Clinical Effect Observation Of The Prescription Of Resolving Phlegm, Activating Blood Circulation And Dissipating Masses In Thyroid Nodule Treatment

[Objectives] To evaluate clinical therapeutic effect about the prescription of activating blood circulation and reducing phlegm in the treatment of thyroid nodules; to investigate the basic TCM pathogenesis of thyroid nodules, and the possible action mechanism of resolving phlegm and removing blood stasis methods in the treatment of thyroid nodules; to eliminate or reduce thyroid nodule, prevent cancerous nodules, improve patient prognosis, reflect and promote the advantages of Chinese medicine.[Methods] From February2012to February2013, selected80outpatient visit or hospitalized benign thyroid nodules patients with normal thyroid function in the endocrinology department of the Third Affiliated Hospital of Nanjing University of Chinese Medicine, according to the TCM syndrome differentiation standards, the patients were divided into four groups:Qi and phlegm stagnation group (28cases), phlegm and blood stasis group (16cases), excessive liver fire group (17cases), both the heart and liver Yin deficiency group (19cases). All of them were intervened with oral intake the prescription of activating blood stasis and resolving phlegm to dissipate masses. Self controlled study was taken before and after treatment, the clinical observations were carried on before the trails,6weeks and12weeks after the trails by accounting symptom scores and testing the decreased nodule diameter with ultrasonography, the clinical symptoms before and after the trail, the thyroid nodule size improvement and the association between clinical effect and nodule size were analyzed.[Results] l.The effective rate of Qi and phlegm stagnation group, phlegm and blood stasis group, excessive liver fire group, and both the heart and liver Yin deficiency group was82.1%、75.0%、76.5%、73.7%respectively, the overall efficacy was77.5%. After the treatment, thyroid nodule diameters and total symptom scores of patients in four groups were significantly improved (P<0.01), the difference was statistically significant.2. For the extent of nodules reduction, Prescription of resolving phlegm, activating blood circulation and dissipating masses effected best on the Qi and phlegm stagnation syndrome of the four group patients (P<0.05); improvement of symptom scores were not significantly different among the patients of four groups (P>0.05). 3.For the association of nodule size and clinical effect:before intervention, the treatment efficacy of nodule diameter>20mm group,10～20mm group and <10mm group was62.5%,75%and82.5%respectively, nodule diameter (before intervention)<10mm group had the highest efficacy. Compared the difference of thyroid nodule diameter of the three groups by rank sum test showed that diameter＜10mm group got the most reduction (P＜0.05), indicating that the smaller nodules has better curative effect.4. It is safe and reliable for taking prescription of resolving phlegm, activating blood circulation and dissipating masses on benign thyroid nodules, before and after the trials, the thyroid, liver and kidney function and other safety indicators of all the patients showed no significant difference (P>0.05).[Conclusions] Qi stagnation, phlegm retention and blood stasis is the basic pathogenesis of thyroid nodular disease, the herbs prescribed following the resolving phlegm, activating blood circulation and dissipating masses method effect significantly on thyroid nodule. It can eliminate or reduce thyroid nodule, but be safe and effective without toxic side effects and be worthy of clinical promotion.