From the point of view of liver meridian, heart, spleen, kidney and liver are the main causes of disease.
From the perspective of traditional Chinese medicine, Hashimoto's thyroiditis usually belongs to the category of "gall disease", "gall tumor" and "gall fatigue" in traditional Chinese medicine. The etiology and pathogenesis are insufficient endowment, emotional disorder, strain and internal injury, which leads to imbalance of liver, spleen and kidney function, deficiency of vital qi, stagnation of qi and phlegm coagulation, blood stasis and phlegm coagulation, and accumulation in front of the neck. Long-term illness consumes qi and hurts yin, and both qi and yin are deficient. Long-term illness and kidney, kidney yang deficiency, life gate fire failure, yang qi damage and yin, can cause yin and yang deficiency. Part of yin does not control yang, which can lead to liver-fire upwelling and become a pathogenic factor. Therefore, Nie Chunhua pointed out that although the pathogenesis of Hashimoto's thyroiditis is complex, it is nothing more than deficiency, depression, phlegm, dampness and blood stasis. As far as viscera are concerned, the disease is located in the circulation part of the liver meridian, and the liver governs the discharge, while the thyroid gland is the collateral vein of the liver meridian, so it will affect the heart, spleen and kidney.
The treatment method is soothing the liver and strengthening the spleen, resolving phlegm and eliminating malnutrition.
The disease is characterized by anxiety, depression or anger, which not only affects the release of the liver, but also damages the transport and transformation of the spleen, causing qi stagnation, qi stagnation, phlegm coagulation, long-term blood circulation stagnation before the neck knot, and furuncle aggravates. Excessive drainage of liver wood will lead to hyperactivity of liver fire, hyperactivity of liver yang, and even hyperactivity of heart fire, which is manifested as hypermetabolic function of the body and a series of symptoms of depression and yin injury such as palpitation and irritability. If the liver and wood are not properly drained, the spleen and kidney function will be weakened, even spleen and kidney deficiency will lead to hypothyroidism, showing some symptoms of spleen and kidney yang deficiency such as swelling of limbs and fear of cold.
Nie Chunhua's Pingjia Xiaoying Decoction is composed of Rhizoma Cyperi, Radix Salviae Miltiorrhizae, Fructus Gardeniae, Poria and Fritillaria thunbergii. The prescription selected Cyperus rotundus for soothing liver, regulating qi, regulating menstruation and relieving pain; Salvia miltiorrhiza has the functions of improving heart function, promoting blood circulation, removing blood stasis, regulating menstruation, relieving pain, calming nerves, cooling blood and eliminating carbuncle. Gardenia has the functions of purging fire and relieving annoyance, clearing heat and promoting diuresis, cooling blood and detoxifying; Poria cocos can improve resistance, prevent cancer cells from invading, induce diuresis and eliminate dampness, strengthen spleen and calm heart; Fritillaria thunbergii has the functions of clearing away heat, resolving hard mass, resolving phlegm and eliminating malnutrition, thus helping to resolve phlegm, reduce turbidity, promote qi circulation and remove blood stasis. The combination of all the medicines has the effects of improving immunity, soothing the liver, regulating qi, resolving phlegm and turbidity, promoting blood circulation and removing blood stasis, invigorating spleen and benefiting qi, treating both the symptoms and root causes, and directly cutting the pathogenesis.
Clinical application, according to its clinical manifestations, on the basis of this prescription, according to the syndrome. In clinical syndrome differentiation, Nie Chunhua pays attention to exploring the focus of phlegm and blood stasis from the change of tongue pulse, such as white and greasy tongue coating and slippery pulse string, which is the syndrome of liver depression and spleen deficiency; The red tip of the tongue, thin yellow fur and rapid pulse are the syndromes of heart-liver fire; If the tongue is red and the pulse is thin or thin, it is a syndrome of deficiency of both qi and yin. The pulse condition is combined with reference and improved with the increase or decrease of the syndrome.
Examples of medical records
Lv Mou, female, 4 1 year old, from Baoding City, Hebei Province, came to the hospital for the first time on April 2 1 day, 2020. 1October 2 19, 165438+2 1, the patient found goiter and abnormal thyroid function in the local hospital, usually accompanied by discomfort symptoms such as chest tightness, abdominal distension and breath holding. Later, he went to the local hospital and received western medicine treatment. After taking the medicine for about 4 months, goiter did not improve, nor did thyroid dysfunction improve. The patient was afraid of cold from the beginning. Bored, eating less, sleeping badly, gaining weight about 10kg, and defecating normally. Fat body, loose stool's discomfort, irregular menstrual cycle, small amount, white tongue coating, heavy and thin pulse. Temperature 36.7, pulse 5 1/ min, respiration 20/ min, blood pressure 1 14/82mmHg.
Western medicine diagnosis: Hashimoto's disease (autoimmune thyroiditis), hypothyroidism. Traditional Chinese medicine diagnosis: neck swelling, accompanied by chills and cold limbs, sallow complexion, edema of limbs, loss of appetite, white and greasy tongue coating, heavy and thin pulse and weakness. Treatment: invigorating qi and spleen, resolving phlegm and turbidity, promoting blood circulation and removing blood stasis, warming yang and tonifying kidney.
Prescription: Rhizoma Cyperi 15g Salvia Miltiorrhiza 15g Gardenia 15g Poria 15g Fritillaria thunbergii 15g. According to its clinical manifestations, there are 7 doses based on this prescription, daily 1 dose. Take warm clothes half an hour after breakfast and dinner. Tell patients to eat less greasy, sweet and spicy things, and avoid drinking or moderate drinking.
Second diagnosis: On April 28th, 2020, sleep improved, chest tightness, abdominal distension, loose stool discomfort, white fur, white greasy fur and light pulse. According to its clinical manifestations, on the basis of this prescription, various drugs are added as appropriate. Fine-tune and take 20 doses.
The third diagnosis: May, 2020 18. The symptoms of fatigue, chills, chest tightness and abdominal distension were obviously relieved, and the tongue was slightly dark, the coating was white and slightly greasy, and the pulse condition was stronger than that at the first diagnosis. Check all indexes: the determination of serum free thyroxine (FT4) decreased: (Results: 6.24 range: 12-22 pmol/I), and the total T4 decreased: (Results: 44.2 1 range: 66-181i). Anti-thyroglobulin antibody test (TGAb) increased: (Results: 134.27 range: 0- 1 15 IU/mL). According to its clinical manifestations, this prescription is based on syndrome differentiation and treatment. Fine-tune and take 20 doses.
The third diagnostic review report shows that
Four diagnosis: June 7, 2020, asymptomatic, red tongue, thin white fur, and thready pulse. All the indexes were normal: serum free thyroxine (FT4) was normal; (Results: 15.74 range: 12-22 pmol/I) serum thyrotropin (TSH) was normal; (Results: 2.67 range: 0.27-4.2 uIU/mL) was antithyroid. The determination of anti-thyroglobulin antibody (TGAb) was normal: (Results: 56 range: 0- 1 15 IU/mL).
After nearly two months of treatment, the patient's symptoms were relieved, and there was no recurrence in recent follow-up, which reached the clinical control standard.
On July 22, the review report showed that
According to the syndrome of deficiency of spleen and kidney yang, patients are afraid of cold limbs, pale face, edema of limbs, eating less and being stupid; Obstruction of phlegm, turbid and gloomy, and poor qi movement will lead to chest tightness; Dampness trapped the spleen, which caused abdominal distension and loose stool's discomfort; The tongue coating is white and greasy, and the pulse is thin and weak, which is characterized by phlegm and blood stasis and poor qi movement. Nie Chunhua believes that the key to Hashimoto's patients with spleen and kidney yang deficiency is to replenish qi and spleen, warm yang and tonify kidney, and at the same time, according to different types of treatment, specific analysis of specific conditions, treating both the symptoms and the root causes, in order to receive effective results.