Based On "Excess Of Yang And Deficiency Of Yin",The Clinical Summary Of Professor Liu Ximing In The Treatment Of Refractory Hyperthyroidism

Objective1.By focusing on "Excess of Yang and Deficiency,discusse the clinical characteristics and pathogenesis of refractory hyperthyroidism.2.Analyze the clinical medication characteristics of Professor Liu Ximing in the treatment of Refractory Hyperthyroidism based on the theory of " Excess of Yang and Deficiency of Yin",summarize the medication characteristics experience of Professor Liu Ximing in the treatment of Refractory Hyperthyroidism,in order to further enrich the understanding,experience and application of traditional Chinese medicine for Refractory Hyperthyroidism.Method1.Data extraction:346 medical records of refractory hyperthyroidism that met the inclusion criteria and exclusion criteria of this study were extracted from Professor Liu Ximing’s outpatient medical record system from January 1,2020 to December 1,2022,including 93 patients.2.Research methods:Collect and process clinical data of gender,age,course of disease,type of refractory hyperthyroidism,medical history related to hyperthyroidism(previous treatment history of hyperthyroidism,ATD drug use),systemic symptoms,thyroid morphology and thyroid function index,TCM diagnosis and clinical differentiation,TCM prescription,etc.The characteristics of the natural process of refractory hyperthyroidism(gender,age,course of disease,type of disease,characteristics of disease treatment segment),clinical characteristics of disease,pathogenesis of traditional Chinese medicine and the clinical medication characteristics of Professor Liu Ximing were analyzed.3.Statistical methods:Input the standardized data into Excel Office 2019 software,establish an electronic database,and use IBM SPSS Statistics 27.0 software for statistical analysis.Excel Office 2019 software was used to make frequency statistics for the prescription of traditional Chinese medicine,and IBM SPSS Modeler 18.0 software was used to analyze association rules.Association information was imported into Cytoscape3.7.1 software for complex network construction.Finally,the highfrequency traditional Chinese medicine was imported into Origin 2021 software for systematic cluster analysis and visualization processing.Result1.General informationAmong the 93 patients with refractory hyperthyroidism included in this study,most were females,with 79 females,accounting for 85.0%of the total patients,and 14 males,accounting for 15.1%of the total patients,with a ratio of 14 males to 14 females:79.Among them,the youngest was 18 years old,the oldest was 75 years old,and the average age was 36.66±12.38 years old.The frequency of young patients(70 patients aged 18-45 years old)was the highest,with a composition ratio of 75.3%;there were 20 middle-aged patients(46-60 years old),with a composition ratio of 21.51%;and 3 elderly patients(over 60 years old),accounting for 0.03%.The mean course of disease was 4.69±3.23 years,among which the shortest course of disease was 1 year and the longest was 20 years.There are 64 recurrent refractory hyperthyroidism and 29 incurable refractory hyperthyroidism.90 patients had a history of oral antithyroid drugs(96.7%).2.Symptom distribution:(1)The top 10 systemic symptoms in TCM were impatience and irritability(30.1%),palpitation(29.2%),fatigue(26.0%),fear of heat(23.4%),excessive sweating(19.9%),excessive dreaming(17.6%),hand tremor(15.3%),redness(11.3%),weight gain(11.0%),difficulty falling asleep(9.8%).(2)Tongue and pulse conditions:red tongue was the main factor,accounting for 63.9%;Tongue shape and texture were the highest in tender tongue(26.3%),followed by lean tongue(19.7%).Lichen(87.0%)was the most common type.The moss color was mainly yellow(84.4%).The top three pulse signs were:chord pulse(89.0%),number pulse(58.4%),fine pulse(32.1%).3.TCM syndrome(1)Distribution of TCM syndromes:Yin deficiency syndrome(38.4%)were the most common,with Yin deficiency syndrome(133)>Syndrome of hyperactivity of fire due to yin deficiency(122)>Fire heat syndrome(91).(2)Distributed relationship between the syndrome and Zang-fu disease position:the disease location of fire heat syndrome was mostly seen in liver(85.7%),heart(62.6%),and stomach(18.7%);the disease position of yin-deficiency and fire-heat syndrome was mostly seen in liver(88.5%),heart(67.2%),stomach(18.9%),and kidney(16.4%);the disease position of yin deficiency syndrome was mostly seen in liver(84.2%),heart(60.2%),spleen(32.3%),and kidney(13.5%).(3)Relationship between syndrome and gender:Yin deficiency syndrome was most common in both females(38.4%)and males(38.6%),with Yin deficiency syndrome>Syndrome of hyperactivity of fire due to yin deficiency>Fire heat syndrome.There was no statistical difference in the composition of syndrome between genders(P>0.05).(4)Relationship between syndrome and age:Overall,the highest percentage of medical records(35.2%)were for Syndrome of hyperactivity of fire due to yin deficiency in 31-40 years old.The proportion of Yin deficiency syndrome was higher than that of Fire heat syndrome and Syndrome of hyperactivity of fire due to yin deficiency in the three age groups of 18～20,21～30,and 51～60 years old,with the proportions of 40.6%,42.0%,and 66.7%,respectively.The proportion of Yin deficiency syndrome was higher than that of the other two syndromes in the age groups of 31-40 and 41-50 years,with 35.2%and 37.9%,respectively,and the proportion of the three syndromes were the same in the age group of 61 years and above,with 33.3%.The distribution of syndrome in different age groups was different(P<0.05).Among them,the syndrome distribution of 51-60 years old was statistically different from that of 31-40 years old and 41-50 years old(P<0.05).(5)Relationship between syndrome and course of disease:Generally speaking,Yin deficiency syndrome(17.1%)with course of disease greater than or equal to 5 years had the most medical records.The disease course of 1～2 yearsand 3～4 years were mainly caused by Syndrome of hyperactivity of fire due to yin deficiency,accounting for 40.2%and 39.7%,respectively.Yin deficiency syndrome was the most common(46.1%)after 5 years and above.There was no difference in the overall distribution of syndromes in the course of disease(P>0.05).(6)Relationship between the syndrome and the type of refractory hyperthyroidism:Yin deficiency syndrome was most common in both recurrent refractory hyperthyroidism and incurable refractory hyperthyroidism,accounting for 36.3%and 43.9%of each type,respectively.In quantity,Yin deficiency syndrome>Syndrome of hyperactivity of fire due to yin deficiency>Fire heat syndrome.There was no statistically significant difference between Chinese medicine syndrome and refractory hyperthyroidism types(P>0.05).(7)Relationship between syndrome and the treatment stage of refractory hyperthyroidism:Fire heat syndrome was most common in the treatment period(48.7%),Syndrome of hyperactivity of fire due to yin deficiency was most common in the medication reduction period(41.9%),and Yin deficiency syndrome was most common in the maintenance period(56.9%).The overall distribution of TCM syndromes in the course of disease was significantly different(P<0.001).Pairwise comparison among different treatment stages showed that P<0.05,and the distribution of syndromes in each stage of treatment for refractory hyperthyroidism was different.4.Medication rules:(1)A total of 346 prescriptions were included in this study,among which 174 kinds of traditional Chinese medicine were involved,and the cumulative use frequency of traditional Chinese medicine was 2,145 times.(2)According to the statistics of the frequency of prescription of Fire heat syndrome,Syndrome of hyperactivity of fire due to yin deficiency,Yin deficiency syndrome,the top 11 drugs that Professor Liu Ximing used most in the treatment of Fire heat syndrome were Rhizoma coptis,Radix scutellaria,Thunbergii fritillary,Forsythia.Bupleurum,Radix paeoniae alba,Poria cocos,Lilium,Cortex moutan,Semen coicis,Ramulus uncariae cum uncis.The top 11 drugs used most in the treatment of Syndrome of hyperactivity of fire due to yin deficiency were Ophiopogon japonicus,Lilium,Radix glehniae,Rhizoma coptis,Rhizoma anemarrhenae,Thunbergii fritillary,Forsythia,Radix paeoniae alba,Dioscorea opposita,Radix scutellaria,Herba dendrobii.The top 11 drugs used most in the treatment of Yin deficiency syndrome were Ophiopogon japonicus,Radix paeoniae alba,Radix astragali,Radix glehniae,Lilium,Thunbergii fritillary,Rhizoma coptis,Radix scrophulariae,Suanzaoren,Radix scutellaria,Forsythia.(3)According to the association rules of the overall prescription,the core medicine used by Professor Liu Ximing in the treatment of refractory hyperthyroidism were mainly divided into two groups.The first group was Rhizoma coptis,Thunbergii Fritillary,Radix paeoniae alba and Radix scutellaria.The second group:Ophiopogon japonicus,Lilium and Radix glehniae.The drug pairs with the highest correlation support were Radix scutellaria and Rhizoma coptis(36.99%support,67.19%confidence),and the drug pairs with the highest confidence were Ophiopogon japonicus and Fructus Schisandra Chinensis(5.20%support,100.00%confidence).The three drug pairs with the highest degree of support were Radix scutellaria,Radix paeoniae alba and Rhizoma coptis(support 15.32%,confidence 69.81%),and the highest degree of confidence were Rhizoma coptis,Lilium and Radix scutellaria(support 6.36%,confidence 95.45%).(4)Through the cluster analysis of the overall prescription,the results showed that the clinical drugs of Professor Liu Ximing could be roughly divided into four categories:the first category:Rhizoma coptis,Radix scutellaria,Semen coicis,Semen lablab album,Thunbergii fri till ary,Forsythia,Spina gleditsiae,Radix astragali,Radix scrophulariae,Rhizoma curcumae,Rhizoma curcumae,Cortex moutan;The second category:Radix paeoniae alba,Ramulus uncariae cum uncis,bupleurum,Aurantii Fructus Immaturus,Radix paeoniae rubra,Poria cocos;The third category:Ophiopogon japonicus,Radix glehniae,Lilium.Rhizoma anemarrhenae,Radix rehmanniae,Suanzaoren;The fourth category:Dioscorea pposite,Radix rehmanniae preparate,Herba dendrobii,Fructus ligustri lucidi.Conclusion1.The natural course of refractory hyperthyroidism accords with the characteristics of "Excess of Yang and Deficiency of Yin":Refractory hyperthyroidism tends to occur in women,mostly in young people,the course of disease is longer,and the type is more common in recurrent hyperthyroidism.2.Refractory hyperthyroidism has clinical characteristics of "Excess of Yang and Deficiency of Yin":The characteristics of fire heat and Yin deficiency can be seen in the clinical symptoms and tongue and pulse characteristics of refractory hyperthyroidism.Zang-fu organs of Fire heat are mostly attributed to liver,heart,stomach,kidney and Zang-fu organs of Yin deficiency are mostly attributed to liver,heart,spleen and kidney.3.The pathogenesis of refractory hyperthyroidism conforms to the evolution law of "Excess of Yang and Deficiency of Yin":Yin deficiency is the foundation,Fire heat is the standard,and deficiency and excess are mixed.Fire is easy to flourish but difficult to eliminate,Yin is difficult to accumulate and easy to be deficient.Fire heat can result in Yin deficiency,Yin deficiency also can contribute to Fire heat.4.Clinical drugs based on "Excess of Yang and Deficiency of Yin".Fire heat syndrome should subdivise Zang-fu organs and distinguish between real fire and weak fire.Bitter cold Chinese medicine are needed for clear real fire;Weak fire will injury Yin.Chinese medicine which is sweet and cold can be used for nourishing Yin.Yin deficiency should subdivise Zang-fu organs and judge the difference between Yin fluid and Qi Yin.If Yin fluid is deficient,the drug should be acid to benefit Yin.If the long course of disease hurts Qi Yin,"strengthening of Qi and Yin”is needed.