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History of the name of the disease
Hyperthyroidism, also known as Grave's disease. The clinical manifestations of hyperthyroidism are mainly characterized by malignant fever or facial heat, self-sweating, palpitations, irritability, fatigue and emaciation, finger and tongue tremor, goiter, etc., and are mostly classified as "thin gas disease" and "depression and labor" in traditional Chinese medicine.
As early as the third century BC, there were ancient documents on the continent about thin disease. In the Warring States period's "Lü's Spring and Autumn Chapter, All the Enemies" has the phrase "close to the water, bald and thin people", and the Sui Dynasty's "Discussion on the Origin of Diseases, Thin Waiting" first mentions a thin disease, and contains "thin people, born of sorrow and anger",... Combat", pointing out that its causes are mainly emotional factors and water and soil factors.
Song's "Shengji Zonglu Thin Tumor Gate" divides the disease into "stone thin, mud thin, labor thin, melancholy thin, and qi thin" from the perspective of etiology. And Chen Wujie's "Three Causes and One Disease Theory and Thin Tumor Treatment" lists another classification method: "Hard and immovable, the name is stone thin: the skin color does not change, then the name is flesh thin: the tendon vein is dewy, the name is thin: the red vein is intertwined, the name blood is thin: with the depression of the elderly, the famous qi tumor."
Ancient Chinese medicine's understanding of the causes of hyperthyroidism
There are many discussions on the causes of thin disease in ancient Chinese medicine. "Discussion on the Origin of Diseases, Thin Waiting" first mentions a thin disease, and also contains "thin people, born of sorrow and anger, and formed by fighting", pointing out that its causes are mainly emotional factors and water and soil factors.
For this disease, most doctors believe that it is related to the geographical environment and the internal injuries of the seven emotions, and the basic pathology is that qi depression gradually develops into phlegm coagulation and blood marks, and eventually causes qi and blood sputum marks to suffocate in the neck.
From the perspective of etiology, the "General Record of Shengji" summarizes thinness as stone thinness, mud thinness, labor thinness, worry thinness, and qi thinness, of which stone thinness and mud thinness are related to the geographical environment, and worry, labor, and qi are mostly caused by emotions. Chen Shigong in the Ming Dynasty proposed that the pathogenesis of thin tumors is not only stagnation of qi and phlegm, but also the coagulation of blood can also become thin.
Modern Chinese medicine's understanding of the causes of hyperthyroidism
Emotional internal injury Long-term emotional depression or tension, or sudden severe mental trauma, resulting in liver qi stagnation, loss of venting, stagnation of qi, abnormal infusion of jin liquid, condensation into phlegm; Or qi depression turns into fire for a long time, heat hurts yin, refining liquid as phlegm: or the liver is strong and takes advantage of the spleen, the spleen loses its luck, gathers moisture into phlegm, phlegm and qi are blocked, with the liver qi upward, the neck becomes thin qi;
Evil gathers in the eyes, and the liver is intrusive: the liver is depressed and the fire is irritable, the face is hot and red, the mouth is bitter and dry: the stomach is blazing, it eats more and hunger: the liver qi invades the spleen, the spleen loses health and luck, it is sugar, emaciation, fatigue and fatigue: fiery and hurts yin, the heart is insufficient, the heart is restless, the heart is palpitating, upset, self-sweating: long-term illness and kidneys, water does not contain wood, can cause yang hyperactivity, see hand trembling and tongue trembling.
Physical factors Yin deficiency, liver and kidney deficiency, or insufficient congenital endowments, plus improper adjustment of the day after the day, resulting in liver and kidney yin deficiency, virtual fire and delirium, tormenting jin liquid into phlegm, condensing the neck into thin qi.
The geographical environment and eating habits of residence can also affect its onset, and the poor mountains and bad water and the fatty and thick diet are easy to cause phlegm, wet drinking, and accumulation of progress, damage to the spleen and stomach, and become a thin tumor disease over time.
In addition, if you accidentally feel the outside, the six lewd evil poisons invade the body through the mouth, nose or fur, internal injuries to the internal organs, phlegm and scars, and agglomerate before the neck, which can also lead to this disease. There is also a serious feeling of external evil or sudden panic, irritation, etc., resulting in a sharp deterioration of the condition. At this time, the liver yang soars above, the yin fluid is depleted below, and there is often a crisis of yin exhaustion and yang detachment, wind movement and recovery.
Modern Chinese medicine's understanding of the mechanism of hyperthyroidism
Most modern Chinese medicine believes that its pathogenesis is mostly due to the dysfunction of the liver, resulting in a series of pathological changes, and involving the kidneys, heart, spleen, stomach and other organs, among which the pathological links are Qi stagnation, liver fire, phlegm coagulation and blood stains, and Qi stagnation is the first. If the sputum is depressed for a long time and heat injury is yin, the manifestation of yin deficiency and yang can be seen.
Jin Shu Shirakawa believes that emotions have a greater impact on hyperthyroidism, and the liver bears the brunt of the resulting disease. After being sick for a long time, the liver and yin are burned, and the upper can trigger the heart fire and consume the heart yin: the lower one damages the kidney water.
Kidney water is insufficient, can not bear the heart fire, including liver wood, resulting in heart and liver yin deficiency, as a result, heart, liver, kidney three internal organs of the yin fluid loss, harm each other, promote the aggravation of the disease. It can also involve the spleen, stomach, large intestine, etc., so that sputum, sleep and other pathological products are knotted with each other and see leptomy, ocular protrusion and other symptoms.
Xia Shaonong and others believe that the causes of hyperthyroidism are mainly healthy qi failure and insufficient kidney water. If the water is insufficient, the fire is strong, the fire is strong, and the yin deficiency even affects the yang, that is, the yin damages and the yang.
Patients with hyperthyroidism often involve the heart, liver and kidneys, and the yin and yang are mainly manifested in the damage of the spleen and yang. Spleen and yang are weak, wet sputum, wet sputum appears goiter or palpation and lumps on the wet sputum against the neck, and exophthalmos can appear in the upper reverse of the eyes.
Invesco attributed the pathogenesis of this disease to yin deficiency and yang, based on the heart, liver and kidney, and the yin deficiency is the liver key, long-term mental depression, or sudden severe mental trauma, can cause heart and liver damage.
Positive development, kidney qi is not strong: or abnormal menstruation, and excessive fetal delivery, can lead to kidney yin damage, kidney yin deficiency will liver loss of nourishment, heart is not good, heart fire is easy to move, on this basis it is easier to form this disease. In addition, craving spicy and spicy products, dry heat and yin, can also promote the occurrence of this disease.
Yang Qingyun regarded liver fire and spleen cutting as the main pathological mechanism of this disease. Spleen deficiency produces phlegm, sputum depression before the neck, causing blood vein obstruction for a long time, phlegm depression into fire, hot injury yin, there are pathological changes of yin deficiency and fire, and its lesions often involve the heart, liver and stomach. If the heart is hot, the heart palpitates and forgetfulness;
Liver fire is impatient and trembling: stomach fire is good hunger, and some people think that women rush; The second and second veins belong to the liver, and the liver is out of breath and blood, which is easy to cause qi depression, liver fire or qi pollution, blood stains, etc., so the disease is more common in women, especially young and middle-aged women.
The pathogenesis of this disease, such as stagnation, phlegm dampness, and blood stains, has been widely recognized by the medical community. In recent years, research has not only recognized that the disease has Qi stagnation, blood stains, phlegm coagulation, liver and yang hyperactivity, etc., but also noted that there is a deficiency of qi, qi and yin, spleen deficiency and other aspects that belong to the deficiency.
Pan believes that hyper-impotence is the appearance of the disease, qi deficiency is the essence, and the size and texture of the thin tumor reflect the severity of the stagnation, and also indirectly reflect the severity of the deficiency of qi.
Wei proposed that this disease should be a disease of the virtual and real, the disease of the mixture of the virtual and the real, the main yin deficiency, gradually reaching the deficiency of qi, the standard is qi, blood, phlegm, and fire prisoner. Sun proposed that the pathogenesis of this disease is based on qi and yin deficiency, and phlegm, blood, and fiery are the targets.
More scholars have proposed that there is a hot and toxic side of the disease, such as Mei's [iJ study] believes that the pathogenesis of this disease lies in the sputum stagnation, qi stasis blood flag and heat poison brewing.
In short, the main pathological factors of this disease are Qi stagnation, liver fire, phlegm coagulation and blood stains, and Qi depression is the first: long-term illness is more deficiency or virtual and real inclusion, the deficiency is mainly Yin deficiency, and gradually qi deficiency or Qi Yin is the same disease. Its disease is located in the front of the neck, which is closely related to the liver, kidney, heart, spleen and stomach and other organs.
Studies of dialectical typing
The etiology of this disease has been relatively clear, but on the clinical classification of thin gas disease, there are still different opinions, some are simplified into two categories, some are divided into five categories, and the name of the symptom disease is also inconsistent, so far there is no unified classification standard. Most doctors base their understanding of the etiology and pathogenesis with clinical diseases to carry out differentiation and treatment based on dialectical classification.
There is a differentiation and classification based on the virtual reality of internal organs, qi, blood, yin and yang: Jiang's divides the disease into five types: (1) liver depression is not thin, phlegm and qi are intertwined type: (2) medium scorch contains heat, stomach fire is blazing: (3) liver and kidney yin deficiency, virtual fire internal disturbance type: (4) stomach strong and weak spleen, virtual and solid inclusion type: (5) spleen deficiency and liver depression, qi and yin deficiency type.
Jiang's (9) divided hyperthyroidism into four types of treatment: (1) liver depression and heart fever type: (2) liver and stomach fire type: (3) heart and kidney yin deficiency type: (4) sputum coagulation type. Some people also use the law to prove it: for example, Zhu's divides the disease into three types: (1) liver thinning and depressant and blood dispersion method, which is suitable for those who cause qi and blood stains due to liver depression and qi and blood inhibition;
(2) Nourishing yin and lowering fire, flat liver quenching method, suitable for yin deficiency and fire, liver wind internal movement disease; (3) Nourishing serum fever, phlegm and wasting, suitable for blood deficiency as the foundation, phlegm fever as the target disease. However, although the two methods of classification are clinically flexible and effective, the classification is more complicated, and due to the different differentiation of doctors, the evidence type is different, and the objectivity is poor.
Some people also use ancient books or Zhang Zhongjing's "Typhoid Miscellaneous Diseases" (i.e. Jing Fang) as the basis for dialectical classification. This method is simple and effective, and the addition and subtraction are flexible, but the method also lacks a certain objectivity and scientificity. For example, Cao's (IIl) according to the ancient texts on the etiology and pathogenesis of the disease, the disease is divided into three types: (1) liver and stomach fire, Qi stagnation and phlegm knots: (2) Qi and Yin deficiency type: (3) liver and kidney yin deficiency, liver wind internal movement type.
Modern doctors give full play to the advantages of TCM dialectical arguments, skillfully expand the application of Jing Fang, and treat hyperthyroidism and receive better clinical results.
Zhao believes that the disease is more likely to occur in women, the beginning of the disease is mostly caused by seven emotions disorder, liver qi depression for a long time, depression and fire, burning yin fluid, eventually causing qi and yin deficiency, liver and kidney damage, belongs to liver qi accumulation, treatment to loosen the liver and regulate qi, phlegm and emaciation, and clear fire, square with small chai hu tang plus and minus: belongs to liver and kidney yin deficiency, qi and yin deficiency, treatment should double supplement qi yin, nourish liver and kidney, square with raw pulse scattered addition and subtraction.
Jiang's also skillfully reduced Chai Hu soup and White Tiger Soup, and used them to treat hyperthyroidism with liver depression, phlegm and gas, and stomach fiery hyperthyroidism.
Based on the fact that each symptom type in the whole course of hyperthyroidism is the main manifestation of different stages of hyperthyroidism, some scholars have clearly put forward the view of "phased medication" for the treatment of hyperthyroidism, and the general law in the pathogenesis of hyperthyroidism is manifested as liver depression and liver fire and yin deficiency and yang, liver fire is only a transient manifestation of hyperthyroidism, and yin deficiency and hyper-yang is the main clinical symptom of hyperthyroidism.
However, with the development and change of the disease, or the transformation from the adolescent type to the senile type and the outcome of Chinese and Western drug treatment, the trend of hyperthyroidism in the disease of hyperthyroidism gradually slows down, the image of yin deficiency gradually disappears, and the symptom type will gradually transform into qi and yin deficiency, spleen and kidney yang deficiency, at the right time, the typical symptoms of hyperthyroidism have ceased to exist, showing an essential manifestation of the decline of the body's immune function.
Therefore, some scholars put forward the view that "hyper-impotence is the appearance, and qi deficiency is the essence", and believe that hyperthyroidism endocrine disorders, "Qi deficiency is the main pathological factor of hyperthyroidism, and runs through the whole process of hyperthyroidism." ”
Therefore, the understanding of the dialectical classification of hyperthyroidism has changed from real to virtual (liver depression, liver fire, yin deficiency and yang) and from yin and yang (yin deficiency yang hyper qi yin two deficiency one spleen kidney yang deficiency), more comprehensively reflect the evolution of hyperthyroidism, and the understanding has been continuously deepened.