曾霖 赵恒侠 刘德亮 楚淑芳 张学文 李惠林

摘要 李惠林教授认为Graves病的病机主要是气郁痰凝血瘀，治疗以开郁化痰散结为法，方用自拟散结甲消汤，可以明显改善Graves病患者的症状。总结李惠林教授治疗Graves病的临床经验，供同行借鉴。

关键词 Graves病;李惠林;开郁化痰散结法

Experience of Professor Li Huilin in Treating Graves′ Disease with the Method of Expelling Stagnation and Reducing Phlegm and Resolving Masses

Zeng Lin1，Li Huilin2，Zhao Hengxia2，Liu Deliang2，Chu Shufang2，Zhang Xuewen3

（1 The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine，Shenzhen 518033，China; 2 Shenzhen Traditional Chinese Medicine Hospital，Shenzhen 518033，China; 3 Institute of National Master of TCM，Shaanxi University of Chinese Medicine，Xianyang 712000，China）

Abstract This paper summarized the clinical experience of Professor Li Huilin in treating Graves′ Disease.The etiology of disease is mainly due to qi stagnation，phlegm coagulation and blood stasis.In clinical practice，the method of expelling stagnation and reducing phlegm and resolving masses is mainly used，and self-made Sanjie Jiaxiao Decoction was adopted，which can significantly improve symptoms of Graves′ Disease.

Key Words Graves′ Disease; Li Huilin; Method of expelling stagnation and reducing phlegm and resolving masses

中图分类号：R249.2/.7文献标识码：Bdoi：10.3969/j.issn.1673-7202.2019.12.047

Graves病（Graves′ Disease，GD）又称为毒性弥漫性甲状腺肿，是一种自身免疫性疾病，其特点是甲状腺素自身合成增加，其典型表现为高代谢征候群、甲状腺弥漫性肿大、Graves眼病（Graves Ophthalmopathy，GO）等[1]，临床上接近80%的甲状腺功能亢进症由本病导致[2]。Graves病的病因及机制尚不明確，多认为与遗传因素、环境因素、免疫因素有关[3]，治疗主要分为抗甲状腺药物、131I以及手术治疗，抗甲状腺药物治疗应用较为广泛，但疗程长，易复发，患者依从性差，131I以及手术治疗则容易导致甲状腺功能减退症[4]。总体而言，目前本病的治疗效果不甚理想。李惠林教授勤求古训，博采众方，曾师从张学文、杜雨茂、熊曼琪、王孟庸等名师。临证30余载，在Graves病方面积累了丰富的经验，尤擅运用开郁化痰散结治疗Graves病，临床疗效显著。现将其经验介绍如下。

1 开郁化痰散结法的理论依据

Graves病在一定程度上可归属中医学“瘿病”“瘿瘤”范畴，中医学对“瘿病”的认识已有数百年，多认为本病与水土、饮食、情志等因素密切相关。如《吕氏春秋》[5]有言“轻水所，多秃与瘿人”，已经认识到瘿病与水土饮食有关。《诸病源候论》[6]则认为瘿病“由忧愤气结所生，亦由饮沙水，沙随气入脉，搏颈下而成之”，《太平圣惠方》[7]则认为“夫瘿之初起，由人忧恚气逆，蕴蓄所成也”。……