基于“阳化气，阴成形”理论解析桥本甲状腺炎的免疫微环境失衡

Elucidating Immune Microenvironment Dysregulation in Hashimoto’s Thyroiditis Based on the Theory of “Yang Transforming Qi and Yin Forming Substance”

摘要: 桥本甲状腺炎是常见的自身免疫性甲状腺疾病，以淋巴细胞浸润、自身抗体阳性及甲减为特征。基于“阳化气，阴成形”理论解析其免疫微环境失衡，将“阳化气”对应于调节性T细胞介导的免疫耐受等动态功能，“阴成形”对应于淋巴细胞浸润、自身抗体沉积及纤维化等病理结构。该病免疫失衡可阐释为“阳化气不足”与“阴成形太过”：前者表现为调节性T细胞功能衰竭，后者表现为辅助性T细胞17异常增殖及纤维化。脾肾阳虚、气化失司为本，导致痰瘀互结形成标实，二者互为因果，形成“阳虚阴凝”的恶性循环。本研究从阴阳失衡角度揭示了该病从功能衰退到结构异化的病机演变规律，为“扶阳化气、祛痰化瘀”法干预提供了理论依据。

Abstract: Hashimoto’s thyroiditis is a common autoimmune thyroid disease characterized by lymphocytic infiltration, autoantibody positivity, and hypothyroidism. Based on the theory of Yang Transforming Qi and Yin Forming Substance, this study analyzes the immune microenvironment imbalance, correlating “Yang transforming Qi” with dynamic functions such as regulatory T cell-mediated immune tolerance, and “Yin forming substance” with pathological structures including lymphocytic infiltration, autoantibody deposition, and fibrosis. The immune imbalance can be interpreted as a disharmony between “insufficiency of Yang transforming Qi” and “excess of Yin forming substance”: the former manifests as regulatory T cell dysfunction, while the latter presents as abnormal T helper 17 cell proliferation and thyroid fibrosis. Spleen-kidney Yang deficiency and dysfunction of Qi transformation constitute the root cause, leading to the intermingling of phlegm and blood stasis as the branch manifestation; these two aspects interact as cause and effect, creating a vicious cycle of “Yang deficiency with Yin congelation”. This study elucidates the pathological evolution from functional decline to structural alienation through the perspective of Yin-Yang imbalance, providing a theoretical basis for clinical intervention using the therapeutic principles of “supporting Yang to transform Qi and dispelling phlegm to resolve stasis”.