Traditional Chinese Herb Formulas Used in China
Chinese physicians sometimes rely on the use of traditional formulas in a manner similar to Kanpo practitioners. The formulas are most often provided in the form of decoctions or pills made from powdered herbs rather than dried extracts, and slight modifications are made in many cases. The practice of selecting traditional formulas in China has no limitations related to government approval. In Formulas and Strategies, formulas mentioned to be useful for hyperthyroidism include three kidney nourishing formulas, Rehmannia Six Formula, Tortoise Shell Formula (Da Bu Yin Wan), and Curculigo and Epimedium Combination (Two Immortals); a yin nourishing formula for stomach deficiency (Zeng Ye Tang, comprised of scrophularia, ophiopogon, and raw rehmannia), Jade Screen Powder, an anti-scrophula pill (Xiao Luo Wan, made of scrophularia, oyster shell, and fritillaria), and a fire-purging formula, Dang Gui Liu Huang Tang.
Two formulas used in Kanpo, Baked Licorice Combination and Bupleurum and Dragon Bone Combination, are also suggested for hyperthyroidism in this source. The Sargassum Jade Pot Decoction (Hai Zao Yu Hu Tang), rich in seaweeds, is suggested for simple goiter, hyperthyroidism, and benign thyroid tumors. A small clinical study of a modified version of this formula with six patients was said to result in five patients cured and one markedly improved. In the treatment of hypothyroidism, Vitality Combination and Aconite and G.L. Combination (Si Ni Tang) were suggested. Both of these formulas contain aconite and dried ginger.
Pharmacological Investigations
If, in fact, most of the patients participating in the clinical trials suffer from an autoimmune disease, the question may be raised-how are they cured? Western medical researchers currently regard such ailments as manageable by appropriate immunosuppressive techniques, but incurable.
Virtually all formulas used for treating hyperthyroidism contain either seashells or seaweeds or both. Their role in treating autoimmunity has not established-for example, they are not used for diabetes, lupus, scleroderma, multiple sclerosis, or myastenia gravis. In those disorders, a few prescriptions contain tortoise shell as a yin tonic, but it would seem that sea materials are not essential to treating autoimmunity. In one study of hyperthyroidism, with no sea materials used, it was claimed that over 62% of those treated were cured, with a low incidence of relapse even years after the therapy was ceased.21 The sea materials might play some role in regulating the thyroid hormones beyond their provision of iodine, and may reduce the duration of treatment necessary to gain satisfactory results. The mechanism of action would have to involve some inhibition of nodules or swellings. The same sea materials are used for tumors, cysts, fatty accumulations, and lymphatic nodules. By removing the thyroid nodules, they would reduce hyperthyroidism.
In addition, virtually all formulas used for hyperthyroidism contain some saponin components. Examples are fritillaria, pinellia, huangyaozi, and ophiopogon. Also, some of the symptom-alleviating herbs contain such components-notably bupleurum and zizyphus. However, in some studies with relatively high cure rates, the proportion of saponin-containing ingredients in the formulations is rather small and may be insufficient to provide an explanation of the clinical effects obtained. Essential oils in prunella, the citruses, and cyperus might contribute some curative effects for which the pharmacology is not yet established.
Ingredients found in treatments for hyperthyroidism that are common to other autoimmune disorders are astragalus, codonopsis, ophiopogon, rehmannia, scrophularia, bupleurum, citrus, salvia, peony, moutan, lycium fruit, and licorice. It should be noted that the majority of these herbs are attributed with some tonic actions, and many of them clear heat. Chinese studies of immune responses, using hemolytic plaque formation as a criterion, have shown that yin-nourishing, qi-regulating, and blood-vitalizing formulas can reduce immunologic attacks, such as those characteristic of autoimmunity and transplant rejection.38 A yang-nourishing formula enhanced immune responses. In terms of treatment of hyper- and hypo-thyroidism, the former is usually treated with yin-nourishing formulas and the latter with yang-nourishing formulas even though autoimmunity may be involved with both. The pharmacologic impact of the different types of herb formula might explain, in part, why apparently less satisfactory results have been obtained in treating hypothyroidism. In animal models with induced hyper- or hypothyroid conditions, it was shown that a mixture of rehmannia and polygonatum (yuzhu) reduced T3 and T4 levels in the hyperthyroid animals, while a mixture of either cinnamon bark and aconite or cistanche and epimedium increased T3 and T4 in hypothyroid animals.49
Recent Japanese investigations have shown that phenolic glycosides, such as acetoside in rehmannia can inhibit the immune attack of cells.48 A decoction of rehmannia was reported to produce remarkable therapeutic effects in most patients with rheumatic and rheumatoid arthritis that were treated in one Chinese study mentioned in Modern Study and Application of Materia Medica. Since arthritis inflammation is due to excessive antibody production and attack of joint tissue, this response may be due to selective immune suppression. A decoction of raw rehmannia proved effective in the treatment of eczema and neurodermatitis when used intermittently in very high doses (90 grams per day). Gentiana has been shown to inhibit antibody formation. Both rehmannia and gentiana inhibit formaldehyde-induced inflammation in rat paws. Scrophularia, a close relative of rehmannia used in several hyperthyroid prescriptions, has glycosides similar to those found in rehmannia.
Feng Guoping and his colleagues at the Department of Pharmacology, Shanghai Second Medical College, studied the effects of two ingredients used for treating deficiency patients, rehmannia and tortoise shell, on renal adrenoreceptors.41 In laboratory rats, they showed that these herbs prevented the increase in renal beta-adrenoreceptors that occurs with hyperthyroidism. Their experimental results were deemed solid basis for the use of yin tonics for correcting hypersensitivity of the sympathetic nervous system. Anemarrhena had a receptor-lowering action similar to that of rehmannia. Since adrenoreceptors influence nervous system functioning, it is possible that the use of these herbs in formulas can help regulate the system that has been adversely influenced by autoimmune attack.
It has long been known that consumption of vegetables in the Brassica Family can inhibit thyroid function. Rabbits fed on a cabbage diet develop goiter, due to content of sulfaguanidine. A Chinese herb from this plant family, sinapis (mustard seed), is sometimes used in hyperthyroid formulas because of its phlegm-resolving quality. Another seed, raphanus (radish seed), has been shown to influence iodotyrosine content of the thyroid gland, suggesting disruption of thyroxin synthesis when the herb is fed to rats for a long period of time. Related experiments show that the formula Tan Yin Wan markedly inhibited the iodine uptake of the thyroid gland in both mice and rats, thus inhibiting overall thyroid function.42 Tan Yin Wan contains atractylodes (red and white), raphanus, sinapis, perilla fruit, cinnamon bark, aconite, and dry ginger. It is of interest to note that this is a warming, yang-nourishing prescription similar to those used for hypothyroidism except for the content of raphanus and sinapis that are used in resolving phlegm-masses.
Khatamines, amphetamine analogues found in the herb Catha edulis, produce an increase in metabolism that is at least partially mediated by thyroid stimulation.43 Ephedra, contained in the Chinese herb ma-huang, has a similar chemical structure and a similar ability to enhance metabolism. Therefore, ma-huang preparations may help increase thyroid function in patients with hypothyroid function. Dr S. I. Esner, at the Capital District Bariatric Clinic in New York, has been using a ma-huang extract preparation for increasing brown adipose tissue thermogenesis for weight loss; he reported that patients with chronic fatigue symptoms obtain relief by using this herb extract.44 This may be through the thyroid stimulation.
Ginseng has been shown to exert at least part of its effects via the pituitary gland. Since ginseng activities include promotion of DNA, RNA, and protein synthesis, enhancement of energy metabolism, and oxygen utilization, it is possible that the pituitary activity leads to enhanced thyroid activity, finally promoting the metabolic changes. Ginseng is a component of many of the hypothyroid formulas. Licorice also strongly influences hormone balance and may play a role in enhancing metabolism through regulation of the pituitary and adrenal cortex.
Gossypol, a Chinese drug derived from the cotton plant used to inhibit male fertility (as a birth control method) and to treat female gynecological disorders including endometriosis, reduces serum levels of T3 and T4 and increases TSH.32 Side effects of this widely used drug, such as fatigue, muscle weakness, and diminished sexual function, may be secondary effects of hypothyroidism induced by the drug. It may thus have some application in treating hyperthyroidism.
Iodine Controversy in Hyperthyroid Treatment
Three articles and one brief report reviewed in preparation of this paper mentioned avoidance of iodine-containing herbs and foods in the treatment of hyperthyroidism. In one paper, on differential treatment of hyperthyroidism, the author states that “because in some patients after taking Laminaria and Ecklonia the thyroid becomes suddenly enlarged and other hyperthyroid symptoms become more serious, the iodine-containing herbs were not recommended in the treatment for those patients.”17 In a brief letter in the Sichuan Journal of TCM, it is pointed out that formulas with iodine-containing herbs are frequently prescribed for hyperthyroidism, but “modern medicine has realized that to apply iodides for the treatment of hyperthyroidism can sometimes induce ill effects. When there is a case of hyperthyroidism, uptake of radioiodine is typically stimulated. Ingesting iodides would produce a higher concentration of iodine in the thyroid, which temporarily inhibits the synthesis of thyroid hormone. At the same time, iodides can also inhibit the release of thyroid hormone, which then accumulates in the thyroid. In this situation, the course of treatment would be increased, the dosage would need to be larger, and the remission rate would be worsened. Long-term use of iodine-containing agents may cause hyper- or hypothyroidism. Iodine use should be limited to preparatory treatment before surgery or to dangerous conditions (e.g., thyroid storm).”20
In the third article, about dietary therapy for hyperthyroidism prepared by California acupuncturist Heidi Middlebrooks, patients are told to avoid iodide-containing foods because iodine provides “the substrate for increased thyroxine production which, over the long term, may delay or counteract the effectiveness of herbal therapy (TCM) or antithyroid therapy (Western medicine), and indeed may precipitate an acute thyroid crisis.”45 No supporting research was mentioned in making this statement. In a brief report by California acupuncturist Ron Golden, based on his experience visiting a hospital in Guanzhou, an opinion by the doctors was relayed: “in cases of hyperthyroidism, one wanted to avoid using any of the seaweeds since they contained too much iodine.”46 In a sample case study from the hospital, neither seaweeds nor seashells were included.
Thus, these authors consider iodine, in any amount, to be of potential harm by worsening hyperthyroidism in some patients and interfering with the cure. In contrast, more than a dozen clinical trials using iodine-containing ingredients claim a high level of positive responses. Other clinicians relaying their personal experiences recommend formulas that contain seaweeds. Also, traditional Chinese dietary therapy for hyperthyroidism usually is based on consuming sea materials (nonetheless, it should be remembered that in earlier times, most goiter was due to iodine deficiency). Thus, the controversy remains unresolved.
Clearly, if consumption of an iodine-containing herb prescription appears to make the hyperthyroid syndrome worse, then a non iodine-containing prescription should be tried as an alternative. However, unless the attending physician regards modest levels of iodine, as might be ingested in herb teas or common dietary items, to be a risk factor, it appears that the weight of opinion is that sea materials are an acceptable part of traditional Chinese therapy.
Symptom Responses
In an evaluation of symptoms for 110 hyperthyroid patients,16 the most common symptoms and the response to a particular treatment (the herb formula Pingyin Fufang) were:
| Symptoms | # of Cases | Eliminated | Alleviated | No Change |
| Palpitation | 105 | 87 | 18 | 0 |
| Shortness of breath | 95 | 84 | 9 | 2 |
| Aversion to heat | 91 | 79 | 12 | 0 |
| Excessive appetite | 89 | 87 | 2 | 0 |
| Shaking (hand) | 88 | 71 | 9 | 8 |
| Brachial artery murmur | 88 | 79 | 9 | 0 |
| Emaciation | 87 | 75 | 9 | 3 |
| Insomnia | 78 | 66 | 10 | 2 |
| Tremor (fingers) | 78 | 57 | 12 | 9 |
| Anxiety | 74 | 68 | 4 | 2 |
There were only about 18 individuals who did not experience elimination of one of these symptoms.
In another study,10 in which specific symptoms were outlined with 50 patients, the main conditions were:
| Symptoms | # of Cases | Eliminated | Alleviated | No Change |
| Fatigue | 50 | 36 | 10 | 4 |
| Palpitation | 48 | 32 | 11 | 5 |
| Neck swelling | 47 | 27 | 17 | 3 |
| Quickly angered | 47 | 28 | 10 | 9 |
| Aversion to heat | 46 | 28 | 16 | 2 |
| Insomnia | 39 | 25 | 11 | 3 |
| Excessive appetite | 34 | 30 | 4 | 0 |
| Irregular menstruation | 29 | 20 | 0 | 9 |
| Low fever | 25 | 24 | 1 | 0 |
| Loose stool | 16 | 10 | 6 | 0 |
This study did not have as strong results as the previous one in terms of symptom relief. A symptom of concern to Western practitioners, exophthalmos, was reported in this study to have affected only 14 of the patients, of which seven were resolved and four more got better, while three were unchanged.
In a clinical evaluation that focused on treatment of exophthalmos,12 there were three formulas that could be selected, one for liver fire and phlegm wetness, one for liver and kidney yin deficiency, and one for excessive liver fire. In the treatment of 12 patients, it was reported that five of the cases were markedly improved and the other seven were somewhat improved. At the same time, other symptoms were improved with similar frequency, such as palpitation, aversion to heat, excessive perspiration, excessive appetite, anxiety, and insomnia.
