甲状腺功能亢进症中医证候学调查

Investigation on TCM Syndrome of Hyperthyroidism

[目的]因甲状腺功能亢进症(以下简称甲亢)发病率增高,严重影响人们的正常生活,研究甲亢的证候学特点,为甲亢的辨证处方提供直接数据支持。[方法]我们于2011年3月-2011年10月在辽宁中医药大学附属医院内分泌科门诊进行临床流行病学调查,按照自愿如实的原则,通过问卷调查的方式记录101例确诊为甲亢的患者的症状、体征及脉象,使用数码相机拍摄患者舌象,汇总以上材料,由两名主任中医师确认甲亢患者的证候。[结果]①常见症状按频率依次为:烦躁、心悸、手震颤、乏力、消瘦、甲状腺肿大等。②舌象特点:舌质最多的是舌质鲜红,58(58%);舌苔最多的是少苔,73(73%)。③脉象最多的是脉弦数,45(45%);④辩证分型:甲亢的证候按出现频率依次为肝肾阴虚证、心肝火旺证、脾虚湿盛证、脾肾阳虚证、痰火内扰证。FT4> 4倍正常值上限的这组中,肝肾阴虚证最多,占总数的44%。正常值上限<FT4 <4倍正常值上限这组中,肝肾阴虚证最多,占总数的60%。[结论]中药治疗甲亢应以滋补肝肾之阴为主,佐以疏肝、化痰及活血之品,为中医辨证用药治疗甲亢在证候学方面提供直接数据支持。

[Objective]Due to the increased incidence of hyperthyroidism which seriously affects people’s normal life,the syndrome characteristics of hyperthyroidism were studied to provide direct data support for the syndrome differentiation and prescription of hyperthyroidism.[Methods]From March 2011 to October2011,we conducted a clinical epidemiological survey in the endocrinology department of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine.According to the principle of voluntariness and truthfulness,the symptoms,signs and pulse conditions of 101 patients diagnosed with hyperthyroidism were recorded by questionnaire survey.The tongue images of the patients were taken by digital camera,and the above materials were summarized and the syndromes of the hyperthyroidism patients were confirmed by two chief Chinese medicine doctors.[Results]①Common symptoms in order of frequency:Irritability,palpitations,hand tremor,fatigue,wasting,goitre,etc.②Tongue characteristics:The most tongue color was bright red[58(58%)].The most tongue coating was little coating[73(73%)].③The most pulse characteristics:String and fast.④Syndrome and differentiation and classification:According to the frequency of occurrence,the syndromes in the order were liver and kidney Yin deficiency syndrome,heart and liver internal heat excessive syndrome,spleen deficiency and dampness excess syndrome,spleen and kidney Yang deficiency syndrome,phlegm and fire disturbing internal syndrome.In the group of FT4>4 times normal upper limit,liver and kidney Yin deficiency syndrome was the most,accounting for 44%of the total.In the group of upper limit of normal value<FT4<4 times of upper limit of normal value,liver and kidney Yin deficiency syndrome was the most,accounting for 60%of the total.[Conclusion]The treatment of hyperthyroidism with traditional Chinese medicine should focus on nourishing Yin of liver and kidney,accompanied by soothing liver,clearing phlegm and invigorating the circulation products so as to provide the direct data support for syndrome differentiation therapy of hyperthyroidism in TCM.