针刺治疗甲状腺功能亢进症案

A case of acupuncture treatment of hyperthyroidism

患者因心慌、心动过速、怕热、多汗、疲乏无力及情绪易激动、失眠、双眼干涩不适,月经失调1年余,于外院内分泌科治疗,2020年7月9日于该院检测甲状腺功能三项均显示异常。后因患者有生育要求拒绝药物治疗,故在其他医生的建议下寻求针灸疗法,遂于2020年7月10日于南京中医药大学附属张家港医院门诊就诊。刻下症:心慌,心动过速,怕热,多汗,双眼干涩不适,焦虑,善食易饥,眠差,二便可。查体:双目有神,无眼突,无颈部增粗,多汗,掌心尤甚,甲状腺Ⅰ度肿大,心率102次/min,舌红,苔薄黄,脉弦数。西医诊断:甲状腺功能亢进症;中医诊断:瘿证(心肝火旺,肾阴不足型)。治则:滋水涵木。选穴:心俞穴、肝俞穴、胆俞穴、肾俞穴、内关穴、神门穴、太溪穴、太冲穴、归来穴、子宫穴。留针30 min,隔日一次,7次为一个疗程。治疗两个疗程后,患者心率由100余次降至70余次;怕热、汗多较前改善;眼睛干涩明显好转;睡眠由原来每日4~5小时增加至7小时左右,月经由原来的推迟15天改善为推迟4天。甲状腺功能三项于2020年7月9日检测均异常,至2020年8月13日复查甲状腺功能三项其中两项恢复正常。继予针刺巩固治疗,于2020年11月16日复查甲状腺功能三项,指标均恢复正常。

The patient has suffered from palpitation,tachycardia,heat intolerance,sweating,fatigue and irritability,insomnia,dry eyes and discomfort,menstrual disorders for more than 1 years.The patient was treated in other hospital.On July 9,2020,the thyroid function was abnormal in all three tests.Later,the patient refused drug treatment due to fertility requirement.So the patient sought acupuncture therapy at the suggestion of other doctors,and then went to Department of Acupuncture and Moxibustion,Zhangjiagang Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine for treatment on July 10,2020.Symptoms:palpitation,tachycardia,heat intolerance,excessive sweating,dry eyes discomfort,anxiety,good appitite and easy hunger,poor sleep,normal urine and stool.Physical examination:the eyes were bright,without eye process,without neck thickening,excessive sweating,especially in the palm,thyroid enlargement I,heart rate 102 times/min,red tongue,thin yellow moss,string and frequent pulse.Western medicine diagnosis:hyperthyroidism.TCM diagnosis:gall syndrome of heart and liver fire,and kidney Yin(阴)deficiency type.Treatment:replenish the water to nourish the wood.Acupoint selection:Xinshu(心俞)(BL15),Ganshu(肝俞)(BL18),Danshu(胆俞)(BL19),Shenshu(肾俞)(BL23),Neiguan(内关)(PC6),Shenmen(神门)(HT7),Taixi(太溪)(KI3),Taichong(太冲)(LR3),Guilai(归来)(ST29),Zigong(子宫)(EX-CA1).The needle was kept for 30 minutes,once every other day,7 times were for a course of treatment.After two cours�es of treatment,the patient’s heart rate was dropped from more than 100 beats to more than 70 beats;heat intolerance and sweating was ameliorated more than before;the dry eyes were visibly better;sleep was increased from 4-5 hours a day to about 7 hours;menstruation was ameliorated from a 15-day delay to a 4-day delay.The three thyroid function tests were abnormal on July 9,2020,and the thyroid function was restored to normal on August 13,2020.Continued acupuncture consolidation therapy,and on November 16,2020,three thyroid function were reviewed,and the indicators returned to normal.