Observation On The Clinical Efficacy Of Acupuncture Treatment Of Hashimoto's Thyroiditis Based On The Combination Of Disease And Syndrom

BackgroundHashimoto’s thyroiditis(HT)is an autoimmune disease more commonly found in women.It is diagnosed by the combination of clinical features,elevation of serum thyroid antibodies level and the reduced echogenicity of thyroid shown by thyroid ultrasound.In recent years,the prevalence and incidence of HT gradually increase.Current HT treatment has its limitations and is considered as a symptomatic treatment.HT patients with hypothyroidism receive hormone replacement therapy,which only addresses the symptoms caused by abnormal thyroid functions.There is no specific treatment for HT patients with hyperthyroidism or euthyroidism.ObjectiveBased on the theory of combination of disease differentiation and syndrome differentiation,this research aims to observe the clinical efficacy of needling the large intestine meridian and stomach meridian in relieving the clinical symptoms of HT patients,which include dysphonia,dyspnea and dysphagia,and improving the thyroid functions and reducing the level of thyroid antibodies.This research aims to provide physicians with a novel approach during the treatment of HT.MethodsMajor acupoints selected were Renying(ST9),Shuitu(ST10),Hegu(LI4),Quchi(LT11),Binao(LT14),Jianyu(LT15),Zhongwan(CV12)and Zusanli(ST36).Shenmen(HT7)and Zhaohai(KI6)were added for patients with yin deficiency with excessive heat syndrome;Taichong(LR3)and Taibai(SP3)were added for patients with liver stagnation and spleen deficiency syndrome;Guanyuan(CV4)and Taixi(KI3)were added for patients with spleen and kidney yang deficiency syndrome.Renying,Shuitu,Hegu,Zhongwan,Zusanli,Shenmen,Guanyuan,Zhaohai,Taichong,Taibai,Taixi were punctured to standardized needling depths.Quchi was penetrated towards Binao to a depth of 2-3 cun.Binao was penetrated towards Jianyu to a depth of 2-3 cun.Jianyu was punctured diagonally downwards to a depth of 0.8-1.5 cun.Each treatment took 30 minutes,three times of treatment per week for a total of 12 weeks.Major observation indexes which included VAS score and TCM Syndrome Scale score were measured before the start of treatment and on the 4th,8th and 12th week after treatment.Auxiliary observation indexes which included serum thyroid stimulating hormone level,serum thyroid hormones level and serum TPOAb and TgAb levels were measured before the start of treatment and on the 6th and 12th week after treatment.Results34 cases were included in this research.3 subjects dropped out and 1 subject was excluded.1.VAS score:VAS score for dysphonia,dyspnea or dysphagia was measured.VAS score decreased after 4 weeks of treatment(P<0.05),and significantly decreased after 8 and 12 weeks of treatment(P<0.001).2.TCM Syndrome Scale score:Score decreased after 4 weeks of treatment(P<0.05),and significantly decreased after 8 weeks(P<0.01)and 12 weeks of treatment(P<0.001).There was a significant difference in the score for each syndrome between the start and the end of treatment(P<0.05).3.Thyroid stimulating hormones and thyroid hormones:Pearson’s Chi-Square test result showed no significant difference before and after treatment.For clinical hypothyroidism and subclinical hypothyroidism cases,there was a significant reduction in TSH level after 12 weeks of treatment.4.Thyroid antibodies:The level of TPOAb and TgAb decreased.However,no significant difference was found before and after treatment.5.Large intestine meridian palpation:Positive reaction,including nodules and pressure pain,was found on the transmission route of the large intestine meridian through the upper arm in 14 cases(46.67%).There were 4 cases(13.33%)in which positive reaction was found in between acupoints Quchi(LT11)and Binao(LT14),and 13 cases(43.33%)in which positive reaction was found in between acupoints Binao(LT14)and Jianyu(LT15).Conclusion1.Needling of large intestine meridian and stomach meridian could significantly relieve neck and body symptoms of HT patients.This treatment plan could reduce blood TSH level of HT patients with clinical and subclinical hypothyroidism.2.Positive reaction could be found on the route of the large intestine meridian of the upper arm.This suggests that large intestine meridian may have a higher correlation with HT.