| ObjectiveThrough the clinical observation of 87 cases of subacute thyroiditis(SAT)in acute stage treated by Professor Liu Ximing,to summarize the clinical experience about "stagnant pathogen of Shaoyang" in SAT treating.This paper discusses the etiology and pathogenesis of SAT in acute stage,enriches the TCM theory of SAT,and provides basis for its TCM treatment.Method1.Cases source:Collected the outpatient cases diagnosed as SAT and whose first visit time was from January 2012 to January 2020,making use of the resources of the case database from Professor Liu Ximing.There were 87 cases with "stagnant pathogen of Shaoyang" syndrome,which also met the inclusion criteria and exclusion criteria.2.Data collection:Record case data based on the real situation,including:general data,clinical symptoms,physical and chemical indicators,treatment history,past medical history,accompanying symptoms and signs,TCM syndrome differentiation and prescriptions,etc,and fill in the case observation form respectively at 0,4,8 and 12 weeks.3.Statistical analysis:The case data was recorded into Excel 2017 to establish the database.SPSS 22.0 was used,and the method of self-control was used for statistical analysis.The data of TCM prescription was input into "Chinese Medicine Inheritance Support System(v2.5)" for statistical analysis.Result1.General data:Among the 87 patients with SAT,16 were male(18.39%),71 were female(81.61%),the ratio of male to female was about 1:4.The average age was 46.03±9.90 years old,most of the patients were between 41-50 years old,including 35 cases(40.23%),followed by 31-40 years old,including 26 cases(29.89%).Spring(34.48%)and autumn(25.29%)were the main morbidity seasons.67.82%of the patients had been previously treated with hormone,NSAIDs or other drugs.2.Clinical manifestations:(1)Thyroid pain;Among 87 patients,85(97.70%)had thyroid pain.Among them,13 patients(15.29%)had bilateral thyroid pain,9 patients(10.59%)had left thyroid pain,25 patients(29.41%)had right thyroid pain,38 patients(44.71%)had metastatic thyroid pain(15 patients metastatic from right to the left,23 patients metastatic from left to the right);21 patients(24.71%)had radiating pain(11 patients radiated to ears,6 patients radiated to pharynx,2 patients radiated to mandible,2 patients radiated to head);44 patients(51.76%)suffered mild pain,18 patients(21.18%)suffered moderate pain,23 patients(27.06%)suffered severe pain.(2)Fever;Among 87 patients,53(60.92%)had fever,30(56.60%)had low fever,15(28.30%)had moderate fever,8(15.10%)had high fever,the highest temperature was 39.9?;20(37.74%)had irregular fever,13(24.53%)had afternoon fever,15(28.30%)had night fever,5(9.43%)had afternoon and night fever.(3)Changes of symptoms before and after treatment:The main symptoms of the 87 patients were:thyroid pain(97.70%),fever(60.92%),goiter(40.23%),hyperhidrosis(39.08%),fatigue(37.93%),irritability(37.93%),etc.At the last visit,20 patients(22.99%)had no symptoms and 67 patients(77.01%)still complained of discomfort.The symptoms with frequency higher than 10%included:hyperhidrosis(17.24%),fatigue(16.09%),dry mouth and thirst(14.94%),palpitation(1 1.49%)and chills(10.34%).3.Physical and chemical inspection:(1)Thyroid function:Among 87 patients,53 cases were transient hyperthyroidism,accounting for 60.92%,the shortest duration of hyperthyroidism lasted for 14 days,33 cases(62.26%)were relieved within 4 weeks,totaled 48 cases(90.57%)were relieved within 8 weeks,15 cases appeared subclinical hypothyroidism,accounting for 17.24%,19 cases appeared hypothyroidism,accounting for 21 84%(2)ESR:44 cases(50.57%)had accelerated ESR,the shortest time of ESR recovery was 11 days,the maximum time was over 12 weeks(5 cases,5.75%),the average time of ESR recovery was 43.26±17.70 days.(3)Thyroid ultrasound:35 cases showed enlargement of thyroid volume,52 cases showed patchy hypoechoic area or uneven echo,19 cases had rich local blood flow,29 cases had thyroid nodule,1 case showed postoperative change of thyroid.4.Curative effect analysis:(1)Analgesic effect:the shortest analgesic time was 2 days,the longest was 83 days,average 26.34±19.30 days.(2)Antipyretic effect:the shortest antipyretic time was 2 days,the longest one occasionally had low fever in 12 weeks,who got intermittent fever for 84 days,the average antipyretic time of the other 52 patients was 16.31±12.21 days.(3)Symptom improvement:the total score of symptoms before treatment was 15.82±7.63,and the total score of symptoms at the last treatment was 2.02±2.58.After paired t test,the difference was statistically significant(P<0.01).The curative effect index was 87.22%(Nimodipine method).5.Medication rule:There are 245 prescriptions which contain 136 kinds of traditional Chinese medicines in total.And the total frequency of drugs is 2103.The most frequently used drugs were Lianqiao(81.63%),Qinghao(71.43%),Chaihu(70.61%),Huangqin(69.39%),Zhebeimu(57.14%),Banxia(55.92%).Conclusion1.Basic characteristics:The incidence of this disease is high in female,the ratio of male to female is about 1:4,which is mostly seen in the middle-aged and young people aged between 31-50.It shows high incidence in spring.2.Pathogenesis:At the acute stage of SAT,it is consistent with the pathogenesis characteristics of "stagnant pathogen of Shaoyang ".97.70%of the patients have pain in the thyroid gland,which means this disease is located in Shaoyang.Radiating pain or metastatic pain belongs to Shaoyang depression.60.92%of the patients have fever,which is usually in the afternoon or at night.The fever is high or low,which is consistent with Shaoyang stagnated heat.The duration of fever is not short,and there is no aversion to cold,or the aversion to cold is not obvious,which is caused by stagnant pathogen stasis in Shaoyang.3.Prescription and medicine:According to the characteristics of SAT "stagnant pathogen of Shaoyang" syndrome,establish the treatment method of harmonizing Shaoyang,expelling pathogens,and detoxifying simultaneously.The prescriptions often choose Xiao Chaihu Tang or Haoqin Qingdan Tang.The commonly used drugs are Chaihu,Qinghao,Huangqin,Lianqiao,Zhebeimu,etc.4.Analgesic and antipyretic effect:TCM treatment shows good effect on relieving the pain of thyroid,with an average time of 26.34±19.30 days;it has a better antipyretic effect,with an average time of 16.31 ± 12.21 days. |
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