Clinical Study On Treatment Of Hyperthyroidism By

Objective:To explore the rule of syndrome and treatment of hyperthyroidism and to observe the efficacy of Jia Kang Ning Capsule combined with treatment according to syndrome differentiation for hyperthyroidism. And then to confirm th e efficacy to treat hyperthyroidism by Nourishing Yin and suppressing yang, resol ving hard lump.Method:645 cases of patients treated in endocrine department of Guang’anmen Hospital during September 2014 to September 2015 were enrolled. Classify the patients by thyroid function to explore the rule of syndrome and treatment of hyperthyroidism by using frequency statistics, association rules. At the same time we enrolled 131 patients of hyperthyroidism to observe. (82 in treatment group,49 in control group) This study was based on randomized controlled methods and all patients were stratified by the test of thyroid function in order to release the capsule or placebo, to fill in the report form and to follow up the 6 months’observation. (16 moderate patients,47 mild patients,68 patients in a stable condition)We set up a database and used SPSS software statistics to analysis the related data to compare the efficacy. Measurement data by using t-test and enumeration data by using chi square test in order to compare the signs and symptoms, the withdrawal rate, the drug reduction rate, the recurrence rate, the thyroid function and the complications.Results:(1) Rules of symptoms:Serve patients of hyperthyroidism showed more tremor, eating more and easy to hungry, dizziness; moderate patients showed more diarrhea, distending pain in hypochondrium and heaving a deep sigh; mild patients showed more soreness and weakness of waist and knees, fatigue and chest tightness; patients in a stable condition still had chest tightness, edema and stuffiness etc.As the patients getting better, palpitation, dizziness, tremor, dysphoria and other symptoms showed a downward trend and stuffiness, fatigue, edema, cold, throat pharyngeal itching and other symptoms showed an upward trend. (2) Charactistics of tongue and pulse: Severe patients mainly had red and fissured tongue, yellow and thin moss, thready and rapid pulse; moderate patients mainly had red tongue, white and thin moss, taut and rapid pulse; mild patients mainly had pink and teethprinted tongue, white and thin moss, taut and thready pulse; patients in a stable condition mainly had pink and bulgy tongue, white and greasy moss, taut and slippery pulse. As the patients getting better, red and fissured tongue, yellow moss, rapid pulse declined and pink tongue, light dark tongue, bulgy tongue, white moss, greasy moss, hydroplaning-slippery moss, thready pulse, deep pulse, moderate pulse and uneven pulse proportion increased. (3) Classification of syndrome: Severe patients mainly had Yin deficiency with Yang hyperactivity; moderate patients mainly had Liver Qi stagnation; mild patients mainly had deficiency in both Qi and Yin; patients in a stable condition mainly had stagnation of phlegm-wetness.As the patients getting better, Yin deficiency with Yang hyperactivity showed a downward trend and stagnation of phlegm-wetness, deficiency in both Yin and Yang showed an upward trend. (4) Central prescription:Severe patients mainly used Decoction for Nourishing Yin and suppressing Yang; moderate patients mainly used Cold Limbs Powder; mild patients mainly used Shen Qi Dihuang Decoction; patients in a stable condition mainly used Decoction of Agastsche, Magnolia, Pinellia and Poria etc. Decoction for warming Yang and strengthening the spleen, Decoction for dispelling wind and resolving stasis, etc. increased in stable condition.(5) Herbs using on the combination of disease and syndrome:Severe patients mainly used herbs to nourish Yin, to settle down Yang and to clear away heat such as figwort, rehmannia, oyster shell, capejasmine, etc; medium patients mainly used herbs to regulate Qi such as bupleurum root, bitter orange, rhizoma cyperi, green tangerine peel, tangerine peel,etc; mild patients mainly used herbs to replenish Qi, to nourish Yin such as pseudostellaria root, astragalus root, bighead atractylodes rhizome,etc; patients in a stable condition mainly used herbs to remove dampness, to resolve phlegm such as agastache, eupatorium, pinellia tuber,etc. Patients in stable condition also associatiated with Schizonepeta, windproof, Curculigo rhizome, epimedium, Achyranthes, Radix Paeoniae Rubra, Radix Platycodi etc.to warm Yang, to dispell wind, to promote blood circulation, to soothe the throat. As the patients getting better, herbs to nourish Yin, to settle down Yang and to clear away heat declined and those remove dampness, to warm Yang, to dispell wind, to soothe the throat, to promote blood circulation increased. (6)Scores of TCM symptoms:From 4W to 24W the score for main symptoms of the treatment group were 9.82±4.50,9.15±4.80,8.17±4.09,7.21±3.90, 6.91±3.78,6.59±3.68 while the control group were 11.91±6.18,11.32±5.04,10.08±5.83, 8.95±4.90,8.49±4.32,8.71±4.79;The incidence of single symptom such as palpitation, sweating, intolerance of heat etc.reduced.(7) Efficacy on heart rate:The heart rate of the treatment group were 83.76±5.67,81.46±5.41,79.46±5.42,78.33±5.38,77.55±5.54, 77.33±5.38 while the control group were 85.14±6.94,83.27±6.20,81.43±5.52, 80.37±5.60,79.59±5.41,79.37±5.60.(8) Efficacy on thyroid goiter. The rate of thyroid goiter reduced to 54.9% and 75.5%.29.3%of degree Ⅰ,24.4% of degree Ⅱ,1.2% of degree Ⅲ in treatment group while 16.3% of degree Ⅰ,49.0% of degree IⅡ10.2% of degree Ⅲ in control group.(9) Efficacy on exophthalmos:The rate of exophthalmos reduced to 13.4% and 28.6%.12.2% mild and 1.2% moderate in treatment group while 18.4% mild and 10.2% moderate in control group.(10) Efficacy on thyroid function:The thyroid function normal rate of the two groups were 75.9% and 59.2%.(11) Drug reduction and withdrawal rate:Drug reduction rate of the two groups were 48.8% and 30.6% while withdrawal rate were 45.1% and 21.9%.(12) Recurrence rate:The recurrence rate of the two groups were 7.7% and 33.3%.(13) Efficacy on complication: Liver damage rate of the two groups were 9.8% and 22.4% while leukocyte reduction rate were 2.4% and 14.3% .A11 results compared above had significant difference at the end of the observation.(P<0.05)Conclusions:(1)The scheme of combination of disease and syndrome: Representative type for severe patients was hyperactivity of Yang due to yin deficiency, treating by Nourishing Yin and suppressing yang, choosing Decoction for Nourishing Yin and suppressing Yang; for moderate patients was the stagnation of liver Qi, treating by soothing the liver and regulating the circulation of Qi, choosing Cold Limbs Powder; for mild patients was deficiency of both qi and Yin, treating by replenishing Qi and nourishing Yin, choosing Shen Qi Dihuang Decoction; for patients in a stable condition was the phlegm dampness stagnation, treating by resolving phlegm and dampness, choosing Decoction of Agastsche, Magnolia, Pinellia and Poria. Besides, there was deficiency in both Yin and Yang among patients in a stable condition, treating by invigorating both Yin and Yang, choosing Decoction for warming Yang and strengthening the spleen.As the patients getting better, the Chinese herbs changed from nourishing Yin and suppressing Yang-soothing the liver and regulating Qi-supplementing Qi and nourishing Yin-reducing phlegm and dampness-warming Yang. We should pay attention to the corresponding increase in herbs of blood circulation, wind expelling,etc. when the condition was stable. (2) Jia Kang Ning Capsule combined with treatment according to syndrome differentiation was safe and effective and it could lessen the syndrome, reduce thyroid volume and hyperthyroidism prominent eyes, reduce heart rate, accelerate the reduction of ATD, reduce the dosage and the side effects of ATD, shorten the course of treatment, stabilize the thyroid function and prevent recurrence.It was efficacy to treat hyperthyroidism by Nourishing Yin and suppressing yang, resolving hard lump.