Single Herb Remedies
Single-herb remedies for hyperthyroidism do not follow the rules of traditional Chinese herb prescribing in addressing the underlying or symptomatic problems. There are three examples mentioned in clinical trials or individual case reports.
The immunosuppresive herb tripterygium (shanhaiteng), which has effects comparable to corticosteroids, was used in at least one study of hyperthyroidism.1 When used alone or with the Western drug tapazole (methimazole), virtually all patients were said to have their symptoms remitted. Interestingly, corticosteroid therapy is not a common method of treatment in the U.S. Tripterygium is considered, by Chinese doctors, to be somewhat safer and more effective than corticosteroids, but because of its potential toxicity even in small doses, the herb is not imported into the U.S. and is not available for use by Western practitioners. Chinese doctors use it for a wide range of autoimmune diseases, especially rheumatoid arthritis (the variety leigongteng is used).
Fagopyrum (suanqiaomai) was used in another study.3 The whole plant (rather than the fruits typically used in Chinese medicine) was combined only with a small amount of poultry trachea (0.5%), decocted and made into tablets. With two grams of herb extract in each tablet, they were taken in the amount of 15 to 16 tablets daily (thus about 30 grams of crude herb equivalent) for 45 to 60 days. This method was claimed to cure 41 of 90 patients (45%),a rate comparable to that obtained with the complex formulas; another 44 patients had some degree of improvement. Fagopyrum is in the same plant family (Polygonaceae) as polygonum stem, used to treat agitation caused by hyperthyroidism. The plant contains glycosides and flavonoids, but the mechanism of action for hyperthyroidism has not been determined. According to the clinical report, in using this remedy during a 3-year period, the doctors found it safe and reliable. No toxicity was revealed upon examination of liver function, potassium and sodium levels, and blood sugar.
The herb huangyaozi is a common ingredient in formulas for hyperthyroidism, and it has been used in individual cases as a sole ingredient. In Practical Traditional Chinese Medicine and Pharmacology Clinical Experiences, a method of using the herb is described: the rhizome is crushed into small pieces and soaked in wine (300 grams rhizome per 1500 ml wine), put into a sealed jar, and heated over a very low fire for 4 hours, then stored in ice water for one week. The patient is then instructed to drink 10 ml of the liquor six times daily, but not before bed (total daily dose equal to about 12 grams huangyaozi). This is indicated in the book as applicable to thyroid adenoma. This herb, like other Dioscorea species, is rich in steroidal compounds. However, it also contains diosbulbins (diterpene lactones) that may have an influence on the thyroid adenoma. An herb with similar lactones, brucea, is used in cancer therapy. Huangyaozi must be used with some caution, however, as it has been reported to cause toxic hepatitis when used in large amounts. Ingestion of decoctions containing 15 to 21 grams for 30 days or 12 to15 grams for 45 days were reported to be sufficient to cause toxic hepatitis, with some symptoms appearing in as little as two weeks [39]. At 30 grams daily, 7 days of administration could cause toxic hepatitis. Therefore, the dose of this herb should not exceed 12 grams per day and liver enzymes should be checked monthly if prolonged therapy that includes this herb is undertaken.
Dosage and Duration of Treatment Complex Formulas
For purposes of analysis, nine studies, which each involved a minimum of 50 patients, were analyzed to determine the influence of method of administration, dosage, and duration of treatment.
Four studies used decoctions only. In a 1986 study using Yiqiyangyin decoction,21 treatment time was 6 months to one year for most of the patients (treatment is terminated when the patients are obviously cured or when it is obviously not helping); however, 12 of the 98 patients were treated for up to 3 years. A high dosage decoction, with about 150 grams per day, was used. The claimed cure rate was 62%. In another study,4 with a dosage of about 120 grams per day in decoction, treatment time was one of 5 months and the claimed cure rate was 42%. Another report described a decoction with a dosage of about 180 grams per day used for one to four months;16 it yielded a claimed effective rate of 34.5%. A heavily modified Bupleurum and Dragon Bone Combination, taken once daily in decoction form with 215 grams/day, produced marked improvement in 50% of the patients with 1 to 3 months of therapy, but no claim of cures.
One study used either decoctions or dried decoction in tablet form.5 The decoction had a dose of 90 grams per day, taken one time per day, and the tablets had a similar dose (after concentration), but were taken in a divided dose three times per day. The cure rate was rather low (12.1%) with 3 months of treatment time, though the rate of “marked improvement” was substantial at 38%.
Two studies used a mix of decoctions and powdered herbs. In one, the decoction was always given first, with a dosage of about 110 grams per day, administered until the disease improved somewhat, but then followed-up by powdering the herbs and taking them as pills (18 grams per day).6 The treatment time was not clearly stated, but appeared to be 3 months or more, with a cure rate of 47%. In the other, herbs were either given as a decoction (about 100 grams per day) or made into a powder and consumed with warm water.13 The treatment time was 3 to 6 months and the claimed cure rate was 20%. No distinction was made in the reported outcome between the two methods of herb preparation.
Two studies used powdered herbs only, in pill form. In a study cited earlier, two large pills were taken daily for 45 to 90 days, and the cure rate was 52%.7 Given the short duration of therapy, the cure rate is remarkably high. Also, the amount of herb materials used, about 30 grams per day (includes binder of 30% to 50% by weight) was far lower that the amounts used for decoctions. In the other [10], patients received 10 grams of herbs per pill (probably includes binder weight), two to three pills per day. The duration of therapy was not stated; a cure was indicated for only 16% of the patients, though the rates for marked improvement were substantial (36%).
In these nine studies, the treatment times varied from one month to more than one year, but the typical treatment time was about 3 months (a review of the Chinese literature reveals that this duration is common for treatment of chronic ailments involving autoimmunity). The treatments were administered mainly as decoctions or large pills or both (not at the same time, however). The decoctions had a range of 90 to 210 grams per day of dosage, with a highly variable cure rate, from zero to over 60%. The pills had a dosage range of 18 to 30 grams per day. Two of the studies that utilized pills (made from powdered herbs, combined with honey, and then chewed and swallowed)-one initiated with decoctions and using pills for the remainder-had relatively high success rates (around 50% cure) with moderate duration of treatment (about three months). In the third study using pills with a cure rate of only 16%, the criteria for participation by most of the patients was a long duration of the disease with failure of Western drugs to control it.
On the basis of this small sampling, it would seem reasonable to use powdered herbs prepared in a convenient form in a dosage of about 20 grams per day for a period of 3 months. This would conserve resources (using about 15% as much herb material as in a decoction), maximize convenience (no cooking of the herbs or drinking a strong tasting tea on a daily basis), and provide a reasonable trial time. As an example, using easy-to-swallow tableted herbs (700 mg herb/tablet), the dosage recommended in the studies would correspond to the use of 9 to 10 tablets each time, three times daily. Using instead bulk powdered herbs swallowed by the spoonful with water, this would correspond to about a tablespoon of powder twice daily.
However, in order to be able to vary the formulation according to individual needs, the use of decoctions or dried single herb extracts may be indicated for part or all of the treatment. In such cases, about 6 to 15 grams of each ingredient (crude herb) with 10 to 15 ingredients per formula is made in decoction form, often divided into two doses per day, and administered as needed. About 18 to 27 grams of dried extracts, taken in two or three divided doses, would be expected to provide comparable effects.
It should be noted that when consuming herb powders or pills, astragalus, or ho-shou-wu may cause digestive problems for some individuals at the higher dosage levels. This is because astragalus contains large amounts of polysaccharides and ho-shou-wu contains emodin glycosides. If problems were to occur, they would likely be gas and abdominal bloating and mushy or loose stool. When consuming herbs in decoction form, the sea materials and the bitter fire-purging herbs may cause nausea or vomiting in some sensitive individuals. Also, hyperthyroid patients should allow the herb tea to cool somewhat before consuming it. An experienced physician, reporting in the book Treatment of Knotty Diseases, has cautioned that herbs should be administered in small portions at frequent intervals rather than single large doses. In most of the studies, two dosages per day were suggested, but a three-times-per-day schedule would not be inconvenient with tablets or dried extracts.
