内外合治甲状腺功能亢进症（Graves病）的理论及临床研究
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摘要
目的:甲状腺功能亢进症(简称“甲亢”),是临床上的常见病和多发病。古往今来,中医在诊治甲状腺疾病方面积累了丰富的经验,但大多从“瘿病”着手,且治法单一。本疾病具有较高的发病率及发病的复杂性,西医学在治疗本病的方法上有一定的局限性和毒副作用,目前中医药往往作为辅助治疗,针对甲亢病机及解剖位置特点,有必要对中医药内外合治本病进行理论研究及临床验证,以便进一步推广应用。
方法:①本文采用文献调研的方法,总结大量古今文献有关中医药治疗该病的经验和规律,结合现代对该病病因病机及疾病演变特点的认识和研究,以求找出该病病因病机和用药规律,为内外合治提供理论依据;②将60例纳入病例按应诊顺序编号,采用随机数字表方法随机分为两组:治疗组(甲亢方内服+甲亢平膏外敷)、对照组(口服丙基硫氧嘧啶),每组30例,4周为一疗程,治疗2个疗程,观察治疗前后主要相关症状和体征及心电图变化,检测血中T_3、T_4、FT_3、FT_4、TSH水平。
结果:①甲亢病的中医治疗法则诸多,组方用药各有特色。本文在总结大量古今文献有关中医药治疗该病的经验和规律的基础上,结合现代对该病病因病机及疾病演变特点的认识和研究,提出了本病病机以气阴两虚、阴虚火旺为本,气滞血瘀痰结为标,益气养阴、化痰散结、活血祛瘀为基本法则,运用内外合治的方法进行治疗甲亢具有很好的理论基础。②内外合治方法治疗甲亢,在临床控制率及显效率优于对照组,治疗组在消除甲状腺肿,改善烦躁、震颤、少寐多梦、神疲乏力、健忘、口干渴等症状上优于对照组。在改善患者心电图异常方面与β-受体阻滞剂心得安有类似功效。在改善甲状腺功能、降低甲状腺激素方面,内外合治法具有与丙基硫氧嘧啶相似的作用。
结论:内外合治法是一条行之有效的治疗方法,具有良好的临床应用价值。
Objective: Hyperthyroidism (Jiakang) is the common and frequently-occurring clinical disease. Since ancient times, traditional Chinese medicine has accumulated rich experience in the treatment of thyroid disease, but mostly from the"goitre disease" to proceed, and the therapeutic methods are one-dimension. The disease has a high morbidity and complicated pathogenesis. The therapeutic method of this disease in western medicine has limitation and side effects . At present TCM treatment is just supportive method . For further extention and application of this treatment , it is necessary to conduct theoratic study and clinical verification on the theory of internal and external integration for curing this disease based on the pathogenic mechanism of this disease and the anatomical characteristic of thyroid.
Methods:①Through applying the method of surveying documents , the author summarized the experience and regularity of curing this disease from ancient and modern documents ,which combined with modern cognition and research on the cause and pathogenesis of this disease ,as well as the developmental character of this disease.This article directed toward finding out the cause and pathogenesis of this disease and the law of administration of drugs. All of this can provide theoratic basis for internal and external integrative treatment of this disease.
②60 cases were randomly divided into cure group (Jiakangfang is taken orally +ointment of Jiakangping is applied outside)and control group(propylthiouracil is taken orally) .Each group had 30 cases which was given 2 periods of treatment, 4 weeks a period.Observe the main symptomes ,signs and the changes of ECG before and after treatment, and test the serum level of T_3,T_4,FT_3,FT_4,TSH.
Result:①There are lots of therapeutic methods on hyperthyroidism in TCM, and each formula has their own characteristic.On the basis of summarizing the experience and regularity of curing this disease in TCM ,it is put forward in this article that the root of this disease is deficiency of qi and yin and hyperactivity of fire due to deficiency of yin ,the branch of this disease is retention of phlegm and stasis of blood caused by qi-stagnation and the basic regularity of treatment is tonifying qi , nourishing yin, resolving phlegm, and stimulating blood circulation to dispel stasis , which combines the modern cognition and research on the cause and pathogenesis of this disease. The internal and external integrative treatment of this disease has good theoretical basis .②Internal and external integration for curing this disease has a superior control rate and higher efficiency than control group,such as improving symptoms of fidgety fremitus ,little sleep with dreaminess, general lassitude, forgettery and thirst .It has a similar effect with propranolol (β-receptor inhibitor) in improving the abnomalities of ECG .The intergration of external of internal treatment posseses an identical effect with propylthiouracil in improving thyroid function and lowering the level of thyroid hormone.
Conclusion: Therefore, internal and external integrative treatment for curing this disease is an effective treatment with a good clinical application value.
方法:①本文采用文献调研的方法,总结大量古今文献有关中医药治疗该病的经验和规律,结合现代对该病病因病机及疾病演变特点的认识和研究,以求找出该病病因病机和用药规律,为内外合治提供理论依据;②将60例纳入病例按应诊顺序编号,采用随机数字表方法随机分为两组:治疗组(甲亢方内服+甲亢平膏外敷)、对照组(口服丙基硫氧嘧啶),每组30例,4周为一疗程,治疗2个疗程,观察治疗前后主要相关症状和体征及心电图变化,检测血中T_3、T_4、FT_3、FT_4、TSH水平。
结果:①甲亢病的中医治疗法则诸多,组方用药各有特色。本文在总结大量古今文献有关中医药治疗该病的经验和规律的基础上,结合现代对该病病因病机及疾病演变特点的认识和研究,提出了本病病机以气阴两虚、阴虚火旺为本,气滞血瘀痰结为标,益气养阴、化痰散结、活血祛瘀为基本法则,运用内外合治的方法进行治疗甲亢具有很好的理论基础。②内外合治方法治疗甲亢,在临床控制率及显效率优于对照组,治疗组在消除甲状腺肿,改善烦躁、震颤、少寐多梦、神疲乏力、健忘、口干渴等症状上优于对照组。在改善患者心电图异常方面与β-受体阻滞剂心得安有类似功效。在改善甲状腺功能、降低甲状腺激素方面,内外合治法具有与丙基硫氧嘧啶相似的作用。
结论:内外合治法是一条行之有效的治疗方法,具有良好的临床应用价值。
Objective: Hyperthyroidism (Jiakang) is the common and frequently-occurring clinical disease. Since ancient times, traditional Chinese medicine has accumulated rich experience in the treatment of thyroid disease, but mostly from the"goitre disease" to proceed, and the therapeutic methods are one-dimension. The disease has a high morbidity and complicated pathogenesis. The therapeutic method of this disease in western medicine has limitation and side effects . At present TCM treatment is just supportive method . For further extention and application of this treatment , it is necessary to conduct theoratic study and clinical verification on the theory of internal and external integration for curing this disease based on the pathogenic mechanism of this disease and the anatomical characteristic of thyroid.
Methods:①Through applying the method of surveying documents , the author summarized the experience and regularity of curing this disease from ancient and modern documents ,which combined with modern cognition and research on the cause and pathogenesis of this disease ,as well as the developmental character of this disease.This article directed toward finding out the cause and pathogenesis of this disease and the law of administration of drugs. All of this can provide theoratic basis for internal and external integrative treatment of this disease.
②60 cases were randomly divided into cure group (Jiakangfang is taken orally +ointment of Jiakangping is applied outside)and control group(propylthiouracil is taken orally) .Each group had 30 cases which was given 2 periods of treatment, 4 weeks a period.Observe the main symptomes ,signs and the changes of ECG before and after treatment, and test the serum level of T_3,T_4,FT_3,FT_4,TSH.
Result:①There are lots of therapeutic methods on hyperthyroidism in TCM, and each formula has their own characteristic.On the basis of summarizing the experience and regularity of curing this disease in TCM ,it is put forward in this article that the root of this disease is deficiency of qi and yin and hyperactivity of fire due to deficiency of yin ,the branch of this disease is retention of phlegm and stasis of blood caused by qi-stagnation and the basic regularity of treatment is tonifying qi , nourishing yin, resolving phlegm, and stimulating blood circulation to dispel stasis , which combines the modern cognition and research on the cause and pathogenesis of this disease. The internal and external integrative treatment of this disease has good theoretical basis .②Internal and external integration for curing this disease has a superior control rate and higher efficiency than control group,such as improving symptoms of fidgety fremitus ,little sleep with dreaminess, general lassitude, forgettery and thirst .It has a similar effect with propranolol (β-receptor inhibitor) in improving the abnomalities of ECG .The intergration of external of internal treatment posseses an identical effect with propylthiouracil in improving thyroid function and lowering the level of thyroid hormone.
Conclusion: Therefore, internal and external integrative treatment for curing this disease is an effective treatment with a good clinical application value.
引文
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[4]林兰,李鸣镝,刘喜明,等.甲亢宁对甲亢大鼠甲状腺激素及心钠素的影响[J],中国中医基础医学杂志,2005,11(1):34-35,60
[5]陶冬青,陈如泉.消瘿甲亢片治疗甲状腺机能亢进症临床研究[J],中医药信息,2005,22(1):36-38
[6]杜玉名,隋淑兰,任喜尧.中西医结合治疗青春期甲亢31例临床观察,中国地方病防治杂志,2003,18(4):251-252
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[8]蒋冰冰,赵伟康,万叔援.益气养阴泻火药对甲亢动物血浆cAMP含量及肝组织氧耗量的影响[J],中医杂志,1982,(12):64
[9]王立琴,刘雪君.甲宁为主治疗甲状腺功能亢进症的临床与实验研究[J],中医杂志,2000,41(7):407-409
[10]张学礼,金国琴,徐品初,等.大补阴颗粒对阴虚火旺证模型大鼠的滋阴泻火作用[J],中药药理与临床,2001,17(1):7-8
[11]刘洁,翁世艾,曹永舒,等.知母对甲亢模型受体-cAMP系统的调节作用[J],中药药理与临床,1996, (4):6
[12]徐品初,金国琴.生地、龟板对甲亢大鼠心肝能量代谢的影响[J],中药药理与临床,1993,(3):30
[13]尹义辉,程益春,孙丰雷,等.消瘿片治疗甲状腺机能亢进症的临床研究[J],中药新药与临床药理,1999,10(5):264
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