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Hypothyroidism and Chinese medicine.

The information below comes from Zhong Guo Zhong Yi Mi Fang Da Quan (A Great Compendium of Chinese National Chinese Medicine Secret Formulas) compiled by Hu Zhao-ming and published by the Literary Publishing House in Shanghai in 1992. This is a collection of abstracts taken from Chinese medical journals. The formulas are "secret" in that they are the "self-composed," "experiential formulas" of individual Chinese doctors rather than standard textbook formulas. However, because they have all been published in Chinese medical journals, they are not really secret. As the reader will see, each of these formulas is, therefore, preceded by the name of the master or doctor who created it. As the reader will also see, all of these Chinese doctors believed that spleen-kidney yang vacuity was the base or at least the most commonly seen pattern of this condition.

[ILLUSTRATION OMITTED]

For instance, in his introduction to hypothyroidism, Dr. Hu equates this condition with the traditional disease categories of xu lao or vacuity taxation and shui zhong or water swelling in Chinese medicine. Vacuity taxation refers to original qi decline and debility, qi and blood insufficiency, and detriment to the viscera and bowels resulting from chronic disease. It manifestations are primarily related to vacuity of the two viscera of the spleen and kidneys, such as a somber white facial complexion, fear of cold, lack of strength, falling hair, dry skin, and a hoarse voice. Water swelling is due to spleen qi debility and vacuity with water dampness gathering and collecting. Kidney yang insufficiency may lead to inhibited opening and closing. Qi is not able to be transformed, and water is not moved. This then also results in water gathering and collecting and then spilling over into the skin, thus also producing water swelling. If water swelling is severe, spilling over and accumulating in the chest cavity and hence causing respiratory or circulatory distress, this is usually due to spleen-kidney yang vacuity.

1. Master Zhang's Hypothyroid Formulas

Functions and Indications

Formula 1. This formula warms the center and fortifies the spleen, supports yang and supplements the kidneys. It mainly treats spleen-kidney yang vacuity pattern hypothyroidism.

Formula 2. This formula has the functions of fortifying the spleen and disinhibiting dampness, leveling or calming the liver. It mainly treats liver effulgence, spleen vacuity pattern hypothyroidism.

Formula Composition

Formula 1:

Fu Zi (Radix Lateralis Praeparatus Aconiti), 6g

Gan Jiang (dry Rhizoma Zingiberis), 3g

Rou Gui (Cortex Cinnamomi), 2.1g

Dang Shen (Radix Codonopsis), 15g

Fu Ling (Poria), 9g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 9g

mix-fried Gan Cao (Radix Glycyrrhizae), 4.5g

Decoct in water and administer.

Formula 2:

Chai Hu (Radix Bupleuri), 6-10g

Bai Shao (Radix Alba Paeoniae), 15g

Dang Shen (Radix Codonopsis), 15g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 10g

Fu Ling (Poria), 15g

Gan Cao (Radix Glycyrrhizae), 3g

Decoct in water and administer.

Pattern Discrimination Additions and Subtractions

Formula 1:

If there is abdominal distention, add Sha Ren (Fructus Amomi), 4.5g. If there is edema, add Che Qian Zi (Semen Plantaginis), 9g, Chi Xiao Dou (Semen Phaseoli Calcarati), 24g, and Ze Xie (Rhizoma Alismatis), 9g.

If there is constipation, add Huang Qi (Radix Astragali), 9g, and Huo Ma Ren (Semen Cannabis), 15g.

Formula 2:

If edema is severe, add Che Qian Zi (Semen Plantaginis), 10g, and Ze Xie (Rhizoma Alismatis), 10g.

If there is a bitter taste in the mouth, insomnia, and vexation and agitation, add Mu Dan Pi (Cortex Moutan), 6-9g, Long Dan Cao (Radix Gentianae), 9g, Yin Chen Hao (Herba Artemisiae Scopariae), 9g, and Zhi Zi (Fructus Gardeniae), 10g.

If there is abdominal distention, add Chen Pi (Pericarpium Citri Reticulatae), 5g, and Sha Ren (Fructus Amomi), 5g.

If there is constipation, add Gua Lou (Fructus Trichosanthis), 15g, and Huo Ma Ren (Semen Cannabis), 15g.

If there is a dry mouth, add Xuan Shen (Radix Scrophulariae), 15g, and Sheng Di (uncooked Radix Rehmanniae), 30g.

Clinical Efficacy

Twenty-seven patients were treated with this protocol for 40-60 days, the median duration of treatment lasting six weeks. Five cases were cured. This meant that the main symptoms of this condition disappeared and that thyroxine levels had returned to normal. Twenty-two patients got a good effect. This meant that their symptoms and their serum analyses were better.

2. Master Deng's Two Formulas

Functions and Indications

These formulas secure the chong and ren, regulate the qi and blood, support the spleen and warm the kidneys. They mainly treat hypothyroidism.

Formula Composition

Formula 1:

Huang Qi (Radix Astragali), 30g

Dang Shen (Radix Codonopsis), 18g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 24g

Dang Gui (Radix Angelicae Sinensis), 12g

mix-fried Gan Cao (Radix Glycyrrhizae), 6g

Chai Hu (Radix Bupleuri), 6g

Sheng Ma (Rhizoma Cimicifugae), 6g

Ba Ji Tian (Radix Morindae Officinalis), 9g

Gou Qi Zi (Fructus Lycii), 9g

Chen Pi (Pericarpium Citri Reticulatae), 3g

Decoct in water and administer.

Formula 2:

Huang Qi (Radix Astragali), 18g

Fu Ling (Poria), 30g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 24g

He Shou Wu (Radix Polygoni Multiflori), 24g

Ze Xie (Rhizoma Alismatis), 9g

Gui Zhi (Ramulus Cinnamomi), 9g

Shan Yao (Radix Dioscoreae), 9g

Yin Yang Huo (Herba Epimedii), 9g

Tu Si Zi (Semen Cuscutae), 12g

Decoct in water and administer.

Clinical Efficacy

One case of hypothyroidism was treated. The symptoms disappeared, and the patient was able to return to a normal workload.

Note: Formula 1 is weighted towards the spleen, while Formula 2 is weighted towards the kidneys. These two formulas were used alternately in order to treat the spleen and kidneys simultaneously.

3. Master Xu's Formula for Treating Hypothyroidism Functions and Indications

This formula boosts the qi and fortifies the spleen, disinhibits water and disperses swelling. It mainly treats hypothyroidism arising as the sequela of a thyroidectomy.

Formula Composition

Calcined Mu Li (Concha Ostreae), 30g

Dang Shen (Radix Codonopsis), 12g

stir-fried Bai Zhu (Rhizoma Atractylodis Macrocephalae), 12g

Niu Xi (Radix Achyranthis Bidentatae), 12g

Bai Shao (Radix Alba Paeoniae), 12g

Mu Gua (Fructus Chaenomelis), 12g

Fu Ling Pi (Cortex Sclerotii Poriae), 12g

Yu Jin (Tuber Curcumae), 12g

Dang Gui (Radix Angelicae Sinensis), 9g

Hong Hua (Flos Carthami), 6g

mix-fried Gan Cao (Radix Glycyrrhizae), 3g

Decoct in water and administer.

Pattern Discrimination Additions and Subtractions

If there is fatigue and low extremity pain and flaccidity and if the eyelids are edematous, remove the Niu Xi, add Yin Yang Huo (Herba Epimedii), 12g, Hong Shen (Radix Rubra Ginseng), 1.5g, Huang Qi (Radix Astragali), 12g, and increase Dang Shen to 15g, Fu Ling Pi 15g, and calcined Mu Li to 60g.

Clinical Efficacy

One case was treated with this protocol, and the patient was cured. This meant that symptoms disappeared, the patient was able to go back to a normal workload, and on follow-up after one year, the patient's condition was still normal.

4. Master Zeng's Warming Yang Formula Functions & Indications

This formula's functions are to boost the qi and warm yang, fortify the spleen and supplement the kidneys. It mainly treats hypothyroidism.

Formula Composition

Dang Shen (Radix Codonopsis), 20g

Huang Qi (Radix Astragali), 30g

Gui Zhi (Ramulus Cinnamomi), 5g

Fu Zi (Radix Lateralis Praeparatus Aconiti), 10g

Fu Ling (Poria), 20g

Ze Xie (Rhizoma Alismatis), 20g

Xian Mao (Rhizoma Curculiginis), 15g

Yin Yang Huo (Herba Epimedii), 15g

Bu Gu Zhi (Fructus Psoraleae), 10g

Gan Cao (Radix Glycyrrhizae), 5g

Decoct in water and administer.

Pattern Discrimination Additions and Subtractions

If fear of cold, chilled limbs, and edema have diminished, add Mai Men Dong (Tuber Ophiopogonis), 12g, Yu Zhu (Rhizoma Polygonati Odorati), 12g, and Wu Wei Zi (Fructus Schisandrae), 5g.

Clinical Efficacy:

One patient was treated with this protocol for two months and was cured. This meant that the symptoms disappeared, the basal metabolic rate increased five percent, and that the electrocardiogram returned to normal.

Note: Master Zeng feels that hypothyroidism should be categorized as spleen-kidney dual vacuity.

5. Master Kuang's Invigorating Yang Formula Functions and Indications

This formula's functions are to assist or invigorate yang, warm the kidneys, and boost the qi. It mainly treats heart-spleen-kidney yang vacuity patterns of hypothyroidism.

Formula Composition

Dang Shen (Radix Codonopsis), 10-30g

Huang Qi (Radix Astragali), 15-30g

Xian Mao (Rhizoma Curculiginis), 9g

Yin Yang Huo (Herba Epimedii), 9-15g

Tu Si Zi (Semen Cuscutae), 9-12g

Shu Di (cooked Radix Rehmanniae), 9-12g

Decoct in water and administer.

Pattern Discrimination Additions and Suntractions

If yang vacuity is severe, add Fu Zi (Radix Lateralis Praeparatus Aconiti), 6-9g, and Gui Zhi (Ramulus Cinnamomi), 6-9g.

If edema is pronounced, add Fu Ling (Poria), 15-30g, and Ze Xie (Rhizoma Alismatis), 15-30g.

Clinical Efficacy

Nineteen cases of primary hypothyroidism were treated with this protocol, and the clinical symptoms improved in all these cases. Patients' T3 and T4 levels went up, and their TSH levels went down. Treatment was conducted in two stages. In the first stage, the patient received only the Chinese medicinals for two to four months. In the second stage, the Chinese medicinals were combined with a small dose of Jia Zhuang Quan Pian (Thyroid Gland Tablets), 30 mg per day for one to two months. Then this was increased to 60 mg per day for one to two months.

Discussion

In the years since 1992, more and more patients in China have been diagnosed with hypothyroidism as a result of a routine physical examination, not in response to overt clinical signs and symptoms. Therefore, the idea that all hypothyroidism equals a qi and yang vacuity is somewhat outmoded. Increasingly, Chinese doctors are realizing that there may be no overt signs and symptoms of spleen and/or kidney yang vacuity. Rather, in patients with asymptomatic hypothyroidism, the emphasis had shifted onto liver depression qi stagnation, phlegm dampness and turbidity, and blood stasis, all with or without depressive heat. Hence, at this point in time, Chinese medical treatment should be based on the patient's personally presenting pattern(s) and not on some a priori assumption that there is a spleen-kidney yang vacuity. Nevertheless, in patients with fear of cold, chilled limbs, fatigue, and supplementing the qi, supplementing the kidneys and invigorating and/or warming yang, and seeping dampness are all still absolutely valid and therapeutically effective.

Copyright [C] Blue Poppy Press, 2008. All right reserved

Keywords: Chinese medicine, endocrinology, hypothyroidism

by Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

www.bluepoppy.com
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Title Annotation:Chinese Medicine
Author:Flaws, Bob
Publication:Townsend Letter
Geographic Code:1USA
Date:Dec 1, 2008
Words:1693
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