基于自然史分期的甲状腺结节中医药论治的研究进展

Research Progress on Traditional Chinese Medicine Treatment of Thyroid Nodules Based on Natural History Staging

摘要: 甲状腺结节在甲状腺疾病中最为常见，我国甲结、甲状腺癌发病率持续升高，中医论治疗效确切但缺乏统一的分期规范。甲状腺结节的自然史指甲状腺结节在无干预情况下的发生、发展、稳定/进展、转归的动态演变过程。本文通过系统检索相关文献，归纳分期理论，以甲状腺结节自然史为切入点，把疾病客观进展与中医分期论治结合，以仝小林院士提出的“郁、瘀、虚”三阶段病机演变为依据，将病程分为三期：稳定期气郁、肝郁气滞；进展期痰凝血瘀；高风险期正虚邪恋。临证将中医证型与自然史分期相对应，分阶段论治，该分期理论可为甲状腺结节的中医辩证统一及中西医结合的分期诊疗治疗提供新思路，同时能够更好地促进“治未病”理念在其中的实施。

Abstract: Thyroid nodules are the most prevalent thyroid disorders, and the incidence of thyroid nodules and thyroid cancer has been steadily rising in China. Traditional Chinese medicine (TCM) achieves definite therapeutic effects in their treatment, yet unified staging criteria remain absent. The natural history of thyroid nodules refers to their dynamic evolutionary process of onset, development, stabilization or progression, and prognosis without clinical intervention. Based on systematic literature retrieval and summary of existing staging theories, this study takes the natural history of thyroid nodules as the entry point, and integrates the objective disease progression with TCM staging treatment. Guided by the three-stage pathogenesis evolution theory of “stagnation, stasis and deficiency” proposed by Academician Tong Xiaolin, thyroid nodules are divided into three phases: the stable phase characterized by qi stagnation and liver depression-qi stagnation; the progressive phase marked by phlegm coagulation and blood stasis; and the high-risk phase dominated by healthy qi deficiency and lingering pathogenic factors. Clinically, TCM syndrome types are matched with natural history stages for phased treatment. This staging theory can provide new insights for unifying TCM syndrome differentiation standards and establishing integrated Chinese and Western medicine staging diagnosis and treatment protocols for thyroid nodules, and further facilitate the implementation of the TCM concept of “preventive treatment of diseases” in clinical practice.