甲状腺纤维化的中医治疗思路
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摘要
甲状腺纤维化是各种因素刺激下,出现的纤维性改变,是多种甲状腺疾病共有的病理过程。甲状腺纤维化严重影响患者生存质量,故针对纤维化治疗具有重要意。中药辨证治疗甲状腺纤维化以疏肝行气、健脾补肾、活血化瘀、祛痰除湿、软坚散结为总原则。根据纤维化早、中、晚三期分别采用半夏厚朴汤,补中益气汤,桂附地黄汤合真武汤加丹参、地龙、贝母等方药治疗。并加入穿山龙、夏枯草、雷公藤、山慈菇、黄药子、人参皂甙等具有抗甲状腺纤维化的中药及单体,以期为临床治疗提供一种新的思路。
Thyroid fibrosis is a fibrous condition that occurs under stimulation of various factors and is a common pathological process of various thyroid diseases. Thyroid fibrosis seriously affects the life quality of patients, so it is of great significance for fibrosis treatment. Guidelines of Chinese medicine syndrome differentiation in treating thyroid fibrosis are activating qi and dispersing stagnated liver-energy, invigorating the spleen and kidney, activating blood circulation to dissipate blood stasis, dispelling phlegm and removing dampness, and softening and resolving hard mass.According to the early, middle and late stages of fibrosis, Banxia Houpu Decoction, Buzhong Yiqi Decoction, Guifu Dihuang Decoction and Zhenwu Decoction plus Danshen(Salvia miltiorrhiza), Dilong(lumbricus), Beimu(fritillaria) and other prescriptions were used. Chinese medicine and monomer with anti-thyroid fibrosis function were added, such as Chuanshanlong(Dioscorea nipponica), Prunella vulgaris, Tripterygium wilfordii, Radix Scutellariae, appendiculate cremastra pseudobulb, Rhizoma dioscoreae bulbiferae, Ginsenoside, etc., so as to provide new ideas for clinical treatment.
Thyroid fibrosis is a fibrous condition that occurs under stimulation of various factors and is a common pathological process of various thyroid diseases. Thyroid fibrosis seriously affects the life quality of patients, so it is of great significance for fibrosis treatment. Guidelines of Chinese medicine syndrome differentiation in treating thyroid fibrosis are activating qi and dispersing stagnated liver-energy, invigorating the spleen and kidney, activating blood circulation to dissipate blood stasis, dispelling phlegm and removing dampness, and softening and resolving hard mass.According to the early, middle and late stages of fibrosis, Banxia Houpu Decoction, Buzhong Yiqi Decoction, Guifu Dihuang Decoction and Zhenwu Decoction plus Danshen(Salvia miltiorrhiza), Dilong(lumbricus), Beimu(fritillaria) and other prescriptions were used. Chinese medicine and monomer with anti-thyroid fibrosis function were added, such as Chuanshanlong(Dioscorea nipponica), Prunella vulgaris, Tripterygium wilfordii, Radix Scutellariae, appendiculate cremastra pseudobulb, Rhizoma dioscoreae bulbiferae, Ginsenoside, etc., so as to provide new ideas for clinical treatment.
引文
1常虹,郭凯,孟洪宇,等.中医异病同治理论治疗多器官纤维化的科学基础评述.中华中医药学刊, 2017, 35(4):849-851.
2 熊维宁,聂静,孙瑞娟,等.脏器纤维化:一个重要的病理生理过程.中国科学基金, 2015(3):172-177.
3 Ramalingam T R. Mechanisms of fibrosis:therapeutic translation for fibrotic disease. Nature Medicine, 2012, 18(7):1028-40.
4 魏军平,郑慧娟,魏璠.甲状腺疾病防治:重视甲状腺纤维化研究.医学研究杂志, 2016, 45(7):1-3.
5 Bajaj J K, Salwan P, Salwan S. Various possible toxicants involved in thyroid dysfunction:A review. Journal of Clinical&Diagnostic Research Jcdr, 2016, 10(1):FE01.
6 牛建昭,姜术霞,李或.多脏器纤维化的络病机制探讨.北京中医药大学学报, 2004, 27(6):4-6.
7 赵钢,陈建杰,高脙.王灵台教授论柔肝冲剂防治肝肾肺等多脏器纤维化的研究思路.中华中医药学刊, 2004, 22(11):1998-1999.
8 张树华.桥本氏甲状腺炎分期的探讨.临床与实验病理学杂志, 1997,13(2):138-140.
9 Zhang X, Xu Y, Qi Y, et al. Potent effects of dioscin against thioacetamide-induced liver fibrosis through attenuating oxidative stress in turn inhibiting inflammation, TGF-β/Smad and MAPK signaling pathways. Journal of Functional Foods, 2015, 16(815):436-447.
10 Gu L, Tao X, Xu Y, et al. Dioscin alleviates BDL-and DMN-induced hepatic fibrosis via Sirt1/Nrf2-mediated inhibition of p38 MAPK pathway. Toxicology&Applied Pharmacology, 2016, 292:19-29.
11 Si L, Xu L, Yin L, et al. Potent effects of dioscin against pancreatic cancer via miR-149-3P-mediated inhibition of the Akt1 signalling pathway. British Journal of Pharmacology, 2017, 174(7):553.
12 Zhang G, Zeng X, Zhang R, et al. Dioscin suppresses hepatocellular carcinoma tumor growth by inducing apoptosis and regulation of TP53,BAX, BCL2 and cleaved CASP3. Phytomedicine, 2016, 23(12):1329-1336.
13 Si L, Zheng L, Xu L, et al. Dioscin suppresses human laryngeal cancer cells growth via induction of cell-cycle arrest and MAPK-mediated mitochondrial-derived apoptosis and inhibition of tumor invasion.European Journal of Pharmacology, 2016, 774(4):105-117.
14 曹拥军,蒋晟昰,罗燕萍,等.穿山龙对桥本甲状腺炎患者Th1/Th2型细胞因子表达的影响.中华中医药杂志, 2016, 3(31):1103-1105.
15 Yin D T, Lei M, Xu J, et al. The Chinese herb Prunella vulgaris promotes apoptosis in human well-differentiated thyroid carcinoma cells via the B-cell lymphoma-2/Bcl-2-associated X protein/caspase-3 signaling pathway. Oncology Letters, 2017, 14(2):1309.
16 Sumra K, Asif J K S, Ali K J, et al. Antimicrobial activity of Prunella Vulgaris extracts against multi-drug resistant Escherichia Coli from patients of urinary tract infection. Pakistan Journal of Medical Sciences,2018, 34(3):616-620.
17 Chen Y, Zhang X, Guo Q, et al. Effects of UV-B radiation on the content of bioactive components and the antioxidant activity of Prunella vulgaris L. Spica during development. Molecules, 2018, 23(5):989.
18 王三强,魏会珍,冯宝佺,等.夏枯草片辅助优甲乐治疗气郁痰阻型甲状腺结节疗效观察.现代中西医结合杂志, 2017, 26(36):4082-4084.
19 Wang S, Li R, He S, et al. Tripterygium wilfordii glycosides upregulate the new anti-inflammatory cytokine IL-37 through ERK1/2 and p38MAPK signal pathways. Evidence-Based Complementray and Alternative Medicine, 2017, 2017(5):9148523.
20 岳筱,王妍妍,杨阳,等.糖皮质激素联合生长抑素、雷公藤多苷治疗甲状腺相关眼病临床疗效及安全性分析.河南医学研究, 2017, 26(1):31-33.
21 吴俊林,卢德成,罗佐杰,等.中药山慈姑对甲状腺癌细胞的促凋亡作用.时珍国医国药, 2014, 25(1):71-74.
22 胡波.张发荣教授治疗甲状腺功能亢进症临证经验.成都中医药大学学报, 2014, 37(4):80-82.
23 Bai L, Gao J, Wei F, et al. Therapeutic potential of ginsenosides as an adjuvant treatment for diabetes. Front Pharmacol, 2018, 9(1):423.
24 冯晓红,黄琦,张寅晓,等.人参皂苷对实验性自身免疫性甲状腺炎大鼠TNF-α及IL-6影响的研究.新中医, 2015, 47(1):217-219.
25 朱振林.柔肝冲剂对肝纤维化患者血清TIMP-1影响的研究.黑龙江中医药大学, 2010.
26 周云.柔肝冲剂对肝纤维化患者血清MMP-2的影响.黑龙江中医药大学, 2010.
27 杨宇,赵月涵,庄海,等.复方鳖甲软肝片防治大鼠肝纤维化作用及机制.贵州医科大学学报, 2018, 43(12):1380-1385.
28 邓莉,申宝德,刘园,等.复方鳖甲软肝片减方对CCl4诱导大鼠肝纤维化的影响及机制研究.中草药, 2018, 49(6):1371-1378.
29 付旭,李均,阳小敏,等.黄芪丹参颗粒药对干预肾纤维化Wnt/β-catenin信号通路的实验研究.世界科学技术-中医药现代化, 2014,16(1):103-108.
30 陶鹏宇,张悦.六味地黄丸通过调控NF-κB及TGF-β/Smad双信号通路减轻糖尿病肾病炎症及纤维化.广州中医药大学学报, 2019, 36(2):245-250.
31 李军娜,马华,马天成,等.大黄?虫丸加减对大鼠肾间质纤维化的保护作用及机制.中国实验方剂学杂志.https://doi.org/10.13422/j.cnki.syfjx.20190736.
32 潘怡,王振兴,郭静,等.补阳还五汤对肺纤维化小鼠中介导细胞自org/10.13422/j.cnki. syfjx.20190602.
33 李木松,张贵贤,魏媛媛,等.茵陈蒿汤对胆汁淤积性肝纤维化大鼠内质网应激PERK通路的影响.中国中医药科技, 2016, 23(5):535-538.
34 王璟,董志春.硒酵母联合左甲状腺素钠片对桥本甲状腺炎患者甲状腺功能减退及炎性因子的影响.现代实用医学, 2016, 28(8):1035-1037.
2 熊维宁,聂静,孙瑞娟,等.脏器纤维化:一个重要的病理生理过程.中国科学基金, 2015(3):172-177.
3 Ramalingam T R. Mechanisms of fibrosis:therapeutic translation for fibrotic disease. Nature Medicine, 2012, 18(7):1028-40.
4 魏军平,郑慧娟,魏璠.甲状腺疾病防治:重视甲状腺纤维化研究.医学研究杂志, 2016, 45(7):1-3.
5 Bajaj J K, Salwan P, Salwan S. Various possible toxicants involved in thyroid dysfunction:A review. Journal of Clinical&Diagnostic Research Jcdr, 2016, 10(1):FE01.
6 牛建昭,姜术霞,李或.多脏器纤维化的络病机制探讨.北京中医药大学学报, 2004, 27(6):4-6.
7 赵钢,陈建杰,高脙.王灵台教授论柔肝冲剂防治肝肾肺等多脏器纤维化的研究思路.中华中医药学刊, 2004, 22(11):1998-1999.
8 张树华.桥本氏甲状腺炎分期的探讨.临床与实验病理学杂志, 1997,13(2):138-140.
9 Zhang X, Xu Y, Qi Y, et al. Potent effects of dioscin against thioacetamide-induced liver fibrosis through attenuating oxidative stress in turn inhibiting inflammation, TGF-β/Smad and MAPK signaling pathways. Journal of Functional Foods, 2015, 16(815):436-447.
10 Gu L, Tao X, Xu Y, et al. Dioscin alleviates BDL-and DMN-induced hepatic fibrosis via Sirt1/Nrf2-mediated inhibition of p38 MAPK pathway. Toxicology&Applied Pharmacology, 2016, 292:19-29.
11 Si L, Xu L, Yin L, et al. Potent effects of dioscin against pancreatic cancer via miR-149-3P-mediated inhibition of the Akt1 signalling pathway. British Journal of Pharmacology, 2017, 174(7):553.
12 Zhang G, Zeng X, Zhang R, et al. Dioscin suppresses hepatocellular carcinoma tumor growth by inducing apoptosis and regulation of TP53,BAX, BCL2 and cleaved CASP3. Phytomedicine, 2016, 23(12):1329-1336.
13 Si L, Zheng L, Xu L, et al. Dioscin suppresses human laryngeal cancer cells growth via induction of cell-cycle arrest and MAPK-mediated mitochondrial-derived apoptosis and inhibition of tumor invasion.European Journal of Pharmacology, 2016, 774(4):105-117.
14 曹拥军,蒋晟昰,罗燕萍,等.穿山龙对桥本甲状腺炎患者Th1/Th2型细胞因子表达的影响.中华中医药杂志, 2016, 3(31):1103-1105.
15 Yin D T, Lei M, Xu J, et al. The Chinese herb Prunella vulgaris promotes apoptosis in human well-differentiated thyroid carcinoma cells via the B-cell lymphoma-2/Bcl-2-associated X protein/caspase-3 signaling pathway. Oncology Letters, 2017, 14(2):1309.
16 Sumra K, Asif J K S, Ali K J, et al. Antimicrobial activity of Prunella Vulgaris extracts against multi-drug resistant Escherichia Coli from patients of urinary tract infection. Pakistan Journal of Medical Sciences,2018, 34(3):616-620.
17 Chen Y, Zhang X, Guo Q, et al. Effects of UV-B radiation on the content of bioactive components and the antioxidant activity of Prunella vulgaris L. Spica during development. Molecules, 2018, 23(5):989.
18 王三强,魏会珍,冯宝佺,等.夏枯草片辅助优甲乐治疗气郁痰阻型甲状腺结节疗效观察.现代中西医结合杂志, 2017, 26(36):4082-4084.
19 Wang S, Li R, He S, et al. Tripterygium wilfordii glycosides upregulate the new anti-inflammatory cytokine IL-37 through ERK1/2 and p38MAPK signal pathways. Evidence-Based Complementray and Alternative Medicine, 2017, 2017(5):9148523.
20 岳筱,王妍妍,杨阳,等.糖皮质激素联合生长抑素、雷公藤多苷治疗甲状腺相关眼病临床疗效及安全性分析.河南医学研究, 2017, 26(1):31-33.
21 吴俊林,卢德成,罗佐杰,等.中药山慈姑对甲状腺癌细胞的促凋亡作用.时珍国医国药, 2014, 25(1):71-74.
22 胡波.张发荣教授治疗甲状腺功能亢进症临证经验.成都中医药大学学报, 2014, 37(4):80-82.
23 Bai L, Gao J, Wei F, et al. Therapeutic potential of ginsenosides as an adjuvant treatment for diabetes. Front Pharmacol, 2018, 9(1):423.
24 冯晓红,黄琦,张寅晓,等.人参皂苷对实验性自身免疫性甲状腺炎大鼠TNF-α及IL-6影响的研究.新中医, 2015, 47(1):217-219.
25 朱振林.柔肝冲剂对肝纤维化患者血清TIMP-1影响的研究.黑龙江中医药大学, 2010.
26 周云.柔肝冲剂对肝纤维化患者血清MMP-2的影响.黑龙江中医药大学, 2010.
27 杨宇,赵月涵,庄海,等.复方鳖甲软肝片防治大鼠肝纤维化作用及机制.贵州医科大学学报, 2018, 43(12):1380-1385.
28 邓莉,申宝德,刘园,等.复方鳖甲软肝片减方对CCl4诱导大鼠肝纤维化的影响及机制研究.中草药, 2018, 49(6):1371-1378.
29 付旭,李均,阳小敏,等.黄芪丹参颗粒药对干预肾纤维化Wnt/β-catenin信号通路的实验研究.世界科学技术-中医药现代化, 2014,16(1):103-108.
30 陶鹏宇,张悦.六味地黄丸通过调控NF-κB及TGF-β/Smad双信号通路减轻糖尿病肾病炎症及纤维化.广州中医药大学学报, 2019, 36(2):245-250.
31 李军娜,马华,马天成,等.大黄?虫丸加减对大鼠肾间质纤维化的保护作用及机制.中国实验方剂学杂志.https://doi.org/10.13422/j.cnki.syfjx.20190736.
32 潘怡,王振兴,郭静,等.补阳还五汤对肺纤维化小鼠中介导细胞自org/10.13422/j.cnki. syfjx.20190602.
33 李木松,张贵贤,魏媛媛,等.茵陈蒿汤对胆汁淤积性肝纤维化大鼠内质网应激PERK通路的影响.中国中医药科技, 2016, 23(5):535-538.
34 王璟,董志春.硒酵母联合左甲状腺素钠片对桥本甲状腺炎患者甲状腺功能减退及炎性因子的影响.现代实用医学, 2016, 28(8):1035-1037.