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Goiter (ying) is an enlargement of the thyroid gland, which causes a swelling in the front part of the neck. There are three types of "ying" mentioned in the ancient literatures: 91) "Ying nang" is an endemic disease characterized by a diffused and symmetrical enlargement of the thyroid gland which is soft, smooth and movable and may even hang down to the chest. 92) "Ying liu" is an unilateral enlargement of the thyroid gland which is hard and adhesive at the bottom and moves up and down along with deglutition. (3) "Ying qi" is a slight or moderate enlargement of the thyroid gland which is soft, smooth and movable; it moves up and down along with deglutition and is accompanied by irritability, exophthalmos, emaciation and polyorexia.

Cases of simple goiter, hyperthyroidism, thyroid tumor and chronic thyroiditis in modern medicine may be differentiated and treated with the principles mentioned in this section.

Etiology and Pathogenesis

A. Emotional upsets such as anger, grief, Anxiety, depression, etc., may impair the liver and spleen, leading to the stagnation of qi, and the retention of phlegm and dampness, which accumulates in the neck. Prolonged accumulation may impede the blood circulation, so that the goiter may become hard or nodular.

B. Prolonged residence in moist districts or improper diet may affect the function of the spleen and stomach, leading to accumulation of phlegm and stagnation of qi.

C. A person of yin-deficiency constitution with stagnation of phlegm and qi is liable to produce of fire which further consumes yin-fluid, and the case becomes intractable. In sum, stagnation of qi, retention of phlegm and blood stasis are responsible for the pathogenesis of goiter, so it usually manifests itself as a sthenia-syndrome in the early stage. As the case is prolonged, fire is produced and yin consumed, and the syndrome of yin-deficiency or deficiency of qi and yin ensues. The liver is the organ chiefly affected, and the heart, spleen and stomach are also involved.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Identification of the basic pathogenesis: A soft mass with unclear outline and varying in size with emotional changes, pain over the chest and hypochondrium and frequent sighing is attributed to qi stagnation. A large, soft and smooth mass accompanied by hoarseness of voice or a sensation of oppression over the chest, poor appetite and greasy tongue coating is attributed to phlegm retention. A hard or nodular mass which is immovable, rapidly enlarges and is accompanied by a dull tongue and uneven pulse is attributed to blood stasis.

(b) Differentiation between asthenia and sthenia syndromes: An incipient case with hyperactivity of evils usually manifests itself as a sthenia-syndrome, while a chronic case as an asthenia-syndrome associated with sthenia-syndrome.

B. Therapeutic principles The basic therapy is to regulate qi, eliminate phlegm and disperse mass and stagnation. In addition, the therapy of activating blood circulation and eliminating blood stasis should be supplemented for the case with a hard and nodular mass, that of tonifying yin and keeping fire downward for the case caused by hyperactivity of fire and deficiency of yin, and that of both elimination of evils and restoration of healthy qi for the case due to deficiency of qi and yin or deficiency of spleen-qi and stomach-qi.

Classification and Treatment

A. Stagnation of qi and retention of phlegm

Manifestations: A soft and painless mass located at the middle of the neck, oppressive sensation over the chest or migratory pain over the chest and hypochondrium, desire for sighing, symptoms varying with emotional changes, thin, white tongue coating and wiry pulse.

Therapeutic principles: Regulate the stagnated liver-qi, eliminate phlegm, and disperse the mass.

Prescription: The Modified Bolus for Releasing Stagnation by Using Four Drugs from the Sea

Sargassum 12 g
Thallus Eckloniae 12 g
Concha Meretricis seu Cyclinae 10 g
Pericarpium Citri Reticulatae 12 g
Radix Aristolochiae 10 g
Radix Curcumae 10 g
Rhizoma Cyperi 10 g
Radix Bupleuri 10 g
Radix Paeoniae Rubra 10 g
Radix Paeoniae Alba 10 g
Rhizoma Chuanxiong 9 g

Remarks: For cases with throat and neck discomfort, add Radix Platycodi, Fructus Arctii and Rhizoma Belamcandae to ease the throat and relieve swelling.

B. Accumulation of phlegm and blood stasis

Manifestations: A hard or nodular goiter associated with a feeling of oppression over the chest, poor appetite, thin and white or white, greasy tongue coating and wiry or uneven pulse.

Therapeutic principles: Regulate qi, activate blood circulation, eliminate phlegm, and disperse the mass.

Prescription: The Modified Decoction of Sargassum of the Jade Vessel

Sargassum 12 g
Thallus Eckloniae 12 g
Pericarpium Citri Reticulatae Viride 10 g
Pericarpium Citri Reticulatae 10 g
Rhizoma Pinelliae 10 g
Bulbus Fritillariae Thunbergii 10 g
Rhizoma Chuanxiong 9 g
Poria 15 g
Fructus Forsythiae 12 g
Radix Curcumae 10 g

Remarks: For cases with a hard and nodular mass, add Rhizoma Dioscoreae Bulbiferae, Rhizoma Sparganii, Rhizoma Zedoariae, Radix Salviae Miltiorrhizae and Squama Manitis Praeparata to strengthen the effect of activating blood circulation, soften the hard mass and disperse stagnation. For cases with restlessness, sweating, red tongue with yellow coating and rapid pulse due to heat formation, add Spica Prunellae, Cortex Moutan Radicis, Cortex Lycii Radicis and Radix Scrophulariae to clear away heat and purge fire.

C. Hyperactivity of liver-fire

Manifestations: A soft and smooth goiter of small or moderate size, irritability, feverish sensation, sweating, exophthalmos, tremor of fingers, red tongue with thin, yellow coating and wiry and rapid pulse.

Therapeutic principles: Clear away liver-fire, eliminate phlegm, and disperse stagnation.

Prescription: The modified Decoction of Gardeniae for Clearing Away Liver-Fire Complicated with the Powder of Sargassum and Dioscoreae Bulbiferae

Radix Bupleuri 10 g
Fructus Gardeniae 10 g
Cortex Moutan Radicis 10 g
Radix Paeoniae Rubra 10 g
Rhizoma Chuanxiong 9 g
Poria 15 g
Sargassum 12 g
Rhizoma Dioscoreae Bulbiferae 10 g
Radix Curcumae 10 g
Spica Prunellae 12 g

Remarks: For cases with exophthalmos and tremor of fingers due to the hyperactivity of wind-yang, add Ramulus Uncariae cum Uncis, Fructus Atriplex Sibiricae, Concha Ostreae and Concha Haliotidis to calm the liver and suppress wind. For cases with polyorexia due to domination of stomach-heat, add Gypsum Fibrosum and Rhizoma Anemarrhenae to clear away stomach-heat.

D. Deficiency of the liver-yin and heart-yin

Manifestations: A soft goiter with slow development, palpitations, restlessness, sweating, sleeplessness, dizziness and dryness of eye, tremor of fingers, fatigue, red tongue and wiry, thready and rapid pulse.

Therapeutic principles: Nourish yin, calm the heart, and soften the liver.

Prescription: The Modification of Yiguan Decoction Integrated with King of Heaven Tonic Pill for Mental Discomfort

Radix Rehmanniae 15 g
Radix Scrophulariae 30 g
Radix Ophiopogonis 10 g
Fructus Lycii 10 g
Poria 15 g
Radix Salviae Miltiorrhizae 15 g
Radix Adenophorae Strictae 12 g
Fructus Schisandrae 9 g
Concha Ostreae (decocted first) 30 g

Remarks: For Cases with loose stool due to dysfunction of the spleen, add Rhizoma Atractylodis Macrocephalae, Rhizoma Dioscoreae and Semen Coicis to benefit spleen-qi. For cases with tinnitus, dizziness and soreness and weakness of lumbus and knees, add Radix Achyranthis Bidentatae, Fructus Ligustri Lucidi, Fructus Corni and Colla Plastri Testudinis to tonify kidney-yin. Aside from medication, mental care to avoid emotional upset and dietetic adjustment to let the patient become acclimatized are also important for the treatment of goiter.

Experiential Prescriptions

A. Radix Scrophulariae (12 g), Concha Ostreae (24 g), Thallus Eckloniae (12 g), Sargassum 912 g), Pumex (12 g), Concha Meretricis seu Cyclinae (12 g), Bulbus Fritillariae Thunbergii (12 g), Rhizoma Sparganii (12 g), Rhizoma Zedoariae (12 g), Spica Prunellae (18 g), Herba Lobeliae Radicantis (9 g) and Radix Trichosanthis (12 g); prepared as decoction; taken daily in 2 divided doses for 10 to 90 days; applicable to the cases with "yin liu."

B. Rhizoma Dioscoreae Bulbiferae (300 g) crushed into small pieces, soaked in 1,500 ml of wine and put into a sealed jar; heated over a slow fire for 4 hours and stored in ice water for one week; drink 10 ml of the liquor 6 times daily but not before bed; applicable to thyroid adenoma.

Copyright 1995 Hopkins Technology


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