实用中医内科杂志

甲状腺结节是甲状腺常见疾病之一，发病机制尚不明确，发病率逐年上升且呈年轻化趋势。虽然绝大多数甲状腺结节没有临床症状，但部分伴有恶化风险，并在一定程度上增加患者心理负担。目前该病治疗多选择抑制促甲状腺激素水平、借助经皮激光消融技术破坏病灶、放射性I治疗等非手术治疗或手术切除。中医学通常将甲状腺结节归属为“瘿瘤”,其发病机制与气、痰、瘀有关。“寒气生浊”出自《素问·阴阳应象大论篇》,寒为阴邪，其性收引凝滞，是中医揭示寒邪通过影响气血、津液运行生成浊邪的一个重要的病机理论。文章试从“寒气生浊”角度探析甲状腺结节的中医病因病机，认为其病机演变规律为寒凝收引为始，浊邪并行为渐，浊化成毒为终。针对不同的病机阶段，在治疗上初始期以温阳散寒为主；进展期以通阳化浊为主；终末期以固本祛浊为主；解毒散结，贯穿始终以消瘿。采用中医中药的方式对甲状腺结节患者进行早期干预，减少结癌转化的发生，降低甲状腺癌发病率。

Thyroid nodules are a common thyroid disorder with an unclear pathogenesis.The incidence rate has been increased year by year and is showing a trend toward affecting younger individuals.Although the vast majority of thyroid nodules are asymptomatic, some carry a risk of malignancy and contribute to patients' psychological burden to some extent.Current treatments often involve non-surgical approaches such as suppressing thyroid-stimulating hormone levels, percutaneous laser ablation to destroy lesions, and radioactive iodine therapy, as well as surgical resection.In traditional Chinese medicine,thyroid nodules are generally classified under the category of “goiter and tumor”.Their pathogenesis is associated with qi, phlegm, and blood stasis.The statement “cold generates turbidity”originates from the Suwen · Yinyang Yingxiang Dalun Pian. Cold, as a pathogenic yin factor, is characterized by contraction and stagnation.This is an important pathological theory in traditional Chinese medicine that explains how cold pathogens affect the movement of qi and blood, as well as body fluids, leading to the production of turbid pathogens.This article attempts to explore the etiology and pathogenesis of thyroid nodules from the perspective of “cold generating turbidity.” It proposes that the pathological evolution follows the pattern: starting with cold condensation and contraction, progressing with the concurrent action of turbid pathogens, and ending with turbidity transforming into toxicity.Corresponding to different stages of pathogenesis, the treatment principles are as follows: in the initial stage, the focus is on warming yang and dispersing cold; in the progressive stage, on unblocking yang and resolving turbidity; and in the terminal stage, on strengthening the root and eliminating turbidity.Additionally, detoxifying and dissipating nodules should be incorporated throughout the treatment to resolve goiter.The aim is to use traditional Chinese medicine for early intervention in patients with thyroid nodules, reduce the transformation of nodules into cancer, and lower the incidence of thyroid cancer.