| There is no equivalent for endocrine diseases in traditional Chinese medicine (TCM); TCM tends to classify endocrine diseases primarily according to the clinical symptoms of the diseases: diabetes mellitus falling into the category of "xiaoke", thyroid diseases "ying diseases", and female prcmcnopausal syndrome "zangzao", "yuzheng" and "baihe" diseases. The discussion on how to diagnose and treat endocrine diseases can be found in many ancient Chinese doctors’ classical works and medical records, among which the treatment through the liver has been frequently mentioned, and has drawn extensive attention and practically been widely applied in clinical practices. However, these ideas have not been systematically discussed and enabled a complete theoretical approach to the treatment of endocrine diseases.Professor LIU Yongnian, Chief of Chinese Medicine and doctorate supervisor, has engaged in the research, teaching and clinical practices of TCM for over 50 years, and has accomplished great achievements in treating internal medical diseases and "difficult diseases". Professor LIU holds that "difficult diseases" include a variety of rare diseases, weird diseases, mutated diseases, refractory diseases, and increasing numbers of newly emerging diseases, and that the kinds of these "difficult diseases" evolve over time. Professor LIU claims that these diseases are difficult to treat because there is a severe lack of knowledge of the causes of these diseases and traditional theories are often found inadequate in providing theoretical guidance for effective remedies. In this context, new theories and treatments are in demand, and they can only be formulated out of practice, based upon large amounts of observation, accumulation, analysis and exploration. Inspired by such arguments as "all diseases are derived from the disorder of qi" and "liver being the origin of diseases", Professor Liu has tried the innovative liver-focused approach to the treatment of difficult diseases by restoring liver functions, and the approach has proved to be effective in treating many difficult diseases, particularly when there is a complicated situation where the doctor is caught in a dilemma to make a sound decision. Based on such TCM understandings of the biological and pathological features of the liver as "liver being substantial yin and functional yang", "liver qi" and "liver yang", the liver-focused ideas have been put into practice in a flexible way in diagnosing and treating endocrine diseases, and are found to be frequently effective in clinical practices.Objectives:1. Theoretical Research:By systematically reviewing and summarizing Professor LIU’s clinical experience, and exploring the origins and formation of Professor LIU’s liver-focused academic thoughts, this research was intended to inherit his legacy by refining and promoting the application of his ideas in clinical practices for the enrichment of TCM methodologies in treating endocrine diseases.2. Clinical Research:By observing Hashimoto thyroiditis (HT) and subclinical hypothyroidism (SCH) patients who had deficiency in spleen qi and stagnation of liver qi, and analyzing a wide range of medical indexes (e.g. TSH, FT3, FT4, TPOAb, IL-10、IL-2、IL-2R, TCM symptom values, etc.), this research was aimed to testify the effectiveness of Jianpi-yiqi-shugan-heluo Remedy in regulating T-cell functions and treating HT and SCH.Methods:1. The theoretical research was conducted through literature review. With the focus on the common endocrine diseases (e.g. diabetes mcllitus, thyroid diseases and premenopausal syndrome) Professor LIU Yongnian has treated, the research examined and analyzed the theoretical foundation of Professor LIU’s liver-focused approach, identified his syndrome differentiation methodologies, researched the features of his liver-focused academic thoughts, and summarized his ideas on the selection and combination of different kinds of medicine for the formation of appropriate remedies.2. The clinical research was conducted by observing HT and SCH patients who had deficiency in spleen qi and stagnation of liver qi. The effectiveness of Jianpi-yiqi-shugan-huoluo Remedy was testified by examining TSH, FT3, FT4, TPOAb,, IL-10、IL-2、IL-2R and TCM symptom values.Results:The subjects of the clinical research were 60 HT and SCH patients, of whom 55 have gone through the whole process of the research. The research lasted for 12 weeks, with the Experimental Group treated with Jianpi-yiqi-shugan-heluo Remedy and the Control Group L-thyroxine. The results showed:(1) HT and SCH had a higher level of occurrence in females. (2) No significant difference in TSH was found between the Experimental Group and Control Group (P>0.05). (3) In the Control Group, FT3 and FT4 were improved yet the improvements were not statistically significant, and the TSH level was found to have declined significantly (P<0.05). (4) In the Experimental Group, FT3 and FT4 had no significant changes (P>0.05), yet the TSH level was significantly reduced (P<0.05). (5) No significant difference in TPOAb was found in the Control Group, while in the Experimental Group there was a significant difference in TPOAb (P<0.05). Regarding the extent of the reduction of TPOAb values, a significant difference was found between the Experimental Group and the Control Group (P<0.05). (6) As for IL-10, IL-2 and IL-2R, no significant differences were found in the Control Group, while there were significant differences in IL-10 and IL-2R in the Experimental Group (P<0.05). Further analysis revealed that there was significant differences regarding the change of IL-10 values between the two Groups (P<0.05). (7) As for the TCM symptoms observation, the Experimental Group was found to be more effective, with the 70.37% overall effectiveness rate as opposed to the 50% overall effectiveness rate of the Control Group. With significant differences found in overall TCM symptom values in both groups, the treatments adopted by both the Experimental Group and the Control Group were effective. Further analysis suggested that the Experimental Group outperformed the Control Group regarding the degree of improvement, and the difference was statistically significant (P<0.05). (8) As for the TCM values of individual symptoms relating to deficiency in spleen qi and stagnation of liver qi, significant differences were found in the symptoms of eating, body weight, fear of cold, belching and sigh between the Experimental Group and the Control Group (P<0.05).Conclusions:(1) Treating endocrine diseases through the liver has both theoretical and practical significance. The approach does not confine the treatment to any particular method or remedy, but emphasizes targeted treatments based on syndrome differentiation methodologies in relation to the biological and pathological characteristics of the liver. In treating endocrine diseases, great importance should be attached to the relationship between the liver and liver functioning, and the treatment of the liver is aimed to restore liver qi at all levels of the unbalance between yin and yang. (2) TCM is effective in treating HT and SCH by regulating the functioning of Hypothalamic-Pituitary-Thyroidal Axis (HPT) in a way similar to thyroid hormone replacement therapy, recovering humoral immune disorder and cell immune disorder which may lead to the damage of thyroid glands, relieving the uncomfortable clinical symptoms, and deterring or ceasing the natural HT processes. The clinical research has testified the feasibility and effectiveness of the liver-focused approach to treating thyroid diseases, and Professor LIU’s liver-focused academic thoughts have laid a solid foundation for clinical practices.To sum up, this dissertation provided a comprehensive summary of Professor, LIU’s experience and academic thoughts in treating common endocrine diseases, and systematically examined the liver-focused approach to treating endocrine diseases. Through the olinical observation of the effects of Jianpi-yiqi-shugan-heluo Remedy on HT and SCH patients who had deficiency in spleen qi and stagnation of liver qi, the working mechanism of the approach was discussed, hence providing theoretical supports for treating thyroid diseases through the liver. |
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