马国庆教授从肝脾肾论治亚临床甲减治验撷菁

Professor Ma Guoqing’s Selected Clinical Experience in Treating Subclinical Hypothyroidism from the Perspective of the Liver, Spleen and Kidney

摘要: 亚临床甲状腺功能减退症(subclinical hypothyroidism, SCH)是防治临床甲减的关键窗口期，现代医学缺乏有效干预手段。马国庆教授基于“神经–内分泌–免疫”网络整体观，提出SCH“肾阳亏虚为本，肝失疏泄为要，脾虚失运为继，寒热错杂为态”的复合病机理论，突破了传统“脾肾阳虚”的单一认识。据此创立“温补肾阳、疏肝解郁、健脾益气、燮理阴阳”之整合治则及核心方“柴芩戟羊汤”。该方寒温并用，疏补兼施，体现了“固本调枢”的学术思想。本文系统阐述其理论内涵、方药解析，并辅以典型验案，详细展示其辨证、处方及动态调方的完整思路，为SCH的中医早期干预提供了理法方药完备的临床范式。

Abstract: Subclinical hypothyroidism (SCH) represents a critical window for preventing the progression to overt hypothyroidism, yet effective interventions are lacking in modern medicine. Professor Ma Guoqing, based on the holistic perspective of the “neuro-endocrine-immune” network, proposes a composite pathogenesis theory of SCH: “kidney yang deficiency as the root cause, liver qi stagnation as the key factor, spleen deficiency and failed transportation as the secondary development, and a state of mixed cold and heat as the overall pattern”. This theory transcends the traditional unidimensional view of “spleen-kidney yang deficiency”. Accordingly, Professor Ma has established an integrated therapeutic principle encompassing “warming and tonifying kidney yang, soothing the liver and relieving depression, invigorating the spleen and benefiting qi, and harmonizing yin and yang”, along with the core formula Chai Qin Ji Yang Tang. This formula combines cold and warm properties, and adopts both dispersing and tonifying methods, embodying the academic concept of “consolidating the root and regulating the pivot”. This article systematically elaborates its theoretical connotation and formula analysis, supplemented by a typical clinical case, and demonstrates in detail the complete approach including syndrome differentiation, prescription, and dynamic modification, providing a comprehensive clinical paradigm with principles, methods, formulas, and medicinals for early TCM intervention in SCH.