中医治疗桥本甲状腺炎的证候分布和方药规律文献研究

Literature Study on Syndrome Distribution and Prescription Rule of Hashimoto's Thyroiditis Treated by Traditional Chinese Medicine

目的探讨桥本甲状腺炎的中医证候分布和遣方用药辨证论治规律。方法检索1979年1月1日至2017年6月30日国内外中国期刊全文数据库(CNKI)、万方数据知识服务平台、维普网、中国生物医学文献数据库及Pub Med数据库收录的中医诊治桥本甲状腺炎的文献资料,分析桥本甲状腺炎中医证候分布和治疗方药规律,及不同证型与年龄、性别、甲状腺功能、甲状腺临床指标的关系。结果共获得桥本甲状腺炎中医证型32个,其中脾肾阳虚、痰瘀互结、肝郁脾虚、痰气郁结、肝郁气滞、气阴两虚为主要证型;共用方剂469首,其中212首成方,以补益剂、和解剂、祛痰剂、清热剂、温里剂为主。共涉及中药311味,频次较高的为补虚药、清热药、活血化瘀药、化痰止咳平喘药、理气药;使用频次较高的51味中药可组成6个聚类方,分别适用于肝郁化火证、脾虚痰凝、痰瘀互结证、气阴两虚、痰火郁结证、肝肾阴虚证、脾肾阳虚证、气滞血瘀痰凝证的桥本甲状腺炎。桥本甲状腺炎证型分布在不同年龄、性别、甲状腺功能、甲状腺激素指标存在差异(P<0.05或P<0.0125或P<0.003125)。结论桥本甲状腺炎患者以脾肾阳虚证最为常见,其次为痰瘀互结、肝郁脾虚证,遣方用药既要疏肝理气、活血化瘀,又要温补脾肾、益气养阴,对症加减,标本兼治。

Objective To study the rules of traditional Chinese medicine( TCM) syndrome distribution,prescriptions in the treatment of Hashimoto’ s thyroiditis based on syndrome differentiation. Methods Literature of TCM treating Hashimoto’s thyroiditis in China National Knowledge Infrastructure( CNKI),Wanfang,VIP,Sino Med,Pub Med from January 1,1979 to June 30,2017 were searched and collected. The TCM syndrome differentiation,prescriptions in the treatment of Hashimoto’ s thyroiditis,as well as the relationship between different syndrome and age,gender,thyroid function and thyroid clinical indexes were analyzed. Results A total of 32 TCM syndromes were counted in Hashimoto’s thyroiditis. Among them,syndrome of spleen and kidney yang deficiency,stagnation of phlegm and blood stasis,liver qi stagnation and spleen deficiency,stagnation of phlegm and qi,liver depression and qi stagnation,deficiency of qi and yin were the main syndromes of Hashimoto’ s thyroiditis; 469 prescriptions were counted,among which 212 were set formulas,mainly involved in tonifying formula,harmonizing formula,phlegmremoving formula,heat-clearing formula,warming interior formula. 311 kinds of Chinese medicine were involved,among which Chinese medicine of tonifying deficiency,clearing heat,activating blood regulation and removing stasis,removing phlegm,relieving cough and asthma,promoting qi circulation were the most frequently used. 6 clustering prescriptions were achieved through hierarchical cluster analysis methods to 51 counted Chinese medicines,which were applied the following syndromes of Hashimoto’s thyroiditis: syndrome of pathogenic fire due to stagnation of liver;syndrome of spleen deficiency and phlegm coagulation,stagnation of phlegm and blood stasis; syndrome of qi and yin deficiency,coagulation of phlegm and fire; syndrome of liver and kidney yin-deficiency; syndrome of spleen and kidney yang-deficiency; syndrome of qi stagnation and blood stasis and phlegm coagulation. There was difference of different syndrome distribution in age,gender,thyroid function,and thyroxine level( P < 0. 05,P < 0. 0125,P <0. 003125). Conclusion Syndrome of spleen and kidney yang-deficiency is the most common syndrome in Hashimoto’s thyroiditis patients,followed by syndrome of stagnation of phlegm and blood stasis,syndrome of liver qi stagnation and spleen deficiency. The application of clinical prescription should not only smooth liver and promote qi circulation,activate blood regulation and remove stasis,but also warm and tonify spleen and kidney,tonify qi and yin,modified according to different syndrome,and treating both symptoms and root causes.