Hashimoto's thyroiditis Treatment with Traditional Chinese Medicine (中英文)

posted Nov 5, 2020, 12:06 PM by Sophia Sophia   [ updated Nov 5, 2020, 1:07 PM ]

Hashimoto's thyroiditis Treatment with Traditional Chinese Medicine

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is more common in middle-aged women. It is also a common cause of sporadic goiter in children. The onset is slow and insidious, and goiter is often found unintentionally, most of which are 2 to 8 times the normal thyroid gland. In the beginning, the thyroid function is normal, sometimes accompanied by hyperthyroidism. But in the later stage, when the thyroid is destroyed to a certain extent, many patients gradually develop hypothyroidism. All middle-aged women with solid diffuse symmetrical goiter should suspect the disease regardless of their thyroid function status.

At present, seven antibodies have been found in serum, including TGA, TMA, thyroid cell membrane, T3, T4, and TSI, some of which are involved in the destruction and pathogenesis of thyroid acinar. It is further clarified that cell-mediated immunity is involved in this disease and activated K cells can exert their cytotoxic effects and cause permanent damage to their thyroid cells. Besides, genetic predisposition and defects in immune monitoring may also be the basis for autoimmune reactions.

This disease is usually thought to be caused by innate genes' combined influence and acquired environmental factors. Risk factors include a family history of this disease or other autoimmune diseases. The diagnosis method tests the value of thyroid-stimulating hormone (TSH), thyroid hormone (T4), and thyroglobulin antibody in the blood. The probability of women suffering from Hashimoto's thyroiditis is about seven times greater than men. It can also occur in adolescents, but the most common incidence is in middle-aged people.

Laboratory examination

Serum TGA: 70% to 80% of patients are positive.
Serum TMA: More than 90% of patients are positive.
Potassium perchlorate excretion test: mostly positive.
T3, T4 decreased, and TSI increased.
Fine needle biopsy of the thyroid gland.

Diagnosis of Traditional Chinese Medicine(TCM) are:

1. Stagnation of liver qi:
Thin and swollen under the neck, tough, painless, and can be swallowed. In the early stage, there may be no typical symptoms, or only depression, irritability, heat fear, etc. Later, chest tightness, hyperhidrosis, and palpitation may be seen. Red tongue with  thin and yellow coat. The pulse is wiry. 

Tx principles: Soothing the liver and regulating qi, removing phlegm and dispelling congestion.
Formula: Chaihu Shugan Powder or Xiaoyao Powder.
Acupuncture points: TE6(Zhigou), LV3(Taichong), GB34(Yanglingquan), SP10(Xuehai), SP8(Diji). BL23(Shenshu), KI3(Taixi), SP6(Sanyinjiao).

2. Yin deficiency and internal heat
Thin and swollen under the neck, severe and painless, nervousness, insomnia, hot flashes and night sweats, men's nocturnal emission, women with low or amenorrhea, or piercing eyes, tremors of hands, palpitation, red tongue with fluid insufficiency, thready rapid pulse or string thready rapid pulse. This type is rare.
Tx principles: Nourishes yin and clears away heat, softens, and clears knots. 
Formula: Qiju Dihuang Tang addition and subtraction. 
Acupuncture points: Gall swelling area, CV22(Tiantu), CV17(Hanzhong), LI4(Hegu), ST36(Zusanli), SP6(Sanyinjiao), SP40(Fenglong), BL18(Ganshu), LV3(Taichong), GB34(Yanglingquan). 
Insufficiency of yin and fire increase in KI3(Taixi), KI7(Fuliu), and HT6(YinQi) relapse nourish yin and reduce the fire.

3. Deficiency of spleen and kidney yang
Thin and swollen underneath the neck, pale complexion, cold limbs, sore waist and knees, dizziness, impotence in men, or less and cold, women with polychromatic menstruation, or amenorrhea, with The lower part is cold, or the expression is dull, and the face is puffy and swollen. The tongue is pale, the coating is white and slippery or greasy, and deep thready pulse or deep thin and weak pulse. This type is most common. 
Tx principles: Warm the spleen and kidney. 
Formula: Jinkui Shenqi Wan.
Acupuncture points: ST36(Zusanli), ST42(Chongyang), CV4(Guanyuan), CV3(Zhongji), CV4(Qihai), SP6(Sanyinjiao), SP9(Yinlingquan), LI11(Quchi), LI4(Hegu), KI3(Taixi), KI2(Rangu), GB39(Xuanzhong), SP10(Xuehai). BL23(Shuitu), BL28(Pangguangshu).

4. Liver Qi and Phlegm Resistance
Swollen neck lumps are painless, difficult in swallowing, irritable, chest oppression, sighing, rib-side pain oppression, sighing, rib-side pain, greasy tongue coat, and wiry pulse.
Tx principles: Soothing the liver and promoting blood circulation, dissipating phlegm, and mass.
Formula: Si Hai Shu Yu Wan. 
Acupuncture points: GB20(Fengchi), BL23(Shenshu), KI3(Taixi), SP6(Sanyinjiao), ST10(Shuitu).

5. Phlegm coagulation stagnation
Hard goiter like stone, large size painful lump, hoarse voice, thin-white-greasy coat, choppy-wiry pulse. 
Tx principlesInvigorate blood and expectorant phlegm.
Formula
: Hai Zao Yu Hu Tang. 
Acupuncture points: ST36(Zusanli), SP6(Sanyinjiao), SP9(Yinlingquan), SP10(Xuehai), SP8(Diji), LV3(Taichong), PC6(Neiguan), ST41(Xiexi), GB39(Xuanzhong), BL60(Kunlun).



中醫治療橋本甲狀腺炎

橋本甲狀腺炎多見於中年女性,也是兒童散發性甲狀腺腫的常見原因。起病緩慢難以察覺,經常在無意中發現甲狀腺腫大才被注意到,大多為常規甲狀腺的28倍。初起時甲狀腺功能正常,經常伴有甲亢表現與症狀,但晚期當甲狀腺破壞到一定程度時,會逐漸出現甲狀腺功能減退。凡中年婦女有對稱性甲狀腺腫大時,不論其甲狀腺功能狀態如何,均應要懷疑為橋本甲狀腺炎。

目前,已發現血清中有TGATMA、甲狀腺細胞膜、T3T3TSI種抗體,其中某些參與甲狀腺腺泡的破壞與致病。現進一步闡明細胞介導免疫參與本病,激活的K細胞可發揮其細胞毒性作用,造成永久性自身甲狀腺細胞的破壞。此外,遺傳傾向及免疫監護功能缺陷也可能是發生自身免疫反應的基礎。

此症通常認為是先天基因與後天環境因素的共同影響所造成。危險因子包含家族有無此病病史,或是其他自體性免疫疾病的病史。診斷方式則是檢驗促甲狀腺激素(TSH)、甲狀腺激素(T4)以及甲狀腺球蛋白抗體的數值。女性患有橋本氏甲狀腺炎的概率大約是男性的七倍,在青少年中也可能出現,但是最常見的發病是在中壯或老壯年人中。

實驗室檢查
血清TGA:陽性。
血清TMA:陽性。
過氯酸鉀排泌試驗:陽性。
甲狀腺細針穿刺活組織檢查。
T3, T4降低,TSI升高。

 中醫的證型有:
1. 證型: 肝氣鬱結。
症狀: 頸下瘦腫,質地堅韌,無痛,可隨吞嚥活動。早期可無典型症狀,或僅見情緒抑鬱,急躁易怒,畏熱等,稍晚則可見胸脅脘悶,多汗,心悸,心慌。舌質紅、苔薄黃,脈弦數。
治則: 疏肝理氣,袪痰散結。
中藥處方: 柴胡疏肝散或逍遙散加減。
針灸處方: 支溝TE6, 太沖(LV3),陽陵泉(GB34),血海(SP10),地機(SP8)。腎俞(BL23)、太溪(KI3)、三陰交(SP6)

2. 證型: 陰虛內熱。
症狀: 頸下瘦腫,質地堅韌無痛,精神緊張,虛煩不寐,潮熱盜汗,男子遺精,女子經少或經閉,或兩目炯炯,雙手震顫,心悸心慌,舌紅少津,脈細數或弦細數。此型較少見。
治則: 滋陰清熱,軟堅散結。
中藥處方: 杞菊地黃湯加減。
針灸處方: 瘿肿局部、天突(CV22)、膻中(CV17)、合谷(LI4)、足三里(ST36)、三阴交(SP6)、丰隆(SP40),肝俞(BL18)、太衝(LV3)、陽陵泉(GB34)。阴虚火旺加太溪(KI3)、复溜(KI17)、阴郄(HT6)滋阴降火

 3. 證型: 脾腎陽虛。
症狀: 頸下瘦腫,面色蒼白,形寒肢冷,腰膝酸軟,頭暈目眩,男子陽萎,或精少、精冷,女子月經過多色淡,或經閉,帶下清冷,或見神情呆鈍,面浮肢腫。舌質淡、苔白滑或膩,脈沉細或沉細弱等。此型最為多見。
治則: 溫補脾腎。
中藥處方: 腎陽偏虛者,金匱腎氣丸加減。脾腎陽虛者, 真武湯加減。
針灸處方: 足三里(ST36),沖陽(ST42),關元(CV4),中級(CV4),氣海(CV6),三陰交(SP6),陰陵泉(SP9),曲池(LI11),合谷(LI4),太溪(KI3),然谷(KI2),懸鐘(GB39),血海(SP10),腎(BL23),胱(BL28)

 4. 證型: 肝氣痰阻
症狀: 腫脹的頸部腫塊不痛,吞嚥困難,煩躁不安,胸部受壓,嘆氣,肋骨側疼痛受壓,嘆氣,肋骨側疼痛,油膩的舌苔,脈細。 
治則: 舒肝
中藥處方: 四海纾瘀丸。
針灸處方: 風池(GB20)、腎俞(BL23)、太溪(KI3)、三陰交(SP6)、水突(ST10)

 5. 證型: 痰凝血滯
症狀: Hard goiter like stone, large size painful lump, hoarse voice, thin-white-greasy coat, choppy-wiry pulse. 
治則: 活血
中藥處方: 海藻玉壺湯

針灸處方: 足三里(ST36),三陰交(SP6),陰陵泉(SP9),血海(SP10),地機(SP8),太沖(LV3),內關(PC6),解溪(ST41),懸鐘(GB39),昆崙(BL60)


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