the treatment of thyroid problems in chinese medicine

Copyright Giovanni Maciocia

馬

萬

里

THE TREATMENT OF THYROID PROBLEMS IN CHINESE

MEDICINE

There is no discussion of thyroid problems in the old classics of Chinese

medicine because they did not have any knowledge of such an organ nor

of the role of thyroxine. However, there are many old books that discuss

the treatment of goitre. For this reason, I will start by discussing the

Chinese pathology and treatment of goitre.

The presentation will encompass four topics:

1) The diagnosis, pathology and treatment of goitre in Chinese medicine

2) The thyroid in Western medicine

3) The treatment of thyroid problems with Chinese medicine

4) Thyroid problems and auto-immunity from a Chinese medicine

perspective

“Goitre” refers to a swelling of the thyroid gland. Although the old

Chinese doctors did not know about the thyroid nor the role of

thyroxine, they did have quite a sophisticated theory on the aetiology,

pathology and treatment of goitre.

A goitre (or goiter) is a swelling of the thyroid gland which can lead to

a swelling of the neck or larynx. Goitre may be associated with a

thyroid gland that is functioning properly or not. Worldwide, over 90%

cases of goitre are caused by iodine deficiency.

The most common cause (90%) of goitre is iodine deficiency in

people who live in mountains and have no access to iodized salt.

Selenium deficiency also plays a role.

Another cause of goitre is Hashimoto’s thyroiditis which is an auto-

immune disease that causes hypothyroidism.

Graves’ disease, that causes hyperthyroidism – also an auto-immune

disease - may also manifest with goitre.

The symptoms of a goitre include:

• Enlargement of the throat, ranging from a small lump to a huge

mass

• Swallowing problems, if the goitre is large enough to press on the

oesophagus

• Breathing problems, if the goitre is large enough to press on the

trachea

Goitres are broadly classified into the two groups of endemic and

sporadic

In Endemic goitre, a whole community is affected by insufficient dietary

iodine. One common reason is that the soil is iodine depleted. Certain

areas of Australia, including Tasmania and areas along the Great Dividing

Range, have low iodine levels in the soil.

Mountainous areas and areas far from the sea are the ones most likely to

be iodine deficient. However, endemic goitres tend to be more prevalent in

developing countries. They are rare in developed countries because of

widespread iodine supplementation.

There is also evidence of a re-emergence of iodine deficiency in cities like

Melbourne and Sydney.

In Sporadic goitre, only the individual is affected. Risk factors for

sporadic goitre include family history, diet, age (over 40 years) and sex

(women are more susceptible than men).

Goitre can be caused by a range of factors, including:

• Insufficient iodine in the diet.

• High consumption of certain foods that neutralise iodine, such as

cabbage, broccoli Brussels sprouts and cauliflower.

• Certain drugs, such as lithium and phenylbutazone

• Thyroid cancer

• Nodules growing on the thyroid gland

• Hyperthyroidism

• Hypothyroidism

Diagnosis methods

A goitre, and its underlying causes, is diagnosed using a number of tests,

including:

• Physical examination

• Blood tests - to check for thyroid hormone levels and particular antibodies

• Ultrasound scan

• Fine needle biopsy

• Radioactive iodine scan

Types of goitre

Goitres can be either diffuse or multi-nodular. A multinodular goitre is

usually a simple goitre that has progressed to nodularity.

Diffuse goitre Nodular goitre

Chinese medicine note:

diffuse goitre suggests Phlegm;

nodular suggests Blood stasis

Treatment options in biomedicine

Treatment depends on the underlying cause:

• Goitre caused by iodine deficiency can be helped with the

introduction of iodine-rich foods into the diet, such as seafood and

iodised salt.

• Hyperthyroidism is managed with drugs that slow the activity of the

thyroid. Methimazole (Tapazole®), Propylthiouracil (PTU) or

radioactive iodine-131.

• Hyperthyroidism may also be treated by surgery: part or all of the

thyroid gland is surgically removed.

• Hypothyroidism is treated by lifelong thyroid hormone replacement

therapy.

• Benign thyroid nodules are shrunk with medications, destroyed with

radioactive iodine treatment or surgically removed, depending on the

type.

• Cancer of the thyroid is treated by surgical removal of the gland,

followed by radioactive iodine treatment.

Thyroid nodules

Thyroid nodules are lumps that grow on the gland. Nodules are

classified into two groups:

Hot or warm - these nodules account for around 15 per cent of cases,

and can cause hyperthyroidism. The cancer risk is low

Cold - these nodules account for around 85 per cent of cases. Around

20 per cent of these are cancerous.

Chinese Medicine Note: hard nodules on thyroid are often due to Blood

stasis or Liver-Fire (or both).

Thyroid cancer

Sometimes, the thyroid gland is enlarged because of cancer. The

incidence rates are very low and the cure rate is very good. Risk factors

include:

• Chronic goitre

• Family history

• Female sex

• Radiation exposure - high doses of radiation were used during the

1950s to treat disorders of the throat and skin.

Chinese Medicine Note: cancer of the thyroid is due to Blood stasis and

Phlegm.

GOITRE 瘿

• Qi stagnation and Phlegm

• Liver-Qi stagnation, Spleen- Qi deficiency and Phlegm

• Phlegm and Blood stasis

• Liver-Fire blazing with Phlegm-Heat

• Heart- and Liver-Yin deficiency with Phlegm

HYPOTHYROIDISM

• Spleen- and Kidney-Yang deficiency

• Qi and Blood deficiency

• Liver- and Kidney-Yin deficiency

HYPERTHYROIDISM

• Liver-Fire

• Heart-Fire

• Liver- and Kidney-Yin deficiency with

Empty Heat

• Liver Phlegm-Heat

• Blood stasis

GOITRE 瘿

The clinical symptom of goitre shall be discussed first as in ancient and

modern Chinese books and then the pathology and treatment of thyroid

problems will also be covered.

“Goitre” is not a “disease” in a Western sense but simply a clinical sign:

hypo- or hyper-thyroidism, by contrast, are “diseases” in a Western sense.

Nevertheless, “Goitre” is a “disease” in the context of Chinese medicine.

In Chinese, goitre is called Ying [瘿]. Ancient books mentioned:

There are records of goitre in Chinese medicine as early as 3rd century BC. The

name Ying appears in a book from the Warring States period:

“There are more people with bald head and with goitre in places of light water.”

This statement shows that the ancient Chinese were aware of environmental

goitre.

You Ying

(Worry

Goitre)

Shi Ying

(Stone

Goitre)

Lao Ying

(Exhaustion

Goitre)

Tu Ying

(Earth

Goitre)

Qi Ying

(Qi Goitre)

Another book tells the following story:

“A man called Jia Gui developed goitre due to anger. The goitre grew

large and he wanted a doctor to remove it. The minister Cao Cao

persuaded him not to have the operation by saying that 9 out of 10 people

who have had the operation died.”

The “General Treatise on the Aetiology and Symptomatology of Diseases”

(Zhu Bing Yuan Hou Zhong Lun, 610 AD) illustrates the cause of goitre as

emotional stress and environment by saying:

“Goitre results from worry leading to Qi stagnation. It may also be caused

by drinking sandy water, the sand follows Qi into the channels and vessels

and accumulates in the neck.”

“ Do not live long in mountainous regions with black earth and spring

water. Drinking such water for a long time may cause goitre.”

The book “Thousand Golden Ducat Prescriptions” (Qian Jin Yao Fang)

by Sun Si Miao records dozens of formulae for goitre recommending the

use of:

thyroid of sheep and deer Hai Zao Kun Bu

This shows that ancient doctors had an understanding of the role of seaweeds

in thyroid disease even though they obviously did not know about iodine and

its role in the thyroid physiology.

Other books classified goitre into “Stone Ying”, “Sand Ying”, “Exhaustion

[Lao] Ying”, “Worry Ying” and “Qi Ying”.

The book “Treatise on the Three Categories of Aetiology of Diseases” (San Yin

Ji Yi Bing Zheng Fang Lun) has a different classification of goitre:

“Goitre that feels hard and tough and does not move is called Stone Ying. A

goitre that does not change the colour of the skin is called Muscle Ying. That

with exposed sinews is called Sinews Ying. That with exposed vessels is called

Blood Ying. That which changes size according to emotions is called Qi Ying.”

“In all five types of goitre do not break [Blood] as this may cause a massive

discharge of pus and blood and untimely death.”

Qi Stone Sinews Muscle Blood

Note that the five tissues skin, muscles, sinews, blood vessels and

bones are often used in the classics as code words for different

energetic layers. They often refer to a different energetic depth of

various pathologies.

They sometimes refer to the 5 Zang organs. For example, in the

chapter where the Nei Jing talks about the “5 Exhaustions” it says that

various activities damage the “skin”, “muscles”, “sinews”, etc.

meaning Lungs (skin), Spleen (Muscles), Liver (Sinews), Heart

(blood vessels) and Kidneys (Bones).

The energetic order of depth is:

• Skin

• Muscles

• Sinews

• Blood vessels

• Bones

In the case of goitre, the above text refers to “Qi” rather than “skin”

and to “Stone” rather than “bones” but with the same energetic depth.

Skin

Muscles

Sinews

Blood vessels

Bones

Su Wen chapter 23: “Excessive use of the eyes injures Blood

[Heart]; excessive sleep injures Qi [Lungs]; excessive sitting

injures the muscles [Spleen]; excessive standing injures the

bones [Kidneys]; excessive walking injures the sinews [Liver].

Lungs

Spleen

Liver

Heart

Kidneys

Another book says:

“All three herbs Hai Zao, Kun Bu and Hai Dai are from the sea. Eat at

least two of them often and goitre will be prevented.”

Another book mentions the use of Huang Yao Zi to cool Blood, drain Fire,

dissolve goitre and resolve Toxin. The book also asks people to look in

the mirror and stop taking Huang Yao Zi when the goitre disappears or

measure the size of the goitre with a thread every day to know exactly the

results of the tincture. This shows that the old doctors were aware of the

potential (liver) toxicity of this herb.

Huang Yao Zi Tuber Dioscoreae bulbiferae

HUANG YAO ZI Tuber Dioscoreae bulbiferae

(Chen JK and Chen T Chinese Medical Herbology and Pharmacology)

1) Disperses stagnation and resolves masses

2) Clear Heat and Toxin

3) Cools Blood and stops bleeding

Cautions

Though rare, the use of Huang Yao Zi has been associated with potential

liver damage. Liver function must be monitored when prescribing Huang

Yao Zi.

Effective in thyroid cancer and hyperthyroidism.

Another book considers Qi stagnation, Phlegm and Blood stasis as the

main pathogenic factors in simple goitre. So the treatment method

should be to move Qi, invigorate Blood, resolve Phlegm and soften

masses. The book mentions the formula Hai Zao Yu Hu Tang that is

still widely used today.

Another book says:

“Simple goitre results from Qi and Blood stagnation. It is a disease

that develops slowly for years; it is called Ying because the skin is

enlarged like a cherry stone [Ying Tao].”

Ancient Chinese doctors were aware that seaweeds can help goitre

even though they did not know about the role of iodine in the

physiology of the thyroid. Note that, from the Chinese point of view,

seaweeds also help goitre because they are “softening”, i.e. the soften

masses.

1. AETIOLOGY

a) EMOTIONAL STRESS

Anger, worry, grief, shame, guilt, fear and pensiveness may all lead to

Qi stagnation after a period of time. This may affect not only the Liver

which loses its free flow of Qi, but also the Lungs (whose Qi fails to

descend and stagnates in the chest and throat), the Stomach (whose Qi

fails to descend), the Heart (whose Qi fails to descend affecting the

throat) and the Spleen (whose Qi fails to ascend giving rise to Phlegm).

Qi stagnation in various organs affects the proper functioning of the Qi

Mechanism and this disrupts the proper movement of Qi in the right

directions and therefore also the movement and transformation of fluids.

This eventually leads to Phlegm.

Emotions

Liver

Lungs

Stomach

Heart

Spleen

Qi stagnation

No free flow

Qi not ascending

Qi not descending

Qi not descending

Qi not descending

Qi stagnation in throat

Qi stagnation and Phlegm interact and both focus on the front of the

throat where the Liver, Lung and Heart channels flow.

In the beginning stages, this type of Phlegm is called “Qi-Phlegm”

and is the most non-substantial type of Phlegm. This type of goitre

lump, especially in the beginning stages when there is only Qi

stagnation, would go up and down in size.

In time, Qi stagnation may lead to both Phlegm and Blood stasis. It leads to

Blood stasis as stagnant Qi fails to move Blood. It leads to Phlegm because

stagnant Qi fails to move fluids which accumulate into Phlegm.

Qi stagnation

Blood stasis

Phlegm

After a prolonged time, Qi stagnation may lead to Blood stasis which,

in itself, interacts with Phlegm: in such cases, the goitre lump would

be hard, not going up and down in size and probably painful.

Please note that Qi stagnation deriving from emotional stress does not

affect only the Liver but also the Lungs, Heart, Stomach and Spleen.

Qi stagnation of all these organs plays a role in the pathology of goitre.

b) DIET

Irregular eating, excessive consumption of greasy foods or dairy foods

weaken the Spleen and Stomach which cannot transform and transport

food essences which leads to the formation of Phlegm.

Irregular diet also disrupts the Qi mechanism and leads to Qi

stagnation and eventually Blood stasis which contributes to the

formation of goitre.

c) ENVIRONMENT

People who live in high mountainous regions lack iodine in the water and

this may contribute to goitre. Although they did not know about the role

of iodine in thyroid disorders, the ancient Chinese doctors did observe the

higher incidence of goitre in people living in high mountains but attributed

that to factors other than iodine. They frequently mentioned the water or

the soil as environmental causes of goitre.

Some ancient books talked about a “cold poison” in the water in high

mountains in the North-West of China. As indicated above, other

doctors mentioned the presence of “sand” in the water; yet others

mentioned “black earth” and “spring water” as environmental causes

of goitre.

Interestingly, although the ancient Chinese doctors did not know

about the role of iodine (or the lack of it) in the pathology of goitre,

they did observe the beneficial effect of seaweeds on goitre.

d) CONSTITUTION

Women are more prone to goitre. This is partly because of the relationship

between the Liver channel on both goitre and menstruation.

Because of menstruation, pregnancy and lactation, the Liver channel is

much more prone to Qi and/or Blood stagnation in women and this causes a

higher incidence of goitre in them. Excessive blood loss after childbirth or

from menorrhagia and overwork may also lead to depletion of Liver and

Kidneys in women and predispose them to goitre.

Another reason why women are more prone to goitre lies in the

relationship between the Uterus and the Ren Mai and Chong Mai.

The Ren and Chong Mai flow through the uterus and they deeply influence

menstruation, conception and pregnancy.

Many cases of goitre in women are a reflection of a pathology of these two

vessels in the Uterus which is transmitted upwards to the throat via the

Ren and Chong Mai.

That is why women with goitre outnumber men by 8:1 and also why

thyroid problems are very often associated with menstrual problems.

2. PATHOLOGY

In “Goitre”, Chinese pathology is essentially concerned only with the Biao

(rather than the Ben) of goitre, i.e. Qi stagnation, Blood stasis and Phlegm.

The Ben is usually a deficiency of Qi, Yang or Yin. In hypothyroidism,

the Ben is usually Yang deficiency and in hyperthyroidism, Fire or Empty

Heat.

There is no direct correspondence between the Chinese disease-symptom

of “Goitre” and thyroid problems in Western medicine. Hence, Chinese

medicine discusses only goitre, while Western medicine discusses many

thyroid dysfunctions such as:

Graves’ disease Hyperthyroidism Hypothyroidism

Chinese medicine disease categories include only “Goitre”. Therefore

ancient Chinese medicine did not provide a theory on the pathology of

thyroid dysfunctions.

Hashimoto thyroiditis

Most doctors consider Qi stagnation, Phlegm and Blood stasis as the

main pathogenic factors in simple goitre. So the treatment method

should be to move Qi, invigorate Blood, resolve Phlegm and soften

masses. The formula Hai Zao Yu Hu Tang that is still widely used today.

Qi stagnation

Phlegm

Blood stasis

Move Qi

Invigorate Blood

Resolve Phlegm

Soften hardness

Dissolve masses

Please note that, while seaweeds are good in hypothyroidism,

they are better avoided in hyperthyroidism. Please keep this

in mind when reviewing the prescriptions for hyperthyroidism

that might have seaweeds.

HAI ZAO YU HU TANG Sargassum Jade Flask Decoction 海藻玉壶汤

Hai Zao Sargassum

Kun Bu Thallus Laminariae seu Ekloniae

Hai Dai Herba Zosterae marinae

Zhe Bei Mu Fructus Fritillariae thunbergii

Ban Xia Rhizoma Pinelliae

Du Huo Radix Angelicae pubescentis

Dang Gui Radix Angelicae sinensis

Chuan Xiong Rhizoma Chuanxiong

Qing Pi Pericarpium Citri reticulatae viride

Chen Pi Pericarpium Citri reticulatae

Lian Qiao Fructus Forsythiae suspensae

Gan Cao Radix Glycyrrhizae

Each of the thyroid biomedical diseases can manifest with or without goitre:

therefore, Chinese medicine does not really have a theory of thyroid

problems without goitre and these must simply be treated according to the

normal identification of patterns.

Thyroid dysfunctions without goitre may correspond to unrelated Chinese

disease categories. For example, hypothyroidism may correspond to

Exhaustion (Xu Lao) or Oedema in Chinese medicine, while

hyperthyroidism may correspond to “Palpitations and Anxiety” or

“Tremors”.

As Chinese medicine focuses only and entirely on goitre, its pathology and

treatment is focussed on the treatment of masses, i.e. it stresses the treatment

methods of “dissolving masses”, “dissolving nodules” and “softening

hardness”.

For thyroid problems without goitre, the treatment principles must therefore

be adapted: i.e. in such cases, it is not necessary to resolve Phlegm (unless

there are symptoms of Phlegm), soften masses or dissolve masses.

PATHOLOGY AND DIAGNOSIS OF GOITRE – SUMMARY

• Qi stagnation (lump goes up and down according to emotional problems)

• Phlegm (lump is relatively soft and does not go up and down)

• Blood stasis (lump is relatively hard, fixed and probably painful)

• Liver-Fire (goitre relatively soft, nodules)

• Phlegm-Fire (goitre large)

• Liver-Yin deficiency (goitre small)

3. DIAGNOSIS

The goitre swelling in itself always indicates Phlegm: indeed, a soft

goitre is a classic example of lump from Phlegm. However, this may

combined with Qi stagnation or Blood stasis.

The following are indications regarding the feel of the goitre lump in

relation to patterns:

Soft goitre with indistinct edges, varying

in size with emotional state:

Qi stagnation and Phlegm

Hard, nodular mass that is immovable

and grows rapidly, dark skin over mass:

Phlegm with Blood stasis

Small or medium-size goitre, relatively

soft, slippery under the finger:

Liver-Fire (with Phlegm)

Large, soft and smooth mass:

Phlegm

4. GENERAL TREATMENT INDICATIONS

a) ACUPUNCTURE

i.Channels involved in goitre

Apart from the predominant patterns, one must pay attention also to

diagnosis of the channel involved.

In terms of channels, the main channels involved are Heart, Liver, Lungs,

Stomach and Ren Mai, all of which go through the front of the throat.

Although other channels also go through the front of the throat (e.g. Spleen,

Kidneys), the above five channels are the main ones involved in the

pathology of goitre. In women, the Ren and Chong Mai pathology

influences the development of goitre through menstrual irregularities.

ii. Main acupuncture points for Goitre

Before discussing the treatment according to patterns, it is useful to discuss

the main acupuncture points and ancient point prescriptions that are

applicable in the treatment of goitre. Acupuncture and herbal medicine

work in different ways and, while the herbal treatment must be firmly

based on pattern identification, acupuncture points are chosen primarily

according to the channel involved.

There are three principal groups of points:

• Ah Shi points for goitre: four points inserted on the top, bottom, left and

right of the goitre, inserted obliquely towards the centre

• Local points: ST-9 Renying, ST-10 Shuitu, ST-11 Qishe, Ren-22 Tiantu,

Ren-23 Lianquan, L.I.-17 Tianding, L.I.-18 Futu, S.I.-17 Tianrong, extra

point Ping Ying (0.7 cun lateral to the space between 4th and 5th cervical

vertebrae), extra point Shang Tian Zhu (0.5 cun above BL-10 Tianzhu).

• Hua Tuo Jia Ji points of the dorsal vertebrae T-1 and T-2.

ST-11 At the superior

border of the clavicle

between the sternal and

clavicular heads of the

sternocleidomastoid muscle.

LI-17 On the lateral

side of the neck, 1 cun

below LI 18 on the

posterior border of the

SCM.

SI-17 Posterior to the

angle of the mandible

in a depression on the

anterior border of the

SCM.

. .

.

Extra point Ping Ying (0.7 cun lateral to the space between 4th and 5th cervical

vertebrae), extra point Shang Tian Zhu (0.5 cun above BL-10).

. .

.

.

.

. Shang Tian Zhu

. .

Huatuojiaji T-1-2

BL-10

GV 23

Ping Ying 平瘿

. .

Notice the use of points in the back

to affect the front

iii. Ancient acupuncture prescriptions

“The ABC of Acupuncture” (Zhen Jiu Jia Yi Jing, AD 259): S.I.-17 Tianrong.

“The Great Treatise of Acupuncture” (Zhen Jiu Da Quan, 1439): LU-7

Lieque, L.I.-18 Futu, Ren-22 Tiantu, L.I.-17 Tianrong, ST-12 Quepen, KI-27

Shufu, Ren-17 Shanzhong, L.I.-4 Hegu, Shixuan (bleeding).

“Thousand Golden Ducat Prescriptions” (Qian Jin Yao Fang, AD 682): T.B.-

13 Naohui, LU-3 Tianfu, ST-11 Qishe.

“The Classic of Acupuncture Endowment” (Zhen Jiu Zi Sheng Jing, 1220):

G.B.-10 Fubai and ST-11 Qishe.

iv. Moxibustion

Ren-22 Tiantu, BL-7 Tongtian, LU-2 Yunmen, L.I.-11 Quchi, Ren-17

Shanzhong, LIV-4 Zhongfeng, G.B.-20 Fengchi, Du-14 Dazhui, ST-11 Qishe,

LU-3 Tianfu, ST-42 Chongyang.

iv. Moxibustion continued

“Practical Acupuncture” (Shi Yong Zhen Jiu Xue) has two groups of points for

moxibustion:

1) G.B.-20 Fengchi, Du-14 Dazhui, L.I.-14 Binao, extra point lateral to Du-14

and 1.5 cun below it.

2) Ren-22 Tiantu, BL-7 Tongtian, LU-2 Yunmen, L.I.-14 Binao, LIV-4

Zhongfeng, Ren-17 Shanzhong, G.B.-20 Fengchi, Du-14 Dazhui, ST-11

Qishe, T.B.-13 Naohui, LU-3 Tianfu, ST-42 Chongyang.

v. Ear acupuncture

Shenmen

thyroid

neck Endocrine

b) HERBAL TREATMENT OF MASSES

Before discussing the herbal treatment according to patterns, it is

opportune to discuss briefly the herbal treatment of masses. In Chinese

medicine, masses may form from Phlegm or from Blood stasis.

Masses from Phlegm are usually soft and painless and goitre is a

typical mass from Phlegm (but if it is hard it is due to a combination of

Phlegm and Blood stasis).

In order to dissolve masses from Phlegm. Three treatment methods are

applied:

• Resolve Phlegm

• Soften hardness

• Dissolve masses

It is necessary to “soften” the masses in order to dissolve them and

some Chinese herbs have this function. The herbs that soften masses

are found in various categories so that each of these herbs has its own

particular action besides that of softening masses. I shall list below the

main herbs that soften masses with their category in brackets.

Obviously, although one can use any of these herbs to soften masses, it

is better to target the herb more precisely so that it softens a particular

type of mass.

For example, Mu Li Concha Ostreae would be better to soften a mass

in the presence of Yin deficiency, while Chuan Shan Jia Squama

Manitis Pentadactylae would be better to soften a mass from Blood

stasis.

In the particular case of goitre, two of the substances that soften masses are

seaweeds and therefore provide a source of iodine. The main herbs that

soften masses are as follows:

Gui Ban Plastrum

Testudinis

Mu Li Concha

Ostreae

Kun Bu Thallus

Eckloniae

Hai Zao Herba

Sargassi

Zhe Bei Mu Bulbus

Fritillariae thunbergii

Jiang Can Bombyx

batrycatus

Of the above herbs that soften hardness, Xia Ku Cao Spica Prunellae

has a particular affinity for masses in the region of the neck.

Xia Ku Cao Spica

Prunellae

Chuan Shan Jia

Squama Manitis

Pentadactylae

Wa Leng Zi

Concha Arcae

Yi Yi Ren Semen

Coicis

The herbs that “dissolve” masses or nodules are also found scattered in

various categories. Herbs that “break Blood” are used to dissolve masses

from Blood stasis, e.g. E Zhu Rhizoma Curcumae and San Leng Rhizoma

Sparganii stoloniferi.

Examples of herbs that dissolve masses or nodules are as follows:

Lou Lu Radix

Rhapontici

Xuan Shen Radix

Scrophulariae Bie Jia Carapax

Trionycis Mu Li Concha

Ostreae

Yu Jin Radix

Curcumae

Tu Bie Chong

Eupolyphaga/

Steleophaga

E Zhu Rhizoma

Curcumae

San Leng Rhizoma

Sparganii stoloniferi

Zhe Bei Mu Bulbus

Fritillariae thunbergii

Fu Shi Pumex Huang Yao Zi Radix

Dioscoreae bulbiferae

Of the above herbs that dissolve masses, Xuan Shen Radix

Scrophulariae and Huang Yao Zi Radix Dioscoreae bulbiferae have

a particular affinity for masses in the region of the neck.

Please note that Huang Yao Zi Semen Dioscoreae bulbiferae (present

in some of the formulae mentioned above and below) may be toxic if

taken for too long. I would advise not prescribing it for longer than

about two months at a time and at a dosage no higher than 6g per

day. Do not use if patient has abnormal liver function.

Liver function should be checked regularly in all patients taking this

herb. Practitioners should also check the legality of this herb in their

particular country.

ACUPUNCTURE TREATMENT OF PHLEGM

Before discussing individual patterns and their treatment I would like to

discuss the acupuncture treatment of Phlegm. Phlegm is an accumulation of

pathological fluids deriving from a disruption of the fluids transformation,

movement and excretion in the Qi Mechanism (Qi Ji) in the Three Burners.

The Triple Burner is the organ in charge of the transformation, movement and

excretion of fluids in each of the three Burners. Chapter 8 of the “Su Wen”

which describes the functions of all the Internal Organs comparing them to

“officials”, says: “The Triple Burner is the official in charge of ditches”.

Paradoxically, to affect the Triple Burner’s functions of movement,

transformation, transportation and excretion, we do not use many points of the

Triple Burner channel. We do use TB-6 to move Qi in the Triple Burner but

we use mostly points from the Ren Mai.

POINTS FOR FLUID TRANSFORMATION

UPPER BURNER: Du-26 Shuigou, LU-7, LI-4, LI-6, TB-4, TB-6, Ren-17,

BL-13.

MIDDLE BURNER: Ren-9 Shuifen, Ren-12, ST-22, Ren-11, ST-40.

LOWER BURNER: ST-28 Shuidao, BL-22, Ren-5, Ren-6, Ren-3, BL-39,

SP-9, SP-6, KI-7, ST-40.

T.B.-6 Zhigou: move Qi in the Triple Burner

T.B.-4 and BL-64: move Qi in the Triple Burner and activate Water Passages.

Thus, to resolve Phlegm with acupuncture, I use more points than I would

normally use in order to activate all three Burners.

.

. . .

Du-26

Ren-9

ST-28

. Ren-9

Ren-5 .

. Ren-17

Shuigou

Shuidao

Shuifen

I use more points from the Burner where the problem is but then add a

few points from the other two Burners.

In the case of goitre, Phlegm is obviously in the Upper Burner so I would

use points such as these below.

Upper Burner: LU-7, Ren-22, L.I.-4, Du-26, L.I.-6 (plus the local points)

Middle Burner: Ren-12, Ren-9, ST-40.

Lower Burner: SP-9, BL-22, KI-7, Ren-5.

These points to resolve Phlegm in the Upper Burner are applicable to

every pattern discussed.

5. IDENTIFICATION OF PATTERNS AND TREATMENT

• Qi stagnation and Phlegm

• Liver-Qi stagnation, Spleen-Qi deficiency and Phlegm

• Phlegm and Blood stasis

• Liver-Fire blazing with Phlegm-Heat

• Heart- and Liver-Yin deficiency with Phlegm

These patterns are interlinked: for example, Qi stagnation and Phlegm

often lead to Phlegm and Blood stasis, while Liver-Fire often leads to

Heart- and Liver-Yin deficiency.

Also, the order in which the patterns are presented broadly reflects the

pathological progression in goitre, i.e. in the beginning stages it is likely to

manifest with Qi stagnation and Phlegm and in the later stages, with Yin

deficiency and Phlegm.

For each pattern, the acupuncture should include the local points discussed

earlier and the points to resolve Phlegm indicated earlier (activating the

Three Burners).

As for the herbal treatment, the formula for each pattern should be

modified with the following aims:

1) Dissolve masses: Lou Lu, Yu Jin, Huang Yao Zi

2) Soften masses: Kun Bu, Hai Zao, Hai Dai, Yi Yi Ren, Xia Ku Cao

3) Resolve Phlegm: Zhe Bei Mu, Ban Xia, Huang Yao Zi, Gua Lou, Dan

Nan Xing

a) QI STAGNATION AND PHLEGM (also called QI GOITRE)

Clinical manifestations

Goitre that is relatively soft and not painful, a feeling of oppression of the

chest, sighing, hypochondrial distension and pain, the size of the goitre may

fluctuate according to emotional state.

Tongue: Swollen with a sticky coating.

Pulse: Wiry.

Heart: palpitations, anxiety, chest discomfort, feeling of constriction in the

throat.

Lungs: sighing, dry cough, feeling of constriction and/or lump in the throat,

slight breathlessness, sadness.

Liver: irritability, depression, pre-menstrual syndrome.

Treatment principle

Move Qi, eliminate stagnation, soothe the Liver, make Lung-Qi descend, make

Heart-Qi descend, resolve Phlegm, dissolve goitre.

Acupuncture

Distal points

T.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, P-6 Neiguan, ST-40

Fenglong, SP-6 Sanyinjiao, Ren-12 Zhongwan, LU-7 Lieque and KI-6

Zhaohai (Ren Mai).

Local points

Points surrounding the goitre, Ren-22 Tiantu, L.I.-17 Tianding.

Heart: HE-5 Tongli, Ren-15 Jiuwei.

Lungs: LU-7 Lieque, L.I.-4 Hegu, Ren-17 Shanzhong, LU-3 Tianfu.

Liver: LIV-3 Taichong, BL-18 Ganshu.

Explanation

• T.B.-6, G.B.-34, LIV-3 and P-6 move Liver-Qi. In particular, T.B.-6

affects the neck.

• ST-40, SP-6 and Ren-12 resolve Phlegm.

• HE-5 and Ren-15 calm the Mind.

• LU-7 and KI-6 open the Ren Mai which regulates the Uterus and flows

over the throat.

• LU-7, L.I.-4, Ren-17 and LU-3 are used if there is a Lung pathology and

excessive sweating.

• BL-18 is added if the stagnation of Liver-Qi is pronounced.

Herbal treatment

Prescription

SI HAI SHU YU WAN

Four Seas Soothe Stagnation Pill

Mu Xiang Radix Aucklandiae 3 g

Chen Pi Pericarpium Citri reticulatae 3 g

Kun Bu Thallus Eckloniae 6 g

Hai Dai Thallus Laminariae 6 g

Hai Zao Sargassum 6 g

Hai Piao Xiao Endoconcha Sepiae 6 g

Hai Ge Ke Concha Meretricis seu Cyclinae 9 g

Explanation

This formula moves Qi, resolves Phlegm, soften hardness and

dissolves masses

Three Treasures remedies

Open the Heart with Limpid Sea:

Open the Heart (a variation of Ban Xia Hou Po Tang) moves Qi in the

Heart and Lungs and treats the chest and throat; Limpid Sea (a

variation of Er Chen Tang) resolves Phlegm.

Bright Spirit:

Bright Spirit moves Qi of the Heart and Liver and resolves Phlegm.

b) LIVER-QI STAGNATION, SPLEEN-QI DEFICIENCY AND

PHLEGM


Large, soft goitre, depression, irritability, feeling of oppression of the chest

and hypochondrium, difficulty in swallowing, feeling of lump in the throat,

loose stools, tiredness, desire to lie down, poor digestion, irregular periods,

pre-menstrual tension.

Tongue: Pale, possibly slightly Red sides, Swollen.

Pulse: Wiry on the left, Weak on the right, Slippery.

Treatment principle

Soothe the Liver, move Qi, tonify Spleen-Qi, resolve Phlegm, dissolve

masses.

Acupuncture

• Distal points: T.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, P-6

Neiguan, Ren-12 Zhongwan, BL-20 Pishu, ST-36 Zusanli.

• Local points: Ren-22 Tiantu, ST-9 Renying, ST-10 Shuitu.

Explanation

• T.B.-6, G.B.-34, LIV-3, P-6 move Liver-Qi.

• Ren-12, BL-20, ST-36 tonify the Spleen and resolve Phlegm.

Herbal treatment

Prescription

XIAO YAO SAN plus LIU JUN ZI TANG Variation

Free and Easy Wanderer Powder plus Six Gentlemen Decoction.

Explanation

These two formulae together move Liver-Qi, tonify the Spleen and resolve

Phlegm. It is modified with the addition of herbs to:

• resolve Phlegm: Zhe Bei Mu Bulbus Fritillariae thunbergii and Ban Xia

Rhizoma Pinelliae preparatum.

• invigorate Blood: Dan Shen Radix Salviae milthiorrizae, Yu Jin Tuber

Curcumae.


Freeing the Moon (a variation of Xiao Yao San) with Soothe the Centre

(Xiang Sha Liu Jun Zi Tang) and Limpid Sea (a variation of Er Chen Tang).

These three remedies move Liver-Qi, tonify Spleen-Qi and resolve

Dampness and Phlegm.

c) PHLEGM AND BLOOD STASIS


Goitre that is hard, possibly with nodules, painful, dark skin over the

goitre, a feeling of oppression or pain of the chest, insomnia, anxiety.

Tongue: Purple, Swollen, sticky coating.

Pulse: Wiry and Slippery.

Treatment principle

Move Qi, invigorate Blood, eliminate stasis, resolve Phlegm, soften

hardness, dissolve masses.

Acupuncture

Distal points

T.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, P-6 Neiguan,

BL-18 Ganshu, SP-10 Xuehai, BL-17 Geshu, SP-4 Gongsun and P-6

Neiguan (Chong Mai), ST-40 Fenglong, Ren-12 Zhongwan, SP-6

Sanyinjiao.

Local points

Ren-22 Tiantu, ST-9 Renying, L.I.-18 Futu, ST-10 Shuitu L.I.-17

Tianding.

Explanation

• T.B.-6, G.B.-34, LIV-3, P-6 and BL-18 move Liver-Qi; moving Qi is

necessary to invigorate Blood (P-6 and LIV-3 also invigorate Blood).

• SP-10 and BL-17 invigorate Blood.

• SP-4 and P-6 open the Chong Mai which invigorates Blood.

• ST-40, Ren-12 and SP-6 resolve Phlegm.

Herbal treatment

i) Prescription

HAI ZAO YU HU TANG

Sargassum Jade Flask Decoction

Hai Zao Sargassum

Kun Bu Thallus Laminariae seu Ekloniae

Hai Dai Herba Zosterae marinae

Zhe Bei Mu Fructus Fritillariae thunbergii

Ban Xia Rhizoma Pinelliae




Qing Pi Pericarpium Citri reticulatae viride

Chen Pi Pericarpium Citri reticulatae

Lian Qiao Fructus Forsythiae suspensae

Gan Cao Radix Glycyrrhizae

Explanation

This formula moves Qi, resolves Phlegm, soften hardness, dissolves masses and

mildly invigorates Blood.

ii) Prescription

JIA SHI JIA KANG FANG

Master Shi’s Formula for Hyperthyroidism

Huang Yao Zi Rhizoma Dioscoreae bulbiferae 6g

Hai Zao Sargassum 6g

Kun Bu Thallus Eckloniae 6g

Hai Fu Shi Pumice 6g

Hai Ge Ke Concha Meretricis seu Cyclinae 6g

Mu Li Concha Ostreae 9g

Lou Lu Radix Rhapontici seu Echinops 6g

Mu Xiang Radix Aucklandiae 3g

San Leng Rhizoma Sparganii 6g

E Zhu Rhizoma Curcumae 6g

Chen Pi Pericarpium Citri reticulatae 3g

Da Huang Radix et Rhizoma Rhei 6g

Explanation

This formula moves Qi, resolves Phlegm, soften hardness, dissolves

masses and strongly invigorates Blood. Compared to the previous

formula, it also has a stronger resolving Phlegm effect.

Modifications (for both prescriptions)

• Nodules on thyroid: add E Zhu Rhizoma Curcumae, Sang Leng

Rhizoma Sparganii stoloniferii and Huang Yao Zi Semen Dioscoreae

bulbiferae (for first formula).

• If Qi stagnation has given rise to Fire add Xia Ku Cao Spica

Prunellae, Mu Dan Pi Cortex Moutan radicis and Xuan Shen Radix

Scrophulariae ningpoensis.


Limpid Sea plus Red Stirring

Limpid Sea (a variation of Er Chen Tang) is a general remedy for

Phlegm and Red Stirring (a variation of Xue Fu Zhu Yu Tang)

invigorates Blood and eliminates stasis in the Upper Burner.

d) LIVER-FIRE BLAZING WITH PHLEGM-HEAT


Small or medium-size goitre, relatively soft, slippery under the finger,

mental restlessness, insomnia, thirst, feeling of heat, irritability, red eyes,

tremor of hands, red face, bitter taste, feeling of oppression of the chest.

Tongue: Red, redder sides and tip, dry-yellow coating, Swollen. Pulse:

Rapid, Slippery, Wiry.

Treatment principle

Drain Fire, clear the Liver, resolve Phlegm, soften hardness, dissolve

goitre, calm the Mind.

Acupuncture

Distal points

LIV-2 Xingjian, HE-8 Shaofu, L.I.-11 Quchi, L.I.-4 Hegu, ST-40

Fenglong, SP-6 Sanyinjiao, HE-7 Shenmen, P-7 Daling.

Local points

Ren-22 Tiantu, L.I.-17 Tianding, ST-9 Renying, L.I.-18 Futu, ST-10

Shuitu.

Explanation

• LIV-2 and HE-8 drain Liver- and Heart-Fire.

• L.I.-11, L.I.-4 clear Heat and influence the throat area.

• ST-40 and SP-6 resolve Phlegm.

• HE-7 and P-7 calm the Mind.

* Prescription by Dr Wang Xue Tai (“Great Treatise of Chinese

Acupuncture” Zhong Guo Zhen Jiu Da Quan): SP-6 Sanyinjiao, KI-6

Zhaohai, KI-7 Fuliu (according to him nourishes Yin and clears Heat),

P-5 Jianshi, LIV-3 Taichong.

• If ST-Heat: ST-44 Neiting

• Tremor of hands: G.B.-34 Yanglingquan

• Goitre big: ST-10 Shuitu and extra point Ping Ying

• Exophthalmos: extra point Shang Tian Zhu and G.B.-20 Fengchi.

Herbal treatment

Prescription

ZHI ZI QING GAN TANG Variation plus HAI YAO SAN Gardenia Clearing

the Liver Decoction plus Sargassum-Dioscorea bulbifera Powder

Shan Zhi Zi Fructus Gardeniae 6 g

Chai Hu Radix Bupleuri 3 g

Bai Shao Radix Paeoniae alba 6 g

Fu Ling Poria 6 g

Gan Cao Radix Glycyrrhizae uralensis 3 g

Dang Gui Radix Angelicae sinensis 6 g

Chuan Xiong Rhizoma Chuanxiong 6 g

Mu Dan Pi Cortex Moutan 6 g

Hai Zao Sargassum 6 g

Huang Yao Zi Rhizoma Dioscoreae bulbiferae 6 g

Niu Bang Zi Fructus Arctii lappae 6g

These two formulae together clear Heat, resolve Phlegm, soften hardness and

dissolve masses. Niu Bang Zi was added to the original prescription to direct

the formula to the throat.

Three Treasures remedy

Drain Fire plus Clear the Soul

Drain Fire (a variation of Long Dan Xie Gan Tang) drains Liver- and

Heart-Fire while Clear the Soul (a variation of Wen Dan Tang) resolves

Phlegm-Heat and acts on the chest and throat.

Settling the Soul

Settling the Soul (a variation of Long Dan Xie Gan Tang) drains Liver-

and Heart-Fire and resolves Phlegm-Heat. Compared to Drain Fire, it

has a stronger Mind-calming action.

e) HEART- AND LIVER-YIN DEFICIENCY WITH PHLEGM


Goitre that may be large or small, relatively soft, slow onset, chronic course,

palpitations, insomnia, feeling of heat in the afternoon, night-sweating, tremor

of hands, dry eyes, blurred vision, tiredness.

Tongue: without coating, Swollen; Red if there is Empty Heat.

Pulse: Floating-Empty, relatively Overflowing on left-Front position.

Treatment principle

Nourish Yin, nourish Heart and Liver, nourish Liver-Blood, calm the Mind,

resolve Phlegm, soften hardness, dissolve goitre.

Acupuncture

Distal points

HE-7 Shenmen, L.I.-4 Hegu, LIV-3 Taichong, SP-6 Sanyinjiao, Ren-4

Guanyuan, LIV-8 Ququan, KI-6 Zhaohai, LU-7 Lieque and KI-6 Zhaohai

(Ren Mai).

Local points

Ah Shi points surrounding the goitre, L.I.-17 Tianding.

Explanation

• HE-7 nourishes Heart-Yin and calms the Mind.

• L.I.-4 and LIV-3 calm the Mind. L.I.-4 influences the throat.

• SP-6, Ren-4, LIV-8, KI-6 nourish Liver-Yin.

• LU-7 and KI-6 open the Ren Mai and nourish Yin. This vessel also

influences the throat.

Herbal treatment

i) Prescription

TIAN WANG BU XIN DAN Variation

Heavenly Emperor Tonifying the Heart Pill

Sheng Di Huang Radix Rehmanniae 6 g

Xuan Shen Radix Scrophulariae 6 g

Mai Men Dong Radix Ophiopogonis 6 g

Tian Men Dong Radix Asparagi 6 g

Ren Shen Radix Ginseng 6 g

Fu Ling Poria 9 g

Wu Wei Zi Fructus Schisandrae 4 g


Dan Shen Radix Salviae miltiorrhizae 6 g

Suan Zao Ren Semen Ziziphi spinosae 6 g

Bai Zi Ren Semen Platycladi 6 g

Yuan Zhi Radix Polygalae 6 g

Jie Geng Radix Platycodi 3 g




Explanation

This formula nourishes Kidney- and Heart-Yin, clears Heart Empty Heat and calms the

Mind.

ii) Prescription

PING YING FU FANG

Formula to Dissolve Goitre

Xuan Shen Radix Scrophulariae 6g

Bai Shao Radix Paeoniae alba 6g

Mu Dan Pi Cortex Moutan 6g

Sheng Di Huang Radix Rehmanniae 6g

Dang Gui Radix Angelicae sinensis 6g

Fu Ling Poria 6g

Shan Zhu Yu Fructus Corni 6g


Xia Ku Cao Spica Prunellae 6g

Zhe Bei Mu Bulbus Fritillariae thunbergii 6g

Wa Leng Zi Concha Arcae 9g

Qing Pi Pericarpium Citri reticulatae viride 3g

San Leng Rhizoma Sparganii 6g

E Zhu Rhizoma Curcumae 6g

This formula nourishes Liver- and Kidney-Yin, soften hardness, dissolves

masses and invigorates Blood.

iii) Prescription

FU FANG JIA KANG GAO

Formula for Hyperthyroidism

Huang Qi Radix Astragali 6g

Dang Shen Radix Codonopsis 6g

Mai Men Dong Radix Ophiopogonis 6g




Dan Shen Radix Salviae miltiorrhizae 6g


Su Zi Fructus Perillae 6g

Wu Wei Zi Fructus Schisandrae 6g

Xiang Fu Rhizoma Cyperi 6g

Bai Jie Zi Semen Sinapis albae 3g

Explanation

This formula nourishes Liver- and Kidney-Yin, tonifies Qi, resolves Phlegm

and softens hardness.

iv) Prescription

ZHI BO YANG WEI TANG

Anemarrhena-Phellodendron Nourishing the Stomach Decoction

Zhi Mu Rhizoma Anemarrhenae 6g

Huang Bo Cortex Phellodendri 6g

Mu Dan Pi Cortex Moutan 6g

Ze Xie Rhizoma Alismatis 6g

Shi Hu Herba Dendrobii 6g

Yu Zhu Rhizoma Poligonati odorati 6g

Shan Yao Rhizoma Dioscoreae 6g

Fu Ling Poria 6g







Explanation

This formula nourishes Liver- and Kidney-Yin, clears Empty Heat, softens hardness,

dissolves masses and resolves Phlegm.

v) Prescription

YU YIN SAN JIE TANG

Nourish Yin and Scatter Nodules Decoction

Bei Sha Shen Radix Glehniae 6g

Tian Men Dong Radix Asparagi 6g



Tian Hua Fen Radix Trichosanthis 6g





Explanation

This formula nourishes Liver- and Kidney-Yin, resolves Phlegm, softens

hardness and dissolves masses.

Modifications (for all the formulae)

• If there internal Wind (tremor), add Gou Teng Ramulus Uncariae, Bai Ji Li

Fructus Tribuli terrestris and Bai Shao Radix Paeoniae alba.

• If there is Spleen deficiency with loose stools, add Bai Zhu Rhizoma

Atractylodis macrocephalae, Yi Yi Ren Semen Coicis lachryma jobi, Shan

Yao Radix Dioscoreae and Mai Ya Fructus Hordei vulgaris germinatus.

• If there is Kidney-Yin deficiency, add Gui Ban Plastrum Testudinis and Tu

Si Zi Semen Cuscutae chinensis.


Nourish the Root plus Limpid Sea:

Nourish the Root (a variation of Zuo Gui Wan) nourishes Liver- and Kidney-

Yin and Limpid Sea (a variation of Er Chen Tang) resolves Phlegm.

Heavenly Empress:

Heavenly Empress is a variation of Tian Wang Bu Xin Dan.

6. PROGNOSIS AND PREVENTION

The prognosis depends on the duration of the disease and the size of

the goitre. If the goitre is small, soft and the duration not too long,

the prognosis is good. Vice versa, if the goitre is large, hard and the

duration long, the prognosis is less good. If the goitre is very hard,

immovable and grows rapidly, the prognosis is the worst. The Qi

goitre reacts best to acupuncture and herbs, and the Muscle Goitre

second best.

For prevention, one must pay attention to dealing with emotional

stress and to avoiding dairy foods and other Phlegm-inducing foods.

THE THYROID IN WESTERN MEDICINE

The thyroid gland is situated at the front of the throat, below the hyoid bone

of the larynx. It comprises two lobes that lie on either side of the trachea and

are joined in the front by an isthmus.

The thyroid gland produces two main hormones — thyroxine (T-4) and

triiodothyronine (T-3). These hormones circulate in the bloodstream and help

regulate metabolism. They maintain the rate at which the body uses fats and

carbohydrates, help control the body temperature, influence heart rate, and

help regulate the production of proteins.

The thyroid gland also produces calcitonin — the hormone that helps regulate

the amount of calcium in the blood.

The pituitary gland and hypothalamus control the rate at which these

hormones are produced and released. The process begins when the

hypothalamus signals to the pituitary gland to make thyroid-stimulating

hormone (TSH).

The pituitary gland releases a certain amount of TSH, depending on how

much thyroxine and T-3 are in the blood. The thyroid gland, in turn,

regulates its production of hormones based on the amount of TSH it

receives from the pituitary gland.

The thyroid gland is under the control of the pituitary gland. When the

level of thyroid hormones (T3 and T4) drops too low, the pituitary gland

produces Thyroid Stimulating Hormone (TSH) which stimulates the

thyroid gland to produce more hormones. Under the influence of TSH,

the thyroid will manufacture and secrete T3 and T4 thereby raising their

blood levels. The pituitary senses this and responds by decreasing its

TSH production.

One can imagine the thyroid gland as a boiler (furnace) and the pituitary

gland as the thermostat. Just as a thermostat cuts off the boiler when the

temperature reaches the desired level, the pituitary gland secretes less

TSH thus reducing the levels of T3 and T4 when an optimal level is

reached.

The thyroid cannot manufacture its hormones without sufficient dietary

iodine. If a person's diet is low in iodine, the pituitary keeps sending

chemical messages to the thyroid, but in vain. The thyroid gland

enlarges (goitre) as it attempts to comply with the pituitary's demands.

BIAN ZHENG

辨证

BIAN BING

辨病

“GOITRE” “Phlegm-Qi stagnation-

Blood stasis”

THYROID

PROBLEMS

“GOITRE” 瘿

Without goitre

“?”

HYPERTHYROIDISM

HYPOTHYROIDISM “OEDEMA”, “XU LAO”

“PALPITATIONS-ANXIETY”,

“TREMOR”

WESTERN MEDICINE CHINESE MEDICINE

HASHIMOTO’S THYROIDITIS

Hashimoto's thyroiditis or chronic lymphocytic thyroiditis is an

autoimmune disease in which the thyroid gland is attacked by a variety

of cell- and antibody-mediated immune processes. It was the first

disease to be recognized as an autoimmune disease. It was first

described by the Japanese specialist Hakaru Hashimoto in Germany in

1912.

The thyroid gland may become firm, large, and lobulated, but changes

in the thyroid can also be non-palpable. Enlargement of the thyroid is

due to lymphocytic infiltration and fibrosis rather than tissue

hypertrophy.

Antibodies against thyroid peroxidase (TPO) and/or thyroglobulin cause

gradual destruction of follicles in the thyroid gland. Accordingly, the

disease can be detected clinically by looking for these antibodies in the

blood. It is also characterized by invasion of the thyroid tissue by

leukocytes, mainly T-lymphocytes. It is associated with non-Hodgkin

lymphoma.

SYMPTOMS AND SIGNS

Constipation

Difficulty concentrating or thinking

Dry skin

Enlarged neck or presence of goiter

Fatigue

Hair loss

Heavy and irregular periods

Intolerance to cold

Mild weight gain

Small or shrunken thyroid gland

Depression

Bradycardia

High cholesterol

Hypoglycemia

Late clinical manifestations

Decreased taste and smell

Hoarseness

Puffy face, hands, and feet

Slow speech

Thickening of the skin

Thinning of eyebrows

The most common cause of hypothyroidism is inflammation of the thyroid

gland, which damages the gland's cells.

Autoimmune or Hashimoto's thyroiditis, in which the immune system

attacks the thyroid gland, is the most common example of this. Notice the

overlap between inflammation and auto-immune disease.

HYPOTHYROIDISM

The thyroid produces thyroid hormones which signal to all cells

in the body to increase oxygen use.

The secretion of T3 and T4 is controlled by the pituitary gland and the

hypothalamus. Thyroid disorders may result not only from defects in the

thyroid gland itself, but also from abnormalities of the pituitary or

hypothalamus.

The two key thyroid hormones are:

L-triiodothyronine (T3) thyroxine (T4).

1. PATHOLOGY

Hypothyroidism occurs when there is an inadequate secretion of thyroid

hormones, resulting in a slowing down of the body’s metabolism. While low

production of these hormones results in hypothyroidism, high production of

these hormones results in hyperthyroidism.

There are various causes of hypothyroidism. The first is a result of

previous (or currently ongoing) inflammation of the thyroid gland

which leaves a large percentage of the cells of the thyroid damaged (or

dead) and incapable of producing sufficient hormone.

The most common type of inflammation of the thyroid gland failure is

autoimmune thyroiditis, a form of thyroid inflammation caused by the

patient's own immune system.

Another major cause of hypothyroidism is surgical removal of a

portion or all of the thyroid gland. If the total mass of thyroid

producing cells left within the body are not enough to meet the needs

of the body, the patient will develop hypothyroidism.

Removal of all or part of the thyroid gland is carried out to remove

tumours or nodules of this gland. Sometimes the remaining thyroid

lobe and isthmus will produce enough hormone to meet the demands

of the body. For other patients, however, it may become apparent years

later that the remaining thyroid cannot keep up with demand.

Hypothyroidism may also derive from radioactive iodine treatment for

goitre. The aim of the radioactive iodine therapy (for benign

conditions) is to kill a portion of the thyroid to prevent goitre from

growing larger. Occasionally, the result of radioactive iodine treatment

will be that too many cells are damaged so the patient develops

hypothyroidism a year or two later.

Postpartum thyroiditis is usually a transient phenomenon observed

following pregnancy and may involve hyperthyroidism,

hypothyroidism or the two sequentially. It is believed to result from the

modifications to the immune system necessary in pregnancy, and

histologically is a lymphocytic thyroiditis. The process is normally

self-limiting, but when conventional antibodies are found there is a

high chance of this proceeding to permanent hypothyroidism.

From a Chinese perspective, this confirms the close link between the

Ren Mai and the thyroid.

Iodine deficiency is a common cause of hypothyroidism in

mountainous areas (the Alps, Himalayas, South America, Central

Africa). In these regions, dietary iodine deficiency still exists, and in

some areas 'endemic goitre' where goitre is occasionally massive, is

common. The patients may be euthyroid or hypothyroid depending on

the severity of iodine deficiency. The mechanism is thought to be

borderline hypothyroidism leading to TSH stimulation and thyroid

enlargement in the face of continuing iodine deficiency.

2. CLINICAL MANIFESTATIONS

Hypothyroidism may cause a variety of symptoms and may affect all body

functions. The body's normal metabolic rate slows down causing mental and

physical sluggishness. The symptoms may vary from mild to severe, with the

most severe form called myxedema, which is a medical emergency.

Risk factors include age over 50 years, female sex, obesity, thyroid surgery,

and exposure of the neck to X-ray or radiation treatments.

The early symptoms and signs of hypothyroidism are:

• Weakness

• Fatigue

• cold intolerance

• constipation

• weight gain

• Depression

• thin, brittle fingernails

• Loss of outer edges of

eyebrows

• low libido

• Paleness

• joint or muscle pain

• thin and brittle hair

Late symptoms and signs include:

• slow speech

• Hoarseness

• thinning of eyebrows

• decreased taste and smell

• poor memory

• dry, flaky skin

• abnormal menstrual periods, usually amenorrhoea

• puffy face, hands and feet

• thickening of the skin

Pitting oedema

Pitting on the left, non-

pitting on the right

Laboratory tests to determine thyroid function include:

T4 test (low)

Serum TSH (high in primary hypothyroidism, low or low-normal in

secondary hypothyroidism)

The purpose of treatment in Western medicine is to replace the deficient

thyroid hormone. Levothyroxine is the most commonly used medication.

The lowest dose effective in relieving symptoms and normalizing the TSH

is used. According to treatment guidelines, life-long therapy is needed and

medication must be continued even when symptoms subside.

Thyroid hormone levels should be monitored yearly after a stable dose of

medication is determined.

As discussed above, there is no direct correspondence between the Chinese

disease-symptom of “Goitre” and thyroid problems in Western medicine.

Hence, Chinese medicine discusses only goitre, while Western medicine

discusses many thyroid dysfunctions such as hypothyroidism,

hyperthyroidism, Graves’ disease and Hashimoto thyroiditis.

Chinese medicine does not really have a theory of thyroid problems without

goitre and these must simply be treated according to the normal identification

of patterns. For example, if without goitre, hypothyroidism may correspond to

“Exhaustion” (Xu Lao) or “Oedema” in Chinese medicine, while

hyperthyroidism may correspond to “Palpitations and Anxiety” or “Tremors”.

As Chinese medicine focuses only and entirely on goitre, its pathology and

treatment is focussed on the treatment of masses. The treatment principles

must therefore be adapted when there are thyroid problems without goitre: i.e.

in such cases, it is not necessary to resolve Phlegm (unless there are symptoms

of Qi-Phlegm), soften masses or dissolving masses.


The main patterns with which hypothyroidism may present are:

• Spleen- and Kidney-Yang deficiency

• Qi and Blood deficiency

• Liver- and Kidney-Yin deficiency

a) SPLEEN- AND KIDNEY-YANG DEFICIENCY


Tiredness, feeling cold, slowness, cold limbs, oedema, pale complexion,

puffy face, puffy under eyes, tiredness, shortness of breath, desire to lie

down, backache, dizziness, poor digestion.

Tongue: Pale, Swollen.

Pulse: Weak-Deep-Slow.

Treatment principle

Warm Yang, strengthen Spleen and Kidneys.

Acupuncture

BL-20 Pishu, Ren-12 Zhongwan, ST-36 Zusanli, Du-14 Dazhui, BL-

23 Shenshu, KI-7 Fuliu, Ren-4 Guanyuan, Du-4 Mingmen, Ren-22

Tiantu, LU-7 Lieque and KI-6 Zhaohai (Ren Mai). Moxa must be

used.

Oedema: BL-13 Feishu, L.I.-6 Pianli, LU-7 Lieque, Ren-9 Shuifen,

BL-20 Pishu, BL-22 Sanjiaoshu, SP-9 Yinlingquan, KI-7 Fuliu.

Explanation

• BL-20, Ren-12 and ST-36 tonify Spleen-Yang.

• Du-14, with direct moxa, strengthens Heart- and Kidney-Yang.

• BL-23, KI-7, Ren-4 and Du-4 tonify Kidney-Yang.

• Ren-22 is a local point that affects the thyroid.

• LU-7 and KI-6 open the Ren Mai and can be used in combination

with Ren-4 (with moxa cones) to tonify Kidney-Yang. The Ren Mai

also regulates the Uterus and should be used if there are menstrual

irregularities.

Herbal treatment

i) Prescription

ZHANG SHI JIA JIAN FANG

Master Zhang’s Hypothyroidism Formula

Fu Zi Radix Aconiti lateralis preparata 6 g

Gan Jiang Rhizoma Zingiberis 3 g

Rou Gui Cortex Cinnamomi 2.1 g

Dang Shen Radix Codonopsis 15 g

Fu Ling Poria 9 g

Bai Zhu Rhizoma Atractylodis macrocephalae 9 g

Zhi Gan Cao Radix Glycyrrhizae uralensis preparata 3 g

Explanation

This formula strongly warms and tonifies Spleen- and Kidney-Yang.

ii) Prescription

JI SHENG SHEN QI TANG plus SI JUN ZI TANG

Kidney-Qi Pill from “Formulae that Aid the Living” plus Four Gentlemen

Decoction

Fu Zi Radix Aconiti lateralis preparata 3 g

Gui Zhi Ramulus Cinnamomi cassiae 4 g

Gan Jiang Rhizoma Zingiberis 4 g

Huang Qi Radix Astragali 6 g

Shu Di Huang Radix Rehmanniae preparata 6 g

Sha Ren Fructus Amomi 3 g

Yin Yang Huo Herba Epimedii 6 g

Tu Si Zi Semen Cuscutae 6 g

Ze Xie Rhizoma Alismatis 6 g

Ren Shen Radix Ginseng 9 g


Fu Ling Poria 6 g


Explanation

This formula strongly warms and tonifies Spleen- and Kidney-Yang.

Compared to the previous formula, it also resolves Dampness.


Strengthen the Root:

Strengthen the Root tonifies Kidney-Yang. It is a variation of You Gui

Wan Restoring the Right [Kidney] Pill.

b) QI AND BLOOD DEFICIENCY


Tiredness, weakness, dizziness, dislike to speak, slowness, palpitations, sallow

complexion, loose stools, blurred vision, dry skin, amenorrhoea, cold limbs.

Tongue: Pale.

Pulse: Choppy.

Treatment principle

Tonify Qi and nourish Blood.

Acupuncture

BL-20 Pishu, Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao, BL-23

Shenshu, Ren-4 Guanyuan, Du-20 Baihui, Ren-22 Tiantu. Moxa can be used.

Explanation

• BL-20, Ren-12, ST-36 and SP-6 tonify Spleen-Qi and nourish Blood.

• BL-23 and Ren-4 tonify the Kidneys and nourish Blood.

• Du-20 lifts Qi.

• Ren-22 is a local point to affect the thyroid.

Herbal treatment

i) Prescription

DENG SHI JIA YI FANG

Master Deng’s Thyroid Formula






Chai Hu Radix Bupleuri 6 g

Sheng Ma Rhizoma Cimicifugae 6 g

Ba Ji Tian Radix Morindae officinalis 9 g

Gou Qi Zi Fructus Lycii chinensis 9 g

Chen Pi Pericarpium Citri reticulatae 3 g

Explanation

This formula primarily tonifies Spleen-Qi and secondarily Kidney-

Yang. It also lifts Qi and can be considered a variation of Bu Zhong Yi

Qi Tang Tonifying the Centre and Benefiting Qi Decoction.

ii) Prescription

XU SHI ZHI JIAN FANG

Master Xu’s Formula for Hypothyroidism

Mu Li Concha Ostreae 30 g



Niu Xi Radix Achyranthis bidentatae 12 g


Mu Gua Fructus Chaenomelis 12 g

Fu Ling Poria 12 g

Yu Jin Radix Curcumae 12 g


Hong Hua Flos Carthami tinctorii 6 g


Explanation

Compared to the previous formula, this formula is more focussed on

nourishing Blood than tonifying Qi (although it does tonify Qi). It is also

aimed at treating goitre.

iii) Prescription

SHI QUAN DA BU TANG Variation

Ten Complete Great Tonification Decoction



Fu Ling Poria 6 g





Chuan Xiong Rhizoma Chuanxiong 6 g


Rou Gui Cortex Cinnamomi 3 g

Dan Shen Radix Salviae miltiorrhizae 6 g

Sha Ren Fructus Amomi 6 g

Shan Yao Rhizoma Dioscoreae 6 g

Explanation

This is a simple variation of the formula Shi Quan Da Bu Tang Ten

Complete Great Tonification Decoction which tonifies Qi and nourishes

Blood.


Precious Sea:

Precious Sea tonifies Qi and nourishes Blood. It is a variation of Ba Zhen

Tang Eight Precious Decoction.

c) LIVER- AND KIDNEY-YIN DEFICIENCY


Tiredness, feeling of heat in the afternoon and evening, night-sweating,

backache, dizziness, tinnitus, blurred vision, dry throat.

Tongue: without coating, Red in case of Empty Heat.

Pulse: Floating-Empty.

Treatment principle

Nourish Yin, strengthen Liver and Kidneys.

Acupuncture

ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan, Ren-4 Guanyuan, KI-3

Taixi, KI-6 Zhaohai, LU-7 Lieque and KI-6 Zhaohai (Ren Mai), Ren-22

Tiantu.

Explanation

• ST-36, SP-6, LIV-8 and Ren-4 nourish Liver-Yin.

• Ren-4, KI-3 and KI-6 nourish Kidney-Yin.

• LU-7 and KI-6 open the Ren Mai and nourish Yin.

• Ren-22 is a local point acting on the thyroid.

Herbal treatment

Prescription

ZUO GUI YIN

Restore the Left [Kidney] Decoction


Shan Zhu Yu Fructus Corni 6 g

Gou Qi Zi Fructus Lycii chinensis 6 g

Shan Yao Rhizoma Dioscoreae 6 g

Fu Ling Poria 6 g



Suan Zao Ren Semen Ziziphi spinosae 6 g

Ju Hua Flos Chrysanthemi 6 g

Explanation

This formula nourishes Liver- and Kidney-Yin.


Nourish the Root

Nourish the Root (a variation of Zuo Gui Wan) nourishes Liver- and

Kidney-Yin.

Four degrees of severity of Yin deficiency

No coating, normal

body colour No coating, red body

colour with red points

No coating, body

colour red the centre

No coating, very slightly

red body colour (pale on

sides)

GRAVES’ DISEASE

Graves' disease is an autoimmune disease where the thyroid is

overactive, producing an excessive amount of thyroid hormones and

causing hyperthyroidism. This is caused by thyroid autoantibodies that

activate the TSH-receptor, thereby stimulating thyroid hormone

synthesis and secretion, and thyroid growth (causing a diffusely enlarged

goitre).

Graves' disease is the most common cause of hyperthyroidism (60-90%

of all cases), and usually presents itself during midlife, but also appears

in children, adolescents, and the elderly. It has a powerful hereditary

component, affects up to 2% of the female population, and is between

five and ten times as common in females as in males.

Graves’ disease is the most common cause of severe hyperthyroidism, which

is accompanied by more clinical signs and symptoms and laboratory

abnormalities as compared with milder forms of hyperthyroidism. About 30-

50% of people with Graves' disease will also suffer from Graves'

exophthalmos (a protrusion of one or both eyes), caused by inflammation of

the eye muscles by attacking autoantibodies.

• Goitre (but not always)

• Insomnia

• Irritability, nervousness

• Heat sensitivity, increased sweating

• Hand tremors

• Rapid heartbeat

• Thinning of skin or fine, brittle hair

• Frequent bowel movements

• Weight loss

• Fatigue or muscle weakness

• Oligomenorrhoea

• Infertility

Three main areas of pathology in Graves’ disease:

1) hyperactivity of the thyroid gland (hyperthyroidism)

2) inflammation of the tissues around the eyes, causing swelling

3) thickening of the skin over the lower legs (pretibial myxedema)

• Graves' disease affects women much more often than men (about 8:1 ratio).

• Graves' disease is often called diffuse toxic goitre because the entire thyroid

gland is enlarged, usually moderately enlarged, sometimes quite big.

• Graves' disease is uncommon over the age of 50 (more common in the 30s and

40s)

• Graves' disease tends to run in families

Graves' disease is the most common cause of hyperthyroidism and is due to an

autoimmune process. Serum IgG antibodies bind to the thyroid TSH receptor

stimulating thyroid hormone production, behaving like TSH. These TSH

receptor antibodies can be measured in serum.

Yersinia enterocolitica as well as Escherichia coli and other Gram-negative

organisms contain TSH binding sites. This raises the possibility that the

initiating event in the pathogenesis may be an infection with possible

'molecular mimicry' in a genetically susceptible individual, but the precise

initiating mechanisms remain unproven in most cases.

Thyroid eye disease accompanies the hyperthyroidism in many cases but other

components of Graves' disease, e.g. Graves' dermopathy, are rare. Rarely

lymphadenopathy and splenomegaly may occur.

Graves' disease is also associated with other autoimmune disorders such as

pernicious anaemia, vitiligo and myasthenia gravis. The natural history is one

of fluctuation, many patients showing a pattern of alternating relapse and

remission; perhaps only 40% of subjects have a single episode. Many patients

eventually become hypothyroid.

Complications and health risks of Graves' Disease

Without treatment, Graves' disease can lead to serious complications.

Because Graves' disease causes tissues behind the eye to become swollen and

irritated, patients may develop double vision and other visual difficulties.

Smokers with Graves' disease usually experience more eye-related

complications than non-smokers.

The skin can also be affected by Graves' disease. The skin covering the lower

legs and feet can become thick, reddened, and bumpy because of profound

swelling known as pretibial myxedema. Though this swelling causes

discomfort, it generally does not lead to additional health problems.

The most serious complication of Graves' disease, however, is thyrotoxic

crisis or “thyroid storm”. An abrupt surge in thyroid hormones causes thyroid

storm to develop and can lead to heart failure and even death if Graves'

disease remains untreated.

Skin reddening, thickening and oedema in Graves’ Disease

Western medicine treatment

Graves' disease can be treated by several methods, including:

Surgery

To remove the thyroid gland. After the thyroid gland is removed, patients

have to take thyroid hormone for the remainder of their lives.

Radioactive iodine pills

When radioactive iodine is ingested, the thyroid draws it in, and the

radioactive material kills cells in the thyroid. After receiving this treatment,

too many hormone-producing cells may be destroyed, resulting in

hypothyroidism so that patients may need to take thyroxine.

Anti-thyroid medications

These drugs (such as Tapazole [methimazole] and propylthiouracil) can be

given to help blunt the thyroid's ability to produce hormones.

HYPERTHYROIDISM

Hyperthyroidism is an imbalance of metabolism caused by overproduction

of thyroid hormone.

1. PATHOLOGY

The main causes of hyperthyroidism are:

• Graves' disease

• Non-cancerous growths of the thyroid gland or pituitary gland

• Inflammation (irritation and swelling) of the thyroid due to viral infections

or other causes

• Ingestion of excessive amounts of thyroid hormone

• Ingestion of excessive iodine

Diagnosis of hyperthyroidism

Thyroid-stimulating hormone (TSH) produced by the pituitary will be

decreased in hyperthyroidism. Thus, the diagnosis of hyperthyroidism is

nearly always associated with a low (suppressed) TSH level. If the TSH

levels are not low, then other tests must be run.

Thyroid hormones themselves (T3, T4) will be increased. For a patient to

have hyperthyroidism, they must have high thyroid hormone levels.

Sometimes all of the different thyroid hormones are not high and only one or

two of the different thyroid hormone measurements are high. This is not too

common, as most people with hyperthyroidism will have all of their thyroid

hormone measurements high (except TSH).

Iodine thyroid scan will show if the cause is a single nodule or the whole

gland.

Iodine Uptake Scan

A means of measuring thyroid function is to measure how much iodine is

taken up by the thyroid gland (RAI uptake). Cells of the thyroid

normally absorb iodine from the blood stream and use it to make thyroid

hormone. Hypothyroid patients usually take up too little iodine and

hyperthyroid patients take up too much iodine.

The test is performed by giving a dose of radioactive iodine on an empty

stomach. The iodine is concentrated in the thyroid gland or excreted in

the urine over the next few hours. The amount of iodine that goes into

the thyroid gland can be measured by a "Thyroid Uptake".

At other times the gland will concentrate iodine normally but will be

unable to convert the iodine into thyroid hormone; therefore,

interpretation of the iodine uptake is usually done in conjunction with

blood tests.

Thyroid Scan

Taking a "picture" of how well the thyroid gland is functioning requires

giving a radioisotope to the patient and letting the thyroid gland

concentrate the isotope (just like the iodine uptake scan above).Therefore,

it is usually done at the same time that the iodine uptake test is

performed.

Both of the scans below show normal sized thyroid glands, but the one on

the left has a "Hot" nodule in the lower aspect of the right lobe, while the

scan on the right has a "Cold" nodule in the lower aspect of the left lobe

(outlined in red and yellow).

Pregnant women should not have thyroid scans performed because the

iodine can cause development troubles within the baby's thyroid gland.

Hot nodule Cold nodule

2. CLINICAL MANIFESTATIONS

The symptoms and signs of hyperthyroidism are:

Increased appetite

Weight loss

Goitre may be present

Menstrual irregularities in women

Nervousness

Additional symptoms that may be associated with this disease are:

Weakness

Clammy skin

Hand tremor

Palpitations

Protruding eyes (exophthalmos)

Breast development in men

Skin blushing or flushing

Restlessness

Heat intolerance

Increased sweating

Frequent bowel movements

Fatigue

Itching all over the body

Diarrhoea

Nausea and vomiting

High blood pressure

Bounding pulse

Amenorrhoea

Sleeping difficulty

Hair loss

In the elderly, a frequent presentation is with atrial fibrillation, other

tachycardias and/or heart failure, often with few other signs. Thyroid

function tests are mandatory in any patient with atrial fibrillation.

Children frequently present with excessive height or excessive growth

rate, or with behavioural problems such as hyperactivity. They may

also show weight gain rather than loss.

The clinical signs show an increased heart rate and the systolic blood

pressure may be elevated. Physical examination may reveal thyroid

enlargement or goitre.

Laboratory tests that evaluate thyroid function:

Serum TSH is usually decreased

T3 and free T4 are usually elevated


The patterns discussed are:

• Liver-Qi stagnation

• Liver-Fire

• Heart-Fire

• Liver- and Kidney-Yin deficiency with Empty Heat

• Liver Phlegm-Heat

• Blood stasis

Please note that the above patterns are all interlinked and they affect one

another. The patterns are listed above more or less in chronological order, i.e.

Liver-Qi stagnation would correspond to an initial stage of hyperthyroidism

while Blood stasis would correspond to a late stage. Of course, this

progression should not be taken too rigidly.

Liver-Wind (causing hand tremor) may develop from Yin deficiency, Liver

Phlegm-Heat or Liver-Fire. The following slide shows the interactions among

patterns.

Liver-Qi

stagnation Heart-Fire

Phlegm Yin deficiency Empty Heat

Liver-Wind

Liver-Wind

Blood stasis

Liver-Fire

a) LIVER-QI STAGNATION


Hyperthyroidism, beginning stage, nervousness, restlessness, heat

intolerance, fatigue, irritability, mental restlessness, depression,

moodiness, abdominal distension, menstrual irregularities in women, pre-

menstrual tension.

Tongue: slightly Red sides.

Pulse: Wiry.

Treatment principle

Soothe the Liver, move Liver-Qi, calm the Shen, settle the Hun.

Acupuncture

T.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, P-6 Neiguan,

L.I.-4 Hegu, Ren-22 Tiantu.

Explanation

• T.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, P-6 Neiguan

move Liver-Qi, calm the Shen and settle the Hun.

• L.I.-4 treats the neck area and, together with LIV-3, calms the Shen and

settles the Hun.

• Ren-22 is a local point to affect the thyroid function.

Herbal treatment

Prescription

EMPIRICAL PRESCRIPTION by Dr Zhao Fen

Chai Hu Radix Bupleuri 6g

Huang Qin Radix Scutellariae 9g

Ban Xia Rhizoma Pinelliae preparatum 6g

Dang Shen Radix Codonopsis 15g

Zi Su Geng Caulis Perillae 6g

Hou Po Cortex Magnoliae officinalis 9g

Lai Fu Zi Semen Raphani 9g

Chen Pi Pericarpium Citri reticulatae 6g

Yu Jin Radix Curcumae 9g

Ku Ding Cha Herba Ilecis cornutae 6g

Gan Cao Radix Glycyrrhizae uralensis 3g

Explanation

This formula is a variation of Xiao Chai Hu Tang Small Bupleurum Decoction.


Open the Heart:

Open the Heart (a variation of Ban Xia Hou Po Tang) moves Lung- and

Heart-Qi and is used to Qi stagnation in these two organs.

Bright Spirit:

Bright Spirit moves Liver-Qi and resolves Phlegm from the chest and

throat.

Release Constraint:

Release Constraint (a variation of Yue Ju Wan) soothes the Liver, moves Qi,

calms the Mind and settles the Hun.

Freeing the Moon:

Freeing the Moon (a variation of Xiao Yao San) moves Liver-Qi, nourishes

Liver-Blood, calms the Mind and settles the Ethereal Soul. It is indicates

when Liver-Qi stagnation occurs against a background of Liver-Blood

deficiency.

b) LIVER-FIRE


Hyperthyroidism, thirst, excessive hunger, irritability, feeling of heat, weight

loss, nervousness, restlessness, fatigue, insomnia, skin flushing, heavy

periods, itching all over the body, bitter taste, exophthalmos, propensity to

outburts of anger, mental restlessness, blood-shot eyes.

Tongue: Red, with redder sides, yellow coating.

Pulse: Wiry-Rapid.

Treatment principle

Move Liver-Qi, drain Liver-Fire, Heart-Fire and Stomach-Heat, calm the

Mind, settle the Hun.

Acupuncture

LIV-2 Xingjian, LIV-3 Taichong, HE-8 Shaofu, HE-7 Shenmen, ST-44

Neiting, L.I.-11 Quchi, G.B.-13 Benshen, Du-24 Shenting, Du-19 Houding,

Ren-15 Jiuwei, SP-6 Sanyinjiao, Ren-22 Tiantu.

Explanation

• LIV-2 drains Liver-Fire.

• LIV-3 moves Liver-Qi.

• HE-8 and HE-7 drain Heart-Fire and calm the Mind.

• ST-44 and L.I.-11 clear Stomach-Heat.

• G.B.-13, Du-24, Du-19 and Ren-15 calm the Mind and settle the Hun.

• SP-6 helps to clear Heat and also calms the Mind.

• Ren-22 is a local point affecting the thyroid function.

Herbal treatment

Prescription

i) EMPIRICAL PRESCRIPTION by Dr Zhao Fen

Zhen Zhu Mu Concha Margaritiferae usta 60g

Gou Teng Ramulus cum Uncis Uncariae 9g

Jiang Can Bombyx batryticatus 9g

Shan Zhi Zi Fructus Gardeniae 9g



Zhu Ru Caulis Bambusae in taeniam 15g


Chi Shao Radix Paeoniae rubra 9g

Ye Jiao Teng Caulis Polygoni multiflori 15g

Bi Yu San 24g (Hua Shi, Gan Cao, Qing Dai)

Explanation

This formula clears Heat in the Liver and Heart and resolves Phlegm-Heat.

If there is no goitre, Zhu Ru and Xia Ku Cao can be omitted.

ii) EMPIRICAL PRESCRIPTION by Dr Zhu Ceng Bo



Shi Gao Gypsum fibrosum 20g


Wu Mei Fructus Mume 6g

Bai Zi Ren Semen Platycladi 9g




Explanation

This formula is for Heat in the Liver, Heart and Stomach.


Drain Fire

Drain Fire (a variation of Long Dan Xie Gan Tang) drains Liver- and

Heart-Fire.

c) HEART-FIRE


Hyperthyroidism, thirst, excessive hunger, irritability, insomnia,

palpitations, feeling of heat, weight loss, nervousness, skin flushing,

itching all over the body, exophthalmos, mental restlessness.

Tongue: Red, with redder tip, yellow coating.

Pulse: Overflowing-Rapid.

Treatment principle

Drain Heart-Fire, calm the Shen.

Acupuncture

HE-8 Shaofu, HE-7 Shenmen, P-7 Daling, L.I.-11 Quchi, Du-19 Houding,

Ren-15 Jiuwei, Ren-22 Tiantu.

Explanation

• HE-8 and P-7 drain Heart-Fire.

• HE-7, Du-19 Houding and Ren-15 Jiuwei calm the Shen.

• L.I.-11 clears Heat in general.

• Ren-22 affects the thyroid function

Herbal therapy

Prescription

QING XIN LIAN ZI YIN

Lian Zi Semen Nelumbinis

Mai Men Dong Radix Ophiopogonis

Huang Qin Radix Scutellariae

Di Gu Pi Cortex Lycii

Fu Ling Poria

Che Qian Zi Semen Plantaginis

Huang Qi Radix Astragali

Ren Shen Ginseng

Zhi Gan Cao Radix Glycyrrhizae preparata

d) LIVER- AND KIDNEY-YIN DEFICIENCY WITH EMPTY HEAT


Hyperthyroidism, mental restlessness, feeling of heat in the evening, weight loss,

nervousness, fatigue, insomnia, skin flushing, itching all over the body, hair loss,

exophthalmos, backache, dizziness, blurred vision, dry eyes, tinnitus, night-

sweating, tremor of hands.

Tongue: Red without coating or partially without coating.

Pulse: Floating-Empty.

Treatment principle

Nourish Liver- and Kidney-Yin, clear Empty Heat, calm the Shen.

Acupuncture

Ren-4 Guanyuan, LIV-8 Ququan, SP-6 Sanyinjiao, KI-3 Taixi, LU-7 Lieque and

KI-6 Zhaohai (Ren Mai), HE-7 Shenmen, Ren-15 Jiuwei, L.I.-4 Hegu with LIV-3

Taichong, Ren-22 Tiantu.

Explanation

- Ren-4, LIV-8, SP-6 and KI-3 nourish Liver- and Kidney-Yin.

- LU-7 and KI-6 open the Ren Mai and nourish Yin.

- HE-7 and Ren-15 nourish and calm the Mind.

- L.I.-4 and LIV-3 are used if there are hand tremors to extinguish internal Wind.

-Ren-22 to affect the thyroid function.

Prescriptions

i) EMPIRICAL PRESCRIPTION by Dr Zhao Fen

Tai Zi Shen Radix Pseudostellariae 15g



Gou Qi Zi Fructus Lycii chinensis 15g

Shou Wu Radix Polygoni multiflori preparata 15g


Zhen Zhu Mu Concha Margaritiferae usta 30g

Yu Zhu Rhizoma Poligonati odorati 15g

Bai Wei Radix Cynanchi atrati 9g



Explanation

This formula nourishes the Yin of the Liver, Kidneys and Heart.

ii) EMPIRICAL PRESCRIPTION by Dr Zhu Ceng Bo

Shan Zhu Yu Fructus Corni 6g

Gui Ban Plastrium Testudinis 9g





Shi Hu Herba Dendrobii 6g


Shu Di Huang Radix Rehmanniae preparata 6g

Long Yan Rou Arillus Longan 6g

Huang Jing Rhizoma Polygonati 6g


Explanation

This formula nourishes Liver- and Kidney-Yin and calms the Mind.

iii) EMPIRICAL PRESCRIPTION BY Dr Wang Zhu Bie




Shi Jue Ming Concha Haliotidis 30g

Tian Kui Zi Radix Semiaquilegiae 10g

Fo Shou Fructus Citri sarcodactylis 6g



Explanation

This formula nourishes Liver- and Kidney-Yin, resolves Phlegm and

extinguishes internal Wind: it can therefore be used if there is a goitre and the

patient has a hand tremor.


Heavenly Empress

Heavenly Empress (a variation of Tian Wang Bu Xin Dan) nourishes Liver-

and Kidney-Yin and clears Heart Empty Heat.

e) LIVER PHLEGM-HEAT


Mental restlessness, feeling of heat, weight loss, nervousness, fatigue,

insomnia, skin flushing, itching all over the body, palpitations,

exophthalmos, blurred vision, goitre, expectoration of phlegm, thirst, a

sticky taste, a feeling of oppression of the chest.

Tongue: Red with a sticky-yellow coating.

Pulse: Wiry-Slippery-Rapid.

Treatment principle

Drain Liver-Fire, resolve Phlegm, soften hardness, dissolve masses, calm

the Mind, settle the Hun.

Acupuncture

LIV-3 Taichong, LIV-2 Xingjian, L.I..-11 Quchi, Ren-12 Zhongwan, Ren-9

Shuifen, ST-40 Fenglong, SP-6 Sanyinjiao, Du-24 Shenting, G.B.-13

Benshen, Ren-22 Tiantu.

Explanation

• LIV-3 and LIV-2 drain Liver-Fire, soothe the Liver, calm the Mind and

settle the Hun.

• L.I.-11 clears Heat.

• Ren-12, Ren-9, ST-40 and SP-6 resolve Phlegm.

• Du-24 and G.B.-13 calm the Mind and settle the Hun.

• Ren-22 to affect the thyroid function.

Herbal treatment

Prescriptions

i. EMPIRICAL PRESCRIPTION by Dr Zhu Ceng Bo



Shi Gao Gypsum fibrosum 20g


Wu Mei Fructus Mume 6g

Bai Zi Ren Semen Platycladi 9g




Explanation

This formula clears Heat, resolves Phlegm, moves Qi (necessary to resolve

Phlegm), nourishes Yin, calms the Mind and settles the Hun.

Prescription

ii. EMPIRICAL PRESCRIPTION

Zhen Zhu Mu Concha Margaritiferae usta 60g (sic)


Jiang Can Bombyx batryticatus 9g




Zhu Ru Caulis Bambusae in taeniam 15g



Ye Jiao Teng Caulis Polygoni multiflori 15g

Bi Yu San 24g (Hua Shi, Gan Cao, Qing Dai)

Explanation

This formula clears Heat, resolves Phlegm, subdues Liver-Qi, calms the

Mind and settles the Hun.


Settling the Soul:

Settling the Soul (a variation of Long Dan Xie Gan Tang) drains Liver- and

Heart-Fire and resolves Phlegm-Heat.

f) BLOOD STASIS


Mental restlessness, feeling of heat, weight loss, nervousness, fatigue,

insomnia, skin flushing, itching all over the body, palpitations, exophthalmos,

goitre that is hard and nodular.

Tongue: Purple.

Pulse: Wiry-Rapid.

Treatment principle

Invigorate Blood, eliminate stasis, calm the Mind.

Acupuncture

P-6 Neiguan, LIV-3 Taichong, BL-17 Geshu, SP-10 Xuehai, SP-6 Sanyinjiao.

Explanation

All the above points invigorate Blood.

Prescription

TONG QIAO HUO XUE TANG

Opening the Orifices and Invigorating Blood Decoction

Chi Shao Radix Paeoniae rubra


Tao Ren Semen Persicae

Hong Hua Flos Carthami

Lao Cong Herba Allii fistulosi

Sheng Jiang Rhizoma Zingiberis recens

Shi Chang Pu Rhizoma Acori

Da Zao Fructus Jujubae

Explanation

This formula invigorates Blood with a specific action on the head region.

Please note that I have replaced She Xiang (musk) in the original formula

with Shi Chang Pu.

Three Treasures

Red Stirring:

Red Stirring (a variation of Xue Fu Zhu Yu Tang) invigorates Heart-Blood

HYPERTHYROIDISM IN CHINESE MEDICINE:

A REVIEW OF CHINESE LITERATURE

From the point of view of Chinese medicine, when confronted with a patient

suffering from hyperthyroidism, the first question we should ask ourselves is

how we should consider this disease from a Chinese perspective. In other

words, we should establish to which Chinese “disease” hyperthyroidism

might correspond to. For example, when treating hypertension we can quite

safely say that this disease corresponds to the three Chinese “diseases” of

“Headaches”, “Dizziness” and “Tinnitus”.

The overwhelming majority of Chinese doctors say that hyperthyroidism

corresponds to the Chinese disease of “Goitre” (Ying Bing). I personally

disagree with this view because hyperthyroidism does not always present

with a goitre; as goitre always indicates Phlegm, it would be wrong to

resolve Phlegm in a patient without goitre. Certainly, if a patient suffering

from hyperthyroidism does have a goitre, it is legitimate to assume that the

pathology and treatment methods of “Goitre” are largely applicable to the

treatment of hyperthyroidism.

Of the Chinese doctors mentioned in the next slides, only two (Zhu Ceng

Bo and Wei Zi Xiao) are of the opinion that hyperthyroidism cannot be

equated to “Goitre”.

From a Chinese perspective, hyperthyroidism without goitre could

correspond to unrelated Chinese diseases such as “Tremors” or “Anxiety

and Palpitations”. However, that is not to say that when seeing a patient

with hyperthyroidism, we can treat him or her purely as a case of

“Tremors” or “Anxiety and Palpitations”.

This raises the question of the importance of the integration of a Chinese

with a Western medical diagnosis. In practically every case, we should

always integrate a Chinese Bian Bing and Bian Zheng diagnosis with a

Western one.

For example, it would be wrong to treat a patient for “Anxiety and

Palpitations” or “Tremors” without investigating whether those two

symptoms are due to a dysfunction of the thyroid.

Dr Wei Zi Xiao

Dr Wei Zi Xiao says that hyperthyroidism may correspond to many

different Chinese “diseases” such as “Palpitations” (Xin Ji), “Insomnia”,

“Depression”, “Sweating”, “Tremors”, “Diabetes” (Xiao Ke), “Fever” (of

internal origin), “Exhaustion” (Xu Lao) and “Phlegm”.

According to Dr. Wei Zi Xiao, in the treatment of hyperthyroidism it is

important to distinguish Fullness from Emptiness and the Root (Ben) from

the Manifestation (Biao). He says that the Root is most often a Deficiency

of Yin and the Manifestation is Full and may consist in Qi stagnation, Blood

stasis, Fire or Phlegm.

The presence of a goitre indicates Phlegm. Dr Wei Zi Xiao says that the

three main organs involved in the pathology of hyperthyroidism are the

Heart, Liver and Kidneys.

HYPERTHYROIDISM

PALPITATIONS

INSOMNIA

DEPRESSION

FEVER

TREMORS

SWEATING DIABETES

XU-LAO

As mentioned above, Dr Wei Zi Xiao says that hyperthyroidism cannot be

equated with “Goitre” of Chinese Medicine; he says that hyperthyroidism

may correspond to many different Chinese “diseases” such as

“Palpitations”, “Insomnia”, “Depression”, “Sweating”, “Tremors”, etc.

In this opinion, Dr Wei differs from most other Chinese doctors who

equate hyperthyroidism with “Goitre” (Ying Bing) of Chinese medicine.

I personally tend to agree with Dr Wei in thinking that hyperthyroidism

corresponds to “Goitre” only when there is a goitre and very many

patients suffering from hyperthyroidism, do not have a goitre.

According to Dr. Wei Zi Xiao, the treatment principles for hyperthyroidism are:

Nourish Yin

Sheng Di Huang Radix Rehmanniae, Dang Gui Radix Angelicae sinensis, Gou Qi Zi

Fructus Lycii chinensis, Nu Zhen Zi Fructus Ligustri lucidi, Han Lian Cao Herba

Ecliptae, Tian Men Dong Radix Asparagi, Mai Men Dong Radix Ophiopogonis, Bie

Jia Carapax Trionycis, Bai Shao Radix Paeoniae alba, Ji Xue Teng Caulis Spatholobi

Clear Heat

• Heart (palpitations, insomnia, anxiety): Huang Lian Rhizoma Coptidis, Shan Zhi Zi

Fructus Gardeniae, Lian Xin Plumula Nelumbinis nuciferae, Bai Zi Ren Semen

Biotae

• Stomach (thirst and hunger): Shi Gao Gypsum Fibrosum, Zhi Mu Radix

Anemarrhaenae, Gan Cao Radix Glycyrrhizae uralensis, Huang Lian Rhizoma

Coptidis, Huang Qin Radix Scutellariae

• Liver (dizziness, blurred vision, irritability, tremor): Huang Qin Radix Scutellariae,

Long Dan Cao Radix Gentianae, Xia Ku Cao Spica Prunellae, Ci Shi Magnetitum,

Mu Li Concha Ostreae.

Eliminate stagnation

(Chai Hu Radix Bupleuri, Xiang Fu Rhizoma Cyperi, Yu Jin Radix Curcumae, Fu

Ling Poria, Bai Zhu Rhizoma Atractylodis macrocephalae).

For goitre, Dr Wei Zi Xiao uses Si Qi Tang Four-Ingredient

Decoction for the Seven Emotions

Fu Ling Poria

Sheng Jiang Rhizoma Zingiberis recens

Ban Xia Rhizoma Pinelliae preparatum

Hou Po Cortex Magnoliae

Zi Su Ye Folium Perillae

Da Zao Fructus Jujubae

Plus:

Gui Zhi Ramulus Cinnamomi cassiae

E Zhu Rhizoma Curcumae

Chuan Shan Jia Squama Manitis Pentadactylae

Bai Jie Zi Semen Sinapis albae

Mu Li Concha Ostreae

For exophthalmos he drains Dampness, resolves Phlegm, eliminates stasis and

extinguishes Wind using:

Mu Tong Caulis Akebiae trifoliatae

Ze Xie Rhizoma Alismatis

Bai Jie Zi Semen Sinapis albae

Ban Xia Rhizoma Pinelliae preparatum

Zhe Bei Mu Bulbus Fritillariae thunbergii

E Zhu Rhizoma Curcumae

Chi Shao Radix Paeoniae rubra

Yi Mu Cao Herba Leonuri

Ju Hua Flos Chrysanthemi

Mu Zei Cao Herba Equiseti hiemalis

Bai Ji Li Fructus Tribuli.

Note: please note that we should not use Mu Tong, even if it is Akebia.

Finally, he uses Hai Zao Herba Sargassi 20-30g per day.

Shanghai Municipal Acupuncture and Channels Research Group

According to the Shanghai Municipal Acupuncture and Channels

Research Group, the main pathology of hyperthyroidism is Yin deficiency

of Liver and Kidneys with Empty Heat in Liver and Heart. These

doctors’ thinking follows very much the Five Elements and they say that

the deficiency of the Water Element affects the Child, i.e. Wood and this,

in turn, affects Fire. For this reason, the treatment principle is to nourish

Water and drain Wood and Fire.

The main points used are:

KI-10 Yingu, KI-7 Fuliu, SP-6 Sanyinjiao and KI-3 Taixi in tonification

to nourish Water and HE-7 Shenmen, P-7 Daling, P-8 Laogong and P-5

Jianshi in reduction to drain Fire.

Other distal points =

L.I.-4 Hegu and ST-40 Fenglong.

Local points for goitre =

ST-10 Shuitu (most important one according to them), extra points Ping

Ying and Shang Tian Zhu.

Dr Zhao Fen

According to Dr Zhao Fen (Fujian College of Traditional Chinese Medicine),

the pathology of hyperthyroidism often starts with Liver-Qi stagnation; this

usually leads to Liver-Fire; Liver-Fire injures the fluids and leads to deficiency

of Yin of the Liver and Kidneys.

Dr Zhao Fen therefore differentiates three stages in the development of

hyperthyroidism: in the initial stage the treatment principle is to move Liver-

Qi, remove stagnation, resolve Phlegm, dissolve goitre, and drain Fire; in the

middle stage the treatment principle is to subdue Liver Yang, clear Heat, cool

Blood and nourish Yin; in the late stage the treatment principle is to nourish the

Liver, tonify Qi and Yin, and clear Empty-Heat.

1) Dr Zhao uses a variation of Xiao Chai Hu Tang Small Bupleurum Decoction

for the initial stage with Liver-Qi stagnation.

2) Dr Zhao uses a variation of Zhen Zhu Mu Tang Concha Margatiriferae

Decoction for the middle stage of hyperthyroidism.

3) The prescription used for the late stage of hyperthyroidism is a variation of

Sheng Mai Tang Nourishing the Pulse Decoction.

Initial stage

The treatment principle is to move Liver-Qi, remove stagnation, resolve

Phlegm, dissolve goitre, and drain Fire

Middle stage

The treatment principle is to subdue Liver Yang, clear Heat, cool Blood and

nourish Yin

Late stage

The treatment principle is to nourish the Liver, tonify Qi and Yin, and clear

Empty-Heat.

Dr Peng Lu Xiang

According to Dr Peng Lu Xiang (Chengdu College of TCM) the main

treatment principles for hyperthyroidism are to move Liver-Qi, nourish

Yin, clear Heat, soften hardness, dissolve nodules, resolve Phlegm, and

eliminate stasis. The main organs involved are Heart, Liver, Spleen and

Stomach.

However, Dr Peng is unique among Chinese doctors in that he considers

that the Lungs are also involved in the pathology of hyperthyroidism. He

says that Liver-Fire can rebel horizontally to invade the Spleen and

Stomach injuring the Yin of these organs. He also says that Liver-Fire can

affect the Lungs (“Wood insulting Metal”). For this reason he uses a

variation of Bai He Di Huang Tang Lilium-Rehmannia Decoction.

Dr Peng gives two main reasons for using this decoction and in particular the

herb Bai He Bulbus Lilii:

1) by entering the Lungs, Bai He clears Metal so that Wood is regulated, Liver-

Qi moves, Fire is subdued, and the Yin fluids nourished. On the other hand,

Sheng Di Huang Radix Rehmanniae nourishes Yin; Zhi Mu Radix

Anemarrhaenae clears Lung- and Stomach-Heat. The combination of these

three herbs clears the Lungs, drains and subdues Liver-Fire, nourishes Yin and

clears Heat.

2) as it enters the Lungs which control channels and blood vessels, this herb

treats channels and blood vessels thereby removing obstructions which cause

goitre. Dr Peng says, that although quite different conditions, there are

similarities between hyperthyroidism and the Lilium Syndrome (Bai He Bing)

mentioned in the “Essential Prescriptions of the Golden Chest” (Jin Gui Yue

Fang).

Note the very interesting use of Bai He Bulbus Lilii

COMMENTS

1) The original text mentions the use of Bai He Zhi Mu Tang to restore Yin

that has been injured by the wrong application of sweating. However, the

modern clinical application of this formula is far broader. It is used for

deep mental-emotional distress occurring against the background of Lung-

and Heart-Yin deficiency.

2) Zhi Mu in the formula nourishes Yin and clears Heat. Bai He also

nourishes Yin, moistens the Lungs and treats the Po.

3) I use this formula for depression and anxiety occurring against the

background of Qi and Yin deficiency of Heart and Lungs from emotional

stress such as sadness, grief, worry and guilt.

4) I also use this formula if the Bai He disease occurs against the

background of Lung- and Kidney-Yin deficiency. This is often caused by

different emotions and especially fear and anxiety. The two formulae may

be combined with the use of Bai He, Zhi Mu and Sheng Di Huang.

Dr Peng recommends the following additions according to symptoms:

• For thirst and dry mouth, add Tian Hua Fen Radix Trichosanthis

• For dark urine, add Hua Shi Talcum

• For Qi stagnation and Blood stasis, add Yu Jin Radix Curcumae and Tao

Ren Semen Persicae

• For insomnia, add Ye Jiao Teng Caulis Polygoni multiflori and Suan Zao

Ren Semen Ziziphi spinosae

• For profuse sweating, add Huang Qi Radix Astragali and Gui Zhi

Ramulus Cinnamomi cassiae.

Dr Ren Duan Xue

According to Dr Ren Duan Xue (Changchun College of Traditional Chinese

Medicine), Qi stagnation is at the root of the pathology of hyperthyroidism.

He says that the emotional root of this disease is anger leading to Qi

stagnation. Stagnant Liver-Qi turns into Fire which flares upwards to disturb

the Heart, causing mental restlessness, palpitations and anxiety. Liver-Fire

flares up to harass the Lungs as well causing excessive sweating.

Moreover, Liver-Fire moves horizontally to invade the Stomach and Spleen

injuring their fluids and causing thirst, hunger, and loss of weight. The Liver

opens into the eyes, and the upward rise of Liver-Fire causes exophthalmos

(bulging of the eyeballs).

Dr Ren therefore says that the main treatment principle for hyperthyroidism is

to move Liver-Qi, subdue Liver-Fire, clear Heat and extinguish Wind. The

prescription he recommends is his own empirical prescription based on these

treatment principles.

Stagnant LIV-Qi LIV-Fire ST

HE-Fire

LUNGS

mental

restlessness,

palpitations

and anxiety

thirst, hunger,

and loss of

weight

excessive

sweating

Exophthalmos

Dr Chen Yuan Sheng

According to Dr Chen Yuan Sheng (Chongqing Chinese Medicine

Research Group), the main treatment principle in hyperthyroidism is to

nourish Liver- and Kidney-Yin, clear Empty–Heat, resolve Phlegm and

dissolve goitre. Dr Chen uses a variation of Chai Shao Long Mu Tang

Bupleurum-Paeonia-Mastodi Ossis fossilia-Concha Ostreae Decoction.

Dr Chen recommends the following additions according to symptoms:

• For Qi deficiency, add Huang Qi Radix Astragali

• For insomnia, add Suan Zao Ren Semen Ziziphi spinosae

• For excessive sweating, add Fu Xiao Mai Fructus Tritici levis

• For goitre, add Bie Jia Carapax Trionycis, Zhe Bei Mu Bulbus

Fritillariae thunbergii, and Xia Ku Cao Spica Prunellae

• For Heat, add Huang Qin Radix Scutellariae, and Shan Zhi Zi Fructus

Gardeniae

• For tremors, add Dang Gui Radix Angelicae sinensis, and Mu Gua

Fructus Chaenomelis.

Dr Chen Duan Ming

According to Dr Chen Duan Ming (Nantong Hospital of Chinese Medicine),

the main treatment principle for hyperthyroidism is to nourish Yin, drain

and subdue Fire, dissolve goitre and dissolve nodules. Dr Chen uses a

variation of Dang Gui Liu Huang Tang Angelica Six Yellow Decoction.

Dr Chen Ze Lin

According to Dr Chen Ze Lin (Shanghai Zhongshan Hospital of the

University of Medical Science), there are two main patterns involved in

hyperthyroidism: the first is Liver-Fire and Stomach-Heat with internal

Wind; the second is Liver-Qi stagnation with Phlegm.

The prescription he uses to drain Liver-Fire, clear Stomach-Heat and

extinguish internal Wind is a variation of Long Dan Xie Gan Tang

Gentiana Draining the Liver Decoction.

Dr Chen suggests the following modifications according to symptoms:

• For Heart-Fire, add Huang Lian Rhizoma Coptidis 3g

• For palpitations, add Zhen Zhu Mu Concha Margatiriferae usta 30g, and

Long Chi Mastodi Dens fossilia 15g

• For dry mouth, add Tian Hua Fen Radix Trichosanthis 30g and Lu Gen

Rhizoma Phragmitis 30g

• For exophthalmos, add Zhe Bei Mu Bulbus Fritillariae thunbergii 9g,

Dan Nan Xing Rhizoma Arisaematis preparatum 6g, Che Qian Zi Semen

Plantaginis 15g, and Ze Xie Rhizoma Alismatis 10g.

• The prescription that Dr Chen uses to move Liver-Qi and resolve Phlegm

is a variation of Si Hai Jie Yu Tang Four Seas Eliminating Stagnation

Decoction.

Dr Chen recommends the following modifications according to

symptoms:

• For feeling of lump in the throat, add Hou Po Cortex Magnoliae

officinalis 9g, and Ban Xia Rhizoma Pinelliae preparatum 9g

• For a large goitre, add San Leng Rhizoma Sparganii stoloniferi 12g, and

Chuan Shan Jia Squama Manitis Pentadactylae 9g

• For insomnia, add Suan Zao Ren Semen Ziziphi spinosae 9g, and Ye

Jiao Teng Caulis Polygoni multiflori 9g

• For Heat, add Shan Zhi Zi Fructus Gardeniae 9g, and Zhi Mu Radix

Anemarrhaenae 9g.

• As an empirical remedy, Dr Chen also recommends the use of seaweeds

such as Kun Bu Thallus Eckloniae and Hai Zao Herba Sargassi in large

doses (at least 50g of each).

Dr Lu Cheng Ren

Dr Lu Cheng Ren (Beijing Medical College) says that hyperthyroidism

corresponds to the Chinese disease of “Goitre” [I personally totally disagree

with this]. He attributes the aetiology of hyperthyroidism to emotional stress

and in particular anger leading to Liver-Qi stagnation; stagnant Liver-Qi turns

into Fire and this dries up the body fluids. Stagnant Liver-Qi upsets the

movement of Qi in the Qi Mechanism and this leads to the formation of

Phlegm. The Liver opens into the eyes and Liver-Qi stagnation causes

exophthalmos.

The Liver influences the sinews and deficiency of Liver-Blood causes tremor

of the hands. Liver-Fire injures the fluids and leads to Heart-Yin deficiency

resulting in insomnia, palpitations and sweating. Liver-Fire invades the

Stomach and causes thirst, excessive hunger and weight loss. Liver and

Kidneys have a common root and the deficiency of Yin of the Liver induces

Kidney-Yin deficiency.

LIV-Qi Stagnation LIV-Fire

HE-Yin

Deficiency

ST-HEAT

Phlegm

LIV-Yin Xu KI-Yin Xu

Dr Lu recommends the treatment principle of nourishing Yin and

clearing Heat to treat hyperthyroidism. He uses a variation of the

formula Zi Shui Qing Gan Yin Nourishing Water and Clearing the

Liver Decoction.

Dr Lu recommends the following modifications according to

symptoms:

• For large goitre, add Hai Fu Shi Pumice, Chi Shao Radix Paeoniae

rubra and Hai Zao Herba Sargassi.

• For bitter taste, dry eyes and dry stools from Liver-Fire add Long

Dan Cao Radix Gentianae. Huang Qin Radix Scutellariae and Da

Huang Radix et Rhizoma Rhei.

• For tremors from Liver-Wind, add Gou Teng Ramulus cum Uncis

Uncariae, Ling Yang Jiao Cornu Saigae tataricae and Zhen Zhu Mu

Concha Margatiriferae usta.

Dr Zhu Ceng Bo

(Hubei College of Traditional Chinese Medicine)

Dr Zhu Ceng Bo thinks that hyperthyroidism cannot be equated to the

Chinese disease of “Goitre”. Dr Zhu distinguishes three main conditions

in hyperthyroidism.

1) The first is characterized by Fire of the Liver, Stomach and Heart with

manifestations such as propensity to outbursts of anger, feeling of heat,

sweating, excessive hunger, weight loss, thirst and insomnia. For this

condition, he recommends an empirical prescription according to his

experience.

2) The second condition is characterized by Liver-Fire invading the

Stomach causing manifestations such as thirst, dry mouth, excessive

hunger, weight loss, insomnia, palpitations. He recommends an empirical

prescription according to his clinical experience.

3) The third condition is characterized by deficiency of Yin with such

clinical manifestations as exhaustion, weight loss, dizziness, palpitations,

anxiety, dry mouth, insomnia, feeling of heat in the evening, 5-palm

heat. Dr Zhu recommends an empirical prescription according to his

experience.

Dr Zhou Guo Xiong

Dr Zhou Guo Xiong distinguishes three main conditions in the pathology

of hyperthyroidism: the first is characterized by Liver-Qi stagnation,

Liver-Fire and Phlegm; the second by Yin deficiency with Empty Heat;

the third by Qi and Yin deficiency.

1) For the first condition with Liver-Qi stagnation, Liver-Fire and

Phlegm, he uses a variation of Hai Zao Yu Hu Tang Sargassum Jade Pot

Decoction.

2) For the second condition with Yin deficiency and Empty Heat, Dr

Zhou uses a variation of Qing Gan Lu Hui Wan Clearing the Liver Aloe

Pill together with Yu Nu Jian Jade Woman Decoction.

3) For the third condition with Qi and Yin deficiency, Dr Zhou uses a

variation of Huang Qi Tang Astragalus Decoction.

Dr Zhang Zhen Ru

Dr Zhang Zhen Ru (Wuhan City College of Traditional Chinese Medicine)

indicates two main treatment principles for hyperthyroidism: the first is to

nourish Liver-Yin; the second is to soften hardness and eliminate Blood

stasis. He formulated his own prescription called Xiao Ying Zhi Kang Tang

Dissolving Goitre and Reducing Hyperthyroidism Decoction.

Dr Wang Zhu Bie

Dr Wang Zhu Bie (Zhejiang Province Public Health Department) considers

that in hyperthyroidism, the main patterns are Liver-Qi stagnation, Yin

deficiency and Phlegm. He thinks that the two main organs involved are the

Liver and Kidneys.

The main treatment principle is to nourish Yin, subdue the Liver, move

Liver-Qi, resolve Phlegm and soften hardness. Dr Wang uses an empirical

prescription according to his experience.

Dr Xu Feng Gong

According to Dr Xu Feng Gong, hyperthyroidism corresponds to the

Chinese disease of “Goitre” and he thinks that the main treatment principle

is to resolve Phlegm, move Liver-Qi, drain Liver-Fire, clear Stomach-Heat,

calm the Mind and extinguish Liver-Wind. Dr Xu uses an empirical

prescription according to his experience

Dr Xu Qing Cheng

Dr Xu Qing Cheng (Wuhan Medical College) thinks that the main

conditions appearing in hyperthyroidism are Heart- and Liver-Yin

deficiency, Heat and Phlegm. He therefore advocates the treatment

principle of supporting Heart-Qi, nourishing Liver-Yin, softening hardness

and dissolving nodules. Dr Xu uses an empirical prescription according to

his experience

Dr Xia Shao Nong

Dr Xia Shao Nong (Shanghai College of Traditional Chinese Medicine)

thinks that hyperthyroidism corresponds to the Chinese disease “Goitre”.

He states that the main treatment principles are three: to nourish Yin and

clear Heat; to move Qi and resolve Phlegm; to tonify Qi and Yin.

Dr Xia recommends his own empirical prescription to treat

hyperthyroidism. He recommends the following modifications according

to symptoms:

• For Spleen-Qi deficiency, remove Sheng Di Huang Radix Rehmanniae

and add Shan Yao Rhizoma Dioscoreae and Bai Zhu Rhizoma

Atractylodis macrocephalae

• For Heart-Fire, add Huang Lian Rhizoma Coptidis

• For Liver-Fire, add Long Dan Cao Radix Gentianae.

Based on the experience of the above doctors and partly my own, the

following patterns are the most common ones in hyperthyroidism:

• Liver-Qi stagnation

• Liver- and Kidney-Yin deficiency with Empty Heat

• Heat in the Liver, Heart and Stomach

• Phlegm-Heat in the Liver

Most of the patterns discussed above assume the absence of goitre. If there is

goitre with hyperthyroidism, one must resolve Phlegm, soften hardness and

dissolve masses with some of the following herbs:

• Zhe Bei Mu Bulbus Fritillariae thunbergii and Ban Xia Rhizoma Pinelliae

preparatum to resolve Phlegm

• Kun Bu Thallus Eckloniae, Hai Zao Herba Sargassi or Zhe Bei Mu Bulbus

Fritillariae thunbergii to soften masses

• Xia Ku Cao Spica Prunella, E Zhu Rhizoma Curcumae or Huang Yao Zi

Radix Dioscoreae bulbiferae to dissolve masses.

From the point of view of acupuncture treatment, if there is a goitre the distal

points are selected according to the patterns discussed below, but the local

points indicates above under “Goitre” should be added.

AUTOIMMUNE DISORDERS

Both Hashimoto’s Thyroiditis and Graves’ Disease are autoimmune disease.

Therefore, we need to see how we would change the treatment in case of

autoimmune diseases.

An autoimmune disorder is a condition that occurs when the immune system

mistakenly attacks and destroys healthy body tissue perceiving it to be “non-

self”. There are more than 80 different types of autoimmune disorders.

Normally the immune system’s white blood cells help protect the body from

antigens such as bacteria, viruses, toxins, cancer cells, and blood or tissues

from another person or species. The immune system produces antibodies that

destroy these harmful substances.

In patients with an autoimmune disorder, the immune system perceives the

body’s own tissues as antigens and attacks them. The result is an immune

response that destroys normal body tissues. This response is a

hypersensitivity reaction similar to the response in allergic conditions.

In allergies, the immune system reacts to an outside substance that it

normally would ignore. With autoimmune disorders, the immune system

reacts to normal body tissues that it would normally ignore.

What causes the immune system to no longer tell the difference between

healthy body tissues and antigens is unknown. One theory is that some

microorganisms (such as bacteria or viruses) or drugs may trigger some

of these changes, especially in people who have genes that make them

more likely to get autoimmune disorders. In my view, immunizations

have a lot to do with it.

An autoimmune disorder may result in:

• The destruction of one or more types of body tissue

• Abnormal growth of an organ

• Changes in organ function

• An autoimmune disorder may affect one or more organ or tissue types.

Symptoms

Symptoms of an autoimmune disease vary enormously based on the

disease and location of the abnormal immune response. Symptoms that

often occur with autoimmune diseases include:

• Fatigue

• Fever

• General ill-feeling (malaise)

From a Chinese perspective these three symptoms could be symptoms of

Yin Fire or Latent Heat.

AUTOIMMUNE DISEASES in CHINESE MEDICINE

In my view, the presence of an auto-immune dysfunction of the immune

system indicates a pathogenic factor that is at a deep energetic level and that

is different from normal exterior pathogenic factors. The immune

dysfunction also indicates a pathology of the Yin aspects of the immune

system, i.e. Blood, Marrow, Kidneys.

However, auto-immune diseases are so many and so disparate that it is

impossible to prescribe a blanket treatment method for them. For example,

the pathology of Hashimoto’s thyroiditis and MS are so different that they

really have very little in common.

The only thing they might have in common is the aetiology. In many, but

not all, auto-immune diseases the aetiology is Latent Heat or Yin Fire.

Especially when in the beginning there are symptoms of Heat, with

lassitude and possibly fever, they have something in common in their

pathology.

Also, if we know we are dealing with an auto-immune disease, it gives us

an important pointer from the point of view of prognosis.

APPROACH TO TREATMENT OF AUTO-IMMUNE DISEASES

• No Chinese theory obviously

• All diseases are very different and must be treated according to their

specific pathology (e.g. MS and Hashimoto’s thyroiditis have nothing in

common from Chinese perspective)

• Being auto-immune affects ease (or difficulty) of treatment and prognosis

• Compare “normal” hypothyroidism and Hashimoto’s thyroiditis: latter has

more severe symptoms and will be more difficult to treat. The same for

hyperthyroidism and Graves’ disease.

• In late stages of auto-immune diseases, there seems to be a common pulse,

i.e. the Leather pulse which is superficial but empty at the deep level. The

surface is kind of “broad” and feels kind of stretched like a drum

Must grasp aetiology, pathology and patterns of the disease ignoring its

auto-immune nature. For example, Sjogren’s Syndrome, Hashimoto

thyroiditis, Crohn’s Disease, MS and RA have very little or nothing in

common in terms of pathology.

• Sjogren’s Syndrome: Yin Xu of ST, LIV

• Hashimoto: Phlegm, SP-Qi Xu, KI-Yang Xu

• Crohn’s Disease: Damp-Heat in Intestines

• MS: Dampness, ST-SP Xu, LIV-KI Xu

• RA: Damp-Heat in joints

Must treat the Kidneys which are the root of the auto-immune process.

This can be KI-Yang, KI-Yin, Jing, Yuan Qi, Minister Fire.

Must treat inflammation with at least one or two anti-inflammatory

herbs.

Check if there is Latent Heat or Yin Fire.

CAUSES OF LATENT HEAT

The main cause of the development of Latent Heat, i.e. that the patient

does not display symptoms at the time of infection and the pathogenic

factor lurks in the Interior to emerge later, is a Kidney deficiency which

causes the immune system not to react to the initial external invasion.

A contributory factor are immunizations. It could be said that

immunizations inject a pathogenic factor directly at the Blood level. In

normal immunity when someone is infected, the pathogenic factor

penetrates from the Wei level and leads to immunity to that bacteria or

virus.

Wei

Xue

Ying

Qi

WHY LATENT HEAT DEVELOPS

Why do some invasions of Wind cause immediate exterior symptoms and

some do not cause immediate symptoms and penetrate into the Interior

where they “lurk” (incubate)?

The answer lies in the immune response. If the immune system does not

react, the pathogenic factor does not cause symptoms and penetrates into

the Interior, to emerge later. This lack of immune response depends not

only on the Lungs but also on the Kidneys.

Ye Tian Shi said that the “lurking Cold” of Winter resided in the Kidneys.

Remember Nei Jing statement “If Jing is not guarded in Winter, Wen Bing

develops in Spring”.

Ye Tian Shi even advocated tonifying the Kidneys to prevent invasion of

external pathogenic factors.

Some doctors of the late Qing too correlated the severity of Latent

pathogenic factor to Kidney and specifically Kidney-Yin.

Many doctors relate the formation of Latent Heat to a Kidney

deficiency. For example, one says that Winter controls storage

and so do the Kidneys. When the Kidneys are healthy, Kidney-

Yang and Kidney-Jing are “stored” in winter so that Cold cannot

invade the body.

Conversely, if mental restlessness, overwork and excessive desire

afflict a person, Yang Qi is dispersed, Yin is consumed and

pathogenic factors can easily invade the body taking advantage of

the Empty condition.

When Kidney-Qi is strong, the Yang Qi of the Ming Men and Triple Burner

consolidate the Cou Li space.

Triple Burner

COU LI 腠理

SUMMARY OF AUTOIMMUNE DISEASE TREATMENT

I would like to summarize here how I would modify the treatment of a

disease if it is autoimmune. As I said, the first thing to do is to treat each

disease according to the normal pattern identification, as if we were ignoring

that it is an autoimmune disease.

The following are the principles I would follow in the case of an

autoimmune disease in addition to the treatment according to pattern

identification.

1. Check whether there is Latent Heat. If there is, clear Heat in the Shao Yin,

i.e. Heart and Kidneys with Ze Xie Rhizoma Alismatis.

2. Use one or two anti-inflammatory herbs such as Mu Dan Pi Cortex

Moutan or Huang Qin Radix Scutellariae.

3. To treat the Root for long-term treatment, tonify the Kidneys (Yin or

Yang) and Kidney-Jing.

1. If there is Yin Fire, besides tonifying the Kidneys and the Yuan Qi, use

Huang Qi Radix Astragali and Chai Hu Radix Bupleuri.

LIST OF ANTI-INFLAMMATORY CHINESE HERBS

(Chen JK and Chen T Chinese Medical Herbology and Pharmacology)

Ba Ji Tian Radix Morindae officinalis

Bai Shao Radix Paeoniae alba

Bai Zhi Radix Angelicae dahuricae

Cang Er Zi Fructus Xanthii

Chai Hu Radix Bupleuri

Chi Shao Radix Paeonia rubra

Chuan Xin Lian Herba Andrographis

Da Huang Radix et Rhizoma Rhei

Da Qing Ye Folium Isatidis

Dan Shen Radix Salviae miltiorrhizae


Dang Shen Radix Codonopsis

Di Yu Radix Sanguisorbae


Du Zhong Cortex Eucommiae

Fang Feng Radix Saposhnikoviae

Hong Hua Flos Carthami

Hei Zhi Ma Semen Sesami nigri

Hu Zhang Rhizoma Polygoni cuspidati

Huai Hua Flos Sophorae

Huang Lian Rhizoma Coptidis

Huang Qi Radix Astragali

Huang Qin Radix Scutellariae

Jiang Huang Rhizoma Curcumae longae

Jie Geng Radix Platycodonis

Jin Qian Cao Herba Lysimachiae

Jin Yin Hua Flos Lonicerae

Jing Jie Herba Schizonepetae

Ku Shen Radix Sophorae flavescentis

Kuan Dong Hua Flos Farfarae

Lei Gong Teng Radix Tripterygii wilfordii

Lian Qiao Fructus Forsythiae

Lu Hui Aloe

Lu Lu Tong Fructus Liquindambaris

Man Jing Zi Fructus Viticis

Mao Dong Qing Radix Ilicis pubescentis

Mu Dan Pi Cortex Moutan

Nu Zhen Zi Fructus Ligustri lucidis

Pi Pa Ye Folium Eriobotryae

Qiang Huo Rhizoma et Radix Notopterygii

Qin Jiao Radix Gentianae macrophyllae

Qin Pi Cortex Fraxini

San Qi Radix Notoginseng

Shan Dou Gen Radix Sophorae tonkinensis

Sheng Ma Radix Cimicifugae

Tao Ren Semen Persicae

Tian Ma Rhizoma Gastrodiae

Wu Jia Pi Cortex Acanthopanacis

Xi Xian Cao Herba Siegesbeckiae

Xi Xin Herba Asari

Xia Ku Cao Spica Prunella

Xian Mao Rhizoma Curculiginis

Xiang Fu Rhizoma Cyperi

Xiao Ji Herba Cirisii

Xu Chang Qing Radix Cynanchi Paniculati

Xue Jie Sanguis Draconis

Xue Yu Tan Crinis Carbonisatus

Xun Gu Feng Herba Aristolochiae Mollissimae

Ye Ju Hua Flos Chysanthemi Indici

Yin Yang Huo Herba Epimedii

Yu Xing Cao Herba Houttuyniae

Ze Xie Rhizoma Alismatis

Zhi Zi Fructus Gardeniae

Zi Cao Gen Radix Lithospermi

Fu Zi Radix Aconiti Lateralis preparata

Cao Wu Radix Aconiti Kusnezoffi

Case history

A 30-year-old woman had been suffering from hyperthyroidism for over

one year: she did not have a goitre and she was not on medication.

Other complaints: palpitations, a feeling of heat and thirst. No menstrual

irregularity. Red tongue with redder sides and tip and a yellow coating.

Wiry and Rapid pulse.

Although she did not have many symptoms, her tongue and pulse showed

the presence of Liver- and Heart-Fire clearly, the tongue being Red in

general and particularly redder on the sides and tip (Liver and Heart area).

I therefore treated her with a variation of Long Dan Xie Gan Tang

Gentiana Draining the Liver Decoction but without Mu Tong Caulis

Akebiae trifoliatae.

She started improving a few weeks after taking the medication. After some

months, her tongue was much less Red. As this formula is bitter and cold

in nature and can therefore injure the Spleen, I decided to suspend it for a

month after six months of continuous use. I treated her again with another

course of four months after that and her tongue and symptoms all reverted

to normal.

CLINICAL STUDIES

Journal Subjects Treatment

Journal of Chinese

Medicine (Zhong Yi

Za Zhi), No. 11,

1992, p. 28.

115 cases of nodules on

thyroid with

hyperthyroidism, raised

T3 and T4.

Chai Hu 240g, Xia Ku Cao 300g, Shan Ci

Gu 200g, Chen Pi 200g, Gui Jian Yu 200g,

Ban Xia 200g, Zhe Bei Mu 200g, Hai Zao

200g, Kun Bu 200g.

Journal of Chinese

Medicine (Zhong Yi

Za Zhi), No. 9,

1984, p. 47.

98 cases of

hyperthyroidism, raised

T3 and T4.

Treatment principle was to tonify Qi and

nourish Yin. Huang Qi 30-45g, Bai Shao

12g, Sheng Di Huang 15g, Xiang Fu 12g,

Xia Ku Cao 30g, Shou Wu 20g. If Spleen-

Qi deficiency: Shan Yao, Bai Zhu. If

Heart-Fire: Huang Lian. If Liver-Fire:

Long Dan Cao.

Journal Subjects Treatment Results

Journal of

Chinese

Medicine (Zhong

Yi Za Zhi) No.

9,1993, p. 542.

Hypothyroidism Formula: Fu Zi, Yin Yang Huo,

Rou Gui, Fu Ling, Bai Zhu, Gan

Jiang, Huang Qi, Dang Gui, Sheng

Di Huang, Shu Di Huang, Shan

Zhu Yu, Bai Shao.

Chinese

Acupuncture and

Moxibustion

(Zhong Guo Zhen

Jiu) No. 5,1986,

p. 15.

129 cases of

hyperthyroidism

Compared three groups of points:

1.Ah Shi points around goitre and

ST-10 Shuitu

2. P-6 Neiguan, P-5 Jianshi, ST-36

Zusanli, SP-6 Sanyinjiao

3. Ah Shi points around goitre, P-6

Neiguan, P-5 Jianshi, ST-36

Zusanli, SP-6 Sanyinjiao.

Best results

were

obtained

with third

group

Journal Subjects Treatment Results

Journal of

Chinese

Medicine (Zhong

Yi Za Zhi), Vol.

46, No. 8, 2005,

pp. 593-4.

40 cases of serious

hypothyroidism

randomly divided

into two groups

22 being treated with a

combination of thyroxine and

Chinese herbs and 18 being

treated with thyroxine only.

The treatment

group was

significantly

superior to the

control group in

improvement of

T3 (P<0.01).

The formula used tonifies and warms Spleen- and Kidney-Yang: Fu Zi Radix Aconiti lateralis

preparata, Rou Gui Cortex Cinnamomi, Yin Yang Huo Herba Epimidii, Shan Zhu Yu Fructus

Corni, Tu Si Zi Semen Cuscutae, Gan Jiang Rhizoma Zingiberis, Fu Ling Poria, Zhi Gan Cao

Radix Glycyrrhizae uralensis preparata.

Review Chinese Literature on Hyperthyroidism - Prescriptions

EMPIRICAL PRESCRIPTION (XIAO YING ZHI KANG

TANG) by Dr Zhang Zhen Ru

Dissolving Goitre and Reducing Hyperthyroidism Decoction

• Sheng Di Huang Radix Rehmanniae 6 g

• Xuan Shen Radix Scrophulariae 6 g

• Mai Men Dong Radix Ophiopogonis 6 g

• Kun Bu Thallus Eckloniae 9 g

• Hai Zao Sargassum 9 g

• Huang Yao Zi Rhizoma Dioscoreae bulbiferae 6 g

• Hai Piao Xiao Endoconcha Sepiae 9 g

• Hai Fu Shi Pumice 9 g

• Yu Jin Radix Curcumae 6 g

• Mu Li Concha Ostreae 9 g

• Zhe Bei Mu Bulbus Fritillariae thunbergii 6 g

• Gui Ban Plastrum Testudinis 6 g

Review Chinese Literature on Hyperthyroidism

EMPIRICAL PRESCRIPTION by Dr Xu Feng Gong

• Kun Bu Thallus Eckloniae 9 g

• Hai Zao Sargassum 9 g

• Xuan Shen Radix Scrophulariae 6 g

• Fu Ling Poria 6 g

• He Huan Pi Cortex Albiziae 6 g

• Hai Fu Shi Pumice 9 g

• Xia Ku Cao Spica Prunellae 6 g

• Suan Zao Ren Semen Ziziphi spinosae 6 g

• Yuan Zhi Radix Polygalae 6 g

• Zhe Bei Mu Bulbus Fritillariae thunbergii 6 g

• Ju Hua Flos Chrysanthemi 6 g

• Chen Pi Pericarpium Citri reticulatae 3 g

• Mu Li Concha Ostreae 9 g


EMPIRICAL PRESCRIPTION by Dr Xu Qing Cheng

•Tai Zi Shen Radix Pseudostellariae 30 g

•Mai Men Dong Radix Ophiopogonis 12 g

•Wu Wei Zi Fructus Schisandrae 10 g

•Bai Shao Radix Paeoniae alba 15 g

•Sheng Di Huang Radix Rehmanniae 20 g

•Suan Zao Ren Semen Ziziphi spinosae 12 g

•Hai Ge Ke Concha Meretricis seu Cyclinae 10 g

•Mu Li Concha Ostreae 30 g

•Zhe Bei Mu Bulbus Fritillariae thunbergii 10 g

•Xia Ku Cao Spica Prunellae 30 g

•Hai Zao Sargassum 10 g

•Kun Bu Thallus Eckloniae 10 g


EMPIRICAL PRESCRIPTION by Dr Chen Yuan Sheng

•Chai Shao Long Mu Tang

•Bupleurum-Paeonia-Mastodi Ossis fossilia-Concha Ostreae Decoction

•Chai Hu Radix Bupleuri

•Bai Shao Radix Paeoniae alba

•Long Gu Mastodi Ossis Fossilia


EMPIRICAL PRESCRIPTION by Dr Xia Shao Nong

• Huang Qi Radix Astragali 30-45 g

• Bai Shao Radix Paeoniae alba 12 g

• Sheng Di Huang Radix Rehmanniae 15 g

• Xiang Fu Rhizoma Cyperi 12 g

• Xia Ku Cao Spica Prunellae 30 g

• Shou Wu Radix Polygoni multiflori preparata 20 g

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the treatment of thyroid problems in chinese medicine

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