橋本氏甲狀腺炎中醫治療病案一則

A Case Study of Hashimoto's Thyroiditis (Lymphadenoid Goiter) with Traditional Chinese Medicine

徐維偵(Wei-Chen Hsu)

《台灣中醫臨床醫學雜誌》 14卷1期 (2008/03) Pp. 70-77

https://doi.org/10.6968/TJCCM.200803.0070

摘要

此病案是橋本氏甲狀腺炎併發甲狀腺功能不足症。經中醫辯證論治，認為病患有肝鬱氣滯造成肝膽經脈濕熱進一步造成氣虛的問題，因此用加味逍遙散及柴胡疏肝散以舒肝解鬱，加上黃耆補氣、鬱金活血開鬱、茵陳利肝膽經濕熱、葛根解肌，並且轉介至新陳代謝科做進一步檢查，抽血檢查確定為自體免疫之原發性甲狀腺機能低下，建議他中西醫合併治療。一般甲狀腺低下症候在中醫診斷治療上，大多歸屬於“虛勞”範疇，而辯證分型多歸於脾腎陽虛型最多，而本病案卻是肝氣鬱結，肝膽經濕熱類型，實屬罕見，因此提出來作為進一步後續研究的參考。

關鍵字

橋本氏甲狀腺炎 ； 甲狀腺功能低下 ； 中醫療法

並列摘要

This is a case of Hashimoto's thyroiditis with complication of insufficient thyroid function. TCM diagnosis shows patient has liver qi stagnation which causes heat and dampness in liver and gall bladder meridians, and further becomes qi deficiency. Therefore, we prescribe JiaWeiXiaoYao powder and ChaiHuShuGan powder to sooth the liver and relieve qi stagnation. HuangQi is used to replenish qi, YuJin to relieve stagnation and promote circulation, YinChen to clear heat and resolve dampness, and GeGen to dispel pathogens in the muscles. The patient is referred to the department of metabolism to have further examination. The blood test shows idiopathic hypothyroidism caused by autoimmune problems. He is suggested to have a combination of conventional and TCM treatments. Hypothyroidism usually belongs to ”deficiency” syndromes in TCM, and often manifests in deficiency in spleen and kidney yang. However, this case shows liver qi stagnation with heat and dampness in liver and gall bladder meridians. Since it's a rare case, we provide the case study for future research reference.

並列關鍵字

Hashimoto's Thyroiditis ； hypothyroidism ； TCM treatment