| Objective:The article summerised the experience of modern doctors in the diagnoise and treatment of subacute thyroiditis by TCM to get a comprehensive understanding of the disease in the cause, the partition based on differentiation of symptoms and signs, and treatment and prescription.It explored and analysed the cause,the development and the change of the disease by statistics,and summerised the feature of the disease and the regularity of medication in different aspects to provide the reference basis for the treatment and scientific research.Methods:Search the Chinese literatures about the treatment of subacute thyroiditis by TCM in CNKI publiced up to now.The literatures were about the experience of the famous old TCM doctors,and the cure rates in the articles were more than 90% based on the treatment of TCM only.Besides,the articles should express the principle-method-recipe-medicines clearly.Reorganize and analysis the etiology and pathogenesis, differentiation of symptoms and signs for classification of syndrome, prescriptions by statistical methods and tcm theory.Discuss each type of syndrome,maily about the characteristics of medication in effects, property and flavor, channel tropism and the variety of different pattern of syndrome.Use cluster analysis about high frequency drugs to abtain meaningful groups of medication.And combine meridians theory to provide new train of thought about the treatment.Results:Got the experience of 37 skilled TCM doctors who made reliable effects and clear discuss of treatment exprence about subacute thyroiditis from CNKI,126 prescriptions,124 types of prescription,1120 cumulative frequencies of prescription.1.Etiology and pathogenesisThe cognizations of the famous experts for the disease maily included 4 kinds:exogenous pathogen,liver qi stagnation,spleen restrained bi liver,andqi asthenia. The pathogenesis mainly included liver dysfunction leaded phlegm dampness and blood stasis which lead to morbidity when exogenous pathogenic factors attack human body.2.Classifications of syndromeThe classifications of syndrome and periodizations of the disease were affection of exogenous wind-heat and eat toxin syndrome of the early stage,damp heat syndrome of liver and gallbladder of the mid-term,and positive deficiency and pathogen resistance of the later period.3. Medication characteristicsIn the early stage,the medicine for heat clearing, exterior syndromerelieving drugs, eliminating phlegm, tonifying and blood activating and stasis eliminating were the main types of medicine.In the mid-term,the main types of medicine were for heat clearing, tonifying, eliminating phlegm, exterior syndromerelieving,blood activating, and promoting qi and resolving dampness.In the latter peried, the main medicines were for tonifying, heat clearing, blood activating, exterior syndromerelieving, promoting qi and resolving dampness, promote the circulation of water, eliminating phlegm,and dispelling internal cold.Cold was the main nature of the medicines during the three periods,the next nature was warm which was inscreasingly used.The flavors were mainly bitter,pungent,and sweet.The cluster combination indicated the treatment of modern doctors for subacute thyroiditis mainly include clearing heat, relieving exterior ayndrom,promoting qi, tonifying spleen,and dispelling internal cold,based on syndrome differentiation,and the messenger medicine was taken seriously.4. Channel tropismThe medicine used by modern skilled doctors for the treatment of subacute thyroiditis mainly belong to the channel of the heart,the spleen,the liver,the lung,the kidney and the stomach.Half of the 12 channels passe the thyroid,and they are just the main channels medicine used for subacute thyroiditis belong to.All the channels of the 12 meridians and eight extrameridians that go through the thyroid are yin channels,and it indicates the disease of the thyroid may have closer relationship with the blood and body fluid.5.Pathogenic changesBy analysising the changes of the medicine used in different stage of the disease,we can see the pathogenic heat was descreasing,the phlegm increased first and descreased then,qi stagnation, blood stasis and the damp evil were increasing during the course of the disease.The exogenous pathogens gose down and the pathogenic heat entered into the nutrient and blood gradually and healthy energy was wearing.Conclusion:1.Pathogenesis evolutionsubacute thyroiditis was made by the healthy energy deficiency and the pathological factors sputum,qi,blood stasis,heat stired up by the exogenous evil expecially the wind-heat toxin evil.In the early stage, the wind-heat toxin evil attacted wei and qi, burned body fluid into sputum,blocked qi and blood,which leaded to the affection of exogenous wind-heat and eat toxin syndrome.If the disease progressed, the pathological factors entered into the inner blood and body fluid part of the body,made the blood stay,consumes qi and blood,and the pathogenic factors increased leading to the damp heat syndrome of liver and gallbladder of the mid-term.If the disease lingered,both the pathogenic factors and the healthy energy decreased and leaded to positive deficiency and pathogen resistance of the later period,when the positive deficiency was the main contradictionaccompanied by the stasis of the pathogenic factors.2.The therapeutic principlesClearing heat and resolving the exterior,resolving phlegm and removing toxical material were the main therapeutic principles of the early stage, assisted with strengthening the body resistance.In the mid-term,clearing heat and nourishing yin, resolving phlegm and the exterior were given the first palce,combined with promoting qi to activate blood.In the later period, invigorating qi and warming yang, replenishing the vital essence and the blood, eliminating pathogenic heat from the blood were the main methods, assisted with promoting blood circulation for removing blood stasis,phlegm and dampness relieving,warming yang and regulating qi.3.Pathological featuresThe change of the rates of the medicine indicated blood stasis,the damp evil,and qi depression were increasing during the course of the disease,while the toxic heat is decreasing,and the phlegm increased first and decreased later,replased by the damp evil.The heat,phlegm, stasis of qi and blood, damp and exogenous pathogens were the main factors of the disease.4.Nature and flavorThe property of the medicine was mainly cool, while the property of warm could both assist and restrict it.The flavour of the medicine was mainly bitter,pungent and sweet, and the astringent and hot medicine and medicine with iodine should be carefully used.5.Channel tropismThe ccour of the disease were mainly related to the heart,liver,lung,stomach,spleenand kidney channels,and had nothing to do with the gall bladder meridian.The main channels were just the ones that pass the thyroid indicating the meridian theory is useful in the treatment of the disease.All the channels of the 12 meridians and eight extrameridians that go through the thyroid are yin channels,and it indicates the disease of the thyroid may have closer relationship with the blood and body fluid. |
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