| This research is one part of the Beijing science and technology plan project, the popularity and verification of the diagnosis and treatment scheme combining disease with syndrome of TCM for hyperthyroidism, (project number:Z121107001012010). The project is composed of three parts.The first part:literature review.The research progress of the treatment according to the diagnosis and treatment scheme combining disease with syndrome of TCM for Hyperthyroidism:This part reviews the Chinese medicine pathogenesis and treatment modes of hyperthyroidism. The results shows that emotional internal injury, internal injury diet, drug related factors and constitution factors are the main pathogenesis of hyperthyroidism. The main pathological factors are liver fire, stasis-heat, phlegm stasis. The disease locates in liver, spleen and thyroid. The disease often shows syndrome of intermingled and excess, and it is root deficiency and branch excess. The modern treatment modes according to the diagnosis and treatment scheme combining disease with syndrome of TCM for hyperthyroidism consists of the treatment of Chinese medicine according to different syndromes, different periods, special recipe for special disease, the treatment used a single drug.The research progress of the western medical treatment for hyperthyroidism:This part summarizes the current methods of western medicine in the treatment of hyperthyroidism. The western medicine in the treatment of hyperthyroidism commonly used four ways:anti-thyroid medication, I131 therapy, surgical treatment and intervention treatment, and discuss the mechanisms, indications, contraindications, complications, etc.The second part:experience summary of tutor. We collected cases reports on the outpatient department and summarized the therapeutic schemes. The paper states the experience of my tutor from the points of hyperthyroidism etiology, pathogenesis and therapeutic principle.The third part:clinical observation.Results:(1) Comparison of symptom score:compared with before treatment, treatment for 12 weeks and 24 weeks of hyperthyroidism diagnosis index, the TCM symptom scores, goiter score and exophthalmus scores were improved (P< 0.05).(2) Goiter:the total number of goiter was declining, and the number of thyroid â… , â…¡, â…¢ degree of swelling also gradually reduced (P< 0.05).Therapy at 24 weeks, before the treatment,78 cases of goiter patients (75.73%), reduced to 38 cases (36.89%), the degree of swelling â… patients before treatment of 22 cases (21.36%), reduced to 13 cases (12.62%);â…¡ degree of swelling by 37 cases (35.92%) reduced to 16 cases (15.53%).By 19 patients with â…¢ degree of swelling (18.45%) reduction in 9 cases (8.74%).(3) the eye:the total number of exophthalmos is gradually reduced, therapy at 24 weeks, before the treatment and 41 patients (39.81%), reduced to 22 cases (21.36%), light, medium and heavy degree of exophthalmus patients respectively also reduce (P< 0.05), the slight exophthalmos by 24 cases (23.30%) reduction in 11 cases (10.68%), moderate exophthalmos is by 14 cases (13.59%) reduction in 9 cases (8.74%), severe exophthalmus person by 3 cases (2.91%) reduced to 2 cases (1.94%).(4) Index change: once every four weeks we observed the change of FT3, FT4, TSH, from 0 weeks to 24 weeks.The index got right gradually (5)We recorded hyperthyroidism complications including liver damage, leukopenia, tachycardia in 0 weeks,12 weeks and 24 weeks. The incidence was significantly decline. We recorded the ALT, AST of patients with hepatic damage and the WBC of leukopenia patients. Compared with before treatments, the indexes changed in 12th,24th week (P< 0.05). (6)Anti-thyroid medications:97 people used anti-thyroid western medicine treatment, the other 6 people adopted the pure traditional Chinese medicine treatment. There were 76 cases of patients took MMI(not including 2 cases of midway changed drugs) accounting for 73.79%.there were 24 cases treated with PTU, accounting for 23.30%. 70 patients taking MMI reduced medicines in 24 weeks, accounting for 92.1%, the time was from 19 day to 141 days, the average time was 65.9 days. Seven of them stopped taking drugs, accounting for 9.22%, the time was from 27 days to 156 days, the average time was 85.7 days.16 patients taking PTU reduced medicines in 24 weeks, accounting for 66.67%, the time was from 27 days to 148 days, the average time was 67.2 days.Two of them stopped taking drugs, accounting for 28.57%, the time was from 27 days to 156 days, the average time was 85.7 days.Using propylthiouracil treatment of the 24 people, there are 16 people by drugs, accounting for 66.67% of the number of using propylthiouracil, drugs shortest time 27 days, up to 148 days, the average time of 67.2 days.Stop drug with 2 people, accounting for 28.57%,The average time is 93 days (P< 0.01). The PTU for the average consumption was 9.36mg/day before treatment and reduced to 4.83mg/day (P< 0.05);MMI was 90.38 mg/day before treatment and reduced to 80.88 mg/day (P<0.05). (7) Symptoms and changes in prescriptions of traditional Chinese medicine:We recorded symptoms of patients in 0 week,12 weeks and 24 weeks. Thick neck was the most, followed by irritability. In the 15 symptoms recored, flustered, irritable, afraid of hot, sweat, less sleep soundly, control heat, tremor, lumbar acid, feed more all belong to syndrome of hyperactivity of yang due to yin deficiency. Irritability, tremor belong to liver fire syndrome.In addition, chest tightness belongs to qi stagnation syndrome, swollen neck scleroma belongs to phlegm and blood stasis syndrome, eyes suddenly pain belong to wind card, often abdominal distention nausea belongs to wet. Therefore, Yin deficiency throughout the course of the hyperthyroidism. Common prescriptions included Zi Yin hyperthyroidism prescription, Dan Zhi xiaoyao powder, Huo Pu Xia ling tonga subtraction and so on.Conclusion:(1) The diagnosis and treatment scheme can improve clinical symptoms such as palpitation, hortness of breath, hidrosis, afraid of hot, restless, hyperthyroidism appetite, weight loss, hand shake. It also can relieve exophthalmos,goiter and improve clinical curative effect, thus improve the quality of life.(2)The diagnosis and treatment scheme can reduce anti-thyroid western medicine dosage. Compared with treatment of western medicines, anti-thyroid western medicine dosage is half in the treatment scheme. PTU average consumption reduced 0.75 mg and MMI average consumption reduced 0.75 mg every four weeks in our research.(3) The diagnosis and treatment scheme reduce the complications such as liver damage, leukopenia, improve the safety of the drug in the treatment of hyperthyroidism. |
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