A Literature Review About The Chinese Medicine Treatment And Syndrome Differentiation To Hyperthyroidism

Background:Hyperthyroidism is a disease of the endocrine system in which thyroid produces excessive thyroid hormone, and causes a variety of symptoms, including enlarged thyroid gland, mental excitation, irritability, palpitation, heat intolerance, fatigue, increased appetite, weight loss, tremor, increased frequency of bowel movements, exophthalmos and so on. Although hyperthyroidism is a commonly seen disease, its pathogenesis and precipitating factors are complicated and not fully understood. At present, the mainstream treatment in conventional medicine is drug therapy, which entails a long treatment course with high recurrence rate as well as numerous side effects such as agranulocytosis, hepatitis, joint pain, et cetera. In recent decades, several studies concluded that the Chinese herbal medicines have similar effect as the anti-thyroid drugs. The combination of Chinese herbal medicines and anti-thyroid drugs had shown remarkable effects, fewer side effects and lower recurrence rate. Through the modernization process, the irreplaceable advantages of Chinese Medicine in the treatment of hyperthyroidism have emerged.Experience inheritance is one of the main characteristics of Chinese Medicine theory development. The famous Chinese Medicine experts’ experiences are inherited from ancient Chinese Medicine theory, which not only represent the highest level of development in Chinese Medicine theory, but also highly valuable for the passing on of knowledge to the younger generation.ObjectiveThrough the Chinese Medicine literature review and analysis, we investigate the content of Traditional Chinese Medicine treatment and symptom differentiation in hyperthyroidism. In addition, the experiences of contemporary outstanding Chinese Medicine experts were analyzed and summarized, in order to find out the regularity of symptom differentiation and prescription in Chinese Medicine. We hope that the results could provide a basic reference for Chinese Medicine Practice.MethodsWe searched the literatures relevant to hyperthyroidism from Internet search engine such as China Knowledge Resource Integrated Database, Google scholar etc. The research range was limited to Chinese Medicine treatment, outstanding Chinese medicine practitioners’experiences. According to the content from the literatures, we established database for analyzing. Through the method of cluster analysis,.we investigate the regularity of the drugs used in Chinese Medicines prescription, and discussed the difference in drug of choice between ancient and modern Chinese Medicine.Results25 outstanding Chinese Medicine experts were included. We summarized their clinical experience as follow:1. Etiology:88% expert point out that the main etiology of hyperthyroidism is emotion imbalance; 64% expert believe that the physical deficiency is another important etiology for hyperthyroidism. Other common etiologies are dietetic habits and environmental factors.2. According to the practitioners’opinion, the common pathogenesis, symptoms and principles of treatment are as follows:(1) Pathogenesis:stagnation of Qi (100%), Yin deficiency (96%), Phlegm stasis (96%), Blood stasis (80%), Qi deficiency (72%), Fire heat and Blood deficiency (20%).(2) Symptoms:Qi and Yin deficiency (84%), Qi and phlegm stasis (80%), phlegm and blood stasis (72%), Liver Qi stasis (60%), hyperactivity of Liver fire (52%), Yang hyperactivity and Yin deficiency (28%), gastric heat hyperactivity (24%), liver and kidney Yin deficiency (24%), liver wind stirring up internally (16%), hyperactivity of Liver-fire and Heart-fire (12%), Heart and Liver Yin deficiency (24%).(3) Principles of treatment:supplementing Qi and nourishing Yin (92%), Heat clearing and Fire purging (84%), dissipating Phlegm and resolving Masses (84%), dispersing stagnated liver Qi (72%), promoting Blood circulation to remove Blood stasis (60%), clearing Liver-fire (60%), strengthening the spleen (52%), consolidating kidney essence (44%), nourishing Heart Yin (40%), supporting Liver Yin (32%), clearing gastric Heat (24%).3. Drug of choice in Chinese Herbal Medicine prescription:(1) We included 50 prescriptions from 25 Chinese Medicine experts, 686 drugs were involved in the prescriptions, the main categories of drugs were:notifying and replenishing drugs (31%), Heat-clearing drugs (20%), apophlegmatisant (10%), drugs for promoting blood circulation and resolving blood stasis (6%), Qi regulating drugs (6%), liver and wind-calming drugs (5%), tranquilizing drugs (5%), damp-clearing and diuretic drugs (5%), astringent drugs (4%), diaphoretic drugs (3%), damp clearing drug (1%), and digestant drugs (1%).(2) We analyzed 21 effective Chinese Herbal Medicine prescription, with 430 drugs were involved, the result of drug categorization was as follow:Heat clearing drugs (23%), notifying and replenishing drugs (21%), apophlegmatisant (10%), drugs for promoting blood circulation and resolving blood stasis (9%), liver and wind-calming drugs (9%), tranquilizing drugs (8%), diaphoretic drugs (5%), Qi regulating drugs (4%), astringent drugs (4%), diuretic and damp-cleaning drugs (3%), digestant drugs (1%), damp cleaning drugs (0.5%), wind-damp dispelling drugs (0.5%) and others.ConclusionEtiology:The most common etiologies of hyperthyroidism are emotion imbalance and physical deficiency. Other causes include environmental factors, poor recovery from illness, prediposing infection and et cetera.Pathogenesis:most of the experts of Chinese Medicine state that the most important pathogenesis of hyperthyroidism is stagnation of Liver Qi, and follow with dysfunction of other organs. The most common pathologic changes are Qi stagnation, Qi deficiency, Yin deficiency, Phlegm stasis, Blood stasis and Fire-heat. During the early stage of hyperthyroidism, gastric heat was formed after the Liver Qi stagnation. In the mid stage, blood and phlegm stasis are developed. In the late stage, Qi and Yin deficiency can be presented. On the other side, hyperthyroidism could be relevant to specific internal organ dysfunction, such as Liver Yin deficiency, Kidney Yin deficiency, Heart Yin deficiency and spleen deficiency.Symptom differentiation and treatment:From the aspect of pathogenic production, the most common symptoms are Qi and Yin deficiency, Qi stagnation and Phlegm stasis, Yang hyperactivity and Yin deficiency. From the aspect of dysfunction of internal organs, the most common symptoms are Liver Qi stagnation, Liver fire hyperactive, Gastric-fire hyperactivity, Liver and Kidney deficiency, liver wind stirring up internally, Liver and Heart Yin deficiency and Liver-fire and Heart-fire hyperactivity. The core treatment principles are:nourishing Yin, supplementing Qi, resolving Phlegm, promoting blood circulation and remove blood stasis, regulating Qi and clearing Heat. The principles to manage the organ dysfunction are:dispersing stagnated Liver Qi, clearing Liver-fire, strengthening spleen, nourishing heart, clearing Gastric heat, supporting Liver and consolidating Kidney essence.Drug of choice:In contemporary Chinese medicine, the most commonly used drugs for the treatment of hyperthyroidism are Heat-clearing drugs and tonifying drugs, with concurrent use of apophlegmatisant, drugs for promoting blood circulation and resolving blood stasis, Qi regulating drugs, liver and wind-calming drugs, tranquilizing drugs et cetera. In the ancient time, Iodine enriched drugs were commonly used for phlegm resolving. These drugs become rarely used nowadays due to the concern of "escape phenomenon". At present, Iodine enriched drugs are recommended for endemic goiter, and still remain controversial for hyperthyroidism.