Dfrierman Hypothyroidism Ln Tcmwt

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Hypothyroidism and TCM

by David Frierman, L.Ac.

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POWER POINT

Image 1: Thyroid and Parathyroid Glands

Image 2: The Thyroid and Surrounding Tissues

© David Frierman & Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine

1

Image 3: Histological section through the thyroid of a horse. 1 follicles, 2 follicular epithelial cells, 3

endothelial cells

Table 1: Three Primary Features of the Thyroid at the Microscopic Level1

Feature Description

Follicles The thyroid is composed of spherical follicles that selectively absorb

iodine (as iodide ions, I-) from the blood for production of thyroid

hormones, but also for storage of iodine in thyroglobulin, in fact iodine

is necessary for other important iodine-concentrating organs as breast,

stomach, salivary glands, thymus etc. (see iodine in biology).Twenty-

five percent of all the body's iodide ions are in the thyroid gland. Inside

the follicles, colloid serves as a reservoir of materials for thyroid

hormone production and, to a lesser extent, acts as a reservoir for the

hormones themselves. Colloid is rich in a protein called thyroglobulin.

Thyroid epithelial cells

(or "follicular cells")

The follicles are surrounded by a single layer of thyroid epithelial cells,

which secrete T3 and T4. When the gland is not secreting

T3/T4 (inactive), the epithelial cells range from low columnar to

cuboidal cells. When active, the epithelial cells become tall columnar

cells.

Parafollicular cells

(or "C cells")

Scattered among follicular cells and in spaces between the spherical

follicles are another type of thyroid cell, parafollicular cells, which

secrete calcitonin.

1 Fawcett, Don; Jensh, Ronald (2002). Bloom & Fawcett's Concise Histology. New York: Arnold Publishers. pp. 257–

258. ISBN 0-340-80677-X.


2

http://en.wikipedia.org/wiki/Iodide

http://en.wikipedia.org/wiki/Thyroglobulin

http://en.wikipedia.org/wiki/Iodine_in_biology

http://en.wikipedia.org/wiki/Thyroglobulin

http://en.wikipedia.org/wiki/Thyroid_epithelial_cell

http://en.wikipedia.org/wiki/Triiodothyronine

http://en.wikipedia.org/wiki/Thyroxine

http://en.wikipedia.org/wiki/Parafollicular_cell

http://en.wikipedia.org/wiki/Calcitonin

http://en.wikipedia.org/wiki/International_Standard_Book_Number

http://en.wikipedia.org/wiki/Special:BookSources/0-340-80677-X

Image 4: The Thyroid System


3

Image 5: Thyroid Gland Physiology

Table 2: Thyroid Hormonal Feedback Loop

T3 and T4 Serum Levels TSH and TRH Output

High Decreases

Low Increases


4

Table 2A: Results of Thyroid Function Tests in Various Clinical Situations2

Physiologic State Serum TSH

Serum Free T4 Serum T3 24-Hour Radio-

Iodine Uptake

Hyper-

thyroidism

Untreated Low High High High

T3 toxicosis Low Normal High Normal or

High`

Hypo-

thyroidism

Primary,

untreated

High Low Low or Normal Low or Normal

Secondary to

pituitary disease

Low or

Normal

Low Low or Normal Low or Normal

Euthyroidism Patient taking

iodine

Normal Normal Normal Low

Patient taking

exogenous

thyroid hormone

Normal Normal in patient

taking T4, low in

patient taking T3

High in patient

taking T3, normal

in patient taking T4

Low

Patient taking

estrogen

Normal Normal High Normal

Euthyroid sick

syndrome

Normal,

Low or

High

Normal or Low Low Normal

T3 = triiodothyronine; T4 = thyroxine; TSH =thyroid stimulating hormone

2http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/thyroid_disorders/overview_of_t

hyroid_function.html?qt=thyroid%20tumor&alt=sh


5

http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/thyroid_disorders/overview_of_thyroid_function.html?qt=thyroid%20tumor&alt=sh

http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/thyroid_disorders/overview_of_thyroid_function.html?qt=thyroid%20tumor&alt=sh

Diagram 1: The Five Phase-Elements, Engendering and Restraining Cycles

Fire (Heart)

Wood (Liver) Earth (Stomach Spleen)

Water Metal

(Kidneys) (Lung)

Engendering 相生 (xiāng shēng)

Restraining 相克(xiāng kè)

Table 3: Treatment Strategies for Different Stages of Treatment

Stage Yin Shi, Yang Xu Treatment Strategies Yang Shi, Yin Xu Treatment Strategies

1st Stage

Warm Interior and Drain Congested

Fluids, Transform Phlegm, Clear any

Heat and Toxins

Clear Heat and Toxins

2nd

Stage Supplement Yang Drain Damp and Transform Phlegm

3rd

Stage Supplement any Xu


6

Table 4: Historical Accounts of Thyroid Disease Rubrics

A. Goiter (瘿 yǐng)

B. Five Slownesses (五迟 wǔ chí)

C. Xu Detriment (虚损 xū sǔn)

D. Diarrhea (便泄 biàn xiè)

E. Fatigue (疲劳 pí láo)

F. Center Burner Dispersion-Thirst (中消 zhōng xiāo)

G. Palpitations, Heart Palpitations (心悸 xīn jì)

H. Sweating Syndrome (汗证 hàn zhèng)

I. Insomnia (失眠 shī mián)

J. Hand Tremor (手颤 shǒu chàn)

K. Constipation (便秘 biàn bì)

L. Cystitis (膀胱炎 páng guāng yān).

M. Vexation, Agitation, and Irascibility (烦燥易怒 fán zào yì nù)

N. Depression Syndrome (郁证 yù zhèng)

O. Phlegm-Rheum (痰饮 tán yǐn) Diseases

P. Water Swelling (水肿 shuǐ zhǒng)

Q. Bulging Eyes (眼球外突 yǎn qiú wài tū)

R. Weight Gain [Obesity, Fatness] (肥胖 féi pàng)

S. Blood Stasis (血瘀 xuè yū)3

3 I.e., various blood stasis diseases.


7

Table A: Important Terms

My Term Common English Translations Chinese

chong mai “penetrating vessel,” thoroughfare vessel” 冲脉 chōng mài

five phases “five elements,” “five phase elements,” “five movements” 五行 wǔ-xíng

jueyin “end of yin,” “terminal yin,” “reverting yin” 厥阴 juéyīn

liu jing “six channels,” “six stages,” “six warps,” “six conformations” 六经 liù jīng

qi “energy,” “ influences” 气 qì

qi “qi [aspect]” 气 qì

shaoyang “small yang,” “lesser yang” 少阳 shàoyáng

shaoyin “small yin,” “lesser yin” 少阴 shàoyīn

shen “spirit” 神 shén

shi “full,” “excess,” “excessive,” “replete,” “repletion” 实 shí

si fen “four divisions,” “four levels,” “four aspects,” 四分 sì fēn

syndrome

differentiation

“pattern,” “pattern identification” 辩证 biàn zhèng

taiyang “big yang,” “great yang,” “greater yang” 太阳 tàiyáng

taiyin “big yin,” “great yin,” “greater yin” 太阴 tàiyīn

wei “defense,” defensive” 卫 wèi

xu “empty,” “deficient,” “deficiency,” “vacuous,” “vacuity” 虚 xū

xue “blood [aspect]” 血 xuè

yangming “yang brightness” 阳明 yángmíng

ying “construction,” “constructive,” “nutritive,” “camp” 营 yíng

yuan qi “source qi,” “original qi,” “congenital qi” 元气 yuán qì

zhen qi “true qi” 真气 zhēn qì

zheng qi “upright qi,” “right qi” 正气 zhèng qì


8

Table B: Pulse Nomenclature

Chinese Characters and

Pinyin

English name Other translations

大脉 (dá mài) Big Large

结脉 (jié mài) Bound Slow-irregularly-interrupted, adherent, knotted, nodular

沉脉 (chén mài) Deep Sunken, submerged, sinking

散脉 (sàn mài) Dissipated Dispersed, scattered

革脉 (gé mài) Drum-skin Tympanic, leather

微脉 (wēi mài) Faint Evanescent, minute, diminutive

细脉 (xì mài) Fine Minute, small, thin, thready

牢脉 (láo mài) Firm Fixed, prison, hard

浮脉 (fú mài) Floating Superficial

伏脉 (fú mài) Hidden Recondite

代脉 (dài mài) Intermittent Regularly interrupted

长脉 (cháng mái) Long

缓脉 (huǎn mài) Moderate Languid, slowed-down, leisurely, retarded, relaxed

正常脉 (zhèng cháng mài) Normal

疾脉 (jí mài) Racing Fast, hurried, rushing, swift

数脉 (shuò mài) Rapid Accelerated, quick

实脉 (shí mài) Replete Full, excess, forceful

涩脉 (sè mài) Rough Grating, choppy, difficult, dry

芤脉 (kōu mài) Scallion-stalk Hollow, onion-stalk, leek-stalk

短脉 (duǎn mài) Short Brief

促脉 (cù mài) Skipping Agitated, hasty, accelerated

滑脉 (huá mài) Slippery

迟脉 (chí mài) Slow Slowed-down

软脉 (ruǎn mài) Soft

濡脉 (rú mài) Soggy Frail, weak-floating, soft

动脉 (dòng mài) Stirred Mobile, moving, agitated, spinning bean

弦脉 (xián mài) String-like Wiry, bowstring, chordal

洪脉 (hóng mài) Surging Flooding, overflowing, tidal

紧脉 (jǐn mài) Tight Tense, taut

虚脉 (xū mài) Vacuous Exhausted, depleted, deficient, empty

弱脉 (ruò mài) Weak Infirm


9

Table 5: Hypothyroid Treatment Strategies

Number Type Common Differentiations Strategies

II.B.1 Pure Xu

Without

Heat

Yin, Yang, Qi, and Blood Xu Supplement any Xu: Yang, Yin, Qi, Blood

II.B.2 Xu

Complicated

with Shi

Spleen and Kidney Qi and Yang

Xu with Damp and Phlegm

Stagnation

Supplement any Xu: Yang, Yin, Qi, Blood

Secondarily, Transform Damp and

Phlegm

II.B.3 Xu Cold

Complicated

with Heat

Spleen and Kidney Qi and Yang

Xu and Liver and Kidney Yin Xu

Fire and/or with Damp and

Phlegm Heat Stagnation

Simultaneously Supplement Xu Humors

and Clear Heat and Toxins (While

Safeguarding Yin), and/or Clear and

Transform Phlegm Heat


10

Table 6: Representative Formulas for Single Medicinals

Medicinal Representative Formula

Shudihuang Jin Kui Shen Qi Wan

Shu Fu Zi 3g

Gui Zhi [now usually replaced with Rou Gui] 3g

Sheng Di Huang [(now usually replaced with Shu Di Huang] 24g

Shan Yao 12g

Shan Zhu Yu 12g

Ze Xie 9g

Fu Ling 9g

Mu Dan Pi 9g

Baishao Xiao Jian Zhong Tang

Yi Tang 20g

Gui Zhi 9g

Bai Shao 18g

Sheng Jiang 6g

Da Zao 5 pieces

Zhi Gan Cao 3g

Si Ni San:

Chai Hu 12g

Zhi Shi 6g

Bai Shao 12g

Zhi Gan Cao 3g

Zhen Wu Tang:

Shu Fu Zi 9g

Bai Zhu 6g

Fu Ling 9g

Bai Shao 9g

Sheng Jiang 9g

Huanglian Huang Lian E Jiao Tang:

Huang Lian 3-6g

E Jiao 9-12g

Huang Qin 9-12g

Bai Shao Yao 9-12g

Ji Zi Huang 2 yolks


11

Table 7: Pure Xu without Heat: Yin, Yang, Qi, and Blood Xu Suggested Formulas (to be

modified)

Differentiation Formula and Ingredients

Qi xu, especially spleen qi xu Bu Zhong Yi Qi Tang:

Huang Qi 12g

Ren Shen 9g

Bai Zhu 12g

Zhi Gan Cao 3g

Dang Gui 9g

Chen Pi 6g

Sheng Ma 9g

Chai Hu 6g

Yang xu, especially spleen

and kidney yang xu:

modifications of Er Xian

Tang plus Jin Kui Shen Qi

Wan modified:

Er Xian Tang:

Xian Mao 9g

Yin Yang Huo 9g

Ba Ji Tian 9g

Huang Bai 9g

Zhi Mu 9g

Dang Gui 9g

Jin Kui Shen Qi Wan:

Shu Fu Zi 3g

Gui Zhi [now usually replaced with Rou Gui] 3g

Sheng Di Huang [(now usually replaced with Shu Di Huang] 24g

Shan Yao 12g

Shan Zhu Yu 12g

Ze Xie 9g

Fu Ling 9g

Mu Dan Pi 9g

Blood and yin xu, especially

liver and heart blood xu, and

liver, heart, and kidney yin

xu: modifications of Liu Wei

Di Huang Wan and Si Wu

Tang.

Liu Wei Di Huang Wan:

Shu Di Huang 25g

Shan Zhu Yu 15g

Shan Yao 15g

Ze Xie 12g

Mu Dan Pi 9g

Fu Ling 12g

Si Wu Tang:

Shu Di Huang 12g

Dang Gui 9g

Bai Shao 9g

Chuan Xiong 9g

Acumoxibustion Choose from Pi Shu (Bl 20), Shen Shu (Bl 23), Guan Yuan (CV 4), Qi

Hai (CV 6), Zu San Li (St 36), San Yin Jiao (Sp 6), Xue Hai (Sp 10), Tai

Xi (Ki 3). For spleen qi xu add Tai Bai (Sp 3). For spleen yang xu moxa

Pi Shu (Bl 20), Qi Hai (CV 6), Zu San Li (St 36), and San Yin Jiao (Sp

6). For kidney yang xu moxa Shen Shu (Bl 23), Ming Men (GV 4), Guan

Yuan (CV 4), Tai Xi (Ki 3). For liver blood xu add Qu Quan (Liv 8). For

heart blood xu add Yin Xi (Ht 6).


12

Case 1 Prescription

Differentiation Prescription

Qi, blood, yin, and yang xu.

Er Xian Tang, modified:

Ba Ji Tian 6g

Yin Yang Huo 8g

Dang Gui 7g

Chuan Xiong 9g

Bai Shao 9g

Bai Zhu 9g

Shu Di Huang 10g

Chen Pi 6g

Dong Chong Xia Cao Jun Si4 1000mg BID

Case 2 Prescription

Differentiation Prescription

Kidney and spleen qi and yang xu.

Dr. Li’s personal formula Jia Di Fu Yuan Tang (Hypothyroid

Restore the Source Decoction) modified:

Ren Shen 10g

Yin Yang Huo 10g

Bai Zhu 10g

Dang Gui 10g

Chuan Xiong 10g

Huang Qi 20g

Mai Men Dong 10g

He Shou Wu 10g

Dong Chong Xia Cao Jun Si one 1000mg tablet BID

4冬虫夏草菌絲 Dōng Chóng Xià Cǎo Jūn Sī, literally “winter worm, summer grass fungus thread” or “winter worm,

summer grass fungus mycelium” is Cordyceps fungus grown on a medium instead of obtained by collecting infected

caterpillars or other insects. Several companies produce Dong Chong Xia Cao Jun Si and the quality varies. Good

quality encapsulated Dong Chong Xia Cao Jun Si should have a significant and pleasant odor.


13

Table 8: Xu complicated with Shi: Spleen and Kidney Qi and Yang Xu with Damp and

Phlegm Stagnation Suggested Formulas (to be modified)

Representative Formula Combination Number 1:

Choose medicinals from Li Zhong Wan, Si Ni Tang,

Er Chen Tang and Bu Zhong Yi Qi Tang

Li Zhong Wan:

Ren Shen 10g

Gan Jiang 10g

Bai Zhu 10g

Gan Cao 3g

Si Ni Tang:

Fu Zi 10g

Gan Jiang 10g

Zhi Gan Cao 6g

Er Chen Tang:

Ban Xia 5g

Chen Pi 4g

Fu Ling 5g

Zhi Gan Cao 1g

Sheng Jiang 3g

Wu Mei 1 piece

Representative Formula Number 2: Dr. Li’s

personal formula Jia Di Fu Yuan Tang

(Hypothyroid Restore the Source Decoction):

Huang Qi 15g

Ren Shen 10g

Zhi Fu Zi 7g

Gan Jiang 4g

Yin Yang Huo 9g

Ba Ji Tian 9g

Shu Di Huang 15g

Dang Gui 7g

Chuan Xiong 7g

Bai Shao 7g

Ban Xia 6g

Fu Ling 9g

Mai Men Dong 10g

Chai Hu 6g

Chen Pi 6g

Shi Hu 1g5

Dong Chong Xia Cao Jun Si 1000mg tablet BID

Acumoxibustion Choose from Pi Shu (Bl 20), Shen Shu (Bl 23),

Guan Yuan (CV 4), Qi Hai (CV 6), Zu San Li (St

36), Feng Long (St 40), Gong Sun (Sp 4), San Yin

Jiao (Sp 6), Yin Ling Quan (Sp 9), Tai Xi (Ki 3).

For spleen qi xu, add Tai Bai (Sp 3). Moxa is

applicable.

5 Shi Hu is now a rare and endangered medicinal, and many substitutes and varying qualities are offered on the

market. This dosage is for true, excellent quality Huo Shan (Huo Mountain in Anhui Province, China) Shi Hu. One

should ask for “fēng dǒu (枫斗)” when buying Shi Hu for use in treating thyroid disease.


14

Table 9: Xu Cold Complicated with Heat: Spleen and Kidney Qi and Yang Xu and Liver

and Kidney Yin Xu Fire and/or with Damp and Phlegm Heat Stagnation Suggested

Formulas to be modified

Yi Guan Jian:

Sheng Di Huang 15g

Bei Sha Shen 9g

Mai Men Dong 9g

Dang Gui 9g

Gou Qi Zi 9g

Chuan Lian Zi 6g

Jing Shui Liu Jun Jian Six Gentlemen of Metal and Water Decoction

Ban Xia 6g

Chen Pi 5g

Fu Ling 6g

Zhi Gan Cao 3g

Dang Gui 6g

Sheng Di Huang 15g

Dr. Li’s Personal Formula: A combination and modification of Huang Lian Jie Du Tang, Yi Guan Jian,

and Xi Jiao Di Huang Tang, (with added yang supplements):

Huang Lian 10g

Xuan Shen 15g

Ban Lan Gen 10g

Lian Qiao 9g

Jin Yin Hua 15g

Mu Dan Pi 9g

Dan Shen 7g

Chi Shao 6g

Bai Shao 6g

Sheng Di 15g

Shu Di Huang 10g

Da Huang 4g

Ban Xia 6g

Fu Ling 9g

Mai Men Dong 10g

Lu Rong 0.1g/ powdered, once every morning


Acumoxibustion: Choose from the point listed in the previous differentiations plus those that

clear heat and nourish yin such as Du 14, LI 11, L1 4, UB 40, LV 3, Ki 3, Ht 6, etc.


15

Formulas in Case 5 Commentary

Qing Ying Tang:

Xi Jiao 9g

Xuan Shen 9g

Sheng Di 15g

Mai Men Dong 9g

Jin Yin Hua 9g

Lian Qiao 6g

Huang Lian 4.5g

Dan Zhu Ye 3g

Dan Shen 6g

Mai Men Dong Tang:

Mai Men Dong 15g

Ren Shen 6g

Geng Mi 9g

Da Zao 5 pieces

Gan Cao 3g

Ban Xia 9g

Table 10: Menopausal Women with Hypothyroidism Representative Formula

A modification and combination of Jin Shui Liu Jun Jian and Liu Wei Di Huang Wan or Xi Jiao Di

Huang Tang minus Xi Jiao:

Ban Xia 9g

Chen Pi 6g

Fu Ling 6g

Zhi Gan Cao 3g

Dang Gui 6g

Shu Di Huang 20-30g

Shan Zhu Yu 12g

Shan Yao 12g

Ze Xie 9g

Mu Dan Pi 9g

Huang Lian 9g

Xuan Shen 20g



16

Table 11: Clinical Research Formulas

Deng Shi Jia Fang (Mr. Deng’s A Formula) consists of:

Huang Qi 30g

Dang Shen 18g

Bai Zhu 24g

Dang Gui 12g

Zhi Gan Cao 6g

Chai Hu 6g

Sheng Ma 6g

Ba Ji Tian 9g

Gou Qi Zi 9g

Chen Pi 3g

Deng Shi Yi Fang (Mr. Deng’s B Formula) consists of:

Huang Qi 18g

Fu Ling 30g

Bai Zhu 24g

He Shou Wu 24g

Ze Xie 9g

Gui Zhi 9g

Shan Yao 9g

Yin Yang Huo 9g

Tu Si Zi 12g


17

Supplemental material

I. A Historical Account of Thyroid Diseases

Chinese medicine has provided effective treatment for thyroid diseases from ancient times to the present.

A selection of the historical records that discuss and suggest treatments for “瘿 yǐng,” as goiter and other

thyroid diseases have historically been known in China.

A. Pre-Han Dynasties

Although only completed in the Han, the Shān Hǎi Jīng (Classic of Mountains and Seas) existed in the

Fourth Century BCE.6 In it “goiter and pestilence” are mentioned.

7

Goiter is mentioned a few times in Zhuāng Zǐ’s writings, thought to be of the Fourth Century BCE. For

example “Dé Chōng Fú” (“The Seal of Virtue Complete”) has the following line: “[A man] who had a

large goiter like an earthenware jar addressed his counsels to Duke Huan of Qi, who was so pleased with

him that he looked on a perfectly formed man as having a neck lean and small in comparison with him.”8

Again, in the Third or Fourth Century BCE, Lü Shì Chūn Qiū (Lü’s Spring and Autumn) states that, “In

regions where the water is ‘light’9 water the people frequently are bald and have goiters on the neck (輕水

所多禿与與人…).”10

Wiseman notes that this “indicates that a connection between goiter, environmental

factors, and baldness had been observed.”11

Furthermore, medicinals to treat goiter are mentioned in the Shén Nóng Bĕn Căo Jīng. Under “Middle

Class Medicinals,” Hai Zao is suggested for the treatment of goiters.12

B. Western Han (206 BCE –9 CE)

6 Leo Bagrow, R. and A. Skelton, History of Cartography, Transaction Publishers, Piscataway, NJ, 2009, p. 204

7 Wang Zhen-guo and Ping Chen History and Development of Traditional Chinese Medicine, Xing Xiao-chen,

editor, Science Press, Beijing, 1999, p. 17

8 http://ctext.org/zhuangzi/seal-of-virtue-complete

9 “輕 qīng” is literally “light.” Knoblock and Riege (see below) translate “輕 qīng” as “brackish,” but it usually

indicates pure, clear water, perhaps without minerals. In fact, the next line in this sequence, “重水所多尰與躄人,”

speaks of “heavy” water, which usually indicates water with dissolved minerals in it.

10 Lǚ Bù-wéi, The Annals of Lü Buwei, trans. Knoblock, John and Riege, Jeffrey K., Stanford University Press,

Stanford, CA 2000, p. 100

11 Wiseman, Nigel and Fang, Ye, A Practical Dictionary of Chinese Medicine, Paradigm Publications, Brookline

MA 02146, 1965, p. 243

12 Shen Nong Ben Cao Jing (The Divine Farmer’s Materia Medica), trans. Yang Shou-zhong, Blue Poppy Press,

Boulder CO, 1998, p. 65


18

http://en.wikipedia.org/wiki/Transaction_Publishers

While the Huáng Dì Nèi Jīng Sù Wèn Líng Shū, Chapter 10, on channels and collaterals, does mention

“yǐng,” the discussion that follows implies that in this context “瘿 yǐng” refers to lymph swelling or

scrofula. However, one can make a case that in a rather disperse and complicated discussion of mania and

withdrawal (癫狂 diān kuáng), thyroid disease symptoms are described. (Early in Chinese history a

connection was made between goiter and emotional disturbance.) Again in same chapter, it is said that

“the stomach foot yangming vessel…rules the diseases that are born of blood such as mania…swollen

neck, throat obstruction…”

C. Eastern Han (25-220 CE)

In what has come to be known as the Jīn Kuì Yào Lüè Fāng Lùn, Chapter 11, Zhāng Zhòng-jǐng says:

Accumulations are diseases of the solid organs, they are immovable throughout. Conglomerations affect the

hollow organs; they bring on regular seizures of migrating pain and are curable… The rule for diagnosing

all accumulations is to look for a thin and submerged pulse that is palpable only when the fingers press

heavily and touch the radial bone. Such a pulse detected on the cun locates the accumulation in the chest; a

little ahead of the cun locates the accumulation in the throat…

In the next chapter, Zhāng Jī discusses phlegm-rheum in detail. This pathological substance is involved in

almost all goiters. Zhāng Jī established certain treatment strategies for phlegm-rheum that are still viable,

and several of his formulas from the Shāng Hán Lùn as well as the Jīn Kuì Yào Lüè Fāng Lùn are still

used to treat various types of thyroid diseases. Examples include Jin Kui Shen Qi Wan, Si Ni San, Si Ni

Tang, Li Zhong Wan, and Ban Xia Xia Xin Tang.

D. Jin Dynasty (265-420 CE)

In the Eastern Jin Dynasty, Gé Hóng used Hai Zao in the first medicinal treatment protocol for “goiter

syndrome” (瘿证 yǐng zhèng) as presented in his book Zhǒu Hòu Bèi Jí Fāng (Emergency Formulas to

Keep up One’s Sleeve).13

Also in the Jin, ChēnYán-zhī, in the 10th scroll of his Xiǎo Pǐn Fāng (The Concise Formulary),

14 “Zhì

Yǐng Bìng Zhū Fāng” (“Formulas for Treating Various Goiters”), states the following.

Goiters: in the beginning they resemble a [fruit] pit. Goiters hang under the neck. In the central states, the

Chinese contract goiter through indignation causing binds, but here the goiter is heavy and without a pit.

The Chang An and Xiang Yang barbarians drink sandy water, producing goiter with a pit...without a root,

and suspended in the skin. When local women contract this disease, [it causes] kidney qi shi. The [water's]

“sandiness” homes to the kidneys, thus causing the kidney shi. This disease results in goiter. Northern

13

Anti-Angiogenic Functional And Medicinal Foods, edited by Losso, Jack N., Shahidi, Fereidoon, and

Bagchi Debasis, 2007, CRC Press, Taylor and Francis Group, Boca Raton, FL, p. 101

14 Xiǎo Pǐn Fāng (The Concise Formulary) was required reading for all Chinese medicine scholars/doctors during

the Tang Dynasty. It disappeared after the Song Dynasty. In 1985, it was “rediscovered” in Japan.


19

women who drink sandy water produce milk only with difficulty, if one does not use acupuncture the milk

will not flow. Home remedies are of no use, but Zhi Ying Fang is efficacious.15

Zhi Ying Fang contains wine-treated Fu Xiao Mai as well as Hai Zao. One can see that this formula treats

the emotions as well as transforming phlegm and softening hardness. (In Western terms, seaweeds supply

iodine.) The diet is also addressed as there is a proscription against salt, raw fish, raw vegetables, and

pork.16

E. Tang Dynasty (618-907 CE)

In the early Tang Dynasty, Wáng Tāo made an exhaustive study and collection of every branch of

medicine from ancient sources up to his own time and published this collection in Wài Tái Mì Yào Fāng

(Medical Secrets of an Official). In scroll 23 on goiter formulas, Wang states,

Goiter springs from various sources, worry, grief, anger, depression, but also sandy water. The sand

following the channels and arrives under the neck...and gradually becomes a goiter.”17

A few examples of his formulas for goiter follow.18

1. One of Wáng’s collected formulas for goiter caused by worry and stress, as well as drinking sandy

water leading to qi constraint and damp stagnation contains Kun Bu 6 fen, Hai Zao 7 fen, Song Luo 4 fen,

Gan Jiang 4 fen, Gui Xin 4 fen, Tong Cao 5 fen.

2. For qi goiter Wáng suggests mixing Su Zi, Gui Xin, Da Huang, Dang Gui, Gan Jiang, Ju Pi, Shu Jiao,

all @3 fen with 1 sheng of pork lard to make pills.

3. For all types of goiter Wáng lists a recommendation of burning moxa on Qu Chi (LI 11) three times,

(for men 18 times on the left, 17 times on the right and for woman 18 times on the right, 17 times on the

left), burning 30 cones of moxa on Da Zhui (GV 14) and a point 1/ ½ cun out from Da Zhui (GV 14), as

well as burning 100 cones of moxa on Fei Shu (Bl 13).

Note Wáng Tāo’s strong correlation between emotional caused “qi constraint” and goiter.

In this same work, Wáng mentions Cuī Zhī-tī, a contemporary of Sūn Sī‐miǎo, who wrote the Gǔ Zhēng

Bìng Jiǔ Fāng (Formulas for Steaming Bone Syndrome). To some scholars, Cuī made a distinction

between tumors and goiters. Wang writes, “Cui said that soft or movable goiters can be cured, but stone-

like tumors cannot be cured...”19

15

http://www.zysj.com.cn/lilunshuji/xiaopinfang/758-14-24.html

16 Ibid.

17 http://www.zysj.com.cn/lilunshuji/waitaimiyao/121-30-1.html#m0-0

18 Wáng Tāo, Wài Tái Mì Yào Fāng (Medical Secrets of an Official), 752 (Tang), Hua Xia, Beijing 1997, Volume 23,

p. 433-439

19The oft-cited conclusion of Temple’s, (Temple, Robert, The Genius of China: 3,000 Years of Science, Discovery,

and Invention, with a forward by Joseph Needham. Simon and Schuster, Inc., New York, 1986, p 134), that Cuī Zhī-


20

http://www.zysj.com.cn/lilunshuji/xiaopinfang/758-14-24.html

Sūn Sī‐miǎo himself, in his Qiān Jīn Yào Fāng (Important Formulas worth a Thousand Gold Pieces), has

dozens of formulas for goiter. These formulas often use Hai Zao, Kun Bu, and the prepared thyroids of

sheep and deer.20

F. Song Dynasty (960-1279 CE)

In his book Sān Yīn Jí Yī Bìng Zhèng Fāng Lùn (A Treatise on the Three Categories of Pathogenic

Factors of Disease), Chén Yán classified goiter into five types: stone, flesh, sinew, blood, and qi goiters.21

G. Yuan Dynasty (1279-1368 CE)

Zhū Dān-xī wrote a short chapter on “Goiter Qi” in his Dān Xī Zhì Fǎ Xīn Yào (The Heart and Essence of

Dan-xi’s Methods of Treatment).

(In order to treat this,) it is first necessary to abstain from thick flavored (food). Powder 1.2 liang [Hai Zao]

and 1 liang of [Huang Lian], put a small amount in the palm, lap from time to time, and swallow with

saliva. When (the goiter) reduces to 2/3 its size, it is necessary to stop administration (of these

medicinals).22

Notable is Zhū’s emphasis on diet and his use of Huang Lian, both of which I hope to discuss at length in

this book. We present another of Zhu’s formulas, this one for accumulations and conglomerations, in

Chapter 5.

H. Ming Dynasty (1368-1644 CE)

An expanded account of the treatment of goiter is to be found in Xú Chūn-fǔ’s Ming dynasty work Gǔ Jīn

Yī Tǒng Dà Quán (Complete Compendium of Ancient and Modern Medicine) Volume 67.23

Some ancient acupuncture prescriptions are presented in Table 1.

I. Present Times

tī made a distinction between a tumor and goiter may be misleading. “瘿 yǐng” can mean “tumor” or “goiter.” The

actual passage, obtained from http://www.theqi.com/cmed/oldbook/book84/b84_23.html , is “崔: 崔氏云凡水"癭氣

癭可瘥，石癭不可治療氣癭方。” It does not end with, “cannot be cured” but with “cannot be cured by qi goiter

formulas.” For a discussion of the types of “瘿 yǐng” or goiters, see Chapter 5.

20 http://www.zysj.com.cn/lilunshuji/beijiqianjinyaofang549/index.html

21 http://www.zysj.com.cn/lilunshuji/sanyinjiyibingzhengfanglun/index.html

22 Zhū Dān-xī, Dān Xī Zhì Fǎ Xīn Yào (The Heart and Essence of Dan-xi’s Methods of Treatment), trans. Yang

Shou-zhong, Blue Poppy Press, Boulder, CO, 1993, p. 311

23 Xú Chūn-fǔ, Gǔ Jīn Yī Tǒng Dà Quán (Complete Compendium of Ancient and Modern Medicine), Book 2,

Peoples Health Publishing Co., Beijing, 1991


21

In one recent study, a general effectiveness rate of 95.74% was achieved using Chinese medicine for

hyperthyroidism.24

Table: Ancient Acupuncture Prescriptions for Goiter25

Author Book Date Prescription

Huáng Fǔ-mì

皇甫谧

Zhēn Jiǔ Jiǎ Yǐ Jīng

针灸甲乙经

(The ABCs of Acumoxibustion)

259 Tian Rong (SI 17)

Sūn Sī-miǎo

孙思邈

Qiān Jīn Yào Fāng

千金要方

(Priceless Prescriptions)

652 Nao Hui (TB 13), Tian Fu (Lu 3),

Qi She (St 11)

Wáng Zhí-

zhōng

王執中

Zhēn Jiǔ Zī Shēng Jīng

针灸资生经

(Fundamentals of Acumoxibustion)

1220 Fu Bai (GB 10), Qi She (St 11)

Xú Fèng

徐凤

Zhēn Jiǔ Dà Quán

针灸大全

(The Complete Collection of

Acumoxibustion)

1439 Lie Que (Lu 7), Fu Tu (LI 18), Tian Tu

(CV 22), Tian Ding (LI 17), Que Pen

(St 12), Shu Fu (Ki 27), Ying Shu (?),

Shan Zhong (CV 17), He Gu (LI 4),

Shi Xuan (M-UE -1) (bleeding)

24

Zhang Bai-meng, “Observation of Symptoms and Signs in Hyperthyroidism Treated by Acupuncture and

Medication.” Shanghai Journal of Traditional Chinese Medicine, Wang Hong, editor, 1999 Volume 4, p 26. A

clinical trial was undertaken to treat hyperthyroidism with Chinese medicine. 47 individuals with hyperthyroidism

were treated. These individuals were between the ages of 21-61 years with an average age of 37.07. Individuals had

had a history of hyperthyroid disease from between one month to 34 years, with an average of 4.41 years. 32 cases

had had strong side effects from anti-thyroid medicine, or had a recurrence when they stopped the medicine. One

case had recurrent hyperthyroidism after surgery. 14 cases had not been treated before the trial. All patients stopped

their Western pharmaceutical regiment for two weeks during the trial. There was also a control group of 35

individuals.

25 http://www.pacificcollege.edu/pcom_static/alumni/newsletters/winter2008/Goiter.html


22

Examples of Five Phases Etiology and Pathology Using Three Important

Causes of Thyroid Disease:

Three major causes of thyroid diseases are a unhealthy or “toxic” diet, exposure to toxic chemicals (these

are considered external toxins or heat and toxins by the Warm Disease School and include pesticides,

heavy metals, and petroleum products, to name a few), and emotional stress. Each of these may cause a

pathological progression in the body that follows the various five phases cycles.

A. A Toxic Diet

A toxic diet is one of the fundamental causes of disease. Inappropriate foods first affect the digestive

system, here under the rubric of the stomach/spleen. The American diet contains large quantities of fat,

salt, sugar, alcohol, caffeine, dairy, gluten-containing foods along with those that are charred, raw, or

cold. Additionally, many food products contain toxins from pesticides, residues of antibiotics, and

disease-causing microorganisms. These damage the stomach/spleen or digestive system causing

inflammatory Western diseases such as gastritis, reflux disease, irritable bowel syndrome, colitis, etc. In

the five phases cycle Earth is restrained by Wood, i.e., the spleen is physiologically restrained by the

liver. When the spleen becomes pathological it can “insult” the liver organ and its channel, or allow the

liver to become shi resulting in Western diseases such as fatty liver, liver tumors and cancers, cirrhosis,

etc.

The liver stores the blood in the chong mai and uterus, and the liver channel winds around the genitals.

When the liver and its liver channel are shi or xu, this can result in dysmenorrhea, pre-menstrual

syndrome (PMS), uterine fibroids, ovarian cysts, etc. The liver channel goes up the throat, and shi in that

channel can lead to thyroid disease.

Earth’s mother is Fire. A weak digestion or inflammation in the digestive and/or in the hepatic systems

can affect the heart causing various heart diseases including angina, enlarged heart, heart attacks and

stroke.

Earth restrains Water, inflammation or toxins in the digestive system may damage the kidneys leading to

infections, stones, and fibrosis. Water, in turn, “communicates” with, or restrains Fire, and shi or xu

Water can exacerbate any heart problems.

Of course, once any of the phase-elements or organs is compromised, their relationships with all the other

organs are compromised.

B. Exposure to Toxins

In the above example, we started with a toxic diet affecting the digestive system. We could also have

started with the inhalation of toxins such as pesticides, preservatives, solvents, viruses, radioactive

materials, etc. which damage the lung. Of course chemical exposure can damage any organ through direct

contamination. However, any primary organ affected may cause organ imbalances in any other organ

through the five phases cycles. For example, the lung’s mother in the generating cycle is the heart, and a


23

weakened lung can draw qi from and weaken the heart. The lung is the upper source of water, water that

ultimately descends to the kidney and bladder. Chemicals inhaled through the lung will eventually

concentrate in the kidney and bladder causing toxic heat in these organs. This can be seen as a shi mother

phase causing shi in her son phase. The lung restrains the liver, but once the lung is shi it can

“overwhelm” the liver causing liver disharmony. In Western terms, toxins inhaled through the lung will

eventually reach the liver, the major detoxifying organ, and damage it. The lung also communicates with

the throat and toxins inhaled through the lung can infiltrated the thyroid.

C. Emotional Stress

Emotional stress refers to the eliciting of inappropriate, negative, or excessive emotions or the

sublimation of normal emotional responses. Each organ is associated with an emotion or emotions that if

inappropriate or excessive can upset the harmonious functioning of that organ. For example, constant

frustration and repressed anger can damage the liver’s function. Through the five phases cycle, once the

liver’s function is compromised, any other organ, but especially the spleen’s functions, can be affected.

That is, the liver restrains the spleen, but if this restraint becomes excessive the liver can overwhelm the

spleen causing spleen xu. Spleen xu can lead to its mother the heart being overtaxed, and the kidney not

being restrained properly. As the sequelae of the liver’s compromised function works their way through

other organs, each of these organs becomes weakened and more susceptible to environmental insults such

as a poor or toxic diet, air pollution, chemical exposure, micro-organism infections, etc. Thus stress can

be thought of as an indirect cause of auto-immune diseases: it weakens the ability of the organs to respond

appropriately to adverse environmental factors, either depriving the organs of the ability to respond, or

causing an over-response that becomes auto-immune disease.

I. Western Medical Designations and Treatment

A. Nosology

The most common types of hypothyroidism are Hashimoto’s thyroiditis, lymphocytic thyroiditis, thyroid

destruction, pituitary or hypothalamic disease, pituitary injury, and severe iodine deficiency. Here I will

discuss hypothyroidism from any cause except iodine deficiency since this type of hypothyroidism has

practically been eliminated in the USA with the advent of iodized salt, and for which treatment is self-

evident.

B. Epidemiology

In iodine-replete communities, the prevalence of spontaneous hypothyroidism is between 1% and 2%. It

is more common in older women and much more common in women than in men.26

C. Definition

26

Vanderpump MPJ. The Epidemiology of Thyroid Diseases. In: Braverman LE, Utiger RD, eds. Werner and

Ingbar's The Thyroid: A Fundamental and Clinical Text, JB Lippincott-Raven, Philadelphia, 2005, 9th

edition, p.

398-406


24

Hypothyroidism is a condition in which the thyroid gland’s production of triiodothyronine (T3) and/or

thyroxine (T4) is compromised. As a result of lowered levels of these hormones in the bloodstream, the

anterior pituitary gland secretes increasing amounts of thyroid-stimulating hormone (also known

as TSH or thyrotropin). See the following Table for “normal” ranges of thyroid hormones.

Table: Blood Levels of T3, T4, and TSH in Hypothyroidism27

T3 and T4 TSH

Low [T3<80; T4 <4.5] High [>3.0-5.0 mIU/L]

D. Etiology and Pathophysiology

Hypothyroidism is usually caused by thyroiditis, that is, inflammation of the thyroid gland that damages

the thyroid gland cells. This inflammation can be autoimmune in nature, as is the case in Hashimoto’s

Thyroiditis, or can be due to a secondary infection after an upper respiratory infection. “Postpartum

thyroiditis” is inflammation resulting from pregnancy. Certain drugs such as Lithium and Amiodarone

may also cause thyroiditis. Other causes include birth defects, radiation treatments, especially to the neck

or brain, and Sheehan syndrome. Finally, hypothyroidism can be caused by the destruction of thyroid

tissue by radioactive iodine used to treat hyperthyroidism, or surgical removal of parts or of the entire

thyroid gland.

E. Risk Factors

Besides the risk factors suggested above, i.e., infections, pregnancy, certain drugs, irradiation or surgery,

the risk factors are as follows. Sex: women are two to eight times more likely to develop hypothyroidism

depending on the age group. Family history: personal or family history of thyroid or other endocrine

gland diseases increases the risk. Age: hypothyroidism risk increases with age, especially after 50 years of

age. Race: whites are most likely, and blacks least likely to develop hypothyroidism. Obesity: Overweight

individuals are more likely to develop hypothyroidism.

F. Symptomatology

Symptoms of hypothyroidism may be divided into early-onset symptoms and later-onset symptoms (if the

disease is not treated). Early onset symptoms include fatigue, weakness, increased sensitivity to cold or

feeling cold, hard stools or constipation, heavier menstrual periods, weight gain, joint or muscle pain, pale

or dry skin with thin brittle hair or fingernails, and depression or melancholy. Later-onset symptoms

include hoarseness and/or slow speech, a decreased sense or taste and smell, a slow pulse, goiter,

puffiness of the face, hands, and feet, numbness of the fingers or hands, thickening of the skin, thinning of

the eyebrows, confusion, and depression or dementia. In addition, in children there is slowed growth,

delayed teething, and slow mental development.

G. Differential Diagnosis 27

The standard for “normal” ranges of hormones is controversial. Different laboratories have different standards.


25

http://en.wikipedia.org/wiki/Triiodothyronine

One must differentiate hypothyroidism from the following diseases: Addison Disease, Anovulation,

Apnea [and other Sleep Disorders], Autoimmune Thyroid Disease and Pregnancy, Cardiac Tamponade,

Chronic Fatigue Syndrome, Constipation, Craniopharyngiomas, DeQuervain’s Thyroiditis, Depression,

Dysmenorrhea, Eosinophilia, Eosinophilia-Myalgia Syndrome, Erectile Dysfunction, Euthyroid Sick

Syndrome, Fibromyalgia, Goiter, Goiter, Lithium-Induced, Goiter, Nontoxic, Hypercholesterolemia,

Familial, Hypercholesterolemia, Polygenic, Hypoalbuminemia, Hypochondriasis, Hypopituitarism

(Panhypopituitarism), Hypothermia, Ileus, Infectious Mononucleosis, Infertility, Infertility, Male, Iodine

Deficiency, Lithium Nephropathy, Lymphomas, Endocrine, Mesenchymal, and Other Rare Tumors of the

Mediastinum, Megacolon, Chronic, Menopause, Myxedema Coma or Crisis, Obesity, Ovarian

Insufficiency, Pericardial Effusion, Pituitary Macroadenomas, Polyglandular Autoimmune Syndrome,

Type I, Polyglandular Autoimmune Syndrome, Type II, Polyglandular Autoimmune Syndrome, Type III,

Prolactin Deficiency, Riedel Thyroiditis, Sleep Disorder, Geriatric Sleep Disorders, Syndrome of

Inappropriate Secretion of Antidiuretic Hormone, Thyroid Lymphoma, Thyroiditis, Subacute, Thyroxine-

Binding Globulin Deficiency.28

H. Diagnosis

Diagnosis includes palpation of the thyroid gland (which may be smaller than normal) and blood tests for

TSH and T4 and T3. Some doctors use total T4 and T3 results, others will require separate tests for free T4

and T3. Other blood tests may include those for cholesterol, complete blood count, liver enzymes,

prolactin, and sodium.

I. Standard Western Medical Treatment and Management

Treatment is directed at replacing thyroid hormone. The most commonly used medication is

Levothyroxine.

J. Prognosis and Complications

Western hormone replacement therapy is expected to be continued throughout the patient’s life. Hormone

levels must be checked with the risk of too high or low dosing. As with all chronic illnesses dependent on

drug therapy, there may be gastroenterological, urinary, emotional, or other side effects. Other

complications include heart disease, increased risk of infection, infertility and miscarriage.

In individuals with untreated hypothyroidism there is a rare risk of myxedema coma. Infection, illness,

exposure to cold, or certain medications may elicit this coma. Symptoms include low body temperature,

shallow breathing, low blood pressure, low blood sugar, and unresponsiveness. Couples with untreated

hypothyroidism are at an increased risk of having offspring with birth defects.

28

http://emedicine.medscape.com/article/122393-differential


26

http://emedicine.medscape.com/article/116467-overview



























































http://emedicine.medscape.com/article/122393-differential

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