张美珍 郝晓晖 杨亚男 倪青

摘要 对《伤寒论》《金匮要略》中与甲状腺功能亢进症发病特点与临床表现相似记载及现代医家使用经方治疗甲状腺功能亢进症的经验进行整理，归纳总结甲状腺功能亢进症发病特点及治疗策略。传统中医学认为，甲状腺功能亢进症病机以少阳枢机不利为要，善用柴胡汤类方，但临证时需辨“症”，活用经方，如桂枝汤类方和瓜蒌汤类方治疗心悸，泻心汤类方治疗甲状腺肿，五苓散治疗甲状腺功能亢进症性突眼等等，并结合“分期辨证”、抗甲状腺药物的使用，将甲状腺功能亢进症经方用药分为初期、中期、后期和恢复期，据证用药。经方临证，症状缓解明显，并可改善甲状腺功能，前景广阔，值得借鉴。

关键词 甲状腺功能亢进症;经方;中医药;治疗;急躁易怒;心悸;甲状腺肿;突眼

Treatment of Hyperthyroidism with Classical Prescriptions Syndrome Differentiation

ZHANG Meizhen，HAO Xiaohui，YANG Yanan，NI Qing

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

Abstract This paper summarizes the characteristics and treatment strategies of disease similar to those of hyperthyroidism in Treatise on Cold Pathogenic Diseases and Synopsis of Golden Chamber，and the experience of modern doctors in treating hyperthyroidism with classical prescriptions.According to traditional Chinese medicine（TCM），the pathogenesis of hyperthyroidism is mainly due to the dysfunction of Shaoyang pivot，and good use of Chaihu Decoction is necessary in clinical practice，such as Guizhi Decoction and Gualou Decoction for palpitation，Xiexin Decoction for goiter，Wuling Powder for treating hyperthyroidism exophthalmos.In the middle，late and recovery period，the drugs were used according to syndromes.Prescriptions in clinics can significantly relieve the symptoms and improve thyroid function in clinical practice，and has a broad prospect and is worthy of reference.

Keywords Hyperthyroidism; Classical prescriptions; Traditional Chinese medicine; Treatment; Irritability; Palpitation; Goiter; Exophthalmos

中圖分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.05.004

甲状腺功能亢进症（Hyperthyroidism），简称甲亢，是一种以神经、循环、消化等系统兴奋性增高和代谢亢进为主的内分泌常见疾病[1]。在国外，欧洲甲亢患病率为0.8%，美国甲亢发病率为1.3%[2]。在我国，甲亢发病率约为3.7%[3]，并以0.2%～0.3%的增长率呈持续增长趋势[4]，且国内外患病人群均以女性为主。甲亢最常见的病因是弥漫性毒性甲状腺肿（Graves病），其次是毒性结节性甲状腺肿。现代医学治疗Graves病以抗甲状腺药物（Antithyroid Drugs，ATDs）、放射性碘治疗和手术治疗为主。但每一种治疗方法，所带来的后果都值得商榷。ATDs治疗要经过12～18个月，缓解率仅20%～30%[5]。粒细胞缺乏症是其最常见的主要不良反应，年发病率估计为0.1%～0.3%[6]。……