Dfrierman Hypothyroidism LN TCMWT

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Hypothyroidism and TCM
by
David Frierman, L.Ac.
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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
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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).Twentyfive 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.
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.
Thyroid epithelial cells

(or "follicular 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.
Fawcett, Don; Jensh, Ronald (2002). Bloom & Fawcett's Concise Histology. New York: Arnold Publishers. pp. 257
258. ISBN 0-340-80677-X.
Image 4: The Thyroid System
Image 5: Thyroid Gland Physiology
Table 2: Thyroid Hormonal Feedback Loop

T3 and T4 Serum Levels
TSH and TRH Output
High
Decreases
Low
Increases
Table 2A: Results of Thyroid Function Tests in Various Clinical Situations2

Physiologic State
Serum
Serum Free T4
Serum T3
24-Hour RadioIodine Uptake
TSH
Hyperthyroidism
Untreated
T3 toxicosis
Low
Low
High
Normal
High
High
High
Normal or
High`
Hypothyroidism
Primary,
untreated
Secondary to
pituitary disease
High
Low
Low or Normal
Low or Normal
Low or
Normal
Low
Low or Normal
Low or Normal
Patient taking
iodine
Patient taking
exogenous
thyroid hormone
Patient taking
estrogen
Euthyroid sick
syndrome
Normal
Normal
Normal
Low
Normal
Normal in patient
taking T4, low in
patient taking T3
Normal
High in patient
taking T3, normal
in patient taking T4
High
Low
Normal or Low
Low
Normal
Euthyroidism
Normal
Normal,
Low or
High
Normal
T3 = triiodothyronine; T4 = thyroxine; TSH =thyroid stimulating hormone
http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/thyroid_disorders/overview_of_t
hyroid_function.html?qt=thyroid%20tumor&alt=sh
Diagram 1: The Five Phase-Elements, Engendering and Restraining Cycles
Fire (Heart)
Wood (Liver)
Water
(Kidneys)
Earth (Stomach Spleen)
Metal
(Lung)
Engendering (xing shng)

Restraining (xing k)
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
Supplement Yang
Clear Heat and Toxins
2nd Stage
3rd Stage
Drain Damp and Transform Phlegm

Supplement any Xu
Table 4: Historical Accounts of Thyroid Disease Rubrics

A. Goiter ( yng)
B. Five Slownesses ( w ch)
C. Xu Detriment ( x sn)
D. Diarrhea ( bin xi)
E. Fatigue ( p lo)
F. Center Burner Dispersion-Thirst ( zhng xio)
G. Palpitations, Heart Palpitations ( xn j)
H. Sweating Syndrome ( hn zhng)
I. Insomnia ( sh min)
J. Hand Tremor ( shu chn)
K. Constipation ( bin b)
L. Cystitis ( png gung yn).
M. Vexation, Agitation, and Irascibility ( fn zo y n)
N. Depression Syndrome ( y zhng)
O. Phlegm-Rheum ( tn yn) Diseases
P. Water Swelling ( shu zhng)
Q. Bulging Eyes ( yn qi wi t)
R. Weight Gain [Obesity, Fatness] ( fi png)
S. Blood Stasis ( xu y)3
I.e., various blood stasis diseases.
Table A: Important Terms

My Term
Common English Translations
Chinese
chong mai
five phases
jueyin
liu jing
qi
qi
shaoyang
shaoyin
shen
shi
si fen
syndrome
differentiation
taiyang
taiyin
wei
xu
xue
yangming
ying
yuan qi
zhen qi
zheng qi
penetrating vessel, thoroughfare vessel

five elements, five phase elements, five movements
end of yin, terminal yin, reverting yin
six channels, six stages, six warps, six conformations
energy, influences
qi [aspect]
small yang, lesser yang
small yin, lesser yin
spirit
full, excess, excessive, replete, repletion
four divisions, four levels, four aspects,
pattern, pattern identification
chng mi
w-xng
juyn
li jng
q
q
shoyng
shoyn
shn
sh
s fn
bin zhng
big yang, great yang, greater yang

big yin, great yin, greater yin
defense, defensive
empty, deficient, deficiency, vacuous, vacuity
blood [aspect]
yang brightness
construction, constructive, nutritive, camp
source qi, original qi, congenital qi
true qi
upright qi, right qi
tiyng
tiyn
wi
x
xu
yngmng
yng
yun q
zhn q
zhng q
Table B: Pulse Nomenclature

Chinese Characters and
Pinyin
English name
Other translations
(d mi)
Big
Large
(ji mi)
Bound
Slow-irregularly-interrupted, adherent, knotted, nodular
(chn mi)
Deep
Sunken, submerged, sinking
(sn mi)
Dissipated
Dispersed, scattered
(g mi)
Drum-skin
Tympanic, leather
(wi mi)
Faint
Evanescent, minute, diminutive
(x mi)
Fine
Minute, small, thin, thready
(lo mi)
Firm
Fixed, prison, hard
(f mi)
Floating
Superficial
(f mi)
Hidden
Recondite
(di mi)
Intermittent
Regularly interrupted
(chng mi)
Long
(hun mi)
Moderate
(zhng chng mi)
Normal
(j mi)
Racing
Fast, hurried, rushing, swift
(shu mi)
Rapid
Accelerated, quick
(sh mi)
Replete
Full, excess, forceful
(s mi)
Rough
Grating, choppy, difficult, dry
(ku mi)
Scallion-stalk
Hollow, onion-stalk, leek-stalk
(dun mi)
Short
Brief
(c mi)
Skipping
Agitated, hasty, accelerated
(hu mi)
Slippery
(ch mi)
Slow
(run mi)
Soft
(r mi)
Soggy
Frail, weak-floating, soft
(dng mi)
Stirred
Mobile, moving, agitated, spinning bean
(xin mi)
String-like
Wiry, bowstring, chordal
(hng mi)
Surging
Flooding, overflowing, tidal
(jn mi)
Tight
Tense, taut
(x mi)
Vacuous
Exhausted, depleted, deficient, empty
(ru mi)
Weak
Infirm
Languid, slowed-down, leisurely, retarded, relaxed
Slowed-down
Table 5: Hypothyroid Treatment Strategies

Number Type
Common Differentiations
Strategies
II.B.1
Yin, Yang, Qi, and Blood Xu
Supplement any Xu: Yang, Yin, Qi, Blood
Spleen and Kidney Qi and Yang

Xu with Damp and Phlegm
Stagnation
Spleen and Kidney Qi and Yang
Xu and Liver and Kidney Yin Xu
Fire and/or with Damp and
Phlegm Heat Stagnation
Supplement any Xu: Yang, Yin, Qi, Blood

Secondarily, Transform Damp and
Phlegm
Simultaneously Supplement Xu Humors
and Clear Heat and Toxins (While
Safeguarding Yin), and/or Clear and
Transform Phlegm Heat
II.B.2
II.B.3
Pure Xu
Without
Heat
Xu
Complicated
with Shi
Xu Cold
Complicated
with 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
Er Xian Tang:
Xian Mao 9g
Yin Yang Huo 9g
Ba Ji Tian 9g
Huang Bai 9g
Zhi Mu 9g
Dang Gui 9g
Yang xu, especially spleen

and kidney yang xu:
modifications of Er Xian
Tang plus Jin Kui Shen Qi
Wan modified:
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.
Acumoxibustion
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
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
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
Qi, blood, yin, and yang xu.
Prescription
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
Kidney and spleen qi and yang xu.
Prescription
Dr. Lis 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
Dng Chng Xi Co Jn S, 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:
Li Zhong Wan:
Choose medicinals from Li Zhong Wan, Si Ni Tang, Ren Shen 10g
Er Chen Tang and Bu Zhong Yi Qi Tang
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
Huang Qi 15g
Representative Formula Number 2: Dr. Lis
Ren Shen 10g
personal formula Jia Di Fu Yuan Tang
Zhi Fu Zi 7g
(Hypothyroid Restore the Source Decoction):
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.
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 fng du () 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. Lis 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. Dengs 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. Dengs 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 yng, as goiter and other
thyroid diseases have historically been known in China.
A. Pre-Han Dynasties
Although only completed in the Han, the Shn Hi Jng (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 Zhung Zs writings, thought to be of the Fourth Century BCE. For
example D Chng F (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, L Sh Chn Qi (Ls Spring and Autumn) states that, In
regions where the water is light9 water the people frequently are bald and have goiters on the neck (
).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 Shn Nng Bn Co Jng. Under Middle
Class Medicinals, Hai Zao is suggested for the treatment of goiters.12
B. Western Han (206 BCE 9 CE)
Leo Bagrow, R. and A. Skelton, History of Cartography, Transaction Publishers, Piscataway, NJ, 2009, p. 204
Wang Zhen-guo and Ping Chen History and Development of Traditional Chinese Medicine, Xing Xiao-chen,
editor, Science Press, Beijing, 1999, p. 17
http://ctext.org/zhuangzi/seal-of-virtue-complete
qng is literally light. Knoblock and Riege (see below) translate qng as brackish, but it usually
indicates pure, clear water, perhaps without minerals. In fact, the next line in this sequence, ,
speaks of heavy water, which usually indicates water with dissolved minerals in it.
10
L B-wi, The Annals of L 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 Farmers Materia Medica), trans. Yang Shou-zhong, Blue Poppy Press,
Boulder CO, 1998, p. 65
18
While the Hung D Ni Jng S Wn Lng Sh, Chapter 10, on channels and collaterals, does mention
yng, the discussion that follows implies that in this context yng refers to lymph swelling or
scrofula. However, one can make a case that in a rather disperse and complicated discussion of mania and
withdrawal ( din kung), 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 vesselrules the diseases that are born of blood such as maniaswollen
neck, throat obstruction
C. Eastern Han (25-220 CE)
In what has come to be known as the Jn Ku Yo L Fng Ln, Chapter 11, Zhng Zhng-jng 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, Zhng J discusses phlegm-rheum in detail. This pathological substance is involved in
almost all goiters. Zhng J established certain treatment strategies for phlegm-rheum that are still viable,
and several of his formulas from the Shng Hn Ln as well as the Jn Ku Yo L Fng Ln 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, G Hng used Hai Zao in the first medicinal treatment protocol for goiter
syndrome ( yng zhng) as presented in his book Zhu Hu Bi J Fng (Emergency Formulas to
Keep up Ones Sleeve).13
Also in the Jin, ChnYn-zh, in the 10th scroll of his Xio Pn Fng (The Concise Formulary),14 Zh
Yng Bng Zh Fng (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
Xio Pn Fng (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, Wng To made an exhaustive study and collection of every branch of
medicine from ancient sources up to his own time and published this collection in Wi Ti M Yo Fng
(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 Wngs 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 Wng 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 Wng 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/ cun out from Da Zhui (GV 14), as
well as burning 100 cones of moxa on Fei Shu (Bl 13).
Note Wng Tos strong correlation between emotional caused qi constraint and goiter.
In this same work, Wng mentions Cu Zh-t, a contemporary of Sn Smio, who wrote the G Zhng
Bng Ji Fng (Formulas for Steaming Bone Syndrome). To some scholars, Cu made a distinction
between tumors and goiters. Wang writes, Cui said that soft or movable goiters can be cured, but stonelike tumors cannot be cured...19
15
http://www.zysj.com.cn/lilunshuji/xiaopinfang/758-14-24.html
16
Ibid.
http://www.zysj.com.cn/lilunshuji/waitaimiyao/121-30-1.html#m0-0
18
Wng To, Wi Ti M Yo Fng (Medical Secrets of an Official), 752 (Tang), Hua Xia, Beijing 1997, Volume 23,
p. 433-439
17
19
The oft-cited conclusion of Temples, (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 Cu Zh-
20
Sn Smio himself, in his Qin Jn Yo Fng (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 Sn Yn J Y Bng Zhng Fng Ln (A Treatise on the Three Categories of Pathogenic
Factors of Disease), Chn Yn classified goiter into five types: stone, flesh, sinew, blood, and qi goiters.21
G. Yuan Dynasty (1279-1368 CE)
Zh Dn-x wrote a short chapter on Goiter Qi in his Dn X Zh F Xn Yo (The Heart and Essence of
Dan-xis 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 Zhs 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 Zhus 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 X Chn-fs Ming dynasty work G Jn
Y Tng D Qun (Complete Compendium of Ancient and Modern Medicine) Volume 67.23
Some ancient acupuncture prescriptions are presented in Table 1.
I. Present Times
t made a distinction between a tumor and goiter may be misleading. yng can mean tumor or goiter. The
actual passage, obtained from http://www.theqi.com/cmed/oldbook/book84/b84_23.html , is : "
It does not end with, cannot be cured but with cannot be cured by qi goiter
formulas. For a discussion of the types of yng 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
Zh Dn-x, Dn X Zh F Xn Yo (The Heart and Essence of Dan-xis Methods of Treatment), trans. Yang
Shou-zhong, Blue Poppy Press, Boulder, CO, 1993, p. 311
23
X Chn-f, G Jn Y Tng D Qun (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
Hung F-m

Zhn Ji Ji Y Jng
259
Tian Rong (SI 17)
652
Nao Hui (TB 13), Tian Fu (Lu 3),
(The ABCs of Acumoxibustion)
Sn S-mio
Qin Jn Yo Fng
Qi She (St 11)
(Priceless Prescriptions)
Wng Zhzhng
Zhn Ji Z Shng Jng
1220
Fu Bai (GB 10), Qi She (St 11)
1439
Lie Que (Lu 7), Fu Tu (LI 18), Tian Tu

(CV 22), Tian Ding (LI 17), Que Pen
(Fundamentals of Acumoxibustion)
X Fng
Zhn Ji D Qun
(The Complete Collection of

Acumoxibustion)
(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.
Earths 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 lungs 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 livers function. Through the five phases cycle, once the
livers function is compromised, any other organ, but especially the spleens 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 livers 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 Hashimotos 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 selfevident.
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 glands 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 Hashimotos
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
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, DeQuervains 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, ThyroxineBinding 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 patients 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
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Image 2: The Thyroid and Surrounding Tissues

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

The thyroid is composed of spherical follicles that selectively absorb

Thyroid epithelial cells

Scattered among follicular cells and in spaces between the spherical

Image 4: The Thyroid System

Image 5: Thyroid Gland Physiology

Table 2: Thyroid Hormonal Feedback Loop

TSH and TRH Output

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

24-Hour RadioIodine Uptake

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

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

Earth (Stomach Spleen)

Engendering (xing shng)

Table 3: Treatment Strategies for Different Stages of Treatment

Yin Shi, Yang Xu Treatment Strategies

Yang Shi, Yin Xu Treatment Strategies

Warm Interior and Drain Congested

Clear Heat and Toxins

Drain Damp and Transform Phlegm

Table 4: Historical Accounts of Thyroid Disease Rubrics

I.e., various blood stasis diseases.

Table A: Important Terms

Common English Translations

penetrating vessel, thoroughfare vessel

big yang, great yang, greater yang

Table B: Pulse Nomenclature

Slow-irregularly-interrupted, adherent, knotted, nodular

Sunken, submerged, sinking

Evanescent, minute, diminutive

Minute, small, thin, thready

Fixed, prison, hard

(zhng chng mi)

Fast, hurried, rushing, swift

Full, excess, forceful

Grating, choppy, difficult, dry