基于心肝阴虚病机探讨天王补心丹加减治疗甲亢恢复期的临证思路及验案举隅

Clinical Exploration, Experience and Typical Case of Modified Tianwang Buxin Decoction in Treating Hyperthyroidism in the Recovery Period Based on the Pathogenesis of Heart-Liver Yin Deficiency

摘要: 目的：探析甲亢恢复期心肝阴虚证的病机规律，总结天王补心丹加减的临床应用思路。方法：梳理瘿病病机演变，解析本方方证对应机制，制定甲状腺专科辨证与加减方案，结合典型病案验证疗效。结果：甲亢恢复期核心病机为火热耗伤心肝阴血、虚火扰神。天王补心丹加减可有效改善心悸失眠、潮热盗汗、手抖焦虑等残留症状，下调甲状腺自身抗体，稳定甲状腺功能。结论：天王补心丹治疗甲亢恢复期心肝阴虚证初步观察到良好效果，中西医协同可观察到免疫指标改善，值得临床推广。

Abstract: Objective: To explore the pathogenesis of liver‑heart yin deficiency in hyperthyroidism recovery stage and summarize the clinical application of modified Tianwang Buxin Decoction. Methods: The pathogenesis evolution of goiter was analyzed, the formula‑syndrome matching mechanism was interpreted, and specialized syndrome differentiation and medication schemes were formulated. Clinical curative effect was verified by a typical case. Results: The core pathogenesis of hyperthyroidism in recovery period is consumption of liver‑heart yin‑blood by stagnant fire and deficient fire disturbing the heart spirit. Modified Tianwang Buxin Decoction can obviously relieve residual symptoms including palpitations, insomnia, night sweats and tremor, decrease thyroid auto‑antibodies and stabilize thyroid function. Conclusion: Preliminary observation confirms that Tianwang Buxin Dan achieves favorable efficacy in treating heart and liver yin deficiency syndrome during the convalescent stage of hyperthyroidism. Synergistic treatment of traditional Chinese medicine and Western medicine can achieve observable improvements in immune indicators, and is worthy of clinical promotion.