Traditional Diagnostic Indicators
According to The Essence and Scientific Background of Tongue Diagnosis, hyperthyroidism consistently produces a cardinal red tongue appearance, while hypothyroidism produces a pale tongue appearance. This is believed to be a direct reflection of changes in basal metabolic rate, which influences blood circulation to the tongue. In the absence of other diseases, the tongue coating should be white, though denuded red tongues are seen in some cases of hyperthyroidism. While a white coating occurs in early stage of disease caused by external pathogens, it has been noted in cases of thyroid adenoma and other thyroid diseases. The tongue may be trembling in hyperthyroid cases and flaccid in hypothyroid cases.
The pulse in hyperthyroid cases can be expected to be rapid, irregular, and knotty. In hypothyroid cases, it is expected to be slow, soft, and deep. Both the tongue appearance and the pulse should be responsive to successful therapies since the alteration in metabolic rate will influence these parameters.
Acupuncture/Moxibustion
Acupuncture is not frequently listed as a treatment for thyroid disorders, but a few suggestions have appeared in the literature.
The Comprehensive Guide To Chinese Herbal Medicine mentions the following as “common points” for hyperthyroidism:
| naohui | (TB13) |
| zusanli | (ST36) |
| tianding | (LI17) |
| hegu | (LI4) |
| tianrong | (SI17) |
| tiantu | (CV22) |
The Treatment of Knotty Diseases with Chinese Acupuncture and Chinese Herbal Medicine lists the following for “senile hyperthyroidism”:
| guanyuan | (CV4) |
| shenshu | (BL23) |
| mingmen | (GV4) |
The above with reinforcing method; those below with reducing technique:
| yongquan | (KI1) |
| shuidao | (ST28) |
| feishu | (BL13) |
| chize | (LU5) |
| xingjian | (LV2) |
This source also lists moxa points: guanyuan (CV4), qihai (CV6), mingmen (GV4), and shenshu (BL23) for cases of impairment of yin affecting yang.
According to Modern Clinic Necessities for Acupuncture and Moxibustion, acupuncture therapy could resolve the symptoms in 25% of patients. Recommended needling points included pingyin andqiyin (near CV22) as primary points, and neiguan (PC6), jianshi (PC5), and zusanli (ST36) as secondary points. For exophthalmos, upper tianzhu (BL10) and fengchi (GB20) are added (with needling to direct sensation to the eye region). Three to five points are selected with a qi-promoting technique to be used at the pingyin point and reducing method to be used at the qiyin point. Needle retention is for thirty minutes, done once or twice daily. Of 129 patients treated by this method, symptoms were controlled in 34 cases (26%). Moxibustion is applied to the main points dazhu (BL11), fengmen (BL12), feishu (BL13), fengfu (GV16), dazhui (GV14) and shengzhu (GV12). Secondary points are neiguan (PC6), jianshi (PC5), taixi (KI13), zaohai (KI16), Fuliu (KI17), and sanyinjiao (SP6). Two to three of the main points and a similar number of secondary points are treated once daily with seven small moxa cones at each point.
A clinical study of acupuncture treatment for benign thyroid nodules (thyroid adenoma, nodular goiter, or cystic goiter, but not thyroid carcinoma or thyroiditis) revealed a long-term effective rate of 90% in resolving the nodules.47 Sixty-five patients were treated by applying six to eight needles surrounding a nodule and one directed at the center of the nodule (not intending to penetrate the nodule, however). Strong stimulation was applied for 20 minutes. In addition, tianzhu (BL10), dazhu(BL11), neiguan (PC6), and qugu (KI2) were needled every other day but with needles withdrawn after the needling sensation (deqi) was felt. Nearly half of the individuals were cured (measured by palpation of the neck and by ultrasonography), and most of the remaining individuals showed marked improvement.
In a clinical study of moxibustion in the treatment of Hashimoto’s thyroiditis,23 points selected were in two groups, the first consisting of dazhui (GV14), shenshu (BL23), and mingmen (GV4), and the second consisting of shenzhong (CV6), zhongwan (CV12), and guanyuan (CV4). These two sets were alternated from one visit to the next and treatments were given every other day for 20 treatments (10 each set). Moxa was done with cones on top of cakes of processed aconite (fuzi). It was reported that the moxibustion treatments reduced serum TGA and MCA (indicating change in the autoimmune process), the total serum T3 and T4 showed a marked increase, and the TSH showed a decrease. The clinical symptoms of hypothyroidism were alleviated. A control group of patients receiving thyroxine showed no change in autoimmunity.
The basic disorder of hyperthyroidism, with suggested treatment strategies, is presented in the book Acupuncture Cases from China. It is said that hyperthyroidism “is related to emotional factors, kidney yin deficiency, fatigue, or congenital weakness. The liver is in charge of purging and discharging. It likes movement and dislikes stagnation. When it is affected by emotional factors the functional qi stagnates. Stagnation of liver qi can transform into fire, which in turn can impair the yin. When the yin is impaired, deficiency fire agitates inside, impairing the heart in the upper heater and the kidney in the lower heater. If this condition lasts for a long time, the yin of the heart, liver, and kidney are consumed, and they act on each other, depleting each other further. The disease is caused by deficiency but its symptoms are excess. The cause is deficiency fire and the symptoms are exuberant fire. Heat in the heart transforms to the stomach, accelerating metabolism and causing hunger. At the same time, heat in the stomach and liver condenses the essence in the yang ming channel into phlegm. Phlegm and qi rise to the neck to form goiter, the swollen thyroid. When the phlegm gets to the liver channel and lodges in the eyes, it causes bulging eyes.” To treat this condition, one may use the following points: jianshi (PC5) and shenmen (HT7) to purge the heat in the heart, relieve heat in the liver, and nourish the stomach. When the heat in the heart is purged, the fire does not burn the metal, so the metal can control the wood. Also, taixi (KI3) and fuliu (KI7) are used to nourish kidney yin. When the water is full it nourishes the liver. Finally, shuitu (ST10) clears the channel qi of the stomach and removes stasis of phlegm in the neck. A female patient suffering from hyperthyroidism for more than two years was treated following this methodology. Needling was done every other day for 9 weeks (with some changes in the selection of points after three and six weeks), at which time she was considered cured; there was no relapse for 6 months of follow-up.
Summary and Conclusion
Thyroid diseases can be cured or controlled in most patients, according to Chinese reports published during the past 12 years. For those who are cured, relapse is relatively rare during a period of up to 5 years following treatment. Among those who are not cured but show symptomatic improvement, usually with accompanying changes in blood parameters, continued use of herbs, alone or with Western drugs, is necessary. In those cases, it appears that Chinese herbs provide better results than using drugs alone. Only a small number of individuals fail to respond to the Oriental therapies.
There is a clear pattern of herb selection for treatment of thyroid diseases. When thyroid nodules or swellings are present, phlegm-resolving herbs are used. Other herbs are selected for treatment of specific syndromes or symptoms. Hyperthyroid cases are treated with yin nourishing and/or fire purging herbs while hypothyroid cases are treated with qi and yang tonifying herbs.
The number of different herbs commonly used by Chinese doctors for treatment of thyroid diseases is relatively small, thus making selection based on accumulated Chinese experience, but applied to new cases, relatively easy. Acupuncture and moxibustion point selection may include local treatment plus a focus on treating the stomach and spleen meridians, the governing and bladder vessels along the back, and the kidney and conception vessels along the front.
The dosage of herbs used in Chinese clinical trials showing effective treatment of thyroid diseases is higher than commonly used by Western practitioners but comparable to those used in treating other chronic ailments. Powdered herbs in pill form are consumed in the amount of 18 to 30 grams per day, while decoctions are consumed in the amount of about 90 to 210 grams per day. Duration of therapy typically ranges from 6 weeks to 6 months, though some patients require more than a year of treatment to obtain satisfactory resolution of symptoms.
Western drugs used in conjunction with Chinese herbs help to resolve symptoms during the treatment period and appear to enhance the overall effects of the therapy towards attaining a cure or major resolution of the disease. Acupuncture and moxibustion also improve the effects of Chinese herb therapy, though their impact on total duration of treatment has not been ascertained. From a single study with moxibustion, it appears this technique can provide rapid relief for hypothyroid cases.
The mechanism of action of the Chinese herb therapies for thyroid diseases, as expressed in Western pharmacology terms, remains unknown. Clearly, some of the herb ingredients used in the complex formulas regulate the hormone system and/or the antibody attack that causes changes in thyroid function. There is some controversy about using iodine-rich materials (mainly seaweeds) in making Chinese herb formulas, but it appears that in most cases there is no problem in utilizing such materials.
The continued use of surgical thyroidectomy and iodine-irradiation of the thyroid gland to remove thyroid activity in hyperthyroid patients may be deemed a last resort rather than a standard method of therapy if Chinese medicine is incorporated into the healthcare system. This can reduce the health problems encountered by Graves’ disease patients and also reduce the cost of life-long health care.
