▲Deng Tietao (1916.10-2019.01) is the first master of traditional Chinese medicine, the representative inheritor of traditional Chinese medicine diagnosis method of national intangible cultural heritage, a tenured professor of Guangzhou University of Chinese Medicine, one of the founders of the Department of Traditional Chinese Medicine Internal Medicine of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, and a famous modern Chinese medicine scientist. He was awarded the second prize of the National Science and Technology Progress Award, the Special Contribution Award for the Fight against SARS in Traditional Chinese Medicine, the Special Contribution Award for the Inheritance of Traditional Chinese Medicine, the Lifetime Achievement Award of the Chinese Association of Traditional Chinese Medicine, and the Medal for the 70th Anniversary of the Founding of the People's Republic of China, and was posthumously awarded the National Outstanding Communist Party Member in 2021.
Speaking of hyperthyroidism, do you think of the image of "protruding eyes" and "big neck"? Hyperthyroidism not only damages the appearance and image and seriously disrupts life, but also has an impact on physical health.
1. Professor Deng Tietao on hyperthyroidism
Hyperthyroidism, which is the abbreviation of hyperthyroidism, is characterized by polyphagia, weight loss, heat intolerance, hyperhidrosis, palpitations, irritability, irritability, and other hypermetabolism and nervous excitability symptoms as the main clinical manifestations. Although there is no corresponding name for hyperthyroidism in Chinese medicine, goiter is often included in the scope of Chinese medicine gall because Chinese medicine calls goiter a gall disease. However, according to the characteristics of its clinical symptoms, it seems to also involve the scope of internal injuries and miscellaneous diseases such as palpitations, insomnia, depression syndrome, sweat syndrome, phlegm syndrome, and fatigue in traditional Chinese medicine. The ancient people of Gaigu have the saying that "phlegm is the mother of all diseases", "phlegm gives birth to all diseases", and "all diseases are mostly caused by phlegm", and Zhu Danxi emphasized that the treatment of miscellaneous diseases should be based on qi, blood and phlegm depression.
According to the main pathological characteristics of this disease, diffuse goiter with hyperthyroidism, combined with the discussion of gall disease and phlegm syndrome by doctors in previous dynasties, as well as the enlightenment of the intention of Cheng's Xiaosputa Pill, and participating in long-term clinical practice, Deng Lao believes that hyperthyroidism should be mainly treated from phlegm.
Etiology and pathogenesis
The etiology and pathogenesis of this disease are mostly caused by insufficient congenital endowment, acquired disorders, or emotional stimulation, internal injury and diet, or mistreatment of diseases, or post-illness malnutrition, resulting in the imbalance of yin and yang qi and blood in the human body, and the dysfunction of internal organs. According to the main clinical manifestations of this disease, although there are many organs involved, the characteristics of its syndrome are still real and false, and the original deficiency is standard and real.
This deficiency is mostly yin deficiency, and gradually becomes the main deficiency of qi and yin, so it is seen that the body is emaciated, fatigue, eating too much and being hungry, being afraid of heat and sweating, hand tremor, red tongue and less moss, and the pulse is thin; the standard is actually phlegm condensation, depression and fire, and the manifestation of mental and nervous symptoms, such as mental tension, shock, forgetfulness, insomnia, irritability, multilingual hyperactivity, etc., thus forming the evidence of qi and yin deficiency, phlegm and stasis obstruction, and the evidence of the deficiency and the reality of the deficiency.
Syndrome differentiation
According to the above etiology and pathogenesis, the treatment of this disease should be mainly to nourish qi and nourish yin, dissolve phlegm and disperse condensation. Therefore, the Shengmai Sanhe and Xiaoguan pills are used to add and subtract the cut.
Basic recipe: 30 grams of Radix Radix Radix, 10 grams of Ophiopogon vulgaris, 6 grams of Schisandra chinensis, 10 grams of Yamaci mushroom, 10 grams of Zhebei, 15 grams of Radix, 30 grams of raw oysters, 15 grams of white peony, 5 grams of licorice.
In the formula, it is used to dissipate the pulse and nourish the yin to treat the root cause, and the Cheng's Xiaoshuang Pill (Xuanshen, Zhebei, and raw oysters) is used to dispel phlegm and clear heat, soft and hard to disperse knots, and white peony and licorice nourish yin and zhong, and the function of Shanci mushroom is to dispel phlegm and disperse knots, which is a necessary medicine for the treatment of hyperthyroidism.
Addition and subtraction: those with liver qi stagnation, it is advisable to soothe the liver and relieve depression, and to combine the four reverse dispersions; those with palpitations, insomnia, and dreams, it is advisable to nourish the heart and calm the nerves, and choose to add ripe jujube kernels, night vines, cypress kernels, yuanzhi, etc.; those who are irritable and irritable, startled and forgetful, with malt and jujube of the dirty and irritable prescriptions; those who sweat a lot add floating wheat, glutinous rice roots, etc.; those with hand tremors reuse white peony and licorice, or cooperate with the nourishing blood and relieving wind, use chicken blood vine, hook vine, shou wu, etc.; add tribulus terrestris, chrysanthemum, wolfberry, etc. for those with protruding eyes; add dendrobium and huai yam for those with stomach yin deficiency; add astragalus, atractylodes, etc. Yun Ling, five-clawed dragon, etc.; those with kidney deficiency should use Erzhi pills or add dodder seeds, sagebrush seeds, mountain firewood meat, psoralen, etc.
Treatment of comorbidities: patients with hyperthyroidism and hepatitis should be combined with Sijunzi Tang plus pearl grass and yellow bark leaves; patients with hyperthyroidism and anemia should add blood-nourishing products on the basis of the original formula, such as Shou Wu, Huangjing, Rehman, Ejiao, etc.; patients with myasthenia gravis should be combined with Xuanshen, Zhebei, oysters, Shanci mushrooms and other expectorant and dispersing products on the basis of reusing Buzhong Yiqi decoction; patients with diabetes mellitus should combine Liuwei Dihuang pills on the basis of the original recipe and reuse Huai Yam, Xianhe grass, corn whiskers, etc.; Ox knee, motherwort and other menstrual medicines. Chronic hyperthyroid myopathy is seen in patients with muscle atrophy reuse astragalus, codonopsis, atractylodes, five-clawed dragon, chicken blood vine, jack pull, etc.; hyperthyroid limb paralysis patients should use astragalus guizhi wuwu decoction, or add willing, pigweed, papaya, old mulberry branch, mulberry parasitic and so on.
Because hyperthyroidism is a disease of the endocrine system, the disease is stubborn and prone to recurrence, therefore, the treatment must be persistent, and it is still necessary to insist on taking the drug for half a year after clinical cure to prevent recurrence. For patients who have already taken antithyroid drugs, the dose should be gradually reduced after the Chinese medicine has taken effect, and the drug should not be stopped abruptly. For patients with hyperthyroid crisis, rescue measures should be taken in time and comprehensive treatment should be taken.
Avoid predisposing factors: Although the onset of hyperthyroidism is related to genetic and autoimmune factors, the symptoms of hyperthyroidism are also related to some predisposing factors, such as infection, mental stimulation, trauma, excessive fatigue, etc. Therefore, it is important to help the patient to stay in good spirits to prevent emotional injury, persuade family members to be understanding and humble to the patient, and avoid emotional fluctuations. Be cautious, avoid wind and cold, prevent colds, and avoid overwork. In terms of diet, it is advisable to eat more high-nutrient foods, vegetables and fruits, less spicy foods and iodine-containing foods such as kelp, shrimp, marine fish, etc., drink less strong tea and coffee, and do not smoke or drink alcohol.
Second, there are two rules for the treatment of hyperthyroidism
Hyperthyroidism with periodic paralysis
Liang, male, 28 years old. Initial visit on 2 September 2000.
Chief complaints: palpitation, shortness of breath, sweating, weakness of both lower limbs for 1 month.
Medical history: In the past 2 years, the patient has experienced swelling in the throat, palpitation, insomnia, shortness of breath, heat intolerance, excessive sweating, thirst, tiredness, dizziness, weight loss, accompanied by muscle soreness, weakness of both lower limbs, aggravation of various symptoms after activity, alleviation after rest, and periodic attacks. Until August this year, due to the sudden aggravation of emotional stress, he went to two hospitals in Guangzhou for diagnosis and treatment, and was admitted to the hospital on the 24th, unable to walk, and diagnosed with "hyperthyroidism and periodic paralysis".
At that time, the examination records were: clarity, cranial nerve (-), symmetrical pain sensation, muscle strength of both upper limbs V., bilateral lower muscle strength class I., double Pap sign (-), decreased tendon reflexes, goiter II degree, heart rate 124 beats/min, hand tremor (+), blood biochemistry: potassium 2.2 mmol/L (reference value 3.5~5.5 mmol/L), T3 8.5 nmol/L (reference value 1.2~3.4 nmol/L), T4 309 nmol/L (reference value 54~147 nmol/L). Emergency admission to endocrinology. Hospitalized for 1 week, a variety of instrument examinations, intravenous infusion and oral administration of a large number of Western medicine (drug unknown) every day, before and after the cost of nearly 10,000 yuan, symptoms did not improve and side effects are large, nausea and vomiting, dizziness and tinnitus, the patient is difficult to accept, and was introduced by a friend to our hospital for treatment of traditional Chinese medicine.
Diagnosis: emaciation, fatigue and shortness of breath, weakness of limbs, muscle aches, neck swelling, limb tremors, palpitation, hot flashes and sweating, and eating and eating good muscles. The tongue is pale red, with tooth marks on the edges, the tongue coating is thick and greasy, yellow and white, and the veins are fine.
Traditional Chinese medicine diagnosis belongs to the scope of "gall disease and impotence syndrome", which distinguishes qi deficiency and phlegm turbidity, liver depression, and spleen and kidney insufficiency. Treated with warm gallbladder decoction and muscle strengthening drink. He was also instructed to temporarily stop taking Western medicine.
Prescription: 10 grams of Zhuru, 6 grams of Citrus aurantium, 6 grams of orange red, 10 grams of gall star, 15 grams of Yunling, 30 grams of Astragalus, 30 grams of Pentacosaurus, 30 grams of Pseudostellaria radix, 10 grams of Schisandra chinensis, 10 grams of Ophiopogon vulgaris, 10 grams of Shanci mushroom, 5 grams of licorice, 30 grams of raw oysters. 3 doses.
Add "hyperthyroidism". The daily diet instructs to eat less cold and more legumes (except mung beans).
Second diagnosis (September 6): After taking traditional Chinese medicine, the symptoms were greatly reduced, palpitation and shortness of breath, insomnia and sweating disappeared, the general condition improved, and the limb tremor was reduced. On examination of the muscle strength of both lower limbs, the tendon reflexes are still low, the tongue is pale red, the lichen is white and thick, and the pulse is thin. The effect does not change the prescription, and the amount of Shanci mushrooms is increased to 15 grams. 7 doses.
Third diagnosis (September 13): occasional palpitation, dry mouth, but sleep improved, muscle soreness disappeared, neck swelling decreased, physical strength increased, face shiny, muscle strength of both upper limbs and lower limbs were V., tendon reflexes were slightly lower, tongue was light red, moss was thin yellow, and the pulse was thin. Considering that patients with hyperthyroidism are prone to internal heat and the muscle strength of the limbs has been restored, go to Astragalus membranaceus and Pentaclaw, add 20 grams of Huai Yam, 15 grams of Dendrobium, and 20 grams of barley, and apply for five re-examinations of thyroid function.
Fourth diagnosis (September 20): The patient's clinical symptoms have basically disappeared and he has been able to go to work. Continue to guard the top, add 15 grams of mountain firewood meat.
Fifth diagnosis (September 27): all five values of thyroid function were within the normal range. The patient is in good spirits, has gained weight, has no tremor in the limbs, and the thyroid gland in the neck is basically normal. In order to consolidate the curative effect, the treatment is still treated with warm gallbladder decoction. At present, it is still treated with traditional Chinese medicine, and there is no recurrence of hyperthyroidism.
Note: This case is the result of his students' clinical results by imitating the experience and theory of Deng Lao Wen Bile Decoction and Muscle Strengthening Drink. Deng Lao Wen Bile Decoction has a wide range of applications, and can be used in multiple systems and diseases of Western medicine, as long as the syndrome differentiation of qi deficiency and phlegm turbidity in traditional Chinese medicine can be added or subtracted. Hyperthyroidism and periodic paralysis, this disease is more common in young and middle-aged men, with swelling of the throat, palpitation, excessive sweating, with weakness of both lower limbs, muscle aches as the main manifestations, combined with blood potassium, T3, T4, electrocardiogram and other test results to confirm the diagnosis.
Traditional Chinese medicine believes that it belongs to the scope of gall disease and impotence syndrome, and its pathological mechanism is liver qi stagnation, qi blockage, which is not enough to metabolize jin fluid, accumulates and produces phlegm, and forms gall disease in the neck; spleen deficiency and blood metaplasia is insufficient, the muscles of the limbs lose their nourishment, the lower limbs are weak, and the muscles are sore, which is the syndrome of impotence. Periodic paralysis disease has a perennial root, which occurs periodically for several months, which is related to the kidney of traditional Chinese medicine, and the clinical observation is mostly kidney yin deficiency. At the time of the initial diagnosis, the patient's lower limbs were weak and his body was emaciated, and the main contradiction was manifested by impotence, so he must add astragalus and pentacrylosaurus when prescribing drugs.
Neck swelling, limb tremor, palpitation, hot flashes and sweating, food and hunger, pale red tongue, tooth marks on the side, thick tongue coating, yellow and white, is the endogenous manifestation of liver depression and spleen deficiency phlegm turbidity, so Deng Lao Wen gallbladder decoction is the main prescription, plus or minus medicine, among which Shanci mushroom is a special medicine for the treatment of the disease. After the condition is stabilized, it is necessary to tonify the kidney to prevent its periodic paralysis from appearing again, the mountain wood meat replenishes the yin of the liver and kidney, the dendrobium nourishes the stomach yin, and the coix seed dispels dampness. In addition to phlegm and invigorating qi, it can be effective in treating the liver, spleen and kidney, which shows that the experience of famous and old Chinese medicine can be repeated, and its theory can guide practice.
(Compiled by Ma Xiaolan in this case)
Hyperthyroid myopathy
Liang, male, 35 years old.
He came to the hospital on June 2, 1988 for treatment due to tremors in his hands, sweating, palpitations for 2 years, and weakness of his limbs for 3 months. After asking about his medical history, he found that his eyes protruded forward on both sides of his eyes in 1986, and at the same time felt heat intolerance, excessive sweating, palpitations, and emotional irritability. However, in recent months, he has gradually developed weakness in his limbs, so that he is unable to lift his upper limbs and has difficulty squatting in his lower limbs.
On physical examination, the body temperature was 36.6°C, the pulse was 92 beats per minute, the exophthalmoism was positive, the ocular movement was limited, the eyelids were insufficiency, and the thyroid gland was mildly enlarged on both sides, moving up and down with swallowing. Proximal muscle atrophy of the upper limbs, most obvious in the deltoid muscle, muscle strength of both upper limbs is grade III.~IV., muscle strength of both lower limbs is grade IV., tendon reflexes of the limbs are present, and no positive signs are found in the neurological examination.
To confirm the diagnosis, a neostigmine test is performed and the result is positive. Electromyography (EMG) shows "myogenic lesions". The diagnosis was: (1) hyperthyroid myopathy, (2) myasthenia gravis with hyperthyroidism, and was treated with pyridostigmine bromide and hyperthyroidism for more than a year, but due to the patient's gastrointestinal reactions such as diarrhea, all western medicines were discontinued after 1990 and transferred to Dr. Deng Zhongguang for treatment.
Dr. Deng's syndrome differentiation was spleen and kidney deficiency and liver qi stagnation, and the main drug prescriptions were as follows: 90 grams of Astragalus membranaceus, 60 grams of Radix Radix (or 60 grams of Niu Dali, 60 grams of Thousand Jin Pull), 30 grams of Atractylodes macrocephala, 30 grams of Codonopsis (or 30 grams of Radix Radix Radix), 10 grams of Angelica sinensis, 10 grams of Cimicifuga sinensis, 10 grams of Bupleurum chinensis, 10 grams of Shanci mushroom, 10 grams of Radix Radix Radix, 3 grams of licorice, and 3 grams of tangerine peel.
If you have an external sense, add pigweed, artemisia annua, mille-feuille paper, scutellaria, fat sea, etc.; if you cough and phlegm sticky, add Zhebei and coix seeds to dissolve phlegm, or take it with three snake gall Chuanbei powder; if you are irritable and insomnia, or sleep a lot at night, add ripe jujube kernel to nourish the heart, and night vine to calm the nerves; if the mouth is dry and bitter, add dendrobium to nourish stomach yin; and see kidney deficiency plus mountain firewood meat, eucommia, Guan Shayuan, dodder seed, etc.
By July 1999, the atrophied forearm muscles had been rehabilitated, the muscle strength of the limbs was V., the weakness of the limbs had disappeared, and the symptoms of neck enlargement, proptosis, palpitations, sweating and other symptoms had improved significantly, and he could continue to live and work normally.
Note: The diagnosis of this disease was originally hyperthyroid myopathy, and later due to the positive neostigmine test, myasthenia gravis and hyperthyroidism were considered. Although the diagnosis of Western medicine is not very clear, according to the clinical manifestations, goiter, proptosis, tremor of the hands, sweating, palpitations, irritability and irritability, and at the same time, there is also weakness of the limbs, especially going up and down stairs, difficulty in squatting and standing up, muscle atrophy, etc., which can be differentiated according to the "gall" and "impotence syndrome" of traditional Chinese medicine. Traditional Chinese medicine believes that the spleen and kidney are deficient, the liver qi is stagnant, and the disease is located in the liver, spleen, and kidney.
Hyperthyroidism is a sign of a mixture of reality and fiction, and it is most closely related to the liver and spleen. The liver is happy to reach, the main is discharged, the main emotional activity, the eyes are opened, and its meridians follow the two flanks and both sides of the neck. If the spirit is anxious, the liver qi is stagnant, the phlegm is turbid and endogenous, the upper eye is disturbed, and the meridians are blocked, the eyeballs are protruding, and the neck qi is formed into a gall. Hyperthyroidism is a chronic disease, which depletes kidney qi and vitality over time, and those who have kidney qi and vitality can not breed without spleen and stomach qi, so it has the same name as the spleen and stomach qi.
Liver qi stagnation, long-term illness and spleen and kidney, liver, spleen, kidney three organs with the same disease. Liver yin is insufficient, liver blood can not nourish the muscles and veins, resulting in weak muscles and veins; spleen and limb muscles, spleen qi is weak, biochemical source is insufficient, qi and blood deficiency can not nourish muscles, so the limbs are weak and muscles are atrophied; the pupil of the eye belongs to the kidney, and if the kidney is deficient, the eyeball does not rotate effectively, and the eyelid is not fully closed. According to the "Neijing" "the deficiency is to make up for it", "the loss is the benefit", and "the laborer is warm", the spleen and kidney and liver are the treatment methods, so the main prescription uses strong muscles to drink, plus mountain mushrooms, scutellaria, Zhejiang fritillary and other liver management to remove phlegm and disperse knots. The dosage of astragalus membranaceus and pentaclawus should be large in order to effectively treat debilitating myopathy.
(Prepared by Li Hui)
[Source: Yue Reading Traditional Chinese Medicine, this article is excerpted from "China's 100 Hundred Chinese Medicine Clinicians Series • Master of Traditional Chinese Medicine Volume: Deng Tietao" published by China Traditional Chinese Medicine Press, edited by Deng Tietao]