Professor Liu Ximing Treats Refractory Hyperthyroidism Based On The Theory Of "strengthening Fire And Eating Qi"

ObjectiveThe study of refractory hyperthyroidism conforms to the theory of "evil fire exhaust qi" in Inner Canon,and establishes the method of suppressing fire and eliminating yang based on"evil fire exhaust qi".Through the clinical observation of 70 cases of refractory hyperthyroidism treated by professor liu ximing with the method of suppressing fire and eliminating Yang,it is confirmed that the method of suppressing fire and eliminating yang is one of the basic treatments for refractory hyperthyroidism,and the clinical experience of professor liu ximing in the treatment of refractory hyperthyroidism is summarized.Method1.From September 2016 to January 2019,the patients with refractory hyperthyroidism who were admitted to the clinic of Professor Liu Ximing of Guang'anmen Hospital of China Academy of Chinese Medical Sciences were collected and met the inclusion criteria,a total of 70 cases.2.Record the clinical symptoms,signs and thyroid related physical and chemical indicators(FT3,FT4,TSH,TRAb),liver function(ALT and AST)and clinical syndrome differentiation at 0,4,8 and 12 weeks.3.The collected case data were standardized into Excel2007 and SPSS22.0,and the Chinese medicine prescription was entered into the V2.5 system of Chinese medicine inheritance platform.To observe the changes of clinical symptoms,signs and thyroid function of traditional Chinese medicine before and after treatment in patients with refractory hyperthyroidism treated with "suppressing fire and eliminating yang".Result1.General information:Among the 70 patients with refractory hyperthyroidism,the prevalence rate of women accounted for 90.14%,and the ratio of male to female prevalence was 1:11.The population is mainly young and middle-aged.The proportion of people aged 20 to 50 accounts for 71.42%.The majority of patients who had previously been treated with MMI accounted for 87.14%.Patients with refractory hyperthyroidism who could not be cured for a long time accounted for 72.86%,with TSH continuing to be low and/or TRAb continuing to be high.Patients with recurrent hyperthyroidism accounted for 27.14%,and the number of recurrences was 2 to 5 times.2.Changes in symptoms and signs of TCM before and after treatment:(1)Before treatment,it was afraid of heat(81.43%),sweating(77.14%),irritable(72.86%),hand tremor(70.00%),palpitations(65.71%)contour metabolic syndrome as the main symptom.After treatment,high metabolic syndrome such as irritability(24.29%),palpitations(22.86%),fear of heat(21.43%),hyperhidrosis(20.00%),and hand tremor(11.43%)were significantly reduced.(2)Changes in individual TCM symptom scores:Symptom scores of fear of heat,sweating,irritability,hand tremors,palpitations,less dreams,fatigue,thirst,weight loss,frequent stools,more food compared with before treatment.The results were that the difference;was statistically significant(P<0.01).(3)Comparison of symptom scores in different time periods:The symptom score for the initial visit is 25.54±10.00.The 4-week symptom score was 14.46±7.84.The symptom score for 8 weeks is 8.40±5.37.The 12-week symptom score was 4.20±3.90.As the treatment time prolonged,the symptom scores continued to decline.Symptom scores after 4,8,and 12 weeks of treatment compared with the initial diagnosis.The result was that the differences were statistically significant(P<0.01).3.Changes in goiter before and after treatment:Before treatment,the goiter was most common in 0B,? degree and ? degree,accounting for 81.43%.After treatment,17.14%of patients had small goiter and 8.57%had enlarged goiter.The result was that the difference was not statistically significant(P>0.05).4.Changes in thyroid function before and after treatment:(1)Before treatment,58.57%of patients had TSH below the reference value,38.57%were within the reference range,2.86%were higher than the reference range;62.86%were TRAb positive,37.15%were negative;37.14%of patients had FT3 higher than the reference value,and 51.43%were Within the reference range,11.43%was below the reference range,44.29%of patients had higher than normal FT4,48.57%were within the reference range,and 7.14%were below the reference range;44.00%of patients with TSH were still lower than 12 weeks after treatment with suppression of fire and yang method Reference range,58.57%in the reference range,1.43%higher than the reference range,54.29%patients TRAb positive,62.86%negative;18.57%patients FT3 higher than the reference value,71.43%in the reference range,10.00%still below the reference value The FT4 of 25.71%patients was higher than the reference value,65.71%was within the reference range,and 8.57%was lower than the reference value.The difference of FT3,FT4 and TSH before and after treatment was statistically significant(P<0.05).There was no statistically significant difference in the number of TRAb between the two groups(P>0.05).(2)Comparison of specific values of FT3,FT4,TSH and TRAb before and after treatment,The result was that the difference of FT3 and FT4 was statistically significant(P<0.05),and the difference of TSH and TRAb was not statistically significant(P>0.05).5.Changes in MMI dose before and after treatment:21 patients did not take ATD before treatment.49 patients were treated with traditional Chinese medicine combined with western medicine.19 patients were treated with MMI maintenance dose(1.25-10 mg/d).The minimum dose is 1.25 mg/d and the maximum dose is 40 mg/d.19 patients did not take ATD after 12 weeks of treatment.2 patients took MMI due to elevated FT3 and FT4.17 patients reduced the dose of MMI.The maximum drug reduction is 22.5mg,and the minimum drug reduction is 2.5mg.2 patients increased the drug dose.6.Changes in TCM syndromes before and after treatment:Before treatment,the hot and sturdy syndrome was mainly heart and liver fire(55.71%),liver and gallbladder fire(31.43%),liver and stomach fire(12.86%).After treatment,Yin deficiency syndrome was the most common,such as liver and kidney yin deficiency(35.71%),heart and liver yin deficiency(27.14%),and qi and yin deficiency(17.14%).7.Medication rule:a total of 102 kinds of traditional Chinese medicines are used.The top 10 drugs are:huanglian?huagnqin?zhebeimu?shengdihuang?baihe?maidong?lianqiao?chaobaishao?zhimu?beishashen.Conclusion1.This disease are mostly female,mainly young and middle-aged.2."Evil fire exhaust qi" was the basic pathogenesis of refractory hyperthyroidism.When the hot and vigorous syndrome was obvious,the main clinical features were high metabolic syndrome such as heat,sweating,palpitations,irritability,hand tremors,weight loss,etc.The heat is mainly concentrated in the heart,liver and stomach;Treatment was suppressing fire and eliminating yang.It often used huanglian and huangqin to clear the heat and ignite the fire,used Shengdihuang,baihe,maidong to add yinye and eliminate yang,used Zhebeimu,lianqiao to clear heat and phlegm,scattered knots to eliminate phlegm.3.Fire suppression and Yang elimination can effectively improve the clinical symptoms of TCM and promote the recovery of FT3?FT4 and TSH levels.