中西医结合诊治亚急性甲状腺炎存在问题及对策

中西医结合诊治亚急性甲状腺炎(简称亚甲炎)目前存在中西医病名不规范以及局部病程阶段、病因病机认识、中药治疗及注意事项、预后等方面的问题。应对《中国甲状腺疾病诊治指南——甲状腺炎》的亚甲炎分类做局部纠正;鉴于糖皮质激素可能高概率引发永久性甲状腺功能减退和延长亚甲炎病程,故推荐西药尽量以解热镇痛药为主;中医病名应首推"瘿毒"或"瘿痛",本病发生的内因是肝胃热盛、肝郁痰凝,从而在特殊时期与风热热毒外侵同气相求,促成对本病的易感和发生发展;中药治疗方面,初发阶段首推疏散风热联合清热解毒之法,按病期中医辨证论治,且内外合治,不可过汗伤正;治愈后不忘避风寒、节饮食、调情志,生活规律,劳逸结合,从而预防本病的复发。

Problems and countermeasures in the diagnosis and treatment of subacute thyroiditis with integrated Chinese and western medicine

It is pointed out in this article that in the diagnosis and treatment of subacute thyroiditis (SAT) with integrated traditional Chinese and western medicine,there are problems at present in terms of nonstandard disease name,non-uniform understandings of course stages,its etiology and pathogenesis,as well as lack of research evidence for the traditional Chinese medicine (TCM) treatment,precautions,prognosis and so on.Hence,it is proposed:(1) that the classification of thyroiditis in The Guidelines of the Chinese Society of Endocrinology for the Diagnosis and Treatment of Thyroid Diseases--Thyroiditis should be partially revised;(2) in view of the high probability that glucocorticoids may cause permanent hypothyroidism and prolong the course of SAT,antipyretic and analgesic drugs are recommended as the main western medicines;(3) the disease name in TCM should be “goiter toxin” or “goiter pain”,with its internal etiologies characterized by heat exuberance in liver and stomach,liver depression and phlegm coagulation,which are liable to be combined with the external invasion by wind-heat pathogens to promote the susceptibility,occurrence and development of the disease;(4) in terms of its TCM treatment,the methods of dispelling wind-heat,clearing heat and removing toxicity should be applied first in its initial stage,and after that,its treatment should be based on syndrome differentiation in different stages,taking a combined internal and external treatment and avoiding excessive sweating;and (5) after healing,be sure to avoid wind and cold,control diet,modulate the mood,have a regular life style and avoid exhaustion,so as to prevent the recurrence of the disease.