Treating Thyroid Conditions with Chinese Medicine 10 CEU/ PDA’S

Treating Thyroid Conditions with Chinese Medicine 10 CEU/ PDA’s

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The Thyroid Federation International estimates there are up to 300 million people worldwide suffering from thyroid dysfunction. Over half or 150 million people are presumed to be unaware of their condition. Most people don’t know what their thyroid does, or what the symptoms may be. Symptoms can be fatigue, cold intolerance, muscle weakness, and muscle cramps, constipation, weight gain, swelling, impaired memory and slower thinking, and depression. Symptoms can also include one’s capacity to exercise and their physical performance, and libido and fertility in both genders.

Women are diagnosed with thyroid tumors twice as often as men. Women are eight times more likely to have hypothyroidism conditions and about four times more likely than men to have hyperthyroid conditions. Affecting women more and those over 50, people tend to dismiss their symptoms, and think it’s merely stress or aging process and there is nothing to be done.

It looks like an even amount of the diagnosed cases of thyroid disease involve both hyperthyroidism and hypothyroidism.

Western medicine sees the main cause is autoimmune disease or an abnormal immune response.

Chinese medicine does not have a single explanation of autoimmune pathology, as a view of the “immune system” didn’t exist in ancient books. We can use pattern differentiation for autoimmune diseases and they can be treated successfully. Chinese medicine is constantly evolving, and using modern terms with acupuncture and herbs being used treating each patient individually according to pathology, aetiology, and patterns despite the fact that is an autoimmune disease.

Giovanni Maciocia believes “Latent Heat is often at the root of autoimmune diseases and that immunizations have a lot to do with the development of Latent Heat.”

Latent Heat is an ancient concept. It is used to describe the manifestation of pathogenic factors (internal or external) that does not create immediate symptoms, but rather remains latent in the body. Latent Heat conditions are also described as originating from pestilent factors. That could include epidemics, febrile diseases, virus, bacteria or fungus “invading” the body. The factor that is agreed upon is that Latent Heat occurs when the body fails to unblock or clear a pathogenic factor.

Latent Heat also tends to injure Qi and/or Yin, thereby establishing a vicious cycle of heat and deficiency. It is also believed that emotional stress is a factor that may bring Latent Heat to the surface. The underlying reason for this is usually a Kidney deficiency.

The original idea the Chinese had for Latent Heat applied the idea to ‘Cold’ which entered in the winter, then turned gradually into Heat and came out in the Spring. An explanation of “Wind” penetrating the Interior is that the pathogen / invasive force has penetrated to a level beyond the reach of the normal defensive forces. The patient did not develop exterior symptoms and the illness develops or “incubates” so to speak, turning into Heat and surfaces months or even years later.

When immunization occurs, ideally the body should defends itself at the Wei Qi / Defensive Qi level. When and if that fails, the theory is that the vaccine toxin travels through the body unnoticed to the deepest Blood level, where it may turn to Heat or Damp-Heat in time. This may take years, when the causative factor has been forgotten.

Latent heat can also cause psychological symptoms, such as anxiety, fears, and sudden outbursts of temper. As it can prevent proper circulation of blood through the heat’s drying effect, normal functions of organs will be impaired.

The classic book “Nei Jing” states: “if there is damage by cold in the winter, there will be a warm pathogen disease in the spring”, and “if there is sufficient essence, there will be no warm disease in the spring.”

Chinese medicine has a long history of using herbal formulas to clear heat and resolve toxins:

! 220 CE Shang Han Lun where Zhong Zhongjing described the six progressive stages of pathogenic factors moving into the body. ! 752 CE Wang Tao formulated Huang Lian Jie Du Wan to fight toxic infections associated with traumatic blood poisoning. ! 13th century Luo Tianyi formulated Pu Ji Xiao Du Yin to treat fever, sore throat and swollen lymph glands in an epidemic now suspected to be diphtheria. ! 1742 Wu Qian developed Wu Wei Xiao Du Wan for boils, carbuncles, and breast mastitis. ! 1798 Wu Jutang recommended Yin Qiao Wan for common cold and flu, and pediatric fevers with rash now known as measles, chicken pox, and rubella.

In more recent times, several popular patent medicines have been studied and gained recognition for their strong antiviral effect: GAN MAO LING CHUAN XIN LIAN ZHONG GAN LING

According to western medicine, TSH (thyroid stimulating hormone) is the gold standard for the diagnosis and treatment of thyroid dysfunction. This test alone does not give complete information. A patient’s medical history, symptoms, family history and thorough physical exam along with full thyroid blood panel is necessary.

If TSH falls in the ‘normal’ range, the thyroid is declared normal, even when symptoms are present. Normal TSH range from 0.5 to 5.0 with variations depending on the laboratory. Commonly fatigue, weight gain, and depression are presented by the patient as symptoms and ignored by doctors.

When the pituitary gland TSH, it stimulates the thyroid gland to produce the thyroid hormones T4 and T3. The majority of thyroid hormones produced by the thyroid are T4, however T3 is the most active form that can be used in the body’s cells. When only TSH or TSH with T4 are tested, the assumption is that the body is properly converting the T4 to T3. It's a complicated process and many people do not convert the hormones correctly.

There is a also difference between Total T4 and Total T3 and Free T4 and Free T3. Thyroid hormones are fat soluble and need to be bound to protein that carry them through the blood vessels to cells all over the body. When they reach the cells, the protein needs to be shed as only the unbound “free” hormones can actually enter the cells. Free T3 is critically important and must be tested for to get a complete picture.

It is important to ask questions about lifestyle because in times of extreme stress, whether emotional or extreme dieting, chronic illness, or a physical trauma like surgery, the body will convert a larger than normal amount of T4 into an inactive form of T3 known as Reverse T3, which can also be tested for.

It is important to request a full thyroid panel for hypothyroidism which should at least include these 6 key thyroid lab tests: TSH Free T4 Free T3 Reverse T3 Thyroid Peroxidase Antibodies (TPOAb) Thyroglobulin Antibodies (TgAb)

Graves disease is the most common autoimmmune disorder that causes hyperthyroidism. It is often recognized by protruding eyes. Western medicine treats this by removing thyroid tissue through surgery or irradiation from an iodine isotope which destroys the tissue. Synthetic thyroid hormone replacement therapy is often necessary to supply the body with thyroid hormones afterwards. There are also thyroid-inhibiting drugs that are used in less severe cases of hyperthyroidism. So the treatment plan is remove it and give synthetic hormones or suppress the thyroid from producing hormones.

Hashimoto's thyroiditis is the most common autoimmune disorder that causes hypothyroidism. Hashimoto’s is a condition in which the body attacks its own thyroid gland. It is treated mainly by giving a synthetic thyroid hormone replacement therapy. It is estimated that 90% of people with hypothyroidism have the condition known as Hashimoto’s Thyroiditis.

There are two thyroid antibodies to test for Hashimoto’s and are part of the full thyroid panel listed above: Thyroid Peroxidase Antibodies (TPOAb) and Thyroglobulin Antibodies (TgAb).

A different form of thyroid disease was the dominant one in earlier times: iodine-deficiency goiter. This disorder often produces a very large mass in the neck. It has become less common in the United States as a result of the practice of adding iodine to the national salt supply and by the recommendations to consume more seafood. It is also relatively easy to diagnose and treat.

Many people continue to have symptoms, even when on synthetic hormone replacement. It’s not so easy to replace hormones as there is a delicate balance. Oftentimes, it can take months for an endocrinologist to figure out the correct dose and blood tests are necessary to measure these hormones, while trying to get it right. It is common to start on low doses and take tests every three to four weeks to try to get it more precise or even change to different thyroid hormones. Many things can affect this, like the time of day medication is taken, whether it was taken with food, and even foods and supplements can interfere with its absorption. Taking too much thyroid hormone can produce symptoms of hyperthyroidism.

In traditional Chinese medicine, both hyperthyroidism and hypothyroidism are considered to be a Yin/Yang imbalance.

There are eight acupuncture channels which are directly or indirectly connected with the thyroid gland around the neck; Kidney, Liver, Gall Bladder, San Jiao, Urinary Bladder, Stomach, Spleen and Small Intestine channels.

Recent research, by both Western and Chinese scientists, offers several exciting theories to reinforce ancient ideas about Yin and Yang balance in the body. Bioelectrons are charged particles that exist in living cells and move freely through the body. It has been demonstrated, by measuring electrical resistance on the skin, and by tracking the movement of bioelectrons in the body, that there is decreased electrical resistance at recognized acupuncture points, and that bioelectrons move noticeably along the classic meridians that carry Qi through the body. External factors (such as diet, weather, and physical injury), and internal factors (such as emotional states, mental stimulation, and hereditary conditions) can all affect bioelectrical movement in the body and cause an imbalance of electrons at a cellular level. This can be interpreted as a Yin/Yang imbalance at the cellular level.

Living cells also contain chemical structures called cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Chinese researchers found that there is a correlation between increased cAMP levels in cell plasma and symptoms of hyperthyroid/Yin Deficiency. There is also a correlation between decreased cAMP/cGMP plasma levels and the symptoms of hypothyroidism/Yang Deficiency. When cAMP and cGMP are in a good balance within the cell, Yin and Yang are balanced at the cellular level, and homeostasis exists in the body’s metabolism of thyroid hormone.

Hyperthyroidism is a likely a combination of qi and yin deficiencies, with Liver fire uprising, and phlegm stagnation. Qi and yin deficiencies are the fundamental causes, while the symptoms and signs show Liver fire and phlegm stagnation. Correlated with western medicine, Liver fire corresponds to the continuous excitation caused by excessive thyroid hormone. Qi and yin deficiencies represent the weakness and fatigue of the body from prolonged over-stimulation, and phlegm stagnation is illustrated in the enlargement of the thyroid gland.

The root of hyperthyroidism is deficiency; the symptoms are excess. Treatment, therefore, must address both the cause and the symptoms simultaneously.

Differential Diagnosis is important so as to distinguish between excess and / or deficiency in hyperthyroid patients so the most appropriate herbal formula is prescribed. The three organs that are usually involved include the Liver, Heart and Kidney. Aside from clearing heat, it is also important to nourish the yin.

Clinically, it has been noted that the symptoms of hyperthyroidism are very similar to those exhibited in xiao ke (wasting thirsting ) syndrome which is what modern medicine calls diabetes. It is important to diagnose correctly so the accurate formula can be prescribed.

Thyroid disease is common in China, and it is frequently treated by herbal medicine or a combination of herbs and drugs. Positive response is a common outcome: the aggregate "cure" rate for hyperthyroidism reported in more than a dozen studies involving more than 700 patients is 42%, with most other patients well-managed even after cessation of the therapy. By "cure," it is meant that the primary hyperthyroid symptoms are removed and that the laboratory measures (such as T3 and T4 levels and iodine uptake) are in the normal range. It does not mean that there is any change in the underlying genetic propensity for autoimmunity, nor is it suggested that the immunologic memory of the T-cells is altered. Rather, the initiating factors for autoimmune attack appear to be diminished and, as shown in two studies, circulating antibodies against thyroid tissue are reduced. Follow-up studies of patients during these treatment programs indicates persistence of the favorable outcome.

The clinical manifestation of Liver Fire include:

Fidgeting, irritability and anger, increased appetite, palpitation, chest oppression, red eyes, bitter taste in mouth, disturbed sleep or insomnia, headaches, tinnitus, dark urine, constipation, high blood pressure, red face.

Useful Herbal Formula: Zhi Zi Qing Gan Tang (Gardenia Decoction to Clear Liver) Clears the Liver and purges fire.

Clinical manifestations of Qi and Yin Deficiencies include:

Fatigue, shortness of breath, dry eyes, palpitations, profuse perspiration, disturbed sleep, dry mouth, lack of thirst, hand tremor

Useful Herbal Formula: Yi Guan Jian (Linking Decoction) Tonifies qi and yin, softens the Liver, and calms the Heart.

Qi and Phlegm Stagnation Irritability, feeling of oppression in the chest, plum-pit syndrome, enlargement of the thyroid gland.

Herbal Formula Chai Hu Shu Gan Tang (Bupleurum Powder to Spread the Liver) Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) Resolves phlegm, regulates qi circulation, and soothe the Liver.

Liver, Kidney and Heart Yin Deficiencies

Irritability, insomnia or light sleep, tremors, emaciation, dry mouth and throat, red tongue, scanty or no coating, thready and rapid pulse.

Herbal Formula Tian Wang Bu Xin Dan (Emperor of Heaven's Special Pill to Tonify the Heart) Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pills)

Patients with hyperthyroidism (other than Grave’s Disease) should notice dramatic improvement within 1 month of herbal treatment. Most symptoms should completely subside within 3 to 6 month of treatment. Ocular protrusion may persist despite herbal treatment. When necessary, traditional formulas with modification may be prescribed depending on the condition of each individual patient.

Herbal formulas offer consistent and reliable benefits in the treatment of both hyperthyroidism and hypothyroidism. The onset of action for herbal therapies may be slower than more immediate conventional therapies and patients should be told this. The effects of herbal medicine are consistent and reliable once the patients are stabilized. Testing may still be necessary as patient may be taking synthetic hormones with herbal treatment. Work with them and their physician.

Treatment of Hyperthyroidism By John Chen, PhD, PharmD, OMD, LAc

More differential diagnosis for hyperthyroidism:

Three patterns of Yin Deficiency for hyperthyroidism:

Kidney Yin Deficiency with Excess Heat Typical symptoms are: an enlarged, soft, smooth thyroid Anxiety, hot tempered, anger. Aversion to heat, a flushed, warm face. Dry mouth with a bitter taste. Increased appetite along with increased volume of bowel movements. Bulging eyes, hand tremor. A red tongue with a dry, yellow coating and a wiry, rapid pulse.

Heart/Liver Yin Deficiency Typical symptoms are: an enlarged, swollen, soft, smooth thyroid. Heart palpitations, anxiety, insomnia. Increased appetite with weight loss. A dry throat. A red tongue with a yellow or no coating and a thin, rapid pulse.

Heart/Kidney Yin Deficiency. Typical symptoms are: enlarged, swollen thyroid. Heart palpitations, hand tremors. Increased appetite. Irregular period or amenorrhea, impotence or low libido with weakness of the knees and lower back. . A dry mouth and dry eyes. A red tongue body without coating, and a deep, thin, rapid pulse.

Herbal Formula Liu Wei Di Huang Wan (Kidney Yin Tonic) is the herbal formula most commonly used for the symptoms of hyperthyroidism. Shu di huang (Rehmannia), Shan yao (dioscorea), and Shan zhu yu (cornus) are well known herbs for effectively treating Yin Deficiency.

Within the first 30 to 90 days of treatment, relief is observed in most patients consuming Chinese herb formulas. While essentially complete remission is indicated in just under half of the patients, alleviation of the majority of symptoms occurs in most of the remaining patients. In order to obtain such high rates of symptom relief, basic herb formulas may be modified by adding one or more ingredients to address specific symptoms or symptom complexes.

Dietary Suggestions:

A traditional recipe for dietary therapy of Yin Deficiency: 3 (three cups) of water 10 gms tremella (silver ear fungus), 10 gms black fungus (black ear mushroom) 30 gms and rock-type sugar Cook for one hour. Eat one serving a day.

Avoid eating spicy and heat producing foods. Style of cooking should be more boiled, steamed, light. Avoiding baking, roasting, grilling etc.

Cooler environments and slow, relaxing exercises like swimming, walking, tai chi, and yoga.

SINGLE-HERB USAGE Single-herb remedies for hyperthyroidism do not follow the rules of traditional Chinese herb prescribing. However, these are examples mentioned in clinical trials or individual case reports.

The herb tripterygium (lei gong teng). In research from the University of Texas and the National Institute of Health, it was reported that the use of a lei gong teng preparation showed that the herb has anti-inflammatory and immunosuppressive effect comparable to prednisone. This herb is also known as qi bu si, literally, "seven steps to death," carrying more than the implication that it is extremely toxic. Chinese doctors use it for a wide range of autoimmune diseases, especially rheumatoid arthritis. Despite its toxicity, tripterygium or isolated components, usually in tablet form, is widely used in China because of its remarkable effectiveness for so many diseases that are not readily treated by Western medicine, including thrombocytic purpura, alopecia, hyperthyroidism, and skin diseases caused by autoimmune processes. The anti- inflammatory action is employed with good results for a wide-range of pain syndromes. Among the most common applications in China today are rheumatoid arthritis, systemic lupus erythematosis, and psoriasis (for the latter, the herb can be given internally and/or applied topically in an creme base). The herb is usually prescribed as a single herb remedy, but is sometimes given in complex formulas. Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine,

Huang yao zi (Dioscorea rhizome) is a common ingredient in formulas for hyperthyroidism and it has been used in as a sole ingredient. Huang yao zi is rich in steroidal compounds. It is effective in reducing swelling of the thyroid glands. Huang yao zi must be used with caution, as it has been reported to cause toxic hepatitis when used in large amounts. 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. Huang Yao Zi was used to destroy hyperplastic thyroid tissues (nodules). During the process of destruction, liver cells could also become damaged. Liver enzymes must be monitored to reduce the change of damaging the liver. After one month, liver enzymes were slightly elevated so treatment with herb was discontinued. Enzymes returned to normal and during several months the growth gradually reduced and thyroid function returned to normal. Treatment was 6 months in duration and one year later no signs and symptoms of Graves Disease were showing. Antibody results were never checked and this case was inadequate as a true clinical study. Treating Autoimmune Disease with Chinese Medicine edited by Wanzhu Hou

In Japan, the thyroid gland is considered the “shock absorber” in the human body. Patients with pressure pain on the thyroid reflex zone (ST 9) may have a family history of thyroid problems according to Kiiko Matsumoto. Her treatment strategy from her book Clinical Strategies Vol. 1. is attached at the end of this document.

KANPO METHODS FOR THYROID DISEASES The characteristic of modern Kanpo is prescription of herb formulas that are included in the national registry and therefore covered by Japanese health insurance. There are about 200 such prescriptions. Kanpo for hypothyroidism, the following have been suggested: Ginseng and Astragalus Combination Ginseng and Ginger Combination Tang-kuei and Peony Formula Tang-kuei, Evodia, and Ginger Combination Vitality Combination

These are all tonic prescriptions that enhance function of the stomach and spleen, nourish the blood, and stimulate circulation. Ginseng, aconite, and/or atractylodes are included in these formulations.

Dr. Keisetsu Otsuka described a case of hyperthyroidism in his book “30 Years of Kanpo”. He treated a 38 year old man with Grave's disease, using Pinellia and Magnolia Combination with Cinnamon, Licorice, Oyster Shell, and Dragon Bone Combination. The patient, who had obviously swollen thyroid, slightly protruding eyes, and a pulse rate of 120 at the beginning of treatment, felt better after only one week and had almost completely recovered in six months use of the formulas.

Hypothyroidism

These people will complain of low energy with on going fatigue and exhaustion. There are other symptoms that are also common: constipation or other bowel irregularities, dryness of skin, brittle hair and fingernails, menstrual problems, weight gain, and complaints of being chilly, cold hands and feet , wearing warm clothes when no one else is. Oftentimes, low thyroid function can be the hidden cause of many illusive symptoms and is a main reason why it is overlooked as the root cause.

Functional hypothyroidism is a term, which is not recognized by all healthcare practitioners. It refers to what Alan Gaby, M.D. author of Nutritional Medicine textbook has called “sub-laboratory hypothyroidism.” Many people have the symptoms of hypothyroidism despite normal laboratory tests. He feels that standard laboratory tests fail to detect hypothyroidism in as many as 80–85% of patients who have clinical evidence of hypothyroidism and who show a positive response to treatment with thyroid hormone. Appropriate clinical evaluation can identify individuals who have an under-functioning thyroid who may benefit from treatment with therapies that may stimulate thyroid function. “With additional clinical experience, I came to rely more on the medical history and physical examination, and less on body temperature, for assessing thyroid function and monitoring treatment.” (Gaby)

Throughout life, disorders associated with hypothyroidism include headaches, migraines, sinus infections, post-nasal drip, visual disturbances, frequent respiratory infections, indigestion, gas, flatulence, constipation, diarrhea, frequent bladder infections, infertility, reduced libido and sleep disturbances, with the person requiring 12 or more hours of sleep at times, intolerance to cold and/or heat, poor circulation, Raynaud's Syndrome (which involves the hands and feet turning white in response to cold) allergies, asthma, heart problems, benign and malignant tumors, cystic breasts and ovaries, fibroids, dry skin, acne, fluid retention, loss of memory, depression, mood swings, fears, and joint and muscle pain. Swelling, tenderness or a feeling of tightness in neck or throat, Hoarseness or coughing Difficulty swallowing or breathing, thick /swollen tongue bruising/clotting problems, slowness or slurring of speech, Puffiness under eyes, Outer part of eyebrow is missing.

There are many patterns of hypothyroidism, and when the pattern is clearly identified an effective treatment plan can be implemented.

Two patterns of Yang Deficiency are differentiated for hypothyroidism:

Spleen/Kidney Deficiency

Symptoms include lethargy and weariness, sleepy. Absent mindedness and poor memory. Dizziness and tinnitus. A lack of strength or weakness of the lower back and knees. Aversion to cold, edema. Irregular menstruation, impotence, Constipation or bowel irregularity. Dry hair and skin. A pale, puffy tongue body with tooth marks along the edge. A white, sticky tongue coating.

Heart/Kidney Deficiency.

Symptoms include heart palpitations; chest congestion and pain; sleepiness; feeling cold. A pale, tender tongue body with a white, slippery coating.

Rou Gui / Cinnamon bark and Fu Zi / Aconite are both warming herbs used in treating Yang Deficiency. Two widely used formulas for treating the symptoms of hypothyroidism are: Jin Gui Shen Qi Wan also called Shen Qi Wan or Kidney Qi Pill from the Golden Cabinet You Gui Wan or Right Restoration Formula

Both formulas use yin-supplementing herbs along with warming herbs. Jin Gui Shen Qi Wan targets the kidney’s function of governing water more directly. For yang vacuity patients that experience problems such as edema this is a better choice. You Gui Wan is more supplementing with less focus on regulating water. You Gui Wan is a better choice for enriching blood and essence in addition to supplementing yang.

A classical dietary recipe for Yang Deficiency is also appropriate for hypothyroidism: Black Pepper 3grams Fresh Ginger, 20grams Dried Tangerine peel 10grams Half pound of fresh carp (since carp is a whitish meat, low fat type of fish, I think a substitution of similar fish is ok) Cook with an appropriate amount of water, and simmer for one hour over a low flame. Eat three servings a week.

Avoid eating and drinking frozen and / or very cold temperature foods, especially in winter.

The many theories developed for diagnosis can be used: Eight Principles, Zang Fu Theory, Four Levels, Six Channel Theory, San Jiao Theory. Often confusing, because patients don’t exhibit textbook symptoms. These theories were developed over centuries as times and diseases changed and manifested differently. However, using this standard of diagnosis allows you to treat the individual and not the disease name.

Wen Bing, or the Four Levels theory, was developed in the Ming and Qing dynasties from 1368-1911. Because it was developed over so many years there were many contributors. Mainly, the Four Levels is designed for identification and treatment of invasions of wind-heat or warm febrile and epidemic diseases. In the 16th century, Wu You Ke came up with the theory that the pulse at ST 9 measures external conditions and the pulse at LU 9 measures internal conditions.

Outermost Level Wei Qi or Defensive-Qi

At this level, the pathogenic factor is kept on the outside. Symptoms depend on wind-heat, summer-heat, damp-heat and dry-heat, but generally there is fever and aversion to cold. Latent Heat is prevented if the disease penetrates no further than this level. The gathering and scattering of Wei qi can be used to explain the relationship between distribution of acupoint and curative effect. Wei qi is circulating on the surface and within the muscles and skin, but not within the meridians. Its circulation is dependent on the Lungs, and is influenced by yang qi in the world in which we live which will vary according to the season.

The function of wei qi is to warm the surface of the body, and to regulate body temperature by opening and closing the pores.

Some signs of Wei Qi deficiency would be prevelance to catch colds easily and frequently. This type may also have difficulty regulating body temperature.

Qi Level

When a disease penetrates to the Qi level, the fever is higher and worst between 1-5 pm. There is more discomfort, reddened sclera also denotes heat at the qi level, with a bitter taste in the mouth and an aversion to heat. Oftentimes a pathogen will move so quickly it is difficult to differentiate. This is particularly true for hidden pathogens.

Look for the Four Bigs: High fever/excessive (big) heat, Profuse (big) sweating, Big Thirst with a desire for cold drinks, Rapid and full (big) pulse.

Ying Qi / Nutritive Qi Level

When the illness reaches the Ying Level, it has penetrated to the interior. Here it begins to damage the Yin and may affect the Shen. The patient exhibits restlessness and discomfort. If the fever is high enough, mental confusion and delirium. The lips and skin becomes dry, there may be eruptions. At this stage herbal treatments should be used.

Ying is the Qi of Blood, the precursor of blood. It circulates through the blood vessels and Heart. The patient will start to lose weight and body fluids will diminish. If the fever is worse at night, it points to yin deficiency.

Xue Qi / Blood Level

This is the deepest energetic level. There is still fever, and the pulse remains rapid. The Heart controls the blood and the Liver stores the blood, so both organs are affected and symptoms may include irritability, twitching, stuttering loss of consciousness, tremor, convulsions. The blood becomes “reckless” and it is seen in the urine, there may be nose bleeds and blood tainted mucous from cough.

Disease doesn’t necessarily follow an order and it may be in several “stages” at once. Oftentimes, in today’s world we will see mixed symptoms that involve more than one channel and it may be both exterior and interior. This is the nature of our world, our medicine and current events.

Six Channel Theory

The six channel theory was developed by Zhang Zhongjing and is detailed in the Shang Han Lun from about 220 AD or about 1700 years ago. It defines stages of diseases so as to develop proper treatment for the patient at each stage. You can see that the Four Levels of Febrile Diseases was most likely developed from these ideas with more emphasis on heat conditions and epidemic disease.

Taiyang or Greater Yang Syndromes Urinary bladder/Small intestine channels

This is the first or initial level of a disease at an exterior level where wei qi / defensive qi stands ready to fight it off. Any fever will be relatively mild because the invading cold is weak compared to the body's Wei Qi. The Tai Yang stage involves “Evil” pathogens (Cold, Wind) on the exterior of the body which need to be released or "sweated out." as the wei qi controls the pores. It is believed to manifest in two ways

Taiyang Zhong Feng Syndrome Mild fever and chills, doesn’t like wind, Headache or stiff neck usually along the taiyang channel. A normal or pale tongue with a thin white coating *Easily/frequently perspires

Useful Formula: Gui Zhi Tang (Cinnamon Twig Decoction) which releases the pathogenic influences from the muscle layer and harmonizes the ying and wei qi. The formula is mildly warming and balancing.

Taiyang Shang Han Syndrome More chills than fever, Headache, Body and neck pain. A normal tongue with a thin white coating * No sweating Traditional Formula: Ma Huang Tang (Ephedra Decoction) Function: Releases the Exterior Cold through diaphoresis / induces sweating. Relieves wheezing and cough, relieves edema while regulating circulation and disperses / scatters cold. substitutes for ma huang are used since its ban in 2003 due to misuse and misunderstanding of its use. For respiratory applications perilla (zi su ye), and cinnamon (gui zhi) are possible substitutes. Other substitutes include eucalyptus, ginger, and tylophora. These have been incorporated into the ephedra-free versions of Minor Blue Dragon, Nasal Tabs, and Clear Air by Health Concerns.

Yangming or Greater Yang Syndromes Stomach and Large Intestine channels

Sometimes the Shaoyang stage is put before the Yangming stage. In any case, this is a very important stage in the disease progression into the interior because of the Yangming channel's richness in Qi and Blood. It is believed to manifest in two ways, one involving channel and the other organs.

Yangming Jing or Channel Syndrome Encompasses the Four Bigs: Big fever, Big sweat, Big thirst, and Big pulse No aversion to cold, Red face, High fever, Profuse sweating, Very thirsty. The tongue is usually red with a yellow and dry coating because of heat. Useful Formula: Bai Hu Tang (White Tiger Decoction) Clears Qi Stage and Yang Ming Channel Heat; Drains Stomach Fire, generates body fluids and alleviates thirst. This formula was also used as an antidote to the overuse of Ma Huang Tang.

Yangming Fu or Organ Syndrome Constant fever that is higher in the afternoon Abdominal distention and pain with constipation because of Large Intestine involvement. The tongue is usually red and may have red prickles. The coating is yellow and dry but thicker than with channel syndrome.

Useful Formula: Da Cheng Qi Tang (Major Order the Qi Decoction) Vigorously purges the Heat Accumulation through the bowel by inducing defecation. In the Yang Ming syndrome, the abdominal pain is aggravated by pressure and heat because it is an excess condition.

Shaoyang or Lesser Yang Syndrome Gallbladder and San Jiao Channels The Yangwei channel is also closely tied to Shaoyang

The step between Taiyang and Yangming, sometimes the stage between a syndrome that is going from interior to exterior. The body is still trying to fight it off so many signs are intermittent and alternating as it goes back and forth as the shao yang is considered the pivot.

Alternating chills and fever Bitter taste in the mouth. Many heat signs due to involvement of GB and SJ Dry throat, Dizziness and blurred vision, Restlessness, irritability Tongue may be red on the sides with a white or thin yellow coat Poor appetite, nausea, vomiting with pain in the hypochondriac region The GallBladder and Liver are overacting on the Middle Jiao and causing both the pain and the poor appetite, nausea, and vomiting.

Useful Formula: Xiao Chai Hu Tang (Minor Bupleurum Decoction) Harmonizes and releases Shao Yang channel disorders.

Taiyin or Greater Yin Syndrome Lung and Spleen Channels

When a disease progresses this far it is an interior problem. Abdominal pain, distention and fullness, Nausea, vomiting, loss of appetite, No thirst because of loss of yang qi Diarrhea. Cold has damaged the yang qi. The spleen is deficient. No energy, no enthusiasm. Treatment aims to clear dampness, warm and stimulate Spleen and Stomach Qi. A pale tongue with white greasy coating

Useful Formula: Li Zhong Wan (Regulate the Middle Pill) Warms the Middle Jiao and strengthens the Spleen and Stomach.

Shaoyin or Lesser Yin Syndromes Heart and Kidney Channels

Manifests in two ways, Shaoyin Cold and Shaoyin Heat. In the Tai Yin syndrome, the abdominal pain is alleviated by pressure and heat because it is a deficiency syndrome.

Shaoyin Cold Syndrome

Kidney Yang deficiency with empty cold symptomology. The cold symptoms here are more severe than in a Taiyin stage. More focused on lower jiao. No fever with aversion to cold,, likes to curl up and wear covers or sweaters. Cold limbs are more pronounced than in the Taiyin stage. Wants to sleep has no energy. Diarrhea with undigested food indicating the cold is affecting Spleen and Kidney. Not necessarily thirsty but will drink warm liquids. Clear urine with increased volume pointing to Kidney yang deficiency. Treatment is aimed at expelling cold and warming and strengthening the yang.

Useful Formula: Si Ni Tang (Frigid Extremities Decoction) Rescues devastated Yang, warms the Middle Jiao, and stops the diarrhea.

Shaoyin Heat Syndrome

Heart and Kidney Yin Deficiency with empty heat pattern

Feels hot, restlessness, irritability, insomnia where you keep waking up or you can’t get to sleep. Night sweats. Dry mouth and throat. Skin may be itchy and dry. Scanty deep-yellow urination Treatments would be aimed at nourishing yin, this condition can happen quickly or slowly as with aging.

Formula: Huang Lian E Jiao Tang (Coptis and Ass-Hide Gelatin Decoction) Nourishes the Yin, causes the empty heat to descend, eliminates irritability and calms the Shen.

Jueyin or Terminal Yin Syndrome Liver and Pericardium Channels

This stage complicated. It is the last stage of a disease before death. At this stage, the problem is severe and symptoms can be complex and varied. The body’s defenses have reached their next-to-last level of resistance.

Upper heat, lower cold Thirst but unable to drink, might vomit it back up Ascending of Qi to the chest Burning sensation or fullness in the chest Hungry, but no desire to eat or vomits it back up Frequent urination, possible lack of control Diarrhea with pain Vomiting of Roundworms were mentioned in old texts The aim is to clear the Heat above and warm the cold below and to get all parts, upper, middle and lower, to harmonize and Qi moving again.

Useful Formula: Wu Mei Wan (Mume Pill) Function: Warms the organs (intestines), calms worms and stops chronic diarrhea. At this stage of disease, the patient may be in shock. The Yang Qi needs to be revitalized or the patient may die. I’m not confident that this formula will do that.

Studies and Clinical Trials

The treatment of hypothyroidism is not mentioned much in Chinese literature, and clinical studies are not that common. Until the past fifty years, thyroid disease could not be definitively diagnosed in China. The symptoms that are characteristic of hypothyroidism are common symptoms belonging to the traditional category of qi and yang deficiency. Patients with Hashimoto's thyroiditis have reduced responsiveness to TSH. The disease can spontaneously remit, and this change can be detected, even while thyroxine replacement therapy continues, by testing for TSH responsiveness. In one evaluation, about 24% of patients were seen to experience spontaneous remission, though no remissions were found among patients with enlarged thyroids or diffuse goiter. The basic herbal treatment for hypothyroidism is to administer qi and yang tonics. An example: 19 cases of hypothyroidism of various causes (10 due to thyroid operation or irradiation in the treatment of hyperthyroidism, 3 were chronic lymphatic thyroiditis, 6 due to unknown causes) were treated for two to four months with a thyroid tablet containing Codonopsis and Astragalus to tonify qi, and Epimedium, Curculigo, and Cuscuta to tonify yang (with cooked Rehmannia to balance the yin and yang). The patients received either herbs alone or herbs with thyroxine. A control group received thyroxine alone. The Chinese herbs improved clinical symptoms, reduced cholesterol and thyroid-stimulating hormone levels, and increased T3 and T4. The addition of thyroxine (at 60 mg/day) gave even better results. A similar prescription, adding psoralea in the standard formula, and aconite and cinnamon twig for more severe cases, was given to seven patients with hypothyroidism, and it was claimed that all patients showed improvement with two to three months treatment . Five of the patients took a small dosage of thyroxine.

In a study of 22 patients with hypothyroidism, 19 of the cases were caused by thyroid treatments (radioactive iodine, surgery, antithyroid drugs). A decoction of aconite, cinnamon bark, ginseng, astragalus, lycium fruit, epimedium, deer antler, psoralea, morinda, salvia, atractylodes, and hoelen was given. Thyroxine tablets were also provided as needed during the treatment period. After two months of therapy, of the 22 patients, 17 had their clinical symptoms eliminated, and the T3, T4, and TSH returned to normal levels, while the other 5 patients showed partial improvement in both symptoms and laboratory values. In one patient cured by this treatment, a follow-up visit after five years showed that she remained healthy. Five patients with lymphatic thyroiditis were treated [50] with a combination of Astragalus and Codonopsis (30 grams each) to tonify qi, Aconite, Cinnamon bark, Curculigo, and Epimedium (9 to 12 grams each) to tonify yang, and Lycium fruit plus Coix. The decoction of herbs, modified as necessary to treat symptoms such as indigestion with diarrhea or constipation, was taken in two divided doses daily for two to three months. The mean body weight of the patients declined from 63 kg to 60 kg, the heart rate increased from 66 to 75 per minute, and cholesterol dropped from 260 to 202. T3 and T4 values increased markedly, while TSH declined. Six patients treated with a high dose decoction of licorice (10 grams) and ginseng (8 grams, reduced to 6 grams after the first month) for three months, using thyroxine in reducing amounts from the beginning to the end of the treatment program, showed good results [28]. Four patients had basal metabolic rate, T3, and T4 return to normal or near normal values and improved symptoms which persisted after the treatment ended; two others improved while on the herbs but within one year of stopping the therapy the symptoms returned and could be controlled by using the decoction again.

As reported in Recent Advances in Chinese Herbal Drugs, an evaluation of patients with kidney yang deficiency syndrome who were not classified as suffering from hypothyroidism but were rather suffering from chronic bronchitis revealed a decreased level of T3 and T4 (average values of 102 and 8.2 respectively). Both chronic bronchitis patients not having kidney yang deficiency and normal adults had comparable levels of these hormones (147 and 9.3 respectively). When the kidney yang deficiency patients were treated for five months using a kidney tonic prescription (ingredients not specified), T3 levels increased (average 164; slightly higher than normal). Thus, kidney yang deficiency may be directly associated with hypothalamus-pituitary-thyroid function which is affected by corrective herbal therapies.

In contrast to the hyperthyroid treatments, herbs for dispersing phlegm and resolving masses are generally not included for hypothyroid cases, and instead the focus is on tonification therapy. A somewhat different approach has been used in two studies, in which tonics are still an important aspect of the treatment but qi and blood regulating herbs are also used. This method was applied in the treatment of 133 patients with Hashimoto's thyroiditis. A combination of Cyperus, Saussurea, Cnidium, Curcuma, and Bupleurum was modified by adding one of two tonic prescriptions: Polygonatum, Dioscorea, Moutan, Hoelen, and Lycium for qi and blood deficiency patients and Rehmannia Eight Formula for yang deficiency patients. By taking the powdered herbs in pill form for one to five months, 29% were cured. In another study, 38 patients with Hashimoto's thyroiditis were treated with Codonopsis (or Ginseng), plus Pinellia, Hoelen, and Licorice to tonify qi and normalize the digestion, and Citrus, Blue citrus, Salvia, and Red Peony to regulate qi and blood. Patients still showing hyperthyroid symptoms were additionally given the yin nourishing combination of Asparagus, Ophiopogon, Rehmannia, and Schizandra, while those showing hypothyroid symptoms were given the yang tonifying combination of Cinnamon twig, Deer antler, and Epimedium. In the event that a thyroid nodule existed (4 cases), Sparganium and Zedoaria would be given. A control group with 20 patients were treated with standard thyroid drugs. Treatment time was six months. Among the group treated with Chinese herbs, 55% of those with hyperthyroid conditions and 93% of those with hypothyroid conditions had normal thyroid levels following treatment. There was no significant difference between this outcome and the results of using Western medicine in the control group.

It is not evident from these two studies that the addition of qi and blood regulating herbs enhanced the outcome of treatment compared to relying primarily on qi and yang tonic herbs alone. Among the several studies of hypothyroid treatment, it does appear that longer treatment times produce better effects.

A one year follow-up to a study of Jia kang ling Pian (a patent formula used for hyperthyroidism) administered for three months, either alone or with Western medication (thiamazole or propranolol) revealed that 85.2% of those treated with herbs only and 90% of those treated with herbs and drugs maintained the improvements that had been attained during the treatment period.

In a study of senile hyperthyroidism, a typical case was presented in which 30 days of decoction was consumed and a follow-up visit one year later showed no recurrence. In 45 cases of hyperthyroidism said to be cured by an Astragalus- based formula (Yi qi yang yin Tang) that were followed up, recurrence was noted in only two cases. Follow-up duration was from less than six months to four years (12 cases under six months and 33 cases from six months to four years). In the study of herb treatments for hyperthyroidism in which Exophthalmos (abnormal protruding of eyeball) was a symptom, a follow-up four years later showed no recurrence of the initial condition. Forty cases of hyperthyroidism treated with herbs for an average of 67 days yielded 24 cures and the remaining 16 either markedly improved or somewhat improved. One year later, the therapeutic benefits remained stable.

Individual cases mentioned in the reports describing various treatments for hyperthyroid or hypothyroid conditions suggested that one to five year follow-up demonstrated continued relief, but that a few individuals might experience a relapse which could be treated effectively by applying again the original treatment. From those studies involving longer-term treatment at the outset, it was evident that symptom improvement might be attained early, but continued administration of herbs was essential to further improve or maintain that effect.

Hypothyroidism and Acupuncture Study

A Russian study (September 2011) examined the effects of acupuncture and other TCM therapies on sub-clinical thyroid syndrome and discovered that TSH levels were reduced to normal levels in 74% of the treatment group. It went on to conclude that acupuncture could be an alternative to substitution therapy in sub-clinical hypothyroidism. More participants in future studies would make these finding more significant but the results are certainly encouraging. In summary, most people with hypothyroidism are in need of more Yang supplementation and most people who suffer from hyperthyroidism need more Yin supplementation. Clinically, we often see a mixture of the two in the one individual.

Acupuncture Today July, 2001, Vol. 02, Issue 07 By Skya Abbate, DOM Based on one case

Female patient was experiencing tenderness in her neck. I conducted what I call a thyroid evaluation by gently palpating the following points bilaterally for tenderness: local points in the proximity of the thyroid gland, ST9 and LI18 and KI3 the source point of the kidney, indicating kidney deficiency. All were tender. In my experience, they may suggest a subclinical or clinical hypothyroid condition. I administered a treatment, the protocol is found in the following chart. Its effect is to regulate and tonify the qi and yang; vitalize the blood; and stimulate and strengthen the immune system. About a week later, she returned for a treatment and said her neck felt good. The treatment was repeated. Two weeks later, she returned for her third treatment. Overall she felt better and described the previous treatment as a "jump start," an analogy I think accurately described the treatment plan and its desired effects. On August 25th, her TSH levels were retested. They had almost halved from 9.02 to 4.98 and were now in the normal range of 0.40-5.50. Her doctor wrote on the lab results, "Great news!" She received three acupuncture treatments over the next three months and then had a follow-up retest that revealed that the TSH levels were now a little lower (4.83). Her doctor pronounced the thyroid as normal and said "Great." My recommendation was to have her see me three to four times a year for health maintenance and continued monitoring of the past problem. In conclusion, while only based on this one case, I do believe that the key to the successful resolution of this disorder was the early detection, diagnosis and treatment of the problem, augmented with high patient compliance, and of course the profound power of the medicine

Hypothyroid Protocol Needle Points used Location Energetics technique GV20 Standard Central reunion Puncture 0.3-0.5 Chinese location point - elevates in. horizontally (baihui) - 7 cun within the yang,benefits in the direction the anterior the marrow of the meridian, hairline, on the (brain function, i.e. towards the midpoint of the i.e. hormonal face. Tonify. line connecting function) the apexes of the two auricles. Yintang Standard Reflex point of Puncture Chinese location the pituitary subcutaneously -- midway gland which downward between the controls the towards the nose medial ends of thyroid gland 0.3-0.5 in. the two Tonify. eyebrows. Naganos Find the ulna This group of Slowly insert bone. Slide over four points are perpendicularly it radially as you the Japanese to a depth of 0.5- move towards equivalent to 1.0 in. Do not Chinese LI10 LI11 (quchi) and look for qi - and 11.The LI10 (shousanli) search for a Naganos are a and have similar gummy, sticky group of four energetics. They feeling with the points located are powerful qi lift /thrust action between the ulna and blood tonics. of the needle. Do bone and the not tonify or large intestine disperse. meridian. They Mechanically lift are located about and thrust one through the fingerbreadth sticky area. apart as you Repeat 2-3 move distally times. These from the elbow points have a crease. Palpate strong bearing each point down sensation deeply one at a on the arms and time on each may be achy arm, looking for during and after the most tender treatment. point on each arm. These are the points to be needled Navel Locate eight According to the Puncture points Nanjing, the obliquely equidistantly navel pertains to towards the around the navel the spleen, hence navel 0.5 in. like points on a it can treat Tonify. compass at a spleen problems. distance of 0.5 Because spleen cun from the is the figurative center of the mother of the navel. lungs, it can treat lung pathology. As the figurative grandmother of the kidney, it can treat the kidney. Thus the cumulative effect of the points is to treat the three major organs pertaining to qi: the spleen, lung and kidney. Kidney 7 Standard The metal point, Puncture Chinese location therefore the perpendicularly (fuliu) - 2 cun directly tonification point 0.3-0.5 in. above KI3 of the kidney. bilaterally. (taixi). Regulates the qi Tonify. of the kidney, especially of the yang. Spleen 6 Standard Group luo of the Puncture Chinese location three leg yin - perpendicularly (sanyinjiao) - 3 cun above the improves 0.5-1.0 in. tip of the medial circulation, bilaterally. malleolus on the vitalizes the Tonify. posterior border blood and of the tibia on tonifies liver, the line spleen and connecting the kidney. medial malleolous to SP9 (yanglingquan).

Insert needles in the order presented above. Retain the needles approximately 15 minutes. All needles are tonified after the de qi sensation is obtained. I use a small amplitude of rotation as my tonification technique with #1 (36g), 1 inch (30mm) needles. Remove needles in the same order as they were inserted.

Is Traditional Chinese medicine effective for reducing hyperthyroidism? J Altern Complement Med. 2010 Nov;16 Chang CC1, Huang ST

Abstract Graves' disease is an autoimmune disease that can affect a few patients with hyperthyroidism. In this case report, we demonstrated that Traditional Chinese Medicine (TCM) was effective for the patient with hyperthyroidism induced by Graves' disease. The patient also remained in the euthyroid state (normally functioning thyroid) for several years after the treatment. SUBJECT AND SETTING: A 33-year-old woman had palpitations, fatigability, and weight loss and was diagnosed as having Graves' disease. Urticaria and itching skin appeared after she took an antithyroid drug. Therefore, she sought treatment with TCM. RESULTS: After regular therapy with Jia Wei Xiao Yao San in addition to Xia Ku Cao, Bei Mu, and oyster shell, her symptoms subsided and the thyroid function level returned to normal range with 3 years' treatment. She still remained in the euthyroid state for 3 years after discontinuing the TCM treatment up to the present. Neither complications nor side-effects were noted during the TCM treatment. CONCLUSIONS: This case demonstrates that TCM is an effective and alternative option for hyperthyroidism induced by Graves' disease, especially for patients who have an allergic reaction caused by thioamides.

Case reports Alan R. Gay, MD

The following case reports illustrate the successful empirical use of desiccated thyroid. Case 1. A 34-year-old woman presented with a history of fatigue, low energy, and sensitivity to the cold throughout most of her life. Other symptoms included intermittent waves of nausea, difficulty with mental concentration, edema, waking up every night at 2–4 a.m. with difficulty falling asleep again, and recurrent palpitations. If she did not eat every 2–3 hours, she would develop a feeling of agitation, followed by severe fatigue. During childhood she developed asthma, which began to increase in severity in her late teens, and which required frequent use of inhaled glucocorticoids and bronchodilators. She suffered from ocular allergies and perennial allergic rhinitis with seasonal exacerbations, and had been treated with various oral, intranasal, and ophthalmic antihistamines and glucocorticoids. She had an 8-year history of irregular menstrual periods, with cycles occurring every 40–50 days. Numerous medications, nutritional supplements, and herbs had been tried for various symptoms, but the results had been for the most part unsatisfactory. Laboratory tests for thyroid function were normal (TSH, 2.34 mU/L [normal range, 0.3–5.50 mU/L]; calculated free T4, 2.24 units [normal range, 1.53–3.85 units]). However, physical examination was consistent with possible hypothyroidism (i.e., delayed Achilles Tendon Reflux return, a subtle myxedematous appearance around the ankles, and a subnormal basal body temperature). The patient was given an empirical trial of 15 mg/day of desiccated thyroid, which was increased to 30 mg/day after 5 days. During the first 2 weeks, she experienced dramatic improvement in most of her symptoms. Asthma and rhinitis improved to the extent that medications for these conditions were rarely needed anymore. Around 2 months after the start of treatment, there was a recurrence of nausea and a decrease in energy level, which improved again after the dosage was increased to 60 mg/day. One month later, a further increase in dosage to 90 mg/day was necessary. At her follow-up visit 10 months after the start of treatment, she rated the degree of improvement in her various symptoms as follows (0% indicates no improvement, 100% indicates complete relief): fatigue and low energy (90%), nausea (90%), difficulty concentrating (95%), irregular menses (99%), asthma (85%), ocular allergies (80%; only seasonal exacerbations remained), palpitations (99%), edema (45%), and waking up at night (70%). Her need to eat every 2–3 hours had been extended to every 3–4 hours. Sensitivity to the cold did not improve. No side effects occurred and the pulse rate and blood pressure did not change.

Case 2. A 23-year-old woman presented with a chief complaint of passing out if she did not eat every 2–3 hours. She had decided to seek medical treatment after being stopped by a policeman for speeding, as she was racing to the nearest food store to obtain some urgently needed food. She collapsed while waiting for the ticket to be issued, and ended up having to pay not only for speeding, but also for the ambulance and the hospital evaluation. The review of systems was positive for intolerance to the cold. Physical examination revealed a delayed ATR return and mild dryness and coarseness of the skin. Thyroid function tests were normal. The patient was treated with 30 mg/day of desiccated thyroid and within 2 weeks was able to fast for up to 8 hours without experiencing any significant problems.

Case 3. A 34-year-old male complained of a 2-year history of greatly diminished libido and intolerance to the cold. Physical examination and thyroid function tests were normal, but basal axillary temperatures averaged 95.8 degrees F (2 degrees below normal). He was given a therapeutic trial of 30 mg/day of desiccated thyroid, which was increased to 60 mg/day after 10 days. Both of his symptoms improved moderately on the lower dose and markedly within several days after increasing the dose. These improvements persisted with continued treatment.

Case 4. A 57-year-old woman presented with a lifelong history of depression. Her parents had been killed in the holocaust and she had lived in orphanages during her early years. During her 38 years in the United States she had worked with at least 8 physicians, psychologists, and counselors. Although she had gradually learned to deal with issues related to post-traumatic stress disorder, her depression had not improved over the years. She also experienced hot and cold sensations, which had occurred repeatedly for many years. Physical examination was unremarkable and the free-T4 index was 7.2 µg/dl (normal range, 5–12 µg/dl). Her basal axillary temperature was consistently below 96.4 degrees F. She was advised to take 30 mg/day of desiccated thyroid for 10 days and then 60 mg/day. Clear improvement was evident within 2 weeks, and at her 3-month follow-up visit she reported a “remarkable improvement” in depression and energy that was far beyond her expectations. The hot and cold sensations also disappeared. She was seen at least annually for the next 10 years, during which time the improvement was maintained with a dose of 60 mg/day of desiccated thyroid, with an increase to 90 mg/day during the winter.

Case 5. A 39-year-old woman presented with depression, hair loss, constipation, irritable bowel syndrome, short-term memory loss, acne vulgaris, and irregular menstrual periods. Most of these symptoms began 9 years previously, after the birth of a child. At that time, her physician diagnosed hypothyroidism, and her symptoms were relieved by 120 mg/day of desiccated thyroid. Approximately 18 months before her first visit to my office, the patient changed physicians, was switched to 0.2 mg/day of levothyroxine, and promptly experienced a recurrence of her previous symptoms, as well as a new symptom (anxiety). Because the TSH level was below normal, the levothyroxine dosage was reduced progressively to 0.125 mg/day. This dosage reduction resulted in a lessening of the anxiety, but a worsening of the other symptoms. Physical examination at the time of her first visit to my office revealed a delayed ATR return and a subtle myxedematous appearance around the ankles. The patient was switched from levothyroxine to 90 mg/day of desiccated thyroid and rapidly experienced substantial symptomatic improvement, with no exacerbation of anxiety. At her follow-up visit 7 weeks later, the ATR return was almost normal and the ankle myxedema was reduced. She continued on 90 mg/day of desiccated thyroid and remained symptom-free for the next 3 years, after which she was lost to follow-up.

Case 6. A 41-year-old woman had a history of borderline hypertension, hypercholesterolemia, a tendency to depression and fatigue, dry skin, diffuse hair loss on the head, and general edema. Thyroid function tests were normal. On physical examination, carotenodermia was noted on the feet and hands, follicular hyperkeratosis was present on the arms, and the ATR return was delayed. Because she had a history of being extremely sensitive to various medications, she was started on 7.5 mg (108 grain) of desiccated thyroid per day, equivalent to approximately 4% of the daily secretion from a normal thyroid gland. On that dose she experienced a rapid and marked improvement in mood, energy level, exercise tolerance, sluggishness, edema, and hair loss; dry skin was moderately improved. Blood pressure became normal within several days and remained normal thereafter. After 3 weeks on 7.5 mg/day she increased the dose to 15 mg/day; this resulted in a sensation of excessive heat for about 2 weeks, which then resolved. As there was no additional improvement at the higher dose, she resumed the original dose of 7.5 mg/day. At that dose, serum cholesterol fell from 270 mg/dl prior to starting thyroid hormone to 223 mg/dl. The patient has been on 7.5 mg/day of desiccated thyroid for 8 years at the time of this writing, without a recurrence of the original symptoms.

Case 7. A 57-year-old woman complained of fatigue, non- exertional chest pain, and palpitations, which began 9 years previously. At that time another physician treated her with 0.1 mg/day of levothyroxine (it was not clear whether thyroid function tests were done), which resulted in an improvement in her symptoms. Seven years later (2 years prior to her first visit to my office), she was taken off of levothyroxine and experienced a return of her symptoms. She underwent a stress thallium test, which revealed coronary artery disease with 80–90% probability, and her chest pain was diagnosed as angina pectoris. Treatment with a calcium-channel blocker (diltiazem) reduced the frequency of anginal episodes. The addition of coenzyme Q10 and L-carnitine 3 months prior to her first visit resulted in some additional improvement, but all of her symptoms still persisted. Past medical history was significant for a partial thyroidectomy at age 14. Recent thyroid function tests were normal. Based on her history, a therapeutic trial was begun with 15 mg per day of desiccated thyroid, which was increased to 30 mg/day after 2 weeks. The patient was advised to reduce the dose or to discontinue treatment if her angina became worse. There was a rapid improvement in symptoms, and at her follow-up visit 2 months later she reported that her angina, fatigue, and palpitations had all disappeared. Although it was not possible to rule out a delayed response to coenzyme Q10 and L-carnitine as the reason for her improvement, the patient was convinced that the improvement was due primarily to the desiccated thyroid. She did experience a recurrence of angina when she tried to discontinue diltiazem. She was therefore maintained on diltiazem plus 30 mg/day of desiccated thyroid and continued do well for the next 2 years, after which she was lost to follow-up.

Why he uses Armour Thyroid over Levothyroxine: Taken from his book, “Levothyroxine consists solely of T4, whereas desiccated thyroid contains approximately 80% T4 and 20% T3, as well as other iodinated compounds (diiodotyrosine and monoiodo-tyrosine). Each of the compounds present in desiccated thyroid is secreted by the human thyroid gland, although the concentration of T3 in porcine thyroid tissue (from which desiccated thyroid is derived) is approximately twice that in human thyroid secretions. While peripheral tissues are capable of converting T4 to T3, the use of T4-only preparations might alter the normal ratio of T4 to T3 in these tissues, especially in people who have variants of one of the deiodinase genes or of the beta-3 adrenergic receptor gene. “

Testing the Achilles Tendon:

This link will take you to a youtube video: https://www.youtube.com/watch?v=BEQ6BbLLucA

References A study on the clinical effects and immunololgical mechanism in the treatment of Hashimoto’s thyroiditis by Moxibustion. Hu G., Chen H., Hou Y., Cheng Z., Wang R. Shanghai research Institute of Acupuncture & Meridian. Journal of Traditional Chinese Medicine. March 13, 1993 Chinese herbal medicines for hyperthyroidism. Zen XX., Yuan Y., Liu Y., Wu TX., Han S. Cochrane Database Systematic Reviews. April 18, 2007. Pg. CD005450 Effects of yang-restoring herb medicines on the levels of plasma corticosterone, testosterone, and triiodothyronine. Kuang A., Chen J., Chen M. Zhong Xi Yi Jie He Zi Zhi. December 9, 1989. Pg 710, 737-8. Thyroid Balance: Traditional and alternative methods for treating thyroid disorders. Rothefeld G., Romaine D. Adams Media Publishing Co. 2003

Traditional Chinese Medicine and Thyroid Disease Alex A. Kecskes Treatment of Hyperthyroidism: Western Medicine vs. Traditional Chinese Medicine

John Chen, Ph.D., Pharm.D., O.M.D., L.Ac.

Gaby, A., “Sub-laboratory Hypothyroidism and the Empirical use of Armour® Thyroid,” Alternative Medicine Review 2004; Volume 9, Number 2 pp. 157-179 Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011

Treatments for Thyroid Diseases with Chinese Herbal Medicine by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Kiiko Matsumoto’s Clinical Strategies Vol 1