庞晴 倪青

摘要 亚急性甲状腺炎是内分泌科常见的疾病之一，是一种急性疼痛性甲状腺炎疾病。近年来发病率逐渐上升，起病急，症状显著，西医治疗无特效药，且不良反應较大，容易复发。中医药治疗亚急性甲状腺炎优势明显，亚急性甲状腺炎归属于“瘿病”范畴，可从少阳枢机不利之角度来辨证治疗。小柴胡汤为少阳病之代表方剂，具有调和营卫、调理脾胃、疏肝理气等功效，在临床上应用广泛，治疗亚急性甲状腺炎疗效确切，值得推广。

关键词 少阳病;枢机不利;亚急性甲状腺炎;瘿病;小柴胡汤;和法;中医药;辨证治疗

Treatment of Subacute Thyroiditis from the Perspective of Dysfunction of Shaoyang Pivot

PANG Qing，NI Qing

（Guang′anmen Hospital，China Academy of Chinese Medical Sciences，Beijing 100053，China）

Abstract Subacute thyroiditis is one of the common diseases in endocrinology and a kind of acute painful thyroiditis.In recent years，the incidence rate has gradually increased，with rapid onset and significant symptoms.Western medicine treatment has no specific medicine with relatively large side effects，and is also easy to relapse.Traditional Chinese medicine（TCM）has obvious advantages of the treatment of subacute thyroiditis.According to TCM，Subacute thyroiditis belongs to the category of “goiter”，which can be treated from the perspective of the dysfunction of Shaoyang pivot.Xiaochaihu Decoction is a representative prescription for Shaoyang disease.It has the functions including harmonizing yingfen and weifen，regulating spleen and stomach conditions，and dispersing liver and regulating qi，which is widely used clinically.It is effective in treating subacute thyroiditis and is worthy of promotion.

Keywords Shaoyang disease; Pivot dysfunction; Subacute thyroiditis; Goiter; Xiaochaihu Decoction; Harmonizing method; Traditional Chinese medicine and drugs; Syndrome differentiation

中图分类号：R256;R581文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.05.003

亚急性甲状腺炎是一种与病毒相关的急性自限性甲状腺疾病，一般好发于中年妇女，起病多急骤，呈发热，伴以怕冷、寒战、疲乏无力和食欲不振等[1]。最为特征性的表现为甲状腺部位的疼痛和压痛，常向颌下、耳后或颈部等处放射，咀嚼和吞咽时疼痛加重。甲状腺病变范围不一，可先从一叶开始，以后扩大或转移到另一叶，或始终限于一叶。病变腺体肿大，坚硬，压痛显著。近年来，亚急性甲状腺炎的发病率逐年上升，且在缺乏检测手段的基层医院，此病易被误诊为甲状腺功能亢进症[2]，若按照甲亢治疗原则给予处理，则会使患者出现药物性甲减。西医对于治疗亚急性甲状腺炎没有特效药，一般为对症处理。对轻型患者采用对乙酰氨基酚或用水杨酸盐可控制症状;病情严重病例，如疼痛、发热明显者可短期应用糖皮质激素[3]，如泼尼松，可迅速缓解临床表现，但使用糖皮质激素周期长，且减少药量或停药后容易出现复发，不良反应明显[4]。……