Summary Of The Dosing Pattern And Experience Of John Guo In The Treatment Of Differentiated Thyroid Cancer After Surgery

AimsThis study aims to analyse Professor Guo Junjie’s post-operative treatment of differentiated thyroid cancer with the aid of the "Traditional Chinese Medicine Inheritance Support System",and to mine the data on his prescriptions and medicines to summarise the effective prescriptions and core combinations corresponding to different periods and types of the disease based on the supervisor’s years of clinical experience and academic thinking,so as to provide a reliable basis for clinical application and effectively alleviate patients’ post-operative discomfort.Methods1.Through clinical shadowing,we familiarized ourselves with the clinical manifestations of postoperative differentiated thyroid cancer,collected their relevant medical records,and summarized and analyzed them according to traditional Chinese medicine theory,modern literature and clinical ideas such as "five organ theory" and "staging theory of treatment" by Professor Guo Junjie.The 150 effective prescriptions for postoperative treatment of differentiated thyroid cancer by Professor Guo were selected by combining the inclusion criteria.2.The 150 valid prescriptions screened were entered into the TCM Heritage Assist System software in order to analyse the distribution of the four types of evidence and the frequency of drugs,their nature and flavour,their generalization and new formula combinations.Results1.The frequency of the evidence types of the disease,in descending order,were:phlegm and stasis intermingling evidence(62.7%),liver and fire exuberance evidence(20%),qi and yin deficiency evidence(14%),and spleen and kidney yang deficiency evidence(3.33%).2.104 herbs were used by Professor Guo during this period in the treatment of differentiated thyroid cancer after surgery,with a total of 10 herbs being used more than 70 times,ranking the top 10 herbs from highest to lowest: Mudanpi,Xuan Shen,Bai Shao,Chrysanthemum,Chen Pi,Niu Knee,Fried Atractylodes,Zhe Bei Mao,Fructus Ligustrum and Yu Jin.3.The proportion of drugs in each of the Four Flavours in descending order is: Cold(46.43%),Warm(25.35%),Plain(14.58%),Cool(13.35%)and Hot(0.29%).The proportion of each of the five tastes,in descending order,is: bitter(40.14%),sweet(26.93%),pungent(19.05%),sour(6.67%),salty(5.39%)and astringent(1.82%).4.The top six drugs in terms of their attribution to the meridians were: liver,lung,kidney,stomach,spleen and heart,in that order.5.Using cluster analysis,a core combination of seven groups of drugs can be derived and from this,seven new prescriptions can be evolved.Conclusions1.Professor Guo Junjie,our mentor,has been working on endocrine diseases for more than 30 years and has his own unique insights on thyroid-related diseases.Professor Guo insists on the principle of "eliminating evil and helping the righteous,clearing and tonifying at the same time" and advocates the identification of the disease from the Five Organs theory,believing that "Qi stagnation,phlegm,heat and stasis" are the main pathological factors of the disease and that the pathological mechanism is mainly a mixture of deficiency and reality.The disease is treated in stages,often divided into the early postoperative stage(evidence of exuberant liver fire and phlegm and stasis)and the late postoperative stage(evidence of deficiency of both qi and yin,and evidence of deficiency of spleen and kidney yang).In addition,regardless of the stage,the method of draining the liver should be used throughout the treatment of this disease.In the use of medicines,"sweet and bitter" are used,and cold medicines are the mainstay,often attributed to the liver,lung and kidney meridians.7 new prescriptions for the treatment of postoperative differentiated thyroid cancer have been developed,providing a new way of thinking and reference for the clinical management of postoperative DTC.2.The students’ subjective perceptions may differ from the results of the objective analysis,but Chinese medicine emphasizes "treating with evidence",so in clinical treatment,we should use the right medicine for the right evidence and should not apply the results of the objective analysis.