Professor Liu Ximing's Clinical Summary On The Treatment Of Refractory Hyperthyroidism Based On The Theory Of "Qi, Food And Less Fire"

ObjectiveThrough the analysis of the medical records of 50 patients with Refractory Hyperthyroidism in acute stage treated by Professor Liu Ximing,to summarize the clinical features of Refractory Hyperthyroidism,discusses the etiology and pathogenesis of it and summarize the clinical experience of Professor Liu about "Qi consume minor fire" in Refractory Hyperthyroidism treating.To enrich the TCM theory of Refractory Hyperthyroidism.Methods1.Extract 50 patients with Refractory Hyperthyroidism who treated by Professor Liu Ximing from January 2016 to January 2020 and met the inclusion and exclusion criteria of this study.2.Take the time of the patient's first visit to 0,collect the clinical data of the 0th,3rd,6th,and 9th months of the extracted cases.The main collection includes basic patient information,current medical history,symptoms,physical examination and physical and chemical examination results,Four-diagnosis of TCM,clinical syndrome differentiation and prescription.3.Standardize the data and input them into Excel 2016,SPSS 25.0,and input the prescriptions of Chinese herb into the ancient and modern cloud medical record platform.Analysis of the changes in symptoms of patients with Refractory Hyperthyroidism before and after treatment by Professor Liu Ximing,the degree of changes in thyroid function and goiter,the evolution of TCM syndromes.Results1.General information:Most of the patients with Refractory Hyperthyroidism included in this study were female,with a male to female ratio of 3:22.The patients were mainly aged from 21 to 40 years old.72%of the patients were underweight.The shortest course of disease was 2 years,the longest was 20 years,and the average course of disease was 5.34±3.34 years.All patients had a history of ATD treatment,and the ways to use drug were oral MMI,oral PTU and topical MMI ointment.22 patients had never stopped using ATD since the diagnosis of Hyperthyroidism,and 28 patients had recurrence more than 2 times after drug withdrawal,including 2 patients who had recurrence after 131I surgery and 1 patient who had recurrence after subtotal thyroidectomy.89.29%of the patients with relapse had relapse inducement,most of which were caused by obvious mood fluctuation.2.Changes in symptoms before and after treatment:(1)The distribution of symptoms:The most frequent symptoms before treatment were palpitation(44%),irritability(42%),fear of heat(40%),sweating(34%)and tremor(30%).After 9 months of treatment,30 cases(60%)had no obvious discomfort,and the symptoms with the frequency of more than 10%were irritability(32%),tiredness(22%),insomnia and dreams(18%),sweating(16%),palpitation(14%).(2)Changes in the symptom score of TCM:The total symptom score was 13.90±11.81 before treatment,8.08±6.40 at the 3rd months,6.44±4.56 at the 6th months,and 4.32±3.71 at the 9th months.The scores of each single item decreased gradually with the prolongation of treatment time.The scores of stool frequency,easy thirst and easy hunger symptoms decreased to 0.08±0.56,0.04±0.28 and 0.00±0.00 after treatment.3.The condition of goiter before and after treatment:all the patients had different degrees of goiter before treatment,with the second degree swelling the most(84%),after 9 months of treatment,37 cases(74%)of the second degree thyroid swelling),13 cases(26%)of thyroid I enlargement.4.Physical and chemical examination changes before and after treatment:Before treatment,7 patients had normal thyroid function,by the 9th month of treatment,there were 16 patients had normal thyroid function.Some patients only suffered from TSH decreased during the whole course of treatment.The values of TRAb has a downward trend with the extension of treatment time.By the 9th month of treatment,there were 19 patients had normal TRAb level.5.The distribution of TCM syndromes before and after treatment:The main TCM syndromes of the recurrence type before treatment were hot and hyperactive syndrome,followed by Yin deficiency with internal heat syndrome.The main TCM syndromes of the uncured type before treatment were Zang-Fu Yin deficiency syndrome.The number of patients with the syndrome of hot and hyperactive and Yin deficiency with internal heat tended to decrease with the extension of treatment time,while the number of patients with the syndrome of Qi and Yin deficiency and Zang-Fu Yin deficiency increased accordingly.There were differences in the distribution of TCM syndromes of different types of refractory hyperthyroidism.The number of patients with hot and hyperactive syndrome,Yin deficiency with internal heat syndrome were always higher than that in the uncured type.7.Medication rule:122 herbs were used in 200 prescriptions,and the total frequency of herbs was 1259 times.The most commonly used herbs were Rhizoma coptidis,Thunberg Fritillaria Bulb,Forsythia Forsythia,Scutellaria Baicalensis,Radix Ophiopogonis,Lilium Brownii,Radix Glehniae and Radix Astragali seu Hedysari.Conclusions1.Most of the patients included in this study are young and middle-aged women.The course of Refractory Hyperthyroidism is longer than general Hyperthyroidism and the hypermetabolic performance is not significant compared with general Hyperthyroidism.2.The distribution of Refractory Hyperthyroidism syndromes was consistent with the pathogenesis of "Evil fire exhaust qi".3.The main treatment methods for Refractory Hyperthyroidism are "Strengthening of Qi and Yin" and "Suppression of Fire and Yang".Commonly used herbs are Rhizoma coptidis,Thunberg Fritillaria Bulb,Forsythia Forsythia,Scutellaria Baicalensis,Radix Ophiopogonis,Lilium Brownii,Radix Glehniae and Radix Astragali seu Hedysari.4.The treatment of Refractory Hyperthyroidism under the guidance of the theory of "Qi consume minor fire" can improve the symptoms,promote the recovery of thyroid function and TRAb.