以肝为枢论治甲状腺功能亢进症

Treatment of Hyperthyroidism Based on the Liver as the Pivot

摘要: 本文基于“以肝为枢”理论，系统探讨甲状腺功能亢进症的中医病机与治疗进展。甲亢病位主要在肝，涉及气、火、痰、瘀、虚等多重病理因素，临床可见肝气郁结、肝火亢盛、肝肾阴虚、痰瘀交阻等多种证型。文章以肝为核心、从肝与他脏、肝与经络以及少阳厥阴等角度，梳理了从肝论治甲亢的辨证体系与用药规律，涵盖疏肝理气、清肝泻火、滋水涵木、痰瘀同治、心肝同调等治法，并引入厥阴病“上热下寒”及少阳相火理论，拓展了乌梅丸、大柴胡汤等经方在甲亢治疗中的运用。研究表明，以肝为枢、五脏同调的中医治疗策略在改善甲亢症状、调节免疫及减少西药不良反应方面具有独特优势，体现了中医整体观念与辨证论治的临床价值，为甲亢的中医药诊治提供了理论依据与实践参考。

Abstract: This paper systematically explores the pathogenesis and therapeutic advances of hyperthyroidism in traditional Chinese medicine based on the theory of “the liver as the pivotal organ.” The primary pathological location of hyperthyroidism is the liver, involving multiple pathological factors such as qi, fire, phlegm, stasis, and deficiency. Clinically, various syndromes can be observed, including liver qi stagnation, excessive liver fire, liver-kidney yin deficiency, and phlegm-stasis obstruction. Centering on the liver, this article examines the therapeutic framework and medication patterns for treating hyperthyroidism through the liver, considering its interactions with other organs, its relationship with meridians, and the perspectives of Shaoyang and Jueyin. It covers therapeutic approaches such as soothing the liver and regulating qi, clearing liver fire, nourishing water to support wood, simultaneous treatment of phlegm and stasis, and coordinated regulation of the heart and liver. It further incorporates theories of Jueyin disease (“heat above, cold below”) and Shaoyang phase fire, expanding the application of classical formulas like Wu Mei Wan and Da Chai Hu Tang in hyperthyroidism management. Research indicates that the TCM therapeutic strategy centered on the liver as the pivotal organ and coordinated regulation of all five zang organs demonstrates unique advantages in alleviating hyperthyroidism symptoms, modulating immunity, and reducing adverse reactions to Western medications. This approach embodies the clinical value of TCM’s holistic perspective and syndrome differentiation-based treatment, providing theoretical foundations and practical references for the diagnosis and treatment of hyperthyroidism with Chinese medicine.