treatment in thyroid diseases of ancient and modern,which has a summary on therapeutics rule in thyroid diseases and discusses the clinical experiences of my tutor,Focus on Doctor Ni Qing, using warming yang and promoting diuresis method in treating this disease. My tutor assert that the occurrence of thyroid diseases is relat ed with native endowment.Postnatal Malnutrition, and emotional maladjustm ent after the concentrate study in ancient article in many years combining with his clinical experiences.The foundation of this disease is in kidney rel ating with spleen,heart and having mutual damage.In the later hyperthyroidi sm, hypothyroidism,thyroiditis are belongs to deficiency in kidney yang qi,as a consequence of Yang-deficiency and water-stagnation symptom which is mostly seen in kidney and spleen. Qi stagnation blood stasis and Phlegm. Stagnation have mutual influence and all of these are mixture of deficiency and excess.During the treatment,my tutor always uses Disease combining with syndrome, and same treatment for different diseases to warm yang and invigorat spleen to diuresis function. my tutor has used Warm yang strength ening spleen to strengthen spleen method in common, which is the middle of the disease short treatment course stable indexes and bettering the sympt oms,as a result,summarize Doctor'academic thought also can enriches the thinking way and theroy in curing this disease pathogenesis. After focusing on spleen and kidney,it also using the method of nourishing yin supplementi ng qi and diuresis function without excession and balence the relationship in qi water and blood."Keep the Pathogenesis, and Symptomatic treatment", Grasping the core pathogenesis,my tutor masters the variety smyptoms in every developement of this diease combining with each patient to cure patie nt more efficiency, that is to say, knowing often up to change, flexibly choosing grass drugs. Doctor Ni Qing, using warming yang and promotin g diuresis method in treating different thyroid diseases has a good reputatio n with improving symptoms quickly, short treatment course stable indexes and bettering the symptoms.In conclusion, summary of the tutor experience in the treatment can also enrich the Chinese medicine treatment theory of the thyroid disease, in addition spire the clinical diagnosis and treatment ideas.
引文
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