| Objective: Analyzing the clinical data of patients with thyroid nodules to discuss the distribution characteristics of TCM syndromes and medication rules of thyroid nodules.Methods: The case data of patients with benign thyroid nodules admitted to the Department of Endocrinology,Breast and thyroid surgery,Affiliated Hospital of Shandong University of TCM from September 2020 to December 2022 were collected.The data were entered into Microsoft Excel 2019 worksheet,and SPSS 26.0 statistical software was used for statistical analysis.Results: 1.General data analysis:(1)Gender and age: 157 cases were included in this study,including 123 females(78%)and 34 males(22%),with a ratio of 1: 3.61.The age of onset is 40-59 years old,with A total of 87 cases,accounting for 55.41%.(2)Thyroid ultrasound: 49 cases(31.57%)had single nodule and 108 cases(68.43%)had multiple nodules.Nodules were located in the left lobe in 27 cases(17.20%),in the right lobe in 32cases(20.38%),and in both lobes in 98 cases(62.42%).The maximum diameter of nodules was ≤10mm in 92 cases(58.60%),11-20 mm in 37 cases(23.57%),21-30 mm in 13 cases(8.28%),31-40 mm in 13 cases(8.28%),and > 40 mm in 2cases(1.27%).There were 46 cases(29.30%)with diffuse thyroid lesions.(3)Thyroid function: 84 patients with normal thyroid function(67.20%),12 patients with hyperthyroidism(including subclinical hyperthyroidism)(9.60%),14 patients with hypothyroidism(including subclinical hypothyroidism)(11.20%),and 31 patients with Hashimoto thyroiditis(24.8%).2.Characteristics of TCM syndromes: 60 cases of qi stagnation and phlegm stagnation(38.22%),44 cases of intermingling of phlegm and static blood(28.03%),22 cases of deficiency both qi and yin(14.01%),15 cases of liver depression and spleen deficiency(9.55%),12 cases of combination of damp and heat(7.64%),4 cases of Yang deficiency of spleen and kidney(2.55%).(2)TCM symptoms,tongue image and pulse condition: the symptoms with high frequency(frequency ≥10%)from high to low were fatigue,emotional impatience,chest tightness,phlegm,thirst,abdominal distention,palpitation,sweating,dizziness,shortness of breath,pharyngeal foreign body sensation,female breast pain and neck enlargement.The tongue images with high frequency were dark red tongue,red tongue,light tongue,thin white tongue,thin yellow tongue,yellow and greasy tongue.Pulse signs with higher frequency were pulse chord,pulse astringency,pulse fine,pulse slippery and pulse number.(3)The correlation between TCM syndrome and general data: there was no significant difference in the distribution of TCM syndrome in gender and whether accompanied by diffuse lesions(P > 0.05),but there was significant difference in the distribution of age and nodule size(P > 0.05).3.Medication rules:(1)Frequency of Chinese herbs: a total of 157 prescriptions were included,involving 204 Chinese herbs,and the Chinese herbs used more than 50 times were Chaihu,Banxia,Fuling,Danggui,Baizhu,Baishao,Gancao,Huangqin,Xiakucao,Zhebeimu,Muli,Chenpi and Dangshen.(2)Categories of traditional Chinese medicine: 204 Chinese herbs were classified into 17 categories,and the top 5 application frequencies from high to low were tonifying deficiency drugs(22.14%),heat-clearing drugs(19.29%),Expectorant Antitussive Antiasthmetics(13.17%),bloodactivating and stasis-resolving medicinal drugs(9.65%)and qi-regulating drugs(7.18%).(3)Four properties,five tastes and meridian distribution of TCM: The distribution of medicinal properties from high to low is cold,warm,flat,cool and hot.The distribution of medicinal flavors from high to low is bitter,sweet,pungent,sour,salty,light and astringent.The meridian tropism is lung meridian,liver meridian,spleen meridian,stomach meridian,heart meridian,gallbladder meridian,kidney meridian,large intestine meridian,small intestine meridian,bladder meridian,pericardium meridian and triple energizer meridian from high to low.(4)Cluster analysis:36 kinds of medium and high-frequency Chinese herbs were systematically clustered and analyzed,and five combinations of traditional Chinese medicines were obtained: C1: Chaihu-Huangqin-Banxia-BaishaoDanggui-Xuanshen-Lianqiao-Xiakucao-Heshouwu-Tongcao-Baizhi.C2: YujinChenpi-Qingpi-Ezhu-Chuanxiong-Fuling-Baizhu-Zhebeimu.C3:Zhiqiao-ChisgaoShengdihuang-Danshen-Taoren.C4:Zhishi-Huanglian-Guizhi-GanjiangHoupu.C5:Huangqi-Maidong-Wuweizi-Longgu-Muli-Suanzaoren.Conclusion:(1)Clinical characteristics of thyroid nodules: the incidence of thyroid nodules is more common in women,and more common in the age group of 40-59 years old.The nodules were mainly located in double lobes with diameters less than or equal to 10 mm.Some patients were complicated with diffuse thyroid disease.Most patients have normal thyroid function.Some patients were complicated with Hashimoto’s thyroiditis.(2)Distribution characteristics of TCM syndromes of thyroid nodule: qi stagnation and phlegm stagnation syndrome and intermingling of phlegm and static blood syndrome are the most common TCM syndromes,followed by deficiency both qi and yin syndrome,liver stagnation and spleen deficiency syndrome and combination of damp and heat syndrome,and Yang deficiency of spleen and kidney syndrome are less.Age has reference significance for the syndrome differentiation of deficiency and excess.(3)Medication rules of thyroid nodule: Attention should be paid to the role of qi,phlegm,blood stasis and deficiency in the pathogenesis of thyroid nodule.Drugs such as softening hard mass,regulating qi and resolving phlegm,promoting blood circulation and removing blood stasis,and invigorating spleen and eliminating dampness are mainly used. |
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