Zeliščna zdravila TKM za hipotiroidizem: trenutni dokazi in 2 primera

Aku Energija
20 hours ago
Branje traja 12 min

Hipotiroidizem je bolezensko stanje, za katero je značilna nezadostna proizvodnja ščitničnih hormonov v ščitnici, ki so ključni za uravnavanje telesne presnove. Tipični simptomi, povezani s hipotirozo, so utrujenost in letargija, povečana občutljivost na mraz, zaprtje, suha in bleda koža, krhki nohti in lasje, zabuhlost obraza, hripav glas, nepojasnjeno povečanje telesne teže, nelagodje v mišicah, občutljivost, togost, šibkost, bolečine v sklepih, otekanje, močnejši menstrualni cikli in simptomi depresije.

Po teoriji tradicionalne kitajske medicine (TKM) je hipotiroza v skladu s filozofskimi načeli jina in janga običajna manifestacija "šibkega janga“. To stanje lahko kaže na pomanjkanje janga, ki predstavlja aktivacijo, moč in gibanje, ali na presežek jina, ki je povezan z zadrževanjem, spokojnostjo in mirovanjem. V klinični praksi imajo bolniki pogosto mešane vzroke, kar privede do zapletene patološke slike. Čeprav se kitajska zeliščna medicina na Kitajskem pogosto uporablja pri različnih boleznih, vključno s hipotirozo, za kitajsko zeliščno medicino pri hipotirozi niso našli nobene raziskave RCT [1]. V tem članku bomo predstavili dva primera hipotiroidizma, ki so ga zdravili s kitajsko zeliščno medicino, ter razpravljali o zeliščni teoriji TKM in izzivih zdravljenja. [Preberi več: Uravnovešenje ščitnice s TKM] [Preberi več: Tradicionalna kitajska medicina za bolezni ščitnice]

Trenutni dokazi o zeliščni medicini TKM za hipotiroidizem

Po podatkih študije iz leta 2015 v angleškem jeziku ni bilo ugotovljenih nobenih raziskav RCT v zvezi s kitajsko zeliščno medicino za zdravljenje hipotiroidizma. Pri novejšem iskanju na kitajski nacionalni infrastrukturi znanja (CNKI) s ključnimi besedami “中藥” (kitajska zeliščna medicina) in “甲減” (hipotiroidizem) je bilo najdenih 175 člankov, vendar vrste in kakovost raziskav niso znane.

V članku iz Pekinga iz leta 2021 je bila predstavljena metaanaliza, ki je preučevala terapevtsko učinkovitost kitajskih zeliščnih receptov za subklinično hipotirozo. Ugotovitve so pokazale, da je TKM sama in v kombinaciji s konvencionalnimi terapijami učinkovita pri zdravljenju subklinične hipotiroze. Te metode lahko zagotovijo precejšnje prednosti pri zniževanju ravni TSH in izboljšanju dislipidemije. [Preberi več: Kako lahko zeliščna medicina pomaga pri uravnavanju hormonov]

V eni od raziskav so analizirali sindrom TKM in z njim povezane dejavnike, ki vplivajo na Hashimotov tiroiditis (HT) v kombinaciji s hipotiroidizmom. Med 232 bolniki s HT v kombinaciji s hipotirozo je bilo 219（94,40 %） žensk in 13（5,60 %） moških. Večina bolnikov je bila stara od 31 do 60 let, največ jih je bilo starih od 46 do 60 let. Srednja starost skupine je bila 45 let, povprečna starost pa 43,64±13,41 let.

Porazdelitev sindroma TKM pri 232 bolnikih s HT v kombinaciji s hipotirozo je bila:

93 (40,09 %) stagnacija jeter in pomanjkanje vranice Simptomi: predmenstrualna napetost dojk, razdražljivost, strunast pulz, suho in tanko blato, odtisi zob na jeziku in neizoblikovano blato
66 (28,45 %) s pomanjkanjem vranice, ledvic in janga Simptomi: otekanje obraza, otekle okončine, šibek menstrualni tok, bolečine in šibkost v pasu in kolenih ter lumbago
42 (18,10 %) z interakcijo sluzi in zastajanja krvi Simptomi: otrplost okončin, dismenoreja, bolečine v vratu in temno rdeč jezik
31 (13,36 %) s pomanjkanjem qi-yina Simptomi: tanek pulz, suhe oči, panika, nočno potenje, rdeč jezik in zaprtje

V drugi študiji, objavljeni leta 2023, so bile preučene značilnosti pristopa profesorja Xiang Nana k zdravljenju Hashimotovega tiroiditisa v povezavi s hipotiroidizmom z organizacijo in analizo zdravstvenih kartotek bolnikov z diagnozo Hashimotovega hipotiroidizma, ki so se med oktobrom 2020 in junijem 2022 zdravili pri profesorju Xiang Nanu na oddelku za bolezni ščitnice bolnišnice tradicionalne kitajske medicine v provinci Hubei. V študijo je bilo vključenih 248 receptov za Hashimotovo hipotirozo, ki so vključevali skupno 163 kitajskih zdravil rastlinskega izvora. Statistika pogostosti kitajskih zelišč je pokazala, da so bila pogosto uporabljena zdravila

Astragalus 黃芪
Radix Codonopsis 黨參
Atractylodes 白朮
Cinnamomum 肉桂
Poria 茯苓
Cistanches 肉蓯蓉
Angelica 當歸
Radix et Rhizoma 甘草
Radix Rehmanniae 地黃
Pericarpium Citri Reticulatae 陳皮

Ključni koncepti TKM, povezani s hipotiroidizmom

Pomanjkanje ledvičnega janga:

V TKM je hipotiroidizem pogosto povezan s pomanjkanjem ledvičnega janga. To pomanjkanje povzroča pomanjkanje toplote in energije, kar se kaže kot simptomi, kot so utrujenost, preobčutljivost na mraz in počasen metabolizem.

Pomanjkanje qija vranice:
Vranica ima pomembno vlogo pri predelavi in prenašanju hranilnih snovi. Pomanjkanje lahko povzroči simptome, kot so utrujenost, napihnjenost in pridobivanje telesne teže, ki so pogosti tudi pri hipotirozi.
Zastoj jetrnega qija:
Čustveni dejavniki lahko prispevajo k zastoju qija jeter, kar lahko še dodatno poruši ravnovesje v telesu in poslabša simptome hipotiroze. [5, 6]

V resnici je slika TKM veliko bolj zapletena. Na primer, za ledvice in jetra je v TKM znano, da imajo isti izvor (肝腎同源), zato moramo pri iskanju patogeneze ledvic pogosto hkrati upoštevati tudi druge sisteme.

Pomanjkanje ledvičnega janga je dejansko le "znak“ nizke energije ognja, vendar ni vedno primarni vzrok. Pogost potek pomanjkanja ledvičnega janga, ki ga opažam v svoji klinični praksi, je pretiran jetrni ogenj, ki ga povzroča močan zastoj jetrnega qija, v TKM znan kot 肝鬱化火. Ko je zastoj jetrnega qija intenziven, kri v jetrih ne more nemoteno krožiti. Ker so jetra v teoriji TKM "general" 將軍之官, so odgovorna za dostavo energije iz globoke ravni in spodnjega grelca v celotno telo. V primeru zastoja jetrnega qija se ministrski ogenj 相火 ne more sprostiti navzgor in navzven, zato se zatakne in pokuri tako jetrni kot ledvični jin. Ko ledvice izgubijo energijo jin, v skladu s soodvisnostjo jina in janga izgubijo tudi energijo jang. To je zelo pomemben koncept, ki usmerja pravilen pristop k zdravljenju. V nasprotnem primeru, če zdravnik TKM preprosto sledi razlagi iz učbenika ali umetne inteligence, ne da bi natančneje opredelil patogenezo TKM, lahko na koncu zgolj "prilijemo olje na ogenj". [Jing, Qi in Shen: trije zakladi v tradicionalni kitajski medicini] [Preberi več: Pomanjkanje Qi energije: kaj to je in kako jo obvladati?]

Študije primerov kitajske zeliščne medicine za hipotiroidizem

Ženska M, 1976

Prvi obisk: 10. 1. 2022

Hipotiroidizem so pacientki diagnosticirali leta 2007, ko je bila v petem mesecu nosečnosti z drugim otrokom. Jemala je levotiroksin in stanje je bilo pod nadzorom, brez posebnih simptomov, povezanih s hipotirozo. Njen spanec in splošna energija sta bila dobra. Poročala se je o nestabilnem menstrualnem toku, ki je včasih močan, včasih šibek, z rahlo bolečino v trebuhu, rdeče barve, 5 dni krvavitve, zadnja menstruacija 20. 12. 2021, maternični vložek uporablja 4 leta. Njen apetit je dober, vendar ni jedla zajtrka.

Jezik je bil svetlordeč, z očitno razpoko na sredini, svetle dlačice.

Nekoliko močnejši in gostejši pulz, močan jetrni pulz, majhen želodčni pulz.

Zdravljenje:

Pri prvih štirih obiskih od januarja 2022 do aprila 2022 je bil glavni poudarek na izboljšanju moči želodca in prebave, obenem pa smo nežno blažili jetra. Od petega obiska maja 2022 so bila dodana zelišča za čiščenje jeter, pri pacientki pa so se pojavili stranski učinki bolečine pod rebri. Naročeno ji je bilo, da zmanjša odmerek, vendar nadaljuje z jemanjem zelišč. [Preberi več: Hrano je potrebno skuhati – tradicionalna kitajska medicina pojasni prebavni sistem]

Ob osmem obisku v juliju 2022 je pacientka po normalnem osnovnem krvnem testu začela prepolavljati odmerek levotiroksina. Opravljen je bil še en krvni test za spremljanje učinka zmanjšanega odmerka levotiroksina, v avgustu 2022 pa se je vrednost antitiroglobulina povečala na nenormalno raven. Krvni test ščitnice so ponovili vsake 3 mesece in število antitiroglobulinov je kazalo trend upadanja. Medtem je pacientka še naprej postopoma zmanjševala odmerek levotiroksina, dokler ga ni julija 2023 popolnoma prenehala jemati. Pacientka je do junija 2024 nadaljevala z zdravljenjem s kitajskim zeliščnim zdravilom rastlinskega izvora, skupaj je opravila 30 obiskov. Zatem je po elektronski pošti sporočila, da je krvni test ščitnice normalen.

Ženska N, 1979

Prvi obisk: 16. 3. 2023

Pacientki so leta 2019 diagnosticirali hipotirozo in od takrat je jemala zdravila. Poročala je tudi o pogostih in ponavljajočih se vnetjih srednjega ušesa in bolečinah v zapestju. V oktobru 2021 in decembru 2022 je imela COVID ter delno izgubila vonj in okus.

Splošni pristop k zdravljenju je enak kot v prvem primeru: najprej se preveri izhodiščni krvni test, nato se postopoma zmanjšuje odmerek levotiroksina. Zdravilo je popolnoma prenehala jemati 20. 4. 2024. Krvni test 16. 5. 2024 je pokazal povišan TSH, vendar se je po ponovitvi zelišč za čiščenje jeter in nadaljnji prilagoditvi obvladovanja stresa vrnil v normalno stanje.

Ključ do uspešnega zdravljenja hipotiroze

Obe pacientki iz primerov sta pokazali močno odločnost in zaupanje v TKM ter sta se kljub začetnim pomanjkljivostim pri prilagajanju ves čas zdravljenja držali priporočenih sprememb življenjskega sloga in prehrane. V drugem primeru se je po prenehanju učinkovanja zdravil izkazalo, da je bil prej zadosten odmerek kitajskega zeliščnega zdravila sam po sebi neučinkovit pri obvladovanju bolezni. Namesto da bi povečali odmerek zelišč, smo se posvetili obsežni razpravi, osredotočeni na prepoznavanje in lajšanje stresnih dejavnikov v njenem življenju. Na srečo sta obe pacientki na koncu občutili koristi svojih prizadevanj. [Preberi več: 8 nasvetov za zdravo ščitnico]

Viri:

Ke LQ, Hu Y, Yang K, Tong N. Chinese herbal medicines for hypothyroidism. Cochrane Database Syst Rev. 2015 Feb 12;2015(2):CD008779. doi: 10.1002/14651858.CD008779.pub2. PMID: 25914906; PMCID: PMC10625441.
[1]邹林蓁,孟淑华,魏军平.中药复方干预亚临床甲状腺功能减退症疗效的Meta分析[J].世界中西医结合杂志,2021,16(10):1765-1777.DOI:10.13935/j.cnki.sjzx.211001. (Therapeutic Efficacy of Chinese Herbal Prescriptions on Subclinical Hypothyroidism:A Meta-Analysis)
吴天强. 桥本甲状腺炎合并甲减的中医证型分布及相关因素分析[D].黑龙江中医药大学,2023.DOI:10.27127/d.cnki.ghlzu.2023.000350. (Analysis of Tcm Syndrome Type Distribution and Related Influencing Factors of Hashimoto’s Thyroiditis Combined with Hypothyroidism)
张丽华. 向楠教授治疗桥本甲状腺炎合并甲状腺功能减退症用药规律及网络药理学研究[D].湖北中医药大学,2023.DOI:10.27134/d.cnki.ghbzc.2023.000129. (Professor Xiang Nan’s Treatment of Hashimoto’s Thyroiditis Combined with Hypothyroidism and Network Pharmacology)
董昭熙，柳红芳，宿家铭，温雅轩，史扬，郑毅成，郭宇鑫.柳红芳从“乙癸同源”论治桥本甲状腺炎经验.[J].中医药导报,2022,28(12):173-176,180.
https://m.fx361.com/news/2023/1217/22778679.html

TCM Herbal Medicine for Hypothyroidism: Current Evidence and 2 Case Reports

Hypothyroidism is a medical condition characterized by the inadequate production of thyroid hormones by the thyroid gland, which are crucial for regulating the body's metabolism. Typical symptoms associated with hypothyroidism include fatigue and lethargy, heightened sensitivity to cold, constipation, dry and pale skin, brittle nails and hair, facial puffiness, a hoarse voice, unexplained weight gain, muscle discomfort, tenderness, stiffness, weakness, joint pain, swelling, heavier menstrual cycles, and depression symptoms.

In Traditional Chinese Medicine (TCM) theory, the philosophical principles of Yin and Yang characterize hypothyroidism as a common manifestation of "weak Yang." This condition may indicate either a deficiency in Yang, which represents activation, strength, and movement, or an excess of Yin, associated with suppression, tranquility, and stillness. In clinical practice, patients often have mixed causes resulting in a complex pathological picture. Even though Chinese herbal medicine is widely used in China for various diseases, including hypothyroidism, no RCTs were found for Chinese herbal medicine on hypothyroidism [1]. In this article, we will share 2 cases of hypothyroidism managed by Chinese herbal medicine and discuss the TCM herbal theory and the challenges of treatment. [Read more: Balancing the Thyroid with TCM] [Read more: Traditional Chinese Medicine for Thyroid Diseases]

Current evidence on TCM herbal medicine for hypothyroidism

According to a study in 2015[1] in English, no RCTs were found in Chinese herbal medicines for hypothyroidism. A more recent search on the China National Knowledge Infrastructure (CNKI) using the keywords “中藥” (Chinese herbal medicine) and “甲減”(hypothyroidism), 175 articles were found but the types and quality of research are unknown.

A 2021 article from Beijing[2] presented a meta-analysis that investigated the therapeutic efficacy of Chinese herbal prescriptions for subclinical hypothyroidism. The findings indicated that TCM, both alone and in conjunction with conventional therapies, is effective in managing subclinical hypothyroidism. These methods may provide considerable advantages in reducing TSH levels and improving dyslipidemia.

One study[3] analyzed the TCM syndrome and related influencing factors of Hashimoto’s Thyroiditis (HT) combined with hypothyroidism. Among 232 patients with HT combined with hypothyroidism 219（94.40%）were female and 13（5.60%）were male. The majority of patients were aged between 31 and 60 years, with the highest number falling within the 46 to 60-year age range. The median age of the group was 45 years, and the average age was 43.64±13.41 years. [Read more: How herbal medicine can help balancing hormones]

The distribution of TCM syndrome in 232 patients with HT combined with hypothyroidism was:

93 (40.09%) liver-depression and spleen-deficiency Symptoms: premenstrual breast distension, irritability, stringy pulse, dry and thin stools, tooth-marked tongue, and loose stools
66 (28.45%) spleen-kidney-yang-deficiency Symptoms: facial swelling, swollen limbs, low menstrual flow, soreness and weakness of the waist and knees, and lumbago
42 (18.10%) phlegm-stasis interaction Symptoms: numbness of the limbs, dysmenorrhea, neck pain, and dark red tongue
31 (13.36%) with qi-yin deficiency Symptoms: thin pulse, dry eyes, panic, night sweats, red tongue, and constipation

Another study published in 2023[4] examined the features of Professor Xiang Nan's approach to treating Hashimoto's thyroiditis in conjunction with hypothyroidism by organizing and analyzing the medical records of patients diagnosed with Hashimoto’s hypothyroidism who received treatment from Professor Xiang Nan at the Department of Thyroid Diseases, Hubei Provincial Hospital of Traditional Chinese Medicine, between October 2020 and June 2022. A total of 248 prescriptions for Hashimoto’s hypothyroidism were included in the study, involving a total of 163 Chinese herbal medicines. The frequency statistics of Chinese herbs showed that the commonly used drugs were

Astragalus 黃芪
Radix Codonopsis 黨參
Atractylodes 白朮
Cinnamomum 肉桂
Poria 茯苓
Cistanches 肉蓯蓉
Angelica 當歸
Radix et Rhizoma 甘草
Radix Rehmanniae 地黃
Pericarpium Citri Reticulatae 陳皮

Key TCM Concepts related to hypothyroidism

Kidney Yang Deficiency:
In TCM, hypothyroidism is often associated with a deficiency of Kidney Yang. This deficiency leads to a lack of warmth and energy, which manifests as symptoms like fatigue, cold intolerance, and slow metabolism.
Spleen Qi Deficiency:
The Spleen plays a vital role in transforming and transporting nutrients. A deficiency can result in symptoms like fatigue, bloating, and weight gain, which are also common in hypothyroidism.
Liver Qi Stagnation:
Emotional factors can contribute to Liver Qi stagnation, which can further disrupt the body's balance and exacerbate hypothyroidism symptoms. [5, 6]

In reality, the TCM picture is much more complicated. For instance, the kidney and Liver are known in TCM for sharing the same origin (肝腎同源), when we look for the pathogenesis of the Kidney, we often need to consider other systems simultaneously.

Kidney Yang deficiency is indeed just a “sign” of low fire energy but it is not always a primary course. A common course of Kidney Yang deficiency as observed in my clinical practice is excessive Liver fire caused by severe Liver Qi Stagnation, known in TCM as 肝鬱化火. When the Liver Qi stagnation is intense, the blood in the liver cannot circulate smoothly. Since the Liver in TCM theory is a “general” 將軍之官, it is responsible for delivering the power from the deep level and lower burner to the whole body. In the case of Liver Qi stagnation, the ministerial fire 相火 is not able to release upward and outward, so it gets stuck and burns out both the Liver and Kidney Yin. When the Kidney loses the Yin energy, according to the Yin and Yang interdependence, the Kidney also loses the Yang energy. This is a very important concept that guides the correct treatment approach. Otherwise, if the TCM physician simply follows the textbook or AI explanation without further defining the TCM pathogenesis, we might end up “putting fuel to the fire”. [Read more: Jing, Qi & Shen: The Three Treasures in Traditional Chinese Medicine] [Read more: Qi deficiency: What is it and how do you manage it?]

Case studies of Chinese herbal medicine for hypothyroidism

Female M, 1976

First visit: 10.1.2022

The patient was diagnosed with hypothyroidism in 2007 when she was 5 months pregnant with her second child. She has been taking Levothyroxine, and the condition is under control with no specific symptoms related to the hypothyroidism. Her sleep and general energy were good. She complained about unstable menstrual flow which is sometimes heavy and sometimes light, with slight abdominal pain, red colour, 5 bleeding days, LMP 20.12.2021, using an intrauterine device for 4 years. Her appetite is good but she did not eat breakfast.

Tongue was light red, with an obvious crack in the middle, light fur.

Slight heavier and thicker pulse, strong liver pulse, small stomach pulse.

Treatment:

For the first 4 visits from 1.2022 to 4.2022, the main focus was to improve her stomach power and digestion, while gently smoothing her liver. From the fifth visit in 5.2022, liver cleansing herbs were added and the patient showed side effects of pain under the ribs. She was instructed to lower the dosage but continue with the herbs. [Read more: Cook your food - digestive system explained in Traditional Chinese medicine]

On the 8th visit in 7.2022, after a normal baseline blood test, the patient started to halve the dosage of Levothyroxine. Another blood test was done to monitor the effect of the lowered Levothyroxine, and the antithyroglobulin increased to an abnormal level in 8.2022. The thyroid blood test was repeated every 3 months and the number of antithyroglobulin was showing a decresing trend. In the meantime, the patient continue to lower the dosage of Levothyroxine gradually, until 7.2023 it was completely stopped. The patient continued the Chinese herbal medicine until 6.2024, with a total of 30 visits. She was followed up by email afterwards and the thyroid blood test came back normal.

Female N, 1979

First visit: 16.3.2023

The patient was diagnosed with hypothyroidism in 2019 and was under medication since. She also complained about frequent and recurring middle ear infections and wrist pain. In 10.2021 and 12.2022 she had COVID and lost part of her smell and taste.

The overall treatment approach is the same as the first case: first check the baseline blood test, then gradually decrease the dosage of Levothyroxine. She stopped the medication completely on 20.4.2024. The blood test on 16.5.2024 showed elevated TSH but back to normal after repeating the liver-cleaning herbs and further adjusting the stress management.

The key to the successful treatment of hypothyroidism

Both patients in the earlier case exhibited strong determination and confidence in TCM and adhered to the recommended lifestyle and dietary changes throughout the treatment process, despite initial imperfections in their adjustments. In the second case, once the effects of the medication wore off, the previously sufficient dosage of Chinese herbal medicine alone proved ineffective in managing the condition. Rather than increasing the herbal dosage, we engaged in an extensive discussion focused on identifying and alleviating stressors in her life. Fortunately, both patients ultimately reaped the benefits of their efforts. [Read more: 8 Healthy Tips for Thyroid]

Reference:

Ke LQ, Hu Y, Yang K, Tong N. Chinese herbal medicines for hypothyroidism. Cochrane Database Syst Rev. 2015 Feb 12;2015(2):CD008779. doi: 10.1002/14651858.CD008779.pub2. PMID: 25914906; PMCID: PMC10625441.
[1]邹林蓁,孟淑华,魏军平.中药复方干预亚临床甲状腺功能减退症疗效的Meta分析[J].世界中西医结合杂志,2021,16(10):1765-1777.DOI:10.13935/j.cnki.sjzx.211001. (Therapeutic Efficacy of Chinese Herbal Prescriptions on Subclinical Hypothyroidism:A Meta-Analysis)
吴天强. 桥本甲状腺炎合并甲减的中医证型分布及相关因素分析[D].黑龙江中医药大学,2023.DOI:10.27127/d.cnki.ghlzu.2023.000350. (Analysis of Tcm Syndrome Type Distribution and Related Influencing Factors of Hashimoto’s Thyroiditis Combined with Hypothyroidism)
张丽华. 向楠教授治疗桥本甲状腺炎合并甲状腺功能减退症用药规律及网络药理学研究[D].湖北中医药大学,2023.DOI:10.27134/d.cnki.ghbzc.2023.000129. (Professor Xiang Nan’s Treatment of Hashimoto’s Thyroiditis Combined with Hypothyroidism and Network Pharmacology)
董昭熙，柳红芳，宿家铭，温雅轩，史扬，郑毅成，郭宇鑫.柳红芳从“乙癸同源”论治桥本甲状腺炎经验.[J].中医药导报,2022,28(12):173-176,180.
https://m.fx361.com/news/2023/1217/22778679.html