Summary of Experience in Treating Hyperthyroidism with TCM Syndrome Differentiation ()
1. Introduction
Hyperthyroidism is a common clinical frequently-occurring disease, and its incidence is increasing year by year. Graves disease (GD) is the most common type, which belongs to the category of goiter in TCM. The main clinical manifestations are overeating, emaciation, fear of heat, hyperhidrosis, palpitation, irritability and other metabolic and nerve excitation symptoms. At present, simple western medicine is effective in the treatment of hyperthyroidism, but it has some limitations. TCM syndrome differentiation treatment has the advantages of overall adjustment, small side effects and low recurrence rate, which is accepted by more and more patients. The treatment of hyperthyroidism based on syndrome differentiation of TCM is summarized as follows.
2. The Etiology and Pathogenesis of Hyperthyroidism
2.1. Emotional Injury
Depression, exasperation and anxiety lead to the loss of liver qi, stagnation of qi, abnormal distribution of body fluid, easy to condense into sputum, phlegm condensation in front of the neck.
2.2. Diet, Soil and Water Inappropriate
Diet and soil and water failure affect the function of spleen and stomach transporting water and dampness, gather and produce phlegm, spleen and stomach disorders affect the operation of qi and blood, leading to blood stasis in front of the neck.
2.3. Individual Physique
Women are born with the liver as their physique, and factors such as diet and emotion are more likely to cause qi depression and phlegm stagnation. In addition, phlegm depression and qi stagnation are more harmful to yin, and the course of disease is difficult to cure.
3. The Syndrome Type of Hyperthyroidism
TCM syndrome differentiation and treatment believes that the same disease in different stages of development, there can be different syndrome types. If the syndrome type is different, the treatment method is different, which is the principle of “different treatment of the same disease” adopted by TCM in the treatment of diseases. There are many syndrome types of hyperthyroidism. Guo Yongyi [1] combined with clinical practice and consulting the literature, GD patients were divided into four syndrome types: exuberant liver fire type, yin deficiency and fire exuberant type, qi-yin deficiency type and phlegm stagnation type, among which exuberant liver fire type and phlegm stagnation type were the most common.
The clinical manifestations of exuberant liver fire type were mild or moderate swelling on both sides of the anterior larynx, soft and smooth, irritable, exophthalmos, trembling fingers, facial heat, bitter mouth, red tongue, thin yellow coating, pulse string count; the clinical manifestations of yin deficiency and fire exuberant type were dizziness, emaciation and sweating, reddish tongue, little or thin yellow fur. The clinical manifestations of qi-yin deficiency type are shortness of breath, spontaneous sweating, low intake and weak pulse. The clinical manifestations of phlegm stagnation type are enlarged mass on both sides of cervical anterior laryngeal nodule, soft and painless, neck distension, chest tightness, like too much breath, or chest pain, and the condition often fluctuates with emotion, thin and white fur, pulse string [2].
TCM treatment of hyperthyroidism mainly embodies the idea of TCM syndrome differentiation and treatment. Different syndrome types adopt different treatment methods, which is not easy to relapse. On the basis of TCM syndrome differentiation, the treatment experience of different syndrome types of hyperthyroidism is summarized, which can be used to guide clinical practice.
4. TCM Syndrome Differentiation in the Treatment of Hyperthyroidism
4.1. Exuberant Liver Fire Type
The exuberant liver fire type is often treated by clearing the liver and purging fire and dispelling goiter.
4.1.1. Prescription Treatment
The clinical observation of Zhang Dongxing et al. [3] found that Gardenia Qinggan decoction was effective in the treatment of exuberant liver fire type. The prescription was composed of Radix bupleuri 20 g, Gardenia jasminoides 15 g, Cortex moutan 10 g, Angelica 15 g, Radix paeoniae alba 30 g, Burdock 10 g, Zhejiang Fritillaria 10 g, Xuanshen 10 g, Raw oyster 30 g. In the prescription, Radix bupleuri soothes the liver and relieves depression, Gardenia lasminoides and Cortex moutan are used to clear the liver and purge fire, Angelica to nourish blood, Radix paeoniae alba to nourish the liver and nourish the liver, Burdock to dissipate heat and pharynx, Raw oyster, Zhejiang Fritillaria to change phlegm to soften and disperse knot, Xuanshen nourishing yin and reducing fire, all medicines are used together to play the effect of clearing liver and purging fire. Li Zhongnan [4] pointed out that it is appropriate to clear the liver and purge fire in the treatment of exuberant liver fire type. Longdan Xiegan decoction is used to add and subtract: Gentian herb 10 g, Scutellaria baicalensis Georgi 10 g, Fried gardenia 10 g, Alisma alisma 15 g, Plantain grass 20 g, Radix rehmanniae 10 g, Licorice 6 g, Bupleurum 10 g. Through clinical observation, Guo Juan [5] found that Danzhi Xiaoyao Powder is also effective in the treatment of hyperthyroidism of liver fire, which is composed of Cortex moutan, Gardenia, Bupleurum, Angelica, Radix paeoniae alba, Yunling and Atractylodes macrocephala. Through the above three prescriptions, we can see that the treatment of exuberant liver fire type is mainly treated by clearing liver and purging fire, resolving phlegm and dispersing blood.
4.1.2. Acupuncture Treatment
Wang Guangan et al. [6] made data statistics on the acupoints of exuberant liver fire type with acupuncture and moxibustion. The results show that most doctors choose Taichong, Hegu, Neiguan, Taixi, Sanyinjiao, Zusanli, Ququan, Qimen, Shenshu, Ganshu, Dazhui, Jiaji, Ashi, Renying, Fengchi, Zanzhu, Qingming, Sizhukong, Shenmen, Fuliu, Zhaohai, Zhigou, Mazhong, Yanglingquan, Tiantuo, Futuo, Shuiyue and other acupoints.
4.1.3. Adjust the Mood
Zhang Yuan et al. [7] think that exuberant liver fire type is mostly related to emotional factors such as exasperation and anxiety, and proper emotional guidance to patients is beneficial to the recovery of the disease.
4.2. Phlegm Stagnation Type
Phlegm stagnation type is often treated by regulating qi and relieving depression, resolving phlegm and eliminating goiter.
4.2.1. Prescription Treatment
In the textbook of Internal Medicine of TCM [8] published by China Traditional Chinese Medicine Press, it is pointed out that Sihai Shuyu pills can be used for phlegm stagnation type. The prescription is composed of Kunbu, Kelp, Seaweed, Cuttlebone, Clam shell, Green wood incense, Green old peel. Ye Renqun [9] pointed out that phlegm stagnation type has a good curative effect when using Xiaoying Sanjie prescription. The prescription is composed of Bupleurum 10 g, Radix paeoniae alba 10 g, Fructus aurantii 10 g, Pinellia ternata 10 g, Ginger magnolia 6 g, Poria 15 g, Prunella vulgaris 10 g, Radix scrophulariae 10 g, Zhejiang Fritillaria 10 g, forsythia 10 g, Albizia flower 10 g, Salvia miltiorrhiza 10 g, Perilla leaf 6 g, licorice 5 g. Sihai Shuyu Pill and Xiaoying Powder are mainly used to treat phlegm stagnation type by resolving phlegm, softening firm and dispelling depression.
4.2.2. Acupuncture Treatment
Wang Guangan et al. [6] in the discussion of the law of acupoint treatment of hyperthyroidism, it is concluded that the phlegm stagnation type is mainly treated at Ashi acupoint, Taichong, Qiuxu, Yanglingquan, Zhaohai, Shenmen, Lieque, Waiguan, Yanglao, Tianrong, Tongziliao, Qiuhou, Toulinqi, Guangming, Zu, Sanyinjiao, Hegu, Neiguan, Zhongwan, Zusanli, Fenglong and other acupoints.
4.3. Yin Deficiency and Fire Exuberant Type
Yin deficiency and fire exuberant type are often treated by nourishing yin and latent yang, nourishing blood and softening the liver.
4.3.1. Prescription Treatment
Professor Li Huilin [10] believes that the root cause of this type is the exuberant fire of yin deficiency, the loss of yin essence, and the self-made prescription for nourishing yin. Drug composition: Ejiao 10 g, Chicken yellow 1, Dry Rehmannia 20 g, Radix paeoniae alba 20 g, Fushen 10 g, Ophiopogon 10 g, Stone cassia 10 g, Hemp seed 10 g, Raw oyster 20 g, Raw turtle shell 15 g, Raw tortoise plate 15 g, Grilled licorice 10 g.
4.3.2. Acupuncture Treatment
Yuan Min et al. [11] treated with acupuncture therapy of fifty battalions. The treatment methods were as follows: Zhongwan, Taiyuan, Hegu, Sanyinjiao, Shenmen, Taixi, Daling, Taichong, Guanyuan. Acupuncture method: with Yingyue reinforcing and reducing method, the needle was injected in turn along the direction of meridian flow, and the needle was retained for 28 minutes and 48 seconds. Once every other day, 10 times as a course of treatment, 6 - 7 consecutive courses of treatment, one week off between each course of treatment. Results: among the 30 cases, 24 patients had varying degrees of goiter, 15 patients improved after treatment, accounting for 62.5%, 3 cases of extraophthalmoplegia improved, 20% of 10 cases of exophthalmos, 5 cases improved, accounting for 50%.
4.4. Qi-Yin Deficiency Type
Qi-yin deficiency type is often treated by replenishing qi and nourishing yin, promoting blood circulation and eliminating gall.
4.4.1. Prescription Treatment
Professor Xiao Wanze [12] thinks that in the later stage of hyperthyroidism, most of them are qi-yin deficiency type, mixed with blood stasis and phlegm fire. Treatment should adopt replenishing qi and nourishing yin, promoting blood circulation and eliminating gall, regulating qi and resolving phlegm. Professor Xiao’s self-made prescription was composed of Radix Astragali 15 g, Shengdi 15 g, Poria cocos 10 g, Fried Atractylodes macrocephala 10 g, Bupleurum 10 g, Radix Paeoniae Alba 10 g, Zelan 20 g, Alisma 10 g, Tangerine peel 10 g, Pinellia ternata 10 g, Zedoary 10 g, Cat claw grass 10 g, Beehive 10 g, Ghost arrow feather 10 g, Licorice 10 g. Through clinical observation, it is found that it has a good curative effect. Lu Shicheng et al. [13] through clinical practice, it is concluded that Oyster powder combined with Shengmai Yin is effective in the qi-yin deficiency type. The prescription was Oyster 30 g, Radix pseudostellariae 10 g, Radix astragali 30 g, Radix paeoniae alba 15 g, Radix scrophulariae 30 g, Shengdi 20 g, Cypress seed 10 g, Atractylodes macrocephala 15 g, Trichosanthes seed 12g, Prunella vulgaris 10 g, Ligusticum chuanxiong 10 g, Ophiopogon 10 g, Mulberry 20 g. Through the above two prescriptions, it can be seen that qi-yin deficiency type is mainly treated with drugs for tonifying qi and nourishing yin, supplemented by drugs for resolving phlegm and resolving phlegm.
4.4.2. Acupuncture Treatment
Ni Qing [14] choose more acupoints such as Taichong, Hegu, Sanyinjiao, Shenmen, Taixi, Zhongwan, Qihai, Taiyuan, Neiguan, Zusanli, Daling, Guanyuan, Ashi, Jian Shi, Shenshu, Ganshu, Dazhui, Jiaji, Qiuxu, Yanglingquan, Zhaohai, Lieque, Waiguan, Yanglao and other acupoints to treat qi-yin deficiency type.
4.4.3. Moxibustion Treatment
Yan Xiaorui et al. [15] use moxibustion to treat qi-yin deficiency type. Acupoints are selected: Dazu, Fengmen, Feishu, Dazhui, Shenzhu, Fengchi as the main acupoints, and acupoints are selected according to the condition combined with syndrome differentiation. The main acupoints were divided into two groups, and the two groups were used alternately. Operation: wheat grain moxibustion and real moxibustion are used respectively, each point is about 7 to 10 moxa cones, until the local skin is flushed and the medicine temperature is heated to the depth. Once a day or every other day, 10 times as a course of treatment, the symptoms basically disappeared after 6 courses of treatment, and there was no recurrence after follow-up for half a year.
5. Summary
In accordance with the principle of TCM syndrome differentiation, hyperthyroidism is classified according to different syndrome types and different treatment methods are adopted, and the effect is remarkable. However, there are still some shortcomings in the current research: 1) TCM syndrome differentiation of hyperthyroidism is different, lack of unified standards, so this paper only summarizes the most common types of GD; 2) Lack of long-term prognosis, recurrence and other related research data of TCM syndrome differentiation treatment with hyperthyroidism. Therefore, it is necessary to make a more systematic, standardized and long-term follow-up study and arrangement of TCM syndrome differentiation in the treatment of hyperthyroidism, so as to formulate relevant TCM diagnosis and treatment guidelines and provide the best TCM diagnosis and treatment plan for the treatment of hyperthyroidism.
Acknowledgements
This work was supported by Health Commission of Hubei Province, China (ZY2019Q036) and Yangtze University (Yz2021300).